What’s new in Hair – February 2018 | Dr. Sergio Vañó-Galván

Alopecia areata: An appraisal of new treatment approaches and overview of current therapies

J Am Acad Dermatol. 2018 Jan;78(1):15-24. doi: 10.1016/j.jaad.2017.04.1142.
Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J.

Interesting review of current and future therapies for alopecia areata, published in the Journal of the American Academy of Dermatology. Some of the most interesting conclusions of the article are:
-As spontaneous remission rates range from 8% to 68%, an expectant attitude may be appropriate for a subgroup of patients.
– Intralesional corticosteroids are considered a first-line treatment method for limited disease, and can be used as adjunctive therapy in extensive disease.
– Pediatric patients may prefer treatment with topical corticosteroids compared to injections.
– Diphenylcyclopropenone has a success rate of approximately 60% to 70%, and is an option for the treatment of patients with extensive disease (>50% scalp involvement).
– Oral Janus kinase inhibitors, including tofacitinib, ruxolitinib, and baricitinib, have
been shown to be efficacious in alopecia areata. The durability of response to these
medications is variable, and most patients experience recurrence of hair loss after discontinuation. Topical Janus kinase inhibitors may also be effective but have not been fully evaluated.
-New lines of research include the evaluation of the potential usefulness of the oral phosphodiesterase-4 inhibitor apremilast and the topical phosphodiesterase-4 inhibitor crisaborole.


Effectiveness Of Low-Level Laser Therapy In Lichen Planopilaris

J Am Acad Dermatol. 2017 Dec 1. pii: S0190-9622(17)32739-1. doi: 10.1016/j.jaad.2017.11.040.
Fonda-Pascual P, Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Pindado-Ortega C, Boixeda P, Vaño-Galvan S.

Experimental study about the potential usefulness of the anti-inflammatory action of low level light therapy (LLLT) in the treatment of lichen planopilaris (LPP). The authors included 8 patients (5 females and 3 males) diagnosed with LPP. Treatment with LLLT (630 nm) 15 min daily as monotherapy was performed for 6 months. Effectiveness was evaluated clinically (LPPAI) and by digital trichoscopy (Vidix®).
A symptomatic improvement in LPPAI was observed in 100% (mean decrease of 0.87 points). An increase in hair density was also observed in 4 patients (50%). No adverse effects were detected during the study.
Although the study had a small sample size, LLLT may be potentially useful in the treatment of LPP, and should be further confirmed in future research.


Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris

J Drugs Dermatol. 2017 Nov 1;16(11):1140-1142.
Strazzulla LC, Avila L, Lo Sicco K, Shapiro J.

Low-dose naltrexone has anti-inflammatory properties and has recently been described in the context of treating autoimmune conditions. At low doses of less than 5 mg daily, naltrexone acts paradoxically leading to an increase in endogenous opioids. In this interesting study, the authors treated with low-dose naltrexone (3 mg daily) 4 patients (2 females and 2 males) diagnosed with lichen planopilaris (LPP). A reduction in symptoms of pruritus, clinical evidence of inflammation of the scalp, and disease progression was achieved in all 4 patients. All patients tolerated naltrexone without adverse effects. These results suggest naltrexone may be a potential adjunctive therapy for LPP.


Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone

Int J Dermatol. 2018 Jan;57(1):104-109. doi: 10.1111/ijd.13838.
Sinclair RD.

In this interesting paper, Dr. Sinclair describes the effectiveness of a new regimen of therapy for female pattern hair loss (FPHL) with low-dose oral minoxidil and low-dose oral spironolactone. A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18–80). All were treated with oral minoxidil 0.25 mg daily plus oral spironolactone 25 mg daily.
Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months, while mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was 4.52 mmHg systolic and 6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment.
Based on these data, once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL.


Tissue and Circulating MicroRNA Co-expression Analysis Shows Potential Involvement of miRNAs in the Pathobiology of Frontal Fibrosing Alopecia

J Invest Dermatol. 2017 Nov;137(11):2440-2443. doi: 10.1016/j.jid.2017.06.030.
Tziotzios C, Ainali C, Holmes S, Cunningham F, Lwin SM, Palamaras I, Bhargava K, Rymer J, Stefanato CM, Kirkpatrick N, Vano-Galvan S, Petridis C, Fenton DA, Simpson MA, Onoufriadis A, McGrath JA.

Micro-ribonucleic acid molecules (MiRNAs) are relatively recently discovered small, endogenous, non-coding RNAs that affect various cellular processes underlying health and disease by exerting target gene expression regulatory functions. MiRNAs have emerged as potential candidates of prognostic, diagnostic and therapeutic interest in several disease processes, including chronic inflammatory, fibrotic and autoimmune diseases. It has recently been discovered that miRNAs can be also detected in plasma and serum, where they circulate in a stable form.
Currently, there are no validated markers of disease activity in frontal fibrosing alopecia (FFA). The objective of this study by Dr. Tziotzios et al was to characterize MiRNAs in FFA and to explore their disease relevance. The study had 2 phases: 1) Tissue miRNA analysis in 7 treatment-naive FFA and 7 healthy controls (all females), 2) Analysis of circulating miRNAs pertinent to fibrosis in another cohort of 10 treatment-naive FFA and 10 matched controls (all females).
There were 17 circulating miRNAs in common between cases and controls. Nine were representative in the FFA disease phenotype. Four of nine circulating miRNAs that correlated with FFA seemed to discriminate between FFA and controls (hsa-let-7d-5p; hsa-miR-18a-5p; hsa-miR-20a-5p; hsa-miR-19a-3p)
Based on these results, circulating miRNAs appear to have potential predictive value as biomarkers that should now be validated in larger cohorts.


Epithelial-to-Mesenchymal Stem Cell Transition in a Human Organ: Lessons from Lichen Planopilaris

J Invest Dermatol. 2017 Oct 26. pii: S0022-202X(17)33083-X.
Imanishi H, Ansell DM, Chéret J, Harries M, Bertolini M, Sepp N, Bíró T, Poblet E, Jimenez F, Hardman J, Panicker SP, Ward CM, Paus R.

Interesting paper about basic hair research in which Imanishi, Paus et al showed that epithelial-to-mesenchymal transition also occurs within the bulge, the epithelial stem cell niche of human scalp hair follicles, in the scarring alopecia lichen planopilaris (LPP). Epithelial-to-mesenchymal transition is critical for embryonic development and wound healing, and occurs in fibrotic disease and carcinoma. In the present study, the authors showed that a molecular epithelial-to-mesenchymal transition signature can be experimentally induced in healthy human epithelial stem cells in situ by antagonizing E-cadherin, combined with TGF-ß1, EGF, and interferon-γ administration. Furthermore, they showed that PPAR-γ agonism also attenuates the epithelial-to-mesenchymal signature even in lesional LPP hair follicles ex vivo.
The authors probed the working hypothesis that epithelial stem cells in the hair follicle bulge undergo epithelial-to-mesenchymal transition in LPP and that this process may be experimentally induced even in healthy human bulge epithelial stem cells ex vivo, if exposed to appropriate epithelial-to-mesenchymal transition-promoting stimuli. If confirmed, such an ex vivo assay should provide an excellent, clinically relevant model system for dissecting the as yet unclear molecular controls of human epithelial stem cells epithelial-to-mesenchymal transition in situ, and for identifying candidate drugs that counteract epithelial-to-mesenchymal transition of stem cells under clinically relevant conditions.

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