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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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Singh R, Kumar P, Kumar D, Aggarwal N, Chopra H, Kumar V. Alopecia areata: review of epidemiology, pathophysiology, current treatments and nanoparticulate delivery system. Ther Deliv 2024; 15:193-210. [PMID: 38449420 DOI: 10.4155/tde-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Alopecia areata (AA) is a kind of alopecia that affects hair follicles and nails. It typically comes with round patches and is a type of nonscarring hair loss. Various therapies are accessible for the management and treatment of AA, including topical, systemic and injectable modalities. It is a very complex type of autoimmune disease and is identified as round patches of hair loss and may occur at any age. This review paper highlights the epidemiology, clinical features, pathogenesis and new treatment options for AA, with a specific emphasis on nanoparticulate drug-delivery systems. By exploring these innovative treatment approaches, researchers aim to enhance the effectiveness and targeted delivery of therapeutic agents, ultimately improving outcomes for individuals living with AA.
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Affiliation(s)
- Robel Singh
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Pawan Kumar
- Indian Pharmacopoeia Commision, Ministry of Health & Family Welfare, Govt. of India
| | - Davinder Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Navidha Aggarwal
- MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, 133207, India
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical & Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | - Virender Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
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Mateos-Haro M, Novoa-Candia M, Sánchez Vanegas G, Correa-Pérez A, Gaetano Gil A, Fernández-García S, Ortega-Quijano D, Urueña Rodriguez MG, Saceda-Corralo D, Bennouna-Dalero T, Giraldo L, Tomlinson J, Vaño-Galván S, Zamora J. Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev 2023; 10:CD013719. [PMID: 37870096 PMCID: PMC10591288 DOI: 10.1002/14651858.cd013719.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body. There are different treatments including immunosuppressants, hair growth stimulants, and contact immunotherapy. OBJECTIVES To assess the benefits and harms of the treatments for alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in children and adults. SEARCH METHODS The Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP were searched up to July 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated classical immunosuppressants, biologics, small molecule inhibitors, contact immunotherapy, hair growth stimulants, and other therapies in paediatric and adult populations with AA. DATA COLLECTION AND ANALYSIS We used the standard procedures expected by Cochrane including assessment of risks of bias using RoB2 and the certainty of the evidence using GRADE. The primary outcomes were short-term hair regrowth ≥ 75% (between 12 and 26 weeks of follow-up), and incidence of serious adverse events. The secondary outcomes were long-term hair regrowth ≥ 75% (greater than 26 weeks of follow-up) and health-related quality of life. We could not perform a network meta-analysis as very few trials compared the same treatments. We presented direct comparisons and made a narrative description of the findings. MAIN RESULTS We included 63 studies that tested 47 different treatments in 4817 randomised participants. All trials used a parallel-group design except one that used a cross-over design. The mean sample size was 78 participants. All trials recruited outpatients from dermatology clinics. Participants were between 2 and 74 years old. The trials included patients with AA (n = 25), AT (n = 1), AU (n = 1), mixed cases (n = 31), and unclear types of alopecia (n = 4). Thirty-three out of 63 studies (52.3%) reported the proportion of participants achieving short-term hair regrowth ≥ 75% (between 12 and 26 weeks). Forty-seven studies (74.6%) reported serious adverse events and only one study (1.5%) reported health-related quality of life. Five studies (7.9%) reported the proportion of participants with long-term hair regrowth ≥ 75% (greater than 26 weeks). Amongst the variety of interventions found, we prioritised some groups of interventions for their relevance to clinical practice: systemic therapies (classical immunosuppressants, biologics, and small molecule inhibitors), and local therapies (intralesional corticosteroids, topical small molecule inhibitors, contact immunotherapy, hair growth stimulants and cryotherapy). Considering only the prioritised interventions, 14 studies from 12 comparisons reported short-term hair regrowth ≥ 75% and 22 studies from 10 comparisons reported serious adverse events (18 reported zero events and 4 reported at least one). One study (1 comparison) reported quality of life, and two studies (1 comparison) reported long-term hair regrowth ≥ 75%. For the main outcome of short-term hair regrowth ≥ 75%, the evidence is very uncertain about the effect of oral prednisolone or cyclosporine versus placebo (RR 4.68, 95% CI 0.57 to 38.27; 79 participants; 2 studies; very low-certainty evidence), intralesional betamethasone or triamcinolone versus placebo (RR 13.84, 95% CI 0.87 to 219.76; 231 participants; 1 study; very low-certainty evidence), oral ruxolitinib versus oral tofacitinib (RR 1.08, 95% CI 0.77 to 1.52; 80 participants; 1 study; very low-certainty evidence), diphencyprone or squaric acid dibutil ester versus placebo (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very-low-certainty evidence), diphencyprone or squaric acid dibutyl ester versus topical minoxidil (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very low-certainty evidence), diphencyprone plus topical minoxidil versus diphencyprone (RR 0.67, 95% CI 0.13 to 3.44; 30 participants; 1 study; very low-certainty evidence), topical minoxidil 1% and 2% versus placebo (RR 2.31, 95% CI 1.34 to 3.96; 202 participants; 2 studies; very low-certainty evidence) and cryotherapy versus fractional CO2 laser (RR 0.31, 95% CI 0.11 to 0.86; 80 participants; 1 study; very low-certainty evidence). The evidence suggests oral betamethasone may increase short-term hair regrowth ≥ 75% compared to prednisolone or azathioprine (RR 1.67, 95% CI 0.96 to 2.88; 80 participants; 2 studies; low-certainty evidence). There may be little to no difference between subcutaneous dupilumab and placebo in short-term hair regrowth ≥ 75% (RR 3.59, 95% CI 0.19 to 66.22; 60 participants; 1 study; low-certainty evidence) as well as between topical ruxolitinib and placebo (RR 5.00, 95% CI 0.25 to 100.89; 78 participants; 1 study; low-certainty evidence). However, baricitinib results in an increase in short-term hair regrowth ≥ 75% when compared to placebo (RR 7.54, 95% CI 3.90 to 14.58; 1200 participants; 2 studies; high-certainty evidence). For the incidence of serious adverse events, the evidence is very uncertain about the effect of topical ruxolitinib versus placebo (RR 0.33, 95% CI 0.01 to 7.94; 78 participants; 1 study; very low-certainty evidence). Baricitinib and apremilast may result in little to no difference in the incidence of serious adverse events versus placebo (RR 1.47, 95% CI 0.60 to 3.60; 1224 participants; 3 studies; low-certainty evidence). The same result is observed for subcutaneous dupilumab compared to placebo (RR 1.54, 95% CI 0.07 to 36.11; 60 participants; 1 study; low-certainty evidence). For health-related quality of life, the evidence is very uncertain about the effect of oral cyclosporine compared to placebo (MD 0.01, 95% CI -0.04 to 0.07; very low-certainty evidence). Baricitinib results in an increase in long-term hair regrowth ≥ 75% compared to placebo (RR 8.49, 95% CI 4.70 to 15.34; 1200 participants; 2 studies; high-certainty evidence). Regarding the risk of bias, the most relevant issues were the lack of details about randomisation and allocation concealment, the limited efforts to keep patients and assessors unaware of the assigned intervention, and losses to follow-up. AUTHORS' CONCLUSIONS We found that treatment with baricitinib results in an increase in short- and long-term hair regrowth compared to placebo. Although we found inconclusive results for the risk of serious adverse effects with baricitinib, the reported small incidence of serious adverse events in the baricitinib arm should be balanced with the expected benefits. We also found that the impact of other treatments on hair regrowth is very uncertain. Evidence for health-related quality of life is still scant.
