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Guo HW, Ye ZM, Chen SQ, McElwee KJ. Innovative strategies for the discovery of new drugs against alopecia areata: taking aim at the immune system. Expert Opin Drug Discov 2024:1-18. [PMID: 39360759 DOI: 10.1080/17460441.2024.2409660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 09/24/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION The autoimmune hair loss condition alopecia areata (AA) exacts a substantial psychological and socioeconomic toll on patients. Biotechnology companies, dermatology clinics, and research institutions are dedicated to understanding AA pathogenesis and developing new therapeutic approaches. Despite recent efforts, many knowledge gaps persist, and multiple treatment development avenues remain unexplored. AREAS COVERED This review summarizes key AA disease mechanisms, current therapeutic methods, and emerging treatments, including Janus Kinase (JAK) inhibitors. The authors determine that innovative drug discovery strategies for AA are still needed due to continued unmet medical needs and the limited efficacy of current and emerging therapeutics. For prospective AA treatment developers, the authors identify the pre-clinical disease models available, their advantages, and limitations. Further, they outline treatment development opportunities that remain largely unmapped. EXPERT OPINION While recent advancements in AA therapeutics are promising, challenges remain, including the lack of consistent treatment efficacy, long-term use and safety issues, drug costs, and patient compliance. Future drug development research should focus on patient stratification utilizing robust biomarkers of AA disease activity and improved quantification of treatment response. Investigating superior modes of drug application and developing combination therapies may further improve outcomes. Spirited innovation will be needed to advance more effective treatments for AA.
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Affiliation(s)
- Hong-Wei Guo
- Department of Dermatology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhi-Ming Ye
- Guangdong Medical University, Zhanjiang, China
| | - Si-Qi Chen
- Guangdong Medical University, Zhanjiang, China
| | - Kevin J McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
- Centre for Skin Sciences, University of Bradford, Bradford, UK
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Kim SR, Park SH, Koh SJ, Park H. Association of Infantile Antibiotic Exposure and its Changes with Pediatric Alopecia Areata. J Invest Dermatol 2024:S0022-202X(24)01917-1. [PMID: 39038533 DOI: 10.1016/j.jid.2024.06.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Joon Koh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Intestinal Mucosa and Skin Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hyunsun Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Intestinal Mucosa and Skin Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Caldas S, Pagan AD, Pulsinelli J, da Rosa JC, Jung S, Sharma D, Adalsteinsson JA, Ungar B. Association of alopecia areata and ischemic heart disease and cerebrovascular in U.S. adults: an all of us database study. Arch Dermatol Res 2024; 316:202. [PMID: 38775975 DOI: 10.1007/s00403-024-02959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Stella Caldas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
- George Washington University School of Medicine, Washington, DC, US
| | - Angel D Pagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
- Ponce Health Sciences University School of Medicine, Ponce, PR, US
| | - Juliana Pulsinelli
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
| | - Joel Correa da Rosa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
| | - Seungyeon Jung
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
- Vanderbilt University School of Medicine, Nashville, TN, US
| | - Divija Sharma
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
- University of Louisville School of Medicine, Louisville, KY, US
| | - Jonas A Adalsteinsson
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY, 10029, US.
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Suzuki M, Mineharu Y, Okawa M, Yoshida K, Nagata M, Yang T, Suzuki K, Takayama N, Yamamoto Y, Tabara Y, Miyamoto S, Arakawa Y, Matsuda F. Common and distinct risk profiles of asymptomatic extra- and intracranial atherosclerosis in the Nagahama cohort. J Stroke Cerebrovasc Dis 2024:107782. [PMID: 38777218 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Atherosclerotic burden increases the risk of both extracranial internal carotid artery stenosis (ICS) and intracranial large artery disease (ICAD). However, the differences in risk profiles have not been thoroughly investigated. METHODS Participants were recruited from the Nagahama study cohort in Japan. Individuals over 60 years old who underwent 1.5-T head and neck magnetic resonance angiography (MRA) between July 2013 and February 2017 were included. ICAD was defined as WASID ≥ 50%, and ICS was defined as NSCET ≥ 30%. The prevalence and association of risk factors, including proatherogenic and proinflammatory factors, and the p.R4810K variant in the RNF213 gene, were investigated. Multivariable logistic regression analyses were performed. RESULTS A total of 3089 individuals participated in the study, with a mean age of 68.1 ± 5.3 years, and 36.0% were males. Among them, 52 (1.7%) had ICS, 119 (3.8%) had ICAD, and 15 (0.49%) had both conditions. Alopecia areata was an independent predictor for both ICS (Odds ratio [OR] 3.5; 95% CI 1.3-8.3) and ICAD (OR 2.1; 95% CI 1.0-3.9). Diabetes (OR 3.7; 95% CI 2.0-7.0) and older age (OR 2.4; 95% CI 1.2-4.5) were associated only with ICS, while the RNF213 variant was associated with only ICAD (OR 5.7; 95% CI 1.6-16.0). ICS and ICAD were also independently associated with each other. CONCLUSIONS In this MRA-based large scale study, alopecia areata, known as a systemic inflammatory disease, was shown to be a common risk factor for ICS and ICAD. While conventional atherosclerotic factors were associated with ICS, non-atherosclerotic factors appear to contribute to ICAD in Japan.
