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.     

Bitemporal alopecia areata

Alopecia areata has various clinical presentations, some of which have recognised prognostic significance. We report five cases of bitemporal alopecia areata, with involvement of the frontal hairline, the therapeutic approach for each case and possible differential diagnoses to also consider.     

母女同患重症斑秃二例

患者1,女,7岁。头发全部脱落6个月余。患者2,女,33岁,系患者1之母,弥漫性脱发2个月余。两例患者毛发镜下可见断发、感叹号样发、黑点征、短毳毛。患者1给予白芍总苷胶囊、复方甘草酸苷片、沙棘颗粒、六味地黄颗粒口服,米诺地尔酊、哈西奈德溶液、卤米松乳膏外用等治疗16个月后病情好转。患者2给予白芍总苷胶囊、活力苏口服液、甲泼尼龙片口服,生发酊、哈西奈德溶液、卤米松乳膏外用等治疗9个月后病情好转。     

Therapy of alopecia areata with diphenylcyclopropenone

With special regard to practical aspects, we discuss the treatment of alopecia areata by topical immunotherapy with diphenylcyclopropenone. Out of 27 patients treated this way, 10 patients showed good and cosmetically acceptable regrowth of terminal hair; 11 patients showed some regrowth, which was not satisfactory, however, for cosmetic reasons; 6 patients developed no hair growth at all. The complete failure of treatment in the latter cases may possibly be due to the long duration of the alopecia.     

Therapy of alopecia areata with diphencyprone

The properties of diphencyprone (DPC), its possible mechanism of action in the therapy of alopecia areata (AA), and its side-effects are summarized. The results of our own study of treatment in 45 patients with AA, with a mean treatment duration of 72 (15-146) weeks, are presented, and compared with the results of previous studies. We suggest that, in future, therapy protocols should define entry criteria and therapy results more precisely, and include follow-up assessments to establish the length of remission. In view of the low response rates and short lengths of remission, the indications for DPC therapy should be set more rigorously.     

Treatment of alopecia areata with diphencyprone

26 patients with alopecia areata were treated topically with diphencyprone. 10 had alopecia universalis, 7 alopecia totalis and 9 had alopecia areata. The treatment lasted from 4 to 14 months. In 13 patients a little response was obtained; only in 1 case it was satisfactory. Factors that appear to influence these results are discussed.     

Therapy of alopecia areata with diphenylcyclopropenone

Induction and maintenance of contact dermatitis of the scalp has proved effective in producing regrowth of hair in patients with alopecia areata. We observed regrowth of hair in 17 out of 20 patients after local application of the contact allergen, diphenylcyclopropenone. Only 3 patients were treated without success. In 3 patients regrowth of hair was also seen in areas that were not treated with diphenylcyclopropenone, suggesting that this treatment has an additional systemic effect. Patient acceptance of the induced dermatitis was excellent.     

Ocular abnormalities occurring with alopecia areata

This study was carried out on 83 patients with alopecia areata. Ophthalmological examinations showed lens changes in 65 patients and alterations in the retinal epithelium in 28 patients. The relationships between pigment cells and hair cycle are discussed.     

Immunohistological evaluation of alopecia areata treated with squaric acid dibutylester (SADBE)

A total of 19 patients with alopecia areata volunteered for serial biopsies of the scalp skin during SADBE treatment. Regrowth of terminal hair was seen in 12 of the 19 patients on the side of the scalp treated with SADBE for a minimum of four months, but not on a control side treated with sodium lauryl sulphate (SLS). Immunocompetent cells were characterized with ANAE staining and monoclonal antibodies in biopsy specimen showing marked peribulbar and perivascular inflammatory cell infiltrates. Inflammatory cell subclasses were repeatedly evaluated during SADBE treatment. No specific alterations in lymphocyte subclasses and macrophages were seen in relation to the hair growth response. In immunofluorescent studies it was found that in patients with regrowth of hair, immunoglobulins, fibrin and complement, appeared in the hair bulb and along the basement membrane during the treatment. Results were negative in patients without regrowth of terminal hair and in SLS-treated skin. As we could not demonstrate that any cell-mediated mechanism was involved, we suggest that SADBE may induce terminal hair growth through as yet uncharacterized mediators.