Utility of dermoscopy in alopecia areata

Background:

Alopecia areata (AA) shows several well-defined dermoscopic features which may help in confirming diagnosis in AA.

Aims:

We carried out a study to examine the dermoscopic features of AA and develop a protocol for diagnosis of AA by dermoscopy.

Materials and Methods:

Dermoscopy was performed in 66 patients with AA. Hanse HVS-500NP dermoscope (magnification of ×32 and ×140) was used.

Results:

The mean age of the patients (46 males and 20 females) was 26.85 years. The mean age of onset was 25.15 years. The mean duration of alopecia was 10.3 months. Most common AA in our study was patchy type (57/66, 87.7%). Single patch was seen in 24 patients and multiple patches in 33 patients. Diffuse AA was seen in five patients. Ophiasis and alopecia universalis were seen in two patients each. Nail changes were fine pitting (4), ridging (2), thinning of nail plate (2). Twenty nail dystrophy, distal onycholysis, striate leukonychia and coarse pitting were seen in one patient each. Intralesional triamcinolone acetonide was the most common therapy offered. Others were oral betamethasone minipulse therapy, dexamethasone pulse, minoxidil, anthralin and corticosteroids. The most common dermoscopic finding was yellow dots seen in 54 patients (81.8%), followed by black dots (44 patients, 66.6%), broken hairs (36 patients, 55.4%), short vellus hair (27 patients, 40.9%) and tapering hairs (8 patients, 12.1%).

Conclusions:

The most common dermoscopic finding of AA in our study was yellow dots, followed by black dots, broken hairs, short vellus hair and tapering hairs. Dermoscopic findings were not affected by the type of AA or the severity of the disease.     

Current Treatment Strategies in Pediatric Alopecia Areata

Alopecia areata (AA) is a non-scarring autoimmune disease of the hair follicle that can present at any age. Pediatric cases are commonly seen in a dermatology clinic, and management can potentially be challenging, with a small proportion of cases experiencing a chronic relapsing course marked by distressing hair loss that can bring about significant psychosocial morbidity. We review the established treatments for pediatric alopecia areata, alongside second and third line therapies that have shown to be efficacious. We also offer a treatment algorithm as a guide to the treatment of pediatric AA.     

The Relationship Between Alopecia Areata and Alexithymia,Anxiety and Depression: A Case-Control Study

Background:

Alopecia areata (AA) is a skin disease characterized by the sudden appearance of areas of hair loss on the scalp and other hair-bearing areas, but its aesthetic repercussions can lead to profound changes in patient''s psychological status and relationships.

Aim:

The goal was to investigate a possible relationship between AA and alexithymia as well as two other emotional dimensions, anxiety and depression.

Materials and Methods:

Fifty patients with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, Sfax were included in this study. Anxiety and depression were evaluated by Hospital Anxiety and Depression scale questionnaire, alexithymia was assessed by Toronto Alexithymia scale 20, and severity of AA was measured by Severity of Alopecia Tool.

Results:

Patient''s mean age was 32.92 years. 52% of patients were females. Depression and anxiety were detected respectively in 38% and 62% of patients. There was statistically significant difference between patients and control group in terms of depression (P = 0.047) and anxiety (P = 0.005). Forty-two percent of patients scored positive for alexithymia. No significant difference was found between patient and control groups (P = 0.683) in terms of alexithymia. Anxiety was responsible for 14.7% of variation in alexithymia (P = 0.047).

Conclusions:

Our study shows a high prevalence of anxiety and depressive symptoms in AA patients. Dermatologists should be aware of the psychological impact of AA, especially as current treatments have limited effectiveness.     

Thyroid Disorders Associated with Alopecia Areata in Egyptian Patients

Context:

Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The etiopathogenesis of the disease is still unclear, but the role of autoimmunity is strongly suggested. AA is commonly associated with various autoimmune disorders; the most frequent among them is autoimmune thyroid disorders.

Aim:

To determine whether AA is associated with thyroid autoimmunity or thyroid function abnormalities in Egyptian patients.

