Alopecia areata

Abstract

Alopecia areata is an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Skin biopsies of affected skin show a lymphocytic infiltrate in and around the bulb or the lower part of the hair follicle in the anagen (hair growth) phase. A breakdown of immune privilege of the hair follicle is thought to be an important driver of alopecia areata. Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease. Several genetic susceptibility loci were identified to be associated with signalling pathways that are important to hair follicle cycling and development. Alopecia areata is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology can be helpful. Alopecia areata is difficult to manage medically, but recent advances in understanding the molecular mechanisms have revealed new treatments and the possibility of remission in the near future.

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Figure 1: Hair cycle.
Figure 2: Breakdown of immune privilege in alopecia areata.
Figure 3: C3H/HeJ mouse model of alopecia areata.
Figure 4: Clinical manifestations of alopecia areata.
Figure 5: Diagnostic tools to validate and differentiate alopecia areata.

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Acknowledgements

This work was supported in part by grants from the US NIH (R01AR056635 to J.P.S.; and P50AR070588, R01AR065963, R01AR056016, U01AR067173 and R21AR061881 to A.M.C.) and the National Alopecia Areata Foundation (L.E.K., A.M.C. and J.P.S.). Core facilities at The Jackson Laboratory were supported by the US National Cancer Institute (CA034196).

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Introduction (all authors); Epidemiology (C.H.P., L.E.K. and J.P.S.); Mechanisms/pathophysiology (C.H.P., L.E.K., A.M.C. and J.P.S.); Diagnosis, screening and prevention (A.G.M., A.M.C., L.E.K. and J.P.S.); Management (L.E.K., A.G.M. and A.M.C.); Quality of life (A.G.M., L.E.K. and J.P.S.); Outlook (L.E.K., A.G.M. and J.P.S.); Overview of the Primer (J.P.S.).

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Correspondence to John P. Sundberg.

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Competing interests

L.E.K. is on the scientific advisory committee for the National Alopecia Areata Foundation (NAAF) and the Cicatricial Alopecia Research Foundation (CARF). A.M.C. is on the scientific advisory committee for the NAAF and is a consultant for Aclaris Therapeutics, Inc. J.P.S. has or has had sponsored research contract with Biocon and the NAAF for preclinical trials using mouse models for alopecia areata, and is on the scientific advisory committee for the NAAF and is Chairman for the CARF. C.H.P. and A.G.M. have no competing interests.

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Pratt, C., King, L., Messenger, A. et al. Alopecia areata. Nat Rev Dis Primers 3, 17011 (2017). https://doi.org/10.1038/nrdp.2017.11

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