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Dainichi T, Iwata M, Kaku Y. Alopecia areata: What's new in the epidemiology, comorbidities, and pathogenesis? J Dermatol Sci 2023; 112:120-127. [PMID: 37833164 DOI: 10.1016/j.jdermsci.2023.09.008] [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: 04/22/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a common, acquired, and nonscarring type of hair loss that affects people of every generation and is intractable in severe and relapsing cases. Patients with AA, especially those with greater scalp involvement, have poor health-related quality-of-life scores. PURPOSE Following our previous review article in the April 2017 issue of the Journal of Dermatological Science, we aim to provide a pair of review articles on recent progress in multidisciplinary approaches to AA. MAIN FINDINGS We found more than 1800 publications on AA from July 2016 to December 2022. CONCLUSIONS In this review, we focused on the latest information on the epidemiology, comorbidities, and pathogenesis of AA.
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Affiliation(s)
- Teruki Dainichi
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan.
| | - Masashi Iwata
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Yo Kaku
- Department of Dermatology, Kagawa University Faculty of Medicine, Kagawa, Japan; Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
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2
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Liu Z, Liu X. Gut microbiome, metabolome and alopecia areata. Front Microbiol 2023; 14:1281660. [PMID: 38033589 PMCID: PMC10684942 DOI: 10.3389/fmicb.2023.1281660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Alopecia areata (AA) is a type of dermatological disease characterized by rapid and non-scarring hair loss of the scalp or body skin that may be related to genetic, immunological and physiological factors. It is now believed that AA is associated with oxidative stress, autoimmune disease, neuropsychological factors, pathogens, immune checkpoint inhibitors and microecological imbalance under the premise of host genetic susceptibility. In recent years, studies have revealed the significant role of the gut microbiome or metabolome in many aspects of human health. Diverse studies have revealed that the gut microbiome and metabolome have an important influence on skin conditions. This review highlights the relationship between AA and the gut microbiome or metabolome to provide novel directions for the prevention, clinical diagnosis and treatment of AA.
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Affiliation(s)
- Zhiyu Liu
- School of Medicine of Zhejiang University, Hangzhou, China
| | - Xiaoyan Liu
- Department of Dermatology, The First Affiliated Hospital, School of Medicine of Zhejiang University, Hangzhou, China
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Waldum H, Fossmark R. Inflammation and Digestive Cancer. Int J Mol Sci 2023; 24:13503. [PMID: 37686307 PMCID: PMC10487643 DOI: 10.3390/ijms241713503] [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: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic inflammation is linked to carcinogenesis, particularly in the digestive organs, i.e., the stomach, colon, and liver. The mechanism of this effect has, however, only partly been focused on. In this review, we focus on different forms of chronic hepatitis, chronic inflammatory bowel disease, and chronic gastritis, conditions predisposing individuals to the development of malignancy. Chronic inflammation may cause malignancy because (1) the cause of the chronic inflammation is itself genotoxic, (2) substances released from the inflammatory cells may be genotoxic, (3) the cell death induced by the inflammation induces a compensatory increase in proliferation with an inherent risk of mutation, (4) changes in cell composition due to inflammation may modify function, resulting in hormonal disturbances affecting cellular proliferation. The present review focuses on chronic gastritis (Helicobacter pylori or autoimmune type) since all four mechanisms may be relevant to this condition. Genotoxicity due to the hepatitis B virus is an important factor in hepatocellular cancer and viral infection can similarly be central in the etiology and malignancy of inflammatory bowel diseases. Helicobacter pylori (H. pylori) is the dominating cause of chronic gastritis and has not been shown to be genotoxic, so its carcinogenic effect is most probably due to the induction of atrophic oxyntic gastritis leading to hypergastrinemia.
