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Clemmesen MER, Gren ST, Frøstrup AG, Thomsen SF, Egeberg A, Thein D. Psychosocial and mental impact of alopecia areata: Analysis of the Danish Skin Cohort. J Eur Acad Dermatol Venereol 2024. [PMID: 38940661 DOI: 10.1111/jdv.20211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024]
Abstract
IMPORTANCE Alopecia areata (AA) carries a psychological burden for patients beyond hair loss. However, quality-of-life measurement tools such as EQ-5D used in clinical trials may not adequately capture the burden of AA, the perceived stigmatization or the psychosocial impact of AA. OBJECTIVE To investigate the potential association between disease severity and the degree of social isolation, perceived stigmatization, anxiety and depression, alcohol consumption and work absenteeism using multiple PRO measures in patients with AA. DESIGN, SETTING AND PARTICIPANTS Using the Danish Skin Cohort, the study included adult patients diagnosed with AA. The study included multiple PRO measures, including Skindex-16, EQ-5D-5L, Work Productivity and Activity Impairment (WPAI), Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Alopecia Areata Symptom Impact Scale (AASIS). The questionnaires were dispatched to the patients in January 2023. The severity of AA was determined based on scalp involvement using a modified Alopecia Areata Scale. Multiple multivariate linear regressions were conducted using Skindex-16, AASIS and WPAI, while multivariate logistic regressions were applied to HADS, AUDIT-C and EQ-5D-5L. RESULTS A total of 376 patients were included, of which 177 (47%) had severe disease, 41 (11%) had moderate disease, 94 (25%) had mild disease, and 64 (17%) were in remission. The median age of patients was 55 (IQR, 47-66 years) and most were female (70%). Skindex-16 and AASIS were the only PRO measures able to distinguish between severity. For these scores, moderate and severe diseases, female sex, and involvement of eyebrows increased the score and negatively impacted patient quality of life. CONCLUSION AND RELEVANCE The results indicate the importance of using the proper tool for the intended measurement of quality of life and that factors such as the severity of AA, as well as female sex and involvement of the eyebrows, may potentially increase the psychosocial burden of AA.
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Affiliation(s)
| | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David Thein
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Lyakhovitsky A, Zilbermintz T, Segal Z, Galili E, Shemer A, Jaworowski B, Baum S, Hermush V, Kaplan B, Barzilai A. Exploring Remission Dynamics and Prognostic Factors in Lichen Planopilaris: a Retrospective Cohort Study. Dermatology 2024:000538355. [PMID: 38574470 DOI: 10.1159/000538355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/10/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Lichen planopilaris (LPP) is a common type of primary cicatricial alopecia. Previous studies focused on the epidemiology, clinical characteristics, and treatment of LPP. A lack of knowledge regarding LPP outcomes and prognostic factors remained. METHODS To delineate the rate and timing of remission in LPP, as well as the prognostic factors for achieving remission, a retrospective cohort study was conducted. The study included 126 patients, from a single tertiary center, diagnosed with LPP between January 2010 and December 2022, who were followed up for a minimum of 6 months. RESULTS There were 89 (70.6%) women and 37 (29.4 %) men included in this study. The mean age of the patients was 47.92±14.2 years. The mean time from disease onset to diagnosis was 33.85 (±30) months, indicating significant diagnostic delays. The mean duration of follow-up was 34.13±22.7 months. Among the cohort, 43 patients achieved complete remission (CR) during the follow-up period, whereas 83 patients did not. Of the 83 patients who did not achieve CR, 35 partially improved and 48 did not improve or worsened. The median time for achieving CR was 46±18.8 months. Milder disease at presentation and comorbid lichen planus were associated with higher CR rates. CONCLUSION This study demonstrates significant diagnostic delays that should be addressed as LPP causes irreversible alopecia, suggests disease severity and comorbid lichen planus as potential prognostic factors. Further, it emphasizes the limited efficacy of current treatments and the need for prolonged treatment in patients with LPP to achieve remission.
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Moussa A, Bennett M, Wall D, Meah N, York K, Bokhari L, Asfour L, Rees H, Abraham LS, Asz-Sigall D, Basmanav FB, Bergfeld W, Betz RC, Bhoyrul B, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Dhurat R, Donovan J, Doroshkevich A, Eisman S, Farrant P, Ferrando J, Gadzhigoroeva A, Green J, Grimalt R, Harries M, Hordinsky M, Irvine A, Jolliffe V, Kaiumov S, King B, Lee J, Lee WS, Li J, Lortkipanidze N, McMichael A, Mesinkovska NA, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Ovcharenko Y, Piraccini BM, Pirmez R, Rakowska A, Reygagne P, Rudnicka L, Corralo DS, Senna M, Shapiro J, Sharma P, Siliuk T, Starace M, Suchonwanit P, Takwale A, Tosti A, Vañó-Galván S, Visser WI, Vogt A, Wade M, Yip L, Zhou C, Sinclair R. The Alopecia Areata Severity and Morbidity Index (ASAMI) Study: Results From a Global Expert Consensus Exercise on Determinants of Alopecia Areata Severity. JAMA Dermatol 2024; 160:341-350. [PMID: 38324292 DOI: 10.1001/jamadermatol.2023.5869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Importance Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact. Objective To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI). Evidence Review A total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022. Findings Of all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss. Conclusions and Relevance This eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.
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Affiliation(s)
- Anthony Moussa
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Nekma Meah
- St Helens & Knowsley National Health Service Trust, St Helens, United Kingdom
- Manchester University, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - Katherine York
- Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | - Laita Bokhari
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Leila Asfour
- Salford Royal Foundation Trust, Northern Care Alliance, Manchester, United Kingdom
| | - Huw Rees
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | - Daniel Asz-Sigall
- Trichology Clinic, Dermatology Department, Dr Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
| | - Fitnat Buket Basmanav
- Institute of Human Genetics, University Hospital of Bonn & University of Bonn, Bonn, Germany
| | | | - Regina C Betz
- Institute of Human Genetics, University Hospital of Bonn & University of Bonn, Bonn, Germany
| | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Andrea Combalia
- Dermatology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Brittany Craiglow
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | | | - Jeff Donovan
- Donovan Hair Clinic, University of British Columbia, Whistler, British Columbia, Canada
| | | | - Samantha Eisman
- Sinclair Dermatology, East Melbourne, Victoria, Australia
- Australasian Hair and Wool Research Society, Melbourne, Victoria, Australia
| | - Paul Farrant
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | - Juan Ferrando
- Dermatology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Aida Gadzhigoroeva
- Moscow Scientific & Practical Center of Dermatology, Venereology and Cosmetology, Russian Federation
| | - Jack Green
- Department of Dermatology, Saint Vincent's Hospital, Victoria, Australia
| | - Ramon Grimalt
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Matthew Harries
- Salford Royal Hospital, Northern Care Alliance National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Alan Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Victoria Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Spartak Kaiumov
- Clinic of Trichology and Cosmetology Nautilus, Saint-Petersburg, Russia
| | - Brett King
- Yale School of Medicine, New Haven, Connecticut
| | | | - Won-Soo Lee
- Department of Dermatology, Yonsei University, Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon-do, Republic of Korea
| | - Jane Li
- Department of Dermatology, Saint Vincent's Hospital, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, Eastern Health, Melbourne, Victoria, Australia
- Skin Health Institute, Carlton, Melbourne, Victoria, Australia
| | | | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Andrew Messenger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - Elise Olsen
- Duke Dermatology Clinic, Durham, North Carolina
| | - Seth J Orlow
- Grossman School of Medicine, New York University, New York, New York
| | - Yuliya Ovcharenko
- Department of Infectious Diseases and Clinical Immunology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences University of Bologna, Bologna, Italy
| | - Rodrigo Pirmez
- Instituto de Dermatologia Professor Rubem David Azulay-Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Reygagne
- Centre de Santé Sabouraud, Hopital Saint Louis, Vellefaux, Paris, France
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - David Saceda Corralo
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maryanne Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jerry Shapiro
- Disorders of the Hair and Scalp, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Pooja Sharma
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Tatiana Siliuk
- Hair Treatment and Transplantation Center, Saint Petersburg, Russian Federation
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anita Takwale
- Editorial Advisory Board, Indian Journal of Dermatology Venereology Leprosy
| | - Antonella Tosti
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sergio Vañó-Galván
- Dermatology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
- Trichology Unit, #TricoHRC Research Group, Madrid, Spain
| | - Willem I Visser
- Division of Dermatology, Stellenbosch University, Cape Town, South Africa
| | - Annika Vogt
- Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Martin Wade
- The London Skin and Hair Clinic, London, United Kingdom
| | - Leona Yip
- Skin Partners Specialist Dermatologists, Brisbane, Australia
| | - Cheng Zhou
- Department of Dermatology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Rodney Sinclair
- Sinclair Dermatology, East Melbourne, Victoria, Australia
