Shared Decision-Making, Therapeutic Choice, and Decisional Regret in Patients With Alopecia Areata

Alopecia areata: What's new in the diagnosis and treatment with JAK inhibitors?

Alopecia areata (AA) affects individuals of all ages and is intractable in severe relapsing cases. Dermatologists and other healthcare providers should consider AA in the medical context and prioritize treatment. Several randomized controlled clinical studies on Janus kinase (JAK) inhibitors with different specificities for the treatment of AA are ongoing. These studies have encouraged us to appreciate the importance of a definitive diagnosis and accurate evaluation of AA before and during treatment. Following our previous review article in 2017, here we provide the second part of this two-review series on the recent progress in the multidisciplinary approaches to AA from more than 1800 articles published between July 2016 and December 2022. This review focuses on the evaluation, diagnosis, and treatment of AA. We also provide the latest information on the safety and efficacy of JAK inhibitors for the treatment of AA and describe their mechanisms of action.

Shared decision-making quality and decisional regret in patients with low-risk superficial basal cell carcinoma: A prospective, multicenter cohort study

Background

Many therapies are available to treat low-risk superficial basal cell carcinoma (lr-sBCC), which may complicate the shared decision-making (SDM) process.

Objective

To assess the SDM process of patients and physicians when deciding lr-sBCC therapy as well as the factors that may influence the SDM process.

Methods

A prospective, multicenter cohort study was conducted over 18 months, from October 2018 to April 2020, in 3 tertiary university hospitals and 1 private hospital.

Results

This study included 107 patients. There was a weak positive correlation between Shared Decision-Making Questionnaire-Patient version (SDM-Q-9) and Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) (Spearman's correlation coefficient [rs] [105] = 0.21; P = .03). Most patients (71%) chose a nonsurgical treatment after the SDM process. Patients with higher satisfaction with the SDM had lower decisional conflict and decisional regret (P < .001). Patients aged >80 years had higher rates of significant decisional conflict. When evaluating treatment decisions, the highest median score for decisional conflict (22, IQR [16]; P = .01) was observed among patients who chose a surgical excision.

Limitations

Patients may have self-selected to participate.

Conclusion

This study suggests that some patients may prefer less invasive therapies for lr-sBCC. The SDM process may reduce decisional conflict and decisional regret.

Online attitudes about the first approved systemic treatment for alopecia areata: a sentiment analysis of Reddit posts

Alopecia areata (AA) is a complex inflammatory skin disease with a tremendous physical and emotional burden. Understanding patient sentiment towards AA treatment, particularly those treatments approved for AA, may help in better addressing patient needs. Here, we analysed 13 771 Reddit posts from the ‘alopecia_areata’ subreddit using sentiment analysis to evaluate online attitudes about the first approved systemic treatment for AA, baricitinib. We show that posts including baricitinib or related terms are more likely to be positive, with a higher likelihood of being positive after Food and Drug Administration approval.

Physician values in alopecia areata treatment decision-making: A qualitative assessment

Background

Alopecia areata (AA) is a disease of hair loss with multiple treatment options. Physicians play an important role in guiding patients during the decision-making process.

Objective

Assess physicians' values and attitudes when helping patients choose an AA treatment.

Methods

Semi-structured qualitative interviews were conducted with dermatologists of varying practice type and location. Each interview was coded independently twice using inductive thematic analysis. Interrater reliability and code frequencies were determined.

Results

Fourteen participants were interviewed. Interrater reliability was κ = 0.85 to 0.97. Dermatologists wanted patients to consider various treatment factors (ie, efficacy, safety, convenience of use, accessibility) and also assessed patients' AA clinical severity and personality traits. Participants often encountered various barriers to effective communication with patients, which may be mitigated by shared decision-making. Shared decision-making tools were perceived to potentially improve patient care and communication, although physicians expressed concern about lack of individualization, limitations of time, and the appropriateness of information.

Conclusion

AA treatment decision-making is a complex process that often utilizes the expertise of a dermatologist, during which shared decision-making tools may be of value to both patients and physicians.

Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Assessing Patient's Values When Selecting Treatments for Alopecia Areata: A Cross-Sectional Survey Study

Introduction

Alopecia areata (AA) is an autoimmune condition that results in nonscarring hair loss. There is currently only one Food and Drug Administration (FDA)-approved treatment for AA; as a result, a wide range of treatments are commonly administered. This study aimed to determine how patients with AA prioritize treatment characteristics when choosing a therapy.

Methods

A cross-sectional national survey was distributed using the National Alopecia Areata Foundation's (NAAF) email list. This study was approved by the Mass General Brigham Institutional Review Board. Participants were asked to rank the importance of five treatment domains.

Results

Of the 1,074 completed surveys (completion rate 77.4%), most respondents were female (85.4%) and white (77.8%) with an average age of 49.3 ± 15.4 years. Respondents had AA for an average of 17.7 ± 15.4 years, with 90.0% experiencing current active hair loss. 95.6% of respondents considered the treatment's ability to achieve hair regrowth as important, 93.9% listed the availability of information about the treatment (e.g., via doctor or online) as important, 89.1% ranked the treatment side effects as important, 75.7% the cost, and 68.0% the convenience of use. A sub-analysis was performed examining responses between respondents who identify as white versus nonwhite, which showed that while the order of importance was the same between groups, a significantly larger proportion of nonwhite respondents attributed higher importance to cost (white: 73.8%, nonwhite: 82.4%; p = 0.006) and convenience (white: 65.3%, nonwhite: 77.3%; p < 0.001) than their white counterparts.

Discussion/Conclusion

These findings identify key domains that can serve as a starting point in shared decision-making between patients and physicians. This knowledge can streamline dermatologist delivery of key information and highlight areas of improvement for future therapeutics. Limitations include the nonrandomized NAAF population with most participants being white females. Future studies should confirm these findings in other patient populations.

Alopecia areata and pattern hair loss (androgenetic alopecia) on social media - Current public interest trends and cross-sectional analysis of YouTube and TikTok contents

BACKGROUND

With an ever-growing influence of social media in healthcare, concurrent with increased emphasis on patient autonomy and shared decision-making, dermatologists treating hair loss need to be cognizant of online interest trends and the types of information disseminated across popular platforms.

OBJECTIVES

To evaluate recent health-related interest trends and assess engagement, quality, and accuracy of alopecia areata (AA) and pattern hair loss (PHL, androgenetic alopecia) contents on social media.

METHODS

Relative search volumes (RSVs) were extracted from Google Trends using the search category 'alopecia areata' and 'pattern hair loss'. Eighty matching videos on TikTok and YouTube were also extracted and characterized. Viewer engagement was estimated using the engagement ratio, and quality and accuracy were assessed using DISCERN and Dy et al. Accuracy Scale (DAS).

CONCLUSIONS

AA-related contents on TikTok discussing personal experiences of female subjects were significantly more engaging. DISCERN and DAS scoring showed significantly higher quality and accuracy in videos created by healthcare providers on YouTube, but not TikTok, which could in part be related to YouTube videos being longer. RSV fluctuations corresponding to news in popular culture had high impact. Sponsorship disclosures were generally not reported in product promotional videos.