Alopecia Areata: Pathophysiology, Current Treatments, and The Emerging Role of Herbal Remedies

Savita Verma, Anupama Kumari, Shaistah Zahrah Maqbool, Anjali Chauhan, Muskan, Abhay Sharma,

doi:10.5281/zenodo.18185816

Review Paper | Open Access
Volume 03 | Issue 01 | Article Id IJPS/250312634

Alopecia Areata: Pathophysiology, Current Treatments, and The Emerging Role of Herbal Remedies
Savita Verma* Anupama Kumari Shaistah Zahrah Maqbool Anjali Chauhan Muskan Abhay Sharma
School of Pharmacy and Emerging Sciences, Baddi University of Emerging Sciences & Technology, Makhnumajra, Distt Solan, Tehsil Baddi, Himachal Pradesh 173205

Abstract

Hair is a keratinized epithelial structure, provides defense against exposure to sunlight. The anagen, catagen and telogen phases are the successive cycles that the hair growth goes through. An autoimmune disease called alopecia areata occurs when there is early transition of hair growth phase from anagen to the catagen, telogen, and exogen phase and results in hair loss. This review paper includes hair physiology, alopecia areata pathophysiology and herbal plants potential of alopecia areata over allopathic treatment.

Keywords

Keratinized epithelial structure, anagen, catagen, telogen, alopecia areata.

Introduction

Keratinization of germinative cells results in better epithelial structure, which is what is known as hair, that provides the scalp with the best defense against exposure to sunlight [1, 2]. It serves as the body’s protective appendages and is regarded as an integumentary accessory structure, together with sweat and sebaceous glands. Chemical components, including carbon, nitrogen and oxygen, combine with keratin to form hair [3]. Human existence is significantly impacted by hair, which serves as a statement of pride. Having beautiful, healthy hair is crucial to one’s image [2, 15]. Although each person’s hair grows differently, on average, it grows 15-30 mm every month [1].

An autoimmune disease called alopecia areata causes variable hair loss on scalp, face or body, which significantly lowers quality of life [7, 8, 23]. Non-scaring type hair loss is the second most prevalent form [7]. Worldwide, the disease’s lifetime incidence is 2% and its prevalence is 1 in 1000 [16]. In 75% of cases of alopecia areata, the scalp’s bald lesions are concentrated in one or more localized patches. Eye lashes and eyebrows may be affected by more widespread hair loss [17]. Although alopecia areata frequently causes psychological distress, it is not a life-threatening condition [7, 18, 19, 20]. Chronic conditions include lupus erythematosus, vitiligo, autoimmune hemolytic anemia, atopic dermatitis, thallium acetate poisoning, hormonal changes and thyroid illness are frequently linked to alopecia areata [7, 9, 21]. Moreover, ocular and nail disorders may be linked to alopecia areata [22]. Although in alopecia areata the leukocyte-mediated inflammation was discovered almost a hundred years ago, the immune system’s role in the pathophysiology of the condition has only been acknowledged as the main underlying cause since the late 1950s [7,9,24,25].

DIAGNOSIS:

Alopecia areata can influence any skin that bears hair, however, it usually influences the scalp first [9]. A well-defined bald patch free of itching, redness, peeling or scarring is the common clinical investigation of alopecia areata [7, 26]. Eight questions in the Alopecia Areata diagnostic form are used to separate patients with alopecia areata [7]. The instrument’s specificity is 97.8%, and it’s sensitivity is 89.9% [7, 27]. In roughly 10% to 15% of instances, alopecia areata can affect the nails; in certain populations, it can affect up to 44% [9, 28, 29, 30]. If alopecia areata’s clinical manifestation is unclear, a punch biopsy is performed [7].

PATHOPHYSIOLOGY:

The anagen, catagen, telogen phase are the successive cycles that the hair growth goes through [4, 12]. The primary factor influencing hair length is the anagen phase, lasts for two to six years on average. 85% of hair follicles on the scalp are in the anagen phase. When the growing cycle ends and a follicle starts to become dormant, the anagen phase is followed by a brief resting phase known as catagen[4, 5, 13, 14]. The catagen phase lasts 10-14 days. When the hairs enter the telogen phase, they go into a resting state. For 90-100 days, this period lasts [6, 10, 11]. 15% of hair follicles on the scalp are in the telogen phase [5].

