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Journal of Cosmetic Dermatology Jun 2022Alopecia Areata (AA) is an autoimmune dermatological disease that could be influenced by psychological factors as part of the pathophysiology of the illness. (Review)
Review
BACKGROUND
Alopecia Areata (AA) is an autoimmune dermatological disease that could be influenced by psychological factors as part of the pathophysiology of the illness.
AIMS
This review article aims to report on psychodermatological and psychopathological aspects involved in the etiopathogenesis and comorbidities of AA, as well as on the psychiatric and psychological management of affected patients.
METHODS
We conducted a literature search on PubMed and Google Scholar from January 1980 to May 2021 employing the search terms of alopecia areata, psychological factors, psychological impact, psychodermatology, and psychopathology. All lists of references from the identified articles were screened for further relevant studies. The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. No specific quality criteria were used for the studies selection.
RESULTS
Several authors have found a high comorbidity rate between AA and mental disorders, concluding that stress and psychological factors are involved in both the development and exacerbation of the illness. More evidences are needed in order to describe the associations between the immune response, stress, and the physiological factors observed in AA patients.
CONCLUSION
AA is a complex illness characterized by multifactorial etiology. An interaction between genetic, autoimmune, hormonal, neural, and psychological factors is supposed. Psychopathological aspects of illness need to be better described and considered in the clinical setting.
Topics: Alopecia Areata; Comorbidity; Humans; Mental Disorders
PubMed: 34449973
DOI: 10.1111/jocd.14416 -
Experimental Dermatology Mar 2020
Topics: Alopecia Areata; Autophagy; Biomedical Research; Dermatology; Hair; History, 20th Century; History, 21st Century; Humans; Inflammation; Signal Transduction
PubMed: 32103561
DOI: 10.1111/exd.14078 -
Journal of the American Academy of... Sep 2023
Topics: Humans; Dermatitis, Atopic; Alopecia Areata; Mendelian Randomization Analysis
PubMed: 37207955
DOI: 10.1016/j.jaad.2023.05.023 -
Association between alopecia areata, anxiety, and depression: A systematic review and meta-analysis.Journal of the American Academy of... May 2023To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression.
OBJECTIVE
We sought to analyze the existing literature to examine the association between alopecia areata, anxiety, and depression.
METHODS
We extracted literature from 4 databases including MEDLINE, Embase, PsychINFO, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (ie, PRISMA) reporting guidelines to finalize a list of relevant articles to be included in our systematic review and meta-analysis. There were no restrictions placed on publication year or age of participants.
RESULTS
Eight studies that included 6010 patients with AA and 20 961 control individuals were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies showed a positive association with anxiety (pooled odds ratio, 2.50; 95% confidence interval, 1.54-4.06) and depression (pooled odds ratio, 2.71; 95% confidence interval, 1.52-4.82).
LIMITATIONS
Publication bias may be a limitation of the study.
CONCLUSION
This study suggests that patients with AA are at higher risk of both anxiety and depression. Health care professionals must be cognizant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated.
Topics: Humans; Alopecia Areata; Depression; Cross-Sectional Studies; Anxiety
PubMed: 31163237
DOI: 10.1016/j.jaad.2019.05.086 -
Advances in Experimental Medicine and... 2022Alopecia areata (AA) is an autoimmune disease that targets the hair follicles (HF) and results in non-scarring hair loss. AA results from the collapse of the HF's immune...
Alopecia areata (AA) is an autoimmune disease that targets the hair follicles (HF) and results in non-scarring hair loss. AA results from the collapse of the HF's immune privilege due to a combination of environmental and genetic factors that either change the local HF dynamics or dysregulate the central immune tolerance. Multiple genetic studies have attempted to identify AA susceptibility genes through candidate gene approaches and genome-wide analysis. These studies were able to show an association between AA and multiple immune-related genes such as those encoding cytokines, chemokines, molecules involved in regulatory T-cell functions, and adaptor molecules along with genes involved in autophagy, melanogenesis, and hair cycling pathways. This chapter aims to explore these genes and their contribution to the pathogenesis of the AA.
Topics: Alopecia Areata; Autoimmune Diseases; Chemokines; Hair Follicle; Humans; Immunogenetics
PubMed: 35286691
DOI: 10.1007/978-3-030-92616-8_2 -
American Journal of Clinical Dermatology Jul 2023Baricitinib (Olumiant), a Janus kinase (JAK) inhibitor, is the first drug approved for the treatment of severe alopecia areata in the USA and the EU. Severe alopecia... (Review)
Review
Baricitinib (Olumiant), a Janus kinase (JAK) inhibitor, is the first drug approved for the treatment of severe alopecia areata in the USA and the EU. Severe alopecia areata is usually difficult to treat and relapse is common. Patients with this disorder are more likely to suffer from anxiety and depression. In two pivotal placebo-controlled phase 3 clinical trials in adults with severe alopecia areata, oral baricitinib once daily was associated with clinically meaningful scalp, eyebrow, and eyelash hair regrowth over 36 weeks. Baricitinib was generally well tolerated with the most common adverse events being infections, headaches, acne, and elevated levels of creatine phosphokinase. While longer-term data will be necessary to more fully understand the benefits and risks of the drug, currently available data suggest that baricitinib is a useful treatment for patients with severe alopecia areata.
