Severe Forms Of Alopecia Areata Research Articles

Real-World Experience of Tofacitinib and Baricitinib Use in Alopecia Areata in Greek Population: A Retrospective Analysis With Focus on Safety.

The introduction of Janus Kinase inhibitors (JAKi) seems to revolutionize the field of alopecia areata (AA) therapeutics. However, real-world data are still missing. To provide evidence about effectiveness and safety of tofacitinib and baricitinib in AA in real-world settings and describe baseline disease characteristics and patients profiles that are considered good candidates for JAKi in the daily practice. Furthermore, we intended to investigate potential correlations between baseline characteristics and treatment outcomes. We retrospectively reviewed the databases of two tertiary Hospitals in Greece, to identify individuals of any age currently being treated with systemic JAKi for severe AA. We identified 42 individuals, including 3 adolescents. In our cohort, 52.3% (22/42) were under tofacitinib and 47.6% (20/42) under baricitinib treatment. Efficacy analysis was performed on the subgroup of 30 patients that had completed at least a 3-month follow-up on treatment. In the latter group, mean time on treatment was 10 months. Mean Severity of Alopecia Tool and mean Dermatology Life Quality Index scores decreased from 84.46% and 12.86 at baseline, to 43.26% and 6.63, respectively. Complete response (CR) was recorded in 4 (13.33%), partial in 12 (40%) and no response in 14 patients (46.66%), correspondingly. Seventeen out of 42 (40.5%) individuals in total, reported at least 1 adverse event. No patient required hospitalization. Among 15 patients (35.7%) who got COVID-19, one suffered from serious infection. The 3 adolescents achieved CR with no significant adverse events. Real-world data suggest efficacy and safety of JAKi in severe forms of AA. Tolerability is optimal in younger individuals.

The Efficacy and Adverse Effects of Corticosteroid Pulse Therapy in Alopecia Areata: A Review Article.

Alopecia areata (AA) is a common, non-scarring, autoimmune hair loss disorder, varying in severity from small round hairless patches to the total loss of scalp or body hair. As steroid pulse therapy outcomes for AA vary, this study aimed to review the related literature regarding the efficacy, relapse rates, side effects, and prognostic factors associated with the response to different pulse corticosteroid treatments. We performed a literature search on August 29, 2022, to provide an overview of the efficacy of pulse steroid therapy in patients with AA. The terms "pulse steroid therapy AND alopecia areata" and "pulse corticosteroid therapy AND alopecia areata" were searched on PubMed and Google Scholar. A total of 24 articles were assessed. There was no difference in outcomes and side effects between intravenous and oral pulse corticosteroid therapy. The relapse rate and efficacy depended on the time of AA onset, age, and AA type: improved outcomes and decreased relapse were linked with recent onset (<6 months), a younger age (<10 years), and the multifocal type of AA. Patients with a past medical history of atopy, nail pitting, or thyroid disease and those with severe forms of AA like alopecia totalis and alopecia universalis had the least improvement. All kinds of mentioned systemic pulse corticosteroids effectively induce hair regrowth in AA. Betamethasone pulse seems to be the most effective agent (followed by intramuscular triamcinolone), especially in severe cases, but more side effects may accompany it. Combining this agent with other medications can reduce the dosage and side effects. Pulses of prednisolone and methylprednisolone are less effective but safer, as they have low relapse rates and adverse effects. A combination of them with other drugs can increase their efficacy.

Serum Zinc Concentration in Patients with Alopecia Areata.

Alopecia areata is an autoimmune non-scarring disease in which the exact mechanism that induces loss of immune privilege is unknown. Zinc is important for DNA stability and repair mechanisms that are essential in maintaining normal hair growth. Zinc deficiency has been investigated as an important factor in many autoimmune diseases, and may have a possible role in the aetiopathogenesis of alopecia areata. This study included 32 patients with severe forms of alopecia areata, and 32 age- and sex-matched healthy controls. When comparing serum zinc levels in these 2 groups, statistically significantly lower zinc concentrations were found in the alopecia areata group (p = 0.017). Detected zinc deficiency was statistically more prevalent in patients with alopecia areata (p = 0.011). Evaluating patients with alopecia areata, a statistically significant negative correlation between serum zinc levels and severity of the disease was found (ρ = 0.006). The results indicate that zinc serum assessment is necessary in patients with alopecia areata. Low serum zinc levels were found to correlate with severity of alopecia areata. Given that most severe forms of alopecia areata are frequently most treatment-resistant, additional randomized control trials examining zinc supplementation are necessary to investigate its potential role in the restoration of hair follicles.

