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Verma S, Sinclair R, Das A. Identical Alopecia Areata in Identical Twin Sisters. Int J Trichology 2021; 12:247-248. [PMID: 33531751 PMCID: PMC7832170 DOI: 10.4103/ijt.ijt_120_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shyam Verma
- Nirvan Skin Clinic, Vadodara, Gujarat, India
| | - Rodney Sinclair
- Department of Dermatology, University of Melbourne, Melbourne, Australia
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Hon KL, Luk DCK, Leung AKC, Ng C, Loo SKF. Childhood Alopecia Areata: An Overview of Treatment and Recent Patents. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2020; 14:117-132. [PMID: 32723274 DOI: 10.2174/1872213x14999200728145822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/14/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alopecia Areata (AA) is a systemic autoimmune condition that 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 "alopecia areata" AND "childhood" as a 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 to 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 the 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, the 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 is lacking. To date, only a few recent patents exist in topical treatments, including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities. CONCLUSION 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.
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Affiliation(s)
- Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - David C K Luk
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantel Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Steven K F Loo
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun 2018; 98:74-85. [PMID: 30558963 DOI: 10.1016/j.jaut.2018.12.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
Alopecia areata is an autoimmune disease that results in non-scarring hair loss, and it is clinically characterised by small patches of baldness on the scalp and/or around the body. It can later progress to total loss of scalp hair (Alopecia totalis) and/or total loss of all body hair (Alopecia universalis). The rapid rate of hair loss and disfiguration caused by the condition causes anxiety on patients and increases the risks of developing psychological and psychiatric complications. Hair loss in alopecia areata is caused by lymphocytic infiltrations around the hair follicles and IFN-γ. IgG antibodies against the hair follicle cells are also found in alopecia areata sufferers. In addition, the disease coexists with other autoimmune disorders and can come secondary to infections or inflammation. However, despite the growing knowledge about alopecia areata, the aetiology and pathophysiology of disease are not well defined. In this review we discuss various genetic and environmental factors that cause autoimmunity and describe the immune mechanisms that lead to hair loss in alopecia areata patients.
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Affiliation(s)
- Teontor Simakou
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK
| | - John P Butcher
- Department of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Stuart Reid
- SUPA, Department of Biomedical Engineering, University of Strathclyde, UK
| | - Fiona L Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, 1 High Street, Paisley, PA1 2BE, UK.
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4
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The autoimmune basis of alopecia areata: A comprehensive review. Autoimmun Rev 2015; 14:81-9. [DOI: 10.1016/j.autrev.2014.10.014] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 02/07/2023]
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Lai CH, Chu NF, Chang CW, Wang SL, Yang HC, Chu CM, Chang CT, Lin MH, Chien WC, Su SL, Chou YC, Chen KH, Wang WM, Liou SH. Androgenic alopecia is associated with less dietary soy, lower [corrected] blood vanadium and rs1160312 1 polymorphism in Taiwanese communities. PLoS One 2013; 8:e79789. [PMID: 24386074 PMCID: PMC3875420 DOI: 10.1371/journal.pone.0079789] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/25/2013] [Indexed: 12/23/2022] Open
Abstract
Background Although the genetic basis of androgenic alopecia has been clearly established, little is known about its non-genetic causes, such as environmental and lifestyle factors. Objective This study investigated blood and urine heavy metals concentrations, environmental exposure factors, personal behaviors, dietary intakes and the genotypes of related susceptibility genes in patients with androgenic alopecia (AGA). Design Age, AGA level, residence area, work hours, sleep patterns, cigarette usage, alcohol consumption, betel nut usage, hair treatments, eating habits, body heavy metals concentrations and rs1998076, rs913063, rs1160312 and rs201571 SNP genotype data were collected from 354 men. Logistic regression analysis was performed to examine whether any of the factors displayed odds ratios (ORs) indicating association with moderate to severe AGA (≧IV). Subsequently, Hosmer-Lemeshow, Nagelkerke R2 and accuracy tests were conducted to help establish an optimal model. Results Moderate to severe AGA was associated with the AA genotype of rs1160312 (22.50, 95% CI 3.99–126.83), blood vanadium concentration (0.02, 95% CI 0.01–0.04), and regular consumption of soy bean drinks (0.23, 95% CI 0.06–0.85), after adjustment for age. The results were corroborated by the Hosmer-Lemeshow test (P = 0.73), Nagelkerke R2 (0.59), accuracy test (0.816) and area under the curve (AUC; 0.90, 0.847–0.951) analysis. Conclusions Blood vanadium and frequent soy bean drink consumption may provide protect effects against AGA. Accordingly, blood vanadium concentrations, the AA genotype of rs1160312 and frequent consumption of soy bean drinks are associated with AGA.
