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King B, Ko J, Kwon O, Vañó-Galván S, Piraccini BM, Dutronc Y, Yu G, Liu C, Somani N, Ball S, Mesinkovska NA. Baricitinib Withdrawal and Retreatment in Patients With Severe Alopecia Areata: The BRAVE-AA1 Randomized Clinical Trial. JAMA Dermatol 2024; 160:1075-1081. [PMID: 39141364 PMCID: PMC11325239 DOI: 10.1001/jamadermatol.2024.2734] [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: 03/21/2024] [Accepted: 06/13/2024] [Indexed: 08/15/2024]
Abstract
Importance Baricitinib has demonstrated efficacy for treating severe alopecia areata in adults. There is currently limited information about the need for continuous therapy after achieving scalp hair regrowth. Objective To report results from the randomized withdrawal period of the BRAVE-AA1 trial. Design, Setting, and Participants BRAVE-AA1 was a randomized, placebo-controlled, phase 3 randomized clinical trial with a treatment withdrawal substudy that was conducted at 70 centers in 3 countries beginning in March 2019. It included 654 adults with severe alopecia areata (AA) (Severity of Alopecia Tool [SALT] score ≥50) who were randomized 3:2:2 to receive treatment with baricitinib, 4 mg; baricitinib, 2 mg; or placebo. Data were analyzed in August 2023. Intervention At week 52, 154 patients who were responders (SALT score ≤20) were rerandomized 3:1 to continue to take their current dose of baricitinib or transition to placebo (randomized withdrawal). Responders randomized to placebo who experienced a loss of treatment benefit (>20-point worsening in SALT score) at any time after week 52 were retreated with their original baricitinib dose. Main Outcome and Measures The proportion of patients who lost treatment benefit through week 152 and the proportion of patients who recaptured response after retreatment. The last observation carried forward was used to impute missing or censored data. Results Of 654 patients who received treatment, the mean (SD) age was 37.1 (13.0) years, and there were 383 women (58.6%). At week 52, 10 of 39 responders taking baricitinib, 2 mg, and 30 of 115 responders taking baricitinib, 4 mg, were rerandomized to placebo. At 4 and 8 weeks of treatment withdrawal, 0% and 10% to 11% of patients, respectively, lost treatment benefit regardless of dose. At week 152, 80% of patients had lost benefit compared with 7% for those who continued baricitinib therapy for both dose groups. Within the follow-up observation periods, 5 of 8 patients taking 2 mg (63%) and 21 of 24 patients taking 4 mg (87.5%) recaptured a SALT score of 20 or less response after retreatment. Conclusions and Relevance Severe AA is a chronic, relapsing condition, and this randomized clinical trial found that withdrawal of therapy for a patient population with severe AA who had achieved meaningful hair regrowth after 1 year of treatment with baricitinib resulted in loss of benefit for almost all patients, indicating that continued therapy is required to maintain hair regrowth. Trial Registration ClinicalTrials.gov Identifier: NCT03570749.
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Affiliation(s)
- Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Justin Ko
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sergio Vañó-Galván
- Hair Disorders Unit, Dermatology Service, Ramon y Cajal Hospital, TricoHRC Research Group, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala, Madrid, Spain
| | - Bianca Maria Piraccini
- Dermatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Guanglei Yu
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Susan Ball
- Eli Lilly and Company, Indianapolis, Indiana
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Parker W, Jirků K, Patel E, Williamson L, Anderson L, Laman JD. Reevaluating Biota Alteration: Reframing Environmental Influences on Chronic Immune Disorders and Exploring Novel Therapeutic Opportunities. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:253-263. [PMID: 38947109 PMCID: PMC11202117 DOI: 10.59249/vunf1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Environmental mismatches are defined as changes in the environment that induce public health crises. Well known mismatches leading to chronic disease include the availability of technologies that facilitate unhealthy diets and sedentary lifestyles, both factors that adversely affect cardiovascular health. This commentary puts these mismatches in context with biota alteration, an environmental mismatch involving hygiene-related technologies necessary for avoidance of infectious disease. Implementation of hygiene-related technologies causes a loss of symbiotic helminths and protists, profoundly affecting immune function and facilitating a variety of chronic conditions, including allergic disorders, autoimmune diseases, and several inflammation-associated neuropsychiatric conditions. Unfortunately, despite an established understanding of the biology underpinning this and other environmental mismatches, public health agencies have failed to stem the resulting tide of increased chronic disease burden. Both biomedical research and clinical practice continue to focus on an ineffective and reactive pharmaceutical-based paradigm. It is argued that the healthcare of the future could take into account the biology of today, effectively and proactively dealing with environmental mismatch and the resulting chronic disease burden.
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Affiliation(s)
- William Parker
- Department of Psychology and Neuroscience, University
of North Carolina, Chapel Hill, NC, USA
- WPLab, Inc., Durham, NC, USA
| | - Kateřina Jirků
- Institute of Parasitology, Biology Centre, Czech
Academy of Sciences, České Budějovice, Czech Republic
| | | | - Lauren Williamson
- Department of Biological Sciences, Northern Kentucky
University, Highland Heights, KY, USA
| | | | - Jon D. Laman
- Department of Pathology & Medical Biology,
University Groningen, University Medical Center Groningen, Groningen, The
Netherlands
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3
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Li J, Green J. A superb way to split hairs. Br J Dermatol 2024; 190:e61. [PMID: 37681515 DOI: 10.1093/bjd/ljad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/28/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Jane Li
- Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy
- The Skin Health Institute, Carlton
- Department of Dermatology, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - Jack Green
- Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy
- The Skin Health Institute, Carlton
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Sun R, Kong D. Bilateral Association Between Atopic Dermatitis® and Alopecia Areata: A Systematic Review and Meta-Analysis. Dermatitis 2024; 35:208-218. [PMID: 37471232 DOI: 10.1089/derm.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This systematic review and meta-analysis aimed to explore the association between atopic Dermatitis® (AD) and alopecia areata (AA). A comprehensive search was conducted in PubMed, Embase, Cochrane, and Web of Science from the inception of each database to November 10, 2022 for relevant studies. As there is a potential bilateral association between the 2 diseases, we assessed the prevalence/incidence of AA in patients with AD and the prevalence/incidence of AD in patients with AA. A total of 29 studies involving 11,233,448 participants were included in this analysis. AA was the exposure factor in 23 studies, AD in 7 studies, and both in 1 study. The meta-analysis revealed that the prevalence of AD was 11.2% (7.7%-15.1%) in patients with AA, and the prevalence of AA was 3.2% (95% confidence interval [CI]: 0.0%-11.5%) in patients with AD. The incidence of AD in AA patients was found to vary with age (P = 0.07). Based on 7 studies, there was a significant association between AD and AA when AA was the exposure factor [odds ratio, OR, = 4.537 (95% CI: 2.409-8.544)]; based on 10 studies, there was also a significant association between AD and AA when AD was the exposure factor [OR = 2.643 (95% CI: 1.737-3.995)]. In conclusion, this meta-analysis demonstrated the 2-way association between AD and AA, providing a clinical reference for disease prevention and control.
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Affiliation(s)
- Rong Sun
- From the The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Deqi Kong
- Epidemic Prevention Department, Center for Disease Control and Prevention of Wuzhong District, Suzhou, China
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Suzuki T, Chéret J, Scala FD, Rajabi-Estarabadi A, Akhundlu A, Demetrius DL, Gherardini J, Keren A, Harries M, Rodriguez-Feliz J, Epstein G, Lee W, Purba T, Gilhar A, Paus R. Interleukin-15 is a hair follicle immune privilege guardian. J Autoimmun 2024; 145:103217. [PMID: 38581915 DOI: 10.1016/j.jaut.2024.103217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
The autoimmunity-promoting cytokine, Interleukin-15 (IL-15), is often claimed to be a key pathogenic cytokine in alopecia areata (AA). Yet, rhIL-15 promotes human hair follicle (HF) growth ex vivo. We have asked whether the expression of IL-15 and its receptor (IL-15R) isoforms is altered in human AA and how IL-15 impacts on human HF immune privilege (HF-IP) in the presence/absence of interferon-γ (IFNγ), the well-documented key AA-pathogenic cytokine, as well as on hair regrowth after experimental AA induction in vivo. Quantitative immunohistomorphometry showed the number of perifollicular IL-15+ T cells in AA skin biopsies to be significantly increased compared to healthy control skin, while IL-15, IL-15Rα, and IL-15Rγ protein expression within the hair bulb were significantly down-regulated in AA HFs. In organ-cultured human scalp HFs, rhIL-15 significantly reduced hair bulb expression of MICA, the key "danger" signal in AA pathogenesis, and increased production of the HF-IP guardian, α-MSH. Crucially, ex vivo, rhIL-15 prevented IFNγ-induced HF-IP collapse, restored a collapsed HF-IP by IL-15Rα-dependent signaling (as documented by IL-15Rα-silencing), and protected AA-preventive immunoinhibitory iNKT10 cells from IFNγ-induced apoptosis. rhIL-15 even promoted hair regrowth after experimental AA induction in human scalp skin xenotransplants on SCID/beige mice in vivo. Our data introduce IL-15 as a novel, functionally important HF-IP guardian whose signaling is constitutively defective in scalp HFs of AA patients. Our data suggest that selective stimulation of intrafollicular IL-15Rα signaling could become a novel therapeutic approach in AA management, while blocking it pharmacologically may hinder both HF-IP restoration and hair re-growth and may thus make HFs more vulnerable to AA relapse.
