Non-scarring Alopecia Research Articles

Micronutrient Deficiencies and Digital Computerized Phototrichogram Analysis in Telogen Effluvium: a Retrospective Correlation Study in a Tertiary Medical Center.

Telogen effluvium (TE) is a common form of non-scarring alopecia that may manifest as acute or chronic hair shedding. Several studies evaluated a possible relationship between various vitamin and mineral deficiencies and TE, but it is still a controversial topic. This study aimed to investigate the status of vitamin and mineral deficiencies in patients diagnosed with TE and to evaluate their correlation with anagen hair ratios (AHR) calculated with an automated digital phototrichogram (ADCP). Electronic records of 973 TE patients were retrospectively analyzed. Demographic, clinical data, parameters such as ferritin, vitamin B12 (Vit-B12), vitamin D (Vit-D), folic acid, zinc and hemoglobin (HGB) serum levels were evaluated. Anagen to telogen hair ratios were also assessed in forty-two patients via ADCP. The rates of anemia, low ferritin level, and Vit-B12, folate, Vit-D, and zinc deficiencies were 11.9% (N = 109), 44% (N = 332), 1.5% (N = 13), 2.5% (N = 14), 87% (N = 51), and 4.5% (N = 2), respectively. A positive correlation was found between HGB levels and AHR in female patients (Spearman rank, r = 0.417, P = 0.008). No statistically significant relationship was found between ferritin, Vit-B12, folate, zinc serum levels and AHR. The relationship between Vit-D and AHR could not be assessed due to the insufficient number of patients with Vit-D data. HGB value is the only marker that is positively correlated with the AHR of patients with TE. Ordering HGB can be used as an initial test for managing TE patients cost-effectively.

Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis.

Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking. The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA. We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023. We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89). These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.

Incidence and prevalence of alopecia areata in the Australian primary care setting: A retrospective analysis of electronic health record data.

Alopecia areata (AA) is a common immune-mediated non-scarring hair loss, with a worldwide incidence between 0.57% and 3.8%. The incidence and prevalence of AA in the Australian general population have not been previously reported. To describe the incidence and prevalence of AA in Australia using primary care data. A secondary objective was to identify common demographic characteristics, comorbidities and treatment patterns among Australians living with AA. We analysed electronic health record data captured from a national clinical practice management software over a 10-year index period between 2011 and 2020 calendar years, inclusive. The incidence of new-onset AA and the prevalence of active records with AA were estimated. Differences in incidence by sociodemographic groups, and patterns of treatment were also evaluated. There were 976 incident AA records. The incidence of new-onset AA in the total study cohort was 0.278 per 1000 person-years (95% CI 0.26-0.295). By age, the incidence was highest in the 19- to 34-year-old age bracket (0.503 per 1000 person-years: 95% CI 0.453-0.554). AA incidence was lower among females than males (IRR 0.763, p < 0.001, 95% CI 0.673-0.865). Among active records, 520 were prevalent AA records. AA point prevalence at 31/12/2020 was 0.13% (1.26 per 1000 persons; 95% CI 1.15-1.37). This is the first study to describe the epidemiology (incidence and point prevalence) and management of AA in the Australian primary health-care population through large-scale database analysis. Incidence and prevalence findings were consistent with earlier estimates from other regions.

Clinical and serological predictors of neuropsychiatric manifestations in patients with systemic lupus erythematosus

