Areas Of Alopecia Research Articles

Efficacy of Methotrexate Microinfusion in Scalp Lesions of Patients with Frontal Fibrosing Alopecia: A Prospective Controlled Trial

Introduction: Topical and systemic drugs, as methotrexate (MTX), do not control the frontal fibrosing alopecia (FFA) activity in most of the cases showing the need for new therapies. Therefore, we aimed to evaluate the effectiveness of MTX microinfusion in FFA. Methods: Prospective, controlled clinical trial, carried out with 17 volunteers with clinical and histological diagnosis of FFA. Applications of MTX by MMP® (microinfusion of drugs into the skin method) were made every 30 days, in a total of 03 applications, in the right half of the alopecia area; the other half served as a control. Results: There was a significant reduction in frontal-glabella and frontal temporoparietal measurements at treated site while in the untreated site the FFA increased. Patient’s referred improvement of pruritus and desquamation but not in hair loss and local erythema. Analysis of the dermoscopic photos and the LPPAI calculation did not show relevant changes. About 95% of the participants were satisfied or very satisfied with the results and none of them had alteration in the laboratory test results. Conclusion: The MTX application by MMP® improved symptoms associated with FFA, and the frontal-glabella and frontal temporoparietal measurements. This technique proved to be safe and well tolerated.

Chrysosporium articulatum mimicking Trichophyton spp. infection in a cat: a case presentation and literature review

BackgroundDermatophytosis is a common skin infection of cats and many other animals. A reliable diagnosis is crucial because of the zoonotic potential of dermatophytes. The routine mycological diagnostic procedures for dermatophytosis are widely known, but in the case of some isolates, identification based on phenotypic characteristics may be incorrect. Infections caused by Chrysosporium spp. are usually described in reptiles, but in other animals they are uncommon.Case presentationThis study presents a description of a cat with dermatological lesions, that was mistakenly diagnosed with Trichophyton spp. dermatophytosis. Clinical material for mycological examination was collected from alopecic areas on the back of the neck, the ventral abdomen, and the hindlimbs. The initial identification based on phenotypic properties indicated Trichophyton spp. The result of the MALDI-ToF MS allowed the exclusion of the Trichophyton genus. Ultimately, the correct identification as Chrysosporium articulatum was obtained based on the sequencing of ribosomal genes.ConclusionsInterpretation of the results of the mycological examination of samples collected from animals’ skin or hair shafts is always challenging. Thus, careful consideration of the primary cause of the clinical lesions observed on the skin is mandatory, and the culture results are worth supporting by molecular methods.

Question Mark Reconstruction Method for Synchronous Multiple Tumor Defects in the Scalp.

Synchronous tumors on the scalp are a common condition, and reconstruction methods of their defects should be considered together. The authors believe that the rotation flap combined with the Burow triangle, whose final scar looks like a question mark, can provide excellent results for suitable multiple tumor defects. From September 2022 to June 2023, the question mark reconstruction method was performed on 8 patients. The mean age of the patients was 74.1 years (range, 69-80y). All tumors were removed with sufficient negative margins. Hair-bearing skin was preserved in all patients, with only a narrow and acceptable scarred alopecic area. The question mark reconstruction method can provide excellent results for synchronous scalp defects by minimizing dog-ear deformity and unnecessary tissue excision and providing a "like-with-like" reconstruction.

A Look Inside-Histopathological Examinations of Different Tail Tip Lesions in Dairy Cows.

Feedlot cattle are frequently affected by inflammation and necrosis of the tail tips, resulting in impeded animal welfare and economic losses. In a recent study, it was demonstrated that dairy cows are also affected by different lesions of the tail tip, including alopecia, annular constrictions, crusting, scaling and swelling. Despite the frequent occurrence of these lesions, the underlying etiology and pathomechanisms are unclear to date. To gain insight into this malady, we histopathologically examined 16 tail tips of slaughtered dairy cows, representing the entire range of different lesions. While macroscopically alopecic areas were characterized by the formation of granulation tissue in the dermis with an inconspicuous epidermis, we found not only dermal granulation tissue but also purulent-necrotizing inflammation with the breakdown of the basement membrane in encrusted lesions. Interestingly, in some cases, we found areas of coagulation necrosis of the epidermal and dermal layers in the crusts. Tails with macroscopical scaling were affected by ortho- and/or parakeratotic hyperkeratosis, and, in tails with macroscopical swelling, we observed a low-protein edema of the central longitudinal connective tissue of the tail. We conclude that the observed lesions might be caused by ischemia of the skin in the distal parts of the tail.

