Alopecia Areata Research Articles

Demographics and Disease Characteristics of Patients with Alopecia Areata with Comorbid Atopic Dermatitis, Vitiligo or Anxiety/Depression: TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic autoimmune disease. Common AA comorbidities include atopic dermatitis (AD), vitiligo, anxiety and depression (AnxDep). TARGET-DERM AA is an ongoing longitudinal, real-world study of United States and Canadian AA patients. The purpose of this analysis is to assess characteristics among AA patients with and without the above comorbidities. Methods At enrollment (December 2021-June 2024), patients reported outcomes (including comorbidities, Patient Global Impression of Severity-AA, and clinician-reported outcome measures: Severity of Alopecia Tool, Measure for Eyebrow/Eyelash Hair Loss). Characteristics were compared across subgroups. Results Of the 267 AA patients with completed patient questionnaires at enrollment, 61.4% were female; 24.4% were aged <12 years, 13.7% 12-17, and 61.7% 18 or older. Overall, 21.0% self-reported an AD diagnosis (19.7% of pediatric, 11.1% of adolescent, and 25.4% of adult AA patients), 7.1% vitiligo (7.0% of pediatric, 3.7% of adolescent, and 8.5% of adult AA patients) and 44.9% AnxDep (21.1% of pediatric, 40.7% of adolescent, and 58.5% of adult AA patients). 42.1% of patients with comorbid vitiligo had severe AA disease (SALT>50) and 27.8% patients without comorbid vitiligo had SALT>50. 28.6% of those with comorbid AD had SALT>50 compared to 28.9% of those not reporting AD, with 30.0% of AnxDep and 27.9% of non-AnxDep having SALT>50, all p>0.2. 42.1% of patients with comorbid vitiligo reported PGIS-AA ‘severe/very severe’ disease, with 41.1% of patients with comorbid AD and 42.5% of patients with comorbid AnxDep reporting severe/very severe AA disease, all numerically higher than patients without comorbid vitiligo (36.3%), AD (35.6%), and AnxDep (31.9%), all p>.07. Among those with and without vitiligo, 42.1% vs 37.9% had eyebrow involvement, 36.8% vs 30.2% eyelash; considering AD, 35.7% vs 38.9% had eyebrow involvement, 28.6% vs 31.3% eyelash; for AnxDep 39.2% vs 37.4% had eyebrow involvement, 30.8% v 30.6% eyelash, all p>0.5. Discussion In this real-world cohort of AA patients, the presence of specific comorbidities was not associated with statistically significant differences in clinician reported AA severity, eyebrow or eyelash involvement. Comorbid AnxDep was associated with increased patient-reported AA disease severity. Additional research characterizing how dermatologic and psychiatric comorbidities impact health-related quality of life and patient burden has the potential to inform management decisions.

Generic vs. Disease-Specific Patient Reported Outcome (PRO) Instruments for Assessing HRQoL Burden Among Patients Diagnosed with Alopecia Areata: Evidence from TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic, autoimmune disease characterized by patchy hair loss. Compared to other disease areas, recent work has signaled a potential shortcoming, that generic quality of life (QOL) questionnaires are not sufficiently sensitive to the impact of AA disease severity. This cross-sectional analysis investigates the Short-Form 36, the dermatology life quality index (DLQI), and the Alopecia Areata Patient Priority Outcomes (AAPPO) for similar shortcomings. Methods Patients of all ages enrolled from December 2021 to June 2024 in TARGET-DERM AA (data collection on-going) in the United States and Canada were grouped by Severity of Alopecia Tool (SALT) score (1-20, 21-49, or 50-100). At enrollment, patients completed the AAPPO and DLQI questionnaire as well as the RAND MOS Short-Form 36. The SF-36 has 8 subdomain scores (vitality, physical function, bodily pain, general health, physical role function, emotional role function, social role function, mental health) along with the physical component summaries (PCS), mental component summaries (MCS), and the SF-6D utility index score. The Kruskal-Wallis test compared differences in mean scores across SALT subgroups defined by severity. Results Of the 141 AA patients, 61.7% were female; 95.0% adults, and 67.4% Non-Hispanic White. When comparing the SALT 1-20 and the >50 subgroups, significant differences in SF-36 derived mean scores were only observed in the PCS and the physical function score (p<0.05). None of the other scores (MCS, SF-6D, or other SF-36 subdomains) showed any differences. Mean DLQI scores were similar across subgroups (p>.05) Notably, the hair loss and activity limitation domains of the AAPPO demonstrated significant differences between the patient subgroups (p<.0001 and p<.05, respectively) Discussion In this real-world cohort, generic QoL instruments, namely the SF-36 and DLQI, did not capture differences in the underlying health-related QoL burden of AA patients with different AA severity. Such differences were clear when HRQoL was measured for AA patients with mild hair loss AAPPO.

