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Asz-Sigall D, Ortega-Springall MF, Smith-Pliego M, Rodríguez-Lobato E, Martinez-Velasco MA, Arenas R, Vincenzi C, Tosti A. White hair in alopecia areata: Clinical forms and proposed physiopathologic mechanisms. J Am Acad Dermatol 2023; 89:758-763. [PMID: 30630022 DOI: 10.1016/j.jaad.2018.12.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
Alopecia areata (AA) is a common form of nonscarring hair loss. It is believed to be a consequence of an immune-mediated stimulus, probably involving autoreactive T cells against antigens present in the hair follicle. The exact antigen is still unknown; however, some authors have proposed that melanogenesis-associated molecules might trigger autoimmunity. Although transient white hair regrowth is a common and well-known situation in AA, there are other types of white hair phenomena in this context, including permanent white hair regrowth, sparing of white hair in a patchy pattern, or sparing in a diffuse pattern, giving the appearance of the so-called overnight graying phenomena or canitis subita. In this review, we aim to describe the different clinical aspects of white hair in AA, as well as the proposed pathophysiologic mechanisms involved in this phenomena.
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Affiliation(s)
- Daniel Asz-Sigall
- Oncodermatology and Trichology Clinic, National University of Mexico, Mexico City, Mexico.
| | | | - Mariam Smith-Pliego
- Dermatology Department, Dr. Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
| | | | | | - Roberto Arenas
- Mycology Section, Dr. Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
| | - Colombina Vincenzi
- Dermatology Division, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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Shakhashiro M, Pasagic S, Wilson CL. Ophiasis Pattern Alopecia Areata in an Infant. Cureus 2023; 15:e44920. [PMID: 37814732 PMCID: PMC10560580 DOI: 10.7759/cureus.44920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Alopecia areata (AA), an autoimmune inflammatory disorder causing non-scarring hair loss, predominantly affects the adult population and is rarely encountered in young infants and neonates. The etiology of this condition remains multifactorial, involving complex interactions between genetic, autoimmune, and environmental factors. In this report, we present a notable case of a four-month-old infant who presented with distinct band-like hair loss on the right inferior lateral forehead, left inferior lateral forehead, and superior middle forehead following a culturally significant head-shaving ritual known as Chudakarana. This unique presentation of ophiasis AA in an infant is an unusual occurrence and has been associated with a poor prognosis. The patient received topical treatment with triamcinolone 0.1% lotion, resulting in improvement of alopecia at the six-week follow-up, although complete resolution of symptoms was not achieved. This case highlights the significance of recognizing atypical presentations of AA in the pediatric population and underscores the complexities in associated cultural factors.
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Affiliation(s)
- Muna Shakhashiro
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Sandro Pasagic
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
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Done N, Bartolome L, Swallow E, Gao W, Carley C, Wang T, Mostaghimi A. Real-World Treatment Patterns among Patients with Alopecia Areata in the USA: A Retrospective Claims Analysis. Acta Derm Venereol 2023; 103:adv12445. [PMID: 37622204 PMCID: PMC10469222 DOI: 10.2340/actadv.v103.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 08/26/2023] Open
Abstract
Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world treatment patterns among patients in the USA with alopecia areata, including the subtypes alopecia totalis and alopecia universalis, in the first year after diagnosis of an episode of alopecia areata. Approximately 5% of all patients (adults (age ≥ 18 years), n = 7,703; adolescents (age 12-17 years), n = 595) had alopecia totalis or alopecia universalis. Corticosteroids were the most common first-line (1L) and second-line (2L) treatments. The mean time from diagnosis of alopecia areata to initiation of 1L treatment was 2.2 days for adults and 2.6 days for adolescents; mean 1L duration was 76.9 and 64.3 days, respectively. For adults (57.5%) and adolescents (59.7%) with 2L therapy, the mean time from 1L discontinuation to 2L initiation was 57.2 and 53.6 days, respectively; the mean duration of 2L treatment was 55.5 and 50.1 days, respectively. More patients with vs without alopecia totalis or alopecia universalis initiated 2L therapy (adults: 71.9% vs 56.8%; adolescents: 71.4% vs 58.9%). The proportion of days covered during the first year post-diagnosis was 36.7% (adults) and 34.1% (adolescents). These results highlight the substantial disease burden of alopecia areata and a need for more effective treatments.
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Affiliation(s)
| | | | | | - Wei Gao
- Analysis Group, Boston, MA, US
| | | | | | - Arash Mostaghimi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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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: 13] [Impact Index Per Article: 13.0] [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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Velásquez-Lopera MM, Hernández N, Jansen AM, García AL, Luna PC, Rico-Restrepo M, del Mar Saez-de-Ocariz M, Tamayo-Buendía MM, Rivitti-Machado MC. Alopecia Areata in Latin America: Where are We and Where are We Going? Dermatol Ther (Heidelb) 2022; 13:95-114. [PMID: 36527577 PMCID: PMC9758465 DOI: 10.1007/s13555-022-00845-4] [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: 09/08/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
Alopecia areata (AA) represents an underrecognized burden in Latin America (LA), severely impacting quality of life (QoL). This impact is exacerbated by limited access to specialized dermatologic care and therapies for AA within and among nations. Many of the unmet needs for AA globally also exist in LA. The region has geographic, ethnic, cultural, and economic conditions. With new AA medicines targeting immunologic pathways on the horizon, LA must prepare regarding regulatory issues, reimbursement, awareness, and education to give adequate and timely treatment for patients with AA. To address these issues, the Americas Health Foundation convened a panel of six dermatologists from Argentina, Brazil, Colombia, and Mexico who are experts in AA and its comorbidities for a 3-day virtual meeting to discuss AA diagnosis and treatment in LA and create a manuscript offering recommendations to address discussed barriers. This publication examines unmet AA needs in LA, treatment, and innovative therapies and recommends improving AA care. Access constraints to conventional and novel medicines hinder appropriate treatments for patients. Therapy initiation delays can affect QoL, mental health, and disease progression. People with AA face stigmas, discrimination, and misconceptions owing to a lack of disease awareness. With promising new treatments for AA on the horizon, all stakeholders must coordinate efforts to enhance LA's AA management landscape and improve patient outcomes.
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Affiliation(s)
- Margarita M. Velásquez-Lopera
- Centro de Investigaciones Dermatológicas CIDERM, Sección de Dermatología, Facultad de Medicina, Universidad de Antioquia, Cra. 51D # 62-29, Medellín, Colombia
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Albash R, El-Dahmy RM, Hamed MIA, Darwish KM, Alahdal AM, Kassem AB, Fahmy AM. Repurposing levocetirizine hydrochloride loaded into cationic ceramide/phospholipid composite (CCPCs) for management of alopecia: central composite design optimization, in- silico and in-vivo studies. Drug Deliv 2022; 29:2784-2795. [PMID: 36047012 PMCID: PMC9448385 DOI: 10.1080/10717544.2022.2108939] [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] [Indexed: 11/05/2022] Open
Abstract
Levocetirizine hydrochloride (LVC) is an antihistaminic drug that is repurposed for the treatment of alopecia. This investigation is targeted for formulating LVC into cationic ceramide/phospholipid composite (CCPCs) for the management of alopecia. CCPCs were fabricated by ethanol-injection approach, through a central composite experiment. CCPCs were evaluated by inspecting their entrapment efficiency (EE%), polydispersity index (PDI), particle size (PS), and zeta potential (ZP). The optimum CCPCs were additionally studied by in-vitro, ex-vivo, in-silico, and in-vivo studies. The fabricated CCPCs had acceptable EE%, PS, PDI, and ZP values. The statistical optimization elected optimum CCPCs composed of 5 mg hyaluronic acid, 10 mg ceramide III, and 5 mg dimethyldidodecylammonium bromide employing phytantriol as a permeation enhancer. The optimum CCPCs had EE%, PS, PDI, and ZP of 88.36 ± 0.34%, 479.00 ± 50.34 nm, 0.377 ± 0.0035, and 20.20 ± 1.13 mV, respectively. The optimum CCPC maintained its stability for up to 90 days. It also viewed vesicles of tube shape via transmission electron microscope. The in-silico assessment resulted in better interaction and stability between LVC and vesicle components in water. The ex-vivo and in-vivo assessments showed satisfactory skin retention of LVC from optimum CCPCs. The histopathological assessment verified the safety of optimum CCPCs to be topically applied. Overall, the optimum CCPCs could be utilized as a potential system for the topical management of alopecia, with a prolonged period of activity, coupled with reduced LVC shortcomings.
