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Dermatology Online Journal Jul 2018La alopecia areata constituye un reto terapéutico, sobre todo en sus formas extensas. Antes de iniciar cualquier tratamiento es necesario tener en cuenta algunas... (Review)
Review
La alopecia areata constituye un reto terapéutico, sobre todo en sus formas extensas. Antes de iniciar cualquier tratamiento es necesario tener en cuenta algunas consideraciones. Se trata de una enfermedad que no afecta de forma directa a la salud del paciente y que puede presentar resolución espontánea. Las formas extensas, las que se inician en la infancia y las de larga evolución son muy rebeldes a los tratamientos y asocian recaídas. Todos los tratamientos tienen efectos secundarios. Ningún tratamiento ha demostrado alterar el curso de la enfermedad, muy pocos han demostrado eficacia en ensayos clínicos aleatorizados y no existen guías terapéuticas salvo la publicada en 2003 y actualizada en 2012 en el British Journal of Dermatology. Por todo ello, es necesario elaborar un plan de tratamiento individualizado en cada paciente. Se debe comenzar con los fármacos más seguros e inocuos, y pasar al siguiente escalón terapéutico cuando el actual haya demostrado su ineficacia durante un periodo de 6 meses. Se revisan las principales propuestas farmacológicas para alopecia areata, aportando datos sobre su mecanismo de acción, efectos secundarios y posicionamiento terapéutico en función de los estudios disponibles. Finalmente, se propone un algoritmo terapéutico como guía en el manejo de esta patología.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Biological Products; Humans; Immunologic Factors; Janus Kinases; Laser Therapy; Minoxidil; Phototherapy; Platelet-Rich Plasma; Prostaglandins; Protein Kinase Inhibitors; Vasodilator Agents
PubMed: 30261562
DOI: No ID Found -
Advances in Therapy Jul 2017Alopecia areata is an extremely common autoimmune condition affecting hair. Severe forms of alopecia areata exist, with existing treatments consisting of systemic... (Review)
Review
Alopecia areata is an extremely common autoimmune condition affecting hair. Severe forms of alopecia areata exist, with existing treatments consisting of systemic immunosuppressants with numerous side effects. Recently, breakthroughs have been made in both understanding the pathogenesis of alopecia areata and the treatment thereof, which hold the promise of being able to target severe cases of alopecia areata with more efficacy and better tolerability. This article serves as an introduction to review papers from two of the leading researchers in the field of alopecia areata.
Topics: Alopecia Areata; Drug-Related Side Effects and Adverse Reactions; Humans; Immunosuppressive Agents
PubMed: 28646391
DOI: 10.1007/s12325-017-0544-5 -
Anais Brasileiros de Dermatologia 2021
Topics: Alopecia Areata; Antibodies, Monoclonal, Humanized; Dermatitis, Atopic; Humans; Psoriasis
PubMed: 34274183
DOI: 10.1016/j.abd.2021.03.005 -
Skin Research and Technology : Official... Jul 2023No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using...
BACKGROUND AND AIM
No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia.
MATERIALS AND METHODS
Forty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata.
RESULTS
At the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively.
CONCLUSIONS
HR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.
Topics: Humans; Alopecia Areata; Diagnosis, Differential; Alopecia; Hair Follicle; Scalp; Magnetic Resonance Imaging
PubMed: 37522498
DOI: 10.1111/srt.13393 -
Acta Dermato-venereologica Oct 2023Alopecia areata is an autoimmune non-scarring disease in which the exact mechanism that induces loss of immune privilege is unknown. Zinc is important for DNA stability...
Alopecia areata is an autoimmune non-scarring disease in which the exact mechanism that induces loss of immune privilege is unknown. Zinc is important for DNA stability and repair mechanisms that are essential in maintaining normal hair growth. Zinc deficiency has been investigated as an important factor in many autoimmune diseases, and may have a possible role in the aetiopathogenesis of alopecia areata. This study included 32 patients with severe forms of alopecia areata, and 32 age- and sex-matched healthy controls. When comparing serum zinc levels in these 2 groups, statistically significantly lower zinc concentrations were found in the alopecia areata group (p = 0.017). Detected zinc deficiency was statistically more prevalent in patients with alopecia areata (p = 0.011). Evaluating patients with alopecia areata, a statistically significant negative correlation between serum zinc levels and severity of the disease was found (ρ = 0.006). The results indicate that zinc serum assessment is necessary in patients with alopecia areata. Low serum zinc levels were found to correlate with severity of alopecia areata. Given that most severe forms of alopecia areata are frequently most treatment-resistant, additional randomized control trials examining zinc supplementation are necessary to investigate its potential role in the restoration of hair follicles.
