Investigating Alopecia Areata and its Connection to The High-Mobility Group Box 1: Review Article

Background: It is a common and reversible hair loss illness known as alopecia areata (AA). Hair loss on the scalp and other regions of the body can begin as a patchy area of full hair loss which may develop to the entire loss of all hair on the body. It is uncertain what causes AA but it is characterized by hair cycle disruption and the presence of mononuclear cell infiltrates in the perifollicular, as well as peribulbar areas. There have been numerous studies that have shown that AA has been linked to various autoimmune illnesses, including vitiligo. Autoimmune disease is becoming more prevalent, and researchers have found a link between chronic inflammation and HMGB1 (high-mobility group box 1). Objective: To evaluate the role of (HMGB1) protein in pathogenesis of AA. Conclusion: HMGB1 is a promising predictor of prognosis and treatment responsiveness in the pathophysiology of alopecia areata

A randomized, double blind, placebo controlled, split patch study to evaluate the effects of platelet rich plasma on alopecia areata

Background: Alopecia Areata is a T-cell–mediated autoimmune, often reversible disease in which the gradual loss of protection provided by immune privilege of the normal hair follicle plays an important role. It manifests as smooth, slightly erythematous (peach color) or normal-colored alopecic patches with short broken hair at the margins. It involves scalp most commonly, although other regions of body may be affected. Platelet rich plasma is an autologous concentration of platelets with a greater count in a small volume of plasma. Study aimed to evaluate the safety and efficacy of PRP therapy in Alopecia Areata.Methods: In this randomised, placebo controlled, split patch study, 30 patients of AA were recruited and injected with 1-1.5ml of autologous PRP made by double spin method into half the bald patch area and other half with placebo using insulin syringe once a month for 3 months. Outcome was assessed at the end of study by clinical photographs as regrowth of hair, dermoscopy findings as reduction in black dots, yellow dots and exclamation hair and Physician and patient self-assessment score.Results: Administration of autologous PRP has led to observable improvement in 20% case of PRP and only 3.3% of control cases. Decrease in number of dystrophic hair and hair regrowth with PRP was seen in 20% cases and in 17% patches.Conclusions: PRP in our setting was found to be minimally effective, but more efficacious than no treatment, and safe for AA patients

Revisions of Theophanes Chrysobalantes De Curatione [version 2; referees: 4 approved]

Background: Theophanes Chrysobalantes' De curatione is a little known but highly relevant therapeutic manual dating to the tenth century AD. The text has come down to us in  an unusually large number of manuscripts, most of which transmit a mainstream version of the text. Methods: In the present article, three versions deriving from the mainstream text are being examined. For this, these versions are being compared to the mainstream text, in order to understand the aim behind the alterations and additions they were subjected to. The overarching goal is to understand, why these changes were made, and how skilled the editors were. It is a rather unusual approach, as divergent versions are usually not examined in research literature, since they are secondary to the original text. Results and conclusions: The results clearly show that the text was redacted several times, but not by highly sophisticated editors. The general aims of the redactions were to make the text easier to understand

Alopecia Areata

Alopecia areata is an organ-specific autoimmune disease targeting hair follicles. It causes nonscarring hair loss. The prevalence rate of the disease is approximately 1 in 1000 people worldwide. The condition is most commonly seen as circular areas of hair loss, but it may sometimes be as extensive as to involve the whole scalp or whole body. The complex pathophysiology of alopecia areata involves an autoimmune basis. Association of alopecia areata with other autoimmune diseases, such as thyroiditis and vitiligo, and the good response of patients to immunosuppressive treatment support an autoimmune etiology. Although some poor prognostic signs are defined, the course of the disease is unpredictable and the response to treatment can be variable. To date, there are neither preventive nor curative measures to deal with the condition. First-line therapy for patchy disease is topical and intralesional steroids, whereas extensive disease is conventionally managed with immunotherapy. New treatment agents, such as excimer laser, low-dose recombinant interleukin 2, Janus kinase inhibitors, and simvastatin/ezetimibe, are promising

Alopecia areata – Current understanding and management

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed

New Modalities in the Treatment of Refractory Alopecia Areata

Alopecia areata (AA) is a common and complex T-cell–mediated inflammatory disorder. It may be patchy (localized), involve the entire scalp (alopecia totalis) or entire body (alopecia universalis). Alopecia totalis and universalis are often difficult to treat. Although many therapeutic options currently exist in alopecia areata, none of them are curative or preventive. Besides, none of them are approved by Food and Drug Administration (FDA). The disease unfortunately has an unpredictable course. The factors indicating a poor prognosis are the extent of hair loss at the presentation, long duration of the disease, and ophiasis pattern of hair loss. There are only a few randomized controlled studies conducted on recalcitrant AA. Recent research on immunology of hair follicle and recent developments in immunopathogenesis, together with the shared pathways of the disease with other autoimmune disorders, led investigators to focus on novel therapies that target specific immunological pathways. Herein, we will review shortly the current treatment options in recalcitrant alopecia areata based on recently published studies and then will focus on the recently developed broad-spectrum and targeted therapeutics

Comparison of oral prednisolone pulse therapy with intravenous methylprednisolone pulse therapy in severe alopecia areata

Objective: To compare the efficacy of oral prednisolone pulse therapy in comparison to the intravenous methylprednisolone pulse therapy in treatment of severe alopecia areata. Patients and methods: In this interventional study, all patients with alopecia areata having at least 30% involvement of scalp or more than 10 patches of alopecia in scalp and body, registered during 2006-2009 in dermatologic department of 5-Azar hospital, Gorgan, Northeast of Iran were included. Forty patients with severe alopecia areata were enrolled and divided into 2 groups. Group A was treated with 200 mg oral prednisolone in one dose, every week for 3 months and group B were treated with 500 mg intravenous methylprednisolone on 3 continuous days each month for 6 months. Results: Recovery rate after 1, 3, 6 and 12th months after treatment was significantly higher in group B compared to group A. Side effects included: acne (5 in group A and 7 in group B), heartburn (4 in group A and 5 in B), striae (4 in group A and 6 in group B) and were more seen in group B but it was not significant statistically. The recovery and rate was not significantly different between two sexes. Conclusion: In this study, 500 mg intravenous methylprednisolone in 3 continuous days each month for 6 months showed a better recovery rate in severe alopecia areata. Patients must be warned about the side effects and outcomes

Frontal Fibrosing Alopecia: A Review

This article is part of the Ph.D. thesis of María Librada Porriño-Bustamante.Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review