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Affiliation(s)
- Megumu Suzuki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Artificial Intelligence in Healthcare and Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan.
| | - Manabu Nagata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Tao Yang
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Keita Suzuki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Naoki Takayama
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yu Yamamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yasuhiro Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Kim SR, Koh SJ, Park H. Childhood Obesity, Weight Change, and Pediatric Immune-Mediated Skin Diseases. J Invest Dermatol 2024; 144:S0022-202X(24)00257-4. [PMID: 39177545 DOI: 10.1016/j.jid.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/21/2023] [Accepted: 01/19/2024] [Indexed: 08/24/2024]
Abstract
Whether childhood obesity or weight gain leads to the development of pediatric immune-mediated skin diseases remains unclear. We aimed to determine the associations between body mass index or body mass index changes and the development of 3 main immune-mediated skin diseases-alopecia areata, atopic dermatitis (AD), and psoriasis-by analyzing a longitudinal cohort of 2,161,900 Korean children from 2009 to 2020. The findings indicated that children who were obese had a higher risk of pediatric immune-mediated skin diseases than those with normal weight (P for trend < .01). An increase in body mass index was associated with a higher risk of AD, whereas a decrease in body mass index was correlated with a reduced risk of AD. Children who gained weight, transitioning from normal to overweight, exhibited a higher AD risk than those who maintained a normal weight (adjusted hazard ratio = 1.15, 95% confidence interval = 1.11-1.20). However, those who shifted from being overweight to achieving a normal weight (adjusted hazard ratio = 0.87, 95% confidence interval = 0.81-0.94) had a lower AD risk than children who were overweight who maintained their weight. In summary, early childhood obesity may increase the risk of pediatric immune-mediated skin diseases. Weight gain may increase AD risk, whereas weight loss may lower the risk.
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Affiliation(s)
- Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Joon Koh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Intestinal Mucosa and Skin Immunology, Seoul, Republic of Korea.
| | - Hyunsun Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Intestinal Mucosa and Skin Immunology, Seoul, Republic of Korea; Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Dainichi T, Iwata M, Kaku Y. Alopecia areata: What's new in the epidemiology, comorbidities, and pathogenesis? J Dermatol Sci 2023; 112:120-127. [PMID: 37833164 DOI: 10.1016/j.jdermsci.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a common, acquired, and nonscarring type of hair loss that affects people of every generation and is intractable in severe and relapsing cases. Patients with AA, especially those with greater scalp involvement, have poor health-related quality-of-life scores. PURPOSE Following our previous review article in the April 2017 issue of the Journal of Dermatological Science, we aim to provide a pair of review articles on recent progress in multidisciplinary approaches to AA. MAIN FINDINGS We found more than 1800 publications on AA from July 2016 to December 2022. CONCLUSIONS In this review, we focused on the latest information on the epidemiology, comorbidities, and pathogenesis of AA.
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Affiliation(s)
- Teruki Dainichi
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan.
| | - Masashi Iwata
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Yo Kaku
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan; Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
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Najafi MT, Abedini R, Ghandi N, Seraji S, Sadeghi Y. Is the severity of alopecia areata associated with arterial stiffness? JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:80. [PMID: 38292334 PMCID: PMC10826848 DOI: 10.4103/jrms.jrms_375_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 02/01/2024]
Abstract
Background This study aimed to evaluate the severity of alopecia areata (AA) associations with metabolic syndrome, body composition evaluated by bioimpedance techniques, and arterial stiffness based on pulse-wave velocity analysis. Materials and Methods This cross-sectional study was conducted on patients referred to AA Clinic at Razi Hospital in 2021 and 2022. Patients with AA with the Severity of Alopecia Tool (SALT) score above 20% and receiving no systemic therapy were included. Patient demographic and clinical information, symptoms of metabolic syndrome, and bioimpedance factors were collected, and the relationship between disease severity, metabolic syndrome, and bioimpedance indicators was evaluated. Results In this study, 59 patients were examined, with 26 (44.07%) being female and 33 (55.93%) being male. The mean age of the patients was 37.42 years (standard deviation [SD] =11.28). The severity of the disease was assessed using the SALT score, with the mean severity in terms of the percentage being 69.83% (SD = 28.57%). In the regression model, SALT score was independently related to the severity of vascular stiffness after adjusting for the effect of other variables (beta = 0.033, 95% CI = 0.009-0.057, P = 0.046). Moreover, SALT score was significantly related to metabolic syndrome after adjusting for the effect of other variables (OR = 1.035, 95% CI = 1.012-1.059, P = 0.002). Conclusion This study found that AA severity is associated with a higher chance of having metabolic syndrome and arterial stiffness which may lead to cardiovascular diseases in patients with AA, and screening patients regarding cardiometabolic diseases is mandated.
