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Park KY, Jang WS, Son IP, Choi SY, Lee MY, Kim BJ, Kim MN, Ro BI. Combination therapy with cyclosporine and psoralen plus ultraviolet a in the patients with severe alopecia areata: a retrospective study with a self-controlled design. Ann Dermatol 2013; 25:12-6. [PMID: 23467536 PMCID: PMC3582915 DOI: 10.5021/ad.2013.25.1.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 11/08/2022] Open
Abstract
Background Alopecia areata (AA) is believed to be an organ-specific autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no definitive therapy for AA. Objective We sought to determine whether the combination therapy of cyclosporine and psoralen plus ultraviolet A (PUVA) could be an effective treatment for severe AA. Methods A total of 41 patients with severe AA were treated with oral cyclosporine and topical PUVA. Cyclosporine was given at an initial daily dose of 200 mg for adult and 100 mg for children for periods of up to 16 weeks. Eight-methoxypsoralen (Methoxsalen) was applied topically 20 minutes prior to ultraviolet A (UVA) exposure, and the patients were irradiated with UVA twice a week for 16 weeks. Results Of the total 41 patients, 2 (7.3%) patients were lost to follow-up, and 1 (2.4%) patient discontinued the treatment due to abdominal discomfort. Six (14.6%) patients were treated for less than 12 weeks. Of remaining 32 patients, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response. Conclusion Although limited by its uncontrolled character, this study shows that the combination therapy with cyclosporine and PUVA may be an additional choice for severe and recalcitrant AA.
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Affiliation(s)
- Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Abstract
Alopecia areata (AA) is a non-scarring autoimmune disease of the hair follicle that can present at any age. Pediatric cases are commonly seen in a dermatology clinic, and management can potentially be challenging, with a small proportion of cases experiencing a chronic relapsing course marked by distressing hair loss that can bring about significant psychosocial morbidity. We review the established treatments for pediatric alopecia areata, alongside second and third line therapies that have shown to be efficacious. We also offer a treatment algorithm as a guide to the treatment of pediatric AA.
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Affiliation(s)
- Etienne Wang
- National Skin Centre, 1 Mandalay Road, Singapore
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54
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Multivariate analysis of prognostic factors in patients with rapidly progressive alopecia areata. J Am Acad Dermatol 2012; 67:1163-73. [DOI: 10.1016/j.jaad.2012.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/14/2012] [Accepted: 06/05/2012] [Indexed: 12/14/2022]
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Squalene-Containing Nanostructured Lipid Carriers Promote Percutaneous Absorption and Hair Follicle Targeting of Diphencyprone for Treating Alopecia Areata. Pharm Res 2012; 30:435-46. [DOI: 10.1007/s11095-012-0888-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/12/2012] [Indexed: 12/13/2022]
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Abstract
Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.
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Affiliation(s)
- Annapurna Kumar
- Department of Ophthalmology, Sri Manakula Vinayagar Medical College, Pondicherry, India
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Sardesai VR, Prasad S, Agarwal TD. A study to evaluate the efficacy of various topical treatment modalities for alopecia areata. Int J Trichology 2012; 4:265-70. [PMID: 23766611 PMCID: PMC3681108 DOI: 10.4103/0974-7753.111223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Alopecia Areata (AA) is a common form of non-scarring hair disorder of unclear etiology. The disease may have serious psychological effect. AIMS The objective is to assess the therapeutic effect and side effects of various topical modalities for the treatment of AA. SETTINGS AND DESIGN Open, randomized, comparative study. MATERIALS AND METHODS For this study, 30 patients were included of all age groups and both sexes having localized (<5 patches and <25% scalp involvement) alopecia, with no underlying disease or family history, and who had not received any treatment before. They were treated sequentially with 5 different combination regimes for 3 months. The response was assessed subjectively as well as objectively by the "Severity of Alopecia Tool Score". STATISTICAL ANALYSIS Chi-square test. RESULTS Out of the 5 modalities studied, the Intralesional and Topical Steroids were the most effective with no significant side effects. CONCLUSIONS Among the various topical modalities used for the treatment of AA, the most effective are the Intralesional and Topical steroids with no significant side-effects.
