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Rudnicka L, Arenbergerova M, Grimalt R, Ioannides D, Katoulis AC, Lazaridou E, Olszewska M, Ovcharenko YS, Piraccini BM, Prohic A, Rakowska A, Reygagne P, Richard MA, Soares RO, Starace M, Vañó-Galvan S, Waskiel-Burnat A. European expert consensus statement on the systemic treatment of alopecia areata. J Eur Acad Dermatol Venereol 2024; 38:687-694. [PMID: 38169088 DOI: 10.1111/jdv.19768] [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: 10/07/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA-approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA-approved for patients with severe alopecia areata. Other systemic medications used off-label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.
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Affiliation(s)
- L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - D Ioannides
- 1st Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - A C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - E Lazaridou
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - M Olszewska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Y S Ovcharenko
- Department of Infectious Diseases and Clinical Immunology of the V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Prohic
- Department of Dermatovenerology, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - A Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - P Reygagne
- Centre de Santé Sabouraud, Hopital Saint Louis, Paris, France
| | - M A Richard
- CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitary Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - R O Soares
- CUF Descobertas Hospital, Lisbon, Portugal
| | - M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - S Vañó-Galvan
- Department Ramon y Cajal Hospital, IRYCIS, Grupo Pedro Jaén Clinic, TricoHRC Research Group, University of Alcala, Madrid, Spain
| | - A Waskiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Singh R, Kumar P, Kumar D, Aggarwal N, Chopra H, Kumar V. Alopecia areata: review of epidemiology, pathophysiology, current treatments and nanoparticulate delivery system. Ther Deliv 2024; 15:193-210. [PMID: 38449420 DOI: 10.4155/tde-2023-0071] [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] [Indexed: 03/08/2024] Open
Abstract
Alopecia areata (AA) is a kind of alopecia that affects hair follicles and nails. It typically comes with round patches and is a type of nonscarring hair loss. Various therapies are accessible for the management and treatment of AA, including topical, systemic and injectable modalities. It is a very complex type of autoimmune disease and is identified as round patches of hair loss and may occur at any age. This review paper highlights the epidemiology, clinical features, pathogenesis and new treatment options for AA, with a specific emphasis on nanoparticulate drug-delivery systems. By exploring these innovative treatment approaches, researchers aim to enhance the effectiveness and targeted delivery of therapeutic agents, ultimately improving outcomes for individuals living with AA.
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Affiliation(s)
- Robel Singh
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Pawan Kumar
- Indian Pharmacopoeia Commision, Ministry of Health & Family Welfare, Govt. of India
| | - Davinder Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Navidha Aggarwal
- MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, 133207, India
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical & Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | - Virender Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
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3
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Joly P, Lafon A, Houivet E, Donnadieu N, Richard MA, Dupuy A, Delaporte E, Bernard P, Machet L, Tosti A, Del Marmol V, Grimalt R, de Viragh PA, Benichou J, Chosidow O, Assouly P, Reygagne P. Efficacy of Methotrexate Alone vs Methotrexate Plus Low-Dose Prednisone in Patients With Alopecia Areata Totalis or Universalis: A 2-Step Double-Blind Randomized Clinical Trial. JAMA Dermatol 2023; 159:403-410. [PMID: 36884234 PMCID: PMC9996454 DOI: 10.1001/jamadermatol.2022.6687] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/29/2022] [Indexed: 03/09/2023]
Abstract