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Affiliation(s)
| | - Robabeh Abedini
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadab Seraji
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Sadeghi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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O'Hagan R, Caldas SA, Correa da Rosa JM, Guttman-Yassky E, Ungar B. Alopecia areata is associated with increased genetic risk of myocardial infarction: A Mendelian randomization study. J Eur Acad Dermatol Venereol 2023; 37:e1341-e1343. [PMID: 37421249 DOI: 10.1111/jdv.19318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Ross O'Hagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stella A Caldas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joel M Correa da Rosa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ly S, Manjaly P, Kamal K, Shields A, Wafae B, Afzal N, Drake L, Sanchez K, Gregoire S, Zhou G, Mita C, Mostaghimi A. Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis. Am J Clin Dermatol 2023; 24:875-893. [PMID: 37464249 DOI: 10.1007/s40257-023-00805-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking. OBJECTIVE The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA. METHODS We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023. RESULTS We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89). CONCLUSION These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Ali Shields
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bruna Wafae
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Carol Mita
- Countway Library of Medicine, Harvard University, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Seok J, Cho SD, Lee J, Choi Y, Kim SY, Lee SM, Kim SH, Jeong S, Jeon M, Lee H, Kim AR, Choi B, Ha SJ, Jung I, Yoon KJ, Park JE, Kim JH, Kim BJ, Shin EC, Park SH. A virtual memory CD8 + T cell-originated subset causes alopecia areata through innate-like cytotoxicity. Nat Immunol 2023; 24:1308-1317. [PMID: 37365384 DOI: 10.1038/s41590-023-01547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Virtual memory T (TVM) cells are a T cell subtype with a memory phenotype but no prior exposure to foreign antigen. Although TVM cells have antiviral and antibacterial functions, whether these cells can be pathogenic effectors of inflammatory disease is unclear. Here we identified a TVM cell-originated CD44super-high(s-hi)CD49dlo CD8+ T cell subset with features of tissue residency. These cells are transcriptionally, phenotypically and functionally distinct from conventional CD8+ TVM cells and can cause alopecia areata. Mechanistically, CD44s-hiCD49dlo CD8+ T cells could be induced from conventional TVM cells by interleukin (IL)-12, IL-15 and IL-18 stimulation. Pathogenic activity of CD44s-hiCD49dlo CD8+ T cells was mediated by NKG2D-dependent innate-like cytotoxicity, which was further augmented by IL-15 stimulation and triggered disease onset. Collectively, these data suggest an immunological mechanism through which TVM cells can cause chronic inflammatory disease by innate-like cytotoxicity.
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Affiliation(s)
- Joon Seok
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Dong Cho
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jeongsoo Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yunseo Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Su-Young Kim
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Min Lee
- Department of Biological Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- KAIST Stem Cell Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sang-Hoon Kim
- The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - Seongju Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Minwoo Jeon
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hoyoung Lee
- The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - A Reum Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Baekgyu Choi
- Department of Biological Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sang-Jun Ha
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Inkyung Jung
- Department of Biological Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Ki-Jun Yoon
- Department of Biological Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- KAIST Stem Cell Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong-Eun Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong Hoon Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Eui-Cheol Shin
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
- The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, Republic of Korea.
| | - Su-Hyung Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
- The Center for Epidemic Preparedness, KAIST Institute, Daejeon, Republic of Korea.
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11
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Ryu JY, Kang MJ, Cho HG, Yang JD, Lee JS. Waist Circumference and Cardiovascular Risk Profiles after Autologous Breast Reconstruction: A Nationwide Population-Based Cohort Study. J Clin Med 2023; 12:jcm12083040. [PMID: 37109376 PMCID: PMC10142238 DOI: 10.3390/jcm12083040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
To date, few studies have examined changes in waist circumference and cardiovascular risk profile (CVRP) after autologous breast reconstruction. Therefore, this study aimed to investigate the effect of flap surgery using autologous tissue on waist circumference and CVRP through a nationwide population-based cohort study. In total, 6926 patients who underwent autologous breast reconstruction between 2015 and 2019 were considered. Of them, we evaluated 3444 patients who underwent the complete Korean National Health Insurance Service Health Screening (NHIS-HealS) before and after surgery. Body measurements, including waist circumference, weight, and body mass index; and CVRP, including blood pressure, fasting blood glucose, and cholesterol levels, were analyzed by type of surgery up to 3-4 years postoperatively. The body measurements of patients who underwent abdominal-based breast reconstruction were reduced 1-2 years after surgery, but returned to preoperative values 3-4 years after surgery. Regardless of the type of surgery, CVRP was worsened at both 1-2 years and 3-4 years after surgery, except for low-density lipoprotein values. Autologous breast reconstruction did not ameliorate the deterioration of CVRP over time. In addition, the abdominoplasty effect of abdominal-based breast reconstruction disappeared 1-2 years after surgery.
