Prevalence of autoantibodies in patients with endemic pemphigus foliaceus (fogo selvagem)

Objective The aim of the present study was to investigate a broad spectrum of autoantibodies in patients with endemic pemphigus foliaceus (EPF)—fogo selvagem—and to determine the possible association between EPF and other autoimmune diseases.Materials and methods Indirect immunofluorescence was used to test 120 patients with EPF and 200 healthy controls for the presence of the following autoantibodies: anti-desmoglein-1 (APF), anti-neutrophil cytoplasmic (ANCA), anti-smooth muscle (SMA), anti-mitochondrial (AMA), anti-nuclear (ANA), anti-liver kidney microsomal (LKM), anti-gastric parietal cells (GPCA) and anti-thyroid microsome (TMA).Results APF antibodies were detected in 62.5% of the patients (75/120), ANA and SMA in 0.8% (1/120), and TMA in 1.6% (2/120). None of the patients was positive for ANCA, AMA, LKM or GPCA. In the control group, a positivity of 2% was observed for SMA (4/200), 1.5% for TMA (3/200), and 0.5% (1/200) for ANA and GPCA. None of the controls was positive for APF, LKM, AMA or ANCA.Conclusions The prevalence of the autoantibodies ANA, SMA, AMA, GPCA, LKM and ANCA in patients with EPF was similar to that observed in the control group. No association with clinical or laboratory manifestations of other concomitant autoimmune diseases was observed in EPF patients. These results confirm the concept that EPF is an organ-specific autoimmune disease.     

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.     

PREVALENCE OF THYROID DISEASES IN PATIENTS WITH ALOPECIA AREATA

Background. The prevalence of thyroid disease in patients with alopecia areata previously reported varied from 0 to 28%. These thyroid diseases include Hashimoto's thyroiditis. Graves' disease, simple goiter, and others. Methods. The prevalence of thyroid diseases was determined in 152 consecutive patients with alopecia areata who presented to the dermatology clinic. A complete history was taken and a physical examination was performed. Thyroxine, triiodothyronine, thyroid-stimulating hormone, and microsomal antibody levels were measured in every patient. The control group consisted of 152 age- and sex-matched volunteers who had skin diseases other than alopecia areata or autoimmune disorders. Results. Among 152 patients, age 10–59 years, four cases (2.6%) had a small simple goiter. Microsomal antibodies were detected in seven other patients (4.6%) with liters ranging from 1:100 to 1:1600. None of these seven patients had signs or symptoms of thyroid disease. Five cases (3.3%) of the control group had positive microsomal antibody tests with titers ranging from 1:100 to 1:400. The prevalence of positive microsomal antibodies in the alopecia areata group was not statistically different from the control group (x²= 0.347, df= 1, P = 0.5558). Conclusions. Among 152 patients with alopecia areata, 4.6% of patients had microsomal antibodies and 2.6% had a small simple goiter. Thus the prevalence of thyroid disease among these patients was 7.2%. The prevalence of positive microsomal antibodies in 4.6% of the patients was not statistically different from that of the control group.     

Dermal mucin in alopecia areata – tell tale sign or incidental finding?

Alopecia areata is an autoimmune disease causing patchy hair loss, which occurs with an increased incidence in patients with lupus erythematosus. We report a 27-year-old African-American female with systemic lupus erythematosus and alopecia areata, whose biopsy showed a marked increase in mucin in the deep dermis and subcutis. Archival biopsies of alopecia areata were then reviewed to see if this finding occurs in patients without systemic lupus. Of 13 recent biopsies diagnostic of alopecia areata, we detected deposition of mucin in 3 (23%), but all mild in degree and in a superficial location. We speculate that the marked deposition of mucin in this patient's biopsy of alopecia areata may be related to her underlying systemic lupus, and that the presence of marked, deep dermal deposition of mucin might serve as a diagnostic clue for the presence of underlying systemic lupus in patients with alopecia areata.     

