Alopecia Areata: Measuring Disease Activity

Serum granulysin as a possible key marker of the activity of alopecia areata.
Ono S, Otsuka A, Yamamoto Y, Kataoka TR, Koyanagi I, Miyachi Y, Kabashima K.
J Dermatol Sci. 2014 Jan;73(1):74-9. doi: 10.1016/j.jdermsci.2013.08.009. Epub 2013 Sep 2.

• Alopecia areata (AA) is an auto-immune inflammatory dermatosis of the scalp resulting in non-scarring rounded patches of alopecia on the scalp. On histological slides: a characteristic “swarm of bees” lymphocytic infiltrate is round around the hair follicles.
• The cause is unknown but it is sometimes associated with other auto-immune conditions such as thyroid disease.
• The problem of this condition is that it is very difficult to predict:

1. if il will become more widespread.
2. how long it is going to last.

• There are negative factors such as its extent, the presence of ophiasis (affecting all the cironferesnce of the head)…

• Additionally, it could be useful to monitor the activity of the disease:

1. as soon as the disease becomes inactive, the patient can expect the hair to regrow sometime in the foreseeable future.
2. Conversely if the disease is very active, it might extend.
3. This is not negligeable, as the disease is a great source of anxiety and social withdrawal.

• The authors found that serum granulysin could fill this role:

1. levels are elevated in acute and chronic AA.
2. in acute AA: higher levels are associated with a larger affected surface and a poorer prognosis.
3. granulysin bearing cells were found when immunohistochemistry was done in the “swarm of bees.”

• Conclusion: serum granulysin appears to be promising in measuring acute AA disease activity as well as prognosis.

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland