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Zinc has numerous pharmacological uses in dermatology. Its antioxidant and immunomodulatory properties are thought to correlate with its efficacy in acne vulgaris and leishmaniasis, amongst other cutaneous conditions. We conducted a review of the literature on the use of zinc in dermatology; in particular, we investigated its role in acne vulgaris, hair loss, hidradenitis suppurativa, leishmaniasis, and warts. We searched MEDLINE selecting only articles in English and evaluating the evidence using the Oxford Center of Evidence-Based Medicine 2011 guidance. This review has found evidence to support the use of zinc in patients in infectious conditions (leishmaniasis and warts), inflammatory conditions (acne rosacea, hidradenitis suppurativa) and in hair loss disorders.Ppatients with zinc deficiency should also receive oral supplementation. Further research and large randomized controlled trials are required to investigate the role of zinc as a monotherapy.

Ginseng has gained fame as one of the most popular herbs originating from Eastern countries. Among different species which are known as ginseng, Panax ginseng C. A. Mey. (Korean or Asian ginseng) is the most frequently used one. Ginsenosides have been proposed to account for most of the biological activities of ginseng. The widely appreciated health-promoting effect of ginseng pertains to the beneficial effects of this plant against immune, cardiovascular and sexual diseases and cancer. In addition, there are some new aspects of the pharmacological activity of this plant which justify its use in dermatologic diseases. In dermatology, ginseng has been investigated mechanistically for its therapeutic effects in photoaging, wound and injury, skin cancer, dermatitis, hair loss, alopecia and cold hypersensitivity. Here, we reviewed experimental and clinical studies exploring the therapeutic efficacy of ginseng and ginsenosides in the field of dermatology., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Mitochondria are eukaryotic cellular organelles that function in energy metabolism, ROS production, and programmed cell death. Cutaneous epithelial and hair follicle dermal papilla cells are energy-rich cells that thereby may be affected by mitochondrial dysfunction and DNA mutation accumulation. In this review, we aimed to summarize the medical literature assessing dermatologic conditions and outcomes associated with mitochondrial dysfunction. A search of PubMed and Embase was performed with subsequent handsearching to retrieve additional relevant articles. Mitochondrial DNA (mtDNA) deletions, mutation accumulation, and damage are associated with phenotypic signs of cutaneous aging, hair loss, and impaired wound healing. In addition, several dermatologic conditions are associated with aberrant mitochondrial activity, such as systemic lupus erythematosus, psoriasis, vitiligo, and atopic dermatitis. Mouse model studies have better established causality between mitochondrial damage and dermatologic outcomes, with some depicting reversibility upon restoration of mitochondrial function. Mitochondrial function mediates a variety of dermatologic conditions, and mitochondrial components may be a promising target for therapeutic strategies.

Central centrifugal cicatricial alopecia (CCCA) nomenclature describes a typical clinical presentation of cicatricial hair loss that begins on the vertex scalp with progressive, symmetric, and centrifugal evolution. However, atypical presentations have been noted clinically by the authors and reported in the literature. We sought to characterize the distribution of hair loss in published cases of adult patients with CCCA. A 3-step search process was used to evaluate research articles in Cumulative Index to Nursing & Allied Health, EMBASE, Google Scholar, MEDLINE, Scopus, and Web of Science databases. Studies with scalp photography or description of hair loss distribution were included. Three researchers evaluated eligible studies for clinical subtypes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was used to report results. Ninety-nine studies consisting of 281 cases of CCCA were included. Hair loss distributions included variants of the classic presentation along with distinct subtypes such as patchy, occipital, parietal, frontal, temporal, and trichorrhexis. Studies had significant homogeneity, as the classic distribution of CCCA was commonly reported. Additionally, clinically diagnosed cases may have concurrent diagnoses, and numerous studies did not report trichoscopy findings. CCCA terminology may not always be reflective of clinical presentation. Understanding atypical presentations is essential to inform appropriate and targeted treatment. [ABSTRACT FROM AUTHOR]

