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Guo HW, Ye ZM, Chen SQ, McElwee KJ. Innovative strategies for the discovery of new drugs against alopecia areata: taking aim at the immune system. Expert Opin Drug Discov 2024:1-18. [PMID: 39360759 DOI: 10.1080/17460441.2024.2409660] [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: 07/28/2024] [Accepted: 09/24/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION The autoimmune hair loss condition alopecia areata (AA) exacts a substantial psychological and socioeconomic toll on patients. Biotechnology companies, dermatology clinics, and research institutions are dedicated to understanding AA pathogenesis and developing new therapeutic approaches. Despite recent efforts, many knowledge gaps persist, and multiple treatment development avenues remain unexplored. AREAS COVERED This review summarizes key AA disease mechanisms, current therapeutic methods, and emerging treatments, including Janus Kinase (JAK) inhibitors. The authors determine that innovative drug discovery strategies for AA are still needed due to continued unmet medical needs and the limited efficacy of current and emerging therapeutics. For prospective AA treatment developers, the authors identify the pre-clinical disease models available, their advantages, and limitations. Further, they outline treatment development opportunities that remain largely unmapped. EXPERT OPINION While recent advancements in AA therapeutics are promising, challenges remain, including the lack of consistent treatment efficacy, long-term use and safety issues, drug costs, and patient compliance. Future drug development research should focus on patient stratification utilizing robust biomarkers of AA disease activity and improved quantification of treatment response. Investigating superior modes of drug application and developing combination therapies may further improve outcomes. Spirited innovation will be needed to advance more effective treatments for AA.
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Affiliation(s)
- Hong-Wei Guo
- Department of Dermatology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhi-Ming Ye
- Guangdong Medical University, Zhanjiang, China
| | - Si-Qi Chen
- Guangdong Medical University, Zhanjiang, China
| | - Kevin J McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
- Centre for Skin Sciences, University of Bradford, Bradford, UK
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Rudnicka L, Trzeciak M, Alpsoy E, Arenberger P, Alper S, Benáková N, Bobko S, Borlu M, Czarnecka Operacz M, Engin B, Ergun T, Sağduyu IE, Filipovská O, Gadzhigoroeva A, Kojanová M, Lesiak A, Michenko A, Murashkin N, Onsun N, Owczarek W, Plzakova Z, Reich A, Selerová M, Gürbüz BA. Disease burden, clinical management and unmet treatment need of patients with moderate to severe alopecia areata; consensus statements, insights, and practices from CERTAAE (Central/Eastern EU, Russia, Türkiye AA experts) Delphi panel. Front Med (Lausanne) 2024; 11:1353354. [PMID: 38741770 PMCID: PMC11089289 DOI: 10.3389/fmed.2024.1353354] [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: 12/10/2023] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives This study aims to update the understanding of Alopecia Areata (AA) in Poland, Czechia, Russia, and Türkiye, focusing on the disease burden, clinical management, and patient journey. It seeks to establish a consensus on optimal management strategies for AA in these regions. Methods A modified 2-round Delphi panel was conveyed with 23 Dermatologists (Russia; 4, Türkiye; 7, Poland; 6, and Czechia; 6). The Delphi questionnaire consisted of 61 statements and 43 questions designed to obtain an overall understanding of the perception and acceptance of available information regarding the care of patients with alopecia areata. Results The study revealed that moderate-to-severe AA significantly impacts patients' and their families' QoL, consistent with previous studies. AA was found to cause more substantial impairment when additional lesions appeared in visible areas besides the scalp. Work and productivity impairment were notably higher in adults with moderate-to-severe AA. Diagnostic consensus highlighted the importance of skin biopsies and trichoscopy, while the need for more practical severity scoring systems was emphasized. Current treatments, including topical therapies, corticosteroids, and systemic immune modifiers, were deemed insufficient, highlighting the unmet medical need. Conclusion The Delphi study underscores a significant disease burden and unmet medical needs in patients with moderate-to-severe AA. It highlights the necessity of access to novel treatments and further research to develop more effective therapies with a tolerable safety profile. The findings align with global research, emphasizing the psychosocial impact of AA and the need for standardized, effective treatment protocols.
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Affiliation(s)
- Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Türkiye
| | - Petr Arenberger
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Sibel Alper
- Department of Dermatology and Venereology, Koç University, İstanbul, Türkiye
| | - Nina Benáková
- Department of Dermatovenereology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Svetlana Bobko
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Murat Borlu
- Dermatology and Venereology Department, Erciyes University, Kayseri, Türkiye
| | | | - Burhan Engin
- Department of Dermatology and Venerology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Tülin Ergun
- Department of Dermatology, Marmara University, İstanbul, Türkiye
| | | | - Olga Filipovská
- Department of Dermatology, Masaryk Hospital in Ústí nad Labem, Ústí nad Labem, Czechia
| | - Aida Gadzhigoroeva
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Martina Kojanová
- Department of Dermatovenereology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Aleksandra Lesiak
- Laboratory of Autoinflammatory, Genetic and Rare Skin Disorders, Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
| | - Anna Michenko
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
- Federal State Budgetary Institution of Continuing Professional Education, Central State Medical Academy, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Murashkin
- National Medical Research Center for Children’s Health, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Dermatology Department, Federal State Autonomous Institution, Scientific Centre of Children’s Health of the Ministry of Health of the Russian Federation, Moscow, Russia
- Research Institute for Pediatrics and Children’s Health Protection, Federal National Public Healthcare Institution “Central Clinical Hospital of the Russian Academy of Sciences”, Ministry of Science and Higher Education, Moscow, Russia
| | - Nahide Onsun
- Dermatology Department, Bezmialem Vakıf University, İstanbul, Türkiye
| | - Witold Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | - Zuzana Plzakova
- Department of Dermatovenereology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Adam Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - Marie Selerová
- Department of Dermatology, Hospital AGEL Novy Jicin, JSC, Novy Jicin, Czechia
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Abadjieva TI, Todorova LN, Gardjeva PA, Murdjeva MA. Platelet-rich plasma efficacy in alopecia areata patients with normal and elevated levels of antibodies against thyroglobulin and thyroid peroxidase. Folia Med (Plovdiv) 2024; 66:66-72. [PMID: 38426467 DOI: 10.3897/folmed.66.e115484] [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: 11/08/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
AIM To evaluate and compare the efficacy of platelet-rich plasma (PRP) therapy in alopecia areata (AA) patients with normal and with elevated levels of anti-thyroglobulin antibodies and/or anti-thyroid peroxidase antibodies.