Beyond Hair Loss: Exploring the Evolution of Androgenetic Alopecia Research based on text mining and Bibliometrics

In this study, word dynamics, co-occurring phrases, and keyword frequency in the area of androgenetic alopecia were thoroughly analysed during a ten-year period. The study tracks changes in word usage, frequency, and context and identifies variations in the distribution and usage patterns of keywords, subjects, and co-occurring phrases using natural language processing techniques and graph theory-based approaches. The research reveals hidden linkages and patterns between diverse ideas, shedding light on the co-occurrence patterns of numerous phrases in the literature on androgenetic alopecia. The study emphasises the value of clearly visualising and disseminating findings to a large audience. In order to communicate the findings of the 10-year trend analysis to patrons, legislatures, and other pertinent audiences, data visualisation tools, infographics, and reports are used. This makes sure that the results are useful, effective, and easily accessible so that they can guide the creation of policies and decisions pertaining to androgenetic alopecia. The results of this study may have substantial ramifications for academics, medical professionals, policymakers, and other industry participants. The research can lead future research paths, prioritise research areas, and suggest areas that require additional examination by highlighting key research challenges and pointing out gaps in the study of androgenetic alopecia. Identifying emergent study issues, analysing the changing patterns in the area, and establishing research strategies can all benefit from an analysis of word dynamics and correlations among terms. The results reveal hidden relationships and patterns, advance knowledge of the research environment in this area, and influence androgenetic alopecia research objectives and policies.

Prevalence and clinico-pathology of PSOROPTIC mange in buffaloes of the Amazon region

Scabies is an important skin disease in several species of domestic and wild animals; however, few reports in Brazil have emphasized its occurrence in buffaloes. This article describes the epidemiological, clinical and pathological aspects and diagnosis of psoroptic mange in buffaloes in a property in the municipality of Castanhal, PA, Amazon region. Of the 41 buffaloes examined, 38 males and females of the Murrah, Baio, Mediterranean and Carabao breeds and their crossbreeds, aged between 2 and 20 years, had a history of pruritus. Clinical examination was performed to map the lesions, skin scrapings were collected to identify the mites, and a biopsy was performed for histopathological examination. Clinical signs, from mild to severe intensity, varied according to the system of creation and handling of the animals and were more severe in buffaloes raised in bays than those raised under a collective regime (pastures and collective troughs). The characteristic clinical signs were intense itching, extensive areas of alopecia, periocular edema, and thickening of the epidermis with exudative crusts covering the face, chamfer, neck, scapular region, back, base of the horn, thoracic and pelvic limbs and chest. The behavior of rubbing the affected regions of the body against structures (troughs, fence posts, gates) or with the horns was frequently observed and provided relief from itching. In the most severe cases, mites were also noted in the crusts, which were identified as Psoroptes natalensis. Histological skin lesions exhibited alterations consistent with immune-mediated dermatitis, which is typical of hypersensitivity to mite-derived allergens.

Allergic Dermatitis in Pêga Breed Donkeys (Equus asinus) Caused by Culicoides Bites in the Amazon Biome, Pará, Brazil.

