Lim Ji-Hoon, Kang Da-Hyun, Moon Haena, Kwon Soon-Hyo, Lew Bark-Lynn
Department of Dermatology, Kyung Hee University hospital at Gang-Dong, Kyung Hee University School of Medicine, Seoul, Korea.
J Dermatol. 2025 Jul;52(7):1138-1145. doi: 10.1111/1346-8138.17745. Epub 2025 May 24.
Acute diffuse and total alopecia (ADTA) is a variant of alopecia areata (AA) that lacks the typical patchy hair loss seen in classical AA and presents with an acute onset of diffuse hair loss. It has a favorable prognosis.
The purpose of this study was to assess the role of T-helper (Th) 17 cells and regulatory T cells (Tregs) in the pathogenesis of ADTA and their relevance to the good prognosis of ADTA.
Twenty-four patients with ADTA and 12 healthy controls were included. Scalp skin samples were obtained for quantitative polymerase chain reaction (qPCR) specific for Th17 cells and Treg-related cytokines. Serum cytokines associated with Th17 cells and Tregs were measured using enzyme-linked immunosorbent assays. Additionally, we performed immunostaining for Th17 cells and Tregs. The correlation of qPCR results, serum cytokine levels, and immunostaining results with clinical characteristics was examined.
Lesional IL-2, IL-10, and IL-23A levels were significantly higher in patients with ADTA than in controls. In the progressive stage, lesional IL-2, IL-13, and IL-23A levels were significantly increased compared to those in controls. Serum IL-15 levels were significantly lower in patients than in controls in the progressive stage. In the recovery stage, lesional IL-13 and IL-23A levels were significantly increased compared to those in controls. The ratios of Th17/CD4+ cells and Tregs/CD4+ cells surrounding hair follicles of the patients were 40.73% and 8.50%, respectively, according to immunostaining results.
The increased activity of Treg cells, suggested through IL-10 and IL-15, is a characteristic of ADTA that is distinct from AA. The increased function of Tregs may explain the favorable prognosis of ADTA. Follow-up studies focusing on Tregs, IL-10, and IL-15 are required.
急性弥漫性全秃（ADTA）是斑秃（AA）的一种变体，缺乏经典斑秃中典型的斑片状脱发，表现为急性弥漫性脱发。其预后良好。
本研究旨在评估辅助性T（Th）17细胞和调节性T细胞（Tregs）在ADTA发病机制中的作用及其与ADTA良好预后的相关性。
纳入24例ADTA患者和12名健康对照。获取头皮皮肤样本，用于Th17细胞和Treg相关细胞因子的定量聚合酶链反应（qPCR）。使用酶联免疫吸附测定法测量与Th17细胞和Tregs相关的血清细胞因子。此外，我们对Th17细胞和Tregs进行了免疫染色。检查qPCR结果、血清细胞因子水平和免疫染色结果与临床特征的相关性。
ADTA患者病变部位的白细胞介素（IL）-2、IL-10和IL-23A水平显著高于对照组。在进展期，病变部位的IL-2、IL-13和IL-23A水平与对照组相比显著升高。进展期患者血清IL-15水平显著低于对照组。在恢复期，病变部位的IL-13和IL-23A水平与对照组相比显著升高。根据免疫染色结果，患者毛囊周围Th17/CD4+细胞和Tregs/CD4+细胞的比例分别为40.73%和8.50%。
通过IL-10和IL-15提示的Treg细胞活性增加是ADTA不同于AA的一个特征。Tregs功能的增强可能解释了ADTA的良好预后。需要开展针对Tregs、IL-10和IL-15的随访研究。
