Thyroid autoimmunity in children and adolescents with alopecia areata

BACKGROUND: Autoimmune thyroiditis (AT) is often associated with alopecia areata (AA) in children and adolescents. METHODS: Forty-six children (23 girls and 23 boys), with a mean age of 9.9 +/- 3.38 years (2.24-17.5 years), were included in a study to assess thyroid function and thyroid autoantibody formation in AA. The size and function of the thyroid gland [triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and thyrotropin releasing hormone (TRH) test; fluoroimmunologic assay (FIA), Delfia], antithyroglobulin (TAT) and antimicrosomal (MAT) antibodies (microhemagglutination method), thyroid gland ultrasound, and indices of cellular and humoral immunity were assessed. RESULTS: Thyromegaly was found in 29 children (63%). Increased basal TSH levels were present in six of the 29 (13.3%) and hypothyroid-type stimulated secretion (TRH test) in two (out of 12). TAT was increased in 17 (39.5%) and MAT in 14 (33.3%) children with AA. Thyroid ultrasound examination was suggestive of AT in 13 (34.2%) and typical of AT in five (13.2%) children. CONCLUSIONS: We diagnosed AT in 22 of 46 children with AA (47.8%). The immune studies revealed increased activated T lymphocytes. We recommend that thyroid gland size and function and antibody formation be examined at the diagnosis of AA and twice a year thereafter.     

Experience with oral tofacitinib in two adolescents and seven adults with alopecia areata

Alopecia areata (AA) is a common disease that results in nonscarring hair loss. Recently, tofacitinib (TOFA) has been a novel promising therapy for AA. The aim of this study is to determine the efficacy of oral TOFA treatment for alopecia areata (AA), and alopecia universalis (AU). Data of nine patients treated with oral TOFA with either AA or AU were retrospectively evaluated. Treatment outcome, disease severity, and therapeutic response were evaluated by Severity of Alopecia Tool (SALT) scores along with regular photographic surveillance done at third and sixth months. Treatment response was established on four categories: complete response (90% change in latest SALT score), intermediate response (51–90% change), moderate response (6–50% change), and nonresponse (<5% change). Nine patients aged 13–33 years were reviewed. Four patients (44.4%) did not respond to oral TOFA therapy, three patients (33.3%) were moderate responders, 1 (11.1%) was intermediate responder, and 1 (11.1%) was complete responder at the end of 6 months. The clinical response rate (those who achieved ≥5–100% change in SALT score) was 41.4% for all patients. Most of the patients who responded to TOFA had AA instead of AU. Adverse effects were mild. The clinical response rate of TOFA seems reasonable and TOFA was well‐tolerated in this cohort. However, to truly evaluate efficacy, future studies are needed to assess the efficacy, adverse effects, and durability of treatment with TOFA in randomized controlled trials.     

136例儿童斑秃发病相关因素分析

目的:了解影响斑秃发病的相关因素。方法:对广州市妇女儿童医疗中心皮肤科收治的136例儿童斑秃临床资料作回顾性分析,包括年龄、性别、既往病史、家族史,首次出现斑秃的年龄,脱发严重程度评分以及实验室结果。结果:136例患儿平均首次发病年龄为(4.66±3.12)岁,85例(62.5%)首次出现斑秃的年龄小于6岁。136例患儿中75例为轻症斑秃,平均发病年龄(4.76±2.02)岁,61例为重症斑秃,平均发病年龄(2.81±2.42)岁。26例(19.12%)患儿患有注意缺陷多动障碍,53例(39%)患有过敏性疾病及9例(6.62%)患有自身免疫性疾病。16例(11.76%)有斑秃家族史,27例(20.59%)有自身免疫性疾病家族史。结论:儿童斑秃可能与遗传、精神心理、自身免疫和变态反应有关。     

儿童及青少年斑秃的研究进展

儿童及青少年斑秃是斑秃患者中比较特殊的群体.与其相关的发病机制涉及遗传学、自身免疫学、精神因素、EB病毒感染和微量元素缺乏等.临床类别的划分主要根据患儿毛发脱失的模式和程度.斑秃患儿除毛发脱失外,还可伴发甲状腺疾病、甲病、特应性疾病、唐氏综合征等多种疾病.治疗方案的选择取决于斑秃患儿的病情严重程度和对治疗的耐受程度.了解儿童及青少年斑秃的发病特点,选择适当的治疗方案,采取有效的预防和干预措施,均有助于儿童及青少年斑秃的转归.     