Importance Poor therapeutic results have been reported in patients with alopecia areata totalis (AT) or universalis (AU), the most severe and disabling types of alopecia areata (AA). Methotrexate, an inexpensive treatment, might be effective in AU and AT. Objective To evaluate the efficacy and tolerance of methotrexate alone or combined with low-dose prednisone in patients with chronic and recalcitrant AT and AU. Design, Setting, and Participants This academic, multicenter, double-blind, randomized clinical trial was conducted at 8 dermatology departments at university hospitals between March 2014 and December 2016 and included adult patients with AT or AU evolving for more than 6 months despite previous topical and systemic treatments. Data analysis was performed from October 2018 to June 2019. Interventions Patients were randomized to receive methotrexate (25 mg/wk) or placebo for 6 months. Patients with greater than 25% hair regrowth (HR) at month 6 continued their treatment until month 12. Patients with less than 25% HR were rerandomized: methotrexate plus prednisone (20 mg/d for 3 months and 15 mg/d for 3 months) or methotrexate plus placebo of prednisone. Main Outcome and Measures The primary end point assessed on photos by 4 international experts was complete or almost complete HR (Severity of Alopecia Tool [SALT] score <10) at month 12, while receiving methotrexate alone from the start of the study. Main secondary end points were the rate of major (greater than 50%) HR, quality of life, and treatment tolerance. Results A total of 89 patients (50 female, 39 male; mean [SD] age, 38.6 [14.3] years) with AT (n = 1) or AU (n = 88) were randomized: methotrexate (n = 45) or placebo (n = 44). At month 12, complete or almost complete HR (SALT score <10) was observed in 1 patient and no patient who received methotrexate alone or placebo, respectively, in 7 of 35 (20.0%; 95% CI, 8.4%-37.0%) patients who received methotrexate (for 6 or 12 months) plus prednisone, including 5 of 16 (31.2%; 95% CI, 11.0%-58.7%) who received methotrexate for 12 months and prednisone for 6 months. A greater improvement in quality of life was observed in patients who achieved a complete response compared with nonresponder patients. Two patients in the methotrexate group discontinued the study because of fatigue and nausea, which were observed in 7 (6.9%) and 14 (13.7%) patients receiving methotrexate, respectively. No severe treatment adverse effect was observed. Conclusions and Relevance In this randomized clinical trial, while methotrexate alone mainly allowed partial HR in patients with chronic AT or AU, its combination with low-dose prednisone allowed complete HR in up to 31% of patients. These results seem to be of the same order of magnitude as those recently reported with JAK inhibitors, with a much lower cost. Trial Registration ClinicalTrials.gov Identifier: NCT02037191.
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Affiliation(s)
- Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Audrey Lafon
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Nathalie Donnadieu
- Department of Pharmacy, Rouen University Hospital, Normandy University, Rouen, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | | | | | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | - Antonella Tosti
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ramon Grimalt
- Department of Dermatology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pierre A. de Viragh
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Jacques Benichou
- Department of Pharmacy, Rouen University Hospital, Normandy University, Rouen, France
| | - Olivier Chosidow
- Department of Dermatology, Henri-Mondor University Hospital, Paris, France
| | - Philippe Assouly
- Department of Dermatology, Centre Sabouraud, Hopital Saint Louis, Paris, France
| | - Pascal Reygagne
- Department of Dermatology, Centre Sabouraud, Hopital Saint Louis, Paris, France
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Malhotra K, Madke B. An Updated Review on Current Treatment of Alopecia Areata and Newer Therapeutic Options. Int J Trichology 2023; 15:3-12. [PMID: 37305188 PMCID: PMC10251289 DOI: 10.4103/ijt.ijt_28_21] [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: 03/09/2021] [Revised: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 06/13/2023] Open
Abstract
Alopecia areata (AA) is a dermatological disease that causes nonscarring hair loss. It can occur at any age and has an unpredictable and variable evolution in individuals. The aim of this review is to provide an update on the novel therapies currently being used, as well as upcoming therapeutic options in the treatment of AA.