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Affiliation(s)
- Miriam Mateos-Haro
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Doctoral programme in Clinical Medicine and Public Health, Universidad de Granada, Granada, Spain
| | - Monica Novoa-Candia
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Andrea Correa-Pérez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Andrea Gaetano Gil
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Tayeb Bennouna-Dalero
- Preventive Medicine and Public Health Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Giraldo
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Sergio Vaño-Galván
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Zamora
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
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Al‐Dhubaibi MS, Alsenaid A, Alhetheli G, Abd Elneam AI. Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis. Skin Res Technol 2023; 29:e13378. [PMID: 37357664 PMCID: PMC10236002 DOI: 10.1111/srt.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations. OBJECTIVE Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns. METHODS Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed. RESULTS Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. CONCLUSION There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.
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Affiliation(s)
| | - Adel Alsenaid
- Department of DermatologyCollege of Medicine, Shaqra UniversityDawadmiSaudi Arabia
- Division of DermatologyJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
| | - Ghadah Alhetheli
- Division of Dermatology and Cutaneous SurgeryCollege of Medicine, Qassim UniversityBuraydahSaudi Arabia
| | - Ahmed Ibrahim Abd Elneam
- Department of Clinical Biochemistry, Department of Basic Medical SciencesCollege of Medicine, Shaqra UniversityDawadmiSaudi Arabia
- Molecular Genetics and Enzymology DepartmentHuman Genetics and Genome Research Institute, National Research CenterDokkiCairoEgypt
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Ali MS, Hafiz HSA, Ahmed NA, Galal SA. Combined microneedling with topical vitamin D3 or bimatoprost versus microneedling alone in the treatment of alopecia areata: A comparative randomized trial. J Cosmet Dermatol 2023; 22:1286-1296. [PMID: 36762396 DOI: 10.1111/jocd.15569] [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: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Alopecia areata (AA) is a challenging disease with variable treatment outcomes. Hair follicles express vitamin D receptors. Therefore, vitamin D3 may be promising for AA treatment through immunomodulatory mechanisms. The efficacy of bimatoprost in scalp AA treatment was reported by few studies. OBJECTIVE To evaluate the efficacy and safety of microneedling (MN) with topical vitamin D3 versus MN with bimatoprost in comparison with MN alone in the treatment of localized AA. PATIENTS AND METHODS Seventy-five patients with localized AA were divided into three groups. The first group: 25 patients were treated with MN alone. The second group: 25 patients treated with MN combined with topical vitamin D3. The third group: 25 patients treated with MN combined with bimatoprost solution. The response was evaluated clinically and dermoscopically. RESULTS At the end of the study, all groups showed a statistically significant decrease in the SALT score compared to the baseline. The clinical response (regrowth scale): vitamin D and bimatoprost groups showed a statistically significant higher regrowth scale compared to MN alone group (p-value = 0.000). After treatment, hair regrowth was significantly higher in MN combined with bimatoprost than in MN combined with topical vitamin D3. However, after 3 months of follow-up, there was no statistically significant difference between both groups. Side effects were mild and transient in all groups. CONCLUSION Topical vitamin D3 and bimatoprost combined with MN are safe and effective therapeutic options for localized AA.
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Affiliation(s)
- Mona S Ali
- Faculty of Medicine (Girls), Al- Azhar University, Cairo, Egypt
| | - Hala S A Hafiz
- Faculty of Medicine (Girls), Al- Azhar University, Cairo, Egypt
| | - Naglaa A Ahmed
- Faculty of Medicine (Girls), Al- Azhar University, Cairo, Egypt
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El Mulla KF, Elmorsy EH, Halwag DI, Hassan EM. Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Micro-needling in Treatment of Alopecia Areata. Dermatol Pract Concept 2022; 12:e2022196. [PMID: 36534509 PMCID: PMC9681232 DOI: 10.5826/dpc.1204a196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Trans-epidermal drug delivery, using "laser-assisted drug delivery", or micro-needling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. OBJECTIVES To evaluate the use of fractional carbon dioxide laser versus micro-needling in trans-epidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. METHODS Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I: Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: micro-needling with Dermapen and triamcinolone acetonide. Group III: fractional carbon dioxide laser and platelet-rich plasma. Group IV: micro-needling with Dermapen and platelet-rich plasma. Patients were evaluated clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. RESULTS In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (P = 0.001) and last (P = 0.008) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit, results were in favor of Dermapen, compared to Carbon dioxide laser for trans-epidermal drug delivery (P = 0.023); and in favor of triamcinolone acetonide, compared to platelet-rich plasma as topical medication (P = 0.015). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (P < 0.001). CONCLUSIONS Micro-needling and fractional carbon dioxide laser are effective tools for trans-epidermal drug delivery for Alopecia areata treatment. Micro-needling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy is highly beneficial in evaluating treatment response in alopecia areata.
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Affiliation(s)
- Khaled Fawzy El Mulla
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Hamed Elmorsy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Dalia Ibrahim Halwag
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Mohamed Hassan
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
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Pinto D, Calabrese FM, De Angelis M, Celano G, Giuliani G, Rinaldi F. Lichen Planopilaris: The first biopsy layer microbiota inspection. PLoS One 2022; 17:e0269933. [PMID: 35849580 PMCID: PMC9292073 DOI: 10.1371/journal.pone.0269933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Lichen Planopilaris (LPP) is a lymphatic disease affecting the scalp that is characterized by a chronic and destructive inflammation process, named as ‘cicatricial alopecia’ in which the hair follicles are targeted and may involve predominantly lymphocytes or neutrophils. Scalp and biopsy layers have never been used to investigate microbial community composition and its relative taxa abundances in LPP. We sought to examine the significant taxa of this chronic relapsing inflammatory skin disease, together with inspect the existing connections with metabolic pathways featuring this microbial community. We used a multilevel analysis based on 16S rRNA marker sequencing in order to detect OTU abundances in pathologic/healthy samples, real time PCR for measuring the levels of IL-23 interleukin expression and urinary metabolomics to find out volatile organic metabolites (VOMs). By using a linear regression model, we described peculiar taxa that significantly differentiated LPP and healthy samples. We inspected taxa abundances and interleukin mRNA levels and the Microbacteriaceae family resulted negatively correlated with the IL-23 expression. Moreover, starting from 16S taxa abundances, we predicted the metabolic pathways featuring this microbial community. By inspecting microbial composition, sample richness, metabolomics profiles and the relative metabolic pathways in a cohort of LPP and healthy samples we deepened the contribution of significant taxa that are connected to inflammation maintenance and microbiota plasticity in LPP pathology.