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Affiliation(s)
- Rofida Albash
- Department of Pharmaceutics, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, 6th of October City, Egypt
| | - Rania Moataz El-Dahmy
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, October 6 University, Cairo, Egypt
| | - Mohammed I A Hamed
- Department of Organic and Medicinal Chemistry, Faculty of Pharmacy, Fayoum University, Faiyum, Egypt
| | - Khaled M Darwish
- Department of Medicinal Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Abdulrahman M Alahdal
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amira B Kassem
- Department of Clinical Pharmacy and Pharmacy Practice Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Abdurrahman M Fahmy
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Giza, Egypt
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Xie B, Sun J, Song X. Hair Follicle Melanocytes Initiate Autoimmunity in Alopecia Areata: a Trigger Point. Clin Rev Allergy Immunol 2022; 63:417-430. [PMID: 36121544 DOI: 10.1007/s12016-022-08954-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
Alopecia areata (AA) is characterized by common non-scarring alopecia due to autoimmune disorders. To date, the specific pathogenesis underlying AA remains unknown. Thus, AA treatment in the dermatological clinic is still a challenge. Numerous clinical observations and experimental studies have established that melanocytes may be the trigger point that causes hair follicles to be attacked by the immune system. A possible mechanism is that the impaired melanocytes, under oxidative stress, cannot be repaired in time and causes apoptosis. Melanocyte-associated autoantigens are released and presented, inducing CD8+ T cell attacks. Thereafter, amplification of the immune responses further spreads to the entire hair follicle (HF). The immune privilege of HF subsequently collapses, leading to AA. Herein, we present a narrative review on the roles of melanocytes in AA pathogenesis, aiming to provide a better understanding of this disease from the melanocyte's perspective.
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Affiliation(s)
- Bo Xie
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Ave 38, Hangzhou, 310009, People's Republic of China
| | - Jiayi Sun
- Graduate School, Zhejiang Chinese Medical University, Binwen Rd 548, Hangzhou, 310053, People's Republic of China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, West Lake Ave 38, Hangzhou, 310009, People's Republic of China.
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Alghamdi MA, AL-Eitan LN, Aljamal HA, Shati AA, Alshehri MA. Genetic association of IL2RA, IL17RA, IL23R, and IL31RA single nucleotide polymorphisms with alopecia areata. Saudi J Biol Sci 2022; 29:103460. [PMID: 36248775 PMCID: PMC9562353 DOI: 10.1016/j.sjbs.2022.103460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
The signalling of cytokine receptors plays a crucial role in regulating tolerance and immunity. Impaired immunological processes result in autoimmune inflammation that target the hair follicles, causing many hair disorders, mainly alopecia areata (AA). Therefore, polymorphisms in cytokine receptor genes are suggested to have a significant impact on the pathogenesis of AA, a disease with a multifactorial basis and uncertain etiology. In the present study, 152 AA patients of the Jordanian population were investigated for their genetic susceptibility to develop AA compared to 150 control subjects. Genomic DNA extraction and genotyping had conducted for IL17RA (rs879575, rs2229151, and rs4819554), IL2RA (rs3118470), IL23R (rs10889677), and IL31RA (rs161704) using the Sequenom MassARRAY® system. The allele frequency of IL17RA rs879575 is significantly higher in patients, while no statistical differences were found for IL2RA, IL23R, and IL31RA SNPs. Also, the recessive model of IL31RA rs161704 showing that AA genotype is significantly associated with AA development. To date, there is no published data regarding the association between AA and the selected genetic variants in our population. However, this study's findings assert that SNPs of IL17RA and IL31RA are linked to AA susceptibility in Jordanian patients.
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Affiliation(s)
- Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
- Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Laith N. AL-Eitan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
- Corresponding author at: Biotechnology & Genetic Engineering Department, Faculty of Science and Arts, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Hanan A. Aljamal
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mohammed A. Alshehri
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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Morad AMAEB, Eyada MMK, Toraih EA, Gomaa AHA, Mohammed GF. A case control study of the oestrogen receptor beta (ER) gene polymorphism (rs1255953 SNP) in patients with alopecia areata. HUMAN GENE 2022; 33:201033. [DOI: 10.1016/j.humgen.2022.201033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Ray M, Swallow E, Gandhi K, Carley C, Sikirica V, Wang T, Done N, Signorovitch J, Mostaghimi A. Healthcare Utilization and Costs Among US Adolescents With Alopecia Areata. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:11-18. [PMID: 35975139 PMCID: PMC9338344 DOI: 10.36469/001c.36229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Background: Alopecia areata (AA) is an autoimmune disease of hair loss affecting people of all ages. Alopecia totalis (AT) and universalis (AU) involve scalp and total body hair loss, respectively. AA significantly affects quality of life, but evidence on the economic burden in adolescents is limited. Objectives: To assess healthcare resource utilization (HCRU) and all-cause direct healthcare costs, including out-of-pocket (OOP) costs, of US adolescents with AA. Methods: IBM MarketScan® Commercial and Medicare databases were used to identify patients aged 12-17 years with ≥2 claims with AA/AT/AU diagnosis (prevalent cases), from October 1, 2015, to March 31, 2018, enrolled for ≥12 months before and after the first AA diagnosis (index). Patients were matched 1:3 to non-AA controls on index year, demographics, plan type, and Charlson Comorbidity Index. Per patient per year HCRU and costs were compared post-index. Results: Patients comprised 130 AT/AU adolescents and 1105 non-AT/AU adolescents (53.8% female; mean age, 14.6 years). Post-index, AT/AU vs controls had more outpatient (14.5 vs 7.1) and dermatologist (3.6 vs 0.3) visits, higher mean plan costs ($9397 vs $2267), including medical ($7480 vs $1780) and pharmacy ($1918 vs $487) costs, and higher OOP costs ($2081 vs $751) (all P<.001). The non-AT/AU cohort vs controls had more outpatient (11.6 vs 8.0) and dermatologist (3.4 vs 0.4) visits, higher mean plan costs ($7587 vs $4496), and higher OOP costs ($1579 vs $805) (all P<.001). Discussion: This large-sample, real-world analysis found that adolescents with prevalent AA had significantly higher HCRU and all-cause costs than matched controls. The greater burden was driven by more frequent outpatient visits, and higher payer medical and pharmacy costs in comparison with controls. Oral corticosteroid use was higher among patients with AT/AU; topical and injectable corticosteroid use was higher for non-AT/AU. Although the data preclude the identification of AA-attributable costs, the matched-control design allows an estimation of incremental all-cause costs associated with AA. Conclusions: Adolescents with AA incurred substantial incremental healthcare costs, with greater costs incurred among those with AT/AU. Study findings suggest that AA incurs costs as a medical condition with a high burden on adolescent patients and health plans.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Arash Mostaghimi
- 3Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Mostaghimi A, Gandhi K, Done N, Ray M, Gao W, Carley C, Wang T, Swallow E, Sikirica V. All-cause health care resource utilization and costs among adults with alopecia areata: A retrospective claims database study in the United States. J Manag Care Spec Pharm 2022; 28:426-434. [PMID: 35332790 PMCID: PMC10373004 DOI: 10.18553/jmcp.2022.28.4.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Alopecia areata (AA) is an autoimmune disorder characterized by hair loss. Patients may present with hair loss of the scalp, eyelashes, eyebrows, and/or body. Alopecia totalis (AT), total scalp hair loss, or alopecia universalis (AU), total body hair loss, are extensive forms. Although the impact of AA on quality of life is understood, evidence of its economic burden is limited. A better understanding of the all-cause health care costs for health plans and patients with AA is critical to comprehend disease burden. OBJECTIVE: To evaluate all-cause health care resource utilization and direct health care costs in US adults with AA with or without AT or AU, vs matched control subjects. METHODS: Patients (≥ 18 years) with AA with no less than 2 claims of AA at diagnosis (October 31, 2015, to March 3, 2018) were identified in the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental databases. Patients were enrolled no less than 12 months before and after first diagnosis (index). Patients were grouped according to AT or AU status (AT/AU group) or AA without AT/AU (non-AT/AU group) and matched 1:3 to control subjects without AA/AT/AU. Summary statistics were calculated for demographic and clinical characteristics at baseline and follow-up. RESULTS: At baseline, there were 14,972 adult patients with AA and 44,916 control subjects. Of patients with AA, 1,250 and 13,722 were in the AT/AU and non-AT/AU groups, respectively. A significantly greater proportion of patients with AA had atopic and autoimmune comorbidities vs control subjects. After index, patients with AA used significantly more corticosteroid treatments (injectable/oral/topical) than control subjects. A greater mean number of annual outpatient and dermatologist visits was observed for both AA groups vs control subjects (outpatient visits: AT/AU group: 17.8 vs 11.8; non-AT/AU group: 15.4 vs 11.2; dermatologist visits: AT/AU group: 3.4 vs 0.4; non-AT/AU group: 3.4 vs 0.4; P < 0.001 for all). Mean total all-cause medical and pharmacy costs (2018 US$) were higher in both AA groups vs control subjects (AT/AU group: $18,988 vs $11,030; non-AT/AU group: $13,686 vs $9,336; P < 0.001 for both). Patient out-of-pocket costs were higher for AA vs control subjects (AT/AU group: $2,685 vs $1,457; non-AT/AU group: $2,223 vs $1,341; P < 0.001 for both). CONCLUSIONS: Compared with control subjects, patients with AA are more likely to have atopic and autoimmune comorbidities, to use corticosteroids, and to make outpatient visits. Patients with AA have greater all-cause medical (including pharmacy) and out-of-pocket costs. The difference in total medical costs for patients with AT/AU vs control subjects is higher than the difference for patients with non-AT/AU vs control subjects. DISCLOSURES: This study was sponsored by Pfizer Inc. Pfizer Inc was involved in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit this report for publication. A. Mostaghimi reports consulting fees from Pfizer Inc, Concert, Lilly, AbbVie, hims, and Digital Diagnostics; reports equity from Lucid and hims; and is an associate editor at JAMA Dermatology. K. Gandhi, M. Ray, and V. Sikirica are former employees of Pfizer Inc and held stock and/or stock options with Pfizer Inc at the time of writing. N. Done, W. Gao, C. Carley, T. Wang, and E. Swallow are employees of Analysis Group, Inc, a consultancy that received payment from Pfizer Inc for participation in this analysis.
