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Wu W, Wang X, He K, Li C, Li S. From mice to men: An assessment of preclinical model systems for the study of vitiligo. Clin Immunol 2024; 262:110171. [PMID: 38462156 DOI: 10.1016/j.clim.2024.110171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
Vitiligo is an autoimmune skin disease of multiple etiology, for which there is no complete cure. This chronic depigmentation is characterized by epidermal melanocyte loss, and causes disfigurement and significant psychosocial distress. Mouse models have been extensively employed to further our understanding of complex disease mechanisms in vitiligo, as well as to provide a preclinical platform for clinical interventional research on potential treatment strategies in humans. The current mouse models can be categorized into three groups: spontaneous mouse models, induced mouse models, and transgenic mice. Despite their limitations, these models allow us to understand the pathology processes of vitiligo at molecule, cell, tissue, organ, and system levels, and have been used to test prospective drugs. In this review, we comprehensively evaluate existing murine systems of vitiligo and elucidate their respective characteristics, aiming to offer a panorama for researchers to select the appropriate mouse models for their study.
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Affiliation(s)
- Wei Wu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Xinju Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Kaiqiao He
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China.
| | - Shuli Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China.
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2
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Ferreira BR, Vulink N, Mostaghimi L, Jafferany M, Balieva F, Gieler U, Poot F, Reich A, Romanov D, Szepietowski JC, Tomas-Aragones L, Campos R, Tausk F, Zipser M, Bewley A, Misery L. Classification of psychodermatological disorders: Proposal of a new international classification. J Eur Acad Dermatol Venereol 2024; 38:645-656. [PMID: 38084889 DOI: 10.1111/jdv.19731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/17/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Several classifications of psychodermatology disorders have been proposed, with most of them based on two to four main disorder category groups. However, there is, to date, no classification that has resulted from a consensus established by psychodermatology experts. The DSM-5-TR (Diagnostic and statistical manual of mental disorders (5th ed.), Text Revision) and the ICD-11 (International classification of diseases (11th revision)) also do not provide a systematized approach of psychodermatology disorders. Taking into consideration that classifications are a key pillar for a comprehensive approach to the pathologies of each branch of medicine, the proposal of a classification in psychodermatology appeared as a central need for the recognition of psychodermatological disorders, in an attempt to improve their recognition and, in that sense, to find a common language for the development of this subspecialty that crosses dermatology and psychiatry. METHODS Previously published classifications in psychodermatology were critically reviewed and discussed by expert opinion from an international multidisciplinary panel of 16 experts in psychodermatology and a new classification system is proposed, considering classical concepts in general dermatology and psychopathology. RESULTS Two main categories of disorders are presented (a main group related to primary mental health disorders and another main group related to primary skin disorders), which are subsequently subdivided into subgroups considering pathophysiological and phenomenological similarities, including key aspects of dermatological examination, namely the presence of visible skin lesions (primary and secondary skin lesions) and psychopathological correlates. CONCLUSION This new classification aims to unify previous classifications, systematize the disorders that belong to psychodermatology and highlight their tenuous boundaries, to improve their management. It has been built and approved by the Psychodermatology Task Force of the European Academy of Dermatology and Venereology (EADV), the European Society for Dermatology and Psychiatry (ESDaP) and the Association for Psychoneurocutaneous Medicine of North America (APMNA).
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Affiliation(s)
- Bárbara Roque Ferreira
- Department of Dermatology, Centre Hospitalier de Mouscron, Mouscron, Belgium
- Univ Brest, LIEN, Brest, Portugal
- CFCUL, Lisboa, Portugal
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ladan Mostaghimi
- Wisconsin Psychocutaneous Clinic, Middleton, Wisconsin, USA
- Dermatology Department, University of Wisconsin, Madison, Wisconsin, USA
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Central Michigan University/CMU Medical Education Partners, Saginaw, Michigan, USA
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Uwe Gieler
- Department of Dermatology, Justus Liebig University of Giessen, Giessen, Germany
- Vitos-Clinic for Psychosomatic Medicine, Giessen, Germany
| | - Françoise Poot
- ULB-Erasme Hospital Department Dermatology, Brussels, Belgium
- IFTS, Charleroi, Belgium
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ricardo Campos
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - Francisco Tausk
- Department of Dermatology, Allergy, Immunology and Rheumatology, University of Rochester, Rochester, New York, USA
| | - Marie Zipser
- Sanatorium Kilchberg - Centre for Psychosomatics, Zurich, Switzerland
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University, London, UK
| | - Laurent Misery
- Univ Brest, LIEN, Brest, Portugal
- Department of Dermatology, University Hospital of Brest, Brest, France
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Taylor S, Korman NJ, Tsai TF, Shimomura Y, Feely M, Dutronc Y, Wu WS, Somani N, Tosti A. Efficacy of Baricitinib in Patients with Various Degrees of Alopecia Areata Severity: Post-Hoc Analysis from BRAVE AA1 and BRAVE AA2. Dermatol Ther (Heidelb) 2023; 13:3181-3191. [PMID: 37740856 PMCID: PMC10689675 DOI: 10.1007/s13555-023-01033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Baricitinib, an oral selective JAK1/JAK2 inhibitor, is approved for the treatment of adults with severe alopecia areata (AA). OBJECTIVE To evaluate differences in response up to week 52 among subgroups based on the baseline severity of AA assessed with the Severity of Alopecia Tool (SALT) score. METHODS Data were pooled from BRAVE-AA1 and BRAVE-AA2, two randomized, placebo-controlled, phase 3 trials, which enrolled adults with a SALT score ≥ 50. Patients were subdivided by the degree of AA severity at baseline. RESULTS Among the 855 patients treated with baricitinib 2 mg and 4 mg, improvements in scalp hair growth continued through to week 52. A superior response was observed in patients with a SALT score of 50-94 versus a score of 95-100. Patients on baricitinib 4 mg had a faster and higher response rate compared to baricitinib 2 mg. CONCLUSION Across all degrees of severity for baricitinib 2 mg and 4 mg doses, the proportion of patients responding was yet to plateau up to week 52. Response to treatment was longer for patients with a baseline SALT score 95-100. Further studies are needed to analyze other parameters that may impact observed response rates.
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Affiliation(s)
- Susan Taylor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Meghan Feely
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Dermatology, Mount Sinai, New York, NY, USA
| | | | - Wen-Shuo Wu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.
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Dong J, Lai Y, Zhang X, Yue Y, Zhong H, Shang J. Optimization of Monobenzone-Induced Vitiligo Mouse Model by the Addition of Chronic Stress. Int J Mol Sci 2023; 24:ijms24086990. [PMID: 37108153 PMCID: PMC10138324 DOI: 10.3390/ijms24086990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Vitiligo is a common primary, limited or generalized skin depigmentation disorder. Its pathogenesis is complex, multifactorial and unclear. For this reason, few animal models can simulate the onset of vitiligo, and studies of drug interventions are limited. Studies have found that there may be a pathophysiological connection between mental factors and the development of vitiligo. At present, the construction methods of the vitiligo model mainly include chemical induction and autoimmune induction against melanocytes. Mental factors are not taken into account in existing models. Therefore, in this study, mental inducement was added to the monobenzone (MBEH)-induced vitiligo model. We determined that chronic unpredictable mild stress (CUMS) inhibited the melanogenesis of skin. MBEH inhibited melanin production without affecting the behavioral state of mice, but mice in the MBEH combined with CUMS (MC) group were depressed and demonstrated increased depigmentation of the skin. Further analysis of metabolic differences showed that all three models altered the metabolic profile of the skin. In summary, we successfully constructed a vitiligo mouse model induced by MBEH combined with CUMS, which may be better used in the evaluation and study of vitiligo drugs.
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Affiliation(s)
- Jing Dong
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Yifan Lai
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Xiaofeng Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Yunyun Yue
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Hui Zhong
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Jing Shang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
- Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 211198, China
- NMPA Key Laboratory for Research and Evaluation of Cosmetics, National Institutes for Food and Drug Control, Beijing 100050, China
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Muntyanu A, Gabrielli S, Donovan J, Gooderham M, Guenther L, Hanna S, Lynde C, Prajapati VH, Wiseman M, Netchiporouk E. The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. J Eur Acad Dermatol Venereol 2023; 37:1490-1520. [PMID: 36708097 DOI: 10.1111/jdv.18926] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
Alopecia areata (AA) is a common inflammatory autoimmune disease of the hair which can have a significant negative impact on quality of life (QoL), mental health and productivity. The aim of this scoping review is to elucidate the burden of AA focusing on these three realms. Inclusion criteria included all original manuscripts with no restriction on study type or statistical method written in English (or having an English abstract). For QoL 40 articles were included, 85 for psychiatric comorbidities, and 9 for work/school absenteeism/presenteeism mostly consisting of cross-sectional and observational cohort studies. QoL impairment was detected in over 75% of patients and up to one-third reported extremely severe QoL impairments. Specific QoL dimensions with the greatest impact were embarrassment, social functioning, as well as shopping and/or housework. Cross-sectional studies assessing the psychological burden of adult patients with AA found that the presence of signs of anxiety and/or depression ranged from 30% to 68% and affected all age groups. Rates of work absenteeism and unemployment were significantly higher in AA patients compared to healthy controls. Up to 62% reported making major life decisions including relationships, education and career based on their AA. Additionally, the extensive camouflage techniques and time lost from work led to a strong financial burden for patients and the numerous physician visits added to the healthcare costs. The overall impact of AA stretches much further than simply being an aesthetic concern and can negatively impact every part of an individual's life. An individualized approach and effective treatments will help reduce the psychosocial consequences and distress and return patients to their normal state of health.