- Australasian Hair and Wool Research Society, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Yeong Lee J, Won Lee J, Lee WS. Comparison of self-estimated and clinician-measured SALT score in patients with alopecia areata: Patients with alopecia areata perceive themselves as more severe than dermatologists. Indian J Dermatol Venereol Leprol 2024; 0:1-3. [PMID: 38314976 DOI: 10.25259/ijdvl_439_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/28/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Ju Yeong Lee
- Department of Dermatology, Wonju Severance Christian hospital, Ilsan-ro 20, Wonju, Korea
| | - Jong Won Lee
- Department of Dermatology, Wonju Severance Christian hospital, Ilsan-ro 20, Wonju, Korea
| | - Won-Soo Lee
- Department of Dermatology, Wonju Severance Christian hospital, Ilsan-ro 20, Wonju, Korea
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Mogawer RM, Fawzy MM, Mourad A, Ahmed H, Nasr M, Nour ZA, Hafez V. Topical sodium valproate-loaded nanospanlastics versus conventional topical steroid therapy in alopecia areata: a randomized controlled study. Arch Dermatol Res 2024; 316:64. [PMID: 38170256 PMCID: PMC10764371 DOI: 10.1007/s00403-023-02785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A myriad of therapeutic modalities for alopecia areata are available; however, none is of high level of evidence, creating an immense need for the evaluation of other treatment modalities, of which topical sodium valproate is of potential role via proposed decrease in beta-catenin breakdown, despite its well-known side effect of hair fall as an oral therapy. OBJECTIVE Evaluating the efficacy and the safety of sodium valproate (SV)-loaded nanospanlastics, in comparison to topical corticosteroids, this is the currently available gold standard topical treatment for patchy AA. METHODOLOGY A total of 66 patients with patchy AA were randomly assigned to receive either topical mometasone furoate lotion or topical SV applied twice daily to all patches except a control patch, which was left untreated. Clinical, trichoscopic and biochemical assessments of beta-catenin tissue levels and Axin-2 gene expression were carried out at baseline and after 3 months. RESULTS Both therapeutic modalities were comparable. Potential efficacy was highlighted by significant improvement in the representative patch, the largest treated patch, to the control patch, the smallest untreated patch in both steroid and valproate groups (p = 0.027, 0.003 respectively). Both beta-catenin levels and Axin-2 gene expression were reduced after treatment, pointing to the inhibitory effect of dominating uncontrolled inflammatory milieu. Baseline beta-catenin was found to significantly negatively correlate with improvement in the representative patch in patients with baseline level above 0.42 ng/ml (p = - 0.042). CONCLUSION Both topical SV and steroids are of comparable modest efficacy. Thus, further evaluation of SV is due in combination with intralesional steroids and other anti-inflammatory treatment modalities, together with developing individualized approaches based on baseline beta-catenin level. CLINICALTRIALS GOV IDENTIFIER NCT05017454, https://clinicaltrials.gov/ct2/show/NCT05017454 .
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Affiliation(s)
- Rania M Mogawer
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Marwa Mohamed Fawzy
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mourad
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Ahmed
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Nasr
- Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Zeinab Ahmed Nour
- Biochemistry Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Bi L, Wang C, Du Y, Su T, Zhao M, Lin X, Fan W, Sun W. Effectiveness and safety of baricitinib in patients with moderate-to-severe refractory alopecia areata in real world: An open-label, single-center study. J Cosmet Dermatol 2023. [PMID: 38116864 DOI: 10.1111/jocd.16123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Baricitinib is a small-molecular drug that selectively inhibits the Janus Kinase (JAK) 1 and 2. However, it showed various efficiency and safety in treating moderate-to-severe alopecia areata (AA). This study was to describe the real-world effectiveness of baricitinib in treating moderate-to-severe refractory AA. METHODS Patients who were affected by moderate-to-severe AA and reported no shrinkage in the alopecia area after 6 months of conventional treatment were enrolled in the retrospective study. The patients were treated with baricitinib orally for at least 24 weeks. The severity of alopecia was evaluated at the end of 4, 12, and 24 weeks of treatment. RESULTS The 32 patients included 23 females and nine males, with a median duration of AA of 14.5 months. Among them, 28 patients received baricitinib 2 mg per day for 24 weeks while the other four patients increased the daily dose from 2 to 4 mg after the first 12 weeks due to the unobvious hair restoration. SALT value showed a significant decrease from baseline at week 12 and 24 (64.45 [44.68-100.00] vs. 26.80 [13.40-62.32], p < 0.0001 and 64.45 [44.68-100] vs. 9.40 [4.85-34.95], p < 0.0001). After 24 weeks of treatment, 50% of patients had an improvement of ≥2 points in IGA scores from the baseline, and IGA scores of 68.75% of patients were less than 2. CONCLUSION This 24-week research showed that baricitinib had favorable clinical efficacy and safety in treating moderate-to-severe AA, which is worthy of attention and expectation.
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Affiliation(s)
- Lingbo Bi
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chaofan Wang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yimei Du
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong Su
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Dermatology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zhao
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuewen Lin
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weixin Fan
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weiling Sun
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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King B, Pezalla E, Fung S, Tran H, Bourret JA, Peeples-Lamirande K, Takiya L, Napatalung L. Overview of alopecia areata for managed care and payer stakeholders in the United States. J Manag Care Spec Pharm 2023; 29:848-856. [PMID: 37219075 PMCID: PMC10394197 DOI: 10.18553/jmcp.2023.22371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Alopecia areata (AA) is an autoimmune disease with a complex pathophysiology resulting in nonscarring hair loss in genetically susceptible individuals. We aim to provide health care decision makers an overview of the pathophysiology of AA, its causes and diagnosis, disease burden, costs, comorbidities, and information on current and emerging treatment options to help inform payer benefit design and prior authorization decisions. Literature searches for AA were conducted using PubMed between 2016 and 2022 inclusive, using search terms covering the causes and diagnosis of AA, pathophysiology, comorbidities, disease management, costs, and impact on quality of life (QoL). AA is a polygenic autoimmune disease that significantly impacts QoL. Patients with AA face economic burden and an increased prevalence of psychiatric disease, as well as numerous systemic comorbidities. AA is predominantly treated using corticosteroids, systemic immunosuppressants, and topical immunotherapy. Currently, there are limited data to reliably inform effective treatment decisions, particularly for patients with extensive disease. However, several novel therapies that specifically target the immunopathology of AA have emerged, including Janus kinase (JAK) 1/2 inhibitors such as baricitinib and deuruxolitinib, and the JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor ritlecitinib. To support disease management, a disease severity classification tool, the Alopecia Areata Severity Scale, was recently developed that evaluates patients with AA holistically (extent of hair loss and other factors). AA is an autoimmune disease often associated with comorbidities and poor QoL, which poses a significant economic burden for payers and patients. Better treatments are needed for patients, and JAK inhibitors, among other approaches, may address this tremendous unmet medical need. DISCLOSURES: Dr King reports seats on advisory boards for and/or is a consultant and/or clinical trial investigator for AbbVie, Aclaris Therapeutics Inc, AltruBio Inc, Almirall, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Meyers Squibb, Concert Pharmaceuticals Inc, Dermavant Sciences Inc, Eli Lilly and Company, Equillium, Incyte Corp, Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, TWi Biotechnology Inc, and Viela Bio; and speakers bureaus for AbbVie, Incyte, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. Pezalla is a paid consultant to Pfizer for market access and payer strategy concerns; Fung, Tran, Bourret, Takiya, Peeples-Lamirande, and Napatalung are employees of Pfizer and hold stock in Pfizer. This article was funded by Pfizer.
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Affiliation(s)
- Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | | | | | - Lynne Napatalung
- Medical Affairs, Pfizer, New York, NY
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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Xia E, Li SJ, Drake L, Reyes-Hadsall S, Mita C, Drucker AM, Mostaghimi A. An Assessment of Current Clinician-Reported and Patient-Reported Outcome Measures for Alopecia Areata: A Scoping Review. J Invest Dermatol 2023; 143:1133-1137.e12. [PMID: 37115113 DOI: 10.1016/j.jid.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 04/29/2023]
Abstract
Although progress has been made in developing outcome measures for AA, the use of these measures remains unstandardized. A scoping review was conducted to identify the clinician-reported outcome measures (ClinROMs) and patient-reported outcome measures (PROMs) used in assessing and treating AA, the results of which revealed heterogeneity in AA outcome measures. Of 23 research studies ultimately included, only 2 ClinROMs were used by >15% of studies; likewise, of 110 clinical trials evaluated, numerous outcome instruments were used, but only one ClinROM was used by >5% of trials (Severity of Alopecia Tool). These results suggest the need for consensus and standardization in both research and trial settings.
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Affiliation(s)
- Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sophia Reyes-Hadsall
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases. J Clin Med 2023; 12:jcm12093259. [PMID: 37176700 PMCID: PMC10179687 DOI: 10.3390/jcm12093259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.