Treatment Response to Diphenylcyclopropenone in Patients with Alopecia Totalis/Universalis.

Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous regrowth is <10%. Topical immunotherapy agent, diphenylcyclopropenone (DPCP) has shown clinical efficacy with limited side effects in severe forms of AA. However, its specific role in AT/AU characterized by complete hair loss over the scalp can help highlight the efficacy of the drug with fewer confounders. Data were collected from 18 patients diagnosed with AT/AU and treated with topical immunotherapy with DPCP as per protocol by Happle et al. Baseline Severity of Alopecia Tool (SALT) score and subclass was recorded. In the case of AU, baseline body hair loss score was also recorded. Patients were reassessed after 6 months of treatment in terms of change in SALT score and hair regrowth was assessed using the Global Assessment Score. The side effects during treatment were also assessed and recorded. Eighteen patients of whom eleven (61.1%) were diagnosed as AU and seven (38.9%) as AT were treated. The mean age was 21.6, with a male: female ratio of 3:2. The comorbidities noted were atopy in six (33.3%), atopy and hypothyroidism in one (5.5%), Down's syndrome in two (11.1%), and hypothyroidism alone in one (5.5%) patient. The mean duration of disease at the time of presentation was 3 years and all patients had remained refractory to various other modalities of treatment. All patients had a baseline SALT score of 100 corresponding to S5. After 6 months of treatment, 27.7% of patients did not show any response (SALT score S5), 16.6% had a score of S4, 11.1% had a score of S3, 11.1% had a score of S2, 22.2% had a score of S1, and 11.1% had a score of S0. On assessing improvement in body hair loss score, 36.3% of patients showed no improvement, 36.3% showed partial improvement, and 27.2% of patients showed complete body hair regrowth. About 55.5% of patients developed notable side effects that included severe local reactions, cervical lymphadenopathy, acne and pigmentation at the site of application as well as untreated sites. The AT/AU subtypes of AA, was amenable to treatment with contact immunotherapeutic agent DPCP with a >75% hair regrowth in 33.3% of patients. The castling phenomenon was seen in 63.6% of AU patients. The adverse effects noted were not severe enough to deter treatment.

Construction of regulatory network for alopecia areata progression and identification of immune monitoring genes based on multiple machine-learning algorithms.

Alopecia areata (AA) is an autoimmune-related non-cicatricial alopecia, with complete alopecia (AT) or generalized alopecia (AU) as severe forms of AA. However, there are limitations in early identification of AA, and intervention of AA patients who may progress to severe AA will help to improve the incidence rate and prognosis of severe AA. We obtained two AA-related datasets from the gene expression omnibus database, identified the differentially expressed genes (DEGs), and identified the module genes most related to severe AA through weighted gene co-expression network analysis. Functional enrichment analysis, construction of a protein-protein interaction network and competing endogenous RNA network, and immune cell infiltration analysis were performed to clarify the underlying biological mechanisms of severe AA. Subsequently, pivotal immune monitoring genes (IMGs) were screened through multiple machine-learning algorithms, and the diagnostic effectiveness of the pivotal IMGs was validated by receiver operating characteristic. A total of 150 severe AA-related DEGs were identified; the upregulated DEGs were mainly enriched in immune response, while the downregulated DEGs were mainly enriched in pathways related to hair cycle and skin development. Four IMGs (LGR5, SHISA2, HOXC13, and S100A3) with good diagnostic efficiency were obtained. As an important gene of hair follicle stem cells stemness, we verified in vivo that LGR5 downregulation may be an important link leading to severe AA. Our findings provide a comprehensive understanding of the pathogenesis and underlying biological processes in patients with AA, and identification of four potential IMGs, which is helpful for the early diagnosis of severe AA.

547 Reduced regulatory microRNA blood expression profile underlie severe forms of alopecia areata

547 Reduced regulatory microRNA blood expression profile underlie severe forms of alopecia areata

Efficacy and safety of tofacitinib for treatment of alopecia areata in children: A systematic review and meta-analysis.

