Primary cicatricial alopecia: diagnosis and treatment.
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ABSTRACT:
SUBMITTER: Filbrandt R
PROVIDER: S-EPMC3855115 | biostudies-literature | 2013 Dec
REPOSITORIES: biostudies-literature
Publications
Primary cicatricial alopecia: diagnosis and treatment.
Filbrandt Rebecca R Rufaut Nicholas N Jones Leslie L Sinclair Rodney R
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20130521 18
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Project description:Background Immune-mediated alopecias (IMAs), a group of hair disorders associated with immunological reactions, remain a therapeutic challenge since available treatments are generally unfavorable with potential side effects. Platelet-rich plasma (PRP) has been recently proposed as a treatment option based on several limited-quality studies; however, there is no systematic evaluation of PRP efficacy on IMAs in the literature. Objective To assess PRP’s effects in treating IMAs using a systematic review. Methods Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases. A search strategy was designed to retrieve all studies exploring PRP in treating IMAs, including alopecia areata (AA) and primary cicatricial alopecias (PCAs). In addition, all randomized and non-randomized studies reporting subjective and/or objective outcomes of alopecia treatment with PRP were included. Results Thirty-two studies were included, comprising 621 patients with AA and 19 patients with PCAs. PRP had superior efficacy as monotherapy in five studies, comparable to intralesional corticosteroids in six studies in AA treatment. In addition, in the analysis of PCAs, including lymphocytic and neutrophilic subtypes, PRP was efficacious in alleviating disease progression in nine studies. Conclusion PRP is considered a promising treatment for AA and PCAs in patients who experienced unfavorable outcomes from conventional treatment. However, its clinical application remains to be standardized, and its recommendation as a treatment for IMAs could not be ascertained due to a lack of high-quality evidence. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353859], identifier [CRD42022353859].
| S-EPMC9731377 | biostudies-literature
Project description:In a large scale screen for skin, hair, and nail abnormalities in null mice generated by The Jackson Laboratory's KOMP center, homozygous mutant Far2tm2b(KOMP)Wtsi/2J (hereafter referrred to as Far2-/-) mice were found to develop focal areas of alopecia as they aged. As sebocytes matured in wildtype C57BL/NJ mice they became pale with fine, uniformly sized clear lipid containing vacuoles that were released when sebocytes disintegrated in the duct. By contrast, the Far2-/- null mice had sebocytes that were similar within the gland but become brightly eosinophilic when the cells entered the sebaceous gland duct. As sebocytes disintegrated, their contents did not readily dissipate. Scattered throughout the dermis, and often at the dermal hypodermal fat junction, were dystrophic hair follicles or ruptured follicles with a foreign body granulomatous reaction surrounding free hair shafts (trichogranuloma). The Meibomian and clitoral glands (modified sebaceous glands) of Far2-/- mice showed ducts dilated to various degrees that were associated with mild changes in the sebocytes as seen in the truncal skin. Skin surface lipidomic analysis revealed a lower level of wax esters, cholesterol esters, ceramides, and diacylglycerols compared to wildtype control mice. Similar changes were described in a number of other mouse mutations that affected the sebaceous glands resulting in primary cicatricial alopecia.
| S-EPMC6205590 | biostudies-literature
Project description:BackgroundCentral centrifugal cicatricial alopecia (CCCA) is a primary cicatricial alopecia that most commonly affects women of African descent. Like CCCA, fibroproliferative disorders (FPDs) such as keloids, atherosclerosis, and fibroids are characterized by low-grade inflammation and irritation, resulting in end-stage fibrosis.ObjectiveWe sought to determine whether fibroproliferative genes were up-regulated in patients with CCCA.MethodsA total of 5 patients with biopsy-proven CCCA were recruited for this study. Two scalp biopsy specimens were obtained from each patient; 1 from CCCA-affected vertex scalp and 1 from the unaffected occipital scalp. Microarray analysis was performed to determine the differential gene expression patterns.ResultsThere was an upregulation of genes implicated in FPDs in patients with CCCA. Specifically, we noted increased expression of platelet derived growth factor gene (PDGF), collagen I gene (COL I), collagen III gene (COL III), matrix metallopeptidase 1 gene (MMP1), matrix metallopeptidase 2 gene (MMP2), matrix metallopeptidase 7 gene (MMP7), and matrix metallopeptidase 9 gene (MMP9) in affected scalp compared with in unaffected scalp. Significant overlap in the canonic pathways was noted between patients with CCCA and patients with both atherosclerosis and hepatic fibrosis (P < .001).LimitationsSmall sample size and the use of whole skin tissue for analysis.ConclusionWe have identified the upregulation of critical genes implicated in FPDs in the gene expression profile of patients with CCCA. These findings may help identify future therapeutic targets for this otherwise difficult-to-treat condition.