Materials and Methods:

Fifty subjects with AA (37 males and 13 females) without clinical evidence of thyroid disorders were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital, Menoufiya Governorate, Egypt, during the period from June 2009 to February 2010. They were divided into 3 groups according to severity of AA. Fifty age and sex-matched healthy volunteers (35 males and 15 females) were selected as a control group. Every case and control were subjected to history taking, complete general and dermatological examination. Venous blood samples were taken from cases and controls after taking their consents for measurement of thyroid stimulating hormone (TSH), free T3, freeT4 and detection of Anti-thyroglobulin Antibody (Tg-Ab) and Anti-thyroid Peroxidase Antibody (TPO-Ab).

Results:

Subclinical hypothyroidism was detected in 16% of cases. There were statistically significant differences between cases and controls regarding levels of TSH, free T3 and free T4. There were significant differences between cases and controls regarding the presence of Tg-Ab and TPO-Ab.

Conclusions:

Every patient with AA should be screened for thyroid functions and presence of thyroid autoantibodies even in absence of clinical manifestations suggestive of thyroid affection.     

斑秃的皮肤镜表现及对治疗的反应

目的 探讨斑秃患者皮肤镜征象表现及其在不同治疗方法治疗后消失的情况.方法 回顾性分析80例初诊或复发后初诊斑秃患者的初始皮肤镜征象以及在不同治疗方法治疗后消失的顺序,并分析其原因.结果 斑秃发病男女比例相近,平均发病年龄为26.5岁,平均病程为32.6个月,临床类型以斑片型多见;斑秃患者皮肤镜征象出现率由高到低依次为黄点（87.5％）、黑点（82.5％）、断发（77.5％）、短毳毛（76.25％）、感叹号发（45.0％）,黄点、断发、短毳毛与斑秃病程呈负相关,感叹号发与轻拉发实验呈正相关,黑点、断发、感叹号发两两之间亦呈显著正相关.二苯环丙烯酮（DPCP）组患者随访期间内均未见明显新生毛发,而另外3组有1种或以上皮肤镜征象消失的患者均伴有新生毛发增多.复方甘草酸苷组、复方倍他米松组、口服激素组中4种征象（黄点、黑点、断发、感叹号发）均有.患者治疗后征象最先消失比例最高的为感叹号发,平均时间为治疗后7.3周,第二消失比例最高的为黑点,平均时间为7.6周,第三消失比例较高的为断发,平均时间为8.2周,最后消失的为黄点,平均时间为8.4周,组间差异无统计学意义.结论 感叹号发与病情活动度呈正相关,DPCP组患者病程长,病情活动度少,以重型及难治型患者占大多数,治疗起效慢.治疗后皮肤镜征象的消失与治疗方法无关,与治疗起效时间有关,开始起效时间约在7.3周左右.超过随访时间所有征象均未消失的患者,说明病情活动未得到控制,需调整治疗方案.治疗起效后毛囊重新进入生长期,引起感叹号发首先消失,随之黑点、断发亦消失。     

ALOPECIA AREATA AND AUTOIMMUNITY: A CLINICAL STUDY

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.     

Tumor necrosis factor-alpha in patients with alopecia areata

Background:

Alopecia areata (AA) is a common form of localized, nonscarring hair loss. It is characterized by the loss of hair in patches, total loss of scalp hair (alopecia totalis, AT), or total loss of body hair (alopecia universalis, AU). The cause of AA is unknown, although most evidence supports the hypothesis that AA is a T-cell-mediated autoimmune disease of the hair follicle and that cytokines play an important role.

Aims:

The aim of the study was to compare the serum levels of tumor necrosis factor-alpha (TNF-α) in patients with AA and the healthy subjects and also to investigate the difference between the localized form of the disease with the extensive forms like AT and AU.

Materials and Methods:

Sixty patients with AA and 20 healthy controls were enrolled in the study. Forty-six patients had localized AA (LAA), and 14 patients had AT, AU, or AT/AU. The serum levels of TNF-α were measured using enzyme-linked immunoassay techniques.

Results:

Serum levels of TNF-α were significantly higher in AA patients than in controls (10.31 ± 1.20 pg ml vs 9.59 ± 0.75 pg/ml, respectively). There was no significant difference in serum levels of TNF-α between patients with LAA and those with extensive forms of the disease.

Conclusion:

Our findings support the evidence that elevation of serum TNF-α is associated with AA. The exact role of serum TNF-α in AA should be additionally investigated in future studies.     

ALOPECIA AREATA IS NOT ASSOCIATED WITH HELICOBACTER PYLORI

Background:

Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes. Helicobacter pylori has been associated with many extra-digestive dermatological conditions. The causal relation between alopecia areata and Helicobacter pylori is discussed in this study.

