A Case Report of Alopecia Areata Treated With Individualized Homoeopathy.

Introduction: Hair is regarded as an essential part of human identity, and losing it has a negative effect on many facets of one's quality of life. Alopecia areata (AA) is a chronic, non-scarring hair loss of the scalp or body hair. It is believed to be an autoimmune disorder where the body cannot recognize its own cells, resulting in the subsequent destruction of the hair follicles. The efficacy of the available treatment is not adequate and remission of hair follicles is unpredictable. However, individualized homoeopathy (iHOM) has shown great results in treating AA. Methods: At the Dermatological Department of D.Y. Patil Homoeopathic Medical College & Research Center, India, an 11-year-old female patient diagnosed with Alopecia areata was treated homeopathically from July 2021 to November 2021. During the follow-up visits, the outcome was assessed. To assess whether the changes were due to homoeopathic medicine, an assessment using the modified Naranjo criteria was performed. Results: Over an observation period of 5 months, beneficial result from iHOM medicine was seen, and so can be used by physicians in treating Alopecia Areata as a complementary health practice. Conclusion: Considering the multi-factorial etiology of Alopecia Areata, iHOM medicine and the auxillary line of treatment are effective in treating Alopecia Areata.

Serum Zinc Concentration in Patients with Alopecia Areata.

Alopecia areata is an autoimmune non-scarring disease in which the exact mechanism that induces loss of immune privilege is unknown. Zinc is important for DNA stability and repair mechanisms that are essential in maintaining normal hair growth. Zinc deficiency has been investigated as an important factor in many autoimmune diseases, and may have a possible role in the aetiopathogenesis of alopecia areata. This study included 32 patients with severe forms of alopecia areata, and 32 age- and sex-matched healthy controls. When comparing serum zinc levels in these 2 groups, statistically significantly lower zinc concentrations were found in the alopecia areata group (p = 0.017). Detected zinc deficiency was statistically more prevalent in patients with alopecia areata (p = 0.011). Evaluating patients with alopecia areata, a statistically significant negative correlation between serum zinc levels and severity of the disease was found (ρ = 0.006). The results indicate that zinc serum assessment is necessary in patients with alopecia areata. Low serum zinc levels were found to correlate with severity of alopecia areata. Given that most severe forms of alopecia areata are frequently most treatment-resistant, additional randomized control trials examining zinc supplementation are necessary to investigate its potential role in the restoration of hair follicles.

Hair loss after drug reaction with eosinophilia and systemic symptoms (DRESS): A multicentric retrospective case series.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous drug adverse reaction characterized by various cutaneous and systemic manifestations. However, reports on the various patterns of alopecia after DRESS are lacking. Thus, we aimed to describe cases of alopecia after DRESS and review the literature. This multicentric retrospective study reviewed the records of 182 patients diagnosed with DRESS from 2009 to 2021; of these, 10 who had alopecia after DRESS were included. Patients were diagnosed with permanent alopecia (n = 4), telogen effluvium (n = 5), and alopecia areata (n = 1), and were treated with topical minoxidil or alfatradiol (6; 60%), topical corticosteroids (3; 30%), dietary supplements (6; 60%), systemic corticosteroids (1; 10%), and intralesional corticosteroid injection (2; 20%). Although patients with permanent alopecia did not show hair regrowth after 6 months, those with telogen effluvium and alopecia areata experienced marked clinical improvement within 6 months. Various types of alopecia can persist over an extended period, even after the resolution of an acute episode of DRESS.

Efficacy of a mixed preparation containing piperine, capsaicin and curcumin in the treatment of alopecia areata.

