-
Journal of the American Academy of... May 2019Several studies have reported associations between alopecia areata and diverse thyroid diseases. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have reported associations between alopecia areata and diverse thyroid diseases.
OBJECTIVE
To investigate the odds ratio and prevalence rate of thyroid dysfunction and autoimmune thyroid diseases in patients with alopecia areata.
METHODS
A systematic review of the studies published before March 20, 2018, was performed by using the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The clinical and laboratory findings associated with thyroid dysfunction and autoimmunity were extracted for quantitative analysis.
RESULTS
A total of 50 studies were analyzed. Patients with alopecia areata had higher odds of abnormal findings on thyroid function tests, thyroid dysfunction, positive thyroid autoantibodies, and autoimmune thyroid diseases. Moreover, their prevalence rate was much higher than that in the general population.
LIMITATIONS
The heterogeneity in baseline characteristics and outcome reporting across the studies.
CONCLUSION
Current evidence suggests that thyroid dysfunction and autoimmune thyroid diseases are more prevalent in patients with alopecia areata. Clinicians may be encouraged to screen for the associated signs and symptoms to achieve better outcomes.
Topics: Alopecia Areata; Autoantibodies; Autoimmune Diseases; Comorbidity; Humans; Prevalence; Thyroid Diseases; Thyroid Function Tests
PubMed: 30447313
DOI: 10.1016/j.jaad.2018.10.066 -
Dermatology (Basel, Switzerland) 2021The link between autoimmune gut disorders and different types of hair loss conditions has been recently investigated with an increased interest. With acknowledgement of... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The link between autoimmune gut disorders and different types of hair loss conditions has been recently investigated with an increased interest. With acknowledgement of the connection between immune dysregulation and the gut microbiome, this pathway is now becoming recognized as playing an important role in hair growth. The inflammatory cascade that results from the disruption of gut integrity such as seen in inflammatory bowel diseases (IBD) has been associated with certain types of alopecia.
OBJECTIVE
The aim of this work was to evaluate the association between alopecia and IBD.
EVIDENCE REVIEW
A primary literature search was conducted using the PubMed, Embase, and Web of Science databases to identify articles on co-occurring alopecia and IBD from 1967 to 2020. A total of 79 studies were included in the review. A one-way proportional meta-analysis was performed on 19 of the studies to generate the pooled prevalence of alopecia and IBD.
FINDING
The pooled prevalence of non-scarring alopecia among IBD patients was 1.12% (k = 7, I2 = 98.6%, 95% CI 3.1-39.9); the prevalence of IBD among scarring and non-scarring alopecia was 1.99% (k = 12; I2 = 99%, 95% CI 6.2-34). The prevalence of non-scarring alopecia areata (AA) among IBD was compared to the prevalence of AA in the general population (0.63 vs. 0.1%; p < 0.0001). Similarly, the prevalence of IBD among the scarring and non-scarring alopecia groups was compared to the prevalence of IBD in the general population (1.99 vs. 0.396%; p = 0.0004).
CONCLUSION
IBD and alopecia, particularly AA, appear to be strongly associated. Dermatology patients with alopecia may benefit from screening for IBD.
Topics: Alopecia; Anti-Inflammatory Agents, Non-Steroidal; Biological Products; Cicatrix; Colitis, Ulcerative; Crohn Disease; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Prevalence
PubMed: 33440387
DOI: 10.1159/000512747 -
Journal of the American Academy of... May 2024
Review
PubMed: 38796079
DOI: 10.1016/j.jaad.2024.05.037 -
Clinical and Experimental Dermatology Feb 2023Alopecia areata (AA) is a nonscarring alopecia with an estimated global prevalence of 2% and limited data on the efficacy of current treatment. Clinical practice...
INTRODUCTION
Alopecia areata (AA) is a nonscarring alopecia with an estimated global prevalence of 2% and limited data on the efficacy of current treatment. Clinical practice guidelines (CPGs) provide recommendations based on best available evidence. It is unclear how many AA CPGs are available globally.
AIM
To systematically search for and identify CPGs on AA and to critically appraise their quality using validated tools.
METHODS
We performed a literature search to identify CPGs published between October 2014 and April 2021, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE), Guidelines International Network, Emergency Care Research Institute guidelines trust, Australian CPGs, Turning Research Into Practice database and DynaMed. The systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Three critical appraisal tools were used: Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer's red flags and United States Institute of Medicine's (IOM) criteria of trustworthiness.