Abstract Background The Severity of Alopecia Tool (SALT) is a clinician‐reported outcome measure of scalp hair loss in alopecia areata (AA). Objectives To characterise the magnitudes of change in SALT scores corresponding to meaningful treatment benefits from the patient's perspective. Methods Anchor‐based methods for the estimation of meaningful within‐patient change thresholds were applied to pooled data from a randomised, double‐blind trial of ritlecitinib. Anchors included a patient‐reported measure of change in AA severity, the Patient Global Impression of Change (PGI‐C) and three items comprising the Patient Satisfaction with Hair Growth (P‐Sat) questionnaire. After reviewing Pearson correlations between change‐from‐baseline SALT scores and each anchor to confirm adequate association, potential thresholds were computed as mean change‐from‐baseline SALT scores among patients who reported moderate improvement on the PGI‐C and/or moderate satisfaction on each of three P‐Sat items at week 24. Results Six hundred and fifty participants (86% adults, 14% adolescents) had mean (standard deviation) SALT scores of 90.6 (14.3) at baseline, suggesting a sample with primarily severe AA. Correlations between SALT change‐from‐baseline scores and the patient‐reported items supported their use as anchors. Estimates based on patients reporting moderate improvement in AA (n = 102) on the PGI‐C and those reporting moderate satisfaction on the P‐Sat item related to the amount of hair growth at week 24 (n = 122) were −42.2 (26.1) and −43.1 (26.8), respectively. Supportive estimates based on the remaining P‐Sat items were similar in magnitude. Conclusions Among patients with severe AA, SALT change‐from‐baseline scores of 42 or 43 represent meaningful improvements. While the achievement of low SALT scores of ≤10–≤20 have been used to characterise efficacy in clinical trials, the amount of change required to meet this endpoint far exceeds the estimates in this study. The treatment goals of individual patients must be considered when evaluating benefit in both clinical trials and clinical practice.

Background: Hair loss can occur in pediatric and adult populations and may have different patterns. The causes of hair loss in pediatric patients include tinea capitis, alopecia areata, telogen effluvium, traction alopecia, anagen effluvium, androgenetic alopecia, loose anagen syndrome, short anagen syndrome, congenital aplasia cutis, congenital triangular alopecia, atrichia congenita, congenital hypotrichosis, and transient neonatal hair loss.Purpose: to understand etiologies of hair loss in pediatrics, and to determine the appropriate examinations for diagnosing and managing hair loss in children.Review: Hair loss in children can be categorized as congenital or acquired. Congenital hair loss is classified based on distribution, while acquired hair loss is classified as either scarring or non-scarring. Hair loss complications in children can be irreversible. The diagnosis of hair loss in pediatric patients includes anamnesis, physical examination, and supporting examinations. The supporting examinations used for diagnosis include fungal cultures, hair pull tests, hair tug tests, light microscopy, and trichoscopy. Conclusion: There are numerous causes of hair loss in pediatric patients that need to be identified before appropriate management can be implemented. The management of hair loss requires a holistic approach, including psychosocial support. Correct diagnosis and treatment of pediatric hair loss can prevent a decrease in the patient's quality of life.

Abstract The minimal adverse-effect profile and positive clinical response of low-dose oral minoxidil (LDOM) have recently caused the drug to gain popularity for the treatment of hair disorders in adults. However, in the pediatric population, hesitancy still surrounds the use of oral minoxidil given the wide profile of potential side effects the drug offers. This review aims to characterize the safety and use of oral minoxidil in children for the treatment of all disorders to equip physicians with ample knowledge when prescribing oral minoxidil in the pediatric population. A total of 41 studies (19 case reports, 10 cohort studies, 7 retrospective chart reviews, and 5 case series) that reported data on 442 pediatric patients for whom oral minoxidil was used for treatment were included. Conditions for which treatment with minoxidil was described were hair disorders (83.9%, 371/442) and hypertension (11.3%, 50/442); accidental usage (4.8%, 21/442) was also noted in the literature and included in this review. This review is broken down by dosage and describes the safety and efficacy of oral minoxidil in pediatric patients aged 0 to 18 years old for the treatment of hair disorders. This review found that LDOM may represent a safe option for the treatment of hair disorders in children. This study also suggests moderate and high doses of oral minoxidil may not be safe for use in children. Additional studies are needed to further understand this drug’s efficacy and safety in children.

Abstract Introduction Recent advancements in androgenetic alopecia (AGA) treatment have highlighted the efficacy of botulinum toxin (BoNT). However, inconsistencies in injection sites and depths warrant attention. It remains unclear which injection strategy is most beneficial for patients. Methods This split-scalp randomized controlled trial divided each enrolled participant’s scalp along the midline: one side was randomized to receive intramuscular BoNT injections in the surrounding muscles, while the other side received intradermal BoNT injections directly into the balding areas. This study evaluated the impact of treatment on hair density and diameter through trichoscopic examinations conducted at baseline and 12 weeks post treatment. Additionally, assessments of pain and overall safety were integrated into the study protocol. Results Twenty-nine patients completed the study, with significant improvements in hair density observed in the intramuscular injection group compared to the intradermal group (p

