Simultaneous development of insulin dependent diabetes mellitus and alopecia areata universalis

Wnt/β-catenin signaling activator restores hair regeneration suppressed by diabetes mellitus

Diabetes mellitus is one of the most prevalent diseases in modern society. Many complicationssuch as hepatic cirrhosis, neuropathy, cardiac infarction, and so on are associated with diabetes. Although a relationship between diabetes and hair loss has been recently reported, the treatment of diabetic hair loss by Wnt/β-catenin activators has not been achieved yet. In this study, we found that the depilation-induced anagen phase was delayed in both db/db mice and high-fat diet (HFD) and streptozotocin (STZ)-induced diabetic mice. In diabetic mice, both hair regrowth and wound-induced hair follicle neogenesis (WIHN) were reduced because of suppression of Wnt/β-catenin signaling and decreased proliferation of hair follicle cells. We identified that KY19382, a small molecule that activates Wnt/β-catenin signaling, restored the capabilities of regrowth and WIHN in diabetic mice. The Wnt/β-catenin signaling activator also increased the length of the human hair follicle which was decreased under high glucose culture conditions. Overall, the diabetic condition reduced both hair regrowth and regeneration with suppression of the Wnt/β-catenin signaling pathway. Consequently, the usage of Wnt/β-catenin signaling activators could be a potential strategy to treat diabetes-induced alopecia patients. [BMB Reports 2022; 55(11): 559-564].

Wnt/β-catenin signaling activator restores hair regeneration suppressed by diabetes mellitus

Diabetes mellitus is one of the most prevalent diseases in modern society. Many complicationssuch as hepatic cirrhosis, neuropathy, cardiac infarction, and so on are associated with diabetes. Although a relationship between diabetes and hair loss has been recently reported, the treatment of diabetic hair loss by Wnt/β-catenin activators has not been achieved yet. In this study, we found that the depilation-induced anagen phase was delayed in both db/db mice and high-fat diet (HFD) and streptozotocin (STZ)-induced diabetic mice. In diabetic mice, both hair regrowth and wound-induced hair follicle neogenesis (WIHN) were reduced because of suppression of Wnt/β-catenin signaling and decreased proliferation of hair follicle cells. We identified that KY19382, a small molecule that activates Wnt/β-catenin signaling, restored the capabilities of regrowth and WIHN in diabetic mice. The Wnt/β-catenin signaling activator also increased the length of the human hair follicle which was decreased under high glucose culture conditions. Overall, the diabetic condition reduced both hair regrowth and regeneration with suppression of the Wnt/β-catenin signaling pathway. Consequently, the usage of Wnt/β-catenin signaling activators could be a potential strategy to treat diabetes-induced alopecia patients. [BMB Reports 2022; 55(11): 559-564].

Recovery from alopecia areata in a patient with autoimmune polyglandular syndrome type 3

Recovery from alopecia is rare in autoimmune polyglandular syndrome (APS). A 41-year-old male was admitted to our hospital with hyperglycemia. He developed alopecia areata (AA) 5 months before admission and developed thirst, polyuria, and anorexia in 2 weeks. His plasma glucose level upon admission was 912 mg/dl (50.63 mmol/l) and HbA1c was 13.7%. Although urinary and plasma C-peptide levels showed that insulin secretion was not depleted, anti-insulinoma-associated antigen 2 antibody was present. In addition, measurement of thyroid autoantibodies revealed the presence of Hashimoto's thyroiditis. These findings suggested a diagnosis of APS type 3. The patient has showed signs of improvement with the continuation of insulin therapy. During the successful control of diabetes, he had total hair regrowth within 2–3 months. Human leukocyte antigen typing showed that DRB1*1501-DQB1*0602 and DQB1*0301 were present. Similar cases should be accumulated to clarify the association of APS type 3 with recovery from AA.

