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American Family Physician Apr 1990Alopecia areata is an asymptomatic, nonscarring hair loss with spontaneous remissions and exacerbations. Although the etiology is unknown, the disorder is associated... (Review)
Review
Alopecia areata is an asymptomatic, nonscarring hair loss with spontaneous remissions and exacerbations. Although the etiology is unknown, the disorder is associated with vitiligo, atopy, pernicious anemia, Down syndrome and thyroiditis. The area of hair loss may remain localized or may involve the entire scalp or all body hair. Treatment is difficult to assess because of individual response and spontaneous remissions, as well as a high rate of relapse. Intralesional injection of corticosteroids is the most common mode of treatment, although systemic steroid therapy, contact allergens, minoxidil, psoralens plus ultraviolet light, and other agents have been tried.
Topics: Adjuvants, Immunologic; Adrenal Cortex Hormones; Alopecia Areata; Dermatitis, Contact; Dinitrochlorobenzene; Hair; Humans; Male; Minoxidil; Photochemotherapy
PubMed: 2181836
DOI: No ID Found -
Journal of the American Academy of... Apr 2000Alopecia areata (AA) is a nonscarring hair loss condition. Among the many factors under investigation in the pathogenesis of AA, the main areas of concentration have... (Review)
Review
Alopecia areata (AA) is a nonscarring hair loss condition. Among the many factors under investigation in the pathogenesis of AA, the main areas of concentration have been genetic constitution as well as nonspecific immune and organ-specific autoimmune reactions. Treatment with intralesional corticosteroid injections for localized patchy AA and topical immunotherapy for extensive AA have proven successful in the majority of patients, although all treatments are palliative and do not change the prognosis of the disease.
Topics: Administration, Topical; Adult; Alopecia Areata; Animals; Anti-Inflammatory Agents; Child; Cyclosporine; Disease Models, Animal; Female; Glucocorticoids; Humans; Immunotherapy; Male; PUVA Therapy; Steroids
PubMed: 10727299
DOI: No ID Found -
Journal of the American Academy of... Jun 2021We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata.
BACKGROUND
We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata.
OBJECTIVE
To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata.
METHODS
Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%.
RESULTS
Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]).
LIMITATIONS
The study had low representation from Africa, South America, and Asia.
CONCLUSION
There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care.
Topics: Alopecia Areata; Comorbidity; Consensus; Delphi Technique; Dermatology; Dermoscopy; Global Burden of Disease; Hair Follicle; Humans; International Cooperation; Practice Guidelines as Topic; Prognosis; Risk Factors; Severity of Illness Index
PubMed: 32926985
DOI: 10.1016/j.jaad.2020.09.028 -
Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation.Journal of the American Academy of... Sep 2004
Topics: Alopecia Areata; Clinical Trials as Topic; Comorbidity; Endpoint Determination; Humans; Nails; Severity of Illness Index
PubMed: 15337988
DOI: 10.1016/j.jaad.2003.09.032 -
The Journal of Dermatology Feb 2024Alopecia areata (AA) affects individuals of all ages and is intractable in severe relapsing cases. Dermatologists and other healthcare providers should consider AA in... (Review)
Review
Alopecia areata (AA) affects individuals of all ages and is intractable in severe relapsing cases. Dermatologists and other healthcare providers should consider AA in the medical context and prioritize treatment. Several randomized controlled clinical studies on Janus kinase (JAK) inhibitors with different specificities for the treatment of AA are ongoing. These studies have encouraged us to appreciate the importance of a definitive diagnosis and accurate evaluation of AA before and during treatment. Following our previous review article in 2017, here we provide the second part of this two-review series on the recent progress in the multidisciplinary approaches to AA from more than 1800 articles published between July 2016 and December 2022. This review focuses on the evaluation, diagnosis, and treatment of AA. We also provide the latest information on the safety and efficacy of JAK inhibitors for the treatment of AA and describe their mechanisms of action.
Topics: Humans; Alopecia Areata; Janus Kinase Inhibitors; Treatment Outcome
PubMed: 38087654
DOI: 10.1111/1346-8138.17064 -
Experimental Dermatology Mar 2020A 3500-year-old papyrus from ancient Egypt provides a list of treatments for many diseases including "bite hair loss," most likely alopecia areata (AA). The treatment of... (Review)
Review
A 3500-year-old papyrus from ancient Egypt provides a list of treatments for many diseases including "bite hair loss," most likely alopecia areata (AA). The treatment of AA remained largely unchanged for over 1500 years. In 30 CE, Celsus described AA presenting as scalp alopecia in spots or the "windings of a snake" and suggested treatment with caustic compounds and scarification. The first "modern" description of AA came in 1813, though treatment still largely employed caustic agents. From the mid-19th century onwards, various hypotheses of AA development were put forward including infectious microbes (1843), nerve defects (1858), physical trauma and psychological stress (1881), focal inflammation (1891), diseased teeth (1902), toxins (1912) and endocrine disorders (1913). The 1950s brought new treatment developments with the first use of corticosteroid compounds (1952), and the first suggestion that AA was an autoimmune disease (1958). Research progressively shifted towards identifying hair follicle-specific autoantibodies (1995). The potential role of lymphocytes in AA was made implicit with immunohistological studies (1980s). However, studies confirming their functional role were not published until the development of rodent models (1990s). Genetic studies, particularly genome-wide association studies, have now come to the forefront and open up a new era of AA investigation (2000s). Today, AA research is actively focused on genetics, the microbiome, dietary modulators, the role of atopy, immune cell types in AA pathogenesis, primary antigenic targets, mechanisms by which immune cells influence hair growth, and of course the development of new treatments based on these discoveries.
