Acute Diffuse and Total Alopecia of the Female Scalp. a new subtype of diffuse alopecia areata that has a favorable prognosis.

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Dermatology 2002;205(4):367-73

Acute Diffuse and Total Alopecia of the Female Scalp. a new subtype of diffuse alopecia areata that has a favorable prognosis.

Background: Athough alopecia areata (AA) usually starts with focal lesions of hair loss and then presents several different clinical forms, AA may begin as diffuse hair loss. We examined 9 female patients who presented with acute, diffuse and total hair loss of the scalp and took a similar clinical course with a favorable prognosis. Objective: To categorize such cases as a new subgroup of diffuse alopecia. Methods: We studied 9 patients who showed acute, diffuse and total hair loss of the scalp within 1 month after their first visit to our hospital by comparing their clinical course, laboratory tests and histopathological findings with those of common, patchy AA, alopecia totalis or alopecia universalis. Results: None of the patients had a background of systemic diseases or telogen effluvium. All the patients were female, and 8 of the 9 cases recovered cosmetically acceptable hair growth within 6 months regardless of steroid administration. The histology of he lesions was indistinguishable from that of AA except for a remarkable eosinophilic infiltrate. Conclusions: These cases can be categorized as a new subtype of inflammatory noncicatricial alopecia that is characterized by a marked female predominance, tissue eosinophilia and uniquely short clinical course. We suggest to name it 'acute diffuse and total alopecia of the female scalp (ADTAFS)'.

Ann Dermatol Venereol 2002 May;129(5 Pt 2):841-4

The hair follicle as a target for gene therapy

The hair follicle possesses progenitor cells required for continuous hair follicle cycling and for epidermal keratinocytes, melanocytes and Langerhans cells. These different cell types can be the target of topical gene delivery in the skin of the mouse. Using a combination of liposomes and DNA, we demonstrate the feasibility of targeting hair follicle cells in human scalp xenografts. We consider liposome composition and stage of the hair cycle as important parameters influencing transfection of human hair follicles. Transfection is possible only during the early anagen phase. Factors and obstacles for the use of gene therapy in treating alopecia and skin diseases are discussed. A theoretical framework for future treatment of cutaneous and systemic disorders using gene therapy is presented.

Eur J Dermatol 2002 May-Jun;12(3):236-9

HLA class II alleles in patients with alopecia areata.

Our purpose was to determine which HLA class II alleles are associated with Turkish alopecia areata patients. Also we investigated whether there was a relationship between the age of onset and severity of disease and HLA alleles or not. Sixty-five patients with alopecia areata were included in this study, and 50 healthy transplant donors were used as a control group. The total group of alopecia areata patients as well as various subgroups according to scalp hair loss were compared to the control group. HLA DNA typing was performed by polymerase chain reaction/sequence specific primer method. The frequency of DQB1*03 allele was 86.1% in all patients compared to 62.0% in controls (P = 0.005). While the frequency of DQB1*03 was significantly increased, the frequency of DRB1*03 was decreased in the all patients group (4.6% versus 22.0%, P = 0.01). In the group of scalp hair loss less than 25%; the frequency of DRB1*03 was decreased (3.2%, P = 0.02). The group of patients with 25-75% scalp hair loss was compared to control group; the frequencies of DRB1*04 (66.7% versus 28.0%, P = 0.02) was increased. When the alopecia totalis, alopecia universalis or alopecia totalis/alopecia universalis group was compared to control group; DQB1*03 was associated with an increased frequency in this group versus control group (90.9%, P = 0.03). There were no significant differences for the other DQ alleles and the DR alleles tested in the patients and in the controls. When patients with early onset were compared to patients with late onset; no significant allele differences were found. Our findings suggested that DQB1*03 allele is a marker for general susceptibility to alopecia areata and may also serve as special genetic marker for susceptibility for the severe form of alopecia areata in our population. However, this association is not related to age at onset of the disease.

J Invest Dermatol 2002 Feb;118(2):335-7

Interleukin-1 receptor antagonist allele 2 and familial alopecia areata.

Alopecia areata affects 1%-2% of the population and is hypothesized to be an autoimmune, organ specific T-cell mediated reaction directed against the human hair follicle. It is characterized by loss of hair in patches (alopecia areata) with progression in some individuals to total loss of scalp hair (alopecia totalis) or to loss of all scalp and body hair (alopecia universalis). The interleukin-1 receptor antagonist (IL-1RN) gene was found to be associated with more severe clinical outcome in several chronic inflammatory diseases, including alopecia areata. The IL-1RN*2 allele was found to be associated with alopecia areata severity in a British case-control study. In this paper, we analyzed alopecia areata probands in a family-based sample (n = 131 parent-offspring trios) to study the association between alleles of the IL-1RN and various phenotypes of alopecia areata. In considering all patients with any form of alopecia areata, no association was found with IL-1RN. IL-1RN*2 allele was not associated with alopecia totalis and alopecia universalis. A borderline association was observed between IL-1RN and patchy alopecia areata but it was not statistically significant (p =0.06). We also observed an association between IL1-RN*1 allele and patchy alopecia areata (p =0.045).

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