Concern about the prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated metastatic vascular calcification or calcinosis universalis / 中华内分泌外科杂志

Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.

An atypical case of a 14-year-old Filipino female with non-classical congenital adrenal hyperplasia presenting with alopecia universalis

Introduction@#Non-classical congenital adrenal hyperplasia (CAH) represents a group of inherited, autosomal recessive disor- ders that typically presents with androgenetic alopecia, but may present with alopecia universalis on rare occasions.@*Case report@#We report a case of a 14-year-old Filipino female with non-classical congenital adrenal hyperplasia presenting with alopecia universalis, treated with a combination of Tretinoin and Minoxidil solution, low dose prednisone and an oral supplement containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium, with noted gradual hair regrowth and improvement in Dermatology Life Quality Index (DLQI).@*Conclusion@#Alopecia universalis in a patient diagnosed with non-classical congenital adrenal hyperplasia is a rare and atypical manifestation, with no case reports available to describe its occurrence. Due to its rarity, there is no standard treatment for pa- tients with this condition. However, the combination of tretinoin and minoxidil solution, low dose prednisone and an oral supple- ment containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium shows promising results.

Alopecia areata y vitamina D sérica en pacientes iraquíes: un estudio de casos y controles / Alopecia Areata And Serum Vitamin D in Iraqi Patients: a case-control study

Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.

Efficacy of Oral Tofacitinib in Patients with Alopecia Areata: Tofacitinib Was Ineffective for Recalcitrant Alopecia Totalis of a Long Duration / 대한피부과학회지

No abstract available.

Azathiopine for the treatment of extensive forms of alopecia areata: A systematic review

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Alopecia areata (AA) is an autoimmune hair disorder, with the clinical variants ophiasis and extensive variants AA totalis and universalis, having poor response to therapy. Oral steroids are used to treat the severe variants, requiring prolonged therapy, which leads to side effects while discontinuation leads to high relapse rate. Azathioprine is a steroid-sparing agent for the severe AA forms.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review the current evidence on the therapeutic efficacy and adverse effects of azathioprine for severe forms of alopecia areata</p><p style="text-align: justify;"><strong>METHODS:</strong> Published articles utilizing azathioprine for alopecia areata were obtained until July 2018 from PubMed, MEDLINE, Cochrane Library, TRIP database, HERDIN, and Google Scholar.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Seven articles underwent a full-length review. Clinical variants include patchy, diffuse, steroid-resistant, reticulate, totalis, universalis, ophiasis, and sisaipho. Doses ranged from 2 to 2.5 mg/kg/day or weekly 5 mg/kg pulse therapy. Initial response ranged from 6 to 12 weeks, with almost complete resolution by 32 weeks. Response was sustained for 6 months upon discontinuation, with only 14% relapsing at 2.5 months. Adverse effects were gastrointestinal discomfort, elevated liver function tests, and myelosuppression.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is emerging evidence on the efficacy and safety of azathioprine for the treatment of extensive forms of alopecia areata. Randomized-controlled trials are needed to evaluate its efficacy.</p>

Alopecia areata universal / Alopecia areata universalis

Introducción: la alopecia areata es una condición común de pérdida de cabello no cicatricial, inducida por un proceso inflamatorio de origen multifactorial. Cualquier área pilosa puede estar afectada, el cuero cabelludo se afecta en un 90 por ciento de los casos, seguida de la zona de la barba, las cejas, las pestañas y la región púbica. La enfermedad puede progresar al punto en que se pierde todo el pelo del cuero cabelludo (alopecia areata total) o incluso de todo el cuerpo (alopecia areata universal). La etiología exacta se desconoce. Se reconoce la autoinmunidad como el proceso patogénico más importante, siento otros factores el genético y el ambiental. Caso clínico: se presenta el caso de una paciente de 45 años de edad, con pérdida progresiva y total del pelo corporal, a la cual se administraron múltiples tratamientos sin lograr mejoría. Conclusiones: aunque la alopecia areata es una de las enfermedades autoinmunes más comunes, la fisiopatología de esta forma crónica y recidivante de pérdida de pelo no está completamente comprendida y las terapias disponibles son decepcionantes(AU)

Introduction: Alopecia areata is a common condition of noncicatricial hair loss, induced by an inflammatory process of multifactorial origin. Any hairy area may be affected, the scalp is affected in 90 percent of cases, followed by the area of the beard, eyebrows, eyelashes and the pubic region. The disease can progress to the point where all the hair on the scalp (total alopecia areata) or even the entire body (alopecia areata universal) is lost. The exact etiology is unknown. Autoimmunity is recognized as the most important pathogenic process, while other factors are genetic and environmental. Clinical case: The case of a 45-year-old patient with progressive and total loss of body hair was presented, to whom multiple treatments were administered without achieving any improvement. Conclusions: Although alopecia areata is one of the most common autoimmune diseases, the pathophysiology of this chronic and recurrent form of hair loss is not completely understood and the therapies available are disappointing(AU)