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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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Prasanna H, Srinivas RT, Kuppuswamy SK, Keloji H, Ravikumar PT. A comparative study of fractional CO 2 laser with topical triamcinolone acetonide versus intralesional triamcinolone acetonide in the treatment of alopecia areata. J Cutan Aesthet Surg 2024; 17:34-40. [PMID: 38736853 PMCID: PMC11086937 DOI: 10.4103/jcas.jcas_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA. Aims and Objectives To assess and compare the efficacy and safety of fractional CO2 laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA. Materials and Methods A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO2 laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting. Results Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (P-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (P-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B. Conclusion This study showed that fractional CO2 laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events.
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Affiliation(s)
- Harish Prasanna
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Rajashekar Talari Srinivas
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Suresh Kumar Kuppuswamy
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Hanumanthayya Keloji
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Pavithra Thotta Ravikumar
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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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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Mateos-Haro M, Novoa-Candia M, Sánchez Vanegas G, Correa-Pérez A, Gaetano Gil A, Fernández-García S, Ortega-Quijano D, Urueña Rodriguez MG, Saceda-Corralo D, Bennouna-Dalero T, Giraldo L, Tomlinson J, Vaño-Galván S, Zamora J. Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev 2023; 10:CD013719. [PMID: 37870096 PMCID: PMC10591288 DOI: 10.1002/14651858.cd013719.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body. There are different treatments including immunosuppressants, hair growth stimulants, and contact immunotherapy. OBJECTIVES To assess the benefits and harms of the treatments for alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in children and adults. SEARCH METHODS The Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP were searched up to July 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated classical immunosuppressants, biologics, small molecule inhibitors, contact immunotherapy, hair growth stimulants, and other therapies in paediatric and adult populations with AA. DATA COLLECTION AND ANALYSIS We used the standard procedures expected by Cochrane including assessment of risks of bias using RoB2 and the certainty of the evidence using GRADE. The primary outcomes were short-term hair regrowth ≥ 75% (between 12 and 26 weeks of follow-up), and incidence of serious adverse events. The secondary outcomes were long-term hair regrowth ≥ 75% (greater than 26 weeks of follow-up) and health-related quality of life. We could not perform a network meta-analysis as very few trials compared the same treatments. We presented direct comparisons and made a narrative description of the findings. MAIN RESULTS We included 63 studies that tested 47 different treatments in 4817 randomised participants. All trials used a parallel-group design except one that used a cross-over design. The mean sample size was 78 participants. All trials recruited outpatients from dermatology clinics. Participants were between 2 and 74 years old. The trials included patients with AA (n = 25), AT (n = 1), AU (n = 1), mixed cases (n = 31), and unclear types of alopecia (n = 4). Thirty-three out of 63 studies (52.3%) reported the proportion of participants achieving short-term hair regrowth ≥ 75% (between 12 and 26 weeks). Forty-seven studies (74.6%) reported serious adverse events and only one study (1.5%) reported health-related quality of life. Five studies (7.9%) reported the proportion of participants with long-term hair regrowth ≥ 75% (greater than 26 weeks). Amongst the variety of interventions found, we prioritised some groups of interventions for their relevance to clinical practice: systemic therapies (classical immunosuppressants, biologics, and small molecule inhibitors), and local therapies (intralesional corticosteroids, topical small molecule inhibitors, contact immunotherapy, hair growth stimulants and cryotherapy). Considering only the prioritised interventions, 14 studies from 12 comparisons reported short-term hair regrowth ≥ 75% and 22 studies from 10 comparisons reported serious adverse events (18 reported zero events and 4 reported at least one). One study (1 comparison) reported quality of life, and two studies (1 comparison) reported long-term hair regrowth ≥ 75%. For the main outcome of short-term hair regrowth ≥ 75%, the evidence is very uncertain about the effect of oral prednisolone or cyclosporine versus placebo (RR 4.68, 95% CI 0.57 to 38.27; 79 participants; 2 studies; very low-certainty evidence), intralesional betamethasone or triamcinolone versus placebo (RR 13.84, 95% CI 0.87 to 219.76; 231 participants; 1 study; very low-certainty evidence), oral ruxolitinib versus oral tofacitinib (RR 1.08, 95% CI 0.77 to 1.52; 80 participants; 1 study; very low-certainty evidence), diphencyprone or squaric acid dibutil ester versus placebo (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very-low-certainty evidence), diphencyprone or squaric acid dibutyl ester versus topical minoxidil (RR 1.16, 95% CI 0.79 to 1.71; 99 participants; 1 study; very low-certainty evidence), diphencyprone plus topical minoxidil versus diphencyprone (RR 0.67, 95% CI 0.13 to 3.44; 30 participants; 1 study; very low-certainty evidence), topical minoxidil 1% and 2% versus placebo (RR 2.31, 95% CI 1.34 to 3.96; 202 participants; 2 studies; very low-certainty evidence) and cryotherapy versus fractional CO2 laser (RR 0.31, 95% CI 0.11 to 0.86; 80 participants; 1 study; very low-certainty evidence). The evidence suggests oral betamethasone may increase short-term hair regrowth ≥ 75% compared to prednisolone or azathioprine (RR 1.67, 95% CI 0.96 to 2.88; 80 participants; 2 studies; low-certainty evidence). There may be little to no difference between subcutaneous dupilumab and placebo in short-term hair regrowth ≥ 75% (RR 3.59, 95% CI 0.19 to 66.22; 60 participants; 1 study; low-certainty evidence) as well as between topical ruxolitinib and placebo (RR 5.00, 95% CI 0.25 to 100.89; 78 participants; 1 study; low-certainty evidence). However, baricitinib results in an increase in short-term hair regrowth ≥ 75% when compared to placebo (RR 7.54, 95% CI 3.90 to 14.58; 1200 participants; 2 studies; high-certainty evidence). For the incidence of serious adverse events, the evidence is very uncertain about the effect of topical ruxolitinib versus placebo (RR 0.33, 95% CI 0.01 to 7.94; 78 participants; 1 study; very low-certainty evidence). Baricitinib and apremilast may result in little to no difference in the incidence of serious adverse events versus placebo (RR 1.47, 95% CI 0.60 to 3.60; 1224 participants; 3 studies; low-certainty evidence). The same result is observed for subcutaneous dupilumab compared to placebo (RR 1.54, 95% CI 0.07 to 36.11; 60 participants; 1 study; low-certainty evidence). For health-related quality of life, the evidence is very uncertain about the effect of oral cyclosporine compared to placebo (MD 0.01, 95% CI -0.04 to 0.07; very low-certainty evidence). Baricitinib results in an increase in long-term hair regrowth ≥ 75% compared to placebo (RR 8.49, 95% CI 4.70 to 15.34; 1200 participants; 2 studies; high-certainty evidence). Regarding the risk of bias, the most relevant issues were the lack of details about randomisation and allocation concealment, the limited efforts to keep patients and assessors unaware of the assigned intervention, and losses to follow-up. AUTHORS' CONCLUSIONS We found that treatment with baricitinib results in an increase in short- and long-term hair regrowth compared to placebo. Although we found inconclusive results for the risk of serious adverse effects with baricitinib, the reported small incidence of serious adverse events in the baricitinib arm should be balanced with the expected benefits. We also found that the impact of other treatments on hair regrowth is very uncertain. Evidence for health-related quality of life is still scant.