Patient Profile and Treatment Characteristics of Early Ritlecitinib Initiators in the US

Introduction: Alopecia Areata (AA) is an autoimmune disease characterized by unpredictable, non-scarring hair loss. In the ALLEGRO phase 2b/3 randomized, placebo-controlled clinical trial, ritlecitinib 50mg demonstrated a significantly greater proportion of patients achieving 80% or more scalp hair coverage at 24 weeks compared to placebo. In June 2023, the FDA approved ritlecitinib (50mg) for treatment of severe AA in adults and adolescents 12 years and older. This study aims to address how ritlecitinib is being integrated into real-world practice by assessing the characteristics of patients prescribed ritlecitinib within the first three months following approval. Methods: This was a retrospective observational study analyzing data from the Komodo Healthcare Map (TM) dataset (Jan 2016-Sept 2023). Komodo Healthcare Map is comprised of open and closed claims for more than 330M lives in the US. The sample included patients aged ≥12 years with ≥1 prescription for ritlecitinib on or after June 23, 2023 (first prescription date defined the index date), ≥1 diagnoses of AA on or before the index date, and ≥12 months of continuous enrollment/eligibility proxy prior to study entry. Clinical characteristics, comorbidities, and AA treatment history were assessed over the 12-month pre-index period. All variables were analyzed descriptively and stratified by age (adolescent: 12-17, adult: ≥18). Results: Among the 150 patients included, 72% were prescribed ritlecitinib by a dermatologist. Over half were female, 52% were adolescents, and 78% were commercially insured. Approximately 30% of patients had alopecia totalis/alopecia universalis (AT/AU); 11% had ≥1 other autoimmune disorder, 23% had ≥1 atopic disorder, and 21% had ≥1 mental/emotional disorders. In the 12 months prior to receiving ritlecitinib, 34% of adolescents received no AA treatments, 30% received systemic immunomodulators (19% Janus kinase inhibitors [JAKi], 13% other systemic immunomodulators), and 20% received topical corticosteroids. Among adults, 24% had no evidence of prior AA treatments, 35% received injectable corticosteroids, and 35% received systemic immunomodulators (21% baricitinib, 13% other JAKi, and 7% other systemic immunomodulators) during the pre-index period. Of those who had received a prior treatment, the mean time between the last days’ supply of the prior therapy and the start of ritlecitinib was 51 days. Conclusion: In the first 3 months following the US approval, ritlecitinib was prescribed to a broad range of patients; including adolescent and adults; those with and without prior treatments; and those with and without various comorbidities. This suggests that ritlecitinib may provide new opportunities to (re)engage in AA-directed care. Funding: this study was funded by Pfizer Inc.

Efficacy of Ritlecitinib in Patients with Alopecia Areata by Extent of Hair Loss: Results from the Phase 2b/3 and Phase 3 ALLEGRO Clinical Trials

