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10. The Alopecia Areata Consensus of Experts (ACE) study part II: Results of an international expert opinion on diagnosis and laboratory evaluation for alopecia areata

Author

Meah, N, Wall, D, York, K, Bhoyrul, B, Bokhari, L, Asz-Sigall, D, Bergfeld, WF, Betz, RC, Blume-Peytavi, U, Callender, V, Chitreddy, V, Combalia, A, Cotsarelis, G, Craiglow, B, Donovan, J, Eisman, S, Farrant, P, Green, J, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Itami, S, Jolliffe, V, King, B, Lee, W-S, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Piraccini, BM, Rakowska, A, Reygagne, P, Roberts, JL, Rudnicka, L, Shapiro, J, Sharma, P, Tosti, A, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, Sinclair, RD, Meah, N, Wall, D, York, K, Bhoyrul, B, Bokhari, L, Asz-Sigall, D, Bergfeld, WF, Betz, RC, Blume-Peytavi, U, Callender, V, Chitreddy, V, Combalia, A, Cotsarelis, G, Craiglow, B, Donovan, J, Eisman, S, Farrant, P, Green, J, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Itami, S, Jolliffe, V, King, B, Lee, W-S, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Piraccini, BM, Rakowska, A, Reygagne, P, Roberts, JL, Rudnicka, L, Shapiro, J, Sharma, P, Tosti, A, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, and Sinclair, RD

Abstract

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.

Published
2021

11. A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS)

Author

Wall, D, Meah, N, York, K, Bhoyrul, B, Bokhari, L, Abraham, LS, Adams, R, Bergfeld, W, Betz, RC, Blume-Peytavi, U, Callender, V, Campbell, C, Chambers, J, Chen, G, Chitreddy, V, Cotsarelis, G, Craiglow, B, Dhurat, R, Dlova, N, Donovan, J, Duque-Estrada, B, Eisman, S, Ellison, A, Farrant, P, Barbera, JF, Gadzhigoroeva, A, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Jolliffe, V, Jones, L, King, B, Lee, W-S, Lortkipanidze, N, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Ovcharenko, Y, Piraccini, BM, Pirmez, R, Rakowska, A, Reygagne, P, Riley, M, Rudnicka, L, Saceda Corralo, D, Shapiro, J, Sharma, P, Silyuk, T, Kaiumov, S, Tobin, DJ, Tosti, A, Vano-Galvan, S, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, Zhou, C, Sinclair, R, Wall, D, Meah, N, York, K, Bhoyrul, B, Bokhari, L, Abraham, LS, Adams, R, Bergfeld, W, Betz, RC, Blume-Peytavi, U, Callender, V, Campbell, C, Chambers, J, Chen, G, Chitreddy, V, Cotsarelis, G, Craiglow, B, Dhurat, R, Dlova, N, Donovan, J, Duque-Estrada, B, Eisman, S, Ellison, A, Farrant, P, Barbera, JF, Gadzhigoroeva, A, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Jolliffe, V, Jones, L, King, B, Lee, W-S, Lortkipanidze, N, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Ovcharenko, Y, Piraccini, BM, Pirmez, R, Rakowska, A, Reygagne, P, Riley, M, Rudnicka, L, Saceda Corralo, D, Shapiro, J, Sharma, P, Silyuk, T, Kaiumov, S, Tobin, DJ, Tosti, A, Vano-Galvan, S, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, Zhou, C, and Sinclair, R

Abstract

IMPORTANCE: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. OBJECTIVE: To generate core domains and domain items for a global network of alopecia areata patient registries. EVIDENCE REVIEW: Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology, Milan, Italy, June 14, 2019. FINDINGS: Ninety-two core data items, across 25 domains, achieved consensus agreement. Twenty further noncore items were retained to facilitate data harmonization in centers that wish to record them. Broad representation across multiple stakeholder groups was sought; however, the opinion of physicians was overrepresented. CONCLUSIONS AND RELEVANCE: This study identifies the domains and domain items required to develop a global network of alopecia areata registries. These domains will facilitate a standardized approach that will enable the recording of a comprehensive, comparable data set required to oversee the introduction of new therapies and harness real-world evidence from existing therapies at a time when the alopecia areata treatment paradigm is being radically and positively disrupted. Reuse of similar, existing frameworks in atopic dermatitis, produced by the Treatment of Atopic Eczema (TREAT) Registry Taskforce, increases the potential to reuse existing resources, creates opportunities for comparison of data across dermatology subspecialty disease areas, and supports the concept of data harmonization.