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Affiliation(s)
- Takahiro Suzuki
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jérémy Chéret
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fernanda D Scala
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ali Rajabi-Estarabadi
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Dermatology, Broward Health, Fort Lauderdale, FL, USA
| | - Aysun Akhundlu
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dana-Lee Demetrius
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer Gherardini
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Matthew Harries
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
| | | | - Gorana Epstein
- Foundation for Hair Restoration, 33143, Miami, Florida, USA
| | - Wendy Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Talveen Purba
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Dr. Phillip Frost Dept. of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; CUTANEON - Skin & Hair Innovations, Hamburg, Germany.
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Sørensen SBT, George P, Jagun O, Wolk R, Napatalung L, Zwillich SH, Iversen L, Ehrenstein V. The Epidemiology of Hospital-Treated Alopecia Areata in Denmark, 1995-2016. Dermatol Ther (Heidelb) 2024; 14:993-1006. [PMID: 38625633 PMCID: PMC11052984 DOI: 10.1007/s13555-024-01145-9] [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: 12/20/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Alopecia areata (AA) is an autoimmune skin disease presenting as nonscarring hair loss. Information on the epidemiology of AA, especially the occurrence of AA and its subtypes within the general population, is scarce. The study aimed to estimate the incidence rates and prevalence of hospital-treated AA and its subtypes in Denmark and to examine the demographic and clinical characteristics of patients with AA, including comorbidities and use of prescription medications. METHODS This was a cohort study based on data from administrative and health registers in Denmark in 1995-2016. The study included individuals who were (1) registered with a hospital inpatient or hospital-based outpatient clinic diagnosis of AA between 1995 and 2016 in the Danish National Patient Registry covering encounters at all Danish hospitals, (2) alive and resided in Denmark anytime between 1995 and 2016, (3) aged ≥ 12 years, and (4) resided uninterrupted in Denmark during the 12 months before the first AA diagnosis during the study period. RESULTS During the study period, 2778 individuals with an incident hospital-based diagnosis of AA were identified; 63.1% were female and 28.7% of the patients were aged ≥ 50 years. Over the study period, the overall incidence rate for any hospital-treated AA per 100,000 person-years was 2.62 (95% confidence interval [CI], 2.53-2.72), and the overall prevalence in 2016 was 71.7 (95% CI 69.4-74.1) per 100,000 persons. Both incidence rate and prevalence increased over time. Prevalence of most hospital-treated comorbidities or history of medication use was below 10% and was similar in the alopecia totalis (AT)/alopecia universalis (AU) and non-AT/AU subtypes of AA. CONCLUSION This cohort study reported incidence rates and prevalence over time and characteristics of individuals with hospital-treated AA in Denmark, which are in agreement with those previously reported in this population.
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Affiliation(s)
- Sissel Brandt Toft Sørensen
- Department of Clinical Medicine and Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | | | | | | | - Lynne Napatalung
- Pfizer Inc., New York, NY, USA
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
- MC2 Therapeutics A/S, Hørsholm, Denmark
| | - Vera Ehrenstein
- Department of Clinical Medicine and Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
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7
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Singh R, Kumar P, Kumar D, Aggarwal N, Chopra H, Kumar V. Alopecia areata: review of epidemiology, pathophysiology, current treatments and nanoparticulate delivery system. Ther Deliv 2024; 15:193-210. [PMID: 38449420 DOI: 10.4155/tde-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Alopecia areata (AA) is a kind of alopecia that affects hair follicles and nails. It typically comes with round patches and is a type of nonscarring hair loss. Various therapies are accessible for the management and treatment of AA, including topical, systemic and injectable modalities. It is a very complex type of autoimmune disease and is identified as round patches of hair loss and may occur at any age. This review paper highlights the epidemiology, clinical features, pathogenesis and new treatment options for AA, with a specific emphasis on nanoparticulate drug-delivery systems. By exploring these innovative treatment approaches, researchers aim to enhance the effectiveness and targeted delivery of therapeutic agents, ultimately improving outcomes for individuals living with AA.
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Affiliation(s)
- Robel Singh
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Pawan Kumar
- Indian Pharmacopoeia Commision, Ministry of Health & Family Welfare, Govt. of India
| | - Davinder Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
| | - Navidha Aggarwal
- MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, 133207, India
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical & Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | - Virender Kumar
- College of Pharmacy, PGIMS, Pt B D Sharma, University of Health Sciences-Rohtak, 124001, India
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Dahabreh D, Jung S, Renert-Yuval Y, Bar J, Del Duca E, Guttman-Yassky E. Alopecia Areata: Current Treatments and New Directions. Am J Clin Dermatol 2023; 24:895-912. [PMID: 37606849 DOI: 10.1007/s40257-023-00808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/23/2023]
Abstract
Alopecia areata is an autoimmune hair loss disease that is non-scarring and is characterized by chronic inflammation at the hair follicle level. Clinically, patients' presentation varies from patchy, circumscribed scalp involvement to total body and scalp hair loss. Current management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases and broad immunosuppressants as the mainstay for more severe cases. Until recently, the limited number of blinded, randomized, placebo-controlled clinical trials for this disease had made establishing an evidence-based treatment paradigm challenging. However, growing insights into the pathogenesis of alopecia areata through blood and tissue analysis of human lesions have identified several promising targets for therapy. T-helper (Th) 1/interferon skewing has traditionally been described as the driver of disease; however, recent investigations suggest activation of additional immune mediators, including the Th2 pathway, interleukin (IL)-9, IL-23, and IL-32, as contributors to alopecia areata pathogenesis. The landscape of alopecia areata treatment has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials. Given the recent US FDA approval of baricitinib and ritlecitinib, Janus kinase (JAK) inhibitors are a promising drug class for treating severe alopecia areata cases. This article will review the efficacy, safety, and tolerability of current treatments for alopecia areata, and will provide an overview of the emerging therapies that are leading the revolution in the management of this challenging disease.
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Affiliation(s)
- Dante Dahabreh
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Seungyeon Jung
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Jonathan Bar
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA.
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Trialonis-Suthakharan N, Pattinson R, Tahmasebi Gandomkari N, Austin J, Janus C, Courtier N, Hewitt RM, Bundy C, Augustin M. Patient prioritisation of impact items to develop the patient-reported impact of dermatological diseases (PRIDD) measure: European Delphi data. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:40-50. [PMID: 37805995 DOI: 10.1111/jdv.19266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/12/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The Global Research on the Impact of Dermatological Diseases (GRIDD) project is developing a patient-reported measure of the impact of dermatological disease on the patient's life called Patient Reported Impact of Dermatological Diseases (PRIDD). We developed a list of 263 potential impact items through a global qualitative interview study with 68 patients. We next conducted a Delphi study to seek consensus on which of these items to prioritize for inclusion in PRIDD. This study aims to explore patterns in demographic (e.g. country) and clinical variables (e.g. disease group) across the impacts ranked as most important to European dermatology patients. METHODS We conducted a modified, two rounds Delphi study, testing the outcomes from the previous qualitative interview study. Adults (≥18 years) living with a dermatological disease were recruited through the International Alliance of Dermatology Patient Organizations' (GlobalSkin) membership network. The survey consisted of a demographic questionnaire and 263 impact items and was available in six languages. Quantitative data were collected using ranking scales and analysed against a priori consensus criteria. Qualitative data were collected using free-text responses and a Framework Analysis was conducted. European data were obtained, and descriptive statistics, including multiple subgroup analyses, were performed. RESULTS Out of 1154 participants, 441 Europeans representing 46 dermatological disease from 25 countries participated. The results produced a list of the top 20 impacts reported by European patients, with psychological impacts accounting for the greatest proportion. CONCLUSION This study identified what patients consider to be the most important issues impacting their lives as a result of their dermatological disease. The data support previous evidence that patients experience profound psychological impacts and require psychological support. The findings can inform research, clinical practice and policy by indicating research questions and initiatives that are of most benefit to patients.