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Affiliation(s)
- Vidyadhar R Sardesai
- Department of Dermatology, STD and Leprosy, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Smita Prasad
- Department of Dermatology, STD and Leprosy, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Trupti D Agarwal
- Department of Dermatology, STD and Leprosy, Bharati Vidyapeeth Deemed University Medical College, Pune, India
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Abstract
Alopecia may indicate underlying systemic disease and is associated with significant impairment of quality of life. A thorough history and examination, including specialist techniques, can give vital clues to the aetiology. This article provides an overview of the common and important hair loss disorders for the busy clinician.
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Affiliation(s)
- Abby Macbeth
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK.
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Staumont-Sallé D, Vonarx M, Lengrand F, Segard M, Delaporte E. Pulse Corticosteroid Therapy for Alopecia Areata: Long-Term Outcome after 10 Years. Dermatology 2012; 225:81-7. [DOI: 10.1159/000341523] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/14/2012] [Indexed: 01/05/2023] Open
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Modjtahedi BS, Kishan AU, Schwab IR, Jackson WB, Maibach HI. Eyelash alopecia areata: case series and literature review. Can J Ophthalmol 2012; 47:333-8. [DOI: 10.1016/j.jcjo.2012.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 04/13/2012] [Accepted: 04/20/2012] [Indexed: 11/26/2022]
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Kim DH, Lee JW, Kim IS, Choi SY, Lim YY, Kim HM, Kim BJ, Kim MN. Successful treatment of alopecia areata with topical calcipotriol. Ann Dermatol 2012; 24:341-4. [PMID: 22879719 PMCID: PMC3412244 DOI: 10.5021/ad.2012.24.3.341] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/09/2011] [Accepted: 06/10/2011] [Indexed: 11/08/2022] Open
Abstract
Alopecia areata (AA) is an inflammatory hair loss of unknown etiology. AA is chronic and relapsing, and no effective cure or preventive treatment has been established. Vitamin D was recently reported to be important in cutaneous immune modulation as well as calcium regulation and bone metabolism. It is well known that areata is common clinical finding in patients with vitamin D deficiency, vitamin D-resistant rickets, or vitamin D receptor (VDR) mutation. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of cytokine production. These effects might explain the efficacy of vitamin D3 derivatives for treating AA. In this study, we report a 7-year-old boy with reduced VDR expression in AA, recovery of whom was observed by topical application of calcipotriol, a strong vitamin D analog.
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Affiliation(s)
- Dong Ha Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Cho HH, Jo SJ, Paik SH, Jeon HC, Kim KH, Eun HC, Kwon OS. Clinical characteristics and prognostic factors in early-onset alopecia totalis and alopecia universalis. J Korean Med Sci 2012; 27:799-802. [PMID: 22787378 PMCID: PMC3390731 DOI: 10.3346/jkms.2012.27.7.799] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 04/19/2012] [Indexed: 11/20/2022] Open
Abstract
Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence (< or ≥ 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.
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Affiliation(s)
- Hyun Hee Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Dermatological Science, Seoul National University, Seoul, Korea
| | - Seung Hwan Paik
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Chan Jeon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Dermatological Science, Seoul National University, Seoul, Korea
| | - Hee Chul Eun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Dermatological Science, Seoul National University, Seoul, Korea
| | - Oh Sang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Dermatological Science, Seoul National University, Seoul, Korea
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Miteva M, Tosti A. Treatment options for alopecia: an update, looking to the future. Expert Opin Pharmacother 2012; 13:1271-81. [PMID: 22594679 DOI: 10.1517/14656566.2012.685160] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hair loss is a very common complaint. The diagnosis is based on clinical, dermoscopic and pathological examination. The treatment is usually continuous and requires strong compliance. AREAS COVERED This article aims to i) summarize current treatment options for the most common forms of hair loss; ii) update the literature on treatment options to emerge over the 3 years since the release of the first edition of this article in 2009; and iii) outline future strategies for treating alopecia. EXPERT OPINION There is good evidence-based information for the treatment of androgenetic alopecia. There are very few good-quality randomized studies, and no information about long-term results for most of the available treatments for alopecia areata and cicatricial alopecias. Significant research success has been achieved over the past few years through i) discovering the genetic profile of alopecia areata; ii) working on follicular neogenesis in androgenetic alopecia; and iii) discovering the PPAR-γ pathway in scarring alopecia.
