Childhood Alopecia Areata: An Overview of Treatment and Recent Patents

2020 ◽  
Vol 14 ◽  
Author(s):  
Kam L. Hon ◽  
David C.K. Luk ◽  
Alexander K.C. Leung ◽  
Chantel Ng ◽  
Steven K.F. Loo
Keyword(s):  
Hair Loss ◽  
Alopecia Areata ◽  
Coal Tar ◽  
Psychological Impact ◽  
Hair Follicles ◽  
The Body ◽  
Whole Body ◽  
Treatment Modalities ◽  
Topical Treatments ◽  
Clinical Queries

Background: Alopecia Areata (AA) is a systemic autoimmune condition which usually starts in childhood. Objective: This article aims to review genetics, therapy, prognosis and recent patents for AA. Methods: We used clinical queries and keywords of “alopecia areata” AND “childhood” as search engine. Patents were searched using the key term “alopecia areata” in Patents.google.com and freepatentsonline.com. Results: Due to an immune mediated damage of the hair follicles, hair is lost from the scalp and other areas of the body temporarily or even permanently. Children with AA are generally healthy. Evidence of genetic association and increased predisposition for AA was found by studying families with affected members. Pathophysiologically, T- lymphocytes attack hair follicles and cause inflammation and destruction of the hair follicles and hair loss. In mild cases, there would be well demarcated round patchy scalp hair loss. The pathognomonic “exclamation mark hairs” may be seen at lesion periphery. In more severe cases, the hair loss may affect the whole scalp and even the whole body. The clinical course is also variable which may range from transient episodes of recurrent patchy hair loss to an indolent gradually deteriorating severe hair loss. The treatment of AA depends on factors including patients’ age, extent of the hair loss, duration of disease, psychological impact, availability and side effect profile of the treatments. For localized patchy alopecia, topical application of corticosteroids and/or intralesional corticosteroids are the treatment of choice. Other topical treatments include minoxidil, anthralin, coal tar and immunotherapy. In severe resistant cases, systemic immunosuppressants may be considered. Although herbal medicine, acupuncture, complementary and alternative medicine may be tried on children in some Asian communities, the evidence to support these practices are lacking. To date, only few recent patents exist in topical treatments including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities. Conclusions: None of the established therapeutic options are curative. However, newer treatment modalities including excimer laser, interleukin-31 antibodies and biologics are evolving so that there may be significant advances in treatment in the near future. AA can be psychosocially devastating. It is important to assess the quality of life, degree of anxiety, social phobia and mood of the patients and their families. Psychological support is imperative for those who are adversely affected psychosocially.

scholarly journals EP06 Successful treatment of alopecia universalis with rituximab therapy

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Anuoluwapo R Oke ◽  
Steven Young-Min
Keyword(s):  
B Cell ◽  
Mhc Class I ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Hair Follicles ◽  
Class I ◽  
Whole Body ◽  
Type I ◽  
Alopecia Universalis ◽  
First Report

