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Piraccini BM, Rapparini L, Quadrelli F, Alessandrini A, Bruni F, Cedirian S, Pampaloni F, Marcelli E, Bortolani B, Giampieri E, Gallo G, Torrelli F, Sciamarrelli N, Quaglino P, Tomasini C, Barruscotti S, Ambrogio F, Foti C, Picciallo M, Caro G, Rossi A, Pellacani G, Ala L, Acri MC, Diluvio L, Matteini E, Bianchi L, Argenziano G, Babino G, Fulgione E, Gnesotto L, Sechi A, Naldi L, Tassone F, Peris K, Caldarola G, Caposiena Caro RD, Bazzacco G, Zalaudek I, Vastarella M, Cantelli M, Patrì A, Dall'oglio F, Lacarrubba F, Micali G, Fraghì A, Boccaletti V, Marzano AV, Barbareschi M, Silvio M, Vagnozzi E, Fargnoli MC, Caponio C, Atzori L, Sanna S, Anedda J, Feliciani C, DE Felici Del Giudice MB, Scandagli I, Prignano F, Rongioletti F, Podo Brunetti A, Bigotto GD, Offidani AM, Simonetti O, Lembo S, Raimondo A, Balestri R, Ioris T, Gisondi P, Bellinato F, Trovato E, Cinotti E, Papini M, Cicoletti M, Corazza M, Starace M. Italian National Registry of Alopecia Areata: an epidemiological study of 699 Italian patients. Ital J Dermatol Venerol 2024; 159:336-343. [PMID: 38808459 DOI: 10.23736/s2784-8671.24.07934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA. METHODS The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients. RESULTS The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life. CONCLUSIONS AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.
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Affiliation(s)
- Bianca Maria Piraccini
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Rapparini
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy -
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Quadrelli
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stephano Cedirian
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Enrico Giampieri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giuseppe Gallo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Torrelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nadia Sciamarrelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carlo Tomasini
- Dermatology Clinic, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefania Barruscotti
- Dermatology Clinic, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Aldo Moro University of Bari, Bari, Italy
| | - Caterina Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Aldo Moro University of Bari, Bari, Italy
| | - Michele Picciallo
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Aldo Moro University of Bari, Bari, Italy
| | - Gemma Caro
- Unit of Dermatology, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Alfredo Rossi
- Unit of Dermatology, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giovanni Pellacani
- Unit of Dermatology, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Lorenzo Ala
- Unit of Dermatology, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, Sapienza University, Rome, Italy
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Cristina Acri
- Unit of Dermatology, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Laura Diluvio
- Unit of Dermatology, Tor Vergata Policlinic Foundation, Tor Vergata University of Rome, Rome, Italy
| | - Enrico Matteini
- Unit of Dermatology, Tor Vergata Policlinic Foundation, Tor Vergata University of Rome, Rome, Italy
| | - Luca Bianchi
- Unit of Dermatology, Tor Vergata Policlinic Foundation, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Argenziano
- Unit of Dermatology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Graziella Babino
- Unit of Dermatology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Fulgione
- Unit of Dermatology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Laura Gnesotto
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Andrea Sechi
- Unit of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Luigi Naldi
- Unit of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Tassone
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Unit of Dermatology, Department of Medicine and Traslational Surgery, Sacred Heart Catholic Univerity, Rome, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Unit of Dermatology, Department of Medicine and Traslational Surgery, Sacred Heart Catholic Univerity, Rome, Italy
| | - Giacomo Caldarola
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Unit of Dermatology, Department of Medicine and Traslational Surgery, Sacred Heart Catholic Univerity, Rome, Italy
| | | | - Giulia Bazzacco
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Maria Vastarella
- Unit of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Cantelli
- Unit of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela Patrì
- Unit of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | | | | | | | - Angelo Valerio Marzano
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mauro Barbareschi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Martina Silvio
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuele Vagnozzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Unit of Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Unit of Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Chiara Caponio
- Unit of Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Laura Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Silvia Sanna
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Jasmine Anedda
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudio Feliciani
- Unit of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Ilaria Scandagli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Franco Rongioletti
- Dermatologic Clinic, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Podo Brunetti
- Dermatologic Clinic, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianmarco D Bigotto
- Dermatologic Clinic, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Oriana Simonetti
- Dermatologic Clinic, Polytechnic University of Marche, Ancona, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Odontology, Scuola Medica Salernitana, Salerno, Italy
| | - Annunziata Raimondo
- Department of Medicine, Surgery and Odontology, Scuola Medica Salernitana, Salerno, Italy
| | | | - Tommaso Ioris
- Division of Dermatology, U.O. Multizonale APSS, Trento, Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Bellinato
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuele Trovato
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Manuela Papini
- Dermatology Clinic of Terni, University of Perugia, Department of Medicine and Surgery, Terni, Italy
| | - Michela Cicoletti
- Dermatology Clinic of Terni, University of Perugia, Department of Medicine and Surgery, Terni, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Michela Starace
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Yang S, Hu X, Zou P, Zeng Z, Hu Y, Xiao R. Roles of blood metabolites in mediating the relationship between vitiligo and autoimmune diseases: Evidence from a Mendelian randomization study. Int Immunopharmacol 2024; 133:112132. [PMID: 38691918 DOI: 10.1016/j.intimp.2024.112132] [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: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study employed Mendelian Randomization (MR) to investigate the causal relationship between genetic susceptibility to vitiligo and the risk of various autoimmune diseases, along with the mediating role of blood metabolites. METHODS We performed two-sample MR analyses using aggregated genome-wide association studies (GWAS) data on 486 blood metabolites, vitiligo, and nine autoimmune diseases to investigate blood metabolites' causal effects on the susceptibility of vitiligo and the associations of vitiligo with nine autoimmune comorbidities. We also applied multivariable MR to unravel metabolites by which vitiligo influences the pathogenesis of autoimmune diseases. RESULTS Our findings indicate that vitiligo amplified the risk of several autoimmune diseases, including rheumatoid arthritis (OR 1.17; 95 % CI 1.08-1.27), psoriasis (OR 1.10; 95 % CI 1.04-1.17), type 1 diabetes (OR 1.41; 95 % CI 1.23-1.63), pernicious anemia (OR 1.23; 95 % CI 1.12-1.36), autoimmune hypothyroidism (OR 1.19; 95 % CI 1.11-1.26), alopecia areata (OR 1.22; 95 % CI 1.10-1.35), and autoimmune Addison's disease (OR 1.22; 95 % CI 1.12-1.33). Additionally, our analysis identified correlations with vitiligo for 14 known (nine risk, five protective) and seven uncharacterized serum metabolites. After adjusting for genetically predicted levels of histidine and pyruvate, the associations between vitiligo and these diseases were attenuated. CONCLUSIONS We substantiated vitiligo's influence on susceptibility to seven autoimmune diseases and conducted a thorough investigation of serum metabolites correlated with vitiligo. Histidine and pyruvate are potential mediators of vitiligo associated with autoimmune diseases.By combining metabolomics with genomics, we provide new perspectives on the etiology of vitiligo and its immune comorbidities.
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Affiliation(s)
- Siyu Yang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Xinglin Hu
- Department of Dermatology and Institute of Translation Medicine, Affiliated the First People's Hospital of Chenzhou of University of South China, Chenzhou, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Puyu Zou
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Zhuotong Zeng
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China
| | - Yibo Hu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Research Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China.
| | - Rong Xiao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, China; Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, No. 139 Renmin Road, Changsha, Hunan 410011, China.
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Sun R, Kong D. Bilateral Association Between Atopic Dermatitis® and Alopecia Areata: A Systematic Review and Meta-Analysis. Dermatitis 2024; 35:208-218. [PMID: 37471232 DOI: 10.1089/derm.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This systematic review and meta-analysis aimed to explore the association between atopic Dermatitis® (AD) and alopecia areata (AA). A comprehensive search was conducted in PubMed, Embase, Cochrane, and Web of Science from the inception of each database to November 10, 2022 for relevant studies. As there is a potential bilateral association between the 2 diseases, we assessed the prevalence/incidence of AA in patients with AD and the prevalence/incidence of AD in patients with AA. A total of 29 studies involving 11,233,448 participants were included in this analysis. AA was the exposure factor in 23 studies, AD in 7 studies, and both in 1 study. The meta-analysis revealed that the prevalence of AD was 11.2% (7.7%-15.1%) in patients with AA, and the prevalence of AA was 3.2% (95% confidence interval [CI]: 0.0%-11.5%) in patients with AD. The incidence of AD in AA patients was found to vary with age (P = 0.07). Based on 7 studies, there was a significant association between AD and AA when AA was the exposure factor [odds ratio, OR, = 4.537 (95% CI: 2.409-8.544)]; based on 10 studies, there was also a significant association between AD and AA when AD was the exposure factor [OR = 2.643 (95% CI: 1.737-3.995)]. In conclusion, this meta-analysis demonstrated the 2-way association between AD and AA, providing a clinical reference for disease prevention and control.
