Alopecia Areata Patients Research Articles

Prevalence of Thyrotropin Receptor Antibodies and Clinical Profile of Patients with Alopecia Areata: A Cross-Sectional Study

Introduction: Alopecia areata (AA) is associated with thyroid dysfunction and abnormal levels of thyroglobulin and thyroid peroxidase autoantibodies. One study detected high prevalence of thyrotropin receptor antibodies (TRAbs) in AA patients. Our aim was to investigate the prevalence of TRAb levels in AA patients and to assess their association with thyroid hormones, other thyroid antibodies, AA severity, and other epidemiological variables. Methods: In this observational study, 139 patients (97 females, 42 males), aged 12 and above, with newly presenting, relapsing, or treatment-resistant AA were included. Medical histories were reviewed, alopecia severity was assessed using the Severity of Alopecia Tool (SALT), and blood tests measured thyroid hormones and autoantibodies. Results: The prevalence of TRAb was significantly higher in AA patients (23.6%) compared to the general population (1–2%) (p < 0.001). Elevated TRAb titers did not correlate with diagnosed thyroid dysfunction or treatment, abnormal thyroid function tests and autoantibodies, AA severity, duration, and onset. Male patients exhibited a significantly higher prevalence of abnormal TRAb titers compared to females (75.0% vs. 21.3%, p = 0.002). Conclusion: A significant proportion of AA patients presented with elevated TRAb levels, independent of thyroid hormone titers, other thyroid autoantibodies, or SALT score. Prevalence of abnormal TRAb levels was higher in males.

The value of immunohistochemical expression of SOX9 and CD34 in alopecia areata

ABSTRACT Background Alopecia areata (AA), an immune-mediated disorder, is marked by temporary, nonscarring hair loss. The bulge area is protected from immune attacks by immune privilege; however, recent studies demonstrated immune cells infiltrating the bulge area. Objective This study aims to investigate the immunohistochemical expression of the sex-determining region Y-box 9 (SOX9) and cluster of differentiation 34 (CD34) in AA patients as markers of hair follicle stem cells (HFSCs) and progenitor cells, respectively. Methods Immunohistochemical staining of SOX9 and CD34 was applied on skin samples of 20 AA patients and 20 healthy controls. Results SOX9 and CD34 were significantly lower in lesional samples of cases compared to perilesional and control skin biopsies. Furthermore, SOX9 level was negatively correlated with the severity of alopecia tool score (SALT score) among the studied AA patients. Moreover, lowered SOX9 expression was present in patients with recurrent attacks. Conclusions The significant reduction of stem cell markers (SOX9 and CD34) in our studied AA cases signifies the pathological affection of HFSCs and their progeny in AA. This is thought to cause a loss of competence in generating new hair in some AA cases, which needs to be validated in further research. Limitations of the study This study has a small sample size.

Dupilumab induces hair regrowth in pediatric alopecia areata: a real-world, single-center observational study

Alopecia areata (AA) is nonscarring hair loss characterized by Th1 and concomitant Th2 skewing, particularly in atopic patients. Despite novel developments for adult AA, safe and effective treatments for pediatric patients remain limited. Dupilumab, with a well-studied safety profile, may have therapeutic potential for atopic pediatric AA. To evaluate the ability of dupilumab to regrow hair in pediatric AA patients. We conducted a single-center, retrospective, observational study to evaluate hair regrowth [using Severity of Alopecia Tool (SALT)] with dupilumab in 20 children with both AD and AA (age range 5–16 years, mean 10.8 years; baseline SALT range 3–100, mean 54.4). Patient demographics, atopic history, IgE and SALT scores were collected at 12wk follow-up visits, up to > 72wks, to evaluate hair regrowth. Spearman correlations with clinical data were performed. Patients showed clinical improvement over the follow-up period (range 24 to > 72wks, mean 67.6wks) with significant mean(± SD) reduction in SALT at 48wks versus baseline [20.4(± 35.1) vs 54.4(± 37.6), respectively; p < 0.01] and continued improvement up to > 72wks [2.2(± 4.9), p < 0.01]. Baseline SALT positively correlated with disease duration (r = 0.54, p < 0.01), and negatively correlated with improvement in SALT at weeks 24, 36, and 48 (|r|≥ 0.65, p < 0.01 for all comparisons). Baseline IgE positively correlated with improvement in SALT at week 36 (r > 0.60, p < 0.05). Dupilumab was well-tolerated, with no new safety concerns. These real-world data support the utility of dupilumab to safely treat pediatric AA patients, corroborating the role of Th2 skewing in children with AA and associated atopy, warranting larger clinical trials.