IntroductionSystemic lupus erythematosus is a chronic autoimmune disease with variable severity, neuropsychiatric manifestations comprise a wide spectrum of syndromes defined according to its central and peripheral involvement. Many pathophysiological mechanisms have been involved in the development of these manifestations, such as the disruption of the blood-brain barrier and the cellular toxicity related to autoantibodies such as anti-aquaporin, anti-ribosomal P and anti-phospholipids. Predictive elements to identify neuropsychiatric compromise will be explored by predictive models in this article. Methodology and methodsRetrospective cross-sectional study, predictive models such as decision trees, naive Bayesian, K-nearest neighbours and generalized linear models were used for the analysis, the best model was selected. Results122 patients were included, of whom 100 (81.9%) were women and 22 (18.1%) men, the prevalence of neuropsychiatric compromise was 59%, anxiety disorders, headache and mood disorders being the most frequent. In the bivariate analysis, oral ulcers (OR 2.52, 95% CI 1.09–6.08 p = 0.02), non-scarring alopecia (OR 4.06, 95% CI 1.76–9.68 p = <0.01), arthritis (OR 2.5, 95% CI 0.99–6.94 p = 0.04), leukopenia (OR 2.81, 95% CI 1.18–7.09 p = 0.04) and patients without accumulated damage measured by the SLICC/ACR-DI damage score (2.1, 95% CI 0.98–4.93 p = 0.01), were associated with greater neuropsychiatric compromise. The best prediction model was the decision tree model, in which non-scarring alopecia, oral ulcers and anti-Ro/SSA antibodies behaved as independent variables related to neuropsychiatric compromise with a precision of 75.6%. ConclusionsThe prevalence of neuropsychiatric involvement in lupus was 59%, the independent variables that best predict these manifestations were anti-Ro/SSA seropositivity, non-scarring alopecia, and oral ulcers through decision trees.

Common Treatment Formulation for Non-Scaring (Androgenetic) Alopecia

In spite of being a non-life-threatening condition, hair loss (alopecia) severely impacts the quality of life of individuals who experience it. Recent studies indicate that the number of patients suffering from alopecia globally is on the rise. Androgenic alopecia (AGA) affects both genders at all ages. Genetic factors and family history are found to greatly impact the likelihood of experiencing hair loss. Statistics reveal that during the course of their lives, 80% of men experience alopecia, while 40 to 50% of women are likely to face some form of hair shedding. AGA is characterized by frontal-temporal hair shedding in men and hair thinning of the midline part of the scalp for women. A variety of herbal formulations are available on the market to combat AGA, while only two FDA-approved medications exist at the moment: oral finasteride and topical minoxidil. Topical formulations of finasteride are still under clinical trials. Minoxidil and finasteride formulations provide effective AGA treatment for both genders. Recent concerns regarding potential side effects of these two medications have drawn interest in providing new innovative alternative formulations (nutrients, minerals and vitamins) to provide a safer treatment against AGA. This article provides a brief overview of the current and alternative AGA formulations.

Patterns of noncicatricial alopecia in children: a cross-sectional study

Background and aim Hair loss in children is an unpleasant complaint. It represents a challenge for the treating physician, is extremely upsetting to the parents, and has a psychosocial complication for the growing child. Our study aims to clarify the causes and forms of noncicatricial alopecia in a sample of pediatric patients and to identify the common trichoscopic features of each illness. Patients and methods This study was conducted on 300 children who attended the outpatient dermatology clinics at Al-Azhar University in Assiut. Their ages ranged between 2 and 18 years old and they complained of scalp disorder and hair loss. Results Tinea capitis (TC) was the most common form of pediatric alopecia (136 patients, 45%), while alopecia areata (AA) and marginal traction alopecia were the second most common causes with a frequency of 57 (19%) and 56 (18.7%), respectively. Toxic alopecia was identified in 30 (10%) of the patients, telogen effluvium in 11 (3.7%), while six (2%) patients presented with female pattern hair loss, three (1%) patients had short anagen syndrome and only one patient presented with Trichotillomania. The most common trichoscopic features in patients who had TC were comma hair and short, broken hair, while microexclamation marks were the most common trichoscopy features among AA patients. Conclusion TC was the most common cause of pediatric alopecia, followed by AA and marginal traction alopecia. Diagnosis of hair and scalp disorders enhances the diagnostic power beyond basic clinical examination and exposes unique aspects of the diseases, leading to better management.