Tofacitinib, a potent JAK inhibitor, has gained increasing interest, in recent years, among dermatologists for the management of refractory alopecia areata. Despite a growing number of studies on its safety and efficacy, there is still a lack of clarity, especially in the pediatric population, in treatment considerations such as proper dosage, treatment duration, side-effect profile, and therapeutic strategies to guide clinicians. Multiple databases were systematically searched. Following the PRISMA diagram, of a pool of 601 papers, seven met a checklist of inclusion criteria. These were observational studies including a total of 59 patients from four to 19 years of age. In the evaluated studies, tofacitinib was administered either orally at a 2.5 to 15 mg daily (mostly 5mg twice a day) dosage for 2 to 38 months or in the form of a 2% topical solution for 3-17 months. Metanalysis showed that 49% (95% CI: 29%-69%, I2 =59.94%) of patients experienced a reversal of alopecia after a minimum of 3 to 9months of therapy. Fifty-five percent (95% CI: 23%-86%, I2 =75.07%) and 41% (95% CI: 23%-59%, I2 =0.00%) showed Good/complete and partial response rates, respectively. Oral administration was significantly more efficacious than topical application (73% vs 23%, p-Value=0.04). Few side effects such as diarrhea and mild liver transaminases abnormalities were noted in several patients. Results of this review suggest that tofacitinib at 2.5-15 mg daily (especially 5mg twice daily) oral formulation or 2% topical solution can be regarded as a viable alternative or adjunct to the conventional treatment options for moderate to severe forms of alopecia areata in children owing to its acceptable efficacy and side-effect profile. However, uncertainties continue to exist around treatment strategies including initial and maintenance dosages, route of administration, dose adjustments, the timing of tapering or discontinuation, and associated treatment modalities.

Alopecia Totalis in a Five-Year-Old Boy: A Case Report

Background:&#x0D; Alopecia totalis (AT) represent the severe form of alopecia areata with a worse prognosis. In population the prevalences of alopecia totalis, is 0,08%. This study shows that Prosential, minoxidil 2% and clobetasol propionate 0.05% therapy for hair loss could be considered&#x0D; Case presentation:&#x0D; A 5-year-old boy weighing 13.4 kg came to the hospital complaining of hair loss all over his head, bald since two months before. The eyebrows, eyelashes, and nose hairs were also missing. The diagnosis is alopecia totalis. The patient was given Prosential therapy for four months. After two months of treatment, hair started to grow slightly, evenly across the head, eyebrows, and eyelashes. After that, the patient was lost contact. 4 months later, the patient returned with hair loss complaints again.The patient’s vital signs are normal. Eyes, ENT, heart, lungs, abdomen: normal. Skin: no hair. Laboratorium: Hemoglobin 12.1 g/dL, leukocytes 6,480/uL, platelets 324,000/uL, hematocrit 35.5%, Diff Count: basophils 0%, eosinophils 22%, stems 1%, segments 27%, lymphocytes 41%, monocytes 9%. Feces and urine analysis were normal. Glucose 86 mg/dL, total cholesterol 128 mg/dL, triglycerides 46 mg/dL. Albumin 4.33 g/dL, globulin 1.41 g/dL. Uric acid 4.64 mg/dL. Kidney and liver function were normal. Thyroid function: FT4: 1.1 ng/dL, TsHs 0.916 uIU/mL. The ANA test was negative. Diagnosis: Idiopathic alopecia totalis with hypereosinophilia. The therapy was Prosential, minoxidil 2% and clobetasol propionate 0.05%.&#x0D; Conclusion: The etiology of AT should be sought in as much detail as possible because alopecia management requires a holistic approach, including psychosocial support. Hair loss is a significant factor affecting the self-esteem of children.

459 Screening for hearing loss in pediatric alopecia areata

Hearing loss has been reported for adults with alopecia areata at higher frequencies than controls. We performed a prospective study of pediatric patients with alopecia to assess risk for hearing loss with emphasis on sensorineural hearing loss. We included 50 children ages 4-12 years of age with alopecia areata with severity greater than 50% and with at least 6 months of disease and tested hearing using standard pure tone audiometry and otoacoustic emission testing. Testing results suggest that hearing screens should be part of clinical care for children with alopecia areata with greater than 50% severity. We hypothesize immune mediated targeting of melanocytes in the hair follicles and inner ear plays a role in this type of hearing loss. Melanocytes play a key role in auditory stimuli transduction and modulation in the inner ear. Since this type of hearing loss is permanent is it important to consider whether we should be more aggressive with systemic therapies in children with severe forms of alopecia areata to prevent these changes. This study once again highlights that alopecia areata is a medical disease and the effects of having this disease are more than cosmetic.

Effectiveness of Paint Psoralen and Ultraviolet-A in Alopecia Areata - Our Experience in the National Skin Center.