The early transition of hair follicles from the anagen phase into the catagen, telogen, and exogen phase results in alopecia areata and causes a decrease in hair growth and a rise in hair fall. It is crucial to remember that the cause of alopecia areata, like any autoimmune disease, is complex [32].

Factor	Explanation
Genetic Factor	Concerning the hereditary predisposition to alopecia areata; Class II Human Leukocyte Antigen (HLA-D) gene (region on human chromosome 6) [9, 31, 33, 34].
Concomitant Factors	Multiple concomitant disorders are linked to alopecia areata, which includes Thyroid disease Vitiligo Lupus erythematosus Psychiatric disorders [2,9,35-41]
Oxidative Stress	There is higher levels of Superoxide Dismutase (SOD) antioxidant activity in the blood of alopecia areata patient [9, 42].
Vasculative System	Generally speaking, inflammation is frequently linked to increased blood flow to the affected areas. Lesions of alopecia areata exhibit elevated temperature, attributed to increased vascularization [9,43].
Environmental Factors	Many triggers variables have been suggested to be responsible for the commencement of an alopecia episode. Most often, it is described as either physical or emotional stress [9, 36, 44].

Alopecia areata’s precise pathophysiology is not fully known [32].The collapse of immunological privilege is thought to be the cause of alopecia areata [31, 45]. Our body has immune privilege in a number of cells and organs, including testes, eyes and central nervous system [32]. Hair follicles also possess immune privilege, as evidenced by their immune privilege site and low expression levels of Major Histocompatibility Complex (MHC) [31, 32, 46]. Immune privilege is thought to be associated with low levels of Major Histocompatibility Complex 1 (MHC 1) and MHC 2 expression in hair follicles, results in loss of this immunological privilege. It was discovered that NKG2D, an activating receptor frequently linked to the natural killer (NK) cell lineage, was expressed by CD8+ T cells in close proximity to the hair follicle. In the cell-transfer murine model of AA, it was discovered that this population of CD8+ NKG2D+ T cells was adequate for causing illness. Pro-inflammatory cytokines like IFNg, which are strongly produced by activated CD8+ T cells, tilt the microenvironment of hair follicles in favor of inflammation [80]. Major Histocompatibility Complex expression is stimulated by interferon gamma, which also enables the follicle’s secreted antigen to be delivered to T cells. The antigen hair follicles damaged by interleukin 15 (IL-15), which causes the regulatory T cells to be suppressed and CD8+ T cells to proliferate. This cause the follicles to accelerate into the catagen phase [32].

Fig.1. Pathophysiology of Alopecia Areata [32]

MANAGEMENT:

Drug Therapy

There are various drug therapies to treat alopecia areata. All therapies for alopecia areata focus on reducing hair loss and encouraging re-growth because there is no solution for the underlying issues. Additionally, because alopecia areata progresses in an unpredictable manner, treatment does not ensure regrowth, andrelapse is always possible. 34-50% alopecia patients experience a spontaneous recovery in hair growth within a year [7, 49].

Drug	Mode of Action	Adverse Effect
Corticosteroids [7,50,51]	Suppression of the pro-inflammatory cytokines and expression of anti-inflammatory cytokines	Folliculitis, atrophy, telangiectasia, acneiform eruptions
Minoxidil [5,47]	Peripheral vasodilator	Dermatitis or pruritus
Methotrexate [7,52]	Inhibiting dihydofolate reductase (DHFR)	Loss of appetite, headache
Sulfasalazine [5,7,47,53]	Prodrug activated to sulfapyridine and 5-aminosalicylic acid (5-ASA) act on T cells.	Gastro-intestinal distress, rash, hepatotoxicity, headache
Cyclosporine [5,7]	Inhibits calcineurine, prevents transcription of cytokines	High blood pressure, gum overgrowth
Apremilast [5,7]	Inhibits PDE4, reduce inflammation by increasing cyclic adenosine monophosphate (cAMP) levels	Weight loss, decreased appetite, insomnia
Anthralin [5,47]	Antimitotic	Swollen lymph nodes, skin staining (yellow-brown)
Anti-depressants [48,54-56]	Stress reduction	Acneiform eruptions
JAK inhibitor [48,57-60]	Down regulation of inflammatory cytokines	Risk of infections
Interlukin-2 (IL-2) [48,61]	Lowers lesional CD+8 count	Fatigue, local reaction at injection site
Platelet rich plasma (PRP) [48,62-65]	Reduce apoptosis of dermal papilla cells	Swelling, redness at injection sites
Parathyroid hormone- collagen binding domain [48,66]	Hair cycle stimulator	Hypercalcemia, localized irritation
Quercetin [48,67]	Reduction in inflammatory cytokines	Headache, tingling
Statins [48,68,69]	Inhibit lymphocyte function	Headache
Valproic acid [48,70]	Increase growth singnaling pathways	Hair loss
finasteride / dutasteride [5]	5-α -reductase	erectile dysfunction
Spironolacton [5]	inhibit production of androgen	Gynecomastia
Cimetidine [5]	Anti-androgen	Gynecomastia

