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Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024. Published by Elsevier Inc.)

The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice., (Copyright © 2023 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

As systemic administration of Janus kinase-inhibitors is associated with safety concerns, local alternatives, such as topical ruxolitinib, have been developed. This review summarizes utilization of topical ruxolitinib in dermatology. A literature search was performed of studies reporting topical use of ruxolitinib in dermatologic conditions. Twenty-four articles were included, representing 2618 patients. Results show improvement with topical ruxolitinib formulations in atopic dermatitis, vitiligo, psoriasis, and lichen planus. Results are conflicting in alopecia areata. Minimal bioavailability and low rates of mild-to-moderate treatment-related adverse events support a favorable safety profile and higher tolerability of topical ruxolitinib compared to oral Janus kinase-inhibitors., Competing Interests: Nadia Kashetsky reports no conflicts of interest. Irina Turchin was a consultant, speaker and/or investigator for AbbVie, Amgen, Arcutis, Aristea, Bausch Health, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, Incyte, Janssen, Kiniksa, Leo Pharma, Novartis, Pfizer, Sanofi, UCB.

Introduction: Numerous cutaneous dermatoses mediated by cytokines depend on the JAK STAT pathway for intracellular signaling. JAK inhibitors form a useful therapeutic approach in treating these conditions. The literature on effectiveness of JAK inhibitors in treatment of alopecia areata, vitiligo, atopic dermatitis, psoriasis and several other inflammatory and autoimmune diseases is growing although very few conditions have sufficiently well performed studies to their credit and, barring a few indications, their use in rest remains empirical as yet., Areas Covered: A search of the PubMed database was made using the keywords Janus kinase inhibitors OR JAK inhibitors AND dermatology with the time duration limited to the last 5 years. Here, we review the JAK STAT pathway, the various conditions in which JAK inhibitors are currently used in dermatology, and other conditions their use is being explored in., Expert Opinion: The pathology of a large number of dermatological disorders is mediated via inflammatory cytokines which signal via the JAK STAT pathway. JAKinibs have shown great promise in treating cutaneous disorders refractory to conventional therapy. Their current clinical use in dermatology is based on robust evidence (for some), and anecdotal evidence for most other dermatoses.

Background/objectives: Patient and caregiver perspectives are critical in understanding dermatologic disease impact, presentation, and management in children. The Pediatric Dermatology Research Alliance (PeDRA) Patient Advisory Committee (PtAC), a group of patient representatives and parents of children with cutaneous disease, pursued a multistep, iterative, consensus-building process to identify comprehensive, high-priority research needs., Methods: Building on discussions at the 2020 PeDRA Annual Conference, a research prioritization survey was developed and completed by PtAC members. Survey themes were aggregated and workshopped by the PtAC through a series of facilitated calls. Emerging priorities were refined in collaboration with additional PeDRA patient community members at the 2021 PeDRA Annual Conference. Subsequently, a final actionable list was agreed upon., Results: Fourteen PtAC members (86.7% female) representing patients with alopecia areata, atopic dermatitis, vascular birthmarks, congenital melanocytic nevi, ectodermal dysplasias, epidermolysis bullosa, Gorlin syndrome, hidradenitis suppurativa, ichthyosis, pemphigus, psoriasis, Sturge-Weber syndrome, and pachyonychia congenita completed the survey. Following serial PtAC meetings, 60 research needs were identified from five domains: psychosocial challenges, health care navigation/disease management, causes/triggers, treatments to preserve or save life, and treatments to preserve or save quality of life., Conclusions: Many pediatric dermatology research priorities align across affected communities and may drive meaningful, patient-centric initiatives and investigations., (© 2022 The Authors. Pediatric Dermatology published by Wiley Periodicals LLC.)

Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient., (© 2022. © Eli Lilly and Company.)

