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JAMA Dermatology Nov 2023Alopecia areata (AA) is characterized by hair loss ranging from patches of hair loss to more extensive forms, including alopecia totalis (AT) and alopecia universalis...
IMPORTANCE
Alopecia areata (AA) is characterized by hair loss ranging from patches of hair loss to more extensive forms, including alopecia totalis (AT) and alopecia universalis (AU). There is a lack of consensus for treatment. Understanding current practice patterns could help the identification of treatment needs and development of standards of care.
OBJECTIVE
To review treatment patterns for adults with AA in the US between 2015 and 2020.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study used medicine and pharmacy claims for commercially insured individuals from the IBM MarketScan Research Database to assess adults (≥18 years) newly treated for AA between October 15, 2015, and February 28, 2020. Alopecia areata was identified based on having at least 1 diagnosis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L63.x. Patients were required to have at least 365 days of continuous health plan enrollment before and after the cohort entry date. Patients were required to be free of AA diagnosis codes 365 days before the cohort entry date. Statistical analyses were conducted between 2019 and 2023.
MAIN OUTCOMES AND MEASURES
Main outcomes were treatment patterns for all patients with AA and subgroups of (1) patients with AT or AU and (2) those cared for by a dermatologist on the cohort entry date. Longitudinal therapy course during the first year after the diagnosis was also examined.
RESULTS
The study cohort consisted of 45 483 individuals (mean [SD] age, 43.8 [14.2] years; 29 903 [65.7%] female). During the year of follow-up, 30 217 patients (66.4%) received at least 1 AA treatment. The most common treatments were intralesional (19 014 [41.8%]), topical (18 604 [40.9%]), intramuscular (17 328 [38.1%]), and oral (9378 [20.6%]) corticosteroids. Compared with patients without AT or AU, patients with AT or AU a lower frequency of intralesional steroid (359 [11.1%] vs 18 655 [44.1%], P < .001) and higher frequency of topical corticosteroid (817 [25.4%] vs 17 787 [42.1%], P < .001) use. Almost half of patients (21 489 [47.2%]) received no treatment on the day of diagnosis. By 12 months, 32 659 (71.8%) were not receiving any treatment, making no treatment the largest study group.
CONCLUSIONS AND RELEVANCE
In this large cohort study of commercially insured individuals, corticosteroids were the most commonly used treatment for adults with AA between 2015 and 2020. At 365 days after diagnosis, more than two-thirds of patients were no longer receiving any AA treatment. Further studies are needed to understand the reasons for the absence of treatment.
Topics: Adult; Humans; Female; Male; Alopecia Areata; Retrospective Studies; Cohort Studies; Alopecia; Adrenal Cortex Hormones
PubMed: 37728940
DOI: 10.1001/jamadermatol.2023.3109 -
The Journal of Dermatology Nov 2017Alopecia areata is a chronic, recurrent and non-scarring alopecia. The prognoses of patients are very diverse. The larger the area of hair loss, the poorer the treatment... (Review)
Review
Alopecia areata is a chronic, recurrent and non-scarring alopecia. The prognoses of patients are very diverse. The larger the area of hair loss, the poorer the treatment response and greater the probability of chronic disease progression. Numerous treatments have been introduced, but curative treatments have yet to be established. The long-term efficacy of the current treatments is minimal, and the therapeutic response varies widely. Recent clinical trials have attempted to apply therapeutic metrics, such as the Severity of Alopecia Tool, and many have been designed as randomized controlled studies, enabling a more precise evaluation of existing treatments. There have been updates in practice, efficacy or indications of therapeutics that have been previously used. Moreover, the use of novel treatments such as biologics has recently been introduced. Commonly, the most important factor in determining the treatment modality for alopecia areata has been the extent of hair loss. However, if the disease activity is high and likely to progress, combination therapy with adjuvant modalities will be more desirable. This review will discuss the therapeutic effects of existing and newly-introduced treatments based on their quantity, quality of evidence and expected complications. In addition, an algorithmic approach to management of alopecia areata is proposed according to clinical subtype, severity, onset and activity of the disease.
Topics: Algorithms; Alopecia Areata; Humans
PubMed: 28635045
DOI: 10.1111/1346-8138.13933 -
JAMA Dermatology Feb 2024
Topics: Humans; Alopecia Areata; COVID-19; Risk Factors
PubMed: 38198177
DOI: 10.1001/jamadermatol.2023.5559 -
Psychiatria Polska 2015The problems of mental disorders and psychological aspects in the condition referred to as alopecia areata in the Polish context are not well researched yet. The... (Review)
Review
The problems of mental disorders and psychological aspects in the condition referred to as alopecia areata in the Polish context are not well researched yet. The objective of our analyses is to present the results of the review of literature devoted to the occurrence of mental disorders and the participation of psychological factors in the aetiology of alopecia areata. Preparing the review of the research conducted hitherto and concerning the participation of psychological factors in the pathogenesis and the course of alopecia areata, it is indicated that stress, a traumatic situation, a high level of neuroticism and alexithymia, may influence the occurrence, duration and exacerbation of the condition in question. Mental disorders occurring most frequently amongst individuals suffering from alopecia areata are: depression, increased level of anxiety, generalized anxiety disorder, social phobia, post-traumatic stress disorder, and suicidal thoughts.
