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He X, Liu J, Gong Y, Lu W, Sha X, Cao C, Li Y, Wang J. Amygdalin ameliorates alopecia areata on C3H/HeJ mice by inhibiting inflammation through JAK2/STAT3 pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 331:118317. [PMID: 38723918 DOI: 10.1016/j.jep.2024.118317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Evidence has demonstrated that Chinese medicine formula Xuefu Zhuyu decoction can markedly promote the formation of new hair in patients and mice with alopecia areata (AA). Amygdalin is one of the active components of Xuefu Zhuyu decoction, but its therapeutic effects and the underlying mechanisms on AA remains largely unrevealed. PURPOSE Therefore, this study aims to investigate the therapeutic effects and to probe its molecular mechanisms of inflammation and immune regulation on AA model of C3H/HeJ mice. STUDY DESIGN The C3H/HeJ female mice were divided into control, AA, rusolitinib (60 mg/kg), and amygdalin groups (60, 90, and 120 mg/kg, 0.2 ml/10 g, i.g.). METHODS The optical microscope was used to observe the feature of the local skin, and the number of lanugo and terminal hair. H&E staining was performed to determine the degree of pathological damage to the skin. ELISA was performed to detect levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in mice serum. Flow cytometry was carried out to analyze the CD4+CD25+FOXP3+, CD4+ and CD8+ of skin tissue. And the levels of CD4+ and CD8+, p-JAK/JAK2, p-STAT3/STAT, and SOCS3 were detected by immunohistochemistry. Western blot and qRT-PCR were employed to examine the expression levels of IL-6, TNF-α, IFN-γ, JAK2, p-JAK, STAT, p-STAT3 and SOCS3 proteins and genes in skin tissues. RESULTS Compared with AA group, amygdalin immensely increased the number of vellus hairs and decreased the number of terminal hairs determined by skin microscopy and H&E staining. ELISA, Western blot and qRT-PCR data showed that the levels of IL-6, TNF-α and IFN-γ in serum and skin tissues of AA mice were significantly increased, while amygdalin administration dramatically restrained the contents of the three pro-inflammatory factors. Flow cytometry and immunohistochemistry hinted that amygdalin observably enhanced the number of CD4+CD25+FOXP3+ and CD4+ cells, while inhibited the number of CD8+ positive cells in mice with AA. Moreover, amygdalin signally reduced JAK2/STAT3 pathway-related protein and gene levels in AA mice. CONCLUSION Amygdalin could inhibit inflammatory response and improve immune function in the treatment of AA. The underlying molecular mechanism may be related to inhibition of JAK2/STAT3 pathway.
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Affiliation(s)
- Xun He
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China.
| | - Jingsong Liu
- Neurosurgery, Institute of Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Yugang Gong
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Wei Lu
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Xiaowei Sha
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Chang Cao
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Yanqun Li
- Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610071, China
| | - Jiawei Wang
- Department of Dermatology, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
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Younis N, Puigmal N, Kurdi AE, Badaoui A, Zhang D, Morales-Garay C, Saad A, Cruz D, Rahy NA, Daccache A, Huerta T, Deban C, Halawi A, Choi J, Dosta P, Guo Lian C, Artzi N, Azzi JR. Microneedle-Mediated Delivery of Immunomodulators Restores Immune Privilege in Hair Follicles and Reverses Immune-Mediated Alopecia. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2312088. [PMID: 38638030 DOI: 10.1002/adma.202312088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/05/2024] [Indexed: 04/20/2024]
Abstract
Disorders in the regulatory arm of the adaptive immune system result in autoimmune-mediated diseases. While systemic immunosuppression is the prevailing approach to manage them, it fails to achieve long-lasting remission due to concomitant suppression of the regulatory arm and carries the risk of heightened susceptibility to infections and malignancies. Alopecia areata is a condition characterized by localized hair loss due to autoimmunity. The accessibility of the skin allows local rather than systemic intervention to avoid broad immunosuppression. It is hypothesized that the expansion of endogenous regulatory T cells (Tregs) at the site of antigen encounter can restore the immune balance and generate a long-lasting tolerogenic response. A hydrogel microneedle (MN) patch is therefore utilized for delivery of CCL22, a Treg-chemoattractant, and IL-2, a Treg survival factor to amplify them. In an immune-mediated murine model of alopecia, local bolstering of Treg numbers is shown, leading to sustained hair regrowth and attenuation of inflammatory pathways. In a humanized skin transplant mouse model, expansion of Tregs within human skin is confirmed without engendering peripheral immunosuppression. The patch offers high-loading capacity and shelf-life stability for prospective clinical translation. By harmonizing immune responses locally, the aim is to reshape the landscape of autoimmune skin disease management.
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Affiliation(s)
- Nour Younis
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Núria Puigmal
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02215, USA
| | - Abdallah El Kurdi
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, 11-0236, Lebanon
| | - Andrew Badaoui
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Dongliang Zhang
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Claudia Morales-Garay
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Anis Saad
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Diane Cruz
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Nadim Al Rahy
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea Daccache
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Triana Huerta
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Christa Deban
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Halawi
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - John Choi
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
| | - Pere Dosta
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02215, USA
| | - Christine Guo Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Natalie Artzi
- Brigham and Woman's Hospital, Department of Medicine, Division of Engineering in Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02215, USA
| | - Jamil R Azzi
- Brigham and Woman's Hospital, Department of Medicine, Renal Division, Harvard Medical School, Boston, MA, 02115, USA
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Peng S, Yang Y, Man Y, Long D, Wang L, Li K, Liu P. Explore the genetic exposure to alopecia areata. Skin Res Technol 2024; 30:e13874. [PMID: 39086160 PMCID: PMC11291861 DOI: 10.1111/srt.13874] [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: 05/19/2024] [Accepted: 07/05/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Alopecia areata is an autoimmune hair loss disorder with an incompletely understood etiology. Although trace elements, serum metabolites, and inflammatory factors are implicated in the disease, the potential causal relationships between these factors and alopecia areata require further investigation. METHODS This study employed Mendelian randomization (MR), utilizing data from genome-wide association studies, to explore the causal relationships between 15 trace elements, 1400 serum metabolites, and 91 inflammatory factors and alopecia areata. The analysis was conducted using the inverse variance weighted (IVW) method complemented by various sensitivity analyses, including Cochran's Q test, MR-Egger regression intercept test, MR-PRESSO global test, and leave-one-out analysis, to assess the robustness of the results. RESULTS MR analysis indicated a negative correlation between copper levels and the risk of developing alopecia areata (odds ratio = 0.86, 95% confidence interval: 0.75-0.99, p = 0.041). Additionally, causal relationships were identified between 15 serum metabolites and 6 inflammatory factors and the risk of alopecia areata (IVW, all p values < 0.05). CONCLUSION This study provides genetic evidence of the relationships between trace elements, serum metabolites, and alopecia areata, underscoring the potential value of targeted therapeutic strategies and preventive measures. Future research should expand to diverse populations and further explore the specific roles of these biomarkers in the disease mechanism.
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Affiliation(s)
- Shaoyi Peng
- Department of CardiologyJiande First People's HospitalHangzhouChina
| | - Yang Yang
- Department of CardiologyAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Yilong Man
- Department of CardiologyCentral Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Dianfei Long
- Department of CardiologyCentral Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Lei Wang
- Department of CardiologyCentral Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Kaiyuan Li
- Graduate School of Dalian Medical UniversityDalian Medical UniversityDalianChina
| | - Peng Liu
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
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Mostaghimi A, Soliman AM, Li C, Barqawi YK, Grada A. Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata. JAMA Dermatol 2024:2821678. [PMID: 39083282 PMCID: PMC11292571 DOI: 10.1001/jamadermatol.2024.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 08/03/2024]
Abstract
Importance Alopecia areata (AA) has been associated with multiple comorbidities, yet information regarding the timing of comorbidity development after AA diagnosis is limited. Objective To evaluate the prevalence and new-onset incidence of psychiatric and autoimmune comorbidities in patients with AA in the US. Design, Setting, and Participants This retrospective cohort analysis used data collected from January 1, 2007, to April 30, 2023, from the Merative MarketScan Research Databases, which contains medical and drug claims data from more than 46 million patients in the US. Data from adolescent and adult patients (aged 12-64 years) diagnosed with AA and patients without AA (ie, controls) were evaluated. For some analyses, patients with AA were matched (1:4) to controls based on sex, age, and geographic region. Main Outcomes and Measures Prevalence (at the time of AA diagnosis) and incidence (new onset after AA diagnosis) of psychiatric and autoimmune diseases were reported as percentage of patients. Risk of developing a new-onset psychiatric or autoimmune disease after AA diagnosis was calculated as adjusted hazard ratios (AHRs) with 95% CIs. Results At baseline, 63 384 patients with AA and 3 309 107 without AA were identified. After matching, there were 16 512 and 66 048 patients in the AA and control groups, respectively, with a mean (SD) age of 36.9 (13.4) years and 50.6% of whom were female. Compared with the unmatched controls, patients with AA had higher prevalence of psychiatric (30.9% vs 26.8%; P < .001) and autoimmune (16.1% vs 8.9%; P < .0001) comorbidities at AA diagnosis; incidence was also higher in patients with AA (without history of these comorbidities) vs the matched control group. Patients with AA vs controls had a significantly higher risk of developing a psychiatric (AHR, 1.3; 95% CI, 1.3-1.4) or autoimmune (AHR, 2.7; 95% CI, 2.5-2.8) comorbidity. Conclusions and Relevance In this cohort study, patients with AA had a higher prevalence of autoimmune and psychiatric comorbidities at AA diagnosis and demonstrated an elevated risk of new-onset autoimmune and psychiatric comorbidities after their diagnosis. These data highlight the most common comorbidities among patients with AA and may help physicians counsel and monitor patients newly diagnosed with AA.