ALOPECIA AREATA AND INCREASED PREVALENCE OF PSYCHIATRIC DISORDERS

Background. The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses. Methods. Two hundred and ninety-four community-based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR). Results. Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population. Conclusions. Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.     

PROFILE OF ALOPECIA AREATA IN NORTHERN INDIA

Background. Epidemiologic studies of alopecia areata (AA) are available from USA, Japan, and European countries, but there is a paucity of literature on AA from Asian countries, especially from the Indian subcontinent. Methods. In a prospective, hospital-based study lasting for a decade (1983–1992), the epidemiology of AA was studied, including associated diseases and risk factors for development of severe AA. Simultaneously a similar study was carried out in age- and sex-matched controls. Results. Eight hundred and eight patients (532 men, 276 women) and 572 age- and sex-matched controls (370 men, 202 men) were studied. The incidence of AA was 0.7% of new dermatology outpatients. The majority of patients (712, 88%) were below 40 years of age, including 196 children < 16 years of age (24%). Almost half (46%) of the women patients had onset of AA in childhood, compared to only 19% in men (P < 0.001). Alopecia was total, universal, or extensive in 154 patients (19%). An onset in the first two decades was more often associated with severe alopecia (P < 0.001), especially in men (P < 0.01). Alopecia areata was recorded in family members of 70 patients (9%), being more frequent in the severe forms of AA (16%). Evidence of atopy was recorded in a total of 146 instances (18%). The frequency of atopy was the same in circumscribed alopecia (18.1%) and severe alopecia (18.2%). Nail changes were found in 162 patients (20%) and were more frequent in 76 (47%) with the severe form of AA (P < 0.001). On 39 occasions (5%), autoimmune-related diseases were detected: vitiligo in 15 (1.8%), thyroid disorders in 8 (1%), lichen planus in 6 (0.7%), collagen vascular diseases in 5 (0.6%), diabetes mellitus in 4 patients (0.4%), and pemphigus foliaceus in 1 (0.1%) patient. Patients with family members having vitiligo (recorded in 5.9% of patients), were more frequently affected with severe alopecia (P < 0.001). Conclusions. Alopecia areata in North Indians showed a preponderance in men (M:F = 2:1) and the majority of persons with disease (88%) were below 40 years of age. Onset in childhood was more frequent in girls or women, but the incidence of severe alopecia was higher in boys or men with onset at an earlier age. Diseases associated with autoimmunity were seen in only 5% of patients. Atopy was found to be associated in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. Presence of vitiligo in family members and onset before 20 years of age, especially in boys or men, were found to be risk factors for severe alopecia. Int J Dermatol 1996; 35:22–27     

Thyroid autoimmunity in patients with alopecia areata

Alopecia areata (AA) is a common form of localized, non-scarring hair loss. It is characterized by the loss of hair in patches, total loss of scalp hair (alopecia totalis), or total loss of body hair (alopecia universalis). The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine dysfunction may be involved. The aim of this study was to determine whether AA is statistically associated with thyroid autoimmunity. In this retrospective epidemiologic study, we compared the frequency of thyroid autoantibodies (thyroglobulin antibody, TgAb, and thyroid peroxidase antibody, TPAb) ATPO) in 70 AA patients and 30 healthy volunteers. Thyroid autoantibodies and thyroid hormones (thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH)) were measured in all subjects. Thyroid functional abnormalities were found in 8 (11.4%) AA patients. Positive autoimmune antibodies were associated with AA in 18 (25.7%) patients, with no significant association between the disease severity and presence of these antibodies. The frequency of thyroid autoantibodies was significantly higher in AA patients than in healthy controls (25.7% vs. 3.3%; p<0.05). Our findings pointed to a significant association between AA and thyroid autoimmunity and showed the tests to detect thyroid autoantibodies to be relevant in AA patients.     

Incidence of alopecia areata in lupus erythematosus.