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Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
| | - Myeong Jae Kang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
| | - Hyun Geun Cho
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
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12
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Kim H, Kim HJ, Ahn HS. Does endometriosis increase the risks of endometrial hyperplasia and endometrial cancer? Gynecol Oncol 2023; 169:147-153. [PMID: 36357191 DOI: 10.1016/j.ygyno.2022.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The risk of developing endometrial hyperplasia after diagnosis of endometriosis has not been determined. Moreover, the risk of endometrial cancer associated with endometriosis is unclear. This nationwide population-based study investigated the associations of endometrial hyperplasia and endometrial cancer with endometriosis, after adjusting for covariates. METHODS This population-based observational study analyzed data from the Korean National Health Insurance (NHI) database, including 147,869 women who were diagnosed with endometriosis from 2002 to 2017, with each patient matched to 20 control women without endometriosis. Cox proportional hazard regression analyses were performed to estimate the hazard ratios (HRs) of endometrial hyperplasia, endometrial cancer, and mortality from endometrial cancer. RESULTS Among three million women in this population, 16,377 women were diagnosed with endometrial hyperplasia, and 1795 women were diagnosed with endometrial cancer over 19,931,794 person-years of follow-up. Women with endometriosis were at significantly higher risks of endometrial hyperplasia (adjusted hazard ratio [aHR] 1.85, 95% confidence interval [CI] 1.75-1.95), and endometrial cancer (aHR 1.35, 95% CI 1.12-1.63) were compared with control women after adjustment for covariates. A diagnosis of endometriosis did not affect survival in patients with endometrial cancer. CONCLUSION The risks of endometrial hyperplasia and endometrial cancer were found to be significantly higher in women with than without endometriosis. The presence of endometriosis did not affect overall survival in women with endometrial cancer. Additional long-term prospective studies with adequate control of confounders are needed.
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Affiliation(s)
- Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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13
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Xu W, Wan S, Xie B, Song X. Novel potential therapeutic targets of alopecia areata. Front Immunol 2023; 14:1148359. [PMID: 37153617 PMCID: PMC10154608 DOI: 10.3389/fimmu.2023.1148359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
Alopecia areata (AA) is a non-scarring hair loss disorder caused by autoimmunity. The immune collapse of the hair follicle, where interferon-gamma (IFN-γ) and CD8+ T cells accumulate, is a key factor in AA. However, the exact functional mechanism remains unclear. Therefore, AA treatment has poor efficacy maintenance and high relapse rate after drug withdrawal. Recent studies show that immune-related cells and molecules affect AA. These cells communicate through autocrine and paracrine signals. Various cytokines, chemokines and growth factors mediate this crosstalk. In addition, adipose-derived stem cells (ADSCs), gut microbiota, hair follicle melanocytes, non-coding RNAs and specific regulatory factors have crucial roles in intercellular communication without a clear cause, suggesting potential new targets for AA therapy. This review discusses the latest research on the possible pathogenesis and therapeutic targets of AA.
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Affiliation(s)
- Wen Xu
- School of Medicine, Zhejiang University, Hangzhou, China
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Sheng Wan
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Bo Xie
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Xiuzu Song,
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14
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Kang Y, Cai Y, Zhao Y, Yang Y. The gut microbiome and Alopecia areata: Implications for early diagnostic biomarkers and novel therapies. Front Nutr 2022; 9:979876. [PMID: 36185693 PMCID: PMC9520310 DOI: 10.3389/fnut.2022.979876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Alopecia areata (AA) accounts for the autoimmune disorder mediated by T cells, whose prognostic outcome cannot be predicted and curative treatment is unavailable at present. The AA pathogenic mechanism remains largely unclear, even though follicular attack has been suggested to result from that attack of immune privilege-losing hair follicles driven by immunity. Recently, gut microbiota is suggested to have an important effect on immunoregulation under autoimmune situations like AA. Fecal microbial transplantation (FMT) may be used to treat AA. Nonetheless, related research remains at the initial stage. To promote the rapid progress of relevant research, the present work aimed to shed more lights on gut microbiota's effect on AA, early diagnostic biomarker and FMT therapeutics.
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Affiliation(s)
- Yongbo Kang
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Kunming, China
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Yongbo Kang
| | - Yue Cai
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Kunming, China
| | - Yanqin Zhao
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Ying Yang
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Kunming, China
- *Correspondence: Ying Yang
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15
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Jadeja SD, Tobin DJ. Autoantigen Discovery in the Hair Loss Disorder, Alopecia Areata: Implication of Post-Translational Modifications. Front Immunol 2022; 13:890027. [PMID: 35720384 PMCID: PMC9205194 DOI: 10.3389/fimmu.2022.890027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
Alopecia areata (AA) is a chronic, multifactorial, polygenic, and heterogeneous disorder affecting growing hair follicles in susceptible individuals, which results in a non-scarring and reversible hair loss with a highly unpredictable course. Despite very considerable research effort, the nature of the precipitating factor(s) responsible for initiating AA in any given hair follicle remains unclear, due largely to significant gaps in our knowledge of the precise sequence of the etiopathogenic events in this dermatosis. However, disease-related changes in the immune-competence of the lower growing hair follicle, together with an active immune response (humoral and cellular) to hair follicle-associated antigens, are key associated phenomena. Confirmation of the hair follicle antigen(s) implicated in AA disease onset has remained stubbornly elusive. While it may be considered somewhat philosophical by some, it is also unclear whether immune-mediated hair loss in AA results from a) an ectopic (i.e., in an abnormal location) immune response to native (unmodified) self-antigens expressed by the healthy hair follicle, b) a normal immune response against modified self-antigens (or neoantigens), or c) a normal immune response against self-antigens (modified/non-modified) that were not previously visible to the immune system (because they were conformationally-hidden or sequestered) but become exposed and presentable in an MHC-I/-II molecule-restricted manner. While some candidate hair follicle antigen target(s) in AA are beginning to emerge, with a potential role for trichohyalin, it is not yet clear whether this represents the initial and immunodominant antigenic focus in AA or is simply one of an expanding repertoire of exposed hair follicle tissue damage-associated antigens that are secondary to the disease. Confirmation of autoantigen identity is essential for our understanding of AA etiopathogenesis, and consequently for developing a more informed therapeutic strategy. Major strides have been made in autoantigen discovery in other autoimmune conditions. In particular, some of these conditions may provide insights into how post-translational modifications (e.g., citrullination, deamidation, etc.) of hair follicle-restricted proteins may increase their antigenicity and so help drive the anti-hair follicle immune attack in AA.