Abstract Background The Severity of Alopecia Tool (SALT) is a standardized method for quantifying scalp hair loss in alopecia areata (AA). SALT scores can be used to guide treatment decisions and are widely used as eligibility criteria and endpoints for clinical trials in AA. However, clinicians may be unfamiliar with assessing and envisioning SALT scores in practice. Objectives To aid clinicians in the determination and application of SALT scores in a clinical setting, this manuscript seeks to contextualize SALT scores using patient images from a clinical trial of adults with severe AA. Methods Images from 722 patients enrolled in BRAVE‐AA1, a phase 2/3 study of baricitinib in adults with severe AA (SALT score ≥50; ≥50% scalp hair loss), were obtained at baseline and Weeks 12, 36, and 52 and compiled into a repository. Photographs were selected to represent SALT scores across the full range of disease (SALT scores 0–100) and to demonstrate the progression of SALT scores during the course of treatment. Results Images of six patients depict the range of SALT scores (0–100). Photographs are of male and female patients of different ages (21–69) and races (Asian, Black, White) with varying extent, density, and patterns of hair loss. Images of two additional patients demonstrate the use of SALT to monitor treatment progress, showing distinct patterns and timing of clinical response over 52 weeks of therapy. Conclusions The SALT is widely used in clinical trials for AA, but clinicians may lack familiarity. Presented patient images show SALT scores commonly used as eligibility criteria and endpoints in clinical trials, which may be useful in identifying patients eligible for systemic treatment and in visualizing therapeutic response.

Background: Low dose oral minoxidil (LDOM) is a preferred treatment for alopecia due to ease of use and efficacy. While LDOM is typically well tolerated, patients may experience a temporary increase in hair shedding starting treatment, colloquially regarded as “dread shed”. One proposed method to combat this is to overlap therapies by maintaining use of topical minoxidil when initiating LDOM. Objective: To evaluate the impact of maintaining topical minoxidil when initiating LDOM on “dread shed”. Methods: We performed a retrospective chart review of patients seen at New York University Langone Health Dermatology from January 1, 2008 to August 1, 2023 prescribed LDOM. Results: A total of 115 patients met inclusion criteria, of whom 37 maintained use of topical minoxidil when initiating LDOM. Six patients experienced “dread shed” when initiating LDOM, 2 of whom overlapped therapies. We did not find that overlapping therapies had a significant impact on decreasing rates of “dread shed”. Limitations: Limitations include retrospective design, sample size, and subjective patient-reported assessment of hair shedding. Conclusions: A total of 5.2% of patients experienced dread shed, which is lower than previously reported in literature. Maintaining topical minoxidil during LDOM initiation does not significantly impact “dread shed”. This remains a significant side effect deserving of further research.

There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. In round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in round 2. After the final round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. This study included only English-speaking, US-based dermatologists and did not consider nonpharmacological therapies. Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA. [ABSTRACT FROM AUTHOR]

Abstract Introduction Androgenetic alopecia (AGA) is a prevalent, multifactorial form of hair loss involving complex aetiological factors, such as altered androgen regulation and energy metabolism. Existing treatments offer limited success, thus highlighting the need for advanced, personalised therapeutic strategies. This study focuses on correlating the genetic mechanisms of AGA with molecular targets involved in the response to current treatment modalities. Methods An anonymised database including 26,607 patients was subjected to analysis. The dataset included information on patients’ genotypes in 26 single nucleotide polymorphisms (SNPs), specifically, and diagnosed AGA grades, representing a broad range of ethnic backgrounds. Results In our sample, 64.6% of males and 35.4% of females were diagnosed with female pattern hair loss. This distribution aligns well with prior studies, thus validating the representativeness of our dataset. AGA grading was classified using the Hamilton–Norwood and Ludwig scales, although no association was found to the grade of the disease. SNP association analysis revealed eight SNPs, namely rs13283456 (PTGES2), rs523349 (SRD5A2), rs1800012 (COL1A1), rs4343 (ACE), rs10782665 (PTGFR), rs533116 (PTGDR2), rs12724719 (CRABP2) and rs545659 (PTGDR2), to be statistically significant with a p-value below 0.05. Conclusions The study establishes a preliminary association between eight specific SNPs and AGA. These genetic markers offer insights into the variability of therapeutic responses, thus underlining the importance of personalised treatment approaches. Our findings show the potential for more targeted research to understand these SNPs’ and further roles in AGA pathophysiology and in modulating treatment response.

