Loss Of Body Hair Research Articles

Integrative analysis of rare copy number variants and gene expression data in alopecia areata implicates an aetiological role for autophagy.

Alopecia areata (AA) is a highly prevalent autoimmune disease that attacks the hair follicle and leads to hair loss that can range from small patches to complete loss of scalp and body hair. Our previous linkage and genome-wide association studies (GWAS) generated strong evidence for aetiological contributions from inherited genetic variants at different population frequencies, including both rare mutations and common polymorphisms. Additionally, we conducted gene expression (GE) studies on scalp biopsies of 96 patients and controlsto establish signatures of active disease. In this study, we performed an integrative analysis on these two datasets to test the hypothesis that rare CNVs in patients with AA could be leveraged to identify drivers of disease in our AA GE signatures. We analysed copy number variants (CNVs) in a case-control cohort of 673patients with AA and 16 311controls independent of the case-control cohort of 96 research participants used in our GE study. Using an integrative computational analysis, we identified 14 genes whose expression levels were altered by CNVs in a consistent direction of effect, corresponding to gene expression changes in lesional skin of patients. Four of these genes were affected by CNVs in three or more unrelated patients with AA, including ATG4B and SMARCA2, which are involved in autophagy and chromatin remodelling, respectively. Our findings identified new classes of genes with potential contributions to AA pathogenesis.

37-Year-Old Man With Fatigue and Erectile Dysfunction

37-Year-Old Man With Fatigue and Erectile Dysfunction

Hair Cortisol in Sheltered Cows and Its Association with Other Welfare Indicators.

Simple SummaryHair cortisol concentrations are measured for the assessment of long-term stress in animals. The objective of this study was to assess the levels of stress in retired, abandoned and unproductive cows housed in traditional shelters through the measurement of their hair cortisol levels. The study further aimed to explore the association of the hair cortisol concentrations with other cow and resource-based welfare indicators. High hair cortisol levels were associated with dung lying in the sheds, low dry bulb temperature and shelters having little access to the yards. At the cow level, high hair cortisol levels were associated with injuries on the joints and body, dehydration, old age, and low body hair loss level. The study concluded that hair cortisol is an effective tool to assess stress levels in cows under field conditions.India, the country with the largest population of dairy cows in the world, has a policy of retiring abandoned and non-lactating cows in shelters, but the level of provision for their welfare in these shelters is unclear. Cows in 54 shelters across India were assessed for historic evidence of physiological stress, through determination of hair cortisol in 540 samples from 10 cows in each shelter by enzyme immunoassay. Animal-based and shelter resource-based welfare measures were recorded and correlations with the hair cortisol investigated by multivariable analysis. High hair cortisol concentrations were associated with dung in the lying area of the cowshed, a low dry bulb temperature there and little cow access to yards, as shelter-based variables. At a cow level, high hair cortisol concentrations were associated with dirty flanks, hock joint ulceration, carpal joint injuries, body lesions, dehydration, an empty rumen, old age, and low levels of body hair loss. Hair cortisol level promises to be an effective biomarker of stress in cows when conducting studies under field conditions.

SUN-207 Hot Flashes, Flushing, and Sweating in a Middle-Aged Man with Pituitary Macroadenoma