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Affiliation(s)
- Helge Waldum
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
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King B, Pezalla E, Fung S, Tran H, Bourret JA, Peeples-Lamirande K, Takiya L, Napatalung L. Overview of alopecia areata for managed care and payer stakeholders in the United States. J Manag Care Spec Pharm 2023; 29:848-856. [PMID: 37219075 PMCID: PMC10394197 DOI: 10.18553/jmcp.2023.22371] [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] [Indexed: 05/24/2023]
Abstract
Alopecia areata (AA) is an autoimmune disease with a complex pathophysiology resulting in nonscarring hair loss in genetically susceptible individuals. We aim to provide health care decision makers an overview of the pathophysiology of AA, its causes and diagnosis, disease burden, costs, comorbidities, and information on current and emerging treatment options to help inform payer benefit design and prior authorization decisions. Literature searches for AA were conducted using PubMed between 2016 and 2022 inclusive, using search terms covering the causes and diagnosis of AA, pathophysiology, comorbidities, disease management, costs, and impact on quality of life (QoL). AA is a polygenic autoimmune disease that significantly impacts QoL. Patients with AA face economic burden and an increased prevalence of psychiatric disease, as well as numerous systemic comorbidities. AA is predominantly treated using corticosteroids, systemic immunosuppressants, and topical immunotherapy. Currently, there are limited data to reliably inform effective treatment decisions, particularly for patients with extensive disease. However, several novel therapies that specifically target the immunopathology of AA have emerged, including Janus kinase (JAK) 1/2 inhibitors such as baricitinib and deuruxolitinib, and the JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor ritlecitinib. To support disease management, a disease severity classification tool, the Alopecia Areata Severity Scale, was recently developed that evaluates patients with AA holistically (extent of hair loss and other factors). AA is an autoimmune disease often associated with comorbidities and poor QoL, which poses a significant economic burden for payers and patients. Better treatments are needed for patients, and JAK inhibitors, among other approaches, may address this tremendous unmet medical need. DISCLOSURES: Dr King reports seats on advisory boards for and/or is a consultant and/or clinical trial investigator for AbbVie, Aclaris Therapeutics Inc, AltruBio Inc, Almirall, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Meyers Squibb, Concert Pharmaceuticals Inc, Dermavant Sciences Inc, Eli Lilly and Company, Equillium, Incyte Corp, Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, TWi Biotechnology Inc, and Viela Bio; and speakers bureaus for AbbVie, Incyte, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. Pezalla is a paid consultant to Pfizer for market access and payer strategy concerns; Fung, Tran, Bourret, Takiya, Peeples-Lamirande, and Napatalung are employees of Pfizer and hold stock in Pfizer. This article was funded by Pfizer.
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Affiliation(s)
- Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | | | | | - Lynne Napatalung
- Medical Affairs, Pfizer, New York, NY
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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Johnston LA, Lu C, Poelman SM. Successful treatment of concomitant alopecia universalis and Crohn’s
disease with upadacitinib: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231160914. [PMID: 36968986 PMCID: PMC10031617 DOI: 10.1177/2050313x231160914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Alopecia areata is a non-scarring, autoimmune hair loss disorder that is
associated with inflammatory bowel disease. Alopecia areata and inflammatory
bowel disease may have a common pathogenic mechanism that involves the Janus
kinase/STAT pathway. In addition, there are previous case reports of patients
who developed alopecia areata while on biologic therapies for inflammatory bowel
disease. JAK1 inhibitors are currently undergoing investigation as potential
therapies for Crohn’s disease. Upadacitinib, an oral JAK1 inhibitor, has
demonstrated efficacy in treating Crohn’s disease during phase III clinical
trials. In this case report, we present a 23-year-old man with Crohn’s disease
who previously developed alopecia areata while on adalimumab. He had
near-complete resolution of his alopecia universalis after 7 months of treatment
with upadacitinib while on concurrent ustekinumab for Crohn’s disease, which he
had been taking for 16 months prior to starting upadacitinib. Upadacitinib may
be a beneficial therapy for treating concomitant alopecia areata and Crohn’s
disease.
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Affiliation(s)
- Leah A Johnston
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Leah A Johnston, Health Sciences Centre,
Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW,
Calgary, AB T2N 4N1, Canada.
