Safety and efficacy of tofacitinib in 97 alopecia areata patients.

BACKGROUND: Alopecia areata (AA) is a recurrent immune-mediated disorder causing hair loss without any scarring being present. It affects hairs on the head or other parts of the body and can occur at any age and in both genders. It seems that AA is associated with a higher rate of psychological disorders resulting from hair loss and the esthetic and social repercussions of it. Common treatments like corticosteroids do not work for every patient and recent treatment options focusing on the immunologic mechanisms like tofacitinib have shown some promising results. METHODS: It's a retrospective study on patients with AA, AT, AU taking oral tofacitinib as a treatment for at least 6 months. Scalp hair loss was assessed before treatment and at each visit using the Severity of Alopecia Tool (SALT) score. RESULTS: Of 97 cases, 69.1% demonstrated over 50% SALT score improvement, with 44.3% having 90% or more decrease in SALT score. Patients who suffered from patchy AA were more responsive compared to patients with AT and AU subtypes and had a greater percent change in SALT score. Tofacitinib was tolerated quite well and no significant adverse events were reported. CONCLUSIONS: Tofacitinib should be taken into consideration as an efficacious treatment option for patients with AA, AT and AU.

Clinical and demographic characteristics associated with nail involvement in alopecia areata: A cross-sectional study of 197 patients.

Background and Aims: Alopecia areata (AA) is an immune-mediated nonscarring alopecia. Nail changes are a common disfiguring feature of AA with an average prevalence of 30%. We aimed to evaluate the frequency of different types of nail changes and determine demographic and clinical associations. Methods: This cross-sectional study included 197 AA patients. Demographic and clinical variables including the Severity of Alopecia Tool (SALT) score, type of AA, and nail changes were evaluated. Results: Among 197 AA patients with a mean age of 28.95 ± 14.45 years, 50.3% were female. Nail changes were detected in 165 patients (83.8%). The most frequent nail abnormalities were pitting (53.3%), linear line (46.7%), and distal notching (26.9%). AA patients with nail abnormalities were significantly younger than patients without nail changes (25.31 ± 14.96 vs. 32.22 ± 9.77 years; p < 0.001). Considering age groups, younger children (less than 10 years) were more likely to have nail changes than adults (97.1% vs. 76.5%; p < 0.001). The prevalence of linear line (69.6%) and distal notching (46.4%) were significantly higher in the universalis variant compared to other variants (p < 0.001). Pitting (54.5%), distal notching (43.9%), and koilonychia (12.1%) were the most common nail changes in severe forms compared to mild-to-moderate forms (p < 0.009). Conclusions: Our study revealed that young patients with severe disease are prone to nail abnormalities. Pitting, distal notching, and linear line were the most common nail changes. Of note, koilonychia, leukonychia, and red spots lunula are more expected in more severe AA.

JAK Inhibitors in the Treatment of Lichen Planopilaris.

Background: Lichen planopilaris (LPP) is an autoimmune disorder leading to lymphocytic cicatricial alopecia. Different agents such as hydroxychloroquine, methotrexate, cyclosporine, and mycophenolate mofetil have been tried to control hair loss with limited efficacy. JAK inhibitors are immune-modulating drugs which interfere with the JAK-STAT signaling pathway in lymphocytes and are used in treatment of inflammatory conditions such as rheumatoid arthritis and alopecia areata. Summary: Our aim was to determine effectiveness of JAK inhibitors in LPP and its clinical variant, frontal fibrosing alopecia. A literature search was conducted using PubMed, Google Scholar, and Cochrane databases. A total of 7 articles describing 35 patients were found. Although data on treatment are limited to retrospective studies and case reports, JAK inhibitors can be considered a new therapeutic option, especially in recalcitrant cases. Large prospective studies and randomized control trials are needed to provide further evidence supporting efficacy. Key Messages: Besides the fact that data on the treatment of LPP and FFA with JAK inhibitors are limited to retrospective studies and case reports, but JAK inhibitors can be considered as a new therapeutic option especially in recalcitrant cases.