Background: Vasomotor symptoms such as hot flashes and sweating, typical of the menopausal syndrome in women, are less commonly seen in males after loss of testicular function. We present an interesting case of a middle-aged man who was evaluated for progressive episodes of hot flashes, sweating and flushing and was eventually diagnosed with pituitary macroadenoma causing secondary hypogonadism. Clinical Case: A 59 y.o. male was referred endocrinology clinic with intermittent episodes of hot flashes and sweating over the last 2 years. He has had progressive episodes of feeling warm, associated with some flushing, and then transient profuse sweating, usually lasting no more than several minutes. His only other medical problem has been chronic recurrent gout requiring Allopurinol 300 mg daily, Probenecid 500mg twice daily and Colchicine 0.6mg twice daily to prevent gout attacks. He denied any headaches, palpitations, feeling tremulous, no vision symptoms, no breast enlargement or loss of body hair, no constipation or diarrhea. Physical exam was significant for paucity of facial and body hair, and no evidence of gynecomastia. He had an episode in the office visit where he became flushed, diaphoretic, his blood pressure was 120/80 and he did not have tachycardia. Lab studies revealed Prolactin= 19 (n= 2-18 pg/dL), Cortisol 8.6 (6-27 ug/dl), Total Testosterone = 22 (n=250-1100 ng/dL), LH = <1 (n=1.5-9.3 mlU/ml), free T4 0.6 (ref 0.6-1.6 ng/dl) with TSH 1.51 (ref: 0.34 -3.00 uIU/ml), IGF-1 = 49 (34-232 ng/dl), Total metanephrines urine 654 ( 233-716 (Normotensive)), VMA = 3.6 (<8.0 mg/24 h) suggestive of secondary hypogonadism with elevated prolactin and low LH. MRI of the brain revealed mass of the sella extending into the suprasellar region measuring up to 2.0 x 2.3 x 1.8 cm. He then underwent endoscopic transsphenoidal resection of pituitary tumor and histopathology revealed null cell adenoma with widespread oncocytic changes consistent with an oncocytoma. On follow up visit in 1 month, his debilitating sweats have diminished significantly but not disappeared. Conclusion: Hot flushes are common in men who are acutely hypogonadal after orchiectomy or testicular injury, but it is an unusual symptom in patients with hypogonadism secondary to pituitary tumors. There are case reports of pituitary adenoma diagnosed through evaluation of sexual dysfunction and frequent hot flashes. This case illustrates the importance of considering broad etiologies when evaluating new onset hot flashes in middle-aged men, especially in the absence of other presenting features of pituitary macroadenoma and when symptoms of hypogonadism (like erectile dysfunction, low libido, impaired concentration and fatigue) go unreported to physicians.

Bi-allelic Mutations in LSS, Encoding Lanosterol Synthase, Cause Autosomal-Recessive Hypotrichosis Simplex

Hypotrichosis simplex (HS) is a rare form of hereditary alopecia characterized by childhood onset of diffuse and progressive scalp and body hair loss. Although research has identified a number of causal genes, genetic etiology in about 50% of HS cases remains unknown. The present report describes the identification via whole-exome sequencing of five different mutations in the gene LSS in three unrelated families with unexplained, potentially autosomal-recessive HS. Affected individuals showed sparse to absent lanugo-like scalp hair, sparse and brittle eyebrows, and sparse eyelashes and body hair. LSS encodes lanosterol synthase (LSS), which is a key enzyme in the cholesterol biosynthetic pathway. This pathway plays an important role in hair follicle biology. After localizing LSS protein expression in the hair shaft and bulb of the hair follicle, the impact of the mutations on keratinocytes was analyzed using immunoblotting and immunofluorescence. Interestingly, wild-type LSS was localized in the endoplasmic reticulum (ER), whereas mutant LSS proteins were localized in part outside of the ER. A plausible hypothesis is that this mislocalization has potential deleterious implications for hair follicle cells. Immunoblotting revealed no differences in the overall level of wild-type and mutant protein. Analyses of blood cholesterol levels revealed no decrease in cholesterol or cholesterol intermediates, thus supporting the previously proposed hypothesis of an alternative cholesterol pathway. The identification of LSS as causal gene for autosomal-recessive HS highlights the importance of the cholesterol pathway in hair follicle biology and may facilitate novel therapeutic approaches for hair loss disorders in general.

Pituitary Macroprolactinoma with Mildly Elevated Serum Prolactin: Hook Effect.

