ArticleLiterature Review

The Role of Micronutrients in Alopecia Areata: A Review

May 2017
American Journal of Clinical Dermatology 18(Spec Issue)

Authors:

Alopecia areata (AA) is a common, non-scarring form of hair loss caused by immune-mediated attack of the hair follicle. As with other immune-mediated diseases, a complex interplay between environment and genetics is thought to lead to the development of AA. Deficiency of micronutrients such as vitamins and minerals may represent a modifiable risk factor associated with development of AA. Given the role of these micronutrients in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation of these nutrients might represent a therapeutic option for AA. While current treatment often relies on invasive steroid injections or immunomodulating agents with potentially harmful side effects, therapy by micronutrient supplementation, whether as a primary modality or as adjunctive treatment, could offer a promising low-risk alternative. However, our review highlights a need for further research in this area, given that the current body of literature largely consists of small case-control studies and case reports, which preclude any definite conclusions for a role of micronutrients in AA. In this comprehensive review of the current literature, we found that serum vitamin D, zinc, and folate levels tend to be lower in patients with AA as compared to controls. Evidence is conflicting or insufficient to suggest differences in levels of iron, vitamin B12, copper, magnesium, or selenium. A small number of studies suggest that vitamin A levels may modify the disease. Though understanding of the role for micronutrients in AA is growing, definitive clinical recommendations such as routine serum level testing or therapeutic supplementation call for additional studies in larger populations and with a prospective design.

An overview of the genetic aspects of hair loss and its connection with nutrition

Article

Full-text available

Oct 2022

Hair loss is a widespread concern in dermatology clinics, affecting both men's and women's quality of life. Hair loss can have many different causes, which are critical to identify in order to provide appropriate treatment. Hair loss can happen due to many variables, such as genetic factors or predisposition, vitamin and mineral deficiencies, skin problems, hair growth disorders, poor diet, hormonal problems, certain internal diseases, drug use, stress and depression, cosmetic factors, childbirth, and the chemotherapy process. Treatment for hair loss varies depending on the type of alopecia, deficiency, or excess of structures such as vitamins and minerals, and also on hair and skin structure. The Mediterranean diet is characterized by low amounts of saturated fat, animal protein, and high amounts of unsaturated fat, fiber, polyphenols, and antioxidants. The main nutrients found in the Mediterranean Diet are rich in antioxidant, anti-inflammatory components. It also has an important place in hair loss treatment, since recently treatment strategies have included polyphenols and unsaturated oils more and more frequently. The goal of this work was to review published articles examining alopecia and its types, the many micronutrients that affect alopecia, and the role of the Mediterranean diet in alopecia. The literature shows that little is known about hair loss, nutritional factors, and diet, and that the data collected are conflicting. Given these differences, research into the function of diet and nutrition in the treatment of baldness is a dynamic and growing topic.

An overview of the genetic aspects of hair loss and its connection with nutrition

Article

Full-text available

Oct 2022

Hair loss is a widespread concern in dermatology clinics, affecting both men's and women's quality of life. Hair loss can have many different causes, which are critical to identify in order to provide appropriate treatment. Hair loss can happen due to many variables, such as genetic factors or predisposition, vitamin and mineral deficiencies, skin problems, hair growth disorders, poor diet, hormonal problems, certain internal diseases, drug use, stress and depression, cosmetic factors, childbirth, and the che-motherapy process. Treatment for hair loss varies depending on the type of alopecia, deficiency, or excess of structures such as vitamins and minerals, and also on hair and skin structure. The Mediterranean diet is characterized by low amounts of saturated fat, animal protein, and high amounts of unsatu-rated fat, fiber, polyphenols, and antioxidants. The main nutrients found in the Mediterranean Diet are rich in antioxidant, anti-inflammatory components. It also has an important place in hair loss treatment, since recently treatment strategies have included polyphenols and unsaturated oils more and more frequently. The goal of this work was to review published articles examining alopecia and its types, the many micronutrients that affect alopecia, and the role of the Mediterranean diet in alo-pecia. The literature shows that little is known about hair loss, nutritional factors, and diet, and that the data collected are conflicting. Given these differences, research into the function of diet and nutrition in the treatment of baldness is a dynamic and growing topic.

Dietary Habits in Japanese Patients with Alopecia Areata

Article

Full-text available

Oct 2021

Purpose: Alopecia areata (AA) is characterized by non-scarring, patchy hair loss caused by autoimmune reactions to anagen hair follicles. The pathogenesis of AA may be affected by the diet. However, the dietary habits of patients with AA have not been precisely examined. Therefore, the aim of this study was to investigate the dietary habits of patients with AA in comparison to those of healthy controls. Patients and methods: We evaluated the dietary habits of 70 adult Japanese patients with AA using a brief-type self-administered diet history questionnaire and compared them to the habits of age- and sex-matched healthy controls. Results: Japanese patients with AA had a higher body mass index (BMI) and higher intakes of vitamin C and fruit than the controls. Logistic regression analysis showed that AA was associated with BMI. Retinol intake was positively correlated with severity of alopecia tool (SALT) score, and linear regression analysis revealed that retinol intake was a predictor of SALT score. Retinol intake among patients with moderate to severe AA (ie, a SALT score >25) was higher than that in patients with mild AA (a SALT score ≤25). The mean age of AA patients with atopic dermatitis (AD) was lower than that of AA patients without AD; however, there were no differences in nutrient or food intake between these two groups. Logistic regression analysis showed that the comorbidity AD was negatively associated with age. Conclusion: AA was associated with a high BMI, and high retinol intake was a predictor of SALT score. Further studies should be conducted to clarify whether dietary intervention to reduce BMI or limit retinol intake can alter the development or severity of AA.

Serum 25-Hydroxy-Vitamin D and Vitamin B12 Levels in Childhood Alopesia Areata

Article

Full-text available

Jan 2021

Objective: Alopecia areata (AA); is a sudden onset, non-scaring hair loss. Twenty percent of cases are children.Although it is thought to be related to genetic predisposition, inflammation, immunological processes or psychological triggers, its pathophysiology is still not fully understood. This study was planned to investigate the levels of serum 25-hydroxy vitamin D, vitamin B12, thyroid-stimulating hormone (TSH) and free T4 FT4) in children with AA and compare the results with age-matched healthy individuals. Methods: A retrospective medical record review was carried out in an outpatient dermatology clinic in a tertiary medical center between January 1,2013 and December 31, 2017. The study included 520 patients (ages 0-18 years) who received a clinical diagnosis of AA.106 patients with AA met the inclusion criteria.Patients in the control group (n=106) were selected among children aged 0-18 years without any medical and/or psychiatric diagnosis. Both past medical and family medical history were also noted. Results of laboratory tests including vitamin D, vitamin B12, TSH, FT4, and thyroid auto-antibodies were noted. Results: There was no significant difference between the patient and control groups in terms of mean age.Mean age of onset was 8.0 years. The number of boys and girls in both the patient and control groups were 55 and 51. Serum levels of FT4 and TSH in patients with AA were significantly higher than the control group. Both vitamin D and vitamin B12 levels of the patients with AA were significantly lower than the control group. Conclusion: Although its role in etiopathogenesis is not understood, the importance of monitoring both vitamins and thyroid functions in childhood AA cases is obvious.

Association Between Vitamin D and Zinc Levels With Alopecia Areata Phenotypes at a Tertiary Care Center

Article

Full-text available

Apr 2021

Objectives Alopecia areata (AA) is a common immune-mediated hair disorder that presents in different clinical patterns. This study aims to find the association between vitamin D and zinc levels with AA phenotypes, to determine the common comorbidities in AA patients, and to assess the influence of age, gender, and body mass index (BMI) on AA phenotypes. Methods This is a cross-sectional study conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Data were collected through retrospective chart review of the electronic medical record system (BestCare) and by utilizing a structured data collection sheet. Results A total of 177 patients were clinically diagnosed with AA with a mean age of 28.37 ± 12.68 years. The mean vitamin D level was 49.14 ± 29.09 nmol/L. Zinc levels were reported in only 22 patients, among which, only one patient had deficient levels. The mean zinc level was 9.8 ± 1.5 µmol/L. Patchy alopecia areata (60.45%) was the most common phenotype followed by universalis (9%) and totalis (7%). Hypothyroidism (11.8%) was the most prevalent comorbidity followed by atopic diseases (10.7%), then both diabetes and mood disorders (6.2%). Conclusion Deficient serum vitamin D levels were present in 62.7% of patients with AA. Nevertheless, no statistically significant relation was detected between vitamin D status and patterns of alopecia areata (P=0.108). A limited number of our sample had records of zinc levels with a mean serum of 9.8 ± 1.5 µmol/L and only one patient was found to be deficient.

Nutrição e saúde dos cabelos: uma revisão (Hair nutrition and health: a review)

Article

Full-text available

Sep 2020

Introduction: Beauty is directly linked to the appearance of hair, always and in all cultures. Being nutrition an important tool for hair health, since the hair follicle cells present several cycles of continuous growth, constantly renewing themselves, and their active metabolism requires an adequate supply of nutrients and energy. Objective: The objective of this study was to evaluate the impact of dietary supplements on hair health. Material and Method: A bibliographic review was carried out in the main health databases: SciElO, Medline, Lilacs with the descriptors: Nutrients, polyphenols, hair in Portuguese and English, considering the period from 2010 to 2020. Results: 209 studies were found, 11 were included and 195 were excluded because they did not meet the eligibility criteria. Conclusion: The analysis of the literature allowed us to conclude that nutrition is closely related to hair health, acting in the entire process of growth and maintenance of hair follicle cells. Nutritional prescription of nutrients is important for maintaining capillary health. However, more randomized clinical studies should be carried out to confirm its effects and establish the appropriate dose of dietary supplements to prevent alopecia.