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Affiliation(s)
- Arash Mostaghimi
- Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
| | | | - Chao Li
- AbbVie Inc, North Chicago, Illinois
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Hammadi AA, Parmar NV, Farghaly M, Dallal SA, Zayed MWA, Ebeid F, Subramanyam K, Ramachandrachar BC, Ahmed HM. A retrospective analysis of disease epidemiology, comorbidities, treatment patterns, and healthcare resource utilization of alopecia areata in the United Arab Emirates using claims database. J Dermatol 2024. [PMID: 39051178 DOI: 10.1111/1346-8138.17381] [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: 01/31/2024] [Revised: 05/29/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
Alopecia areata (AA) is an autoimmune disorder that manifests as nonscarring hair loss and imposes a substantial disease burden. The current study, using an e-claims database, assesses the disease burden, comorbidities, treatment patterns, specialties involved in the diagnosis of AA, healthcare resource utilization (HCRU), and associated costs in privately insured patients with AA in Dubai, United Arab Emirates. The retrospective longitudinal secondary study was conducted using Dubai Real-World Database e-claims data during 01 January 2014 to 30 June 2022. Patients with at least one diagnosis claim of AA during the index period (01 January 2015-30 June 2021) with continuous enrollment (one or more AA/non-AA claim in the post-index period) were included in the analysis. The patients were stratified into subcohorts based on diagnosis code and treatment patterns, as mild, moderate-to-severe, and others. Demographics, comorbidities, treatment patterns, specialists visited, and HCRU were assessed. The study included 11 851 patients with AA (mean age: mild: 37 years; moderate-to-severe: 36 years), with a male predominance (mild: 77.6%; moderate-to-severe: 60.8%). The most prevalent comorbidities in the moderate-to-severe AA subcohort were autoimmune and T-helper 2-mediated immune disorders, including contact dermatitis and eczema (62.1%), atopic dermatitis (36.1%), and asthma (36.1%). Most patients consulted dermatologists for treatment advice (mild AA: 87.4%; moderate-to-severe AA: 47.7%) and, notably, within 1 day of AA diagnosis. Topical steroids were frequently prescribed across cohorts, regardless of disease severity. Analysis of comorbidities among patients with AA indicated an additional HCRU burden among these subsets of patients. The median disease-specific HCRU cost was higher for psychological comorbidities versus autoimmune and T-helper 2-mediated immune disorders (US $224.99 vs US $103.70). There is a substantial disease and economic burden in patients with AA and associated comorbid conditions; therefore, investing in novel therapies that target the underlying autoimmune pathway may address the gap in effective management of AA.
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Bazid HAS, Marae AH, Farag B, Abdallah RA. The value of immunohistochemical expression of SOX9 and CD34 in alopecia areata. J Immunoassay Immunochem 2024:1-15. [PMID: 39041618 DOI: 10.1080/15321819.2024.2383676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Alopecia areata (AA), an immune-mediated disorder, is marked by temporary, nonscarring hair loss. The bulge area is protected from immune attacks by immune privilege; however, recent studies demonstrated immune cells infiltrating the bulge area. OBJECTIVE This study aims to investigate the immunohistochemical expression of the sex-determining region Y-box 9 (SOX9) and cluster of differentiation 34 (CD34) in AA patients as markers of hair follicle stem cells (HFSCs) and progenitor cells, respectively. METHODS Immunohistochemical staining of SOX9 and CD34 was applied on skin samples of 20 AA patients and 20 healthy controls. RESULTS SOX9 and CD34 were significantly lower in lesional samples of cases compared to perilesional and control skin biopsies. Furthermore, SOX9 level was negatively correlated with the severity of alopecia tool score (SALT score) among the studied AA patients. Moreover, lowered SOX9 expression was present in patients with recurrent attacks. CONCLUSIONS The significant reduction of stem cell markers (SOX9 and CD34) in our studied AA cases signifies the pathological affection of HFSCs and their progeny in AA. This is thought to cause a loss of competence in generating new hair in some AA cases, which needs to be validated in further research. LIMITATIONS OF THE STUDY This study has a small sample size.
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Affiliation(s)
- Heba A S Bazid
- Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
| | - Alaa H Marae
- Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
| | - Bassant Farag
- Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
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Yan A, Drake L, Hadsall S, Gaurav A, Xia E, Mostaghimi A. Evaluating the sources and types of dietary and nutritional advice for patients with alopecia areata. Arch Dermatol Res 2024; 316:283. [PMID: 38796551 DOI: 10.1007/s00403-024-02940-2] [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: 12/06/2023] [Revised: 02/09/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
Although there are now two Food and Drug Administration (FDA)-approved treatments for severe alopecia areata (AA), many patients still resort to non-medical therapies and lifestyle modifications such as diet and nutrition. The goal of this study was to evaluate the sources and types of dietary and nutritional advice for patients with AA. We distributed a cross-sectional national survey using the National Alopecia Areata Foundation's email list-serv between August 2022 and January 2023. Most respondents were White (76.3%), employed (58.3%) females (84.4%) with a mean age of 52 years. 163 (19.1%) respondents reported receiving diet and/or nutritional advice and 418 (49.5%) respondents reported searching for diet and/or nutritional advice to help with their AA; the most common source of advice was online. The most common dietary changes were the use of vitamins or supplements (30.6%), adherence to diets (23.2%), and the addition of specific foods (21.4%). 209 (50.2%) respondents reported no change in their disease and 197 (47.4%) respondents reported no change in how they felt about their disease compared to before they tried the change. Many AA patients search for or receive unsolicited dietary and nutritional advice and subsequently modify their behavior to manage their disease. However, the efficacy of these changes is unclear. Providers should be mindful of the sources through which patients obtain treatment information as well as the lifestyle changes patients make to counsel patients with evidence-based information. Further investigation is needed to better characterize the direct and indirect costs of dietary and nutritional modification in the treatment of AA.
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Affiliation(s)
- Allison Yan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Sophia Hadsall
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Ahana Gaurav
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
- Medical College of Georgia, Augusta, GA, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
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Selçukoğlu Kilimci Ö, Yücesoy SN, Turan Ş, Uzunçakmak TK, Kara Esen B, Serdengeçti N, Tarakçıoğlu MC, Serdaroğlu S. Parenting styles and psychological effects on children with alopecia areata: exploring family dynamics, anxiety, and depression. Arch Dermatol Res 2024; 316:260. [PMID: 38795219 DOI: 10.1007/s00403-024-03031-y] [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: 04/17/2024] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Alopecia areata (AA) is an autoimmune disease that develops due to inflammation and causes sudden hair loss. Ithas been observed that family circumstances may contribute to the development of AA. This study aims to assessthe relationship between the development of alopecia areata in children, family functions, and depression andanxiety levels in their parents.Thirty-nine participants diagnosed with AA and 41 healthy controls (HC), agedbetween 8 and 18 years, and their parents participated in the study. The assessment of the children included thecompletion of a socio-demographic data form, the Parenting Style Scale (PSS), and the Revised Children's Anxietyand Depression Scale (RCADS). The parents provided information on a sociodemographic form, the BeckDepression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The children in the control group scoredsignificantly higher on the PSS acceptance/ involvement subscale than those with AA. In the AA group, the numberof authoritative and indulgent (PSS) families was statistically significantly lower than that of the families in the HC,and the number of neglectful families was statistically significantly higher than those of the control group. Totalanxiety and depression t scores (RCADS) were statistically significantly higher in the AA children than in theHC. Our study demonstrates the importance of considering familial factors and parental mental health tounderstand and address alopecia areata in children. Our findings support the psychosomatic component of AA.Implementing comprehensive treatment strategies that target psychological well-being and family dynamics couldprove crucial.
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Affiliation(s)
| | - Sera Nur Yücesoy
- Department of Dermatology, Ministry of Health Hassa State Hospital, Hatay, Turkey
| | - Şenol Turan
- Cerrahpasa Medical Faculty, Department of Psychiatry, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tuğba Kevser Uzunçakmak
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beril Kara Esen
- Esenler District Health Directorate, Istanbul, Istanbul, Turkey
| | - Nihal Serdengeçti
- Department of Child and Adolescent Psychiatry, Ministry of Health, Haydarpaşa Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Cerrahpasa Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Server Serdaroğlu
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Nasimi M, Abedini R, Ghandi N, Teymourpour A, Babaie H. Safety and efficacy of tofacitinib in 97 alopecia areata patients. J Cosmet Dermatol 2024. [PMID: 38736269 DOI: 10.1111/jocd.16356] [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: 11/23/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Alopecia areata (AA) is a recurrent immune-mediated disorder causing hair loss without any scarring being present. It affects hairs on the head or other parts of the body and can occur at any age and in both genders. It seems that AA is associated with a higher rate of psychological disorders resulting from hair loss and the esthetic and social repercussions of it. Common treatments like corticosteroids do not work for every patient and recent treatment options focusing on the immunologic mechanisms like tofacitinib have shown some promising results. METHODS It's a retrospective study on patients with AA, AT, AU taking oral tofacitinib as a treatment for at least 6 months. Scalp hair loss was assessed before treatment and at each visit using the Severity of Alopecia Tool (SALT) score. RESULTS Of 97 cases, 69.1% demonstrated over 50% SALT score improvement, with 44.3% having 90% or more decrease in SALT score. Patients who suffered from patchy AA were more responsive compared to patients with AT and AU subtypes and had a greater percent change in SALT score. Tofacitinib was tolerated quite well and no significant adverse events were reported. CONCLUSIONS Tofacitinib should be taken into consideration as an efficacious treatment option for patients with AA, AT and AU.
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Affiliation(s)
- Maryam Nasimi
- Dermatology, Dermatology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Dermatology, Dermatology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Dermatology, Dermatology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teymourpour
- Statistics, Blood transfusion Research Center, High Institute for Research and Education, Tehran, Iran
| | - Hanie Babaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Zhao B, Cai J, Zhang X, Li J, Bao Z, Chen Y, Wu X. Single nucleotide polymorphisms in the KRT82 promoter region modulate irregular thickening and patchiness in the dorsal skin of New Zealand rabbits. BMC Genomics 2024; 25:458. [PMID: 38730432 PMCID: PMC11088042 DOI: 10.1186/s12864-024-10370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While rabbits are used as models in skin irritation tests, the presence of irregular patches and thickening on the dorsal skin can affect precise evaluation. In this study, genes associated with patchiness or non-patchiness on the dorsal skin of New Zealand rabbits were investigated to identify potential regulators of the patchiness phenotype. RESULTS The results showed that parameters associated with hair follicles (HFs), such as HF density, skin thickness, and HF depth, were augmented in rabbits with the patchiness phenotype relative to the non-patchiness phenotype. A total of 592 differentially expressed genes (DEGs) were identified between the two groups using RNA-sequencing. These included KRT72, KRT82, KRT85, FUT8, SOX9, and WNT5B. The functions of the DEGs were investigated by GO and KEGG enrichment analyses. A candidate gene, KRT82, was selected for further molecular function verification. There was a significant positive correlation between KRT82 expression and HF-related parameters, and KRT82 overexpression and knockdown experiments with rabbit dermal papilla cells (DPCs) showed that it regulated genes related to skin and HF growth and development. Investigation of single nucleotide polymorphisms (SNPs) in the exons and promoter region of KRT82 identified four SNPs in the promoter region but none in the exons. The G.-631G > T, T.-696T > C, G.-770G > T and A.-873 A > C alleles conformed to the Hardy - Weinberg equilibrium, and three identified haplotypes showed linkage disequilibrium. Luciferase reporter assays showed that the core promoter region of KRT82 was located in the - 600 to - 1200 segment, in which the four SNPs were located. CONCLUSIONS The morphological characteristics of the patchiness phenotype were analyzed in New Zealand rabbits and DEGs associated with this phenotype were identified by RNA-sequencing. The biological functions of the gene KRT82 associated with this phenotype were analyzed, and four SNPs were identified in the promoter region of the gene. These findings suggest that KRT82 may be a potential biomarker for the breeding of experimental New Zealand rabbits.
