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Alopecia Areata: Review of Epidemiology, Clinical Features, Pathogenesis, and New Treatment Options.International Journal of Trichology 2018Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and... (Review)
Review
Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and may present at any age. In this article, we review the epidemiology, clinical features, pathogenesis, and new treatment options of AA, with a focus on the immunologic mechanism underlying the treatment. While traditional treatment options such as corticosteroids are moderately effective, a better understanding of the disease pathogenesis may lead to the development of new treatments that are more directed and effective against AA. Sources were gathered from PubMed, Embase, and the Cochrane database using the keywords: alopecia, alopecia areata, hair loss, trichoscopy, treatments, pathogenesis, and epidemiology.
PubMed: 29769777
DOI: 10.4103/ijt.ijt_99_17 -
Indian Dermatology Online Journal 2022Alopecia areata is an autoimmune condition which usually presents as non-scarring patchy alopecia. The disease has varied clinical presentations ranging in severity from... (Review)
Review
Alopecia areata is an autoimmune condition which usually presents as non-scarring patchy alopecia. The disease has varied clinical presentations ranging in severity from patchy circumscribed alopecia, reticular pattern, ophiasis, sisaipho, diffuse, or incognito type to alopecia totalis and alopecia universalis. The various available treatment options include topical/intralesional steroids, topical immunotherapy/contact irritants, systemic steroids, and steroid-sparing agents like cyclosporine, azathioprine, methotrexate, and the JAK-STAT inhibitors. This article aims at providing practical tips to the clinicians based on published data and author's clinical experience which can help them in deciding what and when to choose in a given clinical scenario of AA.
PubMed: 36386728
DOI: 10.4103/idoj.idoj_176_22 -
Dermatology and Therapy Mar 2023Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently...
Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib-A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata.
Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently co-exist with atopic dermatitis (AD), and the coincidence of atopy predisposes to a more severe course of the disease. To date, therapeutic options in AA, especially in the pediatric population, are mainly limited to corticosteroids, irritants, sensitizers, and immunosuppressive agents. Recently, innovative therapies have emerged, among which Janus kinase (JAK) inhibitors, effective in both AD and AA, appear to be the most promising. Here, a 14-year-old girl with alopecia universalis (AU) and mild AD is demonstrated, who was successfully treated with a selective JAK1 inhibitor, upadacitinib, which has been approved for the treatment of AD in adults and children aged 12 years and older. Resolution of eczema and complete hair regrowth was achieved after 3 months of therapy. Apart from transient mild leukopenia at weeks 4 and 8, no adverse events were noted. Data in the literature on the efficacy and safety of JAK inhibitors in the treatment of AA in the pediatric population is based on single case reports and case series. So far, topical tofacitinib and ruxolitinib, as well as systemic tofacitinib, ruxolitinib, and baricitinib have been used off-label in this indication in children. Upadacitinib is another effective treatment option with a good benefit-risk ratio for patients with AA, including cases coexisting with AD.
PubMed: 36639612
DOI: 10.1007/s13555-023-00889-0 -
Journal of the American Academy of... Aug 2022Janus kinase (JAK) activation is suggested to have a pathological role in alopecia areata (AA). CTP-543, a deuterated compound that selectively inhibits JAK1 and JAK2,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Janus kinase (JAK) activation is suggested to have a pathological role in alopecia areata (AA). CTP-543, a deuterated compound that selectively inhibits JAK1 and JAK2, is being developed as an oral treatment for AA.
OBJECTIVE
To assess the safety and efficacy of a 24-week regimen of CTP-543 in patients with chronic, moderate-to-severe AA.
METHODS
In this phase 2, randomized, double-blind, placebo-controlled, sequential-design trial, patients were randomized to receive CTP-543 (4 mg, 8 mg, or 12 mg) or placebo every 12 hours for 24 weeks.
RESULTS
A dose-related increase was observed in the percentage of patients with ≥50% relative reduction in Severity of Alopecia Tool scores from baseline at week 24 (9% placebo, 21% 4 mg twice daily, 47% 8 mg twice daily, and 58% 12 mg twice daily), with statistical significance versus placebo (P < .001) observed for the 8-mg twice daily and 12-mg twice daily groups, with differences from placebo noted as early as 12 weeks after the initiation of treatment. Safety results were consistent with the known safety profiles of JAK inhibitors.
LIMITATIONS
These initial findings are from a relatively small controlled trial, and additional studies are needed to fully characterize the safety and efficacy of CTP-543 in adult patients with AA.
CONCLUSIONS
Patients treated with CTP-543 (8 or 12 mg, twice daily) had a significant reduction in the severity of AA.
Topics: Adult; Alopecia Areata; Cytidine Triphosphate; Humans; Janus Kinase Inhibitors; Pyrimidines; Treatment Outcome
PubMed: 35364216
DOI: 10.1016/j.jaad.2022.03.045 -
The Journal of Clinical and Aesthetic... Oct 2023This review examines the current literature on the gut-skin connection in alopecia and summarizes interventions that impact hair growth by modulation of the gut or skin... (Review)
Review
OBJECTIVE
This review examines the current literature on the gut-skin connection in alopecia and summarizes interventions that impact hair growth by modulation of the gut or skin microbiome.
