Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework.

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss.

Predictors of QOL in Patients with Alopecia Areata.

Although alopecia areata (AA) severity is often defined by the degree of scalp hair loss, its impact on QOL can also be a defining measure of severity. In this cross-sectional study (AA Disease Specific Program), 259 patients were surveyed for demographics, AA illness characteristics, QOL (Skindex-16 AA), and daily impairment (Work Productivity and Activity Impairment). The association between patient demographics and illness variables, the Skindex-16 AA scores, and the Work Productivity and Activity Impairment scores were analyzed using regression analyses. The mean age of patients was 39 years (51% female). Self-reported severity of current AA was rated as mild (21%), moderate (54%), and severe (25%). The highest impairment was observed for the Skindex-16 AA emotions and the Work Productivity and Activity Impairment daily activity performance scores. Although the degree of scalp hair loss (physician Severity of Alopecia Tool score) was not predictive of QOL, patients' self-report of moderate or severe disease, sex (females more impacted), and eyebrow and eyelash involvement were predictors of diminished QOL, consistently and incrementally. The present results suggest patients' perception of severity as well as the presence of eyelash and eyebrow hair loss are also impactful and should be considered in defining the severity of disease.

Development of the alopecia areata scale for clinical use: Results of an academic-industry collaborative effort.

BACKGROUND: The current classification for alopecia areata (AA) does not provide a consistent assessment of disease severity. OBJECTIVE: To develop an AA severity scale based on expert experience. METHODS: A modified Delphi process was utilized. An advisory group of 22 AA clinical experts from the United States was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development. RESULTS: Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing to adopt the proposed scale. LIMITATIONS: The scale is a static assessment intended to be used in clinical practice and not clinical trials. CONCLUSION: The final AA disease severity scale, anchored in the extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.

Functionality of Patients 75 Years and Older Undergoing Mohs Micrographic Surgery: A Multicenter Study.

BACKGROUND: Mohs surgery is indisputably a highly effective treatment for nonmelanoma skin cancers. In the current health care environment, physicians are challenged to provide high quality, efficacious care in a manner that is mindful of the patient's general health and well-being. We have used a functional assessment to evaluate older patients who present for Mohs surgery. OBJECTIVE: The purpose of this study is to categorize the functional status, using the Karnofsky Performance Status (KPS) Scale, of patients 75 years and older undergoing Mohs surgery of a nonmelanoma skin cancer and to identify distinguishing characteristics of lower functioning patients. METHODS: Patients 75 years and older undergoing Mohs surgery for nonmelanoma skin cancer at 8 separate geographically diverse sites were included. Patient and tumor characteristics were recorded. Physicians scored subjects on the KPS scale and administered a questionnaire to categorize the symptoms and impact of their skin cancer. RESULTS: A total of 291 subjects completed the study. The average KPS score was 90.1. 93.1% of our subjects had a KPS score of ≥70. Subjects with a KPS score <70 were more likely to be older with larger symptomatic tumors. CONCLUSION: The vast majority of patients 75 years and older undergoing Mohs surgery are highly functioning. Lower functioning patients are older with larger symptomatic tumors that negatively impact their lives.

Fat transplantation for treatment of the senescent face.

For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face.

Seroma formation following abdominal liposuction.

BACKGROUND: Liposuction of the abdominal region is a common procedure performed in the United States. A variety of complications can occur when performing this procedure. OBJECTIVE: To present a case of a patient with a seroma as a complication of abdominal liposuction and its management. RESULTS: The patient had a recurring seroma of the right lower quadrant of the abdomen that necessitated ultrasound-guided drainage. CONCLUSION: This case provided a valuable lesson. Clinicians should be conscious of the potential for this complication to occur. They must select patients appropriately to limit the risk of adverse events.

A SURVEY OF NONXANTHINE DERIVATIVES AS ADENOSINE RECEPTOR LIGANDS.

The binding affinities at rat A1, A2a, and A3 adenosine receptors of a wide range of heterocyclic derivatives have been determined. Mono-, bi-, tricyclic and macrocyclic compounds were screened in binding assays, using either [3H]PIA or [3H]CGS 21680 in rat brain membranes or [125I]AB-MECA in CHO cells stably transfected with rat A3 receptors. Several new classes of adenosine antagonists (e.g. 5-oxoimidazopyrimidines and a pyrazoloquinazoline) were identified. Various sulfonylpiperazines, 11-hydroxytetrahydrocarbazolenine, 4H-pyrido[1,2-a]pyrimidinone, folic acid, and cytochalasin H and J bound to A3 receptors selectively. Moreover, cytochalasin A, which bound to A1 adenosine receptors with Ki value of 1.9 µM, inhibited adenylyl cyclase in rat adipocytes, but not via reversible A1 receptor binding.

PHOTOLABILE A1-ADENOSINE RECEPTOR AGONISTS AS "CAGED" ELECTROPHYSIOLOGICAL PROBES.

5'-Ether derivatives of the potent adenosine agonist N6-cyclopentyladenosine (CPA) were designed as "caged" ligands for the activation of A1-adenosine receptors following in situ photolysis. The synthesis involved a 2',3'-diol protection scheme using the acid labile ethoxymethynyl group. Generation of CPA was demonstrated chromatographically and in a bioassay measuring the inhibition of synaptic potentials in the rat hippocampus.