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He X, Liu J, Gong Y, Lu W, Sha X, Cao C, Li Y, Wang J. Amygdalin ameliorates alopecia areata on C3H/HeJ mice by inhibiting inflammation through JAK2/STAT3 pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 331:118317. [PMID: 38723918 DOI: 10.1016/j.jep.2024.118317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Evidence has demonstrated that Chinese medicine formula Xuefu Zhuyu decoction can markedly promote the formation of new hair in patients and mice with alopecia areata (AA). Amygdalin is one of the active components of Xuefu Zhuyu decoction, but its therapeutic effects and the underlying mechanisms on AA remains largely unrevealed. PURPOSE Therefore, this study aims to investigate the therapeutic effects and to probe its molecular mechanisms of inflammation and immune regulation on AA model of C3H/HeJ mice. STUDY DESIGN The C3H/HeJ female mice were divided into control, AA, rusolitinib (60 mg/kg), and amygdalin groups (60, 90, and 120 mg/kg, 0.2 ml/10 g, i.g.). METHODS The optical microscope was used to observe the feature of the local skin, and the number of lanugo and terminal hair. H&E staining was performed to determine the degree of pathological damage to the skin. ELISA was performed to detect levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in mice serum. Flow cytometry was carried out to analyze the CD4+CD25+FOXP3+, CD4+ and CD8+ of skin tissue. And the levels of CD4+ and CD8+, p-JAK/JAK2, p-STAT3/STAT, and SOCS3 were detected by immunohistochemistry. Western blot and qRT-PCR were employed to examine the expression levels of IL-6, TNF-α, IFN-γ, JAK2, p-JAK, STAT, p-STAT3 and SOCS3 proteins and genes in skin tissues. RESULTS Compared with AA group, amygdalin immensely increased the number of vellus hairs and decreased the number of terminal hairs determined by skin microscopy and H&E staining. ELISA, Western blot and qRT-PCR data showed that the levels of IL-6, TNF-α and IFN-γ in serum and skin tissues of AA mice were significantly increased, while amygdalin administration dramatically restrained the contents of the three pro-inflammatory factors. Flow cytometry and immunohistochemistry hinted that amygdalin observably enhanced the number of CD4+CD25+FOXP3+ and CD4+ cells, while inhibited the number of CD8+ positive cells in mice with AA. Moreover, amygdalin signally reduced JAK2/STAT3 pathway-related protein and gene levels in AA mice. CONCLUSION Amygdalin could inhibit inflammatory response and improve immune function in the treatment of AA. The underlying molecular mechanism may be related to inhibition of JAK2/STAT3 pathway.
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Affiliation(s)
- Xun He
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China.
| | - Jingsong Liu
- Neurosurgery, Institute of Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Yugang Gong
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Wei Lu
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Xiaowei Sha
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Chang Cao
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Yanqun Li
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Jiawei Wang
- Department of Dermatology, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
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Huang X, Zhao P, Zhang G, Su X, Li H, Gong H, Ma X, Liu F. Application of Non-Pharmacologic Therapy in Hair Loss Treatment and Hair Regrowth. Clin Cosmet Investig Dermatol 2024; 17:1701-1710. [PMID: 39071847 PMCID: PMC11283242 DOI: 10.2147/ccid.s471754] [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: 04/30/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
Purpose Alopecia significantly affects the appearance and psychology of patients, and pharmacological therapies and hair transplantation are the main treatments for alopecia, but both have limitations. This review aimed to summarize the non-pharmacological therapies that promote hair growth and regeneration. Patients and Methods This is a non-systematic review. Multiple databases was searched with relevant data published between 1997 and 2024. Searching and screening followed the PRISMA guidelines. Results Novel therapeutic modalities, such as gas molecules, platelet-rich plasma, laser, and microneedling, can change the microenvironment of hair follicles, activate hair follicle stem cells, and promote hair growth and regeneration. Conclusion This paper reviews research on the application of non-pharmacological therapies in alopecia treatment and hair regeneration, with a view to providing an important basis for future research on alopecia treatment and the postoperative treatment of patients after hair transplantation.