Background:Alopecia areata (AA) is usually a benign cause of patchy hair loss that often resolves within a few weeks to months. Most treatment modalities are ineffective in the treatment of severe AA. The use of paint psoralen and ultraviolet-A (PUVA) in the treatment of patients with severe forms of AA has been reported in the literature.Aims and Objective:The aim of this study was to evaluate the effectiveness of paint PUVA therapy in the treatment of AA in Singapore.Materials and Methods:We performed a 10-year retrospective analysis of patients who underwent paint PUVA for AA. We evaluated patient demographics and treatment outcomes in the form of percentage change in baseline severity of alopecia tool score and final amount of hair regrowth and relapse rate.Results:Ten patients were included in this study. With paint PUVA therapy, significant hair regrowth was seen in six patients. Paint PUVA therapy in our study showed minimal side effects.Conclusion:PUVA gives fair response in AA in a reasonable time as per our center's experience in Singapore.

Alopecia Totalis Treated with 1064 nm Picosecond Nd:YAG Laser: A Case Report

Alopecia areata (AA) is an autoimmune disorder causing nonscarring hair loss. Alopecia totalis (AT), the severe form of AA, is usually refractory to many first-line treatments including topical and intralesional corticosteroids and topical immunotherapy. Systemic corticosteroids, ultraviolet light phototherapy, and immunosuppressants may be effective but can cause side effects and high recurrence rates after discontinuing treatment. Janus kinase inhibitors and numerous types of lasers, such as 308 nm excimer laser or light, low-level laser therapy, and fractional lasers have been explored for alternative treatment of AA over the past few years with beneficial effects. Herein, we presented a case of AT treated with the novel 1064 nm picosecond Nd:YAG laser (ps-Nd:YAG) (Cutera, Brisbane, CA, USA) under a split-scalp study. A 25-year-old woman presenting with AT for two years was treated with topical and intralesional steroid and the 1064 nm Nd-YAG picosecond laser on the right half of the scalp. The laser treatment interval was once a month. The left half of the scalp was treated with topical and intralesional steroids alone. After treatment for six times, the right half of the scalp had greater improvement than the left half of the scalp. 1064 nm picosecond Nd:YAG laser therapy may be an effective alternative adjuvant treatment for AT.

Quality of life in mild and severe alopecia areata patients.

BackgroundAlopecia areata is a relapsing hair disorder characterized by a sudden hairloss and has a considerable impact on patient’s quality of life. The goal of this study was to determine quality of life among patients with mild and severe forms of alopecia areata and compare the two groups.MethodsDuring one year, 176 patients (96 mild, 80 severe) were selected and asked to complete Dermatology Life Quality Index (DLQI) questionnaires.ResultsOur study revealed that the severe group was predominantly female and had higher amount of unemployment, more prolonged disease duration, unstable disease course and facial involvement. The mean DLQI scores in the severe and mild groups were 10.7 ± 7.5 and 5.4 ± 6.8, respectively which was significantly different and severe group had higher DLQI scores and more quality of life impairment. As well, there was a significant association between total DLQI scores and acute stress during last 6 months.ConclusionsOur study confirms that alopecia areata considerably impacts quality of life and this is more pronounced in patients with severe disease and those who had acute stress recently.

The Changing Landscape of Alopecia Areata: An Introduction.

Alopecia areata is an extremely common autoimmune condition affecting hair. Severe forms of alopecia areata exist, with existing treatments consisting of systemic immunosuppressants with numerous side effects. Recently, breakthroughs have been made in both understanding the pathogenesis of alopecia areata and the treatment thereof, which hold the promise of being able to target severe cases of alopecia areata with more efficacy and better tolerability. This article serves as an introduction to review papers from two of the leading researchers in the field of alopecia areata.

The Effect of Mehotrexate in the Treatment of Alopecia Areata

Background: Alopecia areata (AA) is one of the most common autoimmune disorders and its severe types are resistant to almost all conventional therapies. Methotrexate (MTX) has been used as an adjunctive therapy in some autoimmune disorders and has been proposed to be effective in the treatment of severe alopecia areata both as a monotherapy and in combination with corticosteroids. Aim of the study: was toevaluate the outcome and safety of MTX therapy in patients with severe forms of AA, whether as monotherapy or in combination with systemic or intralesional corticosteroids; and to assess therapeutic response according to sex, age, pattern of AA, disease duration and cumulative MTX dose. Methods: 28 patients were evaluated in a retrospective, non-controlled study, with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, and cumulative dose of methotrexate as well as the use of systemic corticosteroids or other treatments, and drug safety. Results: 77.8% % of patients experienced a more than 50% regrowth rate, with the best responses observed in those with Conclusion: methotrexate is a convenient and relatively inexpensive drug that could be used as a safe and well tolerated adjunctive therapy for severe alopecia areata although careful monitoring of adverse effect is necessary.