| | - Cathy Lu
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Gastroenterology,
Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M Poelman
- Health Sciences Centre, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
- Beacon Dermatology, Calgary, AB,
Canada
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Moseley IH, Thompson JM, George EA, Ragi SD, Kang JH, Reginato AM, Qureshi A, Cho E. Immune-mediated diseases and subsequent risk of alopecia areata in a prospective study of US women. Arch Dermatol Res 2022; 315:807-813. [PMID: 36319702 DOI: 10.1007/s00403-022-02444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Alopecia areata (AA) is the most common form of immune-mediated hair loss. Studies have begun to establish the most frequent comorbid diseases of AA; however, results have been inconsistent with few prospective studies. METHODS A total of 63,692 women in the Nurses' Health Study, 53-80 years, were prospectively followed from 2002 to 2014 to determine whether history of immune-mediated disease was associated with AA risk. Hazard ratios (HRs) and 95% confidence intervals (CIs) for AA in relation to immune-mediated conditions were computed using Cox proportional hazard models, adjusted for AA risk factors. RESULTS 133 AA cases were identified during follow-up. Personal history of any immune-mediated disease was associated with increased AA risk (HR 1.72, 95% CI 1.24-2.37). History of systemic lupus erythematosus (HR 5.43, 95% CI 2.11-13.97), multiple sclerosis (HR 4.10, 95% CI 1.40-11.96), vitiligo (HR 3.13, 95% CI 1.08-9.10), psoriasis (HR 2.01, 95% CI 1.00-4.03), hypothyroidism (HR 1.88, 95% CI 1.30-2.71), and rheumatoid arthritis (HR 1.66, 95% CI 1.09-2.52) were associated with increased AA risk. History of inflammatory bowel disease or Graves' disease/hyperthyroidism was not significantly associated with AA risk. CONCLUSIONS In this prospective study, personal history of immune-mediated diseases either individually or overall was associated with increased AA risk.
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Affiliation(s)
- Isabelle H Moseley
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jordan M Thompson
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
| | - Elisabeth A George
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sara D Ragi
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony M Reginato
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, The Warren Alpert Medical School of Brown University, 339 Eddy Street, Providence, RI, 02903, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
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Sánchez-Pellicer P, Navarro-Moratalla L, Núñez-Delegido E, Agüera-Santos J, Navarro-López V. How Our Microbiome Influences the Pathogenesis of Alopecia Areata. Genes (Basel) 2022; 13:genes13101860. [PMID: 36292745 PMCID: PMC9601531 DOI: 10.3390/genes13101860] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022] Open
Abstract
Alopecia areata is a multifactorial autoimmune-based disease with a complex pathogenesis. As in all autoimmune diseases, genetic predisposition is key. The collapse of the immune privilege of the hair follicle leading to scalp loss is a major pathogenic event in alopecia areata. The microbiota considered a bacterial ecosystem located in a specific area of the human body could somehow influence the pathogenesis of alopecia areata, as it occurs in other autoimmune diseases. Moreover, the Next Generation Sequencing of the 16S rRNA bacterial gene and the metagenomic methodology have provided an excellent characterization of the microbiota. The aim of this narrative review is to examine the published literature on the cutaneous and intestinal microbiota in alopecia areata to be able to establish a pathogenic link. In this review, we summarize the influence of the microbiota on the development of alopecia areata. We first introduce the general pathogenic mechanisms that cause alopecia areata to understand the influence that the microbiota may exert and then we summarize the studies that have been carried out on what type of gut and skin microbiota is found in patients with this disease.
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Affiliation(s)
- Pedro Sánchez-Pellicer
- MiBioPath Research Group, Department of Clinical Medicine, Health Sciences Faculty, Catholic University of Murcia, Campus de los Jerónimos 135, 30107 Murcia, Spain
| | - Laura Navarro-Moratalla
- MiBioPath Research Group, Department of Clinical Medicine, Health Sciences Faculty, Catholic University of Murcia, Campus de los Jerónimos 135, 30107 Murcia, Spain
| | - Eva Núñez-Delegido
- MiBioPath Research Group, Department of Clinical Medicine, Health Sciences Faculty, Catholic University of Murcia, Campus de los Jerónimos 135, 30107 Murcia, Spain
| | - Juan Agüera-Santos
- MiBioPath Research Group, Department of Clinical Medicine, Health Sciences Faculty, Catholic University of Murcia, Campus de los Jerónimos 135, 30107 Murcia, Spain
| | - Vicente Navarro-López
- MiBioPath Research Group, Department of Clinical Medicine, Health Sciences Faculty, Catholic University of Murcia, Campus de los Jerónimos 135, 30107 Murcia, Spain
- Infectious Diseases Unit, University Hospital of Vinalopó-Fisabio, Carrer Tonico Sansano Mora 14, 03293 Elche, Spain
- Correspondence:
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Bodryagina E, Odintsova A, Cheremina N, Blatt N, Akberova D, Abdulganieva D. Clinical Case of Tofacitinib Therapy in Autoimmune Alopecia in Patient with Ulcerative Colitis. BIONANOSCIENCE 2022; 12:1394-1396. [PMID: 36185344 PMCID: PMC9510286 DOI: 10.1007/s12668-022-01027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
This article presents the clinical case of a patient with a long history of ulcerative colitis. Seven years after the onset of the disease, other autoimmune disorders such as sacroiliitis and alopecia have manifested. Ulcerative colitis is characterized by severe exacerbations, development of steroid resistance, ineffectiveness of mesalazine therapy, and onset of leukopenia when taking azathioprine and 6-mercaptopurine. Janus kinase inhibitor (tofacitinib) administration leads to remission of the disease, reduced activity of ulcerative colitis and sacroiliitis, and a resumption of hair growth was also observed.
