Frontal fibrosing alopecia (FFA) is a relatively new scarring alopecia that is considered a variant of lichen planopilaris (LPP) with no recognized promising treatments. In this study, we tried to clarify the underlying signaling pathways and their roles in the pathogenesis and progression of FFA. Because of several differences in clinical manifestations, response to treatments, and pathological findings, these two conditions could be differentiated from each other. Taking into account the already discussed signaling pathways and involved players such as T cells, mast cells, and sebaceous glands, different possible therapeutic options could be suggested. In addition to treatments supported by clinical evidence, such as 5 alpha-reductase inhibitors, topical calcineurin inhibitors, hydroxychloroquine, peroxisome proliferator-activated receptor gamma agonists, and oral retinoid agents, various other treatment strategies and drugs, such as phototherapy, Janus kinase inhibitors, dehydroepiandrosterone, sirolimus, cetirizine, and rituximab, could be suggested to mitigate disease progression. Of course, such lines of treatment need further evaluation in clinical trials.
Background
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder that progresses over time, and currently it is the fourth leading cause of death across the globe. The World Health Organization (WHO) predicts that the disease will become the third leading cause of death by 2030. The present study aimed to assess the burden trends of COPD in Iran by estimating the disability-adjusted life years (DALYs) from 1995 to 2015.
Methods
Data were retrospectively collected as the Global Burden of Disease (GBD) from 1995 to 2015 and published by the Institute for Health Metrics and Evaluation. We applied DALYs, incidence and prevalence rate to report the burden of COPD in Iran. To assess the statistical significance according to trend, the Cochran-Armitage test was applied. Additionally, the t-test was used to analyze the DALYs number by gender and Onaway ANOVA by age groups at a significance level set atP < 0.05.
Results
From 1995 to 2015, there were approximately 1.1 million DALYs attributable to COPD in Iran. In both genders and at all ages, the number of DALYs increased significantly from 176,224 in 1995 to 253,618 in 2015. The incidence and prevalence rate were 76.65 and 1491.37 per 100,000 population, respectively in both genders in 2015 in Iran. It is noticeable that the number of deaths during the study years, 1995 to 2015, was 39,064. This study showed that the COPD burden was significantly different by age groups and gender.
Conclusions
COPD is still a public health problem in Iran and has an increasing trend. The majority of DALYs were due to the years of life lost as a result of premature death (YLLs), indicating that prevention and early detection, especially in the age groups of 15 to 70 years, should be considered.
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