Introduction: Ritlecitinib, a dual JAK3/TEC family kinase inhibitor, demonstrated efficacy and safety in patients ≥12 years old with AA and ≥50% scalp hair loss in the phase 2b/3 ALLEGRO study. This post hoc, pooled analysis of the ALLEGRO-2b/3 and phase 3 ALLEGRO-LT studies evaluated the efficacy of ritlecitinib in patients with alopecia areata (AA) by extent of baseline scalp hair loss through Month 24. Methods: Patients aged ≥12 years with AA and ≥50% scalp hair loss who received ritlecitinib 50 mg daily in ALLEGRO-2b/3 and rolled over to ALLEGRO-LT (continued to receive 50 mg) were included. Outcomes included the proportions of patients achieving response based on Severity of Alopecia Tool [SALT] score ≤20 (≤20% scalp hair loss), ≥2-grade improvement in eyebrow assessment [EBA] score (among patients with abnormal score at baseline), and ≥2-grade improvement in eyelash assessment [ELA] score (among patients with abnormal score at baseline). Patients were stratified by extent of scalp hair loss at baseline, defined as severe AA (SALT score 50-94) or very severe AA (SALT score 95-100), as per the Alopecia Areata Investigator Global Assessment (AA-IGA). Data as observed and imputed (last observation carried forward [LOCF]) are reported at the cutoff date (December 9, 2022). Results: Of 191 patients included, 66 (34.6%) had severe AA and 125 (65.4%) had very severe AA at baseline. At Month 12, 64.4% and 34.3% (observed) and 60.6% and 29.6% (LOCF) of patients with severe AA and very severe AA, respectively, achieved SALT ≤20. At Month 24, these proportions increased to 70.2% and 54.8% (observed) and 63.6% and 36.8% (LOCF), respectively. EBA response was achieved in 54.6% and 46.9% (observed) and 52.8% and 42.4% (LOCF) of patients with severe AA and very severe AA, respectively, at Month 12; at Month 24, the proportions were 60.9% and 56.5% (observed) and 50.0% and 45.8% (LOCF). ELA response was achieved in 60.7% and 40.5% (observed) and 61.3% and 38.0% (LOCF) of patients with severe AA and very severe AA, respectively, at Month 12; at Month 24, the proportions were 70.0% and 45.3% (observed) and 61.3% and 38.0% (LOCF). Conclusion: Ritlecitinib 50 mg daily achieves scalp, eyebrow, and eyelash hair regrowth in patients with severe and very severe AA. Funding: This study was funded by Pfizer Inc

Distribution of SALT Scores with Ritlecitinib Treatment up to 24 months from the ALLEGRO Phase 2b/3 and Long-Term Phase 3 Clinical Studies in Alopecia Areata

Background:• Alopecia areata (AA) is an autoimmune disease that has an underlying immuno-inflammatorypathogenesis and is characterized by non-scarring hair loss ranging from small patches to completescalp, face, and/or body hair loss1• Ritlecitinib, an oral JAK3/TEC family kinase inhibitor, demonstrated efficacy and safety up to 48 weeks inpatients aged ≥12 years with AA in the ALLEGRO phase 2b/3 study (NCT03732807; “ALLEGRO-2b/3”)2• The long-term efficacy of ritlecitinib in patients who rolled over from ALLEGRO-2b/3 to the ongoingphase 3, open-label ALLEGRO-LT study (NCT04006457) has been reported in terms of the proportions ofpatients with Severity of Alopecia Tool (SALT) scores of ≤20 and ≤10 (≤20% or ≤10% scalp without hair)at Month 243• However, the distribution of SALT scores in the overall population, including patients not reaching theSALT score ≤20 and ≤10 thresholds, has not yet been describedOBJECTIVE• This study describes changes in the distribution of SALT scores over 24 months of ritlecitinib treatmentin the overall population and in age and disease severity subgroups Methods: Study design and patients• Key inclusion criteria in ALLEGRO-2b/3:- Age ≥12 years- Diagnosis of AA with ≥50% scalp hair loss due to AA (including alopecia totalis [AT] and alopecia universalis [AU])- Maximum duration of current episode of hair loss ≤10 years• This analysis includes patients who received ritlecitinib 50 mg once daily (QD) without a loading dose inALLEGRO-2b/3 and who subsequently rolled over into ALLEGRO-LT where they continued to receiveritlecitinib 50 mg QD (Figure 1)- Continuation criteria for adolescents (aged 12-17 years) in ALLEGRO-LT: ≥50% improvement from baseline in SALT scoreby Month 3 for rollover patients from ALLEGRO-2b/3 and SALT score ≤20 by Month 6 in ALLEGRO-LTFigure 1. Study design and patient populationCombinedritlecitinib50 mg group(N=191)ALLEGRO phase 2b/3 ALLEGRO-LTLoading(4 weeks)Maintenance(20 weeks)Extension(24 weeks)Long-term study(60 months)Group A (n=131) 200 mg 50 mg 50 mg 50 mgGroup B (n=129) 200 mg 30 mg 30 mg 50 mgGroup C (n=130) 50 mg 50 mg 50 mg 50 mgGroup D (n=132) 30 mg 30 mg 30 mg 50 mgGroup E (n=61) 10 mg 10 mg 10 mg 50 mgGroup F (n=63) Placebo Placebo 200 mg 50 mg 50 mgGroup G* (n=61) Placebo Placebo 50 mg 50 mgDe novo group (n=447) 200 mg 50 mg*Data while on placebo were not included in this analysis; data from patients in Groub G were rebaselined from the start of treatment with ritlecitinib.Assessments and statistical analysis• The distribution of patients according to SALT score (as observed) was assessed through Month 24 forthe overall population and subgroups based on age (adults [≥18 years] vs adolescents [12-17 years]) anddisease severity (patients with AT/AU vs those without AT/AU)• The data cutoff date was December 9, 2022 Results: The analysis included 191 patients (27 adolescents and 164 adults) (Table 1)• At the time of data cutoff, 71 patients had discontinued; withdrawal bypatient (n=19), adverse events (n=18), and lack of efficacy (n=14) were themost common reasons for discontinuation• The distribution of participants by SALT score (as observed) at baseline, Month12, and Month 24 are presented for the overall population (Figure 2)(Interactive dynamic plot)• Per the inclusion criteria, all participants had a SALT score of ≥50 at baseline;136/191 patients (71.2%) had SALT >90• Among patients who had a nonmissing SALT score, 56/178 (31.5%), 37/164(22.6%), and 17/120 (14.2%) were in the SALT >90-100 category at Months 6,12, and 24, respectively• Reductions in the number of patients in the other SALT >50 categories wereobserved from baseline through Month 24• At Month 12, 56/164 (34.2%) and 18/164 (11.0%) patients were in the SALT0-10 and >10-20 categories, respectively, with 61/120 (50.8%) and 12/120(10.0%) patients in these categories at Month 24• Among the patients with AT/AU at baseline, 18/69 (26.1%) and 6/69 (8.7%)were in the SALT 0-10 and >10-20 categories, respectively, at Month 12; 25/47(53.2%) and 3/47 (6.4%) were in these categories, respectively, at Month 24(Figure 3) (Interactive dynamic plot)• For the adolescent participants, 10/22 (45.5%) and 4/22 (18.2%) were in theSALT 0-10 and >10-20 categories, respectively, at Month 12, and 11/14(78.6%) and 0/14 (0%) were in these categories at Month 24 (Figure 4) Conclusions:• Over 24 months, daily treatment with ritlecitinib 50 mg resulted in fewer patients inthe highest SALT score categories• These data provide a comprehensive overview of patient response to ritlecitinibtreatment and enable us to understand treatment response and time frames whileon treatment with ritlecitinib • This information can empower clinicians when counseling patients and managingtreatment expectations based on patient characteristics• This study also shows that response to treatment improves over time, whichsuggests that adequate time should be given when assessing treatment efficacy

