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Current Research in Immunology 2021Alopecia areata (AA) is an autoimmune disorder resulting in hair loss. It has numerous variants or patterns, including diffuse type, patchy type, AA totalis, AA... (Review)
Review
Alopecia areata (AA) is an autoimmune disorder resulting in hair loss. It has numerous variants or patterns, including diffuse type, patchy type, AA totalis, AA universalis, and more. In this graphical review, we provide an overview of AA immunopathogenesis, highlighting loss of immune privilege in the hair follicle as well as key immune cell types, cytokines and chemokines that drive autoimmune attack of the hair follicle. We also summarize recent literature identifying agents that block these pathways that could serve as new immunomodulatory treatments for AA.
PubMed: 35492401
DOI: 10.1016/j.crimmu.2021.02.001 -
Journal of the American Academy of... Aug 2022Janus kinase (JAK) activation is suggested to have a pathological role in alopecia areata (AA). CTP-543, a deuterated compound that selectively inhibits JAK1 and JAK2,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Janus kinase (JAK) activation is suggested to have a pathological role in alopecia areata (AA). CTP-543, a deuterated compound that selectively inhibits JAK1 and JAK2, is being developed as an oral treatment for AA.
OBJECTIVE
To assess the safety and efficacy of a 24-week regimen of CTP-543 in patients with chronic, moderate-to-severe AA.
METHODS
In this phase 2, randomized, double-blind, placebo-controlled, sequential-design trial, patients were randomized to receive CTP-543 (4 mg, 8 mg, or 12 mg) or placebo every 12 hours for 24 weeks.
RESULTS
A dose-related increase was observed in the percentage of patients with ≥50% relative reduction in Severity of Alopecia Tool scores from baseline at week 24 (9% placebo, 21% 4 mg twice daily, 47% 8 mg twice daily, and 58% 12 mg twice daily), with statistical significance versus placebo (P < .001) observed for the 8-mg twice daily and 12-mg twice daily groups, with differences from placebo noted as early as 12 weeks after the initiation of treatment. Safety results were consistent with the known safety profiles of JAK inhibitors.
LIMITATIONS
These initial findings are from a relatively small controlled trial, and additional studies are needed to fully characterize the safety and efficacy of CTP-543 in adult patients with AA.
CONCLUSIONS
Patients treated with CTP-543 (8 or 12 mg, twice daily) had a significant reduction in the severity of AA.
Topics: Adult; Alopecia Areata; Cytidine Triphosphate; Humans; Janus Kinase Inhibitors; Pyrimidines; Treatment Outcome
PubMed: 35364216
DOI: 10.1016/j.jaad.2022.03.045 -
Genes Jun 2023Alopecia 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... (Review)
Review
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 , , and , 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.
Topics: Humans; Alopecia Areata; Genetic Predisposition to Disease; Alleles; Protein Tyrosine Phosphatase, Non-Receptor Type 22
PubMed: 37510267
DOI: 10.3390/genes14071362 -
Journal of the American Academy of... Oct 2023Data on the association between the development of autoimmune diseases and COVID-19 vaccination are limited.
BACKGROUND
Data on the association between the development of autoimmune diseases and COVID-19 vaccination are limited.
OBJECTIVE
To investigate the incidence and risk of autoimmune connective tissue disorders following mRNA-based COVID-19 vaccination.
METHODS
This nationwide population-based study was conducted in South Korea. Individuals who received vaccination between September 8, 2020-December 31, 2021, were identified. Historical prepandemic controls were matched for age and sex in 1:1 ratio. The incidence rate and risk of disease outcomes were compared.
RESULTS
A total of 3,838,120 vaccinated individuals and 3,834,804 controls without evidence of COVID-19 were included. The risk of alopecia areata, alopecia totalis, primary cicatricial alopecia, psoriasis, vitiligo, anti-neutrophil cytoplasmic antibody-associated vasculitis, sarcoidosis, Behcet disease, Crohn disease, ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren syndrome, ankylosing spondylitis, dermato/polymyositis, and bullous pemphigoid was not significantly higher in vaccinated individuals than in controls. The risk was comparable according to age, sex, type of mRNA-based vaccine, and cross-vaccination status.
LIMITATIONS
Possible selection bias and residual confounders.
CONCLUSION
These findings suggest that most autoimmune connective tissue disorders are not associated with a significant increase in risk. However, caution is necessary when interpreting results for rare outcomes due to limited statistical power.
Topics: Humans; COVID-19 Vaccines; COVID-19; Autoimmune Diseases; Connective Tissue Diseases; Alopecia Areata; Vaccination; Connective Tissue
PubMed: 37187424
DOI: 10.1016/j.jaad.2023.05.017 -
Pediatric Dermatology May 2021We present a case of a 13-month-old male patient with alopecia totalis that began two months after an episode of hand-foot-and-mouth disease. It is hypothesized that the...
We present a case of a 13-month-old male patient with alopecia totalis that began two months after an episode of hand-foot-and-mouth disease. It is hypothesized that the viral infection triggered an autoimmune response, which lead to production of lymphocytes targeting an antigen present in the hair bulb. Future research is necessary to determine whether and how the pathophysiology of alopecia totalis may be triggered by viral infection.
