Patchy Alopecia Areata Research Articles

Intralesional vitamin D3 versus intralesional triamcinolone acetonoid in patchy alopecia areata: a comparative clinical and dermoscopic study

ABSTRACT Background Alopecia areata (AA) is a common autoimmune T-cell mediated non-scarring, form of hair loss. It affects people of all ages and sexes. Aim To compare the efficacy of intralesional vitamin D3 injection versus that of intralesional triamcinolone acetonide in the treatment of patchy alopecia areata. Patients and methods This clinical study was carried on 40 adult patients with patchy alopecia areata, the patients were categorized into two groups. Group I involved 20 patients who received 1 ml of intralesional injection of vitamin D3 (cholecalciferol aqueous preparation 200 000 IU/2 ml) every 4 weeks for a maximum of three sessions. Group II involved 20 patients who received 1 ml of intralesional injection of triamcinolone acetonide 40 mg/mL every 4 weeks for a maximum of three sessions. Clinical and trichoscopic evaluations were done at the baseline, each session and for 3 months after the last session. Results There was no statistically significant difference between the two studied groups regarding the degree of clinical improvement (p = .8). A statistically significant reduction in AA specific trichoscopic signs was detected at the end of the sessions and after 3 months of follow-up in both groups, without any statistically significant difference between them. Also a statistically significant difference was found between both groups regarding the reported adverse effects with a significant better patient satisfaction encountered toward the intralesional vitamin D3 injection. Conclusion Intralesional vitamin D3 is a promising effective, simple, safe, and inexpensive, therapeutic modality for patchy AA.

Patchy alopecia areata (AA) and diffuse alopecia areata (DAA)

Patchy alopecia areata (AA) and diffuse alopecia areata (DAA)

Safety and efficacy of tofacitinib in 97 alopecia areata patients.

Alopecia areata (AA) is a recurrent immune-mediated disorder causing hair loss without any scarring being present. It affects hairs on the head or other parts of the body and can occur at any age and in both genders. It seems that AA is associated with a higher rate of psychological disorders resulting from hair loss and the esthetic and social repercussions of it. Common treatments like corticosteroids do not work for every patient and recent treatment options focusing on the immunologic mechanisms like tofacitinib have shown some promising results. It's a retrospective study on patients with AA, AT, AU taking oral tofacitinib as a treatment for at least 6 months. Scalp hair loss was assessed before treatment and at each visit using the Severity of Alopecia Tool (SALT) score. Of 97 cases, 69.1% demonstrated over 50% SALT score improvement, with 44.3% having 90% or more decrease in SALT score. Patients who suffered from patchy AA were more responsive compared to patients with AT and AU subtypes and had a greater percent change in SALT score. Tofacitinib was tolerated quite well and no significant adverse events were reported. Tofacitinib should be taken into consideration as an efficacious treatment option for patients with AA, AT and AU.

Current Diagnostic and Therapeutic Practices in Alopecia Areata in Two Mediterranean Countries: A Survey-Based Study.

Alopecia areata (AA) affects approximately 2% of the general population and is associated with significant psychosocial morbidity and poor health-related quality of life. Despite the high incidence of the disease the available clinical practice guidelines to help clinicians and improve patients' care are very poor and of a low methodological quality, as compared to other high-burden dermatoses. The aim of this survey is to capture the current clinical practice in AA management, as performed by dermatologists, in two Mediterranean countries to identify potential disparities and gaps in diagnosis and treatment. A 50-item questionnaire was created in the English language and then translated into Greek and Italian language and sent to the Greek and Italian dermatologists via email. A total of 490 dermatologists from Italy and 234 from Greece participated in the survey. The diagnosis of AA is usually based on history and clinical examination, supported by trichoscopy. The rate of use of severity scores and scales to evaluate impact on quality of life by dermatologists was low. Treatment of patchy AA, in both adult and pediatric populations, is based on use of topical steroids as first-line treatment. Results on special site involvement (eyebrows, beard, and ophiasis), chronic cases, and the pediatric population highlight extreme heterogeneity in treatment approach. Our results highlight that management of AA, in terms of diagnosis and treatment, is still challenging.

