Claudin-3 is a novel intestinal integrity marker in patients with alopecia areata: Correlation with the disease severity

Background

The development of alopecia areata is suggested to be influenced by intestinal permeability and gut dysbiosis. Claudin-3, an essential component of tight junctions which may act as an indicator of intestinal barrier integrity.

Aims

The study's objective was to evaluate the plasma concentration level of Claudin-3 in alopecia areata patients and its relationship to the severity of the condition.

Patients and Methods

In this case–control study, 50 alopecia areata patients and 30 healthy age and sex controls were involved. An enzyme-linked immunosorbent assay was used to determine the concentration of claudin-3 in the blood.

Results

Patients with alopecia areata had significantly higher plasma claudin-3 concentrations than healthy controls [median (interquartile range), 7.73 ng/ml (4.49–33.7) vs. 6.14 ng/ml (4.45–15.6), p < 0.005]. Positive relations were found between claudin-3 and SALT score (r = 0.675 & p-value < 0.001).

Conclusions

Claudin-3, a gut permeability biomarker, is elevated in alopecia areata and correlates with disease severity.     

Serum brain-derived neurotrophic factor and vitamin D: Two concordant players controlling depression among alopecia areata and vitiligo patients: A case–control study

Background

Depression is a common psychiatric comorbidity among chronic dermatology patients. There is extreme lacking in the research studying biomarkers responsible for it. Both brain-derived neurotrophic factor (BDNF) and vitamin D have a significant role in the development of depression.

Aim

To assess BDNF and vitamin D serum levels in different clinical verities of alopecia areata (AA) and vitiligo patients, correlating them with depression prevalence and quality of life.

Methods

In all, 30 AA patients, 30 vitiligo patients, and 30 healthy volunteers were included. Both alopecia and vitiligo severity and activity were evaluated using the suitable clinical scores. Depression was assessed using Beck depression inventory (BDI) scale and quality of life was recorded using Dermatology Life Quality Index (DLQI). Both serum BDNF and vitamin D levels were investigated using ELISA.

Results

In both alopecia and vitiligo patients, serum BDNF and serum vitamin D were significantly lower compared to controls (p = 0.001 for both). Both were associated and negatively correlated with BDI and DLQI. Regarding alopecia, they showed a significant decline in more sever disease and with longer disease duration. However, in vitiligo, BDNF (p = 0.001) and vitamin D (p = 0.03) correlated negatively with disease activity, but not with disease severity. Serum BDNF and vitamin D correlated positively with each other (p = 0.001) in both AA and vitiligo cases.

Conclusion

The inverse association of both serum BDNF and vitamin D with depression, and the positive correlation noted between their serum levels, may indicate a potential combined effect of these two players on development of depression and its negative health-related outcomes.     

Efficacy of Jessener solution versus intralesional steroid in treatment of alopecia areata

Background

Alopecia areata is an autoimmune condition that causes non-scarring hair loss. To date, there is no single cure and treatment remains challenging.

Objectives

To evaluate the efficacy of Jessener solution versus intralesional steroid in treatment of Alopecia Areata.

Methods

This study included 40 patients who presented with multifocal patchy alopecia areata (AA). For each patient, three patches were randomly selected to be treated one with intralesional steroid, another with topical Jessner solution and the third with normal saline. Three sessions were done 3 weeks apart and were followed up for 3 months. Response was assessed clinically and by trichoscope.

Results

Fifteen percent of patches coated with Jessner or injected with steroids showed an excellent response while 20% of patches coated with Jessner and 32.5% patches injected with steroids showed a good response. A significant difference was observed between the three modalities of treatment regarding the prognostic score for response (p < 0.001) as patches coated with Jessner and those steroid injected showed a significant higher response rate than patches injected with saline (p < 0.001) while no significant difference was reported between patches either treated with Jessner or steroids (p > 0.05).

Conclusion

Jessners solution can be a novel and feasible and well tolerated modality of treatment for patients suffering from alopecia areata.     

The burden of gout in acne keloidalis nuchae—Insights from a population-based study

Background

The risk of gout amid patients with acne keloidalis nuchae (AKN) has not been investigated in the past.

Objective

To assess the risk of developing gout among patients with AKN relative to control subjects.