Topics: Adult; Humans; Alopecia Areata; Azetidines; Janus Kinase Inhibitors; Pyrazoles; Clinical Trials, Phase III as Topic
PubMed: 37326792
DOI: 10.1007/s40257-023-00799-z -
American Journal of Clinical Dermatology Mar 2024The ALLEGRO phase 2a and 2b/3 studies demonstrated that ritlecitinib, an oral JAK3/TEC family kinase inhibitor, is efficacious at doses of ≥ 30 mg in patients aged ≥... (Clinical Trial)
Clinical Trial
BACKGROUND
The ALLEGRO phase 2a and 2b/3 studies demonstrated that ritlecitinib, an oral JAK3/TEC family kinase inhibitor, is efficacious at doses of ≥ 30 mg in patients aged ≥ 12 years with alopecia areata (AA).
OBJECTIVE
The objective of this study was to evaluate the safety of ritlecitinib in an integrated analysis of four studies in AA.
METHODS
Two cohorts were analyzed: a placebo-controlled and an all-exposure cohort. Proportions and study size-adjusted incidence rates (IRs) of adverse events (AEs) of interest and laboratory abnormalities are reported.
RESULTS
In the placebo-controlled cohort (n = 881; median exposure: 169 days), the proportion of ritlecitinib-treated patients with AEs was 70.2-75.4% across doses versus 69.5% in the placebo group; serious AEs occurred in 0-3.2% versus 1.9% for the placebo. A total of 19 patients permanently discontinued due to AEs (5 while receiving the placebo). In the all-exposure cohort (n = 1294), median ritlecitinib exposure was 624 days [2091.7 total patient-years (PY)]. AEs were reported in 1094 patients (84.5%) and serious AEs in 57 (4.4%); 78 (6.0%) permanently discontinued due to AEs. The most common AEs were headache (17.7%; 11.9/100 PY), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test (15.5%; 9.8/100 PY), and nasopharyngitis (12.4%; 8.2/100 PY). There were two deaths (breast cancer and acute respiratory failure/cardiorespiratory arrest). Proportions (IRs) were < 0.1% (0.05/100 PY) for opportunistic infections, 1.5% (0.9/100 PY) for herpes zoster, 0.5% (0.3/100 PY) for malignancies (excluding nonmelanoma skin cancer), and 0.2% (0.1/100 PY) for major adverse cardiovascular events.
CONCLUSIONS
Ritlecitinib is well tolerated with an acceptable safety profile up to 24 months in patients aged ≥ 12 years with AA (video abstract and graphical plain language summary available).
TRIAL REGISTRIES
ClinicalTrials.gov: NCT02974868 (date of registration: 11/29/2016), NCT04517864 (08/18/2020), NCT03732807 (11/07/2018), and NCT04006457 (07/05/2019).
Topics: Humans; Alopecia Areata; Antineoplastic Agents; Carbazoles; Janus Kinase 3; Protein Kinase Inhibitors; SARS-CoV-2; Treatment Outcome; Tryptamines
PubMed: 38263353
DOI: 10.1007/s40257-024-00846-3 -
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 -
FP Essentials Jun 2022Alopecia affects men and women and can result in significant distress for patients. Alopecias can be categorized as nonscarring or scarring. Nonscarring alopecias...
Alopecia affects men and women and can result in significant distress for patients. Alopecias can be categorized as nonscarring or scarring. Nonscarring alopecias include male and female pattern alopecias, alopecia areata, telogen effluvium, traction alopecia, trichotillomania, and tinea capitis. Scarring alopecias include central centrifugal cicatricial alopecia, lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, dissecting cellulitis of the scalp, folliculitis decalvans, and acne keloidalis nuchae. Evaluation of patients with alopecia involves assessment of the duration and distribution of hair loss, associated scalp symptoms, and associated conditions. Clinical examination of the hair and scalp may include a hair pull test, tug test, hair mount (ie, trichogram), dermoscopy, laboratory tests, and/or scalp biopsy, depending on the suspected etiology. Hair regrowth cannot occur in established lesions of scarring alopecia, so early identification and prompt initiation of treatment are critical in these cases. Patients with suspected or confirmed alopecias, alopecia areata, or alopecias refractory to treatment may benefit from referral to a dermatologist.
Topics: Alopecia Areata; Cicatrix; Female; Hair; Humans; Lichen Planus; Male
PubMed: 35679467
DOI: No ID Found -
International Journal of Rheumatic... Oct 2023
Topics: Humans; Alopecia Areata
PubMed: 37807618
DOI: 10.1111/1756-185X.14815