Background: Hair loss is the one of the most common complaints in dermatologic patients. The proper cause of female pattern hair loss is still unclear. Many studies have been done on the individual patterns of hair loss but there are very few studies available about the different clinical patterns of hair loss in females in a single study. Objectives: To evaluate the clinical patterns of hair loss in females which manifest in various disorders. Materials and Methods: 120 subjects were studied in a hospital based descriptive study with detailed history, general physical examination, detailed hair, scalp, cutaneous examination, clinical tests, routine haematological investigations, biopsy where indicated. Results: Maximum subjects were in the age group of 20 – 40 years (66.6%). Majority of the subjects presented with a diffuse hair loss (55.8%). In our study although majority of the cases were not associated with any illness (52.5%),among the ones associated with illness the most common associated illness was history of COVID-19 (25.8%).Very few presented with scarring hair loss (5%). Conclusion: Telogen Effluvium was the most common cause of hair loss with maximum prevalence among females aged 20 to 40 years, with majority having hair loss over a period of 6 weeks to 6 month without any concurrent illness. The findings of this study provide baseline information on common clinical presentation of hair loss among women in our setting, thus helping in early clinical diagnosis and planning appropriate treatment.

Proteomic profiling on other primary cicatricial alopecias, such as frontal fibrosing alopecia and lichen planopilaris, have suggested a T helper 1–mediated inflammatory pathway, but in central centrifugal cicatricial alopecia (CCCA), the protein expression patterns are unknown. In this study, we sought to characterize protein expression patterns in CCCA to identify biomarkers of disease activity that will identify potential therapeutic avenues for treatment. Scalp protein quantification was performed to understand protein expression patterns in affected versus unaffected scalps in CCCA. A total of 5444 proteins were identified, of which 148 proteins were found to be differentially expressed in CCCA-affected scalp, with upregulation of adaptive immune pathways (IGHG3, P = .034; IGHG4, P = .01; IGG1, P = .026) and markers of fibrosis (ITGA1, P = .016; SFRP2, P = .045; TPM2, P = .029; SLMAP, P = .016) and downregulation of metabolic proteins (ALOX15B, P = .003; FADS2, P = .006; ELOVL5, P = .007; FA2H, P = .017; FAR2, P = .011; SC5D, P < .001). Our analysis revealed, to our knowledge, previously unknown humoral immune canonical pathways, notably IgG, implicated in CCCA and additionally confirmed aberrant lipid metabolism pathways implicated in diabetes mellitus, suggesting unique mechanisms of disease in patients with CCCA.

Nowadays androgenetic alopecia (AGA) has become a common concern of affected subjects of both sexes. Finasteride is approved by the Food and Drug Administration for the treatment of male AGA. There is no clear evidence to support the use of dutasteride in male AGA. In female AGA, the effectiveness of dutasteride and finasteride is still under debate, and there is no clear evidence to use any of them in female AGA. A systematic review was conducted to compare between dutasteride and finasteride in treating both male and female AGA, and their efficacy, safety, side effects with effective dosage. The review was done using several databases including: PubMed, Ovid Medline, Google Scholar, and Cochrane using the following search terms/keywords: "Dutasteride" AND "Finasteride" AND "Male pattern hair loss" AND "Female pattern hair loss" AND "Efficacy", "Tolerability" AND "Side effects" AND "Comparison". To search for articles related to efficacy, tolerability, side effects, used doses of dutasteride and finasteride in the treatment of male and female AGA. The review encompassed a total of nine studies. Four randomized controlled trials, one single-arm trial, two prospective cohorts, and two retrospective cohort studies. Seven studies exclusively enrolled male participants, while only two included female participants. All groups receiving various doses of dutasteride and finasteride exhibited a significant increase in hair count compared to the placebo group. Notably, dutasteride (0.5 mg) and dutasteride (2.5 mg) were significantly more effective than finasteride (1 mg) in increasing hair counts. Furthermore, no significant difference in adverse events was observed between finasteride and dutasteride. Dutasteride is more potent than finasteride in treating AGA in both males and females. All the adverse events between finasteride and dutasteride were comparable.

