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Journal of the European Academy of... Sep 2019Alopecia areata (AA) is a complex immune and polygenic inflammatory disease that causes hair loss on some or all areas of the body; extent, severity and progression vary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alopecia areata (AA) is a complex immune and polygenic inflammatory disease that causes hair loss on some or all areas of the body; extent, severity and progression vary widely among individuals. Alopecia areata, considered one of the most frequently occurring immune diseases, affects 0.2% of the world population at any given time. Uncertainty prevails about the most appropriate intervention for AA. The aim is to evaluate the effectiveness and safety of over 80 interventions for AA, including minoxidil - one of the most promising interventions for patchy AA in children and adults of both sexes.
MATERIAL AND METHODS
An extensive search was conducted of international medical literature involving randomized clinical trials (RCTs) of AA interventions. RCTs were evaluated qualitatively and quantitatively according to the previously published protocol and for seven specific outcomes.
RESULTS
The meta-analysis involving 5% minoxidil vs. placebo presented a significant difference in favor of 5% minoxidil with the moderate quality of evidence in children and adults with patchy AA (RR 8.37 [3.16-22.14], 95% CI). No severe adverse event was reported.
CONCLUSIONS
Treatment of patchy AA with 5% minoxidil proved effective, and clinically and statistically safe in studies with limited sample size; quality of evidence was moderate. Further studies with sound methodological quality, more participants and outcome observations lasting longer than 6 months are needed to address remaining uncertainties.
Topics: Alopecia Areata; Humans; Minoxidil; Randomized Controlled Trials as Topic; Vasodilator Agents
PubMed: 30835901
DOI: 10.1111/jdv.15545 -
Dermatology (Basel, Switzerland) 2023Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been unclear. Therefore, we aimed to investigate this association between AA and SNHL.
METHODS
We performed a systematic review and searched MEDLINE and Embase on July 25, 2022, for cross-sectional, case-control, or cohort studies that examined the association of AA with SNHL. The Newcastle-Ottawa Scale was used to evaluate their risk of bias. A random-effects model meta-analysis was performed to obtain the mean differences in frequency-specific hearing thresholds between AA patients and age-matched healthy controls and the pooled odds ratio for SNHL in relation to AA.
RESULTS
We included 5 case-control studies and 1 cohort study, with none of them rated with high risk of biases. The meta-analysis showed AA patients had significantly higher mean differences in pure-tone hearing thresholds at 4,000 Hz and 12,000-12,500 Hz. The meta-analysis also found increased odds for SNHL among patients with AA (OR: 3.18; 95% CI: 2.06-4.89; I2 = 0%).
CONCLUSIONS
AA is associated with an increase of SNHL, especially at high frequencies. Otologic consultation may be indicated if AA patients present with hearing loss or tinnitus.
Topics: Humans; Alopecia Areata; Cohort Studies; Cross-Sectional Studies; Hearing Loss, Sensorineural
PubMed: 37094565
DOI: 10.1159/000530784 -
Journal of the European Academy of... Jan 2023Alopecia areata (AA) is an autoimmune-mediated non-scarring hair loss whose stigmatizing effect may have a severe psychosocial impact. AA has been reported to be... (Review)
Review
Alopecia areata (AA) is an autoimmune-mediated non-scarring hair loss whose stigmatizing effect may have a severe psychosocial impact. AA has been reported to be correlated with bullying, reduced quality of life (QoL) and psychiatric comorbidities. The effect of AA on QoL in adult patients has been systematically reviewed and found to be detrimental. No systematic evaluation of QoL in children with AA has been performed. The aim of this review is to systematically describe QoL in the child and adolescent population affected by AA. A systematic review of multiple databases and grey literature sources was conducted. Search terms included, but were not limited to, alopecia areata and quality of life. Only studies reporting results on health-related QoL in children and adolescents were included. We evaluated the studies regarding the risk of bias, and conceptual rigour concerning the quality of life and performed a descriptive synthesis of findings. Eight studies met the inclusion criteria, encompassing 358 participants with AA and 64 healthy peers. Seven studies were quantitative using four different standardized questionnaires and scores to measure QoL. One study used a qualitative design. All studies described impairment of children and adolescents' QoL by AA. The most consistently affected QoL domain was embarrassment and self-consciousness. Further psychosocial implications of AA included bullying and limiting participation in school or spare time activities. Existing evidence indicates a substantial impact of AA on QoL in children. In daily clinical practice as well as for developing new treatments QoL in paediatric AA plays a critical role. It should be considered a key outcome in clinical research and decision-making.
