円形脱毛症の高齢者における糞便微生物移植後の発毛。症例報告および文献のレビュー

Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: A case report and review of the literature.

抄録

背景:

円形脱毛症は、遺伝、自己免疫、およびその他の要因に関連する脱毛症である。円形脱毛症と腸内細菌叢の間には興味深い関連性がある。糞便微生物叢移植（FMT）は、（以前は）感染症の治療に推奨されており、炎症性腸疾患、過敏性腸症候群、非アルコール性脂肪肝疾患の治療にも可能性を示している。

BACKGROUND: Alopecia areata is a hair loss disease associated with genetics, autoimmunity, and other factors. There is an intriguing link between alopecia areata and gut dysbiosis. Fecal microbiota transplantation (FMT) has been recommended to treat (previously known as ) infection, and has also shown potentials in the treatment of inflammatory bowel disease, irritable bowel syndrome, and non-alcohol fatty liver disease.

症例概要:

症例は86歳男性，S状結腸癌の既往があり，6カ月前から腹痛，腹部膨満感，下痢を繰り返し，不適応もみられた．入院時，うつ病と診断された．身体所見では、右後頭部に1.5cm×2.0cmの円形脱毛を認めた。臨床検査、カプセル内視鏡、大腸内視鏡が陰性であったため、非感染性下痢症、うつ病、斑状脱毛症と診断された。高齢者の非感染性下痢は腸内細菌の異常が主な原因と考え、FMTを6回実施した。FMT後1カ月で下痢は著明に改善し，食欲も出て，腹痛，腹部膨満感，抑うつ症状も消失した。驚くべきことに、FMTの前後に円形脱毛症の他の治療法を行うことなく、頭皮の患部に新たな発毛が認められ、白髪の一部が徐々に黒髪に変わっていったと報告した。

CASE SUMMARY: An 86-year-old man, with a history of sigmoid colon carcinoma, suffered from recurrent abdominal pain and distension, and diarrhea for six months, with inappetence. At admission, he was also diagnosed with depression. Upon physical examination, the patient presented with a 1.5 cm × 2.0 cm alopecia areata on his right occiput. Due to the negative results of laboratory testing, capsule endoscopy, and colonoscopy, the patient was diagnosed with noninfectious diarrhea, depressive disorder, and patchy alopecia areata. Considering that noninfectious diarrhea in the elderly patient was mainly caused by gut dysbiosis, he was given six rounds of FMT. His diarrhea improved remarkably one month after FMT, with improved appetite and disappearance of abdominal pain, distension, and depressive symptoms. Surprisingly, he reported new hair growth on the affected region of his scalp, with some of his white hair gradually turning to black, without taking any other therapies for alopecia areata before and after FMT.

結論:

FMTは円形脱毛症患者に対する潜在的な治療法として作用する可能性がある。円形脱毛症におけるFMTの役割を確認するためには、大規模でデザイン性の高い研究が必要である。

CONCLUSION: FMT might act as a potential therapy for patients who suffer from alopecia areata. Large and well-designed studies are required to confirm the role of FMT in alopecia areata.