Areas TA Research Articles

Evaluation of platelet-rich plasma in treatment of alopecia areata

BackgroundAlopecia areata (AA) has major effects on the quality of life and self-esteem, especially in the young patients. Platelet-rich plasma (PRP) promotes hair growth and survival both in vivo and in vitro because of its high concentration of growth factors that stimulate the formation of hair e

Investigation of oxidative stress in patients with alopecia areata by measuring the levels of malondialdehyde and ceruloplasmin in the blood.

IntroductionAlopecia areata (AA) is a chronic, inflammatory and autoimmune disease, presenting with non-scarring hair loss. Although the precise etiopathogenesis of AA remains unknown, oxidative stress is thought to play a role.AimTo investigate the role of oxidative stress in AA by measuring the levels of plasma and erythrocyte malondialdehyde (MDA) and the ceruloplasmin (CER) in serum.Material and methodsThe study included 24 AA patients and a control group consisting of 24 age- and sex-matched healthy volunteers. The levels of MDA and CER were measured and compared between groups.ResultsPlasma MDA levels were significantly higher (p < 0.05) in patients with AA compared with controls. No significant difference was observed in MDA erythrocyte levels (p = 0.990) between the study group and the control group. Ceruloplasmin level was higher in the AA group, but this increase was not statistically significant (p = 0.156).ConclusionsPatients with AA displayed significant plasma MDA levels, which could lead to damage in erythrocytes exposed to high concentrations of free radicals. These results demonstrate the presence of an imbalance in the oxidant-antioxidant system and support the concept of a possible role of oxidative stress in AA etiopathogenesis.

Liquid nitrogen cryotherapy in the treatment of alopecia areata: An Egyptian study

IntroductionAlopecia areata (AA) is a common cause of nonscarring alopecia that occurs in a patchy, confluent or diffuse pattern. It may involve loss of hair from some or all areas of the body, usually from the scalp. The aim of this study was to evaluate the effect of cryotherapy in the treatment of AA. Patients and methodsThrough a nonrandomized and nonblinded study, 17 patients with 20 recalcitrant patchy AA lesions were recruited at the outpatient dermatology clinic, Assiut University Hospital, between August 2014 and September 2016. The lesions were treated with liquid nitrogen cryotherapy spray once weekly for 6 weeks. The lesions were sprayed for 2–3 s, until it became slightly frozen. After the frozen area was thawed (∼3–5 s), a second spray was done in the same manner. The lesions were assessed by direct scalp observation for the size and hair regrowth and by taking photographs. The therapeutic response of the lesions to cryotherapy was evaluated in relation to the age of the patients, the size of the lesions, and the duration of the disease. ResultsA positive therapeutic response was noted in 13 (65%) lesions. By studying the clinical response to cryotherapy in relation to the age of the patients, we found that 53.8% of the lesions which responded to cryotherapy were in patients aged more than 30 years compared with 46.2% in patients aged less than 30 years. Lesions less than or equal to 3 cm have shown a better clinical response than those of more than 3 cm (76.9%). The clinical response of AA lesions was better (84.6%) when the disease duration was less than 6 months. ConclusionSuperficial cryotherapy with liquid nitrogen is a therapeutic option with a good treatment outcome. It has the privilege of being simple, convenient, short-term and office-based technique, especially in mild to moderate recalcitrant AA.

Efficacy of diphenylcyclopropenone in alopecia areata: a comparison of two treatment regimens.

IntroductionAlopecia areata (AA) is a skin disease of unclear etiology. In AA, topical immunotherapy with diphenylcyclopropenone (DPCP) is considered the most effective treatment; however, the most common therapies give unsatisfactory results.AimTo assess the efficacy of a topical application of a solution of DPCP based on the intensity, duration and number of exacerbations of AA and to compare the efficacy of two treatment regimens.Material and methodsIn this prospective study, 39 patients with AA were enrolled. Group A was treated at weekly intervals and group B at 3-week intervals. Hair loss was assessed by independent dermatologists and documented by photography and dermoscopy.ResultsAfter 6 months’ therapy, hair regrowth greater than 50% was observed in 21 patients, while worsening, no regrowth, or regrowth of less than 50% was seen in 18 patients. Regrowth exceeding 50% of initial loss was observed in 12 of 17 patients with baseline hair loss < 50%, in 9 of 22 patients with severe alopecia, and in 4 of 9 patients with alopecia totalis. Both groups showed significant improvement with higher efficacy in group B (54%) than group A (46%).ConclusionsTreatment at longer intervals may be safer and more comfortable for patients; however, further research is required.