Dry dermoscopy in clinical treatment of alopecia areata

Although dermoscopy is conventionally utilized with immersion gel for diagnosis of pigmented tumor, we utilized dry dermoscopy, which is dermoscopy without immersion gel, for clinical treatment of alopecia areata (AA). The scalp skin and hair of a 38-year-old Japanese male, and 23-, 22- and 47-year-old Japanese females with AA, whose normal hair color was black, were examined by dry dermoscopy. Exclamation mark hairs, short hairs, fractured hairs and black dots, all characteristic of AA, were detected by dry dermoscopy of the scalp of the 23-year-old female with ophiasis type AA. In the case of the 47-year-old female with round hair loss on the occipital scalp and diffuse hair loss over the fronto-vertical region, dry dermoscopy was useful for diagnosis of AA based on hair characteristic of AA. After she received corticosteroid pulse therapy with 500 mg of i.v. methylprednisolone on 3 successive days, her hair showed apparent regrowth and disappearance of the abnormal hairs characteristic of AA, evidenced by dry dermoscopy 1 month later. In a case of long-lasting AA in the 23-year-old female, we found a follicular plaque-like appearance at the opened hair follicle pores by dry dermoscopy. Histopathologically, the incompletely differentiated remnant hair shaft was packed in the follicular infundibulum. In addition, regrowing vellus hairs, which were difficult to clinically recognize, were detected by dry dermoscopy. Dry dermoscopy is therefore useful for both diagnosis and follow up of AA.     

Prevalence of alopecia areata in Japan: Estimates from a nationally representative sample

Data on the prevalence of alopecia areata (AA) in Japan is limited and the epidemiology of the disease there is not well understood; therefore, it is critical to examine the prevalence and severity of AA in Japan to inform the need for future treatments and research. A cross-sectional, web-based survey was conducted in Japan from January through March 2021. A total of 45 006 participants were identified through general population survey panels and asked about their experience with AA and hair loss. The Alopecia Assessment Tool and the Scalp Hair Assessment PRO^TM were adopted to screen for history of AA and assess disease severity, respectively. Eligible participants submitted photos of their scalp, which were reviewed by three board-certified dermatologists to evaluate the presence and severity of AA. Prevalence and severity estimates were calculated using participants' self-reported data and verified through the dermatologists' assessments. The participant-reported point prevalence of AA was 2.18%. The adjusted point prevalence following physician adjudication using participant-submitted photos was 1.45%. Topical corticosteroids were the most commonly used treatments, with 34.6% of participants diagnosed with AA reported having ever used them. Participants also reported negative impacts on their mood (70.2%), self-esteem (55.8%), and social interactions (48.9%). Despite the social and emotional impact of hair loss, more than one third of those reporting a physician diagnosis of AA were not currently seeking treatment. The current study identified an estimated prevalence of AA in Japan between 1.45% and 2.18% based on the survey results and physician-adjudication of those findings. Considering the impactful psychological burden of AA, the survey results showing that 38.90% of surveyed patients do not currently seek treatment may indicate an unmet need for remedies.     