Published
2021

12. Clinicopathological characteristics and treatment outcomes of fibrosing alopecia in a pattern distribution: A retrospective cohort study

Author

Jerjen, R, Pinczewski, J, Sinclair, R, Bhoyrul, B, Jerjen, R, Pinczewski, J, Sinclair, R, and Bhoyrul, B

Abstract

BACKGROUND: Fibrosing alopecia in a pattern distribution (FAPD) is a primary cicatricial alopecia considered a subtype of lichen planopilaris (LPP). OBJECTIVE: The clinical and histopathological features, and treatment response of 24 female patients with FAPD were evaluated. METHODS: Demographic, clinical, histopathological and treatment data of patients with FAPD were retrospectively collected. RESULTS: Twenty-four women were included (mean age 60.7 years). The mean Lichen Planopilaris Activity Index score was 1.50, and the median Sinclair grade was 3. Twelve patients had diffuse alopecia in the centroparietal region, four had frontal accentuation and eight had vertex accentuation of hair loss. Eight had associated loss of facial hair. Predominant trichoscopic features included hair shaft diameter variability (100%), perifollicular erythema and/or scaling (95%) and loss of follicular ostia (95%). Histopathological examination revealed features of scarring alopecia with interface changes in follicular epithelia mainly targeting terminal and intermediate hairs, and less frequently, vellus hairs. Treatment with hair growth-promoting, anti-inflammatory and anti-androgen agents arrested disease progression in 14 patients and resulted in hair regrowth in two patients. Six patients had progression of their hair loss in spite of treatment. LIMITATIONS: Referral bias to a specialist hair clinic, retrospective design and small sample size. CONCLUSIONS: We present clinicopathological features of FAPD which can aid in the diagnosis of this insidious scarring alopecia. Our findings suggest a more favourable outcome if treatment is initiated in early stages of the disease.

Published
2021

13. Frontal fibrosing alopecia

Author

Kerkemeyer, KLS, Eisman, S, Bhoyrul, B, Pinczewski, J, Sinclair, RD, Kerkemeyer, KLS, Eisman, S, Bhoyrul, B, Pinczewski, J, and Sinclair, RD

Abstract

Frontal fibrosing alopecia (FFA) is a patterned primary cicatricial alopecia that was first described in 1994. Once rare, the incidence of FFA has increased dramatically, representing the current most common cause of cicatricial alopecia worldwide. FFA typically begins in postmenopausal women with symmetrical, progressive recession of the frontotemporal hairline together with bilateral loss of the eyebrows. FFA has a distinctive clinical phenotype, which remains a challenge. The histology is identical to lichen planopilaris (LPP), but only a small number of patients have coincidental LPP, usually of the scalp. The vast majority of patients have no evidence of lichen planus elsewhere, and the symmetry and patterned nature of the hair loss are unusual for LPP. Familial cases of FFA are reported, and gene associations have been identified in population studies; however, the pathophysiology remains controversial. Without treatment, FFA is slowly progressive, and although many treatments have been prescribed, the response is often disappointing. We review the pathogenesis, epidemiology, clinical features, histology, and treatment of FFA.

Published
2021

16. Oral minoxidil improves background hair thickness in lichen planopilaris

Author

Vano-Galvan, S, Trindade de Carvalho, L, Saceda-Corralo, D, Rodrigues-Barata, R, Kerkemeyer, KL, Sinclair, RD, Hermosa-Gelbard, A, Moreno-Arrones, OM, Jimenez-Cauhe, J, Bhoyrul, B, Vano-Galvan, S, Trindade de Carvalho, L, Saceda-Corralo, D, Rodrigues-Barata, R, Kerkemeyer, KL, Sinclair, RD, Hermosa-Gelbard, A, Moreno-Arrones, OM, Jimenez-Cauhe, J, and Bhoyrul, B

Published
2021

19. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients

Author

Vano-Galvan, S, Pirmez, R, Hermosa-Gelbard, A, Moreno-Arrones, OM, Saceda-Corralo, D, Rodrigues-Barata, R, Jimenez-Cauhe, J, Koh, WL, Poa, JE, Jerjen, R, de Carvalho, LT, John, JM, Salas-Callo, C, Vincenzi, C, Yin, L, Lo-Sicco, K, Waskiel-Burnat, A, Starace, M, Zamorano, JL, Jaen-Olasolo, P, Piraccini, BM, Rudnicka, L, Shapiro, J, Tosti, A, Sinclair, R, Bhoyrul, B, Vano-Galvan, S, Pirmez, R, Hermosa-Gelbard, A, Moreno-Arrones, OM, Saceda-Corralo, D, Rodrigues-Barata, R, Jimenez-Cauhe, J, Koh, WL, Poa, JE, Jerjen, R, de Carvalho, LT, John, JM, Salas-Callo, C, Vincenzi, C, Yin, L, Lo-Sicco, K, Waskiel-Burnat, A, Starace, M, Zamorano, JL, Jaen-Olasolo, P, Piraccini, BM, Rudnicka, L, Shapiro, J, Tosti, A, Sinclair, R, and Bhoyrul, B

Abstract

BACKGROUND: The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. OBJECTIVE: To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. METHODS: Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. RESULTS: A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. LIMITATIONS: Retrospective design and lack of a control group. CONCLUSION: LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.