BH12 Granulomatous alopecia areata

Abstract A 46-year-old woman with Fitzpatrick skin type V presented with sudden-onset accelerated diffuse hair loss. Her other relevant medical history included Graves disease. Trichoscopy showed black dots, broken hairs with exclamation mark-like hairs and yellow dots. She was provisionally diagnosed with diffuse alopecia areata (AA). Laboratory work-up, including complete blood count, liver/renal parameters, antinuclear antibody and complement screen did not reveal any abnormality. Thyroid function and adjusted calcium level were all within the normal range. She had slight iron, folate and vitamin D deficiencies, which were treated with the appropriate supplements. A biopsy was taken from the scalp, and histological examination showed a nonscarring process with miniaturization, significant telogen shift and peribulbar granulomatous inflammation. Subsequent syphilis serology was negative, and serum angiotensin-converting enzyme was within normal limits. No clinical features of sarcoidosis or syphilis were observed. After careful clinicopathological correlation, she was diagnosed with granulomatous AA. We planned to treat her with diphencyprone; however, her hair grew back spontaneously after 2 months. AA is a nonscarring hair loss that can commonly affect the scalp and beard, as well as any hair-bearing surface on the body. It is a T-cell-mediated disease with characteristic histological features, including peribulbar lymphocytic inflammation with or without eosinophils, follicular miniaturization and an increase in catagen/telogen hairs. Peribulbar granulomatous inflammation is a rare histopathological finding in AA. In the context of alopecia, other conditions associated with histopathological granulomatous findings include sarcoidosis, syphilis and various forms of inflammatory and cicatrizing alopecia. To our knowledge, only five other cases of granulomatous AA have been reported. Notably, we describe the first case from the UK and only the second case internationally to show spontaneous resolution, suggesting that the prognosis of granulomatous AA is not dissimilar to histologically typical AA. To summarize, we have described a clinically typical AA with atypical histopathological findings. Granulomatous inflammation should not preclude a diagnosis of AA. This demonstrates the importance of clinicopathological correlation as the histopathology of alopecia could potentially be misleading.

BH02 Online psychological support for patients with alopecia areata: an evaluation of available online psychological support material based on the National Centre for Complementary and Integrated Health guidelines

Abstract Alopecia areata is an autoimmune disorder causing nonscarring hair loss that is associated with significant psychological comorbidity (Macbeth AE, Holmes S, Harries M et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol 2022; 187:73–81). In addition to seeking psychological support from medical professionals, patients will often turn to online resources. In this study, we evaluated the range and quality of the online psychological support material available for patients with alopecia areata. A Google search was undertaken using private browsing on 5 June 2022, with several search terms: ‘alopecia areata online support group UK’, ‘alopecia support’ and ‘alopecia areata psychology’. The National Centre for Complementary and Integrated Health (NCCIH) guidelines for the evaluation of online resources were used. These guidelines assess information source and accuracy, funding, peer review status, linking policies and contemporaneity. Our search generated a total of 154 000 results. Advertisements, scientific articles, educational resources and duplicates were excluded, with nine resources included in the final analysis. Of the nine resources reviewed, three were specific for patients with alopecia areata, with the remaining resources focused on other types of hair loss. Six were authored or reviewed by dermatologists and seven had a documented peer review process of their content. One resource had no clear authorship and three had no clear peer review process. Nine of the resources were charity funded and one was a National Health Service resource. Four had been updated in the last 3 years and a further two within 5 years. All resources had clearly documented security and linking policies. All resources acknowledged the psychological impact of hair loss and eight had links to support groups or discussion forums. Only five had psychological support and advice on their website, with others only referring to the psychological burden and then signposting patients on to other sources for support. Only three of the resources referred to therapies such as cognitive behavioural therapy. The prevalence of mental health comorbidity in alopecia areata is high compared to the general population (Macbeth et al.). Our preliminary study has shown that the online psychological support available is lacking. With patients increasingly turning to the Internet for support and health information, there is an opportunity and need for development in this area.