Abstract Background Alopecia universalis (AU) is a severe subtype of alopecia areata (AA), in which there is non-scarring hair loss affecting the whole body. The pathogenesis involves, increased MHC class I expression in hair follicles, loss of hair follicle immune privilege and autoimmune-mediated damage to pigmented hair. There is no cure for alopecia areata, and though mild cases may have a good chance of either spontaneous or treatment-induced recovery, the prognosis of complete hair loss is poor with less than 10% recovery. Treatment remains a challenge with no reliably effective therapy and in the absence of well-evaluated trials, isolated case reports can influence practice. Here, we present the first report of AU being successfully treated with rituximab with remarkably sustained improvement at 6 years follow up. This case is also the first report of AU developing in adult dermatomyositis (DM) and we speculate upon the implications for the aetiopathogenesis of both conditions. Methods A 55-year-old lady, presented with proximal limb weakness, lethargy, a non-itchy rash, pleurisy and breathlessness. The serum creatinine kinase (3369 u/L) and anti-Jo-1 antibodies were elevated consistent with antisynthetase syndrome and a diagnosis of dermatomyositis was made. There was an initial response to corticosteroids and cyclophosphamide. She then relapsed and was treated with IV rituximab. Seventeen months after her initial presentation, she developed widespread hair loss sparing only white hairs (making Telogen Effluvium unlikely), combined with a concurrent relapse of her dermatomyositis. A diagnosis of alopecia universalis (AU) was made. A further course of IV rituximab therapy administered at this stage led to an excellent response in both her dermatomyositis and AU. At three months review, both the AU and the dermatomyositis had entered remission and this has been sustained 6 years on. Results Please refer to the conclusion section. Conclusion Disease activity in dermatomyositis has been linked with the expression of type I Interferon IFN and this may induce MHC class I expression that is identified on muscle biopsy. It may be that similar type I IFN action on hair follicles may have triggered the development of AU in our case. Whilst this is the first report of AU occurring with adult dermatomyositis, there has been a report of AU occurring in juvenile dermatomyositis. There are also other reports of other combinations of autoimmune conditions occurring with both DM & AU. This case also demonstrates that rituximab, an anti-CD 20 B cell therapy, maybe a useful treatment option in alopecia areata and universalis. This has not been reported elsewhere. Despite postulation that AU is a mainly T cell-driven disease, this case demonstrates that B cells may play a role, in much the same way that we now recognise the importance of B cell involvement in RA. Disclosures A.R. Oke None. S. Young-Min None.

scholarly journals PRP therapy in chronic diffuse alopecia areata – A case report

2021 ◽  
Vol 7 (4) ◽  
pp. 363-366
Author(s):  
Kashish Tyagi ◽  
Sheilly Kapoor ◽  
Ishani Mohapatra ◽  
Komal Sharma
Keyword(s):  
Case Report ◽  
Alopecia Areata ◽  
Hair Growth ◽  
Histopathological Examination ◽  
Hair Follicles ◽  
The Body ◽  
Treatment Modalities ◽  
Immune Disorder ◽  
Excellent Response

Alopecia areata, an auto-immune disorder characterised by the appearance of non-scarring bald patches affecting the hair bearing areas of the body, it can be extremely difficult to treat and has a poor prognosis despite many therapeutic options. Platelet Rich Plasma (PRP) has been previously used to treat variety of alopecia including alopecia areata. A 21-year old girl presented with asymptomatic loss of hair from the scalp for the last more than two years. On examination, there was diffuse loss of hair all over the scalp with few small, thin light-coloured hair in the occipital region. Histopathological examination showed miniaturised hair follicles surrounded by variable inflammatory lymphohistiocytic infiltrate with a marked reduction in terminal-vellus hair ratio to 1:1.The response to previous treatments was poor at the end of 1 year. A trial of PRP was given with no adjuvant treatment with a total of eight sessions of PRP. Dramatic response was noted after 2 sessions in the form of improvement in hair diameter and total volume. Resistant areas also started showing hair growth. There are a few studies assessing the role of PRP therapy in AA. First report to establish the efficacy of PRP as a treatment modality in AA, showed PRP therapy to be superior to TCA and Placebo in growing pigmented hair in AA patches. A case report with ophiasis type AA resistant to intralesional steroid injections showed excellent response to PRP therapy. Previous studies have demonstrated beneficial role of PRP therapy in cases of patchy alopecia areata, in contrast ours was a case of chronic diffuse AA. Inspite of many treatment modalities tried for more than a year, the response was unsatisfactory. PRP therapy yielded amazing results in the form of hair growth over resistant areas and overall increase in pigmented hair which were sustained at one and a half year follow up. Our case was unique in the way that excellent response to PRP treatment was noted (a) In a case of diffuse alopecia areata. (b) In a case non- responsive to standard modalities. (c) In a case with no other supportive treatment.

scholarly journals To Study Dermoscopic Findings in Alopecia Areata

2020 ◽  
pp. 29-35
Author(s):  
Kovi Sneha ◽  
Jayakar Thomas
Keyword(s):  
Clinical Diagnosis ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Liquid Paraffin ◽  
Skin Lesions ◽  
Acute Stage ◽  
Hair Follicles ◽  
The Body ◽  
Cross Sectional ◽  
Exclamation Mark

