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Alopecia Review of Relevant Articles



Epidemiology :



Alopecia areata is a common form of non-scarring alopecia that appears equally in males and females of any age, although children and adolescents are more commonly affected.[1]

It is estimated that 1.7 % of the population will develop AA during the life.[2]

AA affects about 4.6 million people in the USA.[3]

In France it is estimated to have about 80 000 people with one of the alopecia forms according to a major study performed with the collaboration of French physicians.[4]


Symptoms (other than hairs) : We can observe nail changes [5]




Mechanisms :


There is a link between HLA class I alleles and haplotypes with AA.[6]

Lymphocytes CD4 seam to have a role in AA.[7]

The mechanism of AA seams to be due to a T-cell mediated tissue-restricted autoimmune disease of the hair follicle, especially expressing the T-helper-type 1 cytokines interleukin-1beta, interleukin-2, and interferon-gamma. INF Gamma could be an indication of the inflammation in AA and the control of INF-Gamma could be important in the management of the disease.[8]

Alopecia areata is a T-cell mediated autoimmune disease directed against an unknown auto antigen of the hair follicle[9]

A study  support previous findings showing that different HLA susceptibility alleles are associated with mild and severe AA.[10]

A Turkish study shows that 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.[11]

Homozygosity for the rare allele of IL1RN (IL1RN*2) was significantly associated with alopecia areata[12]

The frequency of HLA-B62 was significantly higher in patients than in controls. HLA-A2, HLA-A24, HLA-B35, HLA-DRB1*11, and HLA-DRB1*15 were significantly less common in patients than in the control group[13]

AA is an automimmune disease link to gene and production of cytokine by T lypmhocytes[14]

There is no association between the -2518A/G polymorphism of the MCP-1 gene and susceptibility to alopecia areata.[15]

According a chinese study there is a link between genetic and alopecia areata in some children cases.[16]

Study on the regulation of T cell and the potential in auto immune diseases.[17]


Link with other diseases :


One case report is dedicated to the link between Coelic disease and alopecia areata. In this case one patient who had a free gluten diet, hairs re-grown and as soon as gluten was introduce again, the alopecia came back. It demonstrate the link between the 2  diseases. [18]


According to a letter published, it seams there is no link between Alopecia and Hepatitis  C.[19]



Treatments :


The use of phototoxic dose of UVA  and topical 8-methoxypsoralen as a treatment in AA, AT or AU showed a re-growth of more than 50% in 94 patients out of 149 tested. Some side effects were also observed.[20]

PUVAtherapy is a good method to have re-growth in AA AT or AU.[21]

One case report shows that a transplantation of allogeneic hematopoietic stem cell cured one patient after 11 years of AU. [22]

Treatment by contact sensitizers such as diphenylcyclopropenone or squaric acid dibutylester are effective in a study. In the future improved treatments such as immunosuppressive or immunomodulatory targeting of the autoimmune pathogenesis of AA could be a good way.[23]

Clobetasol propionate 0.05% under occlusion could be helpful in some cases[24]

High dose pulse corticosteroid therapy use as a treatment could have good effect in some cases but also with relapse in long terme.[25]


Etanercept, a TNF-alpha inhibitor seams to not be effective on the treatment of AA, AU or AT. [26]

A case report shows that after bone morrow transplantation , AA could be cured.[27]


As AA could have some pshychic side effect, A dermatology/liaison psychiatry setting could improve the management of AA. [28]


Multifocal alopecia areata responds to intravenous high-dose corticosteroids. Topical immunotherapy with diphenylcyclopropenone (DPC) or PUVA therapy may be effective in long-standing and widespread disease. Contact of patients with self-help organisations may be of help for coping with the disease.[29]

High-dose methylprednisolone pulse therapy is an effective and well-tolerated treatment for patients with severe AA plurifocalis but might be less beneficial for patients with ophasic AA, AA totalis or universalis[30]

A single series of intravenous pulse of methylprednisolone appears to be well tolerated and effective in patients with rapidly progressing extensive multifocal AA, but not those with ophiasic and universalis AA. [31]

