Alopecia Areata: Current Treatments and New Directions

IF 8.6 1区 医学 Q1 DERMATOLOGY
Dante Dahabreh, Seungyeon Jung, Yael Renert-Yuval, Jonathan Bar, Ester Del Duca, Emma Guttman-Yassky
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Abstract

Alopecia areata is an autoimmune hair loss disease that is non-scarring and is characterized by chronic inflammation at the hair follicle level. Clinically, patients’ presentation varies from patchy, circumscribed scalp involvement to total body and scalp hair loss. Current management is guided by the degree of scalp and body involvement, with topical and intralesional steroid injections as primarily first-line for mild cases and broad immunosuppressants as the mainstay for more severe cases. Until recently, the limited number of blinded, randomized, placebo-controlled clinical trials for this disease had made establishing an evidence-based treatment paradigm challenging. However, growing insights into the pathogenesis of alopecia areata through blood and tissue analysis of human lesions have identified several promising targets for therapy. T-helper (Th) 1/interferon skewing has traditionally been described as the driver of disease; however, recent investigations suggest activation of additional immune mediators, including the Th2 pathway, interleukin (IL)-9, IL-23, and IL-32, as contributors to alopecia areata pathogenesis. The landscape of alopecia areata treatment has the potential to be transformed, as several novel targeted drugs are currently undergoing clinical trials. Given the recent US FDA approval of baricitinib and ritlecitinib, Janus kinase (JAK) inhibitors are a promising drug class for treating severe alopecia areata cases. This article will review the efficacy, safety, and tolerability of current treatments for alopecia areata, and will provide an overview of the emerging therapies that are leading the revolution in the management of this challenging disease.

Abstract Image

斑秃:目前的治疗方法和新方向。
斑秃是一种自身免疫性脱发疾病,无疤痕,以毛囊水平的慢性炎症为特征。临床上,患者的表现从斑片状、局限性头皮受累到全身和头皮脱发不等。目前的治疗以头皮和身体受累程度为指导,轻度病例以局部和病灶内类固醇注射为主,较严重病例以广泛免疫抑制剂为主。直到最近,这种疾病的盲法、随机、安慰剂对照临床试验数量有限,这使得建立循证治疗模式具有挑战性。然而,通过对人类病变的血液和组织分析,对斑秃的发病机制有了越来越多的了解,已经确定了几个有前景的治疗靶点。辅助性T细胞(Th)1/干扰素偏斜传统上被描述为疾病的驱动因素;然而,最近的研究表明,其他免疫介质的激活,包括Th2途径、白细胞介素(IL)-9、IL-23和IL-32,是斑秃发病机制的贡献者。斑秃治疗的前景有可能改变,因为几种新的靶向药物目前正在进行临床试验。鉴于美国食品药品监督管理局最近批准了巴里西替尼和利替西替尼,Janus激酶(JAK)抑制剂是一种治疗严重斑秃病例的有前景的药物。这篇文章将回顾目前治疗斑秃的有效性、安全性和耐受性,并概述正在领导这一具有挑战性疾病管理革命的新兴疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
15.20
自引率
2.70%
发文量
84
审稿时长
>12 weeks
期刊介绍: The American Journal of Clinical Dermatology is dedicated to evidence-based therapy and effective patient management in dermatology. It publishes critical review articles and clinically focused original research covering comprehensive aspects of dermatological conditions. The journal enhances visibility and educational value through features like Key Points summaries, plain language summaries, and various digital elements, ensuring accessibility and depth for a diverse readership.
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