Published
2021

21. Treatment review for male pattern hair-loss

Author

York, K, Meah, N, Bhoyrul, B, Sinclair, R, York, K, Meah, N, Bhoyrul, B, and Sinclair, R

Abstract

Introduction: Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. An effective treatment for hair baldness is needed.Areas covered: In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens are key role-players in disease pathogenesis. Herein the authors review the pharmacologic treatment of androgenetic alopecia, which involves 5 alpha reductase inhibitors, minoxidil and prostaglandins. Non-pharmacologic approaches are also explored.Expert opinion: Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.Abbreviations: MPHL: male pattern hair loss; AGA: androgenetic alopecia; DHT: dihydrotestosterone; 5AR: 5-alpha-reductase; VEGF: vascular endothelial growth factor; PG's: prostaglandins (PG's); PGD2R: prostaglandin D2 receptor; VPA: valproic aid; SR: Serenoa Repens; PRP: platelet-rich plasma; PDGF: platelet derived growth factor; TGF: transforming growth factor; ERK: extracellular signal-regulated kinase; PKB: protein kinase B; LLLT: low-level laser therapy; ROS: reactive oxygen species; RCT: randomized control trial; SFRP1: secreted frizzled related protein 1; DP: dermal papilla; PDE5: phosphodiesterase 5.

Published
2020

23. The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata

Author

Meah, N, Wall, D, York, K, Bhoyrul, B, Bokhari, L, Asz Sigall, D, Bergfeld, WF, Betz, RC, Blume-Peytavi, U, Callender, V, Chitreddy, V, Combalia, A, Cotsarelis, G, Craiglow, B, Donovan, J, Eisman, S, Farrant, P, Green, J, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Itami, S, Jolliffe, V, King, B, Lee, W-S, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Piraccini, BM, Rakowska, A, Reygagne, P, Roberts, JL, Rudnicka, L, Shapiro, J, Sharma, P, Tosti, A, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, Sinclair, R, Meah, N, Wall, D, York, K, Bhoyrul, B, Bokhari, L, Asz Sigall, D, Bergfeld, WF, Betz, RC, Blume-Peytavi, U, Callender, V, Chitreddy, V, Combalia, A, Cotsarelis, G, Craiglow, B, Donovan, J, Eisman, S, Farrant, P, Green, J, Grimalt, R, Harries, M, Hordinsky, M, Irvine, AD, Itami, S, Jolliffe, V, King, B, Lee, W-S, McMichael, A, Messenger, A, Mirmirani, P, Olsen, E, Orlow, SJ, Piraccini, BM, Rakowska, A, Reygagne, P, Roberts, JL, Rudnicka, L, Shapiro, J, Sharma, P, Tosti, A, Vogt, A, Wade, M, Yip, L, Zlotogorski, A, and Sinclair, R

Abstract

BACKGROUND: A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials. OBJECTIVE: To produce an international consensus statement on the use and utility of various treatments for AA. METHODS: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus. RESULTS: In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies. LIMITATIONS: The study included a comprehensive list of systemic treatments for AA but not all treatments used. CONCLUSION: Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.

Published
2020

28. Significant hair regrowth in a Middle Eastern woman with central centrifugal cicatricial alopecia.

Author

Lobon, K., Pinczewski, J., and Bhoyrul, B.

Subjects
ALOPECIA areata, BALDNESS, HAIR, SEBACEOUS glands
Abstract

FAPD is a primary cicatricial alopecia characterized by rarefaction of hair on the centroparietal scalp, and, like AGA, is slowly progressive. To our knowledge, our case therefore represents the first report of CCCA in an individual with straight or wavy hair, highlighting that it should be considered in patients with cicatricial hair loss on the crown of the scalp even if they are not of African descent. However, the rapid development and localization of hair loss to the vertex with sparing of the mid-frontal scalp, along with the histopathological features of scarring alopecia are atypical for AGA. [Extracted from the article]

Published
2022
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33. Pili annulati in a case of Rothmund–Thomson syndrome with a novel frameshift mutation in RECQL4.

Author

Bhoyrul, B., Lindsay, H., Robinson, R., Stahlschmidt, J., Palmer, T., Edward, S., and Clark, S. M.

Subjects
*FRAMESHIFT mutation, *SKIN inflammation, *NUCLEOTIDE sequencing
Abstract

The article presents a case study of an 11-month-old baby boy was presented with rashes on the face and arms. Also discusses the diagnosis of variegated pigmentation, telangiectases and erosions on the skin after light microscopy, and identifying frameshift mutation in exons and introns through Sanger sequencing.

