-
Skin Research and Technology : Official... Jun 2023The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations.
OBJECTIVE
Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns.
METHODS
Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed.
RESULTS
Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs.
CONCLUSION
There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.
Topics: Alopecia Areata; Dermoscopy; Vitamin D Deficiency; Humans
PubMed: 37357664
DOI: 10.1111/srt.13378 -
American Journal of Clinical Dermatology Nov 2023Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.
OBJECTIVE
The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.
METHODS
We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.
RESULTS
We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89).
CONCLUSION
These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
Topics: Humans; Alopecia Areata; Cross-Sectional Studies; Comorbidity; Autoimmune Diseases
PubMed: 37464249
DOI: 10.1007/s40257-023-00805-4 -
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 -
Frontiers in Immunology 2023Alopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the widespread application of JAK inhibitors in immune-related diseases,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the widespread application of JAK inhibitors in immune-related diseases, attention is being given to their role in the treatment of AA. However, it is unclear which JAK inhibitors have a satisfactory or positive effect on AA. This network meta-analysis aimed to compare the efficacy and safety of different JAK inhibitors in the treatment of AA.
METHODS
The network meta-analysis was performed according to the PRISMA guidelines. We included randomized controlled trials as well as a small number of cohort studies. The differences in efficacy and safety between the treatment and control groups were compared.
RESULTS
Five randomized controlled trials, two retrospective studies, and two prospective studies involving 1689 patients were included in this network meta-analysis. In terms of efficacy, oral baricitinib and ruxolitinib significantly improved the response rate of patients compared to placebo [MD = 8.44, 95% CI (3.63, 19.63)] and [MD = 6.94, 95% CI, (1.72, 28.05)],respectively. Oral baricitinib treatment significantly improved the response rate compared to non-oral JAK inhibitor treatment [MD=7.56, 95% CI (1.32,43.36)]. Oral baricitinib, tofacitinib, and ruxolitinib treatments significantly improved the complete response rate compared to placebo [MD = 12.21, 95% CI (3.41, 43.79)], [MD = 10.16, 95% CI (1.02, 101.54)], and [MD = 9.79, 95% CI, (1.29, 74.27)], respectively. In terms of safety, oral baricitinib, tofacitinib, and ruxolitinib treatments significantly reduced treatment-emergent adverse event rates compared with conventional steroid treatment [MD = 0.08, 95% CI (0.02, 0.42)], [MD = 0.14, 95% CI (0.04, 0.55)], and [MD = 0.35, 95% CI, (0.14, 0.88)], respectively.
CONCLUSION
Oral baricitinib and ruxolitinib are excellent options for the treatment of AA owing to their good efficacy and safety profiles. In contrast, non-oral JAK inhibitors do not appear to have satisfactory efficacy in treating AA. However, further studies are required to verify the optimal dose of JAK inhibitors for AA therapy.
Topics: Humans; Alopecia Areata; Janus Kinase Inhibitors; Network Meta-Analysis; Prospective Studies; Retrospective Studies; Randomized Controlled Trials as Topic
PubMed: 37138884
DOI: 10.3389/fimmu.2023.1152513 -
The Journal of Clinical and Aesthetic... Aug 2020Central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that commonly affects women of African descent, can be challenging to manage, and there are limited... (Review)
Review
Central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that commonly affects women of African descent, can be challenging to manage, and there are limited treatment modalities available. The use of natural ingredients for nonscarring hair loss has gained popularity among patients, but has not been previously studied for CCCA. We sought to review clinical studies evaluating the use of natural ingredients in the treatment of CCCA. Systematic searches of the PubMed and SCOPUS databases were performed in March 2018 using various ingredient names and the terms , and . Specific ingredients included azelaic acid, peppermint oil, pumpkin seed oil, garlic supplements/shampoo, Black castor oil, jojoba oil, argan oil, olive oil, horsetail plant oil, lavender oil, coconut oil, chamomile oil, thyme oil, tea tree oil, sulfur oil, menthol, and rosemary oil. Two reviewers independently screened titles, leading to the selection of eight clinical studies. A review of the literature revealed no clinical trials that evaluated the treatment of CCCA with natural ingredients. Despite limited evidence-based research for CCCA, several natural ingredients showed efficacy in alopecia areata, androgenetic alopecia, and psoriatic alopecia. Upon review of the literature, there were no randomized, controlled studies evaluating the use of natural ingredients or aromatherapy in the management of CCCA. Despite this, several botanical and natural ingredients do show promise in treating androgenetic alopecia and alopecia areata. More clinical studies need to be performed to evaluate treatment options as a whole, including natural modalities, to better serve these patients.