An allergy to bites from Culicoides (Diptera: Ceratopogonidae) occurs because of a hypersensitivity reaction caused by the inoculation of insect salivary antigens during the bite, resulting in immune-mediated dermatitis. To the best of our knowledge, no previous studies have focused on allergic dermatitis in donkeys in Brazil. Therefore, this study aimed to describe the epidemiological, clinicopathological, and therapeutic aspects of allergic dermatitis in donkeys and to identify the insects involved in its epidemiology. This study reported the occurrence of dermatitis in 17 animals. The clinical signs were restlessness and severe itching. Skin lesions were found on the head, depigmented areas of the muzzle and cheeks, flanks, pelvic and thoracic limbs, and the scrotal sac. The lesions were characterized by areas of alopecia with crusts accompanied by serosanguineous exudates. Histologically, the lesions were characterized as moderate superficial dermatitis with irregular epidermal acanthosis and pronounced diffuse orthokeratotic hyperkeratosis. In total, 378 Culicoides specimens were collected, with Culicoides ocumarensis Ortiz being the most abundant species. The combined application of copaiba oil and a multivitamin emulsion exhibited potential for topical treatment of allergic dermatitis caused by insect bites in donkeys. Our study revealed an association between allergic dermatitis in donkeys and Culicoides.

Necrosulfonamide promotes hair growth and ameliorates DHT-induced hair growth inhibition

BackgroundAlopecia affects patients' appearance and psychology. Mixed-lineage kinase domain-like pseudokinase (MLKL)-mediated necroptosis plays a role in various skin diseases, but its effect on hair growth is unclear. ObjectiveTo investigate the effects of MLKL on hair growth and its regulatory mechanisms and to determine the potential clinical value of Necrosulfonamide (NSA, a MLKL-targeting inhibitor) in promoting hair growth and counteracting dihydrotestosterone (DHT) inhibition of hair growth. MethodsThe expression level of MLKL was detected in the scalp of androgenetic alopecia (AGA) patients and the skin tissues of mice. Knock down MLKL expression or use NSA to observe hair growth in vivo and in vitro. ResultsIn AGA patients, MLKL expression is elevated in the alopecia areas. In mice, MLKL is significantly expressed in the outer root sheath (ORS) cells of hair follicles, peaking during the catagen phase. Knockdown expression of MLKL in mice skin promoted hair growth. NSA enhanced hair growth and prevented hair follicle regression via the Wnt signaling. Reduced MLKL boosts ORS cell proliferation without directly impacting DPCs' growth. Interestingly, NSA boosts DPCs' proliferation and induction when co-cultured with ORS cells. Besides, NSA alleviated the inhibition of DHT on hair growth in vivo and vitro. ConclusionNSA inhibited the activation of MLKL in ORS cells, promoted the activation of Wnt signal in DPC cells, and improved the inhibition of hair growth by DHT, illuminating a new alopecia mechanism and aiding anti-alopecia drug development.

Adaptability of bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection

BackgroundSeveral reconstructive techniques have been used to reconstruct scalp defects. Numerous researchers have studied the utilization of bipedicled scalp advancement flaps for scalp defect coverage. In this study, we will assess the adaptability of a bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection. MethodsThis study was performed at the Plastic Surgery Department, Fayoum University Hospital, on 20 patients with huge scalp tumors treated by adequate excision and reconstructed using a bipedicled scalp advancement flap from December 2021 to July 2023. ResultsThe study was conducted on 20 patients: 16 (80%) were men and 4 (20%) were women presenting with large scalp tumors. The mean age was 57.4 years (33–68 years). The sites of the tumors were 10 (50%) occipital, 6 (30%) parietal, and 4 (20%) parieto-occipital. No major complications occurred postoperatively, and the bipedicled flaps survived well in all cases, with no necrosis. ConclusionHuge scalp defects after tumor resection can be safely reconstructed with a large versatile bipedicled advancement scalp flap, either transversely or longitudinally oriented, with favorable functional results and accepted aesthetic results, apart from the alopecic area over the grafted donor site, which can be treated by tissue expansion if desired later.

Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita.

