Faculty Bibliography

Hair traits are nonpathogenic features that vary among individuals. Unlike hair follicle (HF) diseases, which are rare in the population, hair traits can be measured in everyone. This facilitates the construction of large cohorts that are well-powered for gene discovery. GWASs identify genetic variants that are widely shared among people globally, providing knowledge with broad population relevance. We compile findings from hair trait GWASs to deepen our understanding of HF biology. In reviewing genetic factors that influence hair traits, we demonstrate overlap with disease genes, underscoring that genetic studies of traits improve our knowledge about health and disease.

BACKGROUND:Topical minoxidil, approved for the treatment of androgenetic alopecia, also has efficacy in many other hair loss disorders, its use limited due to the need for at least daily application. Oral minoxidil, in doses below those likely to lower blood pressure (so called "low dose oral minoxidil") has increasingly been used off label to treat a variety of hair loss conditions but without any standard recommended best practices. OBJECTIVES/OBJECTIVE:To provide a review of how experts in hair loss use the available literature on topical and low dose oral minoxidil to educate and treat safely and effectively patients with hair loss METHODS: Dermatologists with expertise in hair disorders met by teleconference and email to review the literature and share their direct experience with topical and oral minoxidil. RESULTS:Provision of basic knowledge of the key aspects of the use of topical or oral minoxidil to insure safe and effective use of either in treating hair loss.

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.

BACKGROUND:Eyebrow and eyelash (EB/EL) involvement is an important consideration in the assessment of alopecia areata (AA) severity. OBJECTIVES/OBJECTIVE:We report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) characterising EB/EL involvement at baseline in patients with AA and response to baricitinib treatment. METHODS:BRAVE-AA1 and BRAVE-AA2 were randomised, double-blind, placebo-controlled trials conducted at 169 centres in 10 countries. Patients were randomised to placebo, baricitinib 2 mg, or baricitinib 4 mg. Pooled data from patients continually treated with baricitinib through Week 52 were included. Outcomes were assessed using the Clinician-Reported Outcome (ClinRO) measure for EB/EL and Severity of Alopecia Tool (SALT) score for scalp. RESULTS:At baseline, patients with more severe EB/EL involvement had more severe scalp hair loss, with mean SALT scores ranging from 70.6 to 96.0 for patients with no gaps to complete absence of hair, respectively, at EB/EL sites. EB/EL response rates [ClinRO (0,1) with ≥1-point improvement] at Week 36 were significantly higher in patients treated with both baricitinib 2 mg (28.2%, odds ratio [OR]=3.27, 25.1% OR=2.95) and baricitinib 4 mg (44.3% OR=6.84, 46.4% OR=8.21) as compared with placebo (12.6%, 12.4%). There was high concordance between EB response and EL response, with approximately 80% of patients who achieved hair regrowth at one site, achieving regrowth at the other with baricitinib 4 mg. Among scalp responders (SALT score <20 at Week 52), 78.5% and 82.6% achieved an EB and EL response, respectively, and 71.1% of patients achieved a response in both EB and EL with baricitinib 4 mg. Among scalp nonresponders (SALT score >20 at Week 52), 46.7% and 48.7% achieved EB and EL responses, respectively, and 35.4% achieved responses in both EB and EL. Similar trends but lower response rates were observed with baricitinib 2 mg. CONCLUSIONS:Baseline severity of EB/EL involvement parallels that of the scalp. Baricitinib was efficacious in achieving holistic response across all three hair-bearing sites in a majority of Week 52 scalp responders. These data detail the benefits of baricitinib across important hair-bearing sites involved in AA and highlight that individual patient treatment success should account for the totality of the clinical presentation. TRIAL REGISTRATION NUMBER/BACKGROUND:BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, September 24, 2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, July 8, 2019.

BACKGROUND:Androgenetic alopecia (AGA) affects at least 80% of men and 50% of women by age 70. This study aimed to assess the efficacy of a non-ablative fractional laser (NAFL) in treating AGA and enhancing hair appearance on the scalp in male and female patients. METHODS:This was a single-center, retrospective, observational study. Case files of all subjects, who were treated for improvement of scalp hair appearance using a 1565-nm NAFL at LaserMed Clinic (Lublin, Poland) between February 24, 2020, and January 31, 2023, were reviewed for study inclusion. The authors were not involved in the administration of treatments but reviewed the data that were obtained for the study. Digital images taken before and following laser treatment were gathered and blindly evaluated by non-treating physicians for quality of results. The study's primary efficacy endpoint was the proportion of image sets correctly classified as before and after treatment. Success was defined as correct identification of the posttreatment image as the image demonstrating scalp hair growth and clinical improvement by at least two out of three blinded reviewers. Safety was evaluated based on the incidence of adverse events or safety issues. RESULTS:A total of 132 patients were included in the study, of whom 98 patients had photos of adequate quality for assessing device efficacy. The overall success rate of correct identification of before and after images among the 98a evaluable patients was 96.9% (95% confidence interval: 91.4%-98.5%) and remained consistently high (> 95%) across the evaluated subgroups (patients with AGA, patients with unknown type of alopecia, males and females). No adverse events were documented in the clinic records for the 132 subjects included. CONCLUSIONS:NAFL is a safe and effective method for promoting visible hair growth and improving the appearance of scalp hair.