Introduction: Alopecia areata is a common chronic autoimmune inflammatory disease that involves hair follicles, characterized by hair loss on the scalp and/or body without scarring. Clinically, the disease presents as smooth, patchy hair loss with various patterns - diffuse or reticulate alopecia, ophiasis, ophiasis inversus, alopecia totalis (loss of hair all the scalp), or alopecia universalis (loss of hair all over the body). Clinical diagnosis of AA is made based on typical pattern of hair loss and the presence of characteristic exclamation mark hair in microscopy. Invasive (punch biopsy) techniques are often required in some cases where the clinical diagnosis is not straight forward Biopsy shows peribulbar lymphocytic infiltrates in a “swarm of bee pattern” which is characteristic of the acute stage of the disease. Dermoscopy is an imaging instrument that immensely magnifies surface features of skin lesions. It works on the principle of illumination and transillumination of skin with different light sources and studying it with a high magnification lens. Dry dermoscopy was done with heine delta 20 dermoscope which was followed by wet dermoscopy. Liquid paraffin was used as the immersion media. It is a noninvasive, repeatable, recordable bedside investigation. Objective: To study dermoscopic findings in alopecia areata. Materials and Methods: Study Design: Cross sectional study; Study Area: Skin Outpatient Department, Sree Balaji Medical College and Hospital; Study Population: All patients with hair loss, attending skin OPD, who are clinically diagnosed as Alopecia Areata; Study Method: Observational study; Sample Size: 30. Results: Clinically, the disease presents as smooth, patchy hair loss with various patterns. Dermoscopy is useful for diagnosis of AA clinically by the presence of cadaverized hairs (black dots), circle hair, coudablity hair, exclamation mark hairs (tapering hairs), broken hairs, yellow dots and clustered short vellus hairs in the hair loss areas. The results wear tabulated.

Disorders of Hair

2013 ◽  
Author(s):  
James Q Del Rosso
Keyword(s):  
Hair Loss ◽  
Alopecia Areata ◽  
Hair Growth ◽  
Growth Cycle ◽  
Hair Follicles ◽  
Common Type ◽  
Diagnosis And Treatment ◽  
Basic Knowledge ◽  
Androgenetic Alopecia ◽  
Broad Overview

A basic knowledge of the hair growth cycle is needed to evaluate disorders of hair growth. This chapter presents a broad overview of the physiology and evaluation of hair growth, as well as discussions of specific types of alopecia. The epidemiology, pathogenesis, diagnosis, and treatment of androgenetic alopecia, the most common type of nonscarring hair loss, are covered. Diffuse hair shedding is generalized hair loss over the entire scalp. Diagnosis and treatment of telogen effluvium, anagen arrest (anagen effluvium), and other causes of diffuse hair shedding are covered in detail. Alopecia areata, typically characterized by patchy hair loss; cicatricial alopecia, which results from permanent scarring of the hair follicles; and miscellaneous causes of hair loss are also discussed. Tables list the causes of diffuse and cicatricial alopecia, telogen effluvium, and miscellaneous chemicals and categories of drugs that can cause alopecia, as well as miscellaneous causes of hair loss. Included is an algorithm outlining the approach to diagnosing nonscarring alopecia, as well as a variety of clinical photographs. This review contains 9 highly rendered figures, 6 tables, and 42 references.

scholarly journals Comparative Study on the Efficacy of Diphenylcyclopropenone Alone and in Combination with Intralesional or Systemic Corticosteroids for the Treatment of Extensive or Refractory Alopecia Areata

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A I E Rasheed ◽  
M Y Soltan ◽  
N N Mohammed
Keyword(s):  
Hair Loss ◽  
Alopecia Areata ◽  
Combined Therapy ◽  
Age At Onset ◽  
Previous History ◽  
Autoimmune Disorder ◽  
University Hospital ◽  
Treatment Modalities ◽  
Clinical Feature ◽  
Significant Difference