METHODS
PubMed searches were done to assess studies of the gut and skin microbiome and forms of alopecia including, alopecia areata (AA), androgenic alopecia (AGA), alopecia universalis (AU), central centrifugal cicatricial alopecia (CCCA) and lichen planopilaris (LPP). Filters were applied for human and animal studies. Articles not translated to English and studies assessing supplemental therapies on alopecia were excluded.
RESULTS
There is evidence that scalp, hair follicle, and gut microbiome alterations are associated with various types of alopecia. There is potential in the use of interventions targeting microbiome dysbiosis, including fecal transplants and probiotics.
LIMITATIONS
This field of study still requires more high-quality research and studies with larger participant populations.
CONCLUSION
Dysbiosis on the scalp, within the hair follicle and the gut seem to have a role in the pathophysiology of various forms of alopecia. There is evidence that interventions targeting dysbiosis may have potential in the treatment and management of hair loss. Further studies are needed to establish a direct connection and to clarify specific effects of these interventions.
PubMed: 37915336
DOI: No ID Found -
Skin Appendage Disorders Jun 2020Toxic metals are not so rare but are often neglected causes of alopecia areata in men and women. Thallium, arsenic, selenium, and mercury are the most common cause of...
Toxic metals are not so rare but are often neglected causes of alopecia areata in men and women. Thallium, arsenic, selenium, and mercury are the most common cause of metals-related alopecia, which is what Vicky Yu and colleagues' found. Other than the presence of thallium, arsenic, mercury, and selenium, cadmium, bismuth, lithium, and copper should also be taken into account when dermatologists are considering toxic metals as a potential cause of alopecia areata in humans.
PubMed: 32656240
DOI: 10.1159/000507296 -
Genes Jun 2023Alopecia areata (AA) is a chronic, non-scarring, immune-mediated skin disease that affects approximately 0.5-2% of the global population. The etiology of AA is complex... (Review)
Review
Alopecia areata (AA) is a chronic, non-scarring, immune-mediated skin disease that affects approximately 0.5-2% of the global population. The etiology of AA is complex and involves genetic and environmental factors, with significant advancements in genetic research occurring in recent years. In addition to well-known genes such as , , and , which have been widely supported as being associated with AA, an increasing number of specific gene-related loci have been discovered through advances in genetic research. For instance, gene analysis of microRNAs can reveal the critical role of miRNAs in regulating gene expression, aiding in the understanding of cellular and organismal functional regulatory mechanisms. Furthermore, numerous studies have confirmed the existence of correlations between AA and other immune-related diseases. Examples include hyperthyroidism and rheumatoid arthritis. By understanding the interrelationships between AA and other immune diseases, we can further comprehend potential shared genetic foundations or pathogenic mechanisms among different diseases. Genetic research plays a crucial role in unraveling the pathogenesis of AA, as the identification of genetic variations associated with AA can assist in formulating more effective and targeted treatment strategies.
Topics: Humans; Alopecia Areata; Genetic Predisposition to Disease; Alleles; Protein Tyrosine Phosphatase, Non-Receptor Type 22
PubMed: 37510267
DOI: 10.3390/genes14071362 -
Orphanet Journal of Rare Diseases Jan 2017Nude severe combined immunodeficiency is a rare inherited disease caused by autosomal recessive loss-of-function mutations in FOXN1. This gene encodes a transcription... (Review)
Review
Nude severe combined immunodeficiency is a rare inherited disease caused by autosomal recessive loss-of-function mutations in FOXN1. This gene encodes a transcription factor essential for the development of the thymus, the primary lymphoid organ that supports T-cell development and selection. To date nine cases have been reported presenting with the clinical triad of absent thymus resulting in severe T-cell immunodeficiency, congenital alopecia universalis and nail dystrophy. Diagnosis relies on testing for FOXN1 mutations, which allows genetic counselling and guides therapeutic management. Options for treating the underlying immune deficiency include HLA-matched genoidentical haematopoietic cell transplantation containing mature donor T-cells or thymus tissue transplantation. Experience from other severe combined immune deficiency syndromes suggests that early diagnosis, supportive care and definitive management result in better patient outcomes. Without these the prognosis is poor due to early-onset life threatening infections.
Topics: Alopecia; Animals; Forkhead Transcription Factors; Mice, Nude; Mice, SCID; Mutation; Receptors, Interleukin-7; Severe Combined Immunodeficiency; T-Lymphocytes
PubMed: 28077132
DOI: 10.1186/s13023-016-0557-1 -
Dermatology Reports Jun 2022Dupilumab is an interleukin-4 receptor alpha antagonist that showed significant improvement of atopic dermatitis (AD). Many reports have shown significant resolution of...
Dupilumab is an interleukin-4 receptor alpha antagonist that showed significant improvement of atopic dermatitis (AD). Many reports have shown significant resolution of alopecia areata, alopecia universalis and alopecia totalis after dupilumab treatment for AD. We present one of reported cases that showed improvement of underlying alopecia universalis treated with dupilumab.
PubMed: 35795833
DOI: 10.4081/dr.2022.9359