Alopecia Areata: Burden of Disease, Approach to Treatment, and Current Unmet Needs

References

• Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. J Invest Dermatol. 2014;134(4):1141–1142. doi:10.1038/jid.2013.464
   PubMed Web of Science ®Google Scholar
• Harries M, Macbeth AE, Holmes S, et al. The epidemiology of alopecia areata: a population-based cohort study in UK primary care. Br J Dermatol. 2022;186(2):257–265. doi:10.1111/bjd.20628
   PubMed Web of Science ®Google Scholar
• Trüeb RM, Dias MF. Alopecia areata: a comprehensive review of pathogenesis and management. Clin Rev Allergy Immunol. 2018;54(1):68–87. doi:10.1007/s12016-017-8620-9
   PubMed Web of Science ®Google Scholar
• Abbott J, Rapini RP. Totalis Alopecia. In: StatPearls. StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
   Google Scholar
• Walker SA, Rothman S. A statistical study and consideration of endocrine influences. J Invest Dermatol. 1950;14(6):403–413. doi:10.1038/jid.1950.52
   PubMed Web of Science ®Google Scholar
• Vélez-Muñiz RDC, Peralta-Pedrero ML, Jurado-Santa Cruz F, Morales-Sánchez MA. Psychological profile and quality of life of patients with alopecia areata. Skin Appendage Disord. 2019;5(5):293–298. doi:10.1159/000497166
   PubMed Web of Science ®Google Scholar
• Zheng C, Tosti A. Alopecia areata: new treatment options including janus kinase inhibitors. Dermatol Clin. 2021;39(3):407–415. doi:10.1016/j.det.2021.03.005
   PubMed Web of Science ®Google Scholar
• Juárez-Rendón KJ, Rivera Sánchez G, Reyes-López M, et al. Alopecia areata. Actualidad y perspectivas. Alopecia areata. Current situation and perspectives. Arch Argent Pediatr. 2017;115(6):e404–e411. doi:10.5546/aap.2017.eng.e404
   PubMedGoogle Scholar
• Bertolini M, McElwee K, Gilhar A, Bulfone-Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Exp Dermatol. 2020;29(8):703–725. doi:10.1111/exd.14155
   PubMed Web of Science ®Google Scholar
• Paus R, Nickoloff BJ, Ito T. A ‘hairy’ privilege. Trends Immunol. 2005;26(1):32–40. doi:10.1016/j.it.2004.09.014
   PubMed Web of Science ®Google Scholar
• Ito T, Ito N, Bettermann A, Tokura Y, Takigawa M, Paus R. Collapse and restoration of MHC class-I-dependent immune privilege: exploiting the human hair follicle as a model. Am J Pathol. 2004;164(2):623–634. doi:10.1016/s0002-9440(10)63151-3
   PubMed Web of Science ®Google Scholar
• Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med. 1993;66(6):541–554.
   PubMed Web of Science ®Google Scholar
• Ohyama M. What is behind the ‘swarm of bees’ in alopecia areata. Br J Dermatol. 2018;179(5):1023–1024. doi:10.1111/bjd.17142
   PubMed Web of Science ®Google Scholar
• McElwee KJ, Boggess D, King LE, Sundberg JP. Experimental induction of alopecia areata-like hair loss in C3H/HeJ mice using full-thickness skin grafts. J Invest Dermatol. 1998;111(5):797–803. doi:10.1046/j.1523-1747.1998.00380.x
   PubMed Web of Science ®Google Scholar
• Shin JM, Choi DK, Sohn KC, et al. Induction of alopecia areata in C3H/HeJ mice using polyinosinic-polycytidylic acid (poly[I:C]) and interferon-gamma. Sci Rep. 2018;8(1):12518. doi:10.1038/s41598-018-30997-3
   PubMedGoogle Scholar
• Aşkın Ö, Yücesoy SN, Coşkun E, Engin B, Serdaroğlu S. Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata. An Bras Dermatol. 2021;96(5):551–557. doi:10.1016/j.abd.2021.03.006
   PubMed Web of Science ®Google Scholar
• Kang H, Wu WY, Yu M, Shapiro J, McElwee KJ. Increased expression of TLR7 and TLR9 in alopecia areata. Exp Dermatol. 2020;29(3):254–258. doi:10.1111/exd.14043
   PubMed Web of Science ®Google Scholar
• Song T, Pavel AB, Wen HC, et al. An integrated model of alopecia areata biomarkers highlights both T(H)1 and T(H)2 upregulation. J Allergy Clin Immunol. 2018;142(5):1631–1634.e13. doi:10.1016/j.jaci.2018.06.029
   PubMed Web of Science ®Google Scholar
• Gautam RK, Singh Y, Gupta A, Arora P, Khurana A, Chitkara A. The profile of cytokines (IL-2, IFN-γ, IL-4, IL-10, IL-17A, and IL-23) in active alopecia areata. J Cosmet Dermatol. 2020;19(1):234–240. doi:10.1111/jocd.12970