Materials and Methods:

We have screened for the presence of H. pylori in patients with AA, in order to determine any potential role in its patho-physiology. We have prospectively studied 31 patients with alopecia areata and 24 healthy volunteers of similar gender, for the presence of H. pylori stool antigen (HpSAg).

Results:

Optical density values for H. pylori infection was positive in 18 of the 31 patients evaluated (58.1%), while in 13 patients, the values did not support H. pylori infection (41.9%). In the control group, 10 of the 24 (41.7%) had positive results. Within the group of alopecia areata, there was no significant difference between HpSAg positive and negative patients.

Conclusions:

The results have shown that a relation between Helicobacter pylori and alopecia areata is not supported. We advise that H. pylori detection need not to be included in the laboratory work up of alopecia areata.     

COMPARATIVE ASSESSMENT OF TOPICAL STEROIDS, TOPICAL TRETENOIN (0.05%) AND DITHRANOL PASTE IN ALOPECIA AREATA

Background:

There have been various controversial reports regarding the efficacy of topical agents in topical therapy of alopecia areata.

Aim:

The study aims to find out the effective ones among the readily available ones for a dermatologist.

Materials and Methods:

Eighty patients were chosen from the skin OPD of Bankura Sammilani Medical College, Bankura, West Bengal, after evaluating the exclusion criterions. Treatments were continued for 3 month period and a follow up after further 3 months. After dividing them into four groups–group-I (topical steroids), group-II (topical tretinoin 0.05%) group-III (dithranol paste 0.25%), and group-IV (white soft petrolatum jelly)–patients were evaluated.

Results:

Seventy percent of group-I, 55% of group-II, 35% of group-III, and 20% of the control group (white soft petrolatum jelly) responded favorably. Side effects in the form of dermatitis and hyperpigmentation were seen in group-III. However, no patient discontinued from the study.

Conclusion:

We conclude that both topical steroids and tretinoin were fairly effective in limited variant of alopecia areata.     

Clinical Relevance for Serum Cold-Inducible RNA-Binding Protein Level in Alopecia Areata

BackgroundAlopecia areata (AA), a chronic, relapsing hair-loss disorder, is considered to be a T-cell-mediated autoimmune disease. Cold-inducible RNA-binding protein (CIRP) belongs to a family of cold-shock proteins that respond to cold stress, and has been identified as a damage-associated molecular pattern (DAMP) molecule that triggers the inflammatory response. Recent studies have shown that high-mobility group box 1, another DAMP molecule, is elevated in serum and scalp tissue of AA patients, suggesting a relationship between DAMP molecules and the pathogenesis of AA.ObjectiveTo investigate the clinical significance of serum CIRP levels in AA.MethodsThe serum levels of CIRP were compared between 68 patients with AA and 20 healthy controls. Additionally, the correlation between CIRP level and various clinical parameters was evaluated.ResultsThe serum CIRP levels were significantly higher in AA patients compared to healthy subjects. Moreover, there was an association between the serum CIRP level and clinical characteristics, such as disease duration and disease activity. However, there was no significant difference in the serum CIRP level among the clinical types of AA (AA multiplex, alopecia totalis, and alopecia universalis).ConclusionThese results suggest that CIRP may play a significant role in the pathogenesis of AA and could be a potential biologic marker for monitoring the disease activity of AA.     

皖籍汉人斑秃的遗传流行病学研究

目的描述斑秃患者的遗传流行病学特征和探索可能的遗传模型。方法应用病例对照研究的方法对1032例斑秃先证者进行遗传流行病学研究。采用Falconer方法和SAGE-REGTL软件进行遗传度和复合分离分析。结果患者平均发病年龄为28.98±13.43岁,男女之间无差异,82.6%的患者第一次脱发发生在40岁以前。有阳性家族史的有87人(8.43%)。早发组患者比晚发组病情更重、病程更长。先证者一、二、三级亲属的患病率分别为1.58%,0.19%和0.03%,显著高于对照组(P<0.001)。斑秃一、二、三级亲属的遗传度分别为47.16%±2.79%,42.53%±7.36%和22.29%±21.63%,三者加权平均遗传度为46.23%±0.07%。根据SAGE-REGTL结果,斑秃的最佳模型是多基因累加模式。结论斑秃具有多基因遗传病的特点,在其发病过程中,遗传起了重要的作用。     