Alopecia Areata - A literature Review

Alopecia areata (AA) is a disease marked by extreme variability in hair loss, not only at the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode. This variable and unpredictable nature of spontaneous re-growth and lack of a uniform response to various therapies has made clinical trials in alopecia areata difficult to plan and implement. It is a type of alopecia that affects males and females equally. It occurs in both children and adults. The peak age of occurrence is 20 to 50 years .The most common clinical presentation is asymptomatic shedding of telogen hairs followed by patchy non scarring hair loss in association with nail pitting, Beau’s line and nail dystrophy. The disease may progress from this limited presentation to total loss of all scalp hairs (Alopecia totalis) or all body hair (alopecia universalis) with significant onychodystrophy. Mostly it is characterised by reversible hair loss involving the scalp although others areas of head including eyelashes, eyebrows and beard may also be affected. Although, it is a mostly cosmetic problem but it often has devastating effects on quality of life and self-esteem. The paper aims at providing an overview of Alopecia areata.

A study of clinical profile of Alopecia areata in a tertiary care hospital in Western Odisha

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

Factors Associated with Severity of Alopecia Areata

BACKGROUND: Alopecia areata is the most common cause of localized, nonscarring alopecia. Unfortunately, there are few data regarding clinical features and epidemiology of alopecia areata in Korean patients, and its clinical course and treatment response rates are unpredictable. OBJECTIVE: This study strived to investigate the differences in clinical profiles according to disease severity and to determine risk factors for severe alopecia areata. METHODS: A total of 1,137 patients from 2006 to 2015 were analyzed retrospectively. Patients were subdivided into two groups: mild-to-moderate and severe alopecia areata. The groups were compared on the basis of age of onset, duration, sex, family history, comorbid disorders including autoimmune diseases, nail changes, and laboratory test results. RESULTS: Eight hundred eighty-three patients were in the mild-to-moderate alopecia areata group and 254 patients were in the severe group. Average onset age was 30.77±17.66 years and 30.60±16.75 years in the mild-to-moderate and severe groups, respectively. Disease duration was statistically longer in the severe group. Male sex, nail changes, and thyroid diseases were more common in the severe group. Hypertension, diabetes mellitus, dyslipidemia, atopic dermatitis, and family history did not differ between groups. Of the serologic values, only alkaline phosphatase was considerably differing between groups. Male sex, presence of nail changes, and disease duration greater than one year were identified as significant risk factors for severe alopecia areata. CONCLUSION: This is the largest case analysis in Korean patients with alopecia areata. Clinical profiles stratified by disease severity warrant further study.

Alopecia.

To understand the causes of hair loss and to treat it by preventing the causative factors and with the help of homoeopathic remedies.

Common variable immunodeficiency and Type 1 Diabetes Mellitus in a 19-year-old Filipino male with Alopecia Universalis / Journal of the ASEAN Federation of Endocrine Societies

@#A 19-year-old Filipino male presents with recurrent respiratory tract symptoms every 4 to 5 months since childhood and sudden onset of diabetes type 1 with ketoacidosis. He had patchy hair loss which started at 7 years old, and was diagnosed with alopecia universalis. Thyroid antibodies and 21-hydroxylase antibody were normal. Common Variable Immunodeficiency with Polyglandular Autoimmune Syndrome IV was considered. The patient is on monthly intravenousimmunoglobulin therapy and basal bolus insulin regimen.

Depigmentation therapies in vitiligo.

Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo.

Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence ( or = 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.

Detection of a Novel Missense Mutations in Atrichia with Papular Lesions

BACKGROUND: Atrichia with papular lesions (APL) is a rare inherited disease characterized by early onset of total hair loss, followed by papular lesions over the extensor areas of the body. Recently, mutations in the human hairless (HR) gene have been implicated in its pathogenesis. The identification of mutations in the HR gene is important for differentiating between APL and alopecia universalis (AU). OBJECTIVE: We compared the HR genes of patients with presumed AU who showed minimal or no response to treatment with the HR genes of healthy controls. METHODS: The subjects were 11 patients with presumed AU who had not responded to treatments. Fifty healthy people were included as controls for molecular analysis. To screen for mutations, polymerase chain reaction was performed. RESULTS: DNA analysis identified a novel heterozygous G-to-A transition at nucleotide position 191 in exon 5. The mutation was not found in the controls, other AU patients, or any unaffected family members except for the patients' mother and maternal grandfather, who were heterozygous HR gene carriers. CONCLUSION: Our study identifies a novel missense mutation in exon 5 of the HR gene in a Korean APL patient previously diagnosed as AU.

