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Fang H, Zhang F, Lin W, Jiang Y, Liu Q, Yang D. Case report: Sequential therapy with dupilumab and baricitinib for severe alopecia areata with atopic dermatitis in children. Front Immunol 2024; 15:1395288. [PMID: 38903518 PMCID: PMC11187300 DOI: 10.3389/fimmu.2024.1395288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
An 8-year-old female child presented with patchy hair loss for 1 year, accompanied by eyebrow loss for 6 months. Microscopic examination of the hair confirmed the features of active stage alopecia areata, with a Severity of Alopecia Tool (SALT) score of 70%. The diagnosis was severe alopecia areata. The patient had a history of atopic dermatitis since infancy, with recurrent episodes of scattered papules and pruritus for 8 years. Initial treatment involved subcutaneous injections of dupilumab 300mg every 2 weeks for 6 months, resulting in a reduction of SALT score to 20% and improvement of atopic dermatitis symptoms. Discontinuation of Dupilumab and initiation of daily oral Baricitinib at a dose of 2mg for a duration of 5 months. According to the SALT score evaluation, the severity of hair loss was less than 10% and there was significant regrowth of hair. No significant adverse reactions were observed during the treatment period.
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Affiliation(s)
- Huijuan Fang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengchuan Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjun Lin
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuqi Jiang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qingwu Liu
- Dermatology Department, China-Japan Friendship Hospital, Beijing, China
| | - Dingquan Yang
- Dermatology Department, China-Japan Friendship Hospital, Beijing, China
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Starace M, Pampaloni F, Lazaridou E, Kyrmanidou E, Stratigos A, Lallas A, Katoulis A, Sgouros D, Quadrelli F, Rapparini L, Cedirian S, Bruni F, Ala L, Rossi A, Piraccini BM, Apalla Z. Current Diagnostic and Therapeutic Practices in Alopecia Areata in Two Mediterranean Countries: A Survey-Based Study. Dermatol Ther (Heidelb) 2024; 14:953-970. [PMID: 38598171 PMCID: PMC11052953 DOI: 10.1007/s13555-024-01141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Alopecia areata (AA) affects approximately 2% of the general population and is associated with significant psychosocial morbidity and poor health-related quality of life. Despite the high incidence of the disease the available clinical practice guidelines to help clinicians and improve patients' care are very poor and of a low methodological quality, as compared to other high-burden dermatoses. The aim of this survey is to capture the current clinical practice in AA management, as performed by dermatologists, in two Mediterranean countries to identify potential disparities and gaps in diagnosis and treatment. METHODS A 50-item questionnaire was created in the English language and then translated into Greek and Italian language and sent to the Greek and Italian dermatologists via email. RESULTS A total of 490 dermatologists from Italy and 234 from Greece participated in the survey. The diagnosis of AA is usually based on history and clinical examination, supported by trichoscopy. The rate of use of severity scores and scales to evaluate impact on quality of life by dermatologists was low. Treatment of patchy AA, in both adult and pediatric populations, is based on use of topical steroids as first-line treatment. Results on special site involvement (eyebrows, beard, and ophiasis), chronic cases, and the pediatric population highlight extreme heterogeneity in treatment approach. CONCLUSIONS Our results highlight that management of AA, in terms of diagnosis and treatment, is still challenging.
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Affiliation(s)
- Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisabeth Lazaridou
- Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kyrmanidou
- Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexander Stratigos
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Aimilios Lallas
- 1st Department of Dermatology and Venereology, Medical School, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attiko" General Hospital, Athens, Greece
| | - Dimitrios Sgouros
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attiko" General Hospital, Athens, Greece
| | - Federico Quadrelli
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stephano Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lorenzo Ala
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - Alfredo Rossi
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 1, 40138, Bologna, Italy.
