Incidence and prevalence of alopecia areata in the Australian primary care setting: A retrospective analysis of electronic health record data.

BACKGROUND: Alopecia areata (AA) is a common immune-mediated non-scarring hair loss, with a worldwide incidence between 0.57% and 3.8%. The incidence and prevalence of AA in the Australian general population have not been previously reported. OBJECTIVE: To describe the incidence and prevalence of AA in Australia using primary care data. A secondary objective was to identify common demographic characteristics, comorbidities and treatment patterns among Australians living with AA. METHODS: We analysed electronic health record data captured from a national clinical practice management software over a 10-year index period between 2011 and 2020 calendar years, inclusive. The incidence of new-onset AA and the prevalence of active records with AA were estimated. Differences in incidence by sociodemographic groups, and patterns of treatment were also evaluated. RESULTS: There were 976 incident AA records. The incidence of new-onset AA in the total study cohort was 0.278 per 1000 person-years (95% CI 0.26-0.295). By age, the incidence was highest in the 19- to 34-year-old age bracket (0.503 per 1000 person-years: 95% CI 0.453-0.554). AA incidence was lower among females than males (IRR 0.763, p < 0.001, 95% CI 0.673-0.865). Among active records, 520 were prevalent AA records. AA point prevalence at 31/12/2020 was 0.13% (1.26 per 1000 persons; 95% CI 1.15-1.37). CONCLUSION: This is the first study to describe the epidemiology (incidence and point prevalence) and management of AA in the Australian primary health-care population through large-scale database analysis. Incidence and prevalence findings were consistent with earlier estimates from other regions.

Recalcitrant erosive flexural lichen planus: successful treatment with a combination of thalidomide and 0.1% tacrolimus ointment.

A 79-year-old woman has had chronically eroded and ulcerated flexural lichen planus for 12 years, resistant to many forms of treatment. She was successfully treated initially with a combination of topical 0.1% tacrolimus ointment and oral thalidomide and then with topical tacrolimus alone. She has remained free of exacerbations for 12 months and treatment has been well tolerated. Erosive lichen planus involving flexures alone is rare. All reports on treatment of this condition address erosive oral or mucosal lichen planus and both thalidomide and topical tacrolimus have been reported individually to be beneficial.

Granulomatous mycosis fungoides presenting as an acquired ichthyosis.

We report a case of a 69-year-old gentleman who presented with a 3-month history of unexplained fevers and malaise who developed generalized pruritus, alopecia and an ichthyosiform erythematous eruption on his forearms, legs, chest and back. Skin histology, immunophenotyping and molecular features were consistent with granulomatous mycosis fungoides. He has been successfully treated with twice weekly PUVA photochemotherapy.

Zosteriform Kaposi's sarcoma.

We report the case of a 92-year-old man with lesions of classic Kaposi's sarcoma occurring in a zosteriform pattern. The mechanisms of dermatomal distribution are speculated and cutaneous lesions presenting in a zosteriform pattern are reviewed.

Induced atelectasis of the middle ear and its clinical behavior.

Atelectatic ears are often treated with ventilating tubes for long periods of time. However, a certain percentage of atelectatic ears and retraction pockets resolve spontaneously over time. In order to determine whether self-aeration had been achieved in atelectatic ears previously fitted with ventilating tubes, the tubes were sealed and the ears were then closely followed. Out of 37 such tests, atelectasis did not recur in 4 ears, allowing their ventilating tubes to be removed. In 33 tests atelectasis redeveloped within 1-2h after the ventilating tube was sealed, with ears reverting to the same degree and shape as the original atelectatic condition. The seals were then removed, resulting in resolution of atelectasis. These observations were enforced by previous observations of similar changes and suggest that the partial pressures of the blood gases may be an important factor in controlling the level and possibly also the pathogenesis of atelectasis. The method of testing described also can be used in selected cases to determine whether or not a given atelectatic ear still requires a ventilating tube.

Airway levels of mast cell-derived mediators in exercise-induced asthma.

In order to assess the role of mast cell-derived mediators in the pathogenesis of exercise-induced asthma (EIA), we completed pre- and postexercise bronchoalveolar lavage (BAL) in seven atopic subjects with EIA. The study subjects were defined as having EIA if they exhibited a greater than 15% decrease in FEV1 after completing 6 min of treadmill exercise. There were no significant differences between mean preexercise and mean postexercise mast cell-derived BAL histamine (186 +/- 67 versus 148 +/- 36 pg/ml), tryptase (4.5 +/- 2.0 versus 2.8 +/- 2.0 ng/ml), prostaglandin D2 (26 +/- 11 versus 32 +/- 25 pg/ml), or leukotriene C4 (less than 100 versus less than 100 pg/ml). In addition, mast cells present in BAL fluid after exercise contained similar amounts of cellular histamine compared with BAL mast cells obtained before exercise (preexercise BAL cellular histamine, 26.6 +/- 12.3 ng/10(6) BAL cells; postexercise BAL cellular histamine, 22.7 +/- 9.1 ng/10(6) BAL cells), indicating that depletion of preformed mast cell mediators are unlikely to account for the refractory period in EIA. This study suggests that the cellular pathogenesis of EIA (mast cell-independent) differs from current theories of the pathogenesis of extrinsic allergen-induced asthma (mast cell-dependent).