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Affiliation(s)
| | | | | | - Nataliya Blatt
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russian Federation
| | | | - Diana Abdulganieva
- Kazan State Medical University, Kazan, Russian Federation
- Republic Clinical Hospital, Kazan, Russian Federation
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TOX Expression in Mycosis Fungoides and Sezary Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12071582. [PMID: 35885488 PMCID: PMC9316398 DOI: 10.3390/diagnostics12071582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Mycosis fungoides (MF) and Sezary syndrome (SS) are the two most common type of cutaneous T-cell lymphoma (CTCL). Currently, no markers can be clearly related to prognosis or to differential diagnosis between early stages and inflammatory benign diseases (IBD). The thymocyte selection-associated high mobility group box factor (TOX), has been proposed as a possible marker in differential diagnosis between early CTCL stages and IBD. Recently TOX has been related to prognosis. We aimed to investigate whether TOX may be a diagnostic or prognostic marker. MF and SS biopsies between 2010 and 2020 were retrieved. New tissues slides were stained with an anti-TOX antibody, (Clone NAN448B). On each slide, 5 fields were examined at high magnification (400×), to evaluate the percentage of marker-positivity in a quantitative way. Thirty-six patients (12 females and 24 males) and 48 biopsies were collected. Nine patients had multiple biopsies. TOX expression in MF/SS cases showed an increase from early to advanced phases. TOX was not regarded as a prognostic marker due to the absence of significant changes by comparing early MF cases with reactive conditions. TOX statistical significance increased in patients alive with disease and in those dead of disease (p = 0.013 and = 0.0005, respectively) as compared with patients in complete remission. Our results show that TOX should be regarded more as a prognostic than a diagnostic marker.
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Lu J, Zhang P, Hu R, Qi S, Zhao Y, Miao Y, Han Y, Zhou L, Yang Q. Gut microbiota characterization in Chinese patients with alopecia areata. J Dermatol Sci 2021; 102:109-115. [PMID: 33893030 DOI: 10.1016/j.jdermsci.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The gut microbiota is known to play a key role in autoimmune diseases. OBJECTIVES To identify and compare the characteristics in the gut microbial composition of patients with alopecia areata (AA) and healthy controls (HCs). METHODS In a cross-sectional discovery cohort, we enrolled 33 patients with AA and 35 HCs from the same geographic location in Shanghai, China. The 16S rRNA gene sequencing and bioinformatic analyses were conducted to analyze DNA extracted from the subjects. RESULTS The α-diversity of the AA group demonstrated no statistically significant differences compared with the HC group (P > 0.05). However, the overall gut microbial communities in the AA group were distinct from the HCs (P = 0.0096). We also adopted a random forest model to select three AA-associated OTU biomarkers: OTU1237(Achromobacter), OTU257(Megasphaera), and OTU1784(Lachnospiraceae Incertae Sedis). CONCLUSION The overall gut microbial composition for AA was distinct from that of HCs. The gut microbial markers we identified may potentially be used for earlier diagnosis and as therapeutic targets.
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Affiliation(s)
- Jinghao Lu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Pan Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ruiming Hu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sisi Qi
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Zhao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Miao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yumei Han
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijuan Zhou
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qinping Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
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