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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 -
Alopecia Areata: Review of Epidemiology, Clinical Features, Pathogenesis, and New Treatment Options.International Journal of Trichology 2018Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and... (Review)
Review
Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and may present at any age. In this article, we review the epidemiology, clinical features, pathogenesis, and new treatment options of AA, with a focus on the immunologic mechanism underlying the treatment. While traditional treatment options such as corticosteroids are moderately effective, a better understanding of the disease pathogenesis may lead to the development of new treatments that are more directed and effective against AA. Sources were gathered from PubMed, Embase, and the Cochrane database using the keywords: alopecia, alopecia areata, hair loss, trichoscopy, treatments, pathogenesis, and epidemiology.
PubMed: 29769777
DOI: 10.4103/ijt.ijt_99_17 -
JAMA Network Open Oct 2023Multiple cases of autoimmune and autoinflammatory diseases after COVID-19 have been reported. However, their incidences and risks have rarely been quantified.
IMPORTANCE
Multiple cases of autoimmune and autoinflammatory diseases after COVID-19 have been reported. However, their incidences and risks have rarely been quantified.
OBJECTIVE
To investigate the incidences and risks of autoimmune and autoinflammatory connective tissue disorders after COVID-19.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective population-based study conducted between October 8, 2020, and December 31, 2021, that used nationwide data from the Korea Disease Control and Prevention Agency COVID-19 National Health Insurance Service cohort and included individuals who received a diagnosis of COVID-19 via polymerase chain reaction testing and a control group with no evidence of COVID-19 identified from National Health Insurance Service of Korea cohort. Data analysis was conducted from September 2022 to August 2023.
EXPOSURES
Receipt of diagnosis of COVID-19.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the incidence and risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19. A total of 32 covariates, including demographics, socioeconomic statuses, lifestyle factors, and comorbidity profiles, were balanced through inverse probability weighting. The incidences and risks of autoimmune and autoinflammatory connective tissue disorders were compared between the groups using multivariable Cox proportional hazard analyses.
RESULTS
A total of 354 527 individuals with COVID-19 (mean [SD] age, 52.24 [15.55] years; 179 041 women [50.50%]) and 6 134 940 controls (mean [SD] age, 52.05 [15.63] years; 3 074 573 women [50.12%]) were included. The risks of alopecia areata (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.05-1.19), alopecia totalis (aHR, 1.74; 95% CI, 1.39-2.17), antineutrophil cytoplasmic antibody-associated vasculitis (aHR, 2.76; 95% CI, 1.64-4.65), Crohn disease (aHR, 1.68; 95% CI, 1.31-2.15), and sarcoidosis (aHR, 1.59; 95% CI, 1.00-2.52) were higher in the COVID-19 group. The risks of alopecia totalis, psoriasis, vitiligo, vasculitis, Crohn disease, ulcerative colitis, rheumatoid arthritis, adult-onset Still disease, Sjögren syndrome, ankylosing spondylitis, and sarcoidosis were associated with the severity of COVID-19.
CONCLUSIONS AND RELEVANCE
In this retrospective cohort study, COVID-19 was associated with a substantial risk for autoimmune and autoinflammatory connective tissue disorders, indicating that long-term management of patients with COVID-19 should include evaluation for such disorders.
Topics: Adult; Humans; Female; Middle Aged; Retrospective Studies; Crohn Disease; COVID-19; Connective Tissue; Sarcoidosis; Alopecia; Vasculitis
PubMed: 37801317
DOI: 10.1001/jamanetworkopen.2023.36120 -
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 -
JAMA Dermatology Apr 2023Poor therapeutic results have been reported in patients with alopecia areata totalis (AT) or universalis (AU), the most severe and disabling types of alopecia areata... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Methotrexate Alone vs Methotrexate Plus Low-Dose Prednisone in Patients With Alopecia Areata Totalis or Universalis: A 2-Step Double-Blind Randomized Clinical Trial.
IMPORTANCE
Poor therapeutic results have been reported in patients with alopecia areata totalis (AT) or universalis (AU), the most severe and disabling types of alopecia areata (AA). Methotrexate, an inexpensive treatment, might be effective in AU and AT.
OBJECTIVE
To evaluate the efficacy and tolerance of methotrexate alone or combined with low-dose prednisone in patients with chronic and recalcitrant AT and AU.
DESIGN, SETTING, AND PARTICIPANTS
This academic, multicenter, double-blind, randomized clinical trial was conducted at 8 dermatology departments at university hospitals between March 2014 and December 2016 and included adult patients with AT or AU evolving for more than 6 months despite previous topical and systemic treatments. Data analysis was performed from October 2018 to June 2019.
INTERVENTIONS
Patients were randomized to receive methotrexate (25 mg/wk) or placebo for 6 months. Patients with greater than 25% hair regrowth (HR) at month 6 continued their treatment until month 12. Patients with less than 25% HR were rerandomized: methotrexate plus prednisone (20 mg/d for 3 months and 15 mg/d for 3 months) or methotrexate plus placebo of prednisone.
MAIN OUTCOME AND MEASURES
The primary end point assessed on photos by 4 international experts was complete or almost complete HR (Severity of Alopecia Tool [SALT] score <10) at month 12, while receiving methotrexate alone from the start of the study. Main secondary end points were the rate of major (greater than 50%) HR, quality of life, and treatment tolerance.
RESULTS
A total of 89 patients (50 female, 39 male; mean [SD] age, 38.6 [14.3] years) with AT (n = 1) or AU (n = 88) were randomized: methotrexate (n = 45) or placebo (n = 44). At month 12, complete or almost complete HR (SALT score <10) was observed in 1 patient and no patient who received methotrexate alone or placebo, respectively, in 7 of 35 (20.0%; 95% CI, 8.4%-37.0%) patients who received methotrexate (for 6 or 12 months) plus prednisone, including 5 of 16 (31.2%; 95% CI, 11.0%-58.7%) who received methotrexate for 12 months and prednisone for 6 months. A greater improvement in quality of life was observed in patients who achieved a complete response compared with nonresponder patients. Two patients in the methotrexate group discontinued the study because of fatigue and nausea, which were observed in 7 (6.9%) and 14 (13.7%) patients receiving methotrexate, respectively. No severe treatment adverse effect was observed.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, while methotrexate alone mainly allowed partial HR in patients with chronic AT or AU, its combination with low-dose prednisone allowed complete HR in up to 31% of patients. These results seem to be of the same order of magnitude as those recently reported with JAK inhibitors, with a much lower cost.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02037191.
Topics: Adult; Humans; Male; Female; Methotrexate; Prednisone; Alopecia Areata; Quality of Life; Neoplasm Recurrence, Local; Double-Blind Method; Treatment Outcome
PubMed: 36884234
DOI: 10.1001/jamadermatol.2022.6687 -
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 -
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