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Affiliation(s)
- Ching-Huang Lai
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Nain-Feng Chu
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taitung Hospital, Department of Health, Executive Yuan, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Shu-Li Wang
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, MiaoLi, Taiwan
| | - Hsin-Chou Yang
- Institute of Statistical Science Academia Sinica, Taipei, Taiwan
| | - Chi-Ming Chu
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| | - Chu-Ting Chang
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Huang Lin
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Sui-Lung Su
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, Taipei, Taiwan
| | - Saou-Hsing Liou
- Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, MiaoLi, Taiwan
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Jabbari A, Petukhova L, Cabral RM, Clynes R, Christiano AM. Genetic basis of alopecia areata: a roadmap for translational research. Dermatol Clin 2012; 31:109-17. [PMID: 23159180 DOI: 10.1016/j.det.2012.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alopecia areata (AA) is a recurrent autoimmune type of hair loss that affects about 5.3 million people in the United States alone. Despite being the most prevalent autoimmune disease, the molecular and cellular mechanisms underlying this complex disease are still poorly understood, and rational treatments are lacking. Further efforts are necessary to clearly pinpoint the causes and molecular pathways leading to this disease and to find evidence-based treatments for AA. The authors focus on the central role of genetics for gaining insight into disease pathogenesis and setting the stage for the rational development of novel effective therapeutic approaches.
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Affiliation(s)
- Ali Jabbari
- Department of Dermatology, Russ Berrie Medical Science Pavilion, Columbia University, 1150 Saint Nicholas Avenue, New York, NY 10032, USA
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Coda AB, Sinha AA. Integration of genome-wide transcriptional and genetic profiles provides insights into disease development and clinical heterogeneity in Alopecia areata. Genomics 2011; 98:431-9. [DOI: 10.1016/j.ygeno.2011.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 08/22/2011] [Accepted: 08/31/2011] [Indexed: 12/22/2022]
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Peripheral blood gene expression in alopecia areata reveals molecular pathways distinguishing heritability, disease and severity. Genes Immun 2010; 11:531-41. [PMID: 20535136 DOI: 10.1038/gene.2010.32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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=5; alopecia universalis, AU, n=4) and healthy controls (unaffected relatives, UaR, n=5; unaffected non-relatives, UaNR, n=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 adhesion-related 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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Abstract
T cells assume a fundamental function in immunosurveillance and maintenance of the cutaneous immune barrier, yet derangement of their requisite role effects a range of cutaneous autoimmune diseases with significant associated morbidity. While blistering skin diseases, such as pemphigus vulgaris (PV), pemphigus foliaceus (PF) and bullous pemphigoid (BP) are mediated by antibodies directed against autoantigens found in the skin, recent evidence has shown that T cell activation is crucial for the initiation and coordination of this humoral response. Non-blistering skin diseases, such as alopecia areata (AA), vitiligo (VL) and psoriasis (PS) are increasingly believed to be directly mediated by the activities of autoreactive T cells. Here, we examine T lymphocyte control of antibody-mediated and cell-mediated processes involved in the pathoimmunology of the above mentioned skin diseases.
