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Frontiers in Pharmacology 2022Due to the lack of comprehensive evidence based on prospective studies, the efficacy and safety of Janus Kinase (JAK) inhibitors (including tofacitinib, ruxolitinib,...
Due to the lack of comprehensive evidence based on prospective studies, the efficacy and safety of Janus Kinase (JAK) inhibitors (including tofacitinib, ruxolitinib, baricitinib, ritlecitinib and brepocitinib) for alopecia areata (AA) are yet to be proved. The systematic review and meta-analysis was performed pursuant to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline and registered on PROSPERO (CRD42022303007). Fourteen prospective studies (5 RCTs and 9 non-RCTs), enrolling a total of 1845 patients with AA, were included for quantitative analysis. In RCTs, oral JAK inhibitors resulted in higher good response rate compared with control (RR: 6.86, 95% CI: 2.91-16.16); topical JAK inhibitors did not show any difference compared with control (RR: 1.00, 95% CI: 0.31-3.18). In non-RCTs, the pooled rate of good response to oral, topical and sublingual JAK inhibitors were 63% (95% CI: 44%-80%), 28% (95% CI: 1%-72%) and 11% (95% CI: 1%-29%), respectively. The pooled recurrence rate in patients treated with JAK inhibitors was 54% (95% CI: 39%-69%), mainly due to the withdrawal of JAK inhibitors. In RCTs, no difference was found in the risk of experiencing most kind of adverse events; in non-RCTs, the reported adverse events with high incidence rate were mostly mild and manageable. JAK inhibitors are efficacious and generally well-tolerated in treating AA with oral administration, whereas topical or sublingual administration lacks efficacy. Subgroup analyses indicate that baricitinib, ritlecitinib and brepocitinib seem to have equal efficacy for AA in RCTs; ruxolitinib (vs. tofacitinib) and AA (vs. AT/AU) are associated with better efficacy outcomes in non-RCT. Due to the high recurrence rate after withdrawal of JAK inhibitors, continuous treatment should be considered to maintain efficacy. PROSPERO: CRD 42022303007.
PubMed: 36091777
DOI: 10.3389/fphar.2022.950450 -
Biomedicines Jul 2022Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients' quality of life. The first line of treatment in patchy AA is... (Review)
Review
BACKGROUND
Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients' quality of life. The first line of treatment in patchy AA is triamcinolone acetonide (TrA); however, the efficacy of the treatment varies greatly. Our aim was to investigate the therapeutic effects of platelet-rich plasma (PRP) in the treatment of AA.
METHOD
We performed a systematic literature search in four databases. Randomized clinical trials (RCT) reporting on patients with AA treated with PRP were included, comparing PRP with TrA or a placebo. The primary outcome was the Severity of Alopecia Tool (SALT) score.
RESULTS
Our systematic search provided a total of 2747 articles. We identified four studies eligible for quantitative analysis. The pooled mean differences from the four studies did not exhibit a significant difference in the mean change in the SALT score when PRP and TrA groups were compared (MD =-2.04, CI: -4.72-0.65; I = 80.4%, = 0.14).
CONCLUSIONS
PRP is a promising topical, steroid-free treatment modality in the therapy of AA. No significant difference was found between PRP and TrA treatment; however, further high-quality RCTs are needed to further assess the efficacy of PRP treatment and strengthen the quality of evidence.
PubMed: 36009377
DOI: 10.3390/biomedicines10081829 -
Journal of Cosmetic Dermatology Sep 2022While there are literature reporting increased incidence of hair loss in COVID-19 patients, insufficient evidence exists on the topic to date. This review aims to... (Review)
Review
OBJECTIVE
While there are literature reporting increased incidence of hair loss in COVID-19 patients, insufficient evidence exists on the topic to date. This review aims to identify the existing evidence and clinical characteristics of hair loss with COVID-19 infection.
METHODS
Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including "Alopecia," "Telogen Effluvium (TE)," and "COVID-19" from their inception to November 20, 2021.