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Affiliation(s)
- Misaki Kinoshita-Ise
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
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10
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Zhang J, Lin P, Lin H, Ma C, Hu Y, Wang Y, Zhang Y. Laser and light therapy combined with topical minoxidil for alopecia areata: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci 2023; 38:74. [PMID: 36800063 DOI: 10.1007/s10103-023-03734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023]
Abstract
We aim to evaluate the clinical efficacy and safety of using laser and light combined with topical minoxidil for alopecia areata. We searched PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), VIP database, and Wanfang Data from their inception to September 18, 2022. The risk of bias of the included RCTs was assessed by the Cochrane Collaboration tool. RevMan 5.3 software and Stata 14.0 software were used to perform the statistical analysis. The GRADE system assessed the quality of evidence. Ten studies were enrolled finally. The results of the meta-analysis showed that compared with topical minoxidil alone, the 308-nm excimer laser/light or He-Ne laser combined with topical minoxidil could reduce the SALT (Severity of Alopecia Tool) score (MD= -5.88, 95% CI [-9.79, -1.98], P=0.003). Whether fractional CO2 laser (RR=1.29, 95% CI [1.14, 1.46], P<0.0001), 308-nm excimer laser/light (RR=1.32, 95% CI [1.12, 1.55], P=0.001), He-Ne laser (RR=1.69, 95% CI [1.07, 2.69], P=0.03), or NB-UVB (RR=1.35, 95% CI [1.07,1.70], P=0.01) combined with topical minoxidil may improve the treatment response rate, comparing with topical minoxidil only. The recurrence rate of laser and light combined with topical minoxidil was lower than that of the minoxidil alone group (RR=0.54, 95% CI [0.31, 0.93], P=0.03) when follow-up time was 1 year. In addition, the incidence of adverse events including irritant contact dermatitis, erythema, desquamation, pain, and pruritus was no significant difference between the two groups (RR=1.50, 95% CI [0.95, 2.36], P=0.08). The level of evidence for outcomes was classified as very low to moderate. Based on the available evidence, laser and light combined with topical minoxidil therapy may be effective and safe for alopecia areata. However, more high-quality trials are required for comprehensive analysis and further verification.
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Affiliation(s)
- Jianfeng Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Peng Lin
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Haiyue Lin
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Cong Ma
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yi Hu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yingdong Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300120, China.
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11
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Gudobba C, Mane T, Bayramova A, Rodriguez N, Castelo-Soccio L, Ogunleye TA, Taylor SC, Cotsarelis G, Bernardis E. Automating Hair Loss Labels for Universally Scoring Alopecia From Images: Rethinking Alopecia Scores. JAMA Dermatol 2023; 159:143-150. [PMID: 36515962 PMCID: PMC9857252 DOI: 10.1001/jamadermatol.2022.5415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Clinical estimation of hair density has an important role in assessing and tracking the severity and progression of alopecia, yet to the authors' knowledge, no automation currently exists for this process. While some algorithms have been developed to assess alopecia presence on a binary level, their scope has been limited by focusing on a re-creation of the Severity of Alopecia Tool (SALT) score for alopecia areata (AA). Yet hair density loss is common to all alopecia forms, and an evaluation of that loss is used in established scoring systems for androgenetic alopecia (AGA), central centrifugal cicatricial alopecia (CCCA), and many more. Objective To develop and validate a new model, HairComb, to automatically compute the percentage hair loss from images regardless of alopecia subtype. Design, Setting, and Participants In this research study to create a new algorithmic quantification system for all hair loss, computational imaging analysis and algorithm design using retrospective image data collection were performed. This was a multicenter study, where images were collected at the Children's Hospital of Philadelphia, University of Pennsylvania (Penn), and via a Penn Dermatology web interface. Images were collected from 2015 to 2021, and they were analyzed from 2019 to 2021. Main Outcomes and Measures Scoring systems correlation analysis was measured by linear and logarithmic regressions. Algorithm performance was evaluated using image segmentation accuracy, density probability regression error, and average percentage hair loss error for labeled images, and Pearson correlation for manual scores. Results There were 404 participants aged 2 years and older that were used for designing and validating HairComb. Scoring systems correlation analysis was performed for 250 participants (70.4% female; mean age, 35.3 years): 75 AGA, 66 AA, 50 CCCA, 27 other alopecia diagnoses (frontal fibrosing alopecia, lichen planopilaris, telogen effluvium, etc), and 32 unaffected scalps without alopecia. Scoring systems showed strong correlations with underlying percentage hair loss, with coefficient of determination R2 values of 0.793 and 0.804 with respect to log of percentage hair loss. Using HairComb, 92% accuracy, 5% regression error, 7% hair loss difference, and predicted scores with errors comparable to annotators were achieved. Conclusions and Relevance In this research study,it is shown that an algorithm quantitating percentage hair loss may be applied to all forms of alopecia. A generalizable automated assessment of hair loss would provide a way to standardize measurements of hair loss across a range of conditions.
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Affiliation(s)
- Cameron Gudobba
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tejas Mane
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aylar Bayramova
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Natalia Rodriguez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Leslie Castelo-Soccio
- Section of Dermatology, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases/National Institutes of Health, Bethesda, Maryland
| | - Temitayo A Ogunleye
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elena Bernardis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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12
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Bhusal M, Bhattarai S, Thapa B, Shrestha P, Sagar GC. Bimatoprost versus clobetasol propionate in scalp alopecia areata: A prospective non-randomized open-label clinical trial. Indian Dermatol Online J 2023; 14:221-225. [PMID: 37089845 PMCID: PMC10115310 DOI: 10.4103/idoj.idoj_299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 03/12/2023] Open
Abstract
Background Alopecia areata (AA) is one of the most common forms of alopecia presenting to the dermatology out patient department (OPD) worldwide as well as in Nepal. It is mostly diagnosed clinically. Treatment depends on the extent, location, and severity of the condition. Various treatment options available are topical, intralesional, and oral medications. Bimatoprost is a relatively newer treatment modality in AA. Aim and Objective To compare the efficacy and safety of topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream in scalp AA. Materials and Methods A total of 50 patients attending the dermatology OPD of a tertiary hospital between March 2018 and February 2019 were included in this prospective non-randomized open-label clinical trial. Patients were divided into two groups i.e., Group A- topical bimatoprost solution 0.01% and Group B- topical clobetasol propionate cream 0.05%, and followed up at weeks 4, 8, and 12. The improvement was analyzed subjectively by hair regrowth and objectively by Severity of Alopecia Tool (SALT) score. Side effects, nature of terminal hair and onset of initial response were also recorded. Results Out of 50 patients, 27 were males and 23 were females with a mean age of 28.5 ± 9.34 years and mean duration of disease of 18.67 ± 46.1 weeks. Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost (p = 0.282 and P = 0.246, respectively). Side effects were seen more in the clobetasol group compared to bimatoprost group (p = 0.002). Onset of cosmetically acceptable hair regrowth was seen earlier in the bimatoprost group (p = 0.017) and also the nature of regrown hairs was more pigmented in bimatoprost group (p = 0.024). Conclusions There is no significant difference in hair regrowth between clobetasol and bimatoprost in the treatment of AA on scalp at the end of 12 weeks, although bimatoprost has an advantage of lesser side effects, more rapid response and growth of more pigmented hairs.
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13
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Sánchez-Díaz M, Díaz-Calvillo P, Ureña-Paniego CA, Molina-Leyva A, Arias-Santiago S. Quality of Life and Mood Status Disturbances in Cohabitants of Patients with Alopecia Areata: A Cross-Sectional Study in a Spanish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16323. [PMID: 36498394 PMCID: PMC9737113 DOI: 10.3390/ijerph192316323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
A poor quality of life has been described in patients suffering from Alopecia Areata (AA). However, there is little evidence on how AA can impact on those living with patients. The aim of this study is to analyze the impact of AA on a cohabitant’s quality-of-life, mood status disturbances and sexual satisfaction. This is a cross-sectional study of AA patients and their cohabitants. Socio-demographic variables and disease severity, the quality of life, mood status disturbances and sexual dysfunction were collected using validated questionnaires. Eighty-four subjects were included in the study: 42 AA patients and 42 cohabitants. A poor quality of life and worse disease control in the patients were associated with a poorer quality of life of the family, higher scores of anxiety and depression, and the lower sexual satisfaction of cohabitants (p < 0.05). Anxiety and depression in patients were associated with worse family quality of life, higher rates of anxiety and less sexual satisfaction in cohabitants (p < 0.05). To conclude, AA seems to have an impact on the quality of life of cohabitants, leading to increased rates of anxiety, depression, a poorer quality of life, and reduced sexual satisfaction. In light of the results, a global approach for AA patients, including the care of the people who live with them, should be implemented.