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Affiliation(s)
- N Trialonis-Suthakharan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Pattinson
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - N Tahmasebi Gandomkari
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Austin
- International Alliance of Dermatology Patient Organizations, Ottawa, Canada
| | - C Janus
- International Alliance of Dermatology Patient Organizations, Ottawa, Canada
| | - N Courtier
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - R M Hewitt
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - C Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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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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Wen L, Zhao J, Yang Y, Chen W, Bao Y, Zhang J, Wei T, Zhou L, Xi B, Zhang Y, Liang T. Sintilimab-induced Alopecia Universalis in a Patient With the Anti-tumor Effect of Complete Remission After Hepatectomy. J Immunother 2023; 46:232-235. [PMID: 37212789 DOI: 10.1097/cji.0000000000000473] [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: 11/08/2022] [Accepted: 04/05/2023] [Indexed: 05/23/2023]
Abstract
Immune checkpoint blockades have been widely used to treat various malignancies. Programmed cell death protein 1 (PD-1) inhibitor-induced alopecia areata, one of the immune-related adverse events, is rarely reported. We present a case of alopecia universalis during the treatment of Sintilimab, a monoclonal anti-PD-1 antibody, in a patient with hepatocellular carcinoma. A 65-year-old male was diagnosed with hepatocellular carcinoma in liver segment VI (S6) and chose to receive Sintilimab due to predicted insufficient residual liver volume for hepatectomy. He presented extensive hair loss in all the parts of the body 4 weeks after Sintilimab treatment. And without using any dermatologic drug, the alopecia areata gradually developed to be alopecia universalis after Sintilimab continuous treatment for 21 months. The pathological examination of skin revealed remarkable increased lymphocytes infiltration around the hair follicles, which contained predominantly CD8 positive T cells in the dermis. During single immunotherapy, the tumor marker of serum alpha-fetoprotein level soon decreased from 512.1 mg/L to a normal level within 3 months, accompanied with a remarkable tumor regression in liver S6 by magnetic resonance imaging scans. The patient received hepatectomy and pathological examination demonstrated the nodule was full of extensive necrosis. By combining immunotherapy and hepatectomy, the patient finally achieved a remarkable anti-tumor effect of complete remission. Immune checkpoint blockades-induced alopecia areata is a rare immune-related adverse event and accompanied with a good anti-tumor efficacy in our case. Regardless of alopecia treatment, PD-1 inhibitor treatment is recommended to be continued, especially when the immunotherapy is effective.
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Affiliation(s)
- Liang Wen
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Jianhui Zhao
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Yixiao Yang
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Wen Chen
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Yingying Bao
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Jian Zhang
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Tao Wei
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Lijuan Zhou
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Xi
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine
- The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou
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Nwosu A, Miteva M. Alopecia Areata Barbae in a Nutshell. Skin Appendage Disord 2023; 9:179-186. [PMID: 37325278 PMCID: PMC10264905 DOI: 10.1159/000529389] [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: 08/08/2022] [Accepted: 01/22/2023] [Indexed: 06/17/2023] Open
Abstract
Beard alopecia areata, or alopecia areata barbae, (BAA) is a subset of alopecia areata, a T-cell mediated inflammatory disease that disrupts the hair follicle cycle leading to early onset of catagen. The aim of this review is to help strengthen clinicians' skills in the evaluation, diagnosis, and management of BAA. We performed a literature review according to the modified PRISMA guidelines, using a combination of relevant key words in electronic databases. According to the data from the 25 articles on BAA reviewed here, BAA mostly affects middle-aged men (mean age 31 years) who typically experience patchy hair loss in the neck region, which spreads to the scalp within 12 months. Similar to AA, BAA is associated with autoimmune diseases such as H. pylori and thyroiditis; however, BAA has no clear genetic pattern of inheritance which is observed in alopecia areata. Common dermoscopic findings in BAA include vellus white hairs and exclamation mark hairs, which may help distinguish it from other pathologies affecting facial hair. In clinical trials, the ALBAS tool offers clinicians an objective metric to evaluate BAA severity. Until recently, topical steroids have been the mainstay therapy; however, topical and oral janus kinase inhibitors are achieving improved results, with up to 75% beard regrowth in an average of 12 months.
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Affiliation(s)
- Adaeze Nwosu
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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13
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Daunton A, Harries M, Sinclair R, Paus R, Tosti A, Messenger A. Chronic Telogen Effluvium: Is it a Distinct Condition? A Systematic Review. Am J Clin Dermatol 2023:10.1007/s40257-023-00760-0. [PMID: 37052778 DOI: 10.1007/s40257-023-00760-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Whilst there are several recognised explanations for persistent telogen-phase hair loss, for a proportion of cases, no clear underlying cause can be identified. These cases have been given the diagnostic label chronic telogen effluvium: a poorly characterised condition where there is legitimate uncertainty as to whether it represents a truly distinct disorder. OBJECTIVE The aim of this review was to evaluate published cases of purported chronic telogen effluvium and how strongly they support its existence as a distinct disorder. METHODS We systematically reviewed the literature identified from searching Embase, MEDLINE and Web-of-Science. An additional manual search was performed from the reference lists of publications identified. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Joanna Briggs Institute's checklists for case reports, case-series, case-control studies and analytical cross-sectional-studies were used to appraise the quality of identified articles. RESULTS Eighteen studies (comprising five case-series, seven cross-sectional studies, three case-control studies, one case report, one quasi-experimental study and one diagnostic-accuracy study) were included for evaluation, containing 1628 cases. Eleven were rated of good quality. 97.5% of all cases were female. No studies documented that they had excluded all possible causes of telogen hair shedding. Only three studies (encompassing eight cases) featured a prospective follow-up. All eight studies that undertook biopsies reported a normal terminal to vellus hair ratio in the samples analysed. No studies objectively evaluated the influence of hair length or psychological distress/preoccupation on the likelihood of being diagnosed with chronic telogen effluvium. CONCLUSIONS The lack of a consensual consistent definition for chronic telogen effluvium is a significant limitation. Many cases presently labelled chronic telogen effluvium likely either represent early female pattern hair loss or incipient secondary telogen effluvium owing to an unidentified underlying secondary cause. Where triggering factors have been definitively excluded, hair shedding may represent an alteration in the hair cycle away from normal total asynchronous cycling. Some cases may also represent a preoccupation with normal hair shedding in anxious long-haired individuals.
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Affiliation(s)
- Adam Daunton
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, M6 8HD, UK.
| | - Matthew Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, M6 8HD, UK
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Rodney Sinclair
- University of Melbourne and Director Sinclair Dermatology, Melbourne, VIC, Australia
| | - Ralf Paus
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew Messenger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Maloh J, Engel T, Natarelli N, Nong Y, Zufall A, Sivamani RK. Systematic Review of Psychological Interventions for Quality of Life, Mental Health, and Hair Growth in Alopecia Areata and Scarring Alopecia. J Clin Med 2023; 12:964. [PMID: 36769612 PMCID: PMC9917611 DOI: 10.3390/jcm12030964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
Alopecia is associated with significant psychological burden. There is limited evidence on the use of psychological interventions in conditions of hair loss. This manuscript systematically reviews the current state of literature on psychological treatments for quality of life, mental health, and hair growth in various forms of alopecia. PubMed and Embase were searched with predefined inclusion and exclusion criteria. Reference lists were also examined for relevant studies. Nine articles met our criteria and are included in this review. Eight of the articles related to alopecia areata and one related to scarring alopecia. Mindfulness-based stress reduction (MBSR) was found to improve quality of life-related subjective symptoms, relationship impacts, anxiety, phobia, distress, and psychological symptom intensity. Alopecia-specific collocated behavioral health (CLBH) treatment showed a trend for psychosocial improvement in areas such as appearance shame, activity avoidance, negative emotions, and coping. Hypnotherapy was found to improve anxiety and depression, quality of life measures, and alexithymia. There was also some evidence for significant hair growth with hypnosis, but the data are mixed. Psychotherapy combined with immunotherapy led to more hair growth, and supported self-confidence. Finally, coping strategies modulated the subjective burden of alopecia, and were associated with disease improvement. Further research will be necessary to better establish the efficacy and optimal administration of these interventions in alopecia.
