Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata

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.

Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology

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.

Reporte de manejo exitoso con simvastatina y ezetimibe en alopecia areata / A report of successful management with simvastatin plus ezetimibe in alopecia areata

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.

Tratamiento con tofacitinib en adolescentes con alopecia areata / Tofacitinib as a treatment of alopecia areata in adolescents

Resumen Introducción: Actualmente no existe un tratamiento estandarizado para la alopecia areata (AA) grave. Se han reportado numerosos casos exitosos del uso de tofacitinib; sin embargo, no existen publicaciones en México. En este trabajo se reportan cuatro casos de pacientes mexicanos con AA grave tratados con tofacitinib oral. Métodos: Serie de casos de adolescentes con alopecia grave tratados con tofacitinib oral. Para determinar la respuesta al tratamiento se utilizó la Escala de gravedad de alopecia (Severity of alopecia tool). Resultados: Se incluyeron cuatro pacientes de entre 13 y 19 años con AA. En todos los casos se observó crecimiento de cabello y disminución de la gravedad de la alopecia después del tratamiento con tofacitinib. En dos pacientes se observó una respuesta intermedia (del 51 al 90%), y en los otros, moderada (del 6 al 50%), sin efectos adversos serios. Las limitaciones del estudio fueron el tamaño reducido de la muestra y la naturaleza retrospectiva de la recolección de los datos. Conclusiones: El tofacitinib demostró ser una buena alternativa de tratamiento para la AA, total y universal, refractarias a otras terapias.

Abstract Background: Currently, no standardized treatment for severe alopecia areata (AA) exists. Numerous successful cases of the use of tofacitinib have been reported in the world literature, but not in Mexico. Four Mexican adolescents with severe AA treated with oral tofacitinib are reported in the present work. Methods: Series of cases of adolescents with severe AA treated with oral tofacitinib. The severity of alopecia tool was used to determine the response to treatment. Results: Four patients from 13 to 19 years old, were included. In all cases, hair growth was observed, and the alopecia severity decreased after the treatment with tofacitinib. In two patients, an intermediate response (from 51 to 90%) was observed; in the other, a moderate response (from 6 to 50%) was observed, without serious adverse effects. The limitations of the study were the small sample size and the retrospective nature of data collection. Conclusions: Tofacitinib showed to be a good treatment alternative for AA, total and universal, refractory to other therapies.

A systematic review of nursing research priorities on health system and services in the Americas / Revisión sistemática de las prioridades de investigación de enfermería en sistemas y servicios de salud en la Región de las Américas

OBJECTIVE: To systematically review literature on priorities in nursing research on health systems and services in the Region of the Americas as a step toward developing a nursing research agenda that will advance the Regional Strategy for Universal Access to Health and Universal Health Coverage. METHOD: This was a systematic review of the literature available from the following databases: Web of Science, PubMed, LILACS, and Google. Documents considered were published in 2008-2014; in English, Spanish, or Portuguese; and addressed the topic in the Region of the Americas. The documents selected had their priority-setting process evaluated according to the "nine common themes for good practice in health research priorities." A content analysis collected all study questions and topics, and sorted them by category and subcategory. RESULTS: Of 185 full-text articles/documents that were assessed for eligibility, 23 were selected: 12 were from peer-reviewed journals; 6 from nursing publications; 4 from Ministries of Health; and 1 from an international organization. Journal publications had stronger methodological rigor; the majority did not present a clear implementation or evaluation plan. After compiling the 444 documents' study questions and topics, the content analysis resulted in a document with 5 categories and 16 subcategories regarding nursing research priorities on health systems and services. CONCLUSIONS: Research priority-setting is a highly important process for health services improvement and resources optimization, but implementation and evaluation plans are rarely included. The resulting document will serve as basis for the development of a new nursing research agenda focused on health systems and services, and shaped to advance universal health coverage and universal access to health.