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Affiliation(s)
- Selwyn Chow
- Department of Dermatology, Weill Medical College of Cornell University, New York, NY 10021, USA
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Blaumeiser B, van der Goot I, Fimmers R, Hanneken S, Ritzmann S, Seymons K, Betz RC, Ruzicka T, Wienker TF, De Weert J, Lambert J, Kruse R, Nöthen MM. Familial aggregation of alopecia areata. J Am Acad Dermatol 2006; 54:627-32. [PMID: 16546583 DOI: 10.1016/j.jaad.2005.12.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 11/21/2005] [Accepted: 12/02/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Familial aggregation of alopecia areata (AA) has been previously described, but systematic studies with information obtained directly from family members have yet to be undertaken. OBJECTIVE We sought to study the pattern of familial aggregation of AA by assessing the affection status of patients' relatives. The study included 206 index patients with a total of 1029 first-degree and 2625 second-degree relatives. METHODS First-degree relatives were directly interviewed, whereas information on second-degree relatives was obtained by interviewing the index patients and their first-degree relatives. RESULTS Estimated lifetime risks were 7.1% in siblings, 7.8% in parents, and 5.7% in offspring. The risk in second-degree relatives was slightly higher than the reported population risk. Age at onset in index patients and first-degree relatives was significantly correlated. LIMITATIONS Using patients drawn from specialized hair clinics may have produced results showing a higher proportion of early onset and severe cases. CONCLUSION The familial aggregation of AA supports the role of genetic factors in the development of the disease. In addition, our data indicate genetic factors might contribute to the age at onset of AA.
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Affiliation(s)
- Bettina Blaumeiser
- Department of Medical Genetics, University Hospital of Antwerp, Antwerp, Belgium.
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Abstract
Trata-se de artigo de revisão em que são analisados os aspectos clínicos, histopatológicos, etiopatogênicos e a terapêutica atual da alopecia areata. Enfatiza-se a posição nosológica atual da alopecia areata como doença auto-imune que se desenvolve em substrato genético e discutem-se os possíveis mecanismos fisiopatológicos da enfermidade, bem como os tratamentos atuais, particularmente para as formas mais graves da doença, compreendendo terapêuticas imunomoduladoras tópicas com dibutilester do ácido esquárico e difenciprona e seus possíveis mecanismos de ação.
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12
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Tsankov N, Angelova I. Rifampin in dermatology. Dis Mon 2004; 50:369-80. [PMID: 15280868 DOI: 10.1016/j.disamonth.2004.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McElwee KJ, Niiyama S, Freyschmidt-Paul P, Wenzel E, Kissling S, Sundberg JP, Hoffmann R. Dietary soy oil content and soy-derived phytoestrogen genistein increase resistance to alopecia areata onset in C3H/HeJ mice. Exp Dermatol 2003; 12:30-6. [PMID: 12631244 DOI: 10.1034/j.1600-0625.2003.120104.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Alopecia areata (AA) is a complex, multi-factorial disease where genes and the environment may affect susceptibility and severity. Diet is an environmental factor with the potential to influence disease susceptibility. We considered dietary soy (soya) oil content and the soy-derived phytoestrogen genistein as potential modifying agents for C3H/HeJ mouse AA. Normal haired C3H/HeJ mice were grafted with skin from spontaneous AA affected mice, a method previously shown to induce AA. Grafted mice were given one of three diets containing 1%, 5% or 20% soy oil and observed for AA development. In a separate study, mice on a 1% soy oil diet were injected with 1 mg of genistein three times per week for 10 weeks or received the vehicle as a control. Of mice on 1%, 5%, and 20% soy oil diets, 43 of 50 mice (86%), 11 of 28 mice (39%), and 2 of 11 mice (18%) developed AA, respectively. Four of 10 mice injected with genistein and 9 of 10 controls developed AA. Mice with AA had hair follicle inflammation consistent with observations for spontaneous mouse AA, but no significant association was observed between the extent of hair loss and diet or genistein injection. Mice that failed to develop AA typically experience white hair regrowth from their skin grafts associated with a moderate macrophage and dendritic cell infiltration. Soy oil and derivatives have previously been reported to modify inflammatory conditions. Hypothetically, soy oil compounds may act on C3H/HeJ mice through modulating estrogen-dependent mechanisms and/or inflammatory activity to modify AA susceptibility.