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Affiliation(s)
- Bohao Zhao
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Jiawei Cai
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Xiyu Zhang
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Jiali Li
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Zhiyuan Bao
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Yang Chen
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China
| | - Xinsheng Wu
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, Jiangsu, China.
- Joint International Research Laboratory of Agriculture & Agri-Product Safety, Yangzhou University, Yangzhou, 225009, Jiangsu, China.
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11
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Perrone V, Sabatino S, Avitabile A, Dovizio M, Leogrande M, Degli Esposti L. Real world evidence: patients with alopecia areata in Italy. Ital J Dermatol Venerol 2024; 159:182-189. [PMID: 38650498 DOI: 10.23736/s2784-8671.24.07785-5] [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: 04/25/2024]
Abstract
BACKGROUND This real-world analysis aimed at characterizing patients hospitalized for alopecia areata (AA) in Italy, focusing on comorbidities, treatment patterns and the economic burden for disease management. METHODS Administrative databases of healthcare entities covering 8.9 million residents were retrospectively browsed to include patients of all ages with hospitalization discharge diagnosis for AA from 2010 to 2020. The population was characterized during the year before the first AA-related hospitalization (index-date) and followed-up for all the available successive period. AA drug prescriptions and treatment discontinuation were analyzed during follow-up. Healthcare costs were also examined. RESULTS Among 252 patients with AA (mean age 32.1 years, 40.9% males), the most common comorbidities were thyroid disease (22.2%) and hypertension (21.8%), consistent with literature; only 44.4% (112/252) received therapy for AA, more frequently with prednisone, triamcinolone and clobetasol. Treatment discontinuation (no prescriptions during the last trimester) was observed in 86% and 88% of patients, respectively at 12 and 24-month after therapy initiation. Overall healthcare costs were 1715€ per patient (rising to 2143€ in the presence of comorbidities), mostly driven by hospitalization and drugs expenses. CONCLUSIONS This first real-world description of hospitalized AA patients in Italy confirmed the youth and female predominance of this population, in line with international data. The large use of corticosteroids over other systemic therapies followed the Italian guidelines, but the high discontinuation rates suggest an unmet need for further treatment options. Lastly, the analysis of healthcare expenses indicated that hospitalizations and drugs were the most impactive cost items.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy -
| | | | | | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Melania Leogrande
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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12
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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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13
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Aslam S, Awan AZ, Iqbal MM, Saeed S, Saeed M, Liaqat Z, Dar SA, Ali S, Asif MA, Mehmood Qadri H. Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata. Cureus 2024; 16:e56282. [PMID: 38623137 PMCID: PMC11018260 DOI: 10.7759/cureus.56282] [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] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.
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Affiliation(s)
- Sana Aslam
- Dermatology, Jinnah Hospital, Lahore, PAK
| | | | | | - Saira Saeed
- Medicine, University Hospital Birmingham, Birmingham, GBR
| | | | | | | | - Salamat Ali
- Medicine, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, PAK
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14
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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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Zabihi F, Cherri M, Guo X, Rancan F, Schumacher F, Mohammadifar E, Kleuser B, Bäumer W, Schirner M, Vogt A, Haag R. Topical Delivery of Tofacitinib in Dermatology: The Promise of a Novel Therapeutic Class Using Biodegradable Dendritic Polyglycerol Sulfates. Pharmaceuticals (Basel) 2024; 17:77. [PMID: 38256910 PMCID: PMC10821331 DOI: 10.3390/ph17010077] [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: 11/30/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Inflammatory skin diseases, such as psoriasis, atopic dermatitis, and alopecia areata, occur when the regulatory tolerance of the innate immune system is disrupted, resulting in the activation of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) inflammatory signaling pathway by interleukin 6 (IL-6) and other key inflammatory cytokines. JAK inhibitors, such as tofacitinib, bind to these enzymes which are coupled to receptors on cell surfaces and block the transcription of inflammatory cytokine-induced genes. The first topical applications are being marketed, yet insufficient effects regarding indications, such as alopecia areata, suggest that improved delivery technologies could help increase the efficacy. In this study, we used sulfated dendritic polyglycerol with caprolactone segments integrated in its backbone (dPGS-PCL), with a molecular weight of 54 kDa, as a degradable carrier to load and solubilize the hydrophobic drug tofacitinib (TFB). TFB loaded in dPGS-PCL (dPGS-PCL@TFB), at a 11 w/w% loading capacity in aqueous solution, showed in an ex-vivo human skin model better penetration than free TFB in a 30:70 (v/v) ethanol/water mixture. We also investigated the anti-inflammatory efficacy of dPGS-PCL@TFB (0.5 w/w%), dPGS-PCL, and free TFB in the water/ethanol mixture by measuring their effects on IL-6 and IL-8 release, and STAT3 and STAT5 activation in ex vivo skin models of simulated inflamed human skin. Our results suggest that dPGS-PCL@TFB reduces the activation of STAT3 and STAT5 by increasing the penetration of the tofacitinib. However, no statistically significant differences with respect to the inhibition of IL-6 and IL-8 were observed in this short incubation time.
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Affiliation(s)
- Fatemeh Zabihi
- Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany; (F.Z.); (M.C.); (E.M.); (M.S.)
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology, and Allergy, Charité Universitaetsmedizin, 10117 Berlin, Germany; (X.G.); (F.R.)
| | - Mariam Cherri
- Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany; (F.Z.); (M.C.); (E.M.); (M.S.)
| | - Xiao Guo
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology, and Allergy, Charité Universitaetsmedizin, 10117 Berlin, Germany; (X.G.); (F.R.)
| | - Fiorenza Rancan
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology, and Allergy, Charité Universitaetsmedizin, 10117 Berlin, Germany; (X.G.); (F.R.)
| | - Fabian Schumacher
- Institute of Pharmacy (Pharmacology and Toxicology), Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany; (F.S.); (B.K.)
- Core Facility BioSupraMol PharmaMS, Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany
| | - Ehsan Mohammadifar
- Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany; (F.Z.); (M.C.); (E.M.); (M.S.)
| | - Burkhard Kleuser
- Institute of Pharmacy (Pharmacology and Toxicology), Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany; (F.S.); (B.K.)
| | - Wolfgang Bäumer
- Institute of Pharmacology and Toxicology, School of Veterinary Medicine, Freie Universität Berlin, Koserstr. 20, 14195 Berlin, Germany;
| | - Michael Schirner
- Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany; (F.Z.); (M.C.); (E.M.); (M.S.)
| | - Annika Vogt
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology, and Allergy, Charité Universitaetsmedizin, 10117 Berlin, Germany; (X.G.); (F.R.)
| | - Rainer Haag
- Institut für Chemie und Biochemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany; (F.Z.); (M.C.); (E.M.); (M.S.)
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Wal P, Wal A. CBD: A Potential Lead against Hair Loss, Alopecia, and its Potential Mechanisms. Curr Drug Discov Technol 2024; 21:e200723218949. [PMID: 37475557 DOI: 10.2174/1570163820666230720153607] [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: 02/06/2023] [Revised: 04/24/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Nowadays, the majority of the population suffers from the problem of hair loss. It leads to disturbed mental health, lower self-confidence, and a lot more problems. A lot of the hair loss therapies available are not reliable and lead to recurrence and side effects after some time. Cannabinoids (CBD) have recently become quite popular for their benefits against hair loss. CBD oil preparations have been used both internally and externally for oral and topical use, respectively. Due to the presence of the endocannabinoid system (ECS) in the body, which naturally targets CB1 and CB2 receptors, the control of hair fall is possible. CBD is used topically for hair loss, whereas it is administered orally for the treatment and management of a medical condition, i.e., alopecia. AIM/OBJECTIVE The present review aimed to provide an in-depth study on hair loss and its management using CBD and its associated mechanisms. METHODS Electronic databases, such as ScienceDirect, Google Scholar, PubMed, Wiley, Springer, and Scopus, were thoroughly searched for information about how CBD is used, how it works, and what role it plays in treating alopecia and hair loss. RESULTS This review has highlighted the use of CBD-based hair loss therapy, and described various types of hair loss and their treatments. This review also details the phytocannabinoids and the potential mechanisms of CBD's activity against hair loss and alopecia. CONCLUSION The data obtained from the literature regarding CBD and hair loss provide a scientific basis for CBD use in alopecia. Additionally, a more precise and comprehensive study concerning CBD needs to be carried out at the pre-clinical and clinical levels.
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Affiliation(s)
- Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology (Pharmacy) NH19 Bhaunti Kanpur, India
| | - Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology (Pharmacy) NH19 Bhaunti Kanpur, India
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Huang J, Qian P, Tang Y, Li J, Liu F, Shi W. Effectiveness and Predictive Factors of Response to Tofacitinib Therapy in 125 Patients with Alopecia Areata: A Single-centre Real-world Retrospective Study. Acta Derm Venereol 2023; 103:adv12425. [PMID: 38112208 PMCID: PMC10753592 DOI: 10.2340/actadv.v103.12425] [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: 05/02/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
Alopecia areata is an autoimmune disorder that greatly impacts patients' quality of life, and its management remains challenging. Tofacitinib is the first Janus kinase inhibitor to be approved for clinical use and is the most extensively studied. Several studies have demonstrated the clinical effectiveness of oral tofacitinib in treating patients with alopecia areata. However, despite being widely used in clinical practice, no prospective randomized controlled trials have been implemented and its indication criteria have not been thoroughly established. Moreover, little is known about the factors associated with response to therapy under real-world conditions. The aims of this retrospective cohort study of patients with alopecia areata treated with tofacitinib for 3 months were to assess the effectiveness of tofacitinib and to identify predictive factors of response to it. Primary outcome was the change in disease severity, as evaluated by Severity of Alopecia Tool (SALT) grade. A total of 125 patients with alopecia areata were included, the incidence of effectiveness was 83.2%, and 16.0% of patients achieved a result of complete remission. Total duration of alopecia areata and previous hair regrowth were independent predictors of response. Combined therapy was associated with relapse after discontinuation. No severe adverse event was observed. This study suggests that tofacitinib provides an effective treatment option for patients with alopecia areata, and that earlier intervention in the treatment of severe alopecia areata with tofacitinib may lead to better outcomes.