BACKGROUND: Alopecia areata is a common non-scarring alopecia, mainly manifested as sudden localized patchy alopecia. It is currently believed to be related to autoimmune, genetic, emotional stress, and endocrine factors. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the mixed preparation of piperine, capsaicin, and curcumin on alopecia areata treatment. METHODS: Sixty patients were enrolled in this study and divided into 2 groups randomly: topical treated with the mixed preparation (case) twice daily and 5%minoxidil (control) once daily for 3 months. The degree of hair loss was assessed by SALT and dermoscopy. RESULTS: On the completion of the study, compared with baseline, statistically significant regrowth occurred in both groups (p < 0.05). The mean SALT scores and hair follicle status under trichoscopy at baseline and at the end of 12 weeks in the mixed preparation group and in the minoxidil group were comparable, respectively. The effective rate of mixed preparation group was 63.33% and minoxidil group was 70%. Adverse symptoms were temporary and no serious adverse event occurred. CONCLUSION: Based on our findings, the mixed preparation of piperine, capsaicin, and curcumin is effective in treating alopecia areata, but it has not been shown to be superior to minoxidil in short-term therapy.

A combination of herbal formulas, acupuncture, and novel pine-needle stimulation for recurrent alopecia areata: A case report.

INTRODUCTION: Head hair is a symbol of vitality, and hair loss by alopecia areata (AA) presents a burden on patients. Although traditional Japanese Kampo medicine (JKM) formulas, acupuncture, and moxibustion have historically been used for treating AA, no studies have utilized a combination of these modalities. PATIENT CONCERNS: A 34-year-old male with a history of childhood asthma presented with a sudden hair loss at the top of his head without any preceding symptoms. Except for a hairless patch of 5 cm × 6 cm, his general appearance was otherwise good. The patient underwent topical immunotherapy on visiting a dermatologist. However, the patient noticed an exacerbation of his hairless lesion. DIAGNOSIS: The AA diagnosis was established based on clinical appearance and dermatological findings. The Severity of Alopecia Tool (SALT) score for alopecia was 19% at diagnosis. INTERVENTIONS: The patient received 2 JKM formulas (saikokaryukotsuboreito and shichimotsukokato) in combination with acupuncture. When relapse occurred, a novel self-administration of pine-needle acupuncture was initiated in combination with the JKM formulas. OUTCOMES: A 50% recovery from the baseline SALT score was achieved using JKM formulas in combination with acupuncture for 4 months. The patient achieved complete remission for 5 months. However, another stressful event induced an AA relapse with multiple lesions harboring a SALT score of 13%. Pine-needle acupuncture was initiated, resulting in faster resolution than the first treatment. Recoveries of 50% and 75% were achieved 3 and 4 months after relapse, respectively, and a long-lasting response without relapse was obtained for at least 3 years. CONCLUSION: A combination of multimodal traditional therapies, including JKM formulas, acupuncture, and self-administered pine-needle stimulation, represents an effective integrative treatment for patients with AA.

Telogen Effluvium - a review of the science and current obstacles.

Telogen effluvium (TE) is a common cause of diffuse non-scarring hair loss that is usually precipitated by physiological stress such as childbirth or sudden weight loss. Despite its high rate of remission, this phenomenon of sudden excessive hair loss can be very worrisome and upsetting for affected individuals and may significantly impact their quality of life. Due to the multifactorial causes and precipitants of TE, it is often challenging to diagnose and manage. Further, the mechanisms through which physiological stress influences the human hair cycle is unknown, and there are no targeted treatments for the management of TE. This review will describe the approach in making a diagnosis of TE, summarize the latest developments made in understanding the mechanisms of TE, outline the treatments tried, and recommend ways for advancing the study of this dermatological condition.

Treatments for alopecia areata: A systematic review and network meta-analysis.