Background: International Dermatology Outcome Measures (IDEOM) is a non-profit organization founded in 2013. It is composed of researchers and stakeholders who work to develop evidenced-based outcome measures to enhance research and treatment recommendations of dermatologic diseases., Summary: The 2021 IDEOM Virtual Annual Meeting occurred from November 19-20, 2021. Contributions were made by leaders and stakeholders from the psoriasis, psoriatic arthritis, pediatric hidradenitis suppurativa, acne, vitiligo, actinic keratosis, alopecia areata, itch, and cutaneous lymphoma workgroups. The psoriasis, psoriatic arthritis, and actinic keratosis workgroups provided an overview of their respective instruments for treatment satisfaction and symptom measurement. The inaugural meetings of the itch, alopecia areata, and cutaneous lymphoma workgroups identified unmet needs of their respective diseases and future goals. The acne, vitiligo, and pediatric hidradenitis suppurativa workgroups discussed concerns of quality of life, instruments for symptom measurement, and screening tools. Additionally, a representative from the US Food and Drug Administration was in attendance and presented an update on topical drugs and generics. This report provides a summary of workgroup updates from the past year and future directions established during the meeting., Key Messages: This report summarizes progress made by each IDEOM workgroup at the 2021 IDEOM Virtual Annual Meeting. J Drugs Dermatol. 2022;21(8):867-874. doi:10.36849/JDD.6974.

Objective: To evaluate the knowledge and attitudes of Iraqi dermatologists regarding understanding, diagnosing, and treating psychocutaneous disorders., Methods: An online survey questionnaire was randomly distributed among Iraqi dermatologists through Google Forms in August 2020. The dermatologists were asked to provide information on their understanding of psychodermatology, referral patterns, level of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in learning more about psychodermatology., Results: Of 200 distributed questionnaires, 61 were returned. The most common psychocutaneous disorder seen was acne, followed by alopecia areata and vitiligo. About half of the participants reported being neutral about their comfort level in treating psychocutaneous disorders, and approximately half had no formal training in psychodermatology. Almost 60% of participants did not know of any community resources, and three-quarters were willing to seek educational activities on psychodermatology., Conclusions: The study results revealed that Iraqi dermatologists have significant gaps in knowledge, training, and treatment of psychocutaneous disorders. The survey findings reveal the importance of addressing the training needs of young physicians, including dermatologists, psychiatrists, and primary care physicians, in relation to the psychological component of skin diseases., (© Copyright 2022 Physicians Postgraduate Press, Inc.)

Janus kinase inhibitors, also commonly referred to as JAK inhibitors, are a novel drug class that target and block cytokine signaling mediated by the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway, thereby regulating immune response and cell growth. Although JAK inhibitors are mainly used for rheumatological conditions such as rheumatoid arthritis, their application in the field of dermatology is actively being investigated. Tofacitinib is US FDA-approved for psoriatic arthritis and showing promise for treating psoriasis. Most recently, regulatory approvals for the US were gained by ruxolitinib as a first-inclass, selective, topical therapy for atopic dermatitis and oral upadacitinib for active psoriatic psoriasis. Additionally, abrocitinib and upadacitinib have demonstrated efficacy in atopic dermatitis and are pending FDA approval for this indication. The therapeutic potential of JAK inhibitors in dermatological conditions such as alopecia areata, psoriasis, atopic dermatitis, vitiligo, and dermatomyositis are showing promising results in clinical trials. Adverse events for JAK inhibitors seem to be similar to that of biologic drugs. Common adverse effects include increased risk of infections and thromboembolic events. Further investigation is needed to not only better understand the safety profile of JAK inhibitors, but also their full utility within the field of dermatology., Competing Interests: None.

Current medical literature and practice utilize limited resources to enhance pediatric patients' coping with and understanding of disease. Here, we provide a template for accessing current resources and developing practice-specific written materials focused on the child's experience., (© 2022 Wiley Periodicals LLC.)