Heggar Venkataramana Sudeep,1 Sriram Rashmi,2 Thomas V Jestin,3 Aleksander Richards,4 Kuluvar Gouthamchandra,1 Kodimule Shyamprasad1 1Department of Biomedicinal Research, R&D Center for Excellence, Vidya Herbs Pvt Ltd, Bangalore, Karnataka, India; 2BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India; 3Department of Clinical Research, Leads Clinical Research and Bio Services Private Ltd, Bangalore, Karnataka, India; 4Department of Clinical Studies, R&D, Vidya Herbs, Red Bank New Jersey USACorrespondence: Heggar Venkataramana Sudeep, Department of Biomedicinal Research, R&D Center for Excellence, Vidya Herbs Pvt Ltd, Bangalore, Karnataka, India, Email research@vidyaherbs.com; sudeepkashyap.82@gmail.comPurpose: Androgenetic alopecia (AGA) is the most common type of hair loss in humans, affecting self-esteem and emotional well-being. This study aimed to assess the safety and efficacy of VISPOTM, a standardized saw palmetto oil (2– 3% β-sitosterol), in subjects with mild-to-moderate AGA.Methods: In a double-blind, placebo-controlled, four-arm clinical study, 80 healthy male and female subjects aged 18– 50 years were randomly allocated (1:1:1:1) to receive either 400 mg capsules of VISPO or 5 mL of a topical formulation containing 20% VISPO or the respective placebo once daily for 16 weeks. The primary endpoints included hair count (hair comb and hair pull tests) and the self-assessment of perceived efficacy. Objective evaluation was performed using the global photographic assessment score. Hair density, thickness, and anagen/telogen ratio were evaluated using phototrichogram analysis.Results: At the end of the study, oral and topical formulations of VISPO reduced hair fall by up to 29% (p< 0.001) and 22.19% (p< 0.01) from the baseline, respectively. Hair density increased by 5.17% and 7.61% in the oral and topical VISPO groups, respectively (p< 0.001). In addition, oral ingestion of VISPO resulted in a marked reduction in serum dihydrotestosterone (DHT) levels in the subjects compared to placebo (p< 0.001). However, the effect of the VISPO formulations on the anagen/telogen ratio was insignificant. No serious adverse effects were observed during the study.Conclusion: VISPO formulations reduced hair fall and promoted hair regrowth and scalp appearance in AGA patients.Keywords: hair loss, androgenetic alopecia, saw palmetto, β-sitosterol, fatty acids

Chen Ji,1 Jun Ma,2 Chengcheng Feng,1 Hongliu Zhu,3 Yanwei Gao,1 Jun Huang,1 Hui Shen,1 Yuegang Wei4 1Department of Dermatology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, People’s Republic of China; 2Department of Dermatology, the Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, People’s Republic of China; 3Department of Dermatology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, People’s Republic of China; 4First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of ChinaCorrespondence: Hui Shen, Department of Dermatology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 4 Kangle Street, Suzhou, Jiangsu Province, 215600, People’s Republic of China, Email zjgzy046@njucm.edu.cn Yuegang Wei, First College of Clinical Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu Province, 210023, People’s Republic of China, Email weiyuegang@163.comPurpose: Supplemented Erzhi Wan (SEZW) is a Traditional Chinese Medicine commonly used in the treatment of androgenetic alopecia (AGA). This study aims to verify the effectiveness of SEZW for the treatment of AGA in mice and explore the potential molecular mechanisms underlying its function using network pharmacology and molecular docking.Methods: Forty mice were divided into five groups: Control, AGA-model, AGA-Positive, SEZW Low Dose, and SEZW High Dose. Hair regrowth in mice was evaluated by scoring hair on days 0, 14, and 28 post-treatment and weighing mouse hair on day 28 post-treatment. The targets of the active compounds of SEZW were obtained using the Traditional Chinese Medicine Database. AGA-related targets were downloaded from five databases. Then, the overlapping genes were identified. A protein-protein interaction network was constructed using the STRING database. Hub targets were determined through analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. Finally, molecular docking of active compounds and hub targets was performed.Results: Hair regrowth in mice in the SEZW treatment groups was significantly enhanced relative to that in the AGA-model mice. A total of 59 potential drug-disease targets were identified. Based on the GO/KEGG analysis results, oxidative stress and gland development were identified as potential mechanisms of action of SEZW in AGA treatment. The PI3K-Akt and AGE-RAGE signaling pathways and seven hub targets were identified as the potential underlying mechanism of SEZW function. Molecular docking results showed that the most active SEZW compounds bind stably to several of the candidate disease targets.Conclusion: SEZW is effective in the treatment of AGA in a mouse model. Combined with network pharmacological analysis, the potential mechanisms, signaling pathways, and hub targets of SEZW in the treatment of AGA were identified, providing new ideas for further studies.Keywords: Chinese herbal formulas, hair loss, hair regeneration, mechanism prediction