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Affiliation(s)
- Mariya Miteva
- University of Miami Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1600 NW 10th Ave, RSMB, Room 2023A, Miami, FL 33136, USA.
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General practitioners' knowledge and practices related to alopecia areata in Qassim region, Saudi Arabia. JOURNAL OF THE EGYPTIAN PUBLIC HEALTH ASSOCIATION 2012; 87:24-8. [PMID: 22415332 DOI: 10.1097/01.epx.0000410949.41795.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The importance of alopecia areata (AA) originated from the social acceptance of its psychological and emotional consequences. This study aimed to explore the knowledge and practices of general practitioners regarding the disease in Qassim region, Saudi Arabia, to obtain baseline data to aid in quality improvement of the available health services. SUBJECTS AND METHODS The study included 142 general practitioners working in primary healthcare centers in the Qassim region. Knowledge on causes, risk factors, and treatment practices was obtained using a self-administrated structured questionnaire. RESULTS The mean (± SD) age of participants was 42.9 ± 7.8 years. More than 35.0% of them had work experience of less than 10 years. Nineteen percent of the participants had low knowledge score, with significant difference in sex and years of work experience. Approximately 45.8% of surveyed doctors reported AA to be an autoimmune disease, 68.3% incorrectly responded that AA is more common in male patients, 64.1% recognized that family history is important, 26.1% blamed personal hygiene, and 16.2% thought that AA is a communicable disease. With regard to management, 45.7% of participants prescribed local steroids for treatment; however, 25.3% prescribed only multivitamins. CONCLUSION AND RECOMMENDATIONS That general practitioners in the Qassim region have satisfactory knowledge of AA, and most of them engage in fair treatment practices. However, there are still some gaps in different aspects that warrant continuous educational programs to improve their quality and performance.
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Bayramgürler D, Demirsoy EO, Aktürk AŞ, Kıran R. Narrowband ultraviolet B phototherapy for alopecia areata. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:325-7. [DOI: 10.1111/j.1600-0781.2011.00612.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dilek Bayramgürler
- Dermatology Department; Kocaeli University Medical Faculty; Kocaeli; Turkey
| | | | - Aysun Şikar Aktürk
- Dermatology Department; Kocaeli University Medical Faculty; Kocaeli; Turkey
| | - Rebiay Kıran
- Dermatology Department; Kocaeli University Medical Faculty; Kocaeli; Turkey
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69
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Ganzetti G, Campanati A, Simonetti O, Cataldi I, Giuliodori K, Offidani A. Videocapillaroscopic Pattern of Alopecia Areata before and after Diphenylciclopropenone Treatment. Int J Immunopathol Pharmacol 2011; 24:1087-91. [DOI: 10.1177/039463201102400428] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alopecia areata (AA) is an inflammatory skin disease the most effective therapy for which is diphenylcyclopropenone (DPCP). Videodermatoscopy and intra-vital capillaroscopy (IVCP) are two non-invasive techniques that help in the differential diagnosis of alopecias. It is known that, after DPCP therapy, there is a histologically proven significant increase of VEGF in hair follicle keratinocites and a consequent increase in capillary vessels in the dermis of the same follicles. The aim of our study is to emphasize any clinical and videodermatoscopic-videocapillaroscopic changes after DPCP treatment in 20 patients affected by alopecia areata. Videodermatoscopic images and an intravital videocapillaroscopic analysis were performed at T0, T12 and T24 to emphasize clinical modifications and microscopic changes in vascular pattern before and after DPCP treatment. At T0, videodermatoscopy showed the presence of “exclamation point” hairs, hair follicles filled with hyperkeratotic plugs (“yellow dots”), hair follicles containing cadaverized hairs (“black dots”) and broken hairs. IVCP highlighted a pale scalp, and vessels were not visible. At 24 weeks (T24), videodermatoscopy revealed the disappearance or a statistically significant reduction of AA hallmarks and an increase of number of vellus hairs. Videocapillaroscopy showed a statistically significant increase of new vessels and, where neoangiogenesis were more marked, a major hair regrowth was evident. Our study emphasizes that, after DPCP therapy, neoangiogenesis is detectable by videocapillaroscopy and these new capillaries could be considered an initial positive attempt to compensate capillary loss of T0 alopecia areata images.
