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

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.

Cure of alopecia areata after eradication of Helicobacter pylori:A new association?

Alopecia areata is a disease of the hair follicles, with strong evidence supporting autoimmune etiology. Alopecia areata is frequently associated with immune-medi- ated diseases with skin manifestations such as psoriasis and lichen planus, or without skin manifestations such as autoimmune thyroiditis and idiopathic thrombocytopenic purpura. Helicobacter py/ori （H. pylorl） infection is present in around 50% of the world＇s population and has been associated with a variety of immune-mediated extra-digestive disorders including autoimmune thyroid- itis, idiopathic thrombocytopenic purpura, and psoriasis. A case of a 43-year old man with an 8-too history of alopecia areata of the scalp and beard is presented. The patient was being treated by a dermatologist and had psychiatric support, without any improvement. He had a history of dyspepsia and the urea breath test confirmed H. pylori infection. The patient went into remission from alopecia areata after H. pylori eradication. If such an association is confirmed by epidemiological studies designed for this purpose, new therapeutic options could be available for these patients, especially in areas where infection with H, pylori is highly prevalent.

Breeding and preliminarily phenotyping of a congenic mouse model with alopecia areata

In the current study, the alopecia areata gene was introduced into the C57BL/6 （B6） mouse through repeated backcrossing/intercrossing, and the allelic homozygosity of congenic AAtJmice （named B6.KM-AA） was verified using microsatellites. The gross appearance, growth characteristics, pathological changes in skin, and major organs of B6.KM-AA mice were observed. Counts and proportions of CD4＋ and CD8＋ T lymphocytes in peripheral blood were determined by flow cytometry. Results show that congenic B6.KM-AA mice were obtained after 10 generations of backcrossing/intercrossing. B6.KM-AA mice grew slower than B6 control mice and AA skin lesions were developed by four weeks of age. The number of hair follicles was reduced, but hair structures were normal. Loss of hair during disease progression was associated with CD4＋ and CD8＋ T lymphocytes infiltration peri- and intrahair follicles. No pathological changes were found in other organs except for the skin. In the peripheral blood of B6.KM-AA mice, the percentage of CD4＋ T cells was lower and percentage of CD8＋ T cells higher than in control mice. These findings indicate that B6.KM-AA mice are characterized by a dysfunctional immune system, retarded development and T-cell infiltration mediated hair loss, making them a promising new animal model for human alopecia areata.

TREATMENT OF 42 CASES OF ALOPECIA AREATA WITH PLUM-BLOSSOM NEEDLE

In the present study, 42 cases of alopecia areata were treated by tapping the locus with plum-blossom needle and rubbing the local skin with fresh ginger. After 1 - 3 courses of treatment, 41 cases were cured, with the cure rate being 97. 62%.

Professor Yanping Bai’s experience in treating alopecia areata

To summarize and analyze Professor Bai Yanping’s clinical experience in treating alopecia areata.Prof.Bai thinks the etiology of alopecia areata is a combination of liver-kidney depletion,qi and blood deficiency,qi stagnation and blood stasis,always along with wind-heat,damp-heat,blood heat and insomnia.It is indispensable to enrich and nourish the liver and kidney,supplement and nourish the qi and blood,invigorate blood and dissolve stasis,and at the same time,the usage of messenger drug and plum-blossom needle is important and formula has to vary from person to person on the basis of commonality.

Targetoid Polycyclic Concentric Hair Regrowth Pattern Is a Sign of Immunological Recovery in Alopecia Areata

Background: Alopecia areata is a common autoimmune disease, where there are many topical and systemic therapies, during which hair growth appears in a uniform pattern. In certain cases, hair regrowth takes a polycyclic pattern simulating a target, so called targetoid phenomena. Objective: To screen all cases of treated alopecia areata for hair targetoid regrowth pattern. ?Methods: This is an observational study, was conducted in Dermatology Department of Baghdad Teaching Hospital in Iraq, during the period, August 2017 to October 2017. All cases treated for alopecia areata with IM triamcinolone 20 - 40 mg injection every 2 weeks with topical clobetasone ointment and zinc sulfate 2 mg/kg/day for 2 months, were examined for the targetoid concentric hair regrowth pattern. Result: Among all cases of alopecia areata, seven patients were recorded to have the targetoid concentric hair pattern, which seen 2 - 4 weeks after therapy, their ages ranged from 4 to 25 years old with a mean 14.5, all of them were males. All these patients returned back with hair growth in a form of rings of hair growth alternating with rings of little or no hair growth forming a typical picture of target. Conclusion: Targetoid polycyclic concentric hair regrowth pattern is an important phenomenon seen in patients receiving treatment for alopecia areata, which is a good sign of recovery where its etiopathogenesis could not well be elucidated but alternating immunological reactions could explain this targetoid pattern.

