Treatment of alopecia areata: An Australian expert consensus statement

Cranwell, William; Lai, Vivien Wy; Photiou, Louise; Meah, Nekma; Wall, Dmitri; Rathnayake, Deepani; Joseph, Shobha; Chitreddy, Vijaya; Gunatheesan, Shyamalar; Sindhu, Kamaldeep; Sharma, Pooja; Green, Jack; Eisman, Samantha; Yip, Leona; Jones, Leslie; Sinclair, Rodney

doi:10.1111/ajd.12941

Cited by 122 publications

(207 citation statements)

References 43 publications

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“…They were, however, unclear on the mode of action, attributing the effect to “a change in local chemical milieu through some such manner as influencing sebaceous gland function or keratinization.” Later, it was recognized that corticosteroids act on inflammatory cells . While there have been attempts to develop other immuno‐suppressive agents for AA (eg), corticosteroids remain the first treatment approach in most clinics worldwide. New immuno‐regulatory treatments, such as JAK inhibitors, are on the horizon; time will tell if they become a mainstream therapeutic approach …”

Section: Treatments For Alopecia Areatamentioning

confidence: 99%

A “hair‐raising” history of alopecia areata

Broadley

McElwee

2020

Experimental Dermatology

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A 3500‐year‐old papyrus from ancient Egypt provides a list of treatments for many diseases including “bite hair loss,” most likely alopecia areata (AA). The treatment of AA remained largely unchanged for over 1500 years. In 30 CE, Celsus described AA presenting as scalp alopecia in spots or the “windings of a snake” and suggested treatment with caustic compounds and scarification. The first “modern” description of AA came in 1813, though treatment still largely employed caustic agents. From the mid‐19th century onwards, various hypotheses of AA development were put forward including infectious microbes (1843), nerve defects (1858), physical trauma and psychological stress (1881), focal inflammation (1891), diseased teeth (1902), toxins (1912) and endocrine disorders (1913). The 1950s brought new treatment developments with the first use of corticosteroid compounds (1952), and the first suggestion that AA was an autoimmune disease (1958). Research progressively shifted towards identifying hair follicle‐specific autoantibodies (1995). The potential role of lymphocytes in AA was made implicit with immunohistological studies (1980s). However, studies confirming their functional role were not published until the development of rodent models (1990s). Genetic studies, particularly genome‐wide association studies, have now come to the forefront and open up a new era of AA investigation (2000s). Today, AA research is actively focused on genetics, the microbiome, dietary modulators, the role of atopy, immune cell types in AA pathogenesis, primary antigenic targets, mechanisms by which immune cells influence hair growth, and of course the development of new treatments based on these discoveries.

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Section: Treatments For Alopecia Areatamentioning

confidence: 99%

A “hair‐raising” history of alopecia areata

Broadley

McElwee

2020

Experimental Dermatology

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“…Alopecia areata (AA) is a common autoimmune disease with an estimated lifetime risk of 2.0% . Most patients experience acute AA with 1–5 circular patches of alopecia that develop in close succession and spontaneously regrow within 6‐12 months . When AA persists beyond 12 months, it is defined as chronic .…”

Section: Summary Of Individual Demographics and Treatment Record Of Pmentioning

confidence: 99%

“…Most patients experience acute AA with 1–5 circular patches of alopecia that develop in close succession and spontaneously regrow within 6‐12 months . When AA persists beyond 12 months, it is defined as chronic . Approximately 30% of patients develop chronic AA with the serial development of multiple patches of alopecia over many years …”

Section: Summary Of Individual Demographics and Treatment Record Of Pmentioning

confidence: 99%

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Treatment of chronic alopecia areata with tildrakizumab: an open‐label pilot study

Kerkemeyer

Sinclair

2020

Int J Dermatology

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“…A total of 272 070 patients with internal malignancies were identified; 401 patients with cutaneous metastasis were included. Previous studies have shown the rate of cutaneous metastasis from internal malignancies to be approximately 0.6-10.4% [1][2][3][4] (Table 1). However, in the current study, only 0.15% of patients developed skin metastases, which may reflect that regular health checks are common in Korea and that only patients who underwent skin biopsy were included.…”

Section: Conflicts Of Interests: Nonementioning

confidence: 99%

Immunotherapy for resistant and/or severe alopecia areata in a university hospital setting in Northern Mexico

et al. 2019

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Immunotherapy for resistant and/or severe alopecia areata in a university hospital setting in Northern MexicoAlopecia areata causes non-scarring alopecia usually involving the scalp; however, it can affect any part of the body. It can start at any age, with no gender predominance. [1][2][3] Its aetiology is autoimmune, mediated by TCD8+ lymphocytes. Severe forms are usually chronic and recurrent. [1][2][3][4] Multiple treatments have been described including topical and intralesional steroids, 3,5-7 topical immunotherapy 3,5,8 and inhibitors of the JAK pathway (tofacitinib), 6,7 all with variable results. 3,[5][6][7] For extensive or resistant cases, immunotherapy with squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) remains a first-line alternative; however, reports on the use of this therapeutic option are scarce in Latin America. Its mechanism of action is unknown, although it is believed to induce antigenic competition by attracting cd4+T cells to the peribulbar region, changing the cd4+/cd8+T lymphocyte ratio. 5,7 Response rates to immunotherapy are varied within the literature, ranging from 4 to 87%. 5 A recent meta-analysis of 2227 patients reported a general growth of any amount of hair in 65.5% patients and complete regrowth in 32.3% with a relapse rate of 38.3% among patients with maintenance therapy and 49% in those without it. 8

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Treatment of alopecia areata: An Australian expert consensus statement

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 122 publications

References 43 publications

A “hair‐raising” history of alopecia areata

A “hair‐raising” history of alopecia areata

Treatment of chronic alopecia areata with tildrakizumab: an open‐label pilot study

Immunotherapy for resistant and/or severe alopecia areata in a university hospital setting in Northern Mexico

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