   PubMed Web of Science ®Google Scholar
• Petukhova L, Duvic M, Hordinsky M, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature. 2010;466(7302):113–117. doi:10.1038/nature09114
   PubMed Web of Science ®Google Scholar
• Moftah NH, El-Barbary RA, Rashed L, Said M. ULBP3: a marker for alopecia areata incognita. Arch Dermatol Res. 2016;308(6):415–421. doi:10.1007/s00403-016-1652-9
   PubMed Web of Science ®Google Scholar
• Leung MC, Sutton CW, Fenton DA, Tobin DJ. Trichohyalin is a potential major autoantigen in human alopecia areata. J Proteome Res. 2010;9(10):5153–5163. doi:10.1021/pr100422u
   PubMed Web of Science ®Google Scholar
• Capalbo A, Giordano D, Gagliostro N, et al. Alopecia areata in a COVID-19 patient: a case report. Dermatol Ther. 2021;34(2):e14685. doi:10.1111/dth.14685
   PubMed Web of Science ®Google Scholar
• Sgubbi P, Savoia F, Calderoni O, Longo R, Stinchi C, Tabanelli M. Alopecia areata in a patient with SARS-Cov-2 infection. Dermatol Ther. 2020;33(6):e14295. doi:10.1111/dth.14295
   PubMed Web of Science ®Google Scholar
• Kurtz M, Wenner K, Schofield C. Alopecia areata in a human immunodeficiency virus–seropositive young man. Infect Dis Clin Pract. 2014;22(1):57–59. doi:10.1097/IPC.0b013e318287c368
   Google Scholar
• Richardson CT, Hayden MS, Gilmore ES, Poligone B. Evaluation of the relationship between alopecia areata and viral antigen exposure. Am J Clin Dermatol. 2018;19(1):119–126. doi:10.1007/s40257-017-0312-y
   PubMed Web of Science ®Google Scholar
• Offidani A, Amerio P, Bernardini ML, Feliciani C, Bossi G. Role of cytomegalovirus replication in alopecia areata pathogenesis. J Cutan Med Surg. 2000;4(2):63–65. doi:10.1177/120347540000400204
   PubMedGoogle Scholar
• Rossi A, Magri F, Michelini S, et al. New onset of alopecia areata in a patient with SARS-CoV-2 infection: possible pathogenetic correlations? J Cosmet Dermatol. 2021;20(7):2004–2005. doi:10.1111/jocd.14080
   PubMed Web of Science ®Google Scholar
• Hollingsworth P, Paci K, Evans M, Miedema J, Morrell DS. Alopecia universalis after drug reaction with eosinophilia and systemic symptoms (Dress). Pediatr Dermatol. 2020;37(5):947–949. doi:10.1111/pde.14217
   PubMed Web of Science ®Google Scholar
• Jackow C, Puffer N, Hordinsky M, Nelson J, Tarrand J, Duvic M. Alopecia areata and cytomegalovirus infection in twins: genes versus environment? J Am Acad Dermatol. 1998;38(3):418–425. doi:10.1016/s0190-9622(98)70499-2
   PubMed Web of Science ®Google Scholar
• Shellow WV, Edwards JE, Koo JY. Profile of alopecia areata: a questionnaire analysis of patient and family. Int J Dermatol. 1992;31(3):186–189. doi:10.1111/j.1365-4362.1992.tb03932.x
   PubMed Web of Science ®Google Scholar
• Sundberg JP, Silva KA, Li R, Cox GA, King LE. Adult-onset Alopecia areata is a complex polygenic trait in the C3H/HeJ mouse model. J Invest Dermatol. 2004;123(2):294–297. doi:10.1111/j.0022-202X.2004.23222.x
   PubMed Web of Science ®Google Scholar
• McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27(5):405–409. doi:10.1046/j.1365-2230.2002.01077.x
   PubMed Web of Science ®Google Scholar
• Betz RC, Petukhova L, Ripke S, et al. Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci. Nat Commun. 2015;6:5966. doi:10.1038/ncomms6966
   PubMed Web of Science ®Google Scholar
• Rajabi F, Abdollahimajd F, Jabalameli N, Nassiri Kashani M, Firooz A. The immunogenetics of alopecia areata. Adv Exp Med Biol. 2022;1367:19–59. doi:10.1007/978-3-030-92616-8_2
   PubMedGoogle Scholar
• Mingorance Gámez CG, Martínez Chamorro A, Moreno Casares AM, et al. Joint study of the associations of HLA-B and the transmembrane short tandem repeat polymorphism of MICA protein with alopecia areata shows independent associations of both with the disease. Clin Exp Dermatol. 2020;45(6):699–704. doi:10.1111/ced.14208
   PubMed Web of Science ®Google Scholar
• Fischer J, Degenhardt F, Hofmann A, et al. Genomewide analysis of copy number variants in alopecia areata in a Central European cohort reveals association with MCHR2. Exp Dermatol. 2017;26(6):536–541. doi:10.1111/exd.13123
