Severity Of Alopecia Tool Score Research Articles

Predictors of QOL in Patients with Alopecia Areata

Although alopecia areata (AA) severity is often defined by the degree of scalp hair loss, its impact on QOL can also be a defining measure of severity. In this cross-sectional study (AA Disease Specific Program), 259 patients were surveyed for demographics, AA illness characteristics, QOL (Skindex-16 AA), and daily impairment (Work Productivity and Activity Impairment). The association between patient demographics and illness variables, the Skindex-16 AA scores, and the Work Productivity and Activity Impairment scores were analyzed using regression analyses. The mean age of patients was 39 years (51% female). Self-reported severity of current AA was rated as mild (21%), moderate (54%), and severe (25%). The highest impairment was observed for the Skindex-16 AA emotions and the Work Productivity and Activity Impairment daily activity performance scores. Although the degree of scalp hair loss (physician Severity of Alopecia Tool score) was not predictive of QOL, patients' self-report of moderate or severe disease, sex (females more impacted), and eyebrow and eyelash involvement were predictors of diminished QOL, consistently and incrementally. The present results suggest patients' perception of severity as well as the presence of eyelash and eyebrow hair loss are also impactful and should be considered in defining the severity of disease.

Serum interleukin 15 level may serve as a new marker for alopecia areata

Background Alopecia areata (AA) is an autoimmune form of nonscarring hair loss that may affect any hair-bearing area. It is one of the most common forms of hair loss seen by dermatologists. The serum level of interleukin 15 (IL-15) is elevated in AA; subsequently, IL-15 limits the suppressive effect of regulatory T cells and activates CD8+NKG2D+ T cells to attack the cells of the hair bulb and initiate AA. Inhibiting IL-15 activity might be a breaking new therapeutic strategy in the treatment of AA. Patients and methods Serum IL-15 levels were measured by an enzyme-linked immunosorbent assay for 30 patients with active AA (group A), 30 patients with stable AA (group B), and 60 healthy participants of age-matched and sex-matched controls (group C). Results Serum levels of IL-15 were significantly increased in patients with AA and showed a significant positive correlation with severity (Severity of Alopecia Tool score) and activity of the disease. Receiver operating characteristics curve detected the validity of serum IL-15 in differentiating patients with AA from controls. The best cutoff point for IL-15 was determined to be more than or equal to 7.66 pg/ml, which was able to predict AA with 98.3 sensitivity and 100% specificity. Receiver operating characteristics curve of IL-15 was also conducted to evaluate the sensitivity and specificity of serum IL-15 as a diagnostic index for discrimination between active and stable AA cases, and the best cutoff point for IL-15 was determined to be more than or equal to 21.2 pg/ml, which was able to predict active AA, with 93.3 sensitivity and 100% specificity. Higher IL-15 levels were associated with prediction of severity and activity of AA. Conclusion Serum IL-15 may represent a new marker for AA diagnosis as well as a predictor of the disease severity and activity.

Leptin and metabolic syndrome in alopecia areata

ObjectivesThe aim of the study was to assess the role of leptin gene polymorphism in alopecia areata with metabolic syndrome (MS).BackgroundAlopecia areata is considered an organ-specific autoimmune disease of hair follicles. Leptin, an adipocyte-derived hormone, represents a link between metabolism, nutritional status, and immune response. T helper1-promoting effects of leptin have been linked to develop experimentally induced autoimmune disease.Patients and methodsThis cross-sectional study was carried out on 50 alopecia areata with MS patients. Body mass index, Severity of Alopecia Tool score, blood pressure, serum fasting glucose, triglyceride, and leptin polymerase chain reaction were done for alopecia areata patients.ResultsIn this cross-sectional study, the males represent 54% (27) and females 46% (23), their age ranging from 30 to 48 years with mean ± SD 36.7 ± 4.93. In all, 80% had sudden onset and 20% had gradual onset; 54% had progressive course of the disease; And 10% had positive family history. Patchy type was present in all cases. Regarding leptin gene polymorphism, GG genotype was present in 54% of patients. GA and alopecia areata were present in 30 and 16% of patients, respectively. No significant relation between leptin gene polymorphism and demographic and clinical data of alopecia areata with MS patients (P > 0.05) was found except for family history.ConclusionsThe study showed significant association between leptin gene polymorphism and susceptibility to alopecia areata with MS patients and ascertained that this polymorphism has a direct relationship with the severity of the disease.