Topical JAK Inhibitors for the Treatment of Alopecia Areata and Vitiligo

Purpose of Review Alopecia areata (AA) and vitiligo are dermatological autoimmune diseases that, until recently, have had no specifically targeted therapies. Here, we review the future of therapies specifically targeted to the treatment of alopecia areata and vitiligo, both of which have JAK-STAT signaling implicated in their pathogenesis.

Serum level of vitamin D in patients with alopecia areata

PurposeAlopecia areata (AA) is an autoimmune disease mediated by both CD4+ and CD8+ T-cells with cytokines playing an important role. Current study aimed at measuring serum 25 hydroxy vitamin D [25(OH) D] level in patients with AA in comparison to controls in our locality. Subjects and methodsThe study recruited 50 subjects, 30AA patients and 20 controls. All patients were subjected to detailed history taking and examination to detect pattern, severity (SALT score) of AA. Blood samples were taken from all subjects to do complete blood count and to assess serum levels of 25(OH)D, parathyroid hormone, random blood sugar, and calcium. ResultsThere was significant decrease in serum 25(OH)D level in AA patients in comparison to controls. Serum 25(OH)D level showed significant decrease in males than in females in patients. Levels of serum calcium were significantly lower in patient group compared to control group with. Regarding blood picture; the only significant difference was in the count of RBCs which showed significant lower levels in AA group compared to control group. Positive linear correlation was found between serum vitamin D and serum calcium in the patients group. Strong positive correlation was found between SALT score and duration of the disease. All patients with total scalp hair loss and body hair loss had duration of disease more than six months, while most of patients with duration of disease less than six months had low SALT scores. ConclusionsSerum levels of 25(OH)D were significantly lower in patients than controls.

Total Regrowth in Chronic Severe Alopecia Areata Treated with Platelet Rich Plasma: A Case Report and Literature Review

1. Anastasios Vekris, MD 2. Dimitra Zafeiratou, MD 3. Antonia Andriopoulou 4. Amalia Tsiatoura (dzafeiratou{at}gmail.com) 1. Athens, Greece Alopecia areata (AA) is a chronic, autoimmune disease that causes inflammation of hair follicles. AA may lead to non-scarring hair loss that can

Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib

BackgroundAlopecia areata (AA) is an autoimmune disease resulting in hair loss with devastating psychosocial consequences. Despite its high prevalence, there are no FDA-approved treatments for AA. Prior studies have identified a prominent interferon signature in AA, which signals through JAK molecules. MethodsA patient with AA was enrolled in a clinical trial to examine the efficacy of baricitinib, a JAK1/2 inhibitor, to treat concomitant CANDLE syndrome. In vivo, preclinical studies were conducted using the C3H/HeJ AA mouse model to assess the mechanism of clinical improvement by baricitinib. FindingsThe patient exhibited a striking improvement of his AA on baricitinib over several months. In vivo studies using the C3H/HeJ mouse model demonstrated a strong correlation between resolution of the interferon signature and clinical improvement during baricitinib treatment. InterpretationBaricitinib may be an effective treatment for AA and warrants further investigation in clinical trials.

Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients.

BackgroundAlopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA.ObjectiveTo evaluate the differences in the comorbidity profile of AA with regard to age at onset.MethodsWe completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results.ResultsOur results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age.ConclusionThis study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.

Tumor necrosis factor α promoter −308G/A polymorphism in patients with patchy alopecia areata

