Alopecia areata: a review of disease pathogenesis

Rajabi, Fateme; Drake, Lynn A.; Senna, Maryanne M.; Rezaei, Nima

doi:10.1111/bjd.16808

Cited by 190 publications

(114 citation statements)

References 271 publications

(409 reference statements)

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“…The primary pathogenesis of AA involves disruption of immune privilege status of the anagen HFs which leads to the activation of the local immune system . One important theory proposed to explain the immune privilege collapse in AA is the local disturbances in HFs . It states that environmental stress can result in a buildup of ROS in HF keratinocytes.…”

Section: Discussionmentioning

confidence: 99%

“…It states that environmental stress can result in a buildup of ROS in HF keratinocytes. This oxidative stress, in turn, promotes MICA (MHC class I chain‐related A) expression by the HF cells . MICA is a distant homolog of major histocompatibility class I which binds with the NKG2D‐activating receptors on natural killer cells .…”

Section: Discussionmentioning

confidence: 99%

“…MICA is a distant homolog of major histocompatibility class I which binds with the NKG2D‐activating receptors on natural killer cells . Normal HFs are usually MICA‐negative while HF cells in AA show strongly positive MICA expression . This stress‐induced MICA expression by HF keratinocytes leads to the activation of innate immune system with subsequent events resulting in HF destruction .…”

Section: Discussionmentioning

confidence: 99%

“…Although the pathogenesis remains incompletely understood, it is thought to occur as a result of the loss of immune privilege status of the hair follicles (HFs) with autoimmune‐mediated inflammatory destruction of HFs . Oxidative stress may induce the disruption of immune privilege status and promote autoimmunity in AA …”

Section: Introductionmentioning

confidence: 99%

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Oxidative stress in alopecia areata: a systematic review and meta‐analysis

Acharya

Mathur

2019

Int J Dermatology

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Background Several studies have investigated the oxidative stress parameters in alopecia areata (AA) patients with variable results. This study aims to analyze the association between oxidative stress and AA based on current literature. Methods A systematic review of the existing literature was performed in PubMed, Scopus, and Cochrane databases by two authors independently. Mean and standard deviation values of oxidative stress parameters of AA patients and healthy controls were extracted for quantitative analysis. Results A total of 18 studies were included in the analysis. Patients with AA had impaired oxidative balance with elevated levels of serum malondialdehyde, nitric oxide, and total oxidant capacity and lower levels of serum superoxide dismutase, paraoxonase, glutathione peroxidase, and total antioxidant capacity. Levels of oxidative parameters were significantly higher in severe AA compared to mild/moderate AA. Heterogeneity in the baseline characteristics of the included studies and limited available data for most parameters were the limitations of this study. Conclusions Current evidence suggests that AA is associated with oxidative stress. More studies are needed to strengthen this association. Moreover, studies evaluating the role of antioxidant use in AA may be rewarding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oxidative stress in alopecia areata: a systematic review and meta‐analysis

Acharya

Mathur

2019

Int J Dermatology

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“…1 The etiopathogenesis of alopecia areata is not completely understood, although it is currently assumed that follicular attack is a consequence of immune-mediated attack of hair follicles that have lost their immune privilege. 1,2 Recent advances in immunology have shown that an imbalanced ratio of lymphocytes Th17 and regulatory T cells (Treg lymphocytes) is involved in the pathophysiology of autoimmune processes. 1,2 Recent advances in immunology have shown that an imbalanced ratio of lymphocytes Th17 and regulatory T cells (Treg lymphocytes) is involved in the pathophysiology of autoimmune processes.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the gut microbiota in alopecia areata: identification of bacterial biomarkers

Moreno‐Arrones

Serrano‐Villar²,

Pérez‐Brocal

et al. 2019

Acad Dermatol Venereol

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Background Alopecia areata is a T‐cell‐mediated autoimmune disease with an unknown etiopathogenesis. Gut microbiota has been revealed as a key modulator of systemic immunity. Objective To determine whether patients affected by alopecia universalis present differences in gut bacteria composition compared with healthy controls and investigate possible bacterial biomarkers of the disease. Methods We conducted a cross‐sectional study that involved 15 patients affected by alopecia universalis and 15 controls. Gut microbiome of the study subjects was analysed by sequencing the 16SrRNA of stool samples. We searched for bacterial biomarkers of alopecia universalis using the linear discriminant analysis effect size (LEFse) tool. Results In total, 30 study subjects (46.6% female; mean [SD] age, 40.1 [9.8] years) were enrolled. Neither alpha (Shannon diversity index 5.31 ± 0.43 vs. 5.03 ± 0.43, P 0.1) or beta diversity (ADONIS P value: 0.35) of gut microbiota showed statistically significant differences between cases and controls. In patients affected with alopecia, we found an enriched presence (LDA SCORE > 2) of Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis. A predictive model based on the number of bacterial counts of Parabacteroides distasonis and Clostridiales vadin BB60 group correctly predicted disease status in 80% of patients (AUC 0.804 (0.633–0.976), P 0.004). Conclusion Alopecia universalis does not seem to affect broadly gut microbiota structure. Bacterial biomarkers found associated with the disease (Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Eggerthellaceae, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis) should be further studied as they could be involved in its pathophysiology or be used as diagnostic tools.

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Association of Sensorineural Hearing Loss in Patients With Alopecia Areata

et al. 2020

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Alopecia areata (AA) is a common autoimmune disease, leading to chronic and relapsing hair loss. 1 Current evidence suggests that follicular melanocytes may be an important target in the autoimmune process of AA. 2 In addition to their presence in the skin, melanocytes are also present as intermediate cells in the stria vascularis of the cochlea, which are critical for normal hearing. In patients with Vogt-Koyanagi-Harada disease, a rare autoimmune disorder that targets melanocytes, sensorineural hearing loss (HL) is a common complication in late-stage disease. Few studies have found audiological abnormalities in patients with AA 3,4 ; however, existing studies are limited by their cross-sectional designs and small sample sizes. This nationwide population-based cohort study was conducted to investigate the risk of HL in patients with AA using claims data from the National Health Insurance Research Database in Taiwan.Methods | This study was approved by the Institutional Review Board of Taipei Veterans General Hospital (2018-07-016AC). The institutional review board waived the requirement to obtain informed consent owing to the use of deidentified data (VGHIRB No.: 2018-07-016AC). We identified patients with AA diagnosed by dermatologists between January 1, 1998, and December 31, 2011. The diagnosis of AA was established according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 704.01. For each patient with AA, 10 controls were selected after matching for age, sex, monthly premium, and residence. The primary outcome assessed was new-onset HL, which was identified by ICD-9-CM code 389. The diagnosis of HL was established by otorhinolaryngologists and was classified into conductive HL (ICD-9-CM code 389.0), sensorineural HL (ICD-9-CM code 389.1), mixed HL (ICD-9-CM code 389.2), and others (ICD-9-CM codes 389.7, 389.8, and 389.9). Participants were observed until a diagnosis of HL, death, or December 31, 2013. Cox regression model was used to calculate adjusted hazard ratios with 95% CIs. Two-sided P values <.05 were considered statistically significant. Data management and analyses were performed using the Statistical Analysis System (SAS) software, version 9.4 (SAS Institute).

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Alopecia areata: a review of disease pathogenesis

Cited by 190 publications

References 271 publications

Oxidative stress in alopecia areata: a systematic review and meta‐analysis

Oxidative stress in alopecia areata: a systematic review and meta‐analysis

Analysis of the gut microbiota in alopecia areata: identification of bacterial biomarkers

Association of Sensorineural Hearing Loss in Patients With Alopecia Areata

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