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Affiliation(s)
- Jessica Maloh
- Zen Dermatology, Sacramento, CA 95819, USA
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
| | - Tess Engel
- School of Medicine, University of California-Davis, Sacramento, CA 95817, USA
| | - Nicole Natarelli
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Yvonne Nong
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Department of Dermatology, University of California-Davis, Sacramento, CA 95816, USA
| | - Alina Zufall
- Department of Dermatology, New York Medical College, Valhalla, NY 10595, USA
| | - Raja K. Sivamani
- Zen Dermatology, Sacramento, CA 95819, USA
- Integrative Skin Science and Research, Sacramento, CA 95815, USA
- Department of Dermatology, University of California-Davis, Sacramento, CA 95816, USA
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
- Pacific Skin Institute, Sacramento, CA 95815, USA
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15
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Yakupu A, Aimaier R, Yuan B, Chen B, Cheng J, Zhao Y, Peng Y, Dong J, Lu S. The burden of skin and subcutaneous diseases: findings from the global burden of disease study 2019. Front Public Health 2023; 11:1145513. [PMID: 37139398 PMCID: PMC10149786 DOI: 10.3389/fpubh.2023.1145513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background The small number of existing integrative studies on the global distribution and burden of all types of skin and subcutaneous diseases hinders relevant comparisons. Objective This study aimed to determine the latest distribution, epidemiological differences, and factors potentially influencing each skin and subcutaneous disease and the policy implications. Methods Data on the skin and subcutaneous diseases were obtained from the Global Burden of Disease Study 2019. The incidence, disability-adjusted life years (DALYs), and deaths due to skin and subcutaneous diseases in 204 countries and regions from 1990 to 2019 were analyzed and stratified by sex, age, geographical location, and sociodemographic index (SDI). The annual age-standardized rate of change in the incidence was obtained to evaluate temporal trends. Results Of 4,859,267,654 (95% uncertainty interval [UI], 4,680,693,440-5,060,498,767) new skin and subcutaneous disease cases that were identified, most were fungal (34.0%) and bacterial (23.0%) skin diseases, which accounted for 98,522 (95% UI 75,116-123,949) deaths. The burden of skin and subcutaneous diseases measured in DALYs was 42,883,695.48 (95%UI, 28,626,691.71-63,438,210.22) in 2019, 5.26% of which were years of life lost, and 94.74% of which were years lived with disability. The highest number of new cases and deaths from skin and subcutaneous diseases was in South Asia. Globally, most new cases were in the 0-4-year age group, with skin and subcutaneous disease incidence slightly higher in men than in women. Conclusion Fungal infections are major contributors to skin and subcutaneous diseases worldwide. Low-middle SDI states had the highest burden of skin and subcutaneous diseases, and this burden has increased globally. Targeted and effective management strategies based on the distribution characteristics of each country are, thus, required to reduce the burden of skin and subcutaneous diseases.
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Affiliation(s)
- Aobuliaximu Yakupu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rehanguli Aimaier
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Yuan
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jia Cheng
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yaohua Zhao
- Department of Burn and Plastic Surgery, Jiangyin Hospital Affiliated to Medical College of Southeast University, Jiangyin, China
| | - Yinbo Peng
- Department of Burns and Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiaoyun Dong
| | - Shuliang Lu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shuliang Lu
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van Dalen M, Muller KS, Kasperkovitz-Oosterloo JM, Okkerse JME, Pasmans SGMA. Anxiety, depression, and quality of life in children and adults with alopecia areata: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1054898. [PMID: 36523776 PMCID: PMC9745337 DOI: 10.3389/fmed.2022.1054898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 09/14/2023] Open
Abstract
Introduction Alopecia areata (AA) is a non-scarring hair loss condition, subclassified into AA, alopecia universalis, and alopecia totalis. There are indications that people with AA experience adverse psychosocial outcomes, but previous studies have not included a thorough meta-analysis and did not compare people with AA to people with other dermatological diagnoses. Therefore, the aim of this systematic review and meta-analysis was to update and expand previous systematic reviews, as well as describing and quantifying levels of anxiety, depression, and quality of life (QoL) in children and adults with AA. Methods A search was conducted, yielding 1,249 unique records of which 93 were included. Results Review results showed that people with AA have higher chances of being diagnosed with anxiety and/or depression and experience impaired QoL. Their psychosocial outcomes are often similar to other people with a dermatological condition. Meta-analytic results showed significantly more symptoms of anxiety and depression in adults with AA compared to healthy controls. Results also showed a moderate impact on QoL. These results further highlight that AA, despite causing little physical impairments, can have a significant amount on patients' well-being. Discussion Future studies should examine the influence of disease severity, disease duration, remission and relapse, and medication use to shed light on at-risk groups in need of referral to psychological care. Systematic review registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022323174].
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Affiliation(s)
- Marije van Dalen
- Department of Pediatric Gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Kirsten S. Muller
- Department of Pediatric Gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | | | - Jolanda M. E. Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology, Center of Pediatric Dermatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
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Dai Z, Sezin T, Chang Y, Lee EY, Wang EHC, Christiano AM. Induction of T cell exhaustion by JAK1/3 inhibition in the treatment of alopecia areata. Front Immunol 2022; 13:955038. [PMID: 36203601 PMCID: PMC9531018 DOI: 10.3389/fimmu.2022.955038] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune disease caused by T cell-mediated destruction of the hair follicle (HF). Therefore, approaches that effectively disrupt pathogenic T cell responses are predicted to have therapeutic benefit for AA treatment. T cells rely on the duality of T cell receptor (TCR) and gamma chain (γc) cytokine signaling for their development, activation, and peripheral homeostasis. Ifidancitinib is a potent and selective next-generation JAK1/3 inhibitor predicted to disrupt γc cytokine signaling. We found that Ifidancitinib robustly induced hair regrowth in AA-affected C3H/HeJ mice when fed with Ifidancitinib in chow diets. Skin taken from Ifidancitinib-treated mice showed significantly decreased AA-associated inflammation. CD44+CD62L- CD8+ T effector/memory cells, which are associated with the pathogenesis of AA, were significantly decreased in the peripheral lymphoid organs in Ifidancitinib-treated mice. We observed high expression of co-inhibitory receptors PD-1 on effector/memory CD8+ T cells, together with decreased IFN-γ production in Ifidancitinib-treated mice. Furthermore, we found that γc cytokines regulated T cell exhaustion. Taken together, our data indicate that selective induction of T cell exhaustion using a JAK inhibitor may offer a mechanistic explanation for the success of this treatment strategy in the reversal of autoimmune diseases such as AA.
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Affiliation(s)
- Zhenpeng Dai
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Tanya Sezin
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Yuqian Chang
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Eunice Y. Lee
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Eddy Hsi Chun Wang
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Angela M. Christiano
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
- *Correspondence: Angela M. Christiano,
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18
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Birkett L, Singh P, Mosahebi A, Dhar S. Possible Associations Between Alopecia Areata and COVID-19 Vaccination and Infection. Aesthet Surg J 2022; 42:NP699-NP702. [PMID: 35724419 PMCID: PMC9384321 DOI: 10.1093/asj/sjac165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Liam Birkett
- Corresponding Author: Dr Liam Birkett, Department of Plastic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail:
| | - Prateush Singh
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Joshi TP, Wang HY, Athukuri P, Bohac S, Farr MA, Hinson D, Kahla JA, Khalfe N, McBee DB, Stroh R, Walters N, Ren V. Biologic Therapies for the Management of Cutaneous Findings in Genodermatoses: A Review. Am J Clin Dermatol 2022; 23:673-688. [PMID: 35606649 DOI: 10.1007/s40257-022-00700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/17/2023]
Abstract
Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Here, we review the evidence regarding the use of available biologic therapies for the management of dermatologic findings in genodermatoses. Biologic therapies appear to be promising therapeutic options for several recalcitrant genodermatoses, especially those with underlying immune dysregulation. However, not all genodermatoses are amenable to biologic therapies, and some have been shown to paradoxically worsen under treatment. Biologic therapies offer a novel avenue to target refractory genodermatoses. However, evidence supporting the use of biologic therapies in the management of genodermatoses is mostly limited to case reports and case series. Further studies are warranted to determine the safety and efficacy of biologic therapies for the management of cutaneous findings in genodermatoses.
