Alopecia areata (AA) is a polygenic and multifactorial autoimmune disease that results in non-scarring hair loss. Both local and systemic environmental factors can trigger the disease.
As Prof. Rodney Sinclair (University of Melbourne, Australia) pointed out, AA is a multifactorial disease with a known genetic background and unknown environmental triggers . Both innate and acquired immunity are involved in the pathogenesis of AA. In a genome-wide association study, 139 single nucleotide polymorphisms could be identified that are significantly associated with AA . Unknown environmental triggers can be divided into local and systemic factors. Local factors are a loss of hair follicle immune privilege causing inflammatory cells to swarm and attack the hair bulb in what is known as the “swarm of bees”. Both intrafollicular CD8 cells and multiple cytokines and chemokines are involved in this process. Systemic factors that might trigger AA are increased serum IFN-γ and serum autoantibodies.
Regrowth within 12 months in most cases of AA
According to textbooks, in 50% of patients, hair will regrow spontaneously within 6 months. In 70% of cases, recovery will occur within 12 months. “But what we notice is that the 30% of patients who have persistent AA over 12 months come back to us,” Prof. Sinclair said, signalling an unmet need. According to an Australian expert consensus statement, patients with a solitary stable patch of AA <12 months have only a 13% risk of developing chronic AA. However, 30.6% of patients with chronic AA will progress to alopecia totalis if not on treatment . As Prof. Sinclair pointed out, the question is whether therapy can alter the risk of progression in chronic AA. This seems to be the case with systemic corticosteroids. “Systemic steroids are the treatment most commonly used, but 50% will relapse if the dose is reduced or stopped,” Prof. Sinclair concluded.
- Sinclair R. Alopecia areata. Real World Data. FS4, SPIN 2022 Congress, 06–08 July, Paris, France.
- Petukhova L, et al. Nature. 2010;466:113-7.
- Cranwell WC, et al. Australas J Dermatol. 2019:60:163-70.
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Table of Contents: SPIN 2022
Letter from the Editor
SPIN 2022 Highlights Podcast
IMIDs in Adults and Children: New Developments
Therapies for atopic dermatitis: still moving forward
Children with AD: high risk of bacterial infections in carriers of a filaggrin gene variant
Men on biologics report fewer adverse events than women
Conceptual framework of adverse drug reactions may improve treatment of patients with IMIDs
Psoriasis: The Beat Goes On
Systemic treatment for psoriasis: what is on the horizon?
Topical therapy in psoriasis: an important partner in combination therapy
GPP flares: pronounced undertreatment is common
IL-17A/F inhibitor bimekizumab shows higher response and maintenance rates compared with secukinumab
Paediatric psoriasis: ixekizumab beneficial in difficult-to-treat areas
Psoriasis patients see great benefit in achieving complete skin clearance
The Future Is Bright for Vitiligo
Predilection sites for skin signs of vitiligo disease activity determined
Where Are We Now in Hidradenitis Suppurativa
IHS4 better suited as an outcome measure in HS trials?
New treatments for HS: IL-17 inhibitors next in practice?
New Treatment Options in Alopecia Areata
Alopecia areata: light at the end of the tunnel
Alopecia areata pathogenesis: known genetic background, unknown environmental triggers
Best of the Posters
Psoriasis treatment: no elevation of MACE and VTE on deucravacitinib
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