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Affiliation(s)
- Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
| | - Pei Qian
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
| | - Fangfen Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Hu Nan Key Laboratory of Aging Biology, Changsha, China.
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Venetsanopoulou AI, Mavridou K, Voulgari PV, Drosos AA. Cutaneous immune-related phenomena in patients with inflammatory arthritides treated with biological therapies: Clinical and pathophysiological considerations. Semin Arthritis Rheum 2023; 63:152272. [PMID: 37788595 DOI: 10.1016/j.semarthrit.2023.152272] [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: 04/17/2023] [Revised: 07/14/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
In recent years, identifying the pathophysiologic mechanisms underlying autoimmune arthritides and systematic diseases has led to the use of biological drugs. The primary targets of those biological therapies are cytokines, B cells, and co-stimulation molecules. So far, these targeted therapies have shown good clinical improvement and an acceptable toxicity profile. However, by blocking components of an intact immune system, autoimmune phenomena and paradoxical inflammation have emerged, and among them many cutaneous immune-related adverse events (irAEs). In this article, we review the current state of knowledge on the clinical features and mechanisms of specific cutaneous irAEs observed during treatment with biological therapies. Among those, psoriatic skin lesions are the most commonly observed. Herein, we also report new cases of cutaneous irAEs recently seen in our clinic to help physicians treating inflammatory arthritides recognize cutaneous irAEs early and better manage patients receiving biologic therapies.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
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Pixley JN, Cook MK, Singh R, Larrondo J, McMichael AJ. A comprehensive review of platelet-rich plasma for the treatment of dermatologic disorders. J DERMATOL TREAT 2023; 34:2142035. [PMID: 36318219 DOI: 10.1080/09546634.2022.2142035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Platelet-rich plasma (PRP) offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well-understood. Our objective is to review the use and effectiveness of PRP for dermatologic conditions. A literature search was performed through PubMed and yielded 54 articles published between January 2000 and November 2021; articles written in English were reviewed. Intradermal injections were associated with increased hair density in androgenic alopecia. Successful treatment of inflammatory nail diseases with PRP has been reported. Improvement in psoriasis was described, but only two studies were available. PRP was associated with higher patient self-assessment scores of photoaging and fine lines. Treatment with PRP in melasma has been associated with improved subjective satisfaction, but not with objective measures of disease improvement. PRP can serve as a safe and potentially effective adjunct for hair loss, vitiligo, nonhealing wounds, photoaging, and acne scars. An important barrier to interpreting PRP research is lack of standardization of PRP preparation protocols, inconsistent clinical endpoints, and frequent combination treatments. However, PRP is relatively noninvasive, has a well-established safety profile, and patient satisfaction is often high as patients perceive great benefit from treatment with PRP.
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Affiliation(s)
- Jessica N Pixley
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Madison K Cook
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Rohan Singh
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Jorge Larrondo
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Amy J McMichael
- Wake Forest Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC, USA
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Taylor S, Korman NJ, Tsai TF, Shimomura Y, Feely M, Dutronc Y, Wu WS, Somani N, Tosti A. Efficacy of Baricitinib in Patients with Various Degrees of Alopecia Areata Severity: Post-Hoc Analysis from BRAVE AA1 and BRAVE AA2. Dermatol Ther (Heidelb) 2023; 13:3181-3191. [PMID: 37740856 PMCID: PMC10689675 DOI: 10.1007/s13555-023-01033-8] [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: 05/17/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Baricitinib, an oral selective JAK1/JAK2 inhibitor, is approved for the treatment of adults with severe alopecia areata (AA). OBJECTIVE To evaluate differences in response up to week 52 among subgroups based on the baseline severity of AA assessed with the Severity of Alopecia Tool (SALT) score. METHODS Data were pooled from BRAVE-AA1 and BRAVE-AA2, two randomized, placebo-controlled, phase 3 trials, which enrolled adults with a SALT score ≥ 50. Patients were subdivided by the degree of AA severity at baseline. RESULTS Among the 855 patients treated with baricitinib 2 mg and 4 mg, improvements in scalp hair growth continued through to week 52. A superior response was observed in patients with a SALT score of 50-94 versus a score of 95-100. Patients on baricitinib 4 mg had a faster and higher response rate compared to baricitinib 2 mg. CONCLUSION Across all degrees of severity for baricitinib 2 mg and 4 mg doses, the proportion of patients responding was yet to plateau up to week 52. Response to treatment was longer for patients with a baseline SALT score 95-100. Further studies are needed to analyze other parameters that may impact observed response rates.
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Affiliation(s)
- Susan Taylor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Meghan Feely
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Dermatology, Mount Sinai, New York, NY, USA
| | | | - Wen-Shuo Wu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.
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21
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Passeron T, King B, Seneschal J, Steinhoff M, Jabbari A, Ohyama M, Tobin DJ, Randhawa S, Winkler A, Telliez JB, Martin D, Lejeune A. Inhibition of T-cell activity in alopecia areata: recent developments and new directions. Front Immunol 2023; 14:1243556. [PMID: 38022501 PMCID: PMC10657858 DOI: 10.3389/fimmu.2023.1243556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune disease that has a complex underlying immunopathogenesis characterized by nonscarring hair loss ranging from small bald patches to complete loss of scalp, face, and/or body hair. Although the etiopathogenesis of AA has not yet been fully characterized, immune privilege collapse at the hair follicle (HF) followed by T-cell receptor recognition of exposed HF autoantigens by autoreactive cytotoxic CD8+ T cells is now understood to play a central role. Few treatment options are available, with the Janus kinase (JAK) 1/2 inhibitor baricitinib (2022) and the selective JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) inhibitor ritlecitinib (2023) being the only US Food and Drug Administration-approved systemic medications thus far for severe AA. Several other treatments are used off-label with limited efficacy and/or suboptimal safety and tolerability. With an increased understanding of the T-cell-mediated autoimmune and inflammatory pathogenesis of AA, additional therapeutic pathways beyond JAK inhibition are currently under investigation for the development of AA therapies. This narrative review presents a detailed overview about the role of T cells and T-cell-signaling pathways in the pathogenesis of AA, with a focus on those pathways targeted by drugs in clinical development for the treatment of AA. A detailed summary of new drugs targeting these pathways with expert commentary on future directions for AA drug development and the importance of targeting multiple T-cell-signaling pathways is also provided in this review.
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Affiliation(s)
- Thierry Passeron
- University Côte d’Azur, Centre Hospitalier Universitaire Nice, Department of Dermatology, Nice, France
- University Côte d’Azur, INSERM, U1065, C3M, Nice, France
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, United States
| | - Julien Seneschal
- Department of Dermatology and Paediatric Dermatology, National Reference Centre for Rare Skin Diseases, Saint-André Hospital, University of Bordeaux, Bordeaux, France
- Bordeaux University, Centre national de la recherche scientifique (CNRS), ImmunoConcept, UMR5164, Bordeaux, France
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Dermatology and Venereology, Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- College of Health and Life Sciences, Hamad Bin Khalifa University-Qatar, Doha, Qatar
| | - Ali Jabbari
- Department of Dermatology, University of Iowa, Iowa City, IA, United States
- Iowa City VA Medical Center, Iowa City, IA, United States
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Desmond J. Tobin
- Charles Institute of Dermatology, UCD School of Medicine, University College Dublin, Dublin, Ireland
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22
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Zhou C, Yang X, Yang B, Yan G, Dong X, Ding Y, Fan W, Li L, Yang D, Fang H, Ji C, Cheng H, Zhang S, Goh AH, Liu R, Gu X, Weng Z, Foley P, Sinclair R, Zhang J. A randomized, double-blind, placebo-controlled phase II study to evaluate the efficacy and safety of ivarmacitinib (SHR0302) in adult patients with moderate-to-severe alopecia areata. J Am Acad Dermatol 2023; 89:911-919. [PMID: 37019385 DOI: 10.1016/j.jaad.2023.02.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a CD8+ T cell-mediated autoimmune disease characterized by nonscarring hair loss. Ivarmacitinib, which is a selective oral Janus kinase 1 inhibitor, may interrupt certain cytokine signaling implicated in the pathogenesis of AA. OBJECTIVE To evaluate the efficacy and safety of ivarmacitinib in adult patients with AA who have ≥25% scalp hair loss. METHODS Eligible patients were randomized 1:1:1:1 to receive ivarmacitinib 2, 4, or 8 mg once daily or placebo for 24 weeks. The primary end point was the percentage change from baseline in the Severity of Alopecia Tool score at week 24. RESULTS A total of 94 patients were randomized. At week 24, the least squares mean difference in the percentage change from baseline in the Severity of Alopecia Tool score for ivarmacitinib 2, 4, and 8 mg and placebo groups were -30.51% (90% CI, -45.25, -15.76), -56.11% (90% CI, -70.28, -41.95), -51.01% (90% CI, -65.20, -36.82), and -19.87% (90% CI, -33.99, -5.75), respectively. Two serious adverse events-follicular lymphoma and COVID-19 pneumonia-were reported. LIMITATIONS A small sample size limits the generalizability of the results. CONCLUSION Treatment with ivarmacitinib 4 and 8 mg doses in patients with moderate and severe AA for 24 weeks was efficacious and generally tolerated.