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Affiliation(s)
- Miriam Mateos-Haro
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Doctoral programme in Clinical Medicine and Public Health, Universidad de Granada, Granada, Spain
| | - Monica Novoa-Candia
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Andrea Correa-Pérez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Andrea Gaetano Gil
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Silvia Fernández-García
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Tayeb Bennouna-Dalero
- Preventive Medicine and Public Health Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucia Giraldo
- Paediatric Dermatology Department, Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Sergio Vaño-Galván
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Zamora
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
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Fatani MIA, Alkhalifah A, Alruwaili AFS, Alharbi AHS, Alharithy R, Khardaly AM, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. Diagnosis and Management of Alopecia Areata: A Saudi Expert Consensus Statement (2023). Dermatol Ther (Heidelb) 2023; 13:2129-2151. [PMID: 37558830 PMCID: PMC10539276 DOI: 10.1007/s13555-023-00991-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Alopecia areata (AA) is a complex autoimmune disease manifesting as a chronic inflammatory disease characterized by non-scarring patches of hair loss over the face, scalp, and body. Several treatments have been proposed for AA, but none are curative nor achieve a state of remission. The present consensus statement aims to present the evidence- and experience-based recommendations on the diagnosis and management of AA in Saudi Arabia. The Ministry of Health in Saudi Arabia has opted to initiate a meeting of a multidisciplinary group to discuss and concede on this topic. Eight dermatology experts and clinical pharmacists convened in eight consensus meetings. All content presented in this document was agreed upon by this working group, including diagnosis and severity assessment, prognostic indicators, and therapeutic options for AA. Special consideration was given to special patient populations including pediatric patients and patients with less frequent presentations of AA. Updates of the current recommendations will take place as new evidence evolves in the treatment of AA.
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Affiliation(s)
| | - Abdullah Alkhalifah
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | - Ru'aa Alharithy
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine and College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
| | - Maysa Tariq Yousef Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
- Department of Dermatology, King Abdullah Medical Complex, Prince Nayef Street, Northern Abhor, 23816, Jeddah, Saudi Arabia.
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9
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Seol JE, Hong SM, Ahn SW, Jang SH, Kim H. Two-dimensional planimetry for alopecia areata severity evaluation compared with severity of alopecia tool: A pilot study. Skin Res Technol 2023; 29:e13440. [PMID: 37753671 PMCID: PMC10444945 DOI: 10.1111/srt.13440] [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: 04/02/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Severity of Alopecia Tool (SALT) is widely used to assess the severity of alopecia areata (AA). However, physician-related subjectivity exists in SALT scoring (S1-5), especially with initial inspection in the clinical practice. This study investigated two-dimensional planimetric method to calculate actual surface area of AA, validating SALT scoring. MATERIALS AND METHODS SALT score was measured twice in each patient based on "initial" inspection in the clinic (SALT-I) and retrospective assessment of the "photograph" (SALT-P). Planimetric surface area was calculated by Image J program. Subgroup analysis was performed depending on the agreement between SALT-I and -P; score was described in the order of SALT-I and SALT-P. RESULTS A total of 93 subjects were enrolled. Planimetric surface area (cm2 ) of SALT-I was 2.5-74.9 (S1), 48.8-100.6 (S2), 83.6-205.4 (S3), and 282-367.9 (S4), while SALT-P was 2.5-59.2 (S1), 41.6-205.4 (S2), 48.8-183.2 (S3), and 282-367.9 (S4). In subgroup analysis, SALT-I and SALT-P agreed group showed planimetric surface area (cm2 ) as 2.5-59.2 (S1-1), 64.2-100.6 (S2-2), 168.3-183 (S3-3), and 282.6-367.9 (S4-4). Disagreed group showed the value as 54.7 (S1-2), 41.6-74.9 (S2-1), 83.6-205.4 (S2-3), and 48.8-88.6 (S3-2). CONCLUSION SALT-P was more clearly correlated with actual surface area than SALT-I. Planimetric surface area measurement could be used as a supplementary method especially in the S1 to S3, suggesting 60 cm2 , 100 cm2 , and 200 cm2 as objective cutoff values to differentiate S1, S2, and S3.
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Affiliation(s)
- Jung Eun Seol
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seong Min Hong
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Sang Woo Ahn
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seung Hee Jang
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Hyojin Kim
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
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10
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Gupta AK, Wang T, Bamimore MA, Piguet V, Tosti A. The relative efficacy of monotherapy with Janus kinase inhibitors, dupilumab and apremilast in adults with alopecia areata: Network meta-analyses of clinical trials. J Cosmet Dermatol 2023; 22:2553-2559. [PMID: 37452455 DOI: 10.1111/jocd.15903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Janus kinase (JAK) inhibitors, biologics, and phosphodiesterase-4 (PDE-4) inhibitors are recent therapies for alopecia areata (AA)-albeit, knowledge gaps exist for these agents' relative efficacy. OBJECTIVES We determined the relative efficacy and safety of monotherapy with the aforementioned agents in adults with AA. METHODS The literature was systematically searched; we used data from randomized trials that investigated the agents' efficacy-as per Severity of Alopecia Tool (SALT) scores. Bayesian network meta-analyses were used to determine relative efficacy and safety. Effect modification was determined using a generalized linear model on aggregate data; evidence quality was evaluated. RESULTS Based on the surface under the cumulative ranking curve estimates obtained from multiple efficacy endpoints, regimens with the highest likelihood of achieving percent reduction in SALT scores, as well as a minimum 90%, 75% or 50% reduction in SALT scores are (in alphabetical order) baricitinib 4 mg once daily (QD), brepocitinib 60/30 mg QD, deuruxolitinib (CTP-543) 12 mg twice daily (BID), ritlecitinib 200/50 mg QD, ruxolitinib 20 mg BID and tofacitinib 5 mg BID. In contrast, dupilumab subcutaneous injections administered weekly and apremilast 30 mg BID were less likely to be effective. Discontinuation due to any adverse event was the least likely with oral JAK inhibitors, and more likely with dupilumab and apremilast. CONCLUSIONS Our results support the conduct of high-quality comparative trials to determine whether JAK inhibitors are more effective and safer than PDE4 inhibitors.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, Florida, USA
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11
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Waśkiel-Burnat A, Rakowska A, Zaremba M, Maciejewska M, Blicharz L, Starace M, Iorizzo M, Piraccini BM, Olszewska M, Rudnicka L. Markers of Venous Thromboembolism Risk in Patients with Alopecia Areata: Is There Anything to Worry about? Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00971-7. [PMID: 37423962 PMCID: PMC10366048 DOI: 10.1007/s13555-023-00971-7] [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: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Numerous studies have indicated that alopecia areata is associated with a chronic systemic inflammation, which is considered as a risk factor for venous thromboembolism. The aim of the study was to evaluate the following markers of venous thromboembolism risk: soluble fibrin monomer complex (SFMC), thrombin-antithrombin complex (TATC), and prothrombin fragment 1 + 2 (F1 + 2) in patients with alopecia areata and compare them with healthy controls. METHODS In total, 51 patients with alopecia areata [35 women and 16 men; mean age: 38 (19-54) years] and 26 controls [18 women and 8 men; mean age: 37 (29-51) years] were enrolled in the study. The serum concentrations of thromboembolism markers were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS An increased level of SFMC was detected in patients with alopecia areata compared with the controls [25.66 (20-34.86) versus 21.46 (15.38-29.48) µg/ml; p < 0.05)]. In addition, a higher level of F1 + 2 was observed in patients with alopecia areata in comparison with the control group [70150 (43720-86070) versus 38620 (31550-58840) pg/ml; p < 0.001]. No significant correlation was detected among SFMC or F1 + 2 and the Severity of Alopecia Tool (SALT) score, disease duration, or the number of the hair loss episodes. CONCLUSION Alopecia areata may be associated with an increased risk of venous thromboembolism. Regular screening and preventive management of venous thromboembolism may be beneficial in patients with alopecia areata, especially before and during systemic Janus kinase (JAK) inhibitors or glucocorticoid therapy.
