Alopecia areata (AA) is an autoimmune condition related to the collapse of the immune privilege of hair follicles. Certain AA populations present severe clinical manifestations, such as total scalp hair or body hair loss and a treatment refractory property. The aim of this study was to assess the effects of allogenic human mesenchymal stem cells (hMSCs) from healthy donors on the peripheral blood mononuclear cells (PBMCs) of severe AA patients, with a focus on the change in the cell fraction of Th1, Th17, and Treg cells and immunomodulatory functions. PBMCs of 10 AA patients and eight healthy controls were collected. Levels of Th17, Th1, and Treg subsets were determined via flow cytometry at baseline, activation status, and after co-culturing with hMSCs. All participants were severe AA patients with SALT > 50 and with a long disease duration. While the baseline Th1 and Treg levels of AA patients were comparable to those of healthy controls, their Th17 levels were significantly lower than those of the controls. When stimulated, the levels of CD4+IFN-γ+ T cells of the AA patients rose sharply compared to the baseline, which was not the case in those of healthy controls. The cell fraction of CD4+Foxp3+ regulatory T cells also abruptly increased in AA patients only. Co-culturing with allogenic hMSCs in activated AA PBMCs slightly suppressed the activation levels of CD4+INF-γ+ T cells, whereas it significantly induced the differentiation of CD4+Foxp3+ regulatory T cells. However, these changes were not prominent in the PBMCs of health controls. To examine the pathomechanisms, PBMCs of healthy donors were treated with IFN-γ to induce AA-like environment and then treated with allogenic grants and compared with ruxolitinib as a positive treatment control. hMSC treatment was shown to significantly inhibit the mRNA levels of proinflammatory cytokines, such as IFN-γ, TNF-α, IL-1α, IL-2R, IL-15, and IL-18, and chemokines, such as CCR7 and CCR10, in IFN-treated PBMCs. Interestingly, hMSCs suppressed the activation of JAK/STAT signaling by IFN in PBMCs with an effect that was comparable to that of ruxolitinib. Furthermore, the hMSC treatment showed stronger efficacy in inducing Foxp3, IL-10, and TGF-β mRNA transcription than ruxolitinib in IFN-treated PBMCs. This study suggests that allogenic hMSC treatments have therapeutic potential to induce immune tolerance and anti-inflammatory effects in severe AA patients.

Background: Several dermoscopic findings that could be helpful in diagnosing onychomycosis have been reported in many cases, but they have not been sufficiently utilized in clinical practice. Objective: To evaluate and identify the dermoscopic findings that may assist in the accurate diagnose of onychomycosis. Methods: The study included 42 patients with clinical features suggestive of onychomycosis based on the clinical history, physical examination, dermoscopic findings, and mycological investigation. Clinical photographs and nail dermoscopy images were obtained, which were retrospectively reviewed and analyzed according to the onychomycosis classification. Results: In total, 42 representative nails were reviewed. Common dermoscopic patterns such as yellow/brown discoloration and subungual hyperkeratosis were found in our onychomycosis patients. Key findings observed in specific subtypes were distolateral subungual onychomycosis with "jagged edges with spikes", proximal subungual onychomycosis or white superficial onychomycosis with irregularly bordered homogeneous leukonychia with postinflammatory hyperpigmentation on the proximal nail fold, and fungal melanonychia with nail plate roughness and nail fold hyperkeratosis. Conclusion: Our study, along with previous studies, demonstrated dermoscopy as a quick and effective tool for diagnosing onychomycosis. In addition, periungual dermoscopic findings can be an important clue in onychomycosis diagnosis, especially in cases of fungal melanonychia and leukonychia.