Pediatric Alopecia Areata

Abstract

Background: Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. Objective: To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata. Methods: The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. Results: AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show “exclamation point hairs” and “yellow dots”. Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA including conservative treatment, and topical, oral, and injectable medications. Conclusion: AA is an autoimmune disease with a heterogenous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.

Alopecia areata in children: an overview of clinical features and recent treatment options

“…Но некоторые факторы могут приводить к потере иммунной привилегии: у детей таковыми являются, как правило, влияние генетических факторов, наличие атопии, аутоиммунные заболевания [5], вследствие чего определённые экспрессирующиеся аутоантигены, в частности трихогиалин и родственный тирозиназе белок 2, распознаются Т-лимфоцитами [21]. В итоге они (по большей части это CD3+CD8+ Т-лимфоциты [22], значительную роль играют также NKG2D+ клетки [23,24]) пролиферируют, мигрируют к фолликулу и инфильтрируют окружающую его дерму [25]. Иммунные клетки начинают продуцировать интерферон-γ (ИНФ-γ), что в свою очередь увеличивает экспрессию MICA (лиганд NKG2D), CXCL10 и MHC I через JAK-STAT каскады, а также продукцию интерлейкина-15 (ИЛ-15) [26].…”

“…Вовлечение в процесс ногтей наблюдается в 10-50% случаев [25], при этом изменения ногтей ассоциируются с более тяжёлым течением ГА у детей, и у таких пациентов выше распространённость офиазиса [34].…”

¿Cuál es su diagnóstico? Alopecia por sífilis

“…Se caracteriza por producir áreas circulares u ovaladas de pérdida de pelo no cicatricial, de fondo limpio, muy bien delimitadas en el cuero cabelludo, las cejas, las pestañas o en cualquier lugar donde haya pelo. 2 El lupus eritematoso sistémico es una enfermedad autoinmune crónica, multisistémica, d e c u r s o v a r i a b l e . E s m á s f r e c u e n t e e n mujeres, sobre todo en edad reproductiva y menos frecuente en la infancia.…”

Quality of life measurement in alopecia areata. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes

“…Patients will often present with patchy, non-scarring hair loss generally affecting the scalp. [1][2][3] The role of hair in human societies is primarily psycho-social. This was corroborated by a systematic review with metaanalysis 4 that concluded that patients with AA experience significant impairment in health-related quality of life (HRQoL), especially in the area of mental health.…”

“…Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non‐scarring hair loss generally affecting the scalp 1–3 …”