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Mostaghimi A, Xenakis J, Meche A, Smith TW, Gruben D, Sikirica V. Economic Burden and Healthcare Resource Use of Alopecia Areata in an Insured Population in the USA. Dermatol Ther (Heidelb) 2022; 12:1027-1040. [PMID: 35381975 PMCID: PMC9021349 DOI: 10.1007/s13555-022-00710-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/11/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Comparative data on the economic burden of alopecia areata relative to the general population are limited. The objective of this retrospective database analysis was to evaluate healthcare resource utilization and direct medical costs among patients with alopecia areata from the US payer perspective compared with matched controls. METHODS Validated billing codes were used to identify patients with alopecia areata from the IQVIA PharMetrics Plus (2016-2018) who had continuous pharmacy and medical enrollment for 365 days both before (baseline period) and after (evaluation period) the index date. Demographic and clinical characteristics were characterized, and baseline comorbidities were assessed with the Quan Charlson Comorbidity Index. RESULTS Using the exact matching feature from Instant Health Data, 14,340 patients with alopecia areata were matched with 42,998 control patients aged ≥ 12 years. Patients with alopecia areata had higher healthcare resource utilization and adjusted total all-cause mean medical costs versus matched controls ($8557 versus $6416; p < 0.0001), because of higher inpatient costs, emergency department visits, ambulatory visits, number of prescriptions and prescription costs, and other costs such as durable medical equipment and home healthcare. The number of inpatient visits did not significantly differ between the two groups. Mean ambulatory costs were $3640 for patients with alopecia areata and $2062 for controls, and mean pharmacy costs were $3287 and $1843, respectively (p < 0.0001 for both). Pharmacy costs related to immunologic agents represented 50.0% of the total difference in pharmacy spending between patients with alopecia areata and controls. Surgery on the integumentary system accounted for 9.5% of the total difference in ambulatory costs. CONCLUSION Alopecia areata is associated with significant incremental healthcare resource utilization and costs relative to matched controls due to increased spending in areas such as surgical procedures and psychological and pharmacological interventions. Costs are primarily driven by ambulatory and pharmacy spending.
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Affiliation(s)
- Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
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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: 10] [Impact Index Per Article: 5.0] [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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22
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Macbeth AE, Holmes S, Harries M, Chiu WS, Tziotzios C, de Lusignan S, Messenger AG, Thompson AR. The associated burden of mental health conditions in alopecia areata: A population-based study in UK primary care. Br J Dermatol 2022; 187:73-81. [PMID: 35157313 PMCID: PMC9542942 DOI: 10.1111/bjd.21055] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/24/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Background Alopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact. Objectives To assess the co‐occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment. Methods In total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre‐existing mental health conditions, rates of mental health‐related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521). Results Depression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new‐onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA. Conclusions People with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence‐based mental health treatment programmes are needed for people with AA.
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Affiliation(s)
- Abby E Macbeth
- Department of Dermatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matthew Harries
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK; Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Wing Sin Chiu
- Pfizer Ltd, Walton Oaks, Walton on the Hill, Tadworth, Surrey, KT20 7NS, UK
| | - Christos Tziotzios
- St. John's Institute of Dermatology, King's College London, London, Guy's Hospital, London, SE1 9RT, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care health Sciences, University of Oxford, UK; Royal College of General Practitioners, Research and Surveillance Centre, London, UK
| | - Andrew G Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Department of Psychology, Cardiff University, 11th Floor, Tower Building, 70 Park Place Cardiff, CF10 3AT, Wales
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23
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Han JJ, Desai S, Li SJ, Lee KJ, Mita C, Joyce C, Mostaghimi A. Placebo group regrowth rate in alopecia areata clinical trials: A systematic review and meta-analysis. J Am Acad Dermatol 2021; 87:389-390. [PMID: 34902493 DOI: 10.1016/j.jaad.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jane J Han
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; School of Medicine, Tufts University, Boston, Massachusetts
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; School of Medicine, Tufts University, Boston, Massachusetts
| | - Karen J Lee
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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24
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Harries M, Macbeth AE, Holmes S, Thompson AR, Chiu WS, Gallardo WR, Messenger AG, Tziotzios C, de Lusignan S. Epidemiology, management and the associated burden of mental health illness, atopic and autoimmune conditions, and common infections in alopecia areata: protocol for an observational study series. BMJ Open 2021; 11:e045718. [PMID: 34785540 PMCID: PMC8596050 DOI: 10.1136/bmjopen-2020-045718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Alopecia areata (AA) is a common cause of immune-mediated non-scarring hair loss. Links between AA and common mental health, autoimmune and atopic conditions, and common infections have previously been described but remain incompletely elucidated and contemporary descriptions of the epidemiology of AA in the UK are lacking. METHODS AND ANALYSIS Retrospective study series using a large population-based cohort (5.2 million) from the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database, exploring four themes: AA epidemiology, mental health comorbidities, autoimmune/atopic associations and common infections.In the epidemiology theme, we will describe the incidence and point prevalence of AA overall and by age, sex and sociodemographic factors. Healthcare utilisation (primary care visits and secondary care referrals) and treatments for AA will also be assessed. In the mental health theme, we will explore the prevalence and incidence of mental health conditions (anxiety, depressive episodes, recurrent depressive disorder, adjustment disorder, agoraphobia, self-harm and parasuicide) in people with AA compared with matched controls. We will also explore the mental health treatment patterns (medication and psychological interventions), time off work and unemployment rates. Within the autoimmune/atopic associations theme, we will examine the prevalence of atopic (atopic dermatitis, allergic rhinitis, asthma) and autoimmune conditions (Crohn's disease, ulcerative colitis, coeliac disease, type 1 diabetes, Hashimoto's thyroiditis, Graves' disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus (SLE), polymyalgia rheumatica, Sjögren's syndrome, psoriasis, vitiligo, multiple sclerosis, pernicious anaemia) in people with AA compared with matched controls. We will also estimate the incidence of new-onset atopic and autoimmune conditions after AA diagnosis. Within the common infections theme, we will examine the incidence of common infections (respiratory tract infection, pneumonia, acute bronchitis, influenza, skin infection, urinary tract infection, genital infections, gastrointestinal infection, herpes simplex, herpes zoster, meningitis, COVID-19) in people with AA compared with matched controls. ETHICS AND DISSEMINATION The Health Research Authority decision tool classed this a study of usual practice, ethics approval was not required. Study approval was granted by the RCGP RSC Study Approval Committee. Results will be disseminated through peer-reviewed publications. OBSERVATIONAL STUDY REGISTRATION NUMBER NCT04239521.
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Affiliation(s)
- Matthew Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Greater Manchester, UK
| | - Abby E Macbeth
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Department of Psychology, Cardiff University, Cardiff, UK
| | | | | | | | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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25
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Paul S, Licona-Vázquez I, Serrano-Cano FI, Frías-Reid N, Pacheco-Dorantes C, Pathak S, Chakraborty S, Srivastava A. Current insight into the functions of microRNAs in common human hair loss disorders: a mini review. Hum Cell 2021; 34:1040-1050. [PMID: 33908022 DOI: 10.1007/s13577-021-00540-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
Alopecia areata (AA) and Androgenic alopecia (AGA) are the most common multifactorial hair loss disorders that have a serious psychological impact on the affected individuals, while frontal fibrosing alopecia (FFA) is comparatively less common. However, due to the unknown etiology and the effect of many adverse factors, the prognosis of these conditions is challenging to predict. Moreover, no approved therapy has been available to date to prevent or treat these disorders. MicroRNAs (miRNAs) are a group of evolutionary conserved small non-coding RNA molecules with significant roles in the posttranscriptional gene regulation either through mRNA degradation or translational repression. A number of biological processes are controlled by these molecules, including cell growth and differentiation, proliferation, inflammation, immune responses, and apoptosis. Recently, a handful of studies have demonstrated the impact of miRNAs on common hair loss-related disorders; however, the exhaustive molecular mechanisms are still unclear. In this review, we discussed the functional implications of miRNAs in common hair loss-related disorders and addressed their efficacy to be used for theranostic purposes shortly.
