Meta-analysis using Rotterdam Criteria Estimates PCOS Prevalence at 11.5% Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age. PCOS is not one condition but rather an array of different presention. Patients may have clinical or laboratory signs of hyperandrogenism and irregular periods. Further evidence of the condition comes from an ultrasound showing cysts or an elevated AMH level. Authors from Iran recently performed a meta-analysis of all published studied related to PCOS to better understand the true prevalence. They found a total of 35 stu ..read more

Scalp alopecia due to a clinically unapparent or minimally apparent neoplasm (SACUMAN) is a rare condition. It refers to a type of alopecia neoplastica wherey neoplastic cells invade the are in and around hair follicles and cause hair loss. However, they do so in a manner which is quite subtle and leave the underlying skin looking fairly normal. I was very interested to read a report recently by Tomasini et al. outlining a cause of basal cell carcinoma mimicking androgenetic alopecia. Tomasini CF et al. 2024 Authors reported the case of a 74-year-old woman who presented with concerns ab ..read more

Authors from Australia Report the Youngest Male Patient to Date with DSC. I was interested to read a report from Australia of a 13 year old male with dissecting cellulitis. Dissecting cellulitis is a neutrophilic scarring alopecia typically affecting males 18-30. The patient’s age makes this case unique and quite unexpected. The patient was initially treated with doxycycline, clindamycin and topical steroids without much benefit. He was then switched to a treatment plan involving isotretinoin 10 mg daily (0.20 mg/kg), sublingual minoxidil 0.45 mg twice daily, oral prednisolone 25 mg daily for ..read more

The Classic Story Of Hair Highlighting Burns I was interested to read a report in the Journal of Clinical Medicine about a scarring alopecia that followed hair highlighting by a 17-year-old female. This story appears all too commonly - and I do wonder if reports are actually increasing worldwide. This is something I’m seeing often! The authors describe a 17 year old who attended a hairdressing salon in order to lighten the hair. Within a very short time of applying the preparation to her hair, the woman felt a strong burning sensation on her scalp. The preparation was then washed off and fur ..read more

Regrowth of Scalp Discoid lupus (DLE) with Hydroxychloroquine Discoid lupus erythematosus (DLE) is an inflammatory condition of the skin that can potentially cause scarring. When DLE affects the scalp, it may cause scarring alopecia. A variety of treatments are available, although topical steroids, steroids injections, calcineurin inhibitors, and hydroxychloroquine (HCQ) are first-line treatments in my practice. Liang K R et al, 2024 I enjoyed reading a case report of a very nice response of a patient with DLE to treatment with HCQ. The study was conducted by Liang et al. in the journal Cure ..read more

Topical tofacitinib for LPP and FFA Oral and topical JAK inhibitors continue to be studied in scarring alopecia. A small number of studies point to potential benefits of oral and topical JAK inhibitors in the treatment of lichen planopilaris and frontal fibrosing alopecia. Topical JAK inhibitors have an obvious interest given that they have less systemic absorption than oral JAK inhibitors. This is important given that oral JAK inhibitors come with their share of side effects including infections, blood test abnormalities, and other issues. To date, there have only been a limited number of pat ..read more

New Study Supports Effectiveness of Baricitinib in Pediatric Patients JAK inhibitors are increasingly used for the treatment of severe AA. In 2023, the JAK inhibitor ritlecitinib became the first drug approved by FDA for treating alopecia areata in individuals in the 12 - 18 age group. Of course, the drug is approved for adults as well. But what’s unique about ritlecitinib is its approval in the 12-18 age group. I can only imagine that we’ll be seeing more and more and more approvals for alopecia areata drugs in the pediatric population. Advanced alopecia areata affects a significant number of ..read more

Generic Tofacitinib for Alopecia Areata The JAK inhibitors ritlecitinib and baricitinib are approved by many health regulatory bodies across the world for the treatment of advanced alopecia. Baricitinib was FDA approved on June 13, 2022 and ritlecitinib was FDA approved on June 23 2023. Even though it’s not formally stamped with the seal of approval, tofacitinib has been used ‘off-label’ for treating alopecia areata since 2015. The world has a lot of experience treating alopecia areata with tofacitinib. While the clinical trial data is not as rigorous for tofacitinib as for baricitinib or rit ..read more

New study Suggests We Don’t Vaccinated Enough - Especially our Younger Patients There is a great deal of information that must be conveyed to patients before starting JAK inhibitors. One of these is a review of infections and ways to reduce the risk of infection through vaccination. Immunization against zoster, influenza and pneumococcus are generally recommended before starting JAK inhibitors. For example, zoster is recommended at age 19 or above now by the CDC (and 50 years of age and over in the general population). Influenza is recommended yearly. Pneumococcous is now recommended at 19 an ..read more

 1 in 3 Patients Using JAK Inhibitors Will Have Some Sort of Infection Authors from Italy set out to retrospectively review infectious disease events in patients receiving JAK inhibitors over the period from July 2021 to October 2023. There were 91 patients in their study, including 85 treated with baricitinib and 6 with upadacitinib. There were no patients treated with ritlecitinib in this particular study as ritlecitinib had not been approved in Europe until Sept 2023. The authors observed 34 infectious events in 28 patients (30.8%). Five patients had multiple infectious events (5.5 ..read more