Herbal Treatment

Alopecia areata can be treated in a no. of ways by various medical systems, such as allopathic, ayurveda or surgery. The majority of people use herbal medicine to prevent or lessen undesirable side effects from allopathic medications. Several herbs are used to stop hair loss and promote hair growth, these are described below [5].

Common Name	Biological Name	Family	Parts used	References
Shoeblack plant	Hibiscus rosa-sinensis Linn	Malvaceae	Leaves & Flower	(kuldeeep singh, 2016)
Giant Dodder	Cuscuta reflexa Roxb	Convolvulaceae	Stems	(kuldeeep singh, 2016)
Maek	Asiasari radix	Aristolochiaceae	Roots & Rhizomes	(kuldeeep singh, 2016)
African basil	Ocimum gratissum Linn	Lamiaceae	Leaves	(kuldeeep singh, 2016)
Aloe Vera	Aloe vera L.	Liliaceae	Leaves	(kuldeeep singh, 2016)
Ginkgo	Ginkgo biloba	Ginkgoaceae	Leaves	(kuldeeep singh, 2016)
Coat button	Tridax procumbens L.	Compositae	Leaves	(kuldeeep singh, 2016)
Shrubby Sophora	Sophora flavescens	Leguminous plants	Roots	(kuldeeep singh, 2016)
Bitter Apple	Citrullus colocynthis Schrad	Cucurbitaceae	Fruits	(kuldeeep singh, 2016)
Indian Spikenard	Nordostachys jatamansi	Valerianaceae	Rhizomes & Roots	(kuldeeep singh, 2016)
False Daisy	Eclipta alba L . Hassak	Asteraceae	Whole plant	(kuldeeep singh, 2016)
Shikakai	Acacia concinna	Mimosaceae	Leaves	(Pushpender kumar jain, 2016)
Neem	Azadirachta indica	Meliaceae	Leaves	(Pushpender kumar jain, 2016)
Brahmi	Bacopa monnieri	Scrophulariaceae	Leaves	(Pushpender kumar jain, 2016)
Camphor	Cinnamomum camphora	Lauraceae Camphor	Leaves	(Pushpender kumar jain, 2016)
Cinnamon	Cinnamomum zeylanicum	Lauraceae	Bark	(Pushpender kumar jain, 2016)
Lemon	Citrus limon	Rutaceae	Fruits	(Pushpender kumar jain, 2016)
Amla	Emblica officinalis	Euphorbiaceae	Fruits	(Pushpender kumar jain, 2016)
Eucalyptus	Eucalyptus sp.	Myrtaceae	Bark	(Pushpender kumar jain, 2016)
Alfalfa	Medicago sativa	Fabaceae	Leaves	(Pushpender kumar jain, 2016)
Indian olive	Olea europaea	Oleaceae	Fruits	(Pushpender kumar jain, 2016)
Avocado	Persea americana	Lauraceae	Fruits	(Pushpender kumar jain, 2016)
Sandalwood	Santalum album	Santalaceae	Bark	(Pushpender kumar jain, 2016)
Ritha	Sapindus mukorossi	Sapindaceae	Dried fruit	(Pushpender kumar jain, 2016)
Bhringraj	Tridax procumbens	Asteraceae	Leaves	(Pushpender kumar jain, 2016)
Greater Burdock	Arctium lappa L.	Asteraceae	leaves and root	(Skowronska W., 2021)
Indian pennywort	Centella asiatica L.	Apiaceae	leaves	(Saansoomchai P., 2018)
Indian Mulberry	Morinda citrifolia	Rubiaceae	fruits	(Susanti L, 2022)
Muskrat root	Acorus calamus	Acoraceae	roots	(Park Sang Oh , 2015)
Shell Ginger	Alpinia zerumbet	Zingiberaceaea	leaves	(Taira N., 2017)
Japanese flowering cherry	Cerasus serrulata		flower	(Zhang B., 2023)
Fragrant glory bower	Clerodendrum fragrans	Lamiaceae	leaves	(Anggraini I., 2019)
Indian coral tree	Erythrina variegata	Fabaceae	leaves	(Mustarichie R., 2017)
Guava	Psidium guajava L.	Myrtaceae	Leaves	(Ruksiriwanich W., 2022)