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Affiliation(s)
- Arash Mostaghimi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kavita Gandhi
- Pfizer, Collegeville, PA, now with Janssen Pharmaceuticals, Titusville, NJ
| | | | - Markqayne Ray
- Pfizer, Collegeville PA, now with Kite Phara, Santa Monica, CA
| | - Wei Gao
- Analysis Group, Inc, Boston, MA
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Connell SJ, Jabbari A. The current state of knowledge of the immune ecosystem in alopecia areata. Autoimmun Rev 2022; 21:103061. [PMID: 35151885 PMCID: PMC9018517 DOI: 10.1016/j.autrev.2022.103061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/18/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease that affects approximately 2% of the general population. Patients with AA most commonly present with one or more patches of hair loss on the scalp in defined circular areas. A fraction of patients progress to more severe forms of the disease, in some cases with involvement of all body surfaces. The healthy anagen stage hair follicle is considered an immune privileged site, described as an environment that suppresses inflammatory immune responses. However, in AA, this immune privileged state collapses and marks the hair follicle as a target for the immune system, resulting in peri- and intrafollicular infiltration by lymphocytes. The complexity of the inflammatory ecosystem of the immune response to the hair follicle, and the relationships between the cellular and soluble participants, in AA remains incompletely understood. Many studies have demonstrated the presence of various immune cells around diseased hair follicles; however, often little is known about their respective contributions to AA pathogenesis. Furthering our understanding of the mechanisms of disease in AA is essential for the novel identification of targeted therapeutics that are efficacious and have few unintended effects.
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Lim SH, Lee H, Lee S, Lee JW, Lee SH, Lee WS. Relationship of Hair Regrowth Pattern in Alopecia Areata Patches According to DIMT Classification with Treatment Modalities and Patch Size: A Retrospective Cross-Sectional Analysis. Ann Dermatol 2022; 34:1-6. [PMID: 35221588 PMCID: PMC8831304 DOI: 10.5021/ad.2022.34.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background The morphology of hair regrowth in alopecia areata (AA) patches could be classified into four types, namely diffuse, irregular, marginal, and targetoid patterns, according to the DIMT classification. However, factors affecting hair regrowth patterns have not been investigated. Objective We investigated whether the DIMT-classified hair regrowth patterns of AA patches are associated with treatment modality and patch size. Methods We conducted a retrospective, cross-sectional study of 152 AA patches with hair regrowth. Results The associations between the diffuse pattern and patch size >2 cm (p=0.006; odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.17~0.74), between the irregular pattern and triamcinolone acetonide intralesional injection (p<0.001; OR: 274.87, 95% CI: 25.75~2,933.56), between the marginal pattern and systemic and topical corticosteroid (p=0.018; OR: 4.89, 95% CI: 1.31~18.27), and between the targetoid pattern and patch size >2 cm (p=0.028; OR: 2.50, 95% CI: 1.10~5.68) were statistically significant. Conclusion Treatment modalities and patch size are the factors affecting hair regrowth patterns in AA patches.
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Affiliation(s)
- Sung Ha Lim
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hanil Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Solam Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Won Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang-Hoon Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won-Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Chanprapaph K, Pomsoong C, Kositkuljorn C, Suchonwanit P. Intramuscular Corticosteroid Therapy in the Treatment of Alopecia Areata: A Time-to-Event Analysis. Drug Des Devel Ther 2022; 16:107-116. [PMID: 35027820 PMCID: PMC8752075 DOI: 10.2147/dddt.s342179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/07/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Intramuscular corticosteroids (IMC) have gained popularity for the treatment of severe alopecia areata (AA) in recent years; however, evidence on their efficacy and safety is still limited. Objective To evaluate the efficacy, relapse rate, and tolerability of IMC in the treatment of AA, as well as factors associated with treatment outcomes. Methods Time-to-event analysis was performed on patients with severe, extensive, or rapidly progressive AA receiving IMC. The IMC regimen comprised triamcinolone acetonide 20–40 mg/mL injected every 4–6 weeks. The evaluated outcomes included initial (25% regrowth), significant (75% regrowth), and complete hair regrowth (100% regrowth). Relapse and adverse events were also noted. Factors associated with treatment outcomes and relapse were analyzed using the Cox proportional hazards model. Results A total of 101 patients were eligible for analysis. Significant hair regrowth was obtained in 80.2% of the patients (n = 81), in a median time of 3.4 months (95% confidence interval [CI] = 2.9–4.4). Complete hair regrowth was achieved in 48.5% of the subjects (n = 49), and relapse was observed in 47.5% (n = 48). Acneiform eruption was the most common adverse effect. Multivariable analysis revealed that nail involvement was a negative predictor of significant hair regrowth (adjusted hazard ratio [HR] = 0.04, 95% CI = 0.01–0.55; P = 0.015), whereas duration of AA longer than 6 months was associated with disease recurrence (adjusted HR = 4.02, 95% CI = 1.52–4.66; P = 0.005). Conclusion This study demonstrated the efficacy and safety of IMC in the treatment of severe or active AA; however, the relapse rate remained relatively high after discontinuation of the therapy. Nail involvement was a negative predictor of significant hair regrowth, while disease duration longer than 6 months predicted AA relapse.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Poonkiat Suchonwanit Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, ThailandTel +66-2-2011141Fax +66-2-201-1211 Ext 4 Email
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Glickman JW, Dubin C, Dahabreh D, Han J, Del Duca E, Estrada YD, Zhang N, Kimmel GW, Singer G, Krueger JG, Pavel AB, Guttman‐Yassky E. An integrated scalp and blood biomarker approach suggests the systemic nature of alopecia areata. Allergy 2021; 76:3053-3065. [PMID: 33721346 DOI: 10.1111/all.14814] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is characterized by immune dysregulation in both scalp and blood, but a large-scale approach establishing biomarkers of AA incorporating both scalp tissue and serum compartments is lacking. We aimed to characterize the transcriptomic signature of AA lesional and nonlesional scalp compared to healthy scalp and determine its relationship with the blood proteome in the same individuals, with comparative correlations to clinical AA disease severity. METHODS We evaluated lesional and nonlesional scalp tissues and serum from patients with moderate-to-severe AA (n = 18) and healthy individuals (n = 8). We assessed 33,118 genes in AA scalp tissue using RNAseq transcriptomic evaluation and 340 inflammatory proteins in serum using OLINK high-throughput proteomics. Univariate and multivariate approaches were used to correlate disease biomarkers with Severity of Alopecia Tool (SALT). RESULTS A total of 608 inflammatory genes were differentially expressed in lesional AA scalp (fold change/FCH>1.5, false discovery rate/FDR<0.05) including Th1 (IFNG/IL12B/CXCL11), Th2 (IL13/CCL18), and T-cell activation-related (ICOS) products. Th1/Th2-related markers were significantly correlated with AA clinical severity in lesional/nonlesional tissue, while keratins (KRT35/KRT83/KRT81) were significantly downregulated in lesional compared to healthy scalp (p < .05). Expression of cardiovascular/atherosclerosis-related markers (MMP9/CCL2/IL1RL1/IL33R/ST2/AGER) in lesional scalp correlated with their corresponding serum expression (p < .05). AA scalp demonstrated significantly greater biomarker dysregulation compared to blood. An integrated multivariate approach combining scalp and serum biomarkers improved correlations with disease severity/SALT. CONCLUSION This study contributes a unique understanding of the phenotype of moderate-to-severe AA with an integrated scalp and serum biomarker model suggesting the systemic nature of the disease, advocating for the need for immune-based systemic treatment.
