Assessment of treatment efficacy of diphenylcyclopropenone (DPCP) for alopecia areata

Allergen-specific immunotherapy improves alopecia totalis in a severe atopic dermatitis patient

House dust mite (HDM) is the most common allergen exacerbating atopic dermatitis (AD), and allergen-specific immunotherapy (AIT) using HDM exhibited significant improvements in previous studies. Alopecia can occur as a complication of AD. Alopecia totalis (AT), a severe form of alopecia areata (AA), does not respond well to treatment and the chance of full recovery is less than 10%. For extensive hair loss, topical immunotherapy such as diphenylcyclopropenone (DPCP) is used as the first-line treatment. However, since DPCP is a kind of contact allergen, it has the potential to exacerbate AD. A 38-year-old man with AD and AA visited our clinic with symptoms worsening from 3 months ago. Although taking oral methylprednisolone (8 mg/day) and cyclosporine (100 mg/day) for 3 months, he has lost over 90% of his hair and the Eczema Area and Severity Index (EASI) was 43. Total serum immunoglobulin E (IgE) levels were 4454 kU/L (normal <100 kU/L) and the specific IgE levels for Dermatophagoides pteronyssinus and Dermatophagoides farinae following ImmunoCAP® were 20.8 and 37.4 kU/L, respectively. This patient did not respond well to previous treatment and was reluctant to use long-term steroids, so subcutaneous AIT using HDM was administered along with oral cyclosporine (100 mg/day). Topical tacrolimus was also applied to the AD lesions throughout the body. To reduce itching, nonsedative antihistamines were used if necessary. Hair loss was almost completely improved 1 year after the AIT initiation and the skin lesions of AD also improved (EASI 2.4). The specific IgE levels for D. pteronyssinus and D. farinae were 3.73 and 7.16 kU/L, respectively. Herein, we report a patient with promising results following AIT for AT with severe AD. In severe alopecic patients with AD refractory to conventional treatment, including immunosuppressants, AIT could be considered as a treatment option.

Review on Alopecia Areata in the Middle East and Africa: Landscape and Unmet Needs

BACKGROUND

Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life.

AIMS AND FINDINGS

AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.

Study on Anti-Inflammatory Mechanism of Angelica pubescens Based on Network Pharmacology and Molecular Docking

References and data show that AP has a certain effect on alleviating inflammation. Based on the methods of network pharmacology and molecular docking, this paper predicts the potential mechanism of anti-inflammatory effect of the effective components. Methods: Active components and target genes of AP were screened out by SymMap, an associated database of TCM syndromes. First, screen out the active components according to the setting conditions, and its molecular structure file was obtained from the PubChem database. The target genes of anti-inflammatory effect were obtained from GeneCards database with “anti-inflammation effect” as the keyword, and then the common gene targets between AP and anti-inflammatory effect were screened. The PPI network diagram was constructed with Cytoscape 3.80 software to screen the core genes. The GO function and KEGG pathway of the core genes were enriched and analyzed by David database; 3D view of proteins encoded by the core gene from the PDB database, conduct molecular docking between the active components and the core proteins in Auto Dock Vina software, and made a heat map with binding free energy. Results: The main anti-inflammatory components were O-Acetylcolumbianetin, isoindigo, Nodakenetin, Marmesin, Diphencyprone; The core targets are TNF, VEGFA, IL6, TP53, IL1B, ESR1, MMP9, PPARG, Jun, CASP3, PTGS2. AP participated in cytokine-mediated signaling pathway, response to drug, positive regulation of gene expression, and other processes by regulating the combination of extracellular space, cell surface with protein and enzyme, and then exert anti-inflammatory activity. The signal pathways mainly involved IL-17 signaling pathway, hepatitis B, TNF signaling pathway, inflammatory bowel disease, rheumatoid arthritis, etc.; Through molecular docking, it was found that the key targets were MMP9, TNF, PTGS2, ESR1, JUN, and PPARG, while the active components which ha,d a strong effect on these genes were O-Acetylcolumbianetin, isoindigo, Nodakenetin, Marmesin, Diphencyprone. Conclusion: This study used network pharmacology and molecular docking methods to predict the potential active components, target genes, and signal pathways of the anti-inflammatory effect of AP, so as to provide a theoretical reference for the follow-up experimental research and clinical treatment of AP.

A systematic review on the treatment of pediatric severe alopecia areata by topical immunotherapy or Anthralin (contact sensitization) or low-level light/laser therapy (LLLT): focus on efficacy, safety, treatment duration, recurrence, and follow-up based on clinical studies

INTRODUCTION

Alopecia areata (AA) in its extensive and severe forms is treatment-challenging, especially in pediatrics.

METHOD

A PRISMA-compliant systematic review of seven electronic databases was searched by the terms "alopecia areata," "pediatric," "topical immunotherapy," "Anthralin," and "light therapy" from inception until March 2021. All the alternative names of the disease and therapies have been included in the search terms. 790 articles went to title abstract review by two independent reviewers. In the subsequent level, a review of the full text of studies was conducted.

RESULTS

Finally, 10 relevant articles in terms of content structure, subject coverage, and purpose, were selected for further review. The highest percentages of complete hair regrowth were 79.6% and 63.61% by SADBE (topical immunotherapy) and laser therapy. By Anthralin (contact sensitization), the complete response rate was below 50% (between 30 and 35%). Regarding average response, the most effective methods were local immunotherapy (with an average effectiveness of 53.8%), laser therapy (52.55%), and the use of Anthralin-induced contact dermatitis (30.86%), respectively. However, recurrence rate-after treatment with induced contact dermatitis by topical medications like Anthralin (contact sensitization)-was lower (mean 43.53%) in comparison with local immunotherapy (57%). In topical immunotherapy, light base therapy, and contact sensitization, the highest percentage of complete hair regrowth and the average response rate were (63.61% and 52.55%), (79.6% and 53.8%) and (32% and 30.8%), respectively. These methods are considered safe in children.

CONCLUSION

A high and more than 50% efficacy in hair regrowth could be expected by topical immunotherapy and light/laser therapy method. No serious side effects have been observed by these methods that are well tolerated in children. Therefore, a combination of local immunotherapy and light/laser therapy could be suggested for the treatment of extensive AA in children. The use of Anthralin could be associated with a lower but more durable response. These points are important for patient selection in individualized situations.