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia seen primarily in women of African descent but rarely reported in men. The etiology of CCCA is unknown, but genetic variants, type 2 diabetes mellitus, and bacterial infections may play a role. We aimed to characterize the demographics, medical histories, and clinical findings of male patients with CCCA with the hypothesis that features may differ from women. This was a case series of adult male patients with biopsy-confirmed CCCA seen at an academic dermatology department between 2012 and 2022. In total, 17 males had a scalp biopsy and clinical findings consistent with CCCA. The average age was 43 years, and 88.2% of cases identified as Black race. Scalp pruritus was the most common symptom, and few patients endorsed high-risk hair care practices. None of the cases had diagnosis of type 2 diabetes mellitus, but 17.6% had history of latent tuberculosis, and 47.1% had a positive family history of alopecia. We observed 8 patients with atypical CCCA, and 29.4% had an overlapping scalp diagnosis. This study is limited by the single center, retrospective design and small sample size. It is important to consider CCCA in the differential diagnosis of alopecia in adult Black males. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Although trichoscopy has been used successfully in the diagnosis of androgenetic alopecia (AGA), its utility in monitoring the therapeutic outcome is not clear. Objectives: To investigate the value of trichoscopy in the follow-up of treatment response in patients with AGA. Methods: Ninety-five patients with AGA were included. Trichoscopic images were obtained on a 1 cm2 circular area in the left frontoparietal scalp pre- and post-treatment in all and in 61 patients, respectively. Two doctors evaluated those images who are less experienced (doctor A) and experienced (doctor B) in hair diseases and trichoscopy. Terminal, vellus and total hair count (THC, VHC, ToHC) and terminal to vellus hair (T/V) ratio were determined. These numerical data were also calculated by TrichoScan analysis of the same area. The agreement between trichoscopy and TrichoScan data was assessed. Results: The agreement between doctor A and TrichoScan was moderate for THC and ToHC pre-treatment and good post-treatment; poor for VHC and T/V ratio pre- and post-treatment. The agreement between doctor B and TrichoScan was excellent for THC, VHC and ToHC; good for T/V ratio pre- and post-treatment. Conclusions: Trichoscopy, when performed by a doctor experienced in hair diseases and trichoscopy, can be used as a sensitive method in monitoring the treatment response in patients with AGA which is based on the determination of THC, VHC, ToHC and T/V ratio. If it is to be performed by a less experienced doctor, it can be preferred as a sensitive follow-up method using THC and ToHC.

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Abstract Introduction Ritlecitinib demonstrated efficacy in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study (NCT03732807). However, hair loss presentation may vary based on location (e.g., scalp, eyebrow/eyelash, body). Here, we sought to identify distinct hair loss profiles at baseline and evaluate whether they affected the efficacy of ritlecitinib. Methods Patients with AA aged ≥ 12 years with ≥ 50% scalp hair loss were randomized to daily ritlecitinib 10 mg (assessed for dose ranging only), 30 or 50 mg (± 4-week, 200-mg loading dose), or placebo for 24 weeks. Latent class analysis (LCA) identified hair loss profiles based on four baseline measurements: clinician-reported extent of scalp (Severity of Alopecia Tool score), eyebrow hair loss, eyelash hair loss, and patient-reported body hair loss. Logistic regression evaluated ritlecitinib (50 and 30 mg) efficacy vs placebo using Patient Global Impression of Change (PGI-C) and Patient Satisfaction with Hair Growth (P-Sat; amount, quality, and overall satisfaction) responses at Week 24, adjusting for key covariates, including latent class membership. Results LCA identified five latent classes: (1) primarily non–alopecia totalis (AT; complete loss of scalp hair); (2) non-AT with moderate non-scalp involvement; (3) extensive scalp, eyebrow, and eyelash involvement; (4) AT with moderate non-scalp involvement; and (5) primarily alopecia universalis (complete scalp, face, and body hair loss). Adjusting for latent class membership, patients receiving ritlecitinib 30 or 50 mg were significantly more likely to achieve PGI-C response (30 mg: odds ratio, 8.62 [95% confidence interval, 4.42–18.08]; 50 mg: 12.29 [6.29–25.85]) and P-Sat quality of hair regrowth (30 mg: 6.71 [3.53–13.51]; 50 mg: 8.17 [4.30–16.46]) vs placebo at Week 24. Results were similar for P-Sat overall satisfaction and amount of hair regrowth. Conclusion Distinct and clinically relevant hair loss profiles were identified in ALLEGRO-2b/3 participants. Ritlecitinib was efficacious compared with placebo, independent of hair loss profile at baseline. Trial registration ClinicalTrials.gov identifier, NCT03732807. Graphical abstract

Abstract Background Numerous studies have indicated that alopecia areata is associated with a chronic systemic inflammation, which is considered as a risk factor for venous thromboembolism. The aim of the study was to evaluate the following markers of venous thromboembolism risk: soluble fibrin monomer complex (SFMC), thrombin–antithrombin complex (TATC), and prothrombin fragment 1 + 2 (F1 + 2) in patients with alopecia areata and compare them with healthy controls. Methods In total, 51 patients with alopecia areata [35 women and 16 men; mean age: 38 (19–54) years] and 26 controls [18 women and 8 men; mean age: 37 (29–51) years] were enrolled in the study. The serum concentrations of thromboembolism markers were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results An increased level of SFMC was detected in patients with alopecia areata compared with the controls [25.66 (20–34.86) versus 21.46 (15.38–29.48) µg/ml; p

Abstract Background Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life. Aims and Findings AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.