Characterizing Lipid Changes and Use of Lipid-Lowering Medications in Patients With Alopecia Areata Treated With Baricitinib: Integrated Results From the BRAVE-AA1 and -AA2 Clinical Trials

Introduction. Elevations in total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) can occur with baricitinib treatment, consistent with a class effect of JAK inhibitors. In this analysis, we characterized changes in lipid levels and use of lipid-lowering medication among patients with severe alopecia areata (AA) treated with baricitinib through 152-weeks of treatment. Methods. Two integrated datasets from the BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) trials were analyzed: 1. Extended BARI AA includes patients treated with continuous baricitinib 2 mg (N=383) and 4 mg (N=565) from baseline and censored at dose change: 2. ALL BARI AA (N=1303) includes data for patients who received ≥1 dose of baricitinib at any time. Outcomes included abnormal changes in lipid parameters, mean change from baseline in lipids, and concomitant use of lipid-lowering medications. Results. At time of enrollment, 43% of patients had hypercholesterolemia. Incidence rates for categorical increases in total cholesterol (TC; ≥240mg/dL), LDL-C (≥130 mg/dL), and HDL-C (>60 mg/dL) were 11.8, 13.3, and 12.9 per 100 patients-years of exposure, respectively in the ALL BARI AA dataset. In the Extended BARI AA the mean maximal increase in lipids (mg/dL) for baricitinib 4 mg was 20.9 for TC, 12.4 for LDL-C, and 8.5 for HDL-C. Changes occurred early and stabilized by one year for TC and LDL-C and by 12 weeks for HDL-C. 6.1% (n=79) of patients in the ALL BARI AA dataset used lipid-lowering medication at baseline; post-baseline, 3.9% (n=51) discontinued this medication and 4.7% (n=61) initiated lipid lowering medication. No patients discontinued baricitinib treatment due to treatment-emergent adverse events related to hyperlipidemia. Conclusions. Elevations in TC, LDL-C, and HDL-C, but not triglycerides were associated with baricitinib treatment in patients with AA, consistent with a class effect of JAK inhibitors. The relatively low use of lipid-lowering medications at baseline despite the prevalence of hypercholesterolemia may reflect undermanagement of this condition in the population. Notably, the mean maximal magnitude of increase in lipid levels on baricitinib was modest. Initiation of lipid-lowering medication was infrequent, and no patients discontinued due to lipid abnormalities.