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Affiliation(s)
- Rong Sun
- From the The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Deqi Kong
- Epidemic Prevention Department, Center for Disease Control and Prevention of Wuzhong District, Suzhou, China
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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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Perales A, Lipsker D, Cribier B, Lenormand C. Non-scarring alopecia of lupus erythematosus: A comprehensive review. Ann Dermatol Venereol 2023; 150:260-269. [PMID: 37598015 DOI: 10.1016/j.annder.2023.04.002] [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: 10/28/2022] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Although non-scarring alopecia (NSA) is a frequent clinical finding in patients with systemic lupus erythematosus (SLE), it has been poorly described in the literature. It is considered a nonspecific sign in the current classification of skin lesions of LE. The aim of this study was to give an updated overview of the spectrum of NSA in LE patients, with emphasis on the clinical significance thereof. METHOD We conducted a review of the English literature using the PubMed-Medline database using the keywords "Alopecia" + "Lupus erythematosus". Publications describing LE patients with NSA were included. RESULTS Data for 237 patients from 27 publications were analyzed. Ninety-one patients had diffuse NSA, 43 had patchy NSA, 83 had lupus hair, 3 had alopecia of dermal cutaneous LE, and 17 had alopecia of linear and annular lupus panniculitis of the scalp. Patients with diffuse/patchy NSA and lupus hair shared the following features: strong association with systemic activity of LE, subtle clinical/trichoscopic signs of inflammation, histological aspect consistent with lesions specific to cutaneous LE, high likelihood of response to SLE therapy, and absence of progression to scarring alopecia. Association with SLE was rare in patients with dermal cutaneous LE or linear and annular lupus panniculitis of the scalp, and skin-directed therapies were most often effective. One patient of each subtype progressed to scarring alopecia. DISCUSSION Diffuse/patchy NSA and lupus hair may represent a topographic variation of a single entity specific for LE. Prospective studies are warranted to further document the clinical significance of this manifestation.
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Affiliation(s)
- A Perales
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - C Lenormand
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France.
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Najafi MT, Abedini R, Ghandi N, Seraji S, Sadeghi Y. Is the severity of alopecia areata associated with arterial stiffness? JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:80. [PMID: 38292334 PMCID: PMC10826848 DOI: 10.4103/jrms.jrms_375_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 02/01/2024]
Abstract
Background This study aimed to evaluate the severity of alopecia areata (AA) associations with metabolic syndrome, body composition evaluated by bioimpedance techniques, and arterial stiffness based on pulse-wave velocity analysis. Materials and Methods This cross-sectional study was conducted on patients referred to AA Clinic at Razi Hospital in 2021 and 2022. Patients with AA with the Severity of Alopecia Tool (SALT) score above 20% and receiving no systemic therapy were included. Patient demographic and clinical information, symptoms of metabolic syndrome, and bioimpedance factors were collected, and the relationship between disease severity, metabolic syndrome, and bioimpedance indicators was evaluated. Results In this study, 59 patients were examined, with 26 (44.07%) being female and 33 (55.93%) being male. The mean age of the patients was 37.42 years (standard deviation [SD] =11.28). The severity of the disease was assessed using the SALT score, with the mean severity in terms of the percentage being 69.83% (SD = 28.57%). In the regression model, SALT score was independently related to the severity of vascular stiffness after adjusting for the effect of other variables (beta = 0.033, 95% CI = 0.009-0.057, P = 0.046). Moreover, SALT score was significantly related to metabolic syndrome after adjusting for the effect of other variables (OR = 1.035, 95% CI = 1.012-1.059, P = 0.002). Conclusion This study found that AA severity is associated with a higher chance of having metabolic syndrome and arterial stiffness which may lead to cardiovascular diseases in patients with AA, and screening patients regarding cardiometabolic diseases is mandated.
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Affiliation(s)
| | - Robabeh Abedini
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadab Seraji
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Sadeghi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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7
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Ly S, Manjaly P, Kamal K, Shields A, Wafae B, Afzal N, Drake L, Sanchez K, Gregoire S, Zhou G, Mita C, Mostaghimi A. Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis. Am J Clin Dermatol 2023; 24:875-893. [PMID: 37464249 DOI: 10.1007/s40257-023-00805-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking. OBJECTIVE The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA. METHODS We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023. RESULTS We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89). CONCLUSION These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Ali Shields
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bruna Wafae
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Carol Mita
- Countway Library of Medicine, Harvard University, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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8
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George P, Jagun O, Liu Q, Wentworth C, Napatalung L, Wolk R, Anway S, Zwillich SH. Prevalence of autoimmune and inflammatory diseases and mental health conditions among an alopecia areata cohort from a US administrative claims database. J Dermatol 2023; 50:1121-1128. [PMID: 37291688 DOI: 10.1111/1346-8138.16839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 06/10/2023]
Abstract
Alopecia areata (AA) is associated with an increased burden of autoimmune and inflammatory disease and mental health conditions that may have a negative impact on quality of life. However, the exact burden of comorbidities on US patients with AA and the clinical subtypes alopecia totalis (AT) and alopecia universalis (AU) compared with those without AA is not well understood. This retrospective cohort study aimed to assess the incidence rates and prevalence of AA and its clinical subtypes and examine the autoimmune and inflammatory disease and mental health condition diagnosis burden in US patients with AA and a matched cohort without AA. The Optum Clinformatics Data Mart database was used to select patients aged ≥12 years enrolled between October 1, 2016, and September 30, 2020, who had two or more AA diagnosis codes for the AA cohort. Three patients without AA were age-, sex-, and race-matched to each patient with AA. Autoimmune and inflammatory diseases and mental health conditions were evaluated at baseline and up to 2 years after the index date. In total, 8784 patients with AA (599 with AT/AU) and 26 352 matched patients without AA were included. The incidence rate of AA was 17.5 per 100 000 person-years (PY; AT/AU: 1.1 per 100 000 PY; non-AT/AU: 16.3 per 100 000 PY), and the prevalence was 54.9 per 100 000 persons (AT/AU: 3.8; non-AT/AU: 51.2). Patients with AA had a higher prevalence of autoimmune and inflammatory diseases than the matched non-AA cohort, including allergic rhinitis (24.0% vs 14.5%), asthma (12.8% vs 8.8%), atopic dermatitis (8.3% vs 1.8%), and psoriasis (5.0% vs. 1.6%). The proportions of anxiety (30.7% vs 21.6%) and major depressive disorder (17.5% vs 14.0%) were higher in patients with AA than those without AA. Patients with AT/AU generally had a greater prevalence of autoimmune and inflammatory disease and mental health conditions than patients with non-AT/AU AA.
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Affiliation(s)
| | | | - Qing Liu
- Pfizer Inc, New York, New York, USA
| | | | - Lynne Napatalung
- Pfizer Inc, New York, New York, USA
- Mount Sinai Hospital, New York, New York, USA
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9
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Doche I, Gerlero P, Magalhães T, Thien CI, Macedo T, Rivitti-Machado MC. Multivariate analysis of clinical characteristics and prognostic factors in early-onset alopecia areata: a retrospective study with 82 Brazilian patients. An Bras Dermatol 2023; 98:681-684. [PMID: 37164790 PMCID: PMC10404497 DOI: 10.1016/j.abd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Isabella Doche
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paula Gerlero
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Tiara Magalhães
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Chan I Thien
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thalita Macedo
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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10
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Shakhashiro M, Pasagic S, Wilson CL. Ophiasis Pattern Alopecia Areata in an Infant. Cureus 2023; 15:e44920. [PMID: 37814732 PMCID: PMC10560580 DOI: 10.7759/cureus.44920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Alopecia areata (AA), an autoimmune inflammatory disorder causing non-scarring hair loss, predominantly affects the adult population and is rarely encountered in young infants and neonates. The etiology of this condition remains multifactorial, involving complex interactions between genetic, autoimmune, and environmental factors. In this report, we present a notable case of a four-month-old infant who presented with distinct band-like hair loss on the right inferior lateral forehead, left inferior lateral forehead, and superior middle forehead following a culturally significant head-shaving ritual known as Chudakarana. This unique presentation of ophiasis AA in an infant is an unusual occurrence and has been associated with a poor prognosis. The patient received topical treatment with triamcinolone 0.1% lotion, resulting in improvement of alopecia at the six-week follow-up, although complete resolution of symptoms was not achieved. This case highlights the significance of recognizing atypical presentations of AA in the pediatric population and underscores the complexities in associated cultural factors.