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Affiliation(s)
| | | | - Jeffrey Donovan
- Donovan Hair Clinic, Whistler, British Columbia, Canada
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
| | - Lyn Guenther
- Division of Dermatology, Western University, London, Ontario, Canada
- Guenther Research Inc., London, Ontario, Canada
| | - Sameh Hanna
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Dermatology on Bloor, Toronto, Ontario, Canada
| | - Charles Lynde
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Vimal H Prajapati
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
| | - Marni Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- SKiNWISE Dermatology, Winnipeg, Manitoba, Canada
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Alopecia Areata: A Review of the Role of Oxidative Stress, Possible Biomarkers, and Potential Novel Therapeutic Approaches. Antioxidants (Basel) 2023; 12:antiox12010135. [PMID: 36670997 PMCID: PMC9854963 DOI: 10.3390/antiox12010135] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Alopecia areata (AA) is a dermatological condition characterized by non-scarring hair loss. Exact etiopathogenesis of AA is still unknown although it is known that several factors contribute to the collapse of the hair-follicle (HF)-immune-privileged (IP) site. Oxidative stress (OS) plays an important role in skin diseases. The aim of this review was to clarify the role of OS in AA pathogenesis and diagnosis, and to discuss potential treatment options. Oxidative-stress markers are altered in serum and skin samples of patients with AA, confirming a general pro-oxidative status in patients with AA. OS induces MHC class I chain-related A (MICA) expression in HF keratinocytes that activates the receptor NKG2D, expressed in NK cells and CD8+ T cytotoxic cells leading to destabilization of the HF immune-privileged site through the production of IFN-γ that stimulates JAK1 and JAK2 pathways. OS also activates the KEAP1-NRF2 pathway, an antioxidant system that contributes to skin homeostasis. In addition, a decrease of ATG5 and LC3B in the hair matrix and an increase in p62 levels indicates a reduction of intrafollicular autophagy during the evolution of AA. Potential biomarkers of OS in AA could be: malondialdehyde (MDA), advanced glycation end-products (AGEs), and ischemic-modified albumin (IMA). JAK inhibitors are the new frontier in treatment of AA and the use of nutraceuticals that modulate the OS balance, in combination with standard treatments, represent promising therapeutic tools.
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Ma Z, Cai M, Yang K, Liu J, Guo T, Liu X, Zhang J. Predicting the risk of autoimmune thyroid disease in patients with vitiligo: Development and assessment of a new predictive nomogram. Front Endocrinol (Lausanne) 2023; 14:1109925. [PMID: 36798661 PMCID: PMC9927026 DOI: 10.3389/fendo.2023.1109925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This study aimed to develop an autoimmune thyroid disease (AITD) risk prediction model for patients with vitiligo based on readily available characteristics. METHODS A retrospective analysis was conducted on the clinical characteristics, demographics, skin lesions, and laboratory test results of patients with vitiligo. To develop a model to predict the risk of AITD, the Least Absolute Shrinkage and Selection Operator (LASSO) method was used to optimize feature selection, and logistic regression analysis was used to select further features. The C-index, Hosmer-Lemeshow test, and decision curve analysis were used to evaluate the calibration, discrimination ability and clinical utility of the model. Internally, the model was verified using bootstrapping; externally, two independent cohorts were used to confirm model accuracy. RESULTS Sex, vitiligo type, family history of AITD, family history of other autoimmune disease, thyroid nodules or tumors, negative emotions, skin involvement exceeding 5% of body surface area, and positive immune serology (IgA, IgG, IgM, C3, and C4) were predictors of AITD in the prediction nomogram. The model showed good calibration and discrimination (C-index: 0.746; 95% confidence interval: 0.701-0.792). The accuracy of this predictive model was 74.6%.In both internal validation (a C-index of 1000 times) and external validation, the C-index outperformed (0.732, 0.869, and 0.777). The decision curve showed that the AITD nomogram had a good guiding role in clinical practice. CONCLUSION The novel AITD nomogram effectively evaluated the risk of AITD in patients with vitiligo.
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Affiliation(s)
- Ze Ma
- Graduate school, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Menghan Cai
- Graduate school, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Kang Yang
- Graduate school, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junru Liu
- Dermatology and Medical Cosmetology Department, Laishan branch of Yantai Yuhuangding Hopitali, Shandong, China
| | - Tao Guo
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Xiaojie Liu
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Junling Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
- *Correspondence: Junling Zhang,
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Paggioli I, Moss J. Alopecia Areata: Case report and review of pathophysiology and treatment with Jak inhibitors. J Autoimmun 2022; 133:102926. [PMID: 36335798 DOI: 10.1016/j.jaut.2022.102926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
Alopecia Areata (AA) is a T-cell mediated autoimmune attack on hair follicles resulting in rapidly developing areas of hair loss involving the scalp and beard that can progress to total scalp hair loss (alopecia totalis) and loss of eyebrows, eyelashes, and total body hair (alopecia universalis). Affected patients have high rates of psychological disorders and decreased quality of life. There are no FDA approved treatments, and the available treatments have a high failure rate. JAK inhibitors are remarkably effective in many autoimmune diseases including Alopecia Areata. Presented is a case report of successful treatment with tofacitinib, and a literature review of the pathophysiology of alopecia areata, the mechanism of action of JAK inhibitors, and the JAK inhibitors in phase 2 and 3 trials.
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Affiliation(s)
| | - Jeremy Moss
- Brookside Dermatology, 4639 Main Street, Bridgeport, CT, 06606, USA.
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Gilding AJ, Ho N, Pope E, Sibbald C. The Burden of Disease in Alopecia Areata: Canadian Online Survey of Patients and Caregivers. JMIR DERMATOLOGY 2022; 5:e39167. [PMID: 37632886 PMCID: PMC10334944 DOI: 10.2196/39167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alopecia areata (AA) is associated with negative impacts on the quality of life (QoL). Data on this impact are lacking for Canadian patients and their caregivers. OBJECTIVE This study aims to investigate the burden of AA on Canadian patients and their caregivers. METHODS We created 4 online surveys for patients 5-11 years old, 12-17 years old, and ≥18 years old and for caregivers of children (<18 years old) with AA. These were disseminated through the Canadian Alopecia Areata Foundation (CANAAF) website and to dermatologists across Canada. RESULTS In total, 115 adult patients (n=100, 87%, female), 14 pediatric patients (n=13, 92.9%, female), and 15 caregivers completed the surveys online. The majority (n=123, 95%) of patients felt uncomfortable or self-conscious about their appearance. Camouflaging hair loss with hats, scarves, and hairpieces was a common practice for 11 (78.6%) pediatric and 84 (73%) adult patients. Avoidance of social situations was reported by 8 (57.1%) pediatric and 75 (65.2%) adult patients. Constant worry about losing the achieved hair growth was a concern for 8 (57.1%) pediatric and 75 (65.2%) adult patients. On a scale of 1-5, the mean score of caregivers' own feelings of sadness or depression about their child's AA was 4.0 (SD 0.9) and of their feelings of guilt or helplessness was 4.2 (SD 1.2). The impact on the QoL was moderate for both children and adults. Based on the Adjustment Disorder New Module-20 (ADNM-20), 71 (61.7%) of 115 patients were at high risk of an adjustment disorder. Abnormal anxiety scores were recorded in 40 (34.8%) patients compared to abnormal depression scores in 20 (17.4%) patients. CONCLUSIONS This study confirmed a significant burden of AA on Canadian patients' and caregivers' QoL.