BackgroundAlopecia areata (AA) is a common recurrent inflammatory nonscarring hair loss disease with a worldwide prevalence ranging from 1 to 2%. Although the exact etiology of AA is unknown, there is evidence for both genetic and autoimmune components. Recently, tumor necrosis factor a (TNF-a) promoter −308 polymorphism was suggested to contribute to the pathogenesis of a wide range of autoimmune and infectious diseases. There is a plausible association between TNF-α polymorphism and AA.ObjectiveThe aim of the study was to determine TNF-α 308 gene polymorphism in patients with patchy AA.Patients and methodsThe present case-control study included 20 patients with patchy AA and 20 age-matched and sex-matched apparently healthy controls. TNF-α 308 gene polymorphism was detected by restricted fragment length polymorphism PCR in all of them.ResultsThe mutant TNF-α 308 gene was found in 28.6% of patients with patchy AA and in 4.8% of controls, with statistically nonsignificant difference (P = 0.093). No statistically significant differences were found between patients with normal genotype and those with mutant genotype with respect to age, sex, disease duration, medical associations, family history of autoimmune diseases, or history of previous attacks. Statistically significant difference was found with respect to family history of AA and number of lesions.ConclusionTNF-α 308 gene polymorphism was present in small percentage of patients with patchy AA, with statistically nonsignificant difference from controls.

Inmunoterapia con difenciprona en alopecia areata extensa. Experiencia en 104 pacientes

IntroductionAlopecia areata (AA) is a T cell-dependent, organ-specific autoimmune disease. Topical diphencyprone is the treatment of choice in extensive AA. Materials and methodsThis study describes a series of 104 patients with extensive AA treated with topical diphencyprone to assess the efficacy and adverse effects of this drug. ResultsAfter a mean follow-up of 1 year, most patients in our series (87.5%) showed some response to treatment. Among responders, approximately half the patients had a poor response (grade 1-2) and the other half a higher response (grade 3-4). Adverse effects were mostly local and mild and included blistering, exudation, postinflammatory hyperpigmentation and microadenopathies. ConclusionWe conclude that immunotherapy with diphencyprone is easy to implement, effective and well tolerated by patients.

Serum granulysin as a possible key marker of the activity of alopecia areata

BackgroundAlopecia areata (AA) is an organ-restricted autoimmune condition of the hair follicles (HFs) that presents as nonscarring hair loss. A collapse of immunoprivilege for cell-mediated cytotoxicity and following attacks by cytotoxic T cells to anagen HFs are considered to play a major role in the pathogenesis of AA. However, there has been no useful marker for the activity of AA to date. ObjectiveThe aim of this study is to examine whether granulysin, which is known to reflect the activity of cytotoxic immune responses, is related to the disease activity of AA. MethodsWe evaluated serum granulysin levels in acute and chronic AA patients compared to healthy controls in the perspective of bald skin areas, prognosis, and co-existence of other allergic diseases. In addition, immunohistochemical analysis for granulysin-, CD4-, CD8-, and CD56-positive cells in the lesional skin of acute and chronic AA patients was performed. ResultsSerum granulysin levels were significantly elevated in both acute and chronic AA patients (p=0.00081 and p=0.0012, respectively). Intriguingly, serum granulysin levels were significantly associated with the broader bald skin areas (Spearman's r=0.59, p=0.017), and poorer prognosis in acute AA patients (p=0.0080). They were also associated with co-existence of allergic disorders in AA patients (p=0.026). Immunohistochemical staining demonstrated that perifollicular granulysin-bearing cells were mainly detected in acute AA lesions with dense lymphocytic infiltration, and that these granulysin-bearing cells were consistent with CD8+ T cells. ConclusionThe serum granulysin level may be a useful and novel marker for the disease activity in the acute phase of AA.

FRI0167 Alopecia areata occuring during tnf blockers therapy : a french multicentric survey

BackgroundAlopecia areata (AA) is an autoimmune disorder targeting the hair follicle, more frequently observed in patients with Pso, RA or IBD. While high amount of TNF is found in the...

Evaluation of Macrophage Migration Inhibitory Factor Level in Sera of Patients with Alopecia Areata

Backgroundalopecia areata(AA) is a common recurrent non‐scarring type of hair loss. the pathogenesis of AA is still uncertain. The immune system has been implicated in its pathogenesis and certain immunomodulatory cytokines play a role in its development. Migration inhibitory factor(MIF) was reported to the first lymphokine which prevents the random migration of macrophages. A recent finding demonstrated that MIF innitiates inflammation and immune response by stimulating the secretion of several pro‐inflammatory cytokines. As regards skin diseases, MIF production by peripheral blood mononuclear cells has been reported to be markedly increased in patients with atopic dermatitis.The aim of the present work was to measure the serum MIF concentration in patients with AA and in health indivduals.Subjects and methodsThe present study was carried out on 30 patients with AA and 15 healthy controls. The serum level of MIF was measured by enzyme linked immunosorbent assay (ELISA).Resultsthe mean level of MIF in AA patients was 6.535ng/ml+3.51(mean+SD), while in healthy individuals was 1.89ng/ml+0.91(mean+SD)with statistical sinificant difference (p‐0.016).ConclusionMean serum MIF in patients with AA was higher than that in healthy subjects indicating that MIF has a role in the etiopathogenesis of AA