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Affiliation(s)
- Shahnawaz D. Jadeja
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Desmond J. Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
- The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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Kim DH, Lee JY, Cho SI, Jo SJ. Risks of Comorbidities in Patients With Palmoplantar Pustulosis vs Patients With Psoriasis Vulgaris or Pompholyx in Korea. JAMA Dermatol 2022; 158:650-660. [PMID: 35476054 PMCID: PMC9047771 DOI: 10.1001/jamadermatol.2022.1081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Palmoplantar pustulosis (PPP) has been reported to be accompanied by systemic conditions. However, the risks of comorbidities in patients with PPP have rarely been evaluated. Objective To assess the risks of comorbidities in patients with PPP compared with patients with psoriasis vulgaris or pompholyx. Design, Setting, and Participants This nationwide population-based cross-sectional study used data from the Korean National Health Insurance database and the National Health Screening Program collected from January 1, 2010, to December 31, 2019. Data were analyzed from July 1, 2020, to October 31, 2021. Korean patients diagnosed with PPP, psoriasis vulgaris, or pompholyx who visited a dermatologist between January 1, 2010, and December 31, 2019, were enrolled. Exposures Presence of PPP. Main Outcomes and Measures The risks of comorbidities among patients with PPP vs patients with psoriasis vulgaris or pompholyx were evaluated using a multivariable logistic regression model. Results A total of 37 399 patients with PPP (mean [SD] age, 48.98 [17.20] years; 51.7% female), 332 279 patients with psoriasis vulgaris (mean [SD] age, 47.29 [18.34] years; 58.7% male), and 365 415 patients with pompholyx (mean [SD] age, 40.92 [17.63] years; 57.4% female) were included in the analyses. Compared with patients with pompholyx, those with PPP had significantly higher risks of developing psoriasis vulgaris (adjusted odds ratio [aOR], 72.96; 95% CI, 68.19-78.05; P < .001), psoriatic arthritis (aOR, 8.06; 95% CI, 6.55-9.92; P < .001), ankylosing spondylitis (aOR, 1.91; 95% CI, 1.61-2.27; P < .001), type 1 diabetes (aOR, 1.33; 95% CI, 1.16-1.52; P < .001), type 2 diabetes (aOR, 1.33; 95% CI, 1.29-1.38; P < .001), Graves disease (aOR, 1.25; 95% CI, 1.11-1.42; P < .001), Crohn disease (aOR, 1.63; 95% CI, 1.11-2.40; P = .01), and vitiligo (aOR, 1.87; 95% CI, 1.65-2.12; P < .001) after adjusting for demographic covariates. The risks of ankylosing spondylitis (aOR, 1.37; 95% CI, 1.16-1.62; P < .001) and Graves disease (aOR, 1.40; 95% CI, 1.23-1.58; P < .001) were significantly higher among patients with PPP vs psoriasis vulgaris. However, the risks of psoriatic arthritis (aOR, 0.54; 95% CI, 0.47-0.63; P < .001), systemic lupus erythematosus (aOR, 0.67; 95% CI, 0.46-0.97; P = .04), Sjögren syndrome (aOR, 0.70; 95% CI, 0.50-0.96; P = .03), systemic sclerosis (aOR, 0.29; 95% CI, 0.11-0.77; P = .01), vitiligo (aOR, 0.53; 95% CI, 0.47-0.60; P < .001), and alopecia areata (aOR, 0.88; 95% CI, 0.81-0.95; P = .001) were significantly lower among those with PPP vs psoriasis vulgaris. Conclusions and Relevance The results of this cross-sectional study suggest that patients with PPP have an overlapping comorbidity profile with patients with psoriasis vulgaris but not patients with pompholyx. However, the risks of comorbidities among patients with PPP may be substantially different from those among patients with psoriasis vulgaris.