SERUM LEVELS OF IL-2 AND IL-17A ARE RELATED TO CLINICAL TYPE AND SEVERITY OF ALOPECIA AREATA

The aim: To check the link between interleukins serum levels (IL-2, IL-10, IL-17A) and alopecia areata (AA) development, severity, and clinical course. Materials and methods: Totally 104 patients with AA and 30 matched control individuals were enrolled in the study. The serum levels of IL-2, IL-10, and IL-17A were evaluated in all participants. Severity of Alopecia Tool (SALT) was used to assess the AA severity. The SPSS 22.0 and Python environment were used for statistical analysis. Results: The comparative analysis has demonstrated that the serum levels of IL-2 and IL-17A in AA patients are higher than in controls (P = 0.008 and P = 0.013, respectively). The blood level of IL-2 in patients with AA depends on disease severity (P = 0.006) and clinical subtype (P = 0.016). The serum concentration of IL-17A was also associated with AA severity (P = 0.010) and subtype (P = 0.004). The positive correlation between SALT score and serum level of IL-17A (r = 0.33, P = 0.001) and IL-2 (r = 0.28, P = 0.004) was revealed. The strong positive correlation between IL-17A and IL-2 was also detected (r = 0.49, P < 0.001). There was no link between AA occurrence, manifestation and IL-10 amount. However, the weak negative correlation between SALT and IL-10 serum level was revealed (r = -0.20, P = 0.042). Conclusions: Our findings demonstrated that the serum levels of IL-2 and IL-17A are intercorrelated and associated with AA development, severity, and clinical type. The link between IL-10 serum level and AA was not detected.

Ritlecitinib and brepocitinib demonstrate significant improvement in scalp alopecia areata biomarkers

Janus kinase (JAK) inhibitors have shown encouraging results in the treatment of alopecia areata (AA), an autoimmune form of hair loss, in small, uncontrolled studies and case reports. We conducted a biopsy substudy during the randomized, double-blind, placebo-controlled first 24 weeks of a phase 2a clinical trial that evaluated the efficacy and safety of ritlecitinib, an inhibitor of JAK3 and the tyrosine kinase expressed in hepatocellular carcinoma (TEC) kinase family, and brepocitinib, an inhibitor of tyrosine kinase 2 (TYK2)/JAK1 in the treatment of AA. Change in biomarkers in lesional scalp biopsy samples between baseline and weeks 12 and 24 was an exploratory end point, and 46 patients participated from the ritlecitinib (n= 18), brepocitinib (n= 16), and placebo (n= 12) groups. Correlations of biomarkers with hair regrowth, measured using the Severity of Alopecia Tool (SALT) score, were also evaluated. NCT02974868. At week 24, both ritlecitinib and brepocitinib demonstrated improvement exceeding 100% in the lesional scalp transcriptome toward a nonlesional profile. At week 12, the improvements in scalp tissue were greater with brepocitinib than ritlecitinib; however, at week 24, the improvements were greater with ritlecitinib. For both ritlecitinib and brepocitinib, improvement in the SALT scores was positively associated with expression of TH1 markers and negatively associated with expression of hair keratins. Larger, long-term clinical trials are warranted.

Validation of the Alopecia Areata Patient Priority Outcomes (AAPPO) Questionnaire in Adults and Adolescents with Alopecia Areata