BACKGROUND--A small percentage of patients with alopecia areata have connective diseases such as systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, and scleroderma. Lupus erythematosus is associated with a number of different types of alopecia, but the incidence of alopecia areata in lupus erythematosus has not been examined. OBSERVATIONS--Of our cohort of 39 patients with lupus erythematosus, alopecia areata developed in 10% (four patients), in contrast to 0.42% of general dermatologic patients. Biopsy specimens of alopecia areata lesions in each of our patients showed continuous granular deposition of IgG at the dermoepidermal junction, a finding usually found in only a minority of alopecia areata cases. Intralesional injections of corticosteroids were effective treatment. CONCLUSIONS--The incidence of alopecia areata in patients with lupus erythematosus is increased. Recognition of this form of alopecia allows for specific therapy with intralesional corticosteroids.     

Alopecia areata and auto-immunity

The prevalence of auto-antibodies against thyroid constituents, gastric parietal cells, smooth muscle cells, mitochondria, reticulin, nuclear constituents and rheumatoid factor in 108 patients with alopecia areata was compared with that found in a previous survey of the local population. Female patients had a significantly increased prevalence of anti-thyroid antibodies which were present in 30% overall and in 44% of the youngest age group (11–17 years). Smooth muscle antibodies were more frequent in female patients but the increase was not significant. Male patients had a significantly increased prevalence of thyroid and gastric parietal cell antibodies (11.4% each). In females, antithyroid antibodies were associated with extensive hair loss: they were found in 42% of female patients with total alopecia and only 20% of males with total hair loss. A family history of alopecia areata was obtained from 24% of patients; 10% had relatives with thyroid disease and 10% had diabetic relatives. These findings confirm the association between alopecia areata and the other auto-immune diseases.     

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。     

The pattern and profile of alopecia areata in Singapore--a study of 219 Asians

BACKGROUND: Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. OBJECTIVE: To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. METHODS: Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed. RESULTS: Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss. CONCLUSIONS: Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.     

Evaluation of thyroid function in north Indians with alopecia areata: response to intravenous injection of 100 micrograms thyrotropin releasing hormone (TRH).

There is a lack of agreement on the overall prevalence of thyroid disease and thyroid function abnormalities in alopecia areata. Only one study is available from the Indian subcontinent. All patients with alopecia areata attending a dermatology outpatient clinic between 1983 and 1997 were screened for the presence of clinical thyroid disease. Sixty-two consecutive patients during the year 1994 were evaluated in detail for thyroid functions by measuring T3, T4, TSH levels and testing for antithyroid and antimicrosomal antibodies. Twenty-two patients randomly selected from the above-mentioned sixty two were studied for TSH response to intravenous injection of 100 micrograms TRH at -20, 0 and 20, 60, and 120 minutes after TRH injection. Thyroid disease was clinically evident in 16 (0.85%) of the 1700 patients with alopecia areata seen over the last fifteen years. All sixty-two patients evaluated for thyroid functions were clinically euthyroid. Seven (11.3%) out of these 62 patients had abnormal thyroid hormone levels. Antithyroid and antimicrosomal antibodies were found in five patients; all five had abnormalities in thyroid function. TSH response to TRH was suggestive of hypothyroidism in 4 (18%) of the 22 patients studied. Manifest thyroid disease is infrequently associated with alopecia areata. Abnormalities in thyroid functional status were more frequent; they were found in 7 (11.3%) out of 62 patients. TSH response to intravenous TRH was abnormal in an even higher proportion [4 (18%) out of 22 patients]. There was no apparent correlation with duration or type of alopecia areata.     