RESULTS
A total of 26 articles, with 9 observational studies and 17 case reports or series (a total of 58 cases), were included. Most studies dealt with TE. There were no clear trends between COVID-19 severity and the extent of hair loss. Analysis of the 58 cases also found similar results with most of the cases being female (82.8%), the median onset of hair loss of 2.0 months, and the median time to recovery of hair loss of 5.0 months with a resolution rate of 95%.
CONCLUSION
While this systematic review revealed uncertainty and a lack of strong evidence regarding the association of COVID-19 and hair loss, hair loss in COVID-19 may mainly include TE and be reversible in nature. Future studies are warranted to determine the detailed pathophysiology and risk factors of hair loss in COVID-19, including possible roles of estrogen, progesterone, and pro-inflammatory cytokines.
Topics: Alopecia; Alopecia Areata; COVID-19; Cytokines; Estrogens; Female; Humans; Male; Progesterone
PubMed: 35801366
DOI: 10.1111/jocd.15218 -
Cutaneous and Ocular Toxicology Jun 2022Alopecia Areata is a nonscarring hair loss disorder and is the most common hair loss cause in children. It is a chronic autoimmune disorder with a severe psychological...
INTRODUCTION
Alopecia Areata is a nonscarring hair loss disorder and is the most common hair loss cause in children. It is a chronic autoimmune disorder with a severe psychological impact in patients' lives. JAK inhibitors, in particular Tofacitinib, have been having promising results on Alopecia Areata Treatment. In this study we aimed to do a Systematic Review on the role of Tofacitinib (either orally or topically), considering efficacy and safety, in treating children with Alopecia Areata.
MATERIALS AND METHODS
PubMed, Cochrane and Web of Science databases were searched (up to 1st of September of 2021) looking for Tofacitinib (all text/all fields) and MeSH/Keyword term Alopecia Areata.
RESULTS AND CONCLUSIONS
We included 14 studies and 64 cases in the Systematic Review. From these, 12 were considering systemic administration (47 patients) and two were considering topical administration (17 patients). Responsiveness was as high as 81.3%. The responsiveness was similar among different genders (78.6% in males and 80.0% in females) and either whether administration was topic (70.6% responsiveness) or systemic (85.1% responsiveness). Adverse effects were rare and, when present, were mild. Studies shows promising results in what considers the efficacy and safety of Tofacitinib in the treatment of Alopecia Areata. As the available evidence to date is of low quality, further randomised studies are required to confirm these findings.
Topics: Alopecia; Alopecia Areata; Child; Female; Humans; Male; Piperidines; Pyrimidines
PubMed: 35687530
DOI: 10.1080/15569527.2022.2084622 -
Dermatologic Surgery : Official... Jul 2022Photobiomodulation is a promising therapy for hair loss with negligible side effects. However, the reported effects of photobiomodulation therapy for hair loss are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Photobiomodulation is a promising therapy for hair loss with negligible side effects. However, the reported effects of photobiomodulation therapy for hair loss are inconsistent.
OBJECTIVE
To assess the curative effect of photobiomodulation therapy for the treatment of hair loss.
METHODS
A systematic review of self-controlled studies and randomized controlled trials was conducted. ScienceDirect, PubMed, and Wiley Online Library were searched from the earliest date to May 30, 2021.
RESULTS
Thirty-six studies (966 patients) were included. Two to 4 meta-analyses with different indices were performed separately on 4 groups of studies to test the effectiveness of the following hair loss treatments: ultraviolet light for alopecia areata (AA), red light for androgenetic alopecia (AGA), infrared light for AA, and infrared light for AGA. All meta-analyses showed that treatments were superior to control ( p < .05).
CONCLUSION
The meta-analyses strongly suggested that photobiomodulation therapies with ultraviolet and infrared light were effective for treating AA, and photobiomodulation therapies with red light and infrared light were effective for treating AGA.
