Disease burden, clinical management and unmet treatment need of patients with moderate to severe alopecia areata; consensus statements, insights, and practices from CERTAAE (Central/Eastern EU, Russia, Türkiye AA experts) Delphi panel.

Objectives: This study aims to update the understanding of Alopecia Areata (AA) in Poland, Czechia, Russia, and Türkiye, focusing on the disease burden, clinical management, and patient journey. It seeks to establish a consensus on optimal management strategies for AA in these regions. Methods: A modified 2-round Delphi panel was conveyed with 23 Dermatologists (Russia; 4, Türkiye; 7, Poland; 6, and Czechia; 6). The Delphi questionnaire consisted of 61 statements and 43 questions designed to obtain an overall understanding of the perception and acceptance of available information regarding the care of patients with alopecia areata. Results: The study revealed that moderate-to-severe AA significantly impacts patients' and their families' QoL, consistent with previous studies. AA was found to cause more substantial impairment when additional lesions appeared in visible areas besides the scalp. Work and productivity impairment were notably higher in adults with moderate-to-severe AA. Diagnostic consensus highlighted the importance of skin biopsies and trichoscopy, while the need for more practical severity scoring systems was emphasized. Current treatments, including topical therapies, corticosteroids, and systemic immune modifiers, were deemed insufficient, highlighting the unmet medical need. Conclusion: The Delphi study underscores a significant disease burden and unmet medical needs in patients with moderate-to-severe AA. It highlights the necessity of access to novel treatments and further research to develop more effective therapies with a tolerable safety profile. The findings align with global research, emphasizing the psychosocial impact of AA and the need for standardized, effective treatment protocols.

Comparison of Clinicopathological Findings of Spitz Nevus in Pediatric and Adult Patients.

OBJECTIVE: The aim of this study is to evaluate the demographic characteristics of patients diagnosed with Spitz nevus and to investigate potential distinctions in clinicopathological findings of Spitz nevi in relation to age and location of the lesion. MATERIALS AND METHODS: Clinical and histopathological findings of 32 patients who were diagnosed with Spitz nevus from our archives between 2010 and 2020 were obtained and evaluated retrospectively. RESULTS: A total of 32 patients were included, of whom 19 (59.4%) were female and 15 (40.6%) were under the age of 18 years. Most of the lesions (14, 43.7%) were located on the upper extremity, followed by the lower extremity and the head and neck. The most common histological subtype was the compound variant. In the pediatric age group, the majority of the lesions were located on the upper extremity, and the most common histological subtypes were pigmented and compound variant. In adults, the lesions were chiefly located on the lower extremitiy and the most common histological subtype was the desmoplastic variant. CONCLUSION: In this study, it was found that the location of the lesions and histopathological subtypes of Spitz nevi may differ in children and adults. Further studies incorporating genetic data and involving larger cohorts of patients are needed in order to determine these differences between age groups more clearly. The small sample size is the main limitation of this study Cite this article as: Uzunçakmak TK, Yücesoy SN, Önenerk AM, Özdil A, Engin B. Comparison of clinicopathological findings of spitz nevus in pediatric and adult patients. Turk Arch Pediatr. 2024;59(1):49-53.

Increased skin reactions with hydroxychloroquine during breast radiotherapy.

With the advances in radiation technology, skin reaction due to postoperative radiotherapy (RT) in breast cancer patients is generally mild and tolerable. However, certain drugs may increase the radiation effect. In literature, only few cases of adverse reactions in the radiation field have been reported with the use of Chloroquine. This report describes the case of a 30-year-old young female who had enhanced skin reactions with hydroxychloroquine (HCQ) treatment during breast RT. HCQ should be used with caution in patients undergoing RT due to its potential radiosensitizer effect.

Screening of antigliadin and antitissue transglutaminase antibodies in patients with chronic plaque psoriasis: a case-control study.