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Affiliation(s)
- G. Ganzetti
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
| | - A. Campanati
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
| | - O. Simonetti
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
| | - I. Cataldi
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
| | - K. Giuliodori
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
| | - A.M. Offidani
- Dermatological Clinic, Department of Medical Sciences, Ancona Hospital, Polytechnic University of Marche, Ancona, Italy
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Royer M, Bodemer C, Vabres P, Pajot C, Barbarot S, Paul C, Mazereeuw J. Efficacy and tolerability of methotrexate in severe childhood alopecia areata. Br J Dermatol 2011; 165:407-10. [DOI: 10.1111/j.1365-2133.2011.10383.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Hair loss is a very common complaint. Patients may describe increased shedding and diffuse or localized alopecia. The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias. This paper describes the clinical approaches and diagnostic tests that are useful in the evaluation of patients presenting with alopecia. It also reviews treatments for noncicatricial alopecias, including androgenetic alopecia, alopecia areata, and telogen effluvium, as well as cicatricial alopecias, including lichen planopilaris, its clinical variant frontal fibrosing alopecia, and discoid lupus erythematosus.
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Affiliation(s)
- Katherine A Gordon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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72
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Campuzano-Maya G. Cure of alopecia areata after eradication of Helicobacter pylori: a new association? World J Gastroenterol 2011; 17:3165-70. [PMID: 21912461 PMCID: PMC3158418 DOI: 10.3748/wjg.v17.i26.3165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/05/2011] [Accepted: 03/12/2011] [Indexed: 02/06/2023] Open
Abstract
Alopecia areata is a disease of the hair follicles, with strong evidence supporting autoimmune etiology. Alopecia areata is frequently associated with immune-mediated diseases with skin manifestations such as psoriasis and lichen planus, or without skin manifestations such as autoimmune thyroiditis and idiopathic thrombocytopenic purpura. Helicobacter pylori (H. pylori) infection is present in around 50% of the world's population and has been associated with a variety of immune-mediated extra-digestive disorders including autoimmune thyroiditis, idiopathic thrombocytopenic purpura, and psoriasis. A case of a 43-year old man with an 8-mo history of alopecia areata of the scalp and beard is presented. The patient was being treated by a dermatologist and had psychiatric support, without any improvement. He had a history of dyspepsia and the urea breath test confirmed H. pylori infection. The patient went into remission from alopecia areata after H. pylori eradication. If such an association is confirmed by epidemiological studies designed for this purpose, new therapeutic options could be available for these patients, especially in areas where infection with H. pylori is highly prevalent.
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Im M, Lee SS, Lee Y, Kim CD, Seo YJ, Lee JH, Park JK. Prognostic factors in methylprednisolone pulse therapy for alopecia areata. J Dermatol 2011; 38:767-72. [PMID: 21592197 DOI: 10.1111/j.1346-8138.2010.01135.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many treatments induce remission in patients with alopecia areata. Systemic steroids, for example, are effective in the treatment of severe alopecia areata but have many side-effects. To avoid these side-effects, high-dose bolus infusions of methylprednisolone have been used to treat severe alopecia areata. The purpose of this study was to evaluate the prognostic factors associated with pulse therapy and to establish proper indications for methylprednisolone pulse therapy. Seventy patients with severe alopecia areata were treated i.v. with methylprednisolone on 3 consecutive days. All of the patients had rapid and extensive hair loss with the bald area exceeding 50% of the scalp. Seventy percent of the patients showed terminal hair growth and 41.4% showed complete responses with acceptable cosmetic outcomes. The prognostic factors that influenced successful outcome were the disease duration before treatment and the type of alopecia areata. Based on these two factors, a good response was obtained for all types of alopecia areata with a duration of 3months or less before treatment and for the plurifocal type of alopecia areata with a duration of 4-6months. Methylprednisolone pulse therapy is indicated for those alopecia areata patients who fall within our good response group.
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Affiliation(s)
- Myung Im
- Department of Dermatology, Chungnam National University Hospital, Daejeon, Korea.
