Psychological Stress-Induced Pathogenesis of Alopecia Areata: Autoimmune and Apoptotic Pathways.

Alopecia areata (AA) is an autoimmune dermatological disease with multifactorial etiology and is characterized by reversible hair loss in patches. AA may be closely related to emotional stress and influenced by psychological factors as part of its pathophysiology; however, its etiology remains predominantly unknown. This review aimed to elucidate the association between AA occurrence and the neuropeptide substance P (SP) and corticotropin-releasing hormone (CRH), which are secreted during emotional stress, and have been understood to initiate and advance the etiopathogenesis of AA. Therefore, this review aimed to explain how SP and CRH initiate and contribute to the etiopathogenesis of AA. To assess the etiopathogenesis of AA, we conducted a literature search on PubMed and ClinicalTrials.gov. Overall, several authors described interactions between the hair follicles (HFs) and the stress-associated signaling substances, including SP and CRH, in the etiology of AA; this was attributed to the understanding in that AA can occur without the loss of HFs, similar to that observed in hereditary hair loss with age. Most studies demonstrated that the collapse of "immune privilege" plays a crucial role in the development and exacerbation of the AA; nonetheless, a few studies indicated that substances unrelated to autoimmunity may also cause apoptosis in keratocytes, leading to the development of AA. We investigated both the autoimmune and apoptotic pathways within the etiology of AA and assessed the potential interactions between the key substances of both pathways to evaluate potential therapeutic targets for the treatment of AA. Clinical trials of marketed/unreviewed intervention drugs for AA were also reviewed to determine their corresponding target pathways.

Seeking Pleasure or Meaning? The Different Impacts of Hedonic and Eudaimonic Tourism Happiness on Tourists' Life Satisfaction.

Although hedonic tourism happiness and eudaimonic tourism happiness coexist in tourism experiences, extant research has primarily approached them and their impact on tourists' life satisfaction separately. Therefore, the purpose of this research is to investigate the impact on life satisfaction of the two types of happiness tourists experience in various activities they encounter in tourist venues and their asymmetric effects. A survey was conducted among tourists who had tourism experiences within a year (October 2018 to September 2019) either abroad or Jeju island, and 736 responses were used in the analysis. Results from structural equation modeling analysis show that most of the hypotheses were supported. Our findings demonstrate that pleasure and detachment experience positively affect hedonic tourism happiness, while personal meaning and self-reflection experiences positively affect eudaimonic tourism happiness. Theoretical and managerial implications are discussed.