Aplasia cutis congenita (ACC) is a heterogeneous group of congenital disorders characterized by the absence of epidermis, dermis, appendages, subcutaneous tissue, and bone. The aim of the study is to describe a clinical report of ACC of the scalp treated with skin expanders. In October 2019, a 16-year-old female patient underwent scalp expansion with 2 rectangular devices (150 and 250cm3; Radovan Mentor-Johnson&Johnson). The inflation started 30 days after surgery and continued once every 7 to 10 days to gain 10% of overexpansion. After 3 months, the patient underwent the second surgical step with the expanded scalp transposed to close the defect. Clinical examination 6 months after surgery revealed an acceptable cosmetic result with a hidden surgical scar and hair growth in the previous area of frontoparietal alopecia. Skin expander for the reconstruction of extensive ACC defects of the scalp is a valid procedure.

Tinea capitis due to Trichophyton soudanense and Microsporum audouinii: A surprising finding

AbstractTinea capitis is a prevalent dermatophyte infection among German children, primarily caused by Microsporum canis, Trichophyton mentagrophytes and Trichophyton benhamiae. Other pathogens, such as T. soudanense and M. audouinii, have also been identified in Germany. This case report describes a 10‐year‐old Angolan girl with chronic osteomyelitis who was brought to Germany for treatment, which was organized by the Friedensdorf International (Peacevillage International). In addition to chronic osteomyelitis of the lower leg, the patient presented with alopecic areas of the scalp with adherent scales, which raised the suspicion of tinea capitis. Fungal cultivation and polymerase chain reaction (PCR) diagnostics revealed a coinfection of T. soudanense and M. audouinii, which, to the best of our knowledge, has not been previously reported in Europe. After 4 weeks of systemic terbinafine treatment and topical use of ciclopirox solution and clotrimazole cream, there was a marked improvement in the patient's condition. This was confirmed by a negative fungal culture and PCR; no adverse events were reported. This report highlights a rare dual dermatophyte infection caused by T. soudanense and M. audouinii in Europe, and the successful response to treatment with systemic terbinafine and topical ciclopirox solution as well as clotrimazole cream.

"Decoding a Decade: The Daring Dance of Over inflation in Tissue Expanders – Unveiling Our Unique Journey."

Background: Reconstruction of large scalp defect like post burn alopecia, post traumatic alopecia and congenital naevi require not only well-vascularized skin but also hair bearing scalp for better aesthetic outcome. Tissue expansion has always been the valuable reconstructive option in scalp reconstruction and is superior to any other option as it provides hair-bearing scalp. We have changed the traditional way of tissue expansion by using over expansion to two to three times of its recommended expansion to prevent multiple expansions. Methodology: This prospective case series was conducted from January 2013 - December 2022. Patients requiring scalp expansion for reconstruction of post burn alopecia , congenital melanotic naevi and post traumatic alopecia were included in this study. Flap advancement for covering the percentage area of the scalp defect was assessed as the outcome. Results: 13 patients were included, 6 (46%) patients required 2 expanders and 7(54%) patients required single tissue expander. Average flap advancement was 9 cm. Average tissue expansion was 650 ml, over expanded twice to thrice the recommended volume. No patient had any expander complication, wound breakdown or flap necrosis. Hair density was adequate on visual analogue scale. Conclusion: two to three times over expansion in tissue expander is valuable and safe tool for covering large area of alopecia without the need of expansion multiple times. Keywords: Tissue expansion, scalp alopecia, post burn scalp defects, congenital melanotic nevus scalp

Effectiveness and safety of baricitinib in patients with moderate-to-severe refractory alopecia areata in real world: Anopen-label, single-center study.

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. 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. 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. 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.

The efficacy of antiparasitic drug in the form of spray based on Flumethrin, Moxidectin and Pyriproxyfen against canine acarosis

