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JAMA Dermatology May 2015Previous studies found conflicting results as to whether atopic dermatitis (AD) is increased in patients with vitiligo and alopecia areata (AA). (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Previous studies found conflicting results as to whether atopic dermatitis (AD) is increased in patients with vitiligo and alopecia areata (AA).
OBJECTIVE
To compare the prevalence of AD between patients with either vitiligo or AA and those without these disorders by performing a meta-analysis of observational studies.
DATA SOURCES
MEDLINE, EMBASE, Cochrane Library, Google Scholar, and a manual search of 12 additional journals between 1946 and April 5, 2014.
STUDY SELECTION
Observational studies published in any language that compared the prevalence of AD among patients with and without either vitiligo or AA.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by 2 independent investigators. Quality of evidence was assessed using the Newcastle-Ottawa Scale and Methodological Evaluation of Observational Research checklist. A meta-analysis of studies assessing AD, vitiligo, and/or AA was performed using a fixed-effects model to estimate pooled odds ratios (ORs). Subset analyses were performed for childhood vs adult-onset vitiligo and alopecia totalis or alopecia universalis vs patchy alopecia.
MAIN OUTCOMES AND MEASURES
Self-reported and/or physician-diagnosed AD, vitiligo, and AA.
RESULTS
In total, 16 studies of vitiligo and 17 studies of AA were included in the review. In the pooled analysis of the studies that included control patients without vitiligo (n = 2) and control patients without AA (n = 3), patients with vitiligo (Cochran-Mantel-Haenszel OR, 7.82; 95% CI, 3.06-20.00, P < .001) or AA (OR, 2.57; 95% CI, 2.25-2.94, P < .001) had significantly higher odds of AD than did control patients without these disorders. Pooled analysis of 3 studies found higher odds of AD in patients with early-onset vitiligo (<12 years) compared with those with late-onset vitiligo (OR, 3.54; 95% CI, 2.24-5.63, P < .001). Pooled analysis of 4 studies found higher odds of AD in patients with alopecia totalis or alopecia universalis compared with those with patchy alopecia (OR, 1.22; 95% CI, 1.01-1.48, P = .04).
CONCLUSIONS AND RELEVANCE
Patients with either vitiligo, especially early-onset disease, or AA, especially alopecia totalis or alopecia universalis, have significantly increased risk for AD.
Topics: Age of Onset; Alopecia Areata; Comorbidity; Dermatitis, Atopic; Humans; Observational Studies as Topic; Prevalence; Risk Factors; Vitiligo
PubMed: 25471826
DOI: 10.1001/jamadermatol.2014.3324 -
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 -
ImmunoTargets and Therapy 2021Alopecia areata (AA) is an autoimmune disease of the hair follicles. It is characterized by a well-defined non-scarring alopecic patch or patches that may extend to the... (Review)
Review
Alopecia areata (AA) is an autoimmune disease of the hair follicles. It is characterized by a well-defined non-scarring alopecic patch or patches that may extend to the entire scalp or lead to total body hair loss. Due to its unpredictable clinical course, AA causes substantial psychological harm. Despite the high prevalence of this disease and extensive research, its exact pathomechanism is unclear, and current treatments have a high relapse rate that has deemed AA incurable. Over the past few decades, researchers have investigated multiple potential factors that may help alleviate its pathogenesis and provide effective treatment. Given its complex immunopathogenesis, AA is considered an autoimmune disease with multiple factors. This review gathers current evidence that emphasizes molecular mechanisms, possible causative etiologies, and targeted immunotherapies for AA. Understanding its underlying mechanisms may shed light on new strategies to effectively manage AA in the future.
PubMed: 34350136
DOI: 10.2147/ITT.S266409 -
Dermatology and Therapy Apr 2022Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved... (Review)
Review
Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss.
PubMed: 35357658
DOI: 10.1007/s13555-022-00711-3 -
International Journal of Trichology 2023Complete scalp hair loss can be a source of distress for affected children and their families. In addition to infectious and trauma-related causes of hair loss, infants... (Review)
Review
Complete scalp hair loss can be a source of distress for affected children and their families. In addition to infectious and trauma-related causes of hair loss, infants and children may present with total scalp alopecia arising from a range of genetic predispositions. Our objective with this review was to identify the common genetic conditions in children with complete scalp alopecia. The PubMed Database was reviewed for all articles from 1962 to 2019 containing the search terms related to genetic alopecia. The conditions with at least five reported cases in the literature were considered for the inclusion. All clinical trials, retrospective studies, and cases on human subjects and written in English were included. Six genetic conditions related to complete scalp alopecia were included in this review. The most common genetic conditions associated with total scalp hair loss include: alopecia totalis/Alopecia universalis (AU), atrichia with papular lesions, AU congenita, hereditary Vitamin D-resistant rickets type IIA, alopecia with mental retardation, and pure hair and nail ectodermal dysplasia. In children presenting with total scalp hair loss, a myriad of genetic and environmental factors may be the underlying cause. Increased awareness of potential genetic conditions associated with total scalp hair loss may assist in diagnosis, with improved the prognosis for the children.