| S-EPMC6348462 | biostudies-literature
Project description:C57BL/6 mice develop dermatitis and scarring alopecia resembling human cicatricial alopecias (CAs), particularly the central centrifugal CA (CCCA) type. To evaluate the role of retinoids in CA, the expression of retinoid metabolism components were examined in these mice with mild, moderate, or severe CA compared with hair cycle-matched mice with no disease. Two feeding studies were conducted with dams fed either NIH 31 diet (study 1) or AIN93G diet (study 2). Adult mice were fed AIN93M diet with 4 (recommended), 28, or 56?IU vitamin A?g(-1) diet. Feeding the AIN93M diet to adults increased CA frequency over NIH 31 fed mice. Increased follicular dystrophy was seen in study 1 and increased dermal scars in study 2 in mice fed the 28?IU diet. These results indicate that retinoid metabolism is altered in CA in C57BL/6J mice that require precise levels of dietary vitamin A. Human patients with CCCA, pseudopelade (end-stage scarring), and controls with no alopecia were also studied. Many retinoid metabolism proteins were increased in mild CCCA, but were undetectable in pseudopelade. Studies to determine whether these dietary alterations in retinoid metabolism seen in C57BL/6J mice are also involved in different types of human CA are needed.
| S-EPMC3546159 | biostudies-literature
Project description:Microarray analyses of LPP and CCCA was undertaken to decipher differential pathophysiological pathways leading to disease initiation and progression
2021-12-21 | GSE59131 | GEO
Project description:BackgroundCicatricial alopecia (CA) refers to various conditions that result in permanent hair loss. Treatment of CA has always been challenging. Regarding immune-mediated pathophysiology for many CA subtypes, the administration of Janus kinase (JAK) and tumor necrosis factor (TNF) inhibitors have potentiated the treatments of CA.MethodsAfter a thorough systematic search in PubMed/Medline, Embase, Web of Science, Scopus, Google Scholar, ClinicalTrials.gov, and WHO ICTRP, a total of 3,532 relevant records were retrieved and screened. Accordingly, 56 studies met the eligibility criteria and entered the review.ResultsAmong JAK inhibitors, oral tofacitinib was the most frequently reported and the most effective treatment in improving signs and symptoms of CA with minimal adverse effects (AEs). Baricitinib was another JAK inhibitor with sustained improvement while causing mild AEs. As a TNF inhibitor, adalimumab induced a rapid and stable improvement in signs and symptoms in most patients with rare, tolerable AEs. Thalidomide was the other frequently reported yet controversial TNF inhibitor, which caused a rapid and significant improvement in the condition. However, it may result in mild to severe AEs, particularly neuropathies. Infliximab is a TNF inhibitor with mostly favorable results, albeit in a few patients caused treatable dermatological AEs. Apremilast and certolizumab pegol caused an incomplete amelioration of signs and symptoms with no AEs. Lenalidomide is another TNF inhibitor that can induce temporary improvement in CA with probable AEs. It is noteworthy that utilizing adalimumab, infliximab, etanercept, golimumab, and an anonymous TNF inhibitor has induced paradoxical CA and other A.E.s in some patients.ConclusionRecent studies have recommended JAK and TNF inhibitors, especially oral tofacitinib and adalimumab, as a new modality or adjuvant therapy to previous medications for primary CA. Nonetheless, monitoring AEs on a regular basis is suggested, and further extensive studies are required before definitive recommendations.