Chronic relapsing pancreatitis with pseudocyst erosion into the portal vein and disseminated fat necrosis.

A 63-year-old man with the triad of chronic relapsing pancreatitis, disseminated fat necrosis with subcutaneous nodular panniculitis, and polyarthritis was found to have a pseudocyst which had eroded into the portal vein. These lesions were associated with markedly elevated serum pancreatic enzymes. Although recent immunological studies by others suggest a possible contribution of immune-mediated tissue injury, clinical and pathological evidence in the present case including direct tissue immunofluorescent findings do not support an immune pathogenesis of this association. The present study further substantiates the concept of physiochemical tissue injury by circulating pancreatic enzymes as the primary pathogenetic mechanism.

Factors affecting adolescents' use of family planning clinics.

PIP: Reports on a survey of family planning clinic and community characteristics in selected US counties where high and low proportions of adolescents obtain family planning services in clinics. In areas where large proportions of teenagers are served, clinics are more numerous, flexible, diverse, innovative, assertive and visible, have larger adolescent caseloads and provide more hours of service, have more varied funding and include more types of agencies. Parental consent or notification is less likely to be required, and other types of health services are more likely to be provided. Higher proportions of continuing adolescent clients, no charge for services, lack of formal appointments, and special outreach and follow-up programs and recruitment activities, are other characteristics of clinics in these areas. They also engender more support and more opposition. In areas where relatively small proportions of teenagers visit clinics, private physicians are less likely to prescribe contraceptives to minors on their own consent, pharmacists are less likely to display contraceptives openly, state laws and policies are more often silent or ambiguous about teenagers' rights and less often encourage teaching birth control in the schools.^ieng

Family planning services in the United States, 1978-1979.

PIP: Presents the findings of the most recent study of the organized family planning network conducted by the Alan Guttmacher Institute. Family planning clinics served 4.5 million women at 5195 locations in 1979, government health departments serving the largest number (about 2/5). More than 1/2 of new patients had no prior experience with contraceptives; 2/3 chose the pill or IUD at last clinic visit. Improved contraceptive practice was most notable among teenage patients: 3/4 had used no method prior to clinic enrollment, and the same proportion chose either pill or IUD. The proportion of clinic patients 19 or younger increased to 1/3 in 1979. Estimated federal expenditures in 1979 for clinic services were 233 million dollars, about 72% of the total. The major share of federal monies came from Title X funds, which are now in danger of being lost through the current administration's proposals to provide funding for health and social services primarily through block grants to the states.^ieng

Telling parents: clinic policies and adolescents' use of family planning and abortion services.

PIP: The Alan Guttmacher institute surveyed some 2500 family planning agencies, 2100 abortion providers and nearly 2400 teenage family planning and abortion recipients, the latter a representative national sample from more than 100 family planning and abortion clinics. 44% of abortion facilities and 20% of family planning providers require parental consent or notification if the teenager is 15 or younger; 30% of abortion providers and 10% of family planning facilities have such requirements for all minors. Substantial numbers of both types say they sometimes waive restrictive policies. 55% of all patients younger than 18 attending abortion clinics said that their parents knew they were doing so. The younger the teenager, the more likely the parents were to know. 23% said their parents did not know, and that they would not have come to the clinic had parental notification been required. Most said they would have had an illegal or self induced abortion or would have carried the unwanted pregnancy to term. 59% of family planning clinic patients younger than 18 said their parents knew or suspected that they were at the clinic. 23% said they would not come to the clinic if parental consent or notification were required. Most would continue to engage in sexual intercourse but use less effective nonprescription methods or no method. Only 2% said they would stop having sex. Extrapolating these findings to all teens attending family planning clinics shows that if all clinics had parental notification or consent requirements, about 125 thousand teenagers would stop using effective methods and would switch to less effective ones; 26 thousand would use nothing. In 1 year, 33 thousand more teenagers would become presgnant, resulting in 14,000 abortions, 9000 out-of-wedlock births, 6000 forced marriages, and 4000 miscarriages. Applying the figure to the 184 thousand teens younger than 18 who had abortions in 1978, some 39 thousand more teenagers might be expected to inform their parents of their abortion decision, but 42 thousand would not do so. Instead, 19 thousand of them would have illegal or self induced abortions, 18 thousand would have unwanted births, and 5000 would leave home.^ieng