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75
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Ohlmeier MC, Traupe H, Luger TA, Böhm M. Topical immunotherapy with diphenylcyclopropenone of patients with alopecia areata--a large retrospective study on 142 patients with a self-controlled design. J Eur Acad Dermatol Venereol 2011; 26:503-7. [PMID: 21569118 DOI: 10.1111/j.1468-3083.2011.04114.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although diphenylcyclopropenone (DCP) is frequently used for the treatment of alopecia areata (AA), large studies with more than 100 patients are still scarce. OBJECTIVE To determine the efficacy of DCP immunotherapy in a large cohort of patients with AA who had been treated in our institute from January 2000 to December 2006. METHODS A total of 142 patients with AA undergoing topical DCP therapy in a self-controlled design were evaluated retrospectively. RESULTS Seven patients (4.9%) were anergic to DCP. Two of 135 patients (1.5%) discontinued DCP therapy because of adverse effects. Fifty-one patients (37.8%) had a complete response (CR: >90% re-growth of hair), 20 patients (14.8%) exhibited a partial response (PR: >50-90% re-growth), 26 patients (19.3%) experienced a minimal response (MR: 10-50% re-growth) and 38 patients (28.1%) had no response after DCP therapy (NR: <10% re-growth). Bivariate logistic analysis revealed that severity of hair loss at the beginning of DCP (P=0.001) is the only significant prognostic factor for therapeutic outcome. Twenty-three patients (45.1%) with CR had relapses upon discontinuation of the treatment or even during prolonged DCP therapy. CONCLUSION Topical immunotherapy with DCP of patients with AA is rather effective and mostly well tolerated. The extent of hair loss before therapy is the main predictor for the therapeutic success of DCP. However, DCP therapy is associated with a high degree of relapse of which patients should be well informed.
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Affiliation(s)
- M C Ohlmeier
- Department of Dermatology, University of Münster, Münster, Germany
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Kamel MM, Salem SAM, Attia HHM. Successful treatment of resistant alopecia areata with a phototoxic dose of ultraviolet A after topical 8-methoxypsoralen application. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:45-50. [DOI: 10.1111/j.1600-0781.2010.00564.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kuldeep CM, Singhal H, Khare AK, Mittal A, Gupta LK, Garg A. Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata. Int J Trichology 2011; 3:20-4. [PMID: 21769231 PMCID: PMC3129118 DOI: 10.4103/0974-7753.82123] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA. AIM To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA. MATERIALS AND METHODS 105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using "HRG Scale"; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%). RESULTS Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus. CONCLUSION Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.
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Affiliation(s)
- CM Kuldeep
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Himanshu Singhal
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Ashok Kumar Khare
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Lalit K Gupta
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Anubhav Garg
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
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Amor KT, Ryan C, Menter A. The use of cyclosporine in dermatology: part I. J Am Acad Dermatol 2010; 63:925-46; quiz 947-8. [PMID: 21093659 DOI: 10.1016/j.jaad.2010.02.063] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 12/15/2009] [Accepted: 02/01/2010] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cyclosporine is a calcineurin inhibitor that acts selectively on T cells. It has been used in dermatology since 1997 for its US Food and Drug Administration indication of psoriasis and off-label for various other inflammatory skin conditions, including atopic dermatitis, blistering disorders, and connective tissue diseases. In the last decade, many dermatologists have hesitated to use this important drug in their clinical practices because of its toxicity profile. The purpose of this article is to review the mechanism of action of cyclosporine and its current uses and dosing schedules. It is our goal to create a framework in which dermatologists feel comfortable and safe incorporating cyclosporine into their prescribing regimens. LEARNING OBJECTIVES After completing this learning activity, participants should be able to describe the mechanism of action of cyclosporine, recognize the potential role of cyclosporine in dermatology and the evidence to support this role, and incorporate cyclosporine into his or her prescribing regimens.