Existing guidelines form no consensus for alopecia areata (AA) treatment due to the absence of a universal standard treatment and arbitrary selection of reference arms in randomized control trials (RCTs). The aim is to identify the best treatment and to rank treatments using systematic review and network meta-analysis. Data were extracted by the two investigators independently. Odds ratio (OR) of treatment success rate was pooled using the frequentist weighted least squares approach to random-model network meta-analysis. RCTs providing data of treatment success rate from PubMed, EMBASE, Web of Science, and manual search were included. About 54 RCTs consisting of 49 treatments and 3149 patients were included. Pentoxifylline plus topical corticosteroids had the highest treatment success rate compared with "no treatment," followed by pentoxifylline alone, topical calcipotriol plus narrowband ultraviolet radiation B phototherapy, topical calcipotriol, intralesional corticosteroids, systemic corticosteroids, minoxidil plus topical corticosteroids, topical bimatoprost, psoralen ultraviolet radiation A phototherapy, and tofacitinib. Even with the network meta-analysis, the best treatment because of independent loops and wide confidence intervals could not be identified. Treatment options above may be reasonable strategies, but further comparison is required.

Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options.

Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.

Topical calcipotriol vs narrowband ultraviolet B in treatment of alopecia areata: a randomized-controlled trial.

Alopecia areata is a chronic relapsing autoimmune inflammatory hair disorder with no novel therapy. The objectives of this study are to compare the efficacy of topical calcipotriol vs narrow band ultraviolet B phototherapy (NB-UVB) in the treatment of alopecia areata and its correlation with serum vitamin D3 levels. A randomized-controlled trial has been conducted on 60 patients with scalp alopecia areata randomized into four groups; topical calcipotriol, NB-UVB, both and placebo. All patients were evaluated by assessment of severity of alopecia areata by severity of alopecia tool (SALT) score at baseline and 3 months after treatment and vitamin D3 levels at baseline and after 3 months. SALT score and vitamin D3 levels were significantly improved in all groups except placebo after treatment with (P = 0.026, P = 0.005, P = 0.004, P = 0.140) and (P = 0.028, P = 0.011, P = 0.003, P = 0.725), respectively. Combined therapy showed non-significant improvement in SALT score (P = 0.530, P = 0.643), respectively, and significant improvement in serum vitamin D3 levels than each line alone with (P = 0.021, P = 0.044), respectively. Both topical calcipotriol and NB-UVB are effective therapies in the treatment of AA and associated with improvement of SALT score and vitamin D3 levels.

Treatment of alopecia areata with nonablative fractional laser combined with topical minoxidil.

BACKGROUND: Alopecia areata (AA) is a relatively common dermatosis with the sudden burst of hair loss on the scalp and other hair-bearing regions. However, because of high relapse and side effects, no satisfactory therapy has been widely accepted. OBJECTIVE: To observe the efficiency and safety of the combination therapy of a nonablative fractional (NAF) laser and topical minoxidil for AA. METHODS: Eight Chinese AA patients were included in this study. These patients received 10 treatments every two weeks. At every time, the subject was given 10 to 15 mJ of energy with a total intensity of 300 spots/cm2 . After the laser treatment, a topical 5% minoxidil tincture was immediately applied twice daily and continued until the final laser treatment. RESULTS: Hair regrowth was observed 1-2 months after treatment. There was complete regrowth in 2 patients, and the lesions of 2 children with alopecia universalis were covered with 30% and 50% regrowth, respectively. All patients except 1 had no relapse at the 1-year follow-up examination. CONCLUSION: The combination of nonablative laser and topical minoxidil may be a good alternative therapy for AA patients, including alopecia totalis and alopecia universalis, without systemic and local side effects.

Terapias tradicional y natural combinadas en pacientes con alopecia areata / Combined traditional and natural therapies in patients with alopecia areata

Se realizó un estudio de intervención terapéutica en 30 pacientes con diagnóstico clínico de alopecia areata en forma de placas, atendidos en la consulta de Dermatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde junio del 2014 hasta igual mes del 2015, con vistas a determinar la efectividad de la terapia tradicional china y la natural combinadas (esencias florales de Bach por modelo transpersonal, acupuntura con martillo de 7 puntas y masaje local con el rizoma del jengibre), para lo cual se conformó un grupo de estudio que la recibió y otro de control que fue tratado con crema esteroidea (triamcinolona a 0,1 por ciento). Los pacientes, cuya mayoría comprendía las edades de 25 a 34 años y era del sexo masculino, fueron evaluados al inicio, y luego a la cuarta, la octava y duodécima semanas. La terapia tradicional y la natural combinadas en pacientes con alopecia areata presentó una mejor respuesta y no existieron efectos secundarios, lo que demostró su efectividad al respecto