Lichen planopilaris (LPP) is a condition where the immune system attacks hair follicles, causing permanent hair loss. Doctors have tried different medications to control the hair loss, but with limited success. JAK inhibitors are drugs that can affect the immune system and are used to treat conditions like rheumatoid arthritis and alopecia areata. We wanted to find out if JAK inhibitors could help with LPP. We looked at research articles in medical databases and found 7 articles that talked about 35 patients. Although the information on treatment is limited to studies that looked back at past cases and individual reports, JAK inhibitors could be a new option for treatment, especially when other treatments have not worked. We need more studies with larger groups of people to get more evidence on how well JAK inhibitors work for LPP.

Effects of age and sex on the comorbidities of alopecia areata: A cross-sectional hospital-based study.

Background and Aims: Alopecia areata (AA) is a common autoimmune nonscarring hair disorder with strong genetic links. It seems to be associated with several comorbidities affecting the AA treatment plan. On the other hand, the prevalence of comorbidities in different populations can be different based on genetic differences. This study aimed to clarify the association between age and sex with various comorbidities in AA patients. Methods: This cross-sectional study was conducted on 402 patients suffering from AA referred to our hospitals between 2018 and 2021. The clinical records of the patients were reviewed, including demographic and clinical information. Results: The most common diseases associated with AA were anxiety (36%), dermatitis (30%), hypothyroidism (9%), hyperlipidemia (5%), and vitamin D deficiency (4%). The most common comorbidities in AA patients over 18 years were allergic rhinitis, psychological problems, diabetes, hypertension, and hypothyroidism (p < 0.05). Hypothyroidism was more common in female patients than in male patients (p = 0.002). In contrast, hyperlipidemia was more common in male patients than in female patients (p = 0.024). There was a significant association between the severity of AA and hyperlipidemia and vitiligo (p = 0.003 and 0.045). Conclusion: Sex and age could affect comorbidities. The prevalence of hypothyroidism was higher in our study; it was higher in women than in men. Thyroid function tests were recommended for AA patients.

Clinicopathological Study of 307 Patients with Lichen Planus Actinicus and Pigmentosus Referred to Razi Skin Hospital From 2016 to 2021.

INTRODUCTION: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA) and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East. OBJECTIVES: We aimed to evaluate the clinicopathological profile of these patients. METHODS: Three hundred and seven cases including 184 LPA and 123 LPP patients were recruited from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March 2021. The clinical features and pathological reports were extracted and analyzed. RESULTS: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar frequency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%), lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin incontinence (52/8%) as the most frequent findings in LPP cases. CONCLUSIONS: LPA and LPP were both more prevalent among women. Face was the most common site of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin incontinence, and hyperkeratosis were more common histological findings in this study.

Comparing the efficacy of three methods of permethrin application in pediculosis capitis: A randomized clinical trial.

BACKGROUND: Pediculosis capitis, also known as head lice, is a common problem that affects individuals of different socio-economic backgrounds. Permethrin is generally considered the first-line treatment option for head lice. AIMS: The objective of this study was to evaluate and compare the therapeutic effects of three different methods of permethrin treatment for head lice. METHOD: A parallel, randomized clinical trial was conducted on 157 patients with head lice. The participants underwent eye examination and dry combing by a trained professional. The subjects were randomly divided into three groups and treated with one of the three methods of permethrin application: permethrin shampoo for 10 min, permethrin shampoo for 1 h, or permethrin cream for 10 min on a weekly basis for 3 weeks. RESULTS: Of the 157 participants, 154 completed the study. The group treated with permethrin shampoo for 1 h had the shortest average time for eradication of lice at 1.226 ± 0.422 weeks, which was significantly lower than the other two groups. Additionally, the 1-h permethrin shampoo group had the lowest time for scalp itching of 2.15 ± 0.632 weeks, which was significantly lower than the other two groups. Moreover, the rate of lice eradication in the first week was significantly higher in the 1-h permethrin shampoo group. CONCLUSION: The results of this study suggest that the use of 1% permethrin shampoo for 1 h is more effective in eradicating head lice within the first week of treatment and in relieving scalp itching during the second week.

The Relationship Between ABO and Rh Blood Groups with Alopecia Areata.