   PubMed Web of Science ®Google Scholar
• Petukhova L, Patel AV, Rigo RK, et al. Integrative analysis of rare copy number variants and gene expression data in alopecia areata implicates an aetiological role for autophagy. Exp Dermatol. 2020;29(3):243–253. doi:10.1111/exd.13986
   PubMed Web of Science ®Google Scholar
• Blaumeiser B, van der Goot I, Fimmers R, et al. Familial aggregation of alopecia areata. J Am Acad Dermatol. 2006;54(4):627–632. doi:10.1016/j.jaad.2005.12.007
   PubMed Web of Science ®Google Scholar
• Hayashi A, Mikami Y, Miyamoto K, et al. Intestinal dysbiosis and biotin deprivation induce alopecia through overgrowth of Lactobacillus murinus in mice. Cell Rep. 2017;20(7):1513–1524. doi:10.1016/j.celrep.2017.07.057
   PubMed Web of Science ®Google Scholar
• Rebello D, Wang E, Yen E, Lio PA, Kelly CR. Hair growth in two alopecia patients after fecal microbiota transplant. ACG Case Rep J. 2017;4:e107. doi:10.14309/crj.2017.107
   PubMed Web of Science ®Google Scholar
• Skogberg G, Jackson S, Åstrand A. Mechanisms of tolerance and potential therapeutic interventions in Alopecia Areata. Pharmacol Ther. 2017;179:102–110. doi:10.1016/j.pharmthera.2017.05.008
   PubMed Web of Science ®Google Scholar
• Lu J, Zhang P, Hu R, et al. Gut microbiota characterization in Chinese patients with alopecia areata. J Dermatol Sci. 2021;102(2):109–115. doi:10.1016/j.jdermsci.2021.04.003
   PubMed Web of Science ®Google Scholar
• Moreno-Arrones OM, Serrano-Villar S, Perez-Brocal V, et al. Analysis of the gut microbiota in alopecia areata: identification of bacterial biomarkers. J Eur Acad Dermatol Venereol. 2020;34(2):400–405. doi:10.1111/jdv.15885
   PubMed Web of Science ®Google Scholar
• Rangu S, Lee JJ, Hu W, Bittinger K, Castelo-Soccio L. Understanding the gut microbiota in pediatric patients with alopecia areata and their siblings: a pilot study. JID Innov. 2021;1(4):100051. doi:10.1016/j.xjidi.2021.100051
   PubMedGoogle Scholar
• Bibbò S, Abbondio M, Sau R, et al. Fecal microbiota signatures in celiac disease patients with poly-autoimmunity. Front Cell Infect Microbiol. 2020;10:349. doi:10.3389/fcimb.2020.00349
   PubMed Web of Science ®Google Scholar
• Won EJ, Jang HH, Park H, Kim SJ. A potential predictive role of the scalp microbiome profiling in patients with alopecia areata: Staphylococcus caprae, Corynebacterium, and Cutibacterium species. Microorganisms. 2022;10(5). doi:10.3390/microorganisms10050864
   Web of Science ®Google Scholar
• Konopiński MK. Shannon diversity index: a call to replace the original Shannon’s formula with unbiased estimator in the population genetics studies. PeerJ. 2020;8:e9391. doi:10.7717/peerj.9391
   PubMed Web of Science ®Google Scholar
• Rinaldi F, Pinto D, Borsani E, Castrezzati S, Amedei A, Rezzani R. The first evidence of bacterial foci in the hair part and dermal papilla of scalp hair follicles: a pilot comparative study in alopecia areata. Int J Mol Sci. 2022;23(19):11956. doi:10.3390/ijms231911956
   PubMed Web of Science ®Google Scholar
• Tosti A, Bellavista S, Iorizzo M. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol. 2006;55(3):438–441. doi:10.1016/j.jaad.2006.05.008
   PubMed Web of Science ®Google Scholar
• Gupta AK, Carviel JL, Foley KA, et al. Monotherapy for alopecia areata: a systematic review and network meta-analysis. Skin Appendage Disord. 2019;5(6):331–337. doi:10.1159/000501940
   PubMed Web of Science ®Google Scholar
• Goebel AS, Neubert RH, Wohlrab J. Dermal targeting of tacrolimus using colloidal carrier systems. Int J Pharm. 2011;404(1–2):159–168. doi:10.1016/j.ijpharm.2010.11.029
   PubMedGoogle Scholar
• El-Ashmawy AA, El-Maadawy IH, El-Maghraby GM. Efficacy of topical latanoprost versus minoxidil and betamethasone valerate on the treatment of alopecia areata. J Dermatol Treat. 2018;29(1):55–64. doi:10.1080/09546634.2017.1330527
   PubMed Web of Science ®Google Scholar
• Roseborough I, Lee H, Chwalek J, Stamper RL, Price VH. Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata. J Am Acad Dermatol. 2009;60(4):705–706. doi:10.1016/j.jaad.2008.08.029