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Affiliation(s)
- Xinlyu Huang
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Pengxiang Zhao
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, People’s Republic of China
| | - Gongjie Zhang
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiangxi Su
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hanlin Li
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Huizi Gong
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xuemei Ma
- College of Chemistry and Life Science, Beijing University of Technology, Beijing, People’s Republic of China
| | - Fang Liu
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Jean-Pierre P, Pulumati A, Kasheri E, Hirsch M, Nouri K. Lasers in the management of alopecia: a review of established therapies and advances in treatment. Lasers Med Sci 2024; 39:102. [PMID: 38630348 PMCID: PMC11023987 DOI: 10.1007/s10103-024-04054-7] [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: 10/24/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
Alopecia, also known as hair loss, is a highly prevalent condition affecting millions of men and women in the United States and worldwide, making it one of the most common complaints by patients presenting to a dermatologist. The symptomology on the presentation of alopecia can be highly variable, ranging from diffuse thinning of hair, discrete and localized patches completely absent of hair, or noticing significant shedding when brushing and showering. Although alopecia does not have a direct negative health impact on patients, it is nonetheless a debilitating disease as it can profoundly impact an individual's self-image and psychosocial well-being. There are multiple treatment options available to patients with alopecia, and they are typically tailored to the patient's needs and preferences. The most common of these is the Food and Drug Administration-approved drugs for alopecia, minoxidil, and finasteride. However, both of these are known to be partially efficacious for all patients, so clinicians often use different modalities in conjunction with them, in particular laser-based therapies. This review article will provide a comprehensive assessment of lasers and other light therapies that may be used to manage the two most common types of alopecia: androgenetic alopecia and alopecia areata.
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Affiliation(s)
- Philippe Jean-Pierre
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA.
| | - Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eli Kasheri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
| | - Melanie Hirsch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
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Rodríguez-Acosta ED, Nieto DF, Berna-Rico E, Galván-García HR, Meza-Castro RG, Rosales-Lerma AK, Guerrero-Cervantes AV, Ramírez-Marín HA. Assessing the Efficacy of Monthly 308 nm Excimer Lamp Double-Stacked Pulse Adjusted Therapy for Alopecia Areata. Skin Appendage Disord 2024; 10:18-25. [PMID: 38313573 PMCID: PMC10836865 DOI: 10.1159/000533993] [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: 03/22/2023] [Accepted: 09/01/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Alopecia areata (AA) is an autoimmune disease characterized by T cell-mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects, pain due to intralesional injections or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308 nm excimer lamp used in a monthly basis in a double-stacked pulse manner for the treatment of AA. Methods This was a prospective study, using 308 nm excimer lamp in a double-stacked pulse therapy for AA. The primary endpoint was the improvement in SALT score. Results A total of 40 patients with AA were enrolled in this study. Forty (100%) patients achieved clinical response. Hyperpigmentation and erythema occurred on the treated alopecic areas of all patients but they were considered tolerable. Patients of younger age or with a smaller area of affection had a better overall treatment response. Conclusion 308 nm excimer lamp therapy is an excellent option for single or multiple AA because it achieves a good clinical response with less adverse effects than other therapies. This therapy may be useful for low-income countries where new JAK inhibitors are not available, however, for patients with extensive hair loss, it is not as effective and thus, it may be unfit for patients with alopecia totalis and alopecia universals.