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Affiliation(s)
- Muna Shakhashiro
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Sandro Pasagic
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
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11
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Done N, Bartolome L, Swallow E, Gao W, Carley C, Wang T, Mostaghimi A. Real-World Treatment Patterns among Patients with Alopecia Areata in the USA: A Retrospective Claims Analysis. Acta Derm Venereol 2023; 103:adv12445. [PMID: 37622204 PMCID: PMC10469222 DOI: 10.2340/actadv.v103.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 08/26/2023] Open
Abstract
Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world treatment patterns among patients in the USA with alopecia areata, including the subtypes alopecia totalis and alopecia universalis, in the first year after diagnosis of an episode of alopecia areata. Approximately 5% of all patients (adults (age ≥ 18 years), n = 7,703; adolescents (age 12-17 years), n = 595) had alopecia totalis or alopecia universalis. Corticosteroids were the most common first-line (1L) and second-line (2L) treatments. The mean time from diagnosis of alopecia areata to initiation of 1L treatment was 2.2 days for adults and 2.6 days for adolescents; mean 1L duration was 76.9 and 64.3 days, respectively. For adults (57.5%) and adolescents (59.7%) with 2L therapy, the mean time from 1L discontinuation to 2L initiation was 57.2 and 53.6 days, respectively; the mean duration of 2L treatment was 55.5 and 50.1 days, respectively. More patients with vs without alopecia totalis or alopecia universalis initiated 2L therapy (adults: 71.9% vs 56.8%; adolescents: 71.4% vs 58.9%). The proportion of days covered during the first year post-diagnosis was 36.7% (adults) and 34.1% (adolescents). These results highlight the substantial disease burden of alopecia areata and a need for more effective treatments.
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Affiliation(s)
| | | | | | - Wei Gao
- Analysis Group, Boston, MA, US
| | | | | | - Arash Mostaghimi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Kincaid CM, Sharma AN, Mesinkovska NA. Alopecia areata is associated with risk of inflammatory arthritis. J Am Acad Dermatol 2023; 89:422-423. [PMID: 37121482 DOI: 10.1016/j.jaad.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Colin M Kincaid
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Ajay N Sharma
- Department of Dermatology, University of California, Irvine, Irvine, California
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13
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King B, Pezalla E, Fung S, Tran H, Bourret JA, Peeples-Lamirande K, Takiya L, Napatalung L. Overview of alopecia areata for managed care and payer stakeholders in the United States. J Manag Care Spec Pharm 2023; 29:848-856. [PMID: 37219075 PMCID: PMC10394197 DOI: 10.18553/jmcp.2023.22371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Alopecia areata (AA) is an autoimmune disease with a complex pathophysiology resulting in nonscarring hair loss in genetically susceptible individuals. We aim to provide health care decision makers an overview of the pathophysiology of AA, its causes and diagnosis, disease burden, costs, comorbidities, and information on current and emerging treatment options to help inform payer benefit design and prior authorization decisions. Literature searches for AA were conducted using PubMed between 2016 and 2022 inclusive, using search terms covering the causes and diagnosis of AA, pathophysiology, comorbidities, disease management, costs, and impact on quality of life (QoL). AA is a polygenic autoimmune disease that significantly impacts QoL. Patients with AA face economic burden and an increased prevalence of psychiatric disease, as well as numerous systemic comorbidities. AA is predominantly treated using corticosteroids, systemic immunosuppressants, and topical immunotherapy. Currently, there are limited data to reliably inform effective treatment decisions, particularly for patients with extensive disease. However, several novel therapies that specifically target the immunopathology of AA have emerged, including Janus kinase (JAK) 1/2 inhibitors such as baricitinib and deuruxolitinib, and the JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor ritlecitinib. To support disease management, a disease severity classification tool, the Alopecia Areata Severity Scale, was recently developed that evaluates patients with AA holistically (extent of hair loss and other factors). AA is an autoimmune disease often associated with comorbidities and poor QoL, which poses a significant economic burden for payers and patients. Better treatments are needed for patients, and JAK inhibitors, among other approaches, may address this tremendous unmet medical need. DISCLOSURES: Dr King reports seats on advisory boards for and/or is a consultant and/or clinical trial investigator for AbbVie, Aclaris Therapeutics Inc, AltruBio Inc, Almirall, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Meyers Squibb, Concert Pharmaceuticals Inc, Dermavant Sciences Inc, Eli Lilly and Company, Equillium, Incyte Corp, Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, TWi Biotechnology Inc, and Viela Bio; and speakers bureaus for AbbVie, Incyte, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. Pezalla is a paid consultant to Pfizer for market access and payer strategy concerns; Fung, Tran, Bourret, Takiya, Peeples-Lamirande, and Napatalung are employees of Pfizer and hold stock in Pfizer. This article was funded by Pfizer.
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Affiliation(s)
- Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | | | | | - Lynne Napatalung
- Medical Affairs, Pfizer, New York, NY
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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14
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Ho CY, Wu CY, Chen JYF, Wu CY. Clinical and Genetic Aspects of Alopecia Areata: A Cutting Edge Review. Genes (Basel) 2023; 14:1362. [PMID: 37510267 PMCID: PMC10379312 DOI: 10.3390/genes14071362] [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: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Alopecia areata (AA) is a chronic, non-scarring, immune-mediated skin disease that affects approximately 0.5-2% of the global population. The etiology of AA is complex and involves genetic and environmental factors, with significant advancements in genetic research occurring in recent years. In addition to well-known genes such as PTPN22, CTLA4, and IL2, which have been widely supported as being associated with AA, an increasing number of specific gene-related loci have been discovered through advances in genetic research. For instance, gene analysis of microRNAs can reveal the critical role of miRNAs in regulating gene expression, aiding in the understanding of cellular and organismal functional regulatory mechanisms. Furthermore, numerous studies have confirmed the existence of correlations between AA and other immune-related diseases. Examples include hyperthyroidism and rheumatoid arthritis. By understanding the interrelationships between AA and other immune diseases, we can further comprehend potential shared genetic foundations or pathogenic mechanisms among different diseases. Genetic research plays a crucial role in unraveling the pathogenesis of AA, as the identification of genetic variations associated with AA can assist in formulating more effective and targeted treatment strategies.
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Affiliation(s)
- Chih-Yi Ho
- Department of Dermatology, College of Medicine and Post Baccalaureat Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Chiu-Yen Wu
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Jeff Yi-Fu Chen
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ying Wu
- Department of Dermatology, College of Medicine and Post Baccalaureat Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
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15
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Al Hammadi A, Parmar NV, Aljefri K, Al Sharif O, Abdallah M, Ahmed HM, Ammoury A. Review on Alopecia Areata in the Middle East and Africa: Landscape and Unmet Needs. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00946-8. [PMID: 37338721 DOI: 10.1007/s13555-023-00946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life. AIMS AND FINDINGS AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.
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Affiliation(s)
| | - Nisha V Parmar
- Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | | | - Osama Al Sharif
- King Fahad General Hospital, Medina, Kingdom of Saudi Arabia
| | | | | | - Alfred Ammoury
- Division of Dermatology, St George University Medical Center, Beirut, Lebanon
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16
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Park SH, Ji KH, Kim JU, Jang SH, Ahn SW, Hong SM, Jin WJ, Seol JE, Kim H. Evaluation of Sleep Disturbance in Alopecia Areata through Questionnaire: Pittsburgh Sleep Quality Index as a Reasonable Tool. Ann Dermatol 2023; 35:183-189. [PMID: 37290952 DOI: 10.5021/ad.22.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. OBJECTIVE This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. METHODS Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. RESULTS A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). CONCLUSION This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
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Affiliation(s)
- So Hee Park
- Department of Dermatology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ki Hwan Ji
- Department of Neurology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jong Uk Kim
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seung Hee Jang
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Sang Woo Ahn
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seong Min Hong
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Woo Jung Jin
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jung Eun Seol
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
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17
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Hao L, Nam KH, Lee GJ, Kim D, Shin JM, Lee Y, Kim CD, Kim SJ, Yun SK, Park BH, Park J. SIRT1 downregulation provokes immune-inflammatory responses in hair follicle outer root sheath cells and may contribute to development of alopecia areata. J Dermatol Sci 2023:S0923-1811(23)00126-3. [PMID: 37268558 DOI: 10.1016/j.jdermsci.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Silent information regulator 1 (SIRT1), a type III histone deacetylase, is involved in various cutaneous and systemic autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and psoriasis. However, little is known about the role of SIRT1 in the development of alopecia areata (AA). OBJECTIVES This study investigated whether SIRT1 regulates the hair follicle immune system and is involved in AA pathogenesis. METHODS SIRT1 expression in human scalp tissue was analyzed using immunohistochemical staining, qPCR, and western blotting. The regulatory effect of SIRT1 was evaluated after stimulation with the double-stranded RNA mimic polyinosinic:polycytidylic acid (poly I:C) in hair follicle outer root sheath (ORS) cells and C3H/HeJ mice. RESULTS SIRT1 expression was significantly reduced in the AA scalp compared to the normal scalp. SIRT1 inhibition upregulated MHC class I polypeptide-related sequence A and UL16 binding protein 3 in hair follicle ORS cells. SIRT1 inhibition also promoted the production of Th1 cytokines (IFN-γ and TNF-α), IFN-inducible chemokines (CXCL9 and CXCL10), and T cell migration in ORS cells. Conversely, SIRT1 activation suppressed the autoreactive inflammatory responses. The counteractive effect of the immune response by SIRT1 was mediated through the deacetylation of NF-κB and phosphorylation of STAT3. CONCLUSION SIRT1 downregulation induces immune-inflammatory responses in hair follicle ORS cells and may contribute to AA development.