Published
2018
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34. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients

Author

David Saceda-Corralo, Juan Jimenez-Cauhe, Sergio Vano-Galvan, Anna Waskiel-Burnat, Michela Starace, Kristen LoSicco, Rebekka Jerjen, Rodrigo Pirmez, Bianca Maria Piraccini, Rita Rodrigues-Barata, Pedro Jaén-Olasolo, Antonella Tosti, Janina Eliza Poa, Lu Yin, Rodney Sinclair, Lara Trindade de Carvalho, Lidia Rudnicka, Bevin Bhoyrul, Wei L. Koh, Colombina Vincenzi, José Luis Zamorano, Oscar M. Moreno-Arrones, Corina Isabel Salas-Callo, Jerry Shapiro, Jared Marc John, Ángela Hermosa-Gelbard, Vano-Galvan, S, Pirmez, R, Hermosa-Gelbard, A, Moreno-Arrones, O M, Saceda-Corralo, D, Rodrigues-Barata, R, Jimenez-Cauhe, J, Koh, W L, Poa, J, Jerjen, R, Trindade de, Carvalho L, John, J, Salas-Callo, C I, Vincenzi, C, Yin, L, Lo-Sicco, K, Waskiel-Burnat, A, Starace, M, Zamorano, J L, Jaén-Olasolo, P, Piraccini, B M, Rudnicka, L, Shapiro, J, Tosti, A, Sinclair, R, and Bhoyrul, B

Subjects
Male, Hypertrichosis, Lightheadedness, hair lo, Administration, Oral, 030207 dermatology & venereal diseases, 0302 clinical medicine, Sleep Initiation and Maintenance Disorders, Tachycardia, Edema, androgenetic alopecia, Child, Aged, 80 and over, lightheadedne, Headache, arterial hypotension, hypertrichosi, Middle Aged, Hair disease, Minoxidil, 030220 oncology & carcinogenesis, Female, Safety, medicine.symptom, medicine.drug, Adult, medicine.medical_specialty, Adolescent, frontal fibrosing alopecia, effluvium, Dermatology, dizzine, Dizziness, Young Adult, 03 medical and health sciences, Internal medicine, new treatment, medicine, Humans, lichen planopilari, Adverse effect, Aged, Retrospective Studies, business.industry, periorbital edema, Frontal fibrosing alopecia, Alopecia, Retrospective cohort study, medicine.disease, fluid retention, Hair loss, business
Abstract

Background The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. Objective To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. Methods Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. Results A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. Limitations Retrospective design and lack of a control group. Conclusion LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.

Published
2021
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35. A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS)

Author

Jeff C. Donovan, Cheng Zhou, Valerie D. Callender, Dmitri Wall, Ncoza C. Dlova, Leonardo Spagnol Abraham, Laita Bokhari, Martin S Wade, Sergio Vano-Galvan, Bruna Duque-Estrada, Alan D. Irvine, Wilma F. Bergfeld, Antonella Tosti, Abby Ellison, David Saceda Corralo, Jen Chambers, Pooja Sharma, Seth J. Orlow, Andrew G. Messenger, Bianca Maria Piraccini, Ulrike Blume-Peytavi, Spartak Kaiumov, Brett A. King, Roisin Adams, Rodney Sinclair, Annika Vogt, Melissa Riley, Katherine York, Rachita Dhurat, Won Soo Lee, Brittany G. Craiglow, Bevin Bhoyrul, Aida Gadzhigoroeva, Leslie Jones, Chel Campbell, V. Jolliffe, Juan Ferrando Barberá, Gang Chen, Regina C. Betz, Adriana Rakowska, Elise A. Olsen, Amy J. McMichael, Samantha Eisman, Abraham Zlotogorski, Matthew Harries, George Cotsarelis, Jerry Shapiro, Paul Farrant, Vijaya Chitreddy, Paradi Mirmirani, Leona Yip, Lidia Rudnicka, Nino Lortkipanidze, Yuliya Ovcharenko, Ramon Grimalt, Pascal Reygagne, Maria K. Hordinsky, Tatiana Silyuk, Rodrigo Pirmez, Desmond J. Tobin, Nekma Meah, Wall D., Meah N., York K., Bhoyrul B., Bokhari L., Abraham L.S., Adams R., Bergfeld W., Betz R.C., Blume-Peytavi U., Callender V., Campbell C., Chambers J., Chen G., Chitreddy V., Cotsarelis G., Craiglow B., Dhurat R., Dlova N., Donovan J., Duque-Estrada B., Eisman S., Ellison A., Farrant P., Barbera J.F., Gadzhigoroeva A., Grimalt R., Harries M., Hordinsky M., Irvine A.D., Jolliffe V., Jones L., King B., Lee W.-S., Lortkipanidze N., McMichael A., Messenger A., Mirmirani P., Olsen E., Orlow S.J., Ovcharenko Y., Piraccini B.M., Pirmez R., Rakowska A., Reygagne P., Riley M., Rudnicka L., Saceda Corralo D., Shapiro J., Sharma P., Silyuk T., Kaiumov S., Tobin D.J., Tosti A., Vano-Galvan S., Vogt A., Wade M., Yip L., Zlotogorski A., Zhou C., and Sinclair R.