INTRODUCTION: Alopecia areata (AA) is a common non-scaring hair loss disease. Genetic susceptibility and environmental factors can develop the disease. OBJECTIVES: We investigated the association between AA and ABO and Rh blood groups. METHODS: This cross-sectional study was done on 200 patients with AA and 200 healthy controls (HCs) between March 2021 and September 2021. RESULTS: The prevalence of blood groups O, A, B, and AB in patients with AA was 30%, 30.5%, 10.5%, and 29%, respectively. A significant difference was detected between the two groups in the frequency of the ABO and ABO*Rh blood groups (p-value < 0.05). Compared to the HCs, the prevalence of the AB and AB+ blood group was higher in AA patients. No significant relationship was detected between sex, BMI, duration of disease, age at onset, severity of alopecia tool (SALT) score, hair loss pattern, and nail involvement with ABO and Rh blood groups (p-value > 0.05). CONCLUSION: In conclusion, the highest difference was related to the AB+ blood group, so compared to HCs, the AB+ blood group frequency was higher in patients with AA. However, more studies with larger sample sizes on different ethnicities should be performed to verify the results of this study.

Characteristics associated with quality of life in the early stages of Mycosis Fungoides.

Background: Mycosis fungoides (MF) is a lymphoproliferative disorder characterized by skin-homing atypical lymphocytes. This study aimed to evaluate the quality of life (QoL) in MF patients in the early stages of the disease and the associated factors using the Dermatology Life Quality Index (DLQI). Methods: Thirty MF patients (21 females/9 males) with a mean age of 46.73±15.9 years and in the early stages of the disease (26 stage Ι and 4 stage ΙΙ) were enrolled and were asked to fill the DLQI questionnaire. Results: The mean DLQI score was 9.93±5.89. The QoL was largely affected by the disease in near half of the patients (46.7% of patients had a DLQI score11-20). QoL was significantly correlated with educational level and was more impaired in patients with lower educational status (DLQI score spearman rho=-0.382, P=0.037). QoL was not associated with sex, age, disease stage and disease duration. The symptom and feeling dimension of DLQI was significantly more impaired in patients with both patch and plaque compared to patch only (spearman rho= 0.397, P= 0.03). Conclusion: This study demonstrates how largely patients' QoL is influenced in the early stages of MF, especially in patients with lower educational levels.

Oxidative stress and antioxidant markers in patients with alopecia areata: A comparative cross-sectional study.

Background Alopecia areata is a chronic inflammatory skin disease. Oxidative stress may contribute to the pathogenesis of this condition. Aim To evaluate the serum oxidative stress markers and antioxidant capacity in patients with alopecia areata. Methods This cross-sectional study was performed on 40 patients with alopecia areata and 40 healthy controls. The fasting blood sugar, C-reactive protein, lipid profile, and serum oxidative markers, including advanced glycation end products and advanced oxidation protein products, were measured in this study. Also, antioxidant enzymes, including paraoxonase-1, lecithin-cholesterol acyltransferase and serum ferric-reducing antioxidant power, were determined. Results The serum levels of advanced glycation end products and advanced oxidation protein products were significantly higher in patients with alopecia areata, compared to the controls (P < 0.001), whereas the levels of ferric-reducing antioxidant power, paraoxonase-1 and lecithin-cholesterol acyltransferase were significantly lower in patients with alopecia areata, compared to the controls (P < 0.001). The mean fasting blood sugar level was significantly higher in patients with alopecia areata, compared to the controls. The ferric reducing antioxidant power level was significantly associated with the percentage of hair loss (P = 0.01, r = 0.4) and the serum C-reactive protein level (P = 0.03, r = -0.3) in patients with alopecia areata. Limitations Since the current study had a cross-sectional design, no cause-effect relationship was established between alopecia areata and oxidative stress. The sample size of our study was also small. Conclusion Based on the present results, the oxidant-antioxidant enzymatic system is impaired in alopecia areata due to the increased oxidative products and decreased antioxidant activity.

Evaluating the Perception of Mycosis Fungoides Patients About Their Disease Before and After Educating Them.

Introduction: Patient-held beliefs are important for disease management and few studies have evaluated illness perception of Mycosis Fungoides (MF) patients. Objectives: Here, we aimed to determine the effect of educating MF patients on their perception of their disease. Methods: Patients with diagnosed MF were asked to fill the Illness Perception Questionnaire-Revised (IPQ-R) once before education and once 3 months later. Results: Fifty-five patients, 41 men and 14 women, with a mean age of 45.5 ± 13.9 years were enrolled. Regarding the main etiologic factor, most patients cited anxiety (91%). After education, the most significant changed belief on disease etiology was immune system dysfunction and the change was twenty-six percent which was observed more in patients with higher educational levels, shorter disease duration, and lower MF stages. Regarding the most prevalent clinical manifestations, most patients mentioned erythema (86%). After education, the greatest change in symptom perception was related to lymphadenopathy (32%) which was significantly associated with less disease duration and those treated with phototherapy. Before education, the mean perception score about the disease chronicity was 23.67 ± 3.549 that increased to 27.71 ± 1.66 (P < 0.001). This change was more observed in men (P = 0.03), those with less disease duration, and those treated with phototherapy. Conclusions: Generally, MF patients hold favorable perspectives about their disease and educating them positively improves their illness perception. Patients with higher educational levels and lower stages of the disease showed more significant changes in various aspects of illness perception. Hence, early education is recommended in patients with lower educational levels.

