Alopecia areata

Objective outcome measures: Collecting meaningful data on alopecia areata

BACKGROUND

Although alopecia areata is a common disorder, it has no US Food and Drug Administration-approved treatment and evidence-based therapeutic data are lacking.

OBJECTIVE

To develop guidelines for the diagnosis, evaluation, assessment, response criteria, and end points for alopecia areata.

METHODS

Literature review and expert opinion of a group of dermatologists specializing in hair disorders.

RESULTS

Standardized methods of assessing and tracking hair loss and growth, including new scoring techniques, response criteria, and end points in alopecia areata are presented.

LIMITATIONS

The additional time to perform the assessments is the primary limitation to use of the methodology in clinical practice.

CONCLUSION

Use of these measures will facilitate collection of standardized outcome data on therapeutic agents used in alopecia areata both in clinical practice and in clinical trials.

Effect of two consecutive earthquakes on outbreaks of alopecia areata

The pathogenesis of alopecia areata (AA) is still unknown. We investigated whether two consecutive earthquakes in Duzce, Turkey within a 3-month interval could precipitate AA. Patients who developed AA after the first earthquake in Duzce were included in this study. The admittance rate and demographic characteristics of AA patients admitted in the same period of the previous year (BE=before earthquake group) were compared to that of AA patients admitted after the earthquake (AE=after earthquake group). The admittance rate and onset of AA after the first earthquake were investigated retrospectively. In addition, possible relationships between the earthquake and age at the first attack, severity of the disease, and ophiasis were studied. The ratio of AA patients in the BE group was 12/1,121 (0.9%), while this value was 26/1,430 (1.8%) in the AE group (p=0.07). There were no significant differences with regard to sex, age of the first attack, severity of the disease, or ophiasis between the two groups. AA appeared between 18-28 weeks after the first earthquake in 14 (53.8%) of the patients. The earthquake did not increase the admittance rate of AA significantly. This finding suggests that a stressful event such a natural disaster is not a unique factor in AA outbreaks.

Bilateral keratoconus associated with Hashimoto's disease, alopecia areata and atopic keratoconjunctivitis

Keratoconus is a progressive non-inflammatory corneal ectasia. Alopecia areata is complete loss of hair patches on the hairy areas of the body in association with some ocular manifestations such as cataract, or disorders of the conjunctiva, iris, lens, choroid and retina pigment epithelium. A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years. The possible association of keratoconus with multisystem autoimmune disease is discussed.

Severe alopecia areata treated with systemic corticosteroids

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.

Prevalence of thyroid diseases in patients with alopecia areata

BACKGROUND

The prevalence of thyroid disease in patients with alopecia areata previously reported varied from 0 to 28%. These thyroid diseases, include Hashimoto's thyroiditis, Graves' disease, simple goiter, and others.

METHODS

The prevalence of thyroid diseases was determined in 152 consecutive patients with alopecia areata who presented to the dermatology clinic. A complete history was taken and a physical examination was performed. Thyroxine, triiodothyronine, thyroid-stimulating hormone, and microsomal antibody levels were measured in every patient. The control group consisted of 152 age- and sex-matched volunteers who had skin diseases other than alopecia areata or autoimmune disorders.

RESULTS

Among 152 patients, age 10-59 years, four cases (2.6%) had a small simple goiter. Microsomal antibodies were detected in seven other patients (4.6%) with titers ranging from 1:100 to 1:1600. None of these seven patients had signs or symptoms of thyroid disease. Five cases (3.3%) of the control group had positive microsomal antibody tests with titers ranging from 1:100 to 1:400. The prevalence of positive microsomal antibodies in the alopecia areata group was not statistically different from the control group (chi 2 = 0.347, DF = 1, P = 0.5558).

CONCLUSIONS

Among 152 patients with alopecia areata, 4.6% of patients had microsomal antibodies and 2.6% had a small simple goiter. Thus the prevalence of thyroid disease among these patients was 7.2%. The prevalence of positive microsomal antibodies in 4.6% of the patients was not statistically different from that of the control group.

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.

Simultaneously occurring alopecia areata and Hodgkin's lymphoma: complete remission of both diseases with MOPP/ABV chemotherapy

A 43-year-old man presented with simultaneously occurring alopecia areata and stage IIIB nodular sclerosing Hodgkin's disease. Systemic symptoms of Hodgkin's disease were present for 6 months, and rapidly developing patchy hair loss of the scalp was present for 2 weeks prior to presentation. The patient was treated with eight cycles of MOPP-ABV chemotherapy that resulted in complete remission of Hodgkin's-disease. Four months after the completion of chemotherapy, the patient had normal hair regrowth with no evidence of alopecia areata. Alopecia areata may be an autoimmune disease and may respond to chemotherapy.

Alopecia totalis in a patient with Crohn's disease and its treatment with azathioprine

A patient with Crohn's disease and alopecia totalis is described. Despite relative inactivity of the Crohn's disease, treatment with azathioprine was commenced. This led to complete regrowth of hair which was lost when the drug was discontinued. Re-institution of azathioprine restored hair to normal again and the patient has since declined to try stopping the drug despite the knowledge of potential side effects.

Anthralin therapy for alopecia areata

Topical anthralin application producing a brisk irritant contact dermatitis has been reported to have therapeutic benefit in alopecia areata. A pilot clinical study was undertaken to determine whether topical anthralin application in doses low enough to produce only minimal contact dermatitis would produce a similar therapeutic response. None of the patients in the study received any benefit from this low-dose regimen. If anthralin is of benefit in the therapy of alopecia areata, a significant irritant contact dermatitis is apparently required.