BACKGROUND: In this study, we aimed to investigate different types of celiac antibodies in psoriasis patients and to see if the presenceof the antibodies was associated with other variables. METHODS: We included patients with plaque psoriasis who were followed up in our dermatology clinic between February 2019 and February 2021 and added a healthy control group for comparison. The antibodies studied were serum antitissue transglutaminase (tTG)-IgA, tTG-IgG, antigliadin antibody (AGA)-IgA, and AGA-IgG. The patients' records were used to note age, sex, the pattern of psoriasis involvement, psoriasis area and severity index (PASI), presence of hypertension, presence of type 2 diabetes mellitus, use of methotrexate, and use of biologic agents. RESULTS: Sixty-five psoriasis patients (31 F, 34 M, mean age: 38.9 ± 15.2) and 65 controls (42 F, 23 M, mean age: 40.7 ± 13.2) wereincluded in the study. There was no significant difference in antibody levels between the groups: tTG-IgA (2.4 U/mL vs 3.2 U/mL, p = 0.11), tTG-IgG (2.2 U/mL vs 3.2 U/mL, p = 0.74), AGA-IgA (2.4 U/mL vs 3.5 U/mL, p = 0.068), and AGA-IgG (3.2 U/mL vs 4.2 U/mL, p = 0.15). One patient from the psoriasis group only had borderline positive antibody levels whereas the rest of the psoriasis and control group had negative levels. Hypertensive psoriasis patients had significantly higher AGA-IgA titers compared to normotensive psoriasis patients (4.2 U/mL vs 2.3 U/mL, p = 0.005). DISCUSSION: There was no increase in the AGA-IgA/IgG and tTG-IgA/IgG levels in psoriasis patients compared to the healthy population. However, hypertensive psoriasis patients had higher AGA-IgA levels compared to normotensive ones.

Subclinical atherosclerosis in patients with hidradenitis suppurativa treated with TNF inhibitors.

BACKGROUND: Hidradenitis suppurativa (HS) is an independent risk factor for the development of subclinical atherosclerosis. Tumour necrosis factor (TNF) inhibitors are effective for the treatment of recalcitrant moderate-to-severe HS. However, the effect of treatment with TNF inhibitors on subclinical atherosclerosis in HS patients has not been previously investigated. OBJECTIVES: In this study, we aimed to assess changes in biochemical parameters (fasting blood glucose and lipid levels) and carotid intima-media thickness (CIMT) values in Hurley stage II and III HS patients undergoing treatment with TNF inhibitors. METHODS: This was a single center prospective study including 30 patients with Hurley stage II and III HS and 30 healthy controls (HCs). Baseline values of biochemical parameters and CIMT were compared to the values recorded after at least 6 months of TNF inhibitor therapy. RESULTS: CIMT values of the HS patients significantly exceeded those of HCs (for right p = 0.011 and for left p = 0.017). After at least 6 months of TNF inhibitor therapy, there was a statistically significant decrease in fasting blood glucose (p = 0.001), whereas total cholesterol levels significantly increased (p = 0.001). CIMT values also significantly increased (for right p = 0.02 and for left p = 0.01). STUDY LIMITATIONS AND CONCLUSIONS: Small sample size is limitation of the current study. Our study shows that patients with Hurley stage II and III HS undergoing TNF inhibitor therapy are under risk for progression of subclinical atherosclerosis.

Effectiveness of anti-interleukin-23 therapy in psoriatic arthritis: A pilot prospective real-world study.