IntroductionIndividuals with alopecia areata (AA) may experience significant impacts on their health-related quality of life. The novel Alopecia Areata Patient Priority Outcomes (AAPPO) questionnaire has been developed to assess hair loss signs, emotional symptoms, and activity limitations associated with AA. The objective of this study was to evaluate psychometric properties and establish scoring of the AAPPO in adults and adolescents with AA.MethodsScoring and measurement properties of the AAPPO were examined using baseline and 2-week follow-up data from a prospective, noninterventional, web-based study of 121 patients with AA (85 adults aged ≥ 18 years, 36 adolescents aged 12–17 years) with Severity of Alopecia Tool (SALT) ≥ 25% scalp hair loss.ResultsExploratory and confirmatory factor analysis supported four single Hair Loss (HL) items, an Emotional Symptoms domain (ES; 4 items), and an Activity Limitations domain (AL; 3 items). Among all patients, the multi-item ES and AL domains had strong internal consistency (α ≥ 0.87); all HL items and domain scores had strong test-retest reliability (weighted kappa or intraclass correlation coefficients ≥ 0.78). All HL item scores demonstrated strong construct validity (r ≥ 0.52) compared with the patient-reported Alopecia Areata Symptom and Impact Scale (AASIS) hair loss subscale score; ES and AL domain scores exhibited strong construct validity (r ≥ 0.66) compared with the SF-36 Mental Component Summary (MCS) score. Using SALT scores, HL mean item scores were better (lower) in the 25–49% SALT subgroup versus those with highest SALT scores (76–100%); however, ES mean domain scores were better in the SALT 76–100% subgroup in the same comparison (p < 0.0001). Using AASIS and MCS score–created subgroups, ES and AL mean domain scores demonstrated hypothesized differences across subgroups (all p values < 0.0001).ConclusionThe AAPPO questionnaire is a reliable, valid disease-specific measure of hair loss severity and impact in individuals with AA.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00648-z.

Alopecia areata and tofacitinib: a prospective multicenter study from a Saudi population.

Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population. It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. The sample size was 68 with an average baseline SALT score of 76.8 ± 27.6%. Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis. Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.

Evaluation of serum 25-hydroxy vitamin D levels in alopecia areata of scalp: a cross sectional observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Alopecia areata (AA) is a T cell-mediated autoimmune disorder of anagen hair follicle leading to distressing and relapsing non-scarring hair loss. Vitamin D an immunomodulator plays important role in regulating normal hair cycle. Recent evidence suggests inconsistent association between vitamin D deficiency and alopecia areata.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Hospital-based cross-sectional observational study of forty untreated cases of alopecia areata and forty age and sex-matched healthy controls in 18-45 years of age group recruited from out-patient department. Each patient will undergo a detailed history, clinical examination and SALT (Severity of alopecia tool) scoring. Enhanced chemiluminesence method (Eci) will be used to estimate serum 25-hydroxy vitamin D [25(OH)D].&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean 25(OH)D level in patients of AA was 12.45±4.80 ng/ml (deficient), while that of controls was 33.73±10.02ng/ml (normal). The difference between the levels of 25(OH)D in patients of AA and controls came out to be statistically significant (p≤0.0001). A strong negative correlation was seen between SALT score and 25(OH)D level (-0.32), which was found to be statistically significant (p=0.0462).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The present study established that vitamin D levels are either insufficient/deficient in alopecia areata and it correlates negatively with severity of SALT (severity of alopecia tool) score.&lt;/p&gt;

Dietary Habits in Japanese Patients with Alopecia Areata.

PurposeAlopecia areata (AA) is characterized by non-scarring, patchy hair loss caused by autoimmune reactions to anagen hair follicles. The pathogenesis of AA may be affected by the diet. However, the dietary habits of patients with AA have not been precisely examined. Therefore, the aim of this study was to investigate the dietary habits of patients with AA in comparison to those of healthy controls.Patients and MethodsWe evaluated the dietary habits of 70 adult Japanese patients with AA using a brief-type self-administered diet history questionnaire and compared them to the habits of age- and sex-matched healthy controls.ResultsJapanese patients with AA had a higher body mass index (BMI) and higher intakes of vitamin C and fruit than the controls. Logistic regression analysis showed that AA was associated with BMI. Retinol intake was positively correlated with severity of alopecia tool (SALT) score, and linear regression analysis revealed that retinol intake was a predictor of SALT score. Retinol intake among patients with moderate to severe AA (ie, a SALT score >25) was higher than that in patients with mild AA (a SALT score ≤25). The mean age of AA patients with atopic dermatitis (AD) was lower than that of AA patients without AD; however, there were no differences in nutrient or food intake between these two groups. Logistic regression analysis showed that the comorbidity AD was negatively associated with age.ConclusionAA was associated with a high BMI, and high retinol intake was a predictor of SALT score. Further studies should be conducted to clarify whether dietary intervention to reduce BMI or limit retinol intake can alter the development or severity of AA.

