Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update

Mahasaksiri, Thipprapai; Kositkuljorn, Chaninan; Anuntrangsee, Tanaporn; Suchonwanit, Poonkiat

doi:10.2147/dddt.s297858

Cited by 23 publications

(4 citation statements)

References 117 publications

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“…Abnormal nail findings in AA correlate with disease severity and poor prognosis. [40][41][42][43] Our further exploration revealed that AA patients with nail changes were at increased risks of other ADs. We hypothesize that nail abnormalities indicate increased immunogenicity in areas other than hair follicles and may help determine individuals with increased susceptibility for developing multiple ADs.…”

Section: Discussionmentioning

confidence: 80%

Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata

Chanprapaph¹,

Mahasaksiri²,

Kositkuljorn³

et al. 2021

JIR

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Background Increased rates of autoimmune diseases (ADs) have been reported in association with alopecia areata (AA); however, the risk factors for coexisting ADs in AA patients have been poorly investigated. Objective To evaluate the prevalence and factors associated with AD comorbidities in patients with AA. Methods This case–control study included patients diagnosed with AA between January 2000 and March 2020. Individuals with AA, both with and without concomitant ADs, were statistically compared. Variables significantly associated with coexisting ADs were identified using univariate and multivariate logistic regression analyses. Multinomial logistic regression analysis was performed to identify the specific risk factors for each concomitant AD. Results Among the 615 patients with AA, comorbid ADs were found in 76 (12.4%). Autoimmune thyroid disease (AITD) exhibited the highest frequency (n = 42, 6.8%), followed by vitiligo (n = 15, 2.4%), and systemic lupus erythematosus (SLE) (n = 12, 2.0%). Logistic regression analyses revealed that female sex (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.24–4.82; P = 0.011), nail abnormalities (OR = 2.49, 95% CI = 1.14–5.46; P = 0.023), and atopic diseases (OR = 1.98, 95% CI = 1.09–2.43; P < 0.001) were significantly associated with coexisting ADs. Regarding each concomitant AD, nail abnormalities were an associated factor for AITD (OR = 4.65, 95% CI = 1.96–7.24; P = 0.01), whereas coexisting atopic diseases were demonstrated as a predictor of vitiligo (OR = 2.48, 95% CI = 1.43–4.58; P = 0.02). Female sex (OR = 1.61, 95% CI = 1.18–4.27; P = 0.04) and family history of AD (OR = 1.85, 95% CI = 1.26–4.19; P = 0.03) were predictors of SLE. Conclusion This study suggests that female AA patients with nail abnormalities and atopic diseases have increased rates of AD comorbidities. A thorough review of systems for associated factors can help physicians screen for concomitant ADs.

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Section: Discussionmentioning

confidence: 80%

Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata

Chanprapaph¹,

Mahasaksiri²,

Kositkuljorn³

et al. 2021

JIR

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“…CD4 and CD8 T cells are demonstrated at the bulb and perifollicular milieu of affected hair follicles and furthermore CD8 cells have the tendency to penetrate intrafollicularly to inhibit the hair growth cycle. Inflammatory cytokines (Th1 mediated) exert their effects in the development and progress of AA through activation of the CD8 T cell pathway and abrupt cessation of the hair growth cycle 10 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of Jessener solution versus intralesional steroid in treatment of alopecia areata

Elshahid

Kadah

Hassan

et al. 2022

J of Cosmetic Dermatology

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Background Alopecia areata is an autoimmune condition that causes non‐scarring hair loss. To date, there is no single cure and treatment remains challenging. Objectives To evaluate the efficacy of Jessener solution versus intralesional steroid in treatment of Alopecia Areata. Methods This study included 40 patients who presented with multifocal patchy alopecia areata (AA). For each patient, three patches were randomly selected to be treated one with intralesional steroid, another with topical Jessner solution and the third with normal saline. Three sessions were done 3 weeks apart and were followed up for 3 months. Response was assessed clinically and by trichoscope. Results Fifteen percent of patches coated with Jessner or injected with steroids showed an excellent response while 20% of patches coated with Jessner and 32.5% patches injected with steroids showed a good response. A significant difference was observed between the three modalities of treatment regarding the prognostic score for response (p < 0.001) as patches coated with Jessner and those steroid injected showed a significant higher response rate than patches injected with saline (p < 0.001) while no significant difference was reported between patches either treated with Jessner or steroids (p > 0.05). Conclusion Jessners solution can be a novel and feasible and well tolerated modality of treatment for patients suffering from alopecia areata.

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“…Topical contact immunotherapy is currently considered the best modality for long-term therapy of patients with recalcitrant AA and is the first line treatment for these cases in our hair clinic. 19 …”

Section: Discussionmentioning

confidence: 99%

Intramuscular Corticosteroid Therapy in the Treatment of Alopecia Areata: A Time-to-Event Analysis

Chanprapaph¹,

Pomsoong²,

Kositkuljorn³

et al. 2022

DDDT

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Introduction Intramuscular corticosteroids (IMC) have gained popularity for the treatment of severe alopecia areata (AA) in recent years; however, evidence on their efficacy and safety is still limited. Objective To evaluate the efficacy, relapse rate, and tolerability of IMC in the treatment of AA, as well as factors associated with treatment outcomes. Methods Time-to-event analysis was performed on patients with severe, extensive, or rapidly progressive AA receiving IMC. The IMC regimen comprised triamcinolone acetonide 20–40 mg/mL injected every 4–6 weeks. The evaluated outcomes included initial (25% regrowth), significant (75% regrowth), and complete hair regrowth (100% regrowth). Relapse and adverse events were also noted. Factors associated with treatment outcomes and relapse were analyzed using the Cox proportional hazards model. Results A total of 101 patients were eligible for analysis. Significant hair regrowth was obtained in 80.2% of the patients (n = 81), in a median time of 3.4 months (95% confidence interval [CI] = 2.9–4.4). Complete hair regrowth was achieved in 48.5% of the subjects (n = 49), and relapse was observed in 47.5% (n = 48). Acneiform eruption was the most common adverse effect. Multivariable analysis revealed that nail involvement was a negative predictor of significant hair regrowth (adjusted hazard ratio [HR] = 0.04, 95% CI = 0.01–0.55; P = 0.015), whereas duration of AA longer than 6 months was associated with disease recurrence (adjusted HR = 4.02, 95% CI = 1.52–4.66; P = 0.005). Conclusion This study demonstrated the efficacy and safety of IMC in the treatment of severe or active AA; however, the relapse rate remained relatively high after discontinuation of the therapy. Nail involvement was a negative predictor of significant hair regrowth, while disease duration longer than 6 months predicted AA relapse.

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Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update

Cited by 23 publications

References 117 publications

Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata

Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata

Efficacy of Jessener solution versus intralesional steroid in treatment of alopecia areata

Intramuscular Corticosteroid Therapy in the Treatment of Alopecia Areata: A Time-to-Event Analysis

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