Real-World Assessment of Disease Characteristics and Clinical Outcomes in Alopecia Areata in a Global Noninterventional Observational Cohort (ADAAGIO)

Background: A range of medications with varying efficacy are used to treat alopecia areata (AA). There remains limited evidence on prevailing treatments, disease characteristics, and clinical outcomes of patients with AA in routine practice, particularly for those with extensive hair loss. This study sought to address this evidence gap.
 Methods: This was a retrospective chart review study spanning the United Kingdom, France, Spain, and Germany. Adult and adolescent patients with ≥50% scalp hair loss were included. The study index date was defined as date of de novo or progression to ≥50% scalp hair loss and patients were required to have ≥6 months of postindex follow-up (i.e., index date to last clinic visit); index dates ranged 2015-2019. Analyses were descriptive and reported patient demographics, baseline clinical characteristics, and Dermatologic Life Quality Index (DLQI) score. The primary clinical endpoint was absolute Severity of Alopecia Tool (SALT) score and was assessed longitudinally based on post-index visits in which SALT was recorded. Sustained SALT ≤20 was also assessed via Kaplan-Meier methods to evaluate time to achieving SALT ≤20 without subsequent regression within 6 months to SALT >30.
 Results: A total of 741 patients were included. Median age at AA diagnosis was 27 years and 52.6% were female. Mean (SD) baseline SALT score at index was 63.5 (15.6), with 80.2% having patchy AA and 19.8% having alopecia totalis or universalis. Among patients with DLQI measured at index, mean (SD) DLQI score was 19.2 (7.2) with 84.5% reporting either a large (DLQI 11-20) or extremely large (DLQI 21-30) impact of AA. Topical corticosteroids were the most common treatment observed post-index, with 55.6% receiving ≥1 course with a median cumulative exposure of 4 months. Intralesional corticosteroids (22.5%), systemic immunosuppressants (22.0%), and oral (17.3%) or topical (19.4%) minoxidil were also common. Among patients with SALT measured at 12 months post-index, there was a mean (SD) absolute SALT reduction of -44.6% (37.3%) from baseline. However, at 12 months post-index, most patients (90.1%) failed to achieve SALT ≤20 that was sustained for ≥6 months.
 Conclusions: Although patients in this study experienced a substantial absolute SALT score reduction, few patients achieved and subsequentially sustained the more clinically meaningful SALT threshold of ≤20. These findings highlight the potential suboptimal effectiveness of the varied treatments applied in this population.

C-reactive protein as a novel biomarker for vitamin D deficiency in alopecia areata.

Alopecia areata (AA) is an autoimmune condition characterized by sudden and unpredictable hair loss, with a lifetime incidence of 2%. AA can be divided into three categories: patchy alopecia, alopecia totalis, and alopecia universalis. It can affect a person's psychological health and overall quality of life. Elevated C-reactive protein (CRP) levels in the liver may indicate an inflammatory response in autoimmune diseases. Vitamin D, essential for immune system control and skin health, may be related to AA. Hair follicles contain vitamin D receptors, which control immunological responses in the skin. However, no study has found a relationship between CRP and vitamin D in AA patients in our region. An analytical cross-sectional study with a case-control design research investigation of 82 AA patients and 81 healthy controls was carried out. Both groups' medical histories were taken. Biochemical analysis was done for both groups as well as the serum vitamin D levels, and CRP. Genetic analysis for CDX2 rs11568820 variant detected by PCR (T-ARMS-PCR) method and vitamin D receptor (VDR) gene expression measured by real-time PCR analysis for both patients and healthy subjects. CRP levels are higher in AA patients, AA patients with G/G genotypes exhibited higher concentrations of CRP when compared to those with A/A and A/G genotypes while patients with A/A genotypes have higher levels of Serum vitamin D as compared to the A/G and G/G genotypes. G allele was more abundant in AA patients. VDR gene expression was lower in AA compared to control and lower in ophiasis compared to localized and multiple patchy AA. An important inverse linear correlation was observed between vitamin D and CRP levels in ophiasis AA. CRP concentrations were found to be elevated in AA patients. The considerable accuracy of CRP in the diagnosis of AA is substantiated by a statistically significant al. A noteworthy inverse linear association was observed between serum vitamin D and CRP concentrations in ophiasis AA.

