Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management

Zhou, Cheng; Li, Xiangqian; Wang, Chen; Zhang, Jianzhong

doi:10.1007/s12016-021-08883-0

Cited by 179 publications

(209 citation statements)

References 208 publications

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“…Though different application strategies of SCs have shown fair efficacy in severe AA, high rates of AEs have restricted the long-term application of SCs ( 2 , 3 ). In a placebo-controlled trial, 23 patients with severe AA were treated with weekly oral prednisolone pulse therapy (200 mg).…”

Section: Discussionmentioning

confidence: 99%

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Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

Zhang

Bai-fu

et al. 2022

Front. Med.

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IntroductionAlopecia areata (AA) is an autoimmune hair loss mediated by CD8 + T cells. Treatment for moderate-to-severe AA is still challenging. Janus kinase inhibitors, such as tofacitinib, have been recently investigated as a promising treatment option for AA. Evidence on the combination use of oral tofacitinib and systemic corticosteroids (SCs) for AA is still lacking.ObjectiveTo compare the efficacy and safety of monotherapy of oral tofacitinib and SCs, as well as their combination in patients with moderate-to-severe AA.MethodsPatients with moderate-to-severe AA, who have been treated with at least 3 months of monotherapy of tofacitinib or SCs, or in their combination, were included in this study. The efficacy and adverse events of these treatments were retrospectively analyzed.ResultsSixty-one patients with moderate-to-severe AA were included in this study. There were 12 (66.7%) of 18 patients in the SCs group, 12 (60.0%) of 20 patients in the tofacitinib group, and 18 (78.3%) of 23 patients achieved SALT50, with no significant difference among the three groups. The ratio of patients who achieved SALT50 was significantly higher in patients with a short duration of current hair loss episode (≤2 years) than in those with a duration of current hair loss episode (>2 years) in all the three groups. There were 66.7% patients in the SCs group, 35.0% patients in the tofacitinib group, and 56.5% patients in the combined group that showed adverse effects.ConclusionTofacitinib was an effective treatment for patients with moderate-to-severe AA, and it was more tolerated than SCs. A combination of tofacitinib and SCs may have higher efficacy than SCs alone. Efficacy significantly decreased in patients with a current episode of disease for more than 2 years.

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Section: Discussionmentioning

confidence: 99%

“…There is still no reliable therapy for severe AA. The traditional treatments, such as systemic corticosteroids (SCs) and immunosuppressants, are limited in terms of treatment efficacy and high risk of adverse effects ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

Zhang

Bai-fu

et al. 2022

Front. Med.

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“…By increasing Bcl-2 expression, melanocyte populations in the hair bulb and melanocyte stem cells in the bulge could be maintained, preventing hair greying. Finally, the compromised redox equilibrium has also been linked to the pathogenesis of androgenetic alopecia, a common heritable, androgen, and age-dependent process that results in large reductions in scalp hair density [ 291 , 292 ]. However, it is important to consider that ROS has an ambivalent function in hair biology.…”

Section: Ros and Hair Greyingmentioning

confidence: 99%

Focus on the Contribution of Oxidative Stress in Skin Aging

et al. 2022

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Skin aging is one of the most evident signs of human aging. Modification of the skin during the life span is characterized by fine lines and wrinkling, loss of elasticity and volume, laxity, rough-textured appearance, and pallor. In contrast, photoaged skin is associated with uneven pigmentation (age spot) and is markedly wrinkled. At the cellular and molecular level, it consists of multiple interconnected processes based on biochemical reactions, genetic programs, and occurrence of external stimulation. The principal cellular perturbation in the skin driving senescence is the alteration of oxidative balance. In chronological aging, reactive oxygen species (ROS) are produced mainly through cellular oxidative metabolism during adenosine triphosphate (ATP) generation from glucose and mitochondrial dysfunction, whereas in extrinsic aging, loss of redox equilibrium is caused by environmental factors, such as ultraviolet radiation, pollution, cigarette smoking, and inadequate nutrition. During the aging process, oxidative stress is attributed to both augmented ROS production and reduced levels of enzymatic and non-enzymatic protectors. Apart from the evident appearance of structural change, throughout aging, the skin gradually loses its natural functional characteristics and regenerative potential. With aging, the skin immune system also undergoes functional senescence manifested as a reduced ability to counteract infections and augmented frequency of autoimmune and neoplastic diseases. This review proposes an update on the role of oxidative stress in the appearance of the clinical manifestation of skin aging, as well as of the molecular mechanisms that underline this natural phenomenon sometimes accelerated by external factors.

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“…Alopecia areata (AA) is an autoimmune disorder causing hair loss. A subtype of AA is alopecia totalis, in which patients experience complete hair loss of the scalp, often accompanied by loss of eyebrows and eyelashes [ 1 ]. Traditional therapies for AA include topical and intralesional corticosteroids, topical immunotherapy, and topical minoxidil for localized disease; systemic immunosuppressive therapies, including cyclosporine, systemic corticosteroids, and JAK/STAT inhibitors have been utilized in widespread disease.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Efficacy of Dupilumab in Alopecia Areata

et al. 2022

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Patient: Male, 16-year-old Final Diagnosis: Alopecia areata Symptoms: Scalp hair loss Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual or unexpected effect of treatment Background: Dupilumab is a relatively new immune-modulating drug that has transformed the way clinicians treat common immunologic conditions, including atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Blocking signaling molecules involved within the Th2 immune response, dupilumab is a proven effective treatment for moderate to severe atopic dermatitis – a condition whose disease pathogenesis is heavily linked to the dysregulation of this immunologic pathway. Interestingly, dupilumab has found broader clinical utility, showing efficacy in treating other distinct dermatologic diseases, including alopecia areata. Case Report: A 16-year-old White male with a past medical history of moderate atopic dermatitis presented to our clinic with complete scalp hair, eyebrow, and eyelash loss. At this time, the patient was given a clinical diagnosis of alopecia totalis. Understanding that dupilumab has been previously used for treatment in adults of this specific autoimmune condition, we started this adolescent patient on dupilumab to concomitantly treat his atopic dermatitis and alopecia areata. The patient gradually experienced complete regrowth of his hair and almost complete resolution of his atopic dermatitis. Three years after starting dupilumab, the patient remains without signs of alopecia totalis. Conclusions: This case report demonstrates the long-term efficacy of dupilumab use in alopecia areata. More investigation is required to understand dupilumab’s broadening clinical indications. Additionally, this case highlights the complex relationship between dysregulation of the Th2 response and autoimmunity. Crosstalk between immune pathways within the disease spectrum of alopecia areata may explain why dupilumab has been reported to both treat and exacerbate alopecia areata.

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Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management

Cited by 179 publications

References 208 publications

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

Focus on the Contribution of Oxidative Stress in Skin Aging

Long-Term Efficacy of Dupilumab in Alopecia Areata

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