   PubMed Web of Science ®Google Scholar
• Faghihi G, Andalib F, Asilian A. The efficacy of latanoprost in the treatment of alopecia areata of eyelashes and eyebrows. Eur J Dermatol. 2009;19(6):586–587. doi:10.1684/ejd.2009.0766
   PubMed Web of Science ®Google Scholar
• Ross EK, Bolduc C, Lui H, Shapiro J. Lack of efficacy of topical latanoprost in the treatment of eyebrow alopecia areata. J Am Acad Dermatol. 2005;53(6):1095–1096. doi:10.1016/j.jaad.2005.06.031
   PubMed Web of Science ®Google Scholar
• Coronel-Pérez IM, Rodríguez-Rey EM, Camacho-Martínez FM. Latanoprost in the treatment of eyelash alopecia in alopecia areata universalis. J Eur Acad Dermatol Venereol. 2010;24(4):481–485. doi:10.1111/j.1468-3083.2009.03543.x
   PubMed Web of Science ®Google Scholar
• Jun M, Lee WS. Therapeutic effect of superficial cryotherapy on alopecia areata: a prospective, split-scalp study in patients with multiple alopecia patches. Ann Dermatol. 2017;29(6):722–727. doi:10.5021/ad.2017.29.6.722
   PubMed Web of Science ®Google Scholar
• Yoo KH, Lee JW, Li K, Kim BJ, Kim MN. Photodynamic therapy with methyl 5-aminolevulinate acid might be ineffective in recalcitrant alopecia totalis regardless of using a microneedle roller to increase skin penetration. Dermatol Surg. 2010;36(5):618–622. doi:10.1111/j.1524-4725.2010.01515.x
   PubMed Web of Science ®Google Scholar
• Lee JW, Yoo KH, Kim BJ, Kim MN. Photodynamic therapy with methyl 5‐aminolevulinate acid combined with microneedle treatment in patients with extensive alopecia areata. Clin Exp Dermatol. 2010;35(5):548–549. doi:10.1111/j.1365-2230.2009.03695.x
   PubMed Web of Science ®Google Scholar
• Al-Mutairi N. 308-nm excimer laser for the treatment of alopecia areata. Dermatol Surg. 2007;33(12):1483–1487. doi:10.1111/j.1524-4725.2007.33320.x
   PubMed Web of Science ®Google Scholar
• Ohtsuki A, Hasegawa T, Komiyama E, Takagi A, Kawasaki J, Ikeda S. 308-nm excimer lamp for the treatment of alopecia areata: clinical trial on 16 cases. Indian J Dermatol. 2013;58(4):326. doi:10.4103/0019-5154.113954
   PubMedGoogle Scholar
• Gupta AK, Carviel JL. Meta-analysis of 308-nm excimer laser therapy for alopecia areata. J Dermatol Treat. 2021;32(5):526–529. doi:10.1080/09546634.2019.1687819
   PubMed Web of Science ®Google Scholar
• Waiz M, Saleh AZ, Hayani R, Jubory SO. Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata. J Cosmet Laser Ther. 2006;8(1):27–30. doi:10.1080/14764170600607368
   PubMedGoogle Scholar
• Chu H, Kim D-Y. Use of lasers in the treatment of alopecia areata. Med Lasers. 2016;5:71–76. doi:10.25289/ML.2016.5.2.71
   Google Scholar
• Lee YB, Lee W-S. Efficacy of antihistamines in combination with topical corticosteroid and superficial cryotherapy for treatment of alopecia areata: a retrospective cohort study. J Am Acad Dermatol. 2021;84(4):1152–1154. doi:10.1016/j.jaad.2020.06.1026
   PubMed Web of Science ®Google Scholar
• Inui S, Nakajima T, Toda N, Itami S. Fexofenadine hydrochloride enhances the efficacy of contact immunotherapy for extensive alopecia areata: retrospective analysis of 121 cases. J Dermatol. 2009;36(6):323–327. doi:10.1111/j.1346-8138.2009.00647.x
   PubMed Web of Science ®Google Scholar
• Strazzulla LC, Wang EHC, Avila L, et al. Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15–24. doi:10.1016/j.jaad.2017.04.1142
   PubMed Web of Science ®Google Scholar
• Fiedler-Weiss VC. Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata. J Am Acad Dermatol. 1987;16(3 Pt 2):745–748. doi:10.1016/s0190-9622(87)80003-8
   PubMed Web of Science ®Google Scholar
• Sharma AN, Michelle L, Juhasz M, Muller Ramos P, Atanaskova Mesinkovska N. Low-dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. Int J Dermatol. 2020;59(8):1013–1019. doi:10.1111/ijd.14933
   PubMed Web of Science ®Google Scholar
• Chang KH, Rojhirunsakool S, Goldberg LJ. Treatment of severe alopecia areata with intralesional steroid injections. J Drugs Dermatol. 2009;8(10):909–912.
