Alopecia Totalis Research Articles

Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management

Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.

28064 The study about clinical characteristics and prognosis of alopecia totalis

Alopecia totalis (AT) usually has a poor prognosis, and treatment failure is seen in most patients regardless of the type of therapy. A current limitation is that these old data are routinely cited in recent review papers. We retrospectively reviewed patients diagnosed with AT through clinical manifestations and skin biopsies from 2006 to 2017 in Kyung Hee University Hospital at Gangdong, Seoul, Korea. Among them, patients with follow-up time less than 2 years were excluded. We collected clinical and demographic information such as age, sex, and underlying diseases at the first visit. Additionally, we reviewed the prognosis through the patients’ clinical charts and photography. Of the 419 patients (males; 192, females; 227), mean age at onset was 25.08 years and the mean duration taken from the onset to visit was 45.8 months. The mean age of first episode onset was 22.9 years, and patients with early onset (≤13) was 24.6% (103/419). The average follow-up period for all patients was 5.1 years. In the follow-up periods, 53.9% (226/419) had more than 50% hair growth, and 19.6% (82/419) of patients showed improvement over 90% hair growth. Among patients who showed improvement over 50%, 36.7% of them (83/226) had no recur. In early studies conducted in the 1950s and 1960s, the chance of full hair regrowth was reported to be less than 10%. In our study, patients with more than 90% improvement in AT patients accounted for 19.6%, which has a better prognosis than previous reports.

Four hypotrichosis families with mutations in the gene LSS presenting with and without neurodevelopmental phenotypes.

Four hypotrichosis families with mutations in the gene LSS presenting with and without neurodevelopmental phenotypes.

PSY6 Differences in All-Cause Health Care Costs of Alopecia Areata in the United States by Patient Subgroups: A Latent Class Approach

Alopecia areata (AA) is an autoimmune hair-loss disease, with variations in clinical expression, including total scalp (alopecia totalis, AT) and total body hair-loss (alopecia universalis, AU). This study identified subgroups of patients with AA in the US with distinct profiles and their corresponding healthcare costs.

Metabolic syndrome in patients with Alopecia Areata: A case-control study.

The aim of this study was to evaluate metabolic syndrome prevalence in patients with Alopecia Areata compared to controls. Sixty eligible patients with Alopecia Areata and 60 healthy subjects frequency matched for age and sex attending to our referral dermatology clinics from 2015 to 2017 were enrolled. Prevalence of metabolic syndrome and its components were compared between the two groups. Metabolic syndrome was only seen in seven patients (11.67%) and four controls (6.67%) without a significant difference (P= .34). The clinical presentations of AA included patch type (38.33%), ophiasis (6.67%), alopecia totalis (16.67%), and alopecia universalis (38.33%). Presence of metabolic syndrome was significantly associated with abdominal circumference (OR: 1.10, 95% CI for OR: 1.02to 1.19). Although there was no significant association between Alopecia Areata and metabolic syndrome, some components of metabolic syndrome were more prevalent in these patients. It may be concluded Alopecia Areata patients are at a higher risk of developing metabolic syndrome in the future. Further studies with larger sample sizes are needed.

Prediction of the Risk of Alopecia Areata Progressing to Alopecia Totalis and Alopecia Universalis: Biomarker Development with Bioinformatics Analysis and Machine Learning