Methods

A population-based retrospective study followed patients with AKN (n = 2677) and age-, sex-, and ethnicity-matched control subjects (n = 13 190). The incidence of new-onset gout was compared between the two groups. Hazard ratio (HR) for the risk of gout was obtained using a multivariate Cox regression model.

Results

The incidence rate of gout was 1.12 (95% CI, 0.68–1.76) and 0.48 (95% CI, 0.34–0.66) per 1000 person-years among patients with AKN and controls, respectively. The crude risk of developing gout was significantly higher in patients with AKN (HR, 2.27; 95% CI, 1.26–4.10; p = 0.007). After controlling for age, sex, and ethnicity, AKN emerged as an independent risk factor of gout (adjusted HR, 2.34; 95% CI, 1.29–4.22; p = 0.005). When adjusting for other confounders such as body mass index, diabetes mellitus, hypertension, and dyslipidemia, the risk of gout in AKN fell out of significance (adjusted HR, 1.39; 95% CI, 0.73–2.65; p = 0.311),

Conclusion

Patients with AKN experience an increased risk of gout. The risk is not independent and is mainly mediated through the metabolic comorbidities typifying AKN. We recommend screening for gout in patients with suggestive complaints.     

Effect of silver-containing hydrofiber dressing on burn wound healing: A meta-analysis and systematic review

Background

Silver sulfadiazine is commonly used to treat local burn wounds. Aquacel-Ag is a hydrogen fiber dressing containing ionic silver that reduces burn wound infection and promotes antimicrobial activity. It is necessary to compare the efficacy of the two in the healing of burns.

Aims

The aim of this study was to systematically evaluate the effect of Aquacel-Ag on burn wound healing.

Methods

A computerized search of CNKI, VIP, Wanfang, SinoMed, PubMed, Cochrane Library, EMbase, Science Direct, Web of Science, Wiley Online Library, and Open Access Library databases was performed from January 1, 2000 to December 31, 2021 for randomized controlled clinical trials. The trials on Aquacel-Ag dressing and silver sulfadiazine in the treatment of burns were selected. Meta-analysis was performed using Review Manager 5.0 software.

Results

Eleven articles were finally included, with 794 burn patients. Meta-analysis results showed that compared with patients treated with silver sulfadiazine, burn patients treated with Aquacel-Ag dressing had shorter wound healing time [MD = −2.49, 95% CI (−5.64–0.65), p = 0.12], significantly lower tumor necrosis factor-α (TNF-α) level [MD = −0.52, 95% CI (−0.82–0.22), p = 0.0008], higher wound healing rate [MD = 8.41, 95% CI (3.39–13.43), p = 0.001], fewer dressing changes [MD = −3.27, 95% CI (−4.90–1.63), p < 0.0001].

Conclusion

Aquacel-Ag dressing can shorten wound healing time and effectively reduce inflammatory reactions in burn patients compared with silver sulfadiazine, but their safety still needs further exploration and analysis.     

Efficacy and Safety of 308-nm Monochromatic Excimer Lamp Versus Other Phototherapy Devices for Vitiligo: A Systematic Review with Meta-Analysis

Background

Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method.

Objective

We aimed to systematically review and meta-analyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo.

Methods

A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy.

Results

The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50 % repigmentation [risk ratio (RR) = 0.97, 95 % confidence interval (CI) 0.84–1.11] and ≥75 % repigmentation (RR = 0.96, 95 % CI 0.71–1.30). Likewise, no study found significant differences between excimer lamps and NB-UVB (RR = 1.14, 95 % CI 0.88–1.48 for ≥50 % repigmentation; RR = 1.81, 95 % CI 0.11–29.52 for ≥75 % repigmentation). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment.

Conclusions

To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo. Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. Safety, effectiveness, and cost are considerations when choosing treatment.

PROSPERO Registration Number

CRD42014015237.

     

Inverse correlation between vitamin D and CRP levels in alopecia areata: A pilot study

Introduction

Alopecia areata (AA) is an autoimmune non-scarring hair loss. The role of micronutrients such as iron, zinc, and vitamins, especially vitamin D, on the natural hair cycle is well defined in literature. This study aims to evaluate the correlation between vitamin D and CRP levels in patients with alopecia areata.

Methods

This cross-sectional study was performed from beginning of October 2020 until end of December 2021. Alopecia areata patients over 18 years of age gave their written consent to participate in the study. The severity of the patients' disease was assessed using the Severity of Alopecia Tool. Serum vitamin D and CRP levels were measured and CBC and LFT were also performed.

