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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 -
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 -
Drugs Sep 2023Ritlecitinib (LITFULO), an orally administered kinase inhibitor, is being developed by Pfizer for the treatment of alopecia areata, vitiligo, ulcerative colitis and... (Review)
Review
Ritlecitinib (LITFULO), an orally administered kinase inhibitor, is being developed by Pfizer for the treatment of alopecia areata, vitiligo, ulcerative colitis and Crohn's disease. On 23 June 2023, ritlecitinib received approval in the USA for the treatment of severe alopecia areata in adults and adolescents 12 years and older. Ritlecitinib was approved in Japan on 26 June 2023 for the treatment of alopecia areata (limited to intractable cases involving widespread hair loss). Ritlecitinib has also received a positive opinion in the EU and is under regulatory review in the UK and China. This article summarizes the milestones in the development of ritlecitinib leading to this first approval for severe alopecia areata.
Topics: Adult; Adolescent; Humans; Alopecia Areata; Colitis, Ulcerative; Crohn Disease; China
PubMed: 37556041
DOI: 10.1007/s40265-023-01928-y -
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 the European Academy of... Mar 2021The field of hair disorders is constantly growing. The most important hair diseases are divided in non- cicatricial and cicatricial ones. Non-cicatricial alopecia are... (Review)
Review
The field of hair disorders is constantly growing. The most important hair diseases are divided in non- cicatricial and cicatricial ones. Non-cicatricial alopecia are more frequent than cicatricial alopecia. The first step is to obtain a good history and physical examination. Laboratory testing is often unnecessary, while trichoscopy is fundamental for all hair diseases. Scalp biopsy is strongly suggested in cicatricial alopecia and in doubtful cases. Androgenetic alopecia, alopecia areata, telogen effluvium, trichotillomania are common causes of non- cicatricial alopecia. Frontal fibrosing alopecia, discoid lupus erythematosus, lichen planopilaris, follicullitis decalvans are some of the most common forms of cicatricial hair loss. Many treatments are available, and a prompt diagnosis is very important for the prognosis.
Topics: Alopecia; Alopecia Areata; Hair Diseases; Humans; Lichen Planus; Scalp; Trichotillomania
PubMed: 33290611
DOI: 10.1111/jdv.17079 -
Actas Dermo-sifiliograficas Jan 2023Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis... (Review)
Review
Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.
Topics: Humans; Alopecia Areata; Dermoscopy; Hair; Alopecia; Hair Follicle; Hair Diseases
PubMed: 36067826
DOI: 10.1016/j.ad.2022.08.018 -
International Journal of Molecular... Jan 2022Alopecia areata is a representative inflammatory skin disease that is associated with various environmental stimuli. While psychological stress is believed to be a major... (Review)
Review
Alopecia areata is a representative inflammatory skin disease that is associated with various environmental stimuli. While psychological stress is believed to be a major pathogenetic trigger in alopecia areata, infants and newborns also suffer from the disease, suggesting the possible presence of other environmental factors. Daily lifestyle is well known to be involved in various inflammatory diseases and influences the severity of inflammatory skin diseases. However, only a limited number of studies have summarized these influences on alopecia areata. In this review article, we summarize lifestyle factor-related influences on the pathogenesis of alopecia areata and focus on environmental factors, such as smoking, alcohol consumption, sleep, obesity, fatty acids, and gluten consumption.
Topics: Alopecia Areata; Autoantigens; Humans; Life Style
PubMed: 35162962
DOI: 10.3390/ijms23031038 -
Giornale Italiano Di Dermatologia E... Dec 2019Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have...
Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.
Topics: Alopecia Areata; Autoimmune Diseases; Evidence-Based Medicine; Hair Follicle; Humans; Italy
PubMed: 31578836
DOI: 10.23736/S0392-0488.19.06458-7 -
The Journal of Dermatology Jan 2022Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence... (Review)
Review
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
Topics: Alopecia Areata; Autoantigens; Hair Follicle; Humans; Immune Privilege; Japan
PubMed: 34709679
DOI: 10.1111/1346-8138.16207 -
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