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Affiliation(s)
- Cheng Zhou
- Peking University People's Hospital, Beijing
| | | | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou
| | - Guofu Yan
- Chongqing Traditional Chinese Medicine Hospital, Chongqing
| | - Xiuqin Dong
- Guangdong Provincial People's Hospital, Guangzhou
| | | | - Weixin Fan
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing
| | - Linfeng Li
- Beijing Friendship Hospital, Capital Medical University, Beijing
| | | | - Hong Fang
- First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Chao Ji
- First Affiliated Hospital of Fujian Medical University, Fuzhou
| | - Hao Cheng
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | | | | | | | | | - Peter Foley
- University of Melbourne, Skin & Cancer Foundation Inc., Melbourne
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23
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Thaçi D, Tziotzios C, Ito T, Ko J, Karadağ AS, Fang H, Edwards RA, Bonfanti G, Wolk R, Tran H, Law E. Hair Loss Profiles and Ritlecitinib Efficacy in Patients with Alopecia Areata: Post Hoc Analysis of the ALLEGRO Phase 2b/3 Study. Dermatol Ther (Heidelb) 2023; 13:2621-2634. [PMID: 37707764 PMCID: PMC10613177 DOI: 10.1007/s13555-023-00997-x] [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: 06/06/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Ritlecitinib demonstrated efficacy in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study (NCT03732807). However, hair loss presentation may vary based on location (e.g., scalp, eyebrow/eyelash, body). Here, we sought to identify distinct hair loss profiles at baseline and evaluate whether they affected the efficacy of ritlecitinib. METHODS Patients with AA aged ≥ 12 years with ≥ 50% scalp hair loss were randomized to daily ritlecitinib 10 mg (assessed for dose ranging only), 30 or 50 mg (± 4-week, 200-mg loading dose), or placebo for 24 weeks. Latent class analysis (LCA) identified hair loss profiles based on four baseline measurements: clinician-reported extent of scalp (Severity of Alopecia Tool score), eyebrow hair loss, eyelash hair loss, and patient-reported body hair loss. Logistic regression evaluated ritlecitinib (50 and 30 mg) efficacy vs placebo using Patient Global Impression of Change (PGI-C) and Patient Satisfaction with Hair Growth (P-Sat; amount, quality, and overall satisfaction) responses at Week 24, adjusting for key covariates, including latent class membership. RESULTS LCA identified five latent classes: (1) primarily non-alopecia totalis (AT; complete loss of scalp hair); (2) non-AT with moderate non-scalp involvement; (3) extensive scalp, eyebrow, and eyelash involvement; (4) AT with moderate non-scalp involvement; and (5) primarily alopecia universalis (complete scalp, face, and body hair loss). Adjusting for latent class membership, patients receiving ritlecitinib 30 or 50 mg were significantly more likely to achieve PGI-C response (30 mg: odds ratio, 8.62 [95% confidence interval, 4.42-18.08]; 50 mg: 12.29 [6.29-25.85]) and P-Sat quality of hair regrowth (30 mg: 6.71 [3.53-13.51]; 50 mg: 8.17 [4.30-16.46]) vs placebo at Week 24. Results were similar for P-Sat overall satisfaction and amount of hair regrowth. CONCLUSION Distinct and clinically relevant hair loss profiles were identified in ALLEGRO-2b/3 participants. Ritlecitinib was efficacious compared with placebo, independent of hair loss profile at baseline. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03732807.
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Affiliation(s)
- Diamant Thaçi
- Institut and Comprehensive Center for Inflammation Medicine, University of Luebeck, Luebeck, Germany
| | | | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Justin Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ayşe Serap Karadağ
- Department of Dermatology, School of Medicine, Memorial Health Group, Istanbul Arel University, Istanbul, Turkey
| | - Hong Fang
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
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24
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Wang L, Qiao S, Xia R, Liu Y, Hu Y, Wu Y, Zhou J, Liang G, Tian T, Cao L. Mesenchymal stromal cell-derived magnetic nanovesicles for enhanced skin retention and hair follicle growth. Cytotherapy 2023; 25:1176-1185. [PMID: 37516947 DOI: 10.1016/j.jcyt.2023.07.001] [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: 04/20/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND AIMS Extracellular vesicles and exosome-mimetic nanovesicles (NVs) derived from mesenchymal stromal cells (MSCs) have emerged as promising to promote hair growth. However, short local skin retention after subcutaneous administration hinders their clinical applications. METHODS In this study, we prepared magnetic nanovesicles (MNVs) from iron oxide nanoparticle-incorporated MSCs. MNVs contained more therapeutic growth factors than NVs derived from naive MSCs, and their localization and internalization were manipulated by external magnetic field. RESULTS Following the subcutaneous injection of MNVs into a mouse model of depilation-induced hair regeneration, the magnetic attraction increased their skin retention. Then, the cellular proliferation and β-catenin signaling in hair follicles (HF) were markedly enhanced by MNV injection and magnetic field application. Furthermore, an acceleration of HF growth was revealed by histological analysis. CONCLUSIONS The proposed strategy can enhance the therapeutic potential of MSC-derived NVs for hair regeneration and other dermatological diseases.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Shuya Qiao
- Department of Neurobiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rushan Xia
- Department of Dermatology, Jiangnan University Medical Center, Wuxi, Jiangsu, China
| | - Yiwen Liu
- Department of Dermatology, Jiangnan University Medical Center, Wuxi, Jiangsu, China
| | - Yifei Hu
- Department of Dermatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yajuan Wu
- Department of Dermatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Junhao Zhou
- Department of Dermatology, Jiangnan University Medical Center, Wuxi, Jiangsu, China
| | - Gaofeng Liang
- School of Basic Medical Sciences, Henan University of Science & Technology, Luoyang, Henan, China
| | - Tian Tian
- Department of Neurobiology, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Lei Cao
- Department of Dermatology, Jiangnan University Medical Center, Wuxi, Jiangsu, China.
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25
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Vats V, Makineni P, Hemaida S, Haider A, Subramani S, Kaur N, Butt AN, Scott-Emuakpor R, Zahir M, Mathew M, Iqbal J. Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review. Cureus 2023; 15:e44549. [PMID: 37790051 PMCID: PMC10544948 DOI: 10.7759/cureus.44549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Pallavi Makineni
- Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical & Dental College, Karachi, PAK
| | | | - Navjot Kaur
- Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Mohammad Zahir
- Medicine, Ayub Medical College, Abottabad, Abottabad, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
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Meguid AMA, Ghazally A, Ahmed AM, Bakr RM. Fractional carbon dioxide laser alone and as an assisted drug delivery for treatment of alopecia areata: a clinical, dermoscopic and immunohistochemical study. Arch Dermatol Res 2023; 315:1675-1688. [PMID: 36809409 PMCID: PMC10338624 DOI: 10.1007/s00403-023-02565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Alopecia areata (AA) is a common cause of hair loss with no available universally successful treatment. Thus, new innovative treatments are urgently needed. This research aimed to evaluate the effectiveness of fractional carbon dioxide laser (FCL) alone or combined with triamcinolone acetonide (TA) solution, platelet-rich plasma (PRP), or vitamin D3 solution in treating AA. Sixty-four AA patients with 185 lesions were recruited and divided into four treatment groups. All patients received FCL either alone (group A, n = 19) or followed by topical TA (group B, n = 16) or PRP (group C, n = 15), or vitamin D3 solution (group D, n = 14). The response was assessed using Alopecia Areata Severity Index (AASI), MacDonald Hull and Norris grading, and trichoscopy. Histopathological features and immunohistochemical decorin expression were studied. All groups showed significant improvement in AASI compared to the baseline, with insignificant differences between them. Post-treatment, trichoscopic features of disease activity significantly decreased in all groups. Compared to control biopsies, both anagen follicles and decorin expression were significantly decreased in all pretreatment specimens. After treatment, all groups showed significantly increased anagen follicles and decorin expression compared to the baseline. Accordingly, FCL is an effective treatment for AA alone or combined with TA, PRP, or vitamin D3 solution. In AA, Decorin expression was downregulated, while enhanced expression following successful treatment occurred. This suggests the role of decorin in AA pathogenesis. However, further research is still recommended to clarify the exact role of decorin in AA pathogenesis and to investigate the therapeutic benefits of decorin-based therapy.
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Affiliation(s)
- Azza Mahfouz Abdel Meguid
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Alaa Ghazally
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Asmaa M. Ahmed
- Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Radwa M. Bakr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
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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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28
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Varghese SA, Nair SS, George AE, Yadev I. Treatment Response to Diphenylcyclopropenone in Patients with Alopecia Totalis/Universalis. Int J Trichology 2023; 15:149-153. [PMID: 38765726 PMCID: PMC11098142 DOI: 10.4103/ijt.ijt_2_22] [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: 01/05/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 05/22/2024] Open
Abstract
Introduction Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous regrowth is <10%. Topical immunotherapy agent, diphenylcyclopropenone (DPCP) has shown clinical efficacy with limited side effects in severe forms of AA. However, its specific role in AT/AU characterized by complete hair loss over the scalp can help highlight the efficacy of the drug with fewer confounders. Methodology Data were collected from 18 patients diagnosed with AT/AU and treated with topical immunotherapy with DPCP as per protocol by Happle et al. Baseline Severity of Alopecia Tool (SALT) score and subclass was recorded. In the case of AU, baseline body hair loss score was also recorded. Patients were reassessed after 6 months of treatment in terms of change in SALT score and hair regrowth was assessed using the Global Assessment Score. The side effects during treatment were also assessed and recorded. Results Eighteen patients of whom eleven (61.1%) were diagnosed as AU and seven (38.9%) as AT were treated. The mean age was 21.6, with a male: female ratio of 3:2. The comorbidities noted were atopy in six (33.3%), atopy and hypothyroidism in one (5.5%), Down's syndrome in two (11.1%), and hypothyroidism alone in one (5.5%) patient. The mean duration of disease at the time of presentation was 3 years and all patients had remained refractory to various other modalities of treatment. All patients had a baseline SALT score of 100 corresponding to S5. After 6 months of treatment, 27.7% of patients did not show any response (SALT score S5), 16.6% had a score of S4, 11.1% had a score of S3, 11.1% had a score of S2, 22.2% had a score of S1, and 11.1% had a score of S0. On assessing improvement in body hair loss score, 36.3% of patients showed no improvement, 36.3% showed partial improvement, and 27.2% of patients showed complete body hair regrowth. About 55.5% of patients developed notable side effects that included severe local reactions, cervical lymphadenopathy, acne and pigmentation at the site of application as well as untreated sites. Conclusion The AT/AU subtypes of AA, was amenable to treatment with contact immunotherapeutic agent DPCP with a >75% hair regrowth in 33.3% of patients. The castling phenomenon was seen in 63.6% of AU patients. The adverse effects noted were not severe enough to deter treatment.