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Affiliation(s)
- Karrie T Amor
- Department of Dermatology at the University of Texas, Houston, Texas, USA
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Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M, Reygagne P, Messenger A. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 2010; 164:5-15. [DOI: 10.1111/j.1365-2133.2010.10011.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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An implication for post-transcriptional control: reciprocal changes of melanocortin receptor type 2 mRNA and protein expression in alopecia areata. Med Hypotheses 2010; 76:122-4. [PMID: 20884125 DOI: 10.1016/j.mehy.2010.08.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 08/26/2010] [Accepted: 08/27/2010] [Indexed: 11/23/2022]
Abstract
Alopecia areata (AA) is a hair follicle-specific autoimmune disease that is inherited genetically but triggered environmentally. Stress response is believed to play a role in the pathogenesis of AA. The hypothalamic-pituitary-adrenal axis (HPA axis), known as the stress axis, plays a cardinal role in the stress response. Growing evidence demonstrates that stress responses are under the control of both the central and peripheral nervous systems. Skin and hair follicles display peripheral HPA axis-like signaling systems. Some studies have revealed that a modified HPA axis, which is characterized by enhanced CRH/CRHR and insufficient glucocorticoid, is involved in the pathology of AA, suggesting that the paradoxical expression differs from that of normal control and should be further examined. Because adrenocorticotropic hormone (ACTH) is an intermediary in the HPA axis, MC2R, which specifically binds ACTH, may be important in the stress response of skin. Therefore, we investigated the gene and protein expression of MC2R in AA lesions and tried to elucidate the connection between HPA axis regulation, MC2R and AA. Reciprocal changes in MC2R mRNA and proteins in human AA were observed in our study; while mRNA levels were higher in lesions from AA patients compared with scalp tissues from normal controls, protein levels of MC2R were lower. The paradoxical expression of MC2R gene and protein levels coincided with evidence that over-responsive HPA activity coexists with a deficient HPA response in AA. We hypothesized that the HPA axis response in human AA may be the following: stressors first activate excess CRH/CRHR to produce increased ACTH, which up-regulates the expression of MC2R mRNA, but the stress response cannot create sufficient cortisol when the binding of ACTH/MC2R is deficient due to decreased MC2R protein. This hypothesis rationally clarifies the changed HPA axis in human AA and highlights the importance of MC2R in the pathogenesis of AA. The inconsistent expression of protein and mRNA implicates post-transcriptional control of human MC2R gene expression as found in murine MC2R gene.
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Affiliation(s)
- M J Harries
- Epithelial Sciences, School of Translational Medicine, University of Manchester.
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84
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Abstract
A 4-year-old, otherwise healthy white girl was referred for a 15-month history of alopecia areata. Anthralin 0.1% cream was prescribed for the left side of the scalp, while corticosteroids for the right side. After 4 months, only the right side of the scalp showed hair regrowth. Half-side strategy, that is, treating one side and managing the other--divided by the mid sagittal suture--as an internal control for no treatment, placebo or other treatment, has been commonly used in clinical studies for decades. In everyday practice, bilateral treatment is useful to evaluate the responsiveness to two topically delivered interventions and diminishes the time necessary to identify an effective one.
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Affiliation(s)
- Daniele Torchia
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida 33125, USA.
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85
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INUI S, NAKAJIMA T, TODA N, ITAMI S. Pigmented contact dermatitis due to therapeutic sensitizer as complication of contact immunotherapy in alopecia areata. J Dermatol 2010; 37:888-93. [DOI: 10.1111/j.1346-8138.2010.00903.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ohyama M, Shimizu A, Tanaka K, Amagai M. Experimental evaluation of ebastine, a second-generation anti-histamine, as a supportive medication for alopecia areata. J Dermatol Sci 2010; 58:154-7. [DOI: 10.1016/j.jdermsci.2010.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/18/2010] [Accepted: 03/16/2010] [Indexed: 11/30/2022]
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Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol 2010; 62:177-88, quiz 189-90. [PMID: 20115945 DOI: 10.1016/j.jaad.2009.10.032] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/08/2009] [Accepted: 10/12/2009] [Indexed: 12/15/2022]
Abstract
UNLABELLED Alopecia areata (AA) is an autoimmune disease that presents as nonscarring hair loss, although the exact pathogenesis of the disease remains to be clarified. Disease prevalence rates from 0.1% to 0.2% have been estimated for the United States. AA can affect any hair-bearing area. It often presents as well demarcated patches of nonscarring alopecia on skin of overtly normal appearance. Recently, newer clinical variants have been described. The presence of AA is associated with a higher frequency of other autoimmune diseases. Controversially, there may also be increased psychiatric morbidity in patients with AA. Although some AA features are known poor prognostic signs, the course of the disease is unpredictable and the response to treatment can be variable. Part one of this two-part series on AA describes the clinical presentation and the associated histopathologic picture. It also proposes a hypothesis for AA development based on the most recent knowledge of disease pathogenesis. LEARNING OBJECTIVES After completing this learning activity, participants should be familiar with the most recent advances in AA pathogenesis, recognize the rare and recently described variants of AA, and be able to distinguish between different histopathologic stages of AA.