Topics: Alopecia Areata; Animals; Autoimmune Diseases; Dermatology; Disease Models, Animal; Egypt; Hair; Hair Follicle; History, 19th Century; History, 20th Century; History, Ancient; Humans; Lymphocytes; Models, Biological
PubMed: 31960494
DOI: 10.1111/exd.14073 -
Paediatric Drugs Oct 2017Pediatric alopecia areata is a spectrum of autoimmune non-scarring alopecia in which some patients lose small patches of hair from their scalp but others lose more or... (Review)
Review
Pediatric alopecia areata is a spectrum of autoimmune non-scarring alopecia in which some patients lose small patches of hair from their scalp but others lose more or all of the hair from the scalp and body, including eyebrows and eyelashes. Few studies have looked at therapies for this disorder in children, so much of the data are derived from adult literature and describe off-label use of medication. Generally, topical therapies consisting of topical steroids and topical irritating compounds/contact sensitizers are used. Systemic therapies that block the immune system, including Janus kinase (JAK) inhibitors, have also been used in this disease. This paper reviews the data on therapy for alopecia areata in pediatric patients.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Child; Drug Administration Routes; Humans; Off-Label Use
PubMed: 28551734
DOI: 10.1007/s40272-017-0239-z -
Indian Journal of Dermatology,... 2013Alopecia areata (AA) is a common form of non-scarring hair loss of scalp and/or body. Genetic predisposition, autoimmunity, and environmental factors play a major role... (Review)
Review
Alopecia areata (AA) is a common form of non-scarring hair loss of scalp and/or body. Genetic predisposition, autoimmunity, and environmental factors play a major role in the etiopathogenesis of AA. Patchy AA is the most common form. Atopy and autoimmune thyroiditis are most common associated conditions. Peribulbar and intrabulbar lymphocytic inflammatory infiltrate resembling "swarm of bees" is characteristic on histopathology. Treatment is mainly focused to contain the disease activity. Corticosteroids are the preferred treatments in form of topical, intralesional, or systemic therapy. Camouflage in the form of wigs may be an alternative option in refractory cases.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Humans; Scalp
PubMed: 23974575
DOI: 10.4103/0378-6323.116725 -
Expert Review of Clinical Immunology Jun 2023Alopecia areata is a heterogenous, immune-mediated hair loss disorder that can affect any hair-bearing site on the body. Despite being one of the most prevalent... (Review)
Review
INTRODUCTION
Alopecia areata is a heterogenous, immune-mediated hair loss disorder that can affect any hair-bearing site on the body. Despite being one of the most prevalent autoimmune skin diseases, treatments have historically been limited to off-label medications that have demonstrated limited efficacy, especially in more severe forms of disease. Thus, there has long been an unmet need for rigorously studied therapeutics in alopecia areata.
AREAS COVERED
Janus kinase inhibitors have proven to be an effective class of drugs for treating several inflammatory disorders. One such drug, baricitinib, has recently demonstrated significant hair regrowth in phase 2 and 3 alopecia areata trials. It has since become the first systemic therapy approved for treating severe alopecia areata. This review examines the role of Janus kinase pathways in alopecia areata's pathogenesis and the safety and efficacy of baricitinib for treating severe alopecia areata.
EXPERT OPINION
The approval of baricitinib for treating severe alopecia areata marks a major milestone in the disease's history. While baricitinib has proven to be efficacious for this indication and has demonstrated an overall good safety profile, patients' individual risk factors for serious adverse events should be assessed during shared decision-making with patients before initiating treatment.
Topics: Humans; Alopecia Areata; Sulfonamides; Pyrazoles
PubMed: 37042112
DOI: 10.1080/1744666X.2023.2200166 -
Dermatologic Therapy Nov 2020Immune checkpoint inhibitors (ICI) improve the ability of the immune system to target cancer cells by blocking signaling through either the cytotoxic... (Review)
Review
Immune checkpoint inhibitors (ICI) improve the ability of the immune system to target cancer cells by blocking signaling through either the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death (PD-1) receptor, or its ligand (PD-L1). They have been found to cause a variety of immune-related adverse events (irAEs) including a form of nonscarring alopecia that resembles alopecia areata (AA) in presentation and histology. Clinical features of ICI-induced AA are poorly described. We queried the Pubmed database for cases of AA secondary to ICI use reporting on extent of hair loss, treatments attempted, alopecia outcome, and time of follow-up with 13 cases identified. Although most patients had localized hair loss with subsequent regrowth, four of them experienced extensive and persistent AA, lasting up to a year. All but one patient continued ICI after the onset of hair loss. Many used topical corticosteroids with varying outcomes. Possible prognostic factors for severe and persistent disease may include young age and male sex. However, the low number of reported cases limits the generalizability of these findings. Tumor response was positive in every case of immune-induced AA where it was reported. Further investigation will be needed to better characterize clinical features of this irAE, risk factors for persistent disease, and determine its optimal management.
Topics: Alopecia Areata; Databases, Factual; Humans; Immune Checkpoint Inhibitors; Male; Neoplasms; Programmed Cell Death 1 Receptor
PubMed: 32799412
DOI: 10.1111/dth.14171