Targeted 308-nm Excimer Laser A Safe and Effective Solution for Inflammatory Skin Disorders

Background: The 308-nanometer excimer laser is a targeted ultraviolet B (UVB) light therapy that delivers high-intensity UVB rays directly to affected skin. It has shown considerable efficacy in managing various inflammatory skin conditions, including Psoriasis, Vitiligo, Atopic dermatitis (Eczema), Leukoderma, Alopecia Areata, Chronic recalcitrant dermatitis, Lichen planus, Cutaneous T-cell Lymphoma (e.g. Mycosis fungoides/ Sezary Syndrome), Parapsoriasis, Pityriasis lichenoides chronica, Pruritus, Urticaria pigmentosa, Superficial mycoses (e.g., dermatophytosis [ringworm]. The patient demographic of some of these conditions (e.g. Vitiligo) tends to skew towards patients with darker skin tones. Results: The excimer laser is particularly effective for treating resistant areas, such as the scalp, palmoplantar psoriasis, and hand and foot dermatitis, which often do not respond well to conventional therapies. It has also demonstrated notable success in promoting repigmentation in facial vitiligo, especially in patients with Fitzpatrick skin types IV–VI. Treatment results are typically observed quickly after 5-10 sessions, with sustained improvement and psoriasis clearance evident even at 1-year follow-up. Over the years, access to the Excimer laser procedures has expanded with the availability of these procedures in many private clinics as well as academic facilities. That has increased the availability of the treatment modality and patient choice of therapy. Conclusions: The excimer laser provides a safe, non-invasive treatment option with a strong record of efficacy for multiple inflammatory skin conditions. It is a viable alternative to systemic therapies and can be used either alone or in conjunction with other treatments for optimal patient outcomes.

Worldwide Clinical and Real-World Exposure to Baricitinib

Introduction: Baricitinib (BARI), an oral selective JAK inhibitor, is approved in many geographies for adults with rheumatoid arthritis or alopecia areata and for patients as young as age 2 years with atopic dermatitis or juvenile idiopathic arthritis. It is also approved in the US for hospitalized patients with COVID-19 infection. We report the worldwide clinical trial and real-world exposure to BARI across a range of diseases, ages and racial backgrounds. Methods: Real-world patient exposure estimates were calculated based on total mg sold, average daily dose, and average length of therapy as reported to regulatory agencies through the cumulative timeframe ending Jan. 31, 2024. Clinical trial exposures were based on actual exposures from completed trials through Feb. 13, 2024, and estimates were made for ongoing blinded trials based on the enrolment/randomization schemes Results: In the real-world setting, an estimated 1,836,600 patients have been exposed to the following BARI doses: 1 mg, ~2,000 (0.1%); 2 mg, ~524,900 (28.6%); 4 mg, ~1,309,600 (71.3%). Of these estimated exposures, ~ 57% were for COVID-19 with the remaining for all other indications combined. Across 59 clinical trials (completed and ongoing), an estimated 14,660 subjects (548 healthy volunteers and 14,112 patients) have received BARI since June 2008. Exposures from completed studies include 10,276 patients (62% female), 399 of whom were <18 yrs of age (≤1 month, N=4; 1 month - ≤2 yrs, N=24; >2 - ≤12 yrs, N=111; >12 - ≤18 yrs, N=260), 8820 were >18 to ≤65 yrs, 1027 were >65 yrs, and 30 had age unknown. An additional 467 adolescent and pediatric patients down to the age of 2 have been treated with BARI for atopic dermatitis in an ongoing clinical trial, bringing the total number of patients <18 years of age to 866 across dermatologic, rheumatologic, other autoimmunologic, and acute infectious diseases (excluding alopecia areata for which there is an ongoing pediatric trial). Clinical trial exposures by racial and ethnic background are as follows: Asian, N=2,491; Black, N=450; Caucasian, N=6,237; other, N=496; multiple, N=135; unknown, N=467. Conclusion: There has been extensive real-world exposure to BARI across indications and populations, and BARI is a well-studied molecule in clinical trials, across varied disease states, racial populations and ages. Since average daily dose and length of therapy may vary over time, real-world exposures are only an estimate of total patients receiving BARI. Exposures in clinical trials include patients as young as less than 1 month of age up to patients over the age of 65 years. While these exposures do not indicate efficacy or safety, they provide data to establish the overall profile of the drug and can inform on its performance over time across a variety of populations.