Topics: Alopecia; Alopecia Areata; Humans; Low-Level Light Therapy; Treatment Outcome
PubMed: 35510860
DOI: 10.1097/DSS.0000000000003472 -
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 -
Association of CTLA-4 gene polymorphisms and alopecia areata: a systematic review and meta-analysis.Biomarkers : Biochemical Indicators of... Jun 2022To provide evidence of the association between CLTA-4 gene polymorphisms and alopecia areata (AA). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To provide evidence of the association between CLTA-4 gene polymorphisms and alopecia areata (AA).
METHODS
PubMed, EMBASE, Web of Science, Cochrane, Wanfang, and CNKI databases were searched until 30 April 2021. The selection was completed according to the inclusion and exclusion criteria. The study quality assessment was based on Newcastle-Ottawa Scale. The assessment of the association was measured by ORs and 95%CIs.
RESULTS
Nine studies, containing 2858 AA cases and 5444 disease-free control subjects were included. For rs231775 polymorphism, no significant association with AA was found, which was A a, OR = 1.02 [0.81, 1.30], = 0.85; AA aa, OR = 1.26 [0.81, 1.97], = 0.31; Aa aa, OR = 1.04 [0.54, 2.01], = 0.91; AA + Aa aa, OR = 1.04 [0.71, 1.53], = 0.82; AA Aa + aa, OR = 1.31 [0.97, 1.78], = 0.08. For rs3087243 polymorphism, also no significant association was found, which was A a, OR = 0.93 [0.78, 1.11]; = 0.40, AA aa, OR = 0.68 [0.44, 1.06]; = 0.09; Aa aa, OR = 0.87 [0.45, 1.68], = 0.68; AA + Aa aa, OR = 0.93 [0.68, 1.28], = 0.66; AA Aa + aa, OR = 0.78 [0.34, 1.81], = 0.57. For rs231726 polymorphism, a significant correlation was found, which was A a, OR = 0.76 [0.70, 0.82], < 0.05.
CONCLUSIONS
A significant correlation between CTLA-4 rs231726 polymorphism and AA susceptibility was found, but no significant association of CTLA-4 gene rs231775 and rs3087243 polymorphisms and AA susceptibility was found.
Topics: Alopecia Areata; CTLA-4 Antigen; Genetic Predisposition to Disease; Humans; Polymorphism, Single Nucleotide
PubMed: 35254172
DOI: 10.1080/1354750X.2022.2046855 -
JAAD International Jun 2022COVID-19 is associated with androgenetic alopecia (AGA), telogen effluvium (TE), and alopecia areata (AA). No studies have analyzed the aggregate data to date. (Review)
Review
BACKGROUND
COVID-19 is associated with androgenetic alopecia (AGA), telogen effluvium (TE), and alopecia areata (AA). No studies have analyzed the aggregate data to date.
OBJECTIVE
We conducted a systematic review to characterize the types, incidence, timing, and clinical outcomes of COVID-19-associated alopecia.
METHODS
We searched PubMed/MEDLINE, Scopus, and Embase for articles published between November 2019 and August 2021 using the key words "alopecia" or "hair" and COVID-19-related search terms, identifying 41 original articles describing patients with alopecia and COVID-19.
RESULTS
The current review included 1826 patients with alopecia and COVID-19 (mean age, 54.5 years; 54.3% male). The most common types of alopecia identified were AGA (30.7%, 86.4% male), TE (19.8%, 19.3% male), and AA (7.8%, 40.0% male). AGA preceded COVID-19 symptoms. TE was usually newly triggered by COVID-19 (93.6%). AA usually occurred in patients with preexisting disease (95.1%).
LIMITATIONS
Definitions of COVID-19 onset varied. Studies differed in methodology and were susceptible to reporting and sampling bias. Studies with large sample sizes may exert a disproportionate influence on data.