The role of fractional laser-assisted drug delivery in enhancing the efficacy of topical bimatoprost solution in the treatment of alopecia areata: An intra-patient comparative randomized clinical trial.

Transepidermal drug delivery is a novel therapeutic technique to boost efficacy of topical drugs. In this clinical trial we evaluate the efficacy of the combination of fractional carbon dioxide (FCO2) laser and bimatoprost solution compared to bimatoprost alone in the treatment of alopecia areata. This is a prospective intra-patient comparative randomized clinical trial on 20 patients with alopecia areata. In each participant two patches were chosen to randomly receive either topical 0.03% bimatoprost solution (twice a day for 12 weeks) alone or in combination with FCO2 laser (every 2 weeks for 12 weeks). Then response to treatment was evaluated by the measurement of the severity of alopecia tool score system (SALT) score, percentage of hair regrowth, physician assessment and patients' satisfaction. SALT score was reduced significantly during treatment sessions and after a 3-month follow-up in both treatment groups (p = 0.000). The mean percentage of improvement in SALT score in the combination therapy and monotherapy groups were 46.43 ± 4.35% and 21.16 ± 4.06% at the end of the study and 46.42 ± 5.75% and16.11 ± 3.10% at the end of the follow-up period, respectively (p = 0.000). A general linear model of two-way analysis demonstrated a significantly superior outcome in the combination therapy group compared to the monotherapy group during time (F1.6, 13.2 = 43.8. p = 0.000). Fractional ablative laser can be considered as an assistant method for enhancing of efficacy of topical drugs especially in refractory cases of patchy alopecia areata.

A comparative study of fractional CO2 laser with topical triamcinolone acetonide versus intralesional triamcinolone acetonide in the treatment of alopecia areata.

Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA. To assess and compare the efficacy and safety of fractional CO2 laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA. A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO2 laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting. Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (P-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (P-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B. This study showed that fractional CO2 laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events.

Anxiety and Depression in Patients with Alopecia Areata in Eskisehir, Turkey.

Conflicting results have emerged in studies conducted to reveal the relationship between alopecia areata (AA) and depression and anxiety. The comorbidity of depression and anxiety in patients with patchy AA who applied to a tertiary care center will be investigated and compared with a healthy control group. This study included 86 patients with AA and 85 healthy volunteers. The patients and controls completed Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BDI). The average BDI of the patient group was 13.45±8.59, while in the control group, it was 7.2±5.7 (p = 0.002). The average BAI of the patient group was 12.56±8.76, while in the control group, it was 6.01±5.87 (p = 0.019). Depression was detected in 30.2% (n = 26) of the patients and anxiety was detected in 19.8% (n = 17) of the patients. In the control group, the rate of depression was 5.9% (n = 5) and the rate of anxiety was 7.1% (n = 6). There was a statistically significant difference between the patients and the control group in terms of depression (p < 0.001) and anxiety (p < 0.001). Depression and anxiety were more prevalent in patients with AA than in healthy volunteers. Dermatologists should keep in mind psychiatric diseases such as depression and anxiety that may accompany patients diagnosed with AA.

Epidemiology of alopecia areata in Baqubah city/Diyala-Iraq

Background: Alopecia areata is a disease scalp and body hair leading to patches of non-scoring alopecia which is heterogeyous ,it is unown as autommutte disease, there is no prevention &amp; hard cure.&#x0D; Objective: To determine the prevalence rate according to sex &amp;age and the causative factors of alopecia areata in Baquba city.&#x0D; Patients and Methods: A cross-sectional study was in Baquba Teaching Hospital dermatological clinic from 1st of October 2020 to 31st of March 2022 at Baquabah teaching Hospital /outpatient Dermatology clinic. The study sample (100) patients with different clinical variants of Alopecia Areata, (71) males and (29) females of different age groups.&#x0D; Results: This study shows that high prevalence among males (71%) with age group (21-30) years old with single patchy alopecia areata with past history of recurrence and associated psychological history. (100) cases of AA were diagnosed. (25%). Single lesion of AA was the most common manifestation (68%). Recurrence history of AA Positive in (55%). Personal history of stress was associated with AA in (64 %). The most common site of alopecia areata was in head (55%).&#x0D; Conclusion: It was concluded that, alopecia areata was more common in male, age (21-30) years, most common single lesion, more in head, with psychological stress history.