PubMed: 36606560
DOI: 10.1111/jdv.18848 -
JAMA Dermatology Jan 2024Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and vitiligo, but there is a current US Food and Drug Administration (FDA) boxed warning label for oral and topical JAK inhibitors regarding increased risk of major adverse cardiovascular events (MACE), venous thromboembolism (VTE), serious infections, malignant neoplasm, and death. However, this boxed warning was precipitated by results of the Oral Rheumatoid Arthritis Trial (ORAL) Surveillance study, which only included patients with rheumatoid arthritis, and the same association may not be observed in dermatologic conditions.
OBJECTIVE
To determine the risk of all-cause mortality, MACE, and VTE with JAK inhibitors in patients with dermatologic conditions.
DATA SOURCES
PubMed and ClinicalTrials.gov were searched from database inception to April 1, 2023.
STUDY SELECTION
This review included phase 3 randomized clinical trials with a placebo/active comparator group of JAK inhibitors used for a dermatologic indication with FDA approval or pending approval or with European Union or Japanese approval. Studies without a comparison group, case reports, observational studies, and review articles were excluded.
DATA EXTRACTION AND SYNTHESIS
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Adverse events using odds ratios (ORs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method. Studies were screened, data abstracted, and quality assessed by 2 independent authors. The protocol was prospectively registered with PROSPERO.
MAIN OUTCOMES AND MEASURES
Primary outcomes were a composite of adjudicated MACE and all-cause mortality, and VTE.
RESULTS
The analysis included 35 randomized clinical trials with 20 651 patients (mean [SD] age, 38.5 [10.1] years; male, 54%) and a mean (SD) follow-up time of 4.9 (2.68) months. Findings did not show a significant difference between JAK inhibitors and placebo/active comparator in composite MACE and all-cause mortality (OR, 0.83; 95% CI, 0.44-1.57) or VTE (OR, 0.52; 95% CI, 0.26-1.04).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, use of JAK inhibitors was not associated with increased risk of all-cause mortality, MACE, and VTE compared to the placebo/active comparator groups. Additional trials with long-term follow-up are needed to better understand the safety risks of JAK inhibitors used for dermatologic indications.
Topics: Humans; Male; Adult; Janus Kinase Inhibitors; Venous Thromboembolism; Arthritis, Rheumatoid; Dermatitis, Atopic; Treatment Outcome
PubMed: 37910098
DOI: 10.1001/jamadermatol.2023.4090 -
International Journal of Dermatology Apr 2020Several studies have investigated the oxidative stress parameters in alopecia areata (AA) patients with variable results. This study aims to analyze the association... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have investigated the oxidative stress parameters in alopecia areata (AA) patients with variable results. This study aims to analyze the association between oxidative stress and AA based on current literature.
METHODS
A systematic review of the existing literature was performed in PubMed, Scopus, and Cochrane databases by two authors independently. Mean and standard deviation values of oxidative stress parameters of AA patients and healthy controls were extracted for quantitative analysis.
RESULTS
A total of 18 studies were included in the analysis. Patients with AA had impaired oxidative balance with elevated levels of serum malondialdehyde, nitric oxide, and total oxidant capacity and lower levels of serum superoxide dismutase, paraoxonase, glutathione peroxidase, and total antioxidant capacity. Levels of oxidative parameters were significantly higher in severe AA compared to mild/moderate AA. Heterogeneity in the baseline characteristics of the included studies and limited available data for most parameters were the limitations of this study.
CONCLUSIONS
Current evidence suggests that AA is associated with oxidative stress. More studies are needed to strengthen this association. Moreover, studies evaluating the role of antioxidant use in AA may be rewarding.
Topics: Alopecia Areata; Antioxidants; Aryldialkylphosphatase; Glutathione Peroxidase; Humans; Malondialdehyde; Nitric Oxide; Oxidative Stress; Superoxide Dismutase
PubMed: 31875951
DOI: 10.1111/ijd.14753 -
Frontiers in Immunology 2023JAK inhibitors treat various autoimmune diseases, but an updated systematic review in treating alopecia areata is currently lacking. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
JAK inhibitors treat various autoimmune diseases, but an updated systematic review in treating alopecia areata is currently lacking.