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Affiliation(s)
- Karan Malhotra
- Department of Dermatology, Venereology and Leprosy, Desun Hospital, Kolkata, West Bengal, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER) (Deemed to be University), Wardha, Maharashtra, India
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5
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Altun E, Yaylı S, Aksu Arıca D, Baykal Selcuk L, Bahadır S. Retrospective analysis of methylprednisolone treatment alone and in combination with methotrexate in patients with extensive alopecia areata. Dermatol Ther 2022; 35:e15776. [DOI: 10.1111/dth.15776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ece Altun
- Department of Dermatology and Venereology Istanbul Medipol University Istanbul Turkey
| | - Savaş Yaylı
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Deniz Aksu Arıca
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Leyla Baykal Selcuk
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Sevgi Bahadır
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
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van Huizen AM, Vermeulen FM, Bik CMJM, Borgonjen R, Karsch SAT, Kuin RA, Gerbens LAA, Spuls PI. On which evidence can we rely when prescribing off-label methotrexate in dermatological practice? - a systematic review with GRADE approach. J DERMATOL TREAT 2021; 33:1947-1966. [PMID: 34425719 DOI: 10.1080/09546634.2021.1961999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
If an authorized drug is prescribed for a use that is not described in the Summary of Product Characteristics, this is defined as 'off-label use.' Methotrexate is often used off-label for dermatological indications. Off-label use is permitted if physicians can justify the treatment based on scientific evidence available to them. Our objective here was therefore to summarize the evidence for the effectiveness, efficacy, and safety of the dermatological off-label use of methotrexate in a systematic review. We searched MEDLINE, EMBASE, and CENTRAL for studies for evidence on the effectiveness, efficacy, and safety of the off-label use of methotrexate in dermatological indications up to November 2019. We used the GRADE system to rate the quality of the evidence. The search retrieved 34,583 hits of which 3566 were selected after the title and abstract screening. After the full-text screening, 143 studies were included, which involved 3688 patients in total. We found low-quality evidence for the effectiveness, efficacy, and safety of the off-label use of methotrexate in 31 dermatological diseases. To optimize the quality of evidence to support off-label use, we need high-quality studies in which well-characterized patients are treated with standardized treatments regimens using well-validated outcomes relevant to patients and physicians.
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Affiliation(s)
- Astrid M van Huizen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Francisca M Vermeulen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Rinke Borgonjen
- Department of Dermatology, Gelderland Valley Hospital, Ede, The Netherlands
| | - Saskia A T Karsch
- Department of Family Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Rosanna A Kuin
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Asilian A, Fatemi F, Ganjei Z, Siadat AH, Mohaghegh F, Siavash M. Oral Pulse Betamethasone, Methotrexate, and Combination Therapy to Treat Severe Alopecia Areata: A Randomized, Double-blind, Placebo-controlled, Clinical Trial. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:267-273. [PMID: 34400956 PMCID: PMC8170764 DOI: 10.22037/ijpr.2020.113868.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to compare oral betamethasone pulse therapy, methotrexate therapy and a combination of the two for patients with Alopecia Areata (AA) as an autoimmune disorder. In this study, 36 patients with severe AA were selected and classified into three groups of 12: 1- Oral betamethasone therapy (3 mg, once a week) with placebo; 2- Oral methotrexate (15 mg, once a week) with placebo; and 3- A combination of methotrexate (15 mg, once a week) and betamethasone (3 mg, once a week). The Severity Alopecia Tool (SALT) was used to measure improvements in the lesions through photographs, and the patients also rated their condition on the Visual Analogue Scale (VAS). Assessments were performed, and the results were compared at baseline and then at intervals of three months for nine months. The demographics and SALT score were similar in the three groups (P > 0.05). All the groups showed improvements in SALT, VAS and photographic scores three months after beginning the treatment (P < 0.001). Betamethasone therapy (P = 0.006) and combination therapy (P < 0.001) provided greater SALT improvement than methotrexate, and combination therapy led to a greater improvement in VAS and photographic findings compared to the two other groups (P < 0.05). Oral steroid, methotrexate and combination pulse therapy were effective treatments for AA, while oral steroid pulse therapy and combination therapy were superior to methotrexate.
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Affiliation(s)
- Ali Asilian
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farahnaz Fatemi
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zakiye Ganjei
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hossein Siadat
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mohaghegh
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Siavash
- Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med 2021; 21:215-230. [PMID: 33386567 DOI: 10.1007/s10238-020-00673-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.
