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Background: Alopecia areata is a chronic inflammatory skin disease. Oxidative stress may contribute to the pathogenesis of this condition. Aim: To evaluate the serum oxidative stress markers and antioxidant capacity in patients with alopecia areata. Methods: This cross-sectional study was performed on 40 patients with alopecia areata and 40 healthy controls. The fasting blood sugar, C-reactive protein, lipid profile, and serum oxidative markers, including advanced glycation end products and advanced oxidation protein products, were measured in this study. Also, antioxidant enzymes, including paraoxonase-1, lecithin-cholesterol acyltransferase and serum ferric-reducing antioxidant power, were determined. Results: The serum levels of advanced glycation end products and advanced oxidation protein products were significantly higher in patients with alopecia areata, compared to the controls (P < 0.001), whereas the levels of ferric-reducing antioxidant power, paraoxonase-1 and lecithin-cholesterol acyltransferase were significantly lower in patients with alopecia areata, compared to the controls (P < 0.001). The mean fasting blood sugar level was significantly higher in patients with alopecia areata, compared to the controls. The ferric reducing antioxidant power level was significantly associated with the percentage of hair loss (P = 0.01, r = 0.4) and the serum C-reactive protein level (P = 0.03, r = –0.3) in patients with alopecia areata. Limitations: Since the current study had a cross-sectional design, no cause-effect relationship was established between alopecia areata and oxidative stress. The sample size of our study was also small. Conclusion: Based on the present results, the oxidant-antioxidant enzymatic system is impaired in alopecia areata due to the increased oxidative products and decreased antioxidant activity
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Abstract The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.
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ObjectiveTo explore the distribution of traditional Chinese medicine （TCM） syndromes of alopecia areata （AA）， and to provide reference for TCM clinical syndrome differentiation and classification of AA. MethodsAA patients who visited the specialized hairiness clinic of Beijing China-Japan Friendship Hospital were included. A questionnaire was developed including general information of the patients， history of hair loss （onset time， triggers and exacerbating factors， disease progression）， current symptoms （symptoms and signs）， medical history， personal history， family history， and hair microscopy examination results. The factor analysis and cluster analysis were used to determine the syndrome elements and to summarize the syndrome types. ResultsA total of 600 patients with AA were included， including 218 males （36.33%） and 382 females （63.67%）. Totally， 128 patients （21.33%） had a family history of hair loss， and 326 patients （54.33%） had a previous related underlying disease. The leading triggering and exacerbating factors of AA were tension and anxiety， accounting for 335 cases （55.83%） and 285 cases （47.50%）， respectively. The top 10 symptoms involved among patients were scalp oil， anxiety， irritability， dreaminess， fatigue， itching， tension， weakness and dandruff. The factor analysis showed that the factor rotation converged after 9 iterations， and finally obtained 12 common factors and 34 variables， with a cumulative contribution rate of 58.59%. In terms of disease location of AA， the main syndrome elements were liver， spleen and kidney， and the disease nature syndrome elements were mainly dampness-heat， qi stagnation， yin deficiency， qi deficiency， and blood deficiency. The clustering analysis of the 12 common factors showed that TCM syndromes could be summarized into four categories： internal retention of damp-heat， liver-kidney deficiency， qi and blood deficiency， and liver constraint and spleen deficiency. There were significant differences in the distribution of TCM syndromes in patients of different ages and genders （P＜0.001）. ConclusionThe main disease location of AA is in the liver， spleen， and kidney， with the liver being the key. The disease mechanism of AA is a deficiency-excess complex， initially manifested as excess and later becoming deficiency. The TCM syndromes mainly include four types which are internal retention of damp-heat， liver-kidney deficiency， qi and blood deficiency， and liver constraint and spleen deficiency.
