Current and future pharmacotherapy for alopecia areata

Introduction: Alopecia areata is a genetic and inflammatory disease that causes cosmetic and emotional distress. Current treatments are mainly focused in controlling inflammation, thus allowing hair regrowth, but not preventing relapse. Recent advances in the knowledge of the pathogenesis at the immunological and genetic level have provided new therapeutic approaches for this condition. Areas covered: Literature regarding available and future treatment options for alopecia areata was reviewed. We describe the mechanisms involved in its physiopathology and discuss extensively existing evidence for current treatment and status of new drugs, which act on specific target molecules such as Janus kinase (JAK) inhibitors, abatacept, IL-2, Hu-Mik-β-1, anti-IFN-γ, platelet-rich plasma (PRP), stem cell educator therapy, ezetimibe/simvastatin and tianeptine. Expert opinion: Advances in the knowledge of the physiopathology of alopecia areata have led to the discovery of new therapeutic targets for this illness. Treatments that have been successful in case reports or small studies are JAK inhibitors, abatacept, IL-2, anti-IFN-γ, PRP, ezetimibe/simvastatin and tianeptine. Even though these drugs have different mechanisms of action, their success will direct future research on drugs that act on a specific target. More clinical trials are needed to establish the safety and efficacy of these drugs, however, new treatment strategies are underway

Scalp Itch: A Systematic Review

Scalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients

The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women

Hair shedding is a common consequence of the normal hair cycle that changes with internal and external factors. Female pattern hair loss (FPHL) is difficult to assess in terms of shedding severity as the conscious perception of hair shedding varies according to each individual, and most utilized methods are semi-invasive or very time consuming. In this study, we establish and validate a hair-shedding scale for women with thick hair of different lengths. A visual analog scale was developed for thick hair of short, medium, and long lengths by dividing a bundle of hairs of each length into nine piles of increasing hair amount that were then photographed and arranged in order of size. Twenty women with no FPHL with each length of hair (60 total) were asked to select the photographed hair bundle that best correlated with the amount of hair they shed on an average day. A total of 94 women with FPHL with excessive shedding were then asked to repeat the same process. Women with no FPHL and short, medium and long hair had mean shedding scores of 2.5, 2.35 and 2.4, respectively. Women with FPHL and short, medium and long hair had mean shedding scores of 7.25, 7.0 and 7.14, respectively. Statistically significant Spearman's ρ coefficient and κ coefficient demonstrated correlation and inter-observer reliability. Our results show that women with FPHL not only shed considerable hair more than women with no FPHL, but that this hair-shedding visual scale is a fast and effective method of evaluating hair-shedding amounts in an office setting

Scalp Rosacea: Rethinking Peripilar Scaling

Introduction: Scalp rosacea is scarcely reported in the literature, but it is probably not uncommon. Trichoscopic findings have not been specifically established for this entity. Case Presentation: We report 4 cases of chronic scalp rosacea with trichoscopic evidence of peripilar scaling that resolved without scarring after treatment. Discussion/Conclusion: Chronic and persistent inflammation around the isthmus produced in scalp rosacea may form peripilar scaling resembling that found in lichen planopilaris

Frontal Fibrosing Alopecia Severity Index: A Trichoscopic Visual Scale That Correlates Thickness of Peripilar Casts with Severity of Inflammatory Changes at Pathology

Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies. However, since progression of FFA is very slow, it is very important to develop a noninvasive technique to assess disease activity to monitor treatment response. To provide a standardized and objective method to assess FFA activity. We evaluated the correlation between trichoscopy and pathological features (degree of lymphocytic infiltration) in 20 dermoscopy-guided biopsies of FFA. At trichoscopy, we divided the severity of peripilar casts into 3 grades according to their thickness. To validate the trichoscopic visual scale, we showed the images to 7 dermatologists with interest in hair diseases. Concordance was assessed using the Kendall Tau-b concordance test. A strong correlation between severity of peripilar casts at trichoscopy and degree of lymphocytic infiltrate was observed by the Kendall Tau-b test. Validation showed very good inter- and intraobserver agreement. The trichoscopic visual scale allows noninvasive assessment of scalp inflammation in FFA in different scalp regions and therefore provides optimal guidance for treatment

Association of Trichorhinophalangeal Syndrome and Loose Anagen Syndrome: A Case Report