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Affiliation(s)
- Manuel Sánchez-Díaz
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18002 Granada, Spain
| | - Pablo Díaz-Calvillo
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18002 Granada, Spain
| | - Clara-Amanda Ureña-Paniego
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18002 Granada, Spain
| | - Alejandro Molina-Leyva
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18002 Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18002 Granada, Spain
- Trichology Clinic, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Dermatology Department, School of Medicine, University of Granada, 18016 Granada, Spain
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14
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Sánchez-Díaz M, Díaz-Calvillo P, Soto-Moreno A, Molina-Leyva A, Arias-Santiago S. The Impact of Sleep Quality on Mood Status and Quality of Life in Patients with Alopecia Areata: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13126. [PMID: 36293700 PMCID: PMC9603703 DOI: 10.3390/ijerph192013126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Alopecia Areata (AA) is a chronic condition which has been associated with poor quality of life and mood status disturbances. The aim of this study is to compare the sleep quality between AA patients and controls, and to analyze the impact of poor sleep quality on patients with AA regarding mood status disturbances, quality of life and sexuality. A cross-sectional study including patients suffering from mild-to-severe AA and sex- and age-matched healthy controls was performed. Socio-demographic and clinical variables, sleep quality, quality of life, sexual disfunction, anxiety, depression and personality were collected using validated questionnaires. A total of 120 participants (60 patients and 60 controls) were included. Patients with AA showed worse sleep scores than controls (p = 0.003), as well as higher rates of anxiety and depression (p < 0.05). After a multivariate analysis, a worse sleep quality was found to be linked to anxiety, depression, a poorer quality of life and a type D personality score independently of the disease severity. In light of the results, patients with AA have a worse sleep quality than healthy controls. A poor sleep quality is associated with anxiety, depression and a worse quality of life, therefore being a general marker of a poor quality of life. Screening for sleep disturbances in specialized units could be useful to detect patients who could benefit from additional psychological support.
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Affiliation(s)
- Manuel Sánchez-Díaz
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18002 Granada, Spain
| | - Pablo Díaz-Calvillo
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18002 Granada, Spain
| | - Alberto Soto-Moreno
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18002 Granada, Spain
| | - Alejandro Molina-Leyva
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18002 Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Unit, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18002 Granada, Spain
- Trichology Clinic, Hospital Universitario Virgen de las Nieves, 18002 Granada, Spain
- Dermatology Department, School of Medicine, University of Granada, 18016 Granada, Spain
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15
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Sanchez-Diaz M, Diaz-Calvillo P, Rodriguez-Pozo JA, Tercedor-Sánchez J, Cantudo-Cuenca MR, Molina-Leyva A, Arias-Santiago S. Tofacitinib for Treatment of Alopecia Areata: Real-world Evidence and Factors Associated with Therapeutic Response. Acta Derm Venereol 2022; 102:adv00736. [PMID: 35578820 PMCID: PMC9574676 DOI: 10.2340/actadv.v102.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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16
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King BA, Senna MM, Ohyama M, Tosti A, Sinclair RD, Ball S, Ko JM, Glashofer M, Pirmez R, Shapiro J. Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework. Dermatol Ther (Heidelb) 2022; 12:825-834. [PMID: 35357658 PMCID: PMC9021348 DOI: 10.1007/s13555-022-00711-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 11/03/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss.
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Affiliation(s)
- Brett A King
- Department of Dermatology, Yale School of Medicine, PO Box 208059, New Haven, CT, 06520, USA.
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Manabu Ohyama
- Department of Dermatology, Faculty of Medicine, Kyorin University, Mitaka-shi, Tokyo, Japan
| | - Antonella Tosti
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Susan Ball
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Rodrigo Pirmez
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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17
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Alopecia Areata and Dexamethasone Mini-Pulse Therapy, A Prospective Cohort: Real World Evidence and Factors Related to Successful Response. J Clin Med 2022; 11:jcm11061694. [PMID: 35330017 PMCID: PMC8949115 DOI: 10.3390/jcm11061694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
The mini-pulse oral corticosteroids treatment for alopecia areata (AA) is an accessible treatment whose efficacy and adverse effects have not yet been properly described. The objective of the study was to assess the effectiveness and safety of the mini-pulse oral corticosteroids treatment in patients with AA, and to explore potential factors associated to the response in a real-world setting. An observational study of a prospective cohort to assess the effectiveness and safety of a mini-pulse dexamethasone treatment in patients with AA, who failed to improve with topical therapies, was performed. A SALT II score and other clinical and safety variables were recorded at baseline, 3, 6, 9, and 12 months. An overall significant and progressive decrease of the SALT score was found during treatment: SALT-50 response was achieved after 9 months in 51.8% of the patients. Hypothyroidism and early age of onset were predictors of the lack of response to treatment. The treatment combination with oral minoxidil showed no effect on the SALT score reduction. Dexamethasone daily and cumulative dose were associated with a higher percentage of side effects. To conclude, the mini-pulse oral corticosteroids treatment is an effective treatment for AA, although patients with an early onset of the disease and hypothyroidism may not benefit.
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18
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Winnette R, Banerjee A, Sikirica V, Peeva E, Wyrwich K. Characterizing the relationships between patient reported outcomes and clinician assessments of alopecia areata in a phase 2a randomized trial of ritlecitinib and brepocitinib. J Eur Acad Dermatol Venereol 2022; 36:602-609. [PMID: 35000236 PMCID: PMC9303953 DOI: 10.1111/jdv.17909] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022]
Abstract
Background The phase 2a ALLEGRO trial (NCT02974868) investigated the safety and efficacy of ritlecitinib (PF‐06651600) and brepocitinib (PF‐06700841) in adults with alopecia areata. No randomized controlled trial for alopecia areata has evaluated correlations between clinician‐assessed hair loss and patient‐reported outcomes. Objectives Report scores from the Alopecia Areata Symptom Impact Scale (AASIS; a patient‐reported outcome tool) and explore the relationships of those scores with clinician‐assessed Severity of Alopecia Tool (SALT) scores at baseline and week 24 of the ALLEGRO trial. Methods Adults with alopecia areata were randomized to ritlecitinib (n = 48), brepocitinib (n = 47) or placebo (n = 47). After 24 weeks, the mixed‐effects model with repeated measures was used to calculate the active treatment groups' AASIS score least‐squares mean differences. Relationships between AASIS and SALT scores at baseline and week 24 were evaluated by Pearson's correlation coefficients using pooled data. Results Baseline AASIS and SALT scores were similar among treatment groups. Both active treatment groups reported significant improvements in AASIS scores at week 24 (least‐squares mean differences vs. placebo for ritlecitinib, −0.8 to −2.3; brepocitinib, −0.9 to −3.7; P < 0.05 for all). At week 24, the mean SALT scores (standard deviation) improved compared with baseline [ritlecitinib, 54.4 (40.3) vs. 89.4 (15.8); brepocitinib, 31.9 (35.7) vs. 86.4 (18.1)]. The correlation coefficients between AASIS global and subscale scores and SALT scores at week 24 ranged from 0.34 to 0.58; P < 0.05 for all. Conclusions Patients randomized to ritlecitinib or brepocitinib reported significantly improved AASIS and SALT scores at week 24 of the ALLEGRO trial compared to placebo. At week 24, medium‐to‐large correlations can be seen between AASIS global and subscale scores and SALT scores. Our experience with AASIS instrument highlighted several aspects that suggest new patient‐reported outcome tools are needed to accurately assess patients' relevant alopecia areata related signs, symptoms and daily functioning. Linked Commentary: H.A. Ramírez‐Marín & A. Tosti J Eur Acad Dermatol Venereol 2022; 36: 494–495. https://doi.org/10.1111/jdv.17984.
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Affiliation(s)
- R Winnette
- Patient-Centered Outcomes Assessment, Pfizer, New York, NY, USA
| | - A Banerjee
- Early Clinical Development, Pfizer, Cambridge, MA, USA
| | - V Sikirica
- Patient & Health Impact, Pfizer, Collegeville, PA, USA
| | - E Peeva
- Inflammation & Immunology, Pfizer, Cambridge, MA, USA
| | - K Wyrwich
- Patient-Centered Outcomes Assessment, Pfizer, New York, NY, USA
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19
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Hagino T, Okazaki S, Serizawa N, Suzuki K, Kaga M, Otsuka Y, Mikami E, Hoashi T, Saeki H, Matsuda H, Mitsui H, Kanda N. Dietary Habits in Japanese Patients with Alopecia Areata. Clin Cosmet Investig Dermatol 2021; 14:1579-1591. [PMID: 34737597 PMCID: PMC8560057 DOI: 10.2147/ccid.s335440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
Purpose Alopecia areata (AA) is characterized by non-scarring, patchy hair loss caused by autoimmune reactions to anagen hair follicles. The pathogenesis of AA may be affected by the diet. However, the dietary habits of patients with AA have not been precisely examined. Therefore, the aim of this study was to investigate the dietary habits of patients with AA in comparison to those of healthy controls. Patients and Methods We evaluated the dietary habits of 70 adult Japanese patients with AA using a brief-type self-administered diet history questionnaire and compared them to the habits of age- and sex-matched healthy controls. Results Japanese patients with AA had a higher body mass index (BMI) and higher intakes of vitamin C and fruit than the controls. Logistic regression analysis showed that AA was associated with BMI. Retinol intake was positively correlated with severity of alopecia tool (SALT) score, and linear regression analysis revealed that retinol intake was a predictor of SALT score. Retinol intake among patients with moderate to severe AA (ie, a SALT score >25) was higher than that in patients with mild AA (a SALT score ≤25). The mean age of AA patients with atopic dermatitis (AD) was lower than that of AA patients without AD; however, there were no differences in nutrient or food intake between these two groups. Logistic regression analysis showed that the comorbidity AD was negatively associated with age. Conclusion AA was associated with a high BMI, and high retinol intake was a predictor of SALT score. Further studies should be conducted to clarify whether dietary intervention to reduce BMI or limit retinol intake can alter the development or severity of AA.