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Affiliation(s)
- K J McElwee
- Department of Dermatology, Philipp University, Marburg, Germany.
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Maia CPA, Fernandes NC. Tratamento da alopecia areata com corticóide tópico: estudo prospectivo randomizado duplo cego em crianças. An Bras Dermatol 2003. [DOI: 10.1590/s0365-05962003000100006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Na alopecia areata há perda súbita e assintomática de pêlos em qualquer área pilosa do corpo. A etiologia é desconhecida, e os tratamentos propostos não costumam alterar o curso natural e imprevisível da doença. Atinge as crianças, menos responsivas às terapêuticas e mais susceptíveis às formas mais extensas. O estado atópico é considerado fator de pior prognóstico; é provável que a relação entre as duas doenças se deva às origens imunológicas, embora sejam desconhecidos seus pontos de intersecção. OBJETIVOS: Avaliar a eficácia do dipropionato de betametasona em creme a 0,05% na alopecia areata da criança e a influência da atopia na resposta terapêutica. MÉTODO: Estudo prospectivo controlado duplo cego em 35 crianças de até 12 anos portadoras de alopecia areata, atendidas no Ambulatório de Dermatologia do Instituto de Puericultura e Pediatria Martagão Gesteira - UFRJ e do Hospital Municipal Jesus, ambos no Rio de Janeiro, RJ, no período de 1996 a 1998. RESULTADOS: Das 35 crianças estudadas, 30 (85,7%) evoluíram com resposta positiva ao final de seis meses de acompanhamento. Os percentuais de resposta foram semelhantes nas terapias utilizadas - dipropionato de betametasona e placebo (p= 0,47). Dos 29 atópicos, 26 (89,6%) tiveram resposta positiva aos tratamentos. Não foi estabelecida correlação estatisticamente significativa entre a resposta terapêutica e a condição atópica (p= 0,19). CONCLUSÃO: Não houve diferença entre as respostas terapêuticas nos grupos estudados; a atopia não influenciou a resposta ao tratamento efetuado.
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Affiliation(s)
- Nikolai Tsankov
- Department of Dermatology and Venereology, Sofia University of Medicine, Bulgaria.
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Nanda A, Alsaleh QA, Al-Hasawi F, Al-Muzairai I. Thyroid function, autoantibodies, and HLA tissue typing in children with alopecia areata. Pediatr Dermatol 2002; 19:486-91. [PMID: 12437547 DOI: 10.1046/j.1525-1470.2002.00216.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A total of 80 Kuwaiti children with alopecia areata (AA), without clinical evidence of thyroid disease, were screened for the presence of thyroid abnormalities, and 50 unrelated children with AA were tissue typed for human leukocyte antigen (HLA) class I and class II antigens. Thyroid abnormalities were detected in 14 children (17.5%). Among these, 11 children (14%) had thyroid autoantibodies. These observations highlight the significance of screening for thyroid abnormalities in children with chronic, recurrent, and/or extensive disease. The Kuwaiti children with AA were observed to have a significant association with HLA B21 (OR 18.850, 95% CI 4.404-80.677), B40 (OR 6.767, 95% CI 1.818-25.181), and HLA B12 (OR 4.833, 95% CI 1.198-19.505) antigens. These findings differed from those reported elsewhere.
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Affiliation(s)
- Arti Nanda
- Asad Al-Hamad Dermatology Center, Al-Sabah Hospital, Salmiya, Kuwait.