The Effect of an Oral Probiotic Mixture on Clinical Evolution and the Gut and Skin Microbiome in Patients with Alopecia Areata: A Randomized Clinical Trial

(1) Background: Given the autoimmune nature of Alopecia Areata (AA) and the immunomodulatory properties of probiotics, this trial was conducted to evaluate the efficacy of a probiotic mixture, consisting of Lactobacillus rhamnosus and Bifidobacterium longum strains, as an adjuvant treatment in a group of AA patients. (2) Method: This study was a 24-week, randomized, double-blind, placebo-controlled clinical trial. Twenty-six patients with AA were included in this study, and their clinical progression, along with changes in gut and skin microbiota, were analyzed. (3) Results: A higher proportion of AA patients treated with the probiotic formula showed improvement compared to the placebo group, based on both the reduction in the number of AA plaques (56% vs. 30%) and the affected scalp surface area (45% vs. 20%). For “activity”, “inactivity”, and “regrowth”, an improvement in 55%, 67%, and 55% of patients was, respectively, observed in the probiotic group, compared to 50%, 40%, and 30% in the placebo group. No changes were observed in the gut microbiota during the intervention period. Regarding skin microbiota, changes were detected in the probiotic group, with reductions in characteristic genera during the study. (4) Conclusions: To our knowledge, this is the first clinical trial assessing the efficacy of a probiotic product in patients with AA. This probiotic mixture in a routine clinical practice setting appears to improve the course of patients. In addition, the skin microbiota of scalp lesions was modified using the probiotic treatment.

Dupilumab for the treatment of alopecia areata in pediatric patients with atopic dermatitis: A scoping review.

Our study aims to synthesize existing evidence of dupilumab for alopecia areata (AA) in pediatric patients with atopic dermatitis (AD). We searched MEDLINE and Embase on March 1, 2024, using keywords related to AD, AA, dupilumab, and pediatric patient populations per PRISMA-ScR guidelines. A mean SALT score reduction of 42.6 following dupilumab treatment (p < .01) over an average of 3.21 months, and a mean reduction of Investigator Global Assessment (IGA) levels of 2.14 units (p < .01) demonstrates the efficacy of dupilumab in pediatric AA when there is concurrent AD. Our findings in combination with dupilumab's favorable safety profile in pediatric AD makes it an appealing option for AA treatment, however, a greater understanding of the underlying mechanisms, optimal pediatric patient selection criteria, long-term efficacy, and safety profile of dupilumab in this context is warranted.

The role of hsa-miR-193a-5p as an important factor for control of inositol in alopecia areata.