OBJETIVO: Revisar sistemáticamente la bibliografía sobre las prioridades de investigación de enfermería en materia de sistemas y servicios de salud en la Región de las Américas, como un paso más en la elaboración de un programa de investigación de enfermería que impulse la Estrategia Regional para el Acceso Universal a la Salud y la Cobertura Universal de Salud. MÉTODOS: Se llevó a cabo una revisión sistemática de la bibliografía disponible en las siguientes bases de datos: Web of Science, PubMed, LILACS y Google. Se tuvieron en cuenta los documentos publicados del 2008 al 2014 en inglés, español o portugués, y que trataran del tema en el ámbito de la Región de las Américas. En los documentos seleccionados se evaluaron los procesos de establecimiento de prioridades según los "nueve temas comunes para buenas prácticas en establecimiento de prioridades de investigación de salud". Mediante un análisis de los contenidos se recopilaron todas las preguntas y temas de estudio, y se clasificaron los documentos por categorías y subcategorías. RESULTADOS: De los 185 artículos o documentos de texto completo evaluados, se seleccionaron 23: 12 procedían de revistas con revisión por pares, 6 de publicaciones de enfermería, 4 de ministerios de salud y 1 de una organización internacional. Las publicaciones de las revistas mostraron un mayor rigor metodológico; la mayoría no presentaba un plan definido de ejecución o evaluación. Después de compilar las 444 preguntas y temas de estudio de los documentos, el análisis de los contenidos dio lugar a un documento con 5 categorías y 16 subcategorías con respecto a las prioridades de investigación de enfermería en materia de sistemas y servicios de salud. CONCLUSIONES: El establecimiento de prioridades de investigación es un proceso muy importante para la mejora de los servicios de salud y la optimización de los recursos, pero raramente se incluyen planes de ejecución y evaluación. El documento resultante servirá de base para la elaboración de una nueva agenda de investigación de enfermería centrada en los sistemas y servicios de salud, y configurada para impulsar la cobertura universal de salud y el acceso universal a la salud.

Intravenous methylprednisolone pulse therapy in severe alopecia areata.

Background: Severe, extensive, therapy resistant alopecia areata represents a clinical challenge. Systemic corticosteroids are a therapeutic tool that still needs to be evaluated. Aim: The purpose of this study was to assess the efficacy and safety of methylprednisolone pulse therapy in alopecia areata and to find prognostic factors for a favourable outcome. Methods: A total of 32 patients with severe multifocal alopecia areata (more than 40% scalp hair loss), alopecia totalis, and alopecia universalis were treated with infusions of 500 mg methylprednisolone for 3 days every month for 3 consecutive months. The end point of the study was 12 months. Results: Of 32 patients, 26 (81.3%) reported a clinical response. Four patients (12.5%) showed complete hair regrowth, 6 patients (18.8%) showed >50% hair regrowth, ten (31.3%) had <50% hair regrowth, 6 (18.75%) were non responders, and another 6 patients (18.8%) had relapse after an initial regrowth. Multivariate analysis revealed that patients reporting at the first episode and those with multifocal disease had the best results. Conclusion: Methylprednisolone infusions represent a possible therapeutic option for patients with multifocal alopecia areata and those presenting with the first episode of the disease.

Efficacy and safety of methotrexate in alopecia areata

BACKGROUND: Alopecia areata is a chronic disorder of the hair follicles and nails, of unknown etiology, with clear autoimmune components and genetic factors. Several therapeutic options have been suggested; however, no treatment is able to modify the disease course. Methotrexate is an immunosuppressant used in various dermatoses and recently introduced as a therapeutic option for alopecia areata. OBJECTIVES: To evaluate the efficacy and safety of methotrexate in alopecia areata. METHODS: In a retrospective, non-controlled study, we evaluated 31 patients with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, cumulative dose of methotrexate, use of systemic corticosteroids or other treatments, and drug safety. RESULTS: Regrowth greater than 50% was observed in 67.7% of patients, with the best responses observed in those with <5 years of disease progression (79%), age over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving systemic corticosteroids in combination with methotrexate, 77.3% had greater than 50% regrowth, compared with 44.4% in those who used methotrexate alone. The therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 33.3% of patients with more than 50% regrowth. CONCLUSION: Methotrexate appears to be a promising and safe medication for the treatment of severe alopecia areata when used alone or in combination with corticosteroids. .

Alopecia areata: An update.

Alopecia areata (AA) is a common form of non-scarring hair loss of scalp and/or body. Genetic predisposition, autoimmunity, and environmental factors play a major role in the etiopathogenesis of AA. Patchy AA is the most common form. Atopy and autoimmune thyroiditis are most common associated conditions. Peribulbar and intrabulbar lymphocytic infl ammatory infi ltrate resembling “swarm of bees” is characteristic on histopathology. Treatment is mainly focused to contain the disease activity. Corticosteroids are the preferred treatments in form of topical, intralesional, or systemic therapy. Camoufl age in the form of wigs may be an alternative option in refractory cases.

Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of alopecia areata.