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Affiliation(s)
- A Sterkens
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - A Bervoets
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Ansari F, Singh S. Azathioprine in combination with methotrexate may not be a good therapeutic alternative in severe and recalcitrant forms of alopecia areata. J Eur Acad Dermatol Venereol 2020; 34:e814-e815. [DOI: 10.1111/jdv.16675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- F. Ansari
- Department of Dermatology, Venereology & Leprology All India Institute of Medical Sciences Jodhpur India
| | - S. Singh
- Department of Dermatology, Venereology & Leprology All India Institute of Medical Sciences Jodhpur India
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Tanakol A, Oba MC, Uzuncakmak TK, Askin O, Kutlubay Z. Treatment of alopecia areata with 2940-nm fractional erbium:yttrium-aluminum-garnet laser. Dermatol Ther 2020; 33:e13978. [PMID: 32633447 DOI: 10.1111/dth.13978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022]
Abstract
Various laser therapies have been used for the treatment of alopecia areata (AA). Enhanced hair regrowth was reported with the use of ablative fractional 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser in a murine model. However, clinical effectiveness of fractional Er:YAG laser for hair disorders has not been investigated in human studies. The aim of our study was to assess the effectiveness of 2940-nm fractional Er:YAG laser in the treatment of chronic AA that is unresponsive to conventional therapies. Twenty-five AA patients underwent three sessions, each 4 to 6 weeks apart, of fractional Er:YAG laser. Clinical evaluation was done at baseline and 1 month post-treatment (follow-up) by photographic assessment. Subjective evaluation by patient satisfaction score was also performed. Photographic evaluation of the patients revealed a mean percent change in SALT score of 17.4 ± 3.5% at follow-up. A total of 16 patients who were treated for patchy AA of the scalp showed 27.8 ± 31.3% regrowth. Five patients who were treated for AA of the beard had 39 ± 34.2% regrowth. Fractional Er:YAG laser might be a therapeutic alternative for patients with patchy AA of the scalp and beard that is unresponsive to conventional therapies.
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Affiliation(s)
- Ali Tanakol
- Cerrahpasa Medical Faculty, Department of Dermatology and Venereology, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Department of Dermatology and Venereology, Diyarbakir Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Muazzez Cigdem Oba
- Cerrahpasa Medical Faculty, Department of Dermatology and Venereology, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Department of Dermatology and Venereology, Sancaktepe Research and Training Hospital, Istanbul, Turkey
| | - Tugba Kevser Uzuncakmak
- Cerrahpasa Medical Faculty, Department of Dermatology and Venereology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Askin
- Cerrahpasa Medical Faculty, Department of Dermatology and Venereology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zekayi Kutlubay
- Cerrahpasa Medical Faculty, Department of Dermatology and Venereology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Lyakhovitsky A, Aronovich A, Gilboa S, Baum S, Barzilai A. Alopecia areata: a long-term follow-up study of 104 patients. J Eur Acad Dermatol Venereol 2019; 33:1602-1609. [PMID: 30887594 DOI: 10.1111/jdv.15582] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a common autoimmune disease that considerably affects the quality of life. Although several studies have investigated the epidemiology, clinical characteristics and treatment of AA, limited recent data are available regarding its long-term course. OBJECTIVES To evaluate the long-term course of AA in different age groups. METHODS A retrospective evaluation of patients who were newly diagnosed with AA from 2008 to 2011 and had at least 7 years of follow-up. Data regarding the initial episode, treatment given, disease-free interval and relapses were analysed. RESULTS A total of 104 cases were analysed: 31 childhood-onset, 63 adult-onset and 10 late-onset. At first episode, 88.5% of patients had mild, 3.8% moderate and 7.7% severe AA. Full or significant re-growth was observed in 74%, 94% and 100% of childhood-onset, adult-onset and late-onset AA patients, respectively. There was no re-growth in 13%, 3% and 0% of childhood-onset, adult-onset and late-onset patients, respectively. The duration of the initial episode and the disease-free interval negatively correlated with age. Systemic steroids were the most effective treatment for the primary episode. The frequency of relapses was high overall (52%, 44% and 30% in childhood-onset, adult-onset and late-onset, respectively), but significantly declined over time with a majority (79%) occurring within the first 4 years. The disease-free interval and relapse rate were not correlated with gender, disease severity at onset or treatment given. CONCLUSIONS The prevalence of severe disease, duration of an initial episode and the rate of relapses decreased with an older age at onset. In addition, the outcome and the disease-free interval improved with age at onset. The frequency of relapses declined over time and most appear early on. The current treatment modalities do not seem to influence the long-term outcome.
