Lessons from a scoping review: Clinical presentations of central centrifugal cicatricial alopecia.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA) nomenclature describes a typical clinical presentation of cicatricial hair loss that begins on the vertex scalp with progressive, symmetric, and centrifugal evolution. However, atypical presentations have been noted clinically by the authors and reported in the literature. OBJECTIVE: We sought to characterize the distribution of hair loss in published cases of adult patients with CCCA. METHODS: A 3-step search process was used to evaluate research articles in Cumulative Index to Nursing & Allied Health, EMBASE, Google Scholar, MEDLINE, Scopus, and Web of Science databases. Studies with scalp photography or description of hair loss distribution were included. Three researchers evaluated eligible studies for clinical subtypes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was used to report results. RESULTS: Ninety-nine studies consisting of 281 cases of CCCA were included. Hair loss distributions included variants of the classic presentation along with distinct subtypes such as patchy, occipital, parietal, frontal, temporal, and trichorrhexis. LIMITATIONS: Studies had significant homogeneity, as the classic distribution of CCCA was commonly reported. Additionally, clinically diagnosed cases may have concurrent diagnoses, and numerous studies did not report trichoscopy findings. CONCLUSION: CCCA terminology may not always be reflective of clinical presentation. Understanding atypical presentations is essential to inform appropriate and targeted treatment.

Factors Affecting Treatment Selection Among Patients With Hidradenitis Suppurativa.

Importance: Despite the US Food and Drug Administration's approval of adalimumab for the treatment of hidradenitis suppurativa (HS), prescription rates remain low, indicating a critical gap between evidence-based guidelines and clinical practice. Understanding the medical decision-making process that these patients use when considering biologic agents and other HS therapies may uncover opportunities for improved patient-physician communication and HS disease control. Objective: To elucidate factors that affect the medical decision-making process for patients with HS, with an emphasis on biologic therapies. Design, Setting, and Participants: Open-ended semistructured interviews were conducted with English-speaking adults with HS (aged ≥18 years) recruited from 2 dermatology clinics that are part of Emory University School of Medicine in Atlanta, Georgia. All participants had an average 7-day pain score of 1 or higher on a 0- to 10-point numeric rating scale. Surveys were conducted between November 2019 and March 2020, and data were analyzed from December 2021 to August 2022. Data collection continued until thematic saturation was reached at 21 interviews. Results: A total of 21 participants (median [IQR] age, 38.5 [27.9-43.4] years; 16 females [76%]) were included in the analysis. Almost all participants (96%) had Hurley stage II or III disease, and 15 (71%) had a history of adalimumab use. Suffering threshold, perceptions of treatment risk, treatment fatigue, disease understanding, and sources of information (included dermatologists, the internet, advertisements, and friends and loved ones) were identified as factors affecting participants' decisions to initiate new treatments for HS. Conclusions and Relevance: Results of this qualitative study suggest that mitigating misconceptions about treatment risk, identifying gaps in disease knowledge, and emphasizing early treatment to prevent scarring and disease progression may empower patients with HS to engage in treatment planning and to try new therapies.

Is orofacial granulomatosis a distinct clinical disorder?

Orofacial granulomatosis is a rare disorder that is heterogeneously defined in the published literature. Herein, we describe a patient with orofacial granulomatosis with clinical and histologic evidence, discuss differential diagnoses, and offer clinical pearls for diagnosing and assessing this disorder. Our case provides support that orofacial granulomatosis is a distinct disorder as opposed to a sequela of other systemic granulomatous diseases. This information will aid dermatologists in decision making and diagnosing the disorder.

Minority hair tax: pricing bias in haircare products.

Background: Black haircare is an estimated $2.51-billion-dollar industry. Black women spend 9 times more on ethnic hair products than non-Black consumers. The haircare industry has adapted to these market trends by developing products catering to the needs of "natural hair," referring to curly to tightly coiled hair texture that has not been chemically straightened with a relaxer. Anecdotally, natural haircare products are relatively expensive. Objective: We aimed to investigate texture-based price differences for haircare products targeting coily/curly compared to straight hair types. Methods: Data were collected in August 2022 from 6 brands available on www.amazon.com. After stratifying the data by manufacturer, hair texture, and average price/oz, we used 2 sample t-test with equal variances to examine cost differences. Results: Overall, there was a significant difference in average price/oz between all coily/curly and straight hair products, with coily/curly hair products being more expensive. When stratified by manufacturer, one leading US manufacturer sold coily/curly hair products at a higher price ($0.66/oz ±$0.05) compared with straight hair products ($0.46/oz ±$0.04), t14 = 2.8967, P < 0.0134. Limitations: A small sample size of only shampoos and conditioners were analyzed, which may not represent the number of haircare products that consumers use. Conclusion: Pricing policies should ensure that all individuals have access to effective, affordable haircare products. Dermatologists should also be cognizant of pricing differences to direct patients with natural hair to fairly priced products.