Presence of Alternaria in Scalp of Patients with Alopecia Areata： Triggering Factor or Coexistence？

AA （Alopecia areata） is the most frequent cause of inflammation-induced hair loss, affecting 0.1 to 0.2% of population worldwide. The development of organ-specific autoimmune reactions directed against anagen hair follicles seems to play a key role in the pathogenesis of alopecia areata. However, the triggering antigen（s） responsible for inducing autoimmune phenomena in these individuals remain unknown. Viral, bacterial or fungal pathogens have been implied as possible triggering factors of autoimmune reactions. The present study aims to identify the role of dematiaceous fungi in the pathogenesis of alopecia areata. 30 patients diagnosed clinically as alopecia areata and 30 normal age matched persons have undergone mycological examination. Mycology examination of the epidermal scrapings was done by DME （direct microscopic examination）, culture on SDA （sabouraud＇s dextrose agar） and imaging. There is significantly higher percentage of positive results for Alternaria species by culture on sabouraud＇s agar in patients group （20%） compared to controls （13.3%） P-value 〈 0.05. The possible role of Alternaria antigens （e.g. antigens involved in melanin synthesis） in triggering autoimmunity in alopecia areata still needs further research on a wider scale of cases.

HLA antigens in individuals with down syndrome and alopecia areata

AIM: To describe human leukocyte antigen(HLA) alleles in individuals with Down syndrome and alopecia areata. METHODS: A cross-sectional study was conducted, which evaluated 109 individuals. Ten with down syndrome(DS) and alopecia areata(AA), ten with DS without AA and ten with AA without DS, and their fami-lies. The individuals were matched by gender and age. The following data were computed: gender, age, ethnic group, karyotype, clinical presentation and family history of alopecia areata. Descriptive analysis: measures of central tendency and frequency distribution. Inferential analysis: Fisher's exact test to compare categorical data between the three groups and Kruskal-Wallis ANOVA test for numerical data.RESULTS: Seventy per cent of evaluated individuals in the DS and AA group were male; presented mean age of 18.6(SD ± 7.2) years and 70% were Caucasian. We observed involvement of the scalp, with a single lesion in 10% and multiple in 90% of subjects. It was observed that there is no significant difference in the frequency distributions of the alleles HLA loci A, B, C, DRB1 and DQB1 of subjects studied. However, according to Fisher's exact test, there is a trend(P = 0.089) of DS group to present higher proportions of HLA-A 36 and HLA-B 15 than the AA group and AA and DS group.CONCLUSION: There was a tendency for the DS group, to present proportion of HLA-A 36 and HLA-B 15 higher than the AA group and group of individuals with AA and DS. However, there was no significant difference in the frequency distribution of the alleles.

Clinical Research Progress of Fire Needle Acupuncture in the Treatment of Alopecia Areata

Alopecia areata is a common disease in dermatology.It is a localized non-inflammatory alopecia that occurs in the head.Its etiology is unclear,but it is thought to be related to a number of factors.At present,there are many methods of treatment with different curative effects.Fire needle acupuncture directly acts on skin lesions,dredges meridians,and regulates Qi and blood.It has a good curative effect.This paper reviews current research progress of fire acupuncture in the treatment of alopecia areata,in order to provide some diagnostic and treatment suggestions for the management of alopecia areata.

