الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Alopecia areata (AA) is a non-scarring, chronic, inflammatory disorder of the hair follicle of unknown etiology. It usually presents as sudden onset of limited, patchy, hair loss on the scalp that may progress and affect the entire scalp or other parts of the body. A trigger (e.g. viral infection, stressful event) may be identified 1-3 months before the onset of the disease (Ito, 2013).
Microneedling is a minimally invasive procedure that utilizes multiple fine needles to create micropunctures in the skin (Hou et al., 2017). The act of creating these two to four cell-wide puncture holes triggers neovascularization, the release of growth factors, and stimulates the expression of Wnt proteins (Dhurat et al., 2013).
Phenytoin (diphenylhydantoin or Dilantin) is one of the highly effective and widely prescribed anticonvulsant agent used for the treatment of grand mal and psychomotor epilepsy (Scheinfeld, 2003).Phenytoin may promote wound healing through multiple mechanisms, including stimulation of fibroblast proliferation facilitation of collagen deposition and antibacterial activity (Anstead et al., 1996).
In current study 30 patients with mulifocal alopecia areata the patients were classified into 2 groups in each patients two lesion are selected one lesion received microneeding and phenytoin, the other lesion received no treatment as control lesion :
group I: 22 patients with multifocal alopecia areata on scalp
group II: 8 patients with multifocal alopecia areata on the beard.
Patients who treated with microneedling and topical phenytoin, showed significant improvement in treated lesion when compared to control lesions. Recommendation This is the first study investigated the synergetic effect of microneedling and topical phenytoin in treating AA. We recommend the use of this therapeutic approach as line of treatment of AA because it is an effective treatment and associated with minimal side effect, but larger study is needed with more standardization to validate it.