A study of therapeutic intervention in 30 patients with diagnosis of patchy alopecia areata, assisted in the Dermatology service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from June, 2014 to the same month in 2015, aimed at determining the effectiveness of the combined Chinese traditional therapy and the natural one (Bach flowers remedies for transpersonal pattern, acupuncture with hammer of 7 tips and local massage with ginger rhizome), for which a study group was formed which received it and another control group which was treated with steroid cream (triamcinolone 0,1 percent). Patients from the age group 25 - 34 years and male sex, were evaluated at the beginning, and then at fourth, eighth and twelfth weeks. The combined traditional and natural therapies in patients with alopecia areata provided a better response and there were no secondary effects, what demonstrated its effectiveness on this respect

Alopecia areata: What's new in epidemiology, pathogenesis, diagnosis, and therapeutic options?

Alopecia areata (AA) is a common and stressful disorder that results in hair loss, and resistant to treatment in some cases. Experimental and clinical evidence suggests that AA is caused by autoimmune attack against the hair follicles. The precise pathomechanism, however, remains unknown. Here, we focus on the recent progress in multidisciplinary approaches to the epidemiology, pathogenesis, and new treatments of AA in 996 publications from January 2010 to July 2016, and provide an overview of the current understanding in clinical management and research directions.

Vitiligo and alopecia areata associated with subclinical/clinical hypothyroidism.

The parents of an 18-year-old woman had noticed white hair while combing their daughter's hair 12 years ago. They found tiny white spots on her scalp, but she was asymptomatic. The spots have since progressed. Examination of the affected skin on the scalp was marked by the presence of a chalky/ivory white macule, 8 to 10 cm in diameter, conforming to that of segmental (zosteriformis) vitiligo (Figure 1). The lesions were located on the temporoparietal region of the scalp. The hair over the macules was white (leukotrichia) and dry, coarse, and brittle. The patient's nails were thin and dull. Her thyroid profile revealed the following: triiodothyronine, 1.12 nmol/L (0.95-2.5 nmol/L); thyroxine, 69.21 nmol/L (60.0-120.0 nmol/L); and thyroid-stimulating hormone, 6.26 microIU/mL (0.25-5.00 microIU/mL), indicative of primary hypothyroidism. Liver and renal function tests were within normal limits. A lipid profile revealed the following: total lipids, 503.8 mg% (400-700 mg %); triglycerides, 123.0 mg % (160 mg %); cholesterol, 212.0 mg % (150-250 mg %); high-density lipoprotein, 43.1 mg % (30-63 mg %); and low-density lipoprotein, 144.3 mg % (50 mg %). Electrocardiographic findings were normal. History of tiredness, constipation, depression, sensitivity to cold, weight gain, muscle weakness, cramps, and increased menstrual flow supported the diagnosis. The patient was administered 100 microg of thyroxine once a day along with methoxsalen, the dose of which was calculated at 0.6 mg/kg to 0.7 mg/kg body weight per day given on alternate days, followed 2 hours later by exposure to UV-A (1 J/cm2) irradiation (psoralen-UV-A [PUVA]), supplemented by 1 mg of beta-methasone, 150 mg of levamisole on 2 consecutive days per week, and an antioxidant. During the course of 7 weeks, the macules (13 exposures) had become erythematous, with an appearance of perifollicular/ marginal pigmentation. Repeat examination showed a thyroid profile of total triiodothyronine (T3), 127.3 microg/dL (86-186); total thyroxine (T4), 6.54 microg/dL (4.5-12.5 microg/dL); and thyroid-stimulating hormone (TSH), 0.32 microIU/mL (0.3-5.6 microIU/mL), supplemented by antithyroid microsomal peroxidase antibodies (thyroid microsomal antibody and thyroid peroxidase), 21.9 IU/mL (1-40 IU/mL), and antithyroglobulin antibodies, 78.1 U/mL (1-100 U/mL). During the patient's treatment period, 4 other patients with clinical symptoms and signs of long-standing hypothyroidism developed vitiligo, the duration of which was variable in each patient (Table I). All of the patients were taking thyroxin. Thyroid and lipid profiles were performed periodically to evaluate the progress (Table I). These patients were also treated with PUVA therapy and thyroxin. During the course of treatment, 2 of the patients noticed asymptomatic, progressive, localized, and well-circumscribed hair loss at the temporal region of the scalp that extended to involve the vertex, conforming to findings of alopecia areata (Figure 2A and Figure 2B).