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Affiliation(s)
- Smitha Ancy Varghese
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sandhya S. Nair
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anuja Elizabeth George
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Induprabha Yadev
- Department of Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
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29
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Ho CY, Wu CY, Chen JYF, Wu CY. Clinical and Genetic Aspects of Alopecia Areata: A Cutting Edge Review. Genes (Basel) 2023; 14:1362. [PMID: 37510267 PMCID: PMC10379312 DOI: 10.3390/genes14071362] [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: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Alopecia areata (AA) is a chronic, non-scarring, immune-mediated skin disease that affects approximately 0.5-2% of the global population. The etiology of AA is complex and involves genetic and environmental factors, with significant advancements in genetic research occurring in recent years. In addition to well-known genes such as PTPN22, CTLA4, and IL2, which have been widely supported as being associated with AA, an increasing number of specific gene-related loci have been discovered through advances in genetic research. For instance, gene analysis of microRNAs can reveal the critical role of miRNAs in regulating gene expression, aiding in the understanding of cellular and organismal functional regulatory mechanisms. Furthermore, numerous studies have confirmed the existence of correlations between AA and other immune-related diseases. Examples include hyperthyroidism and rheumatoid arthritis. By understanding the interrelationships between AA and other immune diseases, we can further comprehend potential shared genetic foundations or pathogenic mechanisms among different diseases. Genetic research plays a crucial role in unraveling the pathogenesis of AA, as the identification of genetic variations associated with AA can assist in formulating more effective and targeted treatment strategies.
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Affiliation(s)
- Chih-Yi Ho
- Department of Dermatology, College of Medicine and Post Baccalaureat Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Chiu-Yen Wu
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Jeff Yi-Fu Chen
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ying Wu
- Department of Dermatology, College of Medicine and Post Baccalaureat Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
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Alsuhibani AS, Alharthi RM, AlSuhaymi S, Alnahdi MA, Almohideb M. Prescription Pattern of Tofacitinib for Alopecia Areata Among the Dermatologists in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e40445. [PMID: 37325685 PMCID: PMC10267882 DOI: 10.7759/cureus.40445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. In Saudi Arabia, AA accounts for 1-2% of new dermatological outpatient visits. It typically presents with sharply demarcated round patches of hair loss and may present at any age. Traditional medical therapies include corticosteroids and immunotherapy. Choosing the ideal treatment depends on multiple factors such as patient age, disease severity, efficacy, side effects, and remission rate. Recent medications that have been used for treating AA are Janus kinase inhibitors. Aim The aim of the study is to assess the awareness and attitude of dermatologists and their use of Tofacitinib in treating AA. Method A cross-sectional study was conducted in 2019 across 14 major cities in Saudi Arabia. A self-administered online questionnaire was specifically developed and used. Dermatologists from government hospitals and private clinics were included through non-probability convenience sampling. The collected data was entered into Microsoft Excel and analyzed using SPSS program version 24. Results In total, out of 546 Dermatologists across Saudi Arabia who responded to the questionnaire, 127 (23.2%) physicians prescribed Tofacitinib in their practice. Out of those who prescribed the drug for AA cases, 58 dermatologists (45.6%) prescribed Tofacitinib after the failure of steroid injections. Among the 127 dermatologists who have utilized Tofacitinib in their practice, 92 (72.4%) believe that Tofacitinib is effective in treating AA. Almost 200 (47.7%) Dermatologists who never prescribed Tofacitinib reported that the main reason was due to the unavailability of the drug in the clinic they were practicing. Conclusions To conclude, out of 546 dermatologists working in Saudi Arabia, 127 (23.2%) prescribe Tofacitinib to treat AA. Ninety-two (72.4%) of the participants reported the effectiveness of Tofacitinib. Two hundred (47.7%) dermatologists who never prescribe Tofacitinib reported that the main reason was due to the unavailability. However, this would raise the need for more research regarding JAK inhibitors generally and Tofacitinib specifically, focusing on the effectiveness versus the side effects of Tofacitinib.
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Affiliation(s)
- Abdulaziz S Alsuhibani
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | | | - Saba AlSuhaymi
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Muhannad A Alnahdi
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, CAN
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Albalawi MA, Hafez AM, Elhawary SS, Sedky NK, Hassan OF, Bakeer RM, El Hadi SA, El-Desoky AH, Mahgoub S, Mokhtar FA. The medicinal activity of lyophilized aqueous seed extract of Lepidium sativum L. in an androgenic alopecia model. Sci Rep 2023; 13:7676. [PMID: 37169776 PMCID: PMC10175567 DOI: 10.1038/s41598-023-33988-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
This study evaluated the topical effect of Lepidium sativum lyophilized seed extract (LSLE) towards Sustanon-induced alopecia in male adult Wistar albino rats in vivo, compared to minoxidil topical reference standard drug (MRD). LC-MS/MS together with molecular networking was used to profile the metabolites of LSLE. LSLE treated group revealed significant changes in alopecia related biomarkers, perturbation of androgenic markers; decline in testosterone level and elevation in 5α-reductase (5-AR); decline in the cholesterol level. On the other hand, LSLE treated group showed improvement in vascular markers; CTGF, FGF and VEGF. Groups treated topically with minoxidil and LSLE showed significant improvement in hair length. LC-MS/MS profile of LSLE tentatively identified 17 constituents: mainly glucosinolates, flavonoid glycosides, alkaloids and phenolic acids. The results point to the potential role of LSLE in the treatment of alopecia through decreasing 5(alpha)-dihydrotestosterone levels. Molecular docking was attempted to evaluate the probable binding mode of identified compounds to androgen receptor (PDB code: 4K7A).
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Affiliation(s)
| | - Ahmed M Hafez
- Department of Biochemistry, School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, Cairo, Egypt
| | - Seham S Elhawary
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nada K Sedky
- Department of Biochemistry, School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, Cairo, Egypt
| | - Omnia F Hassan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, MSA University, 6th of October City, Egypt
| | - Rofanda M Bakeer
- Department of Pathology, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Soha Abd El Hadi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo, Egypt.
| | - Ahmed H El-Desoky
- Department of Pharmacognosy, Pharmaceutical Industries Research Institute, National Research Centre, Dokki, Giza, 112611, Egypt
| | - Sebaey Mahgoub
- Food Analysis Laboratory, Ministry of Health, Zagazig, 44511, Egypt
| | - Fatma A Mokhtar
- Department of Pharmacognosy, Faculty of Pharmacy, El Saleheya El Gadida University, El Saleheya El Gadida, Sia, 44813, Egypt
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A phase 2a randomized vehicle-controlled multi-center study of the safety and efficacy of delgocitinib in subjects with moderate-to-severe alopecia areata. Arch Dermatol Res 2023; 315:181-189. [PMID: 35230488 DOI: 10.1007/s00403-022-02336-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
Alopecia areata/AA is an autoimmune cause of nonscarring hair loss. The pathogenesis of AA involves many immune axes, including Th1/Th2 pathways. Delgocitinib is a pan-Janus kinase/JAK inhibitor that broadly blocks pro-inflammatory cytokines and has been effective in other inflammatory skin conditions. Recent human studies/reports have shown that use of some systemic JAK inhibitors led to hair regrowth, suggesting this medication class as a potential therapy for AA. However, topical treatment is desirable due to potential systemic side effects. To assess the efficacy and safety of topical delgocitinib in AA, we conducted a double-blind, randomized, vehicle-controlled clinical trial in 31 moderate-to-severe AA patients that were randomized 2:1 to receive delgocitinib ointment 30 mg/g (n = 20) or ointment vehicle (n = 11) for 12 weeks. The primary endpoint was change in severity of Alopecia Tool/SALT score from baseline to week 12. The secondary endpoint included safety profile by reported adverse events. Twenty-three subjects completed the trial, with eight discontinuing mostly due to voluntary withdrawal. Ten patients receiving delgocitinib ointment and three patients receiving vehicle showed SALT score improvements after 12 weeks, but the mean percent SALT improvement at week 12 compared to baseline between the two arms was not significant (p = 0.92). Our study suggests that delgocitinib ointment is not effective in moderate-to-severe AA, likely due to its inability to penetrate sufficiently deeply into the dermis of the scalp, but larger studies are necessary to assess whether a different formulation of topical JAK inhibitors may be suitable to treat mild or more localized forms of AA.
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Stefanis AJ. Janus Kinase Inhibitors in the Treatment of Alopecia Areata. Prague Med Rep 2023; 124:5-15. [PMID: 36763827 DOI: 10.14712/23362936.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Alopecia areata is a disease of autoimmune origin which causes non scarring hair loss. The extent of alopecia varies from a small patch to complete scalp and body hair loss, which can have huge psychosocial impact for those affected. Treatment modalities which have been used so far included nonspecific immunosuppressive medications, such as corticosteroids, cyclosporine, and methotrexate, or topical immunomodulators, such as diphencyprone, dithranol, and squaric acid dibutylester. The recognition of the importance of Janus kinase pathway in alopecia areata pathogenesis enabled more specific approaches in treatment. Positive outcomes of Janus kinase inhibitors in several trials granted approval for baricitinib which became the first on-label treatment for alopecia areata. The aim of this review is to summarize the role, efficacy and safety of several Janus kinase inhibitors in alopecia areata.
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Affiliation(s)
- Athanasios J Stefanis
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.
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Mahmoud AM. Effectiveness and safety of baricitinib in patients with alopecia areata: a systematic review and Meta-analysis of randomized controlled trials. Curr Med Res Opin 2023; 39:249-257. [PMID: 36239359 DOI: 10.1080/03007995.2022.2135838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since there is now no medication available that has been approved by the US Food and Drug Administration, alopecia areata (AA) is an autoimmune condition that has a detrimental impact on individuals. Recent clinical trials using baricitinib demonstrated that it may be effective in treating AA. This meta-analysis was done to evaluate the effectiveness and safety of baricitinib in comparison to placebo. METHODS Author looked through Scopus, Web of Science, Cochrane Library, PubMed, for all published, randomized, clinical trials. RESULTS This meta-analysis included 1282 participants from two citations (reporting three stand-alone studies). In term of SALT score, baricitinib significantly outperformed placebo; MD = -34.07, 95% CI [-37.90, -30.23], p < .00001. Additionally, the proportion of patients in the baricitinib group that attained SALT ≤ 20 was significantly higher than in the placebo group; RR = 6.41, 95% CI [4.57, 8.98], p < .00001. The results of the safety analysis revealed no significant differences between the baricitinib and placebo groups for any of the outcomes with the exception of acne, which was significantly higher in the placebo group when compared to the baricitinib group (RR= 4.79, 95% CI [2.38, 9.66], p .0001). CONCLUSION When compared to placebo, baricitinib is an effective and well-tolerated medication for the treatment of AA.