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Affiliation(s)
- A Lyakhovitsky
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Aronovich
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Gilboa
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Baum
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Barzilai
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Phan K, Ramachandran V, Sebaratnam DF. Methotrexate for alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol 2019; 80:120-127.e2. [DOI: 10.1016/j.jaad.2018.06.064] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
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Trüeb RM, Dias MFRG. Alopecia Areata: a Comprehensive Review of Pathogenesis and Management. Clin Rev Allergy Immunol 2018; 54:68-87. [PMID: 28717940 DOI: 10.1007/s12016-017-8620-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Alopecia areata is a common hair loss condition that is characterized by acute onset of non-scarring hair loss in usually sharply defined areas ranging from small patches to extensive or less frequently diffuse involvement. Depending on its acuity and extent, hair loss is an important cause of anxiety and disability. The current understanding is that the condition represents an organ-specific autoimmune disease of the hair follicle with a genetic background. Genome-wide association studies provide evidence for the involvement of both innate and acquired immunity in the pathogenesis, and mechanistic studies in mouse models of alopecia areata have specifically implicated an IFN-γ-driven immune response, including IFNγ, IFNγ-induced chemokines and cytotoxic CD8 T cells as the main drivers of disease pathogenesis. A meta-analysis of published trials on treatment of alopecia areata states that only few treatments have been well evaluated in randomized trials. Nevertheless, depending on patient age, affected surface area and disease duration, an empiric treatment algorithm can be designed with corticosteroids and topical immunotherapy remaining the mainstay of therapy. The obviously limited success of evidence-based therapies points to a more important complexity of hair loss. At the same time, the complexity of pathogenesis offers opportunities for the development of novel targeted therapies. New treatment opportunities based on the results of genome-wide association studies that implicate T cell and natural killer cell activation pathways are paving the way to new approaches in future clinical trials. Currently, there are ongoing studies with the CTLA4-Ig fusion protein abatacept, anti-IL15Rβ monoclonal antibodies and the Janus kinase inhibitors tofacitinib, ruxolitinib and baricitinib. Ultimately, the options available for adapting to the disease rather than treating it in an effort to cure may also be taken into consideration in selected cases of long-standing or recurrent small spot disease.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland.
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Universidade Federal Fluminense, Centro de Ciências Médicas, Hospital Universitário Antonio Pedro, Niterói, Rio de Janeiro, Brazil
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Browne R, Stewart L, Williams H. Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic. Br J Dermatol 2018; 179:609-614. [DOI: 10.1111/bjd.16796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- R. Browne
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
| | | | - H.C. Williams
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
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Alopecia areata. J Am Acad Dermatol 2018; 78:15-24. [DOI: 10.1016/j.jaad.2017.04.1142] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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Trüeb RM, Dutra H, Dias MFRG. A Comment on JAK Inhibitors for Treatment of Alopecia Areata. Int J Trichology 2018; 10:193-197. [PMID: 30607037 PMCID: PMC6290291 DOI: 10.4103/ijt.ijt_62_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A meta-analysis of published trials on the treatment of alopecia areata (AA) came to the conclusion that most have been reported poorly and so small that any important clinical benefits are inconclusive, and considering the possibility of spontaneous remission, especially for those in the early stages of the disease, the options of not being treated or depending on individual preference, and of wearing a wig may be alternative ways of dealing with the condition. And yet, from clinical practice, we know that depending on patient age, surface area, disease duration, and comorbidities an empiric treatment algorithm can be designed that is successful in a significant proportion of patients. More recently, it has been suggested that Janus kinase (JAK) inhibitors may represent the drug of choice for AA, based on robust scientific background and preliminary clinical study results. The fact is that a sophisticated treatment of AA cannot be reduced to one drug, while in many patients, depending on disease duration and surface area, either intravenous methylprednisolone pulse therapy, intralesional triamcinolone acetonide or subcutaneous methotrexate will achieve remission rates in the range of the efficacy of the JAK inhibitors. Moreover, at this time point, affordability of the JAK inhibitors for long-term treatment, sustainability of treatment result, and long-term safety are major issues with regard to the treatment of AA with JAK inhibitors.