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Affiliation(s)
- Daniela Pinto
- Human Advanced Microbiome Project-HMAP, Milan, Italy
- * E-mail: (DP); (FMC)
| | - Francesco Maria Calabrese
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
- * E-mail: (DP); (FMC)
| | - Maria De Angelis
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
| | - Giuseppe Celano
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
| | | | - Fabio Rinaldi
- Human Advanced Microbiome Project-HMAP, Milan, Italy
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Harries M, Macbeth A, Holmes S, Chiu W, Gallardo W, Nijher M, de Lusignan S, Tziotzios C, Messenger A. The epidemiology of alopecia areata: a population-based cohort study in UK primary care. Br J Dermatol 2022; 186:257-265. [PMID: 34227101 PMCID: PMC9298423 DOI: 10.1111/bjd.20628] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of population-based information on the disease burden and management of alopecia areata (AA). OBJECTIVES To describe the epidemiology of AA, focusing on incidence, demographics and patterns of healthcare utilization. METHODS Population-based cohort study of 4·16 million adults and children, using UK electronic primary care records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, 2009-2018. The incidence and point prevalence of AA were estimated. Variation in AA incidence by age, sex, deprivation, geographical distribution and ethnicity was examined. Patterns of healthcare utilization were evaluated in people with incident AA. RESULTS The AA incidence rate was 0·26 per 1000 person-years. AA point prevalence in 2018 was 0·58% in adults. AA onset peaked at age 25-29 years for both sexes, although the peak was broader in females. People of nonwhite ethnicity were more likely to present with AA, especially those of Asian ethnicity [incidence rate ratio (IRR) 3·32 (95% confidence interval 3·11-3·55)]. Higher AA incidence was associated with social deprivation [IRR most vs. least deprived quintile 1·47 (1·37-1·59)] and urban living [IRR 1·23 (1·14-1·32)]. People of higher social deprivation were less likely to be referred for specialist dermatology review. CONCLUSIONS By providing the first large-scale estimates of the incidence and point prevalence of AA, our study helps to understand the burden of AA on the population. Understanding the variation in AA onset between different population groups may give insight into the pathogenesis of AA and its management.
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Affiliation(s)
- M. Harries
- The Dermatology CentreSalford Royal NHS Foundation Trust, Salford, Greater Manchester, M6 8HD UK; Centre for Dermatology ResearchUniversity of ManchesterMAHSC and NIHR Manchester Biomedical Research CentreManchesterM13 9PLUK
| | - A.E. Macbeth
- Department of DermatologyNorfolk & Norwich University Hospitals NHS Foundation TrustNorwichNR4 7UYUK
| | - S. Holmes
- Alan Lyell Centre for DermatologyQueen Elizabeth University HospitalGlasgowG51 4TFUK
| | - W.S. Chiu
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - W.R. Gallardo
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - M. Nijher
- Pfizer LtdWalton Oaks, Walton on the HillTadworthSurreyKT20 7NSUK
| | - S. de Lusignan
- Department of Primary Care Health SciencesUniversity of Oxford, OX2 6GG, UK; Oxford‐Royal College of General Practitioners, Research and Surveillance CentreLondonNW1 2FBUK
| | - C. Tziotzios
- St John’s Institute of DermatologyGuy’s and St Thomas’ Hospitals & King’s College LondonLondonSE1 9RTUK
| | - A.G. Messenger
- Department of DermatologyRoyal Hallamshire HospitalSheffieldS10 2JFUK
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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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10
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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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GAP analysis of pharmacy curriculum regarding topical corticosteroid use and safety. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol 2021; 49:19-36. [PMID: 34709679 DOI: 10.1111/1346-8138.16207] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
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Affiliation(s)
- Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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Development of the alopecia areata scale for clinical use: Results of an academic-industry collaborative effort. J Am Acad Dermatol 2021; 86:359-364. [PMID: 34474079 DOI: 10.1016/j.jaad.2021.08.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current classification for alopecia areata (AA) does not provide a consistent assessment of disease severity. OBJECTIVE To develop an AA severity scale based on expert experience. METHODS A modified Delphi process was utilized. An advisory group of 22 AA clinical experts from the United States was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development. RESULTS Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing to adopt the proposed scale. LIMITATIONS The scale is a static assessment intended to be used in clinical practice and not clinical trials. CONCLUSION The final AA disease severity scale, anchored in the extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.
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Aboeldahab S, Nada EEDAA, Assaf HAE, Gouda ZAE, Abu El-Hamd M. Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial. Dermatol Ther 2021; 34:e15044. [PMID: 34176196 DOI: 10.1111/dth.15044] [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: 03/08/2021] [Accepted: 06/24/2021] [Indexed: 01/02/2023]
Abstract
To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze-thaw cycles of 5 s each. Group (2) was treated by microneedling. Both groups were treated every 2 weeks for 6 sessions and followed up for 3 months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.
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Affiliation(s)
- Soha Aboeldahab
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Hanan Abd-Elrady Assaf
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Zeinab Abu-Elbaha Gouda
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Hamdino M, El-Barbary RA, Darwish HM. Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial. J Cosmet Dermatol 2021; 21:707-715. [PMID: 33749975 DOI: 10.1111/jocd.14090] [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: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern. AIMS Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. PATIENTS/METHODS 40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed. RESULTS At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p-value = 0.028). But, after 3-month follow-up, regrowth scale was higher in MTX group compared to TrA group (p-value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3-month follow-up in both groups. Local adverse events in both groups were transient and disappeared during the follow-up period. CONCLUSION Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA-specific trichoscopic signs and also early detection of adverse effects.
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Affiliation(s)
- Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Rasha Aly El-Barbary
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Hanan Mohammed Darwish
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Fukumoto T, Fukumoto R, Magno E, Oka M, Nishigori C, Horita N. Treatments for alopecia areata: A systematic review and network meta-analysis. Dermatol Ther 2021; 34:e14916. [PMID: 33631058 DOI: 10.1111/dth.14916] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 02/02/2023]
Abstract
Existing guidelines form no consensus for alopecia areata (AA) treatment due to the absence of a universal standard treatment and arbitrary selection of reference arms in randomized control trials (RCTs). The aim is to identify the best treatment and to rank treatments using systematic review and network meta-analysis. Data were extracted by the two investigators independently. Odds ratio (OR) of treatment success rate was pooled using the frequentist weighted least squares approach to random-model network meta-analysis. RCTs providing data of treatment success rate from PubMed, EMBASE, Web of Science, and manual search were included. About 54 RCTs consisting of 49 treatments and 3149 patients were included. Pentoxifylline plus topical corticosteroids had the highest treatment success rate compared with "no treatment," followed by pentoxifylline alone, topical calcipotriol plus narrowband ultraviolet radiation B phototherapy, topical calcipotriol, intralesional corticosteroids, systemic corticosteroids, minoxidil plus topical corticosteroids, topical bimatoprost, psoralen ultraviolet radiation A phototherapy, and tofacitinib. Even with the network meta-analysis, the best treatment because of independent loops and wide confidence intervals could not be identified. Treatment options above may be reasonable strategies, but further comparison is required.