Results

There were significant differences between the patients with the localized form of AA and its universal form in the following variables: Vitamin D levels, SALT score, WBC, ALKP, and CRP. There was also a significant inverse correlation between CRP and vitamin D levels (p < 0.0001).

Conclusion

Vitamin D deficiency is associated with higher CRP levels, and patients with low serum vitamin D and high CRP levels are at a higher risk of developing the universalis form of AA; therefore, these patients should undergo more aggressive treatments.     

The efficacy and safety of tacrolimus as mono- and adjunctive therapy for vitiligo: A systematic review of randomised clinical trials

There is currently no definitive treatment for vitiligo; various modalities include immune modulators phototherapy and skin camouflage. We investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo. Electronic systematic search of the literature was carried out using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo have been included in a systematic review and meta-analysis. Meta-analysis was conducted via RevMan, and risk of bias was assessed through the Cochrane quality assessment tool. The protocol was published through PROSPERO (CRD42018112430). A total of 19 studies including 814 patients were included in our systematic review. The random-effects-model meta-analysis of two studies revealed that the tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy rates is better than NB-UVB alone in inducing >75% repigmentation [RR 1.34 (95% CI: 01.05–1.71), P = 0.02]. Tacrolimus and steroids had similar potency in acheiving >75% repigmentation [RR 1.02 (95% CI: 0.19–5.51), P = 0.98]. Meta-analysis of two studies revealed that the fractional laser and tacrolimus combination therapy is no better than tacrolimus alone in causing >75% repigmentation [RR 2.11 (95% CI: 0.87–5.09), P = 0.10]. Further investigating tacrolimus as mono- or adjuvant therapy for vitiligo is highly recommended. Combining tacrolimus to other treatment options such as steroids, phototherapy and laser may be superior to using tacrolimus alone.     

Relationship of Hair Regrowth Pattern in Alopecia Areata Patches According to DIMT Classification with Treatment Modalities and Patch Size: A Retrospective Cross-Sectional Analysis

BackgroundThe morphology of hair regrowth in alopecia areata (AA) patches could be classified into four types, namely diffuse, irregular, marginal, and targetoid patterns, according to the DIMT classification. However, factors affecting hair regrowth patterns have not been investigated.ObjectiveWe investigated whether the DIMT-classified hair regrowth patterns of AA patches are associated with treatment modality and patch size.MethodsWe conducted a retrospective, cross-sectional study of 152 AA patches with hair regrowth.ResultsThe associations between the diffuse pattern and patch size >2 cm (p=0.006; odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.17~0.74), between the irregular pattern and triamcinolone acetonide intralesional injection (p<0.001; OR: 274.87, 95% CI: 25.75~2,933.56), between the marginal pattern and systemic and topical corticosteroid (p=0.018; OR: 4.89, 95% CI: 1.31~18.27), and between the targetoid pattern and patch size >2 cm (p=0.028; OR: 2.50, 95% CI: 1.10~5.68) were statistically significant.ConclusionTreatment modalities and patch size are the factors affecting hair regrowth patterns in AA patches.     

光疗法在斑秃中的应用

近年来,光疗治疗斑秃取得较好疗效。本文对PUVA疗法、长波紫外线A1、308nm单频准分子光和准分子激光、红外线,低能量激光疗法及点阵二氧化碳激光在斑秃治疗中的应用进行综述。     

Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor-blind split-face controlled trial

Background

Melasma is a hyperpigmentary disorder causing cosmetic disfigurement. We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma.

Methods

This randomized assessor-blind split-face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4-week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS).

Results

All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years). Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] −0.22; 0.85, p = 0.248 and SMD = −0.13, 95% CI −0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = −0.39, 95% CI −0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post-inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001).

Conclusions

TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.     

