What’s new in hair — November 2015 | Dr. Yuval Ramot

Dissecting cellulitis of the scalp treated with tumour necrosis factor-α inhibitors: experience with two agents

Br J Dermatol. 2015 Nov 2. doi: 10.1111/bjd.14269. [Epub ahead of print]

Dissecting cellulitis of the scalp is a chronic, suppurative condition, which can lead to scarring alopecia and significant effect on the patient’s quality of life. Unfortunately, this condition is highly resistant to treatment, and no single treatment modality has been found to be beneficial in this disorder. In this research letter, Mansouri et al. report on two patients with severe dissecting cellulitis of the scalp that were treated with the TNF-α inhibitors adalimumab and infliximab. While the treatment was effective in reducing inflammation, it did not prevent the progression of scarring alopecia in both patients, maybe because of the delay in the initiation of the biologic treatment. This report adds to the very limited data available on the use of TNF-α inhibitors in dissecting cellulitis of the scalp. Additional clinical trials will be needed in order to reliably assess the effectiveness of these agents in this condition.


Extensive alopecia areata is reversed by IL-12/IL-23p40 cytokine antagonism

J Allergy Clin Immunol. 2015 Nov 19. pii: S0091-6749(15)01582-1. doi: 10.1016/j.jaci.2015.11.001. [Epub ahead of print]

The immunologic basis for alopecia areata has been revealed recently in a number of studies. One of the recent studies, performed by Suarez-Farinas et al. (J Am Clin Immunol, 2015) has showed that alopecia areata is associated with TH2 and IL-23p19 and IL-23/IL-12p40 activation in addition to TH1 skewing. This finding suggests that ustekinumab, an IL-12/IL-23p40 blocker that is in clinical use for psoriasis, might also benefit alopecia areata patients. To explore this hypothesis, Guttman-Yaski et al. have treated three patients with extensive alopecia areata with subcutaneous injections of 90 mg ustekinumab. This treatment led to some improvement in two of the patients (25 and 62.5% improvement), but the most striking finding was noted in the third patient, who had alopecia universalis, and experienced 85% of hair regrowth. It should be noted, though, that this patient had the shortest duration of disease (2 years). Scalp biopsies were also taken for microarray analysis, proving that clinical improvement was associated with normalization of immune abnormalities. While this is only a first report on only three patients, it provides evidence for the possibility of using ustekinumab as a treatment modality for alopecia areata, even for the more severe types of this disorder. It should be noted, though, that at least four cases have been reported in the past on alopecia areata developing in patients receiving ustekinumab treatment, therefore necessitating extra care when considering this treatment for alopecia areata patients.


Androgenetic alopecia as an indicator of metabolic syndrome and cardiovascular risk

Blood Press. 2015 Nov 20:1-8. [Epub ahead of print]

Several systemic disorders have been associated previously with androgenetic alopecia, including cardiovascular disease, hypertension, benign prostate hyperplasia and prostate cancer. In order to further assess the connection between androgenetic alopecia and cardiovascular risk and the metabolic syndrome, Ertas et al performed a prospective case–control study, comparing 51 male patients with early-onset androgenetic alopecia with 17 healthy male controls. They found that the metabolic syndrome was more prevalent in androgenetic alopecia patients. Additional studies in these patients showed that the carotid intima–media thickness values were significantly higher in patients with vertex pattern androgenetic alopecia than in patients without vertex baldness and controls and that the pulse-wave velocity values were also significantly higher in the patients. Overall, this study suggests that androgenetic alopecia serves as an independent risk factor for cardiovascular disease and the metabolic syndrome, especially in patients with hair loss on the vertex. However, this study was performed on a limited number of patients, and a larger study should be performed in order to confirm these findings.


Lichen planopilaris epidemiology: a retrospective study of 80 cases

An Bras Dermatol. 2015 Oct;90(5):666-70. doi: 10.1590/abd1806-4841.20153923

Soares et al. have performed a retrospective observational study in order to assess clinical, dermoscopic and histopathological findings in lichen planopilaris patients. Overall, they analysed 80 patients with lichen planopilaris, almost all of them are females. They found that scattered scalp lesions were the most prevalent clinical manifestation, and that vertex lesions alone were the rarest (seen in only 5% of the patients). Dermoscopic findings were reported in 54 patients, and perifollicular hyperkeratosis and reduction of the number of follicles were observed in almost all of the patients. Visible vessels, polytrichia, white dots and isolated terminal stalk were also common findings by dermoscopy. This large cohort exemplifies the variable presentation of lichen planopilaris, but is based on review of medical records, which can obviously bias the results.


Hoxc13 is a crucial regulator of murine hair cycle

Cell Tissue Res. 2015 Nov 9. [Epub ahead of print]

Hoxc13 has been shown previously to be of great importance in hair differentiation, as was also observed in humans with mutations in the encoding gene, resulting in pure hair and nail ectodermal dysplasia. To further explore the role of Hoxc13 in the hair cycle and growth, Qiu et al performed a series of experiments in mice. First, they showed that Hoxc13 expression is highest during the anagen phase, and decreases in the telogen phase. Knockdown of the Hoxc13 gene using ShRNA injections resulted in premature catagen entry, and injection of recombinant Hoxc13 polypeptide prolonged the anagen phase. This effect in suggested to be mediated by inhibiting the TGF-β1 signalling. Overall, this study shows the crucial role of Hoxc13 in the regulation of the hair cycle, and adds to the current available understanding on the importance of this protein for normal hair growth.


ILK index and regrowth in alopecia areata

J Investig Dermatol Symp Proc. 2015 Nov;17(2):47-9. doi: 10.1038/jidsymp.2015.27

Intralesional corticosteroid injections are considered first line therapy for localized alopecia areata. Nevertheless, the exact concentration and dosing of this treatment are still unknown. Therefore, Stallings et al. performed a retrospective study, utilizing a new tool, which they termed the inralesional kenalog index (ILK index), which relates to the ratio of ILK received/initial SALT score. By analysing results from 15 alopecia areata patients, they found that patients with a significant improvement in their SALT score had a higher ILK index, in contrast to the patients with suboptimal results. Taken together, this study shows that the ILK index may become useful in the future for guiding alopecia areata treatment.

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