Topics: Alopecia; Alopecia Areata; Animals; Foot-and-Mouth Disease; Hair Follicle; Humans; Infant; Male
PubMed: 33650159
DOI: 10.1111/pde.14550 -
Journal of the European Academy of... Apr 2020Alopecia totalis (AT) and universalis (AU) represent the most severe subtypes of alopecia areata with more dramatic features and worse prognosis. The goal of this review... (Review)
Review
Alopecia totalis (AT) and universalis (AU) represent the most severe subtypes of alopecia areata with more dramatic features and worse prognosis. The goal of this review is to identify all studies with long-term prognostic data on patients with AT and AU and provide a long-term outcome estimate. The PubMed database was queried to identify all articles discussing the long-term prognosis of AT and AU. A total of nine articles discussing long-term recovery rates of AT and AU were identified. The articles described 689 (162 = AT, 245 = AU, 282 = not specified) total patients. Six of the nine studies identified complete recovery as a potential end point in a total of 375 (39 = AT, 75 = AU, 261 = not specified) patients. According to these studies 8.5% (32/375) of AT and AU patients achieved complete recovery. A larger proportion of patients will obtain at least transient recovery periods of partial or total hair regrowth. The poor long-term outcomes of AT and AU may cause patients to lose hope with treatment. Response to treatment is often unpredictable, and physicians should be aware of the prognosis and its effects in order to properly counsel patients.
Topics: Alopecia; Hair; Humans; Prognosis
PubMed: 31593606
DOI: 10.1111/jdv.15994 -
Indian Dermatology Online Journal 2021Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new... (Review)
Review
Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new technique in the field of permanent cosmetics for eyebrow restoration. Currently, it is one of the most sort after treatment in aesthetic procedures due to the curiosity and awareness raised by social media. Microblading is a form of superficial micropigmentation, wherein pigment is deposited till the papillary dermis, with the help of a manual device and a blade consisting of stacked needles. The resultant crisp, discrete hair like incisions simulate the eyebrow hair to give a natural look. The results are semi-permanent and last only 12-18 months. In the recent years, with the advancement in the instrumentation of microblading there have been several modifications in this procedure. Microblading has now found its applications not only in cosmetic treatments but also in dermatological conditions such as alopecia totalis, hypothyroidism, chemotherapy induced madarosis etc. It is a vital tool in any dermatology or cosmetic practise for its extensive applications. But with the rise in popularity of microblading, there is also a rise of untrained professionals performing it leading to a rise in its side-effects. This article aims at not only guiding on the instrumentation and procedure of microblading but also its pre and post procedure care, interaction with other aesthetic procedures and treating its complications.
PubMed: 33768017
DOI: 10.4103/idoj.IDOJ_230_20 -
International Journal of Dermatology Aug 2017Alopecia areata (AA) is an autoimmune disease directed at the hair follicle. Although usually limited to patchy hair loss over the scalp (focalis), AA can present as... (Review)
Review
Alopecia areata (AA) is an autoimmune disease directed at the hair follicle. Although usually limited to patchy hair loss over the scalp (focalis), AA can present as total loss of scalp hair (totalis; AT) or as total loss of both scalp and body hair (universalis; AU). Management of AT and AU can be challenging, and although multiple treatment modalities have been explored, no therapy is currently FDA-approved. This review focuses on the evidence for current treatment options for AT and AU. The PubMed database was searched from January 1, 2000, to September 1, 2016, for clinical trials, retrospective studies, and case reports of treatments for AT and AU. A total of 40 studies were retrieved and analyzed. Therapies studied for AT/AU included: topical immunotherapy, steroids, photodynamic therapy, immunosuppressive agents, TNFα inhibitors, and other therapies, such as sulfasalazine, bexarotene, JAK inhibitors, and simvastatin/ezetimibe. Although certain treatments showed significant hair regrowth, no treatment was completely effective. The most promising therapies with the highest quality data include diphenylcyclopropenone, squaric acid dibutylester, photodynamic therapy, steroids, and cyclosporine in combination with methylprednisolone. High-quality randomized-controlled trials with large sample sizes are lacking. Unified outcome guidelines are encouraged to facilitate the comparison of future studies.
Topics: Administration, Cutaneous; Administration, Oral; Alopecia; Glucocorticoids; Humans; Immunologic Factors; Photochemotherapy; Tumor Necrosis Factor-alpha
PubMed: 28378336
DOI: 10.1111/ijd.13612 -
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 -
Acta Dermato-venereologica Aug 2023Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world...
Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world treatment patterns among patients in the USA with alopecia areata, including the subtypes alopecia totalis and alopecia universalis, in the first year after diagnosis of an episode of alopecia areata. Approximately 5% of all patients (adults (age ≥ 18 years), n = 7,703; adolescents (age 12-17 years), n = 595) had alopecia totalis or alopecia universalis. Corticosteroids were the most common first-line (1L) and second-line (2L) treatments. The mean time from diagnosis of alopecia areata to initiation of 1L treatment was 2.2 days for adults and 2.6 days for adolescents; mean 1L duration was 76.9 and 64.3 days, respectively. For adults (57.5%) and adolescents (59.7%) with 2L therapy, the mean time from 1L discontinuation to 2L initiation was 57.2 and 53.6 days, respectively; the mean duration of 2L treatment was 55.5 and 50.1 days, respectively. More patients with vs without alopecia totalis or alopecia universalis initiated 2L therapy (adults: 71.9% vs 56.8%; adolescents: 71.4% vs 58.9%). The proportion of days covered during the first year post-diagnosis was 36.7% (adults) and 34.1% (adolescents). These results highlight the substantial disease burden of alopecia areata and a need for more effective treatments.
Topics: Adolescent; Adult; Humans; United States; Child; Alopecia Areata; Insurance Claim Review; Retrospective Studies
PubMed: 37622204
DOI: 10.2340/actadv.v103.12445