Understanding the Gut Microbiota in Pediatric Patients with Alopecia Areata and their Siblings: A Pilot Study

A cross-sectional study of 41 children aged 4–17 years with alopecia areata and 41 of their siblings without alopecia areata was conducted. A total of 51% had the Severity of Alopecia Tool scores in the range of 0–25%, 12% had scores between 26% and 49%, and 36% had scores between 75% and 100%. The fecal microbiome was characterized using shotgun metagenomic sequencing. A comparison of alpha and beta diversity yielded a small but statistically significant difference on the basis of Jaccard distance, which measures species presence and absence between samples. However, a follow-up analysis did not reveal the particular species that were present more often in one group. The relative abundance of one species, Ruminococcus bicirculans, was decreased in patients with alopecia areata relative to that in their sibling controls. An analysis of gene ortholog abundance identified 20 orthologs that were different between groups, including spore germination genes and genes for metal transportation. The associations reported in this study support a view of pediatric alopecia areata as a systemic disease that has effects on hair but also leads to internal changes, including differences in the gut microbiome.

Retrospective Analysis of Pediatric Alopecia Areata Treated with Methotrexate

Abstract Background: Therapy for alopecia areata (AA) in pediatric patients is challenging and unstandardized. Common treatments for alopecia include topical agents, triamcinolone injections, and systemic agents. Treatment using systemic agents in children is controversial due to possible negative side effects and the need for long term therapy because of potential relapse after cessation. The purpose of this study was to evaluate the efficacy and safety of methotrexate therapy for the treatment of AA in pediatric patients. This medication is affordable and routinely used in children for other chronic conditions. Methods: This retrospective chart review included patients treated with methotrexate for AA who were managed by the Dermatology Section at the Children's Hospital of Philadelphia between 2015 and 2018. The following data was extracted from patients' charts: severity of disease measured by Severity of Alopecia Tool (SALT) scores, duration of treatment course, side effects, age, race, and sex. Results: 27 pediatric patients treated with methotrexate were included in the study. There was a statistically significant decrease in SALT score between initial SALT score and score at 12-15 months, but not between initial score and SALT at 6-9 months. Mood changes and gastrointestinal discomfort were the most commonly reported adverse effects. Conclusion: Our study demonstrates that patients treated with methotrexate had a statistically significant improvement in SALT scores at 12-15 months, despite the SALT scores showing no improvement at 6-9 months. This suggests the results of methotrexate may be delayed, but that the mediation is still effective and safe.

Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata

BackgroundAlopecia areata (AA) is a hair disease that causes hair loss without scarring. The etiopathogenesis of AA has not been fully understood yet. ObjectiveTo determine serum interleukin levels (IL-2, IL-4, IL-15, and IL-17) in patients diagnosed with alopecia areata and to investigate the relationship of IL levels with the duration and severity of alopecia areata and the response to tofacitinib therapy. MethodsPatients (≥16 years old) diagnosed with alopecia areata and healthy individuals as a control group was enrolled. Baseline serum interleukin levels of the patients and controls were measured. In the patient group receiving tofacitinib therapy, serum interleukin levels were measured again after 6 months. Disease severity for alopecia areata was assessed using the Severity of Alopecia Tool. ResultsSixty-one AA patients and 30 healthy individuals were included; they were comparable regarding age and sex. The mean disease duration for AA was 7 ± 6 years and the baseline mean Severity of Alopecia Tool score was 71 ± 30 (range, 20–100). Baseline IL-2, IL-4 and IL-15 levels were significantly higher in the patient group than those in the control group (p < 0.001 for each). No significant correlation was found between the baseline interleukin levels and either disease duration or disease severity (baseline Severity of Alopecia Tool score). Among the patients receiving tofacitinib (n = 22), all interleukin levels significantly decreased after treatment. However, no significant relationship between the change in interleukin levels and the change in the Severity of Alopecia Tool scores was observed after tofacitinib treatment. Study limitationsThis is a monocentric study conducted in a single university hospital. ConclusionHigh interleukin levels in alopecia areata patients and the significant decrease with treatment support the idea that interleukins have a role in pathogenesis. Nevertheless, no relationship could be demonstrated between IL levels and disease duration or severity.

Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial.

To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze-thaw cycles of 5s each. Group (2) was treated by microneedling. Both groups were treated every 2 weeks for 6 sessions and followed up for 3months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.

Efficacy and safety of the oral Janus kinase inhibitor baricitinib in the treatment of adults with alopecia areata: Phase 2 results from a randomized controlled study

There are no treatments approved by the Food and Drug Administration for alopecia areata. To evaluate the efficacy and safety of baricitinib in patients with ≥50% scalp hair loss in a phase 2 study of adults with alopecia areata (BRAVE-AA1). Patients were randomized 1:1:1:1 to receive placebo or baricitinib 1mg, 2mg, or 4mg once daily. Two consecutive interim analyses were performed after all patients completed weeks 12 and 36 or had discontinued treatment prior to these time points. The primary endpoint was the proportion of patients achieving a Severity of Alopecia Tool (SALT) score ≤20 at week 36. Logistic regression was used with nonresponder imputation for missing data. A total of 110 patients were randomized (placebo, 28; baricitinib 1-mg, 28; 2-mg, 27; 4-mg, 27). The baricitinib 1-mg dose was dropped after the first interim analysis based on lower SALT30 response rate. At week 36, the proportion of patients achieving a SALT score of ≤20 was significantly greater in baricitinib 2-mg (33.3%, P=.016) and 4-mg (51.9%, P = .001) groups versus placebo (3.6%). Baricitinib was well tolerated with no new safety findings. Small sample size limits generalizability of results. These results support the efficacy and safety of baricitinib in patients with ≥50% scalp hair loss.

PSY18 Validation of AAPPO Questionnaire in Adults and Adolescents with Alopecia Areata

To establish the domain structure and scoring, and evaluate the psychometric properties of the Alopecia Areata Patient Priority Outcomes (AAPPO) questionnaire in adults and adolescents with Alopecia Areata (AA). Measurement properties of the AAPPO were examined using data from a prospective, non-interventional, web-based study of 121 AA patients (36 adolescents ages 12-17 years and 85 adults ages ≥18 years) with ≥25% hair loss, who completed two assessments (baseline and follow up 2 weeks later). Analyses provided here are inclusive of all patients (n=121). Exploratory and confirmatory factor analysis supported 6 domains: 4 individual Hair Loss (HL) items, Emotional Symptoms (ES, 4 items) and Activity Limitations (AL, 3 items). The multi-item ES and AL domains had strong internal consistency (Cronbach’s alpha≥0.87). All domain scores had strong test-retest reliability (ICC≥0.78). The four HL domain scores demonstrated strong construct validity (r≥0.52) when compared to the patient-reported Alopecia Areata Symptom and Impact Scale hair loss scale score. The ES and AL domain scores exhibited strong construct validity (ǀrǀ≥0.66) when compared to the patient-reported SF-36 Mental Component Summary score. Known groups analyses revealed that the HL mean domain scores were better (lower) in the clinician-reported Severity of Alopecia Tool (SALT) 25%-49% subgroup compared to those with highest SALT scores (76%-100%; p<0.0001). However, the ES mean domain scores were better for the SALT 76%-100% group in the same comparison (p<0.0001). These data demonstrate the reliability and validity of the AAPPO to measure symptom severity and impacts in adults and adolescents with AA.

A phase 2a randomized, placebo-controlled study to evaluate the efficacy and safety of the oral Janus kinase inhibitors ritlecitinib and brepocitinib in alopecia areata: 24-week results