Subjects
medicine.medical_specialty, Consensus, Internationality, Alopecia Areata, Delphi Technique, Delphi method, MEDLINE, Redress, Consensu, Dermatology, Disease, Subspecialty, Severity of Illness Index, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Global network, medicine, Humans, Surveys and Questionnaire, Registries, skin and connective tissue diseases, Pharmaceutical industry, integumentary system, business.industry, Alopecia areata, medicine.disease, 030220 oncology & carcinogenesis, Family medicine, business, Human
Abstract

Importance A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective To generate core domains and domain items for a global network of alopecia areata patient registries. Evidence Review Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology, Milan, Italy, June 14, 2019. Findings Ninety-two core data items, across 25 domains, achieved consensus agreement. Twenty further noncore items were retained to facilitate data harmonization in centers that wish to record them. Broad representation across multiple stakeholder groups was sought; however, the opinion of physicians was overrepresented. Conclusions and Relevance This study identifies the domains and domain items required to develop a global network of alopecia areata registries. These domains will facilitate a standardized approach that will enable the recording of a comprehensive, comparable data set required to oversee the introduction of new therapies and harness real-world evidence from existing therapies at a time when the alopecia areata treatment paradigm is being radically and positively disrupted. Reuse of similar, existing frameworks in atopic dermatitis, produced by the Treatment of Atopic Eczema (TREAT) Registry Taskforce, increases the potential to reuse existing resources, creates opportunities for comparison of data across dermatology subspecialty disease areas, and supports the concept of data harmonization.

Published
2021

36. The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata

Author

Wilma F. Bergfeld, Valerie D. Callender, A.D. Irvine, Abraham Zlotogorski, Maria K. Hordinsky, Victoria Jolliffe, Daniel Asz Sigall, Jerry Shapiro, Jack Green, Lidia Rudnicka, Nekma Meah, Elise A. Olsen, Jeff C. Donovan, Adriana Rakowska, Dmitri Wall, Won Soo Lee, Ulrike Blume-Peytavi, Katherine York, Samantha Eisman, George Cotsarelis, Seth J. Orlow, Antonella Tosti, Satoshi Itami, Ramon Grimalt, Matthew Harries, Vijaya Chitreddy, Pooja Sharma, Pascal Reygagne, Leona Yip, Annika Vogt, Amy J. McMichael, Brittany G. Craiglow, Bevin Bhoyrul, Martin S Wade, Brett A. King, Paul Farrant, Laita Bokhari, Regina C. Betz, Paradi Mirmirani, Andrew G. Messenger, Andrea Combalia, Bianca Maria Piraccini, Janet L. Roberts, Rodney Sinclair, and Meah N, Wall D, York K, Bhoyrul B, Bokhari L, Sigall DA, Bergfeld WF, Betz RC, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Donovan J, Eisman S, Farrant P, Green J, Grimalt R, Harries M, Hordinsky M, Irvine AD, Itami S, Jolliffe V, King B, Lee WS, McMichael A, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Piraccini BM, Rakowska A, Reygagne P, Roberts JL, Rudnicka L, Shapiro J, Sharma P, Tosti A, Vogt A, Wade M, Yip L, Zlotogorski A, Sinclair R.

Subjects
Complementary Therapies, medicine.medical_specialty, Alopecia Areata, Delphi Technique, Administration, Topical, Delphi method, Administration, Oral, Topical treatment, Dermatology, Injections, Intralesional, Severity of Illness Index, Systemic therapy, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Adrenal Cortex Hormones, law, Humans, Medicine, Expert Testimony, Patient registry, business.industry, Alopecia areata, Treatments for alopecia areata, Age Factors, alopecia areata, steroid, methotrexate, cyclosporin, Expert consensus, Phototherapy, Alopecia areata, medicine.disease, Combined Modality Therapy, Treatment Outcome, 030220 oncology & carcinogenesis, Expert opinion, Family medicine, Dermatologic Agents, business
Abstract

Background A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials. Objective To produce an international consensus statement on the use and utility of various treatments for AA. Methods Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus. Results In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies. Limitations The study included a comprehensive list of systemic treatments for AA but not all treatments used. Conclusion Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.