Corrigendum.

[This corrects the article DOI: 10.1002/hsr2.602.].

Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study.

Introduction: Lichen planopilaris (LPP) is a lymphocyte-mediated type of scarring alopecia and considered to have autoimmune etiology. Studies about systemic comorbid conditions are limited. Our goal is to identify the prevalence of medical comorbidities in patients with LPP. Methods: In a retrospective case-control study, the medical records of 208 LPP patients and 208 controls were reviewed for existing comorbidities such as thyroid diseases, cardiovascular disorders, hypertension, hyperlipidemia, and lupus erythematous. Results: Hyperlipidemia was found in 41.8% of all patients with LPP and in 17.3% of controls (p value <0.001, OR = 4.167). Chances of hypertension and cardiovascular disorders were lower in the LPP group in comparison to controls (p value = 0.009). Thyroid disorders were more prevalent in LPP patients, but the difference was not statistically significant (p value = 0.277). Conclusion: Our study further emphasizes that LPP patients should be screened for medical comorbidities, especially lipid profile abnormalities.

Demographic aspects, clinical characteristics, and therapeutic approaches in geriatric psoriasis: A study from a tertiary center.

Geriatric psoriasis, due to its unusual clinical manifestations and higher rates of systemic complications in this age group, is a challenging issue for dermatologists. Therefore, we aimed to provide an overview of the epidemiological, clinical, and therapeutic consequences among patients aged over 60 years with psoriasis in a referral center in Iran. This cross-sectional study was conducted on 156 patients over 60 years with the definitive diagnosis of psoriasis that were referred to our center between 2015 and 2019. By reviewing the recorded files of the patients, baseline characteristics including demographics, underlying comorbidities, age of disease onset, clinical type of the disease, clinical manifestations, and therapeutic approaches were extracted. The most common clinical feature was plaque type (73.1%) followed by pustular type (10.9%). The most frequent involved zone was the lower extremities (84.6%). Most of the patients were treated topically (87.1%), while as the most frequent systemic approaches, methotrexate and acitretin were considered for 74.4% and 60.3%, respectively. A significantly higher mean age at disease onset was found in female patients compared to male patients. The plaque type was more prevalent in men than in women. Also, the chance of nail involvement was 2.43 times higher in men than in women (p = 0.011, 95%CI: 1.22-4.84). The disease duration was significantly longer in patients suffering from plaque compared to those without this feature. Conversely, those with palmoplantar type experienced shorter disease duration. Psoriatic arthritis was also revealed in patients of lower ages. As in other societies, in our society, clinical characteristics, disease involvement patterns, as well as considered treatment approaches, can be influenced by demographic characteristics.

Cutaneous manifestations following COVID-19 vaccination: A report of 25 cases.

Various adverse effects particularly cutaneous manifestations associated with different COVID-19 vaccines have been observed in practice. The aim of our study was to evaluate all patients who presented to our tertiary center with skin manifestations following COVID-19 vaccines injection from September to December 2021. All patients with skin manifestation within 30 days or less following COVID-19 vaccination were enrolled in our case-series. All cases included in our study were diagnosed based on clinical and/or histopathological evaluation and all other possible differential diagnoses were ruled out. Twenty-five individuals including 16 (64%) males and 9 (36%) females with the mean age of 47 ± 17.62 years (range 18-91) were enrolled in our study. Twenty-two (88%) patients developed lesions after Sinopharm vaccine injection and 3 (12%) cases manifested lesions after the AstraZeneca vaccine. Six (24%) patients developed new-onset lichen planus (LP) and 1 (4%) patient manifested LP flare-up. Two (8%) individuals developed psoriasis and 1 (4%) case showed psoriasis exacerbation. One (4%) patient developed new-onset pemphigus vulgaris (PV) and 1 (4%) case experienced a flare of PV lesions. One (4%) patient manifested pityriasis lichenoides et varioliformis acuta (PLEVA) flare-up. Other new-onset cases were as follows: toxic epidermal necrolysis (TEN) (n = 1, 4%), bullous pemphigoid (BP) (n = 2, 8%), alopecia areata (AA) (n = 2, 8%), pytriasis rosea (n = 1, 4%), herpes zoster (n = 1, 4%), cutaneous small vessel vasculitis (n = 1, 4%), erythema multiform (EM) and urticaria (n = 3, 12%), and morphea (n = 1, 4%). Physicians should be aware of the possible side effects especially cutaneous manifestations associated with COVID-19 vaccines.