Alopecia areata (AA) is an autoimmune form of hair loss with limited treatments. To evaluate the efficacy and safety of the Janus kinase inhibitors ritlecitinib and brepocitinib in patients who have AA with ≥ 50% scalp hair loss. Patients were randomized to once-daily ritlecitinib, brepocitinib, or placebo. The primary efficacy endpoint was a 24-week change from baseline in the Severity of Alopecia Tool (SALT) score. The key secondary efficacy endpoint was the proportion of patients achieving 30% improvement in SALT score (SALT30). The ritlecitinib, brepocitinib, and placebo groups included 48, 47, and 47 patients, respectively. At week 24, least-squares mean difference from placebo in SALT score change from baseline was 31.1 (95% confidence interval [CI], 18.8-43.5) for ritlecitinib and 49.2 (95% CI, 36.6-61.7) for brepocitinib (P<.0001 for both comparisons with placebo). SALT30 was achieved by 50% (90% CI, 38%-62%) of patients receiving ritlecitinib, 64% (90% CI, 51%-75%) receiving brepocitinib, and 2% (90% CI, 0%-9%) receiving placebo. Two patients experienced a serious adverse event (rhabdomyolysis) in the brepocitinib group only. Only a single-dosage regimen of each study drug was included. Treatment with ritlecitinib or brepocitinib for 24weeks was efficacious and generally well tolerated.

Alopecia areata flare patterns in children and young adults while on systemic tofacitinib

To the Editor: The systemic Janus kinase inhibitor tofacitinib is a novel therapeutic that is used off-label for the treatment of alopecia areata (AA) in both children and adults.1Craiglow B.G. King B.A. Tofacitinib for the treatment of alopecia areata in preadolescent children.J Am Acad Dermatol. 2019; 80: 568-570Google Scholar, 2Castelo-Soccio L. Experience with oral tofacitinib in 8 adolescent patients with alopecia universalis.J Am Acad Dermatol. 2017; 76: 754-755Google Scholar, 3Cheng M.W. Kehl A. Worswick S. Goh C. Successful treatment of severe alopecia areata with oral or topical tofacitinib.J Drugs Dermatol. 2018; 17: 800-803Google Scholar Given that systemic tofacitinib is a relatively new treatment option, little is known about its long-term effectiveness. Previous studies have highlighted the possible transient efficacy of oral tofacitinib and the need for dose escalation or adjuvant therapy in periods of AA relapse, but it remains unclear whether there are any consistent flare patterns among patients.4Chiang A. Ortenzio F. Juhasz M.L.W. Yu V. Mesinkovska N.A. Balance of tofacitinib efficacy and disease flare in the treatment of alopecia universalis: A case report and review of the literature.JAAD Case Rep. 2018; 4: 733-736Google Scholar We report the characteristics and flare patterns of 21 pediatric and young adult patients with moderate-to-severe AA while on systemic tofacitinib (Table I). The mean consecutive time on tofacitinib was 31 months (range, 12-58 months). Most patients had severe AA with the absence of the majority of scalp hair and some with loss of body hair at the time of tofacitinib initiation. AA flare was defined as an increase in overall severity of alopecia tool (SALT) score by greater than 10%. Provoked flares occurring after tofacitinib dose de-escalation or brief discontinuation (eg, during acute illness) were excluded.Table IDemographics and flare characteristics of patients with alopecia areata on long-term systemic tofacitinibPatient characteristicsTotalPatients21Mean age at tofacitinib initiation, years (range)15.5 (6-20)Sex Male10 Female11Race/Ethnicity White, non-Hispanic15 Asian3 African American1 White, Hispanic1 Unreported1Mean consecutive time on tofacitinib, months (range)31 (12-58)SALT score at tofacitinib initiation 1-250 26-501 51-753 76-995 10012History of atopy No12 Yes9History of additional autoimmune disease No15 Yes6AA flares on tofacitinib Yes8 No13Mean time to AA flare, months (range)13.6 (10-18)Mean increase in SALT score with AA flare (range)35.95 (11-97)Mean duration of severe AA episode prior to tofacitinib, months (range) Flare11.8 (7-27) No flare15.1 (4-72)Mean age at diagnosis with AA, years (range) Flare10.3 (4-14) No flare9.3 (1-16)AA, Alopecia areata; SALT, severity of alopecia tool. Open table in a new tab AA, Alopecia areata; SALT, severity of alopecia tool. Eight patients (38.1%) had an AA flare while on daily tofacitinib therapy. Prior to the flare, patients had successful hair regrowth on tofacitinib with a mean SALT score decrease of 79.1 from initiation. The mean time to flare was 13.6 months (range, 10-18 months; Fig 1). The mean increase in the SALT score during a flare was 35.9 (range, 11-97). No patient had more than 1 flare while on therapy. When comparing the group of patients who flared while on tofacitinib to those who did not, there was no significant difference in the mean duration of the most recent severe AA episode (11.8 and 15.1 months, respectively; P = .62) or mean age at AA diagnosis (10.3 and 9.3 years, respectively; P = .67). In the setting of acute flares, 6 of 8 patients continued taking initial doses of tofacitinib (10 mg/day) and for 2 of 8 patients, the dosage increased (15 mg/day). Five patients were followed up after flare, and each had SALT scores comparable (within 5 or lower) to preflare values within 1-5 months. During flares, 2 of these patients continued tofacitinib monotherapy but with an increased dose, 2 patients were treated with a combination of oral prednisone (3-week taper starting at 60 mg and decreasing by 20 mg weekly) and intralesional Kenalog, and 1 patient was treated with intralesional Kenalog alone (Supplementary Table I available via Mendeley at https://doi.org/10.17632/7k99v7gvkg.1). Most patients tolerated tofacitinib well but several reported side effects, such as increased frequency of mild infections (4 patients) and gastrointestinal upset (3 patients). Systemic Janus kinase inhibitors are a treatment option for children and young adults with AA; however, we found that a subgroup of patients on long-term systemic tofacitinib therapy experienced AA flares during treatment. It is important for patients and families to understand that even if rapid hair regrowth is achieved initially on promising therapeutics like tofacitinib, flares are possible despite consistent therapy, given the waxing and waning nature and complex pathophysiology of AA. Patients should be informed in advance of potential decreased treatment response to tofacitinib and should be prepared to discuss dosage escalation and/or adjuvant therapy during flares in order to minimize hair loss. None disclosed.