Background: Alopecia areata (AA) is an autoimmune disease typified by nonscarring hair loss with a variable clinical course. Although there is an increased understanding of AA pathogenesis and progress in its treatments, the outcome of AA patients remains unfavorable, especially when they are progressing to the subtypes of alopecia totalis (AT) or alopecia universalis (AU). Thus, identifying biomarkers that reflect the risk of AA progressing to AT or AU could lead to better interventions for AA patients. Methods: In this study, we conducted bioinformatics analyses to select key genes that correlated to AU or AT based on the whole-genome gene expression of 122 human scalp skin biopsy specimens obtained from NCBI-GEO GSE68801. Then, we built a biomarker using 8 different machine learning (ML) algorithms based on the key genes selected by bioinformatics analyses. Results: We identified 4 key genes that significantly increased (CD28) or decreased (HOXC13, KRTAP1-3, and GPRC5D) in AA tissues, especially in the subtypes of AT and AU. Besides, the predictive accuracy (area under the curve [AUC] value) of the prediction models for forecasting AA patients progressing to AT/AU models reached 90.7% (87.9%) by logistic regression, 93.8% (79.9%) by classification trees, 100.0% (76.3%) by random forest, 96.9% (76.3%) by support vector machine, 83.5% (79.9%) by K-nearest neighbors, 97.1% (87.3%) by XGBoost, and 93.3% (80.6%) by neural network algorithms for the training (internal validation) cohort. Besides, 2 molecule drugs, azacitidine and anisomycin, were identified by Cmap database. They might have the potential therapeutic effects on AA patients with high risk of progressing to AT/AU. Conclusions: In the present study, we conducted high accuracy models for predicting the risk of AA patients progressing to AT or AU, which may be important in facilitating personalized therapeutic strategies and clinical management for different AA patients.

Therapeutic management in paediatric alopecia areata: A systematic review

Alopecia areata is the third-most-common cause of dermatology consultations in children but the treatment of pediatric alopecia areata remains challenging. A systematic review of the literature about the treatment of alopecia areata in children (≤ 18 years old) was performed on 11 May 2020 by searching the PubMed, Scopus and EBSCO databases. The terms used for the search were: "alopecia areata", "alopecia totalis" or "alopecia universalis" combined with "pediatric", "children" or "childhood". A total of 89 articles were included in final evaluation. The most commonly assessed treatment options in pediatric alopecia areata were topical immunotherapy (response rate in monotherapy: 54%; 187/345) intralesional glucocorticosteroids (75%; 211/280), systemic glucocorticosteroids (73%; 102/140), and anthralin (42%; 31/74). Topical glucocorticosteroids (81%; 35/43), systemic Janus kinase (JAK) inhibitors (90%; 27/30), topical calcineurin inhibitors (42%; 8/19), topical JAK inhibitors (63%; 11/17), PUVA therapy (56%; 9/16) and 308-nm excimer laser (77%; 10/13) were also evaluated. Additionally, evaluation in smaller numbers of pediatric patients included methotrexate (100%; 10/10), topical minoxidil (44%; 4/9) and cyclosporine (83%; 5/6). There were limited data considering children with alopecia areata treated with azathioprine, hydroxychloroquine, topical sildenafil, topical prostaglandin analogues, fractional carbon dioxide laser, leflunomide, mesalazine, apremilast, dupilumab, ustekinumab, efalizumab, botulinum toxin, and compound glycyrrhizin. On the basis of the limited data available glucocorticosteroids (systemic, intralesional or topical) and JAK inhibitors (systemic or topical) may be considered the best documented and most effective treatment options in alopecia areata in children. There are no sufficient pediatric data to compare treatment safety and relapse rates in these therapeutic modalities.

Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study.

Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of hair follicles. Chronic inflammatory skin diseases such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases (HDs) remains unclear. Therefore, we conducted this retrospective cohort study to evaluate the risk of subsequent HDs in patients with AA. We reviewed 3770 cases of AA and from 18,850 age, sex, and income level-matched controls from the National Health Insurance Service-National Sample Cohort. In the subgroup analysis, patients who suffered from alopecia totalis, alopecia universalis, and ophiasis were designated as patients with severe AA and patients having the disease for over a year were designated as patients with long-standing AA. As a result, we found that AA was not associated with a higher risk of heart failure, angina pectoris, or myocardial infarction. There was no significant increase in the risk of overall HD associated with AA (adjusted hazard ratio: 1.17; 95% confidence interval: 0.93-1.48; p = 0.177). Neither the severity nor the duration of AA was related to an increased risk of HDs. During the study period, AA patients did not show a significantly higher cumulative incidence of HDs than controls (log-rank p = 0.157). In conclusion, AA does not increase the risk of HD.