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Introducción: La alopecia areata en una enfermedad autoinmune caracterizada por la pérdida no cicatricial de pelo; puede ser catalogada como un problema estético, sin tener en cuenta que tiene alto impacto en la calidad de vida de quien la padece. Objetivo: Identificar las comorbilidades, el impacto psicosocial y los factores asociados en pacientes con alopecia areata. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 50 pacientes con diagnóstico clínico de alopecia areata, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde 2018 hasta 2020. Resultados: En la casuística prevalecieron los pacientes de 29-39 años de edad (46,0 %), el sexo masculino (58,0 %), el estrés y la ansiedad como factores emocionales (76,0 %), seguidos de los focos sépticos (40,0 %); el nivel de escolaridad de técnico medio (52,0 %), el estado civil acompañado (44,0 %) y el tiempo de evolución de la alopecia entre 4 y 12 meses (76,0 %). Conclusiones: Se evidenció que la mayoría de los pacientes presentaron algún episodio emocional o una crisis de ansiedad, previos al inicio de la alopecia areata.
Introduction: The alopecia areata in an autoimmune disease characterized by the non-cicatricial loss of hair; that can be classified as a cosmetic problem, without taking into account that has high impact in the life quality of the one who suffers from the disease. Objective: To identify the comorbidities, psychosocial impact and associated factors in patients with alopecia areata. Methods: An observational, descriptive and cross-sectional study of 50 patients with clinical diagnosis of alopecia areata was carried out, they were assisted in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from 2018 to 2020. Results: In the case material there was a prevalence of the 29-39 years patients (46.0 %), the male sex (58.0 %), stress and anxiety as emotional factors (76.0 %), followed by the septic focus (40.0 %); the school level of technician (52.0 %), accompanied as marital status (44.0 %) and the time of evolution of the alopecia between 4 and 12 months (76.0 %). Conclusions: It was evidenced that most of the patients presented some emotional event or a crisis of anxiety before the beginning of the alopecia areata.
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Comorbidity , Alopecia Areata , Secondary Care , Risk FactorsABSTRACT
Alopecia areata is an autoimmune disease that causes hair loss. It is characterized by patchy hair loss that affects the scalp and other areas of the head, as well as the eyelashes, beard, and complete body hair. Alopecia areata manifests as a circular patch of hair loss that may progress to baldness of the entire scalp (Alopecia areata totalis) or loss of full body hair (Alopecia areata universals). The disease's etiopathogenesis is unknown, however autoimmunity appears to play a signi?cant role. Thyroid problems are frequently linked to AA, the most common of which is autoimmune Thyroid disorders. Aim: The goal of our research is to see if Alopecia Areata (AA) is linked to thyroid hormones (T3, T4, and TSH) and to evaluate the T3, T4, and TSH levels. Material and Methods: The present study included 150 A.A patients(cases) and 150 controls attended to Department of Dermatology in collaboration with Department of Biochemistry, LNMC & J.K Hospital, Bhopal. The levels of T3, T4 and TSH was estimated by ELISA. Result: The present study shows statistically signi?cant differences between patients and controls regarding Thyroid Hormones levels of TSH, T3 and T4. Conclusions: The ?ndings imply an association between Alopecia Areata and Thyroid function issues. Thyroid function abnormalities should be checked in all patients with alopecia areata, regardless of their clinical condition
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Abstract Atopic dermatitis predisposes to skin infections, and on the other hand, some therapies used for atopic dermatitis may worsen viral infections whose lesions may be more diffuse and resistant to treatment. The authors present a patient with severe atopic dermatitis and disseminated molluscum contagiosum infection. The molluscum contagiosum did not clear with topical treatment, and it worsened her atopic dermatitis even more, so the authors started treatment with dupilumab. After two months, the patient's dermatitis went into clinical remission and there was resolution of the infection with no recurrence at the 12-month follow-up. Dupilumab is nowadays a promising treatment for severe atopic dermatitis. To our knowledge, only four reports of molluscum contagiosum during dupilumab therapy have been reported in the literature, with contrasting effects. According to the authors' experience, treatment with dupilumab appears to be a safe alternative for patients with severe atopic dermatitis who are also infected with molluscum contagiosum, as opposed to other treatments such as systemic corticosteroids or cyclosporine.