DISCUSSION:

Human existence is significantly impacted by hair, which serves as a statement of pride. Alopecia areata, an autoimmune condition causes patchy hair loss. Non-scarring type hair loss is the second most prevalent form. The early transition of hair growth phase from anagen into the catagen, telogen, and exogen phases results in alopecia areata. Although its pathophysiology is not fully known. The collapse of immunological privilege is thought to be the cause of alopecia areata. Alopecia areata can be treated with the allopathic method but to prevent undesirable side effects, several herbal plants are used. This article has covered hair cycle physiology, alopecia areata’s pathology, and herbal plants potential over allopathic treatment.

REFERENCES

Ashwini S. Pundkar, Prachi M. Murkute, Snahal Wani, Mohini Tathe; “A Review: Herbal Therapy used in Hair Loss”, Pharmaceutical Resonance 2020 vol. 3- Issue 1.
ArifRubianto, Garnadi Jafar, Deden Indra Dinata, Jajang Japar Sodik; “Review: The Potential of Herbal Plants as Anti-alopecia Medicines”, Medical Sains: JurnalIlmiahKefarmasian vol.9 no.2, April-June 2024.
R. Kaushik, D. Gupta, R. Yadav; “Alopecia: Herbal Remedies”, IJPSR, 2011; vol. 2(7): 1631-1637.
Pushpendra Kumar Jain, Debajyoti Das; “The Wonder of Herbs to Treat – Alopecia”, Innovare Journal of Medical Science, vol 4, issue 5, 2016.
K. Rashid, V. Baskar Ananda Raj, P.S Shiji Kumar, K.M Nishad; “Hair Care Promising Herbs: A Review”, Indo American Journal of Pharmaceutical Research.2020:10(03).
Kuldeep Singh, Faisal Saeed, Zeeshan Ahmad, Farogh Ahsan, Pragati Shakya; “Alopecia: introduction and overview of herbal treatment”, J. Chem. Pharm. Res., 2016, 8(8):59-64.
A. Sterkens, J. Lambert, A. Bervoets; “Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options”, Clinical and Experimental Medicine (2021) 21:215-230.
Tkachenko E, Okhovat J-P, Manjaly P, Huang KP, Senna MM, Mostaghimi A, Complementary & Alternative Medicine for Alopecia Areata: A Systematic Review, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/j.jaad.2019.12.027.
C. Herbert Pratt, Lloyd E. King Jr. Andrew G. Messenger, Angela M. Christiano, John P. Sundberg; “Alopecia areata”, Nat Rev Dis Primers; 3: 17011. doi: 10.1038/nrdp.2017.11.
P Ralf; C George. New Engl, J. Med., 1999, 341, 491-497.
HR Chitme; A Shashi; SK Jain; M Sabharwal. IJPSR, 2010, 1(2), 24-31.
Chase HB. Growth of the hair. Physiol Rev 1954;34:113-26.
Jain PK, Das D, Jain P. Evaluating hair growth activity of herbal hair oil. Int J PharmTech Res 2016;9(3):321-7.
Kevin J McElwee & Rodney Sinclair, Hair physiology and its disorders, Drug Discovery Today: Disease Mechanisms, 5 (2) (2008) 163-171.
Harris, B., 2021. Kerontokan Dan Kebotakan Pada Rambut. IbnuSina J. Kedokt. dan Kesehat. - Fak. Kedokt. Univ. Islam Sumatera Utara 20, 159–168.
Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin CosmetInvestig Dermatol. 2015;8:397–403.
Sato-Kawamura M, Aiba S, Tagami H. Acute diffuse and total alopecia of the female scalp .a new subtype of diffuse alopecia areata that has a favorable prognosis. Dermatology. 2002;205(4):367–73.
Rodgers AR. Why finding a treatment for alopecia areata is important: a multifaceted perspective. J Invest DermSymp. 2018;19(1):S51–3.