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Tazi-Ahnini R, Cox A, McDonagh AJG, Nicklin MJH, di Giovine FS, Timms JM, Messenger AG, Dimitropoulou P, Duff GW, Cork MJ. Genetic analysis of the interleukin-1 receptor antagonist and its homologue IL-1L1 in alopecia areata: strong severity association and possible gene interaction. EUROPEAN JOURNAL OF IMMUNOGENETICS : OFFICIAL JOURNAL OF THE BRITISH SOCIETY FOR HISTOCOMPATIBILITY AND IMMUNOGENETICS 2002; 29:25-30. [PMID: 11841485 DOI: 10.1046/j.1365-2370.2002.00271.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Alopecia areata is an inflammatory hair loss disease with a major genetic component. The presence of focal inflammatory lesions with perifollicular T-cell infiltrates reflects the importance of local cytokine production in the pathogenesis. In addition to its fundamental pro-inflammatory role, the interleukin-1 (IL-1) system has major effects on hair growth regulation in vitro, with the inhibitory actions of IL-1alpha and IL-1beta being opposed by the receptor antagonist IL-1ra. The novel interleukin-1 like molecule 1 (IL-1L1) which has greatest gene sequence homology with IL1RN, the gene encoding IL-1ra, is another potential IL-1 antagonist. In view of previous studies suggesting a significant role for IL1RN polymorphisms in the pathogenesis of autoimmune/inflammatory disease, we have analysed polymorphisms of IL-1ra (IL1RN+2018) and its homologue IL-1L1 (IL1L1+4734) in a case-control association study on 165 patients and a large number of matched controls. Homozygosity for the rare allele of IL1RN (IL1RN*2) was significantly associated with alopecia areata [odds ratio (OR) = 1.89, 95% CI (1.09, 3.28); P = 0.02], confirming our previous findings of significant association with the IL1RN variable number tandem repeat (VNTR). The results also revealed a novel association involving a polymorphism of the interleukin-1 receptor antagonist homologue IL1L1 at position + 4734, IL1RN+2018, and alopecia areata. The effect of a genotype combining three copies of the rare alleles at the IL1RN and IL1L1 loci conferred a more than additive increase in the risk of disease compared to IL1RN+2018 or IL1L1+4734 alone [OR 3.37 (1.60, 7.06); P = 0.002], suggesting possible synergy between the IL1RN and IL1L1 genes. This effect was stronger in patients with severe disease (alopecia totalis/universalis) [OR 4.62 (1.87, 11.40), P = 0.0022], and in those with early age at onset (< 20 years) [OR = 6.38 (2.64, 15.42), P = 0.0002]. Our results suggest that these polymorphisms within IL1RN and IL1L1 themselves or a gene in linkage disequilibrium with IL1RN and IL1L1 predispose to the more severe forms of alopecia areata.
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Affiliation(s)
- R Tazi-Ahnini
- Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Tazi-Ahnini R, McDonagh AJ, Cox A, Messenger AG, Britton JE, Ward SJ, Båvik CO, Duff GW, Cork MJ. Association analysis of IL1A and IL1B variants in alopecia areata. Heredity (Edinb) 2001; 87:215-9. [PMID: 11703512 DOI: 10.1046/j.1365-2540.2001.00916.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Alopecia areata is an inflammatory hair loss disease with a major genetic component. The disease is characterized by focal inflammatory lesions with perifollicular T-cell infiltrates, reflecting the role of local cytokine production in the development of patchy hair loss. IL-1 alpha and IL-1 beta are important inhibitors of hair growth in vitro. Their effect is opposed by the interleukin-1 receptor antagonist, IL-1ra. Genes of the IL-1 cluster are candidate genes in the pathogenesis of alopecia areata. To investigate the role of the IL-1 system in alopecia areata we examined three biallelic polymorphisms within the IL-1 gene cluster (IL1A+4845, IL1B+3954 and IL1B-511) in 165 patients and a large number of matched controls (n=1150). There was no significant association of IL1B-511 or IL1B+3954 genotypes with the overall dataset, or with disease severity or age at onset, in contrast with a previous report. The results suggested the possibility of an association with IL1A+4845 in the overall dataset [OR 1.39 (95% CI 1.00, 1.93)] although this was not statistically significant. This was due mainly to the contribution from mild cases of alopecia areata [OR 1.48 (0.96, 2.29)], suggesting that IL-1 alpha may have a particular role in the pathogenesis of this subgroup.
