Adrenal steroid-genetic activity in subjects with alopecia totalis or subtotalis diffuse alopecia and alopecia areata.
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Direct immunofluroescence studies were performed on hairy and alopecic areas of scalp in patients with alopecia areata, alopecia totalis and male pattern alopecia. Abnormal deposits of C3 and occasionally of IgG and IgM were found in 92% of 12 patients with alopecia areata and in 21% of patients with male pattern alopecia. No abnormalities were seen in 4 patients with alopecia totalis. In both alopecia areata and male pattern alopecia, the deposits were most common along the basement zone of the inferior segment of hair follicles and occurred with equal frequency in alopecic and normal scalp. These observations suggest that immune factors may play a role in the pathogenesis of alopecia areata.
A psychological study on fifteen children with diverse etiologies of hair loss, viz., alopecia areata, alopecia totalis and trichotillomania was conducted in order to assess the degree of underlying psychodynamics in children with hair loss. The results confirm the relationship of the underlying emotional disturbance to the hair loss. Further, it appears that the more severe the psychopathology of the individual, the greater is the hair loss and/or the clinical manifestation of trichotillomania.
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Alopecia areata occurs more often in Down's syndrome than would be expected by chance, sixty cases being found among 1000 patients with this syndrome compared with one case among 1000 subnormal controls. Because alopecia areata is associated with some organ-specific autoimmune disease and thyroid antibodies are often found in Down's syndrome sera from affected patients were examined for the presence of fluorescent autoantibodies. Antibodies against thyroid components tended to be present in female mongols with alopecia areata in comparison with females in a normal population but not in male mongols. Futhermore, eight out of 23 female mongols (35%) with alopecia areata had antibodies against thyroid components compared with two out of 23 female mongols (9%) without alopecia areata.
The prevalence of male pattern alopecia, coronary artery disease, hypertension and smoking habits were studied in 478 male Caucasian hospital in-patients, over the age of 20 years. No association was shown between coronary artery disease and either male pattern alopecia, premature male pattern alopecia or male pattern alopecia with a positive family history.
Elastic fiber stain (acid alcoholic orcein) reveals diagnostically significant differences between several types of alopecia of the scalp. A short outline of elastic fiber distribution on the normal hair follicle emphasizes the elastic coat of the follicular isthmus, the sparsity of elastic fibers on the cyclic lower portion of the hair root, and the presence in the neck of the dermal papilla of an elastin-like body which is formed anew with each hair cycle. This body provides a marker of the gradual shortening of successive anagen hairs in male pattern alopecia. Patterns of elastic fibers in the perifollicular and interfollicular dermis are helpful in differentiating idiopathic pseudopelade of Brocq from pseudopeladic states secondary to lupus erythematosus and other disease processes. Within the idiopathic group, the development of elastic fibres on the lower cyclic portion of the hair root identifies a sub-group that may have a different, non-inflammatory pathogenesis and is provisionally designated as fibrosing alopecia.
Twenty-one of 65 (31%) biopsy specimens from patients with male pattern alopecia demonstrated the presence of individually displaced multinucleate giant cells without a significant concomitant cellular infiltrate. This finding was absent in a diverse group of other forms of alopecia. Whether individually displaced multinucleate cells are a useful histologic marker for diagnosing early stages of androgenetic alopecia remains to be determined.
Systemic Janus kinase inhibitors (JAKIs) have markedly advanced the therapeutic landscape for alopecia areata (AA). Although baricitinib and ritlecitinib are approved in the United States (US) and Europe, and deuruxolitinib in the US for severe AA, the lack of head-to-head randomized controlled trials (RCTs) limits evidence-based prescribing decisions. Moreover, prior meta-analyses excluded data on certain oral JAKIs or incorporated findings from agents and dosing regimens that were abandoned, investigational, clinically ineffective, or associated with unacceptable safety profiles. To compare the efficacy of oral JAKIs, limited to FDA, EMA, or MHRA approved drugs and doses-baricitinib (2 and 4 mg QD), ritlecitinib (50 mg QD), and deuruxolitinib (8 mg BID)-for severe AA, using advanced indirect comparison methodologies. A systematic review was performed following PRISMA 2020 guidelines (CRD420251116775). Bayesian network meta-analysis (NMA) synthesized data from RCTs reporting Week 24 outcomes on Severity of Alopecia Tool (SALT) ≤ 10 and SALT ≤ 20 thresholds. Multilevel network meta-regression (ML-NMR) evaluated heterogeneity and adjusted for baseline imbalances. Additionally, unanchored matching-adjusted indirect comparisons (MAIC) were conducted using individual patient-level data from THRIVE trials. Surface under the cumulative ranking (SUCRA) values were calculated to rank treatments. Seven RCTs (n = 4560 participants) were included. Deuruxolitinib 8 mg significantly outperformed baricitinib 2 and 4 mg on both SALT endpoints. Differences with ritlecitinib 50 mg were directionally favorable for deuruxolitinib but not statistically significant in NMA and ML-NMR models. MAICs confirmed superior odds for deuruxolitinib versus baricitinib 2 mg (OR = 71.55) and ritlecitinib (OR = 18.27) for SALT ≤ 20. SUCRA rankings also consistently favored deuruxolitinib. Among approved oral JAKIs, deuruxolitinib 8 mg shows the highest short-term efficacy for severe AA. These findings provide preliminary evidence to guide treatment decisions but should be interpreted as exploratory pending confirmation.
