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Zhang X, Jiang Y. Predictors and Management of Inadequate Response to JAK Inhibitors in Alopecia Areata. Am J Clin Dermatol 2024:10.1007/s40257-024-00884-x. [PMID: 39225949 DOI: 10.1007/s40257-024-00884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
Alopecia areata is a common autoimmune disorder characterized by non-scarring hair loss on the scalp or other hair-bearing surface. In recent years, Janus kinase (JAK) inhibitors have shown promise in the treatment of alopecia areata by disrupting the signaling pathways involved in immune-mediated hair follicle damage. However, some patients with alopecia areata exhibit insufficient responses to JAK inhibitors. This review aims to explore the predictive factors for poor responses to JAK inhibitors in patients with alopecia areata and to discuss alternative treatment strategies in such cases. Patients with a longer duration of the current episode and higher baseline severity are at an increased risk of inadequate JAK inhibitor responses. Oral administration rather than topical application, and extended treatment durations, correlate with a favorable response. Notably, the poor response to JAK inhibitors in alopecia areata may be related to the amount and functional depletion of regulatory T cells resulting from an augmented T helper-2-type immune response. For patients with poor responses to JAK inhibitors, treatment adjustments may include increasing the dosage, extending the treatment duration, combination therapies, or switching to alternative JAK inhibitors. For patients with atopic comorbidities or psychological problems, it is important to select corresponding treatment options to optimize patient outcomes. Further research is needed to establish more reliable predictors and improve overall patient care.
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Affiliation(s)
- Xiaolin Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yiqun Jiang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
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2
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Diluvio L, Matteini E, Lambiase S, Cioni A, Gaeta Shumak R, Dattola A, Bianchi L, Campione E. Effect of baricitinib in patients with alopecia areata: Usefulness of trichoscopic evaluation. J Eur Acad Dermatol Venereol 2024; 38:e478-e480. [PMID: 38084867 DOI: 10.1111/jdv.19663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/14/2023] [Indexed: 05/26/2024]
Affiliation(s)
- L Diluvio
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - E Matteini
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - S Lambiase
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - A Cioni
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - R Gaeta Shumak
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - A Dattola
- Dermatology Unit, Department of Systems Medicine, University of Rome "La Sapienza", Rome, Italy
| | - L Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - E Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Rudnicka L, Arenbergerova M, Grimalt R, Ioannides D, Katoulis AC, Lazaridou E, Olszewska M, Ovcharenko YS, Piraccini BM, Prohic A, Rakowska A, Reygagne P, Richard MA, Soares RO, Starace M, Vañó-Galvan S, Waskiel-Burnat A. European expert consensus statement on the systemic treatment of alopecia areata. J Eur Acad Dermatol Venereol 2024; 38:687-694. [PMID: 38169088 DOI: 10.1111/jdv.19768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA-approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA-approved for patients with severe alopecia areata. Other systemic medications used off-label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.
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Affiliation(s)
- L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - D Ioannides
- 1st Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - A C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - E Lazaridou
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - M Olszewska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Y S Ovcharenko
- Department of Infectious Diseases and Clinical Immunology of the V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Prohic
- Department of Dermatovenerology, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - A Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - P Reygagne
- Centre de Santé Sabouraud, Hopital Saint Louis, Paris, France
| | - M A Richard
- CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitary Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - R O Soares
- CUF Descobertas Hospital, Lisbon, Portugal
| | - M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Italy School of Specialization Dermatology and Venereology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - S Vañó-Galvan
- Department Ramon y Cajal Hospital, IRYCIS, Grupo Pedro Jaén Clinic, TricoHRC Research Group, University of Alcala, Madrid, Spain
| | - A Waskiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Seol JE, Hong SM, Ahn SW, Jang SH, Kim H. Two-dimensional planimetry for alopecia areata severity evaluation compared with severity of alopecia tool: A pilot study. Skin Res Technol 2023; 29:e13440. [PMID: 37753671 PMCID: PMC10444945 DOI: 10.1111/srt.13440] [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: 04/02/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Severity of Alopecia Tool (SALT) is widely used to assess the severity of alopecia areata (AA). However, physician-related subjectivity exists in SALT scoring (S1-5), especially with initial inspection in the clinical practice. This study investigated two-dimensional planimetric method to calculate actual surface area of AA, validating SALT scoring. MATERIALS AND METHODS SALT score was measured twice in each patient based on "initial" inspection in the clinic (SALT-I) and retrospective assessment of the "photograph" (SALT-P). Planimetric surface area was calculated by Image J program. Subgroup analysis was performed depending on the agreement between SALT-I and -P; score was described in the order of SALT-I and SALT-P. RESULTS A total of 93 subjects were enrolled. Planimetric surface area (cm2 ) of SALT-I was 2.5-74.9 (S1), 48.8-100.6 (S2), 83.6-205.4 (S3), and 282-367.9 (S4), while SALT-P was 2.5-59.2 (S1), 41.6-205.4 (S2), 48.8-183.2 (S3), and 282-367.9 (S4). In subgroup analysis, SALT-I and SALT-P agreed group showed planimetric surface area (cm2 ) as 2.5-59.2 (S1-1), 64.2-100.6 (S2-2), 168.3-183 (S3-3), and 282.6-367.9 (S4-4). Disagreed group showed the value as 54.7 (S1-2), 41.6-74.9 (S2-1), 83.6-205.4 (S2-3), and 48.8-88.6 (S3-2). CONCLUSION SALT-P was more clearly correlated with actual surface area than SALT-I. Planimetric surface area measurement could be used as a supplementary method especially in the S1 to S3, suggesting 60 cm2 , 100 cm2 , and 200 cm2 as objective cutoff values to differentiate S1, S2, and S3.