Background: Intralesional corticosteroids are the treatment of choice for adults with less than 50% of scalp area involvement with alopecia areata. The sensitivity of picking up clinical response to treatment by clinical examination is very variable and has inter individual variation. Aims: To evaluate the efficacy of intralesional triamcinolone acetonide in the treatment of alopecia areata and to use dermoscopy to identify signs of early clinical response and adverse effects. Methods: Seventy patches in 60 patients were injected with steroid at 4 weeks interval and followed up for 24 weeks. Treatment response was evaluated using regrowth scale (RGS). Heine DELTA 20; dermatoscope was used to assess disease activity, response to treatment and side effects. Results: Twenty eight patients responded early and achieved RGS of 4 within 12 weeks and 29 patients responded late and achieved RGS of 4 within 24 weeks of initiating therapy. There were 3 patients who did not achieve RGS of 4 at 24 weeks. Late and incomplete responders showed statistically significant association with family history of alopecia areata (p < 0.0001), presence of recurrent disease (p = 0.0147) and presence of nail changes (p = 0.0007). Dermoscopically, 60 patches demonstrated regrowth of new vellus hair at 4 weeks. Tapering hair disappeared maximally at 4 weeks. At 12 weeks, complete disappearance was seen in tapering hairs, broken hairs and black dots whereas for yellow dots to disappear completely in all patches it took 16 weeks. The adverse effects were observed at an earlier stage using dermoscopy than clinically. Conclusion: Intralesional triamcinolone acetonide is efficacious for treatment of localized patchy alopecia areata. Dermoscopy is very useful to identify signs of early clinical response, adverse effects and markers of disease activity.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.

Alopecia areata of dental origin in a child.

Alopecia areata (AA) is a chronic inflammatory disease that involves the hair follicle. Current evidence indicates that hair follicle inflammation in AA is caused by a T-cell-mediated autoimmune mechanism occurring in genetically predisposed individuals. AA has a reported incidence of 0.1%-0.2%, with a lifetime risk of 1.7%. It has also been found that AA accounts for roughly 2% of new dermatology outpatient cases in the US and the UK, 3.8% of cases in China and 6.7% of cases in Kuwait. Pediatric AA constitutes approximately 20% of all AA cases. AA affects males and females equally. The most common site to be affected is the scalp (90%). The face, eyebrows, eyelashes, beard, underarm hair, and pubic hair may be affected and, sometimes, even the entire body. AA requires combined therapy, involving topical or intralesional corticosteroids, immune therapy with diphenylcyclopropenone, and even psychotherapy. In some cases, treatment consists of simply eliminating the dental infectious process. This case report describes AA of dental origin in a 9-year-old girl, which resolved after management of the dental problem.

Tratamento dermato-odontológico para a alopécia areata. Relato de caso clínico / Dental-dermatological treatment for alopecia areata: case report

A alopécia areata é uma dermatite frequente, caracterizada pela perda de pelo no couro cabeludo, na barba ou em qualquer área pilosa do corpo, em ambos os gêneros e em qualquer idade. A sua etiopatogenia parece ser diversificada e está, por vezes, relacionada com fatores bem definidos, tais como infecções dentárias. Devido à localização em zonas visíveis, como a face, esta desordem dermatológica apresenta um impacto psicológico signifcativo nos seus portadores. Este artigo apresenta um caso clínico de inclusões dentárias e de alopécia areata, resolvido por meio da eliminação dessas inclusões dentárias conjuntamente com um tratamento dermatológico. Com este trabalho, os autores pretendem demonstrar a relação existente entre a inclusão dentária e o aparecimento da alopécia areata, bem como o tratamento preconizado para essa situação clínica.

Alopecia areata is a common dermatitis described by the loss of hair on the scalp, beard or any area of the body with hair follicles, affecting both sexes in any age. Although its etiology seems somewhat multifactorial, in some clinical cases specifc factors can be identified, like teeth infections. Due to the location in anterior locations like the face, this dermatological disorder has a huge psichologic impact the patients. This paper presents a clinical case of impacted teeth and alopecia areata, which was solved by the removal of those teeth and simultaneously with a dermatological treatment. The authors try to demonstrate the relation between impacted teeth and alopecia areata, as well as the standard treatment for this clinical situation.

Efficacy of combination therapy for the management regime of Alopecia areata.

Alopecia areata is a world wide cosmetic problem. Cases are seen in Bangladesh. Due to financial constraint and lack of modern facilities the patients of this country needs cheap, easily available and conveniently usable treatment modality. The present study revealed that the oral administration of prednisolone for 06 weeks followed by topical application of 02% minoxidil for another period of 14 weeks is noninvasive and could act as better remedy for alopecia areata. It is claimed that steroid could induce hair growth through immunosuppression rather than a direct effect on hair growth promotion. When applied together steroid it induced regrowing hair gave more encouraging result. The combination therapy indicated that the gradual loss of hair could be minimized and regrowth of hair could be made possible. To fulfill the demand for the best compliance of treatment modality further study should be directed and dictated amongst a large group of population.