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The Renaissance
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Regarding alopecia and ophiasis, the former involves loss of almost the entire head of hair, whereas ophiasis is a loss in only certain areas and resembles the pattern of a snake (ophis, Greek for snake). When decayed, blood, phlegm, yellow bile, and black bile can each give rise to these types of hair loss. Management of both conditions depends on first determining the causative corrupt humor, then purging the patient of that humor, maintaining a healthy diet that promotes good juices and easy digestion, and avoiding sexual indulgence and other exertions. When blood is the causative humor, the patient is bled from the side of the body more heavily affected by the hair loss; if phlegm is the cause, bleeding is to be avoided, but a separate purging medicament is suggested. For bile, purging using rhubarb pills is appropriate. He described the proper linament (topical agent) to treat the affected areas of the scalp, with the best are ones able to penetrate deep into the scalp and “break up, evacuate, and dissipate heavy humors.”57 His concluding comments that the cantharides enhance penetration of other medications through the blistered skin are still relevant and used in modern dermatology practices.
Emerging Oral Treatments: Oral JAK Inhibitors for Alopecia Areata
Published in Rubina Alves, Ramon Grimalt, Techniques in the Evaluation and Management of Hair Diseases, 2021
Jared Marc John, Rodney Sinclair
Tofacitinib was the first JAK inhibitor to be tested in skin diseases and is the most widely studied. Its efficacy in AA was first reported in 2014 and since then, several open-label studies and case reports have been published (Table 11A.2) [18]. Response rates of about 75% were reported in studies on adults and children, with more than half of all patients experiencing a Severity of Alopecia Tool (SALT) score improvement of ≥50% (Figure 11A.3). Two large studies found that patients with AA and ophiasis subtypes were more responsive than AT and AU [3, 19]. Relapse commonly occurred 3-6 months after tofacitinib discontinuation [3, 20]. It was also observed when tofacitinib dose was tapered [21].
Geriatric hair and scalp disorders
Published in Robert A. Norman, Geriatric Dermatology, 2020
Alopecia areata is an inflammatory, non-scarring form of hair loss characterized by round or oval patches of complete hair loss. Any hair-bearing area can be affected. The loss can progress to loss of all scalp hair (alopecia totalis) or complete loss of all hair on the body (alopecia universalis). There are several distinctive forms affecting between 0.1% and 0.2% of the population147. Twelve per cent of cases initially present over the age of 50 years. In these patients it may present with any form seen in other age groups: patchy, ophiasis, reverse ophiasis, reticulate, diffuse, totalis and universalis. In both cases, seen in Figures 19 and 20, this was the patient’s first episode of alopecia areata. The geriatric population is more likely to present with the expression of other autoimmune diseases, if genetically susceptible. It is recognized that alopecia areata may preferentially attack pigmented hairs and may spare white hair. Patients with significant numbers of gray or white hairs may shed pigmented hairs only. Figure 21 (a 8c b) shows sequential hair loss in one individual over some four months; pigmented hairs were lost before unpigmented ones. The patient was left entirely white haired. This may explain the phenomenon of apparent rapid graying of hair. When hair regrows, it may grow as white hair only, initially or permanently (Figure 22). Although alopecia areata tends to be more severe when presenting in younger age groups, it can be extensive and aggressive even in geriatric patients with a first episode.
Association of Autoimmune Regulator Gene Rs2075876 Variant, but Not Gene Expression with Alopecia Areata in Males: A Case–control Study
Published in Immunological Investigations, 2020
Eman A. Toraih, Hatem M Ameen, Mohammad H. Hussein, Ahmed A. Youssef Elabd, Abeer M. Mohamed, Abdelhady Ragab Abdel-Gawad, Manal S. Fawzy
Stratification analysis by clinical pattern demonstrated poor severity. Stratification by other clinical variables showed that obese patients were more likely to develop associated nail changes (21.2 versus 3.1%, p = .007) and RA (66.7% versus 7. 4%, p = .022). Higher percentage of affected scalp area was associated with ophiasis pattern of hair loss (p < .001). Alopecia patients with therapeutic response were significantly non-atopic (p = .047), having no prior AA manifestations (p = .001), and their current disease lasted less than 1 year (p < .001). A significantly impaired quality of life in AA patients was detected with prolonged disease duration more than 1 year (83.3% versus 45.9%, p < .001), nail changes (93.9% versus 28.1%, p < .001), and concomitant autoimmune disease (84.2% versus 28.8%, p = .028).
Evaluation of HLA class I and HLA class II allele profile and its relationship with clinical features in patients with alopecia areata: a case–control study
Published in Journal of Dermatological Treatment, 2022
Yıldız Hayran, Melek Gunindi Korkut, Ayşe Öktem, Orhan Şen, Güneş Gür Aksoy, Füsun Özmen
Although AA is a benign self-limiting disease, poor prognostic such as extensive hair loss, early onset, ophiasis, and positive family history were also identified (6,42,43). Previous studies investigating genetic factors associated with poor prognosis revealed that HLA-A*02, HLA-A*03, HLA-B*27 alleles were more frequent in patients with positive family history of AA; HLA-A*02, HLA-B*27, HLA-C*07:02 alleles were more frequent in patients with alopecia totalis or universalis, HLA-DQA1*01:04 and HLA-DQB1*06:04 alleles were associated with longer disease duration and similar to our results HLA-DRB1*11 allele was associated with juvenile onset of the disease (16,18,19,44). In our study, HLA-B*13 and HLA-DRB1*11 alleles were associated with presence of at least one poor prognostic factor. Prognostic factors associated with HLA-B*13 and HLA-DRB1*11 alleles were different from each other suggesting a tendency of prognostic factors toward an allele. A previous study conducted in Turkey showed that more severe forms of alopecia areata tend to have longer disease duration. The study also showed that patients with ophiasis had more severe AA, longer disease duration and earlier disease onset suggesting a possible common pathway in etiology of severe, early onset longer AA (45). Our study showed that severe disease, presence of ophiasis, and juvenile onset were more frequent among patients with HLA-DRB1*11 allele. Although disease duration in HLA-DRB1*11 (+) patients was longer, the results did not reach the statistical significance. A common antigen presented on HLA-DRB1*11 molecule could be responsible for longer, severe and early onset AA with ophiasis.
Post-cochlear implant surgery Alopecia Areata in ophiasis pattern
Published in Hearing, Balance and Communication, 2022
Stephen Dalton-Petillo, Peter Volsky
A poorly understood autoimmune phenomenon, alopecia areata (AA) has a lifetime incidence of around 2% [1] and a median age of diagnosis of 33 [2], suspected to be a result of inflammation of hair follicles by CD4+ and CD8+ T-cells due to environmental and genetic factors. There are numerous types of alopecia areata including totalis (involving the entire scalp), universalis (the entire scalp plus face), patchy, persistent patchy, inversus, and ophiasis [2]. Features consistent with alopecia areata ophiasis (AAO) included the complete loss of hair in the temporal and occipital region and the progressive nature [2]. Hair loss can spontaneously cease, although the timeline for hair regrowth is variable from months to years [2].