CXCL10 produced from hair follicles induces Th1 and Tc1 cell infiltration in the acute phase of alopecia areata followed by sustained Tc1 accumulation in the chronic phase

BackgroundAlopecia areata (AA) is an organ-specific and cell-mediated autoimmune disease. T lymphocytes densely surround lesional hair bulbs, which is histologically referred to as “swarm of bees”. However, pathomechanisms of “swarm of bees” are still uncertain. ObjectiveWe investigated the pathological mechanisms of “swarm of bees”, focusing on T-cell chemotaxis so that inhibition of chemotaxis may be strong candidate of novel treatments for AA. MethodsWe investigate the expression of chemokine receptors on T cells obtained from peripheral blood mononuclear cells (PBMCs) and skin infiltrating cells in AA patients. In addition, real-time chemotaxis assay was also demonstrated. ResultsIn PBMCs, the frequency of CXCR3+CD4+ T cells (Th1) was significantly higher in acute-phase AA than in chronic-phase AA or healthy control, while CXCR3+CD8+ T cells (Tc1) were significantly increased in chronic-phase AA. In the skin lesions of acute-phase AA, CXCR3+CD4+ and CXCR3+CD8+ T cells infiltrated in the juxta-follicular area. In chronic-phase AA, CXCR3+CD8+ T cells dominated the infiltrate around hair bulbs, possibly contributing to the prolonged state of hair loss. Lymphocytes obtained from a lesional skin of acute-phase AA contained CXCR3+CD4+ and CXCR3+CD8+ T cells at higher percentages than those of PBMCs, suggesting preferential emigration from the blood. Immunohistochemical and real-time RT-PCR studies demonstrated that hair follicles of acute-phase AA expressed a high level of Th1-associated chemokine CXCL10. By chemotaxis assay, freshly isolated PBMCs from acute-phase AA patients had a strong velocity of chemotaxis toward CXCL10 with increased expression of F-actin. ConclusionsThese results suggest that the increased production of CXCL10 from hair follicles induces preferential infiltrates of highly chemoattracted Th1 and Tc1 cells in the acute phase of AA, and Tc1 infiltration remains prolonged in the chronic phase.

Mast cells and their role in the pathogenesis and treatment of alopecia areata

Recent studies have implied that mast cells are involved in the pathogenesis of skin diseases,especially inflammatory skin diseases.Alopecia areata (AA) is a form of non-scarring inflammatory hair loss of unknown etiology.At present,AA is thought to be a T-cell mediated autoimmune reaction specifically targeting anagen hair follicles.It has been demonstrated that increased mast cells in AA lesions are associated with the expression of neuropeptides,and various inflammatory mediators released by activated mast cells via degranulation may participate in the inflammatory infiltration in AA.The fact that prophylactic use of antihistamines and mast cell stabilizers is effective for the treatment of patients with AA who poorly respond to traditional therapy or have inherited predisposition to allergy hints that mast cells may be involved in the pathogenesis of AA. Key words: Alopecia areata; Mast cells; Neuropeptides; Therapy

Environmental stress but not subjective distress in children or adolescents with alopecia areata

ObjectiveAlopecia areata (AA) has been considered a psychosomatic disease. This case–control study tries to determine whether environmental adverse conditions are associated with AA and to describe the subjective and physiological state of the patients. MethodsA series of 31 children or adolescents with AA (16 boys and 15 girls; aged 12.2±3.8 years [range, 7–19]) were compared with both 23 patients of similar demographic characteristics undergoing a chronic illness (epilepsy) and 25 healthy siblings (HS) of the AA patients. The research protocol included assessment, by interview with the mother, of stressful life events in the 12 months previous to the AA onset and of developmental and family conditions, as well as self-rating instruments for anxiety, depression and family functioning. Some neuroendocrine and immunological parameters were also measured. Logistic regression analyses were used to confirm independent associations with AA. ResultsIn contrast with their HS, AA patients experienced more stressful life events and showed higher 24-h urinary excretion of catecholamines. In contrast with epilepsy patients, AA patients were more likely the member of a single-parent family and perceived less expressiveness within their family. On the other hand, the three groups showed no significant differences in anxiety and depression scores. ConclusionAlopecia areata is a complex skin disorder in juvenile patients whose conscious experience of distress is often absent and that might be precipitated by stressful life events in individuals under the influence of defective family functioning or biological vulnerability.

