Faculty Bibliography

Androgenetic alopecia (AGA) significantly impacts patients' psychological well-being, and treatment options have historically been limited. However, the advent of low-dose oral minoxidil (LDOM) has revolutionized AGA management. This study compares the treatment response and safety of LDOM in patients with AGA alone versus those with AGA unmasked by telogen effluvium. Our findings indicate that LDOM is effective and safe for both groups, showing comparable efficacy and safety profiles. These results support the use of LDOM as a reliable treatment option for AGA, potentially improving patient outcomes and quality of life.

BACKGROUND/UNASSIGNED:Low dose oral minoxidil (LDOM) is a preferred treatment for alopecia due to ease of use and efficacy. While LDOM is typically well tolerated, patients may experience a temporary increase in hair shedding starting treatment, colloquially regarded as "dread shed". One proposed method to combat this is to overlap therapies by maintaining use of topical minoxidil when initiating LDOM. OBJECTIVE/UNASSIGNED:To evaluate the impact of maintaining topical minoxidil when initiating LDOM on "dread shed". METHODS/UNASSIGNED:We performed a retrospective chart review of patients seen at New York University Langone Health Dermatology from January 1, 2008 to August 1, 2023 prescribed LDOM. RESULTS/UNASSIGNED:A total of 115 patients met inclusion criteria, of whom 37 maintained use of topical minoxidil when initiating LDOM. Six patients experienced "dread shed" when initiating LDOM, 2 of whom overlapped therapies. We did not find that overlapping therapies had a significant impact on decreasing rates of "dread shed". LIMITATIONS/UNASSIGNED:Limitations include retrospective design, sample size, and subjective patient-reported assessment of hair shedding. CONCLUSIONS/UNASSIGNED:A total of 5.2% of patients experienced dread shed, which is lower than previously reported in literature. Maintaining topical minoxidil during LDOM initiation does not significantly impact "dread shed". This remains a significant side effect deserving of further research.

BACKGROUND:There is no established standard of care for treating central centrifugal cicatricial alopecia (CCCA), and treatment approaches vary widely. OBJECTIVE:To develop consensus statements regarding the use of various pharmacological therapies in treating adults with CCCA. METHODS:We invited 27 dermatologists with expertise in hair and scalp disorders to participate in a 3-round modified Delphi study between January and March 2023. Statements met strong consensus if 75% of respondents agreed or disagreed. Statements met moderate consensus if 55% or more but less than 75% agreed or disagreed. RESULTS:In Round 1, 5 of 33 (15.2%) statements met strong consensus, followed by 9 of 28 (32.1%) in Round 2. After the final Round 3 meeting, strong consensus was reached for 20 of 70 (28.6%) overall statements. Two statements achieved moderate consensus. LIMITATIONS/CONCLUSIONS:This study included only English-speaking, US-based dermatologists and did not consider non-pharmacological therapies. CONCLUSION/CONCLUSIONS:Despite varying opinions among dermatologists, consensus was reached for several statements to help clinicians manage CCCA. We also highlight areas that lack expert consensus with the goal of advancing research and therapeutic options for CCCA.

BACKGROUND/UNASSIGNED:Janus kinase inhibitor (JAKi) therapy has revolutionized the treatment landscape for alopecia areata (AA); however, access may be limited by a lack of insurance coverage and high out-of-pocket costs. OBJECTIVE/UNASSIGNED:We aimed to evaluate real-world patient experiences regarding access to JAKi therapy. METHODS/UNASSIGNED:We conducted an online patient-centered survey using the National Alopecia Areata Foundation listserv. RESULTS/UNASSIGNED:In total 784 individuals initiated our survey, and 600 completed it in full (76.5%). While more non-White patients considered obtaining JAKi therapy, more White patients reported the use of this medication class. In total, 74.2% lacked insurance coverage or had partial coverage for JAKi, and 52% expressed dissatisfaction with available coverage. However, 52.9% reported delays in starting medication due to insurance approval processes, contributing to worsened AA and related stress. In total, 35% of patients did not try to obtain JAKi therapy due to concerns about costs, and 18.2% discontinued therapy due to financial barriers. Also, 19.8% of patients reported utilizing financial savings to pay for medication, and 55.2% reported using a copay assistance card. Further, 12.2% reported forgoing other necessities to pay for AA expenses. LIMITATIONS/UNASSIGNED:Our results are limited by the subjective nature of survey studies. The recency of FDA approval for JAKi therapy may also influence patients' perceptions of access to care. CONCLUSION/UNASSIGNED:Patients with AA face significant barriers when trying to obtain JAKi therapy, and existing racial inequities may be exacerbated by these barriers. Further advocacy work is needed to improve access to care.