The purpose of the research is to study the efficacy of the drug in the form of spray based on Fipronil, Moxidectin and Pyriproxyfen against canine acarosis.Materials and methods. The assessment of the acaricidal effect of multicomponent drug against canine acarosis was carried out on the basis of the All-Russian Scientific Research Institute of Infectious Diseases (VNIIP), a branch of the Federal State Budgetary Institution FSC VIEV RAS, as well as the veterinary clinic GLOBALVET CLINIC LLC (Moscow) in 2020–2022. 82 dogs were used in the experiments, including those spontaneously infected with Otodectes cynotis (38 sp.), Sarcoptes canis (28 sp.), and Demodex canis (16 sp.). The animals were divided into experimental and control groups. To the infected animals of the experimental groups, the drug was applied in the form of spray to the affected areas of the body at the rate of 1 ml per 10 cm2, 2–4 times with an interval of 7 days. The dogs in the control group were treated at the end of the experiment. The efficacy of the drug was taken into account by examining and recording the number of ticks in animals before and 3, 11, 25, 40 and 60 days after treatment. The results were processed statistically using Microsoft Excel.Results and discussion. On the 11th day, all animals showed extinction of clinical signs, healing of affected skin areas and scratches, and the appearance of new hair in areas of alopecia; microscopy of scrapings revealed single mites, deformed larvae and eggs. Microscopy of skin scrapings on the 25th day revealed single mites in 5 dogs affected by demodicosis. On the 40th day, upon examination and acarological examination of animal skin scrapings, no S. canis, O. cynotis and D. canis mites were found. The research results showed 100% efficacy of the drug.

VASCULAR COMPLICATION AFTER LATERAL TEMPORAL LIFTING TECHNIQUE: A CASE REPORT

Vascular complication after lateral temporal lifting technique with hyaluronic acid-based fillers may result from arterial occlusion by direct injection into the artery or embolization with the product, which is usually immediately manifested by acute pain and scarlet-red spots due to hemorrhagic blisters. Vascular complication can also result from venous occlusion caused by external compression of the vessel with soft tissue filler. Vascular occlusion requires immediate treatment as the risk of tissue damage and skin necrosis increases with time. In this paper we consider a clinical case of vascular complication after the technique of lateral temporal lifting of hyaluronic acid, manifested by painfulness of the area of hyaluronic acid injection, Livedo reticularis, alopecia, and treatment of this patient for 3 months.

Assessing the Efficacy of Monthly 308 nm Excimer Lamp Double-Stacked Pulse Adjusted Therapy for Alopecia Areata

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by T cell‐mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects, pain due to intralesional injections or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308 nm excimer lamp used in a monthly basis in a double-stacked pulse manner for the treatment of AA. Methods: This was a prospective study, using 308 nm excimer lamp in a double-stacked pulse therapy for AA. The primary endpoint was the improvement in SALT score. Results: A total of 40 patients with AA were enrolled in this study. Forty (100%) patients achieved clinical response. Hyperpigmentation and erythema occurred on the treated alopecic areas of all patients but they were considered tolerable. Patients of younger age or with a smaller area of affection had a better overall treatment response. Conclusion: 308 nm excimer lamp therapy is an excellent option for single or multiple AA because it achieves a good clinical response with less adverse effects than other therapies. This therapy may be useful for low-income countries where new JAK inhibitors are not available, however, for patients with extensive hair loss, it is not as effective and thus, it may be unfit for patients with alopecia totalis and alopecia universals.

Reassessing Stephanofilaria stilesi dermatitis in cattle, with characterization of molecular markers for confirming diagnosis