AIM: This study aimed to show the effectiveness of interleukin (IL)-23 inhibitors in psoriatic arthritis (PsA) at weeks 12 and 24 in a real-world setting. MATERIALS AND METHODS: Forty-three patients with active PsA were enrolled in this study. These patients were treated with either guselkumab (n = 20) or risankizumab (n = 23). Treatment responses at the 12th and 24th weeks were evaluated with the parameters of the number of joints with active arthritis, Psoriasis Area Severity Index (PASI) response rate, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, Disease Activity Index for Psoriatic Arthritis (DAPSA) score, and C-reactive protein (CRP) value. The study's primary endpoint was BASDAI ≤ 4 and DAPSA ≤ 14 at week 24, and the secondary endpoint was the absence of joints with clinically active arthritis signs at week 24. RESULTS: IL-23 inhibition significantly improved all treatment response parameters at the 12th and 24th weeks (P < 0.001). While 90% of patients reached the primary endpoint with anti-IL23 therapy, 74% achieved the secondary endpoint. Both biologic-naïve and biologic-experienced patients responded significantly to anti-IL-23 therapy. Also, no adverse events related to anti-IL-23 agents were observed. CONCLUSIONS: The response parameters indicating the severity of PsA (the number of joints with active arthritis, BASDAI score, DAPSA score, and CRP value) and a parameter indicating the severity of skin involvement, that is, PASI score, significantly improved with anti-IL-23 therapy at weeks 12 and 24. Moreover, significant improvement was achieved at week 24 compared to week 12 in all response parameters.

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

Omalizumab versus cyclosporin-A for the treatment of chronic spontaneous urticaria: can we define better-responding endotypes?

Abstract Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. © 2022 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

How to recognize and manage challenging DRESS cases: Two case reports and a review of the literature.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon systemic adverse drug reaction. Furthermore, it is a unique syndrome encompassing various manifestations of fever, facial edema, eosinophilia, atypical lymphocytosis, and organ dysfunction. Since there are no large prospective studies concerning DRESS syndrome, current treatment modalities for DRESS have been mainly determined based on various case reports and expert opinions. Corticosteroids are the mainstay of therapy after the cessation of the culprit drug. Although most cases recover within a couple of months, some may persist and even progress despite 1 mg/kg/day of prednisolone or its equivalent. We herein present two cases of severe DRESS syndrome. Both cases presented with organ dysfunction and remained unresponsive to initial treatment with 1 mg/kg/day of intravenous methylprednisolone. Therefore, plasmapheresis or pulse steroid therapy (250 mg/day methylprednisolone for 3 days) was used. In the follow-up period, the patients' clinical conditions improved dramatically without recurrence. We aimed to share our experience in recognizing and managing severe DRESS cases in this manuscript. Furthermore, we reviewed the literature in comparison with the present cases. In conclusion, plasmapheresis or pulse steroid therapy (250 mg/day of methylprednisolone for 3 days) can be used to treat difficult DRESS cases where organ failure is about to happen.

Omalizumab versus cyclosporin-A for the treatment of chronic spontaneous urticaria: can we define better-responding endotypes?

BACKGROUND: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. OBJECTIVE: To determine indicators of response to Oma or Cs-A in CSU patients. METHODS: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. RESULTS: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). STUDY LIMITATIONS: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. CONCLUSIONS: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success.

The impact of COVID-19 pandemic on psoriasis patients, and their immunosuppressive treatment: a cross-sectional multicenter study from Turkey.

BACKGROUND: Immunosuppressive therapy has been a great concern during the pandemic. This study aimed to evaluate the pandemic's impact on psoriasis patients treated with immunosuppressive drugs. MATERIAL AND METHODS: The multicenter study was conducted in 14 tertiary dermatology centers. Demographic data, treatment status, disease course, and cases of COVID-19 were evaluated in patients with psoriasis using the immunosuppressive treatment. RESULTS: Of 1827 patients included, the drug adherence rate was 68.2%. Those receiving anti-interleukin (anti-IL) drugs were more likely to continue treatment than patients receiving conventional drugs (OR = 1.50, 95% CI, 1.181-1.895, p = .001). Disease worsening rate was 24.2% and drug dose reduction increased this rate 3.26 and drug withdrawal 8.71 times. Receiving anti-TNF or anti-IL drugs was associated with less disease worsening compared to conventional drugs (p = .038, p = .032; respectively). Drug withdrawal causes were 'unable to come' (39.6%), 'COVID concern' (25.3%), and 'physician's and patient's co-decision' (17.4%). Four patients had COVID-19 infection with mild symptoms. The incidence was 0.0022% while it was 0.0025% in the general population. CONCLUSION: Our study shows that psoriasis patients using systemic immunosuppressive do not have a higher, but even lower COVID-19 risk than the general population, and treatment compliance with biological drugs is higher.

