Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration

Photodynamic therapy (PDT) with methyl 5-aminolevulinic acid (MAL) was investigated for treating alopecia totalis in a pilot study involving 8 Korean patients. The study aimed to evaluate whether using a microneedle roller to enhance drug penetration would improve treatment outcomes. Patients received three PDT treatments at 4-week intervals, with one side of the scalp prepared with microneedle rolling and the other side serving as a control. Results showed no hair growth or increase in anagen hair follicle density in either the microneedle-rolled or control lesions, indicating that PDT with MAL was ineffective for treating alopecia totalis, regardless of enhanced skin penetration.