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Affiliation(s)
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Zaremba
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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12
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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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13
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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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14
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Chakraborty A. Disease severity scores in dermatology: An update of the various indices. Indian J Dermatol Venereol Leprol 2023; 0:1-15. [PMID: 37436018 DOI: 10.25259/ijdvl_592_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/15/2022] [Indexed: 07/13/2023]
Affiliation(s)
- Atreyo Chakraborty
- Department of Dermatology Venereology & Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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15
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Nwosu A, Miteva M. Alopecia Areata Barbae in a Nutshell. Skin Appendage Disord 2023; 9:179-186. [PMID: 37325278 PMCID: PMC10264905 DOI: 10.1159/000529389] [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: 08/08/2022] [Accepted: 01/22/2023] [Indexed: 06/17/2023] Open
Abstract
Beard alopecia areata, or alopecia areata barbae, (BAA) is a subset of alopecia areata, a T-cell mediated inflammatory disease that disrupts the hair follicle cycle leading to early onset of catagen. The aim of this review is to help strengthen clinicians' skills in the evaluation, diagnosis, and management of BAA. We performed a literature review according to the modified PRISMA guidelines, using a combination of relevant key words in electronic databases. According to the data from the 25 articles on BAA reviewed here, BAA mostly affects middle-aged men (mean age 31 years) who typically experience patchy hair loss in the neck region, which spreads to the scalp within 12 months. Similar to AA, BAA is associated with autoimmune diseases such as H. pylori and thyroiditis; however, BAA has no clear genetic pattern of inheritance which is observed in alopecia areata. Common dermoscopic findings in BAA include vellus white hairs and exclamation mark hairs, which may help distinguish it from other pathologies affecting facial hair. In clinical trials, the ALBAS tool offers clinicians an objective metric to evaluate BAA severity. Until recently, topical steroids have been the mainstay therapy; however, topical and oral janus kinase inhibitors are achieving improved results, with up to 75% beard regrowth in an average of 12 months.
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Affiliation(s)
- Adaeze Nwosu
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Kim BR, Won SH, Kim JW, Kim M, Jeong JI, Shin JW, Huh CH, Na JI. Development of a new classification and scoring system for scalp conditions: Scalp Photographic Index (SPI). J DERMATOL TREAT 2023; 34:2181655. [PMID: 36809147 DOI: 10.1080/09546634.2023.2181655] [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: 02/23/2023]
Abstract
BACKGROUND AND OBJECTIVES There has been no validated tool for objectively quantifying the overall condition and characteristics of the scalp. This study aimed to establish and validate a new classification and scoring system for evaluating scalp conditions. METHODS The Scalp Photographic Index (SPI) using a trichoscope grades 5 features of scalp conditions (Dryness, Oiliness, Erythema, Folliculitis, and Dandruff) on a score of 0 to 3. To evaluate the validity of SPI, SPI grading was performed by 3 experts on the scalps of 100 subjects along with a dermatologist's assessment of the scalps and a scalp-related symptom survey. For reliability assessment, 20 healthcare providers performed SPI grading for the 95 selected photographs of the scalp. RESULTS SPI grading and the dermatologist's scalp assessment showed good correlations for all five scalp features. Warmth showed a significant correlation with all features of SPI and the subjects' perception of a scalp pimple had a significant positive correlation with the folliculitis feature. SPI grading demonstrated good reliability with excellent internal consistency (Cronbach's α = 0.90) and strong inter- and intra-rater reliability (Kendall's W = 0.84, ICC(3,1) = 0.94). CONCLUSIONS SPI is an objective, reproducible, and validated numeric system for classifying and scoring scalp conditions.
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Affiliation(s)
- Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hyun Won
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Woo Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Minjae Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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17
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Valdebran M. Editorial: Advances in evaluation and management of hair loss disorders. Front Med (Lausanne) 2023; 10:1131286. [PMID: 36744146 PMCID: PMC9895931 DOI: 10.3389/fmed.2023.1131286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manuel Valdebran
- Department of Dermatology, Medical University of South Carolina, Charleston, SC, United States,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States,*Correspondence: Manuel Valdebran ✉
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18
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Zhu B, Zhang L, Wang J, Tan G. Vitamin D supplementation for patients with alopecia areata: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31089. [PMID: 36281137 PMCID: PMC10662846 DOI: 10.1097/md.0000000000031089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have reported an association between low Vitamin D (VD) levels and Alopecia areata (AA), and suggested VD preparations as a potential therapy. VD has immunomodulatory function closely associated with a variety of skin diseases, but there is no conclusive evidence to support VD supplementation for patients with AA. Therefore, we will conduct a meta-analysis to collect and evaluate the efficacy and safety of VD supplementation in the treatment of AA. METHODS We will search the following databases according to the developed strategy: Cochrane Library, PubMed, Web of Science, EMBASE, Scopus, Google scholar for Randomized controlled trials related to VD supplementation for AA. The retrieval time is from the establishment of each database to July 2022. Two reviewers will independently complete the literature search and screening, risk of bias assessment and data extraction. Severity of Alopecia Tool, Alopecia Density and Extent, Lesional area and senstivity (score) will be the primary results. RevMan V.5.3 will be used for data analysis and synthesis. For dichotomous outcomes and the continuous outcomes, we will calculate risk ratio with 95% Confidence intervals and mean differences or standardized mean differences with 95% Confidence intervals respectively. The reporting bias will be investigated using funnel plots, and the asymmetry of the funnel plots will be explained using the Harbord modified test or the Egger's regression test. RESULTS The results of the study expect to provide a high-quality, evidence-based recommendation on VD supplementation in the treatment of AA for clinicians. CONCLUSIONS The study will provide scientific and useful evidence for better use of VD supplementation in treating AA.