New treatment options may lead to an increased interest in using reliable and sensitive instruments to assess health-related quality of life in people with alopecia areata (AA). The purpose of this paper is to present current knowledge about quality of life assessment in AA. The dermatology-specific Dermatology Life Quality Index (DLQI) was the most widely reported health-related quality of life instrument used in AA. Three AA-specific (Alopecia Areata Symptom Impact Scale, Alopecia Areata Quality of Life Index and Alopecia Areata Patients' Quality of Life) and three hair disease-specific instruments (Hairdex, Scalpdex and 'hair-specific Skindex-29') were identified with a range of content and validation characteristics: there is little evidence yet of the actual use of these measures in AA. Scalpdex is the best-validated hair disease-specific instrument. Further extensive validation is needed for all of the AA-specific instruments. The European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes recommends the use of the dermatology-specific DLQI questionnaire, hair disease-specific Scalpdex and the alopecia areata-specific instruments the Alopecia Areata Symptom Impact Scale or Alopecia Areata Quality of Life Index, despite the limited experience of their use. We hope that new treatment methods will be able to improve both clinical signs and health-related quality of life in patients with AA. In order to assess the outcomes of trials on these new treatment methods, it would be helpful when further development and validation of AA-specific instruments is being encouraged and also conducted., (© 2021 European Academy of Dermatology and Venereology.)

Background: We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata., Objective: To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata., Methods: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%., Results: Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%])., Limitations: The study had low representation from Africa, South America, and Asia., Conclusion: There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care., (Copyright © 2020 American Academy of Dermatology, Inc. All rights reserved.)

Background: Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence., Objective: To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata., Methods: Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel., Results/conclusions: Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth., (Copyright © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

On a therapeutic point of view, 2017 in dermatology could be summarized in one disease, one pathway and in one number : atopic dermatitis, JAK inhibitors and 23. 2017 will be the year of the first registration of a biologic treatment in atopic dermatitis, dupilumab, with numerous other drugs currently in development. JAK inhibitors show promising results in several difficult-to-treat conditions, such as alopecia areata, vitiligo or atopic dermatitis, but still warrant confirmation in upcoming controlled trials. Monoclonal antibodies targeting IL-23 have confirmed in phase III studies their great efficacy in controlling psoriasis and will be soon available in practice, illustrating well the optimal link between bench side and bed in this emblematic inflammatory dermatological condition., (© 2017 Elsevier Masson SAS. Tous droits réservés.)

The year 2017 in pediatric dermatology was marked by several consensus recommendations and meta analyzes on childhood psoriasis, atopic dermatitis or PHACE syndrome, case series on the role of anti-JAK treatment in adolescent with alopecia areata, sirolimus for vascular malformations, ivermectine for rosacea, inhibitors of MEK for type 1 neurofibromatosis or on the side effects of the oral isotretinoin for acne or propranolol for immature hemangioma. Only few randomized controlled studies have been published on the interest of adalimumab in the treatment of psoriasis or topical sirolimus for angiofibroma in tuberous sclerosis complex for example. There were also clinical articles on various affections such as the sign of the scalp hair collar sign, childhood prurigo, ichthyosis, atopic dermatitis, warts or Zika virus infection. Finally, numerous publications reported new genes responsible for dermatosis in mosaics with new questionings and perspectives., (© 2017 Elsevier Masson SAS. Tous droits réservés.)

This non-exhaustive review focuses on publications that have been the subject of randomized controlled trials. It will also include results from research that may lead to new therapeutic perspectives. The selected articles were published between October 2013 and September 2014. The vast majority of them were dedicated to the treatment of psoriasis (anti-TNF, ustekinumab, antibodies against IL-17 or its receptors, anti-IL-23, anti-CD6 and ponesimod). Selected papers will also address the following diseases: atopic dermatitis, urticaria, acne, bullous diseases, alopecia areata, skin infections, acne rosacea and leg ulcers., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Some of the more recent advances and newer concepts about certain dermatological conditions are presented. Untoward reactions to drugs, whether to systemic or topical agents, are discussed in detail; emphasis is placed on their frequency and on the diversity of clinical findings. In the management of certain skin tumours (hemangiomas and melanocytic nevi) it is essential that the natural history of the lesion be considered. It is generally agreed that the answer to the problem of staphylococcal infection of the skin will be found in the host rather than the staphylococcus. Keratoacanthoma is a pseudocarcinoma of unknown etiology and sometimes gives rise to considerable difficulty in diagnosis. Diffuse alopecia in women is now a common dermatological problem, the cause of which is unknown. The hair loss associated with it is not permanent.

Upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, has gained FDA approval for conditions such as rheumatoid arthritis and atopic dermatitis. Emerging studies suggest its potential for off-label use in various dermatological disorders. This review systematically explores the off-label dermatological applications of upadacitinib. We conducted a comprehensive literature search across MEDLINE, EMBASE, SCOPUS, and ClinicalTrials.gov. Studies on alopecia areata, hidradenitis suppurativa, vitiligo, and other conditions were included. The review identified two randomized controlled trials (RCTs) evaluating upadacitinib's efficacy in hidradenitis suppurativa and vitiligo. Both trials demonstrated promising improvements in clinical outcomes, though some results were not statistically significant. Additionally, case reports and series highlight its efficacy in alopecia areata and lichen planus. These findings suggest upadacitinib as a viable option for refractory dermatological conditions. However, the limited sample sizes and short follow-up periods underscore the need for further large-scale, long-term studies. [ABSTRACT FROM AUTHOR]

Background: Inflammatory dermatological conditions, including psoriasis, lichen planus, eczema, and alopecia areata, are frequently accompanied by nail findings and can have a significant impact on quality of life. Biologic and small-molecule medications have been approved over the past several decades in treating patients with these inflammatory nail disorders. They may be used in conjunction with longstanding mainstays of treatment (topical and intralesional corticosteroids, topical vitamin D3 analogs). Objectives: Our objectives were to review biologic and small-molecule treatment efficacies for nail psoriasis and alopecia areata-associated nail dystrophy, including Janus kinase inhibitors, apremilast, tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, and IL-23 inhibitors. Materials and Methods: A comprehensive PubMed literature review of clinical research studies, narrative reviews, systematic reviews, and meta-analyses was performed. Conclusion: Many biologics and small molecules are effective in treating nail psoriasis and alopecia areata, with each requiring precautions for adverse events. Clinical trials for use of biologics and small molecules for nail lichen planus and atopic dermatitis have not been published to date. [ABSTRACT FROM AUTHOR]

Huiting Liu,* Sai Yang,* Hua Xian, Yinghui Liu, Yan Zhang, Yangxia Chen, Yingping Xu, Jun Liu, Bin Yang, Ying Luo Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Yang; Ying Luo, Department of Dermatology, Dermatology Hospital, Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, People’s Republic of China, Email yangbin1@smu.edu.cn; luoyingmab@yahoo.comBackground: Alopecia areata (AA) is a common autoimmune disease, causes sudden hair loss on the scalp, face, and sometimes other areas of the body. Previous studies have suggested more severe manifestations and higher recurrence rates in children than in adults. Moreover, pediatric AA patients with atopic predisposition often exhibit elevated IgE levels, early onset, and a poor prognosis.Purpose: This study aimed to investigate the impact of age and IgE levels on AA by conducting RNA sequencing on scalp samples from AA patients with atopic predisposition, age-matched healthy controls, and AA samples with varying IgE levels.Patients and Methods: We employed the single-sample Gene Set Enrichment Analysis (ssGSEA) algorithm in conjunction with gene expression analysis to assess immune infiltration. Differential gene expression analysis was performed using the DESeq package in R. Immunohistochemical staining and qPCR was performed to validate these findings.Results: Our results revealed a more pronounced inflammatory immune infiltration in AA patients across all age groups compared to healthy controls. Pediatric AA was characterized by an upregulation of genes controlling inflammatory responses, such as the IFN-γ pathway and JAK-STAT cascade, contrasting to adult AA. Compared to age-matched healthy controls, pediatric AA patients exhibited a significant increase in the infiltration of B cell subtypes, mast cells, and regulatory T cells. Additionally, high IgE levels in AA patients led to the upregulation of IFN-γ pathway genes, compared to AA patients with normal IgE levels.Conclusion: In summary, the heightened immune and inflammatory responses, along with the more significant infiltration of immune cells in pediatric AA with atopic predisposition, may explain the increased clinical severity and recurrence rates. Dissecting these molecular mechanisms sheds some light on the contributions of age and IgE to the pathogenesis and progression of AA, revealing potential age-specific and allergy-related therapeutic targets.Keywords: alopecia areata, age, IgE, immune response, inflammatory response