   PubMed Web of Science ®Google Scholar
• Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore--a study of 219 Asians. Int J Dermatol. 2002;41(11):748–753. doi:10.1046/j.1365-4362.2002.01357.x
   PubMed Web of Science ®Google Scholar
• Jarratt MT, Spark RF, Arndt KA. The effects of intradermal steroids on the pituitary-adrenal axis and the skin. J Invest Dermatol. 1974;62(4):463–466. doi:10.1111/1523-1747.ep12701707
   PubMed Web of Science ®Google Scholar
• Fredman R, Tenenhaus M. Cushing’s syndrome after intralesional triamcinolone acetonide: a systematic review of the literature and multinational survey. Burns. 2013;39(4):549–557. doi:10.1016/j.burns.2012.09.020
   PubMed Web of Science ®Google Scholar
• Chu TW, AlJasser M, Alharbi A, Abahussein O, McElwee K, Shapiro J. Benefit of different concentrations of intralesional triamcinolone acetonide in alopecia areata: an intrasubject pilot study. J Am Acad Dermatol. 2015;73(2):338–340. doi:10.1016/j.jaad.2015.04.049
   PubMed Web of Science ®Google Scholar
• Atanaskova Mesinkovska N. Emerging unconventional therapies for alopecia areata. J Investig Dermatol Symp Proc. 2018;19(1):S32–s33. doi:10.1016/j.jisp.2017.10.012
   PubMedGoogle Scholar
• Firooz A, Tehranchi-Nia Z, Ahmed AR. Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases. Clin Exp Dermatol. 1995;20(5):363–370. doi:10.1111/j.1365-2230.1995.tb01351.x
   PubMed Web of Science ®Google Scholar
• Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: a systematic review. J Am Acad Dermatol. 2022;86(6):1318–1334. doi:10.1016/j.jaad.2021.04.077
   PubMed Web of Science ®Google Scholar
• Mancuso G, Balducci A, Casadio C, et al. Efficacy of betamethasone valerate foam formulation in comparison with betamethasone dipropionate lotion in the treatment of mild-to-moderate alopecia areata: a multicenter, prospective, randomized, controlled, investigator-blinded trial. Int J Dermatol. 2003;42(7):572–575. doi:10.1046/j.1365-4362.2003.01862.x
   PubMed Web of Science ®Google Scholar
• Tosti A, Piraccini BM, Pazzaglia M, Vincenzi C. Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis. J Am Acad Dermatol. 2003;49(1):96–98. doi:10.1067/mjd.2003.423
   PubMed Web of Science ®Google Scholar
• Happle R. Topical immunotherapy in alopecia areata. J Invest Dermatol. 1991;96(5):71s–72s. doi:10.1111/1523-1747.ep12471884
   PubMed Web of Science ®Google Scholar
• Lamb RC, Young D, Holmes S. Retrospective review of diphencyprone in the treatment of alopecia areata. Clin Exp Dermatol. 2016;41(4):352–358. doi:10.1111/ced.12776
   PubMed Web of Science ®Google Scholar
• Ohlmeier MC, Traupe H, Luger TA, Böhm M. Topical immunotherapy with diphenylcyclopropenone of patients with alopecia areata--a large retrospective study on 142 patients with a self-controlled design. J Eur Acad Dermatol Venereol. 2012;26(4):503–507. doi:10.1111/j.1468-3083.2011.04114.x
   PubMed Web of Science ®Google Scholar
• Vestey JP, Savin JA. A trial of 1% minoxidil used topically for severe alopecia areata. Acta Derm Venereol. 1986;66(2):179–180.