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Affiliation(s)
- Jacob W. Glickman
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Celina Dubin
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Dante Dahabreh
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joseph Han
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Yeriel D. Estrada
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ning Zhang
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Grace W. Kimmel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Giselle Singer
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - James G. Krueger
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Ana B. Pavel
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Biomedical Engineering The University of Mississippi University MS USA
| | - Emma Guttman‐Yassky
- Laboratory of Inflammatory Skin Diseases Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
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Torales J, Castaldelli-Maia JM, Ventriglio A, Almirón-Santacruz J, Barrios I, O'Higgins M, García O, Navarro R, Melgarejo O, Jafferany M. Alopecia areata: A psychodermatological perspective. J Cosmet Dermatol 2021; 21:2318-2323. [PMID: 34449973 DOI: 10.1111/jocd.14416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Alopecia Areata (AA) is an autoimmune dermatological disease that could be influenced by psychological factors as part of the pathophysiology of the illness. AIMS This review article aims to report on psychodermatological and psychopathological aspects involved in the etiopathogenesis and comorbidities of AA, as well as on the psychiatric and psychological management of affected patients. METHODS We conducted a literature search on PubMed and Google Scholar from January 1980 to May 2021 employing the search terms of alopecia areata, psychological factors, psychological impact, psychodermatology, and psychopathology. All lists of references from the identified articles were screened for further relevant studies. The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. No specific quality criteria were used for the studies selection. RESULTS Several authors have found a high comorbidity rate between AA and mental disorders, concluding that stress and psychological factors are involved in both the development and exacerbation of the illness. More evidences are needed in order to describe the associations between the immune response, stress, and the physiological factors observed in AA patients. CONCLUSION AA is a complex illness characterized by multifactorial etiology. An interaction between genetic, autoimmune, hormonal, neural, and psychological factors is supposed. Psychopathological aspects of illness need to be better described and considered in the clinical setting.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Rodrigo Navarro
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Osvaldo Melgarejo
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
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Bellet JS. Pediatric Nail Disorders. Dermatol Clin 2021; 39:231-243. [PMID: 33745636 DOI: 10.1016/j.det.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Many pediatric nail findings are normal variants and are no cause for alarm. Others represent congenital abnormalities or genetic syndromes for which there is no cure. Still others are inflammatory or infectious entities that require treatment. Pediatric nail disorders are reviewed, along with management.
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Affiliation(s)
- Jane Sanders Bellet
- Duke University School of Medicine, 5324 McFarland Drive, Suite 410, Durham, NC 27707, USA.
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Olayinka J(JT, Richmond JM. Immunopathogenesis of alopecia areata. CURRENT RESEARCH IN IMMUNOLOGY 2021; 2:7-11. [PMID: 35492401 PMCID: PMC9040139 DOI: 10.1016/j.crimmu.2021.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune disorder resulting in hair loss. It has numerous variants or patterns, including diffuse type, patchy type, AA totalis, AA universalis, and more. In this graphical review, we provide an overview of AA immunopathogenesis, highlighting loss of immune privilege in the hair follicle as well as key immune cell types, cytokines and chemokines that drive autoimmune attack of the hair follicle. We also summarize recent literature identifying agents that block these pathways that could serve as new immunomodulatory treatments for AA.
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Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med 2021; 21:215-230. [PMID: 33386567 DOI: 10.1007/s10238-020-00673-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.
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Affiliation(s)
- A Sterkens
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - A Bervoets
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Abstract
In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia and provides details on how to approach and manage these diseases according to patient gender. There are a range of tools and tests that can assist with the diagnostic process and help ensure that relevant and high standards of patient care are maintained. In some cases, no medical intervention is always a treatment option. However, appropriate medical treatments, although still relatively limited in some cases, are safe and have proven efficacy. Hair loss has immense emotional and psychological impact in both genders, and it is always important to consider this when planning hair loss management pathways.
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Abedini R, Alipour E, Ghandi N, Nasimi M. Utility of Dermoscopic Evaluation in Predicting Clinical Response to Diphencyprone in a Cohort of Patients with Alopecia Areata. Int J Trichology 2020; 12:107-113. [PMID: 33223734 PMCID: PMC7659740 DOI: 10.4103/ijt.ijt_73_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Alopecia areata (AA) is a chronic and inflammatory disease of hair follicles, causing nonscarring alopecia. While the various types of treatment have been investigated, the definite cure for AA has not been established yet. Objectives: The objective of this study is to evaluate the clinical and dermoscopic features of patients with AA to identify the factors with prognostic values in diphenylcyclopropenone (DPCP) response rate. Methods: Eighty patients with AA were included, and baseline hair loss was calculated based on the severity alopecia tool (SALT) score. The characteristic dermoscopic features of AA were evaluated by two skilled dermatologists separately at baseline, 12 and 24 weeks afterward. Results: The mean SALT score in the 1st, 12th, and 24th week was 77 ± 24.7, 80 ± 27, and 71 ± 35.6, respectively, which were not significantly different over this time period (P = 0.085). SALT score correlated negatively with the short vellus hair/field (ρ = −0.361, P = 0.02), broken hair/field (ρ = −0.317, P = 0.044), and tapering hair/field (ρ = −0.388, P = 0.012) in the 1st week. Forty-one patients continued treatment courses over 24 weeks. Six patients had good response, 11 achieved partial response, and 24 had no hair regrowth. Statistically significant correlation was observed between treatment response and duration of disease (P = 0.04), frequency of relapses (P = 0.033), type of alopecia, and number of black dots (P = 0.028). The mean for all dermoscopic findings showed descending process during our three follow-up sessions which was statistically significant for black dot (P = 0.015) and broken hair (P = 0.006). Conclusion: The number of black dot per field initially was negatively correlated to DPCP therapy and the frequency of dermoscopic findings reduced during the treatment process.
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Affiliation(s)
- Robabeh Abedini
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Alipour
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia and provides details on how to approach and manage these diseases according to patient gender. There are a range of tools and tests that can assist with the diagnostic process and help ensure that relevant and high standards of patient care are maintained. In some cases, no medical intervention is always a treatment option. However, appropriate medical treatments, although still relatively limited in some cases, are safe and have proven efficacy. Hair loss has immense emotional and psychological impact in both genders, and it is always important to consider this when planning hair loss management pathways.