MicroRNAs (miRNAs) are small RNA molecules that play a regulatory role in various biological processes by acting as intracellular mediators. They hold great potential as therapeutic agents for targeting human disease pathways; however, there is still much to be uncovered about their mechanism of gene regulation. Alopecia areata (AA) is a commonly occurring inflammatory condition characterized by the infiltration of T cells that specifically target the anagen-stage hair follicle. The limited understanding of its precise cellular mechanism may be the reason behind the scarcity of effective treatments for AA. The significance and function of hsa-miR-193a-5p as a genetic marker for AA and its potential influence on the advancement of the disease. A case-control study comprised 77 individuals diagnosed with AA who were matched with 75 healthy controls. In order to measure the expression of miR-200c-3p in both groups, the real-time PCR technique was utilized. The prediction of suitable genes for hsa-miR-193a-5p, as well as the identification of pathways and gene-gene interactions, were carried out using bioinformatic tools. The levels of hsa-miR-193a-5p expression were notably elevated in AA patients in comparison to healthy controls. Our prediction suggests that the involvement of hsa-miR-193a-5p in the development of AA is significant due to its influence on the inositol phosphorylation pathway and the Phosphatidylinositol signaling system, achieved through its direct impact on the IPPK gene. For the first time, our study demonstrates the significant over-expression of a new miRNA, hsa-miR-193a-5p, in the blood of AA patients compared to controls, and highlights its impact on the IPPK gene and the inositol phosphorylation and Phosphatidylinositol signaling pathways, suggesting a potential therapeutic role for hsa-miR-193a-5p in AA.

Characteristics, Clinical, and Trichoscopic Features in Pediatric Patients with Alopecia Areata: A Single-Center Observational Study at the Dermatology Clinic of Dr. M. Djamil General Hospital Padang

Background: Alopecia areata (AA) is an autoimmune disease that causes patchy hair loss. In children, AA can have a significant psychological impact. This study aims to identify the characteristics, clinical and trichoscopic features of AA pediatric patients at the dermatology clinic of Dr. M. Djamil General Hospital Padang. Methods: This cross-sectional analytical observational study involved pediatric patients (&lt;18 years) with a diagnosis of AA who came to the dermatology clinic of Dr. M. Djamil General Hospital Padang between January 2020 to December 2023. Demographic data, disease history, clinical features, and trichoscopy examination results were collected and analyzed descriptively. Results: A total of 125 pediatric AA patients met the inclusion criteria. The majority of patients were female (62.4%) with a mean age of 10.5 years. The most common form of AA is patchy (80%), followed by alopecia totalis/universalis (12%) and ophiasis (8%). A history of atopy was found in 35.2% of patients. The most frequently found trichoscopic features were yellow dots (78.4%), black dots (64%), and broken hairs (56%). Conclusion: This study provides a comprehensive description of the characteristics, clinical and trichoscopic characteristics of AA pediatric patients at Dr. M. Djamil General Hospital Padang. These findings may provide a basis for the development of better management strategies for AA in children.

Features of sensitization in patients with alopecia areata, associated with atopic diseases

BACKGROUND: Association of alopecia areata and atopic diseases has been confirmed in clinical, epidemiologic, genetic and immunologic studies. The study of sensitization features and atopic diseases structure in alopecia areata patients makes it possible to phenotype patients with atopy and consider additional treatment options for alopecia areata. AIM: To determine the sensitization spectrum and atopic diseases structure in alopecia areata patients considering the age and clinical form of alopecia. MATERIALS AND METHODS: A comparative uncontrolled study was conducted. The data of 162 patients 5–51 years with alopecia areata, atopic dermatitis, asthma, allergic rhinitis/rhinoconjuctivitis for the period from April 2022 to May 2023 were used. The nature of sensitization and the structure of atopic diseases were analyzed. Clinical forms of alopecia areata were assessed by the hair-loss area. RESULTS: The patients were divided according to alopecia areata status: the first group included 54 alopecia areata patients with atopic diseases, the second ― 108 atopic patients without alopecia areata. Subgroups were formed according to age: in group 1 the mean age was 16.3±1.38 years, 57% were children (5–17 years), 43% were older 18 years; in group 2 the mean age was 17.1±1.43 years, 54% children and 46% adults. Among alopecia areata patients seasonal pollen sensitization prevailed (22/54 people); polyvalent sensitization was observed in 13/54 people, 6 of whom had severe forms of alopecia areata, 6 ― ophiasis. Comparison of the sensitization spectrum between the groups revealed no differences. In group of adult alopecia areata patients isolated respiratory allergies were significantly less frequent (OR 0.21; CI 0.07–0.60; p=0.004), but combined atopic diseases were more frequently observed (OR 4.71; CI 1.43–15.58; p=0.012). Most patients with severe alopecia areata were children (8/12) with polyvalent sensitization and respiratory and combined atopic diseases. CONCLUSION: The comorbidity of alopecia areata and atopy is manifested by an increased incidence of severe alopecia in childhood and a tendency to progression of allergic inflammation, realized as combined atopic diseases. The spectrum of sensitization in patients with and without alopecia areata does not differ and characterized by the predominance of the most common allergens (plant pollen). These results indicate the need for timely phenotyping of alopecia areata patients with allergic predisposition, especially with early onset and progressive alopecia.