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Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.,Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Rie Fukumoto
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Elizabeth Magno
- Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Masahiro Oka
- Department of Dermatology, Kita-Harima Medical Center, Ono, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Horita
- National Human Genome Research Institutes, National Institutes of Health, Bethesda, Maryland, USA
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Bhat S, Handa S, De D. A randomized comparative study of the efficacy of topical latanoprost versus topical betamethasone diproprionate lotion in the treatment of localized alopecia areata. Indian J Dermatol Venereol Leprol 2021; 87:42-48. [PMID: 33580923 DOI: 10.25259/ijdvl_787_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 04/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Topical corticosteroids are the standard therapy for the treatment of alopecia areata. Recently, topical latanoprost has been found effective in the treatment of eyelash alopecia areata. OBJECTIVES The objective of this study was to compare the efficacy of topical latanoprost ophthalmic solution (group 1) with that of topical betamethasone diproprionate lotion (group 2) in the treatment of localized alopecia areata. METHODS This was a single-centre, randomized, two-armed, parallel-group efficacy trial. Fifty consecutive patients with localized alopecia areata were randomized in a 1:1 ratio to receive either topical latanoprost 0.005% ophthalmic solution or topical betamethasone diproprionate 0.05% lotion. Of these 50 patients, 44 patients (21 in group 1 and 23 in group 2) completed the treatment protocol. RESULTS The percentage reduction in area involved with alopecia areata at 16 weeks (primary outcome) was lower in latanoprost vs. betamethasone group (median [interquartile range], 11.1 [0-99.1] vs. 100% [13.6-100], P = 0.02). Significantly lesser patients in the latanoprost group had a complete response to treatment as compared to the betamethasone group (6 [24%] vs. 14 [56%], P = 0.02). The median (interquartile range) hair regrowth score was significantly lower in the latanoprost vs. the betamethasone group (1 [0-4.5] vs. 5 [1-5], P = 0.02). Subjects in the betamethasone group showed a more rapid reduction in the involved area. LIMITATIONS Short duration of treatment and follow-up were limitations of this study. CONCLUSION Our results suggest that topical latanoprost 0.005% ophthalmic solution is less effective but safer than topical betamethasone dipropionate 0.05% lotion in the treatment of localized alopecia areata (clinicaltrials.gov: NCT02350023).
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Affiliation(s)
- Sonali Bhat
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ali S, Ibrahim AM, El Sayed N. Candida antigen immunotherapy versus steroid in the treatment of alopecia areata. Dermatol Ther 2021; 34:e14802. [PMID: 33496068 DOI: 10.1111/dth.14802] [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: 09/29/2020] [Revised: 12/09/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Alopecia areata (AA) is an autoimmune hair follicle disorder that is challenging to treat. Although there are multiple topical immunotherapeutic agents, their side effects limit their use. Candida antigen can serve as another immunotherapeutic treatment, with an easier application and fewer side effects. To evaluate the efficacy of Candida antigen versus intralesional steroids for the treatment of AA. About 48 adult patients with AA were divided into two groups. The Candida group included 24 patients who were injected monthly with 0.1 mL of Candida albicans antigen in one patch of alopecia, and the intralesional corticosteroid group included 24 patients who were injected monthly with 0.1 mL of triamcinolone acetonide, as a control group, in all alopecia patches. After 5 months, there was a highly significant decrease in the severity of AA in both groups with no significant difference between them. In the Candida group, 8 patients showed complete hair regrowth and 9 patients showed partial regrowth. Side effects were mild and transient such as pain during injection, which was significantly lower in the Candida group than in the corticosteroid group. Intralesional Candida antigen is a promising effective treatment for AA with differing severities.
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Affiliation(s)
- Samia Ali
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alshimaa M Ibrahim
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Noura El Sayed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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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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Suchonwanit P, Kositkuljorn C, Mahasaksiri T, Leerunyakul K. A comparison of the efficacy and tolerability of three corticosteroid treatment regimens in patients with alopecia areata. J DERMATOL TREAT 2020; 33:756-761. [DOI: 10.1080/09546634.2020.1773384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Poonkiat Suchonwanit
- Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tippapai Mahasaksiri
- Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchana Leerunyakul
- Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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21
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Effect of physical stimuli on hair follicle deposition of clobetasol-loaded Lipid Nanocarriers. Sci Rep 2020; 10:176. [PMID: 31932640 PMCID: PMC6957495 DOI: 10.1038/s41598-019-56760-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/10/2019] [Indexed: 12/20/2022] Open
Abstract
Clobetasol propionate (CLO) is a potent glucocorticoid used to treat inflammation-based skin, scalp, and hair disorders. In such conditions, hair follicles (HF) are not only the target site but can also act as drug reservoirs when certain formulations are topically applied. Recently, we have demonstrated nanostructured lipid carriers (NLC) containing CLO presenting epidermal-targeting potential. Here, the focus was evaluating the HF uptake provided by such nanoparticles in comparison to a commercial cream and investigating the influence of different physical stimuli [i.e., infrared (IR) irradiation (with and without metallic nanoparticles-MNP), ultrasound (US) (with and without vibration) and mechanical massage] on their follicular targeting potential. Nanosystems presented sizes around 180 nm (PdI < 0.2) and negative zeta potential. The formulation did not alter skin water loss measurements and was stable for at least 30 days at 5 °C. Nanoparticles released the drug in a sustained fashion for more than 3 days and increased passively about 40 times CLO follicular uptake compared to the commercial cream. Confocal images confirmed the enhanced follicular delivery. On the one hand, NLC application followed by IR for heat generation showed no benefit in terms of HF targeting even at higher temperatures generated by metallic nanoparticle heating. On the other hand, upon US treatment, CLO retention was significantly increased in deeper skin layers. The addition of mechanical vibration to the US treatment led to higher follicular accumulation compared to passive exposure to NLC without stimuli. However, from all evaluated stimuli, manual massage presented the highest follicular targeting potential, driving more than double the amount of CLO into the HF than NLC passive application. In conclusion, NLC showed great potential for delivering CLO to HF, and a simple massage was capable of doubling follicular retention.
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22
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The clinical efficacy and safety of oral compound glycyrrhizin in adult patients with mild-to-moderate active alopecia areata: A randomized controlled study. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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23
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Albalat W, Ebrahim HM. Evaluation of platelet-rich plasma vs intralesional steroid in treatment of alopecia areata. J Cosmet Dermatol 2019; 18:1456-1462. [PMID: 31074201 DOI: 10.1111/jocd.12858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 10/29/2018] [Accepted: 12/03/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Alopecia areata (AA) is nonscarring patchy area of hair loss. Platelets rich plasma (PRP) promotes development of new hair follicles. Dermoscopy is a diagnostic tool that helps in evaluation of skin microstructures which are not visible to naked eye. AIM To evaluate safety and efficacy of (PRP) vs intralesional corticosteroid (ILCs) in treatment of AA. PATIENTS AND METHODS This study was conducted on 80 patients of both sexes who had AA. Patients were classified into Group I treated by ILCs and group II treated by (PRP). Results were assessed by dermoscopic evaluation and by hair re-growth score (RGS) at (baseline), 2, 4, 6, 8, and 12 weeks. Patients were followed up for 6 months. RESULTS There was greater hair re-growth after treatment in both groups. In group I, (26) patients (65%) showed improvement >70% compared to 29 patients (72.5%) in group II. There was significant re-growth of pigmented hair and decrease in dystrophic hair (P < 0.001) by dermoscopic evaluation in both groups. The difference between both groups was insignificant (P = 0.57). At follow-up, two (5%) patients in group II had relapse compared to 10 (25%) patients in group I. CONCLUSION Platelets rich plasma is safe and promising therapeutic option in AA.