Actualización terapéutica en alopecia areata / Update on the Treatment of Alopecia Areata

La alopecia areata es una alopecia no cicatricial telogénica de base autoinmune. Se estima que origina un 2 % de las consultas dermatológicas y puede aparecer a cualquier edad, aunque es más frecuente en pacientes jóvenes. Su tratamiento va a depender de varios factores, fundamentalmente de la extensión de la enfermedad, de la edad del paciente, así como de medidas locales y sistémicas. Mientras que los tratamientos locales tienen como objetivo conseguir el recrecimiento piloso, sin influir en la evolución de la enfermedad, los tratamientos sistémicos pueden interferir en la evolución de la misma, siendo ambos medidas paliativas. En este trabajo revisamos la mayoría de las opciones terapéuticas descritas en la literatura para la alopecia areata (AU)

Alopecia areata is nonscarring telogenic alopecia of autoimmune etiology. It is estimated to be the presenting complaint in 2 % of dermatologic consultations, and can appear at any age although it is more common in young patients. Treatment depends on several factors, such as extent of the disease and age, and may be local or systemic. Local treatments aim to achieve hair regrowth, but do not alter the underlying condition, whereas systemic treatments can modify the course of the disease. In neither case does treatment provide a cure. In this article, we review most of the therapeutic options described in the literature for alopecia areata (AU)

Alopecia areata treatment with a phototoxic dose of UVA and topical 8-methoxypsoralen.

Twenty-five patients with alopecia totalis (AT) or alopecia universalis and 124 patients with alopecia areata (AA) were treated with photochemotherapy, combining topical 8-methoxypsoralen (8-MOP) with UV irradiation of the scalp at a phototoxic dose. The mean energy required was 15 J/cm2 for AA and 42 J/cm2 for AT. Ninety-four patients had multiple bald patches and 12 with AT had complete or > 50% hair regrowth. Positive treatment results did not seem to depend on the age of onset or the duration of the disease. Few side-effects of topical psoralens plus UVA (PUVA) treatment were noted, except a for few days of slight erythema caused by the high dose of UV.

PUVA treatment of alopecia areata totalis and universalis: a retrospective study.

The results of PUVA treatment of alopecia areata (AA) totalis and universalis were reviewed in 26 adult patients. Eight of 15 patients with AA totalis and six of 11 patients with AA universalis achieved a complete response (>90% hair regrowth). Patients with AA totalis had a greater incidence of treatment failure (<25% hair regrowth) than those with AA universalis. Patients with a family history of AA were significantly less likely to have a positive response to PUVA than those with no family history. Sex, age at diagnosis and treatment, interval between diagnosis and treatment, and background of atopy were not significant determinants of outcome. Although unable to show significance for clinical response to treatment, this study demonstrates complete hair regrowth in patients with both AA totalis (53%) and universalis (55%) while reporting a low relapse rate among these patients (21%) within a long period of follow up (mean 5.2 years).