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Affiliation(s)
- Anthony Justin Gilding
- Department of Chemistry and Biology, Faculty of Science, Toronto Metropolitan University, Toronto, ON, Canada
- Canadian Alopecia Areata Foundation, King City, ON, Canada
| | - Nhung Ho
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elena Pope
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Padmakar S, Murti K, Pandey K, Kumari S, Kumar R, Siddiqui NA, Pal B. Suicidal ideation associated with vitiligo - A systematic review of prevalence and assessment. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Wang H, Pan L, Wu Y. Epidemiological Trends in Alopecia Areata at the Global, Regional, and National Levels. Front Immunol 2022; 13:874677. [PMID: 35911734 PMCID: PMC9331164 DOI: 10.3389/fimmu.2022.874677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background No comprehensive studies have been published on the global burden of alopecia areata since 2010. Objective We aimed to measure the global, regional, and national incidence of alopecia areata and disability-adjusted life-years (DALYs) by age, sex, and socio-demographic index (SDI) value from 1990 to 2019. Methods Data were extracted from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends in the age-standardized rates of alopecia areata incidence and DALYs. The correlations between EAPCs in the age-standardized rates and SDI values were also analyzed. Results From 1990 to 2019, the alopecia areata incidence number and the associated number of DALYs increased globally by 49.14%, and 49.51%, respectively. The global age-standardized incidence rate decreased (EAPC, −0.13; 95% confidence interval [CI], −0.13 to −0.12) and the age-standardized DALY rate showed a downward trend (EAPC, −0.12; 95% CI, −0.13 to −0.11). The largest increases in the age-standardized incidence rate and age-standardized DALY rate were observed in Low SDI quintile and Western Sub-Saharan Africa regions. The regions with the greatest changes in the incidence of alopecia areata were Central Sub-Saharan Africa and Western Sub-Saharan Africa. The three countries with the largest increases in alopecia areata incidence from 1990 to 2019 were Kuwait (EAPC, 0.15), South Sudan (EAPC, 0.12), and Nigeria (EAPC, 0.11). The age-standardized incidence rate was higher in females than in males. Conclusion Globally, both the age-standardized incidence rate and age-standardized DALY rate of alopecia areata showed decreasing trends. Future preventive strategies should focus on low-income countries, Central Sub-Saharan Africa, Western Sub-Saharan Africa, Kuwait, South Sudan, Nigeria.
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Affiliation(s)
- Haifeng Wang
- Department of Hematology and Oncology, Beilun Branch of the First Affiliated Hospital of Medical College of Zhejiang University, Ningbo, China
- *Correspondence: Yanfeng Wu, ; Haifeng Wang,
| | - Lifang Pan
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Yanfeng Wu
- Department of Anesthesiology, Ningbo Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Ningbo, China
- *Correspondence: Yanfeng Wu, ; Haifeng Wang,
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Edson-Heredia E, Aranishi T, Isaka Y, Anderson P, Marwaha S, Piercy J. Patient and physician perspectives on alopecia areata: A real-world assessment of severity and burden in Japan. J Dermatol 2022; 49:575-583. [PMID: 35343611 PMCID: PMC9310764 DOI: 10.1111/1346-8138.16360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
The criteria used by physicians to assess alopecia areata severity and its associated burden from the patients' point of view are not well understood. We aimed to understand physician‐assessed determinants of disease severity, factors associated with severity, patient–physician concordance, and patient‐reported burden by severity. Data were drawn from the Adelphi Alopecia Areata Disease Specific Programme™, a point‐in‐time survey of dermatologists and their alopecia areata patients in real‐world practice in Japan conducted between January and March 2021. Patients were categorized into three groups by current disease severity according to physician subjective assessment: mild, moderate, or severe. Demographics, clinical characteristics, and outcomes were described within and compared between the three patient groups. Our study of 97 dermatologists and 587 patients found overall scalp hair loss was the most important factor considered by physicians in determining disease severity. More severe disease was associated with loss of eyebrow hair, eyelashes, and hair loss from other body areas. Agreement on disease severity between physicians and patients was moderate. From the patient perspective, greater severity of alopecia areata was associated with greater anxiety and depression, with lower work productivity and worse quality of life. Our study provides insights into which factors physicians use to determine alopecia areata severity, how physician and patient severity assessments compare, and the burden of alopecia areata on patients.
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Liu JW, Tan Y, Chen T, Liu W, Qian YT, Ma DL. Post-Traumatic Stress in Vitiligo Patients: A Neglected but Real-Existing Psychological Impairment. Clin Cosmet Investig Dermatol 2022; 15:373-382. [PMID: 35283640 PMCID: PMC8906700 DOI: 10.2147/ccid.s350000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
Abstract
Background Vitiligo is the most common depigmentation disorder. This disease causes disfiguration and induces psychological burdens, leading to significantly impaired quality of life. Limited research about disease-related post-traumatic stress (PTS) has been conducted in vitiligo patients. Objective To evaluate the prevalence, severity, and risk factors of post-traumatic stress in vitiligo patients. Methods This case-control study was performed from January 2021 to April 2021. A survey questionnaire including baseline information, post-traumatic stress symptoms evaluation, life quality evaluation was conducted. According to the severity of post-traumatic stress symptoms, patients were grouped and compared. The logistic regression model was conducted to analyze the risk factors for post-traumatic stress disorder (PTSD). Results A total of 337 patients were included. A 30.3% of vitiligo patients (102/337) in present cohort had PTS and 12.5% patients (42/337) were confirmed for developing into PTSD. The multivariate logistic regression revealed educational level<university (OR=2.32, 95% CI=1.97–2.93, P=0.003), vitiligo in face and neck (OR=2.65, 95% CI=2.08–3.12, P=0.008), vitiligo in feet and hands (OR=1.86, 95% CI=1.54–2.12, P<0.001) and surgical treatment (OR=3.53, 95% CI=3.12–4.02, P<0.001) were risk factors for PTSD. PTS severity was significantly associated with vitiligo disease activity score (rho=0.54, R2=0.29, P=0.002), vitiligo area scoring index score (r=0.55, R2=0.30, P=0.012), and dermatology life quality index score (r=0.61, R2=0.37, P=0.004). Conclusion Vitiligo-related PTS is prevalent in vitiligo patients and causes psychological impairment. Dermatologists should realize and identify this condition carefully and offer proactive intervention to improve patients’ quality of life.
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Affiliation(s)
- Jia-Wei Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
| | - Yan Tan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
| | - Tian Chen
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
| | - Wei Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
| | - Yue-Tong Qian
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
| | - Dong-Lai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100730, People's Republic of China
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14
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Tzur Bitan D, Berzin D, Kridin K, Sela Y, Cohen A. Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study. Acta Derm Venereol 2022; 102:adv00669. [PMID: 35146527 PMCID: PMC9558328 DOI: 10.2340/actadv.v102.1622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Alopecia areata and depression tend to co-occur; however, their temporal association has not been comprehensively investigated. The aim of this study was to examine the temporal association between alopecia areata and depression. The study included only cases with a comorbid presentation of alopecia areata and depression (n = 1,936), extracted from the databases of the Clalit Health Services, Israel. Survival analyses were used to assess the cumulative probability of receiving alopecia areata as comorbid diagnosis in the years following depression, and vice versa, compared with the opposite trajectory. The results indicate that patients with alopecia areata had greater odds of subsequent depression within 2 years from alopecia areata diagnosis, and showed a steeper increase in cumulative probability of depression as time progressed (log-rank =336.38, p < 0.001), compared with the opposite trajectory. All patients with alopecia areata had comorbid depression within 10 years of alopecia areata, compared with 70% of depression patients receiving diagnoses of comorbid alopecia areata within the same time-frame.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, IL-40700 Ariel, Israel.
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15
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Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22:757-774. [PMID: 34554406 PMCID: PMC8566637 DOI: 10.1007/s40257-021-00631-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Gao Y, Huo S, Sun M, Zhang C, Wang J, Gao J, Wang N, Lv Y. Evaluation of several immune and inflammatory indicators and their association with alopecia areata. J Cosmet Dermatol 2021; 21:2995-3001. [PMID: 34591347 DOI: 10.1111/jocd.14504] [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: 05/31/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder and chronic recurrent inflammatory disease that results in non-scarring hair loss. OBJECTIVES Our aim is to investigate several parameters related to autoimmunity and inflammation in AA patients and to evaluate their association with this disease. METHODS This study included a total of 672 eligible AA patients and 580 age- and sex-matched healthy individuals who were treated at a third-class hospital in Hefei from January 2016 to May 2020. Data for serum C-reactive protein (CRP), 25-hydroxy vitamin D (25(OH)D), T3, T4, thyroid-stimulating hormone (TSH), thyroid antibodies (TPOAbs and TGAbs), antinuclear antibodies (ANA), complements (C3, C4), and several immunoglobulins (IgA, IgM, and IgG) were collected in this study. RESULTS Regarding autoimmune-related functional indicators, there were no statistically significant differences between TSH, TGAbs, C3, C4, IgA, IgM, and IgG levels between AA patients and healthy controls. Only T3, T4, TPOAbs, and ANA values were significantly abnormal in the AA group compared with the healthy individuals (p < 0.05). In addition, the mean serum 25(OH)D concentration was significantly lower in the patient group than that in control group (p < 0.05), and serum CRP was significantly increased (p < 0.05). CONCLUSION Although the etiopathogenesis of AA is not clear, the importance of monitoring the levels of T3, T4, TPOAbs, ANA, and 25 (OH)D in AA cases is indispensable.