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Zoe Apalla
- Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ma Y, Wang W, Shi D. Tofacitinib treatment in a severe pediatric alopecia areata: A case report and a literature review. Skin Res Technol 2024; 30:e13553. [PMID: 38186061 PMCID: PMC10772467 DOI: 10.1111/srt.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Yanting Ma
- Department of Clinical MedicineJining Medical UniversityJiningChina
| | - Wei Wang
- Department of DermatologyJining No.1 People's HospitalJiningChina
| | - Dongmei Shi
- Department of DermatologyJining No.1 People's HospitalJiningChina
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4
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Zhou J, Yang Y, Xu M, Lyu Z, Wu X. Efficacy, safety, and Pharmacoeconomics of Three Common Strategies for Pediatric Alopecia Areata Patients: A Retrospective Cohort Study. Clin Cosmet Investig Dermatol 2023; 16:2947-2956. [PMID: 37873509 PMCID: PMC10590599 DOI: 10.2147/ccid.s425534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/25/2023]
Abstract
Objective To evaluate and explore the efficacy, safety, and pharmacoeconomics of three common strategies for pediatric alopecia areata. Methods Chinese pediatric alopecia areata patients meeting the criteria were included and divided into three groups based on the received treatments. The efficacy, adverse events and pharmacoeconomics of these treatments were retrospectively analyzed. Results Twenty-four pediatric AA patients were recruited in this study. 100% (12/12) of patients from the traditional group achieved SALT100. In the tofacitinib group, 40.0% (2/5) of patients achieved SALT50. 20.0% (1/5) of patients achieved SALT75 and 40.0% (2/5) of patients achieved SALT100. In the MN group, 42.86% (3/7) of patients were non-responders. 14.28 (1/7) of patients achieved SALT75 and 42.86% (3/7) of patients achieved SALT100. The adverse effects (AEs) were mild in all three groups, and none of the patients discontinued the treatments due to the AEs. Comparing the other two groups, the MN treatment would be more time-intensive and more expensive. Conclusion For newly diagnosed or naive pediatric patients, the traditional treatment was the first-line approach. For long-duration, severe and refractory patients, tofacitinib and microneedling can be alternative options.
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Affiliation(s)
- Jiong Zhou
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yang Yang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Mengjun Xu
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhongfa Lyu
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xianjie Wu
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Waśkiel-Burnat A, Rakowska A, Zaremba M, Maciejewska M, Blicharz L, Starace M, Iorizzo M, Piraccini BM, Olszewska M, Rudnicka L. Markers of Venous Thromboembolism Risk in Patients with Alopecia Areata: Is There Anything to Worry about? Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00971-7. [PMID: 37423962 PMCID: PMC10366048 DOI: 10.1007/s13555-023-00971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Numerous studies have indicated that alopecia areata is associated with a chronic systemic inflammation, which is considered as a risk factor for venous thromboembolism. The aim of the study was to evaluate the following markers of venous thromboembolism risk: soluble fibrin monomer complex (SFMC), thrombin-antithrombin complex (TATC), and prothrombin fragment 1 + 2 (F1 + 2) in patients with alopecia areata and compare them with healthy controls. METHODS In total, 51 patients with alopecia areata [35 women and 16 men; mean age: 38 (19-54) years] and 26 controls [18 women and 8 men; mean age: 37 (29-51) years] were enrolled in the study. The serum concentrations of thromboembolism markers were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS An increased level of SFMC was detected in patients with alopecia areata compared with the controls [25.66 (20-34.86) versus 21.46 (15.38-29.48) µg/ml; p < 0.05)]. In addition, a higher level of F1 + 2 was observed in patients with alopecia areata in comparison with the control group [70150 (43720-86070) versus 38620 (31550-58840) pg/ml; p < 0.001]. No significant correlation was detected among SFMC or F1 + 2 and the Severity of Alopecia Tool (SALT) score, disease duration, or the number of the hair loss episodes. CONCLUSION Alopecia areata may be associated with an increased risk of venous thromboembolism. Regular screening and preventive management of venous thromboembolism may be beneficial in patients with alopecia areata, especially before and during systemic Janus kinase (JAK) inhibitors or glucocorticoid therapy.
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Affiliation(s)
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Zaremba
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Park H, Kim JE, Choi JW, Kim DY, Jang YH, Lee Y, Jeon J, Shin HT, Kim MS, Shin JW, Cho SB, Lew BL, Choi GS. Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment. Ann Dermatol 2023; 35:190-204. [PMID: 37290953 DOI: 10.5021/ad.22.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/17/2022] [Accepted: 01/24/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact. OBJECTIVE To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea. METHODS We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus. RESULTS Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used. CONCLUSION The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.
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Affiliation(s)
- Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Do Young Kim
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Tae Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Min Sung Kim
- Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea
| | - Jung Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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7
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Park H, Kim JE, Choi JW, Kim DY, Jang YH, Lee Y, Jeon J, Shin HT, Kim MS, Shin JW, Cho SB, Lew BL, Choi GS. Guidelines for the Management of Patients with Alopecia Areata in Korea: Part II Systemic Treatment. Ann Dermatol 2023; 35:205-216. [PMID: 37290954 DOI: 10.5021/ad.22.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/17/2022] [Accepted: 01/24/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Alopecia areata (AA) is a chronic disease with an unpredictable course and can have a severe psychological impact on an individual. OBJECTIVE To provide evidence and consensus-based statements regarding the treatment of patients with AA in Korea. METHODS We searched for relevant studies from inception to May 2021 regarding the systemic treatment of AA. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statement, and an agreement of 75% or greater was considered as having reached consensus. RESULTS Current evidence supports the efficacy of systemic corticosteroids, oral cyclosporine monotherapy or combination with systemic corticosteroids, and oral Janus kinase inhibitors in severe AA patients. Systemic steroids may be considered for pediatric patients with severe AA. A consensus was achieved in three out of nine (33.3%), and one out of three (33.3%) statements pertaining to systemic treatment in adult and pediatric AA, respectively. CONCLUSION The present study produced up-to-date, evidence-based treatment guidelines for AA associated with the consensus obtained by experts based on the Korean healthcare system.