BackgroundStephanofilaria stilesi is a vector-borne filarioid nematode of cattle in North America that is transmitted via the hematophagous horn fly (Haematobia irritans) intermediate host. Despite being relatively common, little attention has been given to a thorough description of S. stilesi lesions and the potential integration of pathological and molecular diagnostic findings to confirm infection.MethodsTo characterize the cutaneous lesions caused by S. stilesi in cattle (Bos taurus taurus and Bos taurus indicus), skin of the ventral abdominal midline was collected from 22 animals during postmortem examination. Skin samples were processed for histology, transmission electron microscopy (TEM), DNA extraction, PCR, and Sanger sequencing targeting molecular markers cytochrome oxidase c subunit 1 (cox1), 12S, 18S rDNA, and 28S rDNA.ResultsMacroscopically, lesions ranged from 5 × 4 cm to 36 × 10 cm, consisting of one large single lesion, or two to four ovoid areas at the ventral abdominal midline, surrounding the umbilicus. Each lesion presented as ulcerative dermatitis with dry, serocellular crusts, or alopecic and lichenified areas. Histologically, eosinophilic, neutrophilic, and ulcerative dermatitis with furunculosis, folliculitis, and epidermal hyperplasia was observed. Cross sections of adult nematodes were identified in ~ 60% of the cases (n = 13) within intact follicles, sebaceous ducts, crusts, and areas of furunculosis. Stephanofilaria first-stage larvae (L1) were observed in five cases within “vitelline membranes” in the superficial dermis and crusts. Ultrastructurally, the L1 cross sections were compounded of smooth multilayered cuticle and somatic cells. The “vitelline membrane” is a tri-layered membrane where L1 are suspended in a matrix. Stephanofilaria stilesi DNA was found in 5 out of the 13 cases in which adults or L1 were histologically observed (38%) and in 1 out of the 9 cases without adults or L1 present (11%). Phylogenetic analyses suggest a closer relationship of the genus Stephanofilaria with Thelazioidea, instead of the family Filariidae (Filarioidea), in which it has been historically allocated.ConclusionsOur study improved the characterization of lesions and described ultrastructural findings of S. stilesi and highlights that molecular tools should be utilized in combination with histology for improved diagnostic resolution.Graphical

Effect study of Sonic hedgehog overexpressed hair follicle stem cells in hair follicle regeneration

To determine the expression level of Sonic hedgehog (Shh) in the passage of hair follicle stem cells (HFSCs), analyze the effect of Shh overexpression on the proliferation activity of HFSCs, and explore the survival of HFSCs after Shh overexpression and its effect on hair follicle regeneration. Hair follicles from the normal area (H1 group) and alopecia area (H2 group) of the scalp donated by 20 female alopecia patients aged 40-50 years old were taken, and the middle part of the hair follicle was cut under the microscope to culture, and the primary HFSCs were obtained and passaged; the positive markers (CD29, CD71) and negative marker (CD34) on the surface of the fourth generation HFSCs were identified by flow cytometry. The two groups of HFSCs were transfected with Shh-overexpressed lentivirus. Flow cytometry and cell counting kit 8 assay were used to detect the cell cycle changes and cell proliferation of HFSCs before and after transfection, respectively. Then the HFSCs transfected with Shh lentivirus were transplanted subcutaneously into the back of nude mice as the experimental group, and the same amount of saline was injected as the control group. At 5 weeks after cell transplantation, the expression of Shh protein in the back skin tissue of nude mice was detected by Western blot. HE staining and immunofluorescence staining were used to compare the number of hair follicles and the survival of HFSCs between groups. The isolated and cultured cells were fusiform and firmly attached to the wall; flow cytometry showed that CD29 and CD71 were highly expressed on the surface of the cells, while CD34 was lowly expressed, suggesting that the cultured cells were HFSCs. The results of real-time fluorescence quantitative PCR and Western blot showed that the expression levels of Shh protein and gene in the 4th, 7th, and 10th passages of cells in H1 and H2 groups decreased gradually with the prolongation of culture time in vitro. After overexpression of Shh, the proliferation activity of HFSCs in the two groups was significantly higher than that in the blank group (not transfected with lentivirus) and the negative control group (transfected with negative control lentivirus), and the proliferation activity of HFSCs in H1 group was significantly higher than that in H2 group before and after transfection, showing significant differences ( P<0.05). At 5 weeks after cell transplantation, Shh protein was stably expressed in the dorsal skin of each experimental group; the number of hair follicles and the expression levels of HFSCs markers (CD71, cytokeratin 15) in each experimental group were significantly higher than those in the control group, and the number of hair follicles and the expression levels of HFSCs markers in H1 group were significantly higher than those in H2 group, and the differences were significant ( P<0.05). Lentivirus-mediated Shh can be successfully transfected into HFSCs, the proliferation activity of HFSCs significantly increase after overexpression of Shh, which can secrete and express Shh continuously and stably, and promote hair follicle regeneration by combining the advantages of stem cells and Shh.