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Affiliation(s)
- Sujay Paul
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Epigmenio González No. 500 Fracc. San Pablo, 76130, Querétaro, México.
| | - Iván Licona-Vázquez
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Epigmenio González No. 500 Fracc. San Pablo, 76130, Querétaro, México
| | - Francisco I Serrano-Cano
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Epigmenio González No. 500 Fracc. San Pablo, 76130, Querétaro, México
| | - Natalia Frías-Reid
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Epigmenio González No. 500 Fracc. San Pablo, 76130, Querétaro, México
| | - Carolina Pacheco-Dorantes
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Epigmenio González No. 500 Fracc. San Pablo, 76130, Querétaro, México
| | - Surajit Pathak
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai, 603103, Tamil Nadu, India
| | - Samik Chakraborty
- Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Aashish Srivastava
- Section of Bioinformatics, Clinical Laboratory, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5021, Bergen, Norway
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26
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Abstract
Alopecia areata is a condition that affects hair follicles and leads to hair loss ranging from small well-defined patches to complete loss of all body hair. Despite its high incidence, the pathobiology is not fully understood, and no single concept could be universally accepted. Alopecia areata is mostly considered to be an autoimmune disease, in which the collapse of hair follicle immune privilege plays a key role. Higher incidence rate in the female population and increased overall risk of other autoimmune disorders militate in favor of autoimmune hypothesis. Antibodies against multiple components of hair follicles almost exclusively attack in anagen phase, where melanogenesis takes place. It suggests involvement of melanogenesis-associated autoantigens as a target epitope. Some investigators believed that alopecia areata is not a truly autoimmune disease but is only ‘consistent with’ autoimmune mechanisms. High frequency of a positive family history up to 42% may reflects the contribution of heredity factors. In addition, no specific target autoantigen has been identified so far, and autoantibodies to hair follicle-associated antigens are detectable in normal individuals.
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27
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Gilhar A, Laufer Britva R, Keren A, Paus R. Mouse Models of Alopecia Areata: C3H/HeJ Mice Versus the Humanized AA Mouse Model. J Investig Dermatol Symp Proc 2020; 20:S11-S15. [PMID: 33099377 DOI: 10.1016/j.jisp.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The C3H/HeJ model has long dominated basic alopecia areata (AA) in vivo research and has been used as proof-of-principle that Jak inhibitors are suitable agents for AA management in vivo. However, its histologic features are not typical of human AA, and it is questionable whether it is sufficiently clinically predictive for evaluating the therapeutic effects of candidate AA agents. Instead, the humanized mouse model of AA has been used to functionally demonstrate the role of key immune cells in AA pathogenesis and to discover human-specific pharmacologic targets in AA management. Therefore, we advocate the use of both models in future preclinical AA research.
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Affiliation(s)
- Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Rimma Laufer Britva
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Aviad Keren
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ralf Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, United Kingdom; Monasterium Laboratory Skin & Hair Research Solutions GmbH, Muenster, Germany
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28
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Brigham Eyebrow Tool for Alopecia: A Reliable Assessment of Eyebrow Alopecia Areata. J Investig Dermatol Symp Proc 2020; 20:S41-S44. [PMID: 33099383 DOI: 10.1016/j.jisp.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There are no tools to evaluate eyebrow involvement in patients with alopecia areata. We developed and assessed the reliability of the Brigham Eyebrow Tool for Alopecia (BETA) as a quantitative evaluation of eyebrow alopecia areata. BETA uses facial landmarks of eyebrow anatomy and is calculated using surface area and density. A total of 50 eyebrow images with varying levels of hair loss were distributed to six board-certified dermatologists at three academic medical centers with standardized instructions and examples. Interrater and intrarater reliability were calculated using intraclass correlation coefficients (ICCs). BETA demonstrated high interrater (ICC = 0.88, confidence interval = 0.83-0.92 right eyebrow scores and ICC = 0.90, confidence interval = 0.85-0.94 left eyebrow scores) and intrarater (ICC = 0.90, confidence interval = 0.85-0.93 right eyebrow scores and ICC = 0.91, confidence interval = 0.87-0.94 left eyebrow scores) reliability. When measured in the same patient with varying degrees of hair loss over time, BETA demonstrated sensitivity to change. BETA is a simple and reliable objective assessment of eyebrow alopecia areata. BETA is easy-to-use and quick to calculate, making it feasible for a variety of clinical and research settings. Although developed for alopecia areata, we hope that BETA will be investigated in other etiologies of eyebrow alopecia to serve as a universal tool for monitoring disease progression, improvement, and response to treatment.
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29
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Bertolini M, McElwee K, Gilhar A, Bulfone‐Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Exp Dermatol 2020; 29:703-725. [DOI: 10.1111/exd.14155] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Kevin McElwee
- Monasterium Laboratory Münster Germany
- Centre for Skin Sciences University of Bradford Bradford UK
- Department of Dermatology and Skin Science University of British Columbia Vancouver British Columbia Canada
| | - Amos Gilhar
- Laboratory for Skin Research Rappaport Faculty of Medicine Technion‐Israel Institute of Technology Haifa Israel
| | - Silvia Bulfone‐Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
| | - Ralf Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
- Dr. Philip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
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30
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Antoury L, Maloney NJ, Bach DQ, Goh C, Cheng K. Alopecia areata as an immune‐related adverse event of immune checkpoint inhibitors: A review. Dermatol Ther 2020; 33:e14171. [DOI: 10.1111/dth.14171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Layal Antoury
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Nolan J. Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Daniel Q. Bach
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Carolyn Goh
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine University of California Los Angeles California USA
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31
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Abdallah MAER, Shareef R, Soltan MY. Efficacy of intradermal minoxidil 5% injections for treatment of patchy non-severe alopecia areata. J DERMATOL TREAT 2020; 33:1126-1129. [PMID: 32643454 DOI: 10.1080/09546634.2020.1793893] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intradermal minoxidil is used as an off-label treatment for patchy non-severe alopecia areata (AA) either alone or in combination with steroids; however, studies estimating its efficacy are still lacking. OBJECTIVES To assess the efficacy of intradermal delivery of minoxidil 5% alone and in combination with intralesional triamcinolone acetonide for treatment of patchy non-severe AA. PATIENTS AND METHODS One hundred patches in twenty patients with patchy non-severe AA, five patches for each patient, were included in this prospective intra-patient comparative controlled clinical study. Four comparative patches per each patient were randomly assigned to receive 4 sessions, at a 4-week interval, of one of the following treatments: intralesional triamcinolone acetonide, intralesional minoxidil 5%, combination treatment, or micro-needling. The fifth patch was observed as the negative control. Treatment outcomes were assessed at baseline, and 1 month after treatment ends. RESULTS Minoxidil intradermal injection was nearly comparable to the micro-needling effect and its combination to steroids had no additive effect. Hair regrowth in response to minoxidil occurred earlier than the spontaneous recovery. CONCLUSION Monotherapy of intralesional minoxidil is of limited efficacy in treating non-severe patchy AA, but it speeds the recovery.
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Affiliation(s)
| | - Rasha Shareef
- Faculty of Medicine, Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
| | - Marwa Y Soltan
- Faculty of Medicine, Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
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32
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Koguchi-Yoshioka H, Watanabe R, Matsumura Y, Okiyama N, Ishitsuka Y, Nakamura Y, Fujisawa Y, Fujimoto M. The Possible Linkage of Granzyme B-Producing Skin T Cells with the Disease Prognosis of Alopecia Areata. J Invest Dermatol 2020; 141:427-429.e10. [PMID: 32621823 DOI: 10.1016/j.jid.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Hanako Koguchi-Yoshioka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Rei Watanabe
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Yutaka Matsumura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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33
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Nowaczyk J, Makowska K, Rakowska A, Sikora M, Rudnicka L. Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review. Dermatol Ther (Heidelb) 2020; 10:387-399. [PMID: 32270396 PMCID: PMC7211785 DOI: 10.1007/s13555-020-00370-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Cyclosporine is commonly used in treatment for alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various outcomes. METHODS Efficacy of cyclosporine with and without systemic corticosteroids for alopecia areata was evaluated by a systematic review. Cochrane, EBSCOhost, Pubmed, Scopus and Web of Science databases were searched. Only studies published before January 2020 were included. RESULTS A total of 2104 studies were initially examined, of which 14 were eligible for the systematic review. Among 340 reported cases, 213 had focal, multifocal or ophiasis form of alopecia areata, 60 were diagnosed with alopecia totalis and 67 with alopecia universalis. The mean response rate in the whole group of patients at the end of treatment was 65.00% (221/340; range 25-100%). Hair regrowth rate was higher in the group with cases of alopecia areata limited to scalp (124/165; mean 75.15%; range 40-100%) than in the cases with alopecia totalis (30/46; mean 65.22%; range 25-100%) or alopecia universalis (24/52; mean 46.15%; range 25-100%). The combined therapy with systemic corticosteroids was superior to the monotherapy (152/219; mean 69.41%; 0-80% vs. 69/121; mean 57.02%; range 6.67-100%) and had a lower recurrence rate (39/108; mean 36.11% vs. 34/46; mean 73.91%, respectively). The combined treatment with methylprednisolone was significantly more effective when compared to the cyclosporine monotherapy (124/183; mean 67.76%; range 0-80% vs. 69/121; mean 57.02%; range 6.67-100%). The mean time of treatment was 6.75 months (range 2-36). LIMITATIONS Limitations of our study were the retrospective character of included studies, differences in doses of prescribed drugs, and duration of the treatment and follow-up times. CONCLUSION Cyclosporine in combination with oral systemic corticosteroids is more effective than in monotherapy for severe alopecia areata.
