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Microbiota also modulate epithelial secretion of chemokines that attract immune cells&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Scientists who are currently exploring how the gut microbiome can influence immunity at remote sites such as the skin have proposed the existence of a &#8220;skin-gut axis&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An infectious cause of alopecia areata &#40;AA&#41; was hypothesized by David Gruby after he demonstrated the presence of <span class="elsevierStyleItalic">Microsporum audouini</span> around the hair follicles of individuals with the condition&#59; the species was then blamed for epidemics in schools and orphanages&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; while some dermatologists did isolate diverse fungi in patients with AA&#44; others failed to find associations between the disease and pathogens&#59; as a result&#44; attention was drawn away from a role for infection&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nevertheless&#44; there could be a possible role for pathogenic antigens and their increased activity in the immune system&#44; which could induce AA via epitope similarity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Another suggested role for gut microbiota is an effect on the differentiation of peripheral lymphocytes&#44; given that some regulatory T cells &#40;Tregs&#41; could be redirected to a part of the intestine where molecular and microbial signals convert forkhead box P3 negative &#40;Foxp3<span class="elsevierStyleSup">&#8211;</span>&#41; CD4<span class="elsevierStyleSup">&#43;</span> Treg cells to Foxp3<span class="elsevierStyleSup">&#43;</span> ones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The role of microbiota in the pathogenesis of various diseases is an emerging area of research&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Doubts remain about whether dysbiosis is a primary cause of disease or a secondary one associated with changes caused by a primary mechanism&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> but the possibility that therapeutic manipulation of the microbiome might be an option in conditions such as AA has been suggested&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This review summarizes recent evidence on the associations between the microbiome&#44; the process of dysbiosis&#44; its relation to alopecia&#44; and the implications for therapy&#46; We also discuss the composition of the microbiome and differences between that of healthy persons and patients with various types of alopecia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a narrative review of the subject&#46; We obtained articles published between 2015 and 2020 by searching in the Cochrane Library Plus&#44; Scielo&#44; DynaMed&#44; PubMed&#44; and Google Scholar&#46; The search terms were <span class="elsevierStyleItalic">microb&#42;</span> AND <span class="elsevierStyleItalic">alopecia</span>&#46; To identify the articles relevant to the purposes of the review &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; we read abstracts and results&#44; and when necessary&#44; the full texts to ascertain which ones contained pertinent information&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Normal Microbiome of the Skin and Hair Follicles</span><p id="par0025" class="elsevierStylePara elsevierViewall">The scalp has its own microbiome<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in a humid environment protected from UV light and with a pH favorable to microbial growth&#46; The environment contrasts with that of other skin surfaces&#44; which are dry&#44; exposed to UV light&#44; and have a low pH&#46; There exist additional differences related to area of the body&#44; ethnicity&#44; gender&#44; and the environment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Few studies have produced data on the microbiome of hair follicles&#46; However&#44; there is evidence that bacteria of the phyla Actinobacteria&#44; Firmicutes&#44; and Proteobacteria predominate on the surface of the scalp<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and that the most abundant organisms are <span class="elsevierStyleItalic">Cutibacterium</span> species &#40;especially <span class="elsevierStyleItalic">Cutibacterium acnes</span>&#41; and <span class="elsevierStyleItalic">Staphylococcus</span> species &#40;especially <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&#41;&#46; Other bacteria found on the scalp are <span class="elsevierStyleItalic">Corynebacterium</span>&#44; <span class="elsevierStyleItalic">Streptococcus</span>&#44; <span class="elsevierStyleItalic">Acinetobacter&#44;</span> and <span class="elsevierStyleItalic">Prevotella</span> species&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> The most prevalent fungi on the scalp are <span class="elsevierStyleItalic">Malassezia globosa</span> and <span class="elsevierStyleItalic">Malassezia restricta</span>&#46; Fungi in 2 phyla are present&#58; Ascomycota &#40;<span class="elsevierStyleItalic">Acremonium</span> species&#44; <span class="elsevierStyleItalic">Didymella bryoniae</span>&#44; <span class="elsevierStyleItalic">Coniochaeta</span> species&#44; and <span class="elsevierStyleItalic">Rhodotorula</span> species&#41; and Basidiomycota &#40;<span class="elsevierStyleItalic">Cryptococcus liquefaciens</span> and <span class="elsevierStyleItalic">Cryptococcus diffluens</span>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Scalp colonization by eukaryotic DNA viruses such as adeno-associated virus subtype 2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the human papilloma virus has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a><span class="elsevierStyleItalic">Demodex folliculorum</span> has been found in the follicular infundibulum and <span class="elsevierStyleItalic">Demodex brevis</span> in the sebaceous glands&#46; In addition&#44; Naspitz et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> found <span class="elsevierStyleItalic">Dermatophagoides</span> and <span class="elsevierStyleItalic">Euroglyphus</span> species on the scalp&#46; Although it is not known whether these microorganisms contribute to the physiology of the hair follicle&#44; it is known that they can generate proinflammatory and immunosuppressive responses&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Dysbiosis and Disease</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Alopecia Areata</span><p id="par0040" class="elsevierStylePara elsevierViewall">One study that sequenced the scalp microbiome of healthy subjects and patients with AA found between-group variation in bacterial populations&#58; the proportions of bacteria in the Actinobacteria and Firmicutes phyla&#44; respectively&#44; were 57&#46;4&#37; and 29&#46;2&#37; in the AA group and 56&#46;3&#37; and 35&#46;2&#37; in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The proportions assigned to <span class="elsevierStyleItalic">Propionibacterium</span> and <span class="elsevierStyleItalic">Staphylococcus</span> species in the AA group were 55&#46;1&#37; and 27&#46;4&#37;&#44; respectively&#44; and 45&#46;6&#37; and 32&#46;6&#37; in controls&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;Some patients with AA are known to experience a significant increase in <span class="elsevierStyleItalic">P acnes&#46;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;<a class="elsevierStyleCrossRef" href="#fn0005">&#42;</a> Alpha diversity was also higher in the patients&#44; in whom there was a decrease in the proportion of <span class="elsevierStyleItalic">S epidermidis&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> while <span class="elsevierStyleItalic">Staphylococcus aureus</span> proportions remained stable&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The authors found no significant differences in the <span class="elsevierStyleItalic">S epidermidis&#47;S aureus</span> ratio&#44; whereas the <span class="elsevierStyleItalic">P acnes&#47;S epidermidis</span> and <span class="elsevierStyleItalic">P acnes&#47;S aureus</span> ratios were higher&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Polak-Witka et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have noted that it is possible that <span class="elsevierStyleItalic">S aureus</span> superantigens&#44; proteases&#44; and toxins&#44; along with direct interactions between immune cells and bacteria&#44; may contribute to inflammation&#44; altering the skin&#8217;s barrier function and affecting the follicular region&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Changes in the microbiome of different compartments of the skin were also observed in the study&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The proportions of bacteria on the epidermis assigned to the Actinobacteria and Bacteroidetes phyla&#44; respectively&#44; were 33&#46;3&#37; and 20&#46;1&#37; in the AA group and 22&#46;4&#37; and 9&#46;9&#37; in controls&#46; In the dermis the proportions were as follows&#58; Actinobacteria&#44; 6&#46;1&#37; in AA and 11&#46;3&#37; in controls&#59; Proteobacteria&#44; 14&#46;9&#37; in AA and 8&#46;1&#37; in controls&#59; and Bacteroidetes&#44; 14&#46;2&#37; in AA and 4&#46;0&#37; in controls &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The bacterial proportions in the hypodermis were higher in patients with AA than in controls for the following phyla&#58; Proteobacteria&#44; Bacteroidetes&#44; and Firmicutes&#46; Finally&#44; <span class="elsevierStyleItalic">Prevotella copri</span> was detected in all compartments analyzed in patients with AA&#44; and <span class="elsevierStyleItalic">Akkermansia muciniphila</span> &#40;&#60;1&#46;5&#37; of the total microbiome&#41; was detected in subcompartments &#40;especially the hypodermis&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The association between AA and <span class="elsevierStyleItalic">Helicobacter pylori</span> is disputed&#46; Evidence of a role for this bacterium in various autoimmune conditions has been reported&#44; and the resolution of alopecia after treatment for the infection has been observed&#44; although the exact mechanism responsible is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">AA has been linked to certain viral infections&#44; such as swine flu &#40;during the 2009&#8211;2010 outbreaks&#41;&#44; other influenza infections&#44; and mononucleosis &#40;infection by the Epstein-Barr virus&#41;&#59; a role for cytomegalovirus infection has also been debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a> Cytomegaloviral DNA has been found in the follicular tissues of patients with AA&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Finally&#44; a possible connection between this form of alopecia and infection by <span class="elsevierStyleItalic">Alternaria</span> species is possible&#44; based on positive cultures in 20&#37; of cases versus 13&#46;3&#37; of controls&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition to the cutaneous microbiome&#44; the gut microbiome may be involved in AA&#46; Increased permeability of the intestine due to dysbiosis and&#47;or inflammation has been demonstrated&#44; and it may place stress on the immune system in genetically susceptible individuals&#46; Dysbiosis leads to a reduced production of short-chain fatty acids as a result of inadequate intake of fiber in so-called Western diets&#44; altering the intestinal barrier and affecting Tregs&#44; which modulate the immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Patients in this state have been found to have increased populations of <span class="elsevierStyleItalic">Holdemania filiformis</span>&#44; bacteria in the Erysipelotrichacea and Lachnospiraceae families<span class="elsevierStyleItalic">&#44; Parabacteroides johnsonii&#44; Clostridiales vadin</span> BB60 group<span class="elsevierStyleItalic">&#44; Bacteroides eggerthii</span>&#44; and <span class="elsevierStyleItalic">Parabacteroides distasonis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The same study also found an association between these colonizations and the presence of AA&#46; Finally&#44; the presence of <span class="elsevierStyleItalic">Lactobacillus</span> species in the gut has been shown to be essential to the induction of this type of hair loss&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Androgenetic Alopecia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Evidence points to the existence of microinflammation when multiple organisms are present in the superior third of the hair follicle&#44; where <span class="elsevierStyleItalic">Cutibacterium</span> species have been found in 58&#37; of patients with androgenetic alopecia &#40;AGA&#41; versus 12&#37; of controls&#44; according to literature reviewed by Polak-Witka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> These species secrete porphyrins&#44; which stimulate complement activation&#46; Moreover&#44; symptom improvement has been observed after application of antimicrobial agents&#44; supporting the likelihood of a role for scalp microbiota&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A high load of <span class="elsevierStyleItalic">P acnes</span> in the follicles of miniaturized hairs of patients with