BH15 Efficacy and safety of baricitinib in the management of severe alopecia areata over a 6-month period: a real-world experience

Abstract Alopecia areata (AA) is an autoimmune condition that targets the hair follicles, causing nonscarring hair loss. It can manifest with different patterns, ranging from discrete bald patches on the scalp to complete loss of body hairs. Despite being considered a disease of purely aesthetic concern, recent data support its systemic nature. In June 2022, baricitinib, an oral selective inhibitor of Janus kinases 1 and 2, was the first US Food and Drug Administration-approved systemic treatment for adult patients with severe AA. Our objective was to present the efficacy and safety of baricitinib in the management of adult patients with severe AA in real practice at 24 weeks. All consecutive adult patients diagnosed with severe AA, who were started on baricitinib in our specialist hair clinic, and completed 24 weeks of treatment were eligible. Access to baricitinib was granted after approval by the national organization for the provision of health services on a case-by-case basis. Demographic data, disease history, previous treatments for AA and comorbidities were documented. Severity of Alopecia Tool (SALT) score, loss of eyebrows/eyelashes, hair loss in other parts of the body and nail involvement were also assessed. Patients completed the Dermatology Life Quality Index (DLQI), Patient Health Questionnaire (PHQ)-9 and Generalised Anxiety Disorder Assessment (GAD-7) at each visit. Safety profile was also assessed. Visits were performed at T1 (4 weeks), T2 (8 weeks), T3 (12 weeks) and T4 (24 weeks). Ten patients were included in the analysis. The male-to-female ratio was 3 : 2. Mean patient age was 34.8 years. All were White. Sixty per cent of patients had alopecia universalis/totalis, 30% had ophiasis and 10% had patchy alopecia. Mean disease duration was 6.1 years. The most common comorbidities were depression and anxiety. Baseline mean SALT score was 82, which decreased significantly at weeks 8, 12 and 24. Ninety per cent had eyebrow/eyelash regrowth. Patients with more recent disease onset responded quicker than those with a more chronic disease course. Nail involvement was noted in 30% of patients, which improved in all of them at week 24. There was a significant decrease in PHQ-9, GAD-7 and DLQI scores at weeks 8, 12 and 24. Forty per cent of patients developed an acneiform rash, 30% an upper respiratory infection, 10% a vaginal infection, 40% transient raised creatine kinase, 20% dyslipidaemia and 20% transient neutropenia and anaemia. Our real-world data showed a quick onset of action for baricitinib and encouraging results in terms of efficacy at week 24. Safety profile was acceptable, with many of the adverse events being transient and not requiring treatment. No severe adverse events were noted. Studies with a larger number of patients and longer duration of treatment are needed to assess the long-term efficacy and safety of baricitinib in everyday clinical practice. Finally, national registries for patients with AA could play a crucial role.

BH11 Cutis verticis gyrata associated with chronic traction

Abstract Cutis verticis gyrata (CVG) is a rare condition characterized by overgrowth of the skin of the scalp, leading to skinfolds and deep convoluted furrows that resemble the cerebral cortex gyri. Cases of CVG have been classified into primary essential, primary nonessential and secondary. Primary essential CVG has no associated abnormalities. Primary nonessential CVG is associated with neurological or ophthalmological abnormalities. Secondary CVG is due to a local inflammatory or neoplastic process, or an underlying endocrine or genetic cause. We present two cases of CVG associated with chronic traction alopecia. The main clinical features in both cases were thickened skinfolds in the central scalp, which did not extend to the lateral scalp, recession of the frontal hairline with fringe sign and a negative hair-pull test. Histological findings from the zone of alopecia included nonscarring hair loss with the presence of fibrous tracks within the skin but preservation of the sebaceous glands, consistent with chronic traction alopecia. Both patients were advised to reduce tension on the hair and were treated with topical minoxidil and advised on hair transplantation. Patient 1 was a 15-year-old Sikh boy who developed CVG secondary to chronic traction applied from tying his hair at the top of his scalp when wearing a turban. Owing to cultural practices, the patient could not cut his hair, representing a challenge of treating CVG associated with chronic traction in this group of patients. Patient 2 was a 16-year-old girl with a background of joint hypermobility and recurrent hip dislocations, currently undergoing genetic testing for Ehlers-Danlos syndrome. She developed CVG following chronic traction due to hairstyling. Interestingly, cutting her hair resulted in some improvement of the appearance of CVG, possibly due to reduced hair tension. Chronic traction is an uncommon cause of CVG, with only a few cases reported in the literature. It is likely that the persistent tension of tight hairstyles pulls the scalp into folds and contributes to the appearance of CVG. These cases highlight the importance of ascertaining whether a history of traction styling is present in the diagnosis and management of CVG.