   PubMed Web of Science ®Google Scholar
• Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol. 1987;16(3 Pt 2):730–736. doi:10.1016/s0190-9622(87)70095-4
   PubMed Web of Science ®Google Scholar
• Fiedler-Weiss VC, West DP, Buys CM, Rumsfield JA. Topical minoxidil dose-response effect in alopecia areata. Arch Dermatol. 1986;122(2):180–182. doi:10.1001/archderm.1986.01660140070020
   PubMedGoogle Scholar
• Freire PCB, Riera R, Martimbianco ALC, Petri V, Atallah AN. Minoxidil for patchy alopecia areata: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(9):1792–1799. doi:10.1111/jdv.15545
   PubMed Web of Science ®Google Scholar
• Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of low-dose oral minoxidil for hair loss: a multicenter study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644–1651. doi:10.1016/j.jaad.2021.02.054
   PubMed Web of Science ®Google Scholar
• Pirmez R, Salas-Callo CI. Very-low-dose oral minoxidil in male androgenetic alopecia: a study with quantitative trichoscopic documentation. J Am Acad Dermatol. 2020;82(1):e21–e22. doi:10.1016/j.jaad.2019.08.084
   PubMed Web of Science ®Google Scholar
• de Nicolas-Ruanes B, Moreno-Arrones OM, Saceda-Corralo D, et al. Low-dose oral minoxidil for treatment of androgenetic alopecia and telogen effluvium in a pediatric population: a descriptive study. J Am Acad Dermatol. 2022;87(3):700–702. doi:10.1016/j.jaad.2022.04.030
   PubMed Web of Science ®Google Scholar
• Fiedler-Weiss VC, Rumsfield J, Buys CM, West DP, Wendrow A. Evaluation of oral minoxidil in the treatment of alopecia areata. Arch Dermatol. 1987;123(11):1488–1490. doi:10.1001/archderm.1987.01660350088019
   PubMedGoogle Scholar
• Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186–194. doi:10.1111/j.1365-2133.2004.05785.x
   PubMed Web of Science ®Google Scholar
• Yin L, Svigos K, Gutierrez D, Peterson E, Lo Sicco K, Shapiro J. Low-dose oral minoxidil increases hair density and thickness in androgenetic alopecia: a retrospective analysis of 60 patients. J Eur Acad Dermatol Venereol. 2022;36(3):e200–e202. doi:10.1111/jdv.17731
   PubMed Web of Science ®Google Scholar
• Randolph M, Tosti A. Oral minoxidil treatment for hair loss: a review of efficacy and safety. J Am Acad Dermatol. 2021;84(3):737–746. doi:10.1016/j.jaad.2020.06.1009
   PubMedGoogle Scholar
• King B, Ohyama M, Kwon O, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022;386(18):1687–1699. doi:10.1056/NEJMoa2110343
   PubMed Web of Science ®Google Scholar
• Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(5):850–856. doi:10.1111/jdv.15489
   PubMed Web of Science ®Google Scholar
• Dincer D, Tanacan E, Kose Ozkan C. Efficacy of systemic minoxidil and tofacitinib combination in treatment-resistant alopecia universalis. J Cosmet Dermatol. 2021;20(6):1807–1809. doi:10.1111/jocd.13812
   PubMed Web of Science ®Google Scholar
• Wambier CG, Craiglow BG, King BA. Combination tofacitinib and oral minoxidil treatment for severe alopecia areata. J Am Acad Dermatol. 2021;85(3):743–745. doi:10.1016/j.jaad.2019.08.080
   PubMed Web of Science ®Google Scholar
• Fiedler VC, Buys CM. Immunohistochemical characterization of the cellular infiltrate in severe alopecia areata before and after minoxidil treatment. Dermatologica. 1987;175(Suppl 2):29–35. doi:10.1159/000248899
   PubMedGoogle Scholar
• Kennedy Crispin M, Ko JM, Craiglow BG, et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight. 2016;1(15):e89776. doi:10.1172/jci.insight.89776
   PubMed Web of Science ®Google Scholar
• Mackay-Wiggan J, Jabbari A, Nguyen N, et al. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016;1(15):e89790. doi:10.1172/jci.insight.89790
   PubMed Web of Science ®Google Scholar
• Yan D, Fan H, Chen M, et al. The efficacy and safety of JAK inhibitors for alopecia areata: a systematic review and meta-analysis of prospective studies. Front Pharmacol. 2022;13:950450. doi:10.3389/fphar.2022.950450
   PubMedGoogle Scholar
• Serious heart events, cancer, blood clots for certain JAK inhibitors. 2021; Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-about-increased-risk-serious-heart-related-events-cancer-blood-clots-and-death. Accessed March 13, 2023.