Hunt N, McHale S. The psychological impact of alopecia. BMJ (Clin Res). 2005;331(7522):951–3.
Azzawi S, Penzi LR, Senna MM. Immune privilege collapse and alopecia development: is stress a factor. Skin Appendage Disord. 2018;4(4):236–44.
Hordinsky MK. Overview of alopecia areata. J Invest DermSymp. 2013;16(1):S13–5.
Chelidze K, Lipner SR. Nail changes in alopecia areata: an update and review. Int J Dermatol. 2018;57(7):776–83.
Liu LY, King BA, Craiglow BG. Health-related quality of life (HRQoL) among patients with 439 alopecia areata (AA): A systematic review. J Am Acad Dermatol. 2016;75(4):806-812.e3.
McElwee KJ, et al. Comparison of alopecia areata in human and nonhuman mammalian species. Pathobiology: journal of immunopathology, molecular and cellular biology. 1998; 66:90–107.
Xing L, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014; 20:1043–1049. DOI: 10.1038/nm.3645.
Werner B, Mulinari-Brenner F. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata– part II. An Bras Dermatol. 2012;87(6):884–90.
Li DG, Huang KP, Xia FD, Joyce C, Scott DA, Qureshi AA, et al. Development and pilot-testing of the alopecia areata assessment tool (ALTO). PLoS ONE. 2018;13(6):e0196517.
Gandhi V, Baruah MC, Bhattacharaya SN. Nail changes in alopecia areata: incidence and pattern. Indian J Dermatol VenereolLeprol. 2003; 69:114–115.
Kasumagic-Halilovic E, Prohic A. Nail changes in alopecia areata: frequency and clinical presentation. J Eur Acad Dermatol Venereol. 2009; 23:240–241. DOI: 10.1111/j. 1468-3083.2008.02830.x.
Sharma VK, Dawn G, Muralidhar S, Kumar B. Nail changes in 1000 Indian patients with alopecia areata. Eur J Acad Dermatol Venereol. 1998; 10:189–191.
Ralph M. Trueb, Maria Fernanda Reis Gavazzoni Dias; “Alopecia Areata: a comprehensive Review of Pathogenesis and management” Clinic Rev Allerg Immunol (2018) 54:68-87.
The France Foundation, “Pathophysiology of Alopecia Areata”, 21 Jun 2022, https://youtu.be/413JH5Niln8?si=ovaMdernT0jdBqgv.
Price VH, Colombe BW; “Heritable factors distinguish twotypes of alopecia areata”, Dermatol Clin 1996; 14(4):679–689.
Barahmani N, et al. Human leukocyte antigen class II alleles are associated with risk of alopecia areata. J Invest Dermatol. 2008; 128:240–243.
Fricke ACV, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015; 8:397–403.
Chu SY, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011; 65:949–956.
Muller SA, Winkelmann RK; “Alopecia areata. An evaluation of 736 patients”, Arch Dermatol. 1963; 88: 290–297.
Cunliffe WJ, Hall R, Newell DJ, Stevenson CJ; “Vitiligo, thyroid disease and autoimmunity”, Br J Dermatol. 1968; 80(3):135–139.
Cunliffe WJ, Hall R, Stevenson CJ, Weightman D; “Alopecia areata, thyroid disease and autoimmunity”, Br J Dermatol. 1969; 81(12):877–881.
Puavilai S, Puavilai G, Charuwichitratana S, Sakuntabhai A, Sriprachya-Anunt S; “Prevalence of thyroid diseases in patients with alopecia areata” Int J Dermatol. 1994; 33(9):632–633.
Seyrafi H, Akhiani M, Abbasi H, Mirpour S, Gholamrezanezhad A; “Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients”, BMC Dermatol. 2005; 31;5:1.
Fattah NSA, Ebrahim A, Okda ESE. Lipid peroxidation/antioxidant activity in patients with alopecia areata. J Eur Acad Dermatol Venereol. 2011; 25:403–408.