Published
2020

40. Real-world effectiveness and safety of tofacitinib for alopecia areata: A retrospective cohort study of 202 patients.

Author

Cranwell W, Meah N, Wall D, Bhoyrul B, Laita B, and Sinclair RD

Subjects
Humans, Male, Retrospective Studies, Female, Adult, Middle Aged, Young Adult, Minoxidil therapeutic use, Minoxidil adverse effects, Treatment Outcome, Protein Kinase Inhibitors therapeutic use, Protein Kinase Inhibitors adverse effects, Severity of Illness Index, Adrenal Cortex Hormones therapeutic use, Adolescent, Janus Kinase Inhibitors therapeutic use, Janus Kinase Inhibitors adverse effects, Cohort Studies, Sex Factors, Pyrimidines therapeutic use, Pyrimidines adverse effects, Piperidines therapeutic use, Piperidines adverse effects, Alopecia Areata drug therapy
Abstract

Background: Alopecia areata (AA) is an autoimmune hair loss disorder characterised by collapse of hair follicle immune privilege and mediated by autoreactive CD8+ T lymphocytes and natural killer cells. Treatment is often unsatisfactory. The Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway is implicated in the pathogenesis of AA and Janus Kinase inhibitor (JAKi) medications are promising emerging treatments for AA., Objectives: We evaluated the safety and effectiveness of tofacitinib in a real-world setting over 18 months of treatment., Methods: A retrospective cohort study of all patients with scalp AA commenced on tofacitinib between 1 November 2016 and 31 May 2019. The primary endpoint was the percent change in Severity of Alopecia Tool (SALT) score at 18 months., Results: Two hundred and two patients were included. After 18 months of treatment, 55.9%, 42.6% and 29.2% achieved 50%, 75% and 90% reductions in their SALT scores respectively. Increased duration of AA was a negative predictor of hair regrowth. Males and patients with baseline SALT ≥90 were slower to respond to treatment in the first 12 months. One hundred and twenty-four patients and 168 patients received concomitant systemic corticosteroids or low-dose oral minoxidil during tofacitinib therapy respectively. There were no serious adverse events., Conclusion: Tofacitinib was a safe and effective treatment for patients with moderate-to-severe AA. Further randomised controlled studies are needed to establish the optimal treatment regimen., (© 2024 Australasian College of Dermatologists.)

Published
2024
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42. Treatment of moderate-to-severe alopecia areata in patients over the age of 65 years with baricitinib.

Author

Tang GT, Triwongwaranat D, Sinclair R, Joseph S, Eisman S, Rathnayake D, Varathan V, Trindade de Carvalho L, and Bhoyrul B

Subjects
Humans, Male, Female, Aged, Retrospective Studies, Treatment Outcome, Janus Kinase Inhibitors therapeutic use, Janus Kinase Inhibitors adverse effects, Aged, 80 and over, Azetidines therapeutic use, Azetidines adverse effects, Sulfonamides therapeutic use, Sulfonamides adverse effects, Alopecia Areata drug therapy, Purines therapeutic use, Purines adverse effects, Pyrazoles therapeutic use, Pyrazoles adverse effects, Severity of Illness Index
Abstract

Baricitinib is a Janus kinase inhibitor that has been approved by the US Food and Drugs Administration for the treatment of severe alopecia areata (AA) in adults. However, the clinical trials that demonstrated the efficacy of baricitinib in the treatment of severe AA did not include men aged > 60 years or women aged > 70 years. We retrospectively assessed the efficacy and safety of baricitinib in 14 patients aged ≥ 65 years with moderate-to-severe AA. After a mean (SD) duration of 18.5 (11.9) months, a 72% reduction in mean Severity of Alopecia Tool score from baseline was observed. Partial or complete eyebrow and eyelash hair was observed in 57% and 43% of patients, respectively. The adverse effects of baricitinib were mild. No cases of venous thromboembolism, major adverse cardiovascular events or malignancy were reported., Competing Interests: Conflicts of interest S.E. has served on advisory boards for Eli Lilly and has been an investigator in clinical trials or has affiliations with AbbVie, Arena Pharmaceutical, Boston Pharmaceuticals, Botanix, Bristol-Myers Squibb, Dermaliq Therapeutics, Dermira, Eli Lilly, Evelo Biosciences, Immunic Therapeutics, Janssen, Kobiolabs, Kymab, LEO Pharma, L’Oréal, Novartis, Pfizer, Regeneron, Sanofi, Suzhou Connect Biopharmaceuticals, Takeda Pharmaceuticals, TEVA Pharmaceuticals, Tigermed and Zai Lab. R.S. is a Director and Founder of Samson Medical Pty Ltd, which holds patents on the use of oral minoxidil to treat hair-loss disorders; has been on pharmaceutical advisory boards for Eli Lilly, Pfizer and LEO Pharma; has participated in speaker bureaus for AbbVie and Novartis; and has been a principal investigator in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co., Celgene, Coherus Biosciences, Janssen, Regeneron, MedImmune, GlaxoSmithKline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol-Myers Squibb and Galderma. G.T.T. is an Associate Editor of Clinical and Experimental Dermatology. D.T., S.J., D.R., V.V., L.T.C. and B.B. declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Published
2024
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44. The Alopecia Areata Severity and Morbidity Index (ASAMI) Study: Results From a Global Expert Consensus Exercise on Determinants of Alopecia Areata Severity.