Vitiligo Universalis Associated with Chronic Hepatitis B / 대한피부과학회지

Vitiligo universalis is an uncommon variant that is rarely seen. Interestingly, vitiligo universalis often accompanies systemic diseases such as endocrinopathies. A 43-year-old man presented with whole body depigmentation and poliosis affecting most of his scalp and body hair. He had undergone a liver transplant 2 years ago due to liver cirrhosis from a chronic hepatitis B infection and has been treated for diabetes mellitus for several years. Histopathology showed no melanocytes and an absence of epidermal pigmentation on the skin. We herein report a rare case of vitiligo universalis associated with chronic viral hepatitis B.

A Case of Dyschromatosis Universalis Hereditaria Treated with a Q-switched Nd:YAG Laser / 대한피부과학회지

Dyschromatosis universalis hereditaria is a rare pigmentary disorder that's characterized by the presence of both small and irregular sized hyperpigmented and hypopigmented macules in a generalized distribution. The pattern of inheritance is thought to be autosomal dominant, but some sporadic and autosomal recessive inheritance cases have also been reported. We report here on a case of a-15-year old female patient with dyschromatosis universalis hereditaria, which is compatible with autosomal dominant inheritance. The patient presented with numerous small and irregularly sized hyper-and hypopigmented macules on her face, trunk and both the arms and legs, but not on the palms and soles. By analysis of her familial pedigree, we found an autosomal dominant pattern of inheritance. The biopsy specimen taken from the hyperpigmented macules showed increased melanin granules and pigmentation in the basal cell layer of the epidermis. Various therapeutic trials have been introduced to treat these lesions, but there have been few reports of simple effective treatments for the hyper-and hypopigmented lesions. So, we tried treating the hyperpigmented macules with a Q-switched Nd:YAG laser and we obtained a successful result.

Calcinose universal idiopática: apresentação em recém-nascido / Idiopathic calcinosis universalis: infant presentation

A calcinose universal idiopática é uma doença rara, de diagnóstico difícil e que se manifesta em recém-nascidos e crianças. Relatamos o caso de um paciente recém-nascido, do sexo masculino, apresentando calcificação limitada ao tecido subcutâneo do membro superior direito.

The idiopathic calcinosis universalis is a rare disorder of unknown cause which affects infants and children. This article reports on a case of a recent born male patient showing limited calcification inthe subcutaneous tissue of the right upper arm.

A Case of Alopecia Universalis with Vogt-Koyanagi-Harada Syndrome / 대한피부과학회지

Vogt-Koyanagi-Harada (VKH) syndrome is an idiopathic autoimmune disease involving melanocytes. The characteristic features are uveitis, meningismus, tinnitus, alopecia, vitiligo and poliosis, dependent upon the site of melanocyte location. Among the skin manifestations, alopecia usually appears as discrete, alopecic patches around the head. We report a case of fifty-year-old woman who presented with typical features of VKH syndrome, plus alopecia universalis and nail dystrophy.

A Case of Idiopathic Calcinosis Universalis / 대한피부과학회지

Calcinosis cutis results from deposits of calcium and phosphorus in the skin. Calcinosis cutis may be divided into four major categories: dystrophic, metastatic, idiopathic and iatrogenic. A 19-year-old female presented with multiple brown or skin-colored, stony hard plaques on the face, trunk, arm and thigh for 18 months. She did not have any familial and medical history. None of the laboratory findings, including serum calcium, phosphate and autoantibodies for connective tissue disease, was significant. X-ray examination of bones evidenced multiple reticulated heterotrophic calcifications and whole body bone scan evidenced increased radiotracer uptake according to cutaneous or subcutaneous tissue. This case is compatible with idiopathic calcinosis universalis. Treatment with diltiazem was started.

A Case of Juvenile Rheumatoid Arthritis Associated with Alopecia Universalis / 대한피부과학회지

We observed a 25-year-old male patient who had developed juvenile rheumatoid arthritis(RA) associated with alopecia areata at 14 years of age. When he received treatment for RA, his symptoms of RA and hair loss improved at approximately the same time. One year later, as the symptoms of RA aggravated, the hair loss had progressed eventually to alopecia universalis(AU). Thus we suggest that RA and AU may be associated with a common immunologic factor in etiology of the two diseases.