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Affiliation(s)
- Baohua Zhu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Lan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Jun Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Guiyuan Tan
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
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19
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Platelet-Rich Plasma in Alopecia Areata—A Steroid-Free Treatment Modality: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Biomedicines 2022; 10:biomedicines10081829. [PMID: 36009377 PMCID: PMC9405156 DOI: 10.3390/biomedicines10081829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients’ quality of life. The first line of treatment in patchy AA is triamcinolone acetonide (TrA); however, the efficacy of the treatment varies greatly. Our aim was to investigate the therapeutic effects of platelet-rich plasma (PRP) in the treatment of AA. Method: We performed a systematic literature search in four databases. Randomized clinical trials (RCT) reporting on patients with AA treated with PRP were included, comparing PRP with TrA or a placebo. The primary outcome was the Severity of Alopecia Tool (SALT) score. Results: Our systematic search provided a total of 2747 articles. We identified four studies eligible for quantitative analysis. The pooled mean differences from the four studies did not exhibit a significant difference in the mean change in the SALT score when PRP and TrA groups were compared (MD =−2.04, CI: −4.72–0.65; I2 = 80.4%, p = 0.14). Conclusions: PRP is a promising topical, steroid-free treatment modality in the therapy of AA. No significant difference was found between PRP and TrA treatment; however, further high-quality RCTs are needed to further assess the efficacy of PRP treatment and strengthen the quality of evidence.
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20
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Waśkiel-Burnat A, Kotowska M, Dorobek WM, Smyk J, Gąsecka A, Niemczyk A, Blicharz L, Filipiak KJ, Olszewska M, Rudnicka L. Patients with alopecia areata are at risk of endothelial dysfunction: results of a case-control study. Clin Exp Dermatol 2022; 47:1517-1522. [PMID: 35357040 DOI: 10.1111/ced.15206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alopecia areata is an autoimmune form of hair loss which may affect any hair-bearing area. It has been suggested that alopecia areata is associated with an increased risk of metabolic and cardiovascular comorbidities. OBJECTIVES The aim of the study was to evaluate the early predictors of cardiovascular diseases (endothelial function and arterial stiffness) in patients with alopecia areata without prior cardiovascular disease in comparison with healthy controls. METHODS Fifty-two patients with alopecia areata (38 women and 14 men, mean age: 41 [30 - 52]) and 34 healthy controls matched for age, gender and body mass index were enrolled in the study. Endothelial dysfunction expressed as reactive hyperemia index (RHI) and arterial stiffness identified by augmentation index (AI@75) were assessed with the use of the Endo-PAT 2000 device. RESULTS Endothelial dysfunction was observed in 22/52 (42%) patients with alopecia areata and in 4/34 (12%) healthy controls (p=0.002). Moreover, mean RHI was lower in patients with alopecia areata in comparison with control subjects (1.90 ± 0.31 vs 2.11 ± 0.45; p=0.03). No significant difference was present in AI@75 between patients with alopecia areata and the controls. CONCLUSIONS Patients with alopecia areata show abnormalities in the early predictors of cardiovascular diseases. Regular cardiovascular screening might be appropriate in every patient with alopecia areata.
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Affiliation(s)
- Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Maja Kotowska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Wioleta M Dorobek
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Julia Smyk
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Anna Niemczyk
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Pałac Lubomirskich, Plac Żelaznej Bramy 10, 00-136, Warsaw, Poland
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
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21
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Chemokine C-C Motif Ligand 7 (CCL7), a Biomarker of Atherosclerosis, Is Associated with the Severity of Alopecia Areata: A Preliminary Study. J Clin Med 2021; 10:jcm10225418. [PMID: 34830700 PMCID: PMC8624305 DOI: 10.3390/jcm10225418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
Alopecia areata is an autoimmune, inflammatory form of non-scarring hair loss that may affect any hair-bearing area. Recently, an increased risk of cardiovascular disorders has been described in patients with alopecia areata. The aim of the study was to evaluate the serum concentrations of proinflammatory proteins associated with atherosclerosis (chemokine C-C motif ligand 4; CCL4, chemokine C-C motif ligand 7, CCL7; and sortilin, SORT1), and cardiovascular risk (myeloperoxidase, MPO; interleukin 1 receptor-like 1, IL1RL1; and growth differentiation factor 15, GDF15) in patients with alopecia areata without symptoms or prior cardiovascular disease in comparison with healthy controls. Sixty otherwise healthy patients with alopecia areata and twenty control subjects matched for age, gender, and body mass index (BMI) were enrolled in the study. No significant differences in the serum levels of MPO, IL1RL1, CCL4, CCL7, SORT1, and GDF15 were detected between patients with alopecia areata and healthy controls. A positive correlation was found between the serum concentration of CCL7 and the severity of alopecia areata (r = 0.281, p = 0.03), while GDF15 correlated with age at the disease onset (r = 0.509, p < 0.0001). The results of the present study suggest that the severity of alopecia areata may be associated with an increased risk of atherosclerosis.
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22
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AlMarzoug A, AlOrainy M, AlTawil L, AlHayaza G, AlAnazi R, AlIssa A, AlSheikh A, AlKhalifah A, AlHarithy R. Alopecia areata and tofacitinib: a prospective multicenter study from a Saudi population. Int J Dermatol 2021; 61:886-894. [PMID: 34716573 DOI: 10.1111/ijd.15917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population. It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. METHODS A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. RESULTS The sample size was 68 with an average baseline SALT score of 76.8 ± 27.6%. Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis. CONCLUSIONS Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.