Nasser Abdullah Almulhim,1 Heba Yousef Alojail,2 Mohammed Abdullah Aljughayman,2,* Fatimah Hussain Almarri,2,* Norah Hamad Alsultan,1,* Latifah Adel Albash,1,* Sara Khalid Almukhaimar,1,* Ali Abduljalil Alkhamis,1,* Mohammed Abdullah Albaqshi,1,* Amnah Ali Alkhawajah1,* 1College of Medicine, King Faisal University, Alahsa, Saudi Arabia; 2Department of Dermatology, King Faisal University, Alahsa, Saudi Arabia*These authors contributed equally to this workCorrespondence: Amnah Ali Alkhawajah, College of Medicine, King Faisal University, Alahsa, Saudi Arabia, Tel +966551364812, Email AmnahAlkhawajah@gmail.comPurpose: Alopecia Areata (AA) is a complex autoimmune condition characterized by long-term inflammatory non-scarring patches of hair loss on the face, scalp, and body. Its development involves a combination of genetic, immunological, and environmental factors, making it challenging to understand and treat. This study aims to assess the awareness, beliefs, and psychological impact of patients with Alopecia Areata.Patients and Methods: This cross-sectional study was conducted in Eastern and Central provinces of Saudi Arabia and utilized online questionnaires to evaluate knowledge, beliefs, and psychological effects of patients with Alopecia Areata. These questionnaires were distributed using social media platforms.Results: This study enrolled 248 patients with Alopecia Areata (AA), of whom 38.7% were aged 31– 40 years and 55.2% were males. The majority were Saudis (98.4%), married (54%), and residing in the Central Region (60.1%). Nearly half (48.8%) were employed in non-medical fields, and 30.6% were vocational school graduates. Healthcare providers were the main source of AA information (52.8%), with most patients aware of AA’s seriousness, curability, and quality of life impact, though many had low knowledge and experienced negative psychological effects such as shyness, anxiety, and depression.Conclusion: Despite low self-rated knowledge, most patients recognized AA as serious and requiring treatment. Psychological well-being was heavily impacted by AA severity, quality of life, disease duration, and treatment efficacy. Although many patients showed improved AA status and good medication compliance, adverse psychological effects persisted, highlighting the need for larger studies to better understand and address these issues.Keywords: alopecia areata, dermatology, knowledge, Middle East, mental health, survey

Background and Design: Alopecia areata (AA) is a common, chronic, autoimmune disease that causes psychological effects on patients. Distress and psychological factors play roles in the onset and flares of the disease. We aimed to evaluate the relationship between neurotrophins (NT) and psychological distress in AA patients. Materials and Methods: The study included 50 AA patients and 50 healthy volunteers as a control group. The Distress Tolerance Scale (DTS) and the Depression Anxiety Stress Scale-21 (DASS-21) were used in the evaluation of psychological distress. Serum levels of NTs [brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4)] were measured. Results: Scores of DASS-21 were found to be higher, and scores of DTS were found to be lower in AA patients. Serum BDNF and NT-3 levels did not differ significantly between groups. While the serum NGF level was significantly higher, the NT-4 level was significantly lower in the AA group than in the control group. In the AA group, a similar significant relationship was found between BDNF and stress subscale scores; in the control group, no significant correlation was found between serum NT levels and DASS-21 and DTS scores. Conclusion: Our study supports the relationship between AA, psychological factors, and NTs. More studies are needed to investigate the relationship between AA and stress neuroimmunology to understand better the common pathophysiology of AA, stress, and various psychiatric diseases.