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Objective:To investigate changes in the peripheral interleukin-35 (IL-35) level in patients with alopecia areata, and to assess its modulatory effect on regulatory T (Treg) cell activities.Methods:Totally, 81 patients with alopecia areata (alopecia areata group) and 27 healthy volunteers (control group) were enrolled from Shanxi Provincial People′s Hospital between December 2019 and January 2021. Sera and peripheral blood mononuclear cells (PBMCs) were isolated. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum IL-35 level, real-time fluorescence-based quantitative PCR to determine the mRNA expression of IL-35 subunits EBI3 and IL-12p35, and flow cytometry to determine the proportion of CD4 + CD25 + CD127 dim/- Treg cells. Sorted Treg cells were stimulated by recombinant human IL-35, ELISA was performed to detect levels of perforin and granzyme B in the culture supernatant, and real-time fluorescence-based quantitative PCR to determine the mRNA expression of EBI3, IL-12p35, and immune checkpoint molecules, such as programmed death protein 1 (PD-1) , T cell immunoglobulin and mucin protein-3 (Tim-3) , cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and lymphocyte activation gene-3 (LAG-3) in Treg cells. IL-35-stimulated or unstimulated Treg cells were co-cultured with autologous PBMCs, and cell counting kit-8 (CCK8) assay was conducted to assess cellular proliferative activity. Measurement data were compared between 2 groups by using t test, comparisons among multiple groups were carried out by using one-way analysis of variance, correlation analysis was carried out by using Pearson correlation analysis, and enumeration data were compared by using chi-square test. Results:Compared with the control group, the alopecia areata group showed significantly decreased IL-35 levels (90.10 ± 11.98 ng/L vs. 100.74 ± 28.71 ng/L, t= 2.71, P= 0.008) , mRNA expression of EBI3 and IL-12p35 in PBMCs (EBI3: 1.06 ± 0.15 vs. 1.25 ± 0.11, t= 6.09, P < 0.001; IL-12p35: 1.00 ± 0.15 vs. 1.38 ± 0.22, t= 10.16, P < 0.001) , and proportions of Treg cells (5.91% ± 1.17% vs. 6.85% ± 1.23%, t= 3.54, P= 0.001) . In the alopecia areata group, the proportion of Treg cells was positively correlated with the serum IL-35 level ( r= 0.25, P= 0.026) , and the mRNA expression of EBI3 and IL-12p35 in PBMCs ( r= 0.31, 0.24, P= 0.004, 0.032, respectively) . Compared with the control group, the unstimulated Treg cells from the alopecia areata group showed significantly decreased supernatant levels of perforin and granzyme B, mRNA expression of EBI3, IL-12p35 and immune checkpoint molecules ( P < 0.05 or 0.001) , as well as weakened inhibitory effect on the proliferative activity of PBMCs ( P= 0.013) . There was no significant difference in the level of perforin or granzyme B between the recombinant human IL-35-stimulated and unstimulated Treg cells from the patients with alopecia areata (both P > 0.05) . However, the mRNA expression of EBI3, IL-12p35 and immune checkpoint molecules was significantly higher in the IL-35-stimulated Treg cells than in the unstimulated Treg cells in the alopecia areata group ( P < 0.05 or 0.001) , and the inhibitory effect on the proliferative activity of PBMCs was also significantly enhanced in the IL-35-stimulated Treg cells compared with the unstimulated Treg cells ( P= 0.037) . Conclusion:The peripheral IL-35 level was significantly decreased in the patients with alopecia areata, which was closely associated with reduced activities of Treg cells, and IL-35 may be involved in the occurrence of alopecia areata.
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Traditional therapies for alopecia areata, especially moderate to severe alopecia areata and special types of alopecia areata, remain unsatisfactory. Compared with traditional therapies, small-molecule targeted drugs and biological agents have advantages of a more rapid onset of action and more marked efficacy, however, some patients may experience adverse reactions such as infections during treatment or relapses after drug withdrawal. Thus, their efficacy and safety still need to be further evaluated. This review summarizes research progress in small-molecule targeted drugs and biological agents in the treatment of alopecia areata.