PubMed: 33178378
DOI: No ID Found -
The Journal of Dermatology Sep 2022The association between psoriasis and alopecia areata has not been thoroughly investigated. The objective of this study is to investigate the association of psoriasis... (Meta-Analysis)
Meta-Analysis
The association between psoriasis and alopecia areata has not been thoroughly investigated. The objective of this study is to investigate the association of psoriasis with alopecia areata. An electronic search was conducted in August 2021. The analysis included studies that reported sufficient data on the prevalence, odds, or hazard of alopecia areata in patients with psoriasis or that of psoriasis in patients with alopecia areata. Meta-analysis using an inverse variance method was performed with a random-effects model, assuming inherent heterogeneity between the included studies. The subgroup analyses were performed according to the age group and study quality. A total of 27 studies were included. The pooled prevalence of alopecia areata among patients with psoriasis was 0.5% (95% confidence interval [CI], 0.3-0.7%). The pooled odds ratio of alopecia areata among patients with psoriasis was 2.71 (95% CI, 2.29-3.21), whereas the pooled prevalence of psoriasis among patients with alopecia areata was 2.5% (95% CI, 2.0-3.0%). Moreover, the pooled odds ratio of psoriasis among patients with alopecia areata was 3.52 (95% CI, 1.27-9.74). The association of psoriasis and alopecia areata remained in the subgroup analyses according to the age group and study quality. In conclusion, this study suggests a bidirectional association between psoriasis and alopecia areata. Clinical examinations may be necessary to determine the presence of comorbid alopecia areata in patients with psoriasis and vice versa.
Topics: Alopecia Areata; Comorbidity; Humans; Prevalence; Psoriasis
PubMed: 35510645
DOI: 10.1111/1346-8138.16420 -
The British Journal of Dermatology Sep 2016No systematic review has yet evaluated the available evidence on health-related quality of life (HRQOL) in alopecia areata (AA). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
No systematic review has yet evaluated the available evidence on health-related quality of life (HRQOL) in alopecia areata (AA).
OBJECTIVES
To conduct a systematic review and meta-analysis of HRQOL studies among patients diagnosed with AA.
METHODS
A systematic search was performed for papers published between 1946 and 15 December 2014 in Medline, Embase, Web of Science, CINAHL, PsycINFO and the Cochrane Library. Random-effects meta-analyses were conducted to pool data.
RESULTS
Twenty-one studies were included, representing a total of 2530 adult patients with AA. Of the 14 different HRQOL measures used in the studies, Dermatology Life Quality Index (DLQI; n = 8) and SF-36 (n = 7) were the most common. Three AA-specific HRQOL instruments were identified: Alopecia Areata Quality of Life Index, Alopecia Areata Quality of Life and Alopecia Areata Symptom Impact Scale. The mean pooled DLQI score of patients with AA was 6·3 (95% confidence interval 5·6-7·1). Comparing age- and sex-matched controls, the meta-analysis of SF-36 studies revealed significantly reduced HRQOL across the role-emotional, mental health and vitality domains (P < 0·001). Wearing a wig had a positive impact, while scalp involvement, anxiety and depression had a negative impact on HRQOL. Conflicting results were found regarding the association between HRQOL and age, sex, marital status and disease duration.
CONCLUSIONS
Patients with AA experience significant impairment in HRQOL, especially in the area of mental health. Several generic and dermatology-specific HRQOL instruments have been used, but no validation studies have confirmed their applicability in AA. The newly developed AA-specific measures seem very promising; however, a more extensive assessment of validity and reliability is needed.
Topics: Adult; Age Factors; Alopecia Areata; Anxiety; Depression; Epidemiologic Methods; Female; Humans; Male; Psychometrics; Quality of Life; Sex Factors; Socioeconomic Factors
PubMed: 26914830
DOI: 10.1111/bjd.14497 -
Journal of the American Academy of... Jan 2019Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata (AA), though there exists a paucity of definitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata (AA), though there exists a paucity of definitive evidence and guidelines in this setting.
OBJECTIVES
To 1) determine the efficacy and risks associated with methotrexate therapy for AA, 2) determine the differences in efficacy of combination (methotrexate plus corticosteroids) versus stand-alone (methotrexate) treatment, and 3) determine the relative efficacy of methotrexate in adult versus pediatric populations.
METHODS
A systematic review and meta-analysis was performed according to recommended PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines.