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Affiliation(s)
- Alanoud AlMarzoug
- Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - May AlOrainy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Lama AlTawil
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghada AlHayaza
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rasha AlAnazi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Afaf AlSheikh
- Department of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah AlKhalifah
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ruaa AlHarithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
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23
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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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24
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Majid I, Sameem F, Sultan J, Aleem S. Alopecia areata severity index (AASI): A reliable scoring system to assess the severity of alopecia areata on face and scalp-a pilot study. J Cosmet Dermatol 2021; 20:2565-2570. [PMID: 34129730 DOI: 10.1111/jocd.14289] [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: 04/23/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND All scoring systems used in Alopecia Areata (AA) focus mainly on scalp and cannot assess the severity or treatment response when AA involves the beard hair, eyebrows, or eyelashes. AIM This study describes and assesses the reliability of a new scoring system "Alopecia Areata Severity Index" (AASI) for measuring the severity of AA of scalp, beard, and upper face. METHODS Scalp hair, beard hair, upper face (eyebrows and eyelashes) were individually assessed and the severity of AA was scored from 0 to 100 (0-50 in case of upper face). AASI score was then calculated as a sum of all these individual scores as AASI = AASI (scalp) + AASI (upper face) + AASI (beard)+. To test the inter-observer reliability of AASI score, 25 patients with varying severity of AA were scored by 4 trained dermatologists. Repeat scoring was performed after one week to test for intra-observer reliability. RESULTS Excellent inter-rater, as well as intra-observer reliability, was observed with Chronbach's alpha value of 0.999 (CI = 0.989-1.000). The intra-observer correlation coefficient with average measure was 0.999 (CI = 0.990-1.000) with statistically significant F test <0.005. CONCLUSION AASI score is a reliable scoring system to assess the severity of AA in patients with involvement of one or more areas of the body. LIMITATIONS Sample population belonged to single ethnic group.
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Affiliation(s)
- Imran Majid
- CUTIS Institute of Dermatology, Srinagar, India
| | - Farah Sameem
- Department of Dermatology, SKIMS Medical College, Srinagar, India
| | - Javeed Sultan
- Department of Dermatology, Government Medical College, Srinagar, India
| | - Samia Aleem
- Department of Health and Family Welfare, Dermatologist JK Medical Services, Srinagar, India
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25
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Cogan NG, Bao F, Paus R, Dobreva A. Data assimilation of synthetic data as a novel strategy for predicting disease progression in alopecia areata. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2021; 38:314-332. [PMID: 34109398 DOI: 10.1093/imammb/dqab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022]
Abstract
The goal of patient-specific treatment of diseases requires a connection between clinical observations with models that are able to accurately predict the disease progression. Even when realistic models are available, it is very difficult to parameterize them and often parameter estimates that are made using early time course data prove to be highly inaccurate. Inaccuracies can cause different predictions, especially when the progression depends sensitively on the parameters. In this study, we apply a Bayesian data assimilation method, where the data are incorporated sequentially, to a model of the autoimmune disease alopecia areata that is characterized by distinct spatial patterns of hair loss. Using synthetic data as simulated clinical observations, we show that our method is relatively robust with respect to variations in parameter estimates. Moreover, we compare convergence rates for parameters with different sensitivities, varying observational times and varying levels of noise. We find that this method works better for sparse observations, sensitive parameters and noisy observations. Taken together, we find that our data assimilation, in conjunction with our biologically inspired model, provides directions for individualized diagnosis and treatments.
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Affiliation(s)
- N G Cogan
- Department of Mathematics, Florida State University, 208 Love Building, Tallahassee, Fl 32306
| | - Feng Bao
- Department of Mathematics, Florida State University, 208 Love Building, Tallahassee, Fl 32306
| | - Ralf Paus
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA, Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, UK
| | - Atanaska Dobreva
- School of Mathematical and Natural Sciences, Arizona State University - West Campus, Glendale, AZ 85306, USA, and Department of Mathematics, North Carolina State University, Raleigh, NC 27695, USA
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26
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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: 13] [Impact Index Per Article: 4.3] [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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27
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Stefanis AJ, Arenberger P, Arenbergerova M, Gkalpakiotis S. Alopecia barbae severity score: a novel scoring system to estimate the extent of beard loss and success of treatment. Br J Dermatol 2021; 185:847-849. [PMID: 33997953 DOI: 10.1111/bjd.20489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A J Stefanis
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - P Arenberger
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - M Arenbergerova
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - S Gkalpakiotis
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
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28
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Lee S, Lee JW, Choe SJ, Yang S, Koh SB, Ahn YS, Lee WS. Clinically Applicable Deep Learning Framework for Measurement of the Extent of Hair Loss in Patients With Alopecia Areata. JAMA Dermatol 2021; 156:1018-1020. [PMID: 32785607 DOI: 10.1001/jamadermatol.2020.2188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Solam Lee
- Department of Dermatology and Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jong Won Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sejung Yang
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeon Soon Ahn
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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29
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Creadore A, Manjaly P, Li SJ, Joyce C, Huang KP, Mostaghimi A. Evaluating Areas of Preferred Hair Loss: Potential Implications for Rating Alopecia Severity. JAMA Dermatol 2020; 156:1266-1268. [PMID: 32902575 DOI: 10.1001/jamadermatol.2020.2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hordinsky MK. Current Treatment of Alopecia Areata. J Investig Dermatol Symp Proc 2020; 20:S28-S30. [PMID: 33099380 DOI: 10.1016/j.jisp.2020.04.004] [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: 11/18/2022]
Abstract
The number of alopecia areata (AA) clinical trials with Jak inhibitors of cytoplasmic tyrosine kinases, including Jak1, Jak2, Jak3, and tyrosine-protein kinase has increased significantly since the last Research Summit. This fact means that the conversation about current treatments for AA now also needs to include a discussion of traditionally used off-label therapies as well as evolving therapies as with Jak inhibitors.
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Affiliation(s)
- Maria K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
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Ramos PM, Anzai A, Duque-Estrada B, Melo DF, Sternberg F, Santos LDN, Alves LD, Mulinari-Brenner F. Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:39-52. [PMID: 33183894 PMCID: PMC7772599 DOI: 10.1016/j.abd.2020.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. OBJECTIVE To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. METHODS Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. RESULTS/CONCLUSIONS Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.