RESULTS
In total, six AA CPGs from seven manuscripts (one CPG was in two parts published in separate papers) were included. The majority (four of six) of the CPGs focused on treatment. Four CPGs (total of five papers) were in English and two CPGs were only available in the original language (one Russian and one Japanese). All AA CPGs demonstrated low quality in several domains in the AGREE II appraisal, including stakeholder involvement and applicability, with the latter being deemed the worst domain for all CPGs, with an average of 29%. The mean (SD) number of Lenzer's red flags for the included CPGs was 3.4 (1.5) out of a total of 8 possible red flags, while the IOM criteria showed 1.6 (0.8) 'fully met' criteria and 3.1 (1.2) 'not met' out of a total of 9 criteria.
CONCLUSION
We found a limited number of AA CPGs, all of which had significant methodological deficiencies. We encourage guideline development groups to use validated checklists/tools to develop reliable and trustworthy CPGs.
Topics: Humans; Alopecia Areata; Dermatology; Australia; Databases, Factual
PubMed: 36641755
DOI: 10.1093/ced/llac025 -
Dermatologic Therapy Mar 2021Considering the different forms, alopecia could be a very common condition with particular therapeutic concerns; thus, recent therapies still require further... (Review)
Review
Considering the different forms, alopecia could be a very common condition with particular therapeutic concerns; thus, recent therapies still require further assessments. Aim of this systematic review was to evaluate efficacy, safety, and therapeutic durability of platelet rich plasma (PRP) in treating various forms of alopecia. A total of 64 articles were found through a systematic search, and eight original articles were included in the study, based on inclusion/exclusion criteria. In most studies (62.5%) patients' conditions had improved by receiving PRP therapy; these cases experienced an increase in growth and thickness of hair. Simultaneous use of PRP and Minoxidil demonstrated the highest rate of improvement and satisfaction. The highest efficacy in patients with alopecia areata was 76% and the lowest efficacy was 31.7% and in patients with androgenetic alopecia the highest efficacy was 42.75% and the lowest reported efficacy was 25.55%. The main side effect was pain due to PRP injection, which disappeared after ending the treatment and only one article reported more serious side effects. Recurrence after treatment was also reported in only one article. PRP is a safe and easy method for treating hair loss and has limited adverse effects. Optimization of this method depends on dosage, number of sessions and their intervals, and injection techniques. According to the results, the use of PRP due to its relatively high efficiency, low and tolerable side effects, and low recurrence rate can be a good method for the treatment of alopecia and hair loss.
Topics: Alopecia; Alopecia Areata; Hair; Humans; Injections; Minoxidil; Platelet-Rich Plasma; Treatment Outcome
PubMed: 33421285
DOI: 10.1111/dth.14768 -
The Journal of Dermatology Jun 2018The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features... (Review)
Review
The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6-100% patients), short vellus hairs (34-100%), black dots (0-84%), broken hairs (0-71%) and exclamation mark hairs (12-71%). Tapered hairs (5-81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11-96%), pigtail (circle) hairs (4-61%) and Pohl-Pinkus constrictions (2-10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature.
Topics: Alopecia Areata; Dermoscopy; Diagnosis, Differential; Hair; Humans; Tinea Capitis; Trichotillomania
PubMed: 29569271
DOI: 10.1111/1346-8138.14283 -
Journal of the American Academy of... Aug 2022
Meta-Analysis
Topics: Alopecia Areata; Hair; Humans
PubMed: 34902493
DOI: 10.1016/j.jaad.2021.12.009 -
Pediatric Dermatology Jul 2019Epidermolysis bullosa (EB) is a group of rare genetic skin diseases characterized by the gene mutations encoding adhesion proteins within the skin. These adhesion...
BACKGROUND
Epidermolysis bullosa (EB) is a group of rare genetic skin diseases characterized by the gene mutations encoding adhesion proteins within the skin. These adhesion proteins are also present in normal hair follicles. Anecdotally, there have been reports of scalp alopecia as a complication of EB and there are scattered cases in the literature, but alopecia has generally been overlooked in severe blistering diseases because it is regarded as a cosmetic issue. Therefore, there is no consensus about the natural history and clinical manifestations of alopecia in EB to allow potential intervention.
OBJECTIVES
To review the current literature detailing the pathogenesis and clinical presentations of alopecia in EB patients.
METHODS
Relevant human studies were searched in Medline, PubMed, and EMBASE electronic databases up to October 2018.