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Shehata WA, Hammam MA, Abdo A, Tayel N, Abdelsattar S. Mitochondrial DNA copy number as a diagnostic marker and indicator of degree of severity in alopecia areata. J Immunoassay Immunochem 2023; 44:256-268. [PMID: 36681933 DOI: 10.1080/15321819.2023.2168557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Alopecia areata (AA) is a disorder with several etiologies. The evidence suggests that the absolute copy number of mitochondrial deoxyribonucleic acid (mtDNA), as well as proportion of mutated mtDNA copies, determines disease onset. This study aims to quantify the relative index of the mtDNA copy number in patients with AA and healthy controls and correlate the results with the existing clinical information. This case-control study included 50 patients with AA and 50 age- and sex-coordinated healthy persons as controls. The severity of AA was weighed using the Severity of Alopecia Tool and Kavak's classification. The relative index of the mtDNA copy number was measured by real-time qPCR. Significant statistical difference was observed between cases and controls regarding mean mtDNA copy number, p < .001. There was significant positive correlation with SALT score (p = 0.001). A cutoff value of >1.619 N/µL could significantly diagnose AA cases (p < .001), and a cutoff value of > 1.36 N/µL could discriminate mild AA cases from those with moderate AA (p = 0.007). The relative index of mtDNA copy number is significantly elevated in AA cases and could be helpful in diagnosing and evaluating AA severity.
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Affiliation(s)
- Wafaa Ahmed Shehata
- Dermatology, Andrology & STDs Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mostafa Ahmed Hammam
- Dermatology, Andrology & STDs Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Aya Abdo
- General Practitioner in Health Sector, Shebin El-Kom, Menoufia, Egypt
| | - Nermin Tayel
- Department of Molecular Diagnostics & Therapeutics, Genetic Engineering and Biotechnology Research Institute, Sadat City University, Sadat, Egypt
| | - Shimaa Abdelsattar
- Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Menoufia, Egypt
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Zagami M, Klepper E, Wienecke E, Andrzejewski M, Sikder A, Ahmed A, Robinson H. A review of psychocutaneous disorders from a psychotherapeutic perspective—Toolkit for the dermatologist. SKIN HEALTH AND DISEASE 2023. [PMID: 37538328 PMCID: PMC10395638 DOI: 10.1002/ski2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. Aim The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. Methods We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. Results The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Conclusions Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.
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Affiliation(s)
- Mary Zagami
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Edward Klepper
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Eric Wienecke
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | | | - Ahmed Sikder
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Ali Ahmed
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Howard Robinson
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
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Gao W, Mostaghimi A, Gandhi K, Done N, Ray M, Signorovitch J, Swallow E, Carley C, Wang T, Sikirica V. Patient characteristics associated with all-cause healthcare costs of alopecia areata in the United States. J Med Econ 2023; 26:441-444. [PMID: 36896625 DOI: 10.1080/13696998.2023.2188843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Wei Gao
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | | | - Kavita Gandhi
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
| | - Nicolae Done
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Markqayne Ray
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
| | - James Signorovitch
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Elyse Swallow
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Christopher Carley
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Travis Wang
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Vanja Sikirica
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
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Kamil ZA, Abdullah GA, Zalzala HH. Interleukin-15 and Tumor Necrosis Factor- α in Iraqi Patients with Alopecia Areata. Dermatol Res Pract 2023; 2023:5109772. [PMID: 37206670 PMCID: PMC10191747 DOI: 10.1155/2023/5109772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Background Alopecia areata (AA) is a common form of noncicatricial hair loss of unknown cause, affecting 0.1-0.2% of the general population. Most evidence supports the hypothesis that it is disease of the hair follicle of autoimmune nature mediated by T-cells, with important cytokine role. Objective of the Study. The objective of this study is to study the association and changes in serum levels of interleukin-15 (IL-15) and tumor necrosis factor-α (TNF-α) in patients with AA in relation to the type, activity, and disease duration. Patients and Methods. Thirty-eight patients with AA and 22 individuals without the disease as controls were enrolled in this case-controlled study conducted in the Department of Dermatology in the Al-Kindy Teaching Hospital and Baghdad Medical City, Iraq, during a period from the 1st of April 2021 to the 1st of December 2021. Serum concentrations of IL-15 and TNF-α assessed using the enzyme-linked immunosorbent assay. Results The mean serum concentration values for IL-15 and TNF-α were higher significantly in patients with AA than in controls (2.35 versus 0.35 pg/mL and 50.11 versus 20.92 pg/mL, respectively). IL-15 and TNF-α showed no statistically significant differences in level in terms of the type, duration, and activity of the disease, but TNF-α significantly higher in those with totalis-type than in other types. Conclusion Both IL-15 and TNF-α are markers for alopecia areata. The level for these biomarkers was not affected by duration or disease activity, but it was affected by the type of disease, as the concentrations of IL-15 and TNF-α were higher in patient with Alopecia totalis than in other types of Alopecia.
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Affiliation(s)
| | - Galawish A. Abdullah
- Department of Medicine, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Haider Hashim Zalzala
- Head of Microbiology Department, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
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Nouh AH, Abdelaal AM, Fathy AES. Activated Platelet Rich Plasma versus Non-Activated Platelet Rich Plasma in the Treatment of Alopecia Areata. Skin Appendage Disord 2023; 9:42-49. [PMID: 36643192 PMCID: PMC9833001 DOI: 10.1159/000526765] [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: 05/07/2022] [Accepted: 08/21/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Alopecia areata is a common recurrent T cell-mediated autoimmune-induced non-scarring hair loss with not fully understood pathogenesis. It affects nearly 2% of the general population during lifetime. The course of the disease is unpredictable, and currently no treatment is available for complete cure or prevention. Platelet rich plasma (PRP) is an autologous blood-derived product, which has widely spread in the last decades for treatment of different dermatological conditions including hair disorders. Methods The aim of this work was to evaluate the efficacy and safety of activated PRP in comparison to non-activated PRP in the treatment of alopecia areata. This study was conducted on two groups of 20 subjects each who received 4 treatments of intradermal injection of activated and non-activated PRP. Results and Conclusion Data obtained in our research confirm that PRP is safe, effective, and well tolerated by patients as a treatment modality for alopecia areata. Besides, such a method is cost-effective as there is no need for any expensive tools for preparation and it can be done in outpatient clinics. Also, activation of PRP prior to injection is not mandatory as there was no statistically significant difference between both groups.
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Affiliation(s)
- Ahmed Hassan Nouh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine of Al-Azhar University, Cairo, Egypt
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Aranishi T, Ito T, Fukuyama M, Isaka Y, Mackie DS, King-Concialdi K, Senglaub SS, Jaffe DH, Shimomura Y, Ohyama M. Prevalence of alopecia areata in Japan: Estimates from a nationally representative sample. J Dermatol 2023; 50:26-36. [PMID: 36412271 PMCID: PMC10100223 DOI: 10.1111/1346-8138.16606] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/23/2022]
Abstract
Data on the prevalence of alopecia areata (AA) in Japan is limited and the epidemiology of the disease there is not well understood; therefore, it is critical to examine the prevalence and severity of AA in Japan to inform the need for future treatments and research. A cross-sectional, web-based survey was conducted in Japan from January through March 2021. A total of 45 006 participants were identified through general population survey panels and asked about their experience with AA and hair loss. The Alopecia Assessment Tool and the Scalp Hair Assessment PROTM were adopted to screen for history of AA and assess disease severity, respectively. Eligible participants submitted photos of their scalp, which were reviewed by three board-certified dermatologists to evaluate the presence and severity of AA. Prevalence and severity estimates were calculated using participants' self-reported data and verified through the dermatologists' assessments. The participant-reported point prevalence of AA was 2.18%. The adjusted point prevalence following physician adjudication using participant-submitted photos was 1.45%. Topical corticosteroids were the most commonly used treatments, with 34.6% of participants diagnosed with AA reported having ever used them. Participants also reported negative impacts on their mood (70.2%), self-esteem (55.8%), and social interactions (48.9%). Despite the social and emotional impact of hair loss, more than one third of those reporting a physician diagnosis of AA were not currently seeking treatment. The current study identified an estimated prevalence of AA in Japan between 1.45% and 2.18% based on the survey results and physician-adjudication of those findings. Considering the impactful psychological burden of AA, the survey results showing that 38.90% of surveyed patients do not currently seek treatment may indicate an unmet need for remedies.
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Affiliation(s)
- Toshihiko Aranishi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshitaka Isaka
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | | | | | | | | | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata. Dermatol Ther (Heidelb) 2022; 13:285-298. [PMID: 36484916 PMCID: PMC9823171 DOI: 10.1007/s13555-022-00864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patients with alopecia areata (AA) experience psychological and psychosocial symptoms including depression, anxiety, anger, social withdrawal, embarrassment, and low self-esteem. While multiple studies have measured the detrimental emotional impact of AA on patient quality of life, evidence of its effect on work productivity loss (WPL) and daily activities is limited. This study aimed to assess the extent of AA-related emotional symptom (ES) burden on work productivity and activity impairment. METHODS A cross-sectional survey of dermatologists and their adult patients with AA was conducted in the USA in 2019. Dermatologists provided assessments of patients' clinical characteristics, while patients completed sociodemographic questionnaires along with two validated patient-reported outcome measures of the Work Productivity and Activity Impairment (WPAI) and the AA Patient Priority Outcomes (AAPPO) ES subscale. The WPAI assessed AA-related WPL (employed respondents) and activity impairment (all respondents), and the AAPPO-ES assessed AA-related frequency of feeling self-conscious, embarrassed, sad, or frustrated. Multiple linear regression models were fitted to both WPAI scores with the AAPPO ES as an independent variable. RESULTS A total of 242 patients with a mean (SD) age of 39.2 (13.3) years, treated by 59 dermatologists, were evaluated. Mean (SD) ES score was 2.0 (1.1). Mean (SD) work productivity loss [n = 170] and activity impairment [n = 242] were 12.2% (17.4%) and 13.3% (18.3%), respectively. After adjusting for covariates, WPL increased by 4.1% [95% confidence interval (CI) 1.6-6.7%; p = 0.002] and activity impairment increased by 3.1% (95% CI 0.7-5.4%; p = 0.010) for every 1-point increase in ES. For an average patient, a 1-SD decrease (about 1 point) on the ES scale substantially reduced WPL and activity impairment (by at least 25%). CONCLUSIONS Patients with AA reported significant increases in WPL and activity impairment associated with worsening AA-related ES. These findings underscore the substantial emotional and psychosocial burden among patients with AA and a need for improved treatment options.