Vitiligo Cases in the Out-Patient Department in a Tertiary Care Hospital

Background: The prevalence of vitiligo has been reported to range from 0.1% to 8% worldwide. It has a low mortality rate but a high morbidity cost because of its psychological and social effects. Type-1 diabetes mellitus, autoimmune thyroid disease and other autoimmune illnesses have been linked to this condition. This study was performed to assess the occurence of vitiligo among males and females and the epidemiological status of vitiligo in a tertiary Hospital of Dhaka, Bangladesh. Materials and methods: A cross-sectional survey was conducted among 3,212 adults (1,429 males and 1,783 females) in a community of Dhaka between October 2022 and May 2023 at OPD of Delta Medical College. Face-to face interviews were conducted at the OPD of Delta Medical College for each participant and all respondents had their skin examined by dermatologists. The risks of comorbidities associated with vitiligo were evaluated. Results: In this particular research project, most vitiligo patients were between the ages of 13 and 60 years. According to this research, the average age of vitiligo patients was 35.5 years. Here, the proportion rate for this is 2.74%. The ratio of male participants to female participants in this research was M:F = 1:1.51. Only 88 out of the 24 cases were stable, whereas around 64 were unstable. The focused kind of vitiligo was shown to be the most prevalent form of the condition in this particular research. Conclusion: Vitiligo was most common among individuals in Dhaka in their middle 30s and the incidence of the condition rise with age. In adult patients, vitiligo was connected with higher risks of alopecia areata, hypothyroidism, diabetes mellitus and atopic dermatitis. IAHS Medical Journal Vol 7(1), June 2024; 17-21

Platelet-rich plasma and topical minoxidil 5% in the treatment of severe alopecia areata: Report of two cases

Alopecia areata (AA) is an autoimmune non-scarring hair loss that can affect any hair-baring body area. Corticosteroids are considered first-line treatment, but their long-term use may lead to undesirable side effects. Platelet-rich plasma (PRP) is an autologous product, which includes concentrated platelets that secrete growth factors stimulating hair follicle proliferation. Topical minoxidil has been used for mild cases of AA and other types of alopecia. We report two cases of severe multifocal AA, treated successfully with the combination of topical minoxidil 5% and intralesional PRP. PRP was injected once monthly for a total of six visits. Patients were advised to use 5% topical minoxidil twice daily. Trichoscopy was performed and evaluation of the severity of hair loss was done with Severity of Alopecia Tool (SALT). One month after the final PRP procedure, patients showed significant hair regrowth. Further controlled trials with more subjects are needed to validate the reported results.

Laboratory and clinical haemostatic aberrations in primary dermatologic disease: A review.

Inflammatory dermatologic diseases have long been viewed as a "skin limited" disease process. Current literature on inflammatory dermatologic diseases investigates their relationship and influence on thromboembolic states and thromboembolic complications and the understanding of their pathophysiology and molecular mechanisms.Studies specifically discuss known inflammatory skin diseases including alopecia areata, vitiligo, psoriasis, hidradenitis suppurativa, atopic dermatitis, chronic spontaneous urticaria, and autoimmune bullous diseases, and their effects on systemic inflammation, associated cardiovascular comorbidities, and thromboembolic or hypercoagulable states. The limited current literature shows potential for links between inflammatory skin diseases and hypercoagulable states. Biomarkers such as F1 + 2, D-dimer, eosinophilic cationic protein, and PAI-1 are currently being studied to outline the mechanisms connecting inflammatory skin disease to the coagulation system. Further study and larger amounts of data are needed to draw definitive conclusions, especially when interpreting biomarkers alone such as PAI-1.The mechanisms, rates of systemic inflammation, and clinical outcomes of traditionally "skin limited" inflammatory diseases remain chronically understudied in dermatology. Many organ systems have well established connections between inflammatory disease and hypercoagulable states, but there are significant gaps in the literature regarding skin diseases. There is a significant need for comprehensive investigation of molecular mechanisms behind inflammatory dermatologic disease and hypercoagulability, how hypercoagulability effects clinical outcomes, and proper intervention to optimize patient outcomes.

Celiac risk doubles in patients with alopecia areata: a nationwide case -control study.