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Affiliation(s)
- Jung Eun Seol
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seong Min Hong
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Sang Woo Ahn
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seung Hee Jang
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Hyojin Kim
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
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Al‐Dhubaibi MS, Alsenaid A, Alhetheli G, Abd Elneam AI. Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis. Skin Res Technol 2023; 29:e13378. [PMID: 37357664 PMCID: PMC10236002 DOI: 10.1111/srt.13378] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations. OBJECTIVE Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns. METHODS Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed. RESULTS Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. CONCLUSION There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.
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Affiliation(s)
| | - Adel Alsenaid
- Department of DermatologyCollege of Medicine, Shaqra UniversityDawadmiSaudi Arabia
- Division of DermatologyJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
| | - Ghadah Alhetheli
- Division of Dermatology and Cutaneous SurgeryCollege of Medicine, Qassim UniversityBuraydahSaudi Arabia
| | - Ahmed Ibrahim Abd Elneam
- Department of Clinical Biochemistry, Department of Basic Medical SciencesCollege of Medicine, Shaqra UniversityDawadmiSaudi Arabia
- Molecular Genetics and Enzymology DepartmentHuman Genetics and Genome Research Institute, National Research CenterDokkiCairoEgypt
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[Translated article] Trichoscopy in Alopecia Areata. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T25-T32. [PMID: 36368582 DOI: 10.1016/j.ad.2022.08.027] [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: 10/01/2021] [Accepted: 08/07/2022] [Indexed: 11/09/2022] Open
Abstract
Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.
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Gómez-Quispe H, Muñoz Moreno-Arrones O, Hermosa-Gelbard Á, Vañó-Galván S, Saceda-Corralo D. Trichoscopy in Alopecia Areata. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:25-32. [PMID: 36067826 DOI: 10.1016/j.ad.2022.08.018] [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: 10/01/2021] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023] Open
Abstract
Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.
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Affiliation(s)
- H Gómez-Quispe
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España.
| | - O Muñoz Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - Á Hermosa-Gelbard
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - S Vañó-Galván
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
| | - D Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, España; Unidad de Tricología, Grupo de Dermatología Pedro Jaén, Madrid, España
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8
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Afify A, El Sayed M, Ibrahim ND. Superficial cryotherapy versus intralesional corticosteroids injection in alopecia areata: A trichoscopic comparative study. Int J Trichology 2022; 14:8-13. [PMID: 35300102 PMCID: PMC8923143 DOI: 10.4103/ijt.ijt_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Alopecia areata (AA) is an autoimmune disease leading to noncicatricial alopecia. Topical or intralesional corticosteroid (ILCS) is the accepted therapeutic option for mild cases; however, adverse effects are sometimes difficult to reverse. When the exposure to liquefied nitrogen is limited to a few seconds “superficial” cryotherapy, reactive vasodilation may improve microcirculation and nutritional status around hair follicles. Objective: This study aimed to evaluate and compare superficial cryotherapy and ILCS in the treatment of patchy AA. Materials and Methods: This prospective comparative study included 21 patients with patchy AA. Every patient received superficial cryotherapy on one patch, every 2 weeks for 3 months, and ILCS injection for another patch, once monthly for 3 months. Results: Clinical improvement was higher in cryotherapy group compared to ILCS group with a statistically significant difference (P = 0.002). On trichoscopic evaluation, terminal hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS but without statistical significance (P = 0.595) and vellus hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS with a statistical significance (P = 0.002). Conclusions: Cryotherapy is more effective and less painful than ILCS in the treatment of patchy AA.