Ocular findings in alopecia areata

Alopecia areata is a T cell mediated disease with which many disorders may be associated. There are few studies reporting ocular findings in alopecia areata. The aim of the study is to assess tear function and ocular surface pathologies in alopecia areata. Thirty‐two patients with alopecia areata and 20 age‐ and sex‐matched healthy controls were enrolled in the study. Ocular surface disease index questionnaire, Schirmer, tear break‐up time, and corneal staining stage tests were done. The data was analyzed using SPSS 10.0 software. One‐way variance analysis and Chi‐square tests were used as tests of significance. The patient group had significantly higher ocular surface disease index questionnaire and corneal staining stage test scores and lower tear break‐up time test scores compared with the control group (P < 0.05). Dry eye disease (DED) was diagnosed in 27 (84%) of 32 alopecia areata patients and in only 3 (15%) of 20 controls, and there was a significant difference between the groups (P < 0.01). T cell mediated autoimmunity has a prominent role in the etiopathogenesis of alopecia areata and dry eye disease. We think that inflammatory mechanisms causing alopecia areata may trigger dry eye disease or vice versa. All patients with AA should be referred to an ophthalmologist for the evaluation of DED and other possible eye pathologies.     

DETECTION OF AUTOIMMUNITY PARAMETERS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME (aids)

We have examined various autoimmunity parameters in AIDS with special emphasis on the expression of pemphigus and bullous pemphigoid antibodies. Sera from healthy seropositive individuals without syphilis (CS-, n = 17), seropositive individuals with syphilis (cs+, n = 11), and patients with AIDS (n = 6) were studied and compared with normal controls (n = 30); autoimmunity parameters related to dermatology were evaluated. Indirect immunofluorescence (IIF) for pemphigus and pemphigoid antibodies, antinuclear antibodies (ANA), anti-DNA antibodies, antismooth muscle antibodies (ASMA) antimitochondrial antibodies (AMA), and antithyroid antibodies (ATA) was carried out and findings were graded with a cumulative index (CI) for each patient group. Pemphigus and bullous pemphigoid-like antibodies (IgG, PV + BP) were detected in 33% of the AIDS patients. Statistically increased CI (P less than 0.01) was found in the CS- group compared with the CS+ group and in the AIDS group compared with CS- (P less than 0.01).     

Alopecia areata. How not to miss Satoyoshi syndrome?

Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear antibodies are present in 60% of patients. The syndrome primarily affects girls and young women. Trichoscopy shows regularly distributed yellow dots, indistinguishable from typical alopecia areata. The condition may be easily misdiagnosed and treated as alopecia areata. On the basis of an in‐depth analysis of all published cases we developed diagnostic criteria for Satoyoshi syndrome. We also suggest that two subtypes of the disorder should be distinguished, the ANA‐positive Satoyoshi syndrome with generally good response to systemic glucocorticosteroid therapy and the ANA‐negative Satoyoshi with less favorable prognosis. In our opinion all patients will alopecia areata (in particular alopecia totalis) should be inquired about muscle spasms and diarrhea and tested for antinuclear antibodies to decrease the risk of missing Satoyoshi syndrome.     

ALOPECIA AREATA THYROID DISEASE AND AUTOIMMUNITY

SUMMARY.— The incidence of thyroid disease in patients with alopecia areata was greater than in patients with psoriasis and also greater than in a control series of the general population. There was also an increased incidence of alopecia areata and diabetes mellitus in the relatives of patients with alopecia areata. No significant difference was found in the incidence of thyroglobulin and thyroid complement-fixing antibodies in patients with alopecia areata as compared with a general practice population. A negative association between psoriasis and thyroid antibodies was demonstrated.     