Abstract Background Alopecia areata (AA) is an autoimmune disorder characterized by transient, non-scarring hair loss with preservation of the hair follicle. It affects nearly 2% of the general population at some point during their lifetime. Extent of the disease can vary widely from localized hair loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Objectives The aim of this study is to evaluate the efficacy and safety of topical diphenylcyclopropenone alone and in combination with intralesional steroids or systemic steroids for the treatment of extensive and/or refractory cases of alopecia areata. Patients and Methods The study included 21 patients suffering from alopecia areata during January 2018 till November 2018. They were recruited from the Outpatient Clinic of Dermatology, Ain Shams University Hospital and El-houd EL-marsoud Hospital. All patients gave written consent to participate in this work after explanation of the technique, expectations, possible side effects and alternative treatments. The study was approved by Research Ethical committee of Ain Shams University. Results We found that about three quarters of AA patients were males and majority were young adults aged 15 to 50 years. The duration of the disease was more than one year and mean age of first onset was 15 years. About half of the patients was of refractory type. All patients recalled previous history of AA and 90% treated by combined therapy. Scalp was affected in all patients and eyebrow in half of them while nails were affected in 10%. Mean SALT score at time of presentation was 59%. Dermoscopic examination revealed that majority of the patients (95%) had yellow dots; two third had black dots and vellous hair; while exclamation and short thin hairs were found in approximately one third of the patients. The study found that there is statistically significant difference between mean SALT scores among the three treatment modality groups at start of treatment course specifically between group II (40.6 (±20.9)) and group III (82.5 (±21.7)) (p = 0.04). Conclusion DPCP is an effective and safe treatment of extensive and refractory AA especially with intralesional steroid. Older age at onset of the disease is good indicator for a better prognosis. No statistical significant difference between treatment modalities regarding response stratified by other demographic and clinical feature of AA patients.

scholarly journals Hair Follicles from Alopecia Areata Patients Exhibit Alterations in Immune Privilege-Associated Gene Expression in Advance of Hair Loss

2010 ◽  
Vol 130 (11) ◽  
pp. 2677-2680 ◽  
Author(s):  
Hoon Kang ◽  
Wen-Yu Wu ◽  
Blanche K.K. Lo ◽  
Mei Yu ◽  
Gigi Leung ◽  
...  
Keyword(s):  
Gene Expression ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Hair Follicles ◽  
Immune Privilege

scholarly journals Role of Non Androgenic Factors in Hair loss and Hair Regrowth

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Hair Loss ◽  
Hair Growth ◽  
Nutritive Value ◽  
Transforming Growth Factor ◽  
Hair Follicles ◽  
The Body ◽  
Immune Recognition ◽  
Micronutrient Deficiencies ◽  
Poor Growth

Multiple nutritional, environmental and lifestyle factors can directly affect hair follicles, to weaken and make them sensitive to the action of androgens. Hair loss can be corrected and hair growth can be improved by addressing these non-androgenic factors. Patients having hair fall, thinning, loss of volume and poor growth can be precursors to androgenetic alopecia. Recent research has shown that androgens inhibit hair growth through release of Transforming Growth Factor (TGF) ß1. Further study of this mechanism reveals that generation of Reactive Oxygen Species (ROS) induced by androgens leads to release of TGF ß1 and use of ROS scavengers can block the release of TGF ß1, explaining beneficial role of antioxidants in hair growth. The binding of ROS to intracellular proteins also causes hair loss by altering the protein structure, changing their immune recognition and converting them to new antigens targeted by inflammatory and immune systems. Calorie restriction and individual micronutrient deficiencies lead to a new process of intracellular destruction or autophagy before cell apoptosis, which could explain cessation of hair growth. Telogen is not a resting phase but now defined as active conservation of follicles under unfavourable conditions. Thus any stress, trauma, metabolic change or insult causes telogen. Micronutrients zinc, copper, selenium maintains immunity, control inflammation and preserve antioxidant activity of the cells. Vitamins A, C, D have a role in phagocytosis and antibodies maintaining resistance. Vitamin D3 modulates the hair-inductive capacity of dermal papilla cells. Vitamin and micronutrient deficiencies are prevalent among all the population of the world. Nutritive value of the foods has reduced over the years by 30%. Endocrine Disrupting chemicals are creating further damage to the hormonal balance of the body. All these can be countered by use of antioxidants and a well-planned nutritional program which will ensure strengthening and regrowth of hair follicles, without the use of Finasteride.