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Affiliation(s)
- Teppei Hagino
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.,Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Shizuka Okazaki
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Naotaka Serizawa
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Kaori Suzuki
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Mio Kaga
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yohei Otsuka
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Erina Mikami
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Hiroki Matsuda
- Department of Dermatology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Hiroshi Mitsui
- Department of Dermatology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
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20
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Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol 2021; 49:19-36. [PMID: 34709679 DOI: 10.1111/1346-8138.16207] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2- and Th17-associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first-line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced-based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
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Affiliation(s)
- Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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21
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Wall D, Meah N, York K, Bhoyrul B, Bokhari L, Abraham LS, Adams R, Bergfeld W, Betz RC, Blume-Peytavi U, Callender V, Campbell C, Chambers J, Chen G, Chitreddy V, Cotsarelis G, Craiglow B, Dhurat R, Dlova N, Donovan J, Duque-Estrada B, Eisman S, Ellison A, Farrant P, Barberá JF, Gadzhigoroeva A, Grimalt R, Harries M, Hordinsky M, Irvine AD, Jolliffe V, Jones L, King B, Lee WS, Lortkipanidze N, McMichael A, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Ovcharenko Y, Piraccini BM, Pirmez R, Rakowska A, Reygagne P, Riley M, Rudnicka L, Saceda Corralo D, Shapiro J, Sharma P, Silyuk T, Kaiumov S, Tobin DJ, Tosti A, Vañó-Galván S, Vogt A, Wade M, Yip L, Zlotogorski A, Zhou C, Sinclair R. A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS). JAMA Dermatol 2021; 157:1-11. [PMID: 33656556 DOI: 10.1001/jamadermatol.2020.5839] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective To generate core domains and domain items for a global network of alopecia areata patient registries. Evidence Review Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology, Milan, Italy, June 14, 2019. Findings Ninety-two core data items, across 25 domains, achieved consensus agreement. Twenty further noncore items were retained to facilitate data harmonization in centers that wish to record them. Broad representation across multiple stakeholder groups was sought; however, the opinion of physicians was overrepresented. Conclusions and Relevance This study identifies the domains and domain items required to develop a global network of alopecia areata registries. These domains will facilitate a standardized approach that will enable the recording of a comprehensive, comparable data set required to oversee the introduction of new therapies and harness real-world evidence from existing therapies at a time when the alopecia areata treatment paradigm is being radically and positively disrupted. Reuse of similar, existing frameworks in atopic dermatitis, produced by the Treatment of Atopic Eczema (TREAT) Registry Taskforce, increases the potential to reuse existing resources, creates opportunities for comparison of data across dermatology subspecialty disease areas, and supports the concept of data harmonization.
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Affiliation(s)
- Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland.,National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.,Sinclair Dermatology, Melbourne, Australia
| | - Nekma Meah
- Sinclair Dermatology, Melbourne, Australia
| | - Katherine York
- Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | | | | | | | - Roisín Adams
- National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland
| | | | - Regina C Betz
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Chel Campbell
- Australia Alopecia Areata Foundation Inc, Frankston, Australia
| | | | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | | | - George Cotsarelis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Brittany Craiglow
- Dermatology Physicians of Connecticut, Fairfield.,Department of Dermatology, Yale University, New Haven, Connecticut
| | - Rachita Dhurat
- Department of Dermatology, LTM Medical College and Hospital Sion, Mumbai, India
| | - Ncoza Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, Durban, South Africa.,School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Jeff Donovan
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.,Donovan Hair Clinic, Whistler, British Columbia, Canada
| | | | | | - Abby Ellison
- National Alopecia Areata Foundation, San Rafael, California
| | - Paul Farrant
- Brighton and Sussex University Hospitals NHS (National Health Service) Trust, Brighton, United Kingdom
| | - Juan Ferrando Barberá
- Instituto Clínic de Medicina y Dermatología, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Aida Gadzhigoroeva
- Scientific and Practical Center Dermatolovenereology and Cosmetology of the Moscow City Health Department, Moscow, Russian Federation
| | - Ramon Grimalt
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Matthew Harries
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre and National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Victoria Jolliffe
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, London, United Kingdom
| | | | - Brett King
- Yale School of Medicine, New Haven, Connecticut
| | - Won-Soo Lee
- Department of Dermatology, Yonsei Wonju University, Wonju, Korea
| | - Nino Lortkipanidze
- Department of Dermatology and Venereology, David Tvildiani Medical University, Tbilisi, Republic of Georgia
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Andrew Messenger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Paradi Mirmirani
- Department of Dermatology, Kaiser Permanente Vallejo, Vallejo, California
| | - Elise Olsen
- Duke Dermatology Clinic, Durham, North Carolina
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University Medical Center, New York, New York
| | - Yuliya Ovcharenko
- Department of General and Clinical Immunology and Allergology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rodrigo Pirmez
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Reygagne
- Centre de Santé Sabouraud, Hopital Saint Louis, Vellefaux, Paris, France
| | - Melissa Riley
- Canadian Alopecia Areata Foundation, King City, Ontario, Canada
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - David Saceda Corralo
- Dermatology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Jerry Shapiro
- Disorders of the Hair and Scalp, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | | | - Tatiana Silyuk
- Hair Treatment and Transplantation Center, Saint Petersburg, Russian Federation
| | | | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Antonella Tosti
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sergio Vañó-Galván
- Dermatology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain.,Trichology Unit, #TricoHRC Research Group, Madrid, Spain
| | - Annika Vogt
- Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Martin Wade
- The London Skin and Hair Clinic, London, United Kingdom
| | - Leona Yip
- Skin Partners Specialist Dermatologists, Brisbane, Australia
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Cheng Zhou
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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22
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Feldman PR, Fiebig KM, Piwko C, Mints BM, Brown D, Cahan DJ, Guevara-Aguirre J. Safety and efficacy of ALRV5XR in women with androgenetic alopecia or telogen effluvium: A randomised, double-blinded, placebo-controlled clinical trial. EClinicalMedicine 2021; 37:100978. [PMID: 34235415 PMCID: PMC8249777 DOI: 10.1016/j.eclinm.2021.100978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Scalp hair loss (alopecia) in women is a common ageing and senescing condition. It usually presents as androgenetic alopecia (AGA) or telogen effluvium (TE) and often has pronounced psychological consequences. ALRV5XR is a novel treatment aiming to regenerate a normal hair phenotype by targeting multiple molecular pathways linked to hair growth promotion and hair follicle stem cell activation. The primary objectives of this 24-week trial were to evaluate the safety and efficacy of ALRV5XR in terminal hair (TH) regrowth in women with AGA or TE. METHODS This randomised, double-blind, placebo-controlled trial was performed in a USA community clinic. Healthy women 18-65 years of age with AGA or TE of Ludwig classification I-II and Fitzpatrick skin type I-VI were enrolled. They were allocated in a 1:1 ratio into ALRV5XR or placebo treatment groups using a random number table. Masked dermatologist assessments, phototrichograms and blood samples were obtained at baseline, 12 and 24 weeks. Subjects were given a masked treatment regimen of oral capsules, shampoo, conditioner and follicle serum for daily administration. Main outcomes were absolute and per cent changes in TH density and response rates. The trial was registered with clinicaltrials.gov (NCT04450602) and is completed. FINDINGS 46 subjects (23 ALRV5XR, 23 placebo) were enrolled between April 3 and October 20, 2018. Five subjects dropped out and two were non-compliant. Thirty-nine subjects completed the trial (18 ALRV5XR, 21 placebo). At 24 weeks, the absolute change in TH density improved by 30·1THs/cm2 (95% CI: 15·1-45·1; p=0·0002), and the relative density increased by 19·7% (95% CI: 8·0%-31·4%; p=0·0016). The odds ratio for being a responder (≥0 change) was 2·7. Efficacy increased 133% from week 12 to 24. Efficacy outcomes were similar in AGA and TE subjects. 66·7% of the ALRV5XR group responded by regrowing 40THs/cm2 or more hair. No adverse events were reported. INTERPRETATION In women with AGA or TE, ALRV5XR treatment significantly increased hair regrowth without adverse events. ALRV5XR displayed a multi-fold improved efficacy and response rate when compared to published trials of standard therapy. Progressive acceleration of TH regrowth suggests regeneration of the structure and function of non-productive telogen follicles and prolonged treatment may restore a normal hair phenotype.