Alopecia Areata of the Nails: Diagnosis and Management.

Background: Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients. Nail changes are more frequent in severe forms of AA and in children. Methods: Literature related to nail changes in AA was comprehensively reviewed after a search on the PubMed database without time restrictions in order to identify common clinical presentations and associated factors to aid clinicians with the correct evaluation and management of these dystrophies. Results: Nail changes in AA include pitting, trachyonychia, leukonychia, red lunula, and miscellaneous alterations such as longitudinal ridging and brittle nails. Nail changes are usually asymptomatic but, nevertheless, sometimes cosmetically disfiguring and can be associated with a reduced quality of life and impaired daily activities. Conclusions: Nail changes in AA may precede or follow hair loss and can occur as an isolated finding. Diagnosis may require a biopsy for definitive identification. Spontaneous improvement is possible, particularly in children, and treatment is not always necessary. Further research is, however, needed to establish a consensus on treatment approaches according to age and severity.

Effective Role of Cytotoxic CD8+ T Cell in Iraqi Alopecia areata Patients

Abstract Background: The overall lifetime disease risk for Alopecia areata, a common condition affecting the hair and nails, in the general population is 2%. It is believed to be an autoimmune disease, although the exact pathophysiology of AA is still unknown. Variations in cytokines produced by CD4 and CD8 T cells are thought to be the main contributors to hair loss. CD8+ T cells target intra-follicular regions, while NK cells and CD4 + T cells congregate, and CD8+ T cells target intra-follicular regions. Objectives: This study aimed to evaluate the presence of CD8 T cells in Iraqi individuals with Alopecia areata. Materials and Methods: The study groups consisted of two groups: 1) 45 Alopecia areata patients (32 males and 13 females) with ages ranging from 5 to 59, and 2) 45 people in the control group who were in good health, had been examined by a physician, and were between the ages of 4 and 50, using the ELISA technique. The quantitative measurement of serum levels of CD8+ was performed. Results: The findings between the groups under investigation revealed an elevated mean for CD8 + 323.7127.3 ng/mL and healthy controls 159.862.1 ng/mL, respectively. The findings revealed a marked rise in the serum CD8+ mean levels between the sick and healthy control groups, a strong correlation across all parameters (P &lt; 0.05). Conclusion: This study concluded that Alopecia areata is more prevalent in men than in women. It also found a highly significant relationship (P &lt; 0.05) between the mean CD8+ circulating blood levels in patients and the healthy control group.

Possible role of β-hydroxybutyrate in inducing inflammation in alopecia areata.

Alopecia areata (AA) is an autoimmune inflammatory disease characterized by non-scarring hair loss due to an immune response that targets hair follicles. The current treatment approach for AA involves the use of immunosuppressants and immunomodulators to reduce cytokine levels around affected hair follicles. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as potential anti-inflammatory agents with diverse beneficial effects in various medical conditions. This study investigates the role of beta-hydroxybutyrate (BHB), a ketone body produced during SGLT2 inhibition, in the pathogenesis of AA. Serum BHB levels were found to be significantly elevated in patients with AA compared with healthy controls, with higher levels correlating with severity of hair loss. BHB treatment increased inflammatory cytokine production in outer root sheath (ORS) cells, mimicking the inflammatory conditions seen in AA. The results suggest that elevated BHB levels may exacerbate the inflammatory immune response in AA patients and may be associated with chronic hair loss and resistance to treatment. Serum BHB levels may serve as a potential marker of poor prognosis in patients with severe AA. Further research is needed to elucidate the precise role of BHB in the pathogenesis of AA and its implications for disease management.