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Affiliation(s)
- R Tazi-Ahnini
- Biomedical Genetics Project, Division of Genomic Medicine and Department of Dermatology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Affiliation(s)
- A J McDonagh
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, England, U.K
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McMillen R, Duvic M. Alopecia areata occurring in sisters after administration of rifampicin. J Am Acad Dermatol 2001; 44:142-3. [PMID: 11148494 DOI: 10.1067/mjd.2001.109852] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Abstract
Alopecia areata is a common disorder with a genetic predisposition where interaction with environmental factors leads to episodes of terminal hair loss. In this review article, we examine the evidence for a genetic basis to this disorder and discuss the prospects for future research into genetic susceptibility areas and the problems that are likely to be encountered in such research.
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Affiliation(s)
- J Green
- Department of Medicine (Dermatology), University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Affiliation(s)
- A S Al-Fouzan
- Asad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait
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Abstract
Alopecia areata (AA) is a nonscarring hair loss condition. Among the many factors under investigation in the pathogenesis of AA, the main areas of concentration have been genetic constitution as well as nonspecific immune and organ-specific autoimmune reactions. Treatment with intralesional corticosteroid injections for localized patchy AA and topical immunotherapy for extensive AA have proven successful in the majority of patients, although all treatments are palliative and do not change the prognosis of the disease.
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Affiliation(s)
- S Madani
- Division of Dermatology, University of British Columbia
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García-Hernández MJ, Ruiz-Doblado S, Rodriguez-Pichardo A, Camacho F. Alopecia areata, stress and psychiatric disorders: a review. J Dermatol 1999; 26:625-32. [PMID: 10554427 DOI: 10.1111/j.1346-8138.1999.tb02063.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.
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Affiliation(s)
- M J García-Hernández
- Department of Dermatology and Venereology, Virgen Macarena Hospital, School of Medicine, University of Seville, Spain
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Abstract
BACKGROUND Treatment of severe alopecia areata is difficult, and most efforts to successfully treat this condition have been disappointing. Systemic corticosteroids have been demonstrated as an effective treatment of severe alopecia areata. METHODS Eighteen patients with alopecia areata (extensive patchy and totalis universalis types) were treated with systemic corticosteroids. RESULTS Satisfactory hair regrowth was achieved in seven patients (38.9%). Hair fall subsequently occurred in all of these patients on discontinuation or tapering of corticosteroid therapy. CONCLUSIONS Systemic corticosteroid therapy does not prevent the spread or relapse of severe alopecia areata and, when complete regrowth is obtained, it is rarely maintained off therapy.
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Affiliation(s)
- A S Alabdulkareem
- Department of Dermatology, King Fahd Hospital of the University, Dammam, Saudi Arabia
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26
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McMichael AJ. The genetic epidemiology and autoimmune pathogenesis of alopecia areata. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1111/j.1468-3083.1997.tb00225.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Baykal C, Ozkaya-Bayazit E, Aksungur VL, Saylan T, Boyar FZ. Alopecia areata in twin sisters and their brother. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1111/j.1468-3083.1997.tb00500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cork MJ, Crane AM, Duff GW. Genetic control of cytokines. Cytokine gene polymorphisms in alopecia areata. Dermatol Clin 1996; 14:671-8. [PMID: 9238325 DOI: 10.1016/s0733-8635(05)70393-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is likely that alopecia areata is a multifactorial disease determined by a combination of genetic and environmental factors. The interaction of susceptibility genes with environmental factors gives rise to the disease phenotype, and then genetic modifying factors determine the extent of the inflammatory response and thereby the clinical outcome. Cytokines regulate the inflammatory response. Polymorphisms in these genes may therefore determine the amount of a cytokine that is produced in response to an environmental trigger such as a bacterial or viral infection.