CONCLUSION
AGA may be a risk factor for severe COVID-19, whereas TE presents as a sequela of COVID-19. AA generally occurs as a relapse in patients with preexisting alopecia.
PubMed: 35224518
DOI: 10.1016/j.jdin.2022.02.006 -
JAAD International Jun 2022COVID-19 may play a role in various immune-related dermatologic conditions. The relationship between COVID-19 and alopecia areata remains unclear. (Review)
Review
BACKGROUND
COVID-19 may play a role in various immune-related dermatologic conditions. The relationship between COVID-19 and alopecia areata remains unclear.
OBJECTIVE
To review the existing literature for clinical studies and reports investigating the association between new-onset alopecia areata or the exacerbation of preexisting alopecia areata following infection with SARS-CoV-2.
METHODS
A systematic review of the literature was performed using PubMed, Embase, and MEDLINE databases from inception to October 2021. Included articles assessed alopecia areata following infection with SARS-CoV-2.
RESULTS
Of 402 total articles, 9 were identified as meeting the inclusion criteria. Six articles described case reports of 7 patients with new-onset alopecia areata following confirmed infection with SARS-CoV-2, and 3 articles reported on alopecia areata recurrence or exacerbation following SARS-CoV-2 infection in patients with preexisting disease. Studies investigating the exacerbation or recurrence of alopecia areata following infection reported mixed findings.
LIMITATIONS
A majority of the included studies were case reports. The heterogeneity of articles precluded data synthesis.
CONCLUSION
Alopecia areata may be a dermatologic manifestation of COVID-19, with cases most often appearing 1 to 2 months following infection. Additional research is necessary to better elucidate the relationship and draw conclusions.
PubMed: 35165668
DOI: 10.1016/j.jdin.2022.02.002 -
JAMA Dermatology Mar 2022Although there have been increased efforts in dermatologic research to improve representation of patient sex, race, and ethnicity, there are limited data evaluating...
IMPORTANCE
Although there have been increased efforts in dermatologic research to improve representation of patient sex, race, and ethnicity, there are limited data evaluating resulting changes.
OBJECTIVE
To characterize the diversity of participants in dermatologic clinical trials conducted in the US published from 2015 to 2020 pertaining to common dermatologic conditions affecting all patient demographic categories compared with findings from 2010-2015.
EVIDENCE REVIEW
A systematic literature review through the PubMed database was conducted for randomized clinical trials published between July 1, 2015, and July 1, 2020, using keywords alopecia areata, acne, atopic dermatitis, lichen planus, psoriasis, seborrheic dermatitis, and vitiligo. Data collected included distribution of participant demographic characteristics, funding source, and journal type. Reflecting US Census data, studies were defined as unrepresentative of race and ethnicity if they included less than 20% ethnically or racially diverse participants or unrepresentative of sex if they included less than 45% women. Python was used for statistical analysis by χ2 tests or Fisher exact tests.
FINDINGS
A total of 392 randomized clinical trials were included. In comparison with the period from 2010-2015, the reporting rate for race and ethnicity in US studies has increased from 59.8% to 71.9% (P = .05). However, the proportion of reporting articles including at least 20% non-White representation remains unchanged at 38.1% with 37 of 97 reporting randomized clinical trials in 2010-2015 and 53 of 139 reporting randomized clinical trials in 2015-2020 (P = .99). Psoriasis studies included the least diversity, with 12.1% of studies recording at least 20% non-White participants and 29.5% of studies recording at least 45% female participants.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review suggest that reporting racial and ethnic data since 2010-2015 has become more transparent. However, inclusion of representative patient populations may still be considered inadequate, particularly in psoriasis studies. Diversity in clinical trials is important for representation of the affected patient populations, and additional efforts are warranted in support of this endeavor.
Topics: Dermatitis, Atopic; Dermatology; Ethnicity; Female; Humans; Male; Psoriasis; Research Design
PubMed: 35080592
DOI: 10.1001/jamadermatol.2021.5596