Alopecia Universalis Hair Regrowth with Hormones

Alopecia areata (AA) is a chronic, immune-mediated, non-scarring alopecia that causes patches of hair loss, typically on the scalp and face. Alopecia universalis (AU) is a severe form of AA that involves complete hair loss on the scalp and body. Although the genetics and immune pathogenesis have been recently better described, the exact cause and effective therapies remain unclear. We describe a case of a man with long-standing AU that regrew hair after supplementation with testosterone, chorionic gonadotropin (hCG) and DHEA-S.

Three hundred and eight nanometer excimer light therapy for alopecia universalis that is resistant to other treatments: A clinical study of 11 patients

Three hundred and eight nanometer excimer light therapy has recently been reported to be effective against patchy alopecia areata (AA) in several clinical studies. However, these studies only included a few patients with severe forms of AA, and all of them exhibited poor outcomes. We further investigated the use of excimer light as a therapeutic option for cases of alopecia universalis (AU) that are resistant to other treatments. Eleven treatment-resistant AU patients were treated with a 308-nm excimer light at 2-week intervals for more than 16 sessions. Four patients achieved good responses and two patients exhibited poor responses. Three patients had Japanese skin type 1 and all of them achieved good responses. The radiation dose was increased until the patients exhibited marked erythema. The patients with Japanese skin type 3 who achieved good responses exhibited strong pigmentation at the irradiated sites. In conclusion, 308-nm excimer light therapy has significant effects on some AU patients who are resistant to other treatments and may be an alternative therapeutic option for AU. During the treatment of AU, high doses of radiation should be administrated until a strong inflammatory skin reaction is seen.

Limited Effectiveness of Platelet-Rich-Plasma Treatment on Chronic Severe Alopecia Areata

Copyright: © 2014 d’Ovidio R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The platelet is a natural source of a multitude of growth factors and cytokines that promote wound healing. Platelet-Rich Plasma (PRP) is an autologous preparation of platelets in concentrated plasma. Activated platelet alpha granules release numerous cytokines, among others Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor β (TGF β), Vascular Endothelial Growth Factor (VEGF), Insulin-Like Growth Factor (IGF) and Epidermal Growth Factor (EGF) [1]. Several studies evaluated the effects of treatment with PRP in male pattern baldness surgery. The authors observed a significant improvement in hair density and stimulation of growth when follicular units were pretreated with platelet plasma growth factors before their implantation. They hypothesized that growth factors released from platelets may act on stem cells in the bulge area of the follicles, stimulating the development of new follicles and promoting neovascularization [2]. A recently published paper in the British Journal of Dermatology demonstrated PRP usefulness in a randomized double-blind controlled study in the therapy of Alopecia Areata (AA). PRP was found to increase hair re-growth significantly and to decrease hair dystrophy in patients affected by limited forms of AA [3]. We report here our experience with PRP in 25 patients affected by chronic (> 2 y), severe AA (> 50 of the scalp involved). All patients are volunteers of ANMAA (Associazione Nazionale Mediterranea Alopecia Areata. Our protocol was almost similar to the study of Trink et al. and presupposed a minimum of three sessions of infiltration every 45-60 days, injected with a needle 27G 2-4 ml of PRP in areas of about 15-20 cm2 in two symmetrical site of the scalp (occipital or frontal) [3]. More precisely, after the activation of calcium gluconate we wait 2-4 min. before the intradermal injection of PRP. The equipment used is Technica Centric 90, the rpm is 1200 and the time of rotation is 8 min. After several trials we found that the platelet concentration was about 3-4 times higher than the overall quantity found in the blood with no contamination of red and white cells. Two patients with Alopecia Universalis (AU) were also subjected to eyebrows inoculation. Only 9 patients completed the protocol. Eight have carried out only the first session of infiltration and 8 went as far as the second. The follow-up is been done in any case to all of them up to a year. The most common reason for discontinuation of treatment was significant discomfort and pain caused by infiltration, followed by the absence of significant results after the second and fourth month. None of the patients achieved noticeable cosmetic results, which however could have not been achieved due to our decision to practice infiltration only in limited test areas of the scalp. Of the nine evaluable patients at the eighth month, 6 have obtained re-growth of terminal pigmented hair the others noted non-pigmented vellus in the seats of infiltration after the second session of infusion of PRP (also in one of the 2 cases treated at the eyebrows) (Figure 1a). In one case the re-grown hair have proven resistant to an episode of severe relapse of AA (Figure 1b). In another case the infusion of PRP was followed immediately by a severe relapse that hit the areas surrounding the sites of infiltration therefore configuring as a iatrogenic Koebner phenomenon (Figure 1c) [4]. None of the cases at an average follow-up of one year still had the hair re-grown with therapy. In our opinion the treatment with PRP presents some activity in a few cases with severe forms of AA, probably therapeutic results could improve increasing the frequency of infiltration, even with the disadvantages of cost and tolerability. But we underline that this treatment regimen does not seem to be able to give persistent results and fails to inhibit the appearance of new relapses during treatment in our severe forms which are also cases in most need of innovative therapies. On the other hand, the documented induction of re-growth in some of our patients

