الفهرس | Only 14 pages are availabe for public view |
Abstract Alopecia areata is a common type of hair loss. It occurs in either sex, and any age can be affected. It usually presents with an oval patch or multiple confluent patches of asymptomatic, well-circumscribed, nonscarring alopecia areata that regrow spontaneously, but may also persist or progress to all scalp hair alopecia totalis or all body hair, including eyebrows and eyelashes alopecia universalis. Although there are several hypotheses proposed the etiology of AA, many factors have been descried such as genetic susceptibility, the atopic state, non- specific autoimmune reactions, neurological factors, infectious agents, and possible emotional stress . The histologic features of AA vary with the stage of the lesion. Active patches demonstrate peribulbar lymphocyic infiltrate, a reduction in the anagen/telogen ratio and miniaturized dystrophic hairs. In later stage, a reduction in the anagen/telogen ratio, miniaturized hairs, and many fibrous tracts, some with lymphocytic cells or pigment incontinence are seen. Most evidence supports the hypothesis that AA is T-cell mediated autoimmune disease and their cytokines and chemokine play an important role. The immune response present in AA is associated with aberrant lesional expression of IFN-γ, IL-2 and IL-1β and over expression of ICAM-1 and MHC molecules on hair follicle keratinocytes and dermal papilla cells. RANTES production is markedly induced through subsequent stimulation with TNF-α and INF-γ in combination. RANTES production by keratinocytes may contribute to the recruitment of specific inflammatory infiltrate as lymphocytes and eosinophils to which Summary & Conclusion RANTES is chemotactic and which are involved in the pathogenesis of AA. The aim of this study is to evaluate the serum RANTES levels in patients with AA with or without atopy and comparing their levels with normal subjects as controls trying to evaluate its role in pathogenesis of AA and if it could be used as a marker of atopy in AA patients. This study was carried on 75 subjects, 54 patients with AA and 21 apparently health persons they were 33 females and 42 males with age ranging from (7-50) years. The patients were attendants of out patients clinic of Dermatology Department, Menoufiya University hospital during the period from December 2009 to April 2010 . They were classified into the following 4 groups : • Group I: included mono AA patients (one or two lesions). They are 26 patients (34.66%), 10 females (38.5%) and 16males (61.5%), their aged ranged between (7-50) years. • Group II: included poly AA patients (three or more lesions). They were18 patients (24%), 11 females (61.1%) and 7 males (38.9%), their aged ranged between (7-47) years. • Group III: included AT/AU patients (complete loss of body hair ). they were 10 patients (13.33%), 2 females (20%) and 8 males (80%) their aged ranged between (17-45) years. • Group IV: included 21(28%) Age & sex matched healthy subjects as controls 10 females (47.6%) and 11 males (52.4%). Their ages were ranged between (7 -50 ) years. Patients with either spontaneous regrowth of terminal hair at time of presentation, patients using topical, intralesional or systemic agents as steroids or immunosuppressive likely to cause regrowth in AA within the past month or having other types of illness such as autoimmune diseases Summary & Conclusion and parisitic infestation were excluded by time of examination. Each patient was subjected to a detailed history taking and complete examination to detect type of AA and the extent(SALT score) of AA in addition to presence or absence of atopy. Blood samples were taken from all subjects to assess serum RANTES and total IgE and complete blood count. The obtained data are tabulated and subjected to statistical analysis using different tests of significance. Our results revealed that serum levels of RANTES to be significant highly increased in patients with AA when compared with controls. The elevation of serum RANTES levels was positive correlated to the extent of AA and not related to type of AA . Also, elevated serum RANTES levels were associated with the presence or absence of atopy that increased in atopic AA patients. A positive correlation also existed between RANTES levels and IgE as well as eosinophil percent . No correlation was demonstrated between RANTES levels and age, sex of patients, previous episode(s) of AA, Hb concentration, RBCs , platelets and WBCs counts or other skin or systemic diseases. Regarding the IgE level there was a significant difference in serum total IgE in all patients groups of AA when compared to control group and there was also a significant difference of serum level of IgE with and without atopy in all patients groups of AA when compared to control group. This study revealed also that there was a significant difference in the eosinophil percent in all patients groups of AA when compared to control group and there was also a significant difference of eosinophil percent with and without atopy in all patients groups of AA when compared to control group. |