Emergence of Janus kinase inhibitors led to increase in proportion of severe alopecia areata patients receiving treatment: A retrospective cohort study

Emergence of Janus kinase inhibitors led to increase in proportion of severe alopecia areata patients receiving treatment: A retrospective cohort study

Low rates of vaccination among atopic dermatitis, alopecia areata, psoriasis, and psoriatic arthritis patients on biologics.

Biologics and Janus kinase (JAK) inhibitors are immunomodulating and immunosuppressing medications utilized to treat atopic dermatitis (AD), psoriasis (PSO), psoriatic arthritis (PsA), and alopecia areata (AA). Special recommendations must be considered when prescribing vaccinations in this population, as the pneumococcal and herpes zoster vaccine are recommended to patients ≥ 19-years-old (rather than ≥ 65-years-old and ≥ 50-years-old as in the general population, respectively), along with a yearly influenza and up to date COVID-19 vaccination. Additionally, TNF-α and JAK-inhibitors may increase the risk of latent Hepatitis B virus (HBV) reactivation among high-risk patients. Prior to prescribing these medications, a quantitative HepB Surface Antibody (HepB SA) test is performed to determine immunity. This study utilized the SlicerDicer function on EPIC Medical Records to search for any patient ≥ 19-years-old prescribed a biologic or JAK inhibitor for AD, PSO, PsA, or AA between 10/2003 and 10/2023 at a large tertiary institution. Vaccination rates among patients on biologics and JAK inhibitors were low, with rates being significantly lower in patients 19-64 years-old, compared to those ≥ 65 years-old for most disease states (p < 0.01). Among AD, PSO/PsA, and AA patients, on average, 9.39% were vaccinated for influenza, 6.76% for herpes zoster, 16.56% for pneumococcal pneumonia, and 63.98% for COVID-19. Only 3.16% of patients were adequately vaccinated for HepB after an abnormal HepB SA test. Here, extremely low rates of vaccination among patients on biologics and JAK inhibitors at our institution were highlighted, emphasizing the imperative need for ensuring vaccination in this group.

Evaluating the sources and types of dietary and nutritional advice for patients with alopecia areata.

Although there are now two Food and Drug Administration (FDA)-approved treatments for severe alopecia areata (AA), many patients still resort to non-medical therapies and lifestyle modifications such as diet and nutrition. The goal of this study was to evaluate the sources and types of dietary and nutritional advice for patients with AA. We distributed a cross-sectional national survey using the National Alopecia Areata Foundation's email list-serv between August 2022 and January 2023. Most respondents were White (76.3%), employed (58.3%) females (84.4%) with a mean age of 52 years. 163 (19.1%) respondents reported receiving diet and/or nutritional advice and 418 (49.5%) respondents reported searching for diet and/or nutritional advice to help with their AA; the most common source of advice was online. The most common dietary changes were the use of vitamins or supplements (30.6%), adherence to diets (23.2%), and the addition of specific foods (21.4%). 209 (50.2%) respondents reported no change in their disease and 197 (47.4%) respondents reported no change in how they felt about their disease compared to before they tried the change. Many AA patients search for or receive unsolicited dietary and nutritional advice and subsequently modify their behavior to manage their disease. However, the efficacy of these changes is unclear. Providers should be mindful of the sources through which patients obtain treatment information as well as the lifestyle changes patients make to counsel patients with evidence-based information. Further investigation is needed to better characterize the direct and indirect costs of dietary and nutritional modification in the treatment of AA.

Elucidating the role of T-Reg related cytokines: serum transforming growth factor beta and interleukin-35 in alopecia areata.