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Waśkiel-Burnat A, Osińska M, Salińska A, Blicharz L, Goldust M, Olszewska M, Rudnicka L. The Role of Serum Th1, Th2, and Th17 Cytokines in Patients with Alopecia Areata: Clinical Implications. Cells 2021; 10:3397. [PMID: 34943905 PMCID: PMC8699846 DOI: 10.3390/cells10123397] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Alopecia areata is a type of non-scarring hair loss. The dysregulation of numerous systemic Th1 (IL-2, IFN-γ, TNF, IL-12, and IL-18), Th2 (IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17E, IL-31 and IL-33) and Th17 (IL-17, IL-17F, IL-21, IL-22, IL-23 and TGF-β) cytokines was observed in patients with alopecia areata. Positive correlations between the severity of alopecia areata and an increased serum level of various cytokines including IL-2, TNF, IL-12, IL-17, and IL-17E were reported in the literature. An increased serum level of numerous cytokines, such as IL-2, IL-6, TNF, IL-12, IL-17E, and IL-22, was described as positively correlated with the duration of the disease. Moreover, it was shown that increased pre-treatment serum level of IL-12 was a positive, while increased serum levels of IL-4 and IL-13 were negative prognostic markers for the efficacy of diphenylcyclopropenone. In conclusion, alopecia areata is associated with the dysregulation of systemic Th1, Th2 and Th17 cytokines with their role in the pathogenesis, clinical manifestations and prognosis of the disease. Available data indicate the most significant role of serum IL-2, TNF, IL-12, IL-17, and IL-17E as markers of disease activity. The serum levels IL-4, IL-12 and IL-13 may be useful as potential predictors of diphenylcyclopropenone efficacy.
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Affiliation(s)
- Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Marta Osińska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Anna Salińska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (A.W.-B.); (M.O.); (A.S.); (L.B.); (M.O.)
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10
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Gao Y, Huo S, Sun M, Zhang C, Wang J, Gao J, Wang N, Lv Y. Evaluation of several immune and inflammatory indicators and their association with alopecia areata. J Cosmet Dermatol 2021; 21:2995-3001. [PMID: 34591347 DOI: 10.1111/jocd.14504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder and chronic recurrent inflammatory disease that results in non-scarring hair loss. OBJECTIVES Our aim is to investigate several parameters related to autoimmunity and inflammation in AA patients and to evaluate their association with this disease. METHODS This study included a total of 672 eligible AA patients and 580 age- and sex-matched healthy individuals who were treated at a third-class hospital in Hefei from January 2016 to May 2020. Data for serum C-reactive protein (CRP), 25-hydroxy vitamin D (25(OH)D), T3, T4, thyroid-stimulating hormone (TSH), thyroid antibodies (TPOAbs and TGAbs), antinuclear antibodies (ANA), complements (C3, C4), and several immunoglobulins (IgA, IgM, and IgG) were collected in this study. RESULTS Regarding autoimmune-related functional indicators, there were no statistically significant differences between TSH, TGAbs, C3, C4, IgA, IgM, and IgG levels between AA patients and healthy controls. Only T3, T4, TPOAbs, and ANA values were significantly abnormal in the AA group compared with the healthy individuals (p < 0.05). In addition, the mean serum 25(OH)D concentration was significantly lower in the patient group than that in control group (p < 0.05), and serum CRP was significantly increased (p < 0.05). CONCLUSION Although the etiopathogenesis of AA is not clear, the importance of monitoring the levels of T3, T4, TPOAbs, ANA, and 25 (OH)D in AA cases is indispensable.
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Affiliation(s)
- Yamei Gao
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shaohu Huo
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Minghui Sun
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chenchen Zhang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Gao
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Na Wang
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yongmei Lv
- Department of Dermatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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11
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Majid I, Sameem F, Sultan J, Aleem S. Alopecia areata severity index (AASI): A reliable scoring system to assess the severity of alopecia areata on face and scalp-a pilot study. J Cosmet Dermatol 2021; 20:2565-2570. [PMID: 34129730 DOI: 10.1111/jocd.14289] [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: 04/23/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND All scoring systems used in Alopecia Areata (AA) focus mainly on scalp and cannot assess the severity or treatment response when AA involves the beard hair, eyebrows, or eyelashes. AIM This study describes and assesses the reliability of a new scoring system "Alopecia Areata Severity Index" (AASI) for measuring the severity of AA of scalp, beard, and upper face. METHODS Scalp hair, beard hair, upper face (eyebrows and eyelashes) were individually assessed and the severity of AA was scored from 0 to 100 (0-50 in case of upper face). AASI score was then calculated as a sum of all these individual scores as AASI = AASI (scalp) + AASI (upper face) + AASI (beard)+. To test the inter-observer reliability of AASI score, 25 patients with varying severity of AA were scored by 4 trained dermatologists. Repeat scoring was performed after one week to test for intra-observer reliability. RESULTS Excellent inter-rater, as well as intra-observer reliability, was observed with Chronbach's alpha value of 0.999 (CI = 0.989-1.000). The intra-observer correlation coefficient with average measure was 0.999 (CI = 0.990-1.000) with statistically significant F test <0.005. CONCLUSION AASI score is a reliable scoring system to assess the severity of AA in patients with involvement of one or more areas of the body. LIMITATIONS Sample population belonged to single ethnic group.
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Affiliation(s)
- Imran Majid
- CUTIS Institute of Dermatology, Srinagar, India
| | - Farah Sameem
- Department of Dermatology, SKIMS Medical College, Srinagar, India
| | - Javeed Sultan
- Department of Dermatology, Government Medical College, Srinagar, India
| | - Samia Aleem
- Department of Health and Family Welfare, Dermatologist JK Medical Services, Srinagar, India
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