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23
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Shakoei S, Ghiasi M, Ziaee K. Coagulation status in patients with alopecia areata: a cross-sectional study. Ital J Dermatol Venerol 2020; 156:588-592. [PMID: 33034439 DOI: 10.23736/s2784-8671.20.06628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune skin disease that causes non-scarring hair loss with lymphatic infiltration around and within follicles. There are interactions between inflammation and coagulation. The present study investigated the changes in coagulation status in patients with AA. METHODS In this study, the plasma level of three coagulation markers including fibrinogen, C-reactive protein (CRP), and D-dimer were measured in 30 patients (21 females 9 male) and 30 controls (21 females 9 male) matched by age and sex, and the results were compared between groups. RESULTS Plasma D-dimer levels were significantly higher in patients with AA (398.45±300 ng/mL vs. 244.4±129.92 ng/mL, P=0.014). Plasma fibrinogen and CRP levels were not significantly different between the two groups. There was no correlation between the plasma levels of the studied coagulation markers and the severity/duration of the disease, sex, and age. CONCLUSIONS As the present study was the first investigation on the coagulation status in patients with AA, elevated D-dimer levels in alopecia areata may suggest a deficient coagulation in these patients that may contribute to an increase in the risk of thrombosis. Further studies are needed to evaluate this hypothesis using a larger sample size.
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Affiliation(s)
- Safoura Shakoei
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran -
| | - Maryam Ghiasi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kataun Ziaee
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Wyrwich KW, Kitchen H, Knight S, Aldhouse NVJ, Macey J, Nunes FP, Dutronc Y, Mesinkovska N, Ko JM, King BA. Development of Clinician-Reported Outcome (ClinRO) and Patient-Reported Outcome (PRO) Measures for Eyebrow, Eyelash and Nail Assessment in Alopecia Areata. Am J Clin Dermatol 2020; 21:725-732. [PMID: 32803546 PMCID: PMC7473969 DOI: 10.1007/s40257-020-00545-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Eyebrow and eyelash hair loss and nail damage-in addition to scalp hair loss-are important signs/symptoms of alopecia areata (AA) to patients and deserve assessment in AA clinical trials. OBJECTIVES Our objective was to develop clinician-reported outcome (ClinRO) and patient-reported outcome (PRO) measures and accompanying photoguides to aid in the assessment of AA-related eyebrow, eyelash and nail signs/symptoms. METHODS Iterative rounds of qualitative, semi-structured interviews were conducted with US expert dermatologists and North American patients with AA. Patients with eyebrow, eyelash and nail involvement were purposefully sampled. Interview transcripts were qualitatively analyzed. RESULTS Dermatologists (n = 10) described eyebrow and eyelash loss as concerning for affected patients and, along with nail appearance, as deserving assessment. Dermatologist data informed the development of single item, 4-point Likert-type ClinRO and PRO measures of current eyebrow loss, eyelash loss and nail appearance and a PRO measure of eye irritation. Patients (n = 45, age 15-72 years) confirmed the importance and relevance of these signs/symptoms. Interim revision resulted in measures that were understood by and relevant to patients. Dermatologists (n = 5) and patients (n = 10, age 21-54 years) participated in the development of the eyebrow, eyelash and nail photoguides and confirmed that they included photos that appropriately represented different severity levels and were helpful to derive and standardize ratings across raters. CONCLUSIONS The ClinRO and PRO measures for eyebrow, eyelash and nail appearance, with their accompanying photoguides and the PRO Measure for Eye Irritation provide clear and meaningful assessments of outcomes important to patients with AA.
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Affiliation(s)
- Kathleen W. Wyrwich
- Patient-Focused Outcomes Center of Expertise, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Helen Kitchen
- Clinical Outcomes Assessment, DRG Abacus, The Lexicon, Mount Street, Manchester, M2 5NT UK
| | - Sarah Knight
- Clinical Outcomes Assessment, DRG Abacus, The Lexicon, Mount Street, Manchester, M2 5NT UK
| | - Natalie V. J. Aldhouse
- Clinical Outcomes Assessment, DRG Abacus, The Lexicon, Mount Street, Manchester, M2 5NT UK
| | - Jake Macey
- Clinical Outcomes Assessment, DRG Abacus, The Lexicon, Mount Street, Manchester, M2 5NT UK
| | - Fabio P. Nunes
- Lilly Bio-Medicines, Eli Lilly and Company, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Yves Dutronc
- Lilly Bio-Medicines, Eli Lilly and Company, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Natasha Mesinkovska
- University of California Irvine Dermatology Clinical Research Center, Hewitt Hall Building, 843 Health Sciences Road, Room 1001, Irvine, CA 92697 USA
| | - Justin M. Ko
- Stanford Dermatology, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101 USA
| | - Brett A. King
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LMP 5040, New Haven, CT 06520 USA
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25
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Identification and verification of EOMEs regulated network in Alopecia areata. Int Immunopharmacol 2020; 84:106544. [DOI: 10.1016/j.intimp.2020.106544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/25/2023]
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Rinaldi F, Trink A, Pinto D. Efficacy of Postbiotics in a PRP-Like Cosmetic Product for the Treatment of Alopecia Area Celsi: A Randomized Double-Blinded Parallel-Group Study. Dermatol Ther (Heidelb) 2020; 10:483-493. [PMID: 32279227 PMCID: PMC7211773 DOI: 10.1007/s13555-020-00369-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Alopecia areata (AA), also known as 'area Celsi', is the second most common form of hair loss affecting the scalp. Newly proposed treatments for AA include low-level light therapy, biologics such as Janus kinase inhibitors and autologous platelet-rich plasma (PRP), which is a well-known "elixir" for hair growth. Bioactive peptides developed through biotechnological applications have been used to overcome the limitations of PRP. More recently, the involvement of microbiota in hair growth disorders, in AA in particular, has been reported, and the usefulness of microbial metabolites, i.e. postbiotics, has been suggested. METHODS This study was a randomized double-blinded parallel-group study in which 160 persons of both sexes affected by AA and aged between 18 and 60 years were enrolled. The subjects were randomly assigned to a treatment group (group 1), receiving the TR-PRP plus-Celsi cosmetic product, and a placebo group (group 2). The SALT (Severity of Alopecia Tool) score was determined in both groups at baseline and after 2 and 3 months of treatment, and the results compared between groups. RESULTS The subjects in group 1 showed a significant change from baseline in SALT score at 2 months of treatment (61.04% ± 3.45%; p < 0.0001), with a further improvement at the end of treatment (3 months) (69.56% ± 4.32%; p < 0.0001). No significant changes from baseline were reported for the subjects in group 2 (T1: 26.45% ± 3.64%; T3: 27.63% ± 7.61%). CONCLUSIONS The results of this study provide further proof of the efficacy of bioactive peptides that mimick the growth factors present in PRP in subjects affected by AA. They also add to our knowledge of the link between microbiota and hair growth disorders, emphasizing the importance of studies on the microbial community and microbial metabolites as a novel therapeutic approach.
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Affiliation(s)
- Fabio Rinaldi
- Human Advanced Microbiome Project (HMAP), Giuliani SpA, Milan, Italy.