Previous studies demonstrated that Th1 cytokines like IL-2, IL-12 and IFN-γ have initiatory role in alopecia areata (AA) and positive correlation with disease severity. They informed that serum levels of Th17 cytokines, IL-17, IL-22, IL-23 increased in active AA patients and corelated, particularly IL-17, with disease severity. In recent reports it was showed the balance between Th17 and Treg cells is crucial for maintaining tolerance to self-antigens, and an imbalance towards Th17 may contribute to the development of autoimmune diseases like AA. But research on serum Treg markers in AA is limited. It was aimed to investigate whether the Treg cells have a role in the pathogenesis of AA analyzing the serum levels of Treg cytokines IL-35 and TGF-β in the patients with AA. 42 AA patients and 38 healthy controls were enrolled. Patient demographics, clinical data, disease severity assessed by Severity of Alopecia Tool (SALT) scores were recorded. Serum samples were collected and analyzed for TGF-β and IL-35 levels using ELISA kits. The cytokine levels in both groups were statistically compared. Their relation with parameters of demographic and severity of disease was evaluated. The patient and control groups had no statistically significant difference, there was 71.4% males and 28.6% females in patient group, while the control group had 63.2% males and 36.8% females, Severity analysis classified 18 patients with mild AA, 19 with moderate AA, and 5 with alopecia totalis/areata universalis. While TGF-β levels exhibited no significant difference between groups, IL-35 levels were significantly elevated in AA patients (p = 0.002). Logistic regression identified IL-35 as a significant parameter influencing disease status (OR = 1.055). Correlation analysis revealed a weak positive correlation between patient age and IL-35 levels (r = 0.436; p = 0.004). Notably, IL-35 levels displayed a significant decrease in individuals with antinuclear antibody (ANA) positivity. No correlations were identified between cytokine levels and disease severity, prognosis, or disease activity. Elevated IL-35 levels suggest that IL-35 and specific Treg cell subsets can play a role in AA pathogenesis. The nuanced roles of TGF-β and IL-35 highlight the need for comprehensive studies to interpret their implications in the complex immunopathogenesis of AA. These findings open avenues for further research, positioning IL-35 as a prospective target for investigating and potentially intervening in AA pathogenesis.

Health-related quality of life of adult and adolescent patients living with alopecia areata in Australia.

To understand the experiences of adolescent and adult patients living with alopecia areata (AA) in Australia regarding symptom severity and the impact on psychosocial well-being and work/classroom productivity. A cross-sectional online patient survey among adolescent and adult patients diagnosed with AA was recruited via the Australia Alopecia Areata Foundation. Patient-reported outcomes were also assessed. A total of 337 patients (49 adolescents; 288 adults), with a mean ± standard deviation age of 14.7 ± 1.55 and 38.9 ± 13.31 years for adolescents and adults, respectively, were included. In the group with extensive hair loss (Scalp Hair Assessment Patient-Reported Outcome, categories 3 + 4, n = 172), we observed higher emotional symptom and activity limitation scores (Alopecia Areata Patient Priority Outcomes, emotional symptoms: adults 2.5 ± 1.03, adolescents 2.2 ± 1.15; activity limitations: adults 1.4 ± 1.15, adolescents 1.2 ± 0.99). Additionally, in adults, the Alopecia Areata Symptom Impact Scale global score was 4.0 ± 2.10 (symptoms subscale score 4.1 ± 1.91; interference subscale scores 3.8 ± 2.73). Hospital Anxiety and Depression Scale scores were high across participants, irrespective of hair loss extent (adults: anxiety 9.2 ± 3.85, depression 6.6 ± 3.95; adolescents: anxiety 9.7 ± 4.65, depression 5.2 ± 3.59). Work and classroom productivity were substantially impaired due to AA, with 70.5% of adults and 57.1% of adolescents reporting activity impairment, and overall work/classroom impairment reported at 39.2% and 44.9%, respectively. AA impacts the physical, emotional and psychosocial well-being of both adult and adolescent patients. More extensive hair loss more profoundly impacts those living with AA. Patients may benefit from patient-centred care approaches addressing the impact of hair loss on mental and emotional well-being, daily activities and work productivity.