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Affiliation(s)
- Yamei Gao
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shaohu Huo
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Minghui Sun
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chenchen Zhang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Gao
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Na Wang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yongmei Lv
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Dillon KAL. A Comprehensive Literature Review of JAK Inhibitors in Treatment of Alopecia Areata. Clin Cosmet Investig Dermatol 2021; 14:691-714. [PMID: 34211288 PMCID: PMC8242127 DOI: 10.2147/ccid.s309215] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated form of nonscarring alopecia that is multifactorial and results in localized patches. It is often described as a self-limiting condition that results in the spontaneous regrowth of hair in most cases. However, this regrowth may take several months or years to occur in some patients, leading to the development of psychoemotional trauma in those that are affected. Although several therapies for AA have been developed and tested, there is no specific treatment that has been approved, leading to the availability of many off-label conventional treatment options, with very limited responses. More recently, with the advancement of pre-clinical and genetic studies, a greater understanding of the pathomechanisms involved in the development of AA has been uncovered. This has resulted in the introduction of targeted therapies that use small molecules to block specific pathways involved in AA pathophysiology. As such, the use of janus kinase (JAK) inhibitors for treatment of AA has emerged. JAK inhibitors block the T-cell mediated inflammatory response thought to be the driving factor behind AA pathogenesis, by inhibiting the janus kinase (JAK) signal transducer and activator of transcription (STAT) signaling pathway, leading to a reversal of hair loss in AA patients. Thus, in an effort to demonstrate the efficacy of JAK inhibitors in the treatment of AA, several studies have been published within recent years. However, the question remains, “Are JAK inhibitors effective and safe in the management of Alopecia Areata?”. This review aims to provide a comprehensive report on the role, efficacy, and outcomes of using JAK inhibitors in the treatment of AA. To competently answer the research question highlighted, the most recent, quality articles published over a 10–15-year period were sourced using PubMed, NCBI, Research gate, Medline, Cochrane Central Register of Controlled Trials, EMBASE and Google scholar. The literature search was primarily focused on randomized controlled trials (RCTs); however, in the absence of such, only the most recently published case reports, case series, clinical trials and open-label studies published to date were included.
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Affiliation(s)
- Kerry-Ann L Dillon
- Department of Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, True Blue, Grenada.,Department of Dermatology, School of Health, Sport & Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, South Wales, UK
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18
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Increased Circulatory Interleukin-17A Levels in Patients with Progressive and Leukotrichial Vitiligo. Dermatol Res Pract 2021; 2021:5524566. [PMID: 33968147 PMCID: PMC8084637 DOI: 10.1155/2021/5524566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vitiligo is a chronic condition characterized by skin depigmentation. Although not life-threatening, it significantly impacts quality of life. The pathophysiology of vitiligo remains poorly understood, and treatment options are limited. Mounting evidence supports the importance of autoreactive T cells and, particularly interleukin-17A- (IL-17A-) secreting Th17 cells, in vitiligo. IL-17A targeting has been proven successful in various inflammatory dermatological conditions, including psoriasis and lupus erythematosus. Objective We evaluated the relationship between serum levels of IL-17A and the clinicopathological characteristics of Vietnamese vitiligo patients. Methods In this cross-sectional study, we analyzed data from 52 nonsegmental vitiligo patients and 50 age- and sex-matched healthy individuals. Serum levels of IL-17A were measured using an enzyme-linked immunosorbent assay. We evaluated the correlation between IL-17A levels and clinical characteristics including leukotrichia, disease duration, vitiligo activity, and body surface area involvement. Results Patients with progressive vitiligo had significantly higher IL-17A levels than patients with stable vitiligo (P = 0.014) or healthy individuals (P = 0.002). In addition, serum IL-17A levels were higher in vitiligo patients with leukotrichia than in patients without it (P = 0.04). Furthermore, serum IL-17A levels were negatively correlated with age (r = -0.39, P = 0.004) and age of onset (r = -0.33, P = 0.016) in vitiligo patients. Conclusions Higher serum levels of IL-17A in patients with progressive vitiligo and leukotrichia suggest a potential role of IL-17A in melanocyte destruction in the epidermis and the follicular matrix.
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19
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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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20
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Burns LJ, Mesinkovska N, Kranz D, Ellison A, Senna MM. Cumulative Life Course Impairment of Alopecia Areata. Int J Trichology 2020; 12:197-204. [PMID: 33531741 PMCID: PMC7832162 DOI: 10.4103/ijt.ijt_99_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/29/2020] [Indexed: 02/01/2023] Open
Abstract
Alopecia areata (AA), an unpredictable, nonscarring hair loss, is commonly perceived as a cosmetic, rather than medical, concern. However, substantial evidence exists describing the negative impact on quality of life, as the disease affects patients personally, socially, financially, and physically. Over time, the cumulative disability may perpetuate poor confidence, social disconnection, negative coping strategies, and failure to achieve a full life potential. Here, we describe the cumulative life course impairment (CLCI) of AA by examining the complex interaction of (1) stigmatization, (2) physical and psychiatric comorbidities, and (3) coping strategies. The model aggregates existing cross-sectional data, which have previously captured disease burden only as snapshots in time. Thus, by examining cumulative effects, the CLCI model serves as a proxy for longitudinal data to better describe life course epidemiology of the disease.
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Affiliation(s)
- Laura J Burns
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Natasha Mesinkovska
- National Alopecia Areata Foundation, San Rafael, USA.,Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - Dory Kranz
- National Alopecia Areata Foundation, San Rafael, USA
| | - Abby Ellison
- National Alopecia Areata Foundation, San Rafael, USA
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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21
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Wong AYS, Kjaersgaard A, Frøslev T, Forbes HJ, Mansfield KE, Silverwood RJ, Sørensen HT, Smeeth L, Schmidt SAJ, Langan SM. Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo: cohort studies in the UK and Denmark. Br J Dermatol 2020; 183:761-763. [PMID: 32282926 DOI: 10.1111/bjd.19122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Y S Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kjaersgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
| | - K E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
| | - S A J Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
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22
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Toussi A, Barton VR, Le ST, Agbai ON, Kiuru M. Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review. J Am Acad Dermatol 2020; 85:162-175. [PMID: 32561373 DOI: 10.1016/j.jaad.2020.06.047] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an immune-mediated disease resulting in nonscarring hair loss. Systematic reviews on the psychosocial and psychiatric comorbidities, health-related quality of life, and interventions targeting psychosocial well-being are limited. OBJECTIVE To conduct a systematic review of the psychosocial comorbidities, health-related quality of life, and treatment options targeting psychosocial well-being in adult and pediatric AA patients. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines within the PubMed database. Specific search terms included, but were not limited to, alopecia areata, psychosocial, psychiatry, and quality of life. Studies were then evaluated for their design and categorized into corresponding levels of evidence according to the guidelines adapted from the Oxford Center for Evidence Based Medicine. FINDINGS Seventy-three reports met inclusion criteria, involving approximately 414,319 unique participants. AA patients were found to have psychiatric comorbidities, particularly anxiety and depression. Health-related quality of life is reduced in AA patients, but data on pediatric AA quality of life are limited. Psychotherapy is often recommended as adjuvant treatment. CONCLUSION AA has substantial psychosocial impact on patients and results in reduced health-related quality of life. Addressing this should be an active part of treatment.
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Affiliation(s)
- Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, California; School of Medicine, University of California, Davis, Sacramento, California
| | - Virginia R Barton
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Oma N Agbai
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
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Aida Maranduca M, Liliana Hurjui L, Constantin Branisteanu D, Nicolae Serban D, Elena Branisteanu D, Dima N, Lacramioara Serban I. Skin - a vast organ with immunological function (Review). Exp Ther Med 2020; 20:18-23. [PMID: 32508987 DOI: 10.3892/etm.2020.8619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
The skin is an organ with multiple functions, where important inflammatory and immunological processes take place. The integrity of the skin barrier is necessary for it to fulfill its roles. An intact skin barrier requires a physiological keratinization process, but also a normal cutaneous microbial flora. Any change in the proliferation and differentiation of keratinocytes entails the disruption of the skin barrier and the triggering of inflammatory and immunological processes at this level, in response to the aggression of external pathogens. Also, there are several specialised immune cells in the skin (Langerhans cells, T regulator cells, T helper cells), that maintain a balance between pro-inflammatory and anti-inflammatory processes at this level. Disturbing the immune homeostasis causes inflammation and allergic skin reaction. Psoriasis and atopic dermatitis are two inflammatory diseases of the skin, characterized by perturbation of the mechanisms of skin barrier formation. The immune system of the skin is also involved in the pathophysiology of vitiligo and pemphigus. The aim of this review is to offer a brief presentation of the inflammatory and immunological processes that occur in the skin.