二苯环丙烯酮治疗斑秃16例疗效观察

目的观察斑秃患者局部外用二苯环丙烯酮(DPCP)治疗的临床疗效。方法应用DPCP治疗16例斑秃患者,2%DPCP外搽秃发区致敏,1周后用0.001%DPCP外搽患者头皮,每周1次,并据患者反应增加浓度观察其治疗反应及副作用,并与局部外用米诺地尔酊2次/d进行对照。结果治疗组坚持治疗的11例患者中,8例出现终毛生长,有效率为72.73%,达到良好反应的中位时间为(9.07±3.96)月,停止治疗后复发率为25.00%,12.50%患者出现较严重副作用。对照组13例坚持治疗,4例患者出现终毛生长,有效率30.77%,复发率为25.00%。治疗组疗效明显优于对照组(P<0.05)。结论 DPCP治疗斑秃有效率高,安全性相对较好,是值得推荐的一种有效治疗方法。     

308 nm准分子激光治疗斑秃进展

斑秃是皮肤科的一种常见疾病,其治疗包括局部治疗和系统用药,紫外线光疗法是其中的重复方法之一。新近用于临床治疗斑秃的308 nm准分子激光是中波紫外线光疗法的最新进展,其作用机制与诱导皮损处T细胞凋亡、抑制细胞因子产生和影响抗原提呈细胞功能等有关。临床实验研究表明,该疗法方便、高效、安全及患者依从性好。为此,综述了308 nm准分子激光治疗斑秃的作用机制、临床应用及不良反应。     

二苯环丙烯酮局部免疫治疗斑秃的研究进展

国际上以二苯环丙烯酮(DPCP)在局部皮损上诱发接触性皮炎治疗重型斑秃应用最广泛,目前已有近30年历史,取得了良好的疗效。DPCP治疗斑秃的有效率多在50%～60%之间,常见的副作用为局部接触性皮炎,复发率10.6%～68.9%。DPCP治疗斑秃机制不明,目前认为可能是多环节性的,主要包括改变炎症细胞亚群、拮抗Th1免疫反应,重建Th1和Th2的平衡以及引入抑制性T细胞等。本文对有关DPCP局部免疫治疗斑秃的相关文献进行了综述。     

Clinical Presentation and Evaluation of Dermatomyositis

Dermatomyositis (DM) is a chronic inflammatory disorder of the skin and muscles. Evidence supports that DM is an immune-mediated disease and 50–70% of patients have circulating myositis-specific auto-antibodies. Gene expression microarrays have demonstrated upregulation of interferon signaling in the muscle, blood, and skin of DM patients. Patients with classic DM typically present with symmetric, proximal muscle weakness, and skin lesions that demonstrate interface dermatitis on histopathology. Evaluation for muscle inflammation can include muscle enzymes, electromyogram, magnetic resonance imaging, and/or muscle biopsy. Classic skin manifestations of DM include the heliotrope rash, Gottron''s papules, Gottron''s sign, the V-sign, and shawl sign. Additional cutaneous lesions frequently observed in DM patients include periungual telangiectasias, cuticular overgrowth, “mechanic''s hands”, palmar papules overlying joint creases, poikiloderma, and calcinosis. Clinically amyopathic DM is a term used to describe patients who have classic cutaneous manifestations for more than 6 months, but no muscle weakness or elevation in muscle enzymes. Interstitial lung disease can affect 35–40% of patients with inflammatory myopathies and is often associated with the presence of an antisynthetase antibody. Other clinical manifestations that can occur in patients with DM include dysphagia, dysphonia, myalgias, Raynaud phenomenon, fevers, weight loss, fatigue, and a nonerosive inflammatory polyarthritis. Patients with DM have a three to eight times increased risk for developing an associated malignancy compared with the general population, and therefore all patients with DM should be evaluated at the time of diagnosis for the presence of an associated malignancy. This review summarizes the immunopathogenesis, clinical manifestations, and evaluation of patients with DM.     