OBJECTIVE
Evaluate the specific efficacy and safety of JAK inhibitors in alopecia areata by systematic review and meta-analysis.
METHODS
Eligible studies in PubMed, Embase, Web of Science, and Clinical Trials up to May 30, 2022, were searched. We enrolled in randomized controlled trials and observational studies of applying JAK inhibitors in alopecia areata.
RESULTS
6 randomized controlled trials with 1455 patients exhibited SALT (odd ratio [OR], 5.08; 95% confidence interval [CI], 3.49-7.38), SALT (OR, 7.40; 95% CI, 4.34-12.67) and change in SALT score (weighted mean difference [WSD], 5.55; 95% CI, 2.60-8.50) compared to the placebo. The proportion of 26 observational studies with 563 patients of SALT was 0.71(95% CI, 0.65-0.78), SALT was 0.54(95% CI 0.46-0.63), SALT was 0.33(95% CI, 0.24-0.42), and SALT score (WSD, -2.18; 95% CI, -3.12 to -1.23) compared with baseline. Any adverse effects occurred in 921 of 1508 patients; a total of 30 patients discontinued the trial owing to adverse reactions.
LIMITATIONS
Few randomized controlled trials met the inclusion criteria and insufficiency of eligible data.
CONCLUSION
JAK inhibitors are effective in alopecia areata, although associated with an increased risk.
Topics: Humans; Janus Kinase Inhibitors; Alopecia Areata; Autoimmune Diseases; Odds Ratio
PubMed: 37334349
DOI: 10.3389/fimmu.2023.1195858 -
Dermatitis : Contact, Atopic,... 2024This systematic review and meta-analysis aimed to explore the association between atopic Dermatitis® (AD) and alopecia areata (AA). A comprehensive search was conducted... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to explore the association between atopic Dermatitis® (AD) and alopecia areata (AA). A comprehensive search was conducted in PubMed, Embase, Cochrane, and Web of Science from the inception of each database to November 10, 2022 for relevant studies. As there is a potential bilateral association between the 2 diseases, we assessed the prevalence/incidence of AA in patients with AD and the prevalence/incidence of AD in patients with AA. A total of 29 studies involving 11,233,448 participants were included in this analysis. AA was the exposure factor in 23 studies, AD in 7 studies, and both in 1 study. The meta-analysis revealed that the prevalence of AD was 11.2% (7.7%-15.1%) in patients with AA, and the prevalence of AA was 3.2% (95% confidence interval [CI]: 0.0%-11.5%) in patients with AD. The incidence of AD in AA patients was found to vary with age ( = 0.07). Based on 7 studies, there was a significant association between AD and AA when AA was the exposure factor [odds ratio, OR, = 4.537 (95% CI: 2.409-8.544)]; based on 10 studies, there was also a significant association between AD and AA when AD was the exposure factor [OR = 2.643 (95% CI: 1.737-3.995)]. In conclusion, this meta-analysis demonstrated the 2-way association between AD and AA, providing a clinical reference for disease prevention and control.
Topics: Alopecia Areata; Humans; Dermatitis, Atopic; Prevalence; Incidence
PubMed: 37471232
DOI: 10.1089/derm.2023.0114 -
Medicine Aug 2018Published studies have reported conflicting and heterogeneous results regarding the association between human leukocyte antigen (HLA)-DRB1 polymorphisms and alopecia... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Published studies have reported conflicting and heterogeneous results regarding the association between human leukocyte antigen (HLA)-DRB1 polymorphisms and alopecia areata (AA). This study aimed to review and quantitatively analyze the association between HLA-DRB1 polymorphisms and AA.
METHODS
In this study, all relevant publications were searched through December 2016. Odds ratios (ORs) and confidence intervals (CIs) for comparisons between case and control groups were calculated. Stata 14.0 software was used to perform statistical analysis. This research does not require formal ethical approval because the data used in this analysis do not involve personal information and thus do not affect privacy.
RESULTS
Twelve articles were identified. For HLA-DRB1*04 and HLA-DRB1*16 polymorphisms, the OR (95% CIs) was 1.49 (1.24-1.78) and 1.61 (1.08-2.41), and P was <.01 and <.01, respectively. For HLA-DRB1*0301, HLA-DRB1*09, and HLA-DRB1*13 polymorphisms, the OR (95% CIs) was 0.42 (0.28-0.63), 0.74 (0.55-0.99), and 0.62 (0.40-0.98), and P was <.01, <.01, and <.01, respectively. Statistical evidence revealed no publication bias (P > .05).