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Affiliation(s)
- Peter R Feldman
- Arbor Life Labs, Toronto, Ontario, Canada
- Corresponding authors
| | - Klaus M Fiebig
- Arbor Life Labs, Toronto, Ontario, Canada
- Corresponding authors
| | | | | | - Dennis Brown
- Valent Technologies, Menlo Park, California, USA
| | | | - Jaime Guevara-Aguirre
- Universidad San Francisco de Quito (USFQ), Quito, Ecuador
- Institute of Endocrinology, Metabolism, and Reproduction (IEMYR), Quito, Ecuador
- Maastricht University, Maastricht, The Netherlands
- College of Medicine, University of Florida, Gainesville, Florida, USA
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23
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Lee MS, Guo LN, Nambudiri VE. Towards gender equity in artificial intelligence and machine learning applications in dermatology. J Am Med Inform Assoc 2021; 29:400-403. [PMID: 34151976 DOI: 10.1093/jamia/ocab113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
There has been increased excitement around the use of machine learning (ML) and artificial intelligence (AI) in dermatology for the diagnosis of skin cancers and assessment of other dermatologic conditions. As these technologies continue to expand, it is essential to ensure they do not create or widen sex- and gender-based disparities in care. While desirable bias may result from the explicit inclusion of sex or gender in diagnostic criteria of diseases with gender-based differences, undesirable biases can result from usage of datasets with an underrepresentation of certain groups. We believe that sex and gender differences should be taken into consideration in ML/AI algorithms in dermatology because there are important differences in the epidemiology and clinical presentation of dermatologic conditions including skin cancers, sex-specific cancers, and autoimmune conditions. We present recommendations for ensuring sex and gender equity in the development of ML/AI tools in dermatology to increase desirable bias and avoid undesirable bias.
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Affiliation(s)
- Michelle S Lee
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa N Guo
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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24
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Olsen EA, Harries M, Tosti A, Bergfeld W, Blume-Peytavi U, Callender V, Chasapi V, Correia O, Cotsarelis G, Dhurat R, Dlova N, Doche I, Enechukwu N, Grimalt R, Itami S, Hordinsky M, Khobzei K, Lee WS, Malakar S, Messenger A, McMichael A, Mirmirani P, Ovcharenko Y, Papanikou S, Pinto GM, Piraccini BM, Pirmez R, Reygagne P, Roberts J, Rudnicka L, Saceda-Corralo D, Shapiro J, Silyuk T, Sinclair R, Soares RO, Souissi A, Vogt A, Washenik K, Zlotogorski A, Canfield D, Vano-Galvan S. Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG). Br J Dermatol 2021; 185:1221-1231. [PMID: 34105768 DOI: 10.1111/bjd.20567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. OBJECTIVES To enable data to be collected worldwide on FFA using common criteria and assessment methods. METHODS A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. RESULTS Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. CONCLUSIONS These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
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Affiliation(s)
- E A Olsen
- Duke University Medical Center, Durham, NC, USA
| | - M Harries
- University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - A Tosti
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - V Callender
- Callender Dermatology & Cosmetic Center and Howard University College of Medicine, Washington, DC, USA
| | - V Chasapi
- Andreas Sygros Hospital, Athens, Greece
| | - O Correia
- Centro Dermatologia Epidermis, Porto, Portugal
| | - G Cotsarelis
- University of Pennsylvania, Philadelphia, PA, USA
| | - R Dhurat
- LTM Medical College & Hospital Sion, Mumbai, India
| | - N Dlova
- University of KwaZulu Natal, Durban, South Africa
| | - I Doche
- University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - N Enechukwu
- Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - S Itami
- Oita University, Oita, Japan
| | - M Hordinsky
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - K Khobzei
- Kyiv Medical University, Kyiv, Ukraine
| | - W-S Lee
- Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - S Malakar
- Rita Skin Foundation, Kolkata, West Bengal, India
| | | | - A McMichael
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - P Mirmirani
- Kaiser Permanente Northern California, Vallejo, CA, USA
| | - Y Ovcharenko
- V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | | | - G M Pinto
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - R Pirmez
- Instituto de Dermatologia Professor Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - P Reygagne
- Centre Sabouraud, Hôpital Saint Louis, Paris, France
| | - J Roberts
- Northwest Dermatology Institute, Portland, OR, USA
| | - L Rudnicka
- Medical University of Warsaw, Warsaw, Poland
| | - D Saceda-Corralo
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - J Shapiro
- New York University Grossman School of Medicine, New York, NY, USA
| | - T Silyuk
- Hair Treatment and Transplantation Center Private Practice, Saint Petersburg, Russia
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Melbourne, VIC, Australia
| | - R O Soares
- Cuf Descobertas Hospital, Lisbon, Portugal
| | - A Souissi
- Department of Dermatology, University of Tunis El Manar, Tunis, Tunisia
| | - A Vogt
- Charité-Universitaetsmedizin, Berlin, Germany
| | - K Washenik
- Bosley Medical Group, Beverly Hills, CA and New York University Grossman School of Medicine, New York, NY, USA
| | - A Zlotogorski
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Canfield
- Canfield Scientific, Inc, Parsippany, NJ, USA
| | - S Vano-Galvan
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
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25
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Kurtti A, Jagdeo J, Eisinger A, Sukhdeo K. New Diagnostic Tools to Evaluate Hair Loss. Dermatol Clin 2021; 39:375-381. [PMID: 34053591 DOI: 10.1016/j.det.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The precise and reliable diagnosis of hair loss disorders is essential for developing a successful management plan. It is, thus, the responsibility of the dermatologist to select the appropriate diagnostic tools to effectively evaluate patients presenting with hair loss concerns. Fortunately, there is a growing body of noninvasive and invasive diagnostic resources, each with advantages and disadvantages. For the practicing dermatologist, tactile assessments and direct visualization are enhanced with scoring instruments, questionnaires, handheld trichoscopy, and scalp biopsy. For research and clinical study purposes, the more precise, high-resolution tools such as videodermoscopy, optical coherence tomography, and phototrichograms, may be useful.
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Affiliation(s)
- Alana Kurtti
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY 11209, USA
| | - Jared Jagdeo
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY 11209, USA; Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | | | - Kumar Sukhdeo
- Pilaris, OnDERMAND Dermatology, New York, NY 10022, USA.
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26
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Ertugrul G, Ertugrul S, Soylemez E. There is no evidence of cochlear and vestibular melanocyte damage in patients with alopecia areata. Int J Clin Pract 2021; 75:e14040. [PMID: 33484073 DOI: 10.1111/ijcp.14040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Follicular melanocytes are known to be damaged in alopecia areata (AA). However, it is not clear whether melanocytes are the primary target of autoimmunity and whether melanocytes in the inner ear are affected. This study aimed to detect possible cochlear and/or vestibular melanocyte damage in AA patients. METHODS Thirty-two AA patients and 35 sex- and age-matched healthy volunteers were evaluated between November 2018 and March 2020 at the Karabük University Training and Research Hospital. The conventional pure tone audiometry test and distortion product otoacoustic emission test were performed to evaluate hearing. To evaluate the vestibular function, the following tests were performed: the vestibulospinal reflex tests (Romberg test, tandem stance test and tandem walking test); positional balance tests (Dix-Hallpike test, supine roll test and head hanging test); vestibulo-ocular reflex tests (caloric test, head shake test) and oculomotor tests (saccade, smooth pursuit and optokinetic). RESULTS The mean age of AA patients was 31.94 ± 11.86 years (range, 15-67 years). There were no significant differences in the results of the hearing and balance tests between the groups. Furthermore, disease parameters (duration of the last attack, recurrence, positive family history, positive pull test, the severity of the disease, etc) were not associated with hearing loss and vestibular damage. CONCLUSION AA patients did not exhibit hearing loss or balance abnormalities that would indicate cochlear and vestibular melanocyte damage. The lack of damage to the inner ear melanocytes in AA patients may indicate that follicular melanocytes are affected secondary to autoimmune damage in the hair bulb, and melanocytes are not the primary target in the pathogenesis of AA.