An ICP-MS Study for Quantitation of Nickel and Other Inorganic Elements in Urine Samples: Correlation of Patch Test Results with Lifestyle Habits.

Nickel (Ni) is a frequently used metal in the production of many products, and Ni exposure occurs in humans through food, inhalation, and skin. Studies reported Ni as the most common allergen diagnosed in the serial patch test. The main purpose of our study was to determine the concentration of Ni and other elements in the urine samples of individuals with Ni-sensitivity and to determine the effect of lifestyle habits on these variables. This study was conducted with 388 participants; additionally, both Ni patch test and inorganic analysis (for 24 elements) method in urine with inductively coupled plasma-mass spectrometry (ICP-MS) were applied to all participants. Ninety-two (23.7%) of the participants were found to have nickel sensitivity with a mean urine concentration of 4.475 µg/g creatinine (median=4.260; SD=2.527). The urine nickel concentration was significantly different between female and male participants (p =0.001). We found a significant correlation between Ni and other metals alongside various element pairs. The mean urine Ni concentration of the individuals with a positive Ni sensitivity test result was not different from that of the participants without Ni sensitivity (4.475 vs 4.256 µg/g creatinine, respectively; p = 0.068). The high accuracy, recovery, and repeatability data obtained from the analyses indicate that this study is efficient and appropriate for the quantitative determination of nickel and other elements in urine samples. Ni-containing objects and Ni-rich foods should be of concern for individuals with hypersensitivity reactions to the element.

The comparison of demographics and comorbidities of female pattern hair loss according to the clinical subtype and stage.

BACKGROUND: Previous literature regarding the frequencies of each subtype of female pattern hair loss is contradictory and the subtypes have not been compared to each other in terms of their epidemiologic characteristics and relationships with comorbid diseases. OBJECTIVES: The aims of this study are to determine the frequency and the relationship with comorbidities for each subtype, and to determine the relationship of clinical stage with age and comorbid diseases. METHODS: This is a prospective cross-sectional study involving patients with a definitive diagnosis of female pattern hair loss. The age, age at the time of diagnosis, family history for androgenetic alopecia, clinical subtype, clinical stage, and comorbid conditions were noted for each patient. SPSS version 21 (IBM SPSS) was used for statistical analysis. RESULTS: Advanced stages of female pattern hair loss are related to increased age, menopausal state, and hypertension. Acne vulgaris is more prevalent in earlier stages. Hirsutism and acne vulgaris are more commonly encountered in the Ludwig and Hamilton subtypes. Hypertension is more frequent in Ludwig subtype. LIMITATIONS: The confounding effect of age on the relationship between clinical subtype and comorbid diseases. CONCLUSION: The relationship between comorbid diseases and stage in specific subtypes can guide us to the diagnosis of undiagnosed comorbid diseases.

Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata

Abstract Background: Alopecia areata (AA) is a hair disease that causes hair loss without scarring. The etiopathogenesis of AA has not been fully understood yet. Objective: To determine serum interleukin levels (IL-2, IL-4, IL-15, and IL-17) in patients diagnosed with alopecia areata and to investigate the relationship of IL levels with the duration and severity of alopecia areata and the response to tofacitinib therapy. Methods: Patients (≥16 years old) diagnosed with alopecia areata and healthy individuals as a control group was enrolled. Baseline serum interleukin levels of the patients and controls were measured. In the patient group receiving tofacitinib therapy, serum interleukin levels were measured again after 6 months. Disease severity for alopecia areata was assessed using the Severity of Alopecia Tool. Results: Sixty-one AA patients and 30 healthy individuals were included; they were comparable regarding age and sex. The mean disease duration for AA was 7 ± 6 years and the baseline mean Severity of Alopecia Tool score was 71 ± 30 (range, 20-100). Baseline IL-2, IL-4 and IL-15 levels were significantly higher in the patient group than those in the control group (p < 0.001 for each). No significant correlation was found between the baseline interleukin levels and either disease duration or disease severity (baseline Severity of Alopecia Tool score). Among the patients receiving tofacitinib (n = 22), all interleukin levels significantly decreased after treatment. However, no significant relationship between the change in interleukin levels and the change in the Severity of Alopecia Tool scores was observed after tofacitinib treatment. Study limitations: This is a monocentric study conducted in a single university hospital. Conclusion: High interleukin levels in alopecia areata patients and the significant decrease with treatment support the idea that interleukins have a role in pathogenesis. Nevertheless, no relationship could be demonstrated between IL levels and disease duration or severity.