Construction of regulatory network for alopecia areata progression and identification of immune monitoring genes based on multiple machine-learning algorithms

Objectives Alopecia areata(AA)is an autoimmune-related non-cicatricial alopecia,with complete alopecia(AT)or generalized alopecia(AU)as severe forms of AA.However,there are limitations in early identification of AA,and intervention of AA patients who may progress to severe AA will help to improve the incidence rate and prognosis of severe AA.Methods We obtained two AA-related datasets from the gene expression omnibus database,identified the differentially expressed genes(DEGs),and identified the module genes most related to severe AA through weighted gene co-expression network analysis.Functional enrichment analysis,construction of a protein–protein interaction network and competing endogenous RNA network,and immune cell infiltration analysis were performed to clarify the underlying biological mechanisms of severe AA.Subsequently,pivotal immune monitoring genes(IMGs)were screened through multiple machine-learning algorithms,and the diagnostic effectiveness of the pivotal IMGs was validated by receiver operating characteristic.Results A total of 150 severe AA-related DEGs were identified;the upregulated DEGs were mainly enriched in immune response,while the downregulated DEGs were mainly enriched in pathways related to hair cycle and skin development.Four IMGs(LGR5,SHISA2,HOXC13,and S100A3)with good diagnostic efficiency were obtained.As an important gene of hair follicle stem cells stemness,we verified in vivo that LGR5 downregulation may be an important link leading to severe AA.Conclusion Our findings provide a comprehensive understanding of the pathogenesis and underlying biological processes in patients with AA,and identification of four potential IMGs,which is helpful for the early diagnosis of severe AA.

重度斑秃的长期管理

斑秃是一种常见的非瘢痕性脱发,轻症有自愈倾向,而重度斑秃病程长、易复发,且与多种合并症相关,使得重度斑秃的治疗面临诸多挑战,给病人身心造成巨大负担。本文就斑秃治疗方案及病人的长期管理策略展开探讨,以期提高患者生活质量。

维生素D衍生物卡泊三醇对小鼠斑秃治疗有效性及相关炎症因子的影响

目的 研究维生素D衍生物卡泊三醇对小鼠斑秃的缓解情况及对相关炎症因子的影响。方法 构建小鼠斑秃模型,将维生素D衍生物卡泊三醇均匀涂抹在小鼠斑秃区域后,观察小鼠斑秃缓解情况;同时,通过免疫荧光染色技术检测斑秃区域皮肤组织CD4^(+)、CD8^(+) T细胞和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等细胞因子情况。结果 卡泊三醇处理后小鼠斑秃完全消失,治疗有效率达100%;小鼠毛囊细胞周围与炎症反应相关的CD4^(+)和CD8^(+)T细胞数量降低,TNF-α、IL-6等炎症细胞因子分泌水平下降(P<0.05)。结论 卡泊三醇可通过抑制小鼠毛囊细胞周围与炎症反应相关的CD4^(+)和CD8^(+)T细胞数量以及TNF-α、IL-6等炎症细胞因子分泌而改善小鼠斑秃。

可溶性肿瘤坏死因子样凋亡弱诱导因子在斑秃病人血清及皮损中的表达及临床意义

目的检测可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)在斑秃病人血清及皮损中的表达水平,并探讨其在斑秃发病过程中的作用及临床意义。方法以2017年10月至2018年11月在首都医科大学附属北京友谊医院确诊并治疗的斑秃病人70例为斑秃组,依据病情分为轻症组(44例)、重症组(26例)。同期该院因色素痣或皮肤良性肿瘤进行头皮手术的人群65例作为对照组。比较各组sTWEAK及相关细胞因子白细胞介素(IL)-4、IL-12、γ干扰素(IFN-γ)蛋白及mRNA表达水平;采用Pearson法分析两指标间相关性。多元线性回归分析各指标与sTWEAK或脱发严重度工具(SALT)评分的关系。结果斑秃组血清及皮损中sTWEAK表达水平[(196.73±32.48)ng/L,(2.35±0.62)ng/L]高于对照组[(121.75±19.62)ng/L,(1.49±0.45)ng/L](P<0.05)。斑秃组血清及皮损中细胞因子IL-12、IFN-γ表达水平高于对照组(P<0.05),IL-4表达水平比较差异无统计学意义(P>0.05)。斑秃病人血清及皮损中sTWEAK表达水平与IL-12及IFN-γ呈正相关,与IL-4表达水平无明显相关性。轻症组血清及皮损中sTWEAK[(173.25±26.84)ng/L,(2.04±0.57)ng/L]、IL-12及IFN-γ表达水平低于重症组[(236.47±42.02)ng/L,(2.87±0.70)ng/L](P<0.05);轻症组、重症组血清及皮损中IL-4表达水平差异无统计学意义(P>0.05);斑秃病人血清、皮损处sTWEAK、IL-12、IFN-γ与SALT评分均呈正相关(P<0.05)。多元线性回归分析显示,IL-12、IFN-γ与血清和皮损处sTWEAK呈显著正相关;血清及皮损处sTWEAK、IL-12、IFN-γ与SALT评分存在正相关性(P<0.05)。结论斑秃病人血清及皮损中sTWEAK表达水平增加,与IL-12及IFN-γ呈正相关,sTWEAK、IL-12及IFN-γ均与斑秃病情严重程度密切相关,sTWEAK可能参与斑秃炎症反应过程。