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Affiliation(s)
- Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Do Young Kim
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Tae Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Min Sung Kim
- Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea
| | - Jung Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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Wagh N. Tofacitinib: A Promising Treatment for Adolescent Alopecia Areata. Int J Trichology 2023; 15:113-114. [PMID: 38179009 PMCID: PMC10763726 DOI: 10.4103/ijt.ijt_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Nitika Wagh
- Consultant Dermatologist, Siddhivinayak Skin Hair and Cosmetology Clinic, Pune, India
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Kołcz K, Żychowska M, Sawińska E, Reich A. Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib-A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata. Dermatol Ther (Heidelb) 2023; 13:843-856. [PMID: 36639612 PMCID: PMC9984583 DOI: 10.1007/s13555-023-00889-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently co-exist with atopic dermatitis (AD), and the coincidence of atopy predisposes to a more severe course of the disease. To date, therapeutic options in AA, especially in the pediatric population, are mainly limited to corticosteroids, irritants, sensitizers, and immunosuppressive agents. Recently, innovative therapies have emerged, among which Janus kinase (JAK) inhibitors, effective in both AD and AA, appear to be the most promising. Here, a 14-year-old girl with alopecia universalis (AU) and mild AD is demonstrated, who was successfully treated with a selective JAK1 inhibitor, upadacitinib, which has been approved for the treatment of AD in adults and children aged 12 years and older. Resolution of eczema and complete hair regrowth was achieved after 3 months of therapy. Apart from transient mild leukopenia at weeks 4 and 8, no adverse events were noted. Data in the literature on the efficacy and safety of JAK inhibitors in the treatment of AA in the pediatric population is based on single case reports and case series. So far, topical tofacitinib and ruxolitinib, as well as systemic tofacitinib, ruxolitinib, and baricitinib have been used off-label in this indication in children. Upadacitinib is another effective treatment option with a good benefit-risk ratio for patients with AA, including cases coexisting with AD.
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Affiliation(s)
- Kinga Kołcz
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2 Street, 35-055, Rzeszow, Poland
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2 Street, 35-055, Rzeszow, Poland.
| | - Edyta Sawińska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2 Street, 35-055, Rzeszow, Poland
- Department of Cosmetology, University of Information Technology and Management, Rzeszow, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2 Street, 35-055, Rzeszow, Poland
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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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Behrangi E, Barough MS, Khoramdad M, Hejazi P, Koltapeh MP, Goodarzi A. Efficacy and safety of tofacitinib for treatment of alopecia areata in children: A systematic review and meta-analysis. J Cosmet Dermatol 2022; 21:6644-6652. [PMID: 36177815 DOI: 10.1111/jocd.15425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/29/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Tofacitinib, a potent JAK inhibitor, has gained increasing interest, in recent years, among dermatologists for the management of refractory alopecia areata. Despite a growing number of studies on its safety and efficacy, there is still a lack of clarity, especially in the pediatric population, in treatment considerations such as proper dosage, treatment duration, side-effect profile, and therapeutic strategies to guide clinicians. METHODS Multiple databases were systematically searched. Following the PRISMA diagram, of a pool of 601 papers, seven met a checklist of inclusion criteria. These were observational studies including a total of 59 patients from four to 19 years of age. RESULTS In the evaluated studies, tofacitinib was administered either orally at a 2.5 to 15 mg daily (mostly 5 mg twice a day) dosage for 2 to 38 months or in the form of a 2% topical solution for 3-17 months. Metanalysis showed that 49% (95% CI: 29%-69%, I2 = 59.94%) of patients experienced a reversal of alopecia after a minimum of 3 to 9 months of therapy. Fifty-five percent (95% CI: 23%-86%, I2 = 75.07%) and 41% (95% CI: 23%-59%, I2 = 0.00%) showed Good/complete and partial response rates, respectively. Oral administration was significantly more efficacious than topical application (73% vs 23%, p-Value = 0.04). Few side effects such as diarrhea and mild liver transaminases abnormalities were noted in several patients. CONCLUSION Results of this review suggest that tofacitinib at 2.5-15 mg daily (especially 5 mg twice daily) oral formulation or 2% topical solution can be regarded as a viable alternative or adjunct to the conventional treatment options for moderate to severe forms of alopecia areata in children owing to its acceptable efficacy and side-effect profile. However, uncertainties continue to exist around treatment strategies including initial and maintenance dosages, route of administration, dose adjustments, the timing of tapering or discontinuation, and associated treatment modalities.