Trichorhinophalangeal syndrome (TRPS) is an autosomal dominant disease characterized by trichologic, craniofacial, and musculoskeletal abnormalities. Predominant clinical features include a pear-shaped nose with bulbous tip, long philtrum, protruding ears, and sparse hair on both the scalp and the lateral third of the eyebrows. Cone-shaped epiphyses are a common radiographic finding. Loose anagen syndrome (LAS) is a sporadic or autosomal dominant condition due to abnormalities in the hair’s anchoring mechanism. It mostly affects children, who usually have reduced hair length, as well as hair that is easily plucked without pain. Recent contributions regarding trichoscopic findings of LAS have been made, describing rectangular black granular structures as a typical feature. An association between TRPS and LAS has been mentioned by hair experts, but no reports documenting this have been published. This case demonstrates the co-existence of both conditions in a patient with characteristic phenotypic traits of TRPS and LAS

Angioimmunoblastic T-Cell Lymphoma: A Diagnostic Challenge

Angioimmunoblastic T-cell lymphoma (AITL) accounts for 15-20% of all peripheral T-cell lymphomas. It is a rare subtype of CD4 T-cell peripheral lymphoma that affects aged individuals, causing B symptoms, generalized lymphadenopathy and hepatosplenomegaly. Its pathogenesis is still unclear, but in some cases it has been associated with infection, allergic reaction or drug exposure. The majority of patients are diagnosed in an advanced stage and anthracycline based regimen is considered the first-line therapy. Skin involvement is not well characterized, occurring in up to 50% of patients and presenting as nonspecific rash, macules, papules, petechiae, purpura, nodules and urticaria. We present the illustrative case of a 55-year-old woman with an AITL who presented prominent skin findings, arthritis, lymphadenopathy and hypereosinophilia. Skin biopsy reported a T-cell lymphoma and the diagnosis of AITL was confirmed by an axillary lymph node biopsy, which was also positive for Epstein-Barr virus. Chemotherapy with CHOP-21 and thalidomide was given, accomplishing complete remission after six cycles

How to Evaluate Treatment Response in Hair Diseases

When treating patients with scalp diseases, it is essential to be able to evaluate treatment response. Treatment response will allow further decision-making such as increasing or decreasing treatment dose, changing the treatment vehicle, changing therapy, or adding adjuvant treatments. Sometimes, hair disorders have multifactorial causes, so response to treatment may be affected not only by the prescribed therapy but also by other factors. Follow-up must include photographic and trichoscopic documentation, as well as inquiring about patient coping and expectations. Treatment goals must be clear to the patient. We should consider that a patient might have more than one disease or a new disease can appear such as contact dermatitis, impetigo, or tinea. If there is no response after 3–6 months of therapy with good patient compliance, a trichoscopy-guided biopsy might reveal valuable information. Another important challenge to be considered is cicatricial alopecia; even to the most trained eye, cicatricial diseases can mimic noncicatricial pathologies, and cicatricial alopecias tend to have an initial inflammatory phase in which no cicatricial findings are found. Dynamic trichoscopy is the best way to evaluate treatment response since it allows the assessment of trichoscopic signs of active disease. This assessment will benefit therapeutic decision and selection of a biopsy area. Knowledge of trichoscopic signs of active inflammation and signs of fibrosis in each disease will enable the clinician to understand that trichoscopy allows to identify the mechanisms of the disease rather than pathognomonic and unchanging signs. In this chapter, we will describe every step to be taken in all the possible presentations that a physician could face during treatment of hair disorders. The authors have tried to summarize and explain step by step what to expect, how to evaluate, and what to do when treatment is not working, trying to offer a guidance for all those who help patients with hair disorders

Habitabilidad y política de vivienda

En esta obra, en la que participan destacados investigadores y profesores, dedicados al estudio de la problemática habitacional se presentan diferentes análisis que permiten conocer cuales son las condiciones de habitabilidad y las características de la actual política de vivienda de México. En sus capítulos se abordan los principales desafíos que enfrentan las familias mexicanas para acceder a una vivienda digna y decorosa y cuales son los retos económicos, políticos, territoriales, arquitectónicos, ambientales, financieros y culturales de las formas de producción habitacional en México y en otros países, en el marco de una sociedad global