P67 Overall lifetime risk for alopecia areata is 2.1% and is higher in women, non-White ethnic groups and the most deprived: a UK population-based cohort study

Abstract Alopecia areata (AA) is an immune-mediated nonscarring alopecia often associated with substantial morbidity. However, there are limited population-based data on potential disparities in the burden of AA, including across different ethnicities and sociodemographic classifications. We aimed to provide the first large-scale, population-based evaluation of lifetime risk of AA across sociodemographic subgroups. This study used routinely collected data from a large UK population-based database: the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). All children and adults registered with general practices contributing to the RCGP RSC network in the period 2009–2018 without a prior diagnosis of AA were included. People were considered to develop AA if they had an AA diagnosis and, in the subsequent 365 days, no code for an alternative diagnosis (e.g. traction alopecia and scarring alopecia). The cumulative lifetime risk of AA was estimated at age 80 years using survival models, with age as the timescale and accounting for the competing risk of death. Lifetime risk was calculated for the whole population and by sociodemographic subgroups comprising sex, major UK ethnicity groups and socioeconomic deprivation. In a total population of 4 052 231, 6961 developed new-onset AA. The lifetime risk in the overall population was 2.11% [95% confidence interval (CI) 2.06–2.16]. There was substantial difference in lifetime risk of AA by ethnicity; lifetime risk was 1.74% (95% CI 1.68–1.80) in the White subgroup, 5.87% (95% CI 5.51–6.24) in Asian, 3.03% (95% CI 2.63–3.42) in Black, 4.44% (95% CI 3.50–5.37) in mixed and 4.47% (95% CI 3.63–5.31) in other ethnic groups. Females had a higher lifetime risk of AA than males: 2.35% (95% CI 2.28–2.43) vs. 1.88% (95% CI 1.81–1.94). Lifetime risk was greater with increasing socioeconomic deprivation: least-deprived 1.68% (95% CI 1.59–1.78) vs. most-deprived quintile 2.92% (95% CI 2.77–3.07). Our findings demonstrate that AA affects nearly 1 in 50 people over a lifetime. Lifetime risk is substantially greater in people of non-White ethnicity and is highest in those of Asian ethnicity (one in 17 people). The lifetime risk is also higher in females and those with the greatest socioeconomic deprivation. Clinicians should be aware of the disproportionate distribution of AA across the population and support the provision of healthcare resource to groups with the highest burden. Funding sources: this research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and were funded by Pfizer.

BH14 Multiple sclerosis and alopecia areata: drug-induced alopecia areata or coexisting autoimmune phenomena?

Abstract Alopecia areata (AA) is an autoimmune condition characterized by well-demarcated patches of nonscarring alopecia. AA shares multiple gene loci with other autoimmune conditions, including multiple sclerosis (MS). There are limited data on drug-induced alopecia areata (DIAA); however, the literature is expanding, with several targeted therapies implicated including dupilumab, nivolumab and multiple disease-modifying MS treatments, namely, alemtuzumab and ocrelizumab. Alemtuzumab is monoclonal antibody against CD52, which is expressed on T and B lymphocytes, natural killer (NK) cells, monocytes and macrophages. It is considered a highly efficacious treatment; however, there are increasing reports of secondary autoimmunity in up to 40% of patients (Tuohy O, Costellow L, Hill-Cawthorne G et al. Alemtuzumab treatment of MS: long-term safety and efficacy. J Neurol Neurosurg Psychiatry 2015; 86:208–15). A 35-year-old man was referred by his neurologist with concerns of alemtuzumab-induced alopecia universalis (AU). He has relapsing-remitting MS, diagnosed in 2018. His first alemtuzumab course was in 2018 and the second in June 2019, which achieved remission. He reported AU approximately 10 months after this second course with complete spontaneous regrowth. A further episode of AU occurred 6 months later with only minimal eyebrow regrowth. He had no previous history of alopecia or thyroid disease. He had vitamin D insufficiency. There are 12 cases of alemtuzumab-induced AA reported in the literature with variable timeframes of onset, ranging between weeks to over 6–9 months postinfusion. The majority of patients received more than one infusion prior to the onset of AA. Our case echoes other case reports, including one case of AU manifesting 9 months post-alemtuzumab (Zimmermann J. Buhl T, Muller M. AU following alemtuzumab treatment in MS: a barely recognized manifestation of secondary autoimmunity – case report and review of literature. Front Neurol 2017; 8:569). AA pathogenesis, like MS, is hypothesized to be multifactorial with genetic, environmental and autoimmune aspects. It is believed that AA hair follicle cells have increased major histocompatibility complex class I and II activity, presenting autoantigens to CD8+ T cells, CD4+ T cells and NK cells. Interferon (IFN)-γ is considered key in AA pathogenesis. Patients with AA are found to have raised serum levels, along with reports of raised interleukin (IL)-6 levels. Alemtuzumab-induced immunosuppression precedes a phase of immune reconstitution. Cytokines are released post-treatment, including IFN-γ, tumour necrosis factor-α, IL-6 and IL-2. It is plausible that alemtuzumab could trigger AA as a sequela of the immune reconstitution. However, DIAA has been poorly described and the genetic overlap raises the question of both conditions occurring spontaneously. Accurate phenotyping and a multidisciplinary approach will enable us to gain greater clarity, inform our decision-making in the management of these complex patients and provide insights into pathogenic AA pathways.