Topics: Humans; Alopecia Areata; Autoimmune Diseases; Hair Follicle; Malnutrition; Zinc; Male; Female
PubMed: 37787421
DOI: 10.2340/actadv.v103.13358 -
Acta Dermatovenerologica Alpina,... Mar 2018
Topics: Alopecia Areata; Humans; Port-Wine Stain
PubMed: 29589648
DOI: No ID Found -
The Journal of Investigative... Jun 2003It is the aim of this article to review and appraise available data on treatments for alopecia areata (AA) according to the demands of evidence based medicine. Studies... (Review)
Review
It is the aim of this article to review and appraise available data on treatments for alopecia areata (AA) according to the demands of evidence based medicine. Studies evaluating the efficacy of a treatment for AA should include appropriate controls, use cosmetically acceptable hair regrowth as a parameter for treatment success, include patients with AA totalis, universalis or extensive patchy AA, and exclude patients suffering from AA for less than 3 months. Moreover, the treatment must be safe over a prolonged period of time. Among the various therapeutic approaches presently available for AA, only treatment with contact sensitizers such as diphenylcyclopropenone or squaric acid dibutylester has been shown to be effective in studies that fulfill these criteria. Improved future treatments may be immunosuppressive or immunomodulatory targeting of the autoimmune pathogenesis of AA, or they may otherwise protect hair follicles from the injurious effects of inflammation. Such possible future therapeutic approaches include the incorporation of immunomodulatory agents into liposomes as an improved vehicle; inhibition of apoptosis mediated by the Fas-FasL system; inhibition of the lymphocyte homing receptor CD44v10; induction of tolerance.
Topics: Adjuvants, Immunologic; Alopecia Areata; Animals; Humans; Immunosuppressive Agents
PubMed: 12894988
DOI: 10.1046/j.1523-1747.2003.12165.x -
Canadian Family Physician Medecin de... Jul 2020In my family practice, several children have presented with alopecia areata. Families are worried about the ongoing hair loss and have been trying several natural...
In my family practice, several children have presented with alopecia areata. Families are worried about the ongoing hair loss and have been trying several natural health products. I understand that corticosteroids are also considered to treat this condition. Which corticosteroid treatments can I consider and how beneficial are they? Alopecia areata is a source of considerable distress to those affected, and although there are many treatment options available, none have been clinically proven to be consistently effective. Steroids are commonly prescribed and can result in hair regrowth. Topical steroids are most commonly used in children, but intralesional, oral, and even intravenous steroids are available, with varying levels of efficacy.
Topics: Adrenal Cortex Hormones; Alopecia Areata; Biological Products; Child; Child, Preschool; Humans; Steroids
PubMed: 32675094
DOI: No ID Found -
Experimental Dermatology Sep 2013The pathobiology of alopecia areata (AA), one of the most frequent autoimmune diseases and a major unsolved clinical problem, has intrigued dermatologists, hair... (Review)
Review
The pathobiology of alopecia areata (AA), one of the most frequent autoimmune diseases and a major unsolved clinical problem, has intrigued dermatologists, hair biologists and immunologists for decades. Simultaneously, both affected patients and the physicians who take care of them are increasingly frustrated that there is still no fully satisfactory treatment. Much of this frustration results from the fact that the pathobiology of AA remains unclear, and no single AA pathogenesis concept can claim to be universally accepted. In fact, some investigators still harbour doubts whether this even is an autoimmune disease, and the relative importance of CD8(+) T cells, CD4(+) T cells and NKGD2(+) NK or NKT cells and the exact role of genetic factors in AA pathogenesis remain bones of contention. Also, is AA one disease, a spectrum of distinct disease entities or only a response pattern of normal hair follicles to immunologically mediated damage? During the past decade, substantial progress has been made in basic AA-related research, in the development of new models for translationally relevant AA research and in the identification of new therapeutic agents and targets for future AA management. This calls for a re-evaluation and public debate of currently prevalent AA pathobiology concepts. The present Controversies feature takes on this challenge, hoping to attract more skin biologists, immunologists and professional autoimmunity experts to this biologically fascinating and clinically important model disease.
Topics: Alopecia Areata; Animals; Autoimmune Diseases; Disease Models, Animal; Humans; Mice; Models, Immunological; Translational Research, Biomedical
PubMed: 23947678
DOI: 10.1111/exd.12209 -
The Journal of Investigative... Jan 2018Platelet-rich plasma and microneedling have been investigated recently as potential therapeutic options for the treatment of hair disorders. Evidence from laboratory... (Review)
Review
Platelet-rich plasma and microneedling have been investigated recently as potential therapeutic options for the treatment of hair disorders. Evidence from laboratory studies indicates that these treatments enhance growth factor production that in turn facilitates hair follicle development and cycling. Several small studies and case reports have presented encouraging findings regarding the use of these treatments for alopecia areata. Future investigations will be needed to validate these therapeutic techniques for patients with alopecia areata and further refine which subtypes of the disease these methods are best indicated for.
Topics: Alopecia Areata; Female; Humans; Intercellular Signaling Peptides and Proteins; Male; Needles; Platelet-Rich Plasma
PubMed: 29273100
DOI: 10.1016/j.jisp.2017.10.002