DISEASE ASSOCIATED WITH CLINICALLY DIAGNOSED UNTREATED PATIENT OF ALOPECIA AREATA: A CROSS-SECTIONAL STUDY AT TERTIARY CARE HOSPITAL BIKANER (RAJASTHAN)

Background: Alopecia areata (AA) is an autoimmune, non-scarring form of alopecia with wide range of clinical presentations from patchy alopecia to complete loss of scalp hair (Alopecia totalis) and or the entire body (alopecia universalis. To study the disease associated with clinically diagnosed untreated patient of Alopecia Areata.
 Methods: The prospective cross-sectional study was conducted on all new cases of alopecia areata irrespective of age and sex attending the outpatient department of Dermatology, Venereology and Leprosy at SP Medical College, Bikaner from September 2018 to September 2019.
 Results: In our study 20.90% patients were present with associated disease maximum (15.45%) patients were present with atopy followed by 2.72% thyroid disease, 0.91% diabetic, down syndrome, psoriasis respectively.
 Conclusion: Majority of patients were associated with atopy.
 Keywords: Associated disease, Alopecia areata, DM, HT.

Hypotrichosis‐lymphedema‐telangiectasia syndrome: Report of ileal atresia associated with a SOX18 de novo pathogenic variant and review of the phenotypic spectrum

Hypotrichosis-lymphedema-telangiectasia syndrome (HLTS) is a rare condition caused by pathogenic variants in the SOX18 gene. SOX18 plays a key role in angio- and lymphangiogenesis due to its expression in venous endothelial cells from which the lymphatic system develops. It is also expressed in embryonic hair follicles, heart, and vascular smooth muscle cells. The main clinical symptoms of HLTS include sparse hair, alopecia totalis, lymphedema, most often affecting lower limbs, and telangiectatic lesions. Only 10 patients with a SOX18 pathogenic variant have been described that presented with additional features such as hydrocele, renal failure, arterial or pulmonary hypertension, aortic dilatation, and facial dysmorphism. Here, we summarize these phenotypic variations and report an additional HLTS patient, with a 14-nucleotide de novo duplication in SOX18 and congenital ileal atresia, a feature not previously associated with HLTS.

Superficial Cryotherapy, Does It Work In Alopecia Areata?

Abstract:Alopecia areata is a common cause of nonscarring alopecia, with patchy, confluent or diffuse patterns, involving mainly the scalp and other hairy areas of the body. It's considered a therapeutic challenge due to prognosis, unpredictable course and variable efficacy of available therapies. Several studies have evaluated the efficacy of cryotherapy in the treatment of alopecia areata with varying success rates.Superficial cryotherapy using liquid nitrogen mainly was used in several studies for treating alopecia areata with various subtypes including mild, moderate and recalcitrant alopecia areata, and alopecia totalis with variable rates of therapeutically accepted terminal hair regrowth. Its main mechanisms of efficacy in alopecia areata are vascular changes and immunomodulation. Superficial cryotherapy was effective and safe in treating alopecia areata of the eyebrows. It was nearly as effective as topical steroids and topical PUVA therapy, and was combined with topical immunotherapy and topical steroid with increased efficacy. It's well-tolerated, convenient and simple office-based procedure, especially in children who are susceptible to side effects of other conventional therapeutic options.The reported side effects of superficial cryotherapy included vesiculation, erosion, crust formation, transient pigmentary alteration and partial leukotrichia, however they were transient. Key words: alopecia, cryotherapy, liquid nitrogen

Laporan Kasus <i>Acrodermatitis Enteropathica </i>pada Anak 5 Tahun dengan Level Zink Serum Normal