Author

Moussa A, Bennett M, Wall D, Meah N, York K, Bokhari L, Asfour L, Rees H, Abraham LS, Asz-Sigall D, Basmanav FB, Bergfeld W, Betz RC, Bhoyrul B, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Dhurat R, Donovan J, Doroshkevich A, Eisman S, Farrant P, Ferrando J, Gadzhigoroeva A, Green J, Grimalt R, Harries M, Hordinsky M, Irvine A, Jolliffe V, Kaiumov S, King B, Lee J, Lee WS, Li J, Lortkipanidze N, McMichael A, Mesinkovska NA, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Ovcharenko Y, Piraccini BM, Pirmez R, Rakowska A, Reygagne P, Rudnicka L, Corralo DS, Senna M, Shapiro J, Sharma P, Siliuk T, Starace M, Suchonwanit P, Takwale A, Tosti A, Vañó-Galván S, Visser WI, Vogt A, Wade M, Yip L, Zhou C, and Sinclair R

Subjects
Humans, Alopecia diagnosis, Consensus, Morbidity, Quality of Life, Alopecia Areata diagnosis
Abstract

Importance: Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact., Objective: To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI)., Evidence Review: A total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022., Findings: Of all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss., Conclusions and Relevance: This eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.

Published
2024
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45. Comment on ‘Treatment of moderate-to-severe alopecia areata in preadolescent children with baricitinib’: authors’ reply

Author

Asfour L, Bokhari L, Bhoyrul B, Eisman S, Moussa A, Rees H, and Sinclair RD

Subjects
Child, Humans, Alopecia, Sulfonamides therapeutic use, Alopecia Areata drug therapy, Azetidines therapeutic use
Abstract

Competing Interests: Conflicts of interest R.D.S. is an Associate Editor of the AJD; reports being a Director and Founder of Samson Clinical Pty Ltd; participates on the pharmaceutical advisory board for Eli Lilly, Pfizer Inc. and LEO Pharma; is on the speakers bureau for AbbVie and Novartis; and is a Principal Investigator (PI) in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co., Celgene, Coherus BioSciences, Janssen, Regeneron, MedImmune, GlaxoSmithKline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol Myers Squibb and Galderma. S.E. reports being a member of the dermatology advisory board for Eli Lilly and PI in clinical trials for Pfizer Inc., AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol Myers Squibb, Botanix, Dermira, Eli Lilly, LEO Pharma, Novartis, Regeneron, Tigermed, Suzhou Connect Biopharmaceuticals, Janssen, Kymab Ltd, KoBioLabs and Avance Clinical. L.A., A.M., B.B., L.B. and H.R. declare no conflicts of interest.

Published
2023
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46. Switching between tofacitinib and baricitinib in alopecia areata: A review of clinical response.

Author

Kazmi A, Moussa A, Bokhari L, Bhoyrul B, Joseph S, Chitreddy V, Eisman S, Meah N, and Sinclair R

Subjects
Humans, Alopecia, Piperidines therapeutic use, Alopecia Areata drug therapy
Abstract

Competing Interests: Conflicts of interest Dr Eisman is a member of the Australian Dermatology Advisory Board of Eli Lilly and is a principal investigator in clinical trials for Pfizer Inc, AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol-Myers Squibb, Botanic, Dermira, Eli Lilly and Company, LEO Pharma, Novartis, Regeneron, Tigermed, Suzhou Connect Biopharmaceuticals, Janssen, Kymab Ltd, Evelo Biosciences, KoBiolabs, and Avance Clinical. Prof Sinclair is the director and founder of Samson Medical Pty Ltd, which holds patents on the use of low-dose oral minoxidil and sublingual minoxidil to treat hair loss, is a member of the Pharmaceutical Advisory Board of Eli Lilly, Pfizer Inc, and Leo Pharmaceutical, is a member of Speaker Bureau of AbbVie and Novartis, and is a principal investigator in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co, Celgene, Coherus BioSciences, Janssen, Regeneron, MedImmune, GlaxoSmithKline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol Myer Squibb, and Galderma. Drs Kazmi, Moussa, Bokhari, Bhoyrul, Joseph, Chitreddy, and Meah have no conflicts of interest to declare.