Epidemiology of alopecia areata in Baqubah city/Diyala-Iraq

Background: Alopecia areata is a disease scalp and body hair leading to patches of non-scoring alopecia which is heterogeyous ,it is unown as autommutte disease, there is no prevention &amp; hard cure. Objective: To determine the prevalence rate according to sex &amp;age and the causative factors of alopecia areata in Baquba city. Patients and Methods: A cross-sectional study was in Baquba Teaching Hospital dermatological clinic from 1st of October 2020 to 31st of March 2022 at Baquabah teaching Hospital /outpatient Dermatology clinic. The study sample (100) patients with different clinical variants of Alopecia Areata, (71) males and (29) females of different age groups. Results: This study shows that high prevalence among males (71%) with age group (21-30) years old with single patchy alopecia areata with past history of recurrence and associated psychological history. (100) cases of AA were diagnosed. (25%). Single lesion of AA was the most common manifestation (68%). Recurrence history of AA Positive in (55%). Personal history of stress was associated with AA in (64 %). The most common site of alopecia areata was in head (55%). Conclusion: It was concluded that, alopecia areata was more common in male, age (21-30) years, most common single lesion, more in head, with psychological stress history. Keywords: Alopecia areata, prevalence rate, Stress

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.

The frequency of fatty liver in patients with alopecia areata: A case-control study.

Alopecia areata (AA) is an immune-mediated nonscarring hair loss disorder with multiple subtypes, including alopecia universalis (AU). Previous studies have shown a link between serum lipid profile and alopecia. We aimed to investigate the frequency of fatty liver in patients with AU and patchy alopecia areata (PAA) compared to a control group. This case-control study included patients with AU and PAA referred to a dermatology clinic from September 23, 2019 to September 23, 2020. A group of individuals without hair loss disorders attending the same clinic were selected as controls. Participants' general information, including age, sex, weight, height, and waist circumference (WC), was recorded. Body mass index (BMI) was calculated for all participants. Also, hyperlipidemia and statin use were noted and liver enzymes were evaluated. For AU and PAA patients, disease duration and the Severity of Alopecia Tool (SALT) score were also recorded. Then, all subjects underwent ultrasound to assess fatty liver and its grade. Overall, 32 patients were included in each group. All three groups were comparable in age, sex, weight, height, BMI, WC, hyperlipidemia, abnormal liver enzymes, and statin use. Disease duration and SALT score were significantly higher in the AU than in the PAA group (p = 0.009 and p < 0.001, respectively). The frequency of fatty liver was the highest in AU patients (40.6%), followed by 34.4% in PAA patients, and 21.9% in controls (p = 0.263). This was also the case for grade-1 fatty liver, while grade-2 was more common in PAA patients, and grade-3 was only observed in one patient from the AU group (p = 0.496). Fatty liver was more frequent in AU and PAA patients than controls, without statistically significant differences. There might be an association between fatty liver and AA, particularly the AU subtype.

Platelet-Rich Plasma (PRP) As A New Approach And Promising Therapy In Patients With Alopecia Areata