Both alopecia areata (AA) and celiac disease are common immune-mediated diseases. Despite accumulating evidence of bi-directional associations between the two disorders, data remains unclear and inconsistent. In this study we explored the association between alopecia areata and celiac disease in a large representative population cohort. Patients with alopecia areata diagnosed during 2005-2019 were compared with age and gender matched healthy controls for celiac autoimmunity. A total of 33,401 patients with alopecia areata and 66,802 controls were included in the analysis. Overall, 754 patients (0.85) had celiac disease. Compared to controls, celiac prevalence increased twofold among AA patients (1.1% Vs 0.6%, Odds ratio (OR) 1.95, 95% Confidence Interval (CI) 1.69-2.25). Higher prevalence rates were observed among all age groups, with the highest risk in AA patients older than 40 years and older. Alopecia areata may be associated with a significant increased risk for celiac disease, suggesting early diagnostic and preventive measures.

The Importance of Readability: A Guide to Understanding Alopecia Areata through Multilingual Online Resources.

Online resources play a vital role in patient education, yet the readability of alopecia areata-related materials remained understudied. A thorough analysis of online alopecia areata-related materials across 5 languages was conducted using Google search. Search terms "alopecia areata" and "alopecia areata treatment" were translated and queried, generating search result lists. The first 50 articles from each list were evaluated for suitability. The materials were categorized into 2 main groups: those focusing on alopecia areata itself and those addressing its treatment. Treatment materials were further divided into subgroups, including Janus kinase inhibitors and other treatment options. Readability was evaluated using the Lix score. The analysis included 251 articles in English, German, French, Italian, and Spanish. The overall mean Lix score was 52 ± 8, which classified them as very hard to comprehend. Articles on alopecia areata treatment had a mean Lix score of 55 ± 8, which was significantly higher (p < 0.001) than those on alopecia areata itself, 50 ± 8. alopecia areata-treatment articles dedicated to JAK inhibitors had an average Lix score of 57 ± 10 and it was significantly higher (p = 0.043) than those on other treatment, 53 ± 6. Online resources on alopecia areata and its treatments remained challenging to comprehend, particularly regarding JAK inhibitors. Improving clarity in patient education materials is crucial for informed decision-making and therapeutic relationships.

Patient considerations when using ritlecitinib for alopecia areata in adolescents: Guidance for the clinicians

Background: Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss that can affect children, adolescents, and adults. Ritlecitinib, an orally administered Janus kinase (JAK) 3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) kinase family inhibitor, is the first and currently the only treatment approved by the United States Food and Drug Administration for adolescents (aged 12-17 years) with severe AA. Summary: The ALLEGRO Phase 2b–3 trial demonstrated that 25% and 50% of adolescents with a Severity of Alopecia Tool (SALT) score ≥50 at baseline achieved a SALT score ≤20 at week 24 and week 48 after receiving 50mg ritlecitinib daily, respectively. The most common adverse events were headache, acne, and nasopharyngitis in adolescents. This review summarizes the mechanism of action, clinical trial evidence on efficacy and safety profile, factors associated with treatment response to JAK inhibitors for AA, and vaccination considerations for adolescents. Key Messages: This review aims to facilitate the risk-benefit assessment and shared decision-making between clinicians and patients and provide clinical considerations and management recommendations for ritlecitinib use in adolescents with AA.

Impact of Chronic Moderate Psychological Stress on Skin Aging: Exploratory Clinical Study and Cellular Functioning.

Skin is continuously exposed to environmental external and internal factors, including psychological stress (PS). PS has been reported to trigger different dermatoses such as psoriasis, atopic dermatitis, vitiligo, alopecia areata, and acne through the release of cortisol and epinephrine. To clinically explore PS-induced measurable skin aging signs in subjects with moderate versus mild chronic PS, and to investigate the effect of chronic PS on DNA damage at cellular level. In vitro stress tests with cortisol and epinephrine, and with cortisol only on extracellular matrix (ECM) synthesis, as well as on normal human skin fibroblast and keratinocyte functioning, including skin barrier and wound healing were performed. Moderately stressed subjects in the context of the clinical study had a significantly decreased antioxidant potential and impacted skin barrier integrity, as well as significantly increased signs of microrelief alterations (skin texture and fine lines) reaching an increased severity of about 32.9%. At a cellular level, DNA integrity, ECM synthesis, wound healing, and skin barrier parameters were impacted by increased stress hormone levels. The clinical exploratory studies presented herewith, as well as the study of cell functioning under stress, have provided evidence that chronic PS significantly affects skin homeostasis and triggers skin aging.