Altered polyamine profiling in the hair of patients with androgenic alopecia and alopecia areata

Hair follicles are among the most highly proliferative tissues. Polyamines are associated with proliferation, and several polyamines including spermidine and spermine play anti‐inflammatory roles. Androgenic alopecia results from increased dihydrotestosterone metabolism, and alopecia areata is an autoimmune disease. This study aimed to investigate differences in polyamine profiles in hair samples between patients with androgenic alopecia and alopecia areata. Polyamine concentrations were determined through high‐performance liquid chromatography‐mass spectrometry. Hair samples were derivatized with isobutyl chloroformate. Differences in polyamine levels were observed between androgenic alopecia and alopecia areata compared with normal controls. In particular, polyamine levels were higher in alopecia areata patients than in normal controls. Certain polyamines displayed different concentrations between the androgenic alopecia and alopecia areata groups, suggesting that some polyamines, particularly N‐acetyl putrescine (P = 0.007) and N‐acetyl cadaverine (P = 0.0021), are significantly different in androgenic alopecia. Furthermore, spermidine (P = 0.021) was significantly different in alopecia areata. Our findings suggest that non‐invasive quantification of hair polyamines may help distinguish between androgenic alopecia and alopecia areata. Our study provides novel insights into physiological alterations in patients with androgenic alopecia and those with alopecia areata and reveals some differences in polyamine levels in hair loss diseases with two different modes of action.     

Compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo: A systematic review and meta-analysis

Background

Although the 308 nm excimer laser is commonly used to cure vitiligo, its clinical efficacy is limited. Experts have found that the efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo is significantly enhanced, but the specific research methods and clinical data must be clarified.

Objective

To determine the clinical efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo.

Methods

Until August 2022, studies were searched in PubMed, the Cochrane Library, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, and the Wan Fang Database. We also searched for clinical RCTs involving compound glycyrrhizin tablets combined with the 308 nm excimer laser for the treatment of vitiligo. The meta-analysis was conducted in accordance with the Cochrane Handbook's recommendations. Two reviewers regulated the study selection, data extraction, and assessment of bias risk, and consulted a third reviewer as necessary. For the meta-analysis, Review Manager 5.4 was utilized.

Results

Finally, 9 articles and 1052 patients were included. A systematic review compared the efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser to that of the 308 nm excimer laser alone: OR = 3.33, p < 0.00001, 95% confidence interval [2.25, 4.92].

Conclusion

In the treatment of vitiligo, compound glycyrrhizin tablets combined with the 308 nm excimer laser are more effective than the 308 nm excimer laser alone, and there are no serious adverse reactions. It is a safe and efficient way of treatment.     

Functional polymorphisms of the FAS/FASLG genes are associated with risk of alopecia areata in a Chinese population: a case–control analysis

Background The Fas/Fas ligand system plays a key role in regulating cell growth and apoptosis. Previous findings have suggested that FAS and FASLG polymorphisms are associated with systemic lupus erythematosus, autoimmune hepatitis, vitiligo and other autoimmune‐related disorders. However, to the best of our knowledge, there is no reported study on the associations between FAS and FASLG polymorphisms and the risk of alopecia areata. Objectives To investigate the associations between FAS and FASLG polymorphisms and the risk of alopecia areata in a Chinese Han population. Methods In a hospital‐based case–control study of 84 patients with alopecia areata and 84 controls, we genotyped FAS 1377G>A, FAS 670A>G and FASLG 844T>C polymorphisms and assessed their association with alopecia areata risk. Results We found that a reduced risk of alopecia areata appeared to be associated with the FAS 670AG genotype [adjusted odds ratio (OR) 0·43; 95% confidence interval (CI) 0·22–0·86] when compared with the FAS 670AA genotype, but no risk was associated with any of the FAS 1377G>A and FASLG 844T>C genotypes. In the combined analysis, we found that the presence in individuals of two at‐risk alleles of the three FAS/FASLG polymorphisms was associated with a lower risk of alopecia areata (adjusted OR 0·21; 95% CI 0·05–0·89) when compared with the presence of six at‐risk alleles. Conclusions These results suggest that genetic variants in the FAS and FASLG genes may contribute to the aetiology of alopecia areata.     

Effect and safety of probiotics for treating urticaria: A systematic review and meta-analysis

Background

To assess the effect and safety of probiotics for treating urticaria.

Methods

Randomized controlled trial (RCT) papers on the probiotics treatment published before May 2019 were retrieved from various databases like PubMed, EMbase, MEDLINE (Ovid), SCI-Hub, Springer, ClinicalKey, VIP, and CNKI. The treatment plan that we include are oral administration of single probiotic, multiple probiotics, and the combination of probiotics and antihistamines. Meta-analysis of the data was performed by RevMan 5.3 software.