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Affiliation(s)
| | - Diego Fernandez Nieto
- TricoHRC Research Group, Trichology Unit, Dermatology Department, Ramón y Cajal University Hospital, Instituto Ramon y Cajal de Investigación Sanitaria, University of Alcala, Madrid, Spain
- Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
| | - Emilio Berna-Rico
- TricoHRC Research Group, Trichology Unit, Dermatology Department, Ramón y Cajal University Hospital, Instituto Ramon y Cajal de Investigación Sanitaria, University of Alcala, Madrid, Spain
- Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
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Mateos-Haro M, Novoa-Candia M, Sánchez Vanegas G, Correa-Pérez A, Gaetano Gil A, Fernández-García S, Ortega-Quijano D, Urueña Rodriguez MG, Saceda-Corralo D, Bennouna-Dalero T, Giraldo L, Tomlinson J, Vaño-Galván S, Zamora J. Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev 2023; 10:CD013719. [PMID: 37870096 PMCID: PMC10591288 DOI: 10.1002/14651858.cd013719.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body. There are different treatments including immunosuppressants, hair growth stimulants, and contact immunotherapy. OBJECTIVES To assess the benefits and harms of the treatments for alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in children and adults. SEARCH METHODS The Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP were searched up to July 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated classical immunosuppressants, biologics, small molecule inhibitors, contact immunotherapy, hair growth stimulants, and other therapies in paediatric and adult populations with AA. DATA COLLECTION AND ANALYSIS We used the standard procedures expected by Cochrane including assessment of risks of bias using RoB2 and the certainty of the evidence using GRADE. The primary outcomes were short-term hair regrowth ≥ 75% (between 12 and 26 weeks of follow-up), and incidence of serious adverse events. The secondary outcomes were long-term hair regrowth ≥ 75% (greater than 26 weeks of follow-up) and health-related quality of life. We could not perform a network meta-analysis as very few trials compared the same treatments. We presented direct comparisons and made a narrative description of the findings. MAIN RESULTS We included 63 studies that tested 47 different treatments in 4817 randomised participants. All trials used a parallel-group design except one that used a cross-over design. The mean sample size was 78 participants. All trials recruited outpatients from dermatology clinics. Participants were between 2 and 74 years old. The trials included patients with AA (n = 25), AT (n = 1), AU (n = 1), mixed cases (n = 31), and unclear types of alopecia (n = 4). Thirty-three out of 63 studies (52.3%) reported the proportion of participants achieving short-term hair regrowth ≥ 75% (between 12 and 26 weeks). Forty-seven studies (74.6%) reported serious adverse events and only one study (1.5%) reported health-related quality of life. Five studies (7.9%) reported the proportion of participants with long-term hair regrowth ≥ 75% (greater than 26 weeks). Amongst the variety of interventions found, we prioritised some groups of interventions for their relevance to clinical practice: systemic therapies (classical immunosuppressants, biologics, and small molecule inhibitors), and local therapies (intralesional corticosteroids, topical small molecule inhibitors, contact immunotherapy, hair growth stimulants and cryotherapy). Considering only the prioritised interventions, 14 studies from 12 comparisons reported short-term hair regrowth ≥ 75% and 22 studies from 10 comparisons reported serious adverse events (18 reported zero events and 4 reported at least one). One study (1 comparison) reported quality of life, and two studies (1 comparison) reported long-term hair regrowth ≥ 75%. For the main outcome of short-term hair regrowth ≥ 75%, the evidence is very uncertain about the effect of oral prednisolone or cyclosporine versus placebo (RR 4.68, 95% CI 0.57 to 38.27; 79 participants; 2 studies; very low-certainty evidence), intralesional betamethasone or triamcinolone versus placebo (RR 13.84, 95% CI 0.87 to 219.76; 231 participants; 1 study; very low-certainty evidence), oral ruxolitinib versus oral tofacitinib (RR 1.08, 95% CI 0.77 to 1.52; 80 participants; 1 study; very low-certainty evidence), diphencyprone or squaric acid dibutil ester versus placebo (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very-low-certainty evidence), diphencyprone or squaric acid dibutyl ester versus topical minoxidil (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very low-certainty evidence), diphencyprone plus topical minoxidil versus diphencyprone (RR 0.67, 95% CI 0.13 to 3.44; 30 participants; 1 study; very low-certainty evidence), topical minoxidil 1% and 2% versus placebo (RR 2.31, 95% CI 1.34 to 3.96; 202 participants; 2 studies; very low-certainty evidence) and cryotherapy versus fractional CO2 laser (RR 0.31, 95% CI 0.11 to 0.86; 80 participants; 1 study; very low-certainty evidence). The evidence suggests oral betamethasone may increase short-term hair regrowth ≥ 75% compared to prednisolone or azathioprine (RR 1.67, 95% CI 0.96 to 2.88; 80 participants; 2 studies; low-certainty evidence). There may be little to no difference between subcutaneous dupilumab and placebo in short-term hair regrowth ≥ 75% (RR 3.59, 95% CI 0.19 to 66.22; 60 participants; 1 study; low-certainty evidence) as well as between topical ruxolitinib and placebo (RR 5.00, 95% CI 0.25 to 100.89; 78 participants; 1 study; low-certainty evidence). However, baricitinib results in an increase in short-term hair regrowth ≥ 75% when compared to placebo (RR 7.54, 95% CI 3.90 to 14.58; 1200 participants; 2 studies; high-certainty