Faculty Bibliography

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use in children is rapidly expanding, though in contrast to adults, morphologic data on dermatologic adverse events (AEs) in pediatric patients remain sparse, underscoring the need for further focused investigation. We review and synthesize the existing literature on dermatologic AEs of GLP-1 RAs in children in comparison to adults, to summarize current evidence, identify knowledge gaps, and highlight areas for future research. Available reports suggest that rash, urticaria, and alopecia may occur with greater frequency in children on injectable GLP-1 RAs compared with adults, while facial lipodystrophy has been more often described in adults. However, pediatric dermatologic AE data are not as robust as adult data, reducing the ability for direct comparisons. Based on this initial investigation, dermatologic AEs of GLP-1 RAs are seemingly under-described in children and may have important differences compared with adult dermatologic AEs.

Alopecia areata (AA) is an autoimmune hair disease with variable presentations necessitating individualized, stepwise management given patient age, extent of involvement, comorbidities, and treatment tolerability. Historically, severity was defined by percentage of scalp hair loss using the Severity of Alopecia Tool (SALT), with SALT≥50 defining severe disease and systemic therapy eligibility. Recently, severity assessment has expanded beyond scalp involvement with the AA Scale for Clinical Use (AASc), incorporating eyebrow/eyelash involvement, psychosocial impairment, and treatment response to better capture disease burden. First-line therapy for mild-to-moderate AA (SALT<50) includes topical or intralesional corticosteroids, often with topical or oral minoxidil. Observation may be appropriate in select cases given potential for spontaneous regrowth. FDA approval of oral Janus kinase inhibitors (JAKis) for severe AA (SALT≥50) has changed the therapeutic landscape. Selection among baricitinib, ritlecitinib, and deuruxolitinib is guided by patient age, safety considerations, comorbidities, laboratory monitoring, and insurance coverage. Switching between JAKis may still be beneficial after nonresponse to one agent. Adjunctive and alternative therapies include topical immunotherapy, systemic immunosuppressants, emerging biologic/targeted therapies, and procedural modalities, such as platelet-rich plasma, laser- and light-based therapies, and microneedling. This review synthesizes current evidence on AA treatment and offers a practical, contemporary framework for AA management.

Epstein-Barr virus (EBV) plays a role in the pathogenesis of a wide variety of acute and chronic diseases. Cutaneous manifestations of EBV include exanthems, chronic infections, malignancies, and small vessel vasculitides. Clinically and histologically, many of these conditions can imitate each other, making diagnosis challenging. In this report, we present a case of a child who developed Gianotti-Crosti syndrome with histopathologic features of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis in the setting of acute EBV infection. Furthermore, we review the literature on EBV-induced cutaneous small vessel vasculitis and discuss pathogenic mechanisms.

Accessing high-quality, open-access dermatopathology image datasets for learning and cross-referencing is a common challenge for clinicians and trainees. To establish a comprehensive open-access dermatopathology dataset for educational, cross-referencing, and machine-learning purposes, we employed a hybrid workflow to curate and categorize images from the PubMed Central (PMC) repository. We used specific keywords to extract relevant images, and classified them using a novel hybrid method that combined deep learning-based image modality classification with figure caption analyses. Validation on 651 manually annotated images demonstrated the robustness of our workflow, with an F-score of 89.6% for the deep learning approach, 61.0% for the keyword-based retrieval method, and 90.4% for the hybrid approach. We retrieved over 7,772 images across 166 diagnoses and released this fully annotated dataset, reviewed by board-certified dermatopathologists. Using our dataset as a challenging task, we found the current image analysis algorithm from OpenAI inadequate for analyzing dermatopathology images. In conclusion, we have developed a large, peer-reviewed, open-access dermatopathology image dataset, DermpathNet, which features a semi-automated curation workflow.

BACKGROUND:As the incidence of frontal fibrosing alopecia (FFA) continues to rise, there is a need for an optimal treatment algorithm for FFA. OBJECTIVE:To produce an international consensus statement on the treatment modalities and prognostic indicators of FFA. METHODS:Sixty-nine hair experts from six continents were invited to participate in a three-round Delphi process. The final stage was held as a virtual meeting facilitated via Zoom. The consensus threshold was set at ≥66%. RESULTS:Of 365 questions, expert consensus was achieved in 204 (56%) questions following completion of the three rounds. Three additional questions were included at the final meeting. The category with the strongest consensus agreement was disease monitoring (9; 100%). Questions pertaining to physical therapies achieved the least category consensus (15; 40%), followed by systemic therapy (45; 43%). LIMITATIONS/CONCLUSIONS:The study lacked sufficient representation from Africa and South America. CONCLUSION/CONCLUSIONS:SOFFIA highlights areas of agreement and disagreement among experts. Robust research is warranted to provide evidence-based treatment recommendations.