Videodermoscopy Evaluation in Non-scarring Alopecia of Scalp

Introduction: Hair is a versatile structure, and its importance has been linked to it in the beautification of human beings for ages. According to studies on the psychological impacts of androgenetic alopecia (AGA) in men, they are older, weaker, and less appealing. Hair loss in women gives significant stress and lowers self-confidence. Aim: To perform videodermoscopic findings in non-scarring alopecia of scalp versus control volunteers. Material and Methods: Total of 140 patients satisfied the study’s inclusion criteria after a general medical examination, scalp examination (including inspection of the hair shaft and root), and hair anchoring and fragility tests. We examined the lesions with a videodermoscopy, took images, and wrote up our findings. Results: The study found that patients averaged 26.85. Onset averaged 25.15 alopecia averaged 10.3 months. Our sample had 87.7% spotty AA. Conclusion: Videodermoscopy is an effective non-invasive tool of considerable potential in dermatological practice. It is becoming popular as a hair loss differential diagnosis tool.

Review on Alopecia Areata in the Middle East and Africa: Landscape and Unmet Needs.

Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life. AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.

Post-Traumatic Stress Disorder in Patients with Alopecia Areata: A Survey Study in the USA

Introduction: Alopecia areata (AA) is an autoimmune condition that results in nonscarring hair loss. AA is comorbid with mental health disorders including anxiety and depression. This study aimed to evaluate the presence of post-traumatic stress disorder (PTSD) in relation to hair loss in patients with AA. Methods: A cross-sectional national survey was distributed using the National Alopecia Areata Foundation’s (NAAF) email list. This study was approved by the Mass General Brigham Institutional Review Board. Participants were asked to complete the PTSD Checklist for the DSM-5 (PCL-5), a validated screening tool for PTSD in the context of their AA. Results: Of the 1,449 completed surveys (completion rate 79.6%), most respondents were female (83.8%) and white (76.6%) with an average age of 50.6 ± 15.6 years. Respondents had AA for an average of 17.7 ± 15.8 years, with 91.4% experiencing current active hair loss. A total of 33.9% of respondents screened positively for PTSD, with an average score of 48.8 ± 12.3 on the PCL-5 in participants who screened positively. Participants with alopecia totalis have the highest average PCL-5 score of 30.1 ± 19.2, followed by participants with alopecia universalis with an average score of 26.0 ± 19.9, and lastly patchy AA with an average score of 24.5 ± 18.3 (p = 0.003). Feelings of intrusion and avoidance were the predominant reported symptoms. Total PTSD scores were significantly higher in respondents who were younger and identified as Black or African American and Hispanic when compared to white and non-Hispanic respondents, respectively. Conclusion: These findings identify that one in 3 patients with AA in this cohort meet the screening criteria for PTSD specifically relating to their hair loss experience. These results further highlight the mental health comorbidities associated with AA and emphasize that these symptoms may persist even after hair regrowth. Limitations include the nonrandomized NAAF population with most participants being white females. Future studies should confirm these findings in other patient populations. Finally, respondent’s baseline mental health was not assessed; therefore, a causal relationship between AA and PTSD cannot be deduced.