Natural Compounds in Hair Loss Healing

Article

Jan 2023
CURR PHARM DESIGN

Background: Hair loss or alopecia is a common dermatological problem that occurs in up to 2% of the human population. Often it is hereditary male- or female-pattern baldness. However, different environmental factors, unbalanced diet and chronic diseases result in hair loss. Hair loss is not a life-threatening sickness, but it may result in anxiety and depression, and other serious psychological problems affecting the individual`s quality of life. Objective: Different treatments for hair loss, including synthetic or/and natural drugs such as Minoxidil and Finasteride, approved by the Food and Drug Administration (FDA) for hair growth. These drugs are effective, but they have potential side effects. Natural remedies that are used for the treatment of various diseases have been proposed for hair loss healing because many chronic disorders cause alopecia. Therefore, the main focus of our study was search for alternative efficient treatment agents, particularly medicinal plants, with limited side effects. Methods: To find relevant information, different databases, including Scopus, PubMed and Google Scholar, were used, and various search terms such as “Hair loss”, “Alopecia”, “Hair loss AND Natural remedies”, “Alopecia AND natural remedies”, “Herbal treatment AND Hair loss” etc. were applied to extract related articles. Results: Different herbs and other natural compounds are believed to reduce hair loss due to their anti-inflammatory and antioxidant potential as well as due to the ability to improve local metabolism when applied externally. As per the literature, herbal extracts and formulations made from Urtica dioica, Humulus lupulus, Serenoa repens, Pygeum africanum, Vitis vinifera, Cucurbita pepo, Crocus sativus, Medicago sativa, Linum usitatissimum, Broccoli, etc., and some individual herbal compounds, micronutrients, bee products, and keratin have potential to reduce hair loss directly or indirectly. Conclusion: Medicinal plants and several promising natural molecules can promote hair growth and prevent alopecia by reducing the activity of the 5-α-reductase enzyme

Retrospective Evaluation of Clinical Profile and Comorbidities in Patients with Alopecia Areata

Article

Oct 2022

Şule Gökşin

Objective: The aim of the study was to determine the clinical profile of the patients with alopecia areata (AA) and whether or not any differences between the AA patients with and without comorbidity. Methods: A total of 218 patients diagnosed with AA between January 1, 2016, and August 31, 2020, in our outpatient clinic were analyzed retrospectively. Results: The mean age was 27.8±12.3. 61.5% of the patients were male (M/F=1.59). There were AA in 96.3%, alopecia universalis in 3.2%, and alopecia totalis in 0.5% of the patients. Most of them showed unifocal involvement (85.8%) and multifocal involvement to a smaller extent (10.5%). Number of patches was 1 in 75.2%, 2 in 16.7% and 3 or more in 8.1% of AA patients. Average disease duration was 18.1 months. Comorbid diseases were accompanying to 51.8% of the patients. Dermatological diseases were among the most common accompanying diseases (17.9%). However, hypothyroidism (12.8%) was the most frequent comorbid disease. There were thyroidal diseases in 15.1%, allergic disorders in 7.7%, psychiatric disorders in 7.3%, anemia in 5.9%, rheumatic diseases in 2.2%, other endocrine diseases in 1.8%, malignancy in 1.3%, and morbid obesity in 1.3% of the patients. Down syndrome accompanied in 0.9%. Vitamin-D deficiency (38.9%), low ferritin (13.8%), and B12 deficiency (9.6%) were also detected. Female gender (46.9 to 29.5%, p=0.008), extensive disease (p=0.085), Vitamin B12 deficiency (13.3 to 5.7%, p=0.059), and low ferritin level (20.4 to 6.7%, p=0.003) were observed more in patients with comorbidity than those without one. Conclusion: AA accompanies various systemic, autoimmune, and psychiatric diseases. Dermatologists need to recognize potential comorbid diseases, evaluate and manage these patients with a multidisciplinary approach to achieve a better outcome.

Clinical Translation of Microbiome Research in Alopecia Areata: A New Perspective?

Article

Full-text available

May 2022

The continuous research advances in the microbiome field is changing clinicians’ points of view about the involvement of the microbiome in human health and disease, including autoimmune diseases such as alopecia areata (AA). Both gut and cutaneous dysbiosis have been considered to play roles in alopecia areata. A new approach is currently possible owing also to the use of omic techniques for studying the role of the microbiome in the disease by the deep understanding of microorganisms involved in the dysbiosis as well as of the pathways involved. These findings suggest the possibility to adopt a topical approach using either cosmetics or medical devices, to modulate or control, for example, the growth of overexpressed species using specific bacteriocins or postbiotics or with pH control. This will favour at the same time the growth of beneficial bacteria which, in turn, can impact positively both the structure of the scalp ecosystem on the host’s response to internal and external offenders. This approach, together with a “systemic” one, via oral supplementation, diet, or faecal transplantation, makes a reliable translation of microbiome research in clinical practice and should be taken into consideration every time alopecia areata is considered by a clinician.

Role of nutritional supplements in selected dermatological disorders: A review

Article

Sep 2021

Background While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder. Patients/Methods Literature review of last 15 years was made using the terms “diet in dermatology,” “nutrition and skin,” “nutritional supplements in dermatology,” “nutritional agents and acne,” “nutritional agents and alopecia,” and “nutritional agents and psoriasis.” Results While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet. Conclusions Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management.

Dermatologic Manifestations of Nutritional Deficiency

Article

Full-text available

Dec 2020

Dermatologic manifestations of systemic diseases provide distinctive and reliable diagnostic clues that hasten time to intervention and improve overall outcomes. Notably, nutritional deficiencies are a class of diseases with representative and well-established dermatologic associations. Nutritional deficiencies can be primary or secondary and genetic or acquired; however, mucocutaneous findings remain characteristic irrespective of etiology. Purpose of Review This review will summarize the major classifications of nutritional deficiencies with a focus on conditions relevant and of greatest impact to the geriatric population. Recent Findings Recent literature has largely supported the well-known, pathognomonic mucocutaneous findings associated with nutritional deficiencies as well as displayed atypical clinical presentations and elucidated pathophysiologic mechanisms, which increases awareness and expands the breadth of knowledge of these disorders. Summary Total and specific micronutrient deficiencies can produce a vast array of mucocutaneous findings. These dermatologic manifestations of nutritional deficiencies are critical for all clinicians to recognize to enable prompt diagnosis and treatment. The geriatric population is specifically at-risk and attentiveness towards subtle signs of disease may substantially improve overall health outcomes.

Serum Trace Element Levels in Patients with Alopecia Areata

Article

Full-text available

Jul 2020

Nadia A. El Sherif

Predictive Metagenomic Profiling, Urine Metabolomics, and Human Marker Gene Expression as an Integrated Approach to Study Alopecia Areata

Article

Full-text available

Apr 2020

Involvement of the microbiome in many different scalp conditions has been investigated over the years. Studies on the role of the scalp microbiome in specific diseases, such as those involving hair growth alterations like non-cicatricial [androgenetic alopecia (AGA), alopecia areata (AA)] and cicatricial alopecia lichen planopilaris, are of major importance. In the present work, we highlighted the differences in microbial populations inhabiting the scalp of AA subjects and a healthy sample cohort by using an integrated approach relying on metagenomic targeted 16S sequencing analysis, urine metabolomics, and human marker gene expression. Significant differences in genera abundances (p < 0.05) were found in the hypodermis and especially the dermis layer. Based on 16S sequencing data, we explored the differences in predicted KEGG pathways and identified some significant differences in predicted pathways related to the AA pathologic condition such as flagellar, assembly, bacterial chemotaxis, mineral absorption, ABC transporters, cellular antigens, glycosaminoglycan degradation, lysosome, sphingolipid metabolism, cell division, protein digestion and absorption, and energy metabolism. All predicted pathways were significantly enhanced in AA samples compared to expression in healthy samples, with the exceptions of mineral absorption, and ABC transporters. We also determined the expression of TNF-α, FAS, KCNA3, NOD-2, and SOD-2 genes and explored the relationships between human gene expression levels and microbiome composition by Pearson's correlation analysis; here, significant correlations both positive (SOD vs. Staphylococcus, Candidatus Aquiluna) and negative (FAS and SOD2 vs. Anaerococcus, Neisseria, and Acinetobacter) were highlighted. Finally, we inspected volatile organic metabolite profiles in urinary samples and detected statistically significant differences (menthol, methanethiol, dihydrodehydro-beta-ionone, 2,5-dimethylfuran, 1,2,3,4, tetrahydro-1,5,7-trimethylnapthalene) when comparing AA and healthy subject groups. This multiple comparison approach highlighted potential traits associated with AA and their relationship with the microbiota inhabiting the scalp, opening up novel therapeutic interventions in such kind of hair growth disorders mainly by means of prebiotics, probiotics, and postbiotics.

Alopecia Areata: A Review of the Role of Oxidative Stress, Possible Biomarkers, and Potential Novel Therapeutic Approaches

Article

Full-text available

Jan 2023

Alopecia areata (AA) is a dermatological condition characterized by non-scarring hair loss. Exact etiopathogenesis of AA is still unknown although it is known that several factors contribute to the collapse of the hair-follicle (HF)-immune-privileged (IP) site. Oxidative stress (OS) plays an important role in skin diseases. The aim of this review was to clarify the role of OS in AA pathogenesis and diagnosis, and to discuss potential treatment options. Oxidative-stress markers are altered in serum and skin samples of patients with AA, confirming a general pro-oxidative status in patients with AA. OS induces MHC class I chain-related A (MICA) expression in HF keratinocytes that activates the receptor NKG2D, expressed in NK cells and CD8+ T cytotoxic cells leading to destabilization of the HF immune-privileged site through the production of IFN-γ that stimulates JAK1 and JAK2 pathways. OS also activates the KEAP1-NRF2 pathway, an antioxidant system that contributes to skin homeostasis. In addition, a decrease of ATG5 and LC3B in the hair matrix and an increase in p62 levels indicates a reduction of intrafollicular autophagy during the evolution of AA. Potential biomarkers of OS in AA could be: malondialdehyde (MDA), advanced glycation end-products (AGEs), and ischemic-modified albumin (IMA). JAK inhibitors are the new frontier in treatment of AA and the use of nutraceuticals that modulate the OS balance, in combination with standard treatments, represent promising therapeutic tools.

Baricitinib: First Systemic Oral Drug for Alopecia Therapy

Article

Full-text available

Oct 2022

Baricitinib, a Janus kinase inhibitor, was originally approved as anti-rheumatic drug in 2017. In 2020, it was approved for the treatment of COVID-19 in selected hospitalized adults. Baricitinib received priority review designation for treatment of adult patients with severe alopecia areata and got USFDA approval on June 23, 2022 based on the results of 02 phase III trial: BRAVE-AA1 and BRAVE-AA2. In this review, we aim to summarize the different pharmacokinetic and pharmacodynamics aspects including drug interactions, adverse effects/black box warnings and their clinical relevance. We reiterate that oral JAK inhibitors are expensive, may carry significant risks, and are not yet recommended for routine treatment of alopecia areata. There is ongoing research on other topical and oral JAK inhibitors (tofacitinib and ruxolitinib), giving hope that better treatments for alopecia areata will become available in future.

Epidemiological Trends in Alopecia Areata at the Global, Regional, and National Levels

Article

Full-text available

Jul 2022

Background No comprehensive studies have been published on the global burden of alopecia areata since 2010. Objective We aimed to measure the global, regional, and national incidence of alopecia areata and disability-adjusted life-years (DALYs) by age, sex, and socio-demographic index (SDI) value from 1990 to 2019. Methods Data were extracted from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends in the age-standardized rates of alopecia areata incidence and DALYs. The correlations between EAPCs in the age-standardized rates and SDI values were also analyzed. Results From 1990 to 2019, the alopecia areata incidence number and the associated number of DALYs increased globally by 49.14%, and 49.51%, respectively. The global age-standardized incidence rate decreased (EAPC, −0.13; 95% confidence interval [CI], −0.13 to −0.12) and the age-standardized DALY rate showed a downward trend (EAPC, −0.12; 95% CI, −0.13 to −0.11). The largest increases in the age-standardized incidence rate and age-standardized DALY rate were observed in Low SDI quintile and Western Sub-Saharan Africa regions. The regions with the greatest changes in the incidence of alopecia areata were Central Sub-Saharan Africa and Western Sub-Saharan Africa. The three countries with the largest increases in alopecia areata incidence from 1990 to 2019 were Kuwait (EAPC, 0.15), South Sudan (EAPC, 0.12), and Nigeria (EAPC, 0.11). The age-standardized incidence rate was higher in females than in males. Conclusion Globally, both the age-standardized incidence rate and age-standardized DALY rate of alopecia areata showed decreasing trends. Future preventive strategies should focus on low-income countries, Central Sub-Saharan Africa, Western Sub-Saharan Africa, Kuwait, South Sudan, Nigeria.