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Affiliation(s)
- Dong Hyo Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Dermatology, Seoul National University Hospital, Seoul, South Korea
| | - Jin Yong Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Dermatology, Seoul National University Hospital, Seoul, South Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Dermatology, Seoul National University Hospital, Seoul, South Korea
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17
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Mostaghimi A, Xenakis J, Meche A, Smith TW, Gruben D, Sikirica V. Economic Burden and Healthcare Resource Use of Alopecia Areata in an Insured Population in the USA. Dermatol Ther (Heidelb) 2022; 12:1027-1040. [PMID: 35381975 PMCID: PMC9021349 DOI: 10.1007/s13555-022-00710-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/11/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Comparative data on the economic burden of alopecia areata relative to the general population are limited. The objective of this retrospective database analysis was to evaluate healthcare resource utilization and direct medical costs among patients with alopecia areata from the US payer perspective compared with matched controls. METHODS Validated billing codes were used to identify patients with alopecia areata from the IQVIA PharMetrics Plus (2016-2018) who had continuous pharmacy and medical enrollment for 365 days both before (baseline period) and after (evaluation period) the index date. Demographic and clinical characteristics were characterized, and baseline comorbidities were assessed with the Quan Charlson Comorbidity Index. RESULTS Using the exact matching feature from Instant Health Data, 14,340 patients with alopecia areata were matched with 42,998 control patients aged ≥ 12 years. Patients with alopecia areata had higher healthcare resource utilization and adjusted total all-cause mean medical costs versus matched controls ($8557 versus $6416; p < 0.0001), because of higher inpatient costs, emergency department visits, ambulatory visits, number of prescriptions and prescription costs, and other costs such as durable medical equipment and home healthcare. The number of inpatient visits did not significantly differ between the two groups. Mean ambulatory costs were $3640 for patients with alopecia areata and $2062 for controls, and mean pharmacy costs were $3287 and $1843, respectively (p < 0.0001 for both). Pharmacy costs related to immunologic agents represented 50.0% of the total difference in pharmacy spending between patients with alopecia areata and controls. Surgery on the integumentary system accounted for 9.5% of the total difference in ambulatory costs. CONCLUSION Alopecia areata is associated with significant incremental healthcare resource utilization and costs relative to matched controls due to increased spending in areas such as surgical procedures and psychological and pharmacological interventions. Costs are primarily driven by ambulatory and pharmacy spending.
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Affiliation(s)
- Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
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Cinteză E, Voicu C, Filip C, Ioniță M, Popescu M, Bălgrădean M, Nicolescu A, Mahmoud H. Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis. Diagnostics (Basel) 2022; 12:diagnostics12040884. [PMID: 35453932 PMCID: PMC9025069 DOI: 10.3390/diagnostics12040884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/19/2022] Open
Abstract
Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.
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Affiliation(s)
- Eliza Cinteză
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristiana Voicu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristina Filip
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihnea Ioniță
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Monica Popescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihaela Bălgrădean
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Alin Nicolescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Hiyam Mahmoud
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Royal Brompton Hospital, London SW3 6NP, UK
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Waśkiel-Burnat A, Kotowska M, Dorobek WM, Smyk J, Gąsecka A, Niemczyk A, Blicharz L, Filipiak KJ, Olszewska M, Rudnicka L. Patients with alopecia areata are at risk of endothelial dysfunction: results of a case-control study. Clin Exp Dermatol 2022; 47:1517-1522. [PMID: 35357040 DOI: 10.1111/ced.15206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alopecia areata is an autoimmune form of hair loss which may affect any hair-bearing area. It has been suggested that alopecia areata is associated with an increased risk of metabolic and cardiovascular comorbidities. OBJECTIVES The aim of the study was to evaluate the early predictors of cardiovascular diseases (endothelial function and arterial stiffness) in patients with alopecia areata without prior cardiovascular disease in comparison with healthy controls. METHODS Fifty-two patients with alopecia areata (38 women and 14 men, mean age: 41 [30 - 52]) and 34 healthy controls matched for age, gender and body mass index were enrolled in the study. Endothelial dysfunction expressed as reactive hyperemia index (RHI) and arterial stiffness identified by augmentation index (AI@75) were assessed with the use of the Endo-PAT 2000 device. RESULTS Endothelial dysfunction was observed in 22/52 (42%) patients with alopecia areata and in 4/34 (12%) healthy controls (p=0.002). Moreover, mean RHI was lower in patients with alopecia areata in comparison with control subjects (1.90 ± 0.31 vs 2.11 ± 0.45; p=0.03). No significant difference was present in AI@75 between patients with alopecia areata and the controls. CONCLUSIONS Patients with alopecia areata show abnormalities in the early predictors of cardiovascular diseases. Regular cardiovascular screening might be appropriate in every patient with alopecia areata.