Prescription Pattern of Tofacitinib for Alopecia Areata Among the Dermatologists in Saudi Arabia: A Cross-Sectional Study.

Introduction Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. In Saudi Arabia, AA accounts for 1-2% of new dermatological outpatient visits. It typically presents with sharply demarcated round patches of hair loss and may present at any age. Traditional medical therapies include corticosteroids and immunotherapy. Choosing the ideal treatment depends on multiple factors such as patient age, disease severity, efficacy, side effects, and remission rate. Recent medications that have been used for treating AA are Janus kinase inhibitors. Aim The aim of the study is to assess the awareness and attitude of dermatologists and their use of Tofacitinib in treating AA. Method A cross-sectional study was conducted in 2019 across 14 major cities in Saudi Arabia. A self-administered online questionnaire was specifically developed and used. Dermatologists from government hospitals and private clinics were included through non-probability convenience sampling. The collected data was entered into Microsoft Excel and analyzed using SPSS program version 24. Results In total, out of 546 Dermatologists across Saudi Arabia who responded to the questionnaire, 127 (23.2%) physicians prescribed Tofacitinib in their practice. Out of those who prescribed the drug for AA cases, 58 dermatologists (45.6%) prescribed Tofacitinibafter the failure of steroid injections. Among the 127 dermatologists who have utilized Tofacitinib in their practice, 92 (72.4%) believe that Tofacitinib is effective in treating AA. Almost 200 (47.7%) Dermatologists who never prescribed Tofacitinib reported that the main reason was due to the unavailability of the drug in the clinic they were practicing. Conclusions To conclude, out of 546 dermatologists working in Saudi Arabia, 127 (23.2%) prescribe Tofacitinib to treat AA. Ninety-two (72.4%) of the participants reported the effectiveness of Tofacitinib. Two hundred (47.7%) dermatologists who never prescribe Tofacitinib reported that the main reason was due to the unavailability. However, this would raise the need for more research regarding JAK inhibitors generally and Tofacitinib specifically, focusing on the effectiveness versus the side effects of Tofacitinib.

Oxidative stress and alopecia areata.

Alopecia areata (AA) is an inflammatory autoimmune disease characterized by non-scarring hair loss on the scalp or any other part of the hair-bearing skin. While the collapse of the immune privilege is considered as one of the most accepted theories accounting for AA, the exact pathogenesis of this disease remains unclear by now. Other factors, such as genetic predisposition, allergies, microbiota, and psychological stress, also play an important role in the occurrence and development of AA. Oxidative stress (OS), an unbalance between the oxidation and antioxidant defense systems, is believed to be associated with AA and may trigger the collapse of hair follicle-immune privilege. In this review, we examine the evidence of oxidative stress in AA patients, as well as the relationship between the pathogenesis of AA and OS. In the future, antioxidants may play a new role as a supplementary therapy for AA.

A novel predictive model for the recurrence of pediatric alopecia areata by bioinformatics analysis and a single-center prospective study