非剥脱点阵激光联合侧柏叶酊对斑秃小鼠IL-7/IL-7Rα信号通路和Tregs细胞亚群的影响

目的:研究1565 nm非剥脱点阵激光联合侧柏叶酊(Platycladus orientalis tincture,POT)对斑秃(Alopecia areata,AA)小鼠治疗作用以及对白细胞介素7(Interleukin 7,IL-7)/白细胞介素7受体α(Interleukin-7 receptorα,IL-7Rα)信号通路和调节性T细胞(Regulatory T cells,Tregs)亚群的影响。方法:将50只成年雄性C3H/HeJ小鼠随机分为对照组(C组),模型组[M组,环磷酰胺(Cyclophosphamide,CTX)诱导AA模型],M+1565 nm组(1565 nm非剥脱点阵激光治疗AA),M+POT组(POT治疗AA)、M+1565 nm+POT组(1565 nm非剥脱点阵激光联合POT治疗AA),每组10只。流式细胞术检测C组和M组皮损组织中Tregs细胞亚群的比例和所有组血液中单个核细胞中Tregs细胞亚群的比例。Western blot法检测各组小鼠皮损组织中IL-7和IL-7Rα的表达。结果:与C组比,M组皮肤组织IL-7和IL-7Rα的表达均明显增加,而且Tregs细胞比例明显减少(P<0.05)。与M组比,M+1565 nm组和M+POT组IL-7的表达均降低(P<0.05)。与M组比,M+1565 nm+POT组IL-7和IL-7Rα的表达均降低,且Tregs细胞比例都显著增加(P<0.05)。结论:1565 nm非剥脱点阵激光联合POT治疗可以抑制斑秃小鼠IL-7/IL-7Rα信号并减少Tregs细胞的比例。

超脉冲点阵CO_(2)激光联合5%米诺地尔酊治疗斑秃疗效分析

目的:研究超脉冲点阵CO_(2)激光联合5%米诺地尔酊治疗斑秃对患者外观美观度及毛发镜检查结果的影响。方法:选取2021年1月-2023年1月延安市人民医院收治的斑秃患者110例分为外用5%米诺地尔治疗的对照组(55例)和联合10600 nm超脉冲点阵CO_(2)激光治疗的观察组(55例),分组方法为随机抽签法,均治疗6周,后随访6个月。统计两组治疗6周后的临床疗效、随访期间复发情况及治疗期间不良反应发生情况,比较两组斑秃改善情况、外观美观度及治疗前和治疗6周后免疫、炎症指标、毛发镜检查、心理状态、脱发严重程度、生活质量。结果:治疗6周后,观察组总有效率为96.36%,高于对照组81.82%(P<0.05);随访期间,观察组复发率为9.09%,低于对照组23.64%(P<0.05)。观察组毳毛长出时间、毳毛变黑时间短于对照组,治疗6周后新发生长面积、美观度评分高于对照组(P<0.05)。两组治疗6周后外周血CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)、毛发密度、毛囊密度与治疗前比较,升高,观察组高于对照组(P<0.05);外周血CD8^(+)、血清肿瘤坏死因子α(TNF-α)水平、毳毛率及焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)评分、脱发严重程度评分工具(Severity of alopecia tool,SALT)、皮肤病生活质量指数(Dermatology life quality index,DLQI)评分与治疗前比较,降低,观察组低于对照组(P<0.05)。治疗期间,观察组总不良反应发生率为14.55%,对照组总不良反应发生率为9.09%,组间比较差异无统计学意义(P>0.05)。结论:超脉冲点阵CO_(2)激光联合5%米诺地尔酊可有效改善斑秃,提高患者生活质量,且复发风险低,安全性良好。