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Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol 2010; 62:191-202, quiz 203-4. [PMID: 20115946 DOI: 10.1016/j.jaad.2009.10.031] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 09/09/2009] [Accepted: 10/08/2009] [Indexed: 11/24/2022]
Abstract
UNLABELLED Various therapeutic agents have been described for the treatment of alopecia areata (AA), but none are curative or preventive. The aim of AA treatment is to suppress the activity of the disease. The high rate of spontaneous remission and the paucity of randomized, double-blind, placebo-controlled studies make the evidence-based assessment of these therapies difficult. The second part of this two-part series on AA discusses treatment options in detail and suggests treatment plans according to specific disease presentation. It also reviews recently reported experimental treatment options and potential directions for future disease management. LEARNING OBJECTIVES After completing this learning activity, participants should be able to compare the efficacy and safety of various treatment options, formulate a treatment plan tailored to individual patients, and recognize recently described treatments and potential therapeutic approaches.
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Affiliation(s)
- Abdullah Alkhalifah
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Mukherjee N, Morrell DS, Duvic M, Stewart PW, Goldsmith LA. Attitudes of dermatologists in the southeastern United States regarding treatment of alopecia areata: a cross-sectional survey study. BMC DERMATOLOGY 2009; 9:11. [PMID: 19909522 PMCID: PMC2789708 DOI: 10.1186/1471-5945-9-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 11/12/2009] [Indexed: 11/17/2022]
Abstract
Background Little evidence exists to guide treatment of alopecia areata (AA). The current practices in treatment of children compared to adults and of progressive stages of hair loss are unknown. The objective of this study was to examine the current practices of southeastern United States dermatologists for the treatment of AA. Methods Dermatologists were sent anonymous questionnaires regarding their treatment practices by mail. Respondents' frequencies of treatment in children compared to adults and in patchy hair loss compared to widespread hair loss were compared with Wilcoxon signed-ranks tests and Friedman tests. As a secondary source, the National Alopecia Areata Registry (NAAR) database was analyzed for patients' treatment histories. Results Survey results suggested that dermatologists recommend treatment less frequently for children than adults and for more advanced hair loss. NAAR data confirmed that offering no treatment for AA is relatively common. Conclusion Dermatologists' treatment of AA is inconsistent. A stronger evidence base will provide more consistent treatment options.
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Affiliation(s)
- Niyati Mukherjee
- Department of Internal Medicine, University of North Carolina Hospitals, Chapel Hill, USA.
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Efentaki P, Altenburg A, Haerting J, Zouboulis CC. Medium-dose prednisolone pulse therapy in alopecia areata. DERMATO-ENDOCRINOLOGY 2009; 1:310-3. [PMID: 21572877 PMCID: PMC3092572 DOI: 10.4161/derm.1.6.11236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the exact etiology of alopecia areata is still unknown, systemic prednisolone treatment seem to be effective in early stages but significant side effects may occur leading to discontinuation of treatment. OBJECTIVE Evaluation of efficacy and saftety of a short-term medium-dose pulse prednisolone treatment in alopecia areata. RESULTS 84% of the patients with multifocal alopecia areata markedly improved after the completion of the three courses. A patient with the ophiasis type only responded after the third course, but relapsed 7 months later. The patients with alopecia areata totalis and universalis did not respond to the treatment. No major side effects were observed. METHODS Monocenter prospective study of intravenous 100 mg intravenous prednisolone pulse therapy on 3 consecutive days at 1-month-intervals for three courses in 23 patients with active alopecia areata rapidly evolving and/or resistant to topical therapies and no contraindication for systemic steroids. CONCLUSION A series of three monthly courses of medium-dose prednisolone pulse therapy is effective and well tolerated in most patients with active, multifocal alopecia areata. The results are rather disappointing in patients with alopecia areara totalis/universalis.