   Google Scholar
• Wollenhaupt J, Lee EB, Curtis JR, et al. Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther. 2019;21(1):89. doi:10.1186/s13075-019-1866-2
   PubMed Web of Science ®Google Scholar
• Winthrop KL, Citera G, Gold D, et al. Age-based (<65 vs ≥65 years) incidence of infections and serious infections with tofacitinib versus biological DMARDs in rheumatoid arthritis clinical trials and the US Corrona RA registry. Ann Rheum Dis. 2021;80(1):134–136. doi:10.1136/annrheumdis-2020-218992
   PubMed Web of Science ®Google Scholar
• Smolen JS, Genovese MC, Takeuchi T, et al. Safety profile of baricitinib in patients with active rheumatoid arthritis with over 2 years median time in treatment. J Rheumatol. 2019;46(1):7–18. doi:10.3899/jrheum.171361
   PubMed Web of Science ®Google Scholar
• Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med. 2017;376(7):652–662. doi:10.1056/NEJMoa1608345
   PubMed Web of Science ®Google Scholar
• King B, Maari C, Lain E, et al. Extended safety analysis of baricitinib 2 mg in adult patients with atopic dermatitis: an integrated analysis from eight randomized clinical trials. Am J Clin Dermatol. 2021;22(3):395–405. doi:10.1007/s40257-021-00602-x
   PubMed Web of Science ®Google Scholar
• Olumiant (Baricitinib) highlights of prescribing information. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/207924s006lbl.pdf. Accessed March 13, 2023.
   Google Scholar
• Curtis J. Malignancies in patients aged ≥ 50 years with RA and ≥ 1 additional cardiovascular risk factor: results from a phase 3b/4 randomized safety study of tofacitinib vs TNF inhibitors. Arthritis Rheumatol. 1940;73(9):54.
   Google Scholar
• Harigai M. Growing evidence of the safety of JAK inhibitors in patients with rheumatoid arthritis. Rheumatology. 2019;58(Supplement_1):i34–i42. doi:10.1093/rheumatology/key287
   PubMedGoogle Scholar
• Montastruc F, Flumian C, Degboe Y, Constantin A, Ruyssen-Witrand A. OP0268 Comparison of major cardiovascular and thromboembolic events in safety reports between rheumatoid arthritis patients treated with JAK inhibitors versus anti-TNF: results from VigiBase. Ann Rheum Dis. 2022;81(Suppl1):178–179. doi:10.1136/annrheumdis-2022-eular.2686
   Google Scholar
• Meissner Y, Albrecht K, Kekow J, et al. OP0135 Risk of cardiovascular events under janus kinase inhibitors in patients with rheumatoid arthritis: observational data from the German rabbit register. Ann Rheum Dis. 2022;81(Suppl1):86–87. doi:10.1136/annrheumdis-2022-eular.779
   Google Scholar
• Taylor PC, Weinblatt ME, Burmester GR, et al. Cardiovascular safety during treatment with baricitinib in rheumatoid arthritis. Arthritis Rheumatol. 2019;71(7):1042–1055. doi:10.1002/art.40841
   PubMed Web of Science ®Google Scholar
• Salinas CA, Louder A, Polinski J, et al. Evaluation of VTE, MACE, and serious infections among patients with RA treated with baricitinib compared to TNFi: a multi-database study of patients in routine care using disease registries and claims databases. Rheumatol Ther. 2022;1–23. doi:10.1007/s40744-022-00505-1
   Web of Science ®Google Scholar
• Xie F, Yun H, Bernatsky S, Curtis JR. Brief report: risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments. Arthritis Rheumatol. 2016;68(11):2612–2617. doi:10.1002/art.39761
   PubMed Web of Science ®Google Scholar
• Fertig RM, Gamret AC, Cervantes J, Tosti A. Microneedling for the treatment of hair loss? J Eur Acad Dermatol Venereol. 2018;32(4):564–569. doi:10.1111/jdv.14722
   PubMed Web of Science ®Google Scholar
• Gowda BHJ, Ahmed MG, Sanjana A. Can microneedles replace hypodermic needles? Resonance. 2022;27(1):63–85. doi:10.1007/s12045-022-1294-5
   Google Scholar
• Pei D, Chen L, Yao Y, Zeng L, Zhang G. Microneedling combined with compound betamethasone in treatment of severe alopecia areata: a case report. Front Immunol. 2022;13:939077. doi:10.3389/fimmu.2022.939077
   PubMed Web of Science ®Google Scholar
• Chandrashekar B, Yepuri V, Mysore V. Alopecia areata-successful outcome with microneedling and triamcinolone acetonide. J Cutan Aesthet Surg. 2014;7(1):63–64. doi:10.4103/0974-2077.129989
   PubMedGoogle Scholar
• Deepak SH, Shwetha S. Scalp roller therapy in resistant alopecia areata. J Cutan Aesthet Surg. 2014;7(1):61–62. doi:10.4103/0974-2077.129988
   PubMedGoogle Scholar
• Mostaghimi A, Napatalung L, Sikirica V, et al. Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review. Dermatol Ther. 2021;11(3):867–883. doi:10.1007/s13555-021-00512-0