Zexin Zhu,1 Xiaoxue Wang2 1Department of Surgical Oncology, the Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaCorrespondence: Xiaoxue Wang, Department of Dermatology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China, Email 706468579@qq.comObjective: Alopecia areata (AA) is an autoimmune skin disease. Observational studies have reported an association between AA and cancer. However, the causal relationship between AA and cancer has not been reported. We employed a two-sample Mendelian randomization (MR) study to assess the causality between AA and 17 subtypes of cancers.Methods: We employed a two-sample Mendelian randomization (MR) study to assess the causality between AA and 17 subtypes of cancers. AA and cancers’ association genome-wide association study (GWAS) data were collected. The inverse variance weighted (IVW) method was utilized as the principal method in our Mendelian randomization (MR) study, with additional use of the MR-Egger, weighted median, simple mode, and weighted mode methods. After that, we explored the underlying biological mechanisms by Bioinformatic Analysis.Results: According to our MR analysis, AA has a causal relationship with hepatic bile duct cancer (HBDC, (odds ratio [OR] = 0.944, 95% confidence interval [CI] = 0.896– 0.994, P-value = 0.030) and colorectal cancer (CRC, OR = 0.981, 95% CI = 0.963– 0.999, P-value = 0.046). AA could decrease the risk of HBDC and CRC. No causal link between AA and other subtypes of cancers was observed. No heterogeneity or pleiotropy was observed. Furthermore, disease-related genes were obtained, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis results showed that the set of genes associated with immunity-inflammatory signaling pathway.Conclusion: This study provided new evidence of the relationship between AA with HBDC and CRC. AA may play a protective role in both HBDC and CRC progression. This could provide newer avenues for research in search of treatment for HBDC and CRC.Keywords: alopecia areata, cancer, causal relationship, colorectal cancer, hepatic bile duct cancer, Mendelian randomization

Abstract Background Alopecia areata (AA) is an auto‐immune disorder characterized by non‐scarring hair loss. With the emergence of effective therapies for severe AA, there is a need to better understand the prognosis of untreated AA, specifically the potential for spontaneous hair regrowth. Objectives To describe hair regrowth occurring on placebo during the first 36 weeks of the BRAVE‐AA trials. Methods This analysis pools the data of 345 placebo‐treated patients from BRAVE‐AA1 and BRAVE‐AA2, two Phase 3 clinical trials of baricitinib, an oral selective Janus kinase inhibitor, approved for the treatment of adults with severe AA. Scalp hair regrowth was assessed by the mean change from baseline in Severity of Alopecia Tool (SALT), the proportion of patients achieving a SALT score ≤20 (less than 20% hair loss); and SALT50 (50% improvement from baseline in SALT score), between Weeks 0 and 36. Patients achieving Clinician Reported Outcome (ClinRO) measures for eyebrow and eyelash hair loss™ scores of 0 or 1 (full coverage or minimal gaps) with a ≥2‐point improvement from baseline were also assessed. Results At Week 36, the mean [SD] change from baseline in SALT score was −5.5 [20.9], with 14 (4.1%) and 32 (9.3%) of the 345 placebo‐treated patients achieving a SALT score ≤20 and SALT50, respectively. A total of 9 (3.8%) and 8 (4.3%) patients achieved a ClinRO score of 0 or 1 with a ≥2‐point improvement from baseline for eyebrow (n = 236) and eyelash (n = 186), respectively. Patients achieving a SALT score ≤20 tended to have a lower mean SALT score at baseline and a shorter duration since the onset of AA. Conclusions The low likelihood of spontaneous hair regrowth observed in the BRAVE‐AA trials is consistent with other published literature. These results can aid in understanding the prognosis of severe AA when left untreated and, in turn, inform treatment‐related decisions.

Abstract Background Alopecia areata (AA) significantly affects patients' quality of life, leading them to seek community and support on social media platforms. Objectives This study aims to explore the disease's impact on patients' lives by analyzing their discussions on these platforms. Methods Through a retrospective analysis of French social media posts from January 2011 to October 2022, the study employed algorithm‐based methods and machine learning to identify how AA affects patients' quality of life across physical, psychological, social, and financial dimensions. Additionally, qualitative methods (i.e., saturation) were used to detail the main difficulties faced by patients. Results The analysis covered 5075 posts by 4061 patients, primarily from Twitter/X (59.5% of messages) and YouTube (12.9%). It revealed that 81.8% of patients experienced physical impacts, closely linked to psychological issues (66.1%), with many reporting a detrimental cycle of stress and hair loss leading to anxiety and mental fatigue. This cycle adversely affected their self‐image and confidence, resulting in social and professional isolation for 52.0% of patients. Financial strain was also significant, with 35.9% discussing the high costs of treatments and aesthetic maintenance. The primary difficulties included managing stress related to AA (32.1% of messages), handling the disease's duration and relapses (14.1%), and coping with damaged self‐image and self‐esteem issues, such as femininity and societal judgments (11.1%). Conclusions This study highlights the profound and multifaceted impact of AA on patients, who often turn to social media for support. The findings underscore the importance of a holistic approach to managing AA, considering its extensive physical, psychological, social, and financial effects. Integrating insights from social media with traditional healthcare and epidemiological research could offer new directions for improving patient support and treatment strategies.

