Utility of Dermoscopic Evaluation in Predicting Clinical Response to Diphencyprone in a Cohort of Patients with Alopecia Areata

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.

Comparative study between topical application of triamcinolone acetonide after fractional carbon dioxide laser versus microneedling in the treatment of resistant alopecia areata

Alopecia areata (AA) is a disease that affects the psychological well-being of the affected individuals. Laser-assisted drug delivery and microneedling (MN) are promising methods for the treatment of different dermatological diseases. The aim of the study was to compare the efficacy of topical application of triamcinolone acetonide after fractional carbon dioxide laser versus MN in the treatment of resistant AA from a clinical and dermoscopic perspective. Thirty patients were randomly divided into two groups of 15 patients each: the Laser group received fractional CO₂ laser treatment followed by topical application of triamcinolone acetonide, and the MN group received dermapen treatment followed by topical application of triamcinolone acetonide. In our study, we found no statistically significant difference between the studied groups before and after treatment, except for black dot, which is higher in the MN group than in the laser group (46.7% vs. 13.3%). There is a statistically significant difference between the studied groups in terms of treatment response at the first follow-up, with 13.3% of the laser group seeing terminal hair regrowth compared to 0 in the MN group after 12 weeks. Regarding the degree of improvement, there was no statistically significant difference between the laser group and the MN group. The use of fractional CO₂ laser and MN for transepidermal drug delivery (TED) allowed for more uniform drug distribution. There was no significant difference between the two treatment methods in terms of their high effectiveness in the treatment of resistant AA.

Topical immunotherapy treatment of alopecia areata with diphenylcyclopropenone: regulatory T cells as biomarkers for treatment response

Treatment of alopecia areata is often challenging, especially for patients with extended disease. Contact immunotherapy with diphenylcyclopropenone (DPCP) has been reported as an effective topical treatment but the exact immunologic mechanism of diverting the immune response is still unknown. We investigated the efficacy of topical immunotherapy with DPCD in acute, intermediate, and chronic lesions of AA and the response rate was associated with perifollicular infiltrate of T regulatory cells. Approximately two-thirds of our patients (67.5%) had a response rate > 50% after 6 months of DPCP therapy. Patients with acute and intermediate onset of the disease were more likely to respond to the therapy. Although responders demonstrated FOXP3+ positive lymphocytes in immunohistochemistry, this association could not be confirmed by statistical significance (p = 0.052). In patients with multiple lesions, that had different chronological onset, the lesions with more recent onset responded faster than lesions of longer duration. This article is protected by copyright. All rights reserved.