AGA has been hypothesized&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Species in the phyla Actinobacteria&#44; Firmicutes&#44; and Proteobacteria were shown to account for 98&#37; of the scalp microbiota both on healthy scalps and in AGA in one study&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The authors reported that species in the genera <span class="elsevierStyleItalic">Propionibacterium</span> and <span class="elsevierStyleItalic">Staphylococcus</span> account for about 90&#37; of the bacterial load in both healthy subjects and individuals with AGA&#46; The distributions of species in these 2 genera were similar in both groups&#44; at 79&#37; and 12&#37;&#44; respectively&#44; for healthy subjects and 76&#46;5&#37; and 14&#37;&#44; respectively&#44; in AGA&#46; Individuals with AGA had increased presence of <span class="elsevierStyleItalic">Stenotrophomonas geniculate</span>&#44; and the <span class="elsevierStyleItalic">C acnes</span>&#47;<span class="elsevierStyleItalic">S epidermidis</span> ratio was also higher than in control subjects&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">That study enrolled men with grade 3-4 alopecia on the Hamilton-Norwood scale and women with grade II hair loss on the Ludwig scale&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The patients refrained from treating their hair with permanents or dyes for 2 months before the study started&#46; They also refrained from using hair-loss shampoos and oral or topical antifungal treatments for 1 month&#46; None had a history of scalp diseases such as folliculitis&#44; lice infestation&#44; or AA&#46; The authors formed 2 groups&#58; patients with alopecia and controls&#46; A higher rate of bacterial colonization was found in the AGA group &#40;60&#37;&#41; than in the controls &#40;40&#37;&#41;&#46; The species found on the vertex of the scalp in controls belonged to the phyla Ascomycota &#40;73&#46;16&#37;&#41;&#44; Basidiomycota &#40;24&#46;94&#37;&#41;&#44; and Zygomycota<a class="elsevierStyleCrossRef" href="#fn0010"><span class="elsevierStyleSup">&#8224;</span></a> &#40;1&#46;41&#37;&#41;&#46; The occipital scalp region in the control group was colonized by microbes in these phyla in the following proportions&#58; Ascomycota&#44; 63&#46;78&#37;&#59; Basidiomycota&#44; 34&#46;37&#37;&#59; Zygomycota&#44; 0&#46;62&#37;&#59; and other&#44; 1&#46;23&#37;&#46; At the crown of the scalp&#44; species in these phyla accounted for the following proportions of fungal colonization in patients with AGA&#58; Ascomycota&#44; 35&#46;58&#37;&#59; Basidiomycota&#44; 61&#46;03&#37;&#59; Zygomycota&#44; 0&#46;40&#37;&#59; and other&#44; 2&#46;99&#37;&#46; Occipital colonization by species in these phyla in AGA patients was distributed as follows&#58; Ascomycota&#44; 41&#46;18&#37;&#59; Basidiomycota&#44; 54&#46;21&#37;&#59; Zygomycota&#44; 1&#46;87&#37;&#59; and other&#44; 2&#46;74&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The <span class="elsevierStyleItalic">Malassezia</span> species load at the vertex was significantly greater in the men with AGA than in the control group&#44; but the loads were similar in the occipital region in both groups&#46; The load was significantly higher at the vertex than in the occipital region in the patient group&#59; in contrast&#44; the 2 scalp regions had similar fungal loads in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although <span class="elsevierStyleItalic">M restricta</span> and <span class="elsevierStyleItalic">M globosa</span> have been reported to be among the most abundant species on the scalp&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> some researchers have observed lower proportions of <span class="elsevierStyleItalic">M globosa</span> and <span class="elsevierStyleItalic">M restricta</span> in AGA patients &#40;52&#37;&#41; than in controls &#40;56&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has been suggested that <span class="elsevierStyleItalic">Demodex</span> species play a role in AGA and seborrheic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Scarring Alopecia</span><p id="par0080" class="elsevierStylePara elsevierViewall">Whether the massive bacterial superinfection that is associated with some scarring alopecias is part of a primary pathogenic mechanism or is secondary to inflammatory changes that lead to hair follicle dysbiosis is a subject of debate&#46; This is the case for folliculitis decalvans &#40;FD&#41;&#46; The fact that antibiotic therapy by itself is usually ineffective and the condition responds better to retinoids does not rule out dysbiosis as the possible trigger for neutrophilic folliculitis&#44; involving&#44; for example&#44; keratinocytes that secrete neutrophil-attracting cytokines and chemokines&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The presence of <span class="elsevierStyleItalic">S aureus</span> in cultures and a temporary response to antibiotic treatment points to infection as the trigger&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A Spanish study in patients with the typical neutrophilic pattern of FD demonstrated the presence of <span class="elsevierStyleItalic">Staphylococcus</span> species in 25&#46;9&#37; of diseased hair follicles biopsied from affected parts of the scalp&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> These bacteria were present in only 6&#46;6&#37; of the healthy follicles&#46; However&#44; <span class="elsevierStyleItalic">S aureus</span> infection is opportunistic in FD rather than causative&#44; given that some patients show active disease even in the absence of significant levels of this pathogen&#44; especially in lichenoid forms of FD&#46; In addition&#44; these bacteria have been shown to be no more virulent than others in the general population&#46; Therefore&#44; a hypothesis that emerges is that immunologic vulnerability or an altered hair follicle structure leave an individual susceptible to scarring alopecia&#46; The findings of this study contradict earlier theories about how FD develops&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Moreover&#44; Yip et al<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found that 80&#37; of patients were colonized by <span class="elsevierStyleItalic">S aureus</span> on both lesional and healthy skin&#46; They also demonstrated subepidermal colonization by <span class="elsevierStyleItalic">S aureus</span>&#46; Invasion by this opportunistic species&#44; which is the only one that has been shown to colonize over two thirds of patients with FD&#44; points to a compromised epidermal barrier&#44; as mentioned previously&#46; The same study showed that antibiotic treatment did not fully restore the microbiota in patients with FD&#44; suggesting a persistent defect in the epidermal barrier in this disease&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finally&#44; <span class="elsevierStyleItalic">C acnes</span> bacteria have been observed to form biofilm-like structures in biopsy samples&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;14</span></a> Such biofilms may not initially appear to be pathogenic&#44; but in addition to causing inflammation they provide a stable&#44; protective environment from which bacteria can spread out and cause disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;14&#44;15</span></a> Antibiotic treatment can eliminate bacteria released from biofilms and alleviate symptoms&#44; but those that remain inside may still constitute a source of chronic infection&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">FD was classified as a predominantly neutrophilic scarring alopecia in the past&#44; but has recently been described as having a wide spectrum of presentations&#44; including the possible co-occurrence of lichen planopilaris &#40;LPP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Trichoscopy has revealed a dynamic shift in the FD phenotype toward LPP over time in this variant of liquenoid alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15</span></a> One group proposed the Koebner phenomenon or the presence of an unrecognized secondary infection of LPP as mechanisms for chronic inflammation in FD&#46;<span class="elsevierStyleSup">15</span> They also suggested the possibility of a phenotype of FD that includes LPP&#44; in which both have a common origin in microbial dysbiosis that causes follicular damage or stress&#44; leading to an inflammatory response and potential exposure to autoantigens and abnormal immune responses&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Matard et al<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> showed that patients with the FD-LPP had lower loads of <span class="elsevierStyleItalic">S aureus</span> &#40;accounting for less than 20&#37; of the follicular microbiota&#41; than patients with classic FD&#44; in whom the proportion exceeded 20&#37;&#46; Patients with the FD-LPP variant responded to oxacillin and lack the methicillin resistance &#40;<span class="elsevierStyleItalic">mecA</span>&#41; and Panton-Valentine leukocidin &#40;<span class="elsevierStyleItalic">PVL</span>&#41; genes&#46; The authors also suggested that classical FD&#44; characterized by a predominantly neutrophilic infiltrate&#44; is best distinguished from the FD-LPP clinical variant by the presence of staphylococci&#46; This difference suggests that the more acute neutrophilic form could be managed with antibiotics in its acute phases&#44; whereas antiinflammatory agents might be the first line of therapy for managing the FD-LPP variant&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Advances in Therapy</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Fecal Transplantation</span><p id="par0110" class="elsevierStylePara elsevierViewall">Three case reports have described men with AA who experienced sustained follicular growth in response to fecal transplantation&#44; supporting the theory that gut microbiota play a role in inducing this type of hair loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;16&#44;17</span></a> Two of the men had the universalis form of AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;16</span></a> In the first case&#44; a 38-year-old man whose condition was refractory to intralesional corticosteroid therapy&#44; reported hair growth on his arms and head &#40;including his face&#41;&#44; which was confirmed at a clinical appointment 8 weeks later&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The response was maintained 3&#8239;years later&#46; The second was a 20-year-old man with severe ileocolitis &#40;Crohn disease&#41; as well as a 2-year history of AA resistant to therapy with intralesional and topical corticosteroids&#44; stearic acid&#44; and laser&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> He had received treatment for recurrent diarrhea due to <span class="elsevierStyleItalic">Clostridium difficile</span>&#46; After a fecal transplant&#44; his severity of alopecia &#40;SALT&#41; score improved from S4b &#40;95&#37; to 99&#37; hair loss&#41; to S2 &#40;25&#37; to 49&#37; loss&#41;&#46; The patient in the third case was an 86-year-old man with a history of noninfectious diarrhea associated with intestinal dysbiosis who also reported hair growth on his scalp and a change in color from white to black in some residual hairs without direct treatment of the scalp&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The response to treatment was long-lasting in this case too&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Use of Postbiotics</span><p id="par0115" class="elsevierStylePara elsevierViewall">Platelet-rich plasma therapy is used in various types of alopecia&#46; However&#44; the treatment has limitations&#44; among which is the variability of formulations &#40;lack of a standardized platelet concentration&#41;&#46; Modern biotechnology has created bioactive peptides able to simulate the activity of platelet growth factors&#46; These peptides have similar efficacy and can be used topically&#59; formulations for intralesional application may come in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Theories of an association between altered gut microbiota and hair loss&#44; particularly in AA&#44; have suggested a possible therapeutic role for microbial metabolites known as postbiotics&#46; A double-blind placebo-controlled trial enrolling 160 participants with AA &#40;SALT scores&#44; S2&#8211;S5&#41; aged 18 to 60 years assigned the treatment group to receive a preparation containing plantaracin A&#44; <span class="elsevierStyleItalic">Lactobacillus kunkeei</span>&#44; and an extract of <span class="elsevierStyleItalic">Tropaeolum majus</span> flowers&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The 2 groups had similar demographic characteristics and histories of disease refractory to topical and systemic treatments as well as phototherapy&#46; They had not received treatment in the year prior to enrollment in the trial&#46; Complete resolution of symptoms was observed in 47&#46;50&#37; in the treatment group and partial resolution in 13&#46;75&#37;&#59; 6&#46;25&#37; of the actively treated participants had no response&#46; In contrast&#44; only 5&#37; of the control participants achieved complete resolution&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A