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Affiliation(s)
- Paulo Müller Ramos
- Department of Dermatology and Radiotherapy, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Alessandra Anzai
- Department of Dermatology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Duque-Estrada
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Fernandes Melo
- Department of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flavia Sternberg
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leopoldo Duailibe Nogueira Santos
- Department of Medicine, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Dermatology and Allergology, Hospital do Servidor Público Municipal, São Paulo, SP, Brazil
| | - Lorena Dourado Alves
- Department of Tropical Medicine and Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Wyrwich K, Kitchen H, Knight S, Aldhouse N, Macey J, Nunes F, Dutronc Y, Mesinkovska N, Ko J, King B. The Alopecia Areata Investigator Global Assessment scale: a measure for evaluating clinically meaningful success in clinical trials. Br J Dermatol 2020; 183:702-709. [PMID: 31970750 PMCID: PMC7586961 DOI: 10.1111/bjd.18883] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Content-valid and clinically meaningful instruments are required to evaluate outcomes of therapeutic interventions in alopecia areata (AA). OBJECTIVES To develop an Investigator's Global Assessment (IGA) to interpret treatment response in AA treatment studies. METHODS Qualitative interviews were conducted in the USA with expert dermatologists and with patients with AA who had experienced ≥ 50% scalp-hair loss. Thematic data analysis identified critical outcomes and evaluated the content validity of the new IGA. RESULTS Expert clinicians (n = 10) judged AA treatment success by the amount of scalp-hair growth (median 80% scalp hair). Adult (n = 25) and adolescent (n = 5) patients participated. Scalp-hair loss was the most bothersome AA sign/symptom for most patients. Perceived treatment success - short of 100% scalp hair - was the presence of ~ 70-90% scalp hair (median 80%). Using additional clinician and patient insights, the Alopecia Areata Investigator Global Assessment (AA-IGA™) was developed. This clinician-reported outcome assessment is an ordinal, static measure comprising five severity categories of scalp-hair loss. Nearly all clinicians and patients in this study agreed that, for patients with ≥ 50% scalp-hair loss, successful treatment would be hair regrowth resulting in ≤ 20% scalp-hair loss. CONCLUSIONS We recommend using the Severity of Alopecia Tool to assess the extent (0-100%) of scalp-hair loss. The AA-IGA is a robust ordinal measure providing distinct and clinically meaningful gradations of scalp-hair loss that reflects patients' and expert clinicians' perspectives and treatment expectations. What is already known about this topic? The Severity of Alopecia Tool is widely used to assess the extent of scalp-hair loss in patients with alopecia areata. Guidelines define treatment success as a 50% improvement in scalp hair, and clinical trials have used dynamic thresholds of 50% and 90%. However, there is no clinical consensus on these endpoints, and patient perspectives on treatment success are unknown. What does this study add? Through qualitative interviews with 10 expert dermatologists and 30 patients with alopecia areata who had experienced ≥ 50% scalp-hair loss, we developed the Alopecia Areata Investigator Global Assessment (AA-IGA™) to measure five clinically meaningful gradations of alopecia areata scalp-hair loss that reflects patients' and clinicians' perspectives and expectations of treatment success in alopecia areata treatment studies. What are the clinical implications of this work? The AA-IGA is a robust ordinal measure that can inform clinical evaluation of alopecia areata treatment outcomes. The AA-IGA can be used to determine clinically meaningful treatment success for alopecia areata, with success defined by patients and clinicians as reaching ≤ 20% scalp-hair loss. Linked Comment: Blome. Br J Dermatol 2020; 183:609.
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Affiliation(s)
- K.W. Wyrwich
- Patient‐Focused Outcomes Center of ExpertiseEli Lilly and CompanyIndianapolisINUSA
| | - H. Kitchen
- Lilly Bio‐MedicinesEli Lilly and CompanyIndianapolisINUSA
| | - S. Knight
- Lilly Bio‐MedicinesEli Lilly and CompanyIndianapolisINUSA
| | | | - J. Macey
- Lilly Bio‐MedicinesEli Lilly and CompanyIndianapolisINUSA
| | - F.P. Nunes
- Clinical Outcomes AssessmentDRG AbacusManchesterUK
| | - Y. Dutronc
- Clinical Outcomes AssessmentDRG AbacusManchesterUK
| | - N. Mesinkovska
- Dermatology Clinical Research CenterUniversity of CaliforniaIrvineCAUSA
| | - J.M. Ko
- Department of DermatologyStanford University School of MedicineStanfordCAUSA
| | - B.A. King
- Department of DermatologyYale School of MedicineNew HavenCTUSA
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Meah N, Wall D, York K, Bhoyrul B, Bokhari L, Asz-Sigall D, Bergfeld WF, Betz RC, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Donovan J, Eisman S, Farrant P, Green J, Grimalt R, Harries M, Hordinsky M, Irvine AD, Itami S, Jolliffe V, King B, Lee WS, McMichael A, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Piraccini BM, Rakowska A, Reygagne P, Roberts JL, Rudnicka L, Shapiro J, Sharma P, Tosti A, Vogt A, Wade M, Yip L, Zlotogorski A, Sinclair RD. The Alopecia Areata Consensus of Experts (ACE) study part II: Results of an international expert opinion on diagnosis and laboratory evaluation for alopecia areata. J Am Acad Dermatol 2020; 84:1594-1601. [PMID: 32926985 DOI: 10.1016/j.jaad.2020.09.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata. OBJECTIVE To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata. METHODS Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%. RESULTS Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]). LIMITATIONS The study had low representation from Africa, South America, and Asia. CONCLUSION There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care.
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Affiliation(s)
- Nekma Meah
- Sinclair Dermatology, East Melbourne, Victoria, Australia.