Role of allergy in the development of alopecia areata

Article

Jul 2022

Alopecia areata is an autoimmune disease characterized by non-scarring hair loss with preservation of the hair follicle. Hair loss in alopecia areata can be either focal with the appearance of clearly defined foci of alopecia, or diffuse or complete hair loss in any area of the skin where hair follicles are present. Data on the role of food allergy in the development of alopecia areata and the nature of the sensitization spectrum are extremely scarce. Objective: to study the features of the spectrum of sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata. The study involved patients with alopecia areata (n = 17), who were divided into groups according to age: group 1 — children (n = 9) and group 2 — adults (n = 8). All patients underwent a specific allergological examination: collection of an allergic history, skin prick testing with food and pollen allergens (Allergopharma, Germany). Analysis of the spectrum of sensitization to food allergens in patients with alopecia areata revealed features depending on their age. Thus, in the group of sick children, the highest frequency of sensitization to whole chicken eggs, food cereals, yeast, soybeans and cow's milk proteins was noted. In the group of sick adults, the most significant food allergens were: egg protein, rye flour, oats. Among the pollen allergens in the first group of patients, the most common allergens were a mixture of weed and grass pollen, in the second group, a mixture of meadow grass pollen. All patients, taking into account allergological testing, were administered an individual elimination diet with the exclusion of causally significant allergens, taking into account crossreacting allergens. The elimination effect was assessed 2 months after the start of the elimination diet. 70% of patients showed a clinical improvement, i.e., the growth of vellus was noted (vellus depigmented hair) in the foci of alopecia, as well as terminal pigmented hair. Complete regression of alopecia foci occurred on average within 3-6 months from the start of therapy. The sensitization to food and pollen (cross-reacting) allergens in patients with alopecia areata and the positive effect of the elimination diet revealed in our study well supports the role of food allergy in the development of this disorder. Therefore, the study of the causal relationship between food allergy and alopecia areata is of particular relevance and creates prerequisites for the discovery of new diagnostic and therapeutic options.

Possible relationship between poor skin disorders prognosis and serum zinc level: A narrative review

Article

Full-text available

Jul 2022

Zinc is a trace nutrient essential for the normal growth and development of human body. The main aim was to evaluate the significant association between measured zinc status in relation to different skin disorders and their severity. PubMed®, Google® Scholar™ and Cochrane© Reviews databases were searched for studies from January 2017 to June 2021, using the terms; zinc serum levels, zinc plasma levels and different dermatosis in the review, only human studies in English language were reviewed and the studies designs were controlled, cross sectional, observational and analytic types. A total of forty-eight research studies were included in this review. All studies have evaluated serum zinc in skin diseases including psoriasis, atopic dermatitis, pityriasis alba, androgenetic alopecia areata, telogen effluvium, vitiligo, melasma, acne, seborrheic dermatitis and hidradenitis suppuritiva. It was found that 33 studies had validated statistically significant differences in serum zinc levels between patients and controls. There is a predominance of low serum zinc levels in all the dermatoses reviewed. The clinical significance of this finding highlights the possible value, and need to investigate, the use of Zinc supplementation as an adjuvant therapy in the management of chronic inflammatory and autoimmune skin diseases proven to manifest altered zinc levels.

Ischemia-Modified Albumin—A Potential New Marker of Oxidative Stress in Dermatological Diseases

Article

Full-text available

May 2022
MED LITH

There is growing evidence that oxidative stress is involved in the pathogenesis of numerous conditions, including dermatological diseases. Various markers are available to assess oxidative stress, but none of these can be considered the ideal marker. Recent studies have shown that ischemia-modified albumin (IMA) is not only an indicator of ischemia, but also a marker of oxidative stress. We have conducted a narrative review to evaluate the role of IMA in dermatological diseases. We have identified 24 original articles that evaluated IMA in skin disorders (psoriasis, acne vulgaris, hidradenitis suppurativa, urticaria, vitiligo and Behcet’s disease) and hair disorders (alopecia areata, androgenetic alopecia and telogen effluvium). The results of the studies analyzed reveal that IMA may be considered a new marker of oxidative stress in dermatological diseases and offer new insights into the pathogenesis of these disorders and the theoretical basis for the development of new, effective, targeted therapies. To the best of our knowledge, this is the first review that gathers up data on the role of IMA in dermatological diseases.

The Role of Nutrition in Immune-Mediated, Inflammatory Skin Disease: A Narrative Review

Article

Full-text available

Jan 2022

Immune-mediated inflammatory skin diseases are characterized by a complex multifactorial etiology, in which genetic and environmental factors interact both in genesis and development of the disease. Nutrition is a complex and fascinating scenario, whose pivotal role in induction, exacerbation, or amelioration of several human diseases has already been well documented. However, owing to the complexity of immune-mediated skin disease clinical course and breadth and variability of human nutrition, their correlation still remains an open debate in literature. It is therefore important for dermatologists to be aware about the scientific basis linking nutrition to inflammatory skin diseases such as psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata, and whether changes in diet can influence the clinical course of these diseases. The purpose of this narrative review is to address the role of nutrition in immune-mediated inflammatory skin diseases, in light of the most recent and validate knowledge on this topic. Moreover, whether specific dietary modifications could provide meaningful implementation in planning a therapeutic strategy for patients is evaluated, in accordance with regenerative medicine precepts, a healing-oriented medicine that considers the whole person, including all aspects of the lifestyle.

New therapies for alopecia areata

Article

Oct 2021

Over the past few years, better understanding of the explicit pathomechanism of alopecia areata provides new treatment opportunities for effective therapy of the disease, which may revolutionize therapeutic strategies. This exceedingly heterogeneous disease with unpredictable outcome, severely affects the quality of life. Currently, there are no standardized treatment protocols approved by the European Medicines Agency (EMA), resulting a challenge for the therapists in the choice of treatment.In this paper, the authors summarize recent and emerging therapies for severe cases of alopecia areata.

The association between alopecia areata and anxiety, depression, schizophrenia, and bipolar disorder: a population-based study

Article

Full-text available

Jul 2022
ARCH DERMATOL RES

Although Alopecia areata (AA) has been found to be associated with psychological distress, the scope and nature of this association has not been fully delineated. The current study sought to examine the association of AA with anxiety, depression, schizophrenia, and bipolar disorder, utilizing a large-scale matched controlled cohort design. Patients suffering from AA (n = 41,055) were matched to control cases (n = 41,055) by age, sex, and socioeconomic status (SES). The prevalence of the four major mental disorders was assessed while stratifying the sample by age and sex, and after adjusting for marital status, smoking, BMI, hypertension, and diabetes. Data were accessed via the Clalit Health Services (CHS) database, a comprehensive health registry utilized by the largest managed healthcare company in Israel. Anxiety was independently and positively associated with AA (OR 1.22, 95% CI 1.13–1.31, p < 0.001), across all age groups above 30, with similar rates in males and females. Depression was also independently and positively associated with AA (OR 1.09, 95% CI 1.01–1.17, p < 0.005), particularly in the 30–49 age group, with a higher association among females. A negative association was found between AA and schizophrenia (OR 0. 71, 95% CI 0.61–0.83, p < 0.001). No association was found between AA and bipolar disease. Patients with AA are at risk for anxiety and depression, with female patients, and patients in the 30–49 age group being particularly vulnerable to develop a co-occurring mental disorder. Medical treatment should therefore include psychiatric evaluation and appropriate care.

Hair Loss After Metabolic and Bariatric Surgery: a Systematic Review and Meta-analysis

Article

Full-text available

Mar 2021
OBES SURG

Background Hair loss is a common complication after metabolic and bariatric surgery (MBS). There is a lack of published systematic review in the scientific literature on this topic. The aim of this study was to perform a systematic review and meta-analysis on hair loss after MBS in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Methods PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, and four Chinese databases were searched. Data were pooled using Review Manager 5.3 and Stata 12.0, and subgroups were performed if necessary and feasible. Results A total of 18 studies (n = 2538) were included. The pooled results showed that the incidence of hair loss after MBS was 57% (95% CI 42–71%). It decreased with longer follow-up times. Hair loss was significantly more common in younger (mean difference (MD), − 2.45; 95% CI, − 4.26 to − 0.64; p = 0.008) women (OR, 3.87; 95% CI, 0.59 to 17.59; p = 0.08). Serum zinc (standardized mean difference (SMD), − 1.13; 95% CI, − 2.27 to 0.01, p = 0.05), folic acid (SMD = − 0.88, 95% CI − 1.29 to − 0.46, p < 0.0001), and ferritin levels (SMD, − 0.22; 95% CI, − 0.38 to − 0.05; p = 0.01), but not serum iron and vitamin B12, were associated with hair loss following MBS. Conclusions Hair loss is common after MBS especially in younger women, and those with low serum levels of zinc, folic acid, and ferritin. Prospective studies on larger cohorts are needed.

The association between the levels of Ferritin, TSH, Zinc, Hb, vitamin B12, vitamin D and the hair loss among different age groups of women: A retrospective study

Article

Full-text available

Jan 2021

Hair loss is an important factor in clinical dermatology, as it has a major impact on the quality of human life, especially among women. This retrospective study aims to find a link between ferritin, Hb, TSH, zinc, vitamin B12 and vitamin D levels and the problem of hair loss in different age groups of women. Ferritin, zinc, Hb, TSH, vitamin B12 and vitamin D records were obtained from the 300 female patients who were all diagnosed with chronic diffuse hair loss with an estimated age span of 17 to 61 years and from 70 healthy females control group aged between 20-57 years old. The female patients (n=300) were divided into three age-based groups; 17-32 (n=166), 33-48 (n= 73) and 49-61 (n= 61). The control group was classified by age, similar to the age groups of the female patients. The concentrations of ferritin, TSH and Hemoglobin (Hb) were found to be significantly reduced (p<0.05) in female patients aged between 17 to 32 years relative to the control group of similar age. No major decrease was seen in other biochemical parameters (Zn, Vitamin B12 and Vitamin D) in this age group. In women aged between 33-48 years, TSH was found to be significantly decreased (p<0.05), along with a significant decrease in vitamin B12. A significant decrease in TSH (p<0.05), vitamin B12(P<0.05) and vitamin D levels (p<0.05) were observed in the older age group (49-61 years) relative to the control group of comparable ages. This study showed the relationship between levels of ferritin, TSH, zinc, Hb, vitamin B12 and vitamin D among women in different age groups suffering from the hair loss problem. The importance of this study is that the causes of hair loss have been clarified in different age groups, which can be relied on in deciding the treatment method at each age group.

Dissertation_UdS_Brand

Thesis

Jan 2020

Anna Maria Brand

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

Article

Full-text available

May 2021
CLIN EXP MED

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.