Assessing quality of life in patients with autoimmune bullous diseases using the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life questionnaire finds similar effects in women as men.

In autoimmune bullous diseases (AIBDs), autoantibodies loosen molecular adhesions in the skin and/or mucosa and lead to blisters and erosions. Immunosuppressive drugs reduce mortality of the AIBD; therefore, patients will have to live longer with comorbidities. Objective: This study aims to determine the quality of life of AIBD patients undergoing systemic treatment while investigating the survey's relationship with various factors. Methods: In this 2-step cross-sectional study, we initially included 53 consecutive pemphigus patients to investigate reliability and validity of the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaire. Then, we conducted the study on 119 AIBD patients, currently under treatment at an AIBD clinic in Iran. Results: The mean TABQOL score for our patients was 13.87 ± 7.51. The highest TABQOL was for epidermolysis bullosa acquisita (24 ± 8.485) followed by pemphigus foliaceus (20.5 ± 14.181) and the lowest for pemphigus vulgaris (13.24 ± 6.54). There was no significant difference between patients' TABQOL scores and their gender, history of rituximab injection, and disease severity scores. We only found a positive correlation between TABQOL and prednisolone dose. Conclusion: Treatments of AIBD considerably impact the quality of life of patients and an impairment in quality of life is correlated to higher doses of prednisolone.

Treatment satisfaction and response in patients with severe alopecia areata under treatment with diphenylcyclopropenone.

Background and Aims: Alopecia areata (AA) is an autoimmune disease of hair follicles. Treatments currently include topical and intralesional corticosteroids and contact immunotherapy; however, the overall prognosis is usually unfavorable. In severe AA, topical immunotherapy with diphenylcyclopropenone (DPCP) is preferred. Since its effectiveness is heterogeneous and there are several side effects, we decided to measure the patients' satisfaction using the "Version II of the Treatment Satisfaction Questionnaire for Medication," which investigates satisfaction with effectiveness, side effects, convenience, and global satisfaction. Methods: We examined 100 patients under treatment with DPCP for treatment response, asked them to respond to the questionnaire, and calculated their overall scores out of 400. We then investigated the association between the patients' characteristics with their treatment response and satisfaction. Results: The overall satisfaction of patients was 257/400. We observed a significant association between patients' satisfaction scores on effectiveness and global satisfaction with their response to treatment (p < 0.001). The patients' satisfaction with the treatment's convenience had a significantly positive association with the age of receiving the diagnosis (p = 0.028). The overall treatment satisfaction was significantly associated with treatment response (276 vs. 213, p = 0.000). Conclusion: Although there are currently no gold standard treatments for severe AA, DPCP demonstrated a 71% response to treatment, and patients with response were significantly more satisfied with their treatment.

Topical treatment adherence and associated factors in patients with psoriasis: A single center, cross-sectional study.

Topical medications are one of the main treatments for psoriasis. Adherence to treatment is an important factor in achieving successful control of disease. The aim of this study was to evaluate adherence to topical drugs and identify possible associated factors in in patients with psoriasis. Ninety-three patients were evaluated by a two-part questionnaire; the first part examined demographic, socioeconomic and disease-related factors while the second part, the ECOB questionnaire (Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux), examined adherence to topical drugs. The mean self-reported adherence to topical treatment in this study, was 50.5%. Severe disease, involvement of lower extremity, and positive family history of psoriasis were associated with poor adherence to treatment. Patients with a history of diabetes mellitus had better adherence to treatment. In this study adherence to topical treatment was low and had no significant relationship with most of the studied demographic and socioeconomic factors.