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Clinical Reviews in Allergy & Immunology Dec 2021Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact... (Review)
Review
Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.
Topics: Alopecia Areata; Humans
PubMed: 34403083
DOI: 10.1007/s12016-021-08883-0 -
Current Pediatric Reviews 2021Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. (Review)
Review
BACKGROUND
Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology.
OBJECTIVE
To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata.
METHODS
The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles.
RESULTS
AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss, generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show "exclamation point hairs" and "yellow dots". Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA, including conservative treatment, and topical, oral, and injectable medications.
CONCLUSION
AA is an autoimmune disease with a heterogeneous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.
Topics: Alopecia Areata; Autoimmune Diseases; Child; Combined Modality Therapy; Humans
PubMed: 32351186
DOI: 10.2174/1573396316666200430084825 -
Journal of Autoimmunity Mar 2019Alopecia areata is an autoimmune disease that results in non-scarring hair loss, and it is clinically characterised by small patches of baldness on the scalp and/or... (Review)
Review
Alopecia areata is an autoimmune disease that results in non-scarring hair loss, and it is clinically characterised by small patches of baldness on the scalp and/or around the body. It can later progress to total loss of scalp hair (Alopecia totalis) and/or total loss of all body hair (Alopecia universalis). The rapid rate of hair loss and disfiguration caused by the condition causes anxiety on patients and increases the risks of developing psychological and psychiatric complications. Hair loss in alopecia areata is caused by lymphocytic infiltrations around the hair follicles and IFN-γ. IgG antibodies against the hair follicle cells are also found in alopecia areata sufferers. In addition, the disease coexists with other autoimmune disorders and can come secondary to infections or inflammation. However, despite the growing knowledge about alopecia areata, the aetiology and pathophysiology of disease are not well defined. In this review we discuss various genetic and environmental factors that cause autoimmunity and describe the immune mechanisms that lead to hair loss in alopecia areata patients.
Topics: Adrenal Cortex Hormones; Alopecia; Alopecia Areata; Animals; Autoimmunity; Cell Movement; Gene-Environment Interaction; Hair Follicle; Humans; Immunoglobulin G; Insect Proteins; Lectins, C-Type; Lymphocyte Activation; Lymphocytes; Mice; Scalp
PubMed: 30558963
DOI: 10.1016/j.jaut.2018.12.001 -
Clinical and Experimental Medicine May 2021Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact... (Review)
Review
Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Dendritic Cells; Humans; Immunotherapy; Janus Kinase Inhibitors; Minoxidil; PUVA Therapy; Platelet-Rich Plasma; Prognosis; STAT Transcription Factors
PubMed: 33386567
DOI: 10.1007/s10238-020-00673-w -
Journal of the European Academy of... Apr 2024Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete... (Review)
Review
Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA-approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA-approved for patients with severe alopecia areata. Other systemic medications used off-label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.
Topics: Adult; Adolescent; Child; Humans; Alopecia Areata; Quality of Life; Alopecia; Minoxidil; Azathioprine; Janus Kinase Inhibitors
PubMed: 38169088
DOI: 10.1111/jdv.19768 -
Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis.Journal of the American Academy of... Jan 2018Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from... (Review)
Review
Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result-at least in part-from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.
Topics: Adult; Age Factors; Age of Onset; Alopecia Areata; CD4-Positive T-Lymphocytes; Education, Medical, Continuing; Female; Genetic Predisposition to Disease; Hair Follicle; Humans; Incidence; Male; Prognosis; Quality of Life; Severity of Illness Index; Sex Factors
PubMed: 29241771
DOI: 10.1016/j.jaad.2017.04.1141 -
Journal of the American Academy of... Aug 2023Janus kinase (JAK) inhibitors have ushered in a new era in alopecia areata (AA). Historically, moderate-to-severe AA was refractory to treatment. JAK inhibitors have... (Review)
Review
Janus kinase (JAK) inhibitors have ushered in a new era in alopecia areata (AA). Historically, moderate-to-severe AA was refractory to treatment. JAK inhibitors have changed that; now, treatment of moderate-to-severe AA is possible. Here, we briefly review the history of and rationale for JAK inhibitor treatment of AA, phase 3 clinical trial data, and considerations regarding differences among JAK inhibitors, safety, and patient selection.