RESULTS
Only 15 reports detailed 29 EB patients with demographic and clinical manifestations of alopecia. Vertical biopsy sections were the most common method of alopecia diagnosis, and the most common pattern was patchy scalp alopecia (45%) followed by diffuse alopecia (41%). The most robust finding was nonspecific scarring alopecia in all dystrophic EB (DEB) patients and nonspecific nonscarring alopecia in most patients with EB simplex (EBS).
CONCLUSIONS
Hair abnormalities observed in EB are of variable severity despite there being no universal validated alopecia scoring system, with alopecia occurring secondary to blistering, or in areas prone to trauma.
Topics: Adult; Alopecia Areata; Comorbidity; Epidermolysis Bullosa Simplex; Female; Humans; Male; Prognosis; Risk Assessment; Severity of Illness Index
PubMed: 31177584
DOI: 10.1111/pde.13866 -
JAMA Dermatology Oct 2018Contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is a preferred treatment for severe alopecia areata; however, the defined criteria for... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is a preferred treatment for severe alopecia areata; however, the defined criteria for therapeutic hair regrowth and regrowth rate have been highly heterogeneous across studies.
OBJECTIVE
To summarize the clinical outcomes of contact immunotherapy for alopecia areata according to standardized criteria for therapeutic hair regrowth and several prognostic factors.
DATA SOURCE
A database search of MEDLINE, Embase, and Cochrane Library was performed for articles published before November 20, 2017, using the search terms areata, totalis, universalis, sensitizer, sensitization, immunotherapy, DPCP, diphenylcyclopropenone, diphencyprone, SADBE, and squaric.
STUDY SELECTION
Clinical trials or observational studies that investigated contact immunotherapy for alopecia areata and subgrouped the disease into patchy alopecia or alopecia totalis/universalis and reported their hair regrowth rates were included, whereas studies that investigated combination therapy or nonconventional protocol and case series or reviews were excluded.
DATA EXTRACTION AND SYNTHESIS
The following data were extracted from each of the studies included in this meta-analysis: study year and setting, sensitizer type, study population, study population composition by disease subtype, defined criteria for therapeutic hair regrowth, and regrowth rate of contact immunotherapy. The incidence of adverse effects and recurrence rate were also recorded. A random effects model was used for data synthesis because of the expected high heterogeneity of the included studies.
MAIN OUTCOMES AND MEASURES
The main outcome was therapeutic hair regrowth rate according to the 4-grade criteria for therapeutic regrowth. Secondary outcomes included incidence of treatment-related adverse effects and recurrence rate.
RESULTS
Forty-five studies comprising 2227 patients were analyzed. The overall rate of any hair regrowth was 65.5% among patients with alopecia areata (74.6% in the patchy alopecia and 54.5% in the alopecia totalis/universalis subgroups). However, the complete regrowth rate was 32.3% (24.9% in the patchy alopecia and 32.3% in the alopecia totalis/universalis subgroups). Disease extent of 50% or greater (odds ratio [OR], 3.05; 95% CI, 2.26-4.12), atopic history (OR, 1.61; 95% CI, 1.03-2.50), and nail involvement (OR, 2.06; 95% CI. 1.26-3.36) were associated with poorer therapeutic outcome. Recurrence rates were 38.3% among patients receiving maintenance treatment and 49.0% among those not receiving maintenance treatment.
CONCLUSIONS AND RELEVANCE
Various factors were associated with the clinical outcomes of contact immunotherapy for alopecia areata, with significant differences in hair regrowth rates according to the level of expected therapeutic regrowth. Quantitative summarization may improve patient education and lead to better therapeutic adherence and outcomes.
Topics: Adjuvants, Immunologic; Alopecia; Alopecia Areata; Cyclobutanes; Cyclopropanes; Hair; Humans; Immunotherapy; Recurrence
PubMed: 30073292
DOI: 10.1001/jamadermatol.2018.2312 -
Journal of the American Academy of... Mar 2018
Review
Topics: 11-beta-Hydroxysteroid Dehydrogenases; Alopecia Areata; Anthralin; Bimatoprost; Cyclopropanes; Dermatologic Agents; Drug Therapy, Combination; Eyebrows; Eyelashes; Facial Dermatoses; Humans; Latanoprost; Minoxidil; Photosensitizing Agents; Prostaglandins F, Synthetic
PubMed: 28987491
DOI: 10.1016/j.jaad.2017.09.054