Practice pattern and use of serum peptide formulation in patients with alopecia: results of an opinion survey among dermatologists in India

Article

Full-text available

Dec 2020

Rekha Lanjekar

p>To evaluate practice pattern and preference for use of serum peptide formulation by dermatologists for the treatment of alopecia. Dermatologists in India were administered a questionnaire consisting of questions related to number of patients with alopecia seen every week, investigations, prevalence of nutritional deficiencies and use of serum peptide formulation in telogen effluvium (TE) and androgenetic alopecia (AGA). The responses were analysed as number and percentages. Out of 124 dermatologists, 38 (31%) reported that they see 11-15 patients with TE every week and 31 (25%) reported seeing 11-15 patients of AGA per week. According to 51 (41%) dermatologists, 40-60% patients with hair loss have some nutritional deficiency and 95 (77%) reported that iron deficiency profile, thyroid stimulating hormone (TSH), vitamin B1 and vitamin D level estimation is necessary in patients with TE. A total of 86 (69%) dermatologists preferred serum peptide formulation in patients with TE and AGA. Ninety nine (80%) and 75 (60%) dermatologists reported “very good” or “good” efficacy of serum peptide in TE and AGA respectively. Ninety nine (80%) dermatologists said, gender is not an important criterion for choosing a serum peptide in hair fall. For aesthetics related parameters, Folliserum (Abbott Health care Pvt Ltd) was rated as “Very good” and “Good” by 66 (53%) and 38 (31%) dermatologists respectively. According to dermatologists in India, nutritional deficiency is common in patients with alopecia. Majority of the survey participants rated Folliserum as “Very good” or “Good” for its efficacy and aesthetic parameters. </p

Combined Diet and Supplementation Therapy Resolves Alopecia Areata in a Paediatric Patient: A Case Study

Article

Full-text available

Nov 2020

Cliff J Harvey

Alopecia areata (AA) is a common autoimmune condition resulting in spot baldness and, rarely, more extensive hair loss. There is an association between both the incidence and the severity of AA and several micronutrients, including vitamin D and zinc. This case reports an eight-year-old male diagnosed with AA and treated with a diet and supplemental regimen based on unrefined foods, rich in vitamins A and D, zinc, and supplemented with a multi-nutrient, zinc sulfate, and fish oil with vitamin D. Complete remission of AA was achieved within five months.

Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata

Article

May 2020

Background Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth. Aim To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA. Patients/Methods This comparative, randomized, double‐blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3 weeks for 9 weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow‐up visits over 6 months past treatment cessation. Results A total of 19 patients completed the study and showed significant reduction in SALT score. TCA‐ and phenol‐treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected. Conclusions Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.

Enfermedad celiaca silente en paciente obeso con alopecia areata

Article

Full-text available

Mar 2020

Introduction: celiac disease is a medical condition that is characterized by its varied forms of clinical presentation and its association with other autoimmune pathologies. The objective is to describe the case of a patient who presented for consultation due to alopecia areata. Methodology: observational, descriptive, retrospective study of a 24-year-old obese male Results: among the routine studies positive serology for celiac disease was detected and confirmed with digestive endoscopy. Conclusions: the alopecia areata of this patient allowed to reveal another autoimmune disease.

SUBSTANTIATING THE RELEVANCE OF IRON IN HERBAL AND HERBOMINERAL PREPARATIONS FOR COMPREHENSIVE HAIR CARE

Article

Full-text available

Mar 2020

Background: Hair is known as the crown which we never take off. It represents our personality, status, thought, belief and much more. It is indicator of health of a person. Disorders of hair may lower one's morale as it plays a major part in sculpturing his/her persona. Iron plays a paramount role in maintaining vitality of hair. Its inadequacy can lead to loss and depigmentation of hair. In addition to that, it is the most common nutritional deficiency in the world. Researches are being carried out to establish relation between low serum ferritine and hair loss. Hence supplementing iron is considered as a solution for multifold disorders of hair. Ayurvedic classics consider the usage of formulations containing Loha bhasma as Keshya Rasayana. References pertaining to utilization of Iron containing herbs like Bhringraja, Tila and Amalaki are also obtained to support this view. Aim: The present article attempts to emphasize the role of Loha in safeguarding the health of hair through the medium of Ayurvedic formulations. Materials and Methods: Consolidating references of formulations containing Loha and Iron rich herbs from Ayurvedic classics and research articles of various branches so as to establish importance of Iron in maintaining healthy hair. Conclusion: By scrutinizing Ayurveda classics, it is inferred that Loha is used abundantly in various forms by Acharyas for hair care. Ensuring adequacy of Iron in the body helps in maintaining the vitality of Hair.

Hair Loss - Symptoms and Causes: How Functional Food Can Help

Article

Full-text available

May 2019

Background: The impact that hair loss has on an individual's psychological wellness, and subsequent quality of life, is widespread and long lasting. The current standard treatments for hair loss include surgery and medications, ranging from over-the-counter treatments to corticosteroid injections and immunosuppressants. Unfortunately, these current treatments are either expensive, invasive, or have extremely negative side effects. Recently, the role of vitamins, minerals, and functional foods with their associated bioactive compounds, have gained increasing recognition as a potential means to address this issue. Some of these compounds have been shown to decrease the risk of specific forms of hair loss, particularly alopecia, a form of balding that results due from an autoimmune disorder. These include experimental studies using black raspberry extract and egg yolks as well as epidemiological studies using Mediterranean diets and various micronutrients. Other compounds have been shown to promote hair growth on a more general scale, including in vivo studies using rice bran extract and mouse models using red ginseng oil and annurca apple polyphenols. This review identifies key hair growth promoting vitamins, minerals, and functional foods, as well as summarizes the relevant mechanisms of action of these compounds that have been elucidated. Knowledge regarding the effects of these nutriceuticals on reducing hair loss is rapidly expanding. However, it is imperative that further research be done in order to delineate mechanisms of actions for all compounds related to managing and treating hair loss and subsequently integrate these dietary modifications into clinical treatment recommendations for hair loss.Keywords: Hair loss, alopecia, berry extract, mediterranean diet, rice bran, ginseng, annurca apple, thuja orientalis, marine supplement, honey, egg yolk, functional foods, bioactive compounds

Trace element zinc and skin disorders

Article

Full-text available

Jan 2023

Zinc is a necessary trace element and an important constituent of proteins and other biological molecules. It has many biological functions, including antioxidant, skin and mucous membrane integrity maintenance, and the promotion of various enzymatic and transcriptional responses. The skin contains the third most zinc in the organism. Zinc deficiency can lead to a range of skin diseases. Except for acrodermatitis enteropathic, a rare genetic zinc deficiency, it has also been reported in other diseases. In recent years, zinc supplementation has been widely used for various skin conditions, including infectious diseases (viral warts, genital herpes, cutaneous leishmaniasis, leprosy), inflammatory diseases (hidradenitis suppurativa, acne vulgaris, rosacea, eczematous dermatitis, seborrheic dermatitis, psoriasis, Behcet's disease, oral lichen planus), pigmentary diseases (vitiligo, melasma), tumor-associated diseases (basal cell carcinoma), endocrine and metabolic diseases (necrolytic migratory erythema, necrolytic acral erythema), hair diseases (alopecia), and so on. We reviewed the literature on zinc application in dermatology to provide references for better use.

Evaluation of the Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss: A Systematic Review

Article

Nov 2022

Importance Despite the widespread use of nutritional supplements and dietary interventions for treating hair loss, the safety and effectiveness of available products remain unclear. Objective To evaluate and compile the findings of all dietary and nutritional interventions for treatment of hair loss among individuals without a known baseline nutritional deficiency. Evidence Review The MEDLINE, Embase, and CINAHL databases were searched from inception through October 20, 2021, to identify articles written in English with original findings from investigations of dietary and nutritional interventions in individuals with alopecia or hair loss without a known baseline nutritional deficiency. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. Outcomes of interest were disease course, both objectively and subjectively measured. Data were evaluated from January 3 to 11, 2022. Findings The database searches yielded 6347 citations to which 11 articles from reference lists were added. Of this total, 30 articles were included: 17 randomized clinical trials (RCTs), 11 clinical studies (non-RCT), and 2 case series studies. No diet-based interventional studies met inclusion criteria. Studies of nutritional interventions with the highest-quality evidence showed the potential benefit of Viviscal, Nourkrin, Nutrafol, Lamdapil, Pantogar, capsaicin and isoflavone, omegas 3 and 6 with antioxidants, apple nutraceutical, total glucosides of paeony and compound glycyrrhizin tablets, zinc, tocotrienol, and pumpkin seed oil. Kimchi and cheonggukjang, vitamin D 3 , and Forti5 had low-quality evidence for disease course improvement. Adverse effects were rare and mild for all the therapies evaluated. Conclusions and Relevance The findings of this systematic review should be interpreted in the context of each study’s design; however, this work suggests a potential role for nutritional supplements in the treatment of hair loss. Physicians should engage in shared decision-making by covering the potential risks and benefits of these treatments with patients experiencing hair loss. Future research should focus on larger RCTs with active comparators.

On the Potential Role of the Antioxidant Couple Vitamin E/Selenium Taken by the Oral Route in Skin and Hair Health

Article

Full-text available

Nov 2022

The relationship between oxidative stress and skin aging/disorders is well established. Many topical and oral antioxidants (vitamins C and E, carotenoids, polyphenols) have been proposed to protect the skin against the deleterious effect induced by increased reactive oxygen species production, particularly in the context of sun exposure. In this review, we focused on the combination of vitamin E and selenium taken in supplements since both molecules act in synergy either by non-enzymatic and enzymatic pathways to eliminate skin lipids peroxides, which are strongly implicated in skin and hair disorders.

Magnesium (Mg+2)

Chapter

Oct 2022

Konstantinos Anastassakis

Magnesium (Mg+2) is the most common intracellular divalent cation and the second most abundant cation in intracellular fluid, essential to every human body cell. The adult human body contains approximately 24 g (1 mol) of Mg+2; about 60% is found in bone tissue, and the rest 40% in all other soft tissues [1].

Zinc (Zn)

Chapter

Oct 2022

Konstantinos Anastassakis

Zinc is a chemical element with the symbol Zn and atomic number 30. In the periodic table, Zn belongs in group IIb, along with toxic heavy metals such as Cadmium and Mercury. Yet, zinc is relatively non-toxic for humans and living creatures in general [1].

Clinical Relevance of the Microbiome in Pediatric Skin Disease: A Review

Article

Mar 2022
DERMATOL CLIN

The human microbiome encompasses the microorganisms that live in and on the body. During the prenatal and infantile periods, foundations for the cutaneous and gut microbiomes are being established and refined concurrently with the development of immune function. Herein, we review the relevance of the microbiome to 5 conditions commonly encountered in pediatric dermatology: acne, alopecia areata, atopic dermatitis, psoriasis, and seborrheic dermatitis. Understanding the role microbes play in these conditions may establish the groundwork for future therapeutic interventions.

Efficacy of a new combination of a microemulsion and oral supplementation for androgenetic alopecia: an interventional multicentric study

Article

Jan 2022

Background: The aim of this study was to study new therapeutic options for the treatment of female and male androgenetic alopecia (AGA) and to assess the efficacy of a possible new coadjuvant oral and topical therapy, containing a complex of natural substances. Methods: Sixty individuals affected by mild-to-moderate female and male AGA were enrolled in the study and underwent the oral and topical treatment with a microemulsion formulation for 6 months. At baseline and at 3- and 6-month follow-up, global photographs were taken and three expert operators evaluated photographs using the 7-point scale. On a subgroup of our sample, non-invasive phototrichograms with TrichoScan® HD at baseline and follow-ups were performed to collect the trichological parameters of total number of hairs, hair density/cm2, vellus hair density/cm2, terminal hair density/cm2 and hair thickness. One-way ANOVA and Unpaired Student t-test were performed to analyze the data. Results: Using the 7-point scale, a clinically visible improvement of hair loss was observed after three and six months of treatment. A statistically significant increase of all TrichoScan® trichological parameters was observed at both 3- and 6 month-follow-ups. Conclusions: the complex of natural and active substances tested in this work showed good efficacy in improving both male and female hair loss. These new products could represent a valid alternative or coadjuvant therapy of AGA, increasing the efficacy of conventional treatments such as minoxidil or finasteride.