Janus激酶抑制剂治疗斑秃新进展

斑秃是一种慢性、免疫性、炎症性疾病,确切病因未明。重度斑秃难以治疗,严重影响患者生活质量。近年来,越来越多证据表明Janus激酶(JAK)抑制剂具有治疗斑秃的潜力,许多病例报道及大型病例系列研究证实JAK抑制剂治疗斑秃的疗效。2022年6月美国食品药品监督管理局(FDA)批准了巴瑞托尼用于治疗成人重度斑秃。JAK抑制剂通过JAK-信号传导及转录激活因子(STAT)通路阻断细胞因子的细胞内传递,从而抑制多种促炎细胞因子,还可能直接作用于毛囊上皮细胞,促进毛囊周期进入生长期。对于重症、激素治疗无效以及合并其他免疫性疾病的斑秃患者是一个新的选择。该文主要阐述JAK抑制剂的作用机制和口服及外用JAK抑制剂治疗成人以及儿童斑秃的现状。

乌帕替尼治疗重度斑秃12例短期疗效观察

目的 观察乌帕替尼治疗重度斑秃的短期临床疗效及安全性。方法 纳入2023年3月—2024年3月河南科技大学第一附属医院皮肤科门诊12例重度斑秃患者,给予口服乌帕替尼缓释片治疗,12周后观察临床疗效和不良反应情况。结果 治疗12周后,脱发严重程度评估工具评分(SALT)≤20分的患者达到10例(83.33%);毛发平均密度由(29.42±3.23)根/0.46 cm^(2)增加至(35.50±2.87)根/0.46 cm^(2),差异有统计学意义(t=27.62,P<0.001);毛发平均直径由(39.58±2.35)μm增加至(67.75±6.43)μm,差异有统计学意义(t=14.26,P<0.001)。所有患者均未发生严重不良反应。结论 乌帕替尼治疗重度斑秃疗效显著,安全性好,可作为重度斑秃患者新的治疗选择。

Research progress of acupuncture for treatment of alopecia areata in recent ten years

As life pace becomes faster and working pressure gets bigger, incidence of alopecia areata （AA） also increases. The susceptible population presents a trend of getting younger and more diversified. Medical workers in clinic and scientific researchers home and aboard conduct plenty of clinical practices and experimental researches, thus it brings about a lot of new methods, techniques, and theories for treatment of AA. But the effect varies a lot. Therefore, the review summarizes diverse methods and techniques domestic in recent ten years in order to enhance the clinical effect on treatment of AA with acupuncture.

PRP在脱发类疾病中的应用研究进展

富血小板血浆(platelet-rich plasma,PRP)作为第一代自体血制取的生长因子,不断有研究者将PRP应用于脱发类疾病的治疗,成为治疗脱发的有效辅助治疗方法。本文对近年来PRP在治疗脱发类疾病中的作用机制及临床应用进展进行综述。

三种特应性疾病与斑秃发生风险的因果关系:两样本孟德尔随机化研究

目的:应用两样本孟德尔随机化分析哮喘、特应性皮炎、过敏性鼻炎与斑秃发生风险之间的因果关系。方法:根据全基因组关联研究的汇总数据集,提取与哮喘、特应性皮炎和过敏性鼻炎显著相关的单核苷酸多态性(single nucleotide polymorphism,SNP)作为工具变量,使用逆方差加权法、MR-Egger回归、加权中位数、简单模型和加权模型评估三种特应性疾病与斑秃之间的因果关联。结果:选取64个、61个、3个分别与哮喘、特应性皮炎、过敏性鼻炎相关的SNP作为工具变量,逆方差加权法证明哮喘、特应性皮炎是斑秃发生的危险因素(OR:1.45;95%CI:1.67~1.97;OR:1.79;95%CI:1.28~2.51);加权中位数和加权模型方法进一步支持因果关联的显著性。结论:哮喘、特应性皮炎与斑秃发病风险之间存在显著的正向因果关系。