| S-EPMC10857607 | biostudies-literature
Project description:IntroductionCicatricial alopecia not only affects the appearance of children's heads and faces but also their mental health in the long term. This study aims to explore the therapeutic characteristics and clinical effects of autologous hair transplantation technology in children with cicatricial alopecia.MethodsChildren in our department who received autologous hair transplantation technology for cicatricial baldness of the scalp from February 2019 to October 2022 were collected. Their basic information was analyzed, and postoperative follow-up was conducted, including calculation of hair follicle survival rate, hair growth, complications, and an efficacy satisfaction survey given to the children's family members.ResultsThirteen children were included in this study (10 males and 3 females), aged from 4 years 1 month to 12 years 10 months, with an average age of 7 years 5 months. Two hundred to 2500 hair follicular units were extracted, with an average recipient area of 22.7 cm2, an average hair follicle unit density of 55.3 ± 9.1 per cm2, and an average hair/follicular unit (hair/FU) ratio of 1.75 ± 0.07. Thirteen children in this group were followed up for 6-12 months with the following treatment options: FUE (follicular unit extraction, 9 cases), FUT (follicular unit transplantation, 3 cases), and FUT combined with FUE (1 case). The average hair survival rate was 85.3%. Except for one child with temporary folliculitis, there were no complications. The GAIS score is divided into five levels: complete improvement (2 cases), obvious improvement (10 cases), partial improvement (1 case), no improvement (0 cases), and deterioration (0 cases). The patient satisfaction results included very satisfied (2 cases), mostly satisfied (10 cases), and dissatisfied (1 case).ConclusionAutologous hair transplantation technology is a safe and effective method for children with cicatricial alopecia.
| S-EPMC10427550 | biostudies-literature
Project description:Background: Central Centrifugal Cicatricial Alopecia (CCCA) is a primary cicatricial alopecia that most commonly affects women of African descent. Like CCCA, fibroproliferative disorders (FPDs) such as keloids, atherosclerosis and fibroids, are characterized by low-grade inflammation and irritation resulting in end stage fibrosis. Objective: We sought to determine if fibroproliferative genes were upregulated in patients with CCCA Methods: Five patients with biopsy proven CCCA were recruited for this study. Two scalp biopsies were obtained from each patient; one from CCCA affected vertex scalp and one from the unaffected occipital scalp. Microarray analysis was performed to determine the differential gene expression patterns Results: Several pathways responsible for excess collagen deposition and aberrant wound healing were up-regulated in CCCA affected scalp when compared to unaffected scalp with patterns similar to other FPDs. Genes downregulated in CCCA affected tissue included those with roles in lipid metabolism and fatty acid biosynthesis. Limitations: Small sample size and the use of whole skin tissue for analysis. Conclusion: We have identified the up-regulation of critical genes implicated in fibroproliferative disorders in the gene expression profile of patients with CCCA. These findings may help identify future therapeutic targets for this otherwise difficult to treat condition.
2021-03-22 | GSE113052 | GEO
Project description:Background: Androgenetic alopecia (AGA) and alopecia areata (AA) are the most common types of non-cicatricial alopecia. Both diseases have limited effective therapeutic options and affect patient quality of life. Pharmacogenetic tests can help predict the most appropriate treatment option by evaluating the single nucleotide polymorphisms (SNPs) corresponding to genes related to alopecia. The objective of the study was to evaluate and compare selected SNPs and genes in AA and AGA patients from Romania and Brazil. Materials and Methods: We performed a retrospective study regarding the associations between AA and AGA and 45 tag SNPs of 15 genes in 287 Romanian and 882 Brazilian patients. The DNA samples were collected from oral mucosa using a swab. The SNPs were determined by the qPCR technique. Each genetic test displays the subject's genotype of the selected gene and the prediction of a successful treatment (e.g., genotype AA of the GR-alpha gene is related to a predisposition to normal sensibility to topical glucocorticoid, and, therefore, glucocorticoids should be effective). Results: The GR-alpha, GPR44-2, SULT1A1, and CRABP2 genes were statistically significantly different in Brazil compared to Romania. The SULT1A1 activity that predicts the response to minoxidil treatment showed in our analysis that minoxidil is recommended in half of the cases of AGA and AA. Patients with AGA and a high expression of SRD5A1 or PTGFR-2 may benefit from Dutasteride or Latanoprost treatment, respectively. Most of the studied genes showed no differences between the two populations. Conclusions: The DNA analysis of the patients with alopecia may contribute to a successful treatment.
| S-EPMC10537507 | biostudies-literature
Project description:Trichoscopy is a noninvasive visualization tool used to more accurately diagnose hair and scalp disorders. Alopecia areata (AA) in the patient of African descent can mimic the early signs of central centrifugal cicatricial alopecia (CCCA), especially if the initial presentation of hair loss occurs on the central scalp. Two African-American women presented with singular round-ovoid patches of decreased hair loss on the central scalp. Given the clinical presentation, CCCA was the working diagnosis. However, using dermoscopy, the patients were found to have exclamation hairs and short broken hairs on a background of honeycomb-like pigmented network and regular pinpoint white dots consistent with AA. The diagnosis was confirmed on biopsy. We demonstrate the role of dermoscopy for diagnosing AA in the patient of African descent.
| S-EPMC5551311 | biostudies-other