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Affiliation(s)
- Waleed Albalat
- Faculty of Medicine, Department of Dermatology, Venereology and Andrology, Zagazig University, Zagazig, Egypt
| | - Howyda M Ebrahim
- Faculty of Medicine, Department of Dermatology, Venereology and Andrology, Zagazig University, Zagazig, Egypt
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Rossi A, Muscianese M, Piraccini BM, Starace M, Carlesimo M, Mandel VD, Alessandrini A, Calvieri S, Caro G, D'arino A, Federico A, Magri F, Pigliacelli F, Amendolagine G, Annunziata MC, Arisi MC, Astorino S, Babino G, Bardazzi F, Barruscotti S, Belloni Fortina A, Borghi A, Bruni F, Caccavale S, Calzavara-Pinton P, Cameli N, Cardone M, Carugno A, Coppola R, Dattola A, De Felici Del Giudice MB, Di Cesare A, Dika E, Di Nunno D, D'ovidio R, Fabbrocini G, Feliciani C, Fulgione E, Galluzzo M, Garcovich S, Garelli V, Guerriero C, Hansel K, La Placa M, Lacarrubba F, Lora V, Marinello E, Megna M, Micali G, Misciali C, Monari P, Monfrecola G, Neri I, Offidani A, Orlando G, Papini M, Patrizi A, Piaserico S, Rivetti N, Simonetti O, Stan TR, Stingeni L, Talamonti M, Tassone F, Villa L, Vincenzi C, Fortuna MC. Italian Guidelines in diagnosis and treatment of alopecia areata. GIORN ITAL DERMAT V 2019; 154:609-623. [PMID: 31578836 DOI: 10.23736/s0392-0488.19.06458-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.
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Affiliation(s)
- Alfredo Rossi
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy -
| | - Marta Muscianese
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Bianca M Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marta Carlesimo
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Victor D Mandel
- Unit of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Calvieri
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Gemma Caro
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Andrea D'arino
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Alessandro Federico
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Francesca Magri
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Flavia Pigliacelli
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Graziana Amendolagine
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria C Annunziata
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria C Arisi
- Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Stefano Astorino
- Unit of Dermatology and Venereology, Celio Military Hospital, Rome, Italy
| | - Graziella Babino
- Unit of Dermatology, Nuovo Policlinico, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefania Barruscotti
- Unit of Dermatology, S. Matteo University Polyclinic, IRCCS and Foundation, Pavia, Italy
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Bruni
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Caccavale
- Unit of Dermatology, Nuovo Policlinico, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Norma Cameli
- San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Michele Cardone
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Andrea Carugno
- Unit of Dermatology, S. Matteo University Polyclinic, IRCCS and Foundation, Pavia, Italy
| | - Rosa Coppola
- Campus Bio-Medico University (Hospital), Rome, Italy
| | - Annunziata Dattola
- Department of Dermatology, Tor Vergata Polyclinic and University, Rome, Italy
| | | | - Antonella Di Cesare
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Emi Dika
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Donato Di Nunno
- Unit of Dermatology and Venereology, Celio Military Hospital, Rome, Italy
| | | | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Elisabetta Fulgione
- Unit of Dermatology, Nuovo Policlinico, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco Galluzzo
- Department of Dermatology, Tor Vergata Polyclinic and University, Rome, Italy
| | - Simone Garcovich
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Carholic University, Rome, Italy
| | - Valentina Garelli
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Cristina Guerriero
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Carholic University, Rome, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Michelangelo La Placa
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Viviana Lora
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Carholic University, Rome, Italy
| | - Elena Marinello
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Micali
- Department of Dermatology, University of Catania, Catania, Italy
| | - Cosimo Misciali
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paola Monari
- Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Gloria Orlando
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Manuela Papini
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Niccolò Rivetti
- Unit of Dermatology, S. Matteo University Polyclinic, IRCCS and Foundation, Pavia, Italy
| | - Oriana Simonetti
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Teodora R Stan
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marina Talamonti
- Department of Dermatology, Tor Vergata Polyclinic and University, Rome, Italy
| | - Francesco Tassone
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Carholic University, Rome, Italy
| | | | - Colombina Vincenzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Maria C Fortuna
- Division of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
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Lee H, Choe SJ, Lee W. Method for describing patterns and distributions of alopecia areata which may be helpful for patient characterization and predicting prognosis. J Dermatol 2019; 46:739-740. [DOI: 10.1111/1346-8138.14989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hanil Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Won‐Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
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Dabek RJ, Roh DS, Ozdemir D, Austen WG, Bojovic B. Fractional Laser-assisted Hair Regrowth and Microneedling for the Treatment of Alopecia Areata: A Review. Cureus 2019; 11:e4943. [PMID: 31453018 PMCID: PMC6701901 DOI: 10.7759/cureus.4943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Alopecia areata (AA) affects approximately 2.1% of the population, with women being affected more often than men. Current therapies consisting of topical corticosteroids or intralesional injections are often the first choices for treatment, but are limited by unsatisfactory outcomes or risks to patients. Recently, fractional lasers and microneedling, with or without the addition of topical agents, have been examined as treatment options. A literature review was performed to evaluate the efficacy of fractional lasers in the treatment of AA. A total of six fractional lasers and two microneedling studies consisting of small prospective and retrospective studies, and case reports were reviewed. The number of trials and participants are limited, but evidence suggests that fractional lasers and microneedling may be effective therapeutic approaches when coupled with topical agents. Larger studies are required to better understand the effects of these treatment modalities for AA.
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Affiliation(s)
- Robert J Dabek
- Plastic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Daniel S Roh
- Plastic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Derman Ozdemir
- Internal Medicine, Saba University School of Medicine, The Bottom, Caribbean Netherlands, NLD
| | - William G Austen
- Plastic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Branko Bojovic
- Plastic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Rinaldi F, Marzani B, Pinto D, Sorbellini E. Randomized controlled trial on a PRP-like cosmetic, biomimetic peptides based, for the treatment of alopecia areata. J DERMATOL TREAT 2018; 30:588-593. [PMID: 30513014 DOI: 10.1080/09546634.2018.1544405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Alopecia areata (AA) is a non-scarring auto-immune hair disorder. Recent researches explained the role of growth factors (GFs) in hair follicle cycling. The main reservoir of GFs are alpha-granules of platelets and novel procedures have been implemented aimed at collecting platelet-rich plasma (PRP). PRP has been safely implemented in many medical applications and has also been successfully used as alternative cell-based therapy for the treatment of hair growth disorders, among which also AA. Objectives: By means of a randomized double-blinded, placebo and active-controlled, parallel group study we have studied the efficacy of a cosmetic product (named TR-M-PRP plus) comprising biomimetic peptides specific for hair growth, mimicking PRP composition for the treatment of AA. Subjects were treated for three months and evaluated, at the end of the study and after one month of follow-up, as regards hair growth using SALT score. Results: TR-M-PRP plus-like topic produced a statistically significant (p < .001) clinical improvement in SALT score after 3 months of therapy, compared to baseline. Hair growth results further improved after 1 month of follow-up. Conclusions: This clinical investigation suggests that the biotechnological designed PRP-like cosmetic could represent a valid and safer alternative to autologous PRP for the treatment of AA.