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Affiliation(s)
- Ralph Michel Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
| | - Hudson Dutra
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
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Affiliation(s)
- Solam Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Won-Soo Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
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Lim SK, Lim CA, Kwon IS, Im M, Seo YJ, Kim CD, Lee JH, Lee Y. Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata. Ann Dermatol 2017; 29:263-267. [PMID: 28566900 PMCID: PMC5438930 DOI: 10.5021/ad.2017.29.3.263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 12/03/2022] Open
Abstract
Background Alopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA. Objective To evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex. Methods In a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety. Results MTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%~90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort. Conclusion LD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.
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Affiliation(s)
- Seul-Ki Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Cho-Ah Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea
| | - Myung Im
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chang-Deok Kim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeung-Hoon Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
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Freitas Gouveia M, Trüeb RM. Unsuccessful Treatment of Alopecia Areata with Simvastatin/Ezetimibe: Experience in 12 Patients. Skin Appendage Disord 2017; 3:156-160. [PMID: 28879192 DOI: 10.1159/000468991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Alopecia areata is a common immune-mediated hair condition with limited treatment options and success rates. There is evidence that statins, which are used for reducing atherogenesis and cardiovascular disease, have immunomodulatory activities and therefore may also be used for treatment of selected dermatologic conditions, including alopecia areata. Among treatments evaluated for alopecia areata, oral simvastatin/ezetimibe therapy is currently under the scrutiny of expert opinion. METHODS Prospective observational study of the efficacy and tolerability of simvastatin/ezetimibe 40/10 mg (Inegy; MSD Merck Sharp & Dohme AG, Lucerne, Switzerland) over a treatment period of 6 months in alopecia totalis, universalis, multipatch involvement of the scalp >30%, ophiasis, or diffuse alopecia areata. RESULTS Of the 12 patients included in the study, 67% had no hair regrowth, 24% transient diffuse or patchy hair regrowth, and 24% patchy regrowth of pigmented hair which was not considered cosmetically satisfactory. Adverse effects were observed in 24% of patients, who reported myalgia. One patient showed elevation of creatine phosphokinase. CONCLUSION Simvastatin/ezetimibe is not effective for treatment of alopecia areata, at least in severe and/or cases refractory to other treatments, either as monotherapy or as adjuvant. Ultimately, in choosing such a treatment with questionable benefit, one must take the risk of serious adverse effects into careful consideration.
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Affiliation(s)
| | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland
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Vañó-Galván S, Fernández-Crehuet P, Grimalt R, Garcia-Hernandez M, Rodrigues-Barata R, Arias-Santiago S, Molina-Ruiz A, Garcia-Lora E, Dominguez-Cruz J, Brugues A, Ferrando J, Serrano-Falcón C, Serrano S, Paoli J, Camacho F. Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain. J Eur Acad Dermatol Venereol 2016; 31:550-556. [DOI: 10.1111/jdv.13959] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. Vañó-Galván
- Dermatology Service; Trichology Unit; Ramon y Cajal Hospital; IRYCIS; University of Alcala; Madrid Spain
| | - P. Fernández-Crehuet
- Dermatology Service; Hospital Universitario Reina Sofía; Instituto Maimónides de Investigación Biomédica (IMIBIC); Córdoba Spain
| | - R. Grimalt
- Universitat Internacional de Catalunya; Barcelona Spain
| | | | | | - S. Arias-Santiago
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología; Hospital Universitario Virgen de las Nieves; Granada Spain
| | | | - E. Garcia-Lora
- Dermatology Department; Hospital Virgen de las Nieves-Granada; Madrid Spain
| | | | | | | | | | - S. Serrano
- Dermatology Department; Universidad de Granada; Granada Spain
| | - J. Paoli
- Department of Dermatology and Venereology; Sahlgrenska University Hospital; Institute of Clinical Sciences at the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Abstract
Phototherapy is a useful therapeutic method for various skin diseases due to its modulatory effect on the cutaneous immune system. Alopecia areata is a dermatosis characterized by partial or complete hair loss. Collapse of the immune privilege of the hair follicle, which induces noncicatricial alopecia, is an important factor in its etiology. Several forms of phototherapy are used in dermatology.
