Faculty Bibliography

BACKGROUND:Janus kinase inhibitors (JAKis) have transformed the treatment of alopecia areata (AA), but not all patients respond to initial therapy. The utility of switching between JAKis in treatment-refractory AA remains underexplored. OBJECTIVE:To evaluate the efficacy and safety of switching between JAKis in patients with severe AA. METHODS:In this multi-center retrospective study, we analyzed 108 patients with severe AA who switched between oral JAKis after a minimum treatment duration of 6 months. Treatment response was assessed using the Severity of Alopecia Tool (SALT). Multivariable logistic regression was used to identify predictors of response to a second JAKi. RESULTS:Overall, 48.8% of patients achieved SALT ≤20 on their second JAKi, and 32.6% achieved SALT ≤10. Of 24 patients who received a third JAKi, 52.4% achieved SALT ≤20 and 38.1% achieved SALT ≤10. Patients who responded to their first JAKi were more likely to respond to a second (OR 3.33; 95% CI, 1.22-9.68; P=0.022). Adverse events were mild and consistent with prior reports. LIMITATIONS/CONCLUSIONS:Retrospective design, treatment heterogeneity, and potential selection bias. CONCLUSIONS:Switching between JAKis appears to be a viable strategy for severe AA patients, especially those responding to prior JAKi. Prior response may help guide treatment sequencing.

INTRODUCTION/UNASSIGNED:Alopecia treatments can incur significant patient costs; however, this monetary impact has yet to be characterized in scarring alopecia (SA) patients. Our study aims to characterize the financial burden of SA and its psychosocial impact. METHODS/UNASSIGNED:We conducted a cross-sectional study using survey data collected by the Scarring Alopecia Foundation between December 2, 2022, and December 16, 2022. Financial burden metrics and quality of life impacts were analyzed using RStudio. RESULTS/UNASSIGNED:A total of 1,047 individuals (97.4% female, mean age 57.8 years) completed the survey. Most patients (51.4%) spent USD 1-100 monthly on medical treatments, followed by USD 101-250 (22.8%). Annual costs for nonprescription treatments were most commonly <USD 100 (37%), followed by USD 101-500 (26.5%). Annual costs for nonmedical items were more evenly distributed, yet nearly one in five patients spent >USD 1,000. No differences were seen between general dermatologist and hair loss specialist patients. Most patients felt only somewhat supported or not supported by insurance with no difference between public and private coverage. Additionally, no financial metrics were significantly associated with differences in quality of life. CONCLUSION/UNASSIGNED:Regardless of provider type, patients with SA face substantial out-of-pocket costs for nonmedical items with limited insurance support. Further advocacy is needed to lessen the financial burden faced by SA patients.

IMPORTANCE/UNASSIGNED:Persistent chemotherapy-induced alopecia (PCIA) is a distressing adverse effect that can have lasting psychosocial consequences. However, racial and ethnic differences in PCIA incidence and associated distress remain unclear, owing to limited multiracial and multiethnic data. OBJECTIVE/UNASSIGNED:To evaluate racial and ethnic disparities in the incidence of PCIA and alopecia-related psychological distress among women with breast cancer from baseline to 12 months after completion of chemotherapy. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This prospective cohort study was conducted at 2 tertiary cancer centers in the US (August 19, 2015, to December 31, 2021) and South Korea (December 20, 2018, to April 27, 2022). Women (aged ≥18 years) with stage I to III breast cancer who received chemotherapy were included. Data analysis was conducted from June 30 to July 15, 2025. EXPOSURES/UNASSIGNED:Standardized trichoscopic assessments were performed and validated distress questionnaires were administered at baseline and 12 months after treatment. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was PCIA incidence, which was defined as hair thickness or density at 12 months after completion of chemotherapy that fell more than 2 SDs below the level measured before chemotherapy. Secondary outcomes included changes in hair density, hair shaft thickness, and alopecia-related distress, measured using the Chemotherapy-Induced Alopecia Distress Scale (CADS). RESULTS/UNASSIGNED:The 304 women (mean [SD] age, 50.3 [10.6] years) in this study were Asian (n = 159 [52.3%]), Black (n = 20 [6.6%]), Hispanic or Latino (n = 17 [5.6%]), or White (n = 108 [35.5%]). At baseline, Asian women had the thickest hair shafts (mean [SD], 83.2 [13.4] µm) but the lowest follicular density (mean [SD], 136.2 [27.6] hairs/34.34 mm2 at ×50 magnification; P < .001). At 12 months, PCIA incidence was highest in Asian women (59 [42.1%]), followed by White (24 [22.2%]), Black (2 [10.0%]), and Hispanic or Latino (1 [5.1%]) women (P = .001). Asian women also had the greatest increase in CADS scores compared with White women, particularly in the emotional (adjusted mean difference, 1.88 [95% CI, 0.92-2.95]) and activity-related (1.55 [95% CI, 0.58-2.52]) domains. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this prospective multinational cohort study, significant racial and ethnic disparities were observed in the incidence and psychological effects of PCIA. Asian women experienced the greatest burden. These findings underscore the need for personalized counseling, culturally sensitive psychosocial support, and consideration of pharmacogenetic risks in managing chemotherapy-related alopecia.

INTRODUCTION/UNASSIGNED:; hair caliber, µm) provide an objective method for monitoring treatment response. Artificial intelligence (AI) enables trichoscopic analysis without hair clippings. This study examines the perspectives of alopecia patients regarding AI-driven trichoscopy. METHODS/UNASSIGNED:We conducted an IRB-approved survey study and chart review of 101 patients at the NYU Langone hair clinic undergoing AI-driven trichoscopy. Pre- and post-visit surveys measured self-perceived alopecia severity and quality-of-life impact before and after reviewing TMs with their dermatologist. Opinions regarding AI-driven trichoscopy were assessed via Likert scales. Demographics, medical history, and clinician-assessed severity were extracted from medical charts. RESULTS/UNASSIGNED:= 0.0075). Patients endorsed enhanced alopecia care and greater confidence in treatment recommendations with the use of AI-driven trichoscopy. CONCLUSION/UNASSIGNED:Patients with alopecia generally view AI-driven trichoscopy favorably, noting improved quality of care and greater motivation to continue therapy.