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Affiliation(s)
- Lihua Hao
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Kyung-Hwa Nam
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, the Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, the Republic of Korea
| | - Geon-Jong Lee
- Department of Dermatology, Chungnam National University Medical School, Daejeon, the Republic of Korea
| | - Doyeon Kim
- Department of Dermatology, Chungnam National University Medical School, Daejeon, the Republic of Korea
| | - Jung-Min Shin
- Department of Dermatology, Chungnam National University Medical School, Daejeon, the Republic of Korea
| | - Young Lee
- Department of Dermatology, Chungnam National University Medical School, Daejeon, the Republic of Korea
| | - Chang-Deok Kim
- Department of Dermatology, Chungnam National University Medical School, Daejeon, the Republic of Korea
| | - Seong-Jin Kim
- Department of Dermatology, Chonnam National University Medical School, Kwangju, the Republic of Korea
| | - Seok-Kweon Yun
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, the Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, the Republic of Korea
| | - Byung-Hyun Park
- Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, the Republic of Korea; Department of Biochemistry, Jeonbuk National University Medical School, Jeonju, the Republic of Korea
| | - Jin Park
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, the Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, the Republic of Korea.
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Agrawal J, Lal N, Singhal R. Alopecia and Periodontitis: Exploring the connecting dots. J Indian Soc Periodontol 2023; 27:233-237. [PMID: 37346853 PMCID: PMC10281310 DOI: 10.4103/jisp.jisp_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/09/2022] [Accepted: 08/14/2022] [Indexed: 06/23/2023] Open
Abstract
Alopecia areata is a systemic disease with nonscarring hair loss from the scalp, face, or any part of the body. The disease with undetermined etiology and pathogenesis has a considerable impact on the social life of patients which gradually builds up stress and expedites further deterioration of their condition. Interestingly, in such patients, besides stress-relieving exercises and immunomodulators, well-timed dental assessment and prompt treatment have contributed to improving the prognosis of alopecia. This depicts an interrelationship between alopecia and oral foci of infections. Over the past few decades, periodontitis has remained to be one of the predominant forms of oral focus of infection for systemic diseases. The present review throws light on the role of stress and autoimmunity in establishing a possible correlation between alopecia and periodontitis. It is augmented with documented case reports, demanding a complete oral examination in patients with the unexplained origin of alopecia. An interdisciplinary approach is the need of the hour which can prevent the progression of both the diseases as well as other oral infections.
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Affiliation(s)
- Jaya Agrawal
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nand Lal
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rameshwari Singhal
- Department of Periodontology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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Zeng Z, Li S, Ye Y, Ling Y, Gong Y, Zi X, Yang J, McElwee KJ, Zhang X. Allergen desensitization reduces the severity of relapsed alopecia areata in dust-mite allergic patients. Exp Dermatol 2023. [PMID: 37114716 DOI: 10.1111/exd.14819] [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: 09/30/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Atopy may be a facilitating factor in some alopecia areata (AA) patients with early disease onset and more severe/extensive AA. The underlying immune mechanisms are unknown, but allergen responses may support a pro-inflammatory environment that indirectly promotes AA. To investigate the long-term effect of allergen immunotherapy (AIT) against house dust mite (HDM) allergy on disease severity and prognosis for AA patients. An observational comparative effectiveness study was conducted on 69 AA patients with HDM allergy. 34 patients received conventional/traditional AA treatment (TrAA) plus AIT (AIT-TrAA), and 35 patients received TrAA alone. Serum total immunoglobulin E (tIgE), HDM specific IgE (sIgE), HDM specific IgG4 (sIgG4) and cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, IL-33, IFNγ) were quantified in these patients, together with 58 non-allergic AA patients and 40 healthy controls. At the end of the 3-year desensitization course, the AIT-TrAA group presented with lower SALT scores than the TrAA group, especially in non-alopecia totalis/universalis (AT/U) patients and pre-adolescent AT/U patients (age ≤ 14). In patients with elevated tIgE levels before AIT, a decrease in tIgE was correlated to reduced extent of AA on completion of the AIT course. After desensitization, elevation of IL-5 and decrease of IL-33 were observed in HDM allergic-AA patients. Desensitization to HDM in allergic AA patients reduces the severity of relapse-related hair loss over the 3-year AIT treatment course, possibly via opposing Th2 dominance. This adjunctive treatment may help reduce disease severity and curtail the disease process in allergic patients with AA.
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Affiliation(s)
- Zixun Zeng
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, P.R. China
| | - Shuifeng Li
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yanting Ye
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yunxia Ling
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yugang Gong
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Xue Zi
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Jian Yang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Kevin J McElwee
- Centre for Skin Sciences, University of Bradford, Bradford, UK
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xingqi Zhang
- Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
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Holmes S, Harries M, Macbeth AE, Chiu WS, de Lusignan S, Messenger AG, Tziotzios C. Alopecia areata and risk of atopic and autoimmune conditions: population-based cohort study. Clin Exp Dermatol 2023; 48:325-331. [PMID: 36689337 DOI: 10.1093/ced/llac104] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Alopecia areata (AA) has features of both autoimmune and atopic pathogenesis, but information on the risk of people with AA developing autoimmune and atopic conditions is limited. OBJECTIVE To assess the prevalence and incidence of atopic and autoimmune conditions in people with AA. METHODS This was a population-based cohort study of 8051 adults with newly diagnosed AA (AA group) and 32 204 adults in the matched control group, using the UK Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network primary care database, 2009-2018 (trial registration number: NCT04239521). Baseline prevalence of common atopic and autoimmune conditions, and risk of new-onset atopic and autoimmune disease, were estimated. RESULTS Atopic and autoimmune conditions were more prevalent in the AA group than the control group (atopic 37.2% vs. 26.7%, autoimmune 11.5% vs. 7.9%). The AA group were 43% more likely to develop any new-onset atopic condition [adjusted hazard ratio (aHR) 1.43. 95% confidence interval (CI) 1.28-1.61] and 45% more likely to develop any autoimmune condition (aHR 1.45, 95% CI 1.28-1.66) compared with the control group. When examining individual conditions, the AA group were at increased risk of atopic dermatitis (aHR 1.91, 95% CI 1.67-2.19), allergic rhinitis (aHR 1.32, 95% CI 1.14-1.54), autoimmune hypothyroidism (aHR 1.65, 95% CI 1.35-2.02), systemic lupus erythematosus (aHR 4.51, 95% CI 1.88-10.82) and vitiligo (aHR 2.39, 95% CI 1.49-3.82). There was no evidence for a higher incidence of other conditions examined. CONCLUSION People with AA have an increased burden of atopic and autoimmune comorbidity. This supports previous work suggesting that both T helper cell (Th)1 and Th2 immune responses may be implicated in the pathogenesis of AA.
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Affiliation(s)
- Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matthew Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Centre for Dermatology Research, Manchester Academic Health Science Centre (MAHSC) and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Abby E Macbeth
- Department of Dermatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Wing S Chiu
- Pfizer Ltd, Walton on the Hill, Tadworth, Surrey, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, London, UK
| | | | - Christos Tziotzios
- St John's Institute of Dermatology, King's College London, London, UK
- Guy's Hospital, London, UK
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21
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Wan S, Xu W, Xie B, Guan C, Song X. The potential of regulatory T cell-based therapies for alopecia areata. Front Immunol 2023; 14:1111547. [PMID: 37205097 PMCID: PMC10186346 DOI: 10.3389/fimmu.2023.1111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
Cytotoxic T lymphocyte has been a concern for the etiopathogenesis of alopecia areata (AA), some recent evidence suggests that the regulatory T (Treg) cell deficiency is also a contributing factor. In the lesional scalp of AA, Treg cells residing in the follicles are impaired, leading to dysregulated local immunity and hair follicle (HF) regeneration disorders. New strategies are emerging to modulate Treg cells' number and function for autoimmune diseases. There is much interest to boost Treg cells in AA patients to suppress the abnormal autoimmunity of HF and stimulate hair regeneration. With few satisfactory therapeutic regimens available for AA, Treg cell-based therapies could be the way forward. Specifically, CAR-Treg cells and novel formulations of low-dose IL-2 are the alternatives.