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Affiliation(s)
- Oliverio Welsh
- Depatment of Dermatology, University Hospital, Universidad Autonoma de Nuevo Leon, Avenida Francisco I. Madero y GonzalitoS S/N, Mitras Centro, Monterrey, NL, 64460, Mexico.
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Anuset D, Perceau G, Bernard P, Reguiai Z. Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata. Dermatology 2016; 232:242-8. [PMID: 26735937 DOI: 10.1159/000441250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In severe alopecia areata (AA), spontaneous recovery is unlikely, and treatment is not standardized. OBJECTIVE To evaluate the efficacy and safety of methotrexate (MTX) used alone or combined with low- to moderate-dose oral corticosteroids (OC) for treating severe AA (totalis, universalis and severe multifocal). METHODS Retrospective monocentric study of all consecutive patients receiving this treatment between 2006 and 2012. Efficacy was defined as achieving a total regrowth of terminal hair. RESULTS 26 patients were included (17 with AA universalis or totalis and 9 with severe multifocal AA). Total regrowth was noted in 15/26 patients. After 3 months of treatment, hair regrowth >80% was associated with further complete regrowth, and hair regrowth <30% was associated with later treatment failure (p = 0.0014). When treatment was tapered, 11/15 patients with initial complete efficacy experienced AA relapse. CONCLUSION MTX combined with low- to moderate-dose OC may be an efficient and well-tolerated treatment for severe AA. However, long-term maintenance treatment is usually required.
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Affiliation(s)
- Delphine Anuset
- Department of Dermatology, Reims University Hospital, Reims, France
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Smith A, Trüeb RM, Theiler M, Hauser V, Weibel L. High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata. Pediatr Dermatol 2015; 32:481-7. [PMID: 25872976 DOI: 10.1111/pde.12578] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. METHODS Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days). RESULTS Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos). CONCLUSION IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients.
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Affiliation(s)
- Alexandra Smith
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland
| | - Martin Theiler
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Valérie Hauser
- Pediatric Dermatology, Ostschweizer Children's Hospital, St. Gallen, Switzerland
| | - Lisa Weibel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Hammerschmidt M, Mulinari Brenner F. Efficacy and safety of methotrexate in alopecia areata. An Bras Dermatol 2015; 89:729-34. [PMID: 25184911 PMCID: PMC4155950 DOI: 10.1590/abd1806-4841.20142869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/09/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alopecia areata is a chronic disorder of the hair follicles and nails, of unknown
etiology, with clear autoimmune components and genetic factors. Several
therapeutic options have been suggested; however, no treatment is able to modify
the disease course. Methotrexate is an immunosuppressant used in various
dermatoses and recently introduced as a therapeutic option for alopecia
areata. OBJECTIVES To evaluate the efficacy and safety of methotrexate in alopecia areata. METHODS In a retrospective, non-controlled study, we evaluated 31 patients with alopecia
areata in current or prior treatment with methotrexate to assess the therapeutic
response according to sex, age, pattern of alopecia areata, disease duration,
cumulative dose of methotrexate, use of systemic corticosteroids or other
treatments, and drug safety. RESULTS Regrowth greater than 50% was observed in 67.7% of patients, with the best
responses observed in those with <5 years of disease progression (79%), age
over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate
1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving
systemic corticosteroids in combination with methotrexate, 77.3% had greater than
50% regrowth, compared with 44.4% in those who used methotrexate alone. The
therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse
effects. Relapse was observed in 33.3% of patients with more than 50%
regrowth. CONCLUSION Methotrexate appears to be a promising and safe medication for the treatment of
severe alopecia areata when used alone or in combination with corticosteroids.