CONCLUSION
The present meta-analysis suggested that HLA-DRB1*04 and HLA-DRB1*16 polymorphisms might be associated with increased AA risk, while HLA-DRB1*0301, HLA-DRB1*09, and HLA-DRB1*13 polymorphisms might decrease the AA risk. Studies with adequate methodological quality on gene-gene and gene-environment interactions are needed to validate the results in the future.
Topics: Alleles; Alopecia Areata; Case-Control Studies; Genetic Predisposition to Disease; HLA-DRB1 Chains; Humans; Odds Ratio; Polymorphism, Single Nucleotide
PubMed: 30095639
DOI: 10.1097/MD.0000000000011790 -
The Journal of Dermatology Jan 2022Trichoscopy represents a non-invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established,... (Review)
Review
Trichoscopy represents a non-invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established, some key issues remain to be addressed. Complexity and inconsistency in terminology in past literature are likely to confuse investigators when they are recording, reporting, and retrieving the findings. In addition, a diagnostic algorithm adopting sufficiently integrated and updated findings is not readily available. By adopting a systematic review approach, this review attempted to redefine major trichoscopic findings and integrate their synonyms individually into the most frequently used terms besides identifying and discussing terms which potentially cause confusion. The findings are categorized into five subgroups: hair shaft, follicular, perifollicular, scalp findings, and hair distribution pattern abnormalities. The calculation of sensitivities and positive predictive values of such redefined findings was conducted by reviewing the descriptions in the past literature on major hair diseases, including alopecia areata, androgenetic alopecia/female pattern hair loss, telogen effluvium, trichotillomania, lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus erythematosus, folliculitis decalvans, tinea capitis, and dissecting cellulitis, to confirm the diagnostically meaningful findings for representative diseases. This attempt redefined, for instance, yellow dots, short vellus hairs, exclamation mark hairs, black dots, and broken hairs as the findings of diagnostic significance for alopecia areata and hair diameter diversity, peripilar sign, and focal atrichia for androgenetic alopecia/female pattern hair loss. An updated diagnostic flowchart is proposed with the instructions to maximize its usefulness. Current limitations and future perspectives of trichoscopy as well as other emerging non-invasive diagnostic modalities for hair diseases are also discussed.
Topics: Alopecia; Alopecia Areata; Dermoscopy; Female; Hair; Hair Diseases; Humans; Software Design
PubMed: 34806223
DOI: 10.1111/1346-8138.16233 -
Journal of Cosmetic Dermatology May 2023Alopecia areata (AA) is characterized by limited non-scarring patchy alopecia, which appears as round or oval patches and is prone to recurrence, causing severe... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alopecia areata (AA) is characterized by limited non-scarring patchy alopecia, which appears as round or oval patches and is prone to recurrence, causing severe psychological burdens to patients. No specific device has been approved by the FDA for the treatment of baldness, but new treatments are being investigated and treatments such as the excimer laser, He- Ne laser, and excimer lamp have been proposed. A growing number of studies have found that fractional lasers also have great potential in the treatment of AA.
METHODS
A literature search and meta-analysis using Review Manager 5.4 software to investigate the efficacy of fractional laser treatment for AA.
RESULTS
Fractional laser combined with minoxidil (RR 1.32, 95% CI 1.17-1.49, p < 0.00001) or cortisol (RR 1.39, 95% CI 1.15-1.67, p = 0.00006) was more effective than either drug alone in the treatment of AA. Of course, the fractional laser alone was also effective in the treatment of AA (RR 10.33, 95% CI 2.07-51.36, p = 0.004) and more effective than cortisol alone (RR 1.86, 95% CI 1.36-2.52, p < 0.00001), and there was no effect on the occurrence of adverse effects (p = 0.49 > 0.05). When compared to other physical treatments of a comparable kind, fractional laser therapy's effectiveness was not significantly different (p = 0.15 > 0.05).
CONCLUSION
Our results show that the use of fractional lasers can effectively treat alopecia areata.
Topics: Humans; Alopecia Areata; Hydrocortisone; Treatment Outcome; Alopecia; Lasers, Excimer
PubMed: 36718837
DOI: 10.1111/jocd.15630