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Affiliation(s)
- Sheng Wan
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Xu
- School of Medicine, Zhejiang University, Yuhangtang, Hangzhou, China
| | - Bo Xie
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cuiping Guan
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiuzu Song, ; Cuiping Guan,
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiuzu Song, ; Cuiping Guan,
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22
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Zhou Y, Jia L, Zhou D, Chen G, Fu Q, Li N. Advances in microneedles research based on promoting hair regrowth. J Control Release 2023; 353:965-974. [PMID: 36549392 DOI: 10.1016/j.jconrel.2022.12.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Alopecia is the most common and difficult-to-treat hair disorder. It usually brings a significant psychological burden to the patients. With the growing popularity of alopecia, the study of alopecia has gained more attention. Currently, only minoxidil and finasteride have been approved by the FDA for the treatment of alopecia, but the efficacy has always been unsatisfactory. As a new form of transdermal drug delivery, microneedles have been widely used in the treatment of alopecia and have proven to be effective. Microneedles delivery can improve the efficiency of local drug delivery and patients' compliance, which can achieve better therapeutic effects on hair-related diseases. Therefore, microneedles have gained much attention in the field of alopecia and hair regrowth promotion in recent years. This review summarizes the last decade of research on the microneedles delivery design for the treatment of alopecia or promotion of hair regrowth and provides a comprehensive evaluation of this field.
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Affiliation(s)
- Yanjun Zhou
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Luan Jia
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Di Zhou
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Gang Chen
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Qiang Fu
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, PR China.
| | - Ning Li
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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Lee JH, Ju HJ, Seo JM, Almurayshid A, Kim GM, Ezzedine K, Bae JM. Comorbidities in Patients with Vitiligo: A Systematic Review and Meta-Analysis. J Invest Dermatol 2022; 143:777-789.e6. [PMID: 36574529 DOI: 10.1016/j.jid.2022.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Abstract
Vitiligo has been reported to be associated with a variety of diseases, but it has not been systematically reviewed. Therefore, we aimed to identify prevalent diseases in patients with vitiligo and quantify their associations compared with those in healthy controls. A comprehensive search of MEDLINE and EMBASE from the inception to June 2022 was conducted. Observational studies on prevalent diseases in patients with vitiligo compared with those in healthy controls were included, whereas studies limited to pediatrics or providing only laboratory results were excluded. A total of 78 studies were eligible for analyses. Patients with vitiligo showed higher risks of having comorbid autoimmune and connective tissue diseases, including alopecia areata (OR = 2.63, 95% confidence interval [CI] = 2.50‒2.78), discoid lupus erythematosus (OR = 2.54, 95% CI = 1.74‒3.72), Sjogren's syndrome (OR = 2.50, 95% CI = 1.98‒3.16), myasthenia gravis (OR = 2.30, 95% CI = 1.74‒3.02), systemic lupus erythematosus (OR = 1.96, 95% CI = 1.52‒2.52), and rheumatoid arthritis (OR = 1.82, 95% CI = 1.55‒2.15). Thyroid diseases, diabetes mellitus, metabolic syndrome, sensorineural hypoacusis, and ophthalmic abnormalities were also more prevalent in patients with vitiligo. In conclusion, vitiligo is associated with various systemic diseases. Physicians should evaluate and manage potential comorbid conditions in patients with vitiligo.
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Affiliation(s)
- Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Min Seo
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Abdurrahman Almurayshid
- Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj City, Saudi Arabia
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Khaled Ezzedine
- Department of Dermatology, Henry Mondor Hospital, Paris Est Créteil University, Créteil, France
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Rehan ST, Khan Z, Mansoor H, Shuja SH, Hasan MM. Two-way association between alopecia areata and sleep disorders: A systematic review of observational studies. Ann Med Surg (Lond) 2022; 84:104820. [PMID: 36582873 PMCID: PMC9793131 DOI: 10.1016/j.amsu.2022.104820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
Abstract
Background Alopecia Areata (AA) is found to be the most prevalent autoimmune disorder amongst the general population. It was observed that AA patients are at a significantly higher risk of developing obstructive sleep apnea and non-apneic insomnia than patients without AA. On the contrary, patients with identified sleep disorders were found to be more prone to developing AA as compared to the patients without sleep disorders. This study, therefore, validated the hypothesis of a bidirectional association between AA and sleep disorders. Aims In this systematic review, our primary aim is to assess the prevalence of sleep disorders in Alopecia Areata patients while also assessing the inverse relationship between the two disorders. Methods A literature search of MEDLINE, Google Scholar and Cochrane CENTRAL was performed from their inception to April 2022. Articles were selected for inclusion if they met the following eligibility criteria: (a) Studies enrolling patients having alopecia areata to assess the sleep quality. (b) Studies assessing the risks of alopecia areata in individuals with sleep disorder (c) Studies evaluating the bidirectional association between alopecia areata and sleep quality. Case reports, commentaries, and editorials were excluded. The outcomes of recruited studies were qualitatively synthesised and study findings are summarized in the results section and tabulated in summary tables. Results Our search on electronic databases yielded 1562 articles. After abstract screening and full text review, 5 cross sectional and 3 cohort studies are included in this systematic review. Cases with PSQI scores higher than 5 and 6 were found to be in greater numbers amongst the AA patient population when compared to the control population (p < 0.001). Moreover, studies showed that patients with sleep disorders were greatly predisposed to develop subsequent AA as compared to patients without sleep disorders (aHR 4.70; 95% CI 3.99-5.54) (P < 0.0001). Conclusion The findings from our results display a significant bi-directional cause-effect relation between AA and sleep disorders. However, more large-scale observational studies on this subject are required to further validate our findings.
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Affiliation(s)
| | - Zayeema Khan
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, 1902, Bangladesh,Corresponding author.
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Moseley IH, Thompson JM, George EA, Ragi SD, Kang JH, Reginato AM, Qureshi A, Cho E. Immune-mediated diseases and subsequent risk of alopecia areata in a prospective study of US women. Arch Dermatol Res 2022; 315:807-813. [PMID: 36319702 DOI: 10.1007/s00403-022-02444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Alopecia areata (AA) is the most common form of immune-mediated hair loss. Studies have begun to establish the most frequent comorbid diseases of AA; however, results have been inconsistent with few prospective studies. METHODS A total of 63,692 women in the Nurses' Health Study, 53-80 years, were prospectively followed from 2002 to 2014 to determine whether history of immune-mediated disease was associated with AA risk. Hazard ratios (HRs) and 95% confidence intervals (CIs) for AA in relation to immune-mediated conditions were computed using Cox proportional hazard models, adjusted for AA risk factors. RESULTS 133 AA cases were identified during follow-up. Personal history of any immune-mediated disease was associated with increased AA risk (HR 1.72, 95% CI 1.24-2.37). History of systemic lupus erythematosus (HR 5.43, 95% CI 2.11-13.97), multiple sclerosis (HR 4.10, 95% CI 1.40-11.96), vitiligo (HR 3.13, 95% CI 1.08-9.10), psoriasis (HR 2.01, 95% CI 1.00-4.03), hypothyroidism (HR 1.88, 95% CI 1.30-2.71), and rheumatoid arthritis (HR 1.66, 95% CI 1.09-2.52) were associated with increased AA risk. History of inflammatory bowel disease or Graves' disease/hyperthyroidism was not significantly associated with AA risk. CONCLUSIONS In this prospective study, personal history of immune-mediated diseases either individually or overall was associated with increased AA risk.
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Affiliation(s)
- Isabelle H Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jordan M Thompson
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
| | - Elisabeth A George
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony M Reginato
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
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Ray M, Swallow E, Gandhi K, Carley C, Sikirica V, Wang T, Done N, Signorovitch J, Mostaghimi A. Healthcare Utilization and Costs Among US Adolescents With Alopecia Areata. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:11-18. [PMID: 35975139 PMCID: PMC9338344 DOI: 10.36469/001c.36229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Background: Alopecia areata (AA) is an autoimmune disease of hair loss affecting people of all ages. Alopecia totalis (AT) and universalis (AU) involve scalp and total body hair loss, respectively. AA significantly affects quality of life, but evidence on the economic burden in adolescents is limited. Objectives: To assess healthcare resource utilization (HCRU) and all-cause direct healthcare costs, including out-of-pocket (OOP) costs, of US adolescents with AA. Methods: IBM MarketScan® Commercial and Medicare databases were used to identify patients aged 12-17 years with ≥2 claims with AA/AT/AU diagnosis (prevalent cases), from October 1, 2015, to March 31, 2018, enrolled for ≥12 months before and after the first AA diagnosis (index). Patients were matched 1:3 to non-AA controls on index year, demographics, plan type, and Charlson Comorbidity Index. Per patient per year HCRU and costs were compared post-index. Results: Patients comprised 130 AT/AU adolescents and 1105 non-AT/AU adolescents (53.8% female; mean age, 14.6 years). Post-index, AT/AU vs controls had more outpatient (14.5 vs 7.1) and dermatologist (3.6 vs 0.3) visits, higher mean plan costs ($9397 vs $2267), including medical ($7480 vs $1780) and pharmacy ($1918 vs $487) costs, and higher OOP costs ($2081 vs $751) (all P<.001). The non-AT/AU cohort vs controls had more outpatient (11.6 vs 8.0) and dermatologist (3.4 vs 0.4) visits, higher mean plan costs ($7587 vs $4496), and higher OOP costs ($1579 vs $805) (all P<.001). Discussion: This large-sample, real-world analysis found that adolescents with prevalent AA had significantly higher HCRU and all-cause costs than matched controls. The greater burden was driven by more frequent outpatient visits, and higher payer medical and pharmacy costs in comparison with controls. Oral corticosteroid use was higher among patients with AT/AU; topical and injectable corticosteroid use was higher for non-AT/AU. Although the data preclude the identification of AA-attributable costs, the matched-control design allows an estimation of incremental all-cause costs associated with AA. Conclusions: Adolescents with AA incurred substantial incremental healthcare costs, with greater costs incurred among those with AT/AU. Study findings suggest that AA incurs costs as a medical condition with a high burden on adolescent patients and health plans.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Arash Mostaghimi
- 3Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Tsai YC, Tsai TF. Overlapping Features of Psoriasis and Atopic dermatitis: From Genetics to Immunopathogenesis to Phenotypes. Int J Mol Sci 2022; 23:ijms23105518. [PMID: 35628327 PMCID: PMC9143118 DOI: 10.3390/ijms23105518] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/13/2022] Open
Abstract
Psoriasis (PSO) and atopic dermatitis (AD) were once considered to be mutually exclusive diseases, but gradually regarded as a spectrum of disease. Shared genetic loci of both diseases were noted in some populations, including Chinese. Shared immunopathogenesis involving Th17, Th1, Th22 cells, or even IL-13 was found in certain stages or phenotypes. This review discusses the overlapping genetic susceptibility, shared cytokines, immune-mediated comorbidities, and clinical presentations. Overlapping conditions could be classified into mainly PSO lesions with AD features or vice versa, concomitant PSO and AD, or disease transformation as a result of biologics treatment.