Learning points

Diabetic ketoacidosis, thyroiditis and alopecia areata in a child with Down syndrome

A 10-year-old girl with Down syndrome and alopecia areata was admitted with severe ketoacidosis. She had high blood glucose level: 615 mg/dL and her HbAlc level was 13.3 %. After the control of ketoacidosis and reduction of the plasma glucose level, we found low free T4 level and high TSH levels. Thyroid peroxidase antibodies titer was 1383 IU/mL and both gliadin and endomysial antibodies were negative. This was the first report of a child with Down syndrome showing type 1 diabetes combined with alopecia areata and autoimmune thyroid disease.

Pernicious anemia in a patient with Type 1 diabetes mellitus and alopecia areata universalis

A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the outpatient clinics complaining of general fatigue and shortness of breath. A Schilling test was indicative of pernicious anemia. Antigastric parietal cell (AGPA) and anti-intrinsic factor antibodies were positive, confirming diagnosis of pernicious anemia. Thyroid and Addison's disease were excluded. Gastroscopy revealed atrophic gastritis without any evidence of carcinoid tumors. The aim of this case, which, to our knowledge, is the first one to describe a correlation between diabetes mellitus Type 1 (DMT1), pernicious anaemia, and alopecia areata universalis, is to remind the clinician of the increased risk of pernicious anaemia and gastric carcinoids in DMT1 patients. Screening for AGPA followed by serum gastrin and vitamin B(12) levels constitute the most evidence-based diagnostic approach.

Satoyoshi syndrome: an unusual postnatal multisystemic disorder

Satoyoshi syndrome is a rare disorder of unknown cause characterized by progressive, painful intermittent muscle spasms, malabsorption, alopecia, amenorrhea, and skeletal abnormalities mimicking a skeletal dysplasia. We describe a 19-year-old Caucasian woman with characteristic manifestations starting at age 9. The report of this patient confirms that this condition is not limited to the Asian population.

Alopecia areata in aging C3H/HeJ mice

A disease closely resembling human alopecia areata was found in a large production colony of C3H/HeJ mice that had no evidence of thyroid dysfunction or an infectious etiology. Alopecia developed diffusely or in circular areas on the dorsal surface. Histologically, the changes in this non-scarring alopecia were limited to anagen follicles that were surrounded by mononuclear cells. This infiltrate, composed primarily of cytotoxic (CD8+) and helper (CD4+) T cells, was associated with follicular and hair shaft dystrophy. This infiltrate was markedly reduced by intralesional injection of triamcinolone acetonide with subsequent hair regrowth in the affected site. Pedigree tracing of affected C3H/HeJ mice suggests that this non-scarring alopecia may be an inherited disease. Breeding results of normal haired mice with alopecia areata mice or between alopecia areata mice suggests that this is a complex polygenic disease with a female predominance at younger ages. Female mice developed the disease earlier than male mice (3-5 versus > 6 months), with equal numbers affected by 18 months of age. The relative incidence of alopecia areata in one production colony of C3H/HeJ mice was 0.25% for female and 0.035% for male mice, but selective breeding has raised the frequency to nearly 20%. The frequency in an aging colony selectively bred for inflammatory bowel disease reached 4.7%, with equal sex distribution, for mice over 18 months of age, suggesting that this might be a common aging change in C3H/HeJ mice. This C3H/HeJ mouse disease may prove to be a valuable animal model to study specific subtypes of human alopecia areata.

Cutaneous manifestations of diabetes mellitus

Diabetes mellitus (DM) is a heterogeneous group of disorders characterized by a high serum glucose level and by disturbances of carbohydrate and lipid metabolism. It is estimated that 11 million persons in the United States have DM, 90% of whom have non-insulin-dependent DM. At least 30% of persons with diabetes have some type of cutaneous involvement during the course of their chronic disease. This review classifies the cutaneous findings in DM into four categories: (1) skin diseases with strong to weak association with DM; (2) cutaneous infections; (3) cutaneous manifestations of diabetic complications; and (4) skin reactions to diabetic treatment. Each of these categories is reviewed as well as the pathophysiology of the normal and diabetic basement membrane for a better understanding of the cutaneous manifestations of DM.