Alopecia areata

AbstractAlopecia areata (AA) is a nonscarring, autoimmune, inflammatory, hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common site affected is the scalp. Histopathology is characterized by an increased number of the catagen and telogen follicles, the presence of inflammatory lymphocytic infiltrate in the peribulbar region (“swarm of bees”).Corticosteroids are the most popular drugs for the treatment of this disease. Etiologic and pathogenic mechanisms, as well as other current treatments available will be discussed in this article.

Maximizing the Effectiveness of Role-Play Scenario Training Exercises in Development of Police Crisis Intervention Skills

Abstract It has long been ac cepted that “hands-on” prac tice is es -sen tial in cer tain ar eas of po lice training. No one would con sider a stu -dent qual i fied to carry a fire arm af ter at tending only class room sessions con sisting of lectures about safety, stance, and trig ger pull-even if those sessions in cluded watching vid eo tapes of ac tual shootings and dem on-strations of “how to do it” by ex pe ri enced per son nel. In or der to de velop pro fi ciency in any skill, we must even tu ally go beyond the the o ret i cal knowl edge pre sented in the text book and the sec ond-hand ex pe ri ences re lated by oth ers and ap ply the in for mation in real or re al is tic sim u lated sit u ations. Yet, there still ex ist acad e mies and in-ser vice law en force ment training pro grams de voted to the han dling of vol a tile sit u ations (hos tage ne go ti ations, do mes tic dis tur bance, and dispute me di ation courses) which in clude few or no prac ti cal ap pli cation ex er cises. Stu dents are given training that is in com plete and some times use less in the field.

Eigenvector scaling for mode localization in vibrating systems

A new closed-loop mode localization technique known as eigenvector scaling is presented. Eigenvector scaling is a form of eigenstructure placement that uses feedback to alter portions of the original system eigenvectors. When properly applied, this technique restricts energy propagation in a vibrating system. Active eigenvector scaling also permits the development of an analytic solution for the closed-loop mode-localized discrete system. The ability to produce analytic solutions for both the controlled and the uncontrolled systems permits a direct comparison of the absolute displacements between the two cases. It is demonstrated that closed-loop mode localization can be used to restrict vibrations in certain regions of a discrete structure. Three examples are provided that show how this feedback control technique may be applied to multi-degree-of-freedom simple spring-mass and spring-mass- damper systems, as well as to lumped models of more complicated flexible structures. IBRATION of flexible structures is a common problem in dy- namics and controls. The relative ease with which vibrational energy may propagate through complex systems can lead to exces- sive displacements at critical locations, which in turn can lead to reduced performance or failure. It is not always necessary to control vibrations throughout an entire structure, but rather controlling cer- tain areas within the structure that contain sensitive instruments or machines may be most critical. The motivation for this work, then, is to seek vibration control methods that produce quiet areas within a vibrating system subjected to arbitrary disturbances. One way of controlling flexible structure vibration is through mode localization. Mode localization restricts motion by contain- ing vibrational energy within a small area of the total system. This phenomenon was originally described in solid state physics1 but also exists in flexible structures.2'3 Mode-localized structures exhibit ar- eas of comparatively high displacements, with amplitudes in these parts potentially several magnitudes greater than in the rest of the system. In a large number of studies, mode localization has been considered to be unfavorable, as in mistuned rotor blades.4 How- ever, some studies maintain that mode localization may be useful, since it confines system motion within a specific area, preventing the transmission of potentially harmful vibrational energy.5 Addition- ally, if vibrational energy is contained, then it may be more easily controlled with damping or cancellation. Loosely coupled, slightly mistuned flexible structures are espe- cially susceptible to mode localization.2'6'7 As a result, studies have concentrated on the passive mistuning of this type of structure. It is, however, also possible to create mode localization with active, closed-loop feedback control using a technique known as eigen- structure placement, which is the approach used in this paper.