   PubMed Web of Science ®Google Scholar
• Lee S, Lee YB, Kim BJ, Bae S, Lee WS. All-cause and cause-specific mortality risks associated with alopecia areata: a Korean nationwide population-based study. JAMA Dermatol. 2019;155(8):922–928. doi:10.1001/jamadermatol.2019.0629
   PubMed Web of Science ®Google Scholar
• Sánchez-Díaz M, Díaz-Calvillo P, Soto-Moreno A, Molina-Leyva A, Arias-Santiago S. The impact of sleep quality on mood status and quality of life in patients with alopecia areata: a comparative study. Int J Environ Res Public Health. 2022;19(20). doi:10.3390/ijerph192013126
   Web of Science ®Google Scholar
• Park J, Kim DW, Park SK, Yun SK, Kim HU. Role of hair prostheses (Wigs) in patients with severe alopecia areata. Ann Dermatol. 2018;30(4):505–507. doi:10.5021/ad.2018.30.4.505
   PubMed Web of Science ®Google Scholar
• Li SJ, Mostaghimi A, Tkachenko E, Huang KP. Association of out-of-pocket health care costs and financial burden for patients with alopecia areata. JAMA Dermatol. 2019;155(4):493–494. doi:10.1001/jamadermatol.2018.5218
   PubMed Web of Science ®Google Scholar
• Thompson HJ, Vavra T, Jabbari A. Factors associated with insurance coverage of tofacitinib for alopecia areata: a retrospective review from an academic institution. J Am Acad Dermatol. 2020;83(5):1509–1510. doi:10.1016/j.jaad.2020.06.028
   PubMed Web of Science ®Google Scholar
• Klein B, Treudler R, Simon JC. JAK-inhibitors in dermatology - small molecules, big impact? Overview of the mechanism of action, previous study results and potential adverse effects. J Dtsch Dermatol Ges. 2022;20(1):19–24. doi:10.1111/ddg.14668
   Web of Science ®Google Scholar
• Maqsood MH, Weber BN, Haberman RH, Lo Sicco KI, Bangalore S, Garshick MS. Cardiovascular and venous thromboembolic risk with janus kinase inhibitors in immune-mediated inflammatory diseases: a systematic review and meta-analysis of randomized trials. ACR Open Rheumatol. 2022;4(10):912–922. doi:10.1002/acr2.11479
   PubMedGoogle Scholar
• Inui S, Inoue T, Itami S. Psychosocial impact of wigs or hairpieces on perceived quality of life level in female patients with alopecia areata. J Dermatol. 2013;40(3):225–226. doi:10.1111/1346-8138.12040
   PubMed Web of Science ®Google Scholar
• Klein EJ, Shapiro J, Piraccini B, Cummins D, Krueger LD, Lo Sicco K. Giving a voice: dermatologists’ legislative advocacy for patients with hair loss. Br J Dermatol. 2022;187(4):582–583. doi:10.1111/bjd.21667
   PubMed Web of Science ®Google Scholar
• S.4708-117th Congress (2021-2022): A bill to amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes. 2021; Available from: https://www.congress.gov/bill/117th-congress/senate-bill/4708?r=7&s=1. Accessed March 13, 2023.
   Google Scholar
• Kalabokes VD. Alopecia areata: support groups and meetings - how can it help your patient? Dermatol Ther. 2011;24(3):302–304. doi:10.1111/j.1529-8019.2011.01418.x
   PubMed Web of Science ®Google Scholar
• The National Alopecia Areata Foundation. 2023; Available from: https://www.naaf.org/. Accessed March 13, 2023.
   Google Scholar
• Aschenbeck KA, McFarland SL, Hordinsky MK, Lindgren BR, Farah RS. Importance of group therapeutic support for family members of children with alopecia areata: a cross-sectional survey study. Pediatr Dermatol. 2017;34(4):427–432. doi:10.1111/pde.13176
   PubMed Web of Science ®Google Scholar
• Creadore A, Manjaly P, Li SJ, et al. Evaluation of stigma toward individuals with alopecia. JAMA Dermatol. 2021;157(4):392–398. doi:10.1001/jamadermatol.2020.5732
   PubMed Web of Science ®Google Scholar
• Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatization caused by hair loss - a systematic literature review. J Dtsch Dermatol Ges. 2020;18(12):1357–1368. doi:10.1111/ddg.14234
   Web of Science ®Google Scholar
• Yeshua-Katz D, Shvarts S, Segal-Engelchin D. Hierarchy of hair loss stigma: media portrayals of cancer, alopecia areata, and cancer in Israeli newspapers. Isr J Health Policy Res. 2019;8(1):68. doi:10.1186/s13584-019-0338-0
   PubMed Web of Science ®Google Scholar
• Alopecia Justice League. 2015; Available from: https://www.alopeciajusticeleague.com/. Accessed March 13, 2023.
   Google Scholar
• Good skin knowledge youth education program. Available from: https://www.aad.org/public/public-health/good-skin-knowledge. Accessed March 13, 2023.
   Google Scholar