Oral Corticotherapy is not relevant for long term as when the treatment is stopped hairs fall again.[32]

Treatment by immunosuppressor is effective in the studied population.[33]


Treatment by azelaic Acid is well adapted to AA without side effect[34]


Alopecia universalis on a new-born seams to have been  cured with PUVA (+ psoralen).[35]


Cured alopecia with bone morphogenic protein ?[36]



[1] Am J Clin Dermatol. 2000 Mar-Apr;1(2):101-5.  Alopecia areata. Pathogenesis, diagnosis, and therapy. Papadopoulos AJ, Schwartz RA, Janniger CK. New Jersey Medical School, Newark, New Jersey, USA.



[2] Eur J Dermatol. 2004 Nov-Dec;14(6):364-70. Alopecia areata: autoimmune basis of hair loss. Alexis AF, Dudda-Subramanya R, Sinha AA.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.


[3] J Investig Dermatol Symp Proc. 2003 Oct;8(2):199-203. Genetic linkage studies in alopecia areata. Martinez-Mir A, Zlotogorski A, Ott J, Gordon D, Christiano AM. Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.


[4] La pelade, une pathologie invalidante qui toucherait plus de 80 000 personnes en France.  Thomas Hanslik, Michel Cadilhac, Solen Kerneis, Alain Jacques Valleron, Antoine Flahault. Inserm UMR-S 707, Université Pierre et Marie Curie, Paris.

[5] Hautarzt. 2003 Aug;54(8):713-22. [Alopecia areata. Clinical aspects, pathogenesis and rational therapy of a T-cell-induced autoimmune disease] [Article in German] Freyschmidt-Paul P, Happle R, Hoffmann R. Klinik fur Dermatologie und Allergologie, Philipps-Universitat Marburg. freyschm@mailer.uni-marburg.de


[6] J Dermatol Sci. 2005 Sep 22; Association of HLA class I alleles with aloplecia areata in Chinese Hans. Xiao FL, Yang S, Yan KL, Cui Y, Liang YH, Zhou FS, Du WH, Gao M, Sun LD, Fan X, Chen JJ, Wang PG, Zhu YG, Zhou SM, Zhang XJ


[7] : Rev Med Brux. 2004 Sep;25(4):A282-5. [Alopecia areata and treatment][Article in French]

Stene JJ.

Service de Dermatologie, CHU Saint-Pierrre, ULB, Bruxelles.


[8] : Eur J Dermatol. 2004 Jan-Feb;14(1):33-6. Interferon-gamma in alopecia areata.

Arca E, Musabak U, Akar A, Erbil AH, Tastan HB. Department of Dermatology, Gulhane Military Medical Faculty, School of Medicine Etlik, 06018 Ankara, Turkey. earca@gata.edu.tr


[9] Hautarzt. 2003 Aug;54(8):713-22. [Alopecia areata. Clinical aspects, pathogenesis and rational therapy of a T-cell-induced autoimmune disease] [Article in German] Freyschmidt-Paul P, Happle R, Hoffmann R. Klinik fur Dermatologie und Allergologie, Philipps-Universitat Marburg. freyschm@mailer.uni-marburg.de


[10] Hum Genet. 2003 Apr;112(4):400-3. Epub 2003 Feb 14.  Notch4, a non-HLA gene in the MHC is strongly associated with the most severe form of alopecia areata. Tazi-Ahnini R, Cork MJ, Wengraf D, Wilson AG, Gawkrodger DJ, Birch MP, Messenger AG, McDonagh AJ. Dermato-Immunogenetics Group, Biomedical Genetics Project, Division of Genomic Medicine, D Floor Medical School, Royal Hallamshire Hospital, University of Sheffield, Sheffield, S10 2RX, UK. r.taziahnini@sheffield.ac.uk


[11] : Eur J Dermatol. 2002 May-Jun;12(3):236-9.  HLA class II alleles in patients with alopecia areata. Akar A, Orkunoglu E, Sengul A, Ozata M, Gur AR. Department of Dermatology, Gulhane Military Medical Academy, School of Medicine, Ankara 06018, Turkey. aakar@gata.edu.tr