Mijailovi? B, Mladenovi? T, Hrnjak M, Karadagli? D, Nikoli? B. Contact thermometry of lesions in alopecia areata. Vojnosanit Pregl. 1997; 54:31–33.
Fricke ACV, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015; 8:397–403.
Paus R, Bertolini M; “The role of hair follicle immune privilege collapse in alopecia areata: status and perspectives”, J Investig Dermatol Symp Proc. 2013; 16(1):S25–S27.
Paus R, Ito N, Takigawa M, Ito T; “The hair follicle and immune privilege”, J Investig Dermatol Symp Proc. 2003; 8(2):188–194.
Naseeha Islam, Patrick S.C Leung, Arthur C. Huntley, M. Eric Gershwin; “The autoimmune basis of alopecia areata: A comprehensive review”, Autoimmun Rev. 2015; 14(2): 81-9.
Darwin E, Hirt PA, Fertig R, Doliner B, Delcanto G, Jimenez JJ. Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options. Int J Trichol 2018;10:51-60.
Hammerschmidt M, Mulinari BF. Efficacy and safety of methotrexate in alopecia areata. An Bras Dermatol. 2014;89(5):729–34.
Horst HJ, Flad HD. Corticosteroid-interleukin 2 interactions: inhibition of binding of interleukin 2 to interleukin 2 receptors. Clin Exp Immunol. 1987;68(1):156–61.
Lee GC, Yang IM, Kim BJ, Woo JT, Kim SW, Kim JW, et al. Identification of glucocorticoid response element of the rat TRH gene. Korean J Intern Med. 1996; 11(2):138–44.
Lim S-K, Lim C-A, Kwon IS, Im M, Seo Y-J, Kim C-D, et al. Low-dose systemic methotrexate therapy for recalcitrant alopecia areata. Ann Dermatol. 2017; 29(3):263–7.
Rashidi T, Mahd AA. Treatment of persistent alopecia areata with sulfasalazine. Int J Dermatol. 2008; 47(8):850–2.
Kim HM, Lim YY, Kim MY, Son IP, Kim DH, Park SR, et al. Inhibitory effect of tianeptine on catagen induction in alopecia areata like lesions induced by ultrasonic wave stress in mice. Clin Exp Dermatol 2013;38:758 67.
Perini G, Zara M, Cipriani R, Carraro C, Preti A, Gava F, et al. Imipramine in alopecia areata. A double blind, placebo controlled study. Psychother Psychosom 1994;61:195 8.
Cipriani R, Perini GI, Rampinelli S. Paroxetine in alopecia areata. Int J Dermatol 2001;40:600 1.
Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med 2014;20:1043 9.
Anzengruber F, MaulJT, Kamarachev J, Trüeb RM, French LE, NavariniAA, et al. Transient efficacy of tofacitinib in alopecia areata universalis. Case Rep Dermatol 2016;8:102 6.
Mackay Wiggan J, Jabbari A, Nguyen N, Cerise JE, Clark C, Ulerio G, et al. Oral ruxolitinib induces hair regrowth in patients with moderate to severe alopecia areata. JCI Insight 2016;1:e89790.
Kennedy Crispin M, Ko JM, Craiglow BG, Li S, Shankar G, Urban JR, et al. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight 2016;1:e89776.
Castela E, Le Duff F, Butori C, Ticchioni M, Hofman P, Bahadoran P, et al. Effects of low dose recombinant interleukin 2 to promote T regulatory cells in alopecia areata. JAMA Dermatol 2014;150:748 51.
El Taieb MA, Ibrahim H, Nada EA, Seif Al Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatologic therapy. 2017;30(1).
Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet rich plasma: A potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040 6.
Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double blind, placebo and active controlled, half head study to evaluate the effects of platelet rich plasma on alopecia areata. Br J Dermatol 2013;169:690 4.