| | - Anna Trink
- Human Advanced Microbiome Project (HMAP), Giuliani SpA, Milan, Italy
| | - Daniela Pinto
- Human Advanced Microbiome Project (HMAP), Giuliani SpA, Milan, Italy
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Burroway B, Griggs J, Tosti A. Alopecia totalis and universalis long‐term outcomes: a review. J Eur Acad Dermatol Venereol 2020; 34:709-715. [DOI: 10.1111/jdv.15994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- B. Burroway
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - J. Griggs
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - A. Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
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Sayed K, Mohammed F, Abdel Hay R, Ezzeldin N, Rashed L, Fahim A. Elevated serum tumour necrosis factor‐like weak inducer of apoptosis in alopecia areata: a possible marker of disease severity. Clin Exp Dermatol 2019; 45:426-431. [DOI: 10.1111/ced.14118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Affiliation(s)
- K. Sayed
- Department of DermatologyFaculty of Medicine, Cairo University Cairo Egypt
| | - F. Mohammed
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - R. Abdel Hay
- Department of DermatologyFaculty of Medicine, Cairo University Cairo Egypt
| | - N. Ezzeldin
- Department of DermatologyFaculty of Medicine, Cairo University Cairo Egypt
| | - L. Rashed
- Department of Biochemistry Faculty of Medicine, Cairo University Cairo Egypt
| | - A. Fahim
- Department of DermatologyFaculty of Medicine, Cairo University Cairo Egypt
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29
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Marks DH, Naftulin JS, Penzi LR, Manatis-Lornell A, Yasuda MR, Chapman CM, Rao SR, Saavedra A, Senna MM. Histologic and clinical cross-sectional study of chronic hair loss in patients with cutaneous chronic graft-versus-host disease. J Am Acad Dermatol 2019; 81:1134-1141. [DOI: 10.1016/j.jaad.2019.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/15/2019] [Accepted: 03/08/2019] [Indexed: 12/21/2022]
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30
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Lee H, Choe SJ, Lee W. Method for describing patterns and distributions of alopecia areata which may be helpful for patient characterization and predicting prognosis. J Dermatol 2019; 46:739-740. [DOI: 10.1111/1346-8138.14989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hanil Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Won‐Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
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Lee S, Kim BJ, Lee CH, Lee WS. Topographic Phenotypes of Alopecia Areata and Development of a Prognostic Prediction Model and Grading System: A Cluster Analysis. JAMA Dermatol 2019; 155:564-571. [PMID: 30916724 DOI: 10.1001/jamadermatol.2018.5894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Diverse assessment tools and classification have been used for alopecia areata; however, their prognostic values are limited. Objective To identify the topographic phenotypes of alopecia areata using cluster analysis and to establish a prediction model and grading system for stratifying prognoses. Design, Setting, and Participants A retrospective cohort study of 321 patients with alopecia areata who visited a single tertiary referral center between October 2012 and February 2017 and underwent 4-view photographic assessment. Exposures Clinical photographs were reviewed to evaluate hair loss using the Severity of Alopecia Tool 2. Topographic phenotypes of alopecia areata were identified using hierarchical clustering with Ward's method. Differences in clinical characteristics and prognosis were compared across the clusters. The model was evaluated for its performance, accuracy, and interobserver reliability by comparison to conventional methods. Main Outcomes and Measures Topographic phenotypes of alopecia areata and their major (60%-89%) and complete regrowth probabilities (90%-100%) within 12 months. Results A total of 321 patients were clustered into 5 subgroups. Grade 1 (n = 200; major regrowth, 93.4%; complete regrowth, 65.2%) indicated limited hair loss, whereas grades 2A (n = 66; major regrowth, 87.8%; complete regrowth, 64.2%) and 2B (n = 20; major regrowth, 73.3%; complete regrowth, 45.5%) exhibited greater hair loss than grade 1. The temporal area was predominantly involved in grade 2B, but not in grade 2A, despite being comparable in total extent of hair loss. Grade 3 (n = 20; major regrowth, 45.5%; complete regrowth, 25.5%) included diffuse or extensive alopecia areata, and grade 4 (n = 15; major regrowth, 28.2%; complete regrowth, 16.7%) corresponded to alopecia (sub)totalis. No significant differences in prognosis (hazard ratio [HR] for major regrowth, 0.79; 95% CI, 0.56-1.12) were found between grades 2A and 1, whereas grades 2B (HR, 0.41; 95% CI, 0.21-0.81), 3 (HR, 0.24; 95% CI, 0.12-0.50), and 4 (HR, 0.16; 95% CI, 0.06-0.39) had significantly poorer response. Among multiple models, the cluster solution had the greatest prognostic performance and accuracy. The tree model of the cluster solution was converted into the Topography-based Alopecia Areata Severity Tool (TOAST), which revealed an excellent interobserver reliability among 4 dermatologists (median quadratic-weighted κ, 0.89). Conclusions and Relevance Temporal area involvement should be independently measured for better prognostic stratification. The TOAST is an effective tool for describing the topographical characteristics and prognosis of hair loss and may enable clinicians to establish better treatment plans.
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Affiliation(s)
- Solam Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beom Jun Kim
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chung-Hyeok Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Zhang Z, Wang X, Zhang R. Pathogenesis of Alopecia Areata Based on Bioinformatics Analysis. Indian J Dermatol 2019; 64:1-6. [PMID: 30745627 PMCID: PMC6340232 DOI: 10.4103/ijd.ijd_68_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Alopecia areata (AA) describes a sudden localized patchy alopecia. The cause of AA is not completely clear and its incidence may be related to genetic, autoimmune, and environmental factors. Aim: To explore the possible mechanisms of AA and to provide a basis for the early diagnosis and treatment of AA. Methods: Gene microarray data from 122 scalp skin biopsy tissue samples from patients with AA or healthy controls from the Gene-Cloud of Biotechnology Information database were analyzed using bioinformatics analysis methods. Molecular network analysis of the differentially expressed genes (DEGs) was conducted by Cytocluster using the Molecular Complex Detection (MCODE) algorithm. Results: The gene expression profile of skin lesions from patients with AA was significantly altered, with 111 DEGs found in the skin lesions of AA, compared with that of the healthy skin. The DEGs were mainly related to biological processes such as the development of the epidermis and inflammatory reaction. The protein–protein interaction network analysis of DEGs revealed bone morphogenetic protein 2 (BMP2) as a core protein interaction network. BMP2 acted not only via the inflammatory response but also via the signaling pathways in epithelial cell development and epidermal cell differentiation to affect the epidermal development. MCODE analysis further showed that keratins (KRTs) and keratin-associated proteins (KRTAPs) can affect the epidermal development via the epidermal development pathway. Conclusions: The abnormal development of the epidermis and inflammatory reactions in skin tissue play important roles in the pathogenesis of AA and are closely related to BMP2, KRTs, and KRTAPs genes. Limitations: Our study was limited by experimental verification.
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Affiliation(s)
- Zhigang Zhang
- Department of Toxicology, School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Xiaoli Wang
- Department of Dermatology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Rongqiang Zhang
- Department of Toxicology, School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, China
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Crowley EL, Fine SC, Katipunan KK, Gooderham MJ. The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature. J Cutan Med Surg 2019; 23:289-297. [DOI: 10.1177/1203475418824079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated disorder that targets hair follicle epithelium, thereby restricting hair growth in localized patches. Although several therapies for AA have been tested, responses with traditional therapies have been limited. In recent years, numerous reports have been published of patients with AA responding to Janus kinase (JAK) inhibitors. This literature review aims to describe AA pathophysiology, explore how and why JAK inhibitors can be used for AA treatment, and review published case reports, case series, and open-label studies published to date. Pathogenesis of AA includes interactions between genetic, environmental, and immune factors and is mediated by the cytokines interferon-γ and interleukin (IL)-15. JAK inhibition resulting in hair regrowth in some cases supports that AA is associated with the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The emergence of JAK inhibitors for AA therapy is changing the way health care providers think about and treat AA. A mixture of animal model studies and human case studies have reported the use of baricitinib (JAK 1/2), ruxolitinib (JAK 1/2), and tofacitinib (JAK 1/3) for the management of AA. JAK inhibition has shown potential as an effective AA therapy when used in case studies, case series, and open-label trials. Formal clinical trials are ongoing and will yield more definitive conclusions about the safety and efficacy of JAK inhibitors.
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Affiliation(s)
- Erika L. Crowley
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Shamone C. Fine
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Kathleen Kwan Katipunan
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J. Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Queen’s University, Kingston, ON, Canada
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Arousse A, Boussofara L, Mokni S, Gammoudi R, Saidi W, Aounallah A, Belajouza C, Ghariani N, Denguezli M, Nouira R. Alopecia areata in Tunisia: epidemio-clinical aspects and comorbid conditions. A prospective study of 204 cases. Int J Dermatol 2019; 58:811-815. [PMID: 30677128 DOI: 10.1111/ijd.14381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/27/2018] [Accepted: 12/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients. METHODS Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016. RESULTS Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001). CONCLUSIONS Our study aimed to review epidemio-clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early-onset AA, long disease duration, and nail involvement were seen in our study.