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Alopecia areata (AA) is a common inflammatory and non-scarring hair loss condition with unknown pathogenesis, and relapses are common in some patients. Evidence has demonstrated that allergy takes part in the early onset, severe condition, recurrence, and prolonged process in AA. Allergy to dust mites may be one of the reasons for refractory severe AA, especially in childhood, possibly due to the predominance of T helper type 2 (Th2) immune response. Desensitization can suppress the Th2 immune response, alter the immune balance, and reduce disease severity during AA relapses. In addition, high IgE levels may predict favorable efficacy of dupilumab in AA patients before treatment, while high interleukin-4 levels may predict the ineffectiveness of topical immunotherapy with diphenylcyclopropenone, which works by antagonizing Th1 immune response. Therefore, serum total IgE, specific IgE to dust mites, and interleukin-4 can be considered as biomarkers, revealing the predominance of Th2 immune response in AA patients. This article focuses on the relationship between allergy and AA, as well as the role of anti-allergic reactions and desensitization in the treatment of AA, aiming to provide ideas for precise and individualized treatment of AA.
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Objective:To investigate changes of natural killer (NK) cell subsets and interleukin-18 (IL-18) level in peripheral blood of patients with alopecia areata, and to assess the regulatory effect of IL-18 on NK cell activity.Methods:A total of 67 patients with alopecia areata (alopecia areata group) and 25 healthy volunteers (control group) were collected from Shanxi Provincial People′s Hospital between December 2019 and January 2021. Peripheral blood mononuclear cells (PBMCs) and plasma were isolated. The percentage of NK cell subsets was investigated by flow cytometry, and plasma IL-18 level was measured by enzyme-linked immunosorbent assay. PBMCs were stimulated with recombinant human IL-18, and co-culture systems of PBMCs with 721.221 cells, K562 cells and P815-Ab cells were established separately. NK cell function was assessed by determining the percentage of CD107a-expressing NK cells and fluorescence intensity of CD16 + NK cells. Comparisons between groups were performed using t test or paired t test. Results:Compared with the control group, the alopecia areata group showed significantly decreased percentage of CD56 +CD16 - NK cells (8.12% ± 3.14% vs. 10.78% ± 4.08%, t = 3.33, P = 0.001) , but significantly increased percentage of CD56 +CD16 + NK cells (46.08% ± 15.21% vs. 32.14% ± 10.45%, t = 4.22, P < 0.001) , and there was no significant difference in the percentage of CD56 -CD16 + NK cells between the alopecia areata group and control group (28.81% ± 8.65% vs. 27.09% ± 7.62%, t = 0.88, P = 0.383) . The plasma IL-18 level was significantly higher in the alopecia areata group than in the control group (112.0 ± 23.72 pg/ml vs. 99.34 ± 15.15 pg/ml, t = 2.48, P = 0.015) . After co-culture with 721.221 cells, K562 cells and P815-Ab cells, the percentage of CD107a-expressing NK cells was significantly higher in NK cells from the alopecia areata group (9.53% ± 1.70%, 5.15% ± 1.35%, 6.50% ± 1.64%, respectively) than in those from the control group (5.00% ± 1.17%, 4.40% ± 1.09%, 5.13% ± 1.36%, respectively, all P < 0.05) . After the stimulation with P815-Ab cells, the alopecia areata group showed significantly decreased fluorescence intensity of CD16 + NK cells (151.10% ± 59.30%) compared with the control group (221.90% ± 93.56%, t = 4.31, P < 0.001) . After IL-18 stimulation, the percentage of CD107a-expressing NK cells significantly increased in the co-culture system of NK cells with 721.221 cells compared with the unstimulated co-culture system (14.47% ± 2.67% vs. 9.93% ± 1.94%, t = 6.00, P < 0.001) , while there was no significant difference between the IL-8-stimulated co-culture system of NK cells with K562 cells or P815-Ab cells and the unstimulated co-culture systems (both P > 0.05) . Conclusion:IL-18 could enhance NK cell activity in patients with alopecia areata, likely by promoting natural cytotoxicity receptor-mediated cytotoxicity.
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It is currently considered that alopecia areata is caused by the impairment of immune privilege in hair follicles. Stem cells have immunoregulatory functions, and can secrete a variety of cytokines to promote immune privilege in hair follicles. Stem cell therapy, especially umbilical cord- and adipose-derived stem cell therapy, has been applied to a variety of preclinical and clinical studies on alopecia, providing a new approach to refractory alopecia areata.