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Affiliation(s)
- Goksen Ertugrul
- Department of Dermatology, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Suha Ertugrul
- Department of Otorhinolaryngology, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Emre Soylemez
- Department of Audiology, Karabuk University, Karabuk, Turkey
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27
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Gupta AK, Ivanova IA, Renaud HJ. How good is artificial intelligence (AI) at solving hairy problems? A review of AI applications in hair restoration and hair disorders. Dermatol Ther 2021; 34:e14811. [PMID: 33496058 DOI: 10.1111/dth.14811] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 01/09/2023]
Abstract
Artificial intelligence (AI) applications in medicine are rapidly evolving. Deep learning diagnostic models that can accurately classify skin lesions have been developed. New AI applications are also starting to emerge in the hair restoration field. The objective was to review the current and future clinical applications of AI in hair restoration and hair disorder diagnosis. Current AI applications in hair restoration include fully automated systems for hair detection and hair growth measurement. New deep learning-based systems have been proposed for scalp diagnosis and automated hair loss measurements, including devices that can be used for self-diagnosis. Hair restoration experts should recognize the potential benefits and limitations of these emerging technologies as they become more readily available to both clinicians and patients.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Canada.,Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada
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do Nascimento IJB, Harries M, Rocha VB, Thompson JY, Wong CH, Varkaneh HK, Guimarães NS, Rocha Arantes AJ, Marcolino MS. Effect of Oral Minoxidil for Alopecia: Systematic Review. Int J Trichology 2020; 12:147-155. [PMID: 33376283 PMCID: PMC7759057 DOI: 10.4103/ijt.ijt_19_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with major presentations of alopecia experience physically harmful effects and psychological comorbidities, such as depression and anxiety. Oral minoxidil (OM) has been suggested by dermatologists as a potential remedy; however, its effectiveness remains unclear. This systematic review aims to collate published studies and to analyze the effect of OM among patients diagnosed with any type of alopecia. For this systematic review, Medline/PubMed, Cochrane Central, EMBASE, Web of Sciences, and Latin American and Caribbean Health Sciences Information System were searched for relevant studies from inception to September 21, 2019. Of 1960 studies retrieved in several electronic databases and three additional records identified though reference list from potentially eligible studies, nine studies (one randomized controlled trial and eight nonrandomized controlled trials) met the requirements and were used in our analysis. Although we found positive effects in favor of OM, this should be interpreted cautiously due to very low quality of the evidence of outcomes in the selected studies. Definitive conclusions are not possible without high-quality trials. This review has highlighted the absence of high-quality randomized controlled trials evaluating OM in the treatment of various types of alopecia. Given the mild adverse events of OM, future studies should also analyze doses and duration to maximize efficacy and decrease side effects.
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Affiliation(s)
- Israel Junior Borges do Nascimento
- Department of Internal Medicine, University Hospital and School of Medicine, Federal University of Minas Gerais, Brazil.,Department of Internal Medicine, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Harries
- The Dermatology Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.,Centre for Dermatology Research, MAHSC and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Vanessa Barreto Rocha
- Department of Dermatology, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jacqueline Y Thompson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, England, UK
| | - Chun Hoong Wong
- Department of Pharmacy, Serdang Hospital, Kajang, Selangor, Malaysia
| | - Hamed Kord Varkaneh
- Student Research Commitee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alair Junior Rocha Arantes
- Department of Internal Medicine, University Hospital and School of Medicine, Federal University of Minas Gerais, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, University Hospital and School of Medicine, Federal University of Minas Gerais, Brazil
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Mackay-Wiggan J, Sallee BN, Wang EHC, Sansaricq F, Nguyen N, Kim C, Chen JC, Christiano AM, Clynes R. An open-label study evaluating the efficacy of abatacept in alopecia areata. J Am Acad Dermatol 2020; 84:841-844. [PMID: 33045294 DOI: 10.1016/j.jaad.2020.09.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Freda Sansaricq
- Department of Dermatology, Columbia University, New York, New York
| | - Nhan Nguyen
- Department of Dermatology, Columbia University, New York, New York
| | - Carey Kim
- Department of Dermatology, Columbia University, New York, New York
| | - James C Chen
- Department of Dermatology, Columbia University, New York, New York
| | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, New York; Department of Genetics and Development, Columbia University, New York, New York.
| | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, New York
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30
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Rangu S, Rogers R, Castelo-Soccio L. Understanding alopecia areata characteristics in children under the age of 4 years. Pediatr Dermatol 2019; 36:854-858. [PMID: 31468560 DOI: 10.1111/pde.13990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Epidemiologic studies of children with alopecia areata (AA) are sparse, and there are no studies that focus on the youngest children with AA. Evaluation of the clinical presentations of AA in children <4 years of age was performed in order to identify the prognostic factors for disease progression. METHODS We performed a retrospective chart review of 125 pediatric patients seen at the Children's Hospital of Philadelphia with an initial presentation of AA under the age of 4. Disease severity was measured using the Severity of Alopecia Tool (SALT) score at initial presentation, 3-6 months later, 1 year later, and then at 2 years. RESULTS Initial presentation was most common between ages 2 and 4 years. Most children had mild disease severity and continued mild disease over the next 2 years. Children with more than 50% of hair loss at presentation were much more likely to have worsening SALT scores over time and remain more severe. Approximately 41% had concomitant atopic dermatitis, 28% had a family member with AA, and 27% had a first-degree family member with one or more autoimmune diseases. CONCLUSIONS In a diverse patient population, most children with AA even when presenting under age 4 have mild disease (<50% hair loss on scalp). Those who present with more severe disease are more likely to worsen or remain severe over time. These findings can aid family counseling and education.
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Affiliation(s)
- Sneha Rangu
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Rogers
- Biostatistics and Data Management Core (BDMC), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leslie Castelo-Soccio
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Rajan BM, Bhardwaj A. Comment on "Rule of thumb: A simple tool to estimate 1% scalp surface area": Whose thumb is it anyway? J Am Acad Dermatol 2019; 81:e183. [PMID: 31454499 DOI: 10.1016/j.jaad.2019.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Bandhala M Rajan
- Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Bhardwaj
- Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Jodhpur, India.
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32
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Lee H, Choe SJ, Lee W. Method for describing patterns and distributions of alopecia areata which may be helpful for patient characterization and predicting prognosis. J Dermatol 2019; 46:739-740. [DOI: 10.1111/1346-8138.14989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hanil Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
| | - Won‐Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine Yonsei University Wonju College of Medicine Wonju Korea
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Wambier CG, King BA. Rule of thumb: A simple tool to estimate 1% scalp surface area. J Am Acad Dermatol 2019; 81:630-631. [DOI: 10.1016/j.jaad.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 11/16/2022]
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34
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Freire P, Riera R, Martimbianco A, Petri V, Atallah A. Minoxidil for patchy alopecia areata: systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2019; 33:1792-1799. [DOI: 10.1111/jdv.15545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- P.C.B. Freire
- Department of Health Informatics Universidade Federal de São Paulo São Paulo Brazil
| | - R. Riera
- Discipline of Evidence‐Based Medicine Universidade Federal de São Paulo São Paulo Brazil
| | | | - V. Petri
- Department of Dermatology Universidade Federal de São Paulo São Paulo Brazil
| | - A.N. Atallah
- Evidence‐Based Medicine and Emergency Medicine Universidade Federal de São Paulo São Paulo Brazil
- Brazilian Cochrane Centre São Paulo Brazil
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35
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Lee S, Kim BJ, Lee CH, Lee WS. Topographic Phenotypes of Alopecia Areata and Development of a Prognostic Prediction Model and Grading System: A Cluster Analysis. JAMA Dermatol 2019; 155:564-571. [PMID: 30916724 DOI: 10.1001/jamadermatol.2018.5894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Diverse assessment tools and classification have been used for alopecia areata; however, their prognostic values are limited. Objective To identify the topographic phenotypes of alopecia areata using cluster analysis and to establish a prediction model and grading system for stratifying prognoses. Design, Setting, and Participants A retrospective cohort study of 321 patients with alopecia areata who visited a single tertiary referral center between October 2012 and February 2017 and underwent 4-view photographic assessment. Exposures Clinical photographs were reviewed to evaluate hair loss using the Severity of Alopecia Tool 2. Topographic phenotypes of alopecia areata were identified using hierarchical clustering with Ward's method. Differences in clinical characteristics and prognosis were compared across the clusters. The model was evaluated for its performance, accuracy, and interobserver reliability by comparison to conventional methods. Main Outcomes and Measures Topographic phenotypes of alopecia areata and their major (60%-89%) and complete regrowth probabilities (90%-100%) within 12 months. Results A total of 321 patients were clustered into 5 subgroups. Grade 1 (n = 200; major regrowth, 93.4%; complete regrowth, 65.2%) indicated limited hair loss, whereas grades 2A (n = 66; major regrowth, 87.8%; complete regrowth, 64.2%) and 2B (n = 20; major regrowth, 73.3%; complete regrowth, 45.5%) exhibited greater hair loss than grade 1. The temporal area was predominantly involved in grade 2B, but not in grade 2A, despite being comparable in total extent of hair loss. Grade 3 (n = 20; major regrowth, 45.5%; complete regrowth, 25.5%) included diffuse or extensive alopecia areata, and grade 4 (n = 15; major regrowth, 28.2%; complete regrowth, 16.7%) corresponded to alopecia (sub)totalis. No significant differences in prognosis (hazard ratio [HR] for major regrowth, 0.79; 95% CI, 0.56-1.12) were found between grades 2A and 1, whereas grades 2B (HR, 0.41; 95% CI, 0.21-0.81), 3 (HR, 0.24; 95% CI, 0.12-0.50), and 4 (HR, 0.16; 95% CI, 0.06-0.39) had significantly poorer response. Among multiple models, the cluster solution had the greatest prognostic performance and accuracy. The tree model of the cluster solution was converted into the Topography-based Alopecia Areata Severity Tool (TOAST), which revealed an excellent interobserver reliability among 4 dermatologists (median quadratic-weighted κ, 0.89). Conclusions and Relevance Temporal area involvement should be independently measured for better prognostic stratification. The TOAST is an effective tool for describing the topographical characteristics and prognosis of hair loss and may enable clinicians to establish better treatment plans.
