ABSTRACT
Background@#Although alopecia areata (AA) is usually diagnosed based on the patient’s clinical manifestations, histologic features are the key to establishing the correct diagnosis. Moreover, it is possible to know about the progression of AA through understanding the various histologic characteristics of AA. Many studies have reported a lot of literatures related to AA, but studies investigating the correlation between histologic features and prognosis have not yet been reported. @*Objective@#This study aimed to establish the histologic features of AA in scalp biopsy specimens and sought to correlate between histopathologic features and clinical prognosis. @*Methods@#The pathology archives of Kyung Hee University Hospital at Gang-dong were searched for AA in the diagnostic field from the period of 2006 to 2016. The biopsy specimens were sectioned by Tyler technique. A total of 464 patients were included in the analysis. @*Results@#There were reduction of anagen hair count according to the severity of AA, and a higher percentage of telogen ratio and vellus hair counts were observed in the alopecia totalis and alopecia universalis. Total hair counts (9.9) including miniaturized hairs were decreased prominently at more than 5 years of current duration. There was a high ratio of peribulge lymphocytic infiltration (45%) in patients with ophiasis and acute diffuse type and those with total alopecia showed prominent small portions of follicular miniaturization (27%). @*Conclusion@#These histopathologic features mentioned above may shed light on the understanding of disease progression of AA, which have various clinical aspects. Using these histologic features, we will be able to predict the efficacy for therapy and prognosis of AA.
ABSTRACT
BACKGROUND: Management of atopic dermatitis (AD) involves the regular use of emollients together with topical steroids or calcineurin inhibitors for acute flares. However, the long-term use of oral medications in young children may have certain limitations. Wet wrap dressing (WWD) is an interesting alternative therapy for the short-term control of severe or refractory flares, thus avoiding the use of systemic treatments. OBJECTIVE: This study aimed to compare the efficacy between WWD and topical steroid agents and to control and estimate the utility of WWD in pediatric AD. METHODS: A total of 40 patients with mild-to-severe AD (eczema area and severity index of ≥3) aged <13 years were included in this study. Twenty patients were treated with WWD using two layers of cotton bandages or garments (Tubifast™), and the remaining were applied with topical steroid agents without cotton bandages. Improvement in severity of atopic dermatitis was evaluated using the eczema area and severity index (EASI). Improvement in skin barrier dysfunction was evaluated by measuring the transepidermal water loss (TEWL). We compared the two groups after 1 week of treatment using analysis of covariance and t-test. Furthermore, we surveyed the study groups using a questionnaire to estimate the utility of WWD and its adverse effects as well as to evaluate subjective outcomes of WWD. RESULTS: There were significant reductions in the mean EASI (−6.3, 95% confidence interval [CI]: −7.5 to −5.1, p=0.013) and TEWL (−26.7, 95% CI: −31.2 to −22.3, p=0.002) after 1 week of WWD treatment compared with the mean EASI (−4.0, 95% CI: −5.2 to −2.9) and TEWL (−15.4, 95% CI: −19.8 to −10.9) of the control group. Results of patient self-assessment and scores in the visual analogue scale (VAS) for pruritus were improved in both groups, but the differences were not statistically significant. Usefulness of WWD as an alternative therapy for the conventional therapy was satisfactory. CONCLUSION: This study is meaningful in that it estimates both the subjective and objective efficacy of WWD. In view of these findings, WWD showed superior therapeutic effects than conventional steroid application in the treatment of AD in children, with good compliance of patients and parent-caregivers.
Subject(s)
Child , Humans , Bandages , Calcineurin Inhibitors , Clothing , Compliance , Dermatitis, Atopic , Eczema , Emollients , Pruritus , Self-Assessment , Skin , Steroids , Therapeutic Uses , WaterABSTRACT
BACKGROUND: Simvastatin belongs to the statin family, whose members have immunomodulatory activities. Ezetimibe have synergetic effects when co-administered with simvastatin. In several case reports, alopecia totalis and alopecia universalis were successfully treated with simvastatin/ezetimibe, suggesting that this combination could be a new efficient therapy for recalcitrant alopecia areata (AA). OBJECTIVE: To verify the efficacy of the simvastatin/ezetimibe combination therapy for recalcitrant AA and investigate the relationship between various treatment responses and prognostic factors. METHODS: This prospective open study was performed in patients with recalcitrant AA with the bald surface exceeding 75%. All patients took simvastatin (40 mg) and ezetimibe (10 mg) daily. The extent of hair regrowth expressed as percentage of the bald area was used to evaluate the effectiveness of the therapy. RESULTS: Of 14 enrolled patients, 4 patients (28.6%) were judged as responders showing regrowth of 30% to 80% after 3 months of treatment. The mean age of onset in non-responders was significantly lower than in responders. The total score of prognostic factors, calculated as a sum of factors related to poor prognosis, was much lower in responders than in non-responders. CONCLUSION: The remission rate in this study was unsatisfactory. However, since the recruited patients had not responded to any other treatments for AA, simvastatin/ezetimibe can still be considered as an alternative treatment for recalcitrant AA. The total scores of the prognostic factors were statistically different between responders and non-responders. These results can be used to predict the outcome of treatment with simvastatin/ezetimibe and anticipate prognosis.