scholarly journals The development of universal alopecia during therapy with TNF-α inhibitors in patients with ankylosing spondylitis: description of three cases

2021 ◽  
Vol 59 (5) ◽  
pp. 631-637
Author(s):  
M. V. Kireeva ◽  
E. M. Agafonova ◽  
A. E. Dimitreva ◽  
K. V. Sakharova ◽  
S. O. Krasnenko ◽  
...  
Keyword(s):  
Hair Loss ◽  
Hair Follicles ◽  
The Body ◽  
Tumor Necrosis Factors ◽  
Functional Changes ◽  
Chemotherapy Drugs ◽  
Tnf Α ◽  
High Doses ◽  
Pro Inflammatory Cytokines

Alopecia areata (АA) is an autoimmune multifactorial disease characterized by increased hair loss as a result of morphological and functional changes in hair follicles. АA is divided into four main forms, among which the most severe is the universal form (UA), in which complete hair loss is possible throughout the body. Alopecia in the practice of a rheumatologist can occur with some systemic diseases of the connective tissue, with the use of high doses of chemotherapy drugs and, more recently, with the use of inhibitors of tumor necrosis factors alpha (TNF-α). The article presents 3 clinical cases of the development of UA during therapy with TNF-α. Possible mechanisms are discussed, as well as the role of pro-inflammatory cytokines in the development of this condition.

scholarly journals Trichoscopy of Alopecia Areata: Hair Loss Feature Extraction and Computation Using Grid Line Selection and Eigenvalue

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Sunyong Seo ◽  
Jinho Park
Keyword(s):  
Hair Loss ◽  
Alopecia Areata ◽  
Eating Habits ◽  
Hair Follicles ◽  
Smart Device ◽  
Light Reflection ◽  
Grid Line ◽  
Feature Based ◽  
Line Selection ◽  
Vellus Hairs

Recently, the hair loss population, alopecia areata patients, is increasing due to various unconfirmed reasons such as environmental pollution and irregular eating habits. In this paper, we introduce an algorithm for preventing hair loss and scalp self-diagnosis by extracting HLF (hair loss feature) based on the scalp image using a microscope that can be mounted on a smart device. We extract the HLF by combining a scalp image taken from the microscope using grid line selection and eigenvalue. First, we preprocess the photographed scalp images using image processing to adjust the contrast of microscopy input and minimize the light reflection. Second, HLF is extracted through each distinct algorithm to determine the progress degree of hair loss based on the preprocessed scalp image. We define HLF as the number of hair, hair follicles, and thickness of hair that integrate broken hairs, short vellus hairs, and tapering hairs.

scholarly journals Effective management of indralupta (alopecia areata) with jalaukavacharan - a case report

2018 ◽  
Vol 6 (5th) ◽  
Author(s):  
Likhita Sureshrao Dhage ◽  
Pournima Daware
Keyword(s):  
Case Report ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Hair Follicles ◽  
Effective Management

 Panchkarma is said to be best treatment for disease curing by its root. According to Acharyas it is said that untreatable diseases can be treated with Raktamokshan . Raktamokshan is fifth karma among Panchkarma. Indralupta came under kshudra rogas.  Indralupta (alopecia areata) is the disease where hair loss in patient in the form of patches  over scalp is seen. Considering etiopathogenesis of Indralupta Vyadhi, Raktamokshan is said to be best treatment. In this case report, patient with Indralupta over scalp is treated with Jalaukavacharan. It not only work on localized hair loss but also promote hair follicles to grow new hairs.

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