Alopecia areata – Aktuelles Verständnis und Management

Article

Jan 2022

Zusammenfassung Die Alopecia areata (AA) ist eine chronische immunvermittelte Erkrankung, die durch akuten oder chronischen, nicht vernarbenden Haarausfall gekennzeichnet ist. Die klinischen Erscheinungsformen sind sehr unterschiedlich und reichen von kleinen umschriebenen haarlosen Stellen bis hin zum vollständigen Verlust der Kopf- und Körperbehaarung. Diese Übersicht soll aktuelles Wissen zu Pathophysiologie und beteiligten Signalwegen vermitteln sowie diagnostische und therapeutische Empfehlungen geben. Aktuell verfügbare Therapieansätze bei AA, einschließlich topischer, systemischer und injizierbarer Interventionen, zeigen unterschiedlich gutes Ansprechen mit häufigen Rezidiven, was den dringenden Bedarf an effektiven zielgerichteten Therapien widerspiegelt. Neue therapeutische Ansätze und Konzepte, einschließlich Januskinase-Inhibitoren, werden mit großer Spannung erwartet. Diese Übersicht diskutiert traditionelle und neue Therapieansätze für das Management der AA. Diese Erkrankung führt häufig zu einer starken psychosozialen Belastung für die Betroffenen, kann zu Depressionen führen, Angstzustände auslösen und die Lebensqualität beeinträchtigen. Daher sollten psychosoziale Aspekte der Krankheit mit berücksichtigt, beim Patienten angesprochen und die Notwendigkeit einer psychologischen Unterstützung erwogen werden. Summary Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.

Alopecia areata – Current understanding and management

Article

Jan 2022

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.

Skin, Lung, Eyes, and Hair

Chapter

Oct 2021

The impact of aging on the integrity of the outermost layer of our tissue, the epithelium, predisposes the older adult to dysfunction in these tissues found in the skin, lungs, eyes, and hair. As the foundation of health, the health status of the gut lining directs the status of other epithelial tissues due to the impact of nutritional deficiencies from malabsorption as well as the impact of the microbiome that exists on all of these external-facing surfaces. Both environments, the skin and the gut, host microbiomes of immense and diverse proportions. On its own, the gut performs innumerable functions, including but not limited to vitamin production, immune regulation, protection from pathogens, serum lipid modulation, and metabolism of xenobiotics and food components (Ellis et al. Microorganisms 7:550, 2019). The skin serves to maintain the cutaneous immune system. (Ellis et al. Microorganisms 7:550, 2019). Although the mechanisms are not fully elucidated, there are a few prevailing theories. Changes in gut flora due to stress, injury, or inflammation increase epithelial permeability in the gut, which triggers T-cell activation, disrupts tolerance, and leads to systemic inflammation that disturbs cutaneous homeostasis (Arck et al. Exp Dermatol 19:401–5, 2010). Another theory suggests increased gut permeability allows for direct migration of inflammatory products into systemic circulation (Cani et al. Diabetes 56:1761–72, 2007). The connection warrants further research but is likely due to a combination of both neurologic and immunologic responses to environmental changes (Ellis et al. Microorganisms 7:550, 2019). In this chapter, we highlight the most common concerns related to the skin, lungs, eyes, and hair for the older adult: xerosis, psoriasis, eczema, chronic obstructive pulmonary disease, macular degeneration, and alopecia.

Alopecia areata: una revisión de la patogenia y nuevas dianas terapéuticas

Article

Full-text available

Jan 2020

Alopecia areata: a review of pathogenesis and new therapeutic targets RESUMEN La Alopecia areata (AA) es una enfermedad inflamatoria que afecta al folículo piloso produciendo pérdida de cabello no cicatrizal. Esta patología impacta negativamente la calidad de vida del paciente porque no existe tratamiento curativo ni eficaz a largo plazo, además que la respuesta a los tratamientos actuales es muy variable de persona a persona. Esto condiciona ciertos niveles de ansiedad y discapacidad en la población afectada. Es así, que en los últimos años se ha demostrado la importancia del rol inmunológico en la patogenia de la enfermedad, para poder crear nuevas dianas terapéuticas como los inhibidores de JAK, inhibidores de citoquinas, terapias que han demostrado ser seguras y eficaces. En esta revisión describimos, con un enfoque inmunológico, la patogenia de la enfermedad; así como el tratamiento convencional existente y los nuevos rumbos que está tomando el tratamiento en AA. Palabras clave: Alopecia areata, patogénesis, inmunoterapia. ABSTRACT Alopecia areata (AA) is an inflammatory disease that affects the hair follicle causing non-scarring hair loss. This pathology negatively impacts the quality of life of the patient because there is no long-term curative or effective treatment, and the response to current treatments is highly variable from person to person. This determines certain levels of anxiety and disability in the affected population. Thus, in recent years the importance of the immunological role in the pathogenesis of the disease has been demonstrated, in order to create new therapeutic targets such as JAK inhibitors, cytokine inhibitors, therapies that have demonstrated to be safe and effective. In this review we describe, with an immunological approach, the pathogenesis of the disease; as well as the existing conventional treatment and the new directions that AA treatment is taking.

Nutrition and Hair

Article

May 2021
CLIN DERMATOL

delete Edited by K O'Connor, L J Golderg Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.

Medical Treatments for Androgenetic Alopecia

Chapter

Oct 2020

Androgenetic alopecia (AGA) remains the most common etiology of hair loss as it affects up to 50% of men and women over the age of 40 years. Despite its prevalence, the FDA has currently approved only three medical treatments for AGA, including topical minoxidil, oral finasteride, and most recently, low-level laser therapy (LLLT). Although supported by less robust studies, other evidenced-based, off-label treatments available in the United States include oral dutasteride, oral flutamide, oral spironolactone, oral minoxidil, topical ketoconazole, and topical latanoprost. This chapter subsequently discusses the mechanism of action, indication, efficacy, adverse events profile, dosing, administration, and other considerations for both FDA and non-FDA-approved medical treatments for AGA.

‘Omics’ Approaches for Studying the Microbiome in Alopecia Areata

Article

Full-text available

Sep 2020
J INVEST MED

Nowadays, the involvement of the microbiome in human health and many human diseases, including that strictly related to the scalphas been brought to the light. Indeed, more recently, authors highlighted the presence of a significant microbial shift both in nonscarring (Androgenetic alopecia and Alopecia areata) and scarring Alopecias. The advent of novel technologies together with the effort of many scientists in the microbiome field could provide in the nearest future a clearest framework about the strict relationship between human healthiness and symbiotic microorganism resident on different ecosystem of our body. In this view, the use of Omics approaches has to be considered as no longer negligible when studying the microbiome implication in human health and disease.

Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: A case report and review of the literature

Article

Full-text available

Oct 2019

Background: Alopecia areata is a hair loss disease associated with genetics, autoimmunity, and other factors. There is an intriguing link between alopecia areata and gut dysbiosis. Fecal microbiota transplantation (FMT) has been recommended to treat Clostridium difficile (previously known as Clostridioides difficile) infection, and has also shown potentials in the treatment of inflammatory bowel disease, irritable bowel syndrome, and non-alcohol fatty liver disease. Case summary: An 86-year-old man, with a history of sigmoid colon carcinoma, suffered from recurrent abdominal pain and distension, and diarrhea for six months, with inappetence. At admission, he was also diagnosed with depression. Upon physical examination, the patient presented with a 1.5 cm × 2.0 cm alopecia areata on his right occiput. Due to the negative results of laboratory testing, capsule endoscopy, and colonoscopy, the patient was diagnosed with noninfectious diarrhea, depressive disorder, and patchy alopecia areata. Considering that noninfectious diarrhea in the elderly patient was mainly caused by gut dysbiosis, he was given six rounds of FMT. His diarrhea improved remarkably one month after FMT, with improved appetite and disappearance of abdominal pain, distension, and depressive symptoms. Surprisingly, he reported new hair growth on the affected region of his scalp, with some of his white hair gradually turning to black, without taking any other therapies for alopecia areata before and after FMT. Conclusion: FMT might act as a potential therapy for patients who suffer from alopecia areata. Large and well-designed studies are required to confirm the role of FMT in alopecia areata.

Alopecia Areata: Clinical Treatment

Chapter

Jan 2020

Alopecia areata is a complex immune-mediated disease that targets anagen hair follicles. Therapeutic strategies must be directed as either immunosuppressive or immunomodulating and may consist of monotherapy or combination therapy and should be different depending on patient’s age, extent, and chronicity of the disease. The physician must discuss mild and aggressive options, as well as the possibility of no treatment, camouflage options, and social/psychological support. Topical, intralesional, and systemic steroids, as well as corticosteroid-sparing agents and disease-modifying antirheumatic drugs are useful as local or systemic immunosuppressors. Topical immunotherapy, anthralin, and phototherapy have proved useful as immunomodulators. Target therapy with JAK inhibitors is useful in alopecia areata totalis or universalis. Treatment in special areas such as eyelashes, eyebrows, or beard benefit from treatment with steroids, minoxidil, prostaglandin F2a analogs, and topical tofacitinib. Vitamin D3, ezetimibe/simvastatin, platelet-rich plasma, antihistamines, and aromatherapy may be used as adjuvant therapies. We discuss a practical but evidence-based approach for treatment in different cases of alopecia areata with detailed information about doses, administration, and possible side effects.

Role of Oral Supplements: When and How to Choose

Chapter

Jan 2020

People commonly inquire about vitamin and mineral supplementation and diet as a means to prevent or manage dermatological diseases and, in particular, hair loss. Answering these queries is frequently challenging, given the enormous and conflicting evidence that exists on this subject. There are several reasons to suspect a role for micronutrients in non-scarring alopecia. Micronutrients are major elements in the normal hair follicle cycle, playing a role in cellular turnover. The role of nutrition and diet in treating hair loss represents a dynamic and growing area of inquiry. This chapter summarizes the role of vitamins and minerals in non-scarring alopecia. Micronutrients such as vitamins and minerals play an important, but not entirely clear role in normal hair follicle development and immune cell function. Deficiency of such micronutrients may represent a modifiable risk factor associated with development, prevention, and treatment of alopecia.

Epidemiology of alopecia areata, ophiasis, totalis and universalis: A systematic review and meta-analysis

Article

Aug 2019
J AM ACAD DERMATOL

Background: Alopecia areata (AA) is a common autoimmune alopecia with heterogeneous severity and distribution. Previous studies found conflicting results about AA epidemiology. Objective: To determine the prevalence, incidence, and predictors of AA, alopecia totalis, alopecia ophiasis, and alopecia universalis. Methods: A systematic review of all published cohort and cross-sectional studies that analyzed AA and its subtypes. MEDLINE, Embase, LILACS, Scopus, Cochrane Library, and GREAT were searched. At least 2 reviewers performed study title/abstract review and data extraction. Random-effects meta-analysis was used because of significant heterogeneity (I2 = 99.97%). Results: Ninety-four studies met the inclusion criteria. The pooled prevalence (95% confidence interval, N) of AA overall was 2.11% (1.82-2.42, N = 302,157,365), with differences of population-based (0.75% [0.49-1.06%], N = 301,173,403) and clinic-based (3.47% [3.01-3.96], N = 983,962) studies. The prevalences of alopecia totalis, ophiasis, and universalis were 0.08% (0.04-0.13, N = 1,088,149), 0.02% (0.00-0.06, N = 1,075,203), and 0.03% (0.01-0.06, N = 1,085,444), respectively. AA prevalence (95% confidence interval) increased over time (<2000: 1.02% [0.85-1.22]; 2000-2009: 1.76% [1.51-2.03]; >2009: 3.22% [2.59-3.92]; P < .0001) and differed by region. AA prevalence was significantly lower in adults (1.47% [1.18-1.80]) than children (1.92% [1.31-2.65]; P < .0001). Conclusions: AA affects 2% of the global population. AA prevalence is lower in adults than children, is increasing over time, and significantly differs by region.