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Affiliation(s)
- Joanna Nowaczyk
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Makowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
| | - Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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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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Sakai K, Fukushima S, Mizuhashi S, Jinnin M, Makino T, Inoue Y, Ihn H. Effect of topical immunotherapy with squaric acid dibutylester for alopecia areata in Japanese patients. Allergol Int 2020; 69:274-278. [PMID: 31767273 DOI: 10.1016/j.alit.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Japanese guidelines for the treatment of alopecia areata list topical immunotherapies as a drug therapy for this condition. However, there is insufficient evidence of its efficacy to support this recommendation. Thus, we sought to clarify the effect of topical immunotherapy on the progression and severity of alopecia areata in Japanese patients. METHODS To evaluate the effect of topical immunotherapy with squaric acid dibutylester (SADBE) in alopecia areata patients, we performed a retrospective cohort study on 49 alopecia patients who had received topical immunotherapy with SADBE. Patients were evaluated by the change in alopecia severity at 6 and 12 months after the initiation of topical immunotherapy. The improvement rate was calculated by determination of the complete and partial responses rate to treatment with topical immunotherapy by application of SADBE. RESULTS The improvement rate in all alopecia patients treated with SADBE topical immunotherapy was 57.8% (complete response; 11.1% and partial response; 46.7%). CONCLUSIONS Topical immunotherapy with SADBE is an effective treatment for alopecia areata. Therefore, the current treatment recommendations for alopecia areata with topical immunotherapies are appropriate.
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Taneja N, Sreenivas V, Sahni K, Gupta V, Ramam M. A cross-sectional study of spontaneous repigmentation in vitiligo. Indian J Dermatol Venereol Leprol 2019; 86:240-250. [PMID: 31793491 DOI: 10.4103/ijdvl.ijdvl_409_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Spontaneous regression is well documented in several chronic skin diseases such as psoriasis, alopecia areata, and atopic dermatitis. However, information on vitiligo is scarce. Aims We studied the frequency, extent, and factors affecting spontaneous repigmentation in vitiligo. Methods A cross-sectional descriptive study was undertaken in 167 patients with vitiligo with an emphasis on history of spontaneous repigmentation. Where available, photographs documenting spontaneous repigmentation were also obtained. Repigmentation was defined as spontaneous if it occurred when the patient was off treatment for at least 3 consecutive months. Results Spontaneous repigmentation occurred in 36 (21.5%) patients with complete repigmentation in 6 (3.6%) patients. The extent varied from 0.5% to 100% (mean, 35.4 ± 37.9%) of vitiliginous skin. It occurred after 3 months to 47 years (mean, 8.7 ± 9.5 years) of onset of vitiligo and persisted for 2 months to 27 years (mean, 4.4 ± 6.2 years). Diffuse repigmentation was the most common pattern observed in 20 (55.6%) patients and there was a good color match in 26 (72.2%) patients. Likelihood of spontaneous repigmentation was 3.5 times greater in patients with more than 3 years of stable disease (P = 0.001). Limitations The chief limitation was the dependence on patient recall for the data, except when documented by images. Conclusion Spontaneous repigmentation occurs in one-fifth of patients with vitiligo. In some patients, the repigmentation is clinically significant and long-lasting. Considering its frequency and extent, spontaneous repigmentation should be taken into account both when evaluating novel interventions and counselling patients about the course of the disease.
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Affiliation(s)
- Neha Taneja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Dickkopf-1 Expression in Androgenetic Alopecia and Alopecia Areata in Male Patients. Am J Dermatopathol 2019; 41:122-127. [PMID: 30640755 DOI: 10.1097/dad.0000000000001266] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) results from shortening of the anagen phase of the hair cycle and, subsequently, miniaturization of hair follicles. Alopecia areata (AA) is a disease of autoimmunity where T cells attack anagen hair follicles and shows multifactorial etiology. Dickkopf-1 (DKK-1) is a gene that is responsible for transformation of anagen to catagen, which suggests that it is involved in development of both diseases. OBJECTIVES To evaluate the tissue levels of dickkopf-1 in male patients with AGA and AA in comparison with controls, in an attempt to know its role in the pathogenesis of both disorders. METHODS DKK-1 immunohistochemical expression was evaluated in lesional scalp biopsies taken from 20 male patients with AGA evaluated clinically by the modified Norwood-Hamilton score, 20 male patients with AA evaluated clinically by SALT score, and 20 healthy controls within the same age and sex of the studied patients. RESULTS A highly significant difference in DKK-1 expression between patients with AGA and healthy controls was found (P2 < 0.001). There were also significant differences in DKK-1 expression between patients with AA and healthy controls (P3 = 0.013), and between both patient groups (P1 = 0.002). CONCLUSIONS Both AGA and AA showed significant increase in DKK-1 immunohistochemical expression. This may enhance the idea of its possible role in the pathogenesis of AGA and AA, and being a new target for treatment of these hair disorders.
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Muhammad SA, Fatima N, Paracha RZ, Ali A, Chen JY. A systematic simulation-based meta-analytical framework for prediction of physiological biomarkers in alopecia. ACTA ACUST UNITED AC 2019; 26:2. [PMID: 30993080 PMCID: PMC6449998 DOI: 10.1186/s40709-019-0094-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/20/2019] [Indexed: 01/13/2023]
Abstract
Background Alopecia or hair loss is a complex polygenetic and psychologically devastating disease affecting millions of men and women globally. Since the gene annotation and environmental knowledge is limited for alopecia, a systematic analysis for the identification of candidate biomarkers is required that could provide potential therapeutic targets for hair loss therapy. Results We designed an interactive framework to perform a meta-analytical study based on differential expression analysis, systems biology, and functional proteomic investigations. We analyzed eight publicly available microarray datasets and found 12 potential candidate biomarkers including three extracellular proteins from the list of differentially expressed genes with a p-value < 0.05. After expression profiling and functional analysis, we studied protein–protein interactions and observed functional associations of source proteins including WIF1, SPON1, LYZ, GPRC5B, PTPRE, ZFP36L2, HBB, PHF15, LMCD1, KRT35 and VAV3 with target proteins including APCDD1, WNT1, WNT3A, SHH, ESRI, TGFB1, and APP. Pathway analysis of these molecules revealed their role in major physiological reactions including protein metabolism, signal transduction, WNT, BMP, EDA, NOTCH and SHH pathways. These pathways regulate hair growth, hair follicle differentiation, pigmentation, and morphogenesis. We studied the regulatory role of β-catenin, Nf-kappa B, cytokines and retinoic acid in the development of hair growth. Therefore, the differential expression of these significant proteins would affect the normal level and could cause aberrations in hair growth. Conclusion Our integrative approach helps to prioritize the biomarkers that ultimately lessen the economic burden of experimental studies. It will also be valuable to discover mutants in genomic data in order to increase the identification of new biomarkers for similar problems. Electronic supplementary material The online version of this article (10.1186/s40709-019-0094-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Syed Aun Muhammad
- 1Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, 60800 Pakistan
| | - Nighat Fatima
- 2Department of Pharmacy, COMSATS Institute of Information Technology, Abbottabad, 22060 Pakistan
| | - Rehan Zafar Paracha
- 3Research Center of Modeling and Simulation (RCMS), Department of Computational Sciences, National University of Sciences and Technology (NUST), Islamabad, 44000 Pakistan
| | - Amjad Ali
- 4Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, 44000 Pakistan
| | - Jake Y Chen
- 5Informatics Institute, School of Medicine, The University of Alabama (UAB), Birmingham, USA
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Van ATT, Lan AT, Anh MH, Van TN, Minh PPT, Thi PT, Minh TT, Huu ND, Thanh TV, Huyen ML, Hau KT, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience. Open Access Maced J Med Sci 2019; 7:200-203. [PMID: 30745958 PMCID: PMC6364718 DOI: 10.3889/oamjms.2019.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.