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Affiliation(s)
- Minela Aida Maranduca
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Loredana Liliana Hurjui
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Dragomir Nicolae Serban
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicoleta Dima
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH. Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: A nationwide population-based study. J Am Acad Dermatol 2020; 82:1131-1137. [PMID: 32007291 DOI: 10.1016/j.jaad.2019.11.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alopecia areata (AA) has long been associated with major depressive disorder (MDD). However, most evidence to date has derived from cross-sectional or case-control studies. OBJECTIVE To investigate the bidirectional association between AA and MDD among probands and unaffected siblings. METHODS Study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 2123 probands with AA, 2298 unaffected siblings, and 9192 matched controls to assess the risk of MDD. We included 16,543 probands with MDD, 17,352 unaffected siblings, and 69,408 matched controls to assess the risk of AA. The Breslow-Cox model was used to calculate the adjusted relative risk. RESULTS Compared with controls, AA probands and unaffected siblings had adjusted relative risks of 8.22 (95% confidence interval [CI], 6.41-10.54) and 2.55 (95% CI, 1.91-3.40), respectively, for MDD. MDD probands and unaffected siblings had adjusted relative risks for AA of 1.66 (95% CI, 1.24-2.22) and 1.64 (95% CI, 1.27-2.12), respectively. LIMITATION The National Health Insurance Research Database lacked information on disease severity, body mass index, smoking habit, alcohol consumption, and stressful life events. CONCLUSION Our study demonstrated a bidirectional association between AA and MDD among probands and unaffected siblings, thus suggesting shared familial mechanisms underlying AA and MDD.
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Affiliation(s)
- Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data. PLoS One 2020; 15:e0227909. [PMID: 31986193 PMCID: PMC6984686 DOI: 10.1371/journal.pone.0227909] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
Vitiligo is a T-cell mediated skin disorder characterized by progressive loss of skin color. In individuals genetically predisposed to the disease, various triggers contribute to the initiation of vitiligo. Precipitating factors can stress the skin, leading to T-cell activation and recruitment. Though hereditary factors are implicated in the pathogenesis of vitiligo, it is unknown whether precipitating, stressful events play a role in vitiligo. To understand this, we utilized a validated perceived stress scale (PSS) to measure this parameter in vitiligo patients compared to persons without vitiligo. Additionally, we probed a clinical database, using a knowledge linking software called ROCKET, to gauge stress-related conditions in the vitiligo patient population. From a pool of patients in an existing database, a hundred individuals with vitiligo and twenty-five age- and sex-matched comparison group of individuals without vitiligo completed an online survey to quantify their levels of perceived stress. In parallel, patients described specifics of their disease condition, including the affected body sites, the extent, duration and activity of their vitiligo. Perceived stress was significantly higher among vitiligo individuals compared to those without vitiligo. ROCKET analyses suggested signs of metabolic-related disease (i.e., ‘stress’) preceding vitiligo development. No correlation was found between perceived stress and the stage or the extent of disease, suggesting that elevated stress may not be a consequence of pigment loss alone. The data provide further support for stress as a precipitating factor in vitiligo development.
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Hon KL, Luk DCK, Leung AKC, Ng C, Loo SKF. Childhood Alopecia Areata: An Overview of Treatment and Recent Patents. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2020; 14:117-132. [PMID: 32723274 DOI: 10.2174/1872213x14999200728145822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/14/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alopecia Areata (AA) is a systemic autoimmune condition that usually starts in childhood. OBJECTIVE This article aims to review genetics, therapy, prognosis, and recent patents for AA. METHODS We used clinical queries and keywords "alopecia areata" AND "childhood" as a search engine. Patents were searched using the key term "alopecia areata" in Patents.google.com and freepatentsonline. com. RESULTS Due to an immune-mediated damage to the hair follicles, hair is lost from the scalp and other areas of the body temporarily or even permanently. Children with AA are generally healthy. Evidence of genetic association and increased predisposition for AA was found by studying families with affected members. Pathophysiologically, T- lymphocytes attack hair follicles and cause inflammation and destruction of the hair follicles and hair loss. In mild cases, there would be well-demarcated round patchy scalp hair loss. The pathognomonic "exclamation mark hairs" may be seen at the lesion periphery. In more severe cases, the hair loss may affect the whole scalp and even the whole body. The clinical course is also variable, which may range from transient episodes of recurrent patchy hair loss to an indolent gradually deteriorating severe hair loss. The treatment of AA depends on factors including patients' age, the extent of the hair loss, duration of disease, psychological impact, availability and side effect profile of the treatments. For localized patchy alopecia, topical application of corticosteroids and/or intralesional corticosteroids are the treatment of choice. Other topical treatments include minoxidil, anthralin, coal tar and immunotherapy. In severe resistant cases, systemic immunosuppressants may be considered. Although herbal medicine, acupuncture, complementary and alternative medicine may be tried on children in some Asian communities, the evidence to support these practices is lacking. To date, only a few recent patents exist in topical treatments, including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities. CONCLUSION None of the established therapeutic options are curative. However, newer treatment modalities, including excimer laser, interleukin-31 antibodies and biologics, are evolving so that there may be significant advances in treatment in the near future. AA can be psychosocially devastating. It is important to assess the quality of life, degree of anxiety, social phobia and mood of the patients and their families. Psychological support is imperative for those who are adversely affected psychosocially.
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Affiliation(s)
- Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - David C K Luk
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantel Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Steven K F Loo
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Aljasser M, Almutairi S. Does psychological stress trigger or exacerbate vitiligo: More data are needed. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_26_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xie WR, Yang XY, Xia HHX, Wu LH, He XX. Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: A case report and review of the literature. World J Clin Cases 2019; 7:3074-3081. [PMID: 31624757 PMCID: PMC6795734 DOI: 10.12998/wjcc.v7.i19.3074] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/25/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Alopecia areata is a hair loss disease associated with genetics, autoimmunity, and other factors. There is an intriguing link between alopecia areata and gut dysbiosis. Fecal microbiota transplantation (FMT) has been recommended to treat Clostridium difficile (previously known as Clostridioides difficile) infection, and has also shown potentials in the treatment of inflammatory bowel disease, irritable bowel syndrome, and non-alcohol fatty liver disease.
CASE SUMMARY An 86-year-old man, with a history of sigmoid colon carcinoma, suffered from recurrent abdominal pain and distension, and diarrhea for six months, with inappetence. At admission, he was also diagnosed with depression. Upon physical examination, the patient presented with a 1.5 cm × 2.0 cm alopecia areata on his right occiput. Due to the negative results of laboratory testing, capsule endoscopy, and colonoscopy, the patient was diagnosed with noninfectious diarrhea, depressive disorder, and patchy alopecia areata. Considering that noninfectious diarrhea in the elderly patient was mainly caused by gut dysbiosis, he was given six rounds of FMT. His diarrhea improved remarkably one month after FMT, with improved appetite and disappearance of abdominal pain, distension, and depressive symptoms. Surprisingly, he reported new hair growth on the affected region of his scalp, with some of his white hair gradually turning to black, without taking any other therapies for alopecia areata before and after FMT.
CONCLUSION FMT might act as a potential therapy for patients who suffer from alopecia areata. Large and well-designed studies are required to confirm the role of FMT in alopecia areata.
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Affiliation(s)
- Wen-Rui Xie
- Department of Gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Xiao-Ya Yang
- Department of Physiology, Guangzhou Health Sciences College, Guangzhou 510180, Guangdong Province, China
| | - Harry Hua-Xiang Xia
- Department of Gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Li-Hao Wu
- Department of Gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Xing-Xiang He
- Department of Gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
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Relationship between working hours and probability to take alopecia medicine among Korean male workers: a 4-year follow-up study. Ann Occup Environ Med 2019; 31:e12. [PMID: 31583103 PMCID: PMC6761478 DOI: 10.35371/aoem.2019.31.e12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022] Open
Abstract
Background Many studies have reported the negative effects of long working hours on various health problems. However, whether hair loss is associated with working hours has been rarely investigated so far. The main purpose of this study is to explore the relationship between long working hours and the development of alopecia among Korean male workers. Methods A total of 13,391 male workers not to take alopecia medicine in 2013 were followed up to see if they have alopecia medicine after 4 years, and that was used to confirm the alopecia development. Weekly working hours were categorized into three groups: reference working hours (RWH; < 40 hours/week), long working hours (LWH, 40–52 hours/week), and much longer working hours (MLWH; > 52 hours/week). Multiple logistic regression analyses were conducted to investigate the relationship between long working hours and the development of alopecia after adjusting age, marital status, education, monthly household income, smoking, and work schedule within strata of the covariates. Results Long working hours was significantly related to the development of alopecia. The adjusted odds ratios (ORs) for the development of alopecia were 1.57 (95% confidence interval [CI]: 1.21–2.05) for LWH group and 1.74 (95% CI: 1.23–2.47) for MLWH group relative to RWH group. Conclusions Our findings suggest that unintentional development of alopecia is another potential health consequence of long working hours among Korean male workers. Preventive interventions to promote appropriate and reasonable working hours are required in our society.