How to Prevent Nausea and Vomiting during Pregnancy

Article

Full-text available

May 2018

Judy Slome Cohain

To avoid nausea and vomiting during pregnancy, take 50 mg of high-quality vitamin B6 daily for six months before getting pregnant. In addition to avoiding vitamin B6 deficiency, taking this and other proactive steps toward improving health may contribute to a feeling of control over one's body and a sense of well-being. Vitamin B6 is a good present to give women who are considering having children and want to have nausea-free pregnancies.

Serum Vitamin D in patients with alopecia areata

Article

Full-text available

Sep 2016

Background: Alopecia areata (AA) is a common, recurrent, autoimmune hair disorder. It has been found that vitamin D deficiency is associated with many autoimmune diseases. Aims: The current study aimed to estimate serum levels of 25-hydroxy vitamin D in patients with AA. Materials and methods: This case-control study included 60 patients with AA and 60 age, gender, skin phototype, and body mass index-matched healthy subjects as a control group. Levels of serum 25-hydroxy vitamin D were estimated using ELISA technique. Results: Serum 25-hydroxy vitamin D levels were significantly lower in AA cases when compared with healthy controls (P < 0.001). The least values were significantly associated with alopecia totalis/universalis compared with patchy AA (P < 0.001) and ophiasis (P = 0.04). Severe AA showed significantly the lowest vitamin D levels compared with cases with mild (P = 0.002) and moderate disease (P = 0.03). A significant inverse correlation was found between 25-hydroxy vitamin D levels and age of the patients (r = -0.38; P = 0.03). There was no significant association between serum 25-hydroxy vitamin D levels and gender, disease duration, disease recurrence, nail affection, duration of sun exposure/day, or positive family history of AA. Conclusion: AA patients have lower levels of 25-hydroxy vitamin D than healthy subjects. More studies are required to assess the value of vitamin D supplementation in the treatment of that disease.

Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open‑labeled randomized controlled trial

Article

Full-text available

Apr 2016

Background and aims: Although Vitamin D deficiency has been linked to autoimmune thyroid disorders (AITD), the impact of Vitamin D supplementation on thyroid autoimmunity is not known. This study aimed to evaluate the impact of Vitamin D supplementation on thyroid autoimmunity (thyroid peroxidase antibody [TPO-Ab] titers) in patients with newly diagnosed AITD in a randomized controlled trial. Materials and methods: One hundred two patients with newly diagnosed AITD (TPO-Ab > 34 kIU/L and/or sonographic evidence of thyroiditis) patients were randomized into Group-1 (intervention group) and Group-2 (control group). Group-1 received cholecalciferol 60,000 IU weekly and calcium 500 mg/day for 8 weeks; Group-2 received calcium 500 mg/day for 8 weeks. Responders were defined as ≥25% fall in TPO-Ab titers. Individuals with at least 3-month follow-up were analyzed. Trial is registered at ctri.nic.in (CTRI/2015/04/005713). Results: Data from 100 AITD patients (68 with thyroid stimulating hormone [TSH] ≤10 mIU/L, 32 with TSH > 10 mIU/L), 93% having Vitamin D insufficiency, were analyzed. TPO-Ab titers were highest among patients in the lowest 25-hydroxyvitamin D quartile (P = 0.084). At 3 months follow-up, there was significant fall in TPO-Ab in Group-1 (-46.73%) as compared to Group-2 (-16.6%) (P = 0.028). Sixty-eight percentage patients in Group-1 were responders compared to 44% in Group-2 (P = 0.015). Kaplan-Meier analysis revealed significantly higher response rate in Group-1 (P = 0.012). Significantly greater reduction in TPO-Ab titers was observed in AITD with TSH ≤ 10 mIU/L compared to TSH > 10 mIU/L. Cox regression revealed Group-1 followed by TPO-Ab and free tetraiodothyronine levels to be a good predictor of response to therapy (P = 0.042, 0.069, and 0.074, respectively). Conclusion: Vitamin D supplementation in AITD may have a beneficial effect on autoimmunity as evidence by significant reductions in TPO-Ab titers.

Oxidative stress and alopecia areata

Article

Full-text available

Sep 2015

Alopecia areata (AA) is an inflammatory and autoimmune disease presenting with non-scarring hair loss. The aethiopathogenesis of alopecia areata is unclear and many factors including autoimmunity, genetic predisposition, emotional and environmental stress are thought to play important roles in its development. Antioxidant/ oxidant balance perturbation is a common feature in autoimmune, emotional and environmental stress. Therefore, our paper discusses the implications of oxidative stress in alopecia areata. Abbreviations: AA = alopecia areata, ROS = reactive oxygen species, H2O2 = hydrogen peroxide, TBARS = thiobarbituric acid rective substances, MDA = malondialdehyde, TBARS = thiobarbituric acid-reactive substances, SOD = superoxide dismutase, CAT = catalase, GSH-Px = glutathione peroxidase, PON1 = paraoxonase 1, HO-1 = hemoxigenase 1, TrxR = thioredoxin reductase, GSH = glutathione

Epidemiology and burden of alopecia areata: A systematic review

Article

Full-text available

Aug 2015

Alopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure. The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA. A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA's incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data. The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions. AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.

Evaluation of Serum Homocysteine, High-Sensitivity CRP, and RBC Folate in Patients with Alopecia Areata

Article

Full-text available

Nov 2014
Indian J Dermatol

Alopecia areata (AA) is a common type of hair loss with an autoimmune basis. As the role of homocysteine (Hcys), folate, and CRP has been considered in some autoimmune diseases. To evaluate homocysteine, folate and CRP level in AA. This study was performed on 29 patients who had AA for at least 6 months affecting more than 20% of scalp, and 32 healthy controls. Levels of serum Hcys, blood high-sensitivity CRP, and RBC folate were measured in all subjects. The mean level of RBC folate was significantly lower in the patient group than that in controls (P < 0.001). Also, the level of RBC folate was significantly lower in patients with extensive forms of disease (alopecia totalis/alopecia universalis) in comparison with more localized form (patchy hair loss) (P < 0.05). Patients with higher "Severity of Alopecia Total" (SALT) score had lower RBC folate, as well. Serum Hcys and blood high-sensitivity CRP levels did not show a significant difference in two groups. Patients with alopecia areata have lower level of RBC folate which is in negative correlation with both severity and extension of AA.

Comparison of Zn, Cu, and Fe Content in Hair and Serum in Alopecia Areata Patients with Normal Group

Article

Full-text available

Aug 2014

Background: Alopecia Areata (AA) is an autoimmune condition, in which hair is lost from some areas of the body. Though its etio-pathogenesis is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA, which may distort immune function in human populations. In this study, we tried to investigate the relationship between AA and iron, zinc, and copper levels of serum and hair. Materials and Methods: Sixteen female patients with AA (14 -40 years old) and 27 healthy female controls were enrolled in this study. Serum and hair level of iron, zinc, and copper were measured by flame emission spectroscopy. The resulting data was analyzed with SPSS15. Results: Mean age of patients and controls were 26.63 (±8.53) and 25.07 (±5.01) years, respectively, which was not statistically significant. We did not detect a significant difference in the serum and hair level of iron, zinc, and copper between patients and controls. There was a significant correlation between serum and hair level of iron (r = 0.504 P = 0.001) , zinc (r = 0.684 P = 0.0001),and copper (r = 0.759, P = 0.0001) in patients and controls. Discussion&Conclusion: Although low serum iron and zinc levels are considered to be associated with hair loss, according to this study, there was no statistically significant difference between trace elements among AA patients and controls. This study suggests that trace elements level in hair and serum may not be relevant to the immunologic dysfunction that exists in AA patients.

Analysis of Serum Zinc and Copper Concentrations in Hair Loss

Article

Full-text available

Nov 2013

It is well known that some trace elements such as zinc and copper play a significant role in many forms of hair loss. However, the effect of zinc and copper in the pathogenesis of hair loss is still unknown. The purpose of this study is to evaluate the zinc and copper status in each of four types of hair loss. A study was carried out with 30 health controls and 312 patients who were diagnosed with alopecia areata (AA), male pattern hair loss, female pattern hair loss and telogen effluvium (TE) (2008 to 2011; Hallym University Kangdong Sacred Heart Hospital). Zinc and copper serum concentrations were evaluated between controls and each of four types of hair loss patients. In all of the hair loss patients, the mean serum zinc was 84.33±22.88, significantly lower than the control group (97.94±21.05 µg/dl) (p=0.002), whereas the serum copper was 96.44±22.62, which was not significantly different (p=0.975). The analysis of each group showed that all groups of hair loss had statistically lower zinc concentration, but not copper concentrations. However, the ratio of the patients with serum zinc concentration lower than 70 µg/dl was significantly high in only the AA group (odds ratio, OR 4.02; confidence interval, CI 1.13 to 14.31) and the TE group (OR 1.12; CI 1.12 to 17.68). The data led to the hypothesis of zinc metabolism disturbances playing a key role in hair loss, especially AA and TE, whereas the effect of copper on hair growth and shedding cycles still needs more study.

Reduced level of 25-hydroxyvitamin D in chronic/relapsing Alopecia Areata

Article

Full-text available

Apr 2013

Current observations link vitamin D deficiency to many autoimmune diseases. There are limited data on vitamin D in Alopecia Areata, an autoimmune disease which in our experience shows seasonality in most of its remitting-relapsing forms. Our results demonstrate the presence of insufficiency of 25-hydroxyvitamin D (25OH-D) in many patients with various clinical forms, correlated with the expected increase of the values of Parathyroid Hormone (PTH). This could suggest the possible clinical use of vitamin D in the management of this frustrating disease.

Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes

Article

Full-text available

May 2013

OBJECTIVE To quantitatively assess the strength and shape of the association between blood 25-hydroxy vitamin D [25(OH)D] levels and incident risk of type 2 diabetes. RESEARCH DESIGN AND METHODS A systematic search of the MEDLINE and Embase databases and a hand search of references from original reports were conducted up to 31 October 2012. Prospective observational studies that assessed the association between blood levels of 25(OH)D and risk of incident type 2 diabetes were included for meta-analysis. DerSimonian and Laird’s random-effects model was used. A quadratic spline regression analysis was used to examine the shape of the association with a generalized least-squares trend test performed for the dose-response relation. RESULTS A total of 21 prospective studies involving 76,220 participants and 4,996 incident type 2 diabetes cases were included for meta-analysis. Comparing the highest to the lowest category of 25(OH)D levels, the summary relative risk for type 2 diabetes was 0.62 (95% CI 0.54–0.70). A spline regression model showed that higher 25(OH)D levels were monotonically associated with a lower diabetes risk. This inverse association did not differ by sex, duration of follow-up, study sample size, diabetes diagnostic criteria, or 25(OH)D assay method. A linear trend analysis showed that each 10 nmol/L increment in 25(OH)D levels was associated with a 4% lower risk of type 2 diabetes (95% CI 3–6; P for linear trend < 0.0001). CONCLUSIONS Our meta-analysis showed an inverse and significant association between circulating 25(OH)D levels and risk of type 2 diabetes across a broad range of blood 25(OH)D levels in diverse populations.