PubMed: 37701556
DOI: 10.4103/ijt.ijt_70_22 -
Dermatology and Therapy Jun 2020Cyclosporine is commonly used in treatment for alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various... (Review)
Review
INTRODUCTION
Cyclosporine is commonly used in treatment for alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various outcomes.
METHODS
Efficacy of cyclosporine with and without systemic corticosteroids for alopecia areata was evaluated by a systematic review. Cochrane, EBSCOhost, Pubmed, Scopus and Web of Science databases were searched. Only studies published before January 2020 were included.
RESULTS
A total of 2104 studies were initially examined, of which 14 were eligible for the systematic review. Among 340 reported cases, 213 had focal, multifocal or ophiasis form of alopecia areata, 60 were diagnosed with alopecia totalis and 67 with alopecia universalis. The mean response rate in the whole group of patients at the end of treatment was 65.00% (221/340; range 25-100%). Hair regrowth rate was higher in the group with cases of alopecia areata limited to scalp (124/165; mean 75.15%; range 40-100%) than in the cases with alopecia totalis (30/46; mean 65.22%; range 25-100%) or alopecia universalis (24/52; mean 46.15%; range 25-100%). The combined therapy with systemic corticosteroids was superior to the monotherapy (152/219; mean 69.41%; 0-80% vs. 69/121; mean 57.02%; range 6.67-100%) and had a lower recurrence rate (39/108; mean 36.11% vs. 34/46; mean 73.91%, respectively). The combined treatment with methylprednisolone was significantly more effective when compared to the cyclosporine monotherapy (124/183; mean 67.76%; range 0-80% vs. 69/121; mean 57.02%; range 6.67-100%). The mean time of treatment was 6.75 months (range 2-36).
LIMITATIONS
Limitations of our study were the retrospective character of included studies, differences in doses of prescribed drugs, and duration of the treatment and follow-up times.
CONCLUSION
Cyclosporine in combination with oral systemic corticosteroids is more effective than in monotherapy for severe alopecia areata.
PubMed: 32270396
DOI: 10.1007/s13555-020-00370-2 -
JAMA Dermatology Jul 2023Alopecia areata (AA) is associated with diverse autoimmune and psychiatric disorders. However, an investigation on the long-term outcomes for offspring born to mothers...
IMPORTANCE
Alopecia areata (AA) is associated with diverse autoimmune and psychiatric disorders. However, an investigation on the long-term outcomes for offspring born to mothers diagnosed with AA is lacking.
OBJECTIVE
To investigate the risks for autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with AA.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective population-based birth cohort study used the linked birth registration database with the Nationwide Health Insurance Service database of Korea. The participants included all newborns born to mothers with 3 or more visits with International Classification of Diseases, Tenth Revision code of L63 and 1:10 birth year, sex, insurance, income, and location of residence-matched control offspring born to mothers without AA during the years from 2003 to 2015. The analysis was conducted from July 2022 to January 2023.
EXPOSURE
Maternal AA.
MAIN OUTCOMES AND MEASURES
The occurrence of the following diseases was measured in newborns from birth to December 31, 2020: AA, alopecia totalis/universalis (AT/AU), vitiligo, psoriasis, inflammatory bowel disease, rheumatoid arthritis, atopic dermatitis, allergic rhinitis, asthma, hyperthyroidism, hypothyroidism, Graves disease, Hashimoto thyroiditis, attention-deficit hyperactivity disorder, mood disorder, and anxiety disorder. Multivariable Cox proportional hazard analyses were performed with the following covariates: birth year, age, insurance type, income level, location of residence, maternal age, mode of delivery, maternal history of atopic disorders, and autoimmune disorders.
RESULTS
In total, 67 364 offspring born to 46 352 mothers with AA and 673 640 controls born to 454 085 unaffected mothers were analyzed. The risk of AA (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.88-2.30), AT/AU (aHR, 1.57; 95% CI, 1.18-2.08), vitiligo (aHR, 1.47; 95% CI, 1.32-1.63), atopic disorders (aHR, 1.07; 95% CI, 1.06-1.09), hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25), and psychiatric disorders (aHR, 1.15; 95% CI, 1.11-1.20) was significantly increased in offspring born to mothers with AA. Among them, 5088 born to mothers with AT/AU were at much greater risk for the development of AT/AU (aHR, 2.98; 95% CI, 1.48-6.00) and psychiatric disorders (aHR, 1.27; 95% CI, 1.12-1.44).