The genetic basis of alopecia areata: HLA associations with patchy alopecia areata versus alopecia totalis and alopecia universalis

Many diseases, notably those having a strong autoimmune component, have been shown to have an association with specific human leukocyte antigens (HLA). The molecular basis for this genetic association with disease is the fact that HLA bind and present peptides derived from self and foreign protein antigens to the immune system for recognition and activation of the immune response. Previous studies with heterogeneous groups of alopecia areata (AA) patients have suggested associations with some HLA class I and class II antigens. For this study we selected only patients with long-standing disease and stratified them into two groups by strict definitions of duration and extent of disease: those with patchy AA and those with either alopecia totalis (AT) or alopecia universalis (AU). The patients were tissue typed for HLA class II antigens by biomolecular methods that provided antigen discrimination at an allele level. More than 80% of all of the AA patients typed were positive for the antigen DQB1*03 (DQ3), suggesting that this antigen is a marker for general susceptibility to AA. In addition, two other antigens were found significantly increased in frequency only in the group of AT/AU patients, DRB1*0401 (DR4) and DQB1*0301(DQ7). This strongly suggests that the two clinical types of AA, namely patchy AA versus AT/AU, can be distinguished by a genetically based predisposition to extent of disease.     

儿童斑秃与骨密度关系的初步探讨

目的:探讨儿童斑秃的发病与骨密度异常的关系。方法:对71例斑秃患儿[斑秃分为点状(<1cm)秃发、斑状(>1cm)秃发和普秃]及46例成人3种类型斑秃患者进行骨密度,血清锌、钙和铁测定比较及生活习惯调查。结果:儿童组斑秃患者中骨质疏松的阳性百分率明显高于成人斑秃组(P<0.001);儿童组斑秃患者中血清微量元素下降的百分率高于成人斑秃组,尤以锌元素下降明显,但无统计学意义(P>0.05);儿童组斑秃患者中血清锌和钙水平显著低于正常水平(P<0.05);骨密度下降斑秃患儿伴有“常吃零食”和“挑食”的不良生活习惯,并具有除斑秃以外的临床表现。结论:儿童斑秃,尤其是点状脱发和斑状脱发发病与骨密度异常的关系密切,此外血清锌、钙水平降低及不良生活习惯也与儿童斑秃发病有关。     

A clinical study of childhood alopecia areata in Singapore

Alopecia areata (AA) is a common cause of nonscarring alopecia. The aim of this epidemiologic study is to review the clinical characteristics and treatment of childhood alopecia areata in a mixed ethnic population. The study population consisted of a total of 392 children seen over a 4-year period with AA diagnosed before the age of 16 years. The female:male ratio was 1:1.4. There were 309 Chinese (78.8%), 51 Malays (13.0%), and 32 Indians (8.2%). The mean age at the time of diagnosis was 11.2 years. The majority of patients (71.7%) had alopecia of less than 6-months duration and 6% had previous episodes of AA. Females appeared to have more severe involvement. A familial history of AA was observed in 33 patients (8.4%). Associated atopy was found in 26.6% of patients and in 32.3% of their first-degree relatives. Other associations such as vitiligo or Down syndrome were rare. For limited AA, topical and/or intralesional corticosteroid was the first-line treatment used and squaric acid dibutyl ester was the choice of treatment for patients with extensive involvement. The profile of the poor respondents to therapy included young age of onset, past history of AA, Down syndrome, and extensive involvement.     

Tissue-specific autoantibodies and autoimmune disorders in vitiligo and alopecia areata: a retrospective study

We retrospectively analyzed our laboratory reports of tissue-specific autoantibodies (TSA) in 38 patients with alopecia areata (AA) and 31 patients with vitiligo. These reports were based on standard indirect immunofluorescence (IF) procedures, employing monkey tissues as substrates. One or more TSA were detected in 39% of serum samples. Thyroid (microsomal and/or thyroglobulin) antibodies had the highest occurrence rate and, as compared with the normal population, were detected at a greater frequency in both vitiligo and AA. Over half (58%) of our patients with vitiligo had one or more detectable TSA, while only 28% of patients with AA had such antibodies. When compared with the normal population, the occurrence rate of TSA was higher in patients with vitiligo. The only remarkable finding in AA was a higher than normal occurrence rate of antithyroid antibodies.