Economic burden of alopecia areata: A study of direct and indirect cost in Japan using real-world data.

Alopecia area (AA) is a common autoimmune disorder, characterized by hair loss. Although its impact on quality of life is fairly well understood, studies on the economic impact of AA are limited. The aim of this study was to quantify the personal and nationwide economic burden of AA in Japan. Data were drawn from the Adelphi AA Disease Specific Programme (DSP)™, a real-world, cross-sectional survey with retrospective data collection, of Japanese physicians and patients with AA. The study was conducted in 2021, before the approval of Janus kinase inhibitors for AA. Physicians and their consulting AA patients completed questionnaires regarding disease severity, treatment, and AA-related costs. The Work Productivity and Activity Impairment questionnaire was used to evaluate the impact of AA on patients' work and activity. Nationwide estimates of cost and productivity loss were extrapolated from collected patient data. A total of 50 physicians provided data on 235 patients; 58.7% were female, mean ± SD age was 41.1 ± 11.8 years, and mean physician-estimated scalp hair loss was 40.4% ± 30.2%. Prescription medication use was high (92.3% of patients), but the use of over-the-counter medication was low, at 8.7%. Mean cost to patients for medication was ¥ 4263 (US$ 32.42) per month. Productivity while at work (presenteeism) was significantly impaired (23.9% ± 25.7%), but absenteeism was low (0.9% ± 2.8%). The total nationwide cost of AA was estimated at 112.7 billion yen (US$ 857 million), of which 88.1 billion yen (78.2%) was due to productivity loss. Over 2 million days per year of activity time were estimated to be lost due to AA. Thus, despite not being a physically limiting disease, AA has a significant impact in terms of cost and time, both on a personal and national level. These data highlight the need for more targeted interventions to reduce the effects of AA on the Japanese economy.

PA32 Severe lichen planus with co-localization of vitiligo: a rare and unusual case

Abstract A 13-year-old boy was seen in the urology clinic for hypo­pigmented patches on the glans penis. He underwent circumcision for presumed balanitis xerotica obliterans, but histological examination of the skin showed lichen planus (LP). This prompted a full skin check by the team, which showed similar patches on the scrotum, anus and ears. A referral was made to dermatology for further assessment. Closer history revealed a 1-year history of inflamed patches behind the ears that spread to the periorbital and penile regions. Concurrent patchy hair loss was noted over this time period; otherwise, he was asymptomatic, with no relevant past medical or family history. Full skin check revealed extensive areas of well-circumscribed erythema on the penis, peri-orbitally and within the conchal bowl of both ears. Areas of scarring alopecia were present with complete loss of the eyelashes. The severity of his condition warranted the immediate commencement of high-dose oral steroid therapy and a trial of protopic 0.1% ointment. A review 6 months later showed no further erythema but areas of clearly defined depigmentation where there was previously active LP, particularly across the nose and periorbitally, consistent with vitiligo. Ongoing follow-up at 1 year showed the stable appearance of these areas, despite ongoing use of topical calcineurin inhibitor. Co-localization of vitiligo in the context of LP is a rare entity, noted in only 10 case reports in the literature. The fact that both LP and vitiligo are common, each said to affect 1–2% of the general population, may mean that their association is merely a coincidence. However, a number of publications suggest that a causal link must be present as similar immunological mechanisms are shared by the two conditions. The aetiology of both LP and vitiligo is known. Various theories exist, including the autoimmune hypothesis, as both conditions are immunologically mediated. Another assumes inflammatory mediator release from ultraviolet damage, particularly on areas of photosensitive depigmented skin. A third supposes that photodamage induces Koebner phenomenon on vitiligo-affected skin, resulting in LP on these areas. No theory has been proven definitively. In most cases, vitiligo is described as the precursor disease; rarely, both diseases occur concomitantly and progress together. We present a rare case of LP preceding vitiligo. Our case not only demonstrates the importance of a full skin examination in diagnosing lesions, but provides further evidence that this association is more than coincidental. More studies into these conditions are needed to understand this phenomenon in its entirety.