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Affiliation(s)
- Ya-Chu Tsai
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan;
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-23123456 (ext. 65734)
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Şahin T, Öztekin A. Choroidal Thickness In Patients With Alopecia Areata: Is It A Sign For Poor Prognosis? J Cosmet Dermatol 2022; 21:5098-5102. [PMID: 35390212 DOI: 10.1111/jocd.14975] [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: 11/03/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Alopecia areata (AA) is an autoimmune disease which causes non-scarring type hair loss considered to target the pigmentary system. The hair follicle may not be the only site for involvement of the disease. Iris, the ciliary body, choroid and epithelium of the retinal pigment may also be affected. The aim of the present study was to compare retinal pigment epithelium (RPE) and choroidal thicknesses between patients with AA and healthy controls. METHODS The study included 44 patients with alopecia areata, and 44 healthy individuals with similar age and gender distribution. RPE and choroidal thickness measurements were performed through Spectral-domain optical coherence tomography (SD-OCT) (Heidelberg Spectralis® OCT). RESULTS There was not any significant difference between patients with AA and healthy individuals for RPE and choroidal thickness (P = 0.751, P = 0.725, respectively). However, the choroidal thickness (422 ± 79 μm) was significantly thinner in patients with poor prognostic criteria than other patients (371 ± 75 μm) (P = 0.039). CONCLUSION Monitoring of choroidal thicknesses through optic coherence tomography (OCT) may provide an insight for the disease prognosis in patients with AA.
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Affiliation(s)
- Tayfun Şahin
- Hıtıt Unıversıty Medıcıne Faculty, Department of Ophthalmology, 019030, Corum, Turkey
| | - Aynure Öztekin
- Hıtıt Unıversıty Medıcıne Faculty, Department of Dermatology, 019030, Corum, Turkey
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Andersen YMF, Nymand L, DeLozier AM, Burge R, Edson-Heredia E, Egeberg A. Patient characteristics and disease burden of alopecia areata in the Danish Skin Cohort. BMJ Open 2022; 12:e053137. [PMID: 35173000 PMCID: PMC8852234 DOI: 10.1136/bmjopen-2021-053137] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Alopecia areata (AA) is a common disorder of patchy hair loss which carries a substantial psychological burden for patients. The current understanding of AA prevalence, disease course and burden is limited, and further research is needed to improve patient care. This prospective cohort of AA patients within the Danish Skin Cohort was established to provide data that can serve as a tool in future studies of for example, AA epidemiology and disease burden. PARTICIPANTS A total of 1494 patients with dermatologist-verified AA were included in the cohort. Patients were invited and included through electronic or phone-based questionnaires. Information regarding demographics, biometrics, lifestyle factors, skin type, AA onset and development, health-related quality of life and self-reported severity assessment was collected. FINDINGS TO DATE The mean (SD) age of AA onset was 32.7 (17.6) years. The mean body mass index and history of cigarette smoking was comparable with the general population. The majority (92.5%) of participants were Caucasian. In total, 72.4% of patients received their diagnosis by a physician within a year after onset of symptoms, and 66.9% reported to still have symptoms of AA within the past year. A total of 12% reported to have a first-degree family member with AA. In total, 31.4% of patients were missing all or nearly all hairs on their scalp, 32.2% had no or barely no eyelashes and 36.2% had no or barely no eyebrow hairs. Overall, most patients (55.7%) did not experience irritated eyes, but 30% reported slight eye irritation and 47.2% reported no damage to finger nails or toenails. FUTURE PLANS Observational studies regarding comorbidities, psychosocial burden of AA and efficacy of pharmacological interventions will be carried out and additional data will be linked from nationwide registries of routinely collected data. Furthermore, follow-up survey data will be added for longitudinal analyses.
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Affiliation(s)
| | - Lea Nymand
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Amy M DeLozier
- Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Russel Burge
- Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Emily Edson-Heredia
- Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
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30
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata – Aktuelles Verständnis und Management. J Dtsch Dermatol Ges 2022; 20:59-93. [PMID: 35040563 DOI: 10.1111/ddg.14689_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Andria Constantinou
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kathrin Hillmann
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Annika Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Ulrike Blume-Peytavi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
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31
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata - Current understanding and management. J Dtsch Dermatol Ges 2022; 20:59-90. [PMID: 35040577 DOI: 10.1111/ddg.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
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Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Andria Constantinou
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
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32
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The Immunogenetics of Morphea and Lichen Sclerosus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:155-172. [DOI: 10.1007/978-3-030-92616-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Treatment of Crohn's Disease and Concomitant Alopecia Areata With Tofacitinib. ACG Case Rep J 2021; 8:e00690. [PMID: 34840997 PMCID: PMC8613360 DOI: 10.14309/crj.0000000000000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
Alopecia areata (AA) is a type of immune-mediated hair loss and is reported in patients with inflammatory bowel disease. This suggests that there might be a shared molecular pathway in the pathogenesis of AA and inflammatory bowel disease. In addition, tumor necrosis factor-alpha antagonists are also rarely associated with new-onset AA. We present a patient with Crohn's disease treated with adalimumab who developed AA that rapidly progressed to alopecia totalis and universalis. We describe the use of tofacitinib, a Janus kinase 1/3 inhibitor, to not only successfully treat the AA but also maintain her Crohn's disease.
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AlMarzoug A, AlOrainy M, AlTawil L, AlHayaza G, AlAnazi R, AlIssa A, AlSheikh A, AlKhalifah A, AlHarithy R. Alopecia areata and tofacitinib: a prospective multicenter study from a Saudi population. Int J Dermatol 2021; 61:886-894. [PMID: 34716573 DOI: 10.1111/ijd.15917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population. It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. METHODS A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. RESULTS The sample size was 68 with an average baseline SALT score of 76.8 ± 27.6%. Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis. CONCLUSIONS Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.
