Establishing and prioritizing research questions for the prevention,diagnosis and treatment of hair loss (excluding alopecia areata): the Hair Loss Priority Setting Partnership

Hair and scalp problems are common. Various conditions can result in hair loss and may present as increased hair shedding, hair thinning or patchy to complete hair loss. In some conditions the hair may regrow, in others the alopecia (hair loss) is permanent. Frequently overlooked is the psychological impact of hair loss on an individual. The visible nature of hair loss and fear of progression may lead to low self‐esteem, anxiety and depression. Unfortunately, there is a lot of uncertainty around the most effective treatments for these disorders. This study, funded by the charity Alopecia UK, aimed to identify uncertainties in hair loss management, prevention, diagnosis and treatment that are important both to people with hair loss and to healthcare professionals. This was done by creating a hair loss ‘priority setting partnership’ (PSP) between patients, their carers and relatives, and healthcare professionals, to identify the most important uncertainties in hair loss. This study presents the top 10 research priorities for hair loss (excluding alopecia areata) to guide researchers and funding bodies to support studies important both to patients and clinicians.     

The role of the National Alopecia Areata Foundation in the management of alopecia areata

Like a mysterious thief in the night, alopecia areata (AA) suddenly appears without warning—seemingly without rhyme or reason—randomly robbing the hair and subsequently the self-esteem of those affected. Very persuasive scientific evidence now suggests that AA is a T-lymphocyte-mediated autoimmune disease directed against an as yet unidentified hair follicle autoantigen in genetically susceptible individuals. The severity of the clinical phenotypes seen in AA run the gamut from patchy hair loss localized in one or more areas, to total scalp hair loss [alopecia totalis (AT)], to complete body hair loss [alopecia universalis (AU)]. Although not life threatening, AA is most certainly life altering, and its sudden onset, recurrent episodes, and highly unpredictable course have a profound psychological impact on the lives of those with the disease. There are a limited number of therapeutic agents available to treat AA. Responses vary widely and the hard fact remains that any treatment, no matter how successful, does not alter the ultimate course of this capricious and recalcitrant disease. Founded in 1981 to meet the challenges of AA and mollify the deep emotional pain inflicted by this disease, the National Alopecia Areata Foundation (NAAF) now serves as the world center of information and hope for those with AA. The foundation plays a crucial role in the management of AA by encouraging and funding medical research for better treatment and an ultimate cure, by providing support and resources for those with the condition, and by raising public awareness of the disease.     

Developing a protocol to identify and prioritize research questions for psoriasis: a James Lind Alliance Priority Setting Partnership

Psoriasis is a common condition that affects over two million people in the UK and causes red, flaky patches of skin which can sometimes feel sore or itchy. People with psoriasis can be affected by their disease physically, emotionally and socially. There are many unanswered questions about psoriasis. To find out what the most important questions are, a Psoriasis Priority Setting Partnership PSP is being carried out now. The PSP involves patients, families, carers and healthcare professionals working together to follow a process outlined by the James Lind Alliance. The first step is for all groups with an interest in psoriasis to complete a survey about what they think the important research questions are. Survey responses are then checked against existing evidence. Questions raised in the surveys, but which have already previously been answered, will be shared with relevant organisations who may consider how this information can be better shared with clinicians, patients and their families. Questions raised in the surveys, which have not already been answered will be compiled into a list. This list will be sent round to stakeholders in a second survey where they will be ordered by importance. At a final workshop, a ‘top ten’ list of unanswered questions will be agreed by patients, their carers and health professionals. This ‘top ten’ list will be shared widely with psoriasis researchers and funders, to encourage research that focuses on tackling the key issues which really matter to patients, families, carers and healthcare professionals.     