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Affiliation(s)
- Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Malihe Khoramdad
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Pourghahramani Koltapeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Okubo Y, Miyabayashi T, Sato R, Endo W, Inui T, Togashi N, Haginoya K. A first case of childhood chronic inflammatory demyelinating polyneuropathy associated with alopecia universalis. Brain Dev 2022; 44:748-752. [PMID: 35970688 DOI: 10.1016/j.braindev.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired demyelinating disease of the peripheral nervous system with unknown etiology. Alopecia universalis, an advanced form of alopecia areata (AA), is a condition characterized by complete hair loss. Here we report the first case of childhood CIDP associated with AA who was successfully treated with a combination of intravenous immunoglobulin (IVIg) and corticosteroids. CASE REPORT: This case describes a nine-year-old Japanese girl who developed alopecia, progressive muscle weakness, and eventually loss of walking ability (at ages 2, 4, and 7, respectively). She was treated with IVIg and prednisolone combination therapy, which improved muscle weakness and alopecia. She was positive for serum IgG-GM2 type anti-glycolipid antibodies, which may be associated with this rare combination of diseases.
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Affiliation(s)
- Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan.
| | - Takuya Miyabayashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Ryo Sato
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Noriko Togashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan.
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13
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Mahajan R, Daroach M, Handa S, De D. Randomised controlled trial to compare the effectiveness and safety of low dose dexamethasone oral mini‐pulse versus diphenylcyclopropenone contact sensitisation in severe paediatric alopecia areata. Dermatol Ther 2022; 35:e15810. [DOI: 10.1111/dth.15810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rahul Mahajan
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Manju Daroach
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sanjeev Handa
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Dipankar De
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
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14
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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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15
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Stefanaki C, Kontochristopoulos G, Hatzidimitraki E, Stergiopoulou A, Katsarou A, Vosynioti V, Remountaki E, Rigopoulos D. A Retrospective Study on Alopecia Areata in Children: Clinical Characteristics and Treatment Choices. Skin Appendage Disord 2021; 7:454-459. [PMID: 34901176 DOI: 10.1159/000518042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Although children are affected frequently with alopecia areata (AA), data are limited on clinical characteristics and treatment choices. Materials and Methods We retrospectively reviewed the records of the pediatric dermatology department over a 12-year period to identify children with AA. Clinical data were collected. Results Three hundred and sixty-four children with AA were identified, aged 1-12 years, 214 males and 150 females. The mean age of onset was 6.6 years (±3.3). The disease presented with patches on the scalp in the majority (90.7%), whereas only 6 children had alopecia totalis or universalis. The most commonly prescribed treatment was topical steroids (69.1%), followed by the combination of topical steroids and minoxidil 2% (14.3%). Oral steroids were prescribed in only 16 children. Follow-up at 3 months was available for only 70 children and the majority (84.3%) had some hair regrowth. Hair regrowth was unrelated to the number of plaques (p = 0.257), disease location (p = 0.302), and atopy (p = 0.999). Hair regrowth only correlated with the type of treatment (p = 0.003) with potent topical and intralesional steroids giving the best results. Conclusion AA usually presents with a mild form in children, and potent topical steroids are the mainstay of treatment.
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Affiliation(s)
- Christina Stefanaki
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | | | | | | | - Alexandra Katsarou
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - Vasiliki Vosynioti
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
| | - Eleni Remountaki
- Pediatric Dermatology Clinic, Andreas Sygros University Skin Hospital, Athens, Greece
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16
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Elsaie ML, Hasan MS. Successful treatment of long-standing alopecia totalis with intralesional methotrexate. J Cosmet Dermatol 2021; 21:855-856. [PMID: 33780590 DOI: 10.1111/jocd.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Mohamed L Elsaie
- National Research Centre, Cairo, Egypt.,Voluntary instructor, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mohamed S Hasan
- Department of Dermatology, Venereology, Al-Azhar University, Cairo, Egypt
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17
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Manchanda Y, Ramamoorthy R. Revisiting pediatric alopecia areata: Newer insights. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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