A 45-year-old man was admitted in our department with complaints of severe headache for over 6 months period. He also suffered from several problems such as visual field defect, decreased energy and libido, body hair loss, cold intolerance, decreased appetite and dry skin. On physical examination, he was afebrile: BP (blood pressure): 110/70 mm/Hg, PR (pulse rate) :65 beat/min, BMI (body mass index): 24. He had no terminal hair on face or chest and subcutaneous adipose tissue mass had been decreased substantially. Laboratory tests revealed; Hb: 12 g/dL (N: 14–17 g/dL), Total testosterone: 1.2 ng/mL (N:–-10 ng/mL), Luteinizing hormone (LH):3.3MIU/mL (N:1–8 MIU/mL), Follicle Stimulating hormone (FSH):1.3 MIU/mL (N:1–7 MIU/mL), T4:3.4 micg/dL (N:4–12 micg/dL), TSH:0.6 MIU/mL (N:0.5–5 MIU/mL), Prolactin:100 ng/mL (2–24 ng/mL), serum cortisol:6 MIU/mL (N:4–21 MIU/mL), IGF1:162 ng/mL (50–245). Pituitary MRI showed macroadenoma (29*16*14 mm) in left side of sella turcica which bulged to suprasellar cistern with pressure effect on left optic nerve (Figure 1, 2). Visual field examination revealed mild temporal hemianopia. These findings are consistent with macroadenoma and mild prolactin elevation. We also observed a discrepancy between pituitary tumor size and prolactin level. The correct estimate of serum prolactin was obtained after serial dilutional measurement. Serum prolactin after dilution was 6470 ng/mL. With these findings pituitary macroadenoma was diagnosed and treatment with cabergoline (dopamine agonist) 0.5 mg/week was started. After one month follow-up he had no symptoms, visual field defect was improved and pituitary MRI showed significant shrinkage of tumor.

Combination use of triamcinolone acetonide and immunotherapy as a new therapeutic option in alopecia totalis

Alopecia totalis (AT) with body hair loss is the most severe type of alopecia areata (AA). The ability to develop hair is suggested to be poor in such severe AA, because AT does not respond to corticosteroid pulses and immunotherapy using squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP). The purpose of this study is to assess the possibility of hair regrowth in AT with body hair loss. Ten patients with AT who did not respond to topical immunotherapies, received triamcinolone acetonide (TA) injections. Undiluted or 2-fold diluted solutions of TA were prepared and 0.1–0.2 mL of either of the two solutions was administered to each patient. In total, 2 mL of the selected solution was injected monthly into each area. In cases where vellus hair developed after the injections, we restarted the immunotherapy using SADBE or DPCP and continued the therapies for more than half a year. The development of vellus hair after TA injections was defined as a good response. Complete response rate to the topical injection of TA was 10% (1/10), however the partially good response rate was 60% (6/10). The good responders showed the anagen stage of hair follicle after TA injections. Furthermore, the complete responder to TA showed susceptibility to the subsequent immunotherapy and more regrowth of hair was seen. Even if patients with AT have suffered for a prolonged period since onset, it is possible to recover the hair cycle if they show susceptibility to intralesional corticosteroid and subsequent immunotherapy.

The timing and distribution of nonscalp hair loss in patients with lichen planopilaris and frontal fibrosing alopecia: A survey-based study

The timing and distribution of nonscalp hair loss in patients with lichen planopilaris and frontal fibrosing alopecia: A survey-based study

The naked ape as an evolutionary model, 50 years later

Abstract Evolution acts through a combination of four different drivers: (1) mutation, (2) selection, (3) genetic drift, and (4) developmental constraints. There is a tendency among some biologists to frame evolution as the sole result of natural selection, and this tendency is reinforced by many popular texts. “The Naked Ape” by Desmond Morris, published 50 years ago, is no exception. In this paper I argue that evolutionary biology is much richer than natural selection alone. I illustrate this by reconstructing the evolutionary history of five different organs of the human body: foot, pelvis, scrotum, hand and brain. Factors like developmental tinkering, by-product evolution, exaptation and heterochrony are powerful forces for body-plan innovations and the appearance of such innovations in human ancestors does not always require an adaptive explanation. While Morris explained the lack of body hair in the human species by sexual selection, I argue that molecular tinkering of regulatory genes expressed in the brain, followed by positive selection for neotenic features, may have been the driving factor, with loss of body hair as a secondary consequence.

Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A Promising Therapy for the Treatment of Alopecia Areata: A Case Report of Six Patients.

Background:Alopecia areata (AA) is a chronic autoimmune disorder characterized by patchy loss of hair from scalp, beard, eyebrows, or rarely even body hair. Rarely, the disease can be widespread and severe leading to loss of entire scalp and body hair causing apprehension and psychological stress in patients. Management of such cases is equally difficult with the available options of topical and systemic immunosuppressant. Tofacitinib, JAK3 inhibitor, is emerging as a promising drug for the management of severe and resistant cases of AA/totalis/universalis.Objective:Our study aims to show the effectiveness of oral tofacitinib in the treatment of alopecia universalis (AU).Methods:Six patients diagnosed with AU/alopecia totalis duration of disease 6 months–15 years refractory to other treatments were selected and were started on oral tofacitinib 5 mg twice daily up to 10 mg BID and were followed up every 4 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score, and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse.Results:All our six patients showed dramatic response to oral tofacitinib. Patients were followed up every 4 weeks, and results were assessed. Significant hair regrowth was evident in all the patients by the end of 12 weeks. Currently, four of our patients are on oral tofacitinib 10 mg BID and are under follow-up. There was no relapse in one patient after stopping drug for 4 months. Another patient started developed AA patches in the eyebrows within 2 months of stopping tofacitinib. Acneiform eruptions were seen in two patients which were managed with topicals.Conclusion:In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety and confirm efficacy.