Endogenous Retinoids in the Pathogenesis of Alopecia Areata

Article

Full-text available

Sep 2012
J INVEST DERMATOL

Alopecia areata (AA) is an autoimmune disease that attacks anagen hair follicles. Gene array in graft-induced C3H/HeJ mice revealed that genes involved in retinoic acid (RA) synthesis were increased, whereas RA degradation genes were decreased in AA compared with sham controls. This was confirmed by immunohistochemistry in biopsies from patients with AA and both mouse and rat AA models. RA levels were also increased in C3H/HeJ mice with AA. C3H/HeJ mice were fed a purified diet containing one of the four levels of dietary vitamin A or an unpurified diet 2 weeks before grafting and disease progression followed. High vitamin A accelerated AA, whereas mice that were not fed vitamin A had more severe disease by the end of the study. More hair follicles were in anagen in mice fed high vitamin A. Both the number and localization of granzyme B-positive cells were altered by vitamin A. IFNγ was also the lowest and IL13 highest in mice fed high vitamin A. Other cytokines were reduced and chemokines increased as the disease progressed, but no additional effects of vitamin A were seen. Combined, these results suggest that vitamin A regulates both the hair cycle and immune response to alter the progression of AA.Journal of Investigative Dermatology advance online publication, 27 September 2012; doi:10.1038/jid.2012.344.

Successful Treatment of Alopecia Areata with Topical Calcipotriol

Article

Full-text available

Aug 2012
ANN DERMATOL

Alopecia areata (AA) is an inflammatory hair loss of unknown etiology. AA is chronic and relapsing, and no effective cure or preventive treatment has been established. Vitamin D was recently reported to be important in cutaneous immune modulation as well as calcium regulation and bone metabolism. It is well known that areata is common clinical finding in patients with vitamin D deficiency, vitamin D-resistant rickets, or vitamin D receptor (VDR) mutation. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of cytokine production. These effects might explain the efficacy of vitamin D3 derivatives for treating AA. In this study, we report a 7-year-old boy with reduced VDR expression in AA, recovery of whom was observed by topical application of calcipotriol, a strong vitamin D analog.

Can supplementation with Vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature

Article

Full-text available

Jul 2012

Objective: To evaluate whether vitamin D levels are related to the risk of developing autoimmune diseases and whether supplementation with vitamin D can modify the course of the diseases. Methods: We reviewed the most relevant papers published from January 1973 to October 2011, using Medline and EMBASE and the search terms "vitamin D"; "autoimmune disease"; "autoimmunity"; "rheumatoid arthritis"; "systemic lupus erythematosus"; "scleroderma"; "systemic sclerosis"; "type 1 diabetes"; "multiple sclerosis"; and "undifferentiated connective tissue disease". We selected studies on the environmental, genetic and epidemiologic association of vitamin D with autoimmune diseases. Using the strategy described, we identified 1268 articles. 331 articles were eliminated on the basis of the title and another 703 on the basis of the abstract, since they were considered irrelevant for the purposes of the study. Full-text examination was performed on the remaining 234 studies, and a further 15 studies were excluded from the review, since the results had been confirmed or superseded by more recent research. Finally, a systematic review was conducted on 219 articles concerning cross-sectional data on: vitamin D levels and autoimmune diseases; interventional data on vitamin D supplementation in autoimmune diseases; prospective data linking vitamin D level or intake to autoimmune disease risk. Results: Physiopathology studies confirm that hypovitaminosis D, in genetically predisposed subjects, can impair self tolerance by compromising the regulation of dendritic cells, of regulatory T-lymphocytes and of Th1 cells. Cross-sectional studies show that levels of vitamin D <30 ng/mL are present in a significant percentage, not only in patients with autoimmune disease, but also in healthy subjects (30-77%), and link profound deficiency (<10 ng/mL) with aggravation of symptomatology, while genetic studies associate polymorphism of vitamin D receptors to various autoimmune diseases. Among experimental studies on humans, only those on type-1 diabetes prove that the risks are significantly reduced in infants treated with vitamin D after the 7th month (OR 0.71, 95% CI, 0.60 to 0.84) and that a dose-response effect exists. Conclusions: Basic, genetic, and epidemiological studies indicate a potential role of vitamin D in the prevention of autoimmune diseases, but randomized and controlled trials are necessary to establish the clinical efficacy of vitamin D supplementation in ill or at-risk subjects.

The importance of adequate ferritin levels during cyproterone acetate and ethynyl oestradiol treatment for diffuse androgen dependant alopecia in women

Article

Full-text available

Apr 1992
CLIN ENDOCRINOL

object To evaluate the treatment with cyproterone acetate and ethinyl oestradlol of diffuse androgen-dependent alopecia in women design Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once dally from Day 5 to Day 15) and ethinyl oestradlol (EE2, 30 μg once dally from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 μg/I patients Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse and rogen-dependent alopecia, were enrolled into this study measurements Hair variables were assessed initially by the unit area trlchogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months results In the treated group, a significant (P > 0·01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 μ g/l. However, in the control group a significant (P > 0·05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established. conclusion Patients treated with the anti-apdrogen cyproterone acetate and ethinyl oestradlol respond best when serum ferritin is above 40 μg/I

Application of povdone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency

Article

Aug 2017

Background The aim of the present study was to investigate the effect of povidone-iodine (PVP-I) application at delivery on maternal urinary iodine concentration (UIC) and neonatal thyrotropin concentration. Methods In this cross-sectional study, urine samples were collected from each pregnant woman after admission to the hospital and before routine application of the PVP-I for delivery preparation and after delivery at time of screening for congenital hypothyroidism. A heel-prick blood sample was taken from all newborns. Results A total of 394 pregnant women at time of delivery participated in this study. Median (interquartile range [IQR]) maternal UIC values were 120 (105–157) and 253 (126–470) μg/L before and after delivery, respectively (p<0.001). No significant correlations were observed between maternal UIC before and after delivery and neonatal thyrotropin levels. Conclusions Application of PVP-I significantly increased UIC in postpartum mothers; however, thyrotropin concentration in neonates, whose mothers had adequate UIC, was within the normal range.

Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study: NARANG et al.

Article

Jan 2017
DERMATOL THER

Reports have highlighted serum vitamin D deficiency and reduced 1,25-dihydroxyvitamin D(3) receptors(VDR) expression on hair follicles of alopecia areata(AA) patients. Very few studies have demonstrated efficacy of topical calcipotriol (vitamin D analogue) in AA. We intended to study the efficacy of calcipotriol lotion 0.005% in AA and correlate its outcome with serum vitamin D levels. We conducted a prospective study, in which 22 patients with AA were treated with calcipotriol lotion 0.005% twice daily for 3 months. Clinico-epidemiological parameters including severity of AA and SALT score were calculated at baseline and at 12 weeks. Hair regrowth was assessed monthly at 4, 8, 12 weeks. Serum vitamin D levels were measured at baseline. After 12 weeks of treatment, hair regrowth was observed in 13 (59.1%) patients. Mean period for onset of disease stabilization and hair regrowth was 4 weeks and 4.21± 2.13 weeks, respectively. Among these 13 patients, SALT50 and SALT100 was observed in 6(46.2%) and 2(9%) patients, respectively. Response to treatment was better in patients with lower vitamin D levels (p < .009). Topical calcipotriol can be an alternative treatment in AA and it could prove to be more useful in patients who are vitamin D deficient.

Estimated serum vitamin D status, vitamin D intake, and risk of incident alopecia areata among US women

Article

Sep 2016

Studies have identified increased prevalence of vitamin D deficiency in patients with alopecia areata (AA), an autoimmune disease characterized by hair loss, but none have prospectively examined vitamin D status and incident AA. In 55,929 women in the Nurses’ Health Study (NHS), we prospectively evaluated the association between estimated vitamin D status, derived from a prediction model incorporating lifestyle determinants of serum vitamin D, and self-reported incident AA. We evaluated dietary, supplemental, and total vitamin D intake as additional exposures. Using Cox proportional hazards models, we calculated age-adjusted and multivariate hazard ratios (HR) to evaluate risk of AA. We identified 133 cases of AA over a follow-up of 12 years. The age-adjusted HR between top vs. bottom quartiles for serum vitamin D score was 0.94 (95 % CI 0.60–1.48) and the corresponding multivariate HR was 1.08 (95 % CI 0.68–1.73). There was no significant association between dietary, supplemental, or total vitamin D intake and incident AA. This study does not support a preventive role for vitamin D in the risk of developing AA.

Targeting Expression of the Human Vitamin D Receptor to the Keratinocytes of Vitamin D Receptor Null Mice Prevents Alopecia

Article

Dec 2001

Vitamin D receptor (VDR) null mice develop hypocalcemia, hyperparathyroidism, rickets, osteomalacia and alopecia. Normalization of mineral ion homeostasis prevents all of these abnormalities except alopecia. Hair reconstitution assays, performed in athymic nude mice, demonstrate that the lack of VDR in keratinocytes leads to a defect in anagen initiation, similar to that observed in VDR null mice. Although these studies demonstrate that expression of the VDR in keratinocytes is necessary, they do not prove that it is sufficient for maintenance of the normal hair cycle. To address this hypothesis, we generated transgenic mice expressing the human VDR under the control of the keratin 14 (K14) promoter. Two highly expressing transgenic lines were mated with VDR null mice to obtain VDR null mice expressing the human VDR transgene (hVDR+/mVDR−). Expression of the transgene in the VDR null mice prevented alopecia. Furthermore, when subjected to anagen initiation, the hair follicle keratinocytes of the hVDR+/mVDR− mice demonstrated an enhanced proliferative response compared to those of control littermates. Restoration of VDR expression in the keratinocytes of VDR null mice, prevents the hair cycle defect that leads to the development of alopecia.

Article

Jul 2016

Alopecia areata (AA) is a common skin disease that is frequently emotionally devastating. Several studies have examined the effect of AA on health-related quality of life (HRQoL). We performed a systematic review of all published studies of HRQoL in patients with AA. Eleven studies met inclusion criteria, incorporating data from 1986 patients. Patients with AA consistently demonstrate poor HRQoL scores, with greater extent of scalp involvement associated with lower HRQoL. HRQoL experienced by patients with AA is similar to that seen in patients with other chronic skin diseases including atopic dermatitis and psoriasis.

Assessment of vitamin D receptors in alopecia areata and androgenetic alopecia

Article

May 2016
J Cosmet Dermatol

Background: Alopecia areata (AA) is a frequent autoimmune disease, the pathogenesis of which is still unknown. Androgenetic alopecia (AGA) is a noncicatricial type of patterned hair loss. Expression of vitamin D receptors (VDRs) on keratinocytes is essential for maintenance of normal hair cycle, especially anagen initiation. Objective: To assess VDRs in the skin and blood of AA and AGA patients, in order to evaluate their possible role in these hair diseases. Methods: This study recruited 20 patients with AA, 20 patients with AGA, and 20 healthy controls. Blood samples and lesional scalp biopsies were taken from all participants for detection of VDR levels. Results: Serum and tissue VDR levels were lower in AA as well as AGA patients when compared to controls (P = 0.000). Serum and tissue VDR were positively correlated in each group. Tissue VDR was significantly lower in female patients with AA than males (P = 0.046) although serum and tissue VDR levels were significantly higher in female AGA patients than males (P = 0.004). Conclusion: This study suggests an important role for VDR in the pathogenesis of AA and AGA through documenting lower serum and tissue VDR levels in AA and AGA patients in comparison with controls.