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Affiliation(s)
- Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Maja Kotowska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Wioleta M Dorobek
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Julia Smyk
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Anna Niemczyk
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Pałac Lubomirskich, Plac Żelaznej Bramy 10, 00-136, Warsaw, Poland
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
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20
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Chemokine C-C Motif Ligand 7 (CCL7), a Biomarker of Atherosclerosis, Is Associated with the Severity of Alopecia Areata: A Preliminary Study. J Clin Med 2021; 10:jcm10225418. [PMID: 34830700 PMCID: PMC8624305 DOI: 10.3390/jcm10225418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
Alopecia areata is an autoimmune, inflammatory form of non-scarring hair loss that may affect any hair-bearing area. Recently, an increased risk of cardiovascular disorders has been described in patients with alopecia areata. The aim of the study was to evaluate the serum concentrations of proinflammatory proteins associated with atherosclerosis (chemokine C-C motif ligand 4; CCL4, chemokine C-C motif ligand 7, CCL7; and sortilin, SORT1), and cardiovascular risk (myeloperoxidase, MPO; interleukin 1 receptor-like 1, IL1RL1; and growth differentiation factor 15, GDF15) in patients with alopecia areata without symptoms or prior cardiovascular disease in comparison with healthy controls. Sixty otherwise healthy patients with alopecia areata and twenty control subjects matched for age, gender, and body mass index (BMI) were enrolled in the study. No significant differences in the serum levels of MPO, IL1RL1, CCL4, CCL7, SORT1, and GDF15 were detected between patients with alopecia areata and healthy controls. A positive correlation was found between the serum concentration of CCL7 and the severity of alopecia areata (r = 0.281, p = 0.03), while GDF15 correlated with age at the disease onset (r = 0.509, p < 0.0001). The results of the present study suggest that the severity of alopecia areata may be associated with an increased risk of atherosclerosis.
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Ting HC, Ma SH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Association between alopecia areata and retinal diseases: A nationwide population-based cohort study. J Am Acad Dermatol 2021; 87:771-778. [PMID: 34794815 DOI: 10.1016/j.jaad.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing evidence has revealed abnormalities in the retinal structures of patients with alopecia areata (AA). However, the relationship between AA and retinopathy remains unclear. OBJECTIVE To investigate the association between AA and retinal diseases. METHODS The study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9909 patients with AA and 99,090 matched controls to assess the risk of retinal diseases. A Cox regression model was used for all analyses. RESULTS Compared with the controls, patients with AA had an adjusted hazard ratio (aHR) of 3.10 (95% confidence interval [CI] 2.26-4.26) for retinal diseases. With respect to individual retinal diseases, Patients with AA had significantly higher risks of developing retinal detachment (aHR 3.98; 95% CI 2.00-7.95), retinal vascular occlusion (aHR 2.45; 95% CI 1.22-4.92), and retinopathy (aHR 3.24; 95% CI 2.19-4.81) than controls. LIMITATIONS This was a retrospective cohort study. Meanwhile, almost all the participating individuals were residents of Taiwan; therefore, the validity of our findings in other demographics remains unclear. CONCLUSION Patients with AA had a significantly higher risk of retinal disease than controls. Further studies are needed to clarify the pathophysiology of AA and retinal diseases.
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Affiliation(s)
- Hui-Chu Ting
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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22
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Glickman JW, Dubin C, Dahabreh D, Han J, Del Duca E, Estrada YD, Zhang N, Kimmel GW, Singer G, Krueger JG, Pavel AB, Guttman‐Yassky E. An integrated scalp and blood biomarker approach suggests the systemic nature of alopecia areata. Allergy 2021; 76:3053-3065. [PMID: 33721346 DOI: 10.1111/all.14814] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is characterized by immune dysregulation in both scalp and blood, but a large-scale approach establishing biomarkers of AA incorporating both scalp tissue and serum compartments is lacking. We aimed to characterize the transcriptomic signature of AA lesional and nonlesional scalp compared to healthy scalp and determine its relationship with the blood proteome in the same individuals, with comparative correlations to clinical AA disease severity. METHODS We evaluated lesional and nonlesional scalp tissues and serum from patients with moderate-to-severe AA (n = 18) and healthy individuals (n = 8). We assessed 33,118 genes in AA scalp tissue using RNAseq transcriptomic evaluation and 340 inflammatory proteins in serum using OLINK high-throughput proteomics. Univariate and multivariate approaches were used to correlate disease biomarkers with Severity of Alopecia Tool (SALT). RESULTS A total of 608 inflammatory genes were differentially expressed in lesional AA scalp (fold change/FCH>1.5, false discovery rate/FDR<0.05) including Th1 (IFNG/IL12B/CXCL11), Th2 (IL13/CCL18), and T-cell activation-related (ICOS) products. Th1/Th2-related markers were significantly correlated with AA clinical severity in lesional/nonlesional tissue, while keratins (KRT35/KRT83/KRT81) were significantly downregulated in lesional compared to healthy scalp (p < .05). Expression of cardiovascular/atherosclerosis-related markers (MMP9/CCL2/IL1RL1/IL33R/ST2/AGER) in lesional scalp correlated with their corresponding serum expression (p < .05). AA scalp demonstrated significantly greater biomarker dysregulation compared to blood. An integrated multivariate approach combining scalp and serum biomarkers improved correlations with disease severity/SALT. CONCLUSION This study contributes a unique understanding of the phenotype of moderate-to-severe AA with an integrated scalp and serum biomarker model suggesting the systemic nature of the disease, advocating for the need for immune-based systemic treatment.