Published
2023
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47. Treatment of moderate-to-severe alopecia areata in pre-adolescent children with baricitinib.

Author

Asfour L, Bokhari L, Bhoyrul B, Eisman S, Moussa A, Rees H, and Sinclair RD

Subjects
Humans, Child, Purines, Alopecia Areata drug therapy, Azetidines therapeutic use
Abstract

Competing Interests: Conflicts of interest R.D.S. is an Associate Editor of the AJD; reports being a Director and Founder of Samson Clinical Pty Ltd; participates on the pharmaceutical advisory board for Eli Lilly, Pfizer Inc. and Leo Pharmaceutical; is on the speakers bureau for AbbVie and Novartis; and is a Principal Investigator (PI) in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co., Celgene, Coherus BioSciences, Jannsen, Regeneron, MedImmune, GlaxoSmithKline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol Myer Squibb and Galderma. S.E. reports being a member of the dermatology advisory board for Eli Lilly and PI in clinical trials for Pfizer Inc., AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol-Myers Squibb, Botanix, Dermira, Eli Lilly, LEO Pharma, Novartis, Regeneron, Tigermed, Suzhou Connect Biopharmaceuticals, Janssen, Kymab Ltd, KoBiolabs and Avance Clinical. L.A., A.M., B.B., L.B. and H.R. declare no conflicts of interest.

Published
2023
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49. Treatment of moderate-to-severe alopecia areata in adolescents with baricitinib: A retrospective review of 29 patients.

Author

Moussa A, Eisman S, Kazmi A, Poa J, Chitreddy V, Rathnayake D, Joseph S, Sinclair RD, and Bhoyrul B

Subjects
Humans, Adolescent, Retrospective Studies, Alopecia therapy, Pyrazoles therapeutic use, Alopecia Areata drug therapy
Abstract

Competing Interests: Conflicts of interest Dr Eisman is a principal investigator in clinical trials for Pfizer Inc, AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol-Myers Squibb, Botanix, Dermira, Eli Lilly and company, LEO Pharma, Novartis, Regeneron, Tigermed, Suzhou Connect Biopharmaceuticals, Janssen, Kymab Ltd, Evelo Biosciences, KoBiolabs, and Avance Clinical. Dr Sinclair is the Director and Founder of Samson Medical Pty Ltd which holds patents on the use of oral minoxidil to treat hair loss disorders; is on the Pharmaceutical advisory board of Eli Lilly, Pfizer Inc, and Leo Pharmaceutical; is on the Speaker bureau of Abbvie, Novartis; is a principal investigator in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co, Celgene, Coherus BioSciences, Jannsen, Regeneron, MedImmune, Glaxo Smith Kline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol Myer Squibb, and Galderma. Drs Moussa, Kazmi, Poa, Chitreddy, Rathnayake, Joseph, and Bhoyrul have no conflicts of interest to declare.

Published
2023
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50. Treatment of alopecia areata of the beard with baricitinib.

Author

Moussa A, Eisman S, Sinclair RD, and Bhoyrul B

Subjects
Humans, Alopecia, Pyrazoles therapeutic use, Alopecia Areata drug therapy, Azetidines therapeutic use
Abstract

Competing Interests: Conflicts of interest Dr Eisman is on the Dermatology advisory board Eli Lilly and a principal investigator in clinical trials for Pfizer Inc, AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol-Myers Squibb, Botanix, Dermira, Eli Lilly and Company, LEO Pharma, Novartis, Regeneron, Tigermed, Suzhou Connect Biopharmaceuticals, Janssen, Kymab Ltd, Evelo Biosciences, KoBiolabs, and Avance Clinical. Prof Sinclair is the Director and Founder Samson Medical Pty Ltd, which holds patents on the use of low-dose oral minoxidil to treat hair loss disorders; on the Pharmaceutical advisory board of Eli Lily, Pfizer Inc, Leo Pharmaceutical; a speaker for bureau AbbVie, Novartis; and a principal investigator in clinical trials for Amgen, Novartis, Arcutis Biotherapeutics, Aerotech, Merck and Co, Celgene, Coherus BioSciences, Jannsen, Regeneron, MedImmune, Glaxo Smith Kline, Samson Clinical, Boehringer Ingelheim, Oncobiologics, Roche, Ascend, Dermira, AstraZeneca, Akesobio, Reistone Biopharma, UCB, Sanofi, Connect, Arena, Sun Pharma, Bristol Myer Squibb, and Galderma. Drs Moussa and Bhoyrul have no conflicts of interest to declare.

Published
2023
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