large number of biomimetic peptides have been developed in an effort to overcome the limitations of platelet-rich plasma&#46; Short chains of 10 to 15 aminoacids have been reported to behave similarly to natural growth factors by simulating their structure&#44; their activity&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> These peptides have greater stability and specificity than platelet-rich plasma&#44; are more economical&#44; and can be more easily incorporated into topical formulations&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Another study investigated the effect of probiotics on generating short-chain fatty acids&#44; butyrate in particular&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Chronic AA was not reversed in 16 weeks of treatment&#44; but the Tregs&#47;CD4<span class="elsevierStyleSup">&#43;</span> ratio in cutaneous lymph nodes did improve in 15&#37; of those in the treatment group &#40;vs in 12&#37; of controls&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Other Possible Future Treatments</span><p id="par0135" class="elsevierStylePara elsevierViewall">Diviccaro et al<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> studied the long-term effect on microbiota of discontinuing finasteride in a rat model evaluating stool samples 1 month after stopping treatment&#46; The alpha diversity did not change&#44; but bacteria in the phylum Firmicutes decreased from baseline&#44; whereas those in the phylum Bacteroidetes increased&#46; Bacteria in the Bacteroidaceae and Prevotellaceae families were the most abundant&#44; followed by species in the Lactobacillaceae&#44; Lachnospiraceae&#44; and Ruminococcacea families&#46; <span class="elsevierStyleItalic">Bacteroides</span>&#44; <span class="elsevierStyleItalic">Prevotella&#44; Lactobacillus&#44; Oscillospira&#44; Lachnospira&#44; Ruminococcus</span>&#44; and <span class="elsevierStyleItalic">Coprococcus</span> species were most prevalent&#46; In contrast&#44; <span class="elsevierStyleItalic">Oscillospira</span> and <span class="elsevierStyleItalic">Lachnospira</span> species significantly declined in the absence of finasteride&#46; Finally&#44; in the group still on finasteride&#44; bacteria in the Bacteroidetes phylum and the Prevotellaceae family increased&#44; supporting the hypothesis that exposure to finasteride can affect the composition of gut microbiota&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Borde and &#197;strand<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> noted in a review of novel therapies that mammalian G-protein-coupled receptors 41 and 43 are possible therapeutic targets in immune disorders&#46; Although their role is still not clear&#44; the authors note&#44; they cite GPR43-deficient mouse models that have demonstrated exacerbated or persistent inflammation in colitis&#44; arthritis&#44; and asthma&#44; suggesting that this receptor may aggravate inflammatory diseases&#46; Moreover&#44; intestinal propionate may stimulate GPR43&#47;41 or GPR43&#47;109&#41;&#44; inducing more Tregs that can protect hair follicles from an immune attack&#46; The reviewers describe a pilot study that saw hair regrowth in 5 out of 5 mice 11 weeks after treatment with propionate versus none in the control group&#46; After 4 more weeks&#44; the researchers&#8217; analysis of differences in cellularity with treatment found a large increase in the Treg&#47;CD4<span class="elsevierStyleSup">&#43;</span> ratio versus the control group&#46; An attempt to replicate that study&#44; however&#44; could not produce the same effects on hair growth&#46; Finally&#44; prophylactic treatment was unable to prevent the development of disease symptoms&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Polyphenols and terpenes have been said to have a positive effect on cells involved in follicular growth&#44; by intensifying cellular proliferation in dermal papillae cells and increasing the concentrations of factors such as type 1 insulin-like growth factor and vascular endothelial growth factor&#44; reducing oxidative stress and improving hair growth&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">One study enrolled 12 patients with AGA between 40&#8239;and 65&#8239;years of age and classified as having stage 3&#8239;or 4 hair loss on the Hamilton-Norwood scale&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> When entering the study&#44; the patients had not used antibiotics in the previous 30 days&#44; had not used probiotics within 15 days&#44; and had not shampooed within 48&#8239;hours&#46; They had not undergone antitumor&#44; immunosuppressant&#44; or radiotherapy &#40;3 months&#41;&#44; used topical or hormone treatments for hair growth &#40;3 months&#41;&#44; or used minoxidil or finasteride &#40;6 months&#41;&#46; Nor did they have a history of other progressive dermatologic or inflammatory diseases affecting the scalp &#40;such as psoriasis&#59; seborrheic dermatitis&#59; or severe erythema&#44; excoriation&#44; or sunburn&#41;&#46; A phototrichogram was used to assess hair density on days 1 and 84&#44; focusing mainly on Hamilton-Norwood stage 3 hair loss&#46; A preparation containing a 1&#37; extract of <span class="elsevierStyleItalic">Lindera strychnifolia</span> and a placebo preparation were applied twice daily for 84 days on 2 areas of the scalp &#40;treatment and placebo areas&#41;&#46; Application of the active treatment did not affect alpha diversity but did achieve maintenance of bacterial biodiversity&#46; The researchers reported a significant decrease in <span class="elsevierStyleItalic">C acnes</span> &#40;15&#37;&#41;&#44; an increase in <span class="elsevierStyleItalic">S epidermidis</span> &#40;33&#37;&#41;&#44; and a decrease in the <span class="elsevierStyleItalic">C acnes&#47;S epidermidis</span> ratio &#40;37&#46;8&#37;&#41;&#46; The <span class="elsevierStyleItalic">L strychnifolia</span> application reestablished &#8220;normal&#8221; fungal populations&#44; especially fungi of the Basidiomycota phylum and 3 genera &#40;<span class="elsevierStyleItalic">Wallemia&#44; Eurotium</span>&#44; and <span class="elsevierStyleItalic">Malassezia</span>&#41;&#46; The researchers observed abundant <span class="elsevierStyleItalic">Malassezia</span> species&#44; which increased by 3&#37;&#44; and <span class="elsevierStyleItalic">M restricta</span> loads were restored to the level of the healthy controls&#46; <span class="elsevierStyleItalic">Eurotium</span> and <span class="elsevierStyleItalic">Wallemia</span> species were seen to decrease&#46; Finally&#44; hair growth increased significantly&#44; by 7&#37;&#46;</p></span></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The skin microbiome is a complex microbiological system with multiple interactions that can lead to both local and distant changes in homeostasis&#46; Imbalances can trigger disease processes such as immune cell dysfunction and can also lead to functional changes&#44; such as in hair follicles&#46; Therefore&#44; the system may be associated with inflammatory processes&#44; such as AA&#44; or changes in the hair follicle cycle&#44; as in AGA&#46; Multiple changes in skin surface or scalp microbiota&#44; whether bacterial or fungal&#44; have been described in both AA and AGA&#46; However&#44; the meaning of the associations remains uncertain&#44; and the issue is complicated by our poor understanding of the follicular microbiome&#46; The microbiology of the hair follicle must be better profiled so that we can learn more about its possible role in pathogenesis&#46; The field of research is still fairly wide&#44; and the possible therapeutic applications are many&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the profiles described above&#44; the importance of changes in both the genera and species of bacterial populations associated with AA must be emphasized&#46; Also important are cases in which disease has regressed after the use of postbiotics or bacterial therapies in association with conventional therapies such as platelet-rich plasma&#46; Other common therapies can also be considered&#58; corticosteroids can change the proportional distribution of microbes and also play an immunomodulatory role&#44; leading to questions about the mechanism by which they act as either modulators or triggers of disease&#46; Cases in which improvement has followed fecal transplantation have been reported&#44; introducing another possible therapeutic target&#58; gut microbiota&#46; However&#44; so far&#44; studies have involved few patients and must be replicated in larger trials before efficacy and possible adverse effects can be evaluated&#46; Finally&#44; the literature in this novel area focusing on the role of the microbiome is scarce in certain diseases&#46; Currently&#44; more is known about the microbiome&#8217;s role in inflammatory diseases such as atopic dermatitis and psoriasis&#46; We therefore emphasize that this line of of research holds promise for finding novel therapeutic targets in the gut or cutaneous microbiomes&#46; Possibilities include local&#44; systemic&#44; and diet therapies as well as the use of live organisms such as those found in probiotics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The human microbiome includes viruses&#44; bacteria&#44; and fungi&#46; There is evidence that in addition to microbiome variation in different areas of the body or according to ethnicity and sex&#44; the microbiome specific to the scalp is conditioned by such factors as humidity&#44; protection from UV light&#44; and pH&#46; Although little information has yet been published about the microbiome of hair follicles and its role in the pathogenesis of diseases&#44; interest in this area of research is emerging&#46; Studies have shown that components of the follicular microbiome influence such disorders as androgenetic alopecia and alopecia areata&#46; A current hypothesis is that interventions that target the microbiome may lead to innovative therapies for many diseases&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El microbioma incluye microorganismos como virus&#44; bacterias y hongos&#46; Se ha evidenciado que el cuero cabelludo tiene su propio microbioma dado por factores &#250;nicos como humedad&#44; protecci&#243;n de luz ultravioleta y pH&#44; adicionalmente existen diferencias entre distintas &#225;reas corporales&#44; etnias y sexos&#46; Existen pocas publicaciones o datos sobre el microbioma folicular y se ha denotado el rol de la microbiota en la patog&#233;nesis de varias enfermedades siendo un &#225;rea de investigaci&#243;n emergente&#46; Algunos estudios demuestran la influencia de esta composici&#243;n con enfermedades capilares como la alopecia areata y alopecia androgen&#233;tica&#46; Finalmente se ha postulado que la manipulaci&#243;n del microbioma puede representar una opci&#243;n terap&#233;utica innovadora para muchas enfermedades&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Translator&#8217;s note&#58; <span class="elsevierStyleItalic">Cutibacterium acnes</span> is the name by which <span class="elsevierStyleItalic">Propionibacterium acnes</span> is known in the current nomenclature&#46; The authors use both names in the article&#46; For the sake of preserving consistency between this translation and the original Spanish version&#44; the translation follows the authors&#8217; usage&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Barquero-Orias D&#44; Mu&#241;oz Moreno-Arrones O&#44; Va&#241;&#243;-Galv&#225;n S&#46; Alopecia y microbioma&#58; &#191;futura diana terap&#233;utica&#63; Actas Dermosifiliogr&#46; 2021&#59;112&#58;495&#8211;502&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Translator&#8217;s note&#58; The former phylum Zygomycota is currently divided into 2 phyla &#40;Mucoromycota and Zoopagomycota&#41;&#46; This translation follows the authors&#8217; use of nomenclature&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of bacterial colonization of the scalps of patients with AA and controls&#46; AA refers to alopecia areata&#46; Data source&#58; Pinto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of fungal colonization of the scalps of patients with AGA and controls&#46; AGA refers to androgenetic alopecia&#46; Data source&#58; Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Concepts in Publications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relevant References&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current Knowledge</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Effects of diet on the microbiome</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polak-Witka et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fecal transplantation</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rebello et al&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xie et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microbiotic profile under finasteride treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diviccaro et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mammalian G protein-coupled receptors 43&#47;41 as therapeutic targets</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maslowski et al&#44; 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyphenols and terpenes</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shin