Reversible alopecia universalis secondary to PEG-interferon ??-2b and ribavirin combination therapy in a patient with chronic hepatitis C virus infection

Kartal, Elif Doyuk; Alpat, Saygın Nayman; Özgüneş, İlhan; Usluer, Gaye

doi:10.1097/meg.0b013e32818b27e5

Cited by 40 publications

(36 citation statements)

References 21 publications

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“…28 Several case reports have described severe AA/AU as a side effect of interferon-a therapy for various diseases. [56][57][58] Furthermore, IFN-a has been shown to promote NK-cell cytotoxicity and promote autoimmune disease, 59 thus it is plausible that IFN-a may function as a systemic amplifier in terms of disease extent and severity of AA. We also report that expression of FK506-binding proteins (FKBP), such as FKBP4 and FKBP15, are downregulated in AU compared with AAP.…”

Section: Discussionmentioning

confidence: 99%

Peripheral blood gene expression in alopecia areata reveals molecular pathways distinguishing heritability, disease and severity

Coda¹,

Hysa²,

Seiffert-Sinha³

et al. 2010

Genes Immun

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Alopecia areata (AA) is an autoimmune hair loss disorder in which systemic disturbances have been described, but are poorly understood. To evaluate disease mechanisms, we examined gene expression in the blood of defined clinical subgroups (patchy AA persistent type, AAP, n ¼ 5; alopecia universalis, AU, n ¼ 4) and healthy controls (unaffected relatives, UaR, n ¼ 5; unaffected non-relatives, UaNR, n ¼ 4) using microarrays. Unsupervised hierarchical clustering separates all four patient and control groups, producing three distinct expression patterns reflective of 'inheritance', 'disease' and 'severity' signatures. Functional classification of differentially expressed genes (DEGs) comparing disease (AAP, AU) vs normal (UaR) groups reveals upregulation in immune response, cytokine signaling, signal transduction, cell cycle, proteolysis and cell adhesionrelated genes. Pathway analysis further reveals the activation of several genes related to natural killer-cell cytotoxicity, apoptosis, mitogen activated protein kinase, Wnt signaling and B-and T-cell receptor signaling in AA patients. Finally, 35 genes differentially expressed in AA blood overlap with DEGs previously identified in AA skin lesions. Our results implicate innate and adaptive immune processes while also revealing novel pathways, such as Wnt signaling and apoptosis, relevant to AA pathogenesis. Our data suggest that peripheral blood expression profiles of AA patients likely carry new biomarkers associated with disease susceptibility and expression.

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Section: Discussionmentioning

confidence: 99%

Peripheral blood gene expression in alopecia areata reveals molecular pathways distinguishing heritability, disease and severity

Coda¹,

Hysa²,

Seiffert-Sinha³

et al. 2010

Genes Immun

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“…16 Patients receiving interferon alfa treatment have been reported to develop AA, suggesting a possible role of IFN in promoting inflammation in AA. 17 It is possible that in predisposed individuals TNF inhibitors induce aberrant IFN production at the tissue level, leading to the loss of immune privilege that is essential in the development of AA. 16 Genetics has an important role in the pathogenesis of AA, which may account for the variability in response to TNF inhibitors.…”

Section: Figure 3 Alopecia Universalis Treated With Adalimumabmentioning

confidence: 99%

Alopecia Universalis Successfully Treated With Adalimumab

2014

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IMPORTANCE Alopecia universalis is an uncommon form of alopecia areata (AA) involving hair loss over the entire scalp and body and is often difficult to treat. Tumor necrosis factor (TNF)inhibitors have been largely unsuccessful in treating AA and have been reported to induce or worsen AA in patients.We report herein a case of alopecia universalis successfully treated with adalimumab and discuss the possible mechanism.OBSERVATIONS A woman in her 30s with alopecia universalis, refractory to multiple treatment modalities, was successfully treated with adalimumab.CONCLUSIONS AND RELEVANCE Tumor necrosis factor has multiple important roles in the pathogenesis of AA, and its interplay with other cytokines, specifically interferons, may be responsible for the development of AA in patients treated with TNF inhibitors.Pharmacogenetics and the inherent physiologic levels of TNF may explain why TNF inhibitors cause AA in some individuals, while treating AA in others. These conclusions warrant further investigation on this subject.

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“…[79][80][81][82] Alopecia has been reported in 19% of patients treated with combination interferon and ribavirin, 83 including alopecia areata 84,85 and alopecia universalis. [86][87][88] Vitiligo has been reported in a number of patients who were treated for Hepatitis C with interferron. 89 Cases of cutaneous necrosis, 90,91 fixeddrug eruption, 92,93 lichenoid eruptions [94][95][96][97][98] (Fig.…”

Section: Interferonmentioning

confidence: 99%

Cutaneous Reactions to Novel Therapeutics

Hoang

Kroshinsky²

2012

The American Journal of Dermatopathology

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In the last 2 decades the introduction new biologic agents such as tumor necrosis factor alpha inhibitors has resulted in potent disease modifying effects in a variety of immune-mediated diseases. In addition, there were major advancements in cancer treatment due to chemotherapeutic agents including granulocyte macrophage-colony-stimulating factor, interferon, epidermal growth factor receptor inhibitors, and kinase inhibitors for the treatment of hematologic malignancies as well as solid tumors. However, a variety of toxicities including cutaneous reactions is seen in association with these agents. Awareness of commonly associated skin toxicities and recognition of corresponding histologic features is of importance.

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Reversible alopecia universalis secondary to PEG-interferon ??-2b and ribavirin combination therapy in a patient with chronic hepatitis C virus infection

Cited by 40 publications

References 21 publications

Peripheral blood gene expression in alopecia areata reveals molecular pathways distinguishing heritability, disease and severity

Peripheral blood gene expression in alopecia areata reveals molecular pathways distinguishing heritability, disease and severity

Alopecia Universalis Successfully Treated With Adalimumab

Cutaneous Reactions to Novel Therapeutics

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