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Behrangi E, Barough MS, Khoramdad M, Hejazi P, Koltapeh MP, Goodarzi A. Efficacy and safety of tofacitinib for treatment of alopecia areata in children: A systematic review and meta-analysis. J Cosmet Dermatol 2022; 21:6644-6652. [PMID: 36177815 DOI: 10.1111/jocd.15425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/29/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Tofacitinib, a potent JAK inhibitor, has gained increasing interest, in recent years, among dermatologists for the management of refractory alopecia areata. Despite a growing number of studies on its safety and efficacy, there is still a lack of clarity, especially in the pediatric population, in treatment considerations such as proper dosage, treatment duration, side-effect profile, and therapeutic strategies to guide clinicians. METHODS Multiple databases were systematically searched. Following the PRISMA diagram, of a pool of 601 papers, seven met a checklist of inclusion criteria. These were observational studies including a total of 59 patients from four to 19 years of age. RESULTS In the evaluated studies, tofacitinib was administered either orally at a 2.5 to 15 mg daily (mostly 5 mg twice a day) dosage for 2 to 38 months or in the form of a 2% topical solution for 3-17 months. Metanalysis showed that 49% (95% CI: 29%-69%, I2 = 59.94%) of patients experienced a reversal of alopecia after a minimum of 3 to 9 months of therapy. Fifty-five percent (95% CI: 23%-86%, I2 = 75.07%) and 41% (95% CI: 23%-59%, I2 = 0.00%) showed Good/complete and partial response rates, respectively. Oral administration was significantly more efficacious than topical application (73% vs 23%, p-Value = 0.04). Few side effects such as diarrhea and mild liver transaminases abnormalities were noted in several patients. CONCLUSION Results of this review suggest that tofacitinib at 2.5-15 mg daily (especially 5 mg twice daily) oral formulation or 2% topical solution can be regarded as a viable alternative or adjunct to the conventional treatment options for moderate to severe forms of alopecia areata in children owing to its acceptable efficacy and side-effect profile. However, uncertainties continue to exist around treatment strategies including initial and maintenance dosages, route of administration, dose adjustments, the timing of tapering or discontinuation, and associated treatment modalities.
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Affiliation(s)
- Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Malihe Khoramdad
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Pourghahramani Koltapeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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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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Zhu B, Zhang L, Wang J, Tan G. Vitamin D supplementation for patients with alopecia areata: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31089. [PMID: 36281137 PMCID: PMC10662846 DOI: 10.1097/md.0000000000031089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have reported an association between low Vitamin D (VD) levels and Alopecia areata (AA), and suggested VD preparations as a potential therapy. VD has immunomodulatory function closely associated with a variety of skin diseases, but there is no conclusive evidence to support VD supplementation for patients with AA. Therefore, we will conduct a meta-analysis to collect and evaluate the efficacy and safety of VD supplementation in the treatment of AA. METHODS We will search the following databases according to the developed strategy: Cochrane Library, PubMed, Web of Science, EMBASE, Scopus, Google scholar for Randomized controlled trials related to VD supplementation for AA. The retrieval time is from the establishment of each database to July 2022. Two reviewers will independently complete the literature search and screening, risk of bias assessment and data extraction. Severity of Alopecia Tool, Alopecia Density and Extent, Lesional area and senstivity (score) will be the primary results. RevMan V.5.3 will be used for data analysis and synthesis. For dichotomous outcomes and the continuous outcomes, we will calculate risk ratio with 95% Confidence intervals and mean differences or standardized mean differences with 95% Confidence intervals respectively. The reporting bias will be investigated using funnel plots, and the asymmetry of the funnel plots will be explained using the Harbord modified test or the Egger's regression test. RESULTS The results of the study expect to provide a high-quality, evidence-based recommendation on VD supplementation in the treatment of AA for clinicians. CONCLUSIONS The study will provide scientific and useful evidence for better use of VD supplementation in treating AA.
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Affiliation(s)
- Baohua Zhu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Lan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Jun Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Guiyuan Tan
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
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Shi Y, Zhao J, Li H, Yu M, Zhang W, Qin D, Qiu K, Chen X, Kong M. A Drug-Free, Hair Follicle Cycling Regulatable, Separable, Antibacterial Microneedle Patch for Hair Regeneration Therapy. Adv Healthc Mater 2022; 11:e2200908. [PMID: 35817085 DOI: 10.1002/adhm.202200908] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/02/2022] [Indexed: 01/27/2023]
Abstract
The development of painless hair loss therapy without side-effect is challenging. The dermal papilla is the signal center of hair follicles and plays a key role in the regulation of their cycling. Activation of dermal papilla cells (DPCs) would promote hair regeneration. In this study, a separable microneedle patch comprised of chitosan lactate (CL) and exosomes (EXO) from adipose-derived stem cells is fabricated. After insertion of the microneedle into the skin, the hyaluronic acid substrate dissolves fast and the swellable polyvinyl alcohol needles are retained. The EXO sustainedly released from needles can be endocytosed by DPCs and promote cell proliferation via the activation of the Wnt signaling pathway, while the L-lactate released by CL can promote cell growth by activating lactate dehydrogenase. CL and EXO synergetically facilitate hair regeneration through regulating hair follicle cycling. In animal tests, compared with topical administration of minoxidil, the drug-free microneedle patches can more significantly promote hair regeneration within 7 days with lower dosing frequency. Furthermore, the inherent antibacterial properties of CL make it possible to avoid potential infection. Such transdermally administrated drug-free microneedle patches provide a simple, safe, and efficient strategy for hair loss treatment and exhibit great potential in clinical application.
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Affiliation(s)
- Yan Shi
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Jiaxuan Zhao
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Hu Li
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Miao Yu
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Wenxue Zhang
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Di Qin
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Kaijin Qiu
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
| | - Xiguang Chen
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China.,Qingdao National Laboratory for Marine Science and Technology, 168 Wenhai Middle Road, Qingdao, 266237, P. R. China
| | - Ming Kong
- College of Marine Life Science, Ocean University of China, 5 Yushan Road, Qingdao, 266003, P. R. China
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Alghamdi MA, AL-Eitan LN, Aljamal HA, Shati AA, Alshehri MA. Genetic association of IL2RA, IL17RA, IL23R, and IL31RA single nucleotide polymorphisms with alopecia areata. Saudi J Biol Sci 2022; 29:103460. [PMID: 36248775 PMCID: PMC9562353 DOI: 10.1016/j.sjbs.2022.103460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
The signalling of cytokine receptors plays a crucial role in regulating tolerance and immunity. Impaired immunological processes result in autoimmune inflammation that target the hair follicles, causing many hair disorders, mainly alopecia areata (AA). Therefore, polymorphisms in cytokine receptor genes are suggested to have a significant impact on the pathogenesis of AA, a disease with a multifactorial basis and uncertain etiology. In the present study, 152 AA patients of the Jordanian population were investigated for their genetic susceptibility to develop AA compared to 150 control subjects. Genomic DNA extraction and genotyping had conducted for IL17RA (rs879575, rs2229151, and rs4819554), IL2RA (rs3118470), IL23R (rs10889677), and IL31RA (rs161704) using the Sequenom MassARRAY® system. The allele frequency of IL17RA rs879575 is significantly higher in patients, while no statistical differences were found for IL2RA, IL23R, and IL31RA SNPs. Also, the recessive model of IL31RA rs161704 showing that AA genotype is significantly associated with AA development. To date, there is no published data regarding the association between AA and the selected genetic variants in our population. However, this study's findings assert that SNPs of IL17RA and IL31RA are linked to AA susceptibility in Jordanian patients.
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Affiliation(s)
- Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
- Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Laith N. AL-Eitan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
- Corresponding author at: Biotechnology & Genetic Engineering Department, Faculty of Science and Arts, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Hanan A. Aljamal
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mohammed A. Alshehri
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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L'Ecuyer A, Ronsley R, Lam J, Dix DB. Complete resolution of alopecia totalis following chemotherapy for B-cell acute lymphoblastic leukemia. Pediatr Dermatol 2022; 39:655-656. [PMID: 35297096 DOI: 10.1111/pde.14977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alopecia totalis (AT) is a cosmetically debilitating chronic disease characterized by non-scarring hair loss of the entire scalp. The clinical course of AT is highly unpredictable, and effective durable treatment options are limited. The resolution of alopecia has been reported post-autologous and allogeneic hematopoietic stem cell transplantation; however, no cases of AT remission following chemotherapy alone have been described. Herein, we present a case of complete remission of AT following chemotherapy for B-cell acute lymphoblastic leukemia in a pediatric patient.
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Affiliation(s)
- Ariane L'Ecuyer
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Ronsley
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Lam
- Division of Pediatric Dermatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - David B Dix
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Wang L, Lv S, Lin W, Yang D. Autologous Concentrated Growth Factor Used to Treat Linear Scleroderma En Coup de Sabre: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:675-679. [PMID: 35444437 PMCID: PMC9015785 DOI: 10.2147/ccid.s356972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
Abstract
Linear scleroderma en coup de sabre (LSCS) is a variant of localized scleroderma associated with band-like fibrotic lesions in the frontoparietal area. We report a case of LSCS in a woman who presented with progressive mild hyperchromia on the right side of her forehead, with dermal atrophy and hair and eyebrow loss. After the failure of conservative treatments, the patient responded dramatically to injection of autologous localized concentrated growth factor. After three treatments, the atrophy, stiffness, and angiotelectasis on the affected area had improved. No recurrence was detected 24 months after the last treatment. This is the first study describing the use of autologous concentrated growth factor injection to alleviate clinical symptoms of LSCS. This suggests that concentrated growth factor may be a treatment for LSCS in the clinic.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Shuying Lv
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China.,School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Wenjun Lin
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China.,School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Dingquan Yang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, People's Republic of China
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Pelechas E, Voulgari PV, Drosos AA. TNFα inhibitor biosimilars associated with alopecia areata. Case-based review. Rheumatol Int 2022; 42:1113-1117. [DOI: 10.1007/s00296-022-05129-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
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50
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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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