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Affiliation(s)
- Pinelopi Efentaki
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
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Abstract
Alopecia areata is a common condition causing nonscarring hair loss. It may be patchy, involve the entire scalp (alopecia totalis) or whole body (alopecia universalis). Patients may recover spontaneously but the disorder can follow a course of recurrent relapses or result in persistent hair loss. Alopecia areata can cause great psychological distress, and the most important aspect of management is counseling the patient about the unpredictable nature and course of the condition as well as the available effective treatments, with details of their side effects. Although many treatments have been shown to stimulate hair growth in alopecia areata, there are limited data on their long-term efficacy and impact on quality of life. We review the evidence for the following commonly used treatments: corticosteroids (topical, intralesional, and systemic), topical sensitizers (diphenylcyclopropenone), psoralen and ultraviolet A phototherapy (PUVA), minoxidil and dithranol.
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Affiliation(s)
- Seema Garg
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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92
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Kim BJ, Uk min S, Park KY, Choi JW, Park SW, Youn SW, Park KC, Huh CH. Combination therapy of cyclosporine and methylprednisolone on severe alopecia areata. J DERMATOL TREAT 2009; 19:216-20. [DOI: 10.1080/09546630701846095] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Galán-Gutiérrez M, Rodríguez-Bujaldón A, Moreno-Giménez J. Actualización terapéutica en alopecia areata. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70820-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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94
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Alexandroff A, Burd R. Footprints of the EADV: a meeting report from the 17th Congress of the European Academy of Dermatology and Venereology. Br J Dermatol 2009; 160:938-45. [DOI: 10.1111/j.1365-2133.2009.09107.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Razeghinejad MR, Nowroozzadeh MH, Sharifi M, Monabati A. Acute-onset madarosis following MMR vaccination. J Pediatr Ophthalmol Strabismus 2009; 46:123-4. [PMID: 19343978 DOI: 10.3928/01913913-20090301-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kolde G, Meffert H, Rowe E. Successful treatment of alopecia areata with efalizumab. J Eur Acad Dermatol Venereol 2008; 22:1519-20. [DOI: 10.1111/j.1468-3083.2008.02665.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lew BL, Shin MK, Sim WY. Acute diffuse and total alopecia: A new subtype of alopecia areata with a favorable prognosis. J Am Acad Dermatol 2008; 60:85-93. [PMID: 18992964 DOI: 10.1016/j.jaad.2008.08.045] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 08/21/2008] [Accepted: 08/29/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alopecia areata (AA) appears in several clinical forms, all having different clinical courses and different prognoses. Acute diffuse and total alopecia (ADTA) has been reported to have a short clinical course ranging from acute hair loss to total baldness, followed by rapid recovery. OBJECTIVE To determine the clinical course and prognosis of ADTA through precise clinical observations. METHODS Thirty Korean patients who showed ADTA of the scalp within an average of 10 weeks after the onset of hair loss were studied. RESULTS Most patients were women who were older than 20 years of age. The histopathology of the lesion revealed infiltration of mononuclear cells around the hair follicles and prominent pigment incontinence. The patients experienced hair regrowth within about 6 months, without regard to the method of treatment. LIMITATIONS The duration of follow-up after remission ranged from 3 to 49 months, with a mean of 24 months. CONCLUSIONS These cases can be categorized as having "acute diffuse and total alopecia," a new subtype of AA that is associated with a favorable prognosis and rapid and spontaneous recovery even without treatment.
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Affiliation(s)
- Bark-Lynn Lew
- Department of Dermatology, College of Medicine, Kyunghee University, Seoul, Korea
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100
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Abstract
Alopecia areata (AA) is an autoimmune disease leading to loss of scalp hairs. The disease seems triggered by stress. Data on the possibility of using hypnotherapy in the treatment of AA are very limited. Twenty-eight patients with extensive AA, all refractory to previous conventional treatment, were treated with hypnosis at the Academic Hospital UZ Brussel, Brussels, Belgium. This paper describes in detail the authors' hypnotherapeutic approach combining symptom-oriented suggestions with suggestions to improve self-esteem. Twelve out of 21 patients, including 4 with total loss of scalp hair, presented a significant hair growth. All patients presented a significant decrease in scores for anxiety and depression. Although the exact mechanism of hypnotic interventions has not been elucidated, the authors' results demonstrate that hypnotic interventions may ameliorate the clinical outcome of patients with AA and may improve their psychological well-being.
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Affiliation(s)
- Ria Willemsen
- Department of Dermatology, Academic Hospital UZ Brussel, Brussels, Belgium.
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