RESULTS
Methotrexate has reasonable effectiveness in patients with severe AA; adults appear to be more responsive to methotrexate treatment than pediatric patients. Combination treatment results in a higher complete response rate than methotrexate stand-alone treatment. A large proportion of patients had recurrence in the setting of tapering treatment. Complication rates were acceptable and similar between adult and pediatric patients.
LIMITATIONS
The studies reviewed were retrospective observational studies with heterogeneity between centers in terms of methotrexate dosages and protocols in use for AA, and there was a lack of data beyond 1 year for the adjunctive treatments.
CONCLUSION
Methotrexate is an effective monotherapy or adjunct therapy in combination with corticosteroids in the treatment of severe AA.
Topics: Alopecia Areata; Humans; Methotrexate
PubMed: 30003990
DOI: 10.1016/j.jaad.2018.06.064 -
Annals of Medicine and Surgery (2012) Dec 2022Alopecia Areata (AA) is found to be the most prevalent autoimmune disorder amongst the general population. It was observed that AA patients are at a significantly higher... (Review)
Review
BACKGROUND
Alopecia Areata (AA) is found to be the most prevalent autoimmune disorder amongst the general population. It was observed that AA patients are at a significantly higher risk of developing obstructive sleep apnea and non-apneic insomnia than patients without AA. On the contrary, patients with identified sleep disorders were found to be more prone to developing AA as compared to the patients without sleep disorders. This study, therefore, validated the hypothesis of a bidirectional association between AA and sleep disorders.
AIMS
In this systematic review, our primary aim is to assess the prevalence of sleep disorders in Alopecia Areata patients while also assessing the inverse relationship between the two disorders.
METHODS
A literature search of MEDLINE, Google Scholar and Cochrane CENTRAL was performed from their inception to April 2022. Articles were selected for inclusion if they met the following eligibility criteria: (a) Studies enrolling patients having alopecia areata to assess the sleep quality. (b) Studies assessing the risks of alopecia areata in individuals with sleep disorder (c) Studies evaluating the bidirectional association between alopecia areata and sleep quality. Case reports, commentaries, and editorials were excluded. The outcomes of recruited studies were qualitatively synthesised and study findings are summarized in the results section and tabulated in summary tables.
RESULTS
Our search on electronic databases yielded 1562 articles. After abstract screening and full text review, 5 cross sectional and 3 cohort studies are included in this systematic review. Cases with PSQI scores higher than 5 and 6 were found to be in greater numbers amongst the AA patient population when compared to the control population ( < 0.001). Moreover, studies showed that patients with sleep disorders were greatly predisposed to develop subsequent AA as compared to patients without sleep disorders (aHR 4.70; 95% CI 3.99-5.54) (P < 0.0001).
CONCLUSION
The findings from our results display a significant bi-directional cause-effect relation between AA and sleep disorders. However, more large-scale observational studies on this subject are required to further validate our findings.
PubMed: 36582873
DOI: 10.1016/j.amsu.2022.104820 -
Frontiers in Medicine 2022Immune-mediated alopecias (IMAs), a group of hair disorders associated with immunological reactions, remain a therapeutic challenge since available treatments are...
BACKGROUND
Immune-mediated alopecias (IMAs), a group of hair disorders associated with immunological reactions, remain a therapeutic challenge since available treatments are generally unfavorable with potential side effects. Platelet-rich plasma (PRP) has been recently proposed as a treatment option based on several limited-quality studies; however, there is no systematic evaluation of PRP efficacy on IMAs in the literature.
OBJECTIVE
To assess PRP's effects in treating IMAs using a systematic review.
METHODS
Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases. A search strategy was designed to retrieve all studies exploring PRP in treating IMAs, including alopecia areata (AA) and primary cicatricial alopecias (PCAs). In addition, all randomized and non-randomized studies reporting subjective and/or objective outcomes of alopecia treatment with PRP were included.
RESULTS
Thirty-two studies were included, comprising 621 patients with AA and 19 patients with PCAs. PRP had superior efficacy as monotherapy in five studies, comparable to intralesional corticosteroids in six studies in AA treatment. In addition, in the analysis of PCAs, including lymphocytic and neutrophilic subtypes, PRP was efficacious in alleviating disease progression in nine studies.
CONCLUSION
PRP is considered a promising treatment for AA and PCAs in patients who experienced unfavorable outcomes from conventional treatment. However, its clinical application remains to be standardized, and its recommendation as a treatment for IMAs could not be ascertained due to a lack of high-quality evidence.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353859], identifier [CRD42022353859].
PubMed: 36507528
DOI: 10.3389/fmed.2022.1058431