Abstract Introduction Alopecia areata (AA) is an autoimmune disease that causes scalp, face, and/or body hair loss. Recently, oral treatments with kinases inhibition became the first approved therapies for severe AA. An understanding of the use and effectiveness of traditional therapies in real-world treatment settings is needed to guide integration of novel therapies into the treatment paradigm. This study aimed to describe traditional treatment patterns, dermatologists’ reasons for therapy choice, and dermatologists’ satisfaction with disease control among patients with AA. Methods Data were drawn from the 2021–2022 Adelphi Real World AA Disease Specific Programme™, a cross-sectional survey of dermatologists and adult patients with AA, conducted in France, Germany, Italy, Spain, and the UK. For each patient, using data from patient consultation and medical records, dermatologists reported % scalp hair loss (SHL), characteristics of current and prior AA therapies, and satisfaction with disease control. Results Overall, 239 dermatologists provided data for 1720 patients with AA. Mean (SD) patient age was 35.8 (11.6) years, and 51% were male. Based on dermatologist perception, among patients with ≤ 10% SHL, 74% were experiencing mild AA, while ≥ 95% of patients with ≥ 50% SHL were experiencing severe/very severe AA. In patients with ≥ 50% SHL, the most common therapies received included systemic immunosuppressants (31%), topical corticosteroids (24%), and oral corticosteroids (24%). Among all patients who had switched therapies, 49%, 26%, and 24% switched because of worsening AA, lack of initial efficacy with prior treatment, and loss of response over time, respectively. Among those with SHL ≥ 50%, dermatologists reported satisfaction with current therapy in < 30% of patients. Conclusion Dermatologists reported low satisfaction with traditional AA therapies used in patients with extensive SHL, with some patients discontinuing treatment because of worsening disease. This suggests more effective treatments are needed for patients with severe AA.

Abstract Introduction Alopecia areata (AA) is an autoimmune disease causing non-scarring hair loss, with both genetic and environmental factors implicated. Recent research highlights a possible role for scalp microbiota in influencing both local and systemic inflammatory responses, potentially impacting AA progression. This study examines the link among scalp microbiota imbalances, AA severity, and systemic inflammation. Methods We conducted a cross-sectional study with 24 participants, including patients with AA of varying severities and healthy controls. Scalp microbial communities were analyzed using swab samples and ion torrent sequencing of the 16S rRNA gene across multiple hypervariable regions. We explored correlations among bacterial abundance, microbiome metabolic pathways, and circulating inflammatory markers. Results Our findings reveal significant dysbiosis in the scalp microbiota of patients with AA compared to healthy controls. Severe AA cases had an increased presence of pro-inflammatory microbial taxa like Proteobacteria, whereas milder cases had higher levels of anti-inflammatory Actinobacteria. Notable species differences included abundant gram-negative bacteria such as Alistipes inops and Bacteroides pleibeius in severe AA, contrasted with Blautia faecis and Pyramydobacter piscolens predominantly in controls. Significantly, microbial imbalance correlated with AA severity (SALT scores) and systemic inflammatory markers, with elevated pro-inflammatory cytokines linked to more severe disease. Conclusion These results suggest that scalp microbiota may play a role in AA-related inflammation, although it is unclear whether the shifts are a cause or consequence of hair loss. Further research is needed to clarify the causal relationship and mechanisms involved.