Organic effects of associating paclitaxel with a lipid-based nanoparticle system on a nonhuman primate, Cebus apella.

Lipid-based nanoparticle systems have been used as vehicles for chemotherapeutic agents in experimental cancer treatments. Those systems have generally been credited with attenuating the severe toxicity of chemotherapeutic agents. This study aimed to investigate the effects of associating paclitaxel (PTX) with a lipid-based nanoparticle system on a nonhuman primate, Cebus apella, documenting the toxicity as measured by serum biochemistry, which is a detailed analysis of blood and tissue. Eighteen C. apella were studied: three animals were treated with cholesterol-rich nanoemulsion (LDE) only, without PTX, administered intravenously every 3 weeks, during six treatment cycles; six animals were treated with PTX associated with LDE at the same administration scheme, three with lower (175 mg/m2) and three with higher (250 mg/m2) PTX doses; and six animals were treated with commercial PTX, three with the lower and three with the higher doses. In the LDE-PTX group, no clinical toxicity appeared, and the weight–food consumption curve was similar to that of the controls. Two animals treated with commercial PTX presented weight loss, nausea and vomiting, diarrhea, skin flaking, 70% loss of body hair, and decreased physical activity. The use of LDE as a carrier at both lower and higher doses reduced the toxicity of the drug in this species, which is closely related to human subjects. This was observed not only by clinical, biochemical, and hematological profiles but also by the histopathological analysis. The results of this study support the assumption that lipid-based nanoparticle systems used as drug carriers can serve as valuable tools to decrease the toxicity and increase the safety of chemotherapeutic agents.

Review of treatment for alopecia totalis and alopecia universalis.

Alopecia areata (AA) is an autoimmune disease directed at the hair follicle. Although usually limited to patchy hair loss over the scalp (focalis), AA can present as total loss of scalp hair (totalis; AT) or as total loss of both scalp and body hair (universalis; AU). Management of AT and AU can be challenging, and although multiple treatment modalities have been explored, no therapy is currently FDA-approved. This review focuses on the evidence for current treatment options for AT and AU. The PubMed database was searched from January 1, 2000, to September 1, 2016, for clinical trials, retrospective studies, and case reports of treatments for AT and AU. A total of 40 studies were retrieved and analyzed. Therapies studied for AT/AU included: topical immunotherapy, steroids, photodynamic therapy, immunosuppressive agents, TNFα inhibitors, and other therapies, such as sulfasalazine, bexarotene, JAK inhibitors, and simvastatin/ezetimibe. Although certain treatments showed significant hair regrowth, no treatment was completely effective. The most promising therapies with the highest quality data include diphenylcyclopropenone, squaric acid dibutylester, photodynamic therapy, steroids, and cyclosporine in combination with methylprednisolone. High-quality randomized-controlled trials with large sample sizes are lacking. Unified outcome guidelines are encouraged to facilitate the comparison of future studies.

Pituitary Ependymoma, 10-Year Follow-Up after Partial Resection and Radiation Therapy.

Ependymoma usually arises within the ventricles and central canal of the spinal cord. These tumors, found in the sellar region, are extremely rare. We report a case of pituitary ependymoma followed up over 10 years. A 59-year-old male patient presented with fatigue, general weakness, erectile dysfunction, and loss of body hair, including pubic hair. Brain magnetic resonance imaging (MRI) revealed a 3.3×3.5×2.3-cm sellar and suprasellar snowman-shaped enhancing mass. The tumor was partially resected via the trans-sphenoidal approach followed by postoperative radiation therapy. The pathologic confirmation was pituitary ependymoma. At the 10-year follow up, MRI revealed no evidence of tumor progression. With lack of knowledge about pituitary ependymoma, our case is the only case in which the disease has been well controlled over a long period of time without tumor progression.