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Affiliation(s)
- Solam Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beom Jun Kim
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chung-Hyeok Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Institute of Hair and Cosmetic Medicine, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Hillmann K, Blume-Peytavi U. 5/w mit bandförmigem okzipitalem Haarausfall ohne sichtbare Entzündungszeichen. Hautarzt 2019; 70:37-40. [DOI: 10.1007/s00105-018-4328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Almutairi N, Nour T, Hussain N. Janus Kinase Inhibitors for the Treatment of Severe Alopecia Areata: An Open-Label Comparative Study. Dermatology 2019; 235:130-136. [DOI: 10.1159/000494613] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
<b><i>Background:</i></b> Alopecia areata (AA) is a common autoimmune disorder characterized by patchy hair loss. There are many treatments available for AA. However, treatments of severe forms of AA are not satisfactory. Recently, oral Janus kinase (JAK) inhibitors were found to be effective for the treatment of severe AA variants. <b><i>Objective:</i></b> The aim of this work was to evaluate and compare the efficacy, side effects, and durability of two oral JAK inhibitor medications (ruxolitinib and tofacitinib) in the treatment of severe AA. <b><i>Methods:</i></b> This study included 75 patients with AA with more than 30% scalp hair loss, alopecia totalis, and alopecia universalis randomized into 2 groups. The first group (<i>n</i> = 38) received ruxolitinib 20 mg twice daily, and the second group (<i>n</i> = 37) received oral tofacitinib 5 mg twice daily. The treatment continued for 6 months followed by 3 months of follow-up off therapy. Efficacy of treatment was assessed by monitoring the change in the Severity of Alopecia Tool (SALT) score. <b><i>Results:</i></b> Both tofacitinib and ruxolitinib induced remarkable hair regrowth, with a mean change in SALT score of 93.8 ± 3.25 in the ruxolitinib group and 95.2 ± 2.69 in the tofacitinib group. However, the ruxolitinib group showed a shorter duration for initial hair regrowth. There was no statistically significant difference between the groups regarding hair regrowth at the end of the 6-month treatment and relapse rate at the end of the 3-month follow-up. Around two thirds of cases experienced relapse. Both drugs were well tolerated, with no reported serious adverse effects. <b><i>Conclusion:</i></b> Both ruxolitinib and tofacitinib could be considered effective and well-tolerated treatments for extensive AA.
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Olsen EA, Roberts J, Sperling L, Tosti A, Shapiro J, McMichael A, Bergfeld W, Callender V, Mirmirani P, Washenik K, Whiting D, Cotsarelis G, Hordinsky M. Objective outcome measures: Collecting meaningful data on alopecia areata. J Am Acad Dermatol 2018; 79:470-478.e3. [PMID: 29128463 PMCID: PMC7450487 DOI: 10.1016/j.jaad.2017.10.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although alopecia areata is a common disorder, it has no US Food and Drug Administration-approved treatment and evidence-based therapeutic data are lacking. OBJECTIVE To develop guidelines for the diagnosis, evaluation, assessment, response criteria, and end points for alopecia areata. METHODS Literature review and expert opinion of a group of dermatologists specializing in hair disorders. RESULTS Standardized methods of assessing and tracking hair loss and growth, including new scoring techniques, response criteria, and end points in alopecia areata are presented. LIMITATIONS The additional time to perform the assessments is the primary limitation to use of the methodology in clinical practice. CONCLUSION Use of these measures will facilitate collection of standardized outcome data on therapeutic agents used in alopecia areata both in clinical practice and in clinical trials.
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Affiliation(s)
- Elise A Olsen
- Duke University Medical Center, Durham, North Carolina.
| | - Janet Roberts
- Northwest Dermatology and Research Center, Portland, Oregon
| | | | | | | | - Amy McMichael
- Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina
| | | | | | | | - Ken Washenik
- New York University, New York, New York; Bosley Medical Group, Beverly Hills, California
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Development and validation of the Frontal Fibrosing Alopecia Severity Score. J Am Acad Dermatol 2018; 78:522-529. [DOI: 10.1016/j.jaad.2017.09.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 01/06/2023]
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40
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Lee SH, Moon JH, Ban DH, Byun JW, Shin J, Choi GS. Can the Cytokine Analysis of the Scales on Alopecic Patch Predict the Response to Diphenylcyclopropenone Treatment in Alopecia Areata Patients? Ann Dermatol 2018; 30:150-157. [PMID: 29606811 PMCID: PMC5839885 DOI: 10.5021/ad.2018.30.2.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022] Open
Abstract
Background Contact immune modulating therapy with diphenylcyclopropenone (DPCP) is a topical treatment option for extensive alopecia areata (AA). Because the response to DPCP treatment varies according to the patient, and it takes several months to evaluate the clinical effectiveness of the treatment, it is necessary to identify the factors that can predict the prognosis of the disease while treating with topical DPCP. Objective In this study, cytokine levels in the scales of alopecic patches were investigated to identify whether they could predict response to DPCP during the early treatment period. Methods Scale samples were taken from the alopecic patches in eight AA patients at 1 week, 2 months, and 4 months after DPCP sensitization. The patients were divided into responders and non-responders according to the clinical responses of DPCP treatment. Interferon (IFN)-gamma, interleukin (IL)-2, IL-12 and IL-10 levels of the subjects were compared in several perspectives. Results Cytokine levels after 1 week of DPCP sensitization showed no statistically significant difference between two groups. After 4 months of treatment, IFN-gamma levels were significantly lower in responders than in non-responders. Conclusion The results of this study show IFN-gamma levels in the scales of alopecic patches might possibly reflect the clinical response in AA patients treated with DPCP. However, initial cytokine levels could not predict the treatment response.
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Affiliation(s)
- Si Hyub Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jong Hyuk Moon
- Department of Dermatology, Naval Pohang Hospital, Pohang, Korea
| | | | - Ji Won Byun
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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Bernardis E, Nukpezah J, Li P, Christensen T, Castelo-Soccio L. Pediatric severity of alopecia tool. Pediatr Dermatol 2018; 35:e68-e69. [PMID: 29105836 DOI: 10.1111/pde.13327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Severity of Alopecia Tool serves as a tool for alopecia research and a clinical guideline for following progression of disease. The original Severity of Alopecia Tool score does not take into account pediatric age groups. As new clinical trials for alopecia areata include more children, a more accurate tool should be available for this population. By collecting images from patients 2-21 years of age and aligning the hair-bearing regions of the scalp, we created an adaptation of the Severity of Alopecia Tool for scoring hair loss percentage of the top, parietal, and occipital scalp in individuals 2-5, 6-11, and 12-21 years of age.
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Affiliation(s)
- Elena Bernardis
- Division of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ping Li
- Shenzhen Children's Hospital, Shenzhen, China
| | | | - Leslie Castelo-Soccio
- Division of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bernardis E, Castelo-Soccio L. Quantifying Alopecia Areata via Texture Analysis to Automate the SALT Score Computation. J Investig Dermatol Symp Proc 2018; 19:S34-S40. [PMID: 29273104 DOI: 10.1016/j.jisp.2017.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Quantifying alopecia areata in real time has been a challenge for clinicians and investigators. Although several scoring systems exist, they can be cumbersome. Because there are more clinical trials in alopecia areata, there is an urgent need for a quantitative system that is reproducible, standardized, and simple. In this article, a computer imaging algorithm to recreate the Severity of Alopecia Tool scoring system in an automated way is presented. A pediatric alopecia areata image set of four view-standardized photographs was created, and texture analysis was used to distinguish between normal hair and bald scalp. By exploiting local image statistics and the similarity of hair appearance variations across the pediatric alopecia examples, we then used a reference set of hair textures, derived from intensity distributions over very small image patches, to provide global context and improve partitioning of each individual image into areas of different hair densities. This algorithm can mimic a Severity of Alopecia Tool (score) and may also provide more information about the continuum of changes in density of hair seen in alopecia areata.
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Affiliation(s)
- Elena Bernardis
- Division of Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie Castelo-Soccio
- Division of Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Departments of Pediatrics and Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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43
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Alopecia areata. J Am Acad Dermatol 2018; 78:1-12. [DOI: 10.1016/j.jaad.2017.04.1141] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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