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Abstract Background: Alopecia areata (AA) is a hair disease that causes hair loss without scarring. The etiopathogenesis of AA has not been fully understood yet. Objective: To determine serum interleukin levels (IL-2, IL-4, IL-15, and IL-17) in patients diagnosed with alopecia areata and to investigate the relationship of IL levels with the duration and severity of alopecia areata and the response to tofacitinib therapy. Methods: Patients (≥16 years old) diagnosed with alopecia areata and healthy individuals as a control group was enrolled. Baseline serum interleukin levels of the patients and controls were measured. In the patient group receiving tofacitinib therapy, serum interleukin levels were measured again after 6 months. Disease severity for alopecia areata was assessed using the Severity of Alopecia Tool. Results: Sixty-one AA patients and 30 healthy individuals were included; they were comparable regarding age and sex. The mean disease duration for AA was 7 ± 6 years and the baseline mean Severity of Alopecia Tool score was 71 ± 30 (range, 20-100). Baseline IL-2, IL-4 and IL-15 levels were significantly higher in the patient group than those in the control group (p < 0.001 for each). No significant correlation was found between the baseline interleukin levels and either disease duration or disease severity (baseline Severity of Alopecia Tool score). Among the patients receiving tofacitinib (n = 22), all interleukin levels significantly decreased after treatment. However, no significant relationship between the change in interleukin levels and the change in the Severity of Alopecia Tool scores was observed after tofacitinib treatment. Study limitations: This is a monocentric study conducted in a single university hospital. Conclusion: High interleukin levels in alopecia areata patients and the significant decrease with treatment support the idea that interleukins have a role in pathogenesis. Nevertheless, no relationship could be demonstrated between IL levels and disease duration or severity.
Subject(s)
Humans , Adolescent , Interleukin-2 , Alopecia Areata/drug therapy , Severity of Illness Index , Interleukins , Interleukin-4 , Interleukin-15 , Interleukin-17ABSTRACT
A Covid-19, doença causadora de síndrome gripal e insuficiência respiratória aguda, vem demonstrando provocar danos a diversos outros órgãos e sistemas. Várias manifestações dermatológicas já foram descritas. Relatamos um quadro de alopecia areata (AA) desencadeada possivelmente pela Covid-19 em paciente que, apesar de ter seu RT-PCR para SARS-CoV-2 negativo, apresentou IgM reagente e sintomatologia clássica relacionada à doença. Acreditamos que a Covid-19 possa ter desencadeado resposta imunológica autoimune, com a consequente produção de interferons, que levou ao quadro de AA.
COVID-19, a disease that causes flu-like syndrome and acute respiratory failure, has been shown to cause damage to several other organs and systems. Several dermatological manifestations have been regular. We report a case of Alopecia Areata possibly triggered by COVID-19 in a patient who, despite his negative SARS-COV 2 RT- PCR, presented IgM reactor, in addition to classic symptoms related to the disease. We believe that a COVID-19 can trigger the autoimmune immune response with the consequent production of interferons that led to Alopecia areata.
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INTRODUCTION@#Alopecia areata incognita is a rare form of alopecia areata which was first reported in 1987. The prevalence of this disease is unknown but it is more common in women. The usual presentation of alopecia areata incognita is acute, diffuse hair thinning. In most cases, it lacks the typical alopetic patches seen in alopecia areata. It may resemble telogen effluvium and androgenetic alopecia. The prognosis of this disease is favorable and recovery is rapid and spontaneous. Case: A 19- year-old Filipino female presents with a two-month history of alopecia areata incognita. She initially had a solitary round patch of hair loss on the scalp with proximally tapered hair, rapidly evolving into diffuse hair thinning. CBC, TFTS, FBS, HBA 1 c, ANA and VDRL were unremarkable. Histopathology demonstrated dense peribulbar lymphocytic infiltrate, miniaturized hair and increased catagen hair consistent with alopecia areata. There was gradual hair growth after treatment with minoxidil 5% lotion and topical betamethasone dipropionate 0.05% lotion.