Enrico Matteini,1,&ast; Laura Diluvio,1,&ast; Sara Lambiase,1 Arnaldo Cioni,1 Ruslana Gaeta Shumak,1 Gaetana Costanza,2 Caterina Lanna,1 Giacomo Caldarola,3,4 Luca Bianchi,1 Elena Campione1 1Dermatology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy; 2Department of Experimental Medicine, University of Rome ”Tor Vergata”, Rome, Italy; 3UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; 4Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy&ast;These authors contributed equally to this workCorrespondence: Laura Diluvio, Dermatology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, Rome, 00133, Italy, Tel +39 06 20902743, Fax +39 06 20902742, Email lauradiluvio@yahoo.itAbstract: Alopecia areata represents an autoimmune disease that specifically damages growing hair follicles on the scalp and/or around the body. Janus kinase inhibitors have been identified as an effective therapy in adult patients and topical formulations, such as Brevilin-A, might represent a well-tolerated treatment for mild-moderate disease in children and adolescents. The mechanism of action of Brevilin-A, a sesquiterpene lactone isolated from Centipeda minima, could consist in blocking STAT3 and STAT1 signaling as well as the JAKs activity by inhibiting the JAKs tyrosine kinase domain JH1. We report our cases of successful application of Brevilin-A in pediatric patients, suggesting this treatment as a safe and effective therapeutic option also for recalcitrant alopecia areata in pediatric population.Keywords: alopecia areata, brevelin A, pediatric, topical JAK inhibitors

This study systematically reviews existing data on the efficacy of Tyrosine Kinase 2 (TYK2) inhibitors in comparison to placebo or standard treatments for therapeutic benefit and improving quality of life in dermatological diseases. Seventeen records representing 13 clinical trials, one matching‐adjusted indirect comparison, and one case study were included. Results indicate that Deucravacitinib is superior to placebo, Apremilast and Adalimumab in treating adult patients with moderate‐to‐severe plaque psoriasis and superior to placebo in the treatment of adults with systemic lupus erythematosus. Comparative investigations on Brepocitinib and Ropsacitinib were more limited. Oral Brepocitinib demonstrated superiority over placebo in managing alopecia areata, and hidradenitis suppurativa. Topical Brepocitinib exhibited superiority over placebo in treating atopic dermatitis, but not plaque psoriasis. Ropsacitinib demonstrated superiority over placebo in the management of plaque psoriasis. Brepocitinib and Ropsacitinib had more side effects than Deucravacitinib. [ABSTRACT FROM AUTHOR]

To determine vitiligo prevalence and detailed clinical characteristics in a Saudi cohort. Methods: Cross-sectional study over six years. All cases were electronically identified and manually verified. Prevalence and sex were determined based on all vitiligo cases. Detailed analysis was done only for patients seen in a specialized vitiligo clinic with standardized documentation. Results: There were 1555 vitiligo cases (prevalence 0.235% [95% confidence interval 0.224– 0.247], 938 [60.32%] were female). Detailed analysis for other variables was done in 573 patients. Onset before age 20 years was found in 49%. Family history of vitiligo was reported in 42.15%. Triggering factors were present in 32% with stress being the most common (24%). Proportion of clinical characteristics was as follows: nonsegmental vitiligo (88%), signs of activity (49%), lesional pruritus (25%), halo nevi (4%), leukotrichia (19%). Some patients had isolated facial involvement and others had leukotrichia on the eyelids (not eyelashes). Atopy and hypothyroidism were the most prevalent systemic diseases, while alopecia areata, atopic dermatitis, and psoriasis were the top skin conditions. Antithyroid antibodies were high in approximately a third of patients and the majority of patients had low vitamin D. Elevated erythrocyte sedimentation rate (ESR) was observed more in patients with clinical signs of activity (70% vs 54%, p-value 0.0007). Conclusion: Prevalence of vitiligo was found to be similar to worldwide figures, with a higher proportion having affected family members. Stress as a trigger, lesional pruritus, signs of activity, thyroid disease, and low vitamin D were all common and should be routinely checked. Novel findings include isolated facial involvement, eyelid leukotrichia, and high ESR in active vitiligo. [ABSTRACT FROM AUTHOR]