Evaluation of the level of serum Interleukins (IL-2, IL-4, IL-15 andIL-17) and its relationship with disease severity in patients with alopecia areata.

BACKGROUND: Alopecia areata (AA) is a hair disease that causes hair loss without scarring. The etiopathogenesis of AA has not been fully understood yet. OBJECTIVE: To determine serum interleukin levels (IL-2, IL-4, IL-15, and IL-17) in patients diagnosed with alopecia areata and to investigate the relationship of IL levels with the duration and severity of alopecia areata and the response to tofacitinib therapy. METHODS: Patients (≥16 years old) diagnosed with alopecia areata and healthy individuals as a control group was enrolled. Baseline serum interleukin levels of the patients and controls were measured. In the patient group receiving tofacitinib therapy, serum interleukin levels were measured again after 6 months. Disease severity for alopecia areata was assessed using the Severity of Alopecia Tool. RESULTS: Sixty-one AA patients and 30 healthy individuals were included; they were comparable regarding age and sex. The mean disease duration for AA was 7 ± 6 years and the baseline mean Severity of Alopecia Tool score was 71 ± 30 (range, 20-100). Baseline IL-2, IL-4 and IL-15 levels were significantly higher in the patient group than those in the control group (p < 0.001 for each). No significant correlation was found between the baseline interleukin levels and either disease duration or disease severity (baseline Severity of Alopecia Tool score). Among the patients receiving tofacitinib (n = 22), all interleukin levels significantly decreased after treatment. However, no significant relationship between the change in interleukin levels and the change in the Severity of Alopecia Tool scores was observed after tofacitinib treatment. STUDY LIMITATIONS: This is a monocentric study conducted in a single university hospital. CONCLUSION: High interleukin levels in alopecia areata patients and the significant decrease with treatment support the idea that interleukins have a role in pathogenesis. Nevertheless, no relationship could be demonstrated between IL levels and disease duration or severity.

Treatment of periorbital and perioral wrinkles with fractional Er:YAG laser: What are the effects of age, smoking, and Glogau stage?

BACKGROUND: Dynamic and static wrinkling are observed on the facial skin as a result of aging. Previously, it was showed that fractional Er:YAG laser was effective in the treatment of facial wrinkles. AIMS: The aims of this study are to determine the effects of age, Glogau stage, and smoking status on the treatment efficacy of fractional Er:YAG laser; and to compare the success of laser treatment on periorbital wrinkles with perioral wrinkles. MATERIAL/METHOD: Periorbital and perioral wrinkles of the same patient were treated with fractional Er:YAG laser (2940 nm) for 4 sessions with monthly intervals. Treatment parameters were affluence of 1.5J, a spot size of 7 mm, and a frequency of 5 Hz. Treatment efficacy was evaluated by a blinded physician evaluation scale and patient satisfaction scale 2 months after the final treatment session. RESULTS: Fifteen patients completed the study. The mean age of the patients was 42.8 years. The blinded physician evaluation of the improvement in the periorbital wrinkles decreased (P =.034) and the patient satisfaction in perioral wrinkles decreased (P =.049) with increasing age. The relationship between smoking and patient satisfaction in the treatment of periorbital wrinkles was also statistically significant (P =.014). No difference in terms of treatment efficacy was found between periorbital and perioral regions. CONCLUSION: Fractional Er:YAG laser (2940 nm) is equally successful in the treatment of periorbital and perioral wrinkles. The treatment success decreases with smoking and increasing age.