Assessment of Zinc and Copper Contents in the Hair and Serum and Also Superoxide Dismutase, Glutathion Peroxidase and Malondi Aldehyde in Serum in Androgenetic Alopecia and Alopecia Areata

Article

Mar 2013

Alopecia areata (AA) is a recurrent nonscarring type of hair loss that can affect any hair-bearing area. Androgenetic alopecia (AGA) or male pattern hair loss is a very common condition that has a significant psychosocial impact for patients. There are claims that imbalance of trace elements may trigger the onset of alopecia. The aim of this research was to assess the level of zinc, copper contents in the hair and level of lipid peroxidation as super oxide dismutase, Glutathion peroxidase and malon di aldehyde in serum in androgenic and areata alpecia. The prospective study was conducted in department of Dermatology of Sina Hospital and Biochemistry department of Tabriz University of medical science. The study population consists of 27 patients with alopecia areata and 27 patients with androgenetic alopecia. 27 age and sex matched healthy control subjects were studied. The level of zinc, copper contents in the hair and serum and level of lipid peroxidation as super oxide dismutase (SOD), Glutathion peroxidase(GPX-Px) and malon di aldehyde (MDA) in serum in androgenetic, areata alpecia and healthy control subjects were measured in all samples. The collected data were statistically analyzed, using SPSS. The duration of hair loss varied between 1-240 month among patients with alopecia areata and 6-180 month among patients with androgenetic alopecia. The mean of hair zinc level in AA patients, AGA patients and controls were 98.33 μg/dl, 105.35 μg/dl and 129.52 μg/dl. The mean level of hair copper level in study and control groups were, 7.91, 7.25 and 10.34. The mean of serum level of SOD, MDA and GPX-Px in study and control groups were (1945.25, 1861.57 and 2296.77), (3.64, 3.49 and 1.62) and (129.11, 118.84 and 138.74). Zinc and copper contents of hair and serum were significantly lower among patients with alopecia areata and androgenetic alopecia compared to controls (P<0.05). The serum level of SOD, GPX-Px were significantly lower and level of MDA were higher among patients with alopecia areata and androgenetic alopecia compared to controls (P<0.05). These results suggest that low levels of zinc and copper of hair and serum and lipid peroxidation and alterations in the oxidantantioxidant enzymatic system (SOD, GPX-Px) with high level of MDA at serum may play a role in the pathogenesis of AA and AGA.

Sunlight and Vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease

Article

Jan 2004

Michael F Holick

Vitamin D receptor mutations and hereditary 1,25-dihydroxyvitamin D resistant rickets

Article

Jan 1991

Evaluation of serum zinc level in patients with newly diagnosed and resistant alopecia areata

Article

Jul 2015

Alopecia areata (AA) is a non-scarring, autoimmune, inflammatory hair loss disease. Zinc is a trace element involved in important functional activities of hair follicles. To evaluate serum zinc levels in patients with newly diagnosed and resistant lesions of AA in comparison to age- and sex-matched healthy controls. The present study included 100 subjects: 50 patients with AA divided into two equally distributed subgroups (25 patients with recent onset AA [subgroup 1] and 25 patients with resistant AA [subgroup 2]) and 50 age- and sex-matched healthy controls. Serum zinc levels were assessed in all subjects. Comparison of mean serum zinc levels was done between all patients and controls, between patients' subgroups as well as between patient's subgroup and controls. Correlations between serum zinc level and extent of AA and its duration were also done in all patients and each patient's subgroup. A significantly lower serum zinc level was found in patients with AA compared with controls and was significantly lower in patients with resistant AA compared to patients with newly diagnosed AA. Significant inverse correlations existed between serum zinc level, severity of AA, and disease duration in all patients as well as in patients with resistant AA. Lower serum zinc level existed in patients with AA and correlated inversely with disease duration, severity of AA, and its resistance to therapies. Therefore, assessment of serum zinc level in patients with AA appears useful as a marker of severity, disease duration, and resistance to therapies. Accordingly, zinc supplements may provide a therapeutic benefit. © 2015 The International Society of Dermatology.

Topical Calcipotriol Therapy for Mild-to-Moderate Alopecia Areata: A Retrospective Study

Article

Jun 2015

Alopecia areata (AA) is considered a T-cell mediated autoimmune disease characterized by patchy loss of hair from scalp and other body parts with no definitive treatment. Calcipotriol is a vitamin D analogue and a potent immunomodulatuary molecule. In recent studies, low serum vitamin D levels have been observed in patients with AA and various autoimmune diseases. Previous reports have also described the effects of vitamin D on hair follicles. OBJECTIVE : The aim of the study was to evaluate the efficacy and safety of topical calcipotriol for the treatment of mild-to-moderate patchy AA. METHOD: Forty-eight patients with mild-to-moderate AA were enrolled in the retrospective, 12-week trial. Calcipotriol cream was applied to the affected areas twice a day. Severity of Alopecia Tool (SALT) score and hair regrowth rate were calculated at baseline and at 3, 6, 9, and 12 weeks. RESULTS: At week 12, the total response was achieved in 69.2% of patients. When the mean SALT score of patients at week 12 was compared to that of patients at baseline, the value at week 12 was significantly lower ( P = 0.001). A regrowth score (RGS) ≥ 3 (hair regrowth of ≥ 50%) was observed in 75% of patients, whereas a RGS ≥ 4 (hair regrowth of ≥ 75%) was observed in 62.5% of patients and the complete regrowth rate (hair regrowth= 100%) was 27.1%. CONCLUSION: Calcipotriol may serve as a safe and effective treatment option in mild-to-moderate patchy AA, and calls for more extensive controlled studies with this treatment. J Drugs Dermatol . 2015;14(6):616-620.

Autoimmune Mechanisms in Pernicious Anaemia & Thyroid Disease

Article

Apr 2015

Pernicious anaemia (PA) and some types of thyroid disease result from autoimmune processes. The autoimmune mechanisms in these conditions have not been fully elucidated. This review discusses the autoimmune mechanisms involved in PA and how these affect diagnosis and disease progression. In addition to gastric antibodies, antibodies to the vitamin B12 binding protein transcobalamin which can result in high serum B12 levels are also addressed with regards to how they affect clinical practice. The role of autoimmune susceptibility is investigated by comparing PA to one of its most common comorbidities, autoimmune thyroid disease (AITD). Thyroid disease (although not exclusively AITD) and B12 deficiency are both also implicated in the pathology of hyperhomocysteinemia, an elevated homocysteine in plasma. Since hyperhomocysteinemia is a risk factor for cardiovascular occlusive disease, this review also address how thyroid disease in particular leads to changes in homocysteine levels. Copyright © 2015. Published by Elsevier B.V.

Combination therapy with zinc gluconate and PUVA for alopecia areata totalis: An adjunctive but crucial role of zinc supplementation

Article

Mar 2015
DERMATOL THER

Christine Lux-Battistelli

Spontaneous remission occurs in less than 10% of patients suffering from alopecia areata (AA) totalis for more than 2 years. The efficacy of PUVA therapy is controversial due to recurrence of hair loss after cessation. We report two cases presenting with AA totalis and AA universalis. After hair regrowth, relapse of hair loss occurred upon cessation of PUVA and zinc gluconate combination therapy. However, hair regrowth was noted upon the reintroduction of zinc gluconate and sulfur amino acids without PUVA in the first case and with episodic PUVA in the second case. The chronology of events appears to support the notion that zinc has a significant effect. Our findings suggest the possibility of a subgroup of zinc-responsive patients, but the identification of these patients remains difficult. Metallothioneins and zinc transporters regulating the entrance and exit of zinc in cells might play a key role. Combination therapy with immunomodulators may be administered to facilitate enhanced zinc-targeted action. Taking into account the safety profile of zinc, 30-40 mg/day of zinc metal may be used during at least 1 year, although we recommend to monitor its serum and hair levels. Studies with a larger number of patients are required to further investigate the therapeutic effect of zinc. © 2015 Wiley Periodicals, Inc.

Vitamin D Concentrations are Decreased in Patients with Alopecia Areata

Article

Jan 2012

Vitamin D has been of increased interest in the role of maintaining immune system balance. Alopecia Areata (AA) is a T-cell mediated autoimmune disease which causes anagen-stage hair follicles. Low concentration of vitamin D may be a risk factor for AA. We aimed to determine vitamin D concentrations in patients with AA. 25-hydroxyvitamin D (25(OH)-D) concentrations and 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) were determined from sera collected from patients with AA (n=42) and healthy controls (n=42). 25(OH)-D and 1,25(OH)2D3 concentrations were measured by ELISA method. The concentrations of both 25(OH)-D and 1,25(OH)2D3 were found to be significantly lower in patients with AA than control group (p<0.001 for each analysis). The results show that there is a significant difference between AA patients and normal subjects in terms of serum vitamin D concentrations. Therefore, it is suggested that vitamin D deficiency may have a role in the setting of AA.

Diet in dermatology : Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer

Article

Nov 2014
J AM ACAD DERMATOL

Patients commonly inquire about dietary modifications as a means to prevent or manage skin disease. Answering these questions is often challenging, given the vast and conflicting evidence that exists on this topic. This 2-part continuing medical education article summarizes the evidence to date to enable physicians to answer patients' questions in an evidence-based manner. Part I includes atopic dermatitis, acne, and nonmelanoma skin cancer. The role of dietary supplementation, dietary exclusion, food allergy, maternal diet, and breastfeeding in the development and/or prevention of atopic dermatitis is summarized. The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications. Finally, evidence and recommendations for restriction or supplementation of dietary factors in the prevention of nonmelanoma skin cancer, including fat, vitamins A, C, D, and E, and selenium, are reported. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Diet in dermatology : Part II. Melanoma, chronic urticaria, and psoriasis

Article

Nov 2014
J AM ACAD DERMATOL

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Dietary vitamin A regulates wingless-related MMTV integration site signaling to alter the hair cycle

Article

Oct 2014

Alopecia areata (AA) is an autoimmune hair loss disease caused by a cell-mediated immune attack of the lower portion of the cycling hair follicle. Feeding mice 3-7 times the recommended level of dietary vitamin A accelerated the progression of AA in the graft-induced C3H/HeJ mouse model of AA. In this study, we also found that dietary vitamin A, in a dose dependent manner, activated the hair follicle stem cells (SCs) to induce the development and growth phase of the hair cycle (anagen), which may have made the hair follicle more susceptible to autoimmune attack. Our purpose here is to determine the mechanism by which dietary vitamin A regulates the hair cycle. We found that vitamin A in a dose-dependent manner increased nuclear localized beta-catenin (CTNNB1; a marker of canonical wingless-type Mouse Mammary Tumor Virus integration site family (WNT) signaling) and levels of WNT7A within the hair follicle bulge in these C3H/HeJ mice. These findings suggest that feeding mice high levels of dietary vitamin A increases WNT signaling to activate hair follicle SCs.

The Autoimmune Basis of Alopecia Areata: A Comprehensive Review

Article

Oct 2014
AUTOIMMUN REV

Naseeha Islam

The Role of Micronutrients in Alopecia Areata: A Review

Abstract

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