Yan Xin, Tayier Munire, Cheang Sin Tong, Liao Zhongmin, Dong Yi, Yang Yifeng, Ye Yanting, Zhang Xingqi
Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangdong Province 510080, China.
Ther Adv Chronic Dis. 2023 Aug 4;14:20406223231191049. doi: 10.1177/20406223231191049. eCollection 2023.
Alopecia areata (AA) is a chronic inflammatory disease mainly involving Th1 immunoreaction, but Th2 is also involved. A 9-year-old girl presented to our clinic with severe alopecia for 2 months and pruritus-related rashes for 8 years. She was diagnosed with AA and atopic dermatitis (AD), and the Severity of Alopecia Tool (SALT) score was 98. She used a 0.05% halometasone cream (occlusive dressing) topically applied overnight (6 days weekly) for 10 months. After 2 months of treatment, she had regrowth of both black and white hair. However, relapse occurred and she gradually lost all black terminal hair, but white terminal hair remained, with a SALT score of 70. Continuous topical occlusion resulted in white hair regrowth with a SALT score of 20 at the end of month 10. Dupilumab was initially prescribed as a 600-mg subcutaneous injection and maintained at 300 mg every 4 weeks thereafter. Hair repigmentation (10% of whole hair density) started, with black hair shaft appearing at the proximal end in parietal-occipital and occipital areas after three injections at week 12 of dupilumab therapy, with a SALT score of 10. After seven injections at week 28, the percentage of black hair shaft reached up to 90, and she regained her black hair and the pigmented section of hair shaft continued to grow longer at the rate of normal hair growth. Nevertheless, 4 months after termination of dupilumab therapy, the black terminal hair began to fall off, and white vellus hair gradually regrew on the scalp, with a SALT score of 80. Dupilumab induces hair regrowth and repigmentation of white terminal hair without disturbing the anagen phase of hair follicles. Therefore, melanocytes in AA may be a potential target of Th2-related factors. Persistent regrowth of white hair may be used as a signal of Th2 dominance in AA management.
斑秃（AA）是一种主要涉及Th1免疫反应的慢性炎症性疾病，但Th2也参与其中。一名9岁女孩因严重脱发2个月、伴有瘙痒相关皮疹8年前来我院就诊。她被诊断为斑秃和特应性皮炎（AD），脱发严重程度工具（SALT）评分98分。她外用0.05%卤米松乳膏（封包），每周6天，每晚一次，持续10个月。治疗2个月后，她的黑白头发均有再生。然而，病情复发，她逐渐失去了所有黑色终毛，但白色终毛仍在，SALT评分为70分。持续外用封包治疗使白色头发再生，在第10个月末SALT评分为20分。最初使用度普利尤单抗600mg皮下注射，此后每4周维持300mg。毛发色素沉着（占全发密度的10%）开始出现，在度普利尤单抗治疗第12周注射3次后，顶枕部和枕部近端出现黑色毛干，SALT评分为10分。在第28周注射7次后，黑色毛干的比例达到90%，她重新长出了黑发，毛干的色素沉着部分继续以正常头发生长速度生长。然而，度普利尤单抗治疗终止4个月后，黑色终毛开始脱落，头皮上逐渐重新长出白色毳毛，SALT评分为80分。度普利尤单抗可诱导白发再生和色素沉着，且不干扰毛囊的生长期。因此，斑秃中的黑素细胞可能是Th2相关因子的潜在靶点。白发持续再生可能作为斑秃治疗中Th2占主导地位的一个信号。