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Background@#Alopecia areata (AA) is the most common cause of non-scarring alopecia.1 Many studies reported decreased serum vitamin D levels in patients with AA compared to healthy subjects.1-8 This study aimed to assess the prevalence of vitamin D deficiency in patients with AA compared to patients without AA. The secondary objective was to determine the correlation between vitamin D deficiency with disease severity and the pattern of AA.@*Methods@#This research was a case control study involving patients with AA from the dermatology clinic in Hospital Raja Permaisuri Bainun. All the subjects and controls were age, sex and Fitzpatrick skin type matched. Serum vitamin D (25-hydroxyvitamin D) (25 OHD) levels were obtained and analysed by the chemiluminescence immunoassay method. AA severity was assessed by Severity of Alopecia Tool (SALT) score.@*Results@#A total of 50 subjects, out of which 25 patients with AA and 25 controls, were recruited. The median serum vitamin D level was 54.15 nmol/L (IQR 139) in the AA group and 53.79 nmol/L (IQR 64.47) in the control group. However, the difference was not statistically significant (p=0.823). The prevalence of vitamin D deficiency was higher in the AA group (12%) compared to the control group (4%), but it was not statistically significant (p=0.304). There was no statistical significance in serum vitamin D levels with disease severity (SALT score) (p=0.171) and pattern of AA (p=0.657).@*Conclusion@#There was no statistical difference in the prevalence of vitamin D deficiency between patients with and without AA. There was no correlation between serum vitamin D levels with disease severity and pattern of AA. Further studies using a larger sample size is needed to justify measuring serum vitamin D levels in patients with AA.
Subject(s)
Alopecia Areata , Vitamin DABSTRACT
Alopecia areata is a kind of non-scarring hair loss that often occurs in young adults. Alopecia areata often occurs in hairy parts of the body, with normal local skin and no self-conscious symptoms, and is a kind of temporary hair loss. The onset of alopecia areata is usually sudden and unconscious. Therefore, it is also called "ghost shaved head" in Chinese folks. Most ordinary alopecia areata patients can self-heal, but in a few cases alopecia areata will recur and it is difficult to treat. As for the causes of alopecia areata, genetic factors, mental and neurological factors, trace elements, autoimmune factors, etc. can all cause alopecia areata. Alopecia areata looks like a local lesion of the hair, but actually it involves the nervous system, immune system, circulatory system, etc. The etiology of alopecia areata is quite complicated. The possible specific mechanism of alopecia areata is as follows: the hair follicle tissue has ischemia, hypoxia, or immune damage, and then the hair root loses its physiological growth function, and finally the hair falls off. This review paper aims to classify and explain the pathogenesis of alopecia areata in detail, and provide sufficient theoretical basis for clinical treatment of alopecia areata.
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Resumen El folículo piloso es una estructura compleja que presenta diversas características morfológicas macroscópicas, microscópicas e inmunológicas especiales que permiten el adecuado funcionamiento de la misma, en algunasenfermedades estos mecanismos de regulación inmunológica se ven alteradose incluso exacerbados por factores como el estrés emocional. El objetivo de esta revisión es conocer los mecanismos inmunobiológicos específicos del folículo pilosoanalizando el papel que juegan diversos factores como la pérdida delinmunoprivilegio y el estrés emocional en el desarrollo de la alopecia areata.
Abstract The hair follicle is a complex structure that presents diverse morphologicaland immunological characteristics that allow the proper functioning of the unit.In some diseases as alopecia areata these mechanisms of immune regulation are disrupted by external factorssuch as emotional stress preventing the growth of the hair shaft. The objective of this review is to recognize the specific immunobiological mechanisms of the hair follicle, analyzing the role played by the loss of immunoprivilege and emotional stress in the development of alopecia areata.