斑秃皮损性激素受体的检测

用荧光素类固醇激素结合法对２１例斑秃患者和１６例正常人头皮组织雌激素受体（ＥＲ）、孕激素受体（ＰＲ）和雄激素受体（ＡＲ）进行对照研究。结果显示斑秃表皮基层ＰＲ高于正常人（Ｐ＜０．０５），汗腺分泌部 ＡＲ显著低于正常人（Ｐ＜０．０１）。皮损毛囊外根鞘 ＥＲ、ＰＲ显著增多（Ｐ＜０．０１），ＡＲ无变化，毛母质细胞出现ＥＲ、ＰＲ和ＡＲ阳性表达，而正常为阴性；斑秃毛乳头ＥＲ、ＰＲ和ＡＲ显著降低（Ｐ＜０．０１）；立毛肌和皮脂腺上ＥＲ、ＰＲ、ＡＲ在两组间无显著性差异（Ｐ＞０．０５）。     

斑秃外周血T细胞亚群及β_2微球蛋白观察与意义探讨

本文用茶硷抑制试验测定斑秃20例与正常对照组60例的外周血T细胞亚群及放射免疫法测定β_2微球蛋白。结果表明:斑秃A花环及T花环形成能力均降低,T_R降低,T_R/T_S比例失调(P<0.01)。β_2微球蛋白则升高(P<0.01)。提示斑秃患者存在T细胞网络紊乱及体液免疫失调。     

96例斑秃皮肤镜临床表现分析

目的:探讨皮肤镜下斑秃临床特征表现。方法:分析2013年12月至2014年11月我科门诊确诊为斑秃的96例患者的临床资料、皮肤镜特征。结果:斑秃患者脱发区域皮肤镜征象包括黄点征、黑点征、断发、感叹号样发、短毳毛(新生短发<10 mm)。其中黄点征发生率最高,达69.8%,是诊断斑秃的敏感指标;感叹号样发、黑点征、断发在活动期发生率高,分别是40.6%、52.1%、48.9%,是斑秃重要的皮肤镜征象。结论:上述皮肤镜征象在斑秃的诊断、活动性评判及疗效评估上有较高的应用价值。     

Poroma with Sebaceous Differentiation: Dermoscopy for the Diagnosis of Skin Tumor with Sebaceous Differentiation

Although divergent adnexal differentiations are occasionally seen in poroma, poroma with sebaceous differentiation is extremely rare. We present here the second case of dermoscopy on poroma with sebaceous differentiation. A 38-year-old Japanese female presented with a 2-year history of a slow-growing nodule on her left forearm. Dermoscopically, fine hairpin-like vessels, beige lobular structures were seen in the nodule. Many small yellow dots were scattered between beige lobular structures, giving orange-beige in color as a whole. On the basis of histopathologic findings, a diagnosis of poroma with sebaceous differentiation was made. Some sebaceous tumors are known to exhibit yellowish structures on dermoscopy. Tumors with sebaceous differentiation, as well as conventional sebaceous tumors, can show yellow structures on dermoscopy.     

Role of Substance P in Regulating Micro-Milieu of Inflammation in Alopecia Areata

BackgroundAlopecia areata (AA) is an autoimmune disease characterized by chronic inflammation, the pathogenesis of which is unknown. Stress is believed to play a role; however, evidence remains insufficient. A recent study showed that substance P (SP) damaged hair follicles by causing neurogenic inflammation, activating perifollicular mast cells, and inducing keratinocyte apoptosis.ObjectiveWe aimed at studying the role of SP in AA pathogenesis. We investigated the SP levels in the lesional scalp tissues and serum. We also studied the effect of SP on the inflammatory response and hair growth in the outer root sheath (ORS) cells.MethodsWe compared the serum levels of SP in 58 AA patients and 28 healthy subjects. Then, we checked the expression of SP and SP receptor, neurokinin-1 receptor (NK-1R) in the scalps of AA patients and healthy controls using immunohistochemical staining. Finally, we analyzed the mRNA expression of inflammatory cytokines and hair growth-related factors in ORS cells.ResultsSP and NK-1R expression were markedly higher in the hair follicles and interfollicular epidermis of the scalp lesions of AA patients. However, there was no statistically significant difference in serum SP levels between controls and patients, regardless of the type of alopecia. SP significantly increased the mRNA expression of inflammatory cytokines and decreased hair growth-related growth factors in ORS cells, but the results were not dramatic.ConclusionSP triggered a localized micro-inflammation in lesional hair follicles, provoked an inflammatory response, and inhibited hair growth, thereby confirming the pathogenic role of SP in AA.