The Eczema Priority Setting Partnership: a collaboration between patients,carers, clinicians and researchers to identify and prioritize important research questions for the treatment of eczema

Background Eczema is a common condition, yet there are uncertainties regarding many frequently used treatments. Knowing which of these uncertainties matter to patients and clinicians is important, because they are likely to have different priorities from those of researchers and funders. Objectives To identify the uncertainties in eczema treatment that are important to patients who have eczema, their carers and the healthcare professionals (HCPs) who treat them. Methods An eczema Priority Setting Partnership was established, including patients, HCPs and researchers. Eczema treatment uncertainties were gathered from patients and clinicians, and then prioritized in a transparent process, using a methodology advocated by the James Lind Alliance. Results In the consultation stage 493 participants (including 341 patients/carers) made 1070 submissions, of which 718 were uncertainties relating to the treatment of eczema. Treatment uncertainties with more than one submission were grouped into 52 ‘indicative uncertainties’, which were then ranked by 514 participants (including 399 patients/carers). The top 14 treatment uncertainties were prioritized for research. The first four were common to patients/carers and HCPs (shared uncertainties): (i) the best and safest way of using topical steroids (including frequency of application, potency, length of time, alternation with other topical treatments and age limits); (ii) the long‐term safety of topical steroids; (iii) the role of food allergy tests; and (iv) the most effective and safe emollients in treating eczema. The remaining 10 of the top 14 uncertainties comprised the next five highest ranked uncertainties for patients and the next five highest ranked uncertainties for HCPs. At a workshop involving 40 participants (patients, HCPs and researchers), shared uncertainties were formulated into possible research questions. Conclusions The top 14 treatment uncertainties around the treatment of eczema provide guidance for researchers and funding bodies to ensure that future research answers questions that are important to both clinicians and patients.     

DPCP for the treatment of alopecia areata

Topical immunotherapy with diphencyprone (DPCP) for the treatment of severe alopecia areata has been used since 1983 and is felt to be the treatment of choice by many dermatologists. Although there have been no major side effects reported since its initial use, there remain some unknowns regarding its safety. Because DPCP has at least a 40% success rate for cosmetically acceptable regrowth in extensive alopecia areata, its availability is an important matter for patients with alopecia areata.     

Alopecia syphilitica, a simulator of alopecia areata: histopathology and differential diagnosis

Alopecia syphilitica (AS) may be "moth-eaten" or diffuse, clinically, and be confused with alopecia areata (AA) or other alopecias. The English language literature contains scant information regarding the histopathology of AS, and the resemblance between AS and AA has not been given adequate recognition. We report the histopathological findings of AS from nine patients with secondary syphilis and acute hair loss. The alopecia was moth-eaten in four patients and diffuse, but slightly moth-eaten, in five. Microscopically, the dermoepidermal interface was not involved. The numbers of hair follicles were diminished, with increased numbers of catagens and telogens. Lymphocytic infiltration was present around the hair bulbs and fibrous tracts in eight cases. Plasma cells were present in four biopsies. Other less common findings included lymphocytes in the isthmus, parabulbal lymphoid aggregates, and granulomatous infiltrate in the upper dermis. The findings, save for the follicular changes, resembled those of macular/maculopapular syphilides outside the scalp. With the follicular changes, the overall patterns resembled AA closely. The modified Steiner stain did not reveal spirochetes in any of our cases and failed to differentiate between AS and AA. Comparing the AS cases to 13 cases of AA, we found only a few differentiating features. The presence of peribulbal eosinophils strongly suggests AA. Without peribulbal eosinophils, the presence of plasma cells, abundant lymphocytes in the isthmus, or parabulbal lymphoid aggregates suggests AS.     