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Gürpınar A, Doğan Günaydın S, Kılıç C, Karaduman A. Association of serum cortisol and dehydroepiandrosterone sulfate (DHEAS) levels with psychological stress in patients with vitiligo. Turk J Med Sci 2019; 49:832-837. [PMID: 31203593 PMCID: PMC7018254 DOI: 10.3906/sag-1812-84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background/aim Vitiligo is a depigmentation disorder that leads to serious psychological burden in patients, who are frequently reported to have depression and anxiety. The aim of this study was to investigate the association between stress-related hormone levels and psychological stress in vitiligo. Materials and methods In this study 46 vitiligo patients and 46 controls were enrolled; their cortisol, dehydroepiandrosterone sulfate (DHEAS), and cortisol/DHEAS levels were measured. Psychological burden was assessed by the Beck Depression Inventory and Perceived Stress Scale. Results Patients and controls did not differ in terms of cortisol, DHEAS, or cortisol/DHEAS. Patients had higher perceived stress than controls but did not differ in terms of depression scores. Correlation analyses revealed that cortisol/DHEAS correlated positively with perceived stress (P = 0.009, r = 0.272). The correlation between cortisol/DHEAS and perceived stress was stronger in the patient group (P = 0.013, r = 0.363) and close to zero among controls. In regression analyses, lower depression and higher perceived stress were shown to predict cortisol/DHEAS values. Conclusion Vitiligo patients significantly differed from the healthy population in terms of hormones and psychological distress. There was also an association between perceived stress and cortisol/DHEAS ratio in vitiligo. Abnormality of hormonal response to distress lowers DHEAS, which is known for its antioxidant properties, a possible mechanism for vitiligo development. Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components. We suggest its use in future studies on psychological distress–hormone relationships.
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Affiliation(s)
- Ahmet Gürpınar
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Doğan Günaydın
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cengiz Kılıç
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşen Karaduman
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Lei ZX, Chen WJ, Liang JQ, Wang YJ, Jin L, Xu C, Kang XJ. The association between rs2476601 polymorphism in PTPN22 gene and risk of alopecia areata: A meta-analysis of case-control studies. Medicine (Baltimore) 2019; 98:e15448. [PMID: 31096440 PMCID: PMC6531179 DOI: 10.1097/md.0000000000015448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The single nucleotide polymorphism (SNP) rs2476601 of the protein tyrosine phosphatase, nonreceptor type 22 (PTPN22) gene has been presented to implicate in the pathogenesis of alopecia areata (AA) in a few association investigations with limited sample size and inconsistent conclusions. METHODS The aim of the current meta-analysis was to assess and synthesize the presently available data on the connection between rs2476601 and AA vulnerability. Six electronic databases, including EMBASE, PubMed, Web of Science, the Cochrane Library, Wanfang data, and the China National Knowledge Infrastructure database (CNKI), were systematically retrieved for relevant observational studies published previous to November 2018. Total odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were analyzed to evaluate the correlation between PTPN22 polymorphism and AA. Risk of bias was estimated according to the Newcastle-Ottawa Scale (NOS). Sensitivity analyses were carried out using the RevMan 5.3 software. RESULTS In general, 5 case-control studies including 1129 AA patients and 1702 healthy control individuals were obtained for this meta-analysis. The pooled results suggested that rs2476601 SNP was significantly associated with AA susceptibility under allelic model (C vs T, OR = 0.77, 95% CI, 0.64-0.92, P = .003) and recessive model (CC vs CT + TT, OR = 0.73, 95% CI, 0.60-0.88, P = .001). CONCLUSION On the basis of the results of the current research, the rs2476601 polymorphism of PTPN22 gene is significantly correlated with AA susceptibility. The C-allele and CC-genotype carriers at this locus have a lower risk of AA.
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Affiliation(s)
- Zi-Xian Lei
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
- Xinjiang Medical University, Urumqi, China
| | - Wen-Jing Chen
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
- Xinjiang Medical University, Urumqi, China
| | - Jun-Qin Liang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
| | - Yan-Jun Wang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
- Xinjiang Medical University, Urumqi, China
| | - Lan Jin
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
- Xinjiang Medical University, Urumqi, China
| | - Chen Xu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
- Xinjiang Medical University, Urumqi, China
| | - Xiao-Jing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
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Effects of anxiety and depression symptoms on oxidative stress in patients with alopecia areata. Postepy Dermatol Alergol 2019; 37:412-416. [PMID: 32792885 PMCID: PMC7394168 DOI: 10.5114/ada.2019.83879] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/20/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Increased oxidative stress (OXS) and a high prevalence of psychiatric disorders are seen in alopecia areata (AA). However, OXS and psychiatric disorders have been studied separately in AA patients. Aim To determine the effects of anxiety and depression symptoms on OXS in AA patients. Material and methods The anxiety and depression levels of 33 AA patients and 33 normal controls (NC) were determined using the Hospital Anxiety and Depression Scale. The oxidative stress index (OSI) was calculated by measuring serum total antioxidant status (TAS) and total oxidant status (TOS) levels in AA patients and NC. Results The AA patients had higher anxiety and depression scores than NC (p < 0.001 for both). Total oxidant status (p = 0.002) and OSI (p < 0.001) values were higher, and TAS (p < 0.001) levels were lower, in patients with AA compared to NC. However, patients’ anxiety and depression scores were not correlated with the TAS, TOS, or OSI values (p > 0.05). There was no significant difference in TAS, TOS, or OSI values between patients with high and low anxiety or depression scores (p > 0.05). Conclusions These results show that OXS, anxiety, and depression scores were higher in patients with AA compared to NC. However, anxiety and depression scores were not associated with OXS in AA patients. More extensive studies should be performed to investigate the relationship between psychological status and OXS in patients with AA.
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Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun 2018; 98:74-85. [PMID: 30558963 DOI: 10.1016/j.jaut.2018.12.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
Alopecia areata is an autoimmune disease that results in non-scarring hair loss, and it is clinically characterised by small patches of baldness on the scalp and/or around the body. It can later progress to total loss of scalp hair (Alopecia totalis) and/or total loss of all body hair (Alopecia universalis). The rapid rate of hair loss and disfiguration caused by the condition causes anxiety on patients and increases the risks of developing psychological and psychiatric complications. Hair loss in alopecia areata is caused by lymphocytic infiltrations around the hair follicles and IFN-γ. IgG antibodies against the hair follicle cells are also found in alopecia areata sufferers. In addition, the disease coexists with other autoimmune disorders and can come secondary to infections or inflammation. However, despite the growing knowledge about alopecia areata, the aetiology and pathophysiology of disease are not well defined. In this review we discuss various genetic and environmental factors that cause autoimmunity and describe the immune mechanisms that lead to hair loss in alopecia areata patients.
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Affiliation(s)
- Teontor Simakou
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK
| | - John P Butcher
- Department of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Stuart Reid
- SUPA, Department of Biomedical Engineering, University of Strathclyde, UK
| | - Fiona L Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK.
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Baldini E, Odorisio T, Tuccilli C, Persechino S, Sorrenti S, Catania A, Pironi D, Carbotta G, Giacomelli L, Arcieri S, Vergine M, Monti M, Ulisse S. Thyroid diseases and skin autoimmunity. Rev Endocr Metab Disord 2018; 19:311-323. [PMID: 29948572 DOI: 10.1007/s11154-018-9450-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The skin is the largest organ of the body, at the boundary with the outside environment. Primarily, it provides a physical and chemical barrier against external insults, but it can act also as immune organ because it contains a whole host of immune-competent cells of both the innate and the adaptive immune systems, which cooperate in eliminating invading pathogens following tissue injury. On the other hand, improper skin immune responses lead to autoimmune skin diseases (AISD), such as pemphigus, bullous pemphigoid, vitiligo, and alopecia. Although the interplay among genetic, epigenetic, and environmental factors has been shown to play a major role in AISD etiology and progression, the molecular mechanisms underlying disease development are far from being fully elucidated. In this context, epidemiological studies aimed at defining the association of different AISD with other autoimmune pathologies revealed possible shared molecular mechanism(s) responsible for disease progression. In particular, over the last decades, a number of reports have highlighted a significant association between thyroid diseases (TD), mainly autoimmune ones (AITD), and AISD. Here, we will recapitulate the epidemiology, clinical manifestations, and pathogenesis of the main AISD, and we will summarize the epidemiological evidence showing the associations with TD as well as possible molecular mechanism(s) underlying TD and AISD pathological manifestations.