Background: Alopecia areata (AA) is a disease of hair loss with multiple treatment options. Physicians play an important role in guiding patients during the decision-making process. Objective: Assess physicians’ values and attitudes when helping patients choose an AA treatment. Methods: Semi-structured qualitative interviews were conducted with dermatologists of varying practice type and location. Each interview was coded independently twice using inductive thematic analysis. Interrater reliability and code frequencies were determined. Results: Fourteen participants were interviewed. Interrater reliability was κ = 0.85 to 0.97. Dermatologists wanted patients to consider various treatment factors (ie, efficacy, safety, convenience of use, accessibility) and also assessed patients’ AA clinical severity and personality traits. Participants often encountered various barriers to effective communication with patients, which may be mitigated by shared decision-making. Shared decision-making tools were perceived to potentially improve patient care and communication, although physicians expressed concern about lack of individualization, limitations of time, and the appropriateness of information. Conclusion: AA treatment decision-making is a complex process that often utilizes the expertise of a dermatologist, during which shared decision-making tools may be of value to both patients and physicians.

Finn Abeck,1 Inga Hansen,1 Isabell Wiesenhütter,2 Florian Schröder,3 Julian Kött,1 Stefan W Schneider,1 Johannes von Büren3 1Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Munich University Institute for Psychotherapy Training (MUNIP), Munich, Germany; 3Wellster Healthtech Group, Munich, GermanyCorrespondence: Finn Abeck, University Medical Center Hamburg-Eppendorf, Department of Dermatology and Venereology, Martinistrasse 52, W14, Hamburg, D-20246, Germany, Email finn.abeck@uke.dePurpose: The number of online prescription platforms (OPPs) offering telemedical diagnosis and treatment, including finasteride, for androgenetic alopecia (AA) by using medical questionnaires (MQs) has increased. This type of care delivery differs completely from traditional forms. This study aimed to investigate a potential paradigm shift in AA treatment by measuring the extent of traffic generated by OPPs that exclusively treat AA and furthermore by characterizing sociodemographic features of men undergoing finasteride treatment from an OPP in Germany.Patients and Methods: Examination of three OPPs (Keeps, Shapiro MD, Myspring), offering finasteride treatment via MQ between Q1 2018 and Q1 2022 was performed by using SEMRush, a marketing software platform for traffic analysis. Further data regarding sociodemographic characteristics were collected from Myspring by recruiting men with AA who obtained finasteride prescriptions between March 2021 and January 2022.Results: A high number of unique quarterly visitors was recorded. The number of visitors increased on all platforms (Keeps 846%, Shapiro MD 109%, Myspring 427%). Most patients had accessed the platforms from mobile devices. Further data from Myspring included a total of 2904 men. Of all patients who answered the follow-up questionnaire (n = 177), 33.9% had been referred to the platform by television advertising. Of all respondents, 21.5% reported a monthly net income below 1000 euros. 45.2% of responding patients reported being single, while 15.3% considered themselves homosexual, and 4.5% bisexual. Convenience was the most common reason indicated for using an OPP (79.1%).Conclusion: The tremendous increase in the number of visits to OPPs for AA suggests a paradigm shift in medical care, particularly regarding MQ-based finasteride treatment. Sociodemographic data and reasons for platform use suggest that the shift away from traditional care models may increase in the future. The broad use of these digital health services warrants further investigation, particularly regarding patient safety.Keywords: androgenetic alopecia, hair loss, finasteride, telemedicine, teledermatology, online prescription platform

Yujing Zhang, Jianzhong Zhang, Cheng Zhou Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of ChinaCorrespondence: Cheng Zhou, Department of Dermatology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, People’s Republic of China, Tel +86-10-88325472, Fax +86 10-68318386, Email chengzhou@live.cnAbstract: Perinevoid alopecia (PA) is a rare variant of alopecia areata (AA) associated with a central pigmented nevus. In this study, we reported two cases of PA and reviewed 14 cases from 11 studies in the literature. In one of our cases, PA was combined with a halo nevus and white terminal hairs were spared in the hair loss patch, which was rarely reported in the literature. It is implicated that antigens from melanocytes might be involved in the development of AA in PA.Keywords: alopecia areata, hair loss, nevus, halo nevus

Platelet-rich plasma (PRP) offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well-understood. Our objective is to review the use and effectiveness of PRP for dermatologic conditions. A literature search was performed through PubMed and yielded 54 articles published between January 2000 and November 2021; articles written in English were reviewed. Intradermal injections were associated with increased hair density in androgenic alopecia. Successful treatment of inflammatory nail diseases with PRP has been reported. Improvement in psoriasis was described, but only two studies were available. PRP was associated with higher patient self-assessment scores of photoaging and fine lines. Treatment with PRP in melasma has been associated with improved subjective satisfaction, but not with objective measures of disease improvement. PRP can serve as a safe and potentially effective adjunct for hair loss, vitiligo, nonhealing wounds, photoaging, and acne scars. An important barrier to interpreting PRP research is lack of standardization of PRP preparation protocols, inconsistent clinical endpoints, and frequent combination treatments. However, PRP is relatively noninvasive, has a well-established safety profile, and patient satisfaction is often high as patients perceive great benefit from treatment with PRP.

Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). Inability to determine causation and limited generalizability. TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) is a common hair loss condition that impacts both men and women. Age and genetic susceptibility are recognized as potential risk factors for developing AGA. The second to fourth digit ratio is a measurement of the length ratios between the index and ring fingers. This ratio has been utilized as a predictor for multiple hyperandrogenism-related medical conditions. More recently, the 2D:4D ratio was investigated as a predictor for AGA. This article will examine the evidence supporting this relationship, discuss its diagnostic implications, and identify potential areas for future research.

Background: Severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) was responsible for coronavirus disease (COVID-19) pandemic. As patients recovered from COVID-19 infection, hair loss was increasingly observed as a distressing symptom. Methods: This was a prospective cross-sectional study of patients with post COVID-19 hair loss between July to December 2021 at a tertiary care centre. Detailed history, clinical examination, trichoscopy and biochemical tests were performed and recorded. COVID-19 disease severity was assessed based on duration of COVID-19 infection and place of management. Results: The study included 120 patients with mean age being 39.6 years. Majority of the patients were females, treated at home and had COVID-19 infection for >2 weeks. Mean visual analog scale (VAS) score for stress was 5.25. Vitamin D deficiency was present in 56.7% and low ferritin in 30% of cases. Mean time of onset of hair loss post COVID-19 was 49 days. Patients mainly presented with diffuse hair loss. Trichodynia was present in 15.8% of cases. The degree of hair loss was severe in 55.8% of the subjects. Positive hair pull test was seen in 65% of patients. Most common trichoscopic features included single hair follicles’ (81.7%) and vellus hair >10% (60%). Conclusions: The mean time of onset of hair loss post COVID-19 infection was less than 2 months. Majority patients had diffuse pattern and severe degree of hair loss. Trichoscopy can aid in unmasking co-existing patterned hair loss in patients presenting clinically with diffuse hair loss.

Background: Alopecia areata (AA) is a disease of hair loss in which patients may benefit from comprehensive understanding of AA’s disease process and therapeutic options during treatment decision-making. Objective: Determine factors influencing patients’ AA treatment decision-making. Methods: Qualitative interviews were conducted using semi-structured interview guides. Interviews were coded using inductive thematic analysis. Results: Twenty-one participants with AA were interviewed. Coding interrater reliability was κ = 0.87-0.91, indicating strong-almost perfect agreement. Participants faced multiple barriers, including lack of access to health care (n = 10, 47.6%) and lack of transparency about their condition and treatment options (n = 9, 42.9%). Information about AA was sought from primarily the internet (n = 15, 71.4%) and physician recommendation (n = 15, 71.4%). When choosing AA treatments, patients often considered treatment efficacy (n = 21, 100%), safety (n = 21, 100%), and convenience of use (n = 20, 95.2%). Limitations: Referral and regional biases may be present and limit generalizability. Conclusions: Patients with AA face various challenges including medical uncertainty and lack of information. Patients need trustworthy and accessible sources of information regarding their treatment that also take into consideration their preferences and values.

Mitochondria are eukaryotic cellular organelles that function in energy metabolism, ROS production, and programmed cell death. Cutaneous epithelial and hair follicle dermal papilla cells are energy-rich cells that thereby may be affected by mitochondrial dysfunction and DNA mutation accumulation. In this review, we aimed to summarize the medical literature assessing dermatologic conditions and outcomes associated with mitochondrial dysfunction. A search of PubMed and Embase was performed with subsequent handsearching to retrieve additional relevant articles. Mitochondrial DNA (mtDNA) deletions, mutation accumulation, and damage are associated with phenotypic signs of cutaneous aging, hair loss, and impaired wound healing. In addition, several dermatologic conditions are associated with aberrant mitochondrial activity, such as systemic lupus erythematosus, psoriasis, vitiligo, and atopic dermatitis. Mouse model studies have better established causality between mitochondrial damage and dermatologic outcomes, with some depicting reversibility upon restoration of mitochondrial function. Mitochondrial function mediates a variety of dermatologic conditions, and mitochondrial components may be a promising target for therapeutic strategies.