Results

A total of nine RCT papers were included: four papers for oral administration of single probiotic, three papers for oral administration of multiple probiotics, and two papers for oral administration of a probiotic combined with antihistamines. The results of meta-analysis showed that the therapeutic effect of the probiotic group was significantly higher than the control group (placebo or antihistamines) (RR = 1.09, 95% CI: 1.03–1.16, p = 0.006). And compared with the placebo group, the therapeutic effect of single probiotic group was significantly improved (RR = 1.11, 95% CI: 1.01–1.21, p = 0.03). Regarding therapeutic effect, there was no statistically significant difference between the multiple probiotics group and placebo group (RR = 1.00, 95% CI: 0.94 ~ 1.07, p = 0.91); the therapeutic effect of single probiotic combined antihistamine group was significantly higher than the antihistamine group (RR = 1.13, 95% CI: 1.07–1.19, p < 0.0001). Regarding the incidence of adverse reactions, there was no significant difference between the probiotic group and the control group (p = 0.46).

Conclusion

The treatment plan of oral administration of probiotics has significant therapeutic effects on urticaria, but the therapeutic effects of the administration of multiple probiotics and the safety of probiotic therapy are still not yet obvious. Some large-scale, multi-centered RCT studies are needed in the future for clarification.     

Comparison of NB-UVB combination therapy regimens for vitiligo: A systematic review and network meta-analysis

Background

Vitiligo was an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance repigmentation.

Objectives

To compare the effectiveness of current NB-UVB combination regimen at the improvement in repigmentation through a systematic review and network meta-analysis.

Methods

We searched the electronic databases for randomized controlled trials related to NB-UVB combination therapy for vitiligo till October 2022. STATA15.0 software was applied to carrying out data analysis.

Results

A total of 28 eligible studies involving 1194 participants were enrolled in the analysis. The NMA results revealed that compared with NB-UVB, carboxytherapy [OR = 32.35, 95% CI (1.79, 586.05)], Er: YAG laser+ topical 5% 5-FU [OR = 10.74, 95% CI (4.05, 28.49)], needling/micro-needling [OR = 3.42, 95% CI (1.18, 9.88)], betamethasone intramuscular injection [OR = 3.08, 95% CI (1.17, 8.13)], topical tacrolimus [OR = 2.54, 95% CI (1.30, 4.94)], and oral Chinese herbal medicine compound [OR = 2.51, 95% CI (1.40, 4.50)] integrated with NB-UVB were more efficacious in excellent to complete repigmentation response rate (≥75%). Besides, NB-UVB+ Er: YAG laser+ topical 5% 5-FU [OR = 0.17, 95% CI (0.04, 0.67)] and NB-UVB+ needling/micro-needling [OR = 0.24, 95% CI (0.06, 0.88)] were less likely evaluated as ineffective repigmentation response (≤25%).

Conclusions

All combination therapies ranked higher than NB-UVB monotherapy in inducing successful repigmentation and avoiding failed treatment in patients with vitiligo. Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5% 5-FU and NB-UVB+ needling/microneedling would be the preferred therapeutic approaches.     

Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata

BackgroundAlopecia areata (AA) is a hair disease that causes hair loss without scarring. The etiopathogenesis of AA has not been fully understood yet.ObjectiveTo determine serum interleukin levels (IL-2, IL-4, IL-15, and IL-17) in patients diagnosed with alopecia areata and to investigate the relationship of IL levels with the duration and severity of alopecia areata and the response to tofacitinib therapy.MethodsPatients (≥16 years old) diagnosed with alopecia areata and healthy individuals as a control group was enrolled. Baseline serum interleukin levels of the patients and controls were measured. In the patient group receiving tofacitinib therapy, serum interleukin levels were measured again after 6 months. Disease severity for alopecia areata was assessed using the Severity of Alopecia Tool.ResultsSixty-one AA patients and 30 healthy individuals were included; they were comparable regarding age and sex. The mean disease duration for AA was 7 ± 6 years and the baseline mean Severity of Alopecia Tool score was 71 ± 30 (range, 20–100). Baseline IL-2, IL-4 and IL-15 levels were significantly higher in the patient group than those in the control group (p < 0.001 for each). No significant correlation was found between the baseline interleukin levels and either disease duration or disease severity (baseline Severity of Alopecia Tool score). Among the patients receiving tofacitinib (n = 22), all interleukin levels significantly decreased after treatment. However, no significant relationship between the change in interleukin levels and the change in the Severity of Alopecia Tool scores was observed after tofacitinib treatment.Study limitationsThis is a monocentric study conducted in a single university hospital.ConclusionHigh interleukin levels in alopecia areata patients and the significant decrease with treatment support the idea that interleukins have a role in pathogenesis. Nevertheless, no relationship could be demonstrated between IL levels and disease duration or severity.     