Evaluation Effect of COVID -19 Vaccines on Alopecia Areata

This study investigates the impact of COVID-19 vaccination on Alopecia Areata (AA) severity, particularly focusing on gender differences. Data from 65 AA patients (30 vaccinated, 35 unvaccinated) and 1,602,596 healthy controls were analyzed. Physical examinations, laboratory tests, and Severity of Alopecia Tool (SALT) scores were used. Results showed a significant increase in AA severity among vaccinated individuals, especially males, with Pfizer's vaccine having a stronger effect post-second dose. These findings highlight the need for continued research and monitoring of AA post-COVID-19 vaccination. Highlight: Severity Rise: COVID-19 vaccination linked to increased Alopecia Areata severity, especially in males. Pfizer's Impact: Second dose shows stronger Alopecia Areata association than AstraZeneca. Continued Monitoring: Emphasizes need for ongoing research on vaccine-autoimmune disorder interactions. Keyword: Alopecia Areata, COVID-19 Vaccination, Gender Differences, Severity, Monitoring

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.

Infectious events in patients with alopecia areata treated with JAK inhibitors: low burden and minimal impact on persistence in treatment

ABSTRACT Background Alopecia areata (AA) is a non-scarring disorder characterized by hair loss that greatly affects patients’ quality of life and has a chronic, recurring course. This disease is marked by an inflammatory process, mainly on an autoimmune basis primarily regulated by Janus kinase (JAK). Research design and methods We conducted a retrospective study evaluating the safety of JAKi in a real-world setting in 91 AA patients, with a specific focus on the assessment of infectious events. Results Overall, 34 infectious events were observed in 28 patients (30.8%), among them 17 patients (60.7%) suspended treatment with JAKi until the infection was clinically resolved. Only in one case the infectious event led to a permanent discontinuation of the treatment. The data we observed in the study are consistent with results reported in clinical trials. Conclusion It can be stated that, during treatment with JAKi in AA patients, infectious events may occur, but in most cases these events are easily manageable and do not result in permanent discontinuation of the drug.

Diphenylcyclopropenone in severe alopecia areata in children and adolescents: long-term follow-up and relapse rate

Background Reports on the long-term treatment of alopecia areata (AA) in children with diphenylcyclopropenone (DPCP) are few. Objective To assess response, side effects, and relapse rates during long-term follow-up in children with severe AA treated with DPCP. Effect of different patient and treatment-related factors on prognosis and value of maintenance therapy were also assessed. Patients and methods In this interventional prospective study, 144 patients of AA were treated with DPCP. Response was assessed according to sex, type of AA, age of onset, and duration of disease. Excellent response was defined as terminal hair covering more than 75% of the scalp. Maintenance therapy meant ongoing therapy once every 2–4 weeks after excellent response. Follow up for an average of 22 months was performed to detect any relapse of AA which meant more than 25% hair loss. Results Ninety-two patients completed 12 months of therapy. Thirty (32.6%) patients achieved excellent response, 33 (35.9%) moderate, and 29 (31.5%) poor response. Seventy-three patients completed 18 months of therapy. Fouty-eight (65.8%) achieved excellent response, 10 (13.7%) moderate, and 15 (20.5%) poor response. Different clinical variables did not affect the response, however, a significant difference in the beginning of terminal hair growth according to type of AA was found (P=0.002) where 10% of responders among alopecia universalis patients started to grow terminal hair more than 12 months after the onset of therapy. Side effects were few and tolerable. Relapse occurred in 47% of patients on maintenance and 78% of patients without maintenance therapy (P=0.048). Conclusion DPCP is an effective and safe treatment of severe AA in children. Prolonging the duration of therapy may improve the response in alopecia universalis and alopecia totalis. Maintenance therapy is recommended to reduce the risk of relapse.