Radiotherapy is frequently employed in the management of head and neck neoplasia, either as an adjunct to surgery or as the sole treatment modality. Consequently, radiation alopecia--a well-known complication of high-dosage radiotherapy--is seen often. Longer patient survival, especially with earlier discovery of the malignancy and more refined treatment regimens, will provide the surgeon with the opportunity to treat radiation alopecia by means of the punch graft technique of hair transplantation. The technique is substantially similar to that employed in treating male pattern baldness, although the approach to the recipient and donor areas must be modified. A successful case report is documented and a modified approach is highlighted.
Cellular and humoral immune parameters were studied in 10 patients with alopecia areata totalis and universalis. Trends to low normal immunoglobulins levels and in vitro lymphocyte transformation to concanavalin A were observed. Serum CH-50 levels and skin test responses to mumps, candida, trichophytin and dinitrochlorobenzene (DNCB) not found in vitro. 1 patient with alopecia universalis of 33 years duration developed hair at the site of DNCB skin testing. The findings point to rather subtle immune defects in patients with this disease.
The skin of 214 institutionalized patients with the Down syndrome was carefully examined. There were 19 cases of alopecia areata and four cases of vitiligo. Since persons with the Down syndrome are predisposed to immunological deficiency in thymus-dependent (T-cell) function, findings from the skin examinations suggest that immunologic factors might contribute to the increased incidence of vitiligo and alopecia areata seen in the Down syndrome. Syringoma was also common and affected female patients twice as frequently as male patients.
Ninety patients with alopecia areata were treated with weekly applications to one side of the head of dinitrochlorobenzene (DNCB) dissolved in acetone, the other side of the head serving as control region. In 80 patients (89%) hair regrew either exclusively on the treated side, or considerably faster and denser on this side. The difference was noted, in the majority of cases, within eight weeks. The initial response, however, could not be maintained in all of these patients. Persistent response was observed in 72 patients (80%). Peribulbar round cell infiltrates were found to be more constant and denser on the treated side, suggesting that topically applied DNCB affects the peribulbar infiltrate present in alopecia areata. Possibly, the therapeutic result is due to altered local immunoregulation.
Alopecia mucinosa was found in the hypopigmented skin of two black patients. Alopecia mucinosa should be included in the differential diagnosis of hypopigmented papular skin lesions.
Persistent refractory alopecia areata in 26 patients was treated topically with dinitrochlorobenzene (DNCB). Sixteen patients have had excellent regrowth of hair; three patients could either not be initially sensitized or an adequate allergic contact dermatitis on the scalp did not develop. Two patients discontinued therapy within two months; hair growth did not develop in five patients despite an adequate trial. Augmentation of the T-lymphocyte pool via DNCB sensitization and challenge may become effective therapy for some patients with severe alopecia areata.
A new concept and technique of treatment of male-pattern alopecia are described. The concept is to remove, in serial stages, segments of skin that measure about 3 cm by 7 to 10 cm from the bald area of an alopecic scalp, and to raise the remaining hairy portion into the previously bald area.The technique consists of undermining the skin in the normal plane of cleavage between the galea and the sub-aponeurotic loose connective tissue after each removal of bald skin and "lifting" of hairy skin into the operative defects as they are obliterated by primary closure. By this method, which we call hair-lifting, the patient benefits also from an associated partial face-lift. Whatever remains of baldness after as much hair-lifting as feasible has been performed, is filled with "punch" grafts or free or pedicled strips. Each stage of the procedure is done under local anesthesia. The entire procedure is particularly suitable for tonsure baldness in men and even in the skull-cap type of androgenic alopecia in women.
A sixty-eight year old woman with lichen sclerosus et atrophicus since the age of fity-two, alopecia totalis since the age of thirty-six, and polymyalgia rheumatica since the age of fifty-eight is presented. Besides alopecia totalis, the patient has typical lichen sclerosus et atrophicus changes on the trunk, upper arms, and thighs, and at the first visit an ulcer on her left breast. An immunologic link between her three diseases is suspected. As shown in this case Wood's light is of great value in depigmented skin changes.
BACKGROUND: Alopecia areata (AA) is a multifactorial disorder with immune dysregulation and genetic susceptibility, affecting 0.5-2% globally. OBJECTIVE: This study investigated angiotensin converting enzyme (ACE) gene insertion /deletion (I/D) polymorphism and serum ACE activity in Iraqi AA patients and their association with inflammatory cytokines (interleukin [IL]-17) and nutritional markers to understand disease progression. METHODS: This case-control study included 50 AA patients (Male and Female) and 35 healthy controls. ACE gene polymorphism (rs1799752) was analyzed using real-time polymerase chain reaction (qPCR) with high-resolution melting (HRM) analysis. Serum IL-17 levels were determined by enzyme-linked immunosorbent assay (ELISA), and biochemical markers were measured using an automated analyzer. RESULTS: ACE gene polymorphism (rs1799752) showed non-significant genotype distribution between patient and control groups (p > 0.05), though a trend toward DD genotype enrichment was observed in patients. Serum ACE levels were significantly higher in patients versus controls (p < 0.0001) with high diagnostic performance. ACE correlated positively with IL-17 (P < 0.0001) and negatively with vitamin D3 and zinc (P < 0.0001). Female patients had significantly higher ACE levels than males (P < 0.01). CONCLUSIONS: ACE emerges as an immunometabolic hub in AA pathogenesis, integrating inflammation with nutritional deficits, suggesting its potential as a biomarker and therapeutic target.