evidence). For the incidence of serious adverse events, the evidence is very uncertain about the effect of topical ruxolitinib versus placebo (RR 0.33, 95% CI 0.01 to 7.94; 78 participants; 1 study; very low-certainty evidence). Baricitinib and apremilast may result in little to no difference in the incidence of serious adverse events versus placebo (RR 1.47, 95% CI 0.60 to 3.60; 1224 participants; 3 studies; low-certainty evidence). The same result is observed for subcutaneous dupilumab compared to placebo (RR 1.54, 95% CI 0.07 to 36.11; 60 participants; 1 study; low-certainty evidence). For health-related quality of life, the evidence is very uncertain about the effect of oral cyclosporine compared to placebo (MD 0.01, 95% CI -0.04 to 0.07; very low-certainty evidence). Baricitinib results in an increase in long-term hair regrowth ≥ 75% compared to placebo (RR 8.49, 95% CI 4.70 to 15.34; 1200 participants; 2 studies; high-certainty evidence). Regarding the risk of bias, the most relevant issues were the lack of details about randomisation and allocation concealment, the limited efforts to keep patients and assessors unaware of the assigned intervention, and losses to follow-up. AUTHORS' CONCLUSIONS We found that treatment with baricitinib results in an increase in short- and long-term hair regrowth compared to placebo. Although we found inconclusive results for the risk of serious adverse effects with baricitinib, the reported small incidence of serious adverse events in the baricitinib arm should be balanced with the expected benefits. We also found that the impact of other treatments on hair regrowth is very uncertain. Evidence for health-related quality of life is still scant.
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Affiliation(s)
- Miriam Mateos-Haro
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Doctoral programme in Clinical Medicine and Public Health, Universidad de Granada, Granada, Spain
| | - Monica Novoa-Candia
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Andrea Correa-Pérez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Andrea Gaetano Gil
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Tayeb Bennouna-Dalero
- Preventive Medicine and Public Health Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Giraldo
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Sergio Vaño-Galván
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Zamora
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
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Park H, Kim JE, Choi JW, Kim DY, Jang YH, Lee Y, Jeon J, Shin HT, Kim MS, Shin JW, Cho SB, Lew BL, Choi GS. Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment. Ann Dermatol 2023; 35:190-204. [PMID: 37290953 DOI: 10.5021/ad.22.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/17/2022] [Accepted: 01/24/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact. OBJECTIVE To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea. METHODS We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus. RESULTS Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used. CONCLUSION The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.
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Affiliation(s)
- Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Do Young Kim
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Tae Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Min Sung Kim
- Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea
| | - Jung Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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Zhang J, Lin P, Lin H, Ma C, Hu Y, Wang Y, Zhang Y. Laser and light therapy combined with topical minoxidil for alopecia areata: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci 2023; 38:74. [PMID: 36800063 DOI: 10.1007/s10103-023-03734-0] [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: 11/29/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023]
Abstract
We aim to evaluate the clinical efficacy and safety of using laser and light combined with topical minoxidil for alopecia areata. We searched PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), VIP database, and Wanfang Data from their inception to September 18, 2022. The risk of bias of the included RCTs was assessed by the Cochrane Collaboration tool. RevMan 5.3 software and Stata 14.0 software were used to perform the statistical analysis. The GRADE system assessed the quality of evidence. Ten studies were enrolled finally. The results of the meta-analysis showed that compared with topical minoxidil alone, the 308-nm excimer laser/light or He-Ne laser combined with topical minoxidil could reduce the SALT (Severity of Alopecia Tool) score (MD= -5.88, 95% CI [-9.79, -1.98], P=0.003). Whether fractional CO2 laser (RR=1.29, 95% CI [1.14, 1.46], P<0.0001), 308-nm excimer laser/light (RR=1.32, 95% CI [1.12, 1.55], P=0.001), He-Ne laser (RR=1.69, 95% CI [1.07, 2.69], P=0.03), or NB-UVB (RR=1.35, 95% CI [1.07,1.70], P=0.01) combined with topical minoxidil may improve the treatment response rate, comparing with topical minoxidil only. The recurrence rate of laser and light combined with topical minoxidil was lower than that of the minoxidil alone group (RR=0.54, 95% CI [0.31, 0.93], P=0.03) when follow-up time was 1 year. In addition, the incidence of adverse events including irritant contact dermatitis, erythema, desquamation, pain, and pruritus was no significant difference between the two groups (RR=1.50, 95% CI [0.95, 2.36], P=0.08). The level of evidence for outcomes was classified as very low to moderate. Based on the available evidence, laser and light combined with topical minoxidil therapy may be effective and safe for alopecia areata. However, more high-quality trials are required for comprehensive analysis and further verification.