Background: Alopecia areata (AA) is a non-scarring, autoimmune, inflammatory condition that causes well-defined areas of hair loss on the scalp and/or body. A new biotechnology called platelet-rich plasma (PRP) was developed as a result of increased interest in tissue engineering and cell-based therapies. This therapy is defined as an autologous, non-allergic preparation of platelets in concentrated plasma. Study aimed to evaluate the effect of PRP treatment in alopecia areata. Case: This study included 3 patients complaining of multiple patchy alopecia areata. They were treated with combination of PRP therapy, topical fluocinolone acetonide 0.025% cream, minoxidil 2 and 5%, and ketoconazole 2% scalp solution. One patient was also treated with intralesional triamcinolone acetonide injections. PRP was injected intradermally every 4 weeks and final monitoring was conducted after 4-6 sessions. Evaluation and follow up results were determined using photographic monitoring as well as patient’s satisfaction. Results: Administration of autologous PRP had significance hair regrowth in all three patients in this study. PRP treatment sessions varied from 3 to 6 sessions. However, significance outcomes in these patients were established after 3 sessions of PRP treatment, while the best results were obtained after 4-6 sessions of PRP treatment. No major side effects was reported. Conclusion: PRP is effective in promoting hair growth. PRP treatment for alopecia areata is safe, easy to perform, and can achieve patient’s satisfaction, without any major adverse effects. However, further research on standardized protocol of PRP methods are needed.

Combined intralesional platelet-rich plasma and intralesional steroid versus intralesional steroid alone in the treatment of alopecia areata

Background Platelet-rich plasma (PRP) is a promising treatment method of alopecia, but there is a debate about its role in the treatment of alopecia areata. Intralesional steroid is the first-line treatment option for patchy alopecia areata. Combination therapy represents an option for increasing the efficacy of the different lines of treatment.Objective To compare the therapeutic efficacy of traditional treatment of alopecia areata with intralesional injection of triamcinolone acetonide versus combination therapy with intralesional triamcinolone acetonide and intralesional PRP alternatively.Patients and methods In this comparative randomized single-blinded study, 30 patients with two nonadjacent patches of alopecia areata were included. One patch was treated with intralesional triamcinolone acetonide alone (group I) every 4 weeks for 3 months, and the other patch was treated with intralesional triamcinolone acetonide alternating with intralesional PRP (group II) every 2 weeks for 3 months. Evaluation was done by MacDonald Hull and Norris grading and dermoscopy.Results A significant increase in the mean grading score was noted before each intralesional steroid injection session in both groups. However, group II patches treated with intralesional triamcinolone acetonide alternating with intralesional PRP showed significantly higher mean grading score as compared with group I patches treated with intralesional triamcinolone acetonide alone. The dermoscopic features of alopecia areata significantly decrease or disappear at the end of treatment sessions in both groups.Conclusion Combined use of intralesional steroid and intralesional PRP in the treatment of alopecia areata yields better results than using intralesional steroid alone and could be considered as a more effective line of treatment. However, further research studies are needed to determine the optimal dose, intervals, and duration of treatment.

588 Platelet-rich plasma in alopecia areata – a steroid-free treatment modality. A systematic review and meta-analysis of randomized clinical trials

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 limited 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. We performed a systematic literature search in four databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), Embase, and Web of Science, from inception to 15 October 2021.

The usefulness and wellbeing of Tofacitinib in the treatment of Alopecia Areata

Introduction: Treatment options for alopecia areata are limited and often inadequate but the use of an oral Janus kinase inhibitor such as Tofacitinib is considered promising treatment of alopecia areata. Objective: To evaluate the usefulness and wellbeing of Tofacitinib in the treatment of alopecia areata. Materials and Methods: This clinical trial was conducted at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during July 2018 to December 2019. A total of 45 patients with patchy alopecia areata (at least&gt; 50% scalp involvement), in the form of alopecia totalis and alopecia universalis were treated with Tofacitinib at 5mg twice daily for 6 months. Clinical testing was performed on the basis of the Severity of Alopecia Tool Score (SALT). Results: The average age of the patients was 33.00 ± 13.1 years. For them 40.0% of patients' age was less than 20 years. In addition, 26 (57.8%) were infected with patchy alopecia areata with&gt; 50% of scalp involvement, 11 (24.4%) had Alopeciatotalis and 8 (17.8%) Alopecia universalis. The average duration of illness was 1.2 ± 0.6 years. Clinical follow-up revealed that among the 26 patients with patchy alopecia areata with&gt; 50% of scalp involvement, 15.4% had a gradual growth and 84.6% re-growth of full hair. Of the 11 patients with Alopecia totalis, 27.3% had a partial rejuvenation and 72.7% re-growth of hair and among the 8 patients with Alopecia universalis, 37.5% had a gradual increase and 62.5% had a recurrence for perfect hair. In terms of well-being, 34 patients (75.6%) did not experience side effects but 11 patients (24.4%) experienced side effects such as 18.2% nausea, 72.7% headache and 9.1% had high infection of respiratory tract (URTI). Conclusion: The treatment of alopecia areata by tofacitinib, Janus kinase inhibitors are effective, safe and sound in the treatment of alopecia areata. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 43-47