CONCLUSIONS AND RELEVANCE
In this Korean retrospective population-based birth cohort study, maternal AA was associated with the development of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders in their offspring. Clinicians and parents need to be aware of the potential for these comorbidities to occur.
Topics: Female; Humans; Infant, Newborn; Alopecia Areata; Mothers; Retrospective Studies; Cohort Studies; Vitiligo; Hypothyroidism
PubMed: 37223925
DOI: 10.1001/jamadermatol.2023.1261 -
Recent Patents on Inflammation &... 2020Alopecia Areata (AA) is a systemic autoimmune condition that usually starts in childhood. (Review)
Review
BACKGROUND
Alopecia Areata (AA) is a systemic autoimmune condition that usually starts in childhood.
OBJECTIVE
This article aims to review genetics, therapy, prognosis, and recent patents for AA.
METHODS
We used clinical queries and keywords "alopecia areata" AND "childhood" as a search engine. Patents were searched using the key term "alopecia areata" in Patents.google.com and freepatentsonline. com.
RESULTS
Due to an immune-mediated damage to the hair follicles, hair is lost from the scalp and other areas of the body temporarily or even permanently. Children with AA are generally healthy. Evidence of genetic association and increased predisposition for AA was found by studying families with affected members. Pathophysiologically, T- lymphocytes attack hair follicles and cause inflammation and destruction of the hair follicles and hair loss. In mild cases, there would be well-demarcated round patchy scalp hair loss. The pathognomonic "exclamation mark hairs" may be seen at the lesion periphery. In more severe cases, the hair loss may affect the whole scalp and even the whole body. The clinical course is also variable, which may range from transient episodes of recurrent patchy hair loss to an indolent gradually deteriorating severe hair loss. The treatment of AA depends on factors including patients' age, the extent of the hair loss, duration of disease, psychological impact, availability and side effect profile of the treatments. For localized patchy alopecia, topical application of corticosteroids and/or intralesional corticosteroids are the treatment of choice. Other topical treatments include minoxidil, anthralin, coal tar and immunotherapy. In severe resistant cases, systemic immunosuppressants may be considered. Although herbal medicine, acupuncture, complementary and alternative medicine may be tried on children in some Asian communities, the evidence to support these practices is lacking. To date, only a few recent patents exist in topical treatments, including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities.
CONCLUSION
None of the established therapeutic options are curative. However, newer treatment modalities, including excimer laser, interleukin-31 antibodies and biologics, are evolving so that there may be significant advances in treatment in the near future. AA can be psychosocially devastating. It is important to assess the quality of life, degree of anxiety, social phobia and mood of the patients and their families. Psychological support is imperative for those who are adversely affected psychosocially.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Anthralin; Child; Humans; Immunotherapy; Minoxidil; Patents as Topic
PubMed: 32723274
DOI: 10.2174/1872213X14999200728145822 -
Scientific Reports Jun 2018The cancer risk in patients with alopecia areata (AA) or alopecia totalis (AT)/alopecia universalis (AU) remains unknown. In this study, national statistical data were...
The cancer risk in patients with alopecia areata (AA) or alopecia totalis (AT)/alopecia universalis (AU) remains unknown. In this study, national statistical data were used to study the association between these forms of alopecia and the risk of cancer. We enrolled 668,604 patients who were treated for alopecia from 2007 to 2014, and age- and sex-matched control subjects. AA and AT/AU patients had slightly higher overall cancer risks (hazard ratio (HR), 1.043; 95% confidence interval (CI), 1.022-1.065 and HR, 1.07; 95% CI, 1.013-1.129, respectively) than controls, after adjusting for confounding factors. The risks of oral cavity, esophagus, liver, biliary tract, pancreas, larynx, lung, kidney, breast, cervix, ovary, uterus, testis, nerve, and skin cancers; and lymphoma, multiple myeloma, and leukemia, were not increased in alopecia patients. In AA or AT/AU patients, the only increased risk was that of thyroid cancer. In AA patients alone, the risks of bladder and prostate cancers were increased. Thus, the cancer risks varied by the alopecia subtype. Careful monitoring is needed to explore if the actual risks of thyroid, bladder, and prostate cancers are increased in alopecia patients.
Topics: Adult; Alopecia; Alopecia Areata; Female; Humans; Male; Middle Aged; Neoplasms; Proportional Hazards Models; Prostatic Neoplasms; Thyroid Neoplasms; Urinary Bladder Neoplasms
PubMed: 29950587
DOI: 10.1038/s41598-018-28142-1 -
The Australasian Journal of Dermatology May 2019Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals...
Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.
Topics: Alopecia Areata; Autoimmune Diseases; Disease Progression; Down Syndrome; Glucocorticoids; Humans; Immunosuppressive Agents; Immunotherapy; Minoxidil; Nail Diseases; Prognosis; Vasodilator Agents
PubMed: 30411329
DOI: 10.1111/ajd.12941