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Affiliation(s)
- M J Cork
- Section of Dermatology, University of Sheffield, United Kingdom
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29
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Abstract
Knowledge of the disease mechanisms in alopecia areata is discussed in the light of progress in hair biology, immunology, and genetics. A disease model is presented incorporating polygenic determination of disease severity and susceptibility with largely unknown trigger factors responsible for initiating clinical disease expression. Experimental systems including animal models for alopecia areata offer new opportunities for investigation of alopecia areata and developing novel therapies.
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Affiliation(s)
- A J McDonagh
- Department of Dermatology, Royal Hallamshire Hospital, United Kingdom
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Affiliation(s)
- A S Alabdulkareem
- Department of Dermatology, King Fahd Hospital of the University, Dammam, Saudi Arabia
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Abstract
Aproximately 1% of the population will have had alopecia areata by the age of 50 and the peak incidence occurs in children and young adults. All body hair may be affected including lashes and brows. Alopecia areata is a systemic disease with frequent involvement of nails or eyes. Alopecia areata has been associated with atopic dermatitis, autoimmune disease, vitiligo, and endocrine disease. The pathogenesis is unclear. There is no excellent therapy for alopecia areata although many interventions are tried. Immunotherapy with diphenylcyprone is currently being optimistically evaluated. The harmful psychological effects of alopecia areata in children must be anticipated and prevented.
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Affiliation(s)
- E E Sahn
- Department of Dermatology and Pediatrics, Medical University of South Carolina, Charleston 29425-2215, USA
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Tarlow JK, Clay FE, Cork MJ, Blakemore AI, McDonagh AJ, Messenger AG, Duff GW. Severity of alopecia areata is associated with a polymorphism in the interleukin-1 receptor antagonist gene. J Invest Dermatol 1994; 103:387-90. [PMID: 8077705 DOI: 10.1111/1523-1747.ep12395398] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One of the most potent pro-inflammatory mediators is the early-acting cytokine interleukin-1. Its actions are regulated by a structurally related anti-inflammatory cytokine known as the interleukin-1 receptor antagonist. We have previously characterized a DNA polymorphism in this gene (IL-1rn) and have found associations between allele 2 and several chronic inflammatory diseases. In the present study, we tested the frequency of allele 2 of the IL-1rn gene in 90 patients with alopecia areata compared with 261 healthy controls. There was a significant association between allele 2 of the polymorphism and the severity of alopecia areata. The frequency of allele 2 increased from 24.1% in the control population to 25.9% in patchy alopecia areata, 36.1% in alopecia totalis, and 47.2% in alopecia universalis (p = 0.005). This severity association is similar to that found in other epithelial-related diseases, including inflammatory bowel disease, lichen sclerosus, and systemic lupus erythematosus.
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Affiliation(s)
- J K Tarlow
- Section of Molecular Medicine, University of Sheffield, U.K
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Abstract
In common with a number of inflammatory autoimmune diseases, genetic factors including HLA class II associations have been identified in alopecia areata. No consensus has been reached on the identity of a specific disease target within the hair follicle in alopecia areata. Suggested candidate cell types include the dermal papilla cells, the keratinocytes of the matrix and presumptive cortex and the hair bulb melanocytes, but these need not be mutually exclusive. The pathogenesis is known to involve disturbance of immune function but there is no proof that an autoimmune mechanism is fundamental. We propose a pathogenetic model incorporating polygenic determination of disease susceptibility and severity with additional, possibly environmental, factors as triggers for disease expression.
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Affiliation(s)
- A J McDonagh
- Department of Dermatology, Bradford Royal Infirmary, West Yorkshire, United Kingdom
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