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Affiliation(s)
- Fabio Rinaldi
- a International Hair Research Foundation , Milan , Italy
| | | | - Daniela Pinto
- a International Hair Research Foundation , Milan , Italy
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28
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Wu SZ, Wang S, Ratnaparkhi R, Bergfeld WF. Treatment of pediatric alopecia areata with anthralin: A retrospective study of 37 patients. Pediatr Dermatol 2018; 35:817-820. [PMID: 30338548 DOI: 10.1111/pde.13703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Data on treatment options in pediatric alopecia areata are limited. Topical anthralin has been demonstrated to be an effective treatment option in adults and has minimal systemic toxicity. Prior results on its efficacy in children with alopecia areata have been mixed. METHODS Medical records of 37 patients with alopecia areata who were started on topical anthralin before age 17 were reviewed for efficacy and safety data. Scalp regrowth was quantified by serial photography if available or by medical record documentation if photographs were unavailable. Mean duration of clinical follow-up was 2.5 years. RESULTS Most patients were started on anthralin while continued on prior therapies, including topical corticosteroids, minoxidil, and/or intralesional corticosteroids. Twelve patients (32%) experienced complete scalp regrowth, while 25 patients (68%) experienced at least 50% maximal scalp regrowth with using anthralin. Of the patients with at least 50% scalp regrowth, mean time to first clinically observed response was 3.4 months. Mean time to maximal response was 15 months. Four patients stopped anthralin due to skin irritation. Relapses affected 64% of those with at least 50% maximal scalp regrowth. CONCLUSIONS Topical anthralin provides children with alopecia areata an additional option that offers potential for significant scalp regrowth with minimal systemic effects. Treatment course may need to be continued for at least 1 year in order to achieve maximal efficacy. The efficacy of anthralin may be limited by high rate of recurrence and local adverse effects.
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Affiliation(s)
- Sean Z Wu
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Sophie Wang
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Wilma F Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
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29
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Trüeb RM, Dias MFRG. Alopecia Areata: a Comprehensive Review of Pathogenesis and Management. Clin Rev Allergy Immunol 2018; 54:68-87. [PMID: 28717940 DOI: 10.1007/s12016-017-8620-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Alopecia areata is a common hair loss condition that is characterized by acute onset of non-scarring hair loss in usually sharply defined areas ranging from small patches to extensive or less frequently diffuse involvement. Depending on its acuity and extent, hair loss is an important cause of anxiety and disability. The current understanding is that the condition represents an organ-specific autoimmune disease of the hair follicle with a genetic background. Genome-wide association studies provide evidence for the involvement of both innate and acquired immunity in the pathogenesis, and mechanistic studies in mouse models of alopecia areata have specifically implicated an IFN-γ-driven immune response, including IFNγ, IFNγ-induced chemokines and cytotoxic CD8 T cells as the main drivers of disease pathogenesis. A meta-analysis of published trials on treatment of alopecia areata states that only few treatments have been well evaluated in randomized trials. Nevertheless, depending on patient age, affected surface area and disease duration, an empiric treatment algorithm can be designed with corticosteroids and topical immunotherapy remaining the mainstay of therapy. The obviously limited success of evidence-based therapies points to a more important complexity of hair loss. At the same time, the complexity of pathogenesis offers opportunities for the development of novel targeted therapies. New treatment opportunities based on the results of genome-wide association studies that implicate T cell and natural killer cell activation pathways are paving the way to new approaches in future clinical trials. Currently, there are ongoing studies with the CTLA4-Ig fusion protein abatacept, anti-IL15Rβ monoclonal antibodies and the Janus kinase inhibitors tofacitinib, ruxolitinib and baricitinib. Ultimately, the options available for adapting to the disease rather than treating it in an effort to cure may also be taken into consideration in selected cases of long-standing or recurrent small spot disease.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland.
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Universidade Federal Fluminense, Centro de Ciências Médicas, Hospital Universitário Antonio Pedro, Niterói, Rio de Janeiro, Brazil
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Yun D, Silverberg NB, Stein SL. Alopecia areata treated with hydroxychloroquine: A retrospective study of nine pediatric cases. Pediatr Dermatol 2018; 35:361-365. [PMID: 29575039 DOI: 10.1111/pde.13451] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Alopecia areata is a common hair loss condition that is often emotionally devastating for patients. There is a paucity of effective treatments available. Hydroxychloroquine has been reported as variably effective in inducing significant hair regrowth in adults with alopecia areata. The objective of this retrospective study was to assess the benefit and tolerability of hydroxychloroquine in pediatric alopecia areata. METHODS We conducted a retrospective review of nine children with a history of alopecia areata treated with hydroxychloroquine. Clinical data were obtained from patients treated at two tertiary care centers in the United States between July 1, 2013, and July 1, 2015. RESULTS Alopecia scores of five patients improved by 6 months of treatment. Four patients experienced no improvement from baseline evaluation. The most common side effect associated with treatment was gastrointestinal intolerance and headache. CONCLUSION This retrospective series suggests that hydroxychloroquine can be considered as a treatment option for alopecia areata in children.
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Affiliation(s)
- Duri Yun
- Division of Dermatology, University of Chicago Medicine, Chicago, IL, USA
| | - Nanette B Silverberg
- Mt Sinai St. Luke's-Roosevelt Hospital Center, Mt Sinai Beth Israel Medical Center, New York, NY, USA
| | - Sarah L Stein
- Division of Dermatology, University of Chicago Medicine, Chicago, IL, USA
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Affiliation(s)
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology - Miller School of Medicine, University of Miami, Miami, FL, USA
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Alopecia areata. J Am Acad Dermatol 2018; 78:15-24. [DOI: 10.1016/j.jaad.2017.04.1142] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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Wang ECE, Dai Z, Christiano AM. Novel therapies for alopecia areata: The era of rational drug development. J Allergy Clin Immunol 2017; 141:499-504. [PMID: 29155099 DOI: 10.1016/j.jaci.2017.10.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 12/19/2022]
Abstract
Treatments for alopecia areata (AA) have evolved over the decades from broad and nonspecific therapies to those that are now more targeted and rationally selected. This was achieved by means of close cooperation and communication between clinicians and basic scientists, which resulted in the elucidation and understanding of the unique pathophysiology of AA. In this review we discuss this evolution and how novel therapies for AA have changed over the decades, what we have in our current arsenal of drugs for this potentially devastating disease, and what the future holds.
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Affiliation(s)
- Etienne C E Wang
- Department of Dermatology, Columbia University, New York, NY; National Skin Center, Singapore
| | - Zhenpeng Dai
- Department of Dermatology, Columbia University, New York, NY
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Unal M. Use of adapalene in alopecia areata: Efficacy and safety of mometasone furoate 0.1% cream versus combination of mometasone furoate 0.1% cream and adapalene 0.1% gel in alopecia areata. Dermatol Ther 2017; 31. [PMID: 29193637 DOI: 10.1111/dth.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 12/01/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease characterized by non-cicatricial hair loss. No definitive therapy currently exists for AA. To compared the efficacy and safety of the mometasone furoate 0.1% cream alone with the mometasone furoate 0.1% cream plus adapalene 0.1% gel in treatment of AA. Twenty patients with AA and with mean age of 27.4 ± 9.2 years were enrolled. Patches with a diameter of < 5 cm were treated with mometasone furate 0.1% cream (M), and patches with a diameter of ≥5 cm were treated with mometasone furate 0.1% cream plus adapalene 0.1% gel (M + D) for a period of 12 weeks. Hair regrowth was evaluated using a Re-growth score (RGS). Mean RGSs of M + D group were higher than M group for 4th week (2.60 vs. 1.45); 8th week (3.85 vs. 2.40) and 12th week (4.40 vs. 3.30). Mean percentages of hair re-growth in M + D group were statistically higher than M group for 4th (50.2% vs. 23.5%), 8th (78.5% vs. 50.7%), and 12th week (90.5% vs. 71%). Study revealed the efficacy and safety of adapalene and mometasone furoate combination in AA. Adapalene can be used as a new therapeutic modality in AA.
