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Postgraduate Medicine Nov 2021Alopecia Areata is an inflammatory and T cell-mediated autoimmune reaction against unknown autoantigen of hair follicles characterized by patchy, non-scarring loss of... (Comparative Study)
Comparative Study
Alopecia Areata is an inflammatory and T cell-mediated autoimmune reaction against unknown autoantigen of hair follicles characterized by patchy, non-scarring loss of hair follicles in the anagen phase. Although its etiology is minimally understood, genetic susceptibility, autoimmunity and stress are thought to be causative factors. It occurs in episodic and recurrent patterns with an incidence rate of 0.1-0.2% in the general population and 7-30 cases per 1000 dermatological patients with a lifetime risk of 1.7%. The lesions can be single and self-limiting or may be widespread. Autoimmune disorders such as Hashimoto's thyroiditis, Vitiligo, celiac disease, diabetes mellitus, psoriasis ad lupus erythematosus were observed as an associated comorbid disorder in AA patients, but hypothyroidism and Vitiligo have the strongest association. Its clinical course is unpredictable and shows no significant predilection to age, gender or race. AA is a heterogeneous variant of alopecia and has clinical types such as patchy alopecia, alopecia reticularis and alopecia totalis. Various epidemiological reports demonstrate an increased frequency of AA in thyroid disease patients. Contemporary research has shed spotlight on circulating auto-reactive cells in evolution of AA, which may play a role in ultimately linking these diseases. Comprehension of complex interplay between autoantigens and immune cells is still evolving. The present study will explore this association of Alopecia Areata in patients with thyroid dysfunction. This correlation was studied briefly with literature available in the medical database such as PubMed and Google Scholar.
Topics: Adult; Aged; Aged, 80 and over; Alopecia Areata; Antibodies; Autoimmunity; Female; Humans; Incidence; Male; Middle Aged; Peroxidase; Recurrence; Sex Factors; Thyroglobulin; Thyroid Diseases
PubMed: 34455910
DOI: 10.1080/00325481.2021.1974689 -
JAMA Dermatology Apr 2023Prevalences of alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) are poorly established.
IMPORTANCE
Prevalences of alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) are poorly established.
OBJECTIVE
To estimate overall and subgroup prevalences of AA and its subtypes.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study using electronic records comprising the Explorys database (Watson Health, IBM Corporation) included children, adolescents, and adults seeking healthcare across the 4 census regions in the US between January 1, 2019, and December 31, 2019. The statistical analysis was conducted between July 21, 2022, and December 22, 2022.
MAIN OUTCOMES AND MEASURES
Prevalent cases of AA, AT, and AU.
RESULTS
Of the 1 093 176 patients who met inclusion criteria, 1812 had at least 1 code for AA, 1216 female (67%) and 596 male (33%) patients. Overall age-and-sex standardized prevalences among adults and among children and adolescents were observed to be 0.18% and 0.10%, respectively. The age-standardized prevalence ratio in women to men was 1.32. Standardized prevalence was highest in those aged 30 to 39 (297 per 100 000; 95% CI, 263-335) and 40 to 49 (270 per 100 000; 95% CI, 240-303) years. The highest standardized prevalence was observed among Asian patients (414 per 100 000; 95% CI, 306-548), followed by patients reporting another race or multiple races (314 per 100 000; 95% CI, 266-368), Black (226 per 100 000; 95% CI, 199-255), and Hispanic/Latino (212 per 100 000; 95% CI, 129-328) patients. White patients had the lowest standardized prevalence (168 per 100 000; 95% CI, 157-179) among racial and ethnic subgroups. Relative to White patients, standardized prevalence ratios for Asian, Black, and Hispanic/Latino patients were 2.47 (95% CI, 2.17-2.81), 1.35 (95% CI, 1.26-1.44), and 1.26 (95% CI, 1.03-1.55), respectively. Cases of AT and AU comprised approximately 9% of patients diagnosed with AA.
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study suggest that there is a significant burden of AA, AT, and AU in the US in which people of color, particularly Asian Americans, appear to be disproportionately affected.
Topics: Adult; Child; Adolescent; Female; Male; Humans; Alopecia Areata; Prevalence; Cross-Sectional Studies; Cost of Illness
PubMed: 36857044
DOI: 10.1001/jamadermatol.2023.0016 -
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 -
International Journal of Adolescent... Oct 2022Hair is important for individuals due to its cosmetic functions and its anatomical and physiological features. Hair loss in children significantly affects their social...
OBJECTIVES
Hair is important for individuals due to its cosmetic functions and its anatomical and physiological features. Hair loss in children significantly affects their social and psychological well-being and may lead to significant psychological distress in those not benefiting from medical and/or traditional therapies. Accordingly, the aim of the present study was to evaluate the self-esteem in children and adolescents with alopecia areata.
METHODS
This comparative study included children and adolescents with the diagnosis of alopecia and age- and sex-matched healthy controls. Self-esteem was evaluated by the Rosenberg Self-Esteem Scale (RSES).
RESULTS
The study included 64 patients with alopecia (M/F, 32/32; mean age, 12.2 ± 3.0 years) and 60 healthy controls (M/F, 30/30; mean age, 12.0 ± 3.0 years). Age (p=0.64) and sex (p=1.0) distributions were similar between the groups. Of the patients, 35 had alopecia areata, 21 had alopecia universalis, and eight had alopecia totalis. The RSES score of patients was significantly higher than that of the controls (median [interquartile range], 1 [0-2] and 1 [0-1], respectively; p=0.008). The distribution of the participants according to the level of self-esteem (low, moderate, and high) based on the RSES scores revealed that, the proportion of patients with low and moderate self-esteem were significantly higher as compared with controls (p=0.001). The diagnostic subtype and sex did not affect the distribution of self-esteem scores in both groups.