et al&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Filaire et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of <span class="elsevierStyleItalic">Lindera strychnifolia</span> extract in androgenetic alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Filaire et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biomarkers in alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moreno-Arrones et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of antimicrobial therapy in androgenetic alopecia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mahe et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polak-Witka et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Composition of the microbiota in androgenetic alopecia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mahe et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ho et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lousada et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Composition of the microbiota in alopecia areata</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skinner et al&#44; 1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offidani et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rudnicka et al&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hisham Diab Gaber et al&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mohan et al&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geoghegan et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pinto et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lousada et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of <span class="elsevierStyleItalic">Lactobacillus</span> species in hair follicle inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ark et al&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Helicobacter pylori</span> in alopecia areata</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti et al&#44; 1997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Campuzano et al&#44; 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Simakou et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use de postbiotics en alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rinaldi et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probiotics and short-chain fatty acids</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smith et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arpaia et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Furusawa et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2608362.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Lines of Future Research&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomized controlled trials of recently discovered treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of diet modifications&#58; their effects on the composition of microbiota and their therapeutic uses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Better descriptions of changes in the microbiome and their pathogenic roles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Research on possible therapeutic uses of probiotics and postbiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adverse effects of experimental treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Research on the effects of conventional treatments and how they change the microbiota&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uses of biomarkers and precision medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Molecular and cellular therapeutic targets&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of the gut microbiome and its implications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of fecal transplantation as an alternative therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost-effectiveness comparisons between new therapies and current ones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2608361.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Current Knowledge and Lines of Research for the Future</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exploring the human hair follicle microbiome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lousada"
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                            3 => "T&#46; Rouill&#233;"
                            4 => "D&#46; Ajdic"
                            5 => "Y&#46; Uchida"
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                      "titulo" => "What&#8217;s new in the pathophysiology of alopecia areata&#63; The possible contribution of skin and gut microbiome in the pathogenesis of alopecia&#8212;big opportunities&#44; big challenges&#44; and novel perspectives"
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                          "etal" => false
                          "autores" => array:2 [
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                        "volumen" => "29"
                        "paginaInicial" => "208"
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                      "titulo" => "Functional heterogeneity of gut-resident regulatory T cells"
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                          "autores" => array:3 [
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                        "volumen" => "6"
                        "paginaInicial" => "e156"
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                            4 => "J&#46; Sundberg"
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                          0 => array:2 [
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                      "titulo" => "Scalp bacterial shift in Alopecia areata"
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                            "web" => "Medline"
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                0 => array:2 [
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                      "titulo" => "The role of the microbiome in scalp hair follicle biology and disease"
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                          "etal" => false
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                    0 => array:2 [
                      "titulo" => "Investigation on microecology of hair root fungi in androgenetic alopecia patients"
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                            2 => "S&#46; Pradhan"
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                            4 => "Y&#46; Dai"
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Review
Alopecia and the Microbiome: A Future Therapeutic Target?
Alopecia y microbioma: ¿futura diana terapéutica?
D. Barquero-Oriasa,
Autor para correspondencia
drdanielbarquero@gmail.com

Corresponding author.
, O. Muñoz Moreno-Arronesb, S. Vañó-Galvánb
a Dermatología Integral, San José, Costa Rica
b Servicio de Dermatología, Unidad de Tricología, Grupo de Investigación #TricoHRC, Hospital Universitario Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The microbiome describes the genome of all commensal&#44; symbiotic&#44; and pathogenic organisms in the human body&#44; including viruses&#44; bacteria&#44; and fungi&#46; The composition is influenced by such factors as age&#44; nutrition&#44; gender&#44; and lifestyle&#46; The rise in the prevalence of autoimmune diseases&#44; especially in Western countries&#44; has been thought to be related to modern lifestyles&#44; their effect on the normal flora of the body&#44; and consequent immune dysregulation&#46; A state of dysbiosis can trigger T-cell dysregulation and cause a variety of disorders locally or at a distance&#46; These changes in the intestinal or cutaneous microbiota can alter cell differentiation in both the innate and adaptive immune systems&#46; Microbiota also modulate epithelial secretion of chemokines that attract immune cells&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Scientists who are currently exploring how the gut microbiome can influence immunity at remote sites such as the skin have proposed the existence of a &#8220;skin-gut axis&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An infectious cause of alopecia areata &#40;AA&#41; was hypothesized by David Gruby after he demonstrated the presence of <span class="elsevierStyleItalic">Microsporum audouini</span> around the hair follicles of individuals with the condition&#59; the species was then blamed for epidemics in schools and orphanages&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; while some dermatologists did isolate diverse fungi in patients with AA&#44; others failed to find associations between the disease and pathogens&#59; as a result&#44; attention was drawn away from a role for infection&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nevertheless&#44; there could be a possible role for pathogenic antigens and their increased activity in the immune system&#44; which could induce AA via epitope similarity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Another suggested role for gut microbiota is an effect on the differentiation of peripheral lymphocytes&#44; given that some regulatory T cells &#40;Tregs&#41; could be redirected to a part of the intestine where molecular and microbial signals convert forkhead box P3 negative &#40;Foxp3<span class="elsevierStyleSup">&#8211;</span>&#41; CD4<span class="elsevierStyleSup">&#43;</span> Treg cells to Foxp3<span class="elsevierStyleSup">&#43;</span> ones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The role of microbiota in the pathogenesis of various diseases is an emerging area of research&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Doubts remain about whether dysbiosis is a primary cause of disease or a secondary one associated with changes caused by a primary mechanism&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> but the possibility that therapeutic manipulation of the microbiome might be an option in conditions such as AA has been suggested&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This review summarizes recent evidence on the associations between the microbiome&#44; the process of dysbiosis&#44; its relation to alopecia&#44; and the implications for therapy&#46; We also discuss the composition of the microbiome and differences between that of healthy persons and patients with various types of alopecia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a narrative review of the subject&#46; We obtained articles published between 2015 and 2020 by searching in the Cochrane Library Plus&#44; Scielo&#44; DynaMed&#44; PubMed&#44; and Google Scholar&#46; The search terms were <span class="elsevierStyleItalic">microb&#42;</span> AND <span class="elsevierStyleItalic">alopecia</span>&#46; To identify the articles relevant to the purposes of the review &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; we read abstracts and results&#44; and when necessary&#44; the full texts to ascertain which ones contained pertinent information&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Normal Microbiome of the Skin and Hair Follicles</span><p id="par0025" class="elsevierStylePara elsevierViewall">The scalp has its own microbiome<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in a humid environment protected from UV light and with a pH favorable to microbial growth&#46; The environment contrasts with that of other skin surfaces&#44; which are dry&#44; exposed to UV light&#44; and have a low pH&#46; There exist additional differences related to area of the body&#44; ethnicity&#44; gender&#44; and the environment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Few studies have produced data on the microbiome of hair follicles&#46; However&#44; there is evidence that bacteria of the phyla Actinobacteria&#44; Firmicutes&#44; and Proteobacteria predominate on the surface of the scalp<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and that the most abundant organisms are <span class="elsevierStyleItalic">Cutibacterium</span> species &#40;especially <span class="elsevierStyleItalic">Cutibacterium acnes</span>&#41; and <span class="elsevierStyleItalic">Staphylococcus</span> species &#40;especially <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>&#41;&#46; Other bacteria found on the scalp are <span class="elsevierStyleItalic">Corynebacterium</span>&#44; <span class="elsevierStyleItalic">Streptococcus</span>&#44; <span class="elsevierStyleItalic">Acinetobacter&#44;</span> and <span class="elsevierStyleItalic">Prevotella</span> species&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> The most prevalent fungi on the scalp are <span class="elsevierStyleItalic">Malassezia globosa</span> and <span class="elsevierStyleItalic">Malassezia restricta</span>&#46; Fungi in 2 phyla are present&#58; Ascomycota &#40;<span class="elsevierStyleItalic">Acremonium</span> species&#44; <span class="elsevierStyleItalic">Didymella bryoniae</span>&#44; <span class="elsevierStyleItalic">Coniochaeta</span> species&#44; and <span class="elsevierStyleItalic">Rhodotorula</span> species&#41; and Basidiomycota &#40;<span class="elsevierStyleItalic">Cryptococcus liquefaciens</span> and <span class="elsevierStyleItalic">Cryptococcus diffluens</span>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Scalp colonization by