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Affiliation(s)
- Mehmet Unal
- Faculty of Medicine, Department of Dermatology, Selcuk University, Konya, Turkey
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Langasco R, Tanrıverdi ST, Özer Ö, Roldo M, Cossu M, Rassu G, Giunchedi P, Gavini E. Prolonged skin retention of clobetasol propionate by bio-based microemulsions: a potential tool for scalp psoriasis treatment. Drug Dev Ind Pharm 2017; 44:398-406. [PMID: 29098874 DOI: 10.1080/03639045.2017.1395458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Novel effective and cosmetically acceptable formulations are needed for the treatment of scalp psoriasis, due to the poor efficacy of the current products. The challenge in developing safe, efficient, and convenient delivery systems for this drug was addressed in the present work by formulating clobetasol propionate-loaded W/O microemulsions (MEs). Pseudo-ternary phase diagrams were constructed by using a combination of biocompatible and biodegradable excipients. Characterization studies demonstrated that selected MEs had suitable technological features such as being Newtonian fluids, possessing low viscosity, and high thermodynamic stability. Photomicrographs showed a significant alteration of the skin structure after treatment with MEs, and a preferential concentration of these in the stratum corneum and epidermis. These data, together with ex vivo permeation results, suggested an enhanced topical targeted effect due to an increased drug retention efficacy in the upper skin layers, as desired. Moreover, the bio-based excipients selected could contribute to the healing of the psoriatic scalp. In this way, the improvement of clobetasol efficacy is combined with the useful properties of the microemulsion components and with environmental safety.
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Affiliation(s)
- Rita Langasco
- a Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Sakine Tuncay Tanrıverdi
- b Department of Pharmaceutical Technology, Faculty of Pharmacy , Ege University , Izmir , Turkey
| | - Özgen Özer
- b Department of Pharmaceutical Technology, Faculty of Pharmacy , Ege University , Izmir , Turkey
| | - Marta Roldo
- c School of Pharmacy and Biomedical Sciences , University of Portsmouth , Portsmouth , UK
| | - Massimo Cossu
- a Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Giovanna Rassu
- a Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Paolo Giunchedi
- a Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Elisabetta Gavini
- a Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
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Herman A, Herman AP. Topically used herbal products for the treatment of hair loss: preclinical and clinical studies. Arch Dermatol Res 2017; 309:595-610. [DOI: 10.1007/s00403-017-1759-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022]
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Affiliation(s)
- Solam Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Won-Soo Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
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Abstract
Alopecia areata is an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Skin biopsies of affected skin show a lymphocytic infiltrate in and around the bulb or the lower part of the hair follicle in the anagen (hair growth) phase. A breakdown of immune privilege of the hair follicle is thought to be an important driver of alopecia areata. Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease. Several genetic susceptibility loci were identified to be associated with signalling pathways that are important to hair follicle cycling and development. Alopecia areata is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology can be helpful. Alopecia areata is difficult to manage medically, but recent advances in understanding the molecular mechanisms have revealed new treatments and the possibility of remission in the near future.
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Affiliation(s)
- C Herbert Pratt
- Department of Genetic Resource Sciences, The Jackson Laboratory, Bar Harbor, Maine, USA
| | - Lloyd E King
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Angela M Christiano
- Departments of Dermatology and Genetics &Development, Columbia University, New York, New York, USA
| | - John P Sundberg
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Research and Development, The Jackson Laboratory, 600 Main Street, Bar Harbor, Maine 04609-1500, USA
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Özdemir M, Balevi A. Bilateral Half-Head Comparison of 1% Anthralin Ointment in Children with Alopecia Areata. Pediatr Dermatol 2017; 34:128-132. [PMID: 28044367 DOI: 10.1111/pde.13049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Alopecia areata (AA) is one of the most difficult skin diseases to manage well. In children, anthralin is commonly used for the treatment of AA. Available research consists of a limited number of uncontrolled trials that assessed the effectiveness of anthralin in promoting hair growth in patients with AA. The objective of this study was to validate the clinical effectiveness of short-contact anthralin 1% ointment in children with AA. METHODS Thirty children with chronic, severe, treatment-refractory, extensive AA were treated with 1% anthralin ointment. One side of the scalp was treated with anthralin for 12 months and the other side was left untreated. Outcomes were evaluated according to the Severity of Alopecia Tool (SALT) score. RESULTS The mean time to first response in terms of new hair growth was 3 months and the mean time to maximal response was 9 months. In the first 12-month period, 10 patients (33.4%) achieved complete response to treatment and 11 patients (36.6%) had a partial response. Of the 11 patients with partial response at the end of the first year, 6 achieved a complete response before the end of the study. Total SALT scores for the entire scalp decreased from the end of the first year to the end of the 2-year period. No serious adverse events were observed. CONCLUSION Anthralin 1% is an effective therapy for AA and should be continued at least 9 months. At 9 months of topical anthralin therapy, the patients with at least a 50% reduction in their pretreatment SALT scores should continue the same treatment for at least 1 year. Anthralin is safe in children with chronic, severe, treatment-refractory, extensive AA.
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Affiliation(s)
- Mustafa Özdemir
- Department of Dermatology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ali Balevi
- Department of Dermatology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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In Vivo Assessment of Clobetasol Propionate-Loaded Lecithin-Chitosan Nanoparticles for Skin Delivery. Int J Mol Sci 2016; 18:ijms18010032. [PMID: 28035957 PMCID: PMC5297667 DOI: 10.3390/ijms18010032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/11/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
The aim of this work was to assess in vivo the anti-inflammatory efficacy and tolerability of clobetasol propionate (CP) loaded lecithin/chitosan nanoparticles incorporated into chitosan gel for topical application (CP 0.005%). As a comparison, a commercial cream (CP 0.05% w/w), and a sodium deoxycholate gel (CP 0.05% w/w) were also evaluated. Lecithin/chitosan nanoparticles were prepared by self-assembling of the components obtained by direct injection of soybean lecithin alcoholic solution containing CP into chitosan aqueous solution. Nanoparticles obtained had a particle size around 250 nm, narrow distribution (polydispersity index below 0.2) and positive surface charge, provided by a superficial layer of the cationic polymer. The nanoparticle suspension was then loaded into a chitosan gel, to obtain a final CP concentration of 0.005%. The anti-inflammatory activity was evaluated using carrageenan-induced hind paw edema test on Wistar rats, the effect of formulations on the barrier property of the stratum corneum were determined using transepidermal water loss measurements (TEWL) and histological analysis was performed to evaluate the possible presence of morphological changes. The results obtained indicate that nanoparticle-in-gel formulation produced significantly higher edema inhibition compared to other formulations tested, although it contained ten times less CP. TEWL measurements also revealed that all formulations have no significant disturbance on the barrier function of skin. Furthermore, histological analysis of rat abdominal skin did not show morphological tissue changes nor cell infiltration signs after application of the formulations. Taken together, the present data show that the use of lecithin/chitosan nanoparticles in chitosan gel as a drug carrier significantly improves the risk-benefit ratio as compared with sodium-deoxycholate gel and commercial cream formulations of CP.