Alopecia areata: treatment of today and tomorrow

It is the aim of this article to review and appraise available data on treatments for alopecia areata (AA) according to the demands of evidence based medicine. Studies evaluating the efficacy of a treatment for AA should include appropriate controls, use cosmetically acceptable hair regrowth as a parameter for treatment success, include patients with AA totalis, universalis or extensive patchy AA, and exclude patients suffering from AA for less than 3 months. Moreover, the treatment must be safe over a prolonged period of time. Among the various therapeutic approaches presently available for AA, only treatment with contact sensitizers such as diphenylcyclopropenone or squaric acid dibutylester has been shown to be effective in studies that fulfill these criteria. Improved future treatments may be immunosuppressive or immunomodulatory targeting of the autoimmune pathogenesis of AA, or they may otherwise protect hair follicles from the injurious effects of inflammation. Such possible future therapeutic approaches include the incorporation of immunomodulatory agents into liposomes as an improved vehicle; inhibition of apoptosis mediated by the Fas-FasL system; inhibition of the lymphocyte homing receptor CD44v10; induction of tolerance.     

Alopecia areata: identification and current treatment approaches

Alopecia areata is a disease which occurs in 1.7% of the population (Safavi et al., 1995), often with devastating effects to patients and their families. In the past, this condition has been misunderstood and treated inadequately. New treatment modalities and support systems are offering hope to patients with alopecia areata.     

JAK抑制剂治疗斑秃的研究进展

【摘要】 斑秃是一种突然发生的局限性脱发,严重者可进展为全秃或普秃。目前认为斑秃是一种具有遗传背景的器官特异性自身免疫性疾病,毛囊免疫赦免结构的破坏是重要的发病机制。目前,斑秃的治疗方法有口服、外用、肌内或局部皮损内注射糖皮质激素、外用米诺地尔酊等,但仍有一部分患者治疗无效。近年来,国外开展了很多有关JAK抑制剂治疗斑秃的临床试验。研究显示,在采用口服JAK抑制剂治疗的患者中,约半数中重度斑秃患者在治疗后毛发几乎完全长出,疗效较明显。也有报道外用鲁索替尼治疗斑秃,但疗效不一。尽管部分患者在停药后复发或是在治疗过程中出现感染等不良反应,JAK抑制剂确实为有效治疗中重度斑秃提供了一种选择。     

Alopecia neoplastica simulating alopecia areata and antedating the detection of primary breast carcinoma

A woman with no previous history of breast carcinoma presented with focal hair loss, which was presumptively diagnosed as alopecia areata. After treatment failures, a scalp biopsy was performed, which subsequently led to the diagnosis of breast carcinoma. This case illustrates the subtle course which breast cancer can take and the insidious manner in which it may present. It alerts clinicians and pathologists to the possibility of secondary causes, including malignancy, in the differential diagnosis of alopecia refractory to usual treatments.     

Diphencyprone in the treatment of alopecia areata

27 patients suffering from either extensive alopecia areata (n = 5) or alopecia totalis (n = 22) were treated topically with diphencyprone, a new potent contact allergen. The duration of treatment ranged from 4 to 17 months. Unilateral induction of hair growth after unilateral treatment was observed in 23 patients. A continuous response after continuous treatment has been observed so far in 18 of these patients. Thus, diphencyprone was found to be as effective as DNCB or squaric acid dibutylester in the treatment of alopecia areata. Unlike DNCB, diphencyprone is not mutagenic in the Ames test. Compared with squaric acid dibutylester, diphencyprone is more stable and thus more suitable for storage when dissolved in acetone. Further investigative evaluation of diphencyprone may show whether this drug is suitable for a more general use in the treatment of severe forms of alopecia areata.     

斑秃治疗进展

斑秃是一种皮肤科常见的良性、以非瘢痕性脱发为主要表现的疾病,严重影响美观.传统的治疗方法基于局部或系统应用糖皮质激素或米诺地尔等促毛发生长药物.随着对斑秃发病机制研究的不断深入,出现了一些新的尝试性的治疗方法,如免疫调节剂、新型生物制剂、308 nm准分子激光、PUVA 等,由于这些疗法缺乏大规模随机对照试验的证据支持并存在较多不良反应,因此在临床上的应用受到限制,但为以后开发新型治疗药物提供了有益的思路.今后斑秃治疗研究的热点将是针对发病机制的靶向治疗并最大限度减少不良反应.