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Affiliation(s)
- Aycha Arousse
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Lobna Boussofara
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sana Mokni
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rima Gammoudi
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Wafa Saidi
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Amina Aounallah
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Najet Ghariani
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rafia Nouira
- Dermatology Department, Farhat Hached University Hospital, Sousse, Tunisia
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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: 78] [Impact Index Per Article: 13.0] [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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36
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Kimura H, Nagase K, Narisawa Y. Perinevoid alopecia: a case report and literature review. Br J Dermatol 2018; 179:969-970. [PMID: 29704462 DOI: 10.1111/bjd.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hiromi Kimura
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Kotaro Nagase
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
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37
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Wolf JJ, Hudson Baker P. Alopecia Areata: Factors That Impact Children and Adolescents. JOURNAL OF ADOLESCENT RESEARCH 2018. [DOI: 10.1177/0743558418768248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Research suggests that several factors affect children and adolescents with alopecia areata (AA). While hair loss is mostly associated with individuals undergoing chemotherapy, AA also causes individuals to lose the hair on their scalp and elsewhere on the body. This loss can be particularly devastating to children and adolescents, and can affect them socially, as well as psychologically. A mixed method research design was used to combine survey data with interview transcripts and field notes to capture a more detailed picture of AA and its effect on children and adolescents. The data reported here were extracted from a larger study utilizing nine demographic items, four independent variable items (gender, age, duration of diagnosis, age of onset), and 27 dependent variable items regarding impact factors. Subsequently, six follow-up interview questions were used with a small group for additional context. An exploratory factor analysis revealed five impact factors: Confidence/Self-Esteem, Psychological Effects, Appearance/Acceptance, Socialization, and Communication. Female participants reported significantly greater difficulty adjusting and managing AA than did their male counterparts. While most participants revealed a positive attitude about themselves, the majority were affected psychologically by this condition. Open communication with family and friends gave comfort and support to the vast majority.
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Czarnowicki T, He HY, Wen HC, Hashim PW, Nia JK, Malik K, Estrada Y, Kimmel GW, Taliercio M, Krueger JG, Guttman-Yassky E. Alopecia areata is characterized by expansion of circulating Th2/Tc2/Th22, within the skin-homing and systemic T-cell populations. Allergy 2018; 73:713-723. [PMID: 29083474 DOI: 10.1111/all.13346] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characterizing blood profile of alopecia areata (AA) is important not only for treatment advancements, but also for possibly identifying peripheral biomarkers that will eliminate the need for scalp biopsies. We aimed to compare frequencies of skin homing (CLA+ ) vs systemic (CLA- ) "polar" CD4+ and CD8+ and activated T-cell subsets in AA vs atopic dermatitis (AD) and control blood. METHODS Flow cytometry was used to measure IFN-γ, IL-13, IL-9, IL-17, and IL-22 cytokines in CD4+ and CD8+ T cells. Inducible co-stimulator molecule (ICOS) and HLA-DR were used to define mid- and long-term T-cell activation. We compared peripheral blood from 32 moderate-to-severe AA adults with 43 moderate-to-severe AD patients and 30 age-matched controls. RESULTS AA patients had increased CLA+ /CLA- Th2 (P < .007), CLA+ Tc2 (P = .04), and CLA+ Th22 (P < .05) frequencies than controls. Except of CLA- Tc1 cells (P = .03), IFN-γ levels were mostly similar between AA, AD, and controls (P > .1). ICOS and HLA-DR activation were significantly higher in AA than controls (P < .05). T regulatory cells were significantly decreased in AA patients than controls (P < .01) and were correlated with activated CD8+ T cells and with multiple cytokine subsets (P < .05). While Th2 and Tc2 clustered with disease severity, IFN-γ producing cells were linked with AA duration. CONCLUSIONS Alopecia areata is accompanied by Th2/Tc2 activation in skin-homing and systemic subsets, correlating with disease severity, while IFN-γ is linked to disease chronicity. These data hint for a possible role of diverse T-cells subsets in disease pathogenesis and emphasize the systemic nature of AA supporting the need for systemic therapeutic strategies in severe patients.
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Affiliation(s)
- T. Czarnowicki
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - H. Y. He
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - H.-C. Wen
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - P. W. Hashim
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. K. Nia
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - K. Malik
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
- SUNY Downstate College of Medicine; Brooklyn NY USA
| | - Y. Estrada
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - G. W. Kimmel
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Taliercio
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - J. G. Krueger
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
| | - E. Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; The Rockefeller University; New York NY USA
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Malik K, Guttman-Yassky E. Cytokine Targeted Therapeutics for Alopecia Areata: Lessons from Atopic Dermatitis and Other Inflammatory Skin Diseases. J Investig Dermatol Symp Proc 2018; 19:S62-S64. [PMID: 29273110 DOI: 10.1016/j.jisp.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Alopecia areata is a T-cell-mediated disease that shares phenotypic similarities with other inflammatory diseases, particularly atopic dermatitis, and lacks safe, effective, mechanism-specific treatments. Increasing data suggests that alopecia areata harbors contributions of T helper type 1, T helper type 2, T helper type 17/IL-23, and phosphodiesterase pathways. Antagonism of these axes is undergoing evaluation, and might elucidate the underlying molecular circuitry of alopecia areata, advancing the translational revolution for this disease.
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Affiliation(s)
- Kunal Malik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA; College of Medicine, SUNY Downstate, New York, New York, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Genetics and Genomics Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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40
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Trüeb RM, Dutra H, Dias MFRG. A Comment on JAK Inhibitors for Treatment of Alopecia Areata. Int J Trichology 2018; 10:193-197. [PMID: 30607037 PMCID: PMC6290291 DOI: 10.4103/ijt.ijt_62_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A meta-analysis of published trials on the treatment of alopecia areata (AA) came to the conclusion that most have been reported poorly and so small that any important clinical benefits are inconclusive, and considering the possibility of spontaneous remission, especially for those in the early stages of the disease, the options of not being treated or depending on individual preference, and of wearing a wig may be alternative ways of dealing with the condition. And yet, from clinical practice, we know that depending on patient age, surface area, disease duration, and comorbidities an empiric treatment algorithm can be designed that is successful in a significant proportion of patients. More recently, it has been suggested that Janus kinase (JAK) inhibitors may represent the drug of choice for AA, based on robust scientific background and preliminary clinical study results. The fact is that a sophisticated treatment of AA cannot be reduced to one drug, while in many patients, depending on disease duration and surface area, either intravenous methylprednisolone pulse therapy, intralesional triamcinolone acetonide or subcutaneous methotrexate will achieve remission rates in the range of the efficacy of the JAK inhibitors. Moreover, at this time point, affordability of the JAK inhibitors for long-term treatment, sustainability of treatment result, and long-term safety are major issues with regard to the treatment of AA with JAK inhibitors.
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Affiliation(s)
- Ralph Michel Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
| | - Hudson Dutra
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
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41
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Alopecia areata. J Am Acad Dermatol 2018; 78:1-12. [DOI: 10.1016/j.jaad.2017.04.1141] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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42
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Mahmoudi H, Salehi M, Moghadas S, Ghandi N, Teimourpour A, Daneshpazhooh M. Dermoscopic Findings in 126 Patients with Alopecia Areata: A Cross-Sectional Study. Int J Trichology 2018; 10:118-123. [PMID: 30034191 PMCID: PMC6028992 DOI: 10.4103/ijt.ijt_102_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Dermoscopy is used increasingly in dermatological practice. Although dermoscopic findings of alopecia areata (AA) are described in the literature, studies are limited. Aim: Our aim was to evaluate dermoscopic findings of Iranian patients with AA and correlate them with disease activity and severity. Subjects and Methods: Totally 126 patients were examined using a Dermlite II multispectral dermoscope. Severity, activity, pull test, nail changes, treatments, and dermoscopic findings were recorded. Statistical Analysis Used: Statistical analysis was done by SPSS version 22, using appropriate statistical tools. Results: The most common dermoscopic findings were yellow dots (84.1%), vellus hairs (62.6%), black dots (48.4%), exclamation mark (30.9%), and broken hair (9.5%), in decreasing order. Furthermore, the most common dermoscopic findings in patients on diphencyprone were vellus hairs and yellow dots. Yellow dots and vellus hairs were most common in patients with alopecia universalis. However, broken hairs and exclamation mark hairs were mostly observed in patchy multiple AA patients. Yellow dots and exclamation mark hairs were also significantly more common in patients with positive pull test. Furthermore, vellus hairs were more common in patients with remitting disease pattern. With regard to scalp severity, yellow dots related positively, while vellus hairs, broken hairs, and exclamation mark hairs related negatively with severity of disease. Conclusions: Dermoscopic findings differ in various stages of activity and severity of AA. Dermoscopy is a valuable tool for the dermatologist for the diagnosis, follow-up, and evaluation of response to treatment.