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Introducción: Las manifestaciones cutáneas primarias de la infección por el SARS-CoV-2 se agrupan en cinco patrones clínicos dermatológicos. Sin embargo, las implicaciones de la pandemia COVID-19 en cuanto a afecciones de la piel también incluyen el empeoramiento de enfermedades cutáneas preexistentes, el aumento en la incidencia de dermatosis relacionadas con el estrés y otras relacionadas con factores físico-químicos. Objetivo: Presentar un paciente con herpes simple ocular y alopecia areata de la barba como manifestaciones cutáneas secundarias a la pandemia COVID-19. Presentación del caso: Paciente masculino, 22 años de edad, con antecedentes patológicos personales de salud aparente, estudiante de Medicina, que se encuentra realizando las labores de pesquisa activa de sintomáticos respiratorios, como apoyo al enfrentamiento a la COVID-19. Se diagnostica, aproximadamente 8 semanas después de diagnosticado el primer caso de la COVID-19 en Cuba, primoinfección de herpes simple tipo 1 ocular, con recidiva 15 días después, así como alopecia areata de la barba en placa única. Conclusiones: El herpes simple y la alopecia areata constituyen manifestaciones cutáneas secundarias a la pandemia COVID-19, debido a que las modificaciones en el estilo de vida que esta ha provocado, pueden ser el factor desencadenante de estas dermatosis relacionadas con el estrés; ante lo cual el personal de salud se encuentra más vulnerable que el resto de la población(AU)
Introduction: The primary cutaneous manifestations of SARS-CoV-2 infection are grouped into five clinical dermatologic patterns. However, the implications of the COVID-19 pandemic in terms of skin conditions also include a worsening of pre-existing skin diseases, an increase in the incidence of stress-related dermatoses and others related to physical-chemical factors. Objective: To present a patient with ocular herpes simplex and alopecia areata of the beard as secondary cutaneous manifestations to the COVID-19 pandemic. Case presentation: Twenty-two-year-old male patient, medical student, with personal pathological history of apparent health who is conducting the active investigation of respiratory symptoms in support of the confrontation with COVID-19. Primary ocular infection with herpes simplex virus type 1 with recurrence 15 days later as well as alopecia areata of the beard in single plaque were diagnosed approximately 8 weeks after the first case of COVID-19 was diagnosed in Cuba. Conclusions: Herpes simplex and alopecia areata are skin manifestations secondary to the COVID-19 pandemic. The changes in lifestyle that this disease has caused may be the triggering factor for these stress-related dermatoses to which health care personnel are more vulnerable than the rest of the population(AU)
Subject(s)
Humans , Male , Young Adult , Skin Diseases , Skin Manifestations , Students, Medical , Adaptation, Psychological , Alopecia Areata , COVID-19 , Life StyleABSTRACT
Abstract Background: Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. Objective: To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. Methods: Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. Results/Conclusions: Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.
Subject(s)
Humans , Adult , Dermatology , Alopecia Areata/drug therapy , Quality of Life , Brazil , ConsensusABSTRACT
La alopecia areata es un tipo común de alopecia no cicatricial. Aunque la patogénesis exacta permanece sin dilucidar, se piensa que la alopecia areata tiene una etiología multifactorial en donde se interrelacionan predisposición genética y factores ambientales. En pacientes susceptibles, se han documentado que el estrés, infecciones y microtraumas disminuyen las citoquinas inmunosupresoras que normalmente mantienen el privilegio inmune del folículo piloso. Actualmente no hay terapia curativa para la alopecia areata, aunque ciertos tratamientos pueden inducir el crecimiento del cabello en un porcentaje de pacientes. Se postula que la simvastatina restablece el privilegio inmune y ezetimibe aportaría un efecto inmunomodulador y antiinflamatorio. Se presenta el caso de una mujer de 23 años con alopecia areata, exitosamente tratada con simvastatina y ezetimibe.
Alopecia areata is a common type of non-scarring alo¬pecia. Although the exact pathogenesis remains elusive, alopecia areata is thought to have a multifactorial etiology described as an interplay of genetic predisposition and environmental exposures. In patients with genetic susceptibility, stress, infection, and microtrauma have been documented to decrease immunosuppressive cytokines that generally maintain the hair follicle's immune privilege. There is currently no curative therapy for alopecia areata, although some treatments can induce hair growth in a percentage of patients. It has been postulated that simvastatin reestablishes the immune privilege, and ezetimibe would provide an immunomodulatory and anti-inflammatory effect. We report a case of a 23 years-old woman with alopecia areata successfully treated with simvastatin/ezetimibe.