CONCLUSIONS
Hair loss is a significant factor affecting self-esteem of children and adolescents. Deteriorations in self-esteem may progress to psychological comorbidities if not approached, diagnosed, and treated timely and efficiently.
PubMed: 32829314
DOI: 10.1515/ijamh-2020-0100 -
Expert Opinion on Investigational Drugs May 2024Alopecia areata (AA) is an immune-mediated disease that causes non-scarring hair loss. While acute, solitary patches often spontaneously remit, developing secondary... (Review)
Review
INTRODUCTION
Alopecia areata (AA) is an immune-mediated disease that causes non-scarring hair loss. While acute, solitary patches often spontaneously remit, developing secondary patches or failure of the disease to resolve within 6-12 months predicts a poor prognosis, with an increased risk of alopecia totalis or universalis. Chronic AA increases the risk of depression and suicidality and reduces quality of life. Treatment options for chronic or acute diffuse AA were previously limited to corticosteroids and traditional immunomodulators. Two Janus Kinase (JAK) inhibitors are now approved for the treatment of chronic AA.
AREAS COVERED
The results of landmark phase 3 trials for three JAK inhibitors, baricitinib, ritlecitinib, and deuruxolitinib are discussed. Evidence for other JAK inhibitors, biologics, and phosphodiesterase-4 inhibitors are also presented. Therapies currently undergoing clinical trials are listed.
EXPERT OPINION
JAK inhibitors are a safe and efficacious treatment of moderate-to-severe AA. Early intervention, regardless of severity, allows for improved treatment efficacy. It is uncertain how long patients should remain on JAK inhibitors; discontinuation often leads to relapse. A black-box warning for JAK inhibitors was extrapolated from safety data in a rheumatoid arthritis cohort; recent meta-analyses of JAK inhibitors used in dermatology cohorts do not demonstrate the same risk profile.
Topics: Humans; Alopecia Areata; Janus Kinase Inhibitors; Drugs, Investigational; Quality of Life; Severity of Illness Index; Animals; Chronic Disease; Prognosis; Drug Development
PubMed: 38682280
DOI: 10.1080/13543784.2024.2348062 -
The Journal of Dermatology Nov 2014Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear... (Review)
Review
Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear antibodies are present in 60% of patients. The syndrome primarily affects girls and young women. Trichoscopy shows regularly distributed yellow dots, indistinguishable from typical alopecia areata. The condition may be easily misdiagnosed and treated as alopecia areata. On the basis of an in-depth analysis of all published cases we developed diagnostic criteria for Satoyoshi syndrome. We also suggest that two subtypes of the disorder should be distinguished, the ANA-positive Satoyoshi syndrome with generally good response to systemic glucocorticosteroid therapy and the ANA-negative Satoyoshi with less favorable prognosis. In our opinion all patients will alopecia areata (in particular alopecia totalis) should be inquired about muscle spasms and diarrhea and tested for antinuclear antibodies to decrease the risk of missing Satoyoshi syndrome.
Topics: Alopecia; Alopecia Areata; Bone and Bones; Diarrhea; Humans; Spasm
PubMed: 25289915
DOI: 10.1111/1346-8138.12633 -
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 -
Dermatology and Therapy Nov 2023Ritlecitinib demonstrated efficacy in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study (NCT03732807). However, hair loss presentation may vary based on...
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.
PubMed: 37707764
DOI: 10.1007/s13555-023-00997-x -
International Journal of Trichology 2023Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous...
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 . 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.
PubMed: 38765726
DOI: 10.4103/ijt.ijt_2_22 -
Dermatology Practical & Conceptual Oct 2023Alopecia areata (AA) is a common, non-scarring, autoimmune hair loss disorder, varying in severity from small round hairless patches to the total loss of scalp or body... (Review)
Review
INTRODUCTION
Alopecia areata (AA) is a common, non-scarring, autoimmune hair loss disorder, varying in severity from small round hairless patches to the total loss of scalp or body hair. As steroid pulse therapy outcomes for AA vary, this study aimed to review the related literature regarding the efficacy, relapse rates, side effects, and prognostic factors associated with the response to different pulse corticosteroid treatments.
METHODS
We performed a literature search on August 29, 2022, to provide an overview of the efficacy of pulse steroid therapy in patients with AA. The terms "pulse steroid therapy AND alopecia areata" and "pulse corticosteroid therapy AND alopecia areata" were searched on PubMed and Google Scholar.
RESULTS
A total of 24 articles were assessed. There was no difference in outcomes and side effects between intravenous and oral pulse corticosteroid therapy. The relapse rate and efficacy depended on the time of AA onset, age, and AA type: improved outcomes and decreased relapse were linked with recent onset (<6 months), a younger age (<10 years), and the multifocal type of AA. Patients with a past medical history of atopy, nail pitting, or thyroid disease and those with severe forms of AA like alopecia totalis and alopecia universalis had the least improvement.
CONCLUSIONS
All kinds of mentioned systemic pulse corticosteroids effectively induce hair regrowth in AA. Betamethasone pulse seems to be the most effective agent (followed by intramuscular triamcinolone), especially in severe cases, but more side effects may accompany it. Combining this agent with other medications can reduce the dosage and side effects. Pulses of prednisolone and methylprednisolone are less effective but safer, as they have low relapse rates and adverse effects. A combination of them with other drugs can increase their efficacy.
PubMed: 37992355
DOI: 10.5826/dpc.1304a255