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Affiliation(s)
- Alanoud AlMarzoug
- Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - May AlOrainy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Lama AlTawil
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghada AlHayaza
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rasha AlAnazi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Afaf AlSheikh
- Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah AlKhalifah
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ruaa AlHarithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
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Chanprapaph K, Mahasaksiri T, Kositkuljorn C, Leerunyakul K, Suchonwanit P. Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata. J Inflamm Res 2021; 14:4881-4891. [PMID: 34588794 PMCID: PMC8473714 DOI: 10.2147/jir.s331579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Increased rates of autoimmune diseases (ADs) have been reported in association with alopecia areata (AA); however, the risk factors for coexisting ADs in AA patients have been poorly investigated. OBJECTIVE To evaluate the prevalence and factors associated with AD comorbidities in patients with AA. METHODS This case-control study included patients diagnosed with AA between January 2000 and March 2020. Individuals with AA, both with and without concomitant ADs, were statistically compared. Variables significantly associated with coexisting ADs were identified using univariate and multivariate logistic regression analyses. Multinomial logistic regression analysis was performed to identify the specific risk factors for each concomitant AD. RESULTS Among the 615 patients with AA, comorbid ADs were found in 76 (12.4%). Autoimmune thyroid disease (AITD) exhibited the highest frequency (n = 42, 6.8%), followed by vitiligo (n = 15, 2.4%), and systemic lupus erythematosus (SLE) (n = 12, 2.0%). Logistic regression analyses revealed that female sex (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.24-4.82; P = 0.011), nail abnormalities (OR = 2.49, 95% CI = 1.14-5.46; P = 0.023), and atopic diseases (OR = 1.98, 95% CI = 1.09-2.43; P < 0.001) were significantly associated with coexisting ADs. Regarding each concomitant AD, nail abnormalities were an associated factor for AITD (OR = 4.65, 95% CI = 1.96-7.24; P = 0.01), whereas coexisting atopic diseases were demonstrated as a predictor of vitiligo (OR = 2.48, 95% CI = 1.43-4.58; P = 0.02). Female sex (OR = 1.61, 95% CI = 1.18-4.27; P = 0.04) and family history of AD (OR = 1.85, 95% CI = 1.26-4.19; P = 0.03) were predictors of SLE. CONCLUSION This study suggests that female AA patients with nail abnormalities and atopic diseases have increased rates of AD comorbidities. A thorough review of systems for associated factors can help physicians screen for concomitant ADs.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thipprapai Mahasaksiri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchana Leerunyakul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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36
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Torales J, Castaldelli-Maia JM, Ventriglio A, Almirón-Santacruz J, Barrios I, O'Higgins M, García O, Navarro R, Melgarejo O, Jafferany M. Alopecia areata: A psychodermatological perspective. J Cosmet Dermatol 2021; 21:2318-2323. [PMID: 34449973 DOI: 10.1111/jocd.14416] [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: 06/05/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Alopecia Areata (AA) is an autoimmune dermatological disease that could be influenced by psychological factors as part of the pathophysiology of the illness. AIMS This review article aims to report on psychodermatological and psychopathological aspects involved in the etiopathogenesis and comorbidities of AA, as well as on the psychiatric and psychological management of affected patients. METHODS We conducted a literature search on PubMed and Google Scholar from January 1980 to May 2021 employing the search terms of alopecia areata, psychological factors, psychological impact, psychodermatology, and psychopathology. All lists of references from the identified articles were screened for further relevant studies. The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. No specific quality criteria were used for the studies selection. RESULTS Several authors have found a high comorbidity rate between AA and mental disorders, concluding that stress and psychological factors are involved in both the development and exacerbation of the illness. More evidences are needed in order to describe the associations between the immune response, stress, and the physiological factors observed in AA patients. CONCLUSION AA is a complex illness characterized by multifactorial etiology. An interaction between genetic, autoimmune, hormonal, neural, and psychological factors is supposed. Psychopathological aspects of illness need to be better described and considered in the clinical setting.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Rodrigo Navarro
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Osvaldo Melgarejo
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
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Suchonwanit P, Kositkuljorn C, Pomsoong C. Alopecia Areata: An Autoimmune Disease of Multiple Players. Immunotargets Ther 2021; 10:299-312. [PMID: 34350136 PMCID: PMC8328385 DOI: 10.2147/itt.s266409] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/17/2021] [Indexed: 12/12/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune disease of the hair follicles. It is characterized by a well-defined non-scarring alopecic patch or patches that may extend to the entire scalp or lead to total body hair loss. Due to its unpredictable clinical course, AA causes substantial psychological harm. Despite the high prevalence of this disease and extensive research, its exact pathomechanism is unclear, and current treatments have a high relapse rate that has deemed AA incurable. Over the past few decades, researchers have investigated multiple potential factors that may help alleviate its pathogenesis and provide effective treatment. Given its complex immunopathogenesis, AA is considered an autoimmune disease with multiple factors. This review gathers current evidence that emphasizes molecular mechanisms, possible causative etiologies, and targeted immunotherapies for AA. Understanding its underlying mechanisms may shed light on new strategies to effectively manage AA in the future.
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Affiliation(s)
- Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Alopecia is a dermatologic condition in which sudden or gradual loss of hair occurs on 1 or more areas of the body, most commonly the scalp. Hair loss can be acute or chronic in nature as a result of underlying inflammation, autoimmune processes, stressors, chemotherapy, or hairstyling practices. Alopecia can have substantial psychological consequences, having a negative impact on the quality of life in affected patients. The ability to both recognize and distinguish these condition holds great significance not only in providing adequate and timely treatment to improve outcomes but also meeting patient needs.
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Affiliation(s)
- Taylor A Jamerson
- University of Michigan Medical School, 1050 Wall Street, Apartment 2D, Ann Arbor, MI 48105, USA
| | - Crystal Aguh
- Department of Dermatology, Johns Hopkins University School of Medicine, 10710 Charter Drive, Shared Suite 420, Baltimore, MD 21044, USA.
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Lee H, Kim YC, Choi JW. Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study. PLoS One 2021; 16:e0250216. [PMID: 33961663 PMCID: PMC8104430 DOI: 10.1371/journal.pone.0250216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of hair follicles. Chronic inflammatory skin diseases such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases (HDs) remains unclear. Therefore, we conducted this retrospective cohort study to evaluate the risk of subsequent HDs in patients with AA. We reviewed 3770 cases of AA and from 18,850 age, sex, and income level-matched controls from the National Health Insurance Service-National Sample Cohort. In the subgroup analysis, patients who suffered from alopecia totalis, alopecia universalis, and ophiasis were designated as patients with severe AA and patients having the disease for over a year were designated as patients with long-standing AA. As a result, we found that AA was not associated with a higher risk of heart failure, angina pectoris, or myocardial infarction. There was no significant increase in the risk of overall HD associated with AA (adjusted hazard ratio: 1.17; 95% confidence interval: 0.93-1.48; p = 0.177). Neither the severity nor the duration of AA was related to an increased risk of HDs. During the study period, AA patients did not show a significantly higher cumulative incidence of HDs than controls (log-rank p = 0.157). In conclusion, AA does not increase the risk of HD.
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Affiliation(s)
- Heera Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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40
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Jo UH, Lee JY, Lee H, Kim DY, Kang S, Koh SJ, Park H. Various skin manifestations related to inflammatory bowel disease: A nationwide cross-sectional study on the Korean population. J Dermatol 2021; 48:431-438. [PMID: 33608949 DOI: 10.1111/1346-8138.15676] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
Inflammatory bowel disease (IBD) presents with various extraintestinal manifestations. As part of them, various skin diseases are suggested to be related to IBD. We aimed to identify the epidemiology and risk of developing skin manifestations in patients with IBD. We used Korean insurance claims data and selected patients with IBD and age/sex-matched non-IBD subjects between 2013 and 2017 using the diagnosis code and prescription records of IBD-specific medications. The prevalence and risk of concurrent skin diseases were estimated. We identified 64 837 patients with IBD. Reactive skin eruptions including pyoderma gangrenosum and erythema nodosum were associated with IBD with highest odds ratios among three categories of reactive, inflammatory, and autoimmune skin diseases. Inflammatory skin diseases including rosacea, psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne conglobata were significantly associated with IBD, but the association was less marked compared to reactive skin eruptions. The patients with IBD also had a higher risk of autoimmune skin diseases including vitiligo and alopecia areata than non-IBD subjects. We determined that IBD was related to various skin diseases including reactive, inflammatory, and autoimmune skin diseases. Considering these relationships can allow better management of patients with IBD and comorbid skin diseases.
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Affiliation(s)
- Ui Hyeon Jo
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Jin Yong Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.,HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Hanjae Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Do-Yeop Kim
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Sungchan Kang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Seong-Joon Koh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Intestinal Mucosa and Skin Immunology, Seoul, Korea
| | - Hyunsun Park
- Laboratory of Intestinal Mucosa and Skin Immunology, Seoul, Korea.,Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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41
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Shin JW, Kang T, Lee JS, Kang MJ, Huh CH, Kim MS, Kim HJ, Ahn HS. Time-Dependent Risk of Acute Myocardial Infarction in Patients With Alopecia Areata in Korea. JAMA Dermatol 2021; 156:763-771. [PMID: 32401269 DOI: 10.1001/jamadermatol.2020.1133] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Alopecia areata (AA) is a common autoimmune disease presenting as nonscarring hair loss. Although AA can be associated with other autoimmune comorbidities or atopic diseases, little is known about the risk of cardiovascular diseases in patients with AA. Objective To investigate the risk of acute myocardial infarction (AMI) and cardiovascular risk profiles (CVRPs) in patients with AA via a large-scale epidemiologic study. Design, Setting, and Participants This was a retrospective cohort study using data from the Korean National Health Insurance claims database, including data from the National Health Screening Program. Patients aged 30 to 89 years who were newly diagnosed with AA between January 1, 2006, and December 31, 2017, and controls without AA matched by age and sex were enrolled. Data were analyzed between July 2018 and August 2019. Exposures Presence of AA. Main Outcomes and Measures The CVRPs and incidence rates of AMI were assessed in participants with and without AA. The stratified Cox regression hazard model was used to estimate the relative hazards over time. Results A total of 228 886 patients with AA, ranging in age from 30 to 89 years (mean [SE] age, 44.37 [0.005] years; 127 564 [55.7%] men) and 4 577 720 matched controls without AA were identified. Patients with AA tended to have slightly better CVRPs than controls in all items except smoking status before and after the diagnosis (participants with normal systolic blood pressure who were nonsmokers: 44.6% vs 42.7% and 57.8% vs 61.6% in patients with AA vs controls before and after the diagnosis, respectively). In the early phase of observation, the cumulative incidence of AMI in patients with AA was lower than that in controls (incidence rate ratio of AMI in patients with AA compared with that in controls, 0.52 [95% CI, 0.42-0.65] between 2-4 years); however, during the later phase of the 12-year follow-up period, it increased exponentially and was greater than in the control group (incidence rate ratio, 2.06 [95% CI, 1.71-2.45] between 8-10 years). Similarly, after adjusting for CVRPs, the risk of developing AMI was lower in patients with AA than in controls at the beginning of the observation period (adjusted hazard ratio (HR), 0.17 [95% CI, 0.12-0.25] between 0-2 years); however, by 8 years postdiagnosis, the risk was higher in those with AA (adjusted HR, 1.37 [95% CI, 1.11-1.70] between 8-10 years), and it increased thereafter (adjusted HR, 4.51 [95% CI, 3.65-5.58] between 10-12 years). Conclusions and Relevance In patients with AA, there was a significantly increased risk of AMI over time during the 12-year follow-up period independent of CVRPs. Close long-term monitoring of cardiovascular health in patients with AA might be appropriate.