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Iorizzo M, Oranje AP. Current and future treatments of alopecia areata and trichotillomania in children. Expert Opin Pharmacother 2016; 17:1767-73. [DOI: 10.1080/14656566.2016.1217990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Arnold P. Oranje
- Kinderhuid.nl, Rotterdam & Hair Outpatient Clinic, Breda & Dermicis Skin Clinic, Alkmaar, the Netherlands
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Wolff H, Fischer TW, Blume-Peytavi U. The Diagnosis and Treatment of Hair and Scalp Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:377-86. [PMID: 27504707 PMCID: PMC4908932 DOI: 10.3238/arztebl.2016.0377] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hair loss is caused by a variety of hair growth disorders, each with its own pathogenetic mechanism. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed, on the current German and European guidelines, and on the authors' clinical and scientific experience. RESULTS Excessive daily hair loss (effluvium) may be physiological, as in the postpartum state, or pathological, due for example to thyroid disturbances, drug effects, iron deficiency, or syphilis. Androgenetic alopecia generally manifests itself in women as diffuse thinning of the hair over the top of the scalp, and in men as receding temporal hairlines and loss of hair in the region of the whorl on the back of the head. Alopecia areata is patchy hair loss arising over a short time and involving the scalp, eyebrows, beard, or entire body. The hair loss of alopecia areata is reversible in principle but hard to treat. Folliculitis decalvans is a form of alopecia with scarring, characterized by inflamed papules, pustules, and crusts at the edges of the lesions. Lichen planopilaris generally presents with small patches of baldness, peripilar erythema, and round areas of skin scaling. Kossard's frontal fibrosing alopecia is characterized by a receding hairline and loss of eyebrows. CONCLUSION Hair loss is a symptom, not a diagnosis. The pathogenesis of the alopecias involves a range of genetic, endocrine, immune, and inflammatory processes, each of which calls for its own form of treatment.
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Affiliation(s)
- Hans Wolff
- Department of Dermatology and Allergology, Ludwig-Maximilians-Universität München
| | - Tobias W Fischer
- Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein: University of Lübeck
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
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Mathes C, Melero A, Conrad P, Vogt T, Rigo L, Selzer D, Prado W, De Rossi C, Garrigues T, Hansen S, Guterres S, Pohlmann A, Beck R, Lehr CM, Schaefer U. Nanocarriers for optimizing the balance between interfollicular permeation and follicular uptake of topically applied clobetasol to minimize adverse effects. J Control Release 2016; 223:207-214. [DOI: 10.1016/j.jconrel.2015.12.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/11/2015] [Accepted: 12/08/2015] [Indexed: 12/14/2022]
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Anuset D, Perceau G, Bernard P, Reguiai Z. Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata. Dermatology 2016; 232:242-8. [PMID: 26735937 DOI: 10.1159/000441250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In severe alopecia areata (AA), spontaneous recovery is unlikely, and treatment is not standardized. OBJECTIVE To evaluate the efficacy and safety of methotrexate (MTX) used alone or combined with low- to moderate-dose oral corticosteroids (OC) for treating severe AA (totalis, universalis and severe multifocal). METHODS Retrospective monocentric study of all consecutive patients receiving this treatment between 2006 and 2012. Efficacy was defined as achieving a total regrowth of terminal hair. RESULTS 26 patients were included (17 with AA universalis or totalis and 9 with severe multifocal AA). Total regrowth was noted in 15/26 patients. After 3 months of treatment, hair regrowth >80% was associated with further complete regrowth, and hair regrowth <30% was associated with later treatment failure (p = 0.0014). When treatment was tapered, 11/15 patients with initial complete efficacy experienced AA relapse. CONCLUSION MTX combined with low- to moderate-dose OC may be an efficient and well-tolerated treatment for severe AA. However, long-term maintenance treatment is usually required.
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Affiliation(s)
- Delphine Anuset
- Department of Dermatology, Reims University Hospital, Reims, France
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Abstract
INTRODUCTION Alopecia is a common concern encountered in the medical practice. Treatment approach varies according to the type and severity of alopecia. However, available treatment options have limited efficacy and several adverse effects. Presently, there are different treatment options being studied to overcome these limitations. Additionally, cellular pathways involved in the pathophysiology of alopecia are further being clarified to potentially target pathogenic molecules. AREAS COVERED We searched the literature for recently published articles discussing new treatment options as well as mechanisms involved in alopecia. We discuss the use of stem cells, growth factors, cellular pathways and robotic hair transplant, among other emerging therapies used for alopecia. EXPERT OPINION Future looks very promising and new effective treatments such as janus kinase inhibitors could possibly be available for alopecia areata. The stem-cell technology is advancing and companies involved in hair follicle neogenesis are starting clinical trials on patients with androgenetic alopecia.
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Affiliation(s)
- Leyre Falto-Aizpurua
- University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery , 1475 NW 12th Avenue, Suite 2175, Miami, FL 33136 , USA
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Abstract
BACKGROUND There is no cure for alopecia areata, nor is there any universally proven therapy that induces and sustains remission. Treatment choices are frequently based on disease duration, extent, and activity as well as the age of the patient. OBJECTIVE Our objective was to review all randomized controlled studies on the treatment of alopecia areata. METHODS We performed a search in the biomedical literature database PubMed, and used the terms 'alopecia areata treatment' and article type 'randomized controlled trials'. RESULTS Following this algorithm, we reviewed, analyzed, and reported on 29 trials that examined the efficacy of anthralin, antidepressants, biologics, calcineurin inhibitors, corticosteroids (topical and systemic), minoxidil, prostaglandin analogs, sensitizers, and a miscellaneous group of topical and oral drugs with less scientific evidence (aromatherapy, photodynamic therapy, azelaic acid, garlic gel, bexarotene, triiodothyronine, inosiplex, and total glucosides of paeony). CONCLUSION Using the American College of Physicians Guideline grading system, our assessment is that the majority of published randomized controlled studies of alopecia areata are only of moderate quality. A number of treatments were found to be effective, for example, topical and oral corticosteroids and the sensitizing agents diphenylcyclopropenone and dinitrochlorobenzene; however, most studies had major limitations that hinder the interpretation of these results.
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Narrow band-ultraviolet B versus clobetasol propionate foam in the treatment of vitiligo: a retrospective study. Dermatol Ther (Heidelb) 2013; 3:95-105. [PMID: 23888259 PMCID: PMC3680636 DOI: 10.1007/s13555-013-0028-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Several therapeutic options are available for the treatment of vitiligo; among these phototherapy and topical steroids are the most widely documented. A topical formulation of 0.05% clobetasol propionate foam (CPF) has been introduced in the market, but no data are available about the efficacy and tolerability of this new formulation in the treatment of vitiligo. The aim of this study was to investigate the efficacy and tolerability of CPF in the treatment of vitiligo, in comparison with narrowband-ultraviolet B (NB-UVB) phototherapy. METHODS The medical records of the first 60 vitiligo patients treated with NB-UVB phototherapy or with CPF were selected. Response to the treatment was determined for each anatomic site (neck, upper and lower limbs, trunk, hands/wrists, feet/ankles). Based on the area of repigmentation, treatment outcome was calculated according to a scale ranging from 0 (absent) to 4 (excellent). The incidence of adverse effects was also noted as a secondary endpoint. Significance level was set at P = 0.05. RESULTS For each anatomic site, statistical analyses demonstrated that the efficacy of CPF was significantly higher compared to NB-UVB. Side effects occurred in 4 patients (13.33%) in the CPF group compared to none in the NB-UVB group. DISCUSSION Clobetasol propionate has been used in vitiligo in different vehicles, but never in foam. The data showed that CPF is effective and seems to be superior to NB-UVB phototherapy, with furthermore a good safety profile. CONCLUSION This new foam formulation of clobetasol propionate may expand the options currently available for vitiligo therapy; however, further investigations are needed to confirm our preliminary observations.
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