Alopecia areata is one of the most common forms of hair loss in children. Meantime, its clinical picture is similar to trichotillomania, thus, it leads to incorrect diagnosis and management. The article provides major differential diagnosis signs for these related forms of alopecia and describes in details trichoscopic features of alopecia areata and trichotillomania.
Трихоскопия является основным неинвазивным методом диагностики андрогенетической алопеции (АГА). Сформулированы трихоскопические критерии АГА, однако не существует однозначных данных о встречаемости основных трихоскопических признаков, в том числе при различных стадиях потери волос.
ЦЕЛЬ ИССЛЕДОВАНИЯ
Оценить частоту встречаемости основных трихоскопических маркеров у пациентов с АГА в зависимости от пола и стадии потери волос.
МАТЕРИАЛ И МЕТОДЫ
Обследованы 92 практически здоровых пациента с АГА. Всем пациентам в лобно-теменной зоне проведена трихоскопия при увеличении в 20 и 60 раз. Изучены основные трихоскопические маркеры АГА: анизотрихоз, увеличение доли одиночных фолликулярных юнитов и веллусных волос, наличие «желтых точек» и перифолликулярной гиперпигментации. Для определения встречаемости признаков в зависимости от стадии АГА всех пациентов разделили на две группы: группу с ранними стадиями алопеции и группу с выраженными стадиями алопеции.
РЕЗУЛЬТАТЫ
У пациентов с АГА наиболее часто встречающимися трихоскопическими признаками являются анизотрихоз, наличие «желтых точек» и увеличение доли веллусных волос, которые соответственно определяются в 86%, 85% и 83% случаев. Частота встречаемости этих признаков не зависит достоверно от пола пациента. При выраженных стадиях АГА по сравнению с ранними стадиями выявлено снижение частоты встречаемости веллусных волос — 64% и 91% соответственно (p<0,05) и увеличение частоты встречаемости одиночных фолликулярных юнитов — 86% и 45% соответственно (p<0,05).
ЗАКЛЮЧЕНИЕ
Основными трихоскопическими маркерами на ранних стадиях АГА являются анизотрихоз, увеличение доли веллусных волос и наличие «желтых точек», наличие 2 из 3 этих признаков обеспечивает постановку диагноза АГА на ранних стадиях с чувствительностью 73%. Основными трихоскопическими маркерами на выраженных стадиях АГА являются анизотрихоз, наличие «желтых точек» и увеличение доли одиночных фолликулярных юнитов, наличие 2 из 3 этих признаков обеспечивает постановку диагноза АГА с чувствительностью 78%.
Objectives This study aims to update the understanding of Alopecia Areata (AA) in Poland, Czechia, Russia, and Türkiye, focusing on the disease burden, clinical management, and patient journey. It seeks to establish a consensus on optimal management strategies for AA in these regions. Methods A modified 2-round Delphi panel was conveyed with 23 Dermatologists (Russia; 4, Türkiye; 7, Poland; 6, and Czechia; 6). The Delphi questionnaire consisted of 61 statements and 43 questions designed to obtain an overall understanding of the perception and acceptance of available information regarding the care of patients with alopecia areata. Results The study revealed that moderate-to-severe AA significantly impacts patients’ and their families’ QoL, consistent with previous studies. AA was found to cause more substantial impairment when additional lesions appeared in visible areas besides the scalp. Work and productivity impairment were notably higher in adults with moderate-to-severe AA. Diagnostic consensus highlighted the importance of skin biopsies and trichoscopy, while the need for more practical severity scoring systems was emphasized. Current treatments, including topical therapies, corticosteroids, and systemic immune modifiers, were deemed insufficient, highlighting the unmet medical need. Conclusion The Delphi study underscores a significant disease burden and unmet medical needs in patients with moderate-to-severe AA. It highlights the necessity of access to novel treatments and further research to develop more effective therapies with a tolerable safety profile. The findings align with global research, emphasizing the psychosocial impact of AA and the need for standardized, effective treatment protocols.
Background There is limited insight into the current disease burden and everyday clinical management of moderate-to- severe AD in Poland, Czechia, Russia, and Turkiye. Therefore, this study aimed to get information-driven insights regarding the current disease burden and clinical management of patients with moderate-to-severe AD with common and differentiating aspects of the patient journey and establish a consensus. Methods In this modified 2-round Delphi panel, 133 questions were asked in total to 27 dermatologists. A consensus was achieved when 70% of the panel members strongly agreed or agreed (or strongly disagreed or disagreed) with an item. Statements with <40% agreement dropped from the Delphi rounds and were not repeated. Results The results state that AD has a significant impact on the quality of life for both patients and their families with social and economic consequences in these countries. While there were significant dissimilarities regarding the current treatment approach by preference order and treatment duration among participants, there was also a high percentage of consensus on literature and guideline-based statements. Current topical therapies and the immune response modifiers were not found to be sufficient by panelists to cover the therapeutic needs of patients with moderate-to-severe AD. Moreover, panelists highlighted the significant burden of adverse events with the off-label use of currently available immunosuppressants. Conclusions These results underlined that there is a significant disease burden with an unmet treatment need for patients with moderate-to-severe AD in Poland, Czechia, Russia, and Turkiye.
Introduction . Atopic dermatitis (AD) is among a comorbid conditions in alopecia areata (AA), that influence the risk of development, severity of AA and the immunologic profile of the perifollicular inflammatory process. Narrowband UVB-311 nm, which has been successfully used in AD, is considered as a treatment for AA with limited efficacy, but may contribute to AA regression when combined with other therapies. The anti-inflammatory effect combined with the relative safety make it relevant to study the possibility of using this method in the treatment of AA in children. Aim . To evaluate the efficacy of NB-UVB 311 nm in the complex therapy of pediatric patients with coexisting diseases: AA and AD. Materials and methods . We conducted an open cohort comparative study with 49 patients 5–12 years old (mean age 7.4 ± 0.38 y.o.) with different clinical forms of AA. Group 1 included 22 patients with concomitant AD, group 2 consisted of 27 patients without AD. All patients received standard therapy of AA with topical glucocorticosteroids; patients of the first group also received a course of total NB-UVB 311 nm for the treatment of AD. The response to treatment was evaluated after 3 months and was considered as positive when hair regrowth was more than 30%. Results . In group 1 there was a significant predominance of patients who responded to treatment (77%) compared to group 2 – 48% (OR 3.7; CI [1.05;12.8] p = 0.045); the mean percentage value of SALT index in group 1 decreased by 46% from baseline values, in group 2 – by 26.6%; when comparing the groups by the percentage of alopecia regression p = 0.027. Conclusions . Combined treatment of AA including NB-UVB 311 nm, contributes to the tendency to more intensive hair regrowth. NB-UVB 311 nm can be considered as an additional option in the treatment of AA, associated with AD.
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