Correlation of serum ferritin levels, in female patients with chronic diffuse hair loss: A cross sectional study

Context: Iron is involved in critical physiological processes within the hair follicle, suggesting that iron deficiency (ID) could disrupt hair synthesis. The relationship between body iron status and hair loss has been investigated in a number of studies, however, with relatively discrepant findings. Aim: The aim of this study is to evaluate whether chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) in patients were associated with decreased tissue iron stores, as measured by serum ferritin levels. Setting and Design: This was a cross-sectional study, conducted in a teaching hospital. Materials and Methods: Forty female patients aged between 15 and 45 years, having chronic diffuse hair loss, were recruited. Statistical Analysis Used: Statistical analysis used in this study was Mean ± standard deviation, Pearson's correlation coefficient, and one-sample t-test. Results: The mean serum ferritin levels in all participants, CTE, and FPHL were 18.6 μg/L, 16 μg/L, and 36.64 μg/L, respectively. Almost 57.5% of participants had serum ferritin levels Conclusion: Participants of this study had low serum ferritin levels at different definitions of ID, and the participants showed ID, which was significant. Hence, chronic diffuse hair loss was associated with decreased iron stores.

Topical Nanoemulgel: A Novel Pathway for Investigating Alopecia

Alopecia areata (hair loss) is an auatoimmune disease occurs in both sexes and is characterized by partial, complete and total body hair loss. The severity of the condition and the patient’s age are the tailored factors responsible for the hair loss. The FDA approved Minoxidil as a topical medication with proven efficacy for treating different types of alopecia’s. This review will discuss the effect of topical nanoemulgel over other formulations for the treatment of alopecia areata. The nanoemulgel will shows better solubility and permeability of the active components at the site of application via opening of hair follicles or other routes, as compared to other formulations.

Serum level of vitamin D in patients with alopecia areata

PurposeAlopecia areata (AA) is an autoimmune disease mediated by both CD4+ and CD8+ T-cells with cytokines playing an important role. Current study aimed at measuring serum 25 hydroxy vitamin D [25(OH) D] level in patients with AA in comparison to controls in our locality. Subjects and methodsThe study recruited 50 subjects, 30AA patients and 20 controls. All patients were subjected to detailed history taking and examination to detect pattern, severity (SALT score) of AA. Blood samples were taken from all subjects to do complete blood count and to assess serum levels of 25(OH)D, parathyroid hormone, random blood sugar, and calcium. ResultsThere was significant decrease in serum 25(OH)D level in AA patients in comparison to controls. Serum 25(OH)D level showed significant decrease in males than in females in patients. Levels of serum calcium were significantly lower in patient group compared to control group with. Regarding blood picture; the only significant difference was in the count of RBCs which showed significant lower levels in AA group compared to control group. Positive linear correlation was found between serum vitamin D and serum calcium in the patients group. Strong positive correlation was found between SALT score and duration of the disease. All patients with total scalp hair loss and body hair loss had duration of disease more than six months, while most of patients with duration of disease less than six months had low SALT scores. ConclusionsSerum levels of 25(OH)D were significantly lower in patients than controls.

Frontal Fibrosing Alopecia in Men: Presentations in 12 Cases and a Review of the Literature

BackgroundFrontal fibrosing alopecia (FFA) is a scarring disease in which the hairline recedes and the eyebrows can be affected. Usually seen in postmenopausal women, FFA is much less common in men. ObjectiveTo describe the clinical characteristics of FFA in a case series of men and compare this series to those reported in the literature. Material and methodsMen with FFA being treated in our dermatology department from January 2010 to December 2015 were included prospectively for this descriptive study. We collected patient information and clinical and treatment characteristics. ResultsTwelve men (mean age, 75 years) were recruited. Alopecia was the reason for seeking medical care in only 4 cases. The hairline had receded 3cm on average. Half the patients had facial papules, and 83% had androgenetic alopecia or hair loss on eyebrows or extremities. Follicular hyperkeratosis and erythema were present in 66%, and only 25% of the men reported pruritus. The most commonly prescribed treatments were topical: corticosteroids in 8 patients (66%) and minoxidil in 4 (33%). ConclusionsFacial papules, androgenetic alopecia, and loss of body hair are more often observed in men with FFA than in women. The men in this series were older on average than in other FFA case series in the literature, possibly accounting for the higher prevalence of associated androgenetic alopecia and the fact that most of these men were seeking care for conditions other than hair loss.