Evaluation of serum neurokinin A level in alopecia areata patients

Alopecia areata (AA) is a complex autoimmune condition with increase of some pro-inflammatory mediators. The association of the novel neurokinin A with AA is still unclear. Data concerning other inflammatory diseases suggest a possible role of this neurokinin A in the pathophysiology of AA Aim The aim of this work was to evaluate serum level of neurokinin A in patients with AA and the impact of the AA on dermatological life quality index (DLQI) and depression anxiety stress scale (DASS). Patients and Methods Neurokinin A concentrations were measured in 50 patients with AA and 30 healthy controls using enzyme-linked immunosorbent assay (ELISA). Results The mean serum levels of neurokinin A was higher in patients than controls with significance p value is (<0.001). It was higher in male patients than females with no significance (p= 0.668). It was statistically significant higher in patient with chronic disease (p=0.023). There was statistically significant positive correlation found between serum neurokinin A level and severity of alopecia tool (SALT) score and stress in DASS subscales (as, p= <0.001, p=0.025) respectively Conclusion The mean serum levels of neurokinin A was higher in patients than controls with significance p value. It was statistically significant higher in patient with chronic disease also There was statistically significant positive correlation between serum neurokinin A level and SALT score and stress in DASS subscales.

Alopecia areata treated with topical and systemic brevilin A: A case series.

Alopecia areata (AA) is an autoimmune T CD8 cell mediated condition clinically characterized by hair loss from single or few small patches to complete hair loss. The management of AA is challenging and all available therapies does not ensure a long-term remission. To assess the safety and efficacy of both systemic and topical brevilin A, a natural compound, in AA patients not responding to other treatments. After obtaining informed consent, we administered off-label brevilin A to 13 adult patients affected by AA, for a period ranging from 6 to 18 months. Medical records for each patient and the severity of alopecia tool (SALT) score before and after brevilin A administration were recorded. The mean SALT score of our patients was 81.03 (SD 34.9) at baseline and 75.8 (SD 37.4) after brevilin A therapy, meaning no statistically significant improvement was observed (P = .2385 Paired t test). However, three multifocal AA (MAA) patients out of four attained an improvement (75%) suggesting that brevilin A may be represent an alternative therapy in this form of AA. Authors conclude that brevilin A could represent in the future a possible effective treatment in MAA forms but further studies are required.

Dupilumab therapy for alopecia areata in pediatric patients with concomitant atopic dermatitis

Dupilumab therapy for alopecia areata in pediatric patients with concomitant atopic dermatitis