d’Ovidio R, Roberto M. Limited effectiveness of platelet rich plasma treatment on chronic severe alopecia areata. Hair Ther Transplant 2014;4. DOI: 10.4172/2167-0951.1000116.
Katikaneni R, Seymour AW, Gulati R, Ponnapakkam T, Gensure RC. Therapy for alopecia areata in mice by stimulating the hair cycle with parathyroid hormone agonists linked to a collagen binding domain. J Investig Dermatol Symp Proc 2015;17:13 5.
Wikramanayake TC, Villasante AC, Mauro LM, Perez CI, Schachner LA, Jimenez JJ, et al. Prevention and treatment of alopecia areata with quercetin in the C3H/HeJ mouse model. Cell Stress Chaperones 2012;17:267 74.
Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, et al. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol 2015;72:359 61.
Loi C, Starace M, Piraccini BM. Alopecia areata (AA) and treatment with simvastatin/ezetimibe: Experience of 20 patients. J Am Acad Dermatol 2016;74:e99 e100.
Lee SH, Yoon J, Shin SH, Zahoor M, Kim HJ, Park PJ, et al. Valproic acid induces hair regeneration in murine model and activates alkaline phosphatase activity in human dermal papilla cells. PLoS One 2012;7:e34152.
Skowronska W., Granica S., Dziedzic M., Kurkowiak J., Ziaja, M., Bazylko, A., “Comparison of Anti-Lipoxygenase and Antioxidant Activity as and from Roots”, 2021.
Saansoomchai P., Limmongkon A., Surangkul D., Chewonarin, T., Srikummool, M., “Enhanced VEGF expression in hair follicle dermal papilla cells by Centella asiatica linn.” Chiang Mai Univ. J. Nat. Sci., 2018, 17, 25–37.
Susanti, L., Mustarichie, R., Halimah, E., Kurnia, D., Setiawan, A., Maladan, Y., 2022. AntiAlopecia Activity of Alkaloids Group from Noni Fruit against DihydrotestosteroneInduced Male Rabbits and Its Molecular Mechanism: In Vivo and In Silico Studies. Pharmaceuticals 15.
Park SangOh, P.S., Park ByungSung, P.B., Noh GaYeong, N.G., 2015. Action mechanism of Natural Plant Extracts for hair loss prevention and hair growth promotion in C57BL/6 mice.
Taira, N., Nguyen, B.C.Q., Tawata, S., 2017. Hair Growth Promoting and Anticancer Effects of p21-Activated kinase 1 (PAK1) Inhibitors Isolated from Different Parts of Alpinia zerumbet. Molecules 22, 1–10.
Zhang, B., Zhang, W., Luo, J., He, J., Zheng, X., Zhu, S., Rong, B., Ai, Y., Zhang, L., He, T., 2023. Screening the Chemical Composition and Bioactivity of Cerasus serrulata Flower Extracts Using Two Extraction Methods . Pharmacogn. Mag. 19, 551–563.
Anggraini, I., Ferniah, R.S., Kusdiyantini, E., 2019. Bioteknologi & Biosains Indonesia. Bioteknol. Biosains Indones. 6, 39–52.
Mustarichie, R., Wicaksono, I.A., Gozali, D., 2017. Anti-alopecia activity of dadap (Erythrina variegata L.) leaves ethanol extract. J. Pharm. Sci. Res. 9, 1849–1854.
Ruksiriwanich, W., Khantham, C., Muangsanguan, A., Phimolsiripol, Y., Barba, F.J., Sringarm, K., Rachtanapun, P., Jantanasakulwong, K., Jantrawut, P., Chittasupho, C., Chutoprapat, R., Boonpisuttinant, K., Sommano, S.R., 2022b. Guava (Psidium guajava L.) Leaf Extract as Bioactive Substances for Anti-Androgen and Antioxidant Activities. Plants 11, 1–14.
Lensing M and Jabbari A (2022) an overview of JAK/STAT pathways and JAK inhibition in alopecia areata. Front. Immunol. 13:955035. doi: 10.3389/fimmu.2022.955035