| | - Dmitri Wall
- Hair Restoration Blackrock, Ireland; National and International Skin Registry Solutions (NISR), Ireland
| | - Katherine York
- Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Laita Bokhari
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | | | - Regina C Betz
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital, Bonn, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Andrea Combalia
- Department of Dermatology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - George Cotsarelis
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Brittany Craiglow
- Dermatology Physicians of Connecticut, Farifield, Connecticut; Yale Department of Dermatology, New Haven, Connecticut
| | | | | | - Paul Farrant
- Brighton and Sussex University Hospitals Trust, United Kingdom
| | - Jack Green
- Department of Dermatology, St. Vincent's Hospital, Victoria, Australia
| | - Ramon Grimalt
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya Josep Trueta s/n 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Matthew Harries
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester, Manchester, United Kingdom; Biomedical Research Centre, Manchester, United Kingdom; The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Satoshi Itami
- Department of Dermatology, Oita University, Idaigaoka, Yufu City, Oita, Japan
| | - 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 University Wonju College of Medicine, Wonju, Republic of Korea
| | - Amy McMichael
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Andrew Messenger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
| | - Paradi Mirmirani
- Kaiser Permanente Vallejo, Department of Dermatology, California
| | - Elise Olsen
- Duke Dermatology Clinic-Clinic 3K, Durham, North Carolina
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, New York
| | - Bianca Maria Piraccini
- International Relations, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Dermatology Unit, Bologna, Italy
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Reygagne
- Centre de santé Sabouraud, Hôpital Saint Louis, Paris, France
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, New York
| | - Pooja Sharma
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine
| | - 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, Queensland, Australia
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Novoa-Candia M, Sánchez Vanegas G, Arevalo-Rodriguez I, Vaño-Galván S, Urueña Rodriguez MG, Giraldo L, Saceda-Corralo D, Tobias A, Tomlinson J, Ortega-Quijano D, Zamora J. Treatments for alopecia areata: a network meta-analysis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Monica Novoa-Candia
- Paediatric Dermatology Department; Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS; Bogotá Colombia
| | | | - Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Centro Asociado Cochrane de Ecuador; Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE; Quito Ecuador
| | | | | | - Lucia Giraldo
- Paediatric Dermatology Department; Hospital San Jose-Fundación Universitaria de Ciencias de la Salud-FUCS; Bogotá Colombia
| | | | - Aurelio Tobias
- Tommy’s National Centre for Miscarriage Research, Institute of Metabolism and Systems Research; University of Birmingham; Birmingham UK
| | | | | | - Javier Zamora
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Women’s Health Research Unit, Centre for Primary Care and Public Health; Queen Mary University of London; London UK
- Cochrane Associate Centre of Madrid; Madrid Spain
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Lee JH, Eun SH, Kim SH, Ju HJ, Kim GM, Bae JM. Excimer laser/light treatment of alopecia areata: A systematic review and meta-analyses. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:460-469. [PMID: 32745343 DOI: 10.1111/phpp.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The excimer laser/light (EL) has been reported to be effective for alopecia areata (AA), but its treatment response has not been systematically reviewed. OBJECTIVE To determine the treatment response and safety of EL treatment of AA. METHODS A comprehensive search of the Medline, EMBASE, Cochrane library, and Web of Science (from inception to December 31, 2018) was conducted to identify prospective clinical studies assessing the treatment response of EL for AA. The primary outcome was cosmetically acceptable hair regrowth (hair regrowth ≥75%); random-effects meta-analyses using generic inverse variance weighting were performed to estimate treatment responses. The study was registered with PROSPERO (CRD42019121092). RESULTS Of 52 records initially identified, 13 full-text articles were finally assessed in terms of eligibility. A total of 9 prospective clinical studies (129 AA patients) including 5 controlled clinical trials were identified. Cosmetically acceptable hair regrowth was achieved in 50.2% (95% confidence interval 31.5%-68.9%; 8 studies). EL treatment significantly improved hair regrowth compared with untreated controls (relative risk 7.83; 95% confidence interval 2.11-29.11; 5 controlled clinical trials). No serious adverse effect was noted. CONCLUSIONS EL treatment appeared to produce a favorable therapeutic response in AA patients. The use of EL should be encouraged for AA patients with the advantages of the non-invasiveness and no systemic effect.
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Affiliation(s)
- Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hye Eun
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hyung Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gyong Moon Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Abdallah MAER, Shareef R, Soltan MY. Efficacy of intradermal minoxidil 5% injections for treatment of patchy non-severe alopecia areata. J DERMATOL TREAT 2020; 33:1126-1129. [PMID: 32643454 DOI: 10.1080/09546634.2020.1793893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intradermal minoxidil is used as an off-label treatment for patchy non-severe alopecia areata (AA) either alone or in combination with steroids; however, studies estimating its efficacy are still lacking. OBJECTIVES To assess the efficacy of intradermal delivery of minoxidil 5% alone and in combination with intralesional triamcinolone acetonide for treatment of patchy non-severe AA. PATIENTS AND METHODS One hundred patches in twenty patients with patchy non-severe AA, five patches for each patient, were included in this prospective intra-patient comparative controlled clinical study. Four comparative patches per each patient were randomly assigned to receive 4 sessions, at a 4-week interval, of one of the following treatments: intralesional triamcinolone acetonide, intralesional minoxidil 5%, combination treatment, or micro-needling. The fifth patch was observed as the negative control. Treatment outcomes were assessed at baseline, and 1 month after treatment ends. RESULTS Minoxidil intradermal injection was nearly comparable to the micro-needling effect and its combination to steroids had no additive effect. Hair regrowth in response to minoxidil occurred earlier than the spontaneous recovery. CONCLUSION Monotherapy of intralesional minoxidil is of limited efficacy in treating non-severe patchy AA, but it speeds the recovery.
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Affiliation(s)
| | - Rasha Shareef
- Faculty of Medicine, Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
| | - Marwa Y Soltan
- Faculty of Medicine, Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
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The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata. J Am Acad Dermatol 2020; 83:123-130. [PMID: 32165196 DOI: 10.1016/j.jaad.2020.03.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/26/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials. OBJECTIVE To produce an international consensus statement on the use and utility of various treatments for AA. METHODS Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus. RESULTS In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies. LIMITATIONS The study included a comprehensive list of systemic treatments for AA but not all treatments used. CONCLUSION Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.
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Olsen EA, Kornacki D, Sun K, Hordinsky MK. Ruxolitinib cream for the treatment of patients with alopecia areata: A 2-part, double-blind, randomized, vehicle-controlled phase 2 study. J Am Acad Dermatol 2019; 82:412-419. [PMID: 31622643 DOI: 10.1016/j.jaad.2019.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are currently no treatments for alopecia areata (AA) that are universally effective or approved by the US Food and Drug Administration. Oral ruxolitinib has shown efficacy in extensive AA. Ruxolitinib cream would potentially avoid systemic adverse effects. OBJECTIVE To assess the efficacy and safety of 1.5% ruxolitinib cream in patients with AA who had at least 25% hair loss by Severity of Alopecia Tool score. METHODS This was a 2-part study. Part A was an open-label, 24-week study of 1.5% ruxolitinib cream in patients with 25% to 99% hair loss followed by a 24-week extension period. Part B was a double-blind, vehicle-controlled, 24-week study of 1.5% ruxolitinib cream in patients with 25% to 100% hair loss, followed by a crossover to ruxolitinib cream in the vehicle group for 24 weeks and additional treatment time for the ruxolitinib cream group. RESULTS Although Part A results suggested potential efficacy of 1.5% ruxolitinib cream, there was no significant difference in hair regrowth based on 50% improvement in Severity of Alopecia Tool scores between patients receiving 1.5% ruxolitinib cream and vehicle in part B. There were no significant safety issues with 1.5% ruxolitinib cream. LIMITATIONS Single strength of ruxolitinib cream. CONCLUSIONS The 1.5% ruxolitinib cream did not have a significant effect in patients with AA.
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Affiliation(s)
- Elise A Olsen
- Department of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Kang Sun
- Incyte Corporation, Wilmington, Delaware
| | - Maria K Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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Waśkiel‐Burnat A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Alopecia areata predictive score: A new trichoscopy‐based tool to predict treatment outcome in patients with patchy alopecia areata. J Cosmet Dermatol 2019; 19:746-751. [DOI: 10.1111/jocd.13064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 06/05/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | - Adriana Rakowska
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - Mariusz Sikora
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | | | - Lidia Rudnicka
- Department of Dermatology Medical University of Warsaw Warsaw Poland
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40
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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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