eukaryotic DNA viruses such as adeno-associated virus subtype 2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the human papilloma virus has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a><span class="elsevierStyleItalic">Demodex folliculorum</span> has been found in the follicular infundibulum and <span class="elsevierStyleItalic">Demodex brevis</span> in the sebaceous glands&#46; In addition&#44; Naspitz et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> found <span class="elsevierStyleItalic">Dermatophagoides</span> and <span class="elsevierStyleItalic">Euroglyphus</span> species on the scalp&#46; Although it is not known whether these microorganisms contribute to the physiology of the hair follicle&#44; it is known that they can generate proinflammatory and immunosuppressive responses&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Dysbiosis and Disease</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Alopecia Areata</span><p id="par0040" class="elsevierStylePara elsevierViewall">One study that sequenced the scalp microbiome of healthy subjects and patients with AA found between-group variation in bacterial populations&#58; the proportions of bacteria in the Actinobacteria and Firmicutes phyla&#44; respectively&#44; were 57&#46;4&#37; and 29&#46;2&#37; in the AA group and 56&#46;3&#37; and 35&#46;2&#37; in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The proportions assigned to <span class="elsevierStyleItalic">Propionibacterium</span> and <span class="elsevierStyleItalic">Staphylococcus</span> species in the AA group were 55&#46;1&#37; and 27&#46;4&#37;&#44; respectively&#44; and 45&#46;6&#37; and 32&#46;6&#37; in controls&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;Some patients with AA are known to experience a significant increase in <span class="elsevierStyleItalic">P acnes&#46;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;<a class="elsevierStyleCrossRef" href="#fn0005">&#42;</a> Alpha diversity was also higher in the patients&#44; in whom there was a decrease in the proportion of <span class="elsevierStyleItalic">S epidermidis&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> while <span class="elsevierStyleItalic">Staphylococcus aureus</span> proportions remained stable&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The authors found no significant differences in the <span class="elsevierStyleItalic">S epidermidis&#47;S aureus</span> ratio&#44; whereas the <span class="elsevierStyleItalic">P acnes&#47;S epidermidis</span> and <span class="elsevierStyleItalic">P acnes&#47;S aureus</span> ratios were higher&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Polak-Witka et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have noted that it is possible that <span class="elsevierStyleItalic">S aureus</span> superantigens&#44; proteases&#44; and toxins&#44; along with direct interactions between immune cells and bacteria&#44; may contribute to inflammation&#44; altering the skin&#8217;s barrier function and affecting the follicular region&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Changes in the microbiome of different compartments of the skin were also observed in the study&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The proportions of bacteria on the epidermis assigned to the Actinobacteria and Bacteroidetes phyla&#44; respectively&#44; were 33&#46;3&#37; and 20&#46;1&#37; in the AA group and 22&#46;4&#37; and 9&#46;9&#37; in controls&#46; In the dermis the proportions were as follows&#58; Actinobacteria&#44; 6&#46;1&#37; in AA and 11&#46;3&#37; in controls&#59; Proteobacteria&#44; 14&#46;9&#37; in AA and 8&#46;1&#37; in controls&#59; and Bacteroidetes&#44; 14&#46;2&#37; in AA and 4&#46;0&#37; in controls &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The bacterial proportions in the hypodermis were higher in patients with AA than in controls for the following phyla&#58; Proteobacteria&#44; Bacteroidetes&#44; and Firmicutes&#46; Finally&#44; <span class="elsevierStyleItalic">Prevotella copri</span> was detected in all compartments analyzed in patients with AA&#44; and <span class="elsevierStyleItalic">Akkermansia muciniphila</span> &#40;&#60;1&#46;5&#37; of the total microbiome&#41; was detected in subcompartments &#40;especially the hypodermis&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The association between AA and <span class="elsevierStyleItalic">Helicobacter pylori</span> is disputed&#46; Evidence of a role for this bacterium in various autoimmune conditions has been reported&#44; and the resolution of alopecia after treatment for the infection has been observed&#44; although the exact mechanism responsible is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">AA has been linked to certain viral infections&#44; such as swine flu &#40;during the 2009&#8211;2010 outbreaks&#41;&#44; other influenza infections&#44; and mononucleosis &#40;infection by the Epstein-Barr virus&#41;&#59; a role for cytomegalovirus infection has also been debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a> Cytomegaloviral DNA has been found in the follicular tissues of patients with AA&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Finally&#44; a possible connection between this form of alopecia and infection by <span class="elsevierStyleItalic">Alternaria</span> species is possible&#44; based on positive cultures in 20&#37; of cases versus 13&#46;3&#37; of controls&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition to the cutaneous microbiome&#44; the gut microbiome may be involved in AA&#46; Increased permeability of the intestine due to dysbiosis and&#47;or inflammation has been demonstrated&#44; and it may place stress on the immune system in genetically susceptible individuals&#46; Dysbiosis leads to a reduced production of short-chain fatty acids as a result of inadequate intake of fiber in so-called Western diets&#44; altering the intestinal barrier and affecting Tregs&#44; which modulate the immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Patients in this state have been found to have increased populations of <span class="elsevierStyleItalic">Holdemania filiformis</span>&#44; bacteria in the Erysipelotrichacea and Lachnospiraceae families<span class="elsevierStyleItalic">&#44; Parabacteroides johnsonii&#44; Clostridiales vadin</span> BB60 group<span class="elsevierStyleItalic">&#44; Bacteroides eggerthii</span>&#44; and <span class="elsevierStyleItalic">Parabacteroides distasonis</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The same study also found an association between these colonizations and the presence of AA&#46; Finally&#44; the presence of <span class="elsevierStyleItalic">Lactobacillus</span> species in the gut has been shown to be essential to the induction of this type of hair loss&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Androgenetic Alopecia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Evidence points to the existence of microinflammation when multiple organisms are present in the superior third of the hair follicle&#44; where <span class="elsevierStyleItalic">Cutibacterium</span> species have been found in 58&#37; of patients with androgenetic alopecia &#40;AGA&#41; versus 12&#37; of controls&#44; according to literature reviewed by Polak-Witka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> These species secrete porphyrins&#44; which stimulate complement activation&#46; Moreover&#44; symptom improvement has been observed after application of antimicrobial agents&#44; supporting the likelihood of a role for scalp microbiota&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A high load of <span class="elsevierStyleItalic">P acnes</span> in the follicles of miniaturized hairs of patients with AGA has been hypothesized&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Species in the phyla Actinobacteria&#44; Firmicutes&#44; and Proteobacteria were shown to account for 98&#37; of the scalp microbiota both on healthy scalps and in AGA in one study&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The authors reported that species in the genera <span class="elsevierStyleItalic">Propionibacterium</span> and <span class="elsevierStyleItalic">Staphylococcus</span> account for about 90&#37; of the bacterial load in both healthy subjects and individuals with AGA&#46; The distributions of species in these 2 genera were similar in both groups&#44; at 79&#37; and 12&#37;&#44; respectively&#44; for healthy subjects and 76&#46;5&#37; and 14&#37;&#44; respectively&#44; in AGA&#46; Individuals with AGA had increased presence of <span class="elsevierStyleItalic">Stenotrophomonas geniculate</span>&#44; and the <span class="elsevierStyleItalic">C acnes</span>&#47;<span class="elsevierStyleItalic">S epidermidis</span> ratio was also higher than in control subjects&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">That study enrolled men with grade 3-4 alopecia on the Hamilton-Norwood scale and women with grade II hair loss on the Ludwig scale&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The patients refrained from treating their hair with permanents or dyes for 2 months before the study started&#46; They also refrained from using hair-loss shampoos and oral or topical antifungal treatments for 1 month&#46; None had a history of scalp diseases such as folliculitis&#44; lice infestation&#44; or AA&#46; The authors formed 2 groups&#58; patients with alopecia and controls&#46; A higher rate of bacterial colonization was found in the AGA group &#40;60&#37;&#41; than in the controls &#40;40&#37;&#41;&#46; The species found on the vertex of the scalp in controls belonged to the phyla Ascomycota &#40;73&#46;16&#37;&#41;&#44; Basidiomycota &#40;24&#46;94&#37;&#41;&#44; and Zygomycota<a class="elsevierStyleCrossRef" href="#fn0010"><span class="elsevierStyleSup">&#8224;</span></a> &#40;1&#46;41&#37;&#41;&#46; The occipital scalp region in the control group was colonized by microbes in these phyla in the following proportions&#58; Ascomycota&#44; 63&#46;78&#37;&#59; Basidiomycota&#44; 34&#46;37&#37;&#59; Zygomycota&#44; 0&#46;62&#37;&#59; and other&#44; 1&#46;23&#37;&#46; At the crown of the scalp&#44; species in these phyla accounted for the following proportions of fungal colonization in patients with AGA&#58; Ascomycota&#44; 35&#46;58&#37;&#59; Basidiomycota&#44; 61&#46;03&#37;&#59; Zygomycota&#44; 0&#46;40&#37;&#59; and other&#44; 2&#46;99&#37;&#46; Occipital colonization by species in these phyla in AGA patients was distributed as follows&#58; Ascomycota&#44; 41&#46;18&#37;&#59; Basidiomycota&#44; 54&#46;21&#37;&#59; Zygomycota&#44; 1&#46;87&#37;&#59; and other&#44; 2&#46;74&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The <span class="elsevierStyleItalic">Malassezia</span> species load at the vertex was significantly greater in the men with AGA than in the control group&#44; but the loads were similar in the occipital region in both groups&#46; The load was significantly higher at the vertex than in the occipital region in the patient group&#59; in contrast&#44; the 2 scalp regions had similar fungal loads in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although <span class="elsevierStyleItalic">M restricta</span> and <span class="elsevierStyleItalic">M globosa</span> have been reported to be among the most abundant species on the scalp&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> some researchers have observed lower proportions of <span class="elsevierStyleItalic">M globosa</span> and <span class="elsevierStyleItalic">M restricta</span> in AGA patients &#40;52&#37;&#41; than in controls &#40;56&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has been suggested that <span class="elsevierStyleItalic">Demodex</span> species play a role in AGA and seborrheic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Scarring Alopecia</span><p id="par0080" class="elsevierStylePara elsevierViewall">Whether the massive bacterial superinfection that is associated with some scarring alopecias is part of a primary pathogenic mechanism or is secondary to inflammatory changes that lead to hair follicle dysbiosis is a subject of debate&#46; This is the case for folliculitis decalvans &#40;FD&#41;&#46; The fact that antibiotic therapy by itself is usually ineffective and the condition responds better to retinoids does not rule out dysbiosis as the possible trigger for neutrophilic folliculitis&#44; involving&#44; for example&#44; keratinocytes that secrete neutrophil-attracting cytokines and chemokines&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The presence of <span class="elsevierStyleItalic">S aureus</span> in cultures and a temporary response to antibiotic treatment points to infection as the trigger&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A Spanish study in patients with the typical neutrophilic pattern of FD demonstrated the presence of <span class="elsevierStyleItalic">Staphylococcus</span> species in 25&#46;9&#37; of diseased hair follicles biopsied from affected parts of the scalp&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> These bacteria were present in only 6&#46;6&#37; of the healthy follicles&#46; However&#44; <span class="elsevierStyleItalic">S aureus</span> infection is opportunistic in FD rather than causative&#44; given that some