Demographic and Clinical Features of 1,641 Patients with Alopecia Areata, Alopecia Totalis, and Alopecia Universalis: A Single-Center Retrospective Study.

BACKGROUND/AIM: Alopecia areata (AA) is a common autoimmune hair disorder which is characterized by noncicatricial hair loss. AA commonly presents with localized patches on the scalp and face but may affect any hair-bearing region of the body leading to even more generalized involvement. AA may affect any age group, gender, and race. The current study investigates the demographic characteristics of the patients with AA and subgroups of AA including alopecia totalis (AT) and alopecia universalis (AU) and the prevalence of disease, sex, and age distribution and seasonal variation retrospectively in a tertiary dermatology clinic in Turkey. MATERIALS AND METHODS: In this retrospective, cross-sectional study, 1,641 patients diagnosed with AA, AT, and AU in the dermatology clinic of a public university hospital were included. The dermatology outpatient database was reviewed retrospectively. The diagnosis of AA was based on patient history, clinical examinations, and histopathologic findings. RESULTS: Fifty-four thousand one hundred sixty-eight patients were admitted to our outpatient clinic in 4 years time, and 1,641 were diagnosed as having AA, AT, and AU. One thousand three hundred ninety-two patients (84.8%) had AA, 81 (4.9%) had AT, and 168 (10.2%) had AU. Among the 1,641 patients included in the study, 877 were females (53.4%) and 764 were males (46.6%). The mean age was 29.86 ± 14.48 years in AA, 29.50 ± 16.18 in AT, and 32.81 ± 14.48 in AU; 77.4, 72.8, and 68.5% of patients were aged under 40 years in AA, AT, and AU. There was no statistically significant difference in seasonal presentation times. CONCLUSION: AA is affecting approximately 2% of the general population without any sex, race, or age group predilection. In this study, we found a lower prevalence of AA in the pediatric age group in comparison with adults. This finding may support the hypothesis of the increasing prevalence of AA over time. The higher ratio of AA regarding this study may support that the frequency of AA and subtypes varies between regions.

Dermatological side effects of immunotherapy drugs and targeted cancer therapies: Importance of dermatology and oncology collaboration.

INTRODUCTION: Novel anti-cancer drugs such as targeted cancer therapies and immune check-point inhibitors (ICIs) have adverse events, especially concerning the skin. The aim of this study is to report an overview of the commonly consulted dermatological side effects of ICIs and targeted cancer therapies in clinical practice, along with their management. METHODS: In this single-center study, we evaluated consecutive oncological patients who were referred from the oncology outpatient clinic to the dermatology outpatient clinic due to skin side effects of ICIs and targeted therapies. All patients were examined and treated at the same day of referral by experienced dermatologists. Patient characteristics, clinical findings, diagnostic workups and treatments were retrieved from outpatient records. RESULTS: Sixty three patients were enrolled. Most common diagnoses were lung carcinoma, melanoma and colon carcinoma. Fifty patients (79%) were using targeted therapies while 13 (21%) were using ICIs. Xerosis was the most common side effect (44%), followed by acneiform rash, paronychia, eczema and pruritus. Majority of the side effects were grade 2 and 3. Psoriasis was a common side effect of ICIs. One patient had a newly developed dysplastic nevus on vemurafenib treatment. Oncological treatment was not withheld in any of the patients. CONCLUSIONS: This study revealed the most commonly consulted skin side effects of novel anti-cancer drugs and their management in daily practice. We underlie the importance of collaborative work of oncology and dermatology professionals as early management of cutaneous side effects of targeted therapies and ICIs improves patient outcomes.