PTPN22 gene polymorphism in Egyptian alopecia areata patients and its impact on response to diphencyprone immunotherapy

PTPN22 1858C>T gene polymorphism has been associated with several autoimmune disorders including alopecia areata. The aim of the current study was to investigate the effect of the inherited genetic polymorphism 1858C>T of PTPN22 gene on the predisposition to severe forms of alopecia areata and its effect on the response to DPC treatment. To achieve our aim, PTPN22 1858C>T genotyping was performed by PCR-based restricted fragment length polymorphism (PCR-RFLP) analysis. The study included 103 Egyptian patients with extensive alopecia areata treated by DPC. Hundred healthy age and sex matched blood donors were included in the current study as a control group. Results of genotyping showed that PTPN22 CT and TT mutant genotypes were significantly higher in AA patients compared to controls and conferred increase risk of AA (OR=2.601, 95% CI=1.081–6.255). Statistical comparison between AA patients with wild and mutant genotypes revealed that the duration of the illness was significantly longer in those harboring the mutant genotypes. Moreover, the association of other autoimmune diseases as atopy and diabetes mellitus was higher in patients with mutant genotypes. Furthermore, PTPN22 1858C>T genetic polymorphism did not affect the patients' response to DPC immunotherapy.

Sa1345 Increased Duodenal IL12A mRNA Expression in Celiac Disease Patients Might Lead to Increased IL-35 Production

BACKGROUND. Celiac disease (CD) is an autoimmune enteropathy that affects 1% of the general population. The association between CD and other autoimmune disorders is well established and increased prevalence of CD has been found in patients with type 1 diabetes (7%) and autoimmune thyroiditis (2%). Some reports on co-morbidity of CD and alopecia areata (AA), an autoimmune skin disorder that causes hair loss, have shown a variable hair re-growth upon institution of a gluten-free diet. No studies have addressed the association between CD and the different clinical subtypes of AA, which vary in duration and degree of hair loss. The aim of this study was to investigate the prevalence of CD across the phenotypic spectrum of AA using serological screening methods that have high sensitivity and specificity for CD diagnosis. METHODS. Sera obtained through the National Alopecia Areata Registry of the United States from 16 patients with transient AA (AAT), 24 with patchy persistent AA (AAP), 27 with total scalp hair loss (AT) and 32 with complete body hair loss (AU), were screened for CD using a commercial ELISA kit against combined antitissue transglutaminase and anti-deamidated gliadin peptide IgA and IgG antibodies (antitTG/DGP) from INOVA Diagnostics Inc. Titers >20 IU were considered positive and titers >30 IU were considered strongly positive and suggestive of CD. RESULTS. Of 99 samples (females=64, males=35), a total of 9 (9%) patients (all female) were positive for anti-tTG/ DGP antibodies (range 20.4 61.7 IU) and 4% (2 AT, 1 AU and 1 AAP) were strongly positive. By type of presentation, anti-tTG/DGP titers were elevated in 15% AT, 9% AU and 8% AAP patients but in none of AAT patients. CONCLUSIONS. These results demonstrate that AA patients have a higher prevalence of CD-associated antibodies (9%) than the general population (~3%). CD seropositivity is present in the more severe forms of AA, where hair loss is experienced for more than one year and/or results in total loss of hair from the scalp and/or body. Patients with the least severe form of the disease, transient hair loss lasting less than one year, do not appear to have an elevated risk for CD. Screening for CD is recommended in AA for early detection and institution of a gluten-free diet.

Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence (< or ≥ 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.