Topics: Humans; Alopecia Areata; Janus Kinase Inhibitors; Patient Selection; Clinical Trials, Phase III as Topic
PubMed: 37591562
DOI: 10.1016/j.jaad.2023.05.049 -
Journal of Dermatological Science Dec 2023Alopecia areata (AA) is a common, acquired, and nonscarring type of hair loss that affects people of every generation and is intractable in severe and relapsing cases.... (Review)
Review
BACKGROUND
Alopecia areata (AA) is a common, acquired, and nonscarring type of hair loss that affects people of every generation and is intractable in severe and relapsing cases. Patients with AA, especially those with greater scalp involvement, have poor health-related quality-of-life scores.
PURPOSE
Following our previous review article in the April 2017 issue of the Journal of Dermatological Science, we aim to provide a pair of review articles on recent progress in multidisciplinary approaches to AA.
MAIN FINDINGS
We found more than 1800 publications on AA from July 2016 to December 2022.
CONCLUSIONS
In this review, we focused on the latest information on the epidemiology, comorbidities, and pathogenesis of AA.
Topics: Humans; Alopecia Areata; Alopecia; Comorbidity; Quality of Life; Recurrence
PubMed: 37833164
DOI: 10.1016/j.jdermsci.2023.09.008 -
Journal of the American Academy of... Mar 2020Alopecia areata (AA) is a common autoimmune alopecia with heterogeneous severity and distribution. Previous studies found conflicting results about AA epidemiology. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alopecia areata (AA) is a common autoimmune alopecia with heterogeneous severity and distribution. Previous studies found conflicting results about AA epidemiology.
OBJECTIVE
To determine the prevalence, incidence, and predictors of AA, alopecia totalis, alopecia ophiasis, and alopecia universalis.
METHODS
A systematic review of all published cohort and cross-sectional studies that analyzed AA and its subtypes. MEDLINE, Embase, LILACS, Scopus, Cochrane Library, and GREAT were searched. At least 2 reviewers performed study title/abstract review and data extraction. Random-effects meta-analysis was used because of significant heterogeneity (I = 99.97%).
RESULTS
Ninety-four studies met the inclusion criteria. The pooled prevalence (95% confidence interval, N) of AA overall was 2.11% (1.82-2.42, N = 302,157,365), with differences of population-based (0.75% [0.49-1.06%], N = 301,173,403) and clinic-based (3.47% [3.01-3.96], N = 983,962) studies. The prevalences of alopecia totalis, ophiasis, and universalis were 0.08% (0.04-0.13, N = 1,088,149), 0.02% (0.00-0.06, N = 1,075,203), and 0.03% (0.01-0.06, N = 1,085,444), respectively. AA prevalence (95% confidence interval) increased over time (<2000: 1.02% [0.85-1.22]; 2000-2009: 1.76% [1.51-2.03]; >2009: 3.22% [2.59-3.92]; P < .0001) and differed by region. AA prevalence was significantly lower in adults (1.47% [1.18-1.80]) than children (1.92% [1.31-2.65]; P < .0001).
CONCLUSIONS
AA affects 2% of the global population. AA prevalence is lower in adults than children, is increasing over time, and significantly differs by region.
Topics: Alopecia; Alopecia Areata; Humans; Incidence; Prevalence
PubMed: 31437543
DOI: 10.1016/j.jaad.2019.08.032 -
Indian Dermatology Online Journal 2022Alopecia areata is an autoimmune condition which usually presents as non-scarring patchy alopecia. The disease has varied clinical presentations ranging in severity from... (Review)
Review
Alopecia areata is an autoimmune condition which usually presents as non-scarring patchy alopecia. The disease has varied clinical presentations ranging in severity from patchy circumscribed alopecia, reticular pattern, ophiasis, sisaipho, diffuse, or incognito type to alopecia totalis and alopecia universalis. The various available treatment options include topical/intralesional steroids, topical immunotherapy/contact irritants, systemic steroids, and steroid-sparing agents like cyclosporine, azathioprine, methotrexate, and the JAK-STAT inhibitors. This article aims at providing practical tips to the clinicians based on published data and author's clinical experience which can help them in deciding what and when to choose in a given clinical scenario of AA.
PubMed: 36386728
DOI: 10.4103/idoj.idoj_176_22