University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository




Dr. Tom Colletti, DHSc, PA-C, DFAAPA



Alopecia Areata (AA) is a complex dermatology condition with various manifestations and an unpredictable range of hair loss. Most of the treatments of AA are off label with limited efficacy, adverse effects are a significant concern in all types of AA treatment, and their probability of relapse is highly likely. Currently, available therapies are clinically more beneficial for milder AA cases. With a better understanding of AA pathogenesis, there is a future for more targeted therapies that are more effective with fewer side effects. This article review highlights the function of the hair follicle immune privilege and the epithelial cells that generate potent immunosuppressant agents. The immune privilege is a unique site where antigens are recognized without eliciting an inflammatory response. An autoimmune attack is driven by autoantigens, cytokines, and chemokines, leading to the excessive production of IFN-γ and interleukins. Alopecia areata results from overexpression of critical processes that attack the area of immune privilege around the hair follicles. Over the last few decades, genome-wide association studies (GWAS) have highlighted numerous potential factors that influence the cascade of mechanisms causing this polyautoimmune and inflammatory process, emphasizing possible causative etiologies and aiding in developing targeted therapies. These studies have identified that the pro-inflammatory cytokines such as IFN-γ and interleukins are responsible for activating the JAK-STAT signaling pathway. Understanding the JAK-STAT signaling pathway has directed research in developing targeted therapies that impede specific areas of these pathways to negate the activation of inflammatory disease states. JAK inhibitors (JAKis) are an emerging class of medication that have proven efficacious in treating inflammatory disease states but have not been FDA approved.


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