Topics: Alopecia Areata; Anxiety Disorders; Comorbidity; Depression; Humans; Mental Disorders; Phobic Disorders; Risk Factors
PubMed: 26688846
DOI: 10.12740/PP/39064 -
Paediatric Drugs May 2024Alopecia areata (AA) lifetime incidence is around 2%, with many patients first experiencing symptoms during childhood. However, ritlecitinib is the only FDA-approved... (Review)
Review
Alopecia areata (AA) lifetime incidence is around 2%, with many patients first experiencing symptoms during childhood. However, ritlecitinib is the only FDA-approved treatment for pediatric patients 12 years and older. This review outlines reported topical, injectable, and oral treatment options for pediatric patients with AA. Clinical studies were obtained via a PubMed search using the following search terms: alopecia areata, areata, universalis, or totalis and medication, therapy, treatment, drug, or management. Only studies with pediatric patients were included in this review. Commonly used therapies, including corticosteroids, methotrexate, and minoxidil, newer promising medications, such as Janus kinase inhibitors, and less frequently used topical and systemic treatments are included. A summary of the drug development pipeline and ongoing interventional clinical trials with pediatric patients is provided. Treatments demonstrate variable efficacy, and many patients require combination therapy for maximal response. More robust clinical data is needed for many of the medications reviewed in order to provide better care for these patients.
Topics: Humans; Alopecia Areata; Child; Adolescent; Minoxidil; Adrenal Cortex Hormones; Janus Kinase Inhibitors
PubMed: 38466519
DOI: 10.1007/s40272-024-00620-2 -
International Journal of Molecular... May 2024Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss.... (Review)
Review
Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient's quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.
Topics: Alopecia Areata; Humans; Animals; Hair Follicle
PubMed: 38891839
DOI: 10.3390/ijms25115652 -
Journal of Cosmetic Dermatology Nov 2022There may be an association between increased intestinal permeability and the progression of alopecia areata (AA).
BACKGROUND
There may be an association between increased intestinal permeability and the progression of alopecia areata (AA).
OBJECTIVE
The present study aimed to investigate the role of intestinal permeability in the etiopathogenesis of AA and its association with the severity of the disease.
METHODS
Serum zonulin levels of 70 patients with AA who were not receiving any systemic treatment and of 70 healthy control subjects were measured.
RESULTS
The median serum zonulin level in the patient group (46.38 ng/mL) did not differ significantly from that in the control group (50.34 ng/mL) (p = 0.828). Moreover, there was no significant relationship between serum zonulin levels and the severity of the disease (p = 0.549).
LIMITATIONS
The present study had a cross-sectional design, and it did not include patients with alopecia totalis (AT) or alopecia universalis (AU).
CONCLUSION
We did not observe an increase in intestinal permeability secondary to zonulin expression in patients with AA. However, in order to generalize this result to all patients with AA, serum zonulin levels need to be evaluated in studies including more patients with severe disease, AT, and AU.
Topics: Humans; Alopecia Areata; Cross-Sectional Studies; Permeability
PubMed: 35579378
DOI: 10.1111/jocd.15095 -
Journal of the American Academy of... Jan 2024
Topics: Humans; Alopecia Areata
PubMed: 37207950
DOI: 10.1016/j.jaad.2023.05.022 -
Canadian Family Physician Medecin de... Sep 2015To provide family physicians with a background understanding of the therapeutic regimens and treatment outcomes for alopecia areata (AA), as well as to help identify... (Review)
Review
OBJECTIVE
To provide family physicians with a background understanding of the therapeutic regimens and treatment outcomes for alopecia areata (AA), as well as to help identify those patients for whom dermatologist referral might be required.
SOURCES OF INFORMATION
PubMed was searched for relevant articles regarding the treatment of AA.
MAIN MESSAGE
Alopecia areata is a form of autoimmune hair loss affecting both children and adults. While there is no associated mortality with the disease, morbidity from the psychological effects of hair loss can be devastating. Upon identification of AA and the disease subtype, an appropriate therapeutic regimen can be instituted to help halt hair loss or possibly initiate hair regrowth. First-line treatment involves intralesional triamcinolone with topical steroids or minoxidil or both. Primary care physicians can safely prescribe and institute these treatments. More advanced or refractory cases might require oral immunosuppressants, topical diphenylcyclopropenone, or topical anthralin. Eyelash loss can be treated with prostaglandin analogues. Those with extensive loss might choose camouflaging options or a hair prosthesis. It is important to monitor for psychiatric disorders owing to the profound psychological effects of hair loss.
CONCLUSION
Family physicians will encounter many patients experiencing hair loss. Recognition of AA and an understanding of the underlying disease process will allow an appropriate therapeutic regimen to be instituted. More advanced or refractory cases need to be identified, allowing for an appropriate dermatologist referral when necessary.
Topics: Adult; Alopecia Areata; Anthralin; Child; Cyclopropanes; Dermatologic Agents; Humans; Immunosuppressive Agents; Primary Health Care; Referral and Consultation; Steroids
PubMed: 26371098
DOI: No ID Found -
JPMA. the Journal of the Pakistan... May 2023
Topics: Humans; Alopecia Areata; Azetidines; Sulfonamides
PubMed: 37218276
DOI: 10.47391/JPMA.7687