Intervenções para alopecia areata - revisão sistemática e metanálise

• Ano de defesa: 2018
• Autor(a) principal: Freire, Paulo Celso Budri [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Patchy alopecia areta; Alopecia areata totalis; Alopecia areata universalis; Systematic review; Meta-analysis; Alopecia areata; Alopecia areta focal; Alopecia areata total; Alopecia areata universal; Revisão sistemática; Metanálise
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6867307; https://repositorio.unifesp.br/handle/11600/52492

Introduction: Alopecia areata (AA) is a complex immune and polygenic inflammatory disease that causes loss of hair from any area of the body. The extent, severity, and progression of the disease vary widely among individuals. It is considered one of the most frequent immune diseases, affecting 0.2% of the world population at any time of life. There are many uncertainties about the most appropriate interventions for AA. This is an update of the review published in 2008. Objectives: To update and evaluate the effectiveness and safety of AA interventions in children and adults of both sexes in its three most frequent subtypes, patchy AA (including ophiasis), AA totalis, and AA universalis. Methods: An extensive search was made in the world medical literature of randomized clinical trials on interventions. These were evaluated qualitatively and quantitatively according to the previously published protocol and seven defined outcomes. Results: 59 studies were selected, covering 73 types of topical and systemic interventions, grouped into 15 therapeutic groups, 86 statistical analyzes and 7 meta-analyses. The meta-analysis with minoxidil 5% vs. placebo presented a significant difference favorable to minoxidil, with the moderate quality of evidence in children and adults Focal AA (RR 8.37 [3.16 to 22.14], 95% CI). Zinc Sulfate Vs. placebo, in AA Focal children / adults (RR 7.33 [2.34 to 22.95], 95% CI); and clobetasol propionate 0.05% vs. placebo in AA Focal / AT of adults (RR 3.67 [1.12 to 11.9], 95% CI), presented significant differences over placebo, with evidence of very low quality. Conclusion: Treatments of patchy AA with high potency corticosteroids (betamethasone, clobetasol and triamcinolone), minoxidil, bimatoprost, latanoprost, PRP, garlic gel, onion juice, carboxytherapy, and aromatherapy showed statistically significant differences in studies with limited sample size. For AT and AU no statistically significant differences were found for the systemic treatments. Due to the low methodological quality of the studies, we are not confident that the evidence found are conclusive in relation to the interventions analyzed. Further studies with better methodological quality are required, with more participants and observation for longer than 6 months.