Alopecia Areata Occurring after COVID-19 Vaccination: A Single-Center, Cross-Sectional Study

: BackgroundLimited data concerning the development of autoimmune skin diseases after COVID-19 vaccination are currently available. Recently, a few reports described the development, worsening or recurrence of alopecia areata after the administration of COVID-19 vaccines. High variability in terms of disease onset following vaccination as well as the heterogeneous topical and/or systemic treatment approaches have been described. Methods: All patient-related data and images were obtained as part of clinical routine. Diagnosis of alopecia areata was established according to clinical and trichoscopic findings, along with the exclusion of common differential diagnoses. Results. Twenty-four patients, 20 females (83.3%) and four males (16.7%), with a mean age of 39.1 years (age range: 14–66 years), were examined for the occurrence of alopecia areata within 16 weeks after COVID-19 vaccination. Out of 24, 14 patients (58.3%) experienced a patchy alopecia areata, while an extensive disease occurred in 10/24 patients (41.7%): six patients with whole scalp involvement (alopecia areata totalis) and four patients with the whole body affected (alopecia areata universalis). Twelve patients reported a history of autoimmune disease (50%). Treatment with topical corticosteroid was performed in almost all patients with patchy alopecia areata, whilst it was associated with systemic drugs (corticosteroids, minoxidil, cyclosporin) in the case of generalized alopecia areata and alopecia areata universalis. Mean baseline values of Severity of Alopecia Tool (SALT) score decreased from 43.4 to 36.6 after 12 weeks of treatment, with evidence of hair regrowth in 16/21 patients. Conclusion. This study described the occurrence of alopecia areata after COVID-19 vaccination and its management that implicates the use of both topical and systemic therapies.

33540 Altered expression of soluble and membrane-bound programmed death receptors and ligands may cause activated state of cytotoxic T lymphocytes in patients having alopecia areata

Introduction: The occurrence of alopecia areata (AA) in cancer patients receiving programmed death (PD) inhibitors is known.(1) We assessed the expression of programmed death receptors (PD-1) and ligands (PDL-1) in patients with de novo AA. Methods: Forty consecutive patients with active patchy AA and 20 healthy controls were recruited. The expression of membrane-bound PD-1 (mPD-1) and PDL-1 (mPDL-1) was studied on the cytotoxic T-cells (Tc), type-1 helper T-cells (Th1) and activated regulatory T-cells (Tregs) in the peripheral blood of patients using cell specific markers through flow cytometry. Serum levels of soluble PD-1 and PDL-1 (sPD-1 and sPDL-1, respectively) were assessed using ELISA. Disease severity was assessed using severity of alopecia tool (SALT). Results: The mean SALT of our patients was 8.84 ± 11.47 with mean duration of illness being 12.12 ± 2.79 months. The percentage of Th1 and Tc was significantly higher in patients (P < .01 each) than healthy controls. Serum concentration of sPD-1 and sPDL-1 was significantly higher in patients than controls (P < .01 each). The expression of mPD-1 and mPDL-1 was significantly increased on Tc and Tregs respectively, of patients than controls (P < .01 and 0.001 respectively). A moderately significant correlation was seen between mPD-1 on Tc and sPD-1 (spearman rho 0.349, P < .01). None of the parameters demonstrated a significant correlation with SALT. Conclusion: Increased sPD-1 in AA patients probably saturates mPDL-1 on Tregs, thus increasing activity of Tc. Enhanced expression of mPD-1 and mPDL-1 on Tc and Tregs respectively, and increased sPDL-1 possibly represent a compensatory response to limit ongoing autoimmunity.

Platelet-Rich Plasma in Alopecia Areata-A Steroid-Free Treatment Modality: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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; I2 = 80.4%, p = 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.