CLINICAL-EPIDEMIOLOGIC STUDY OF ALOPECIA AREATA

Background. Alopecia areata is a common disease and may be associated with autoimmune disease, atopy, Down syndrome, emotional stress, and foci of sepsis. Methods. Seven cases of alopecia areata were diagnosed among workers in the Water and Effluent Treatment Sector (WETS) of a paper factory, representing a 0.6% incidence, when the value for the population at large is 0.1%. Three of these workers are assigned to the WETS on a permanent basis and four provide maintenance services. One of the latter patients had alopecia areata that fully regressed. Because biologic treatment of water and effluents involves saprophytic bacteria and fungi as well as chemical substances such as acrylamide, a clinical examination and laboratory tests were performed on all workers assigned permanently to the WETS (N = 9) and on 25% of the workers, selected at random providing services to the sector (N = 14). Results. There was no association between alopecia areata and atopy, dermatophytosis, or bacteria isolated. Toxicologic evaluation revealed an acrylamide-like substance in 7 workers with alopecia areata, with a statistically significant correlation. Measures were taken at the workplace to decrease worker contact with the mists (probably containing acrylamide) in the pulp-pressing room; no other cases of alopecia areata had been detected 1 year after the study. Conclusions. A survey of the literature did not show reports of alopecia areata as an occupational dermatosis, but our conclusion is, that this dermatosis could be due to the professional activities of the workers at the paper factory studied.     

Reappraisal of Ikeda's Classification of Alopecia Areata: Analysis of 356 Cases from Chandigarh,India

Three hundred and fifty six patients (234 males, 122 females) with alopecia areata were classified according to Ikeda's classification. The common type of alopecia areata was most frequently seen in 239 (67.13%) patients, followed by atopic in 60 (16.85%), prehypertensive in 48 (13.4%), and autoimmune/endocrine in 9 (2.52%) patients. Severe alopecia did not occur with a higher frequency in atopic or endocrine/autoimmune alopecia areata than in the common type (p>0.05). Prehypertensive alopecia areata had the lowest frequency of severe alopecia in the present study. The odds for developing severe alopecia were highest (2.6) when onset was before 16 years of age, followed by female sex (2.12), atopy (0.86), autoimmune/endocrine (0.53), and prehypertensive (0.28) types. Alopecia areata should be broadly classified as childhood (<16 years) and adult onset with subtypes of atopic, autoimmune/endocrine, and common type under both. The prehypertensive type should be combined with the common type of alopecia areata.     

Treatment of persistent alopecia areata with sulfasalazine

Background  Alopecia areata is an autoimmune disease with no definitive treatment, and some cases persist despite standard therapies. Sulfasalazine has been reported to show success in the treatment of persistent cases of alopecia areata.
Objective  To assess the efficacy of sulfasalazine in cases of recalcitrant alopecia areata that do not respond to topical and intralesional corticosteroids, 5% minoxidil, or psoralen plus ultraviolet-A (PUVA) therapy.
Methods  Thirty-nine patients with persistent alopecia areata received 3 g of oral sulfasalazine for 6 months, and terminal hair regrowth was quantified as no response, moderate response, or good response.
Results  A good response occurred in 10 of the 39 patients (25.6%), a moderate response in 12 (30.7%), and a poor or no response in 17 (43.5%).
Conclusion  Sulfasalazine can be used as an alternative drug in patients with persistent alopecia areata.     

Value of pathologic thyroid gland findings in alopecia areata

As we had frequently found goiters in patients with alopecia areata, we performed specific thyroid diagnostics in 120 patients suffering from this kind of loss of hair. By means of palpatory, sonographic, and scintigraphic examination of the thyroid gland, we found in 18% no goiters, in 70% diffuse goiters, and in 12% nodular goiters. In 115 patients, the metabolic condition showed euthyroidism, 3 patients had subclinical hypothyroidism, and 2 patients subclinical hyperthyroidism. We did not detect any increased incidence of antibodies against thyroglobulin or thyroid microsomes; only one patient showed Hashimoto's thyroiditis. The resected goiter tissue of 3 patients with thyroid enlargement and alopecia areata predominantly revealed the typical regressive changes usually seen in colloid and common goiters. But, contrary to the scalp biopsies, the goiter tissue only showed slight antigen expression of HLA-DR. On account of the high incidence of non-toxic diffuse goiters, we discuss the possibility of a goitrogenic factor associated with alopecia areata.