Acrodermatitis enterophatica (AE) is an inherited or acquired condition associated with zinc malabsorption. Clinical symptoms of AE are periorificial and acral dermatitis, alopecia, and diarrhea. Serum zinc levels usually decrease in AE patients. A 5-year-old boy presented with crusted erosion on the face, trunks and extremities that have been appeared for one year and worsened last month. It also accompanied by hair and eyebrow loss, diarrhea, and eating disorder. Patient was also malnourished. Dermatovenereology examination showed papules, patches, multiple erythematous plaques with squama, erosions with brownish yellow crust above located on perioral, periorbital, posterior trunk, inguinal, perianal, cubital, popliteal and dorsum pedis region. The oral region showed stomatitis and cheilitis. The orbital region showed conjunctival injection and eye discharge. The scalp, eyebrows and lashes showed total alopecia. Laboratory test showed normal serum zinc levels and decreased levels of alkaline phosphatase. The patient was diagnosed with acquired form of AE. Clinical improvement was seen after zinc supplementation. The diagnosis of AE cannot be made only by low serum zinc levels. If a classical triad of AE was found, we must be able to recognize it immediately, thus prompt and appropriate therapy could be given.

A case-control study evaluating association of serum vitamin D level with alopecia areata

A case-control study evaluating association of serum vitamin D level with alopecia areata - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.040, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Trichorhinophalangeal Syndrome Type 1: Unusual Case Report and Review of Literature

Trichorhinophalangeal syndrome type 1 [TRPS1; (OMIM #190350)] is a rare autosomal dominant genetic disorder on chromosome 8q24. The carrier of the syndrome may present skeletal, craniofacial, and oral manifestations. The main characteristics that the individual may present are scarce hair or total alopecia, thin upper lip, long erased nasolabial filter, bulbous nose and low set ears. In the oral cavity, there may be changes such as supernumerary teeth and hypodontia, size changes, including macrodontia and microdontia, and teeth in malocclusion.

CCL13 is upregulated in alopecia areata lesions and is correlated with disease severity.

Alopecia areata (AA) is a multi-factors disease characterized by non-scarring hair loss. AA could be classified into three main clinical phenotypes including patchy type AA (AAP), alopecia totalis (AT) and alopecia universalis (AU) based on the severity and areas of hair loss. Recent studies suggested immunological factor was critical in AA, but the precise aetiology and pathogenesis of AA still need exploration. In the work, we screened two gene expression profiles (GSE45512 and GSE68801) from Gene Expression Omnibus (GEO). Based on the two data sets, 10 upregulated genes and 107 downregulated genes in AA skin biopsies were identified. CCL13, as one of the remarkably upregulated genes, was found to have potential biological functions in aberrant immune response of AA according to the GO and KEGG analyses. The PPI network showed CCL13 was associated with multiple immune-related genes. The expression of CCL13 was increased depending on the severity of disease in AA patients. Cytotoxic lymphocytes, T cells and myeloid dendritic cells accumulated remarkably in scalp tissue depending on the severity of AA, and CCL13 was significantly correlated to cytotoxic lymphocytes, T cells and myeloid dendritic cells in AA patients. Our RT-PCR and ELISA results found CCL13 was upregulated in skin biopsy and serum of AA patients, and the immunohistochemistry (IHC) detection showed CCL13 was expressed by both the hair follicle epithelium and infiltrating immune cells. In conclusion, the upregulated of CCL13 and subsequent immune cell infiltration was related to AA, which could be a promising target for diagnosis and therapy in AA patients.

Effective treatment of alopecia universalis with oral tofacitinib: A case report

Alopecia areata is a common autoimmune disease presenting itself with patches of hair loss on the scalp, eyebrows, eyelashes, or any part of the body. It may manifest itself as a single patch, involving the entire scalp (alopecia totalis), or affecting the entire body, thus the name alopecia universalis. Multiple lines of treatment may be employed, but no single most effective treatment exists, especially if the condition is generalized and, thus, becomes more difficult to treat. Herein, we report a case of alopecia universalis treated with oral tofacitinib with an excellent and persistent response one year after.

Association of Alopecia Areata With Attention-Deficit/Hyperactivity Disorder Stimulant Medication: A Case-Control Study.