[12] Eur J Immunogenet. 2002 Feb;29(1):25-30.  Genetic analysis of the interleukin-1 receptor antagonist and its homologue IL-1L1 in alopecia areata: strong severity association and possible gene interaction. Tazi-Ahnini R, Cox A, McDonagh AJ, Nicklin MJ, di Giovine FS, Timms JM, Messenger AG, Dimitropoulou P, Duff GW, Cork MJ. Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK. r.taziahnini@sheffield.ac.uk


[13] Association between alopecia areata and HLA Class I and II in Turkey. Aliagaoglu C, Pirim I, Atasoy M, Egerci N, Aktas A. Erzurum Numune State Hospital, Department of Dermatology, Ataturk University, Medical School, Erzurum, Turkey. 


[14] Autoimmun Rev. 2006 Jan;5(1):64-9. Epub 2005 Aug 8.   Alopecia Areata: A tissue specific autoimmune disease of the hair follicle.     Gilhar A, Kalish RS.     Laboratory for Skin Research, Rappaport Building, Technion Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Flieman Med Center, P.O.B. 9649, Bat-Galim, Haifa, 31096, Israel.


[15] J Korean Med Sci. 2006 Feb;21(1):90-4.      Analysis of the monocyte chemoattractant protein 1 -2518 promoter polymorphism in korean patients with alopecia areata.  Hong SB, Jin SY, Park HJ, Jung JH, Sim WY. Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea.


[16] Pediatr Dermatol. 2006 Jan-Feb;23(1):13-8.  The epidemiology of childhood alopecia areata in china: a study of 226 patients.   Xiao FL, Yang S, Liu JB, He PP, Yang J, Cui Y, Yan KL, Gao M, Liang YH, Zhang XJ.     Insititute of Dermatology and Department of Dermatology, Anhui Medical University and Key Laboratory of Genome Research Anhui, Hefei, China.

[17] J Investig Dermatol Symp Proc. 2005 Dec;10(3):280-281 Regulatory T cells in autoimmune diseases and their potential.   McElwee K, Zoller M, Freyschmidt-Paul P, Hoffmann R. Vancouver Coastal Health and Research Institute, Vancouver, Canada.


[18] Minerva Gastroenterol Dietol.  1999 Dec;45(4):283-285.  Reappearence of alopecia areata in a coeliac patient during an unintentional challenge with gluten.  Viola F, Barbato M, Formisano M, Premate FM, Lucarelli S, Frediani T, Cardi E.   Servizio di Gastroenterologia Pediatrica, Universita degli Studi di Roma, <<La sapienza>>, Roma, Italy.


[19] Eur J Dermatol. 2006 Jan-Feb;16(1):94-5. These is no relationship between hepatitis C virus and alopecia areata.   Jadali Z, Mansouri P, Jadali F.


[20] J Eur Acad Dermatol Venereol. 2005 Sep;19(5):552-5. Alopecia areata treatment with a phototoxic dose of UVA and topical 8-methoxypsoralen.

Mohamed Z, Bhouri A, Jallouli A, Fazaa B, Kamoun MR, Mokhtar I.

Department of Dermatology, Hopital Habib Thameur, Tunis, Tunisia. mohamed.zghol@rns.tn


[21] Australas J Dermatol. 2003 May;44(2):106-9. PUVA treatment of alopecia areata totalis and universalis: a retrospective study. Whitmont KJ, Cooper AJ. Royal North Shore Hospital, Pacific Highway, St Leonards, New South Wales, Australia.



[22] Blood. 2005 Jan 1;105(1):426-7. Epub 2004 Apr 8. Complete remission of alopecia universalis after allogeneic hematopoietic stem cell transplantation.

Seifert B, Passweg JR, Heim D, Rovo A, Meyer-Monard S, Buechner S, Tichelli A, Gratwohl A. Stem Cell Transplant Team, Hematology Division, Department of Internal Medicine, Basel University Hospitals, Switzerland.