patients show active disease even in the absence of significant levels of this pathogen&#44; especially in lichenoid forms of FD&#46; In addition&#44; these bacteria have been shown to be no more virulent than others in the general population&#46; Therefore&#44; a hypothesis that emerges is that immunologic vulnerability or an altered hair follicle structure leave an individual susceptible to scarring alopecia&#46; The findings of this study contradict earlier theories about how FD develops&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Moreover&#44; Yip et al<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found that 80&#37; of patients were colonized by <span class="elsevierStyleItalic">S aureus</span> on both lesional and healthy skin&#46; They also demonstrated subepidermal colonization by <span class="elsevierStyleItalic">S aureus</span>&#46; Invasion by this opportunistic species&#44; which is the only one that has been shown to colonize over two thirds of patients with FD&#44; points to a compromised epidermal barrier&#44; as mentioned previously&#46; The same study showed that antibiotic treatment did not fully restore the microbiota in patients with FD&#44; suggesting a persistent defect in the epidermal barrier in this disease&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finally&#44; <span class="elsevierStyleItalic">C acnes</span> bacteria have been observed to form biofilm-like structures in biopsy samples&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;14</span></a> Such biofilms may not initially appear to be pathogenic&#44; but in addition to causing inflammation they provide a stable&#44; protective environment from which bacteria can spread out and cause disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;14&#44;15</span></a> Antibiotic treatment can eliminate bacteria released from biofilms and alleviate symptoms&#44; but those that remain inside may still constitute a source of chronic infection&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">FD was classified as a predominantly neutrophilic scarring alopecia in the past&#44; but has recently been described as having a wide spectrum of presentations&#44; including the possible co-occurrence of lichen planopilaris &#40;LPP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Trichoscopy has revealed a dynamic shift in the FD phenotype toward LPP over time in this variant of liquenoid alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15</span></a> One group proposed the Koebner phenomenon or the presence of an unrecognized secondary infection of LPP as mechanisms for chronic inflammation in FD&#46;<span class="elsevierStyleSup">15</span> They also suggested the possibility of a phenotype of FD that includes LPP&#44; in which both have a common origin in microbial dysbiosis that causes follicular damage or stress&#44; leading to an inflammatory response and potential exposure to autoantigens and abnormal immune responses&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Matard et al<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> showed that patients with the FD-LPP had lower loads of <span class="elsevierStyleItalic">S aureus</span> &#40;accounting for less than 20&#37; of the follicular microbiota&#41; than patients with classic FD&#44; in whom the proportion exceeded 20&#37;&#46; Patients with the FD-LPP variant responded to oxacillin and lack the methicillin resistance &#40;<span class="elsevierStyleItalic">mecA</span>&#41; and Panton-Valentine leukocidin &#40;<span class="elsevierStyleItalic">PVL</span>&#41; genes&#46; The authors also suggested that classical FD&#44; characterized by a predominantly neutrophilic infiltrate&#44; is best distinguished from the FD-LPP clinical variant by the presence of staphylococci&#46; This difference suggests that the more acute neutrophilic form could be managed with antibiotics in its acute phases&#44; whereas antiinflammatory agents might be the first line of therapy for managing the FD-LPP variant&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Advances in Therapy</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Fecal Transplantation</span><p id="par0110" class="elsevierStylePara elsevierViewall">Three case reports have described men with AA who experienced sustained follicular growth in response to fecal transplantation&#44; supporting the theory that gut microbiota play a role in inducing this type of hair loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;16&#44;17</span></a> Two of the men had the universalis form of AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;16</span></a> In the first case&#44; a 38-year-old man whose condition was refractory to intralesional corticosteroid therapy&#44; reported hair growth on his arms and head &#40;including his face&#41;&#44; which was confirmed at a clinical appointment 8 weeks later&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The response was maintained 3&#8239;years later&#46; The second was a 20-year-old man with severe ileocolitis &#40;Crohn disease&#41; as well as a 2-year history of AA resistant to therapy with intralesional and topical corticosteroids&#44; stearic acid&#44; and laser&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> He had received treatment for recurrent diarrhea due to <span class="elsevierStyleItalic">Clostridium difficile</span>&#46; After a fecal transplant&#44; his severity of alopecia &#40;SALT&#41; score improved from S4b &#40;95&#37; to 99&#37; hair loss&#41; to S2 &#40;25&#37; to 49&#37; loss&#41;&#46; The patient in the third case was an 86-year-old man with a history of noninfectious diarrhea associated with intestinal dysbiosis who also reported hair growth on his scalp and a change in color from white to black in some residual hairs without direct treatment of the scalp&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The response to treatment was long-lasting in this case too&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Use of Postbiotics</span><p id="par0115" class="elsevierStylePara elsevierViewall">Platelet-rich plasma therapy is used in various types of alopecia&#46; However&#44; the treatment has limitations&#44; among which is the variability of formulations &#40;lack of a standardized platelet concentration&#41;&#46; Modern biotechnology has created bioactive peptides able to simulate the activity of platelet growth factors&#46; These peptides have similar efficacy and can be used topically&#59; formulations for intralesional application may come in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Theories of an association between altered gut microbiota and hair loss&#44; particularly in AA&#44; have suggested a possible therapeutic role for microbial metabolites known as postbiotics&#46; A double-blind placebo-controlled trial enrolling 160 participants with AA &#40;SALT scores&#44; S2&#8211;S5&#41; aged 18 to 60 years assigned the treatment group to receive a preparation containing plantaracin A&#44; <span class="elsevierStyleItalic">Lactobacillus kunkeei</span>&#44; and an extract of <span class="elsevierStyleItalic">Tropaeolum majus</span> flowers&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The 2 groups had similar demographic characteristics and histories of disease refractory to topical and systemic treatments as well as phototherapy&#46; They had not received treatment in the year prior to enrollment in the trial&#46; Complete resolution of symptoms was observed in 47&#46;50&#37; in the treatment group and partial resolution in 13&#46;75&#37;&#59; 6&#46;25&#37; of the actively treated participants had no response&#46; In contrast&#44; only 5&#37; of the control participants achieved complete resolution&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A large number of biomimetic peptides have been developed in an effort to overcome the limitations of platelet-rich plasma&#46; Short chains of 10 to 15 aminoacids have been reported to behave similarly to natural growth factors by simulating their structure&#44; their activity&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> These peptides have greater stability and specificity than platelet-rich plasma&#44; are more economical&#44; and can be more easily incorporated into topical formulations&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Another study investigated the effect of probiotics on generating short-chain fatty acids&#44; butyrate in particular&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Chronic AA was not reversed in 16 weeks of treatment&#44; but the Tregs&#47;CD4<span class="elsevierStyleSup">&#43;</span> ratio in cutaneous lymph nodes did improve in 15&#37; of those in the treatment group &#40;vs in 12&#37; of controls&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Other Possible Future Treatments</span><p id="par0135" class="elsevierStylePara elsevierViewall">Diviccaro et al<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> studied the long-term effect on microbiota of discontinuing finasteride in a rat model evaluating stool samples 1 month after stopping treatment&#46; The alpha diversity did not change&#44; but bacteria in the phylum Firmicutes decreased from baseline&#44; whereas those in the phylum Bacteroidetes increased&#46; Bacteria in the Bacteroidaceae and Prevotellaceae families were the most abundant&#44; followed by species in the Lactobacillaceae&#44; Lachnospiraceae&#44; and Ruminococcacea families&#46; <span class="elsevierStyleItalic">Bacteroides</span>&#44; <span class="elsevierStyleItalic">Prevotella&#44; Lactobacillus&#44; Oscillospira&#44; Lachnospira&#44; Ruminococcus</span>&#44; and <span class="elsevierStyleItalic">Coprococcus</span> species were most prevalent&#46; In contrast&#44; <span class="elsevierStyleItalic">Oscillospira</span> and <span class="elsevierStyleItalic">Lachnospira</span> species significantly declined in the absence of finasteride&#46; Finally&#44; in the group still on finasteride&#44; bacteria in the Bacteroidetes phylum and the Prevotellaceae family increased&#44; supporting the hypothesis that exposure to finasteride can affect the composition of gut microbiota&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Borde and &#197;strand<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> noted in a review of novel therapies that mammalian G-protein-coupled receptors 41 and 43 are possible therapeutic targets in immune disorders&#46; Although their role is still not clear&#44; the authors note&#44; they cite GPR43-deficient mouse models that have demonstrated exacerbated or persistent inflammation in colitis&#44; arthritis&#44; and asthma&#44; suggesting that this receptor may aggravate inflammatory diseases&#46; Moreover&#44; intestinal propionate may stimulate GPR43&#47;41 or GPR43&#47;109&#41;&#44; inducing more Tregs that can protect hair follicles from an immune attack&#46; The reviewers describe a pilot study that saw hair regrowth in 5 out of 5 mice 11 weeks after treatment with propionate versus none in the control group&#46; After 4 more weeks&#44; the researchers&#8217; analysis of differences in cellularity with treatment found a large increase in the Treg&#47;CD4<span class="elsevierStyleSup">&#43;</span> ratio versus the control group&#46; An attempt to replicate that study&#44; however&#44; could not produce the same effects on hair growth&#46; Finally&#44; prophylactic treatment was unable to prevent the development of disease symptoms&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Polyphenols and terpenes have been said to have a positive effect on cells involved in follicular growth&#44; by intensifying cellular proliferation in dermal papillae cells and increasing the concentrations of factors such as type 1 insulin-like growth factor and vascular endothelial growth factor&#44; reducing oxidative stress and improving hair growth&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">One study enrolled 12 patients with AGA between 40&#8239;and 65&#8239;years of age and classified as having stage 3&#8239;or 4 hair loss on the Hamilton-Norwood scale&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> When entering the study&#44; the patients had not used antibiotics in the previous 30 days&#44; had not used probiotics within 15 days&#44; and had not shampooed within 48&#8239;hours&#46; They had not undergone antitumor&#44; immunosuppressant&#44; or radiotherapy &#40;3 months&#41;&#44; used topical or hormone treatments for hair growth &#40;3 months&#41;&#44; or used minoxidil or finasteride &#40;6 months&#41;&#46; Nor did they have a history of other progressive dermatologic or inflammatory diseases affecting the scalp &#40;such as psoriasis&#59; seborrheic dermatitis&#59; or severe erythema&#44; excoriation&#44; or sunburn&#41;&#46; A phototrichogram was used to assess hair density on days 1 and 84&#44; focusing mainly on Hamilton-Norwood stage 3 hair loss&#46; A preparation containing a 1&#37; extract of <span class="elsevierStyleItalic">Lindera strychnifolia</span> and a placebo preparation were applied twice daily for 84 days on 2 areas of the scalp &#40;treatment and placebo areas&#41;&#46; Application of the active treatment did not affect alpha diversity but did achieve maintenance of bacterial biodiversity&#46; The researchers reported a significant decrease