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Affiliation(s)
- Anh Tran Thi Van
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Anh Tran Lan
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Minh Ha Anh
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | | | - Phuong Trinh Thi
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Trang Trinh Minh
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Nghi Dinh Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Tung Vu Thanh
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - My Le Huyen
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Khang Tran Hau
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Marco Gandolfi
- Unit of Dermatology, University of Parma, Parma, Italy,Correspondence: Marco Gandolfi. Unit of Dermatology, University of Parma, Parma, Italy. E-mail:
| | | | | | - Michael Tirant
- University of Rome G. Marconi, Rome, Italy,Psoriasis Eczema Clinic, Melbourne, Australia
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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El-Mofty M, Rasheed H, El-Eishy N, Hegazy RA, Hafez V, Shaker O, El-Samanoudy SI. A clinical and immunological study of phototoxic regimen of ultraviolet A for treatment of alopecia areata: a randomized controlled clinical trial. J DERMATOL TREAT 2019; 30:582-587. [DOI: 10.1080/09546634.2018.1543847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Medhat El-Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rasheed
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermin El-Eishy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A. Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olfat Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Shivadikar A. Evidence- based homoeopathy: Case report of alopecia areata in an 11 year old boy. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2019. [DOI: 10.4103/ijrh.ijrh_18_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Efficacy of diphenylcyclopropenone in alopecia areata: a comparison of two treatment regimens. Postepy Dermatol Alergol 2018; 35:577-581. [PMID: 30618524 PMCID: PMC6320486 DOI: 10.5114/ada.2018.77608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Alopecia areata (AA) is a skin disease of unclear etiology. In AA, topical immunotherapy with diphenylcyclopropenone (DPCP) is considered the most effective treatment; however, the most common therapies give unsatisfactory results. Aim To assess the efficacy of a topical application of a solution of DPCP based on the intensity, duration and number of exacerbations of AA and to compare the efficacy of two treatment regimens. Material and methods In this prospective study, 39 patients with AA were enrolled. Group A was treated at weekly intervals and group B at 3-week intervals. Hair loss was assessed by independent dermatologists and documented by photography and dermoscopy. Results After 6 months’ therapy, hair regrowth greater than 50% was observed in 21 patients, while worsening, no regrowth, or regrowth of less than 50% was seen in 18 patients. Regrowth exceeding 50% of initial loss was observed in 12 of 17 patients with baseline hair loss < 50%, in 9 of 22 patients with severe alopecia, and in 4 of 9 patients with alopecia totalis. Both groups showed significant improvement with higher efficacy in group B (54%) than group A (46%). Conclusions Treatment at longer intervals may be safer and more comfortable for patients; however, further research is required.
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Kuroda Y, Kawai T, Goto K, Matsuda S. Bilateral osteonecrosis of the femoral head associated with corticosteroid therapy for alopecia areata: a case report and review of the literature. Ther Clin Risk Manag 2018; 14:1399-1405. [PMID: 30147323 PMCID: PMC6098421 DOI: 10.2147/tcrm.s164999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Corticosteroids have been widely used for the treatment of various inflammatory diseases because they provide an acute response of immunosuppression. Numerous side effects of corticosteroids have also been known, with varying degrees of severity. Osteonecrosis of the femoral head (ONFH) is a rare and serious complication that directly inhibits walking because of femoral head collapse. However, sometimes, clinicians who consider that corticosteroids are required for primary disease do not recognize steroid-induced ONFH. The final stage of ONFH is severe osteoarthritis, requiring total hip arthroplasty. We describe a 23-year-old woman with bilateral ONFH after corticosteroid treatment for alopecia areata (AA). She was administered several intralesional corticosteroid injections to the scalp and repeated systemic corticosteroid therapy for extensive AA. While undergoing therapy, she lost her balance and complained of right groin pain when standing. The patient was subsequently diagnosed with bilateral ONFH. She recovered from AA, but she complained of persistent right hip pain, which subsequently required total hip arthroplasty. We would like to emphasize that patients on corticosteroid therapy for any common disease should be considered as having a potential risk for ONFH. An early stage detection of ONFH is crucial for its treatment. MRI evaluation warrants a higher level of accuracy in early diagnosis of ONFH for the opportunity to undergo joint-preservation surgery in patients with ONFH.
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Affiliation(s)
- Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan,
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan,
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan,
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan,
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Karanovic S, Harries M, Kaur MR. Diphenylcyclopropenone for alopecia areata: a U.K. survey. Br J Dermatol 2018; 179:514-515. [PMID: 29480935 DOI: 10.1111/bjd.16489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Karanovic
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, B91 2JL, U.K
| | - M Harries
- Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, U.K
| | - M R Kaur
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, B91 2JL, U.K
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. Establishing and prioritizing research questions for the prevention, diagnosis and treatment of hair loss (excluding alopecia areata): the Hair Loss Priority Setting Partnership. Br J Dermatol 2018; 178:535-540. [DOI: 10.1111/bjd.15810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A. Macbeth
- Department of Dermatology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane Norwich NR4 7UY U.K
| | | | - A. Messenger
- Department of Dermatology; University of Sheffield; Royal Hallamshire Hospital; Sheffield U.K
| | - K. Moore-Millar
- Department of Design, Manufacturing and Engineering; University of Strathclyde; Glasgow U.K
| | | | - A. Shipman
- Department of Dermatology; Warwick Hospital; Warwick Warwickshire U.K
| | - J. Kassim
- Dermatology Centre; St Mary's Hospital; Portsmouth U.K
| | - J. Brockley
- Department of Dermatology; Cannock Chase Hospital; Cannock U.K
| | - W. Szczecinska
- Department of Dermatology; Heart of England NHS Foundation Trust Standard Institution; Birmingham U.K
| | - P. Farrant
- Department of Dermatology; Brighton and Sussex University Hospitals NHS Trust; Brighton U.K
| | - R. Robinson
- Department of Dermatology; Harrogate and District NHS Foundation Trust; Harrogate North Yorkshire U.K
| | | | | | | | - M. Harries
- The Dermatology Centre; University of Manchester; Salford Royal NHS Foundation Trust; Salford Greater Manchester U.K
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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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Jang YH, Jung HJ, Moon SY, Lee WJ, Lee SJ, Lee WK, Kim DW. Systematic review and quality analysis of studies on the efficacy of topical diphenylcyclopropenone treatment for alopecia areata. J Am Acad Dermatol 2017; 77:170-172.e1. [PMID: 28619558 DOI: 10.1016/j.jaad.2017.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Han Jin Jung
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sun Young Moon
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won Kee Lee
- Center of Biostatistics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea.
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. Establishing and prioritizing research questions for the treatment of alopecia areata: the Alopecia Areata Priority Setting Partnership. Br J Dermatol 2017; 176:1316-1320. [DOI: 10.1111/bjd.15099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A.E. Macbeth
- Department of Dermatology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane; Norwich NR4 7UY U.K
| | | | - A.G. Messenger
- Dermatology; University of Sheffield; Royal Hallamshire Hospital; Sheffield U.K
| | - K. Moore-Millar
- Design, Manufacturing and Engineering; University of Strathclyde; Glasgow U.K
| | | | | | - J.M. Kassim
- Dermatology Centre; St Mary's Hospital; Portsmouth U.K
| | - J.R. Brockley
- Cannock Chase Hospital; The Royal Wolverhampton NHS Trust; Cannock U.K
| | - W. Szczecinska
- Dermatology Department; Solihull Hospital; Heart of England NHS Foundation Trust; Solihull U.K
| | - P. Farrant
- Department of Dermatology; Brighton and Sussex University Hospitals NHS Trust; Brighton U.K
| | - R. Robinson
- Harrogate and District NHS Foundation Trust; Harrogate U.K
| | | | | | | | - M.J. Harries
- The Dermatology Centre; University of Manchester; Salford Royal NHS Foundation Trust; Salford U.K
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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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Herz-Ruelas ME, Gomez-Flores M, Miranda-Maldonado I, Welsh E, Ocampo-Candiani J, Welsh O. Escalating dosimetry of UVA-1 in the treatment of alopecia areata. Int J Dermatol 2017; 56:653-659. [DOI: 10.1111/ijd.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/30/2016] [Accepted: 01/09/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Maira E. Herz-Ruelas
- Dermatology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
| | - Minerva Gomez-Flores
- Dermatology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
| | - Ivett Miranda-Maldonado
- Pathology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
| | - Esperanza Welsh
- Dermatology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
| | - Oliverio Welsh
- Dermatology Department; Universidad Autonoma de Nuevo Leon; Facultad de Medicina; University Hospital; Monterrey Mexico
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