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

Baricitinib is a Janus kinase inhibitor which is now FDA approved for the treatment of severe alopecia areata (AA) in adults. However, the clinical trials which demonstrated the efficacy of baricitinib in the treatment of severe AA did not include men aged >60 years and 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 72.0% reduction in the mean SALT score from baseline was observed. Partial or complete eyebrow and eyelash hair was observed in 57.1% and 42.9% of patients respectively. Adverse effects of baricitinib were mild. No cases of venous thromboembolism (VTE), major adverse cardiovascular events (MACE) or malignancy were reported.

Alopecia Areata Mimicking Frontal Fibrosing Alopecia.

Alopecia areata (AA) is an autoimmune nonscarring alopecia that has variable clinical patterns, most commonly patchy disease. We report a case of AA with unusual involvement of the frontal hairline, mimicking frontal fibrosing alopecia (FFA), a form of scarring alopecia. Dermoscopic findings and response to treatment favored a diagnosis of AA. These findings highlight the major role of trichoscopy as well as the importance of including AA in the differential diagnosis for FFA.

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

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.

Treatment of alopecia areata in pre-adolescent children with oral tofacitinib: A retrospective study.

BACKGROUND: Alopecia areata (AA) is an autoimmune hair loss condition that affects people of all ages. Early age of onset and prolonged disease duration indicate poor prognosis. Janus kinase inhibitors are being investigated in phase 3 clinical trials in adolescents and adults with AA OBJECTIVE: To evaluate the use of oral tofacitinib in pre-adolescent patients with AA. METHODS: A retrospective review of case records of all pre-adolescent patients with AA treated with oral tofacitinib in a single center between 2018 and 2019. RESULTS: Fourteen patients were identified, aged 7 to 11 years. Nine patients experienced clinically significant improvement in their SALT (Severity of Alopecia Tool) score. Three patients achieved complete remission (SALT score of 0), seven (63.6%) achieved over 50% improvement in SALT score from baseline. One patient had no change from baseline, another experienced additional hair loss. After an average of 9 months of treatment, the median SALT score improvement was 67.7%. The improvement was similar in patients with baseline SALT scores greater than 50 and those with baseline SALT scores below 10. Adverse events were mild. LIMITATIONS: The retrospective nature of the data, small sample size, lack of a control group, referral bias to a specialist hair center, and concomitant use of other medications including oral minoxidil in all patients. CONCLUSION: There is a role for tofacitinib as a systemic therapy in AA and this should be further evaluated in prospective clinical trials in pre-adolescents.

Recalcitrant lichen planopilaris and frontal fibrosing alopecia responding to tildrakizumab.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic, cicatricial alopecias. Clinically, LPP presents with multifocal patchy alopecia, while FFA, considered a variant of LPP, results in hairline recession. Frontal recession in FFA may progress as far as the mid-scalp and infrequently beyond. Treatment to arrest the inflammatory process can be challenging and response variable. We report a case of recalcitrant lichen planopilaris and frontal fibrosing alopecia demonstrating significant clinical improvement after four doses of the interleukin-23 monoclonal antibody tildrakizumab.

Bitemporal alopecia areata.

Alopecia areata has various clinical presentations, some of which have recognised prognostic significance. We report five cases of bitemporal alopecia areata, with involvement of the frontal hairline, the therapeutic approach for each case and possible differential diagnoses to also consider.