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Affiliation(s)
- Jianfeng Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Peng Lin
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Haiyue Lin
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Cong Ma
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yi Hu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yingdong Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300120, China.
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Afvari S, Kazlouskaya M, Cline A. Reply to “Vitamin D status in scarring and nonscarring alopecia”. J Am Acad Dermatol 2022; 87:e89-e90. [DOI: 10.1016/j.jaad.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
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Tawfik AA, Mostafa I, Soliman M, Soliman M, Abdallah N. Low Level Laser versus Platelet-rich Plasma in Treatment of Alopecia Areata: A Randomized Controlled Intra-patient Comparative Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background: Non-scarring alopecia areata (AA) is a disease that is mediated through autoimmunity. Recently, autologous platelet-rich plasma (PRP) and photobiomodulation (PBM), commonly known as low-level laser (or light, LLLT) have been suggested to provide a valuable role in stimulating the growth of hair follicles (HF)
Aim: Compare between the significance and wellbeing of PRP and LLLT in the management of AA.
Patients & methodology: Thirty patients, each having three patches of AA participated in the study. Patches were assigned randomly to have one of the two treatments: PRP or LLLT. The third patch served as a control and received placebo treatment. PRP was done once weekly whereas LLLT was done 3 sessions per week for a maximum of 6 weeks. Patients were followed up at one month and three months. The thickness and density of hair were evaluated by the folliscope.
Results: A noteworthy higher improvement was detected in the thickness and the density of hair in the PRP treated patches as evaluated by the folliscope and patients satisfaction. The obtained outcomes were sustained during the 12 week follow-up period in most of patients.
Conclusion: PRP and LLLT could be considered as efficacious alternatives for the treatments of AA with the least morbidity in addition to a little cost profit ratio.
KEYWORDS: Alopecia areata, platelet-rich plasma, folliscope, photobiomodulation, low level laser therapy.
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Moattari CR, Granstein RD. Neuropeptides and neurohormones in immune, inflammatory and cellular responses to ultraviolet radiation. Acta Physiol (Oxf) 2021; 232:e13644. [PMID: 33724698 DOI: 10.1111/apha.13644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/16/2022]
Abstract
Humans are exposed to varying amounts of ultraviolet radiation (UVR) through sunlight. UVR penetrates into human skin leading to release of neuropeptides, neurotransmitters and neuroendocrine hormones. These messengers released from local sensory nerves, keratinocytes, Langerhans cells (LCs), mast cells, melanocytes and endothelial cells (ECs) modulate local and systemic immune responses, mediate inflammation and promote differing cell biologic effects. In this review, we will focus on both animal and human studies that elucidate the roles of calcitonin gene-related peptide (CGRP), substance P (SP), nerve growth factor (NGF), nitric oxide and proopiomelanocortin (POMC) derivatives in mediating immune and inflammatory effects of exposure to UVR as well as other cell biologic effects of UVR exposure.
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11
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Fukumoto T, Fukumoto R, Magno E, Oka M, Nishigori C, Horita N. Treatments for alopecia areata: A systematic review and network meta-analysis. Dermatol Ther 2021; 34:e14916. [PMID: 33631058 DOI: 10.1111/dth.14916] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 02/02/2023]
Abstract
Existing guidelines form no consensus for alopecia areata (AA) treatment due to the absence of a universal standard treatment and arbitrary selection of reference arms in randomized control trials (RCTs). The aim is to identify the best treatment and to rank treatments using systematic review and network meta-analysis. Data were extracted by the two investigators independently. Odds ratio (OR) of treatment success rate was pooled using the frequentist weighted least squares approach to random-model network meta-analysis. RCTs providing data of treatment success rate from PubMed, EMBASE, Web of Science, and manual search were included. About 54 RCTs consisting of 49 treatments and 3149 patients were included. Pentoxifylline plus topical corticosteroids had the highest treatment success rate compared with "no treatment," followed by pentoxifylline alone, topical calcipotriol plus narrowband ultraviolet radiation B phototherapy, topical calcipotriol, intralesional corticosteroids, systemic corticosteroids, minoxidil plus topical corticosteroids, topical bimatoprost, psoralen ultraviolet radiation A phototherapy, and tofacitinib. Even with the network meta-analysis, the best treatment because of independent loops and wide confidence intervals could not be identified. Treatment options above may be reasonable strategies, but further comparison is required.