[23] J Investig Dermatol Symp Proc. 2003 Jun;8(1):12-7. Alopecia areata: treatment of today and tomorrow. Freyschmidt-Paul P, Happle R, McElwee KJ, Hoffmann R. Department of Dermatology, Philipp University, Marburg, Germany. freyschm@mailer.uni-marburg.de


[24] : J Am Acad Dermatol. 2003 Jul;49(1):96-8.  Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis. Tosti A, Piraccini BM, Pazzaglia M, Vincenzi C. Department of Dermatology, University of Bologna, Italy. tosti@almadns.unibo.it


[25] Ann Dermatol Venereol. 2003 Mar;130(3):326-30.  Comment in:

Ann Dermatol Venereol. 2004 Mar;131(3):286-7. [Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients] [Article in French]

Assouly P, Reygagne P, Jouanique C, Matard B, Marechal E, Reynert P, Bachelez H, Dubertret L. Centre de Sante Sabouraud, Paris. p.assouly@wanadoo.fr


[26] J Am Acad Dermatol. 2005 Jun;52(6):1082-4. Etanercept does not effectively treat moderate to severe alopecia areata: an open-label study. Strober BE, Siu K, Alexis AF, Kim G, Washenik K, Sinha A, Shupack JL. The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA. b_strober@hotmail.com


[27] Arch Dermatol. 2002 Aug;138(8):1102-3.  Alopecia universalis completely resolved following autologous bone marrow transplantation. Feher O, Sant'Ana RO, Valadares AD, Anelli A.


[28] Int J Dermatol. 2003 Jun;42(6):434-7. Alopecia areata: psychiatric comorbidity and adjustment to illness. Ruiz-Doblado S, Carrizosa A, Garcia-Hernandez MJ.

Consultation-Liaison Psychiatric Unit, Osuna Hospital, and Department of Dermatology, School of Medicine, University of Seville, Seville, Spain. sergioruiz@cica.es



[29] : Ther Umsch. 2002 May;59(5):233-7.  [Alopecia areata][Article in German]Friedli A, Harms M. Policlinique de la Dermatologie, Hopital Cantonal Universitaire de Geneve.


[30] Dermatology. 2001;202(3):230-4.  High-dose pulse corticosteroid therapy in the treatment of severe alopecia areata. Seiter S, Ugurel S, Tilgen W, Reinhold U. Department of Dermatology, Saarland University Hospital, Homburg/Saar, Germany.



[31] J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):597-602.  Pulse methylprednisolone therapy for severe alopecia areata: an open prospective study of 45 patients. Friedli A, Labarthe MP, Engelhardt E, Feldmann R, Salomon D, Saurat JH. Department of Dermatology, University Hospital of Geneva, Switzerland.


[32] Int J Dermatol. 1998 Aug;37(8):622-4.  Severe alopecia areata treated with systemic corticosteroids. Alabdulkareem AS, Abahussein AA, Okoro A. Department of Dermatology, King Fahd Hospital of the University, Dammam, Saudi Arabia.


[33] Int J Tissue React. 2005;27(3):107-10. Oral administration of cyclosporin A in patients with severe alopecia areata.   Rallis E, Nasiopoulou A, Kouskoukis C, Roussaki-Schulze A, Koumantaki E, Karpouzis A, Arvanitis A.    Department of Dermatology, Veterans Administration Hospital (NIMTS) of Athens, Greece. efrall@otenet.gr


[34] Am J Clin Dermatol. 2005;6(6):403-6.    Comparison of azelaic Acid and anthralin for the therapy of patchy alopecia areata : a pilot study.    Sasmaz S, Arican O.     Department of Dermatology, School of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.


[35] Int J Dermatol. 2005 Dec;44(12):1065-7.                Infant alopecia universalis: role of topical PUVA (psoralen ultraviolet A) radiation.     Yoon TY, Kim YG.    

[36] Br J Dermatol. 2006 Jan;154(1):190-1.   Alopecia universalis treated with bone morphogenetic protein?

    Leslie KS, Shah SN, Darrah C, Cooper A, Valentin-Opran A, Patel AD, Donel ST.    



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