Treating Alopecia Areata: Current Practices Versus New Directions.

Alopecia areata (AA) is non-scarring hair loss resulting from an autoimmune disorder. Severity varies from patchy hair loss that often spontaneously resolves to severe and chronic cases that can progress to total loss of scalp and body hair. Many treatments are available; however, the efficacy of these treatments has not been confirmed, especially in severe cases, and relapse rates are high. First-line treatment often includes corticosteroids such as intralesional or topical steroids for mild cases and systemic steroids or topical immunotherapy with diphenylcyclopropenone or squaric acid dibutylester in severe cases. Minoxidil and bimatoprost may also be recommended, usually in combination with another treatment. Ongoing research and new insights into mechanisms have led to proposals of innovative therapies. New directions include biologics targeting immune response as well as lasers and autologous platelet-rich plasma therapy. Preliminary data are encouraging, and it is hoped this research will translate into new options for the treatment of AA in the near future.

Alopecia frontal fibrosante en el varón: presentación de 12 casos y revisión de la literatura

BackgroundFrontal fibrosing alopecia (FFA) is a scarring disease in which the hairline recedes and the eyebrows can be affected. Usually seen in postmenopausal women, FFA is much less common in men. ObjectiveTo describe the clinical characteristics of FFA in a case series of men and compare this series to those reported in the literature. Material and methodsMen with FFA being treated in our dermatology department from January 2010 to December 2015 were included prospectively for this descriptive study. We collected patient information and clinical and treatment characteristics. ResultsTwelve men (mean age, 75 years) were recruited. Alopecia was the reason for seeking medical care in only 4 cases. The hairline had receded 3cm on average. Half the patients had facial papules, and 83% had androgenetic alopecia or hair loss on eyebrows or extremities. Follicular hyperkeratosis and erythema were present in 66%, and only 25% of the men reported pruritus. The most commonly prescribed treatments were topical: corticosteroids in 8 patients (66%) and minoxidil in 4 (33%). ConclusionsFacial papules, androgenetic alopecia, and loss of body hair are more often observed in men with FFA than in women. The men in this series were older on average than in other FFA case series in the literature, possibly accounting for the higher prevalence of associated androgenetic alopecia and the fact that most of these men were seeking care for conditions other than hair loss.

546 Gene expression signatures and ALADIN score correlates with response of alopecia areata patients to treatment with JAK inhibitors

Alopecia areata (AA) is an autoimmune disease in which the hair follicle is the target of immune attack and manifests clinically as hair loss. The more extreme forms of the disease can result in lifelong alopecia with complete loss of scalp, face and body hair. Currently, there are no FDA-approved drugs for AA, and response to treatments are highly variable and often disappointing. Biomarkers for the purposes of precise quantitative tracking of disease severity, disease course prediction, and response to drug are valuable tools in the evaluation of novel treatments in clinical trials for AA. Previous studies by our group, including large genome-wide association studies and meta-analyses, gene expression analyses conducted on human AA scalp skin biopsies and animal models, and targeted cytokine antibody treatments in the murine form of AA, provided a strong rationale for targeting Janus kinase signaling intermediates for the purposes of treatment. Our center recently completed two pilot, open-label clinical trials of the JAK inhibitors ruxolitinib and tofacitinib, for the treatment of AA. Using previously collected whole genome gene expression data collected from a large cohort of patients with AA as well as normal controls, a multifactorial metric we termed the Alopecia Areata Disease Activity Index, or ALADIN, was created. In this study, we used the ALADIN metric to measure responses of AA patients enrolled in our clinical trials of JAK inhibitors. This tool tracked with clinical score and demonstrated strong correlation with response to treatment. Furthermore, ALADIN component genes, which include GZMA, PRF1, CXCL9, CXCL10 as well as hair-keratin associated genes, differentiated eventual responders from nonresponders at baseline in some cases. ALADIN is a powerful biomarker tool that will be useful in clinical trials of novel treatments for AA, particularly in larger randomized clinical trials.