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Affiliation(s)
- Jacob W. Glickman
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Celina Dubin
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Dante Dahabreh
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joseph Han
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Yeriel D. Estrada
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ning Zhang
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Grace W. Kimmel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Giselle Singer
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - James G. Krueger
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Ana B. Pavel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Biomedical Engineering The University of Mississippi University MS USA
| | - Emma Guttman‐Yassky
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
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23
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Peterson D, Wambier C, Dai F, Lampert R, Ahmad T, Yale KL, Mesinkovska NA, King B. Electrocardiogram Findings in Patients with Alopecia Areata. Dermatol Ther (Heidelb) 2021; 11:2217-2223. [PMID: 34564797 PMCID: PMC8611143 DOI: 10.1007/s13555-021-00614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction While autoimmune comorbidities are common in alopecia areata, little is known about comorbid cardiovascular disease. The purpose of this study was to evaluate the incidence of bradyarrhythmia in patients with alopecia areata. Methods Retrospective review of electrocardiograms of 124 patients with \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 50% scalp hair loss (severe alopecia areata) was conducted and compared to National Health and Nutrition Examination Survey (NHANES) data. Results The prevalence of bradycardia in females with alopecia areata was 24.3% (95% CI, 14.5–34.1%) and in those age 40 years or older was 40.8% (95% CI, 22.2–53.5%) compared to 19.5% in the NHANES III population. The prevalence of bradycardia in males with alopecia areata was 36.0% (95% CI, 22.7–49.3%) and in those age 40 years or older was 50.0% (95% CI, 21.7–78.3%) compared to 26.9% in the NHANES III population. Conclusion The potential association between bradycardia and alopecia areata merits further investigation.
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Affiliation(s)
- Danielle Peterson
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Wambier
- Department of Dermatology, Brown University, Providence, RI, USA
| | - Feng Dai
- Center for Analytical Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Lampert
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tariq Ahmad
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Katerina L Yale
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | | | - Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.
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Lee H, Kim YC, Choi JW. Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study. PLoS One 2021; 16:e0250216. [PMID: 33961663 PMCID: PMC8104430 DOI: 10.1371/journal.pone.0250216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of hair follicles. Chronic inflammatory skin diseases such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases (HDs) remains unclear. Therefore, we conducted this retrospective cohort study to evaluate the risk of subsequent HDs in patients with AA. We reviewed 3770 cases of AA and from 18,850 age, sex, and income level-matched controls from the National Health Insurance Service-National Sample Cohort. In the subgroup analysis, patients who suffered from alopecia totalis, alopecia universalis, and ophiasis were designated as patients with severe AA and patients having the disease for over a year were designated as patients with long-standing AA. As a result, we found that AA was not associated with a higher risk of heart failure, angina pectoris, or myocardial infarction. There was no significant increase in the risk of overall HD associated with AA (adjusted hazard ratio: 1.17; 95% confidence interval: 0.93-1.48; p = 0.177). Neither the severity nor the duration of AA was related to an increased risk of HDs. During the study period, AA patients did not show a significantly higher cumulative incidence of HDs than controls (log-rank p = 0.157). In conclusion, AA does not increase the risk of HD.
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Affiliation(s)
- Heera Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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25
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Cho SI, Yu DA, Kim SI, Lee SM, Kwon O. Pregnancy Outcomes in Female Patients with Alopecia Areata: A Nationwide Population-Based Study. J Invest Dermatol 2021; 141:1844-1847.e4. [PMID: 33422620 DOI: 10.1016/j.jid.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Da-Ae Yu
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea.
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26
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D’Incan PM. Quoi de neuf en Clinique en 2020 ? Ann Dermatol Venereol 2020; 147:12S1-12S8. [DOI: 10.1016/s0151-9638(20)31101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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Cigarette Smoking, Alcohol Consumption, and Risk of Alopecia Areata: A Population-Based Cohort Study in Taiwan. Am J Clin Dermatol 2020; 21:901-911. [PMID: 32761499 DOI: 10.1007/s40257-020-00547-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effects of cigarette smoking and alcohol consumption on the risk of alopecia areata (AA) are unclear. OBJECTIVE The aim was to examine the association of cigarette smoking and alcohol consumption with AA. METHODS We collected participants from four rounds (2001, 2005, 2009, and 2013) of the Taiwan National Health Interview Survey. Incident AA cases were identified from the National Health Insurance database. RESULTS Of the 60,055 participants, 154 developed AA during the 647,902 person-years of follow-up. After controlling for confounders, current smokers had a higher risk of incident AA than never smokers [adjusted hazard ratio (aHR) 1.88; 95% confidence interval (CI) 1.22-2.88]. There was a trend toward an increased risk of AA with increasing numbers of years of smoking and cumulative pack-years of smoking among current smokers. The aHRs (95% CIs) of current smokers of > 5 and ≤ 15 cigarettes per day, > 10 and ≤ 20 years of smoking, ≤ 10, and > 10 and ≤ 20 pack-years of smoking were 2.03 (1.17-3.51), 2.25 (1.21-4.18), 1.86 (1.12-3.09), and 2.04 (1.04-4.01), respectively. Conversely, social and regular drinkers had significantly lower risks of AA than never drinkers [aHRs (95% CIs) 0.65 (0.43-0.98) and 0.49 (0.26-0.93), respectively]. CONCLUSION Current smokers had an increased risk of developing AA, while alcohol consumption was associated with a decreased risk of AA.
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[Not Available]. MMW Fortschr Med 2020; 162:3. [PMID: 32578119 DOI: 10.1007/s15006-020-0588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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