Background: Both psychiatric disorders and diverse medications used to treat them have been associated with alopecia. The objective of our study was to investigate the existence of an association between attention-deficit/hyperactivity disorder (ADHD) stimulant medication (ASM) and various types of alopecia.Methods: We conducted a retrospective case-control medical record review of patients between the ages of 6 and 18 years seen in dermatology clinics during a 10-year period. Cases included patients diagnosed with alopecia areata (AA), alopecia totalis (AT), or alopecia universalis (AU). We matched 3 controls on age and sex to each case. We reviewed patients’ medical records for the following medications: lisdexamfetamine, amphetamine/dextroamphetamine, dexmethylphenidate, and methylphenidate. We examined the association between medications used to treat ADHD and diagnoses of AA, AT, and/or AU by calculating a series of odds ratios and 95% CIs.Results: We identified 124 cases (110 with AA, 11 with AT, and 3 with AU) and 372 controls. We found a strong association between AU and ASM use (P<0.0071). No relationship between ASM use and other types of hair loss was found.Conclusion: Although the sample size of cases with AU was small, we found a significant association between AU and ASM. While further study is needed, practitioners may consider close monitoring of patients with AA who use ASM for the development of worsening disease and discontinue the medication if the patient experiences an increase in hair loss that appears to be progressing to AU.

Alopecia Totalis Successfully Treated with Modified Platelet-Rich Plasma Therapy in a Patient Recalcitrant to Traditional Treatment Modalities

Alopecia areata (AA) is an autoimmune, nonscarring, inflammatory disorder of the scalp and/or body resulting in hair loss. Extensive AA such as alopecia totalis is increasingly unresponsive to conventional treatment modalities. We report a case of alopecia totalis showing a promising response with the application of platelet-rich plasma therapy modified with triamcinolone acetonide.

Combining 308-monochromatic excimer phototherapy with monthly IM triamcinolone acetonide for the treatment of resistant alopecia totalis

Background: Treatment of resistant alopecia totalis AT is a major problem in general practice. Some studies reported the use of either excimer-308 or intra-muscular triamcinolone acetonide as a monotherapy, with conflicting results. Objective: To evaluate the therapeutic effect of combining 308-excimer phototherapy and intramuscular triamcinolone acetonide for the treatment of alopecia totalis. Methods and Material: Ten patients with alopecia totalis were evaluated in this prospective interventional study. All patients were assigned to receive the thera-peutic regimen that includes monthly IM triamcinolone acetonide (TAC) for a maximum of six pulses and twice-weekly excimer phototherapy for 24 sessions. Results: The overall response rate for this regimen was 90%, with four patients 40% achieving complete regrowth of hair (100%). Three patients have exhibited a satisfactory response (&gt;70% regrowth). Unsatisfactory response ( &gt;10-&lt; 70% regrowth) was reported in two patients . Younger patients responded better, as did those with a shorter history of the disease P &lt; 0.05. At follow-up, which continued for 8–12 months, recurrence was noted in two (22.2%) of the nine responders. Conclusions: Combining excimer phototherapy with triamcinolone acetonide showed a promising effect on resistant AT. This treatment modality was effective and well tolerated particularly in young patients.

Microblading and the Science Behind it.

Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new technique in the field of permanent cosmetics for eyebrow restoration. Currently, it is one of the most sort after treatment in aesthetic procedures due to the curiosity and awareness raised by social media. Microblading is a form of superficial micropigmentation, wherein pigment is deposited till the papillary dermis, with the help of a manual device and a blade consisting of stacked needles. The resultant crisp, discrete hair like incisions simulate the eyebrow hair to give a natural look. The results are semi-permanent and last only 12-18 months. In the recent years, with the advancement in the instrumentation of microblading there have been several modifications in this procedure. Microblading has now found its applications not only in cosmetic treatments but also in dermatological conditions such as alopecia totalis, hypothyroidism, chemotherapy induced madarosis etc. It is a vital tool in any dermatology or cosmetic practise for its extensive applications. But with the rise in popularity of microblading, there is also a rise of untrained professionals performing it leading to a rise in its side-effects. This article aims at not only guiding on the instrumentation and procedure of microblading but also its pre and post procedure care, interaction with other aesthetic procedures and treating its complications.