in <span class="elsevierStyleItalic">C acnes</span> &#40;15&#37;&#41;&#44; an increase in <span class="elsevierStyleItalic">S epidermidis</span> &#40;33&#37;&#41;&#44; and a decrease in the <span class="elsevierStyleItalic">C acnes&#47;S epidermidis</span> ratio &#40;37&#46;8&#37;&#41;&#46; The <span class="elsevierStyleItalic">L strychnifolia</span> application reestablished &#8220;normal&#8221; fungal populations&#44; especially fungi of the Basidiomycota phylum and 3 genera &#40;<span class="elsevierStyleItalic">Wallemia&#44; Eurotium</span>&#44; and <span class="elsevierStyleItalic">Malassezia</span>&#41;&#46; The researchers observed abundant <span class="elsevierStyleItalic">Malassezia</span> species&#44; which increased by 3&#37;&#44; and <span class="elsevierStyleItalic">M restricta</span> loads were restored to the level of the healthy controls&#46; <span class="elsevierStyleItalic">Eurotium</span> and <span class="elsevierStyleItalic">Wallemia</span> species were seen to decrease&#46; Finally&#44; hair growth increased significantly&#44; by 7&#37;&#46;</p></span></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The skin microbiome is a complex microbiological system with multiple interactions that can lead to both local and distant changes in homeostasis&#46; Imbalances can trigger disease processes such as immune cell dysfunction and can also lead to functional changes&#44; such as in hair follicles&#46; Therefore&#44; the system may be associated with inflammatory processes&#44; such as AA&#44; or changes in the hair follicle cycle&#44; as in AGA&#46; Multiple changes in skin surface or scalp microbiota&#44; whether bacterial or fungal&#44; have been described in both AA and AGA&#46; However&#44; the meaning of the associations remains uncertain&#44; and the issue is complicated by our poor understanding of the follicular microbiome&#46; The microbiology of the hair follicle must be better profiled so that we can learn more about its possible role in pathogenesis&#46; The field of research is still fairly wide&#44; and the possible therapeutic applications are many&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the profiles described above&#44; the importance of changes in both the genera and species of bacterial populations associated with AA must be emphasized&#46; Also important are cases in which disease has regressed after the use of postbiotics or bacterial therapies in association with conventional therapies such as platelet-rich plasma&#46; Other common therapies can also be considered&#58; corticosteroids can change the proportional distribution of microbes and also play an immunomodulatory role&#44; leading to questions about the mechanism by which they act as either modulators or triggers of disease&#46; Cases in which improvement has followed fecal transplantation have been reported&#44; introducing another possible therapeutic target&#58; gut microbiota&#46; However&#44; so far&#44; studies have involved few patients and must be replicated in larger trials before efficacy and possible adverse effects can be evaluated&#46; Finally&#44; the literature in this novel area focusing on the role of the microbiome is scarce in certain diseases&#46; Currently&#44; more is known about the microbiome&#8217;s role in inflammatory diseases such as atopic dermatitis and psoriasis&#46; We therefore emphasize that this line of of research holds promise for finding novel therapeutic targets in the gut or cutaneous microbiomes&#46; Possibilities include local&#44; systemic&#44; and diet therapies as well as the use of live organisms such as those found in probiotics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The human microbiome includes viruses&#44; bacteria&#44; and fungi&#46; There is evidence that in addition to microbiome variation in different areas of the body or according to ethnicity and sex&#44; the microbiome specific to the scalp is conditioned by such factors as humidity&#44; protection from UV light&#44; and pH&#46; Although little information has yet been published about the microbiome of hair follicles and its role in the pathogenesis of diseases&#44; interest in this area of research is emerging&#46; Studies have shown that components of the follicular microbiome influence such disorders as androgenetic alopecia and alopecia areata&#46; A current hypothesis is that interventions that target the microbiome may lead to innovative therapies for many diseases&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El microbioma incluye microorganismos como virus&#44; bacterias y hongos&#46; Se ha evidenciado que el cuero cabelludo tiene su propio microbioma dado por factores &#250;nicos como humedad&#44; protecci&#243;n de luz ultravioleta y pH&#44; adicionalmente existen diferencias entre distintas &#225;reas corporales&#44; etnias y sexos&#46; Existen pocas publicaciones o datos sobre el microbioma folicular y se ha denotado el rol de la microbiota en la patog&#233;nesis de varias enfermedades siendo un &#225;rea de investigaci&#243;n emergente&#46; Algunos estudios demuestran la influencia de esta composici&#243;n con enfermedades capilares como la alopecia areata y alopecia androgen&#233;tica&#46; Finalmente se ha postulado que la manipulaci&#243;n del microbioma puede representar una opci&#243;n terap&#233;utica innovadora para muchas enfermedades&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Translator&#8217;s note&#58; <span class="elsevierStyleItalic">Cutibacterium acnes</span> is the name by which <span class="elsevierStyleItalic">Propionibacterium acnes</span> is known in the current nomenclature&#46; The authors use both names in the article&#46; For the sake of preserving consistency between this translation and the original Spanish version&#44; the translation follows the authors&#8217; usage&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Barquero-Orias D&#44; Mu&#241;oz Moreno-Arrones O&#44; Va&#241;&#243;-Galv&#225;n S&#46; Alopecia y microbioma&#58; &#191;futura diana terap&#233;utica&#63; Actas Dermosifiliogr&#46; 2021&#59;112&#58;495&#8211;502&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Translator&#8217;s note&#58; The former phylum Zygomycota is currently divided into 2 phyla &#40;Mucoromycota and Zoopagomycota&#41;&#46; This translation follows the authors&#8217; use of nomenclature&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Article selection process&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of bacterial colonization of the scalps of patients with AA and controls&#46; AA refers to alopecia areata&#46; Data source&#58; Pinto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of fungal colonization of the scalps of patients with AGA and controls&#46; AGA refers to androgenetic alopecia&#46; Data source&#58; Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Concepts in Publications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relevant References&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current Knowledge</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Effects of diet on the microbiome</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polak-Witka et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fecal transplantation</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rebello et al&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xie et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microbiotic profile under finasteride treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diviccaro et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mammalian G protein-coupled receptors 43&#47;41 as therapeutic targets</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maslowski et al&#44; 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyphenols and terpenes</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shin et al&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Filaire et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of <span class="elsevierStyleItalic">Lindera strychnifolia</span> extract in androgenetic alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Filaire et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biomarkers in alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moreno-Arrones et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of antimicrobial therapy in androgenetic alopecia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mahe et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polak-Witka et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Composition of the microbiota in androgenetic alopecia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mahe et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ho et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lousada et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Composition of the microbiota in alopecia areata</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skinner et al&#44; 1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offidani et al&#44; 2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rudnicka et al&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hisham Diab Gaber et al&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mohan et al&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geoghegan et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pinto et al&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lousada et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of <span class="elsevierStyleItalic">Lactobacillus</span> species in hair follicle inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ark et al&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Helicobacter pylori</span> in alopecia areata</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti et al&#44; 1997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Campuzano et al&#44; 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Simakou et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use de postbiotics en alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rinaldi et al&#44; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probiotics and short-chain fatty acids</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smith et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arpaia et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Furusawa et al&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borde et al&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2608362.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Lines of Future Research&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomized controlled trials of recently discovered treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of diet modifications&#58; their effects on the composition of microbiota and their therapeutic uses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Better descriptions of changes in the microbiome and their pathogenic roles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Research on possible therapeutic uses of probiotics and postbiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adverse effects of experimental treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Research on the effects of conventional treatments and how they change the microbiota&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uses of biomarkers and precision medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Molecular and cellular therapeutic targets&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Role of the gut microbiome and its implications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of fecal transplantation as an alternative therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost-effectiveness comparisons between new therapies and current ones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2608361.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Current Knowledge and Lines of Research for the Future</p>"
        ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exploring the human hair follicle microbiome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lousada"
                            1 => "T&#46; Lachnit"
                            2 => "J&#46; Edelkamp"
                            3 => "T&#46; Rouill&#233;"
                            4 => "D&#46; Ajdic"
                            5 => "Y&#46; Uchida"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/BJD.19461"
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                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What&#8217;s new in the pathophysiology of alopecia areata&#63; The possible contribution of skin and gut microbiome in the pathogenesis of alopecia&#8212;big opportunities&#44; big challenges&#44; and novel perspectives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Migacz-Gruszka"
                            1 => "W&#46; Branicki"
                            2 => "A&#46; Obtulowicz"
                            3 => "M&#46; Pirowska"
                            4 => "K&#46; Gruszka"
                            5 => "A&#46; Wojas-Pelc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/ijt.ijt_76_19"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Trichol&#46;"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "185"
                        "itemHostRev" => array:3 [
