alopecia areata
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Introduction
A sudden loss of hair.
Etiology
- emotional disturbances
- autoimmune[3]
- atopic dermatitis
Epidemiology
- generally occurs in young, otherwise health persons
- generally presents befor 30 years of age
Pathology
- a subset of cytotoxic T-cells attack hair follicles, through IFN-gamma pathways which act via Janus kinases[7]
- preserved follicular openings
Clinical manifestations
- often abrupt onset
- painless loss of hair in patches
- complete loss of hair
- no visible effect on skin (non-scarring)
- easily extracted hairs at the periphery
- hairs may narrow close to skin at periphery
- nail pitting may be present
- ophiasis is a loss of hair in the shape of a wave at the circumference of the head
Complications
- increased risk of
- relapses common after initial resolution
Differential diagnosis
- Tinea capitis
- androgenic alopecia
- discoid lupus (scarring alopecia, dyspigmented atrophic plaques)
Management
- most cases resolve spontaneously
- watchful wating
- intralesional or topical steroids +/- minoxidil
- systemic glucocorticoids for refractory or extensive disease[3]
- anthralin cream may produce hair growth, but may result in dermatitis
- photochemotherapy, topical allergens, & minoxidil have not been shown to be superior to spontaneous resolution
- methotrexate 10-15 mg PO weekly[8]
- baricitinib (Olumiant) FDA-approved as of June 2022[14]
- baricitinib increases hair regrowth by >= 75% at 12-26 weeks[16]
Clinical trials
- oral administration of Janus kinases inhibitor ruxolitinib (Jakafi) to 5 patients with alopecia areata resulted in nearly complete regrowth of hair within 5 months[7]
- two phase 3 randomized trials of the Janus kinase (JAK) inhibitor baricitinib (Olumiant) for patients with severe alopecia areata show promising results[13] (FDA-approved as of June 2022)[14]
Comparative biology
- systemic administration of Janus kinase inhibitor prevents alopecia areata in a mouse model
More general terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 862
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 916-18
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018. 2022.
- ↑ Messenger AG et al British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol 2012 May;166(5):916-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22524397 (corresponding NGC guideline withdrawn Dec 2017)
- ↑ Wikipedia: Ophiasis http://en.wikipedia.org/wiki/Ophiasis
- ↑ Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010 Feb;62(2):177-88 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20115945
- ↑ 7.0 7.1 7.2 Xing L et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med 2014 Sep; 20:1043. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25129481
- ↑ 8.0 8.1 Callen JP Methotrexate for Alopecia Areata NEJM Journal Watch. Feb 11, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Hammerschmidt M and Mulinari Brenner F. Efficacy and safety of methotrexate in alopecia areata. An Bras Dermatol 2014 Sep/Oct; 89:729. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25184911 - ↑ 9.0 9.1 Alopecia areata (image) American Academy of Dermatology https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata
- ↑ 10.0 10.1 Bolduc C, Elston DM (images) Medscape: Alopecia Areata http://emedicine.medscape.com/article/1069931-overview
- ↑ 11.0 11.1 DermNet NZ. Alopecia areata (images) http://www.dermnetnz.org/hair-nails-sweat/alopecia-areata.html
- ↑ Gilhar A, Etzioni A, Paus R Alopecia Areata N Engl J Med 2012; 366:1515-1525. April 19, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22512484 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1103442
- ↑ 13.0 13.1 King B et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med 2022 Mar 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35334197 https://www.nejm.org/doi/10.1056/NEJMoa2110343
- ↑ 14.0 14.1 14.2 King B et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med 2022 Mar 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35334197 https://www.nejm.org/doi/10.1056/NEJMoa2110343
Frellick M FDA OKs First Systemic Treatment for Alopecia Areata, Medscape. June 13, 2022 https://www.medscape.com/viewarticle/975487 - ↑ Strazzulla LC, Wang EH, Avila L, et al. Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol. 2018;78:1-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29241771
- ↑ 16.0 16.1 Mateos-Haro M, Novoa-Candia M, Sanchez Vanegas G et al Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev. 2023 Oct 23;10(10):CD013719. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37870096 Review.
- ↑ Alopecia Areata https://www.niams.nih.gov/health-topics/alopecia-areata
National Alopecia Areata Foundation http://www.naaf.org - ↑ National Alopecia Areata Foundation http://www.naaf.org/site/PageServer
Patient information
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