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Lazzarini R, Capareli GC, Buense R, Lellis RF. Alopecia universalis during treatment with leflunomide and adalimumab - case report. An Bras Dermatol 2014; 89:320-2. [PMID: 24770511 PMCID: PMC4008065 DOI: 10.1590/abd1806-4841.20142944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/05/2013] [Indexed: 11/22/2022] Open
Abstract
Alopecia areata is a non-scarring form of alopecia that can be localized or widespread. Its etiology is unknown, but immunological factors are implicated in its pathogenesis. With the more frequent use of anti TNFα biologic drugs, some alopecia areata cases during their use have been described. We report a case of universal alopecia in a patient with rheumatoid arthritis while using adalimumab and leflunomide.
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Friedland R, Tal R, Lapidoth M, Zvulunov A, Ben Amitai D. Pulse Corticosteroid Therapy for Alopecia Areata in Children: A Retrospective Study. Dermatology 2013; 227:37-44. [DOI: 10.1159/000351559] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/19/2013] [Indexed: 11/19/2022] Open
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Staumont-Sallé D, Vonarx M, Lengrand F, Segard M, Delaporte E. Pulse Corticosteroid Therapy for Alopecia Areata: Long-Term Outcome after 10 Years. Dermatology 2012; 225:81-7. [DOI: 10.1159/000341523] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/14/2012] [Indexed: 01/05/2023] Open
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Miteva M, Tosti A. Treatment options for alopecia: an update, looking to the future. Expert Opin Pharmacother 2012; 13:1271-81. [PMID: 22594679 DOI: 10.1517/14656566.2012.685160] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hair loss is a very common complaint. The diagnosis is based on clinical, dermoscopic and pathological examination. The treatment is usually continuous and requires strong compliance. AREAS COVERED This article aims to i) summarize current treatment options for the most common forms of hair loss; ii) update the literature on treatment options to emerge over the 3 years since the release of the first edition of this article in 2009; and iii) outline future strategies for treating alopecia. EXPERT OPINION There is good evidence-based information for the treatment of androgenetic alopecia. There are very few good-quality randomized studies, and no information about long-term results for most of the available treatments for alopecia areata and cicatricial alopecias. Significant research success has been achieved over the past few years through i) discovering the genetic profile of alopecia areata; ii) working on follicular neogenesis in androgenetic alopecia; and iii) discovering the PPAR-γ pathway in scarring alopecia.
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Affiliation(s)
- Mariya Miteva
- University of Miami Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1600 NW 10th Ave, RSMB, Room 2023A, Miami, FL 33136, USA.
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Mazereeuw-Hautier J, Maza-Rioland A, Royer M. [Childhood alopecia areata]. Ann Dermatol Venereol 2012; 139:151-5; quiz 149, 156. [PMID: 22325758 DOI: 10.1016/j.annder.2011.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/23/2011] [Accepted: 12/01/2011] [Indexed: 11/26/2022]
Affiliation(s)
- J Mazereeuw-Hautier
- Service de dermatologie, centre de référence des maladies rares de peau, hôpital Larrey, 24, chemin de Pouvourville, 31059 Toulouse cedex 09, France.
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Droitcourt C, Milpied B, Ezzedine K, Hubiche T, Belin E, Akpadjan F, Taïeb A, Seneschal J. Interest of High-Dose Pulse Corticosteroid Therapy Combined with Methotrexate for Severe Alopecia Areata: A Retrospective Case Series. Dermatology 2012; 224:369-73. [DOI: 10.1159/000339341] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/08/2012] [Indexed: 11/19/2022] Open
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Abstract
Many therapeutic modalities have been used to treat alopecia areata, with variable efficacy and safety profiles. Unfortunately, none of these agents is curative or preventive. Also, many of these therapeutic agents have not been subjected to randomized, controlled trials, and, except for topical immunotherapy, there are few published studies on long-term outcomes. The treatment plan is designed according to the patient's age and extent of disease. In this paper, the therapeutic agents are organized according to their efficacy and safety profiles into first-line, second-line, and third-line options.
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Affiliation(s)
- Adel Alsantali
- Department of Dermatology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
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Royer M, Bodemer C, Vabres P, Pajot C, Barbarot S, Paul C, Mazereeuw J. Efficacy and tolerability of methotrexate in severe childhood alopecia areata. Br J Dermatol 2011; 165:407-10. [DOI: 10.1111/j.1365-2133.2011.10383.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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