Unresponsive Alopecia Areata Treated Successfully with Liquid Nitrogen Cryotherapy: A Study of Five Patients


Vijay Zawar
Jaya Suresh Bharati
Manoj Pawar
Shrikant Kumavat
Joy Das


Introduction: Alopecia Areata (AA) is one of the most common form of hair loss seen in dermatology. Treatment failures can occur with almost every conventional therapy, either singly or in combination. Aims and Objectives: To study the clinical profiles and management outcome of Liquid Nitrogen Cryotherapy (LNC) for the treatment of unresponsive cases of AA. Materials and Methods: A prospective study was conducted on five patients who showed no response to conventional topical treatment for six months. The subjects were enrolled in the study after written consent. Clinical photographs were recorded at each visit. Patients were given 3-5 sittings of LNC at 2 week intervals. Each session consisted of dual freeze thaw cycles of 15 seconds each, with a cryospray technique following application of topical anaesthetic cream. Suitable antibiotics and anti-inflammatory agents were prescribed post-operatively for five days. The clinical response was evaluated by using regrowth scale at 4th week and 8th week. Final end point evaluation of patient post 3 months after the last treatment session was done to observe sustained regrowth of hair. Results: Five patients were recruited, out of which three patients showed an excellent response, 1 each had a satisfactory response and a fair response respectively. Commonly seen adverse effects were slight pain, erythema, edema, erosion, crusting, dyspigmentation/hypopigmentation, which were transient and did not require withdrawal of treatment. Conclusion: Liquid Nitrogen Cryotherapy is a cheaper, easily available with transient adverse effects and can be worth trying in unresponsive Alopecia Areata.


How to Cite
Zawar, V., Bharati, J. S., Pawar, M., Kumavat, S., & Das, J. (2020). Unresponsive Alopecia Areata Treated Successfully with Liquid Nitrogen Cryotherapy: A Study of Five Patients. MVP Journal of Medical Sciences, 288–294. https://doi.org/10.18311/mvpjms/2020/v7i2/24570


  1. Ganjoo S, Thappa DM. Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of Alopecia Areata. Indian J Dermatol Venereol Leprol. 2013; 79:408–17.PMid:23619446. https://doi.org/10.4103/0378-6323.110767.
  2. Seetharam KA. Alopecia Areata: An update. Indian J Dermatol Venereol Leprol. 2013; 79:563–75.PMid:23974575. https://doi.org/10.4103/0378-6323.116725.
  3. Zawar VP, Karad GM. Liquid nitrogencryotherapy in recalcitrant Alopecia Areata: A study of 11 patients. Int J Trichol. 2016; 8:15–20. PMid:27127370 PMCid:PMC4830166.https://doi.org/10.4103/0974-7753.179403.
  4. Schwartz RA, Janniger CK. Alopecia Areata. Cutis. 1997; 59:238–41.
  5. Sharma VK, Khandpur S. Guidelines for cryotherapy. Indian J Dermatol Venereol Leprol. 2009; 75:90–100. PMid:19439873. https://doi.org/10.4103/0378-6323.51238.
  6. Pimentel CB, Moraes AM, Cintra ML. Angiogenic effects of cryosurgery with liquid nitrogen on the normal skin of rats, through morphometric study. An Bras Dermatol. 2014; 89:410–3. PMid:24937813 PMCid:PMC4056697. https:// doi.org/10.1590/abd1806-4841.20142249.
  7. Christoph T, Müller-Rover S, Audring H, Tobin DJ, Hermes B, Cotsarelis G, et al. The human hair follicle immune system: Cellular composition and immune privilege. Br J Dermatol. 2000; 142:862–73.PMid:10809841. https://doi. org/10.1046/j.1365-2133.2000.03464.x.
  8. Tobin DJ. Characterization of hair follicle antigens targeted by the anti-hair follicle immune response. J Investig Dermatol Symp Proc. 2003; 8:176–81. PMid:14582669. https://doi.org/10.1046/j.1087-0024.2003.00805.x.
  9. Gita F, Mohammadreza R. Liquid Nitrogen Cryotherapy vs. betamethasone lotion in the management of Alopecia Areata. J Clin Med Res. 2013; 5:18–22. https://doi.org/10.5897/JCMR11.041.
  10. Hong SP, Jeon SY, Oh TH, Lee WS. Retrospective study of the effect of superficial cryotherapy on Alopecia Areata. Korean J Dermatol. 2006; 44:274–80.
  11. Radmanesh M, Azar Beig M. Cryotherapy as an alternative therapy for the treatment of recalcitrant Alopecia Areata. Iran J Dermatol. 2013; 16:49–52.
  12. Amirnia M, Mahmoudi SS, Karkon-Shayan F, Alikhah H, Piri R, Naghavi-Behzad M, et al. Comparative study of intralesional steroid injection and cryotherapy in Alopecia Areata. Niger Med J. 2015;56:249-52. PMid:26759508 PMCid:PMC4697211. https://doi.org/10.4103/0300-1652.165034.