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Affiliation(s)
- Enke Baldini
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Teresa Odorisio
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Chiara Tuccilli
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | | | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Antonio Catania
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Carbotta
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Stefano Arcieri
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Massimo Vergine
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Massimo Monti
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Salvatore Ulisse
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
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Zhou L, Cai M, Ren Y, Wu H, Liu M, Chen H, Shang J. The different roles of 5-HT1A/2A receptors in fluoxetine ameliorated pigmentation of C57BL/6 mouse skin in response to stress. J Dermatol Sci 2018; 92:222-229. [PMID: 30527375 DOI: 10.1016/j.jdermsci.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND 5-HT1A receptor was participated in fluoxetine induced melanogenesis in melanocytes and in normal C57BL/6 mice, but we know little about whether other 5-HT receptors are involved in regulation of fluoxetine promotes pigmentation. OBJECTIVE To investigate the role of 5-HT receptors in regulation of fluoxetine ameliorates chronic unpredictable mild stress (CUMS) and chronic restraint stress (CRS) induce hypopigmentation in C57BL/6 mice. METHODS CUMS and CRS were used to induce depigmentation in mice and evaluate the effect of fluoxetine. Western blot, immunohistochemistry and Q-PCR assay were used to determine the levels of protein and mRNA. Masson Fontana staining was used for melanin staining and FITC-Phalloidin staining was used to detect the expression of F-actin. Zebrafish and B16F10 cells were used for the mechanism research. RESULTS Fluoxetine (2.6 mg/kg, ig) ameliorated hypopigmentation induced by CUMS and CRS in mice, significantly increased the mRNA and protein levels of 5-HT1 A and 5-HT2 A receptors in mice and B16F10 cells. The effect of fluoxetine on melanogenesis in B16F10 cells and zebrafish were inhibited by WAY100635 (a selective 5-HT1 A receptor antagonist) and ketanserin (a 5-HT2 A receptor antagonist), respectively. Activation of p38 MAPK signaling pathways was contributed to fluoxetine induced melanogenesis and inhibited by WAY100635, but not ketanserin. However, ketanserin selectively weakened the action of fluoxetine promoted migration and up-regulated Rab27a protein expression in B16F10 cells. CONCLUSIONS 5-HT1 A and 2 A receptors contribute to melanogenesis and migration property of fluoxetine. The newly revealed mechanism indicates that fluoxetine and its analogues may be a potential drug for treatment of depigmentation disorders.
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Affiliation(s)
- Liangliang Zhou
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Minxuan Cai
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Yingying Ren
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Huali Wu
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, PR China
| | - Meng Liu
- Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Haijuan Chen
- Qinghai Key Laboratory of Tibetan Medicine Pharmacology and Safety Evaluation, Northwest Institute of Plateau Biology, University of the Chinese Academy of Sciences, Xining 810008, PR China
| | - Jing Shang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, PR China.
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37
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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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Lu YY, Lu CC, Yu WW, Zhang L, Wang QR, Zhang CL, Wu CH. Keloid risk in patients with atopic dermatitis: a nationwide retrospective cohort study in Taiwan. BMJ Open 2018; 8:e022865. [PMID: 30021755 PMCID: PMC6059319 DOI: 10.1136/bmjopen-2018-022865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The pathogenesis of keloid is largely unknown. Because keloid and atopic dermatitis have overlapping pathophysiological mechanisms, we aimed to evaluate keloid risk in patients with atopic dermatitis. STUDY DESIGN Population-based retrospective cohort study. SETTING The Taiwan National Health Insurance Research Database was used to analyse data for people who had been diagnosed with atopic dermatitis. PARTICIPANTS We identified 8371 patients with newly diagnosed atopic dermatitis during 1996-2010. An additional 33 484 controls without atopic dermatitis were randomly identified and frequency matched at a one-to-four ratio. PRIMARY AND SECONDARY OUTCOME MEASURE The association between atopic dermatitis and keloid risk was estimated using Cox proportional hazard regression models. RESULTS After adjustment for covariates, the atopic dermatitis patients have a 3.19-fold greater risk of developing keloid compared with the non-atopic dermatitis group (3.19vs1.07 per 1000 person-years, respectively). During the study period, 163 patients with atopic dermatitis and 532 patients without atopic dermatitis developed keloid. Notably, keloid risk increased with severity of atopic dermatitis, particularly in patients with moderate to severe atopic dermatitis. CONCLUSIONS Our results indicate that patients with atopic dermatitis had a higher than normal risk of developing keloid and suggest that atopic dermatitis may be an independent risk factor for keloid.
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Affiliation(s)
- Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ching Lu
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li Zhang
- Department of Neurosurgery, Zhangjiagang First People’s Hospital, Zhangjiagang, China
| | - Qing-Rui Wang
- Department of Neurosurgery, Qinghe County Central Hospital, Qinghe, China
| | - Cong-Liang Zhang
- Department of Cardiology, Hebei Quyang Renji Hospital, Quyang, China
| | - Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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39
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Kundu RV, Mhlaba JM, Rangel SM, Le Poole IC. The convergence theory for vitiligo: A reappraisal. Exp Dermatol 2018; 28:647-655. [PMID: 29704874 DOI: 10.1111/exd.13677] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/15/2022]
Abstract
Vitiligo is characterized by progressive loss of skin pigmentation. The search for aetiologic factors has led to the biochemical, the neurologic and the autoimmune theory. The convergence theory was then proposed several years ago to incorporate existing theories of vitiligo development into a single overview of vitiligo aetiology. The viewpoint that vitiligo is not caused only by predisposing mutations, or only by melanocytes responding to chemical/radiation exposure, or only by hyperreactive T cells, but rather results from a combination of aetiologic factors that impact melanocyte viability, has certainly stood the test of time. New findings have since informed the description of progressive depigmentation. Understanding the relative importance of such aetiologic factors combined with a careful selection of the most targetable pathways will continue to drive the next phase in vitiligo research: the development of effective therapeutics. In that arena, it is likewise important to acknowledge that pathways affected in some patients may not be altered in others. Taken together, the convergence theory continues to provide a comprehensive viewpoint of vitiligo aetiology. The theory serves to intertwine aetiologic pathways and will help to define pathways amenable to disease intervention in individual patients.
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Affiliation(s)
- Roopal V Kundu
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Julia M Mhlaba
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | | | - I Caroline Le Poole
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Department of Microbiology and Immunology, Northwestern University, Chicago, IL, USA
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40
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Khurrum H, AlGhamdi KM. Prepubertal and postpubertal vitiligo: a multivariate comparative study in 375 patients. An Bras Dermatol 2018; 92:811-815. [PMID: 29364437 PMCID: PMC5786395 DOI: 10.1590/abd1806-4841.20176154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022] Open
Abstract
Background The onset of vitiligo during childhood is common. Limited data exist that
compare the clinical associations of prepubertal and postpubertal vitiligo
in Arabs. Objective To compare the clinical profile of pre and postpubertal onset vitiligo. Methods A cross-sectional observational study was conducted. The Vitiligo European
Task Force questionnaire was completed for each patient. Results A total of 375 patients were included; 199 had postpubertal vitiligo (>12
years), and 176 had prepubertal onset vitiligo (<12years). There were
more females in the prepubertal group (49%) than in the postpubertal group
(29%), p-value <0.001. The prepubertal group has had more involvement
than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental
vitiligo were observed; five were observed in the prepubertal group of
patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus
(OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9)
were positively associated with prepubertal vitiligo. Stress, as an onset
factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with
postpubertal onset vitiligo. Study limitations A possible selection bias toward more severe vitiligo cases can be a
limitation, because the study was conducted in a clinic specialized in
vitiligo. Moreover, a likelihood of false recall bias cannot be
excluded. Conclusions Our data present clinical evidence that vitiligo behaves mostly the same way
in the prepubertal group as in the postpubertal group. However, female
over-representation, more face involvement and more halo nevi were observed
in prepubertal vitiligo, while stress was more prevalent as an aggravating
factor in postpubertal vitiligo patients.
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Affiliation(s)
- Huma Khurrum
- Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M AlGhamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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41
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Chelidze K, Lipner SR. Nail changes in alopecia areata: an update and review. Int J Dermatol 2018; 57:776-783. [DOI: 10.1111/ijd.13866] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/11/2017] [Accepted: 11/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Khatiya Chelidze
- Department of Dermatology; Weill Cornell Medicine; New York NY USA
| | - Shari R. Lipner
- Department of Dermatology; Weill Cornell Medicine; New York NY USA
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42
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Liao S, Lv J, Zhou J, Kalavagunta PK, Shang J. Effects of two chronic stresses on mental state and hair follicle melanogenesis in mice. Exp Dermatol 2017; 26:1083-1090. [DOI: 10.1111/exd.13380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Sha Liao
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of TCM Evaluation and Translational Research; China Pharmaceutical University; Nanjing China
- Key Laboratory of Resource Biology and Biotechnology in Western China; Ministry of Education; Northwest University; Xi'an China
| | - Jinpeng Lv
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of TCM Evaluation and Translational Research; China Pharmaceutical University; Nanjing China
| | - Jia Zhou
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of TCM Evaluation and Translational Research; China Pharmaceutical University; Nanjing China
| | - Praveen Kumar Kalavagunta
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of TCM Evaluation and Translational Research; China Pharmaceutical University; Nanjing China
| | - Jing Shang
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of TCM Evaluation and Translational Research; China Pharmaceutical University; Nanjing China
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43
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Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. New discoveries in the pathogenesis and classification of vitiligo. J Am Acad Dermatol 2017; 77:1-13. [DOI: 10.1016/j.jaad.2016.10.048] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 02/07/2023]
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44
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Mavrogiorgou P, Juckel G. [Dermatological diseases and their importance for psychiatry]. DER NERVENARZT 2017; 88:254-267. [PMID: 26975652 DOI: 10.1007/s00115-016-0082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.
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Affiliation(s)
- P Mavrogiorgou
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland
| | - G Juckel
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland.
