Combined Microneedling With Either 1% Lactic Acid Solution or Vitamin D3 or Triamcinolone Acetonide in The Treatment of Alopecia Areata

Patients in all groups will be subjected to microneedling (MN) using a dermapen "Dr.Pen") with adjustable needle length ranging from 1.5 to 2 mm, using the highest speed level (4-5). First, topical anesthetic cream will be applied. Then, they will be stroked by dermapen diagonally, vertically, and horizontally in a repeated manner until pinpoint bleeding appears which will be regarded as an endpoint. * First group (A): 22 AA patients will be treated with MN combined with lactic acid solution 1%. (Sharquis et al., 2015). * Second group (B): 22 AA patients will be treated with MN combined with topical application of vitamin D3 (an aqueous preparation of cholecalciferol (Devarol® ampoule 200 000 IU/2 ml, Memphis, Egypt) (2.5 mg/ ml), The maximum total amount of vitamin D3 injected into a patient in every session will be 2.5 mg (1 ml) (Ali et al., 2023). * Third group (C): 22 AA patients will be treated with MN combined with triamcinolone acetonide injectable suspension (Epirelefan®, 40mg/ ml, Eipico, Egypt) (10 mg/ml) will be used in a dose of 0.1 ml/cm2 area (Arora et al., 2022). * Fourth group (D): 22 AA patients will be treated with MN combined with normal saline 0.9% In all groups, sessions were done every 2 weeks for a maximum of six sessions. V. Photographs will be taken by (Iphone 13 pro max Camera) before, during and after treatment.