Alopecia areata: the need for guidelines and evidence-based dermatology

Abstract

In our study normally painful electrical stimuli elicited itch in a patient suffering from HES-induced pruritus. This reaction was most pronounced in those skin areas in which spontaneous itch was perceived. As the tested skin sites did not show the expected spreading erythema during neurogenic inflammation induced by depolarization of sensory nerve fibres, there is no evidence for a peripheral sensitization process. In addition, peripheral sensitization would be expected to enhance pain sensitivity and therefore pain ratings would increase, sensations that were clearly not enhanced in our patient. Thus, we conclude that the most probable explanation for the electrically and mechanically induced itch is sensitization of the spinal processing of itch. Ongoing activity of peripheral 'itch-neuron' itch receptors has been proposed to induce and maintain the state of hypersensitivity to pruritic stimuli in the spinal cord. 8 Our results cannot explain the mechanism by which the peripheral itch receptors are activated in the HES-treated patient. However, the identification of central sensitization as a component of this clinical itch condition might have therapeutic implications; in neuropathic pain conditions central sensitization has been successfully treated by gabapentin. 9 It will be of major interest to explore further the therapeutic implications of central sensitization for the treatment of pruritus induced by HES.

Lymphocytes, neuropeptides, and genes involved in alopecia areata

“…While mild disease, defined as limited circles of hair loss, shows a high rate of spontaneous hair regrowth and often responds to intralesional administration of corticosteroids, severe disease, such as AA totalis or universalis, shows an overall poor response to treatment. This problem is aggravated by the fact that generally accepted, strictly evidence-based medicine guidelines for AA management remain to be developed (8,15). Immunotherapy with allergic contact sensitizers can be effective (16,17).…”

Footprints of the EADV: a meeting report from the 17th Congress of the European Academy of Dermatology and Venereology

“…Dr R. Trueb shared his experience of treating erosive pustular dermatosis of the scalp with topical tacrolimus ointment. Dr R. Hoffmann gave a state of the art lecture on the complex pathogenesis and emerging treatments for alopecia areata (AA) 79,84,91–93 . Similar to other inflammatory diseases, the imbalance of suppressor immunocytes and/or T helper1/T helper 2 and possibly T helper 17 equilibrium may play an important role in this well‐known disorder 94–101 .…”

“…Dr R. Hoffmann gave a state of the art lecture on the complex pathogenesis and emerging treatments for alopecia areata (AA). 79,84,[91][92][93] Similar to other inflammatory diseases, the imbalance of suppressor immunocytes and ⁄or T helper1 ⁄T helper 2 and possibly T helper 17 equilibrium may play an important role in this well-known disorder. [94][95][96][97][98][99][100][101] On the other hand, anti-TNF-a or LFA-1 agents, known to be effective for the treatment of psoriasis, did not appear to be effective for the treatment of AA.…”

Efficacy and Adverse Effects of Corticosteroid Pulse Therapy in Alopecia Areata

“…The severity of AA ranges from small round hairless patches to the total loss of scalp or body hair (alopecia totalis/alopecia universalis), which can cause devastating psychosocial effects, such as major depression, anxiety, mood disorders, and social phobia [4][5][6].…”

“…Implementing and evaluating treatment protocols for AA is challenging due to the disease's uncertain pathogenesis and unpredictable remission rates [6]. The treatment should also cover the patient's psychological needs, making management more difficult.…”