Background Alopecia areata (AA) is a disease featured by recurrent, non-scarring hair loss with a variety of clinical manifestations. The outcome of AA patients varies greatly. When they progress to the subtypes of alopecia totalis (AT) or alopecia universalis (AU), the outcome is unfavorable. Therefore, identifying clinically available biomarkers that predict the risk of AA recurrence could improve the prognosis for AA patients. Methods In this study, we conducted weighted gene co-expression network analysis (WGCNA) and functional annotation analysis to identify key genes that correlated to the severity of AA. Then, 80 AA children were enrolled at the Department of Dermatology, Wuhan Children’s Hospital between January 2020 to December 2020. Clinical information and serum samples were collected before and after treatment. And the serum level of proteins coded by key genes were quantitatively detected by ELISA. Moreover, 40 serum samples of healthy children from the Department of Health Care, Wuhan Children’s Hospital were used for healthy control. Results We identified four key genes that significantly increased ( CD8A, PRF1 , and XCL1 ) or decreased ( BMP2 ) in AA tissues, especially in the subtypes of AT and AU. Then, the serum levels of these markers in different groups of AA patients were detected to validate the results of bioinformatics analysis. Similarly, the serum levels of these markers were found remarkedly correlated with the Severity of Alopecia Tool (SALT) score. Finally, a prediction model that combined multiple markers was established by conducting a logistic regression analysis. Conclusion In the present study, we construct a novel model based on serum levels of BMP2, CD8A, PRF1 , and XCL1 , which served as a potential non-invasive prognostic biomarker for forecasting the recurrence of AA patients with high accuracy.

Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication.

Surgical facelifts and noninvasive techniques such as mesotherapy, hyaluronic fillers and botulinum toxin, among other procedures are widely used nowadays to reverse skin ageing and achieve rejuvenation effects. Secondary alopecia due to cosmetic procedures is a rare side effect and is poorly described in the literature. The mechanisms in which hair loss develops after an aesthetical procedure or surgical technique are not well known. The development of secondary scarring alopecia or non-scarring alopecia depends upon the interaction between different external factors, the individual host response and the extent of damage to the hair follicle anatomy. Current knowledge hints at the type of substance used, pressure to hair structures and vasculature due to the materials used, previously unknown or unaware hair disorder, and poor surgical techniques to be the main factors contributing to the development of secondary alopecia. Physicians and patients must be aware of all the substances used for the procedures and be attentive to any change in hair density or hair loss. Clinicians must have a low threshold to take biopsies if the risk of scarring alopecia may occur. Herein, we review the clinical, trichoscopic, histopathological findings and potential pathophysiological mechanisms of hair loss due to different aesthetic procedures.

Autoimmune Systemic Diseases in Children: Epidemiology and Clinical Phenotypes in Senegal

Introduction: Systemic diseases (SD) include all non-organ-specific autoimmune and/or inflammatory disorders. In children, their severity is related to severe visceral damage and iatrogenic complications of treatment. This study aimed to determine the epidemiological, clinical evolutionary aspects of systemic diseases in children. Methodology: A cross-sectional, analytic study was carried out in the Dermato-pediatrics Department of the Albert Royer Hospital in Dakar from January 2020 to June 2022 (30 months). We included all children aged 0 to 16 years followed up for systemic autoimmune disease. Results: We collected 18 cases of systemic diseases in children, representing a hospital frequency of 0.36%. The SD were of the lupus type in 7 cases, dermatomyositis in 4 cases, scleroderma in 3 cases, mixed connectivity’s in 3 cases and APLS in 1 case. The sex ratio was 0.12. The mean age of the children was 10 years [4-14 years]. In lupus, lesions were acute in 5 cases, subacute in 1 case and chronic in 1 case. In dermatomyositis, the cutaneous manifestations were: periorbital erythredema, ulcer-necrotic lesions, atrophic lesions of photo-exposed areas, non-erosive cheilitis, a non-scarring alopecia, Gottron papules, poikiloderma and calcinosis. Dermatomyositis was associated with extracutaneous muscular, articular, cardiovascular and pulmonary involvement. In scleroderma, cutaneous manifestations included sclerodactyly, Raynaud's phenomenon and cutaneous sclerosis. Visceral involvement included rhythm disturbances and pulmonary fibrosis. Necrotic ulcers and cyanosis of the extremities were the circumstances in which APLS was discovered. The association lupus-dermatomyositis represented (66.7%) and lupus-APLS (33.3%). Corticosteroid therapy was administered in 38.8% of cases. The outcome was favorable in 27.77% (n=5), with death noted in 3 cases. Conclusion: Systemic autoimmune diseases of children are rare disorders. They are characterized by their clinical polymorphism and the severity of visceral damage. Early treatment and therapeutic education of parents can improve prognosis.