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Affiliation(s)
- Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeuk Kang
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Kang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min-Su Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Vafaeian A, Taghizadeh E, Daneshpazhooh M, Mahmoudi H. Patchy Alopecia in a Patient with Rheumatoid Arthritis: A Practical Application of Trichoscopy. Case Rep Dermatol 2021; 13:42-46. [PMID: 33613233 PMCID: PMC7879245 DOI: 10.1159/000511536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
Trichoscopy is an efficient, convenient, and accurate diagnostic dermatological procedure which is widely used in the examination of patients with skin diseases. Herein, we report a 56-year-old woman with a long-term history of rheumatoid arthritis complaining of pruritic patchy alopecia on her scalp who was referred for biopsy to exclude cutaneous lupus erythematosus. Taking advantage of trichoscopy, we were able to quickly diagnose tinea capitis. Following administration of the proper treatment the disease resolved completely.
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Affiliation(s)
- Ahmad Vafaeian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Elham Taghizadeh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
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Cho SI, Yu DA, Kim SI, Lee SM, Kwon O. Pregnancy Outcomes in Female Patients with Alopecia Areata: A Nationwide Population-Based Study. J Invest Dermatol 2021; 141:1844-1847.e4. [PMID: 33422620 DOI: 10.1016/j.jid.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Da-Ae Yu
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea.
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Yamamoto M, Yamamoto T. Discoid Lupus Erythematosus in a Patient With Alopecia Totalis. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2019.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Afford R, Leung AKC, Lam JM. Pediatric Alopecia Areata. Curr Pediatr Rev 2021; 17:45-54. [PMID: 32351186 DOI: 10.2174/1573396316666200430084825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. OBJECTIVE To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata. METHODS The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. RESULTS AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss, generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show "exclamation point hairs" and "yellow dots". Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA, including conservative treatment, and topical, oral, and injectable medications. CONCLUSION AA is an autoimmune disease with a heterogeneous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.
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Affiliation(s)
- Rebecca Afford
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Egeberg A, Anderson S, Edson-Heredia E, Burge R. Comorbidities of alopecia areata: a population-based cohort study. Clin Exp Dermatol 2020; 46:651-656. [PMID: 33175413 DOI: 10.1111/ced.14507] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have associated alopecia areata (AA) with a number of comorbidities. However, the timing between AA and the development of such comorbidities remains poorly understood. AIM To examine the temporal relationship between AA diagnosis and comorbidity development in Denmark. METHODS A Danish nationwide register-based cohort study was performed on all individuals diagnosed with AA between 2007 and 2016 (n = 1843), and each patient was matched for age and sex with 10 healthy controls (HCs). Time between AA and comorbidity development was assessed, and incidence rate ratios (IRRs) were calculated to assess risk of comorbidity following initial AA diagnosis. RESULTS Use of antidepressant and anxiolytic drugs were mostly started prior to AA diagnosis, and these drugs were used more frequently before than after diagnosis with AA. Additional frequent comorbidities included thyroid disease, hyperlipidaemia, type 2 diabetes and asthma. Most comorbidities occurred prior to AA diagnosis; however, among those that occurred after AA diagnosis, antidepressants (IRR = 1.26, 95% CI 1.01-1.56), anxiolytics (IRR = 1.55, 95% CI 1.17-2.05), atopic dermatitis (AD; IRR = 9.41, 95% CI 4.00-22.16), asthma (IRR = 2.17, 95% CI 1.46-3.21), vitiligo (IRR = 30.35, 95% CI 6.13-150.39), Crohn disease (CD; IRR = 3.04; 95% CI 1.22-7.56) and thyroid disease (IRR = 2.38; 95% CI 1.72-3.29) occurred more frequently among patients with AA compared with controls. CONCLUSION A diagnosis of AA was significantly associated with risk of several comorbidities, most notably vitiligo, AD and CD. Nonetheless, the majority of patients appeared to have developed these comorbidities prior to AA diagnosis, suggesting that a thorough medical history screening by dermatologists at the initial visit may be appropriate.
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Affiliation(s)
- A Egeberg
- Department of Dermatology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S Anderson
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - R Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,Division of Pharmaceutical Sciences, University of Cincinnati, Cincinnati, OH, USA
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Abstract
Alopecia areata is a condition that affects hair follicles and leads to hair loss ranging from small well-defined patches to complete loss of all body hair. Despite its high incidence, the pathobiology is not fully understood, and no single concept could be universally accepted. Alopecia areata is mostly considered to be an autoimmune disease, in which the collapse of hair follicle immune privilege plays a key role. Higher incidence rate in the female population and increased overall risk of other autoimmune disorders militate in favor of autoimmune hypothesis. Antibodies against multiple components of hair follicles almost exclusively attack in anagen phase, where melanogenesis takes place. It suggests involvement of melanogenesis-associated autoantigens as a target epitope. Some investigators believed that alopecia areata is not a truly autoimmune disease but is only ‘consistent with’ autoimmune mechanisms. High frequency of a positive family history up to 42% may reflects the contribution of heredity factors. In addition, no specific target autoantigen has been identified so far, and autoantibodies to hair follicle-associated antigens are detectable in normal individuals.
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48
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Marks DH, Senna MM. A Potential Role for IL-4 and IL-13 in an Alopecia Areata-Like Phenotype: A Clinical Perspective. J Investig Dermatol Symp Proc 2020; 20:S58-S59. [PMID: 33099387 DOI: 10.1016/j.jisp.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although alopecia areata (AA) has been traditionally classified as a strictly T helper type 1-mediated process, the T helper type 2 (Th2) pathway may contribute to an AA-like phenotype in some individuals. Herein, we describe three clinical cases that support the potential role of Th2 activity through the upregulation of IL-4 and IL-13 in an AA-like phenotype.
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Affiliation(s)
- Dustin H Marks
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.
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Wei Y, Tai Y, Dai Y, Chang Y, Chen T, Chen M. Bidirectional association between alopecia areata and atopic dermatitis: A population‐based cohort study in Taiwan. Clin Exp Allergy 2020; 50:1406-1414. [DOI: 10.1111/cea.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yu‐Hsun Wei
- Department of Dermatology Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang‐Ming University Taipei Taiwan
| | - Ying‐Hsuan Tai
- School of Medicine National Yang‐Ming University Taipei Taiwan
- Department of Anesthesiology Shuang Ho Hospital Taipei Medical University New Taipei City Taiwan
- Department of Anesthesiology School of Medicine College of Medicine Taipei Medical University Taipei Taiwan
| | - Ying‐Xiu Dai
- Department of Dermatology Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang‐Ming University Taipei Taiwan
| | - Yun‐Ting Chang
- Department of Dermatology Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang‐Ming University Taipei Taiwan
| | - Tzeng‐Ji Chen
- School of Medicine National Yang‐Ming University Taipei Taiwan
- Department of Family Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Mu‐Hong Chen
- School of Medicine National Yang‐Ming University Taipei Taiwan
- Department of Psychiatry Taipei Veterans General Hospital Taipei Taiwan
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50
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Yamamoto M, Yamamoto T. Discoid Lupus Erythematosus in a Patient With Alopecia Totalis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:77-79. [PMID: 32926840 DOI: 10.1016/j.ad.2019.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/28/2019] [Accepted: 02/03/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- M Yamamoto
- Departamento de Dermatología, Universidad Médica de Fukushima, Fukushima, Japón.
| | - T Yamamoto
- Departamento de Dermatología, Universidad Médica de Fukushima, Fukushima, Japón
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