Analysis of Serum Zinc and Copper Concentrations in Hair Loss

Background

It is well known that some trace elements such as zinc and copper play a significant role in many forms of hair loss. However, the effect of zinc and copper in the pathogenesis of hair loss is still unknown.

Objective

The purpose of this study is to evaluate the zinc and copper status in each of four types of hair loss.

Methods

A study was carried out with 30 health controls and 312 patients who were diagnosed with alopecia areata (AA), male pattern hair loss, female pattern hair loss and telogen effluvium (TE) (2008 to 2011; Hallym University Kangdong Sacred Heart Hospital). Zinc and copper serum concentrations were evaluated between controls and each of four types of hair loss patients.

Results

In all of the hair loss patients, the mean serum zinc was 84.33±22.88, significantly lower than the control group (97.94±21.05 µg/dl) (p=0.002), whereas the serum copper was 96.44±22.62, which was not significantly different (p=0.975). The analysis of each group showed that all groups of hair loss had statistically lower zinc concentration, but not copper concentrations. However, the ratio of the patients with serum zinc concentration lower than 70 µg/dl was significantly high in only the AA group (odds ratio, OR 4.02; confidence interval, CI 1.13 to 14.31) and the TE group (OR 1.12; CI 1.12 to 17.68).

Conclusion

The data led to the hypothesis of zinc metabolism disturbances playing a key role in hair loss, especially AA and TE, whereas the effect of copper on hair growth and shedding cycles still needs more study.     

Transepidermal drug delivery: A new treatment option for areata alopecia?

Background: Transepidermal drug delivery (TED) is a new potential method in dermatology. Permeability alterations induced by ablative fractional resurfacing have been described with the aim to increasing the delivery of different substances into the skin. Objective: To evaluate clinical response and side effects of TED in areata alopecia (AA) treatment using ablative fractional methods associated with acoustic pressure ultrasound (US) to deliver triamcinolone solution into the skin. Methods and materials: Five cases of AA underwent treatment which comprised of 3 steps: 1) Ablative fractioned RF or CO₂ laser 2) topical application of triamcinolone 3) acoustic pressure wave US. The number of sessions varied according to the clinical response, ranging from one to six sessions. Results: All patients had complete recovery of the area treated. Two of them treated with ablative fractional RF + triamcinolone + US had complete response after three and six sessions. The other two treated with ablative fractional CO₂ + triamcinolone + US had complete response after one session. Conclusion: Fractioned ablative resurfacing associated with acoustic pressure wave US is a new option to areata alopecia treatment with good clinical result and low incidence of side effects.     

Comorbid autoimmune diseases in patients with pemphigus: a nationwide case-control study in Taiwan

Background

Previous studies have proposed the association between pemphigus and several autoimmune diseases, but no large-scale study has been reported.

Objectives

To delineate the association between pemphigus and autoimmune diseases including psoriasis.

Materials & Methods

A total of 1,998 patients with pemphigus and 7,992 control subjects were enrolled from the National Health Insurance Research Database in Taiwan from 1997 to 2010. The odds of comorbidities between these two groups were analysed by multivariate logistic regression.

Results

Compared with control subjects, patients with pemphigus were much more likely to have Sjögren’s syndrome (odds ratio [OR]: 15.0; 95% confidence interval [CI]: 3.16-71.5), psoriasis (OR: 7.18; 95% CI: 5.55-9.29), systemic lupus erythematosus (OR: 4.46; 95% CI: 1.88-10.6), and alopecia areata (OR: 2.68; 95% CI: 1.26-5.67). According to gender-stratified analyses, however, the association between pemphigus and Sjögren’s syndrome or alopecia areata was found to be significant only in the female patients.

Conclusion

We confirm the association between pemphigus and some autoimmune diseases, including Sjögren’s syndrome, systemic lupus erythematosus, and alopecia areata. In addition, we present the novel finding that patients with pemphigus have an increased risk of psoriasis.