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Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.,Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Rie Fukumoto
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Elizabeth Magno
- Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Masahiro Oka
- Department of Dermatology, Kita-Harima Medical Center, Ono, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Horita
- National Human Genome Research Institutes, National Institutes of Health, Bethesda, Maryland, USA
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12
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Benezeder T, Painsi C, Patra V, Dey S, Holcmann M, Lange-Asschenfeldt B, Sibilia M, Wolf P. Dithranol targets keratinocytes, their crosstalk with neutrophils and inhibits the IL-36 inflammatory loop in psoriasis. eLife 2020; 9:e56991. [PMID: 32484435 PMCID: PMC7266641 DOI: 10.7554/elife.56991] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
Despite the introduction of biologics, topical dithranol (anthralin) has remained one of the most effective anti-psoriatic agents. Serial biopsies from human psoriatic lesions and both the c-Jun/JunB and imiquimod psoriasis mouse model allowed us to study the therapeutic mechanism of this drug. Top differentially expressed genes in the early response to dithranol belonged to keratinocyte and epidermal differentiation pathways and IL-1 family members (i.e. IL36RN) but not elements of the IL-17/IL-23 axis. In human psoriatic response to dithranol, rapid decrease in expression of keratinocyte differentiation regulators (e.g. involucrin, SERPINB7 and SERPINB13), antimicrobial peptides (e.g. ß-defensins like DEFB4A, DEFB4B, DEFB103A, S100 proteins like S100A7, S100A12), chemotactic factors for neutrophils (e.g. CXCL5, CXCL8) and neutrophilic infiltration was followed with much delay by reduction in T cell infiltration. Targeting keratinocytes rather than immune cells may be an alternative approach in particular for topical anti-psoriatic treatment, an area with high need for new drugs.
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Affiliation(s)
| | - Clemens Painsi
- State Hospital KlagenfurtKlagenfurt am WörtherseeAustria
| | - VijayKumar Patra
- Department of Dermatology, Medical University of GrazGrazAustria
| | - Saptaswa Dey
- Department of Dermatology, Medical University of GrazGrazAustria
| | - Martin Holcmann
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of ViennaViennaAustria
| | | | - Maria Sibilia
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of ViennaViennaAustria
| | - Peter Wolf
- Department of Dermatology, Medical University of GrazGrazAustria
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13
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Li A, Meng X, Xing X, Tan H, Liu J, Li C. Efficacy and Influence Factors of 308-nm Excimer Lamp with Minoxidil in the Treatment of Alopecia Areata. Lasers Surg Med 2020; 52:761-767. [PMID: 31919885 DOI: 10.1002/lsm.23210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Alopecia areata (AA) is an autoimmune disease characterized by T cell-mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308-nm excimer lamp with minoxidil in the treatment of AA. STUDY DESIGN/MATERIALS AND METHODS This was a prospective, single-blinded, self-control study, using 308-nm excimer lamp with minoxidil for the treatment of AA. One selected alopecia lesion was divided into the control and treated side. Topical minoxidil (2% solution) was used on both sides, but 308-nm excimer lamp was only added to the treated side. The primary endpoint was the discrepancy of hair growth on each side. RESULTS A total of 38 patients (24 males and 14 females) with AA were enrolled in this study, and 34 of them (21 males and 13 females) completed the whole treatment. Thirty-two (94.2%) patients achieved clinical response, and 21 (44.1%) patients achieved with >50% hair regrowth on the treated side after a 12-week treatment. The hair number and diameter on the treated side had significantly increased compared with the control side with statistical differences. Hyperpigmentation and erythema occurred on the treated side of all the patients but they were considered tolerable. Patients of younger age or with smaller area of lesion had better effect. CONCLUSIONS The 308-nm excimer lamp with minoxidil therapy can be considered as an effective and safe treatment for single or multiple AA. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Anqi Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.,Medical College of Nankai University, Tianjin, 300071, China
| | - Xianfu Meng
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaojing Xing
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Hong Tan
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.,Medical College of Nankai University, Tianjin, 300071, China
| | - Junlian Liu
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Chengxin Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
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