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Affiliation(s)
- Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Salehi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Moghadas
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teimourpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kaur G, Kuldeep CM, Bhargava P, Mathur DK, Sharda S, Chaturvedi P. Insignificant Correlation between Thyroid Hormone and Antithyroid Peroxidase Antibodies in Alopecia Areata Patients in Northern Rajasthan. Int J Trichology 2017; 9:149-153. [PMID: 29118518 PMCID: PMC5655622 DOI: 10.4103/ijt.ijt_32_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Alopecia areata (AA) is a common, recurrent form of nonscarring alopecia which often presents as circumscribed patches of spontaneous hair loss. The global prevalence of this disease varies from 0.1% to 0.2% in general population and 7-30 cases per 1000 dermatological patients. The etiology of AA still remains uncertain; however, genetic or environmental factor and autoimmunity are claimed responsible for it. Various autoimmune diseases, such as Hashimoto's thyroiditis, diabetes mellitus, vitiligo, and lupus erythematosus, have been reported in association with AA. Aim The index study was aimed at estimation of serum T3, T4, thyroid-stimulating hormone, and antithyroid peroxidase (TPO) antibodies. Material and Methods Similar age/sex-matched AA patients and controls (110 in each group). Enhanced chemiluminescence immunoassay for thyroid profile and anti-TPO antibody level estimation in veinous blood sample. Observations The mean/standard deviation (SD) of T3 was 3.30 ± 0.84 pg/ml in AA while 3.27 ± 0.67 pg/ml in controls (P = 0.302). Serum mean/SD of T4 level was1.23 ± 0.76 ng/dl in AA patients while 1.17 ± 0.34 ng/dl in controls (P = 0.522). The mean/SD of anti-TPO levels in AA patients was 21.52 ± 35.09 while 56.43 ± 140.72 in controls (P = 0.136). Limitation The limitation of this study was moderate number of AA patients and different genotype of study population. Conclusion Occurrence of thyroid dysfunction and evidence of anti-TPO antibodies in AA is rare event in this study population.
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Affiliation(s)
- Gagandeep Kaur
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
| | - C M Kuldeep
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
| | - Puneet Bhargava
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
| | - Deepak Kumar Mathur
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
| | - Sonam Sharda
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
| | - Pulkit Chaturvedi
- Department of Dermatology, STDs and Leprosy, SMS Medical College, Jaipur, Rajasthan, India
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44
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Abstract
Hair loss is a common condition that affects most people at some point in their lives. It can exist as an isolated problem or with other diseases and conditions. Androgenetic alopecia (AGA) and its association with the metabolic syndrome (MetS) have received increasing interest since 1972, when the first link between cardiovascular risk factors and hair loss was raised. We have reviewed studies concerning the relationship between alopecia and MetS. Many studies have investigated the relationship among AGA and MetS and its individual components, particularly in men, where a disproportionately large number of these studies supports this association. AGA has also been associated with other metabolic-related conditions, including coronary artery disease, polycystic ovary syndrome, and Cushing syndrome, as well as several nutritional deficiencies, all of which have led to many clinicians advocating for the screening of MetS and cardiovascular risk factors in patients who present with AGA.
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Abstract
Alopecia areata (AA), a prevalent inflammatory cause of hair loss, lacks FDA-approved therapeutics for extensive cases, which are associated with very poor rates of spontaneous hair regrowth and major psychological distress. Current treatments for severe cases include broad immune-suppressants, which are associated with significant adverse effects, precluding long-term use, with rapid hair loss following treatment termination. As a result of the extent of the disease in severe cases, topical contact sensitizers and intralesional treatments are of limited use. The pathogenesis of AA is not yet fully understood, but recent investigations of the immune activation in AA skin reveal Th1/IFN-γ, as well as Th2, PDE4, IL-23, and IL-9 upregulations. Tissue analyses of both animal models and human lesions following broad-acting and cytokine-specific therapeutics (such as JAK inhibitors and ustekinumab, respectively) provide another opportunity for important insights into the pathogenesis of AA. As reviewed in this paper, numerous novel therapeutics are undergoing clinical trials for AA, emphasizing the potential transformation of the clinical practice of AA, which is currently lacking. Dermatologists are already familiar with the revolution in disease management of psoriasis, stemming from better understanding of immune dysregulations, and atopic dermatitis will soon follow a similar path. In light of these recent developments, the therapeutic arena of AA treatments is finally getting more exciting. AA will join the lengthening list of dermatologic diseases with mechanism-targeted drugs, thus changing the face of AA.
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Affiliation(s)
- Yael Renert-Yuval
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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46
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WITHDRAWN: Frequency of Alopecia areata in patients with autoimmune thyroid diseases. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Alopecia areata is an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Skin biopsies of affected skin show a lymphocytic infiltrate in and around the bulb or the lower part of the hair follicle in the anagen (hair growth) phase. A breakdown of immune privilege of the hair follicle is thought to be an important driver of alopecia areata. Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease. Several genetic susceptibility loci were identified to be associated with signalling pathways that are important to hair follicle cycling and development. Alopecia areata is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology can be helpful. Alopecia areata is difficult to manage medically, but recent advances in understanding the molecular mechanisms have revealed new treatments and the possibility of remission in the near future.
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Affiliation(s)
- C Herbert Pratt
- Department of Genetic Resource Sciences, The Jackson Laboratory, Bar Harbor, Maine, USA
| | - Lloyd E King
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Angela M Christiano
- Departments of Dermatology and Genetics &Development, Columbia University, New York, New York, USA
| | - John P Sundberg
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Research and Development, The Jackson Laboratory, 600 Main Street, Bar Harbor, Maine 04609-1500, USA
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Taketomo Y, Noso S, Babaya N, Hiromine Y, Ito H, Kanto K, Niwano F, Oiso N, Kawada A, Kawabata Y, Ikegami H. Common phenotype and different non-HLA genes in Graves’ disease and alopecia areata. Hum Immunol 2017; 78:185-189. [DOI: 10.1016/j.humimm.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/08/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
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49
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Hussain ST, Mostaghimi A, Barr PJ, Brown JR, Joyce C, Huang KP. Utilization of Mental Health Resources and Complementary and Alternative Therapies for Alopecia Areata: A U.S. Survey. Int J Trichology 2017; 9:160-164. [PMID: 29118520 PMCID: PMC5655624 DOI: 10.4103/ijt.ijt_53_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The efficacy of traditional medical treatments for alopecia areata (AA) is limited, leading some to pursue alternative treatments. The utilization and nature of these treatments are unclear. Objective To assess the extent to which patients with AA pursue alternative treatments and to characterize these treatments. Methods A 13-item electronic survey was E-mailed by the National Alopecia Areata Foundation (NAAF) to their patient database and shared on the NAAF social media to individuals with AA. Results Of 1083 respondents, 78.1% of patients were very or somewhat unsatisfied, compared to 7.7% who were very or somewhat satisfied with the current medical treatments for AA. Approximately a third of patients pursued therapy-related mental health services (31.2%) and attended support groups (29.0%). Patients were more likely to pursue a mental health-related therapy if they had long-standing alopecia, or if they were young, female, or white. Limitations This was a convenience sample of patients recruited online and via the NAAF AA registry. Conclusion Many patients with AA are dissatisfied with current treatments and are seeking mental health treatment for AA. While the efficacy of alternative therapies is unknown, further research is needed to determine their role in the treatment of AA.
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Affiliation(s)
- Salman T Hussain
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,The Geisel School of Medicine, Hanover, NH, USA
| | - Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,The Geisel School of Medicine, Hanover, NH, USA
| | - Cara Joyce
- Loyola University Medical Center, Maywood, IL, USA
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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50
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El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther 2016; 30. [DOI: 10.1111/dth.12437] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Moustafa A. El Taieb
- Department of Dermatology, Venereology and Andrology; Aswan University; Aswan Egypt
| | - Hassan Ibrahim
- Department of Dermatology, Venereology and Andrology; South Valley University; Qena Egypt
| | - Essam A. Nada
- Department of Dermatology, Venereology and Andrology; Sohag University; Sohag Egypt
| | - Mai Seif Al-Din
- Department of Dermatology; Qina General Hospital; Qena Egypt
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