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45
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Abstract
Vitiligo is a chronic common skin disease. The asymptomatic hypopigmented cutaneous lesions are considered by many health care professionals as a cosmetic problem only; however, vitiligo can have a major psychosocial impact on patients' lives. We review some of the factors responsible for this impact, such as the general public's wrong perception of the disease, feelings and emotional responses from patients, how stressful events can act as triggers of the disease, stigmatization experiences suffered by the patients, the prevalence of psychiatric morbidity, the effects on relationships and sex life, how quality of life in adults and children is impaired, and how treatment can improve it.
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Affiliation(s)
- Felipe Cupertino
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - João Paulo Niemeyer-Corbellini
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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46
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Baldini E, Odorisio T, Sorrenti S, Catania A, Tartaglia F, Carbotta G, Pironi D, Rendina R, D’Armiento E, Persechino S, Ulisse S. Vitiligo and Autoimmune Thyroid Disorders. Front Endocrinol (Lausanne) 2017; 8:290. [PMID: 29163360 PMCID: PMC5663726 DOI: 10.3389/fendo.2017.00290] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022] Open
Abstract
Vitiligo represents the most common cause of acquired skin, hair, and oral depigmentation, affecting 0.5-1% of the population worldwide. It is clinically characterized by the appearance of disfiguring circumscribed skin macules following melanocyte destruction by autoreactive cytotoxic T lymphocytes. Patients affected by vitiligo usually show a poorer quality of life and are more likely to suffer from depressive symptoms, particularly evident in dark-skinned individuals. Although vitiligo is a non-fatal disease, exposure of affected skin to UV light increases the chance of skin irritation and predisposes to skin cancer. In addition, vitiligo has been associated with other rare systemic disorders due to the presence of melanocytes in other body districts, such as in eyes, auditory, nervous, and cardiac tissues, where melanocytes are thought to have roles different from that played in the skin. Several pathogenetic models have been proposed to explain vitiligo onset and progression, but clinical and experimental findings point mainly to the autoimmune hypothesis as the most qualified one. In this context, it is of relevance the strong association of vitiligo with other autoimmune diseases, in particular with autoimmune thyroid disorders, such as Hashimoto thyroiditis and Graves' disease. In this review, after a brief overview of vitiligo and its pathogenesis, we will describe the clinical association between vitiligo and autoimmune thyroid disorders and discuss the possible underlying molecular mechanism(s).
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Affiliation(s)
- Enke Baldini
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Teresa Odorisio
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata-IRCCS, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Antonio Catania
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Giovanni Carbotta
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Roberta Rendina
- Department of Internal Medicine and Medical Specialties, “Sapienza” University of Rome, Rome, Italy
| | - Eleonora D’Armiento
- Department of Internal Medicine and Medical Specialties, “Sapienza” University of Rome, Rome, Italy
| | | | - Salvatore Ulisse
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Salvatore Ulisse,
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Rokni GR, Golpour M, Gorji AH, Khalilian A, Ghasemi H. Effectiveness and safety of topical tacrolimus in treatment of vitiligo. J Adv Pharm Technol Res 2017; 8:29-33. [PMID: 28217552 PMCID: PMC5288968 DOI: 10.4103/2231-4040.197388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vitiligo is one of the most primitive well-known dermatoid disorders with different suggested therapies. Therefore, this study investigated the efficiency and safety of topical tacrolimus in treatment of patients with vitiligo. This study was a clinical randomized designed study pre- post-test method, has been conducted on thirty cases with vitiligo who have referred to polyclinic and dermatology clinic. Participant's evaluated and demographic information recorded in designed checklist. In the next stage, the disease activity scored by vitiligo index disease activity system. Photography and depigmentation percent has recorded before treatment and further in 4th, 8th, 12th, 16th, 20th, and 24th weeks. Finally, gathered data compared through SPSS-20 software. The final sample comprised 30 persons including: 12 men (40%) and 18 women (60%). The average of patient's age in this study was 26/13 ± 18/20 (2-76-year-old). Eleven persons was ≤15 years old and rest was older than 15. Sixty-six lesions have funded in patients that maximum has accrued on face and neck (37/87%) and trunk (21/21%). In addition, minimum of lesions is related to genitalia (9/09%). In the in 4th, 8th, 12th, 16th weeks, improvement in face and neck had increased significantly, into the past weeks. In the 20th and 24th weeks, the improvement has increased although it was not significant enhancement. Also about trunk, in the 4th week the improvement does not have significant increasing in compare to the past week. In the eighth, 12th, 16th, 20th, and 24th weeks the improvement has been increased significantly in compare to the past weeks. Although in the case of limbs and genitalia, the improvement was lower. There was no significant difference between male and females and age. Although the improvement was, slow in older persons. Study results, has presented applying topical tacrolimus in vitiligo, particularly in face and neck, could be effective and does not seen any specified adverse effects during consumption of tacrolimus, it could be effective in decreasing effects in use of corticosteroid.
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Affiliation(s)
| | - Massoud Golpour
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Alireza Khalilian
- Department of Epidemiology and Biostatistics, Health Science Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamta Ghasemi
- GP, Mazandaran University of Medical Sciences, Sari, Iran
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48
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Shin H, Choi SJ, Cho AR, Kim DY, Kim KH, Kwon O. Acute Stress-Induced Changes in Follicular Dermal Papilla Cells and Mobilization of Mast Cells: Implications for Hair Growth. Ann Dermatol 2016; 28:600-606. [PMID: 27746640 PMCID: PMC5064190 DOI: 10.5021/ad.2016.28.5.600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/12/2016] [Accepted: 02/15/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Stress is a known cause of hair loss in many species. OBJECTIVE In this study, we investigated the role of acute stress on hair growth using a rat model. METHODS Rats were immobilized for 24 hours and blood samples, and skin biopsies were taken. The effect of stress-serum on the in vitro proliferation of rat and human dermal papilla cells (hDPCs), as well as serum cortisol and corticotropin-releasing hormone levels, were measured. Mast cell staining was performed on the biopsied tissue. In addition, Western blot and quantitative real time polymerase chain reaction were used to assess mast cell tryptase and cytokine expression, respectively in rat skin biopsies. RESULTS Stress-serum treatment reduced significantly the number of viable hDPCs and arrested the cell cycle in the G1 phase, compared to serum from unrestrained rats (p<0.05, respectively). Moreover, restrained rats had significantly higher levels of cortisol in serum than unrestrained rats (p<0.01). Acute stress serum increased mast cell numbers and mast cell tryptase expression, as well as inducing interleukin (IL)-6 and IL-1β up-regulation. CONCLUSION These results suggest that acute stress also has an inhibitory effect on hair growth via cortisol release in addition to substance P-mast cell pathway.
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Affiliation(s)
- Hyoseung Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Soon-Jin Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - A-Ri Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Young Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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49
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Shaker OG, Eltahlawi SMR, Tawfic SO, Eltawdy AM, Bedair NIE. Corticotropin-releasing hormone (CRH) and CRH receptor 1 gene expression in vitiligo. Clin Exp Dermatol 2016; 41:734-40. [DOI: 10.1111/ced.12907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 01/20/2023]
Affiliation(s)
- O. G. Shaker
- Department of Biochemistry Medical Biochemistry and Molecular Biology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - S. M. R. Eltahlawi
- Department of Dermatology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - S. O. Tawfic
- Department of Dermatology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - A. M. Eltawdy
- Department of Dermatology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - N. I. E. Bedair
- Department of Dermatology; Students’ Hospital; Cairo University; Cairo Egypt
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50
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Adult Onset Vitiligo: Multivariate Analysis Suggests the Need for a Thyroid Screening. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8065765. [PMID: 27747240 PMCID: PMC5055927 DOI: 10.1155/2016/8065765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/30/2016] [Indexed: 12/02/2022]
Abstract
Background. There are limited epidemiological studies evaluating the effect of age at onset on disease features in vitiligo. Objectives. To identify factors associated with adult onset vitiligo in comparison with childhood onset vitiligo. Patients and Methods. We retrospectively collected medical records of 191 patients. Such records included clinical examination, personal and familial medical history, laboratory evaluations, concomitant vitiligo treatment and drug assumption. Results. 123 patients with a disease onset after the age of 40 (adult onset vitiligo) were compared with 68 patients who developed vitiligo before the age of 12 (childhood onset vitiligo). Multivariate analysis revealed that personal history of thyroid diseases (P = 0.04; OR 0.4), stress at onset (P = 0.002; OR = 0.34), personal history of autoimmune thyroid disease (ATD) (P = 0.003; OR = 0.23), and thyroid nodules (P = 0.001; OR 0.90) were independently associated with adult onset vitiligo, whereas family history of dermatological diseases (P = 0.003; OR = 2.87) and Koebner phenomenon (P < 0.001; OR = 4.73) with childhood onset vitiligo. Moreover, in the adult onset group, concomitant thyroid disease preceded vitiligo in a statistically significant number of patients (P = 0.014). Conclusions. Childhood onset and adult onset vitiligo have different clinical features. In particular, ATD and thyroid nodules were significantly associated with adult onset vitiligo, suggesting that a thyroid screening should be recommended in this group of patients.
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