                          "pii" => "S0954611111003325"
                          "estado" => "S300"
                          "issn" => "09546111"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A &#8220;hair&#8208;raising&#8221; history of alopecia areata"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Broadley"
                            1 => "K&#46; McElwee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/exd.14073"
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                        "tituloSerie" => "Exp Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "29"
                        "paginaInicial" => "208"
                        "paginaFinal" => "222"
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674913017107"
                          "estado" => "S300"
                          "issn" => "00916749"
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                  ]
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              ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional heterogeneity of gut-resident regulatory T cells"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Luu"
                            1 => "U&#46; Steinhoff"
                            2 => "A&#46; Visekruna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/cti.2017.39"
                      "Revista" => array:4 [
                        "tituloSerie" => "Clin Trans Immunol&#46;"
                        "fecha" => "2017"
                        "volumen" => "6"
                        "paginaInicial" => "e156"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alopecia areata"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Pratt"
                            1 => "L&#46; King"
                            2 => "A&#46; Messenger"
                            3 => "A&#46; Christiano"
                            4 => "J&#46; Sundberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrdp.2017.11"
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                        "tituloSerie" => "Nat Rev Dis Primers&#46;"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "17011"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28300084"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scalp bacterial shift in Alopecia areata"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Pinto"
                            1 => "E&#46; Sorbellini"
                            2 => "B&#46; Marzani"
                            3 => "M&#46; Rucco"
                            4 => "G&#46; Giuliani"
                            5 => "F&#46; Rinaldi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0215206"
                      "Revista" => array:4 [
                        "tituloSerie" => "PLOS ONE&#46;"
                        "fecha" => "2019"
                        "volumen" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31891643"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of the microbiome in scalp hair follicle biology and disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Polak-Witka"
                            1 => "L&#46; Rudnicka"
                            2 => "U&#46; Blume-Peytavi"
                            3 => "A&#46; Vogt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/exd.13935"
                      "Revista" => array:6 [
                        "tituloSerie" => "Exp Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "29"
                        "paginaInicial" => "286"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30974503"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0040"
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                    0 => array:2 [
                      "titulo" => "Androgenetic alopecia&#58; microbiota landscape and role of Lindera strychnifolia roots extract as a natural solution for hair loss"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Filaire"
                            1 => "A&#46; Dreux"
                            2 => "C&#46; Boutot"
                            3 => "F&#46; Volat"
                            4 => "E&#46; Ranouille"
                            5 => "J&#46; Demangeon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sofw J&#46;"
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                        "paginaInicial" => "16"
                        "paginaFinal" => "22"
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0045"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Alopecia areata&#58; a multifactorial autoimmune condition"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Simakou"
                            1 => "J&#46; Butcher"
                            2 => "S&#46; Reid"
                            3 => "F&#46; Henriquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaut.2018.12.001"
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                        "tituloSerie" => "J Autoimmun&#46;"
                        "fecha" => "2019"
                        "volumen" => "98"
                        "paginaInicial" => "74"
                        "paginaFinal" => "85"
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                    ]
                  ]
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              "identificador" => "bib0050"
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                      "titulo" => "Analysis of the gut microbiota in alopecia areata&#58; identification of bacterial biomarkers"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "S&#46; Serrano-Villar"
                            2 => "V&#46; Perez-Brocal"
                            3 => "D&#46; Saceda-Corralo"
                            4 => "C&#46; Morales-Raya"
                            5 => "R&#46; Rodrigues-Barata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.15885"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2019"
                        "volumen" => "34"
                        "paginaInicial" => "400"
                        "paginaFinal" => "405"
                        "itemHostRev" => array:3 [
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              "identificador" => "bib0055"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Alopecia areata and the gut&#8212;the link opens up for novel therapeutic interventions"
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                          "etal" => false
                          "autores" => array:2 [
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                        "tituloSerie" => "Expert Opin Ther Targets&#46;"
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                        "volumen" => "22"
                        "paginaInicial" => "503"
                        "paginaFinal" => "511"
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Investigation on microecology of hair root fungi in androgenetic alopecia patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Huang"
                            1 => "Y&#46; Ran"
                            2 => "S&#46; Pradhan"
                            3 => "W&#46; Yan"
                            4 => "Y&#46; Dai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11046-019-00345-8(01234"
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                        "tituloSerie" => "Mycopathologia&#46;"
                        "fecha" => "2019"
                        "volumen" => "184"
                        "paginaInicial" => "505"
                        "paginaFinal" => "515"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31240449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Folliculitis decalvans is characterized by a persistent&#44; abnormal subepidermal microbiota"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "M&#46; Resche&#8208;Rigon"
                            3 => "A&#46; Tristan"
                            4 => "D&#46; Farhi"
                            5 => "C&#46; Rousseau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/exd.13916"
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                        "tituloSerie" => "Exp Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "29"
                        "paginaInicial" => "295"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30907453"
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                          "pii" => "S009167491830616X"
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              ]
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              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Folliculitis decalvans and lichen planopilaris phenotypic spectrum&#58; a case series of biphasic clinical presentation and theories on pathogenesis"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "M&#46; Harries"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ced.13989"
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                        "tituloSerie" => "Clin Exp Dermatol&#46;"
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                        "volumen" => "45"
                        "paginaInicial" => "63"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31017678"
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                          "pii" => "S0140673618313631"
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                          "issn" => "01406736"
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                  ]
                ]
              ]
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              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Folliculitis decalvans microbiological signature is specific for disease clinical phenotype"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Moreno-Arrones"
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                            5 => "S&#46; Serrano-Villar"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2020"
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                    ]
                  ]
                ]
              ]
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            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hair growth in two alopecia patients after fecal microbiota transplant"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Rebello"
                            1 => "E&#46; Wang"
                            2 => "E&#46; Yen"
                            3 => "P&#46; Lio"
                            4 => "C&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "ACG Case Rep J&#46;"
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                        "volumen" => "4"
                        "paginaInicial" => "e107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28932754"
                            "web" => "Medline"
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                    ]
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                ]
              ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata&#58; a case report and review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46; Xie"
                            1 => "X&#46; Yang"
                            2 => "H&#46; Xia"
                            3 => "L&#46; Wu"
                            4 => "X&#46; He"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.12998/wjcc.v7.i19.3074"
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                        "tituloSerie" => "World J Clin Cases&#46;"
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                        "paginaInicial" => "3074"
                        "paginaFinal" => "3081"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31624757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of postbiotics in a PRP-like cosmetic product for the treatment of alopecia area Celsi&#58; a randomized double-blinded parallel-group study"
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                            2 => "D&#46; Pinto"
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                  "host" => array:1 [
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                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2020"
                        "volumen" => "10"
                        "paginaInicial" => "483"
                        "paginaFinal" => "493"
                        "itemHostRev" => array:3 [
                          "pii" => "S0022202X19335006"
                          "estado" => "S300"
                          "issn" => "0022202X"
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                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of male rats with finasteride&#44; an inhibitor of 5alpha-reductase enzyme&#44; induces long-lasting effects on depressive-like behavior&#44; hippocampal neurogenesis&#44; neuroinflammation and gut microbiota composition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "S&#46; Diviccaro"
                            1 => "S&#46; Giatti"
                            2 => "F&#46; Borgo"
                            3 => "M&#46; Barcella"
                            4 => "E&#46; Borghi"
                            5 => "J&#46; Trejo"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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