Mechanisms of autophagy and their implications in dermatological disorders

Autophagy is a highly conserved cellular self-digestive process that underlies the maintenance of cellular homeostasis. Autophagy is classified into three types: macrophage, chaperone-mediated autophagy (CMA) and microphagy, which maintain cellular homeostasis through different mechanisms. Altered autophagy regulation affects the progression of various skin diseases, including psoriasis (PA), systemic lupus erythematosus (SLE), vitiligo, atopic dermatitis (AD), alopecia areata (AA) and systemic sclerosis (SSc). In this review, we review the existing literature focusing on three mechanisms of autophagy, namely macrophage, chaperone-mediated autophagy and microphagy, as well as the roles of autophagy in the above six dermatological disorders in order to aid in further studies in the future.

Complete responses and SALT zero scores in alopecia areata: not the same

Complete responses and SALT zero scores in alopecia areata: not the same

Budget impact analysis of baricitinib for treatment of alopecia areata: A Saudi hospital perspective

ObjectivesTo perform a budget impact analysis (BIA) of the adoption of baricitinib for the management of alopecia areata (AA) by a Saudi public sector payer. MethodsA BIA model was developed to calculate the expected financial impact under two scenarios: the baseline scenario, which reflects the current mix of treatments without baricitinib, and the projected scenario, in which baricitinib is adopted. The model assumed that patients with severe AA and those with mild-to-moderate AA who did not respond to other treatments were eligible for baricitinib treatment. The model input was based on published evidence, expert opinions, and the Saudi Expert Consensus Statement on the Diagnosis and Management of AA. ResultsAssuming a hypothetical total eligible population of 368 patients received different AA treatments over the 12-months study period. The aggregated 5-years cost in the baseline scenario was SR 5836616. Upon the introduction of baricitinib as an alternative treatment for severe AA, the projected aggregated budget impact was SR 7569120. Sensitivity analysis showed that the results were most sensitive to AA prevalence, percentage of severe AA, and predicted market share for baricitinib over the 5-year time horizon. ConclusionThe addition of baricitinib to formularies is likely to increase the cost impact from a government hospital perspective. However, this addition expands the treatment options for patients with AA and may result in improved outcomes. Future cost-effectiveness analyses are recommended to estimate the cost per incremental improvement in the outcomes.

Efficacy and Safety of Laser Therapy and Phototherapy in Cicatricial and NonCicatricial Alopecia: A Systematic Review Study.

In recent years, the application of various light and laser devices in the treatment of different types of alopecia has been established. This systematic review aims to assess the efficacy and safety of laser therapy and phototherapy in cicatricial and non-cicatricial alopecia. A comprehensive search was conducted on PubMed, Scopus, Science Direct, and Google Scholar. Articles were evaluated across four subgroups: alopecia areata, androgenic alopecia, telogen effluvium, and cicatricial alopecia. Included studies were published in English or Persian between January 2010 and September 2023, focusing on interventional, cohort, or case series research that achieved a minimum score of 75% on the EBL checklist. Exclusion criteria encompassed animal and in vitro studies, review articles, case reports, duplicated or irrelevant research, as well as studies that did not meet the designated EBL score. Editorial letters and case studies were also excluded. Initially, 965 records were collected, resulting in the inclusion of 58 studies in the final review: 26 on alopecia areata, 26 on androgenic alopecia, five on cicatricial alopecia, and one on telogen effluvium. Narrow-band ultraviolet B, 308-nm excimer laser, and psoralen ultraviolet A therapy showed varying effectiveness; specifically, the excimer laser was notably effective for patients with shorter disease duration. In androgenic alopecia, erbium-glass and thulium lasers effectively increased hair density but showed a gradual decline posttreatment. Low-level light/laser therapy also increased hair density and diameter and exhibited potential benefits when used alongside minoxidil, but did not significantly enhance outcomes in telogen effluvium treatment. Light/laser therapy can serve as an additive treatment for cicatricial alopecia, particularly lichen planopilaris, but has limited efficacy in treating telogen effluvium. Overall, light/laser therapies exhibit a significant positive effect on increasing hair density and diameter across various alopecia types.

Alopecia Areata Following the Use of Belimumab in a Patient with Systemic Lupus Erythematosus and Arthritis Who Responded Well to Baricitinib: A Case Report

Alopecia Areata Following the Use of Belimumab in a Patient with Systemic Lupus Erythematosus and Arthritis Who Responded Well to Baricitinib: A Case Report