Retrospective Analysis of the Effect of Comorbid Atopic Dermatitis on the Treatment Response to Topical Immunotherapy in Pediatric Alopecia Areata Patients

Ayşe Mine  Gök; Özge  Aşkın; Server Serdaroğlu; Zekayi Kutlubay

doi:10.5826/dpc.1401a6

Retrospective Analysis of the Effect of Comorbid Atopic Dermatitis on the Treatment Response to Topical Immunotherapy in Pediatric Alopecia Areata Patients

Authors

Ayşe Mine Gök Şırnak State Hospital Dermatology Department, Şırnak, Turkey
Özge Aşkın Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Dermatology Department, Istanbul, Turkey
Server Serdaroğlu Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Dermatology Department, Istanbul, Turkey
Zekayi Kutlubay Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Dermatology Department, Istanbul, Turkey

Keywords:

alopecia areata, atopic dermatitis, topical immunotherapy

Abstract

Introduction: Alopecia areata is an organ-specific autoimmune disease. In addition, treatment options are limited in pediatric patients. Topical immunotherapy treatment may be preferred, especially in pediatric patients with severe and/or refractory alopecia areata.

Objectives: In this study, it was aimed to examine the effect of atopic dermatitis, which is one of the poor prognostic factors in pediatric alopecia areata, on topical immunotherapy treatment.

Methods: The data of patients aged 18 years and younger who received at least 20 sessions of topical immunotherapy with the diagnosis of alopecia areata in our clinic between January 2018 and December 2020 were analyzed.

Results: A total of 139 patients were included in the study. The mean age of the patients was 10.29 years, 67 (48.20%) of the patients were female, 72 (51.80%) were male, 24 (17.26%) of the patients had mild disease, 115 of them (82.73%) had severe disease. Atopic dermatitis accompanying alopecia areata was detected in 38 of the patients. Inadequate response was obtained in 60 (43.17%) patients and adequate response was obtained in 79 (56.83%) patients with topical immunotherapy treatment. In addition, the presence of atopic dermatitis in the patient group with inadequate response to treatment was found to be statistically significantly higher than the patient group with adequate response to treatment.

Conclusions: Topical immunotherapy treatment was found to be effective in 56.83% of pediatric alopecia areata patients included in the study. Our study showed that questioning pediatric alopecia areata patients for atopic dermatitis before topical immunotherapy treatment can predict the response to treatment.

References

Juárez-Rendón KJ, Rivera Sánchez G, Reyes-López MÁ, et al. Alopecia Areata. Current situation and perspectives. Arch Argent Pediatr. 2017;115(6):e404-e411. DOI: 10.5546/aap.2017.eng.e404. PMID: 29087123.

Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers. 2017;3:17011. DOI: 10.1038/nrdp.2017.11. PMID: 28300084. PMCID: PMC5573125.

Katakam BK, Behera B, Ranugha P, et al. IADVL SIG Pediatric Dermatology (Academy) Recommendations on Childhood Alopecia Areata. Indian Dermatol Online J. 2022;13(6):710-720. DOI: 10.4103/idoj.idoj_54_22. PMID: 36386742. PMCID: PMC9650746.

Zhou C, Li X, Wang C, Zhang J. Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management. Clin Rev Allergy Immunol. 2021;61(3):403-423. DOI: 10.1007/s12016-021-08883-0. PMID: 34403083.

Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev. 2006;5(1):64-69. DOI: 10.1016/j.autrev.2005.07.001. PMID: 16338213.

Serdaroğlu S, Oğuz O. Saç hastalıkları. In: Tüzün Y, Gürer MA, Serdaroğlu S, Oğuz O, Aksungur VL, editors. Dermatoloji. 2. 3. Baskı ed. İstanbul: Nobel Tıp Kitabevleri; 2008:1295-1344.

Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun. 2019;98:74-85. DOI: 10.1016/j.jaut.2018.12.001. PMID: 30558963.

Chanprapaph K, Mahasaksiri T, Kositkuljorn C, Leerunyakul K, Suchonwanit P. Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata. J Inflamm Res. 2021;14:4881-4891. DOI: 10.2147/JIR.S331579. PMID: 34588794. PMCID: PMC8473714.

Harries M, Macbeth AE, Holmes S, et al. Epidemiology, management and the associated burden of mental health illness, atopic and autoimmune conditions, and common infections in alopecia areata: protocol for an observational study series. BMJ Open. 2021;11(11):e045718. DOI: 10.1136/bmjopen-2020-045718. PMID: 34785540. PMCID: PMC8596050.

Hordinsky MK. Current Treatments for Alopecia Areata. J Investig Dermatol Symp Proc. 2015;17(2):44-46. DOI: 10.1038/jidsymp.2015.41. PMID: 26551946.

Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol. 2022;86(6):1318-1334. DOI: 10.1016/j.jaad.2021.04.077. PMID: 33940103. PMCID: PMC8556406.

Rattananukrom T, Suchonwanit P. Are drug treatment strategies really effective against alopecia areata? Expert Opin Pharmacother. 2021;22(3):257-260. DOI: 10.1080/14656566.2020.1854728. PMID: 33280456.

Boztepe G, Demirgüneş E, Gündüz Ö, Erkin G, Şahin S. Diphencyprone immunotherapy for alopecia areata: prospective clinical study. Turkderm-Turk Arch Dermatol Venereol. 2006;40(1):11-16.

Cranwell WC, Lai VW, Photiou L, et al. Treatment of alopecia areata: An Australian expert consensus statement. Australas J Dermatol. 2019;60(2):163-170. DOI: 10.1111/ajd.12941. PMID: 30411329.

Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore--a study of 219 Asians. Int J Dermatol. 2002;41(11):748-753. DOI: 10.1046/j.1365-4362.2002.01357.x. PMID: 12452996.

Trüeb RM, Dias MFRG. Alopecia Areata: a Comprehensive Review of Pathogenesis and Management. Clin Rev Allergy Immunol. 2018;54(1):68-87. DOI: 10.1007/s12016-017-8620-9. PMID: 28717940.

Conic RZ, Tamashunas NL, Damiani G, et al. Comorbidities in pediatric alopecia areata. J Eur Acad Dermatol Venereol. 2020;34(12):2898-2901. DOI: 10.1111/jdv.16727. PMID: 32531131.

Serarslan G, Savaş N, Yenin JZ. Is atopy and autoimmunity more prevalent in patients with alopecia areata? A comparative study. J Eur Acad Dermatol Venereol. 2012;26(6):720-723. DOI: 10.1111/j.1468-3083.2011.04152.x. PMID: 21692870.

Lee HJ, Hong NS, Kim SH, Jang YH. Association between Alopecia Areata and Comorbid Allergies: Implications for Its Clinical Course. Ann Dermatol. 2020;32(6):523-525. DOI: 10.5021/ad.2020.32.6.523. PMID: 33911798. PMCID: PMC7875230.

Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol. 2006;20(9):1055-1060. DOI: 10.1111/j.1468-3083.2006.01676.x. PMID: 16987257.

Zerbinati N, Esposito C, D'Este E, Calligaro A, Valsecchi R. Topical Immunotherapy of Alopecia Areata: A Large Retrospective Study. Dermatol Ther (Heidelb). 2018;8(1):101-110. DOI: 10.1007/s13555-018-0226-5. PMID: 29442292. PMCID: PMC5825331.