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MedRxiv : the Preprint Server For... Jun 2024Individuals with Down syndrome (DS), the genetic condition caused by trisomy 21 (T21), display clear signs of immune dysregulation, including high rates of autoimmune...
Individuals with Down syndrome (DS), the genetic condition caused by trisomy 21 (T21), display clear signs of immune dysregulation, including high rates of autoimmune disorders and severe complications from infections. Although it is well established that T21 causes increased interferon responses and JAK/STAT signaling, elevated autoantibodies, global immune remodeling, and hypercytokinemia, the interplay between these processes, the clinical manifestations of DS, and potential therapeutic interventions remain ill defined. Here, we report a comprehensive analysis of immune dysregulation at the clinical, cellular, and molecular level in hundreds of individuals with DS. We demonstrate multi-organ autoimmunity of pediatric onset concurrent with unexpected autoantibody-phenotype associations. Importantly, constitutive immune remodeling and hypercytokinemia occur from an early age prior to autoimmune diagnoses or autoantibody production. We then report the interim analysis of a Phase II clinical trial investigating the safety and efficacy of the JAK inhibitor tofacitinib through multiple clinical and molecular endpoints. Analysis of the first 10 participants to complete the 16-week study shows a good safety profile and no serious adverse events. Treatment reduced skin pathology in alopecia areata, psoriasis, and atopic dermatitis, while decreasing interferon scores, cytokine scores, and levels of pathogenic autoantibodies without overt immune suppression. Additional research is needed to define the effects of JAK inhibition on the broader developmental and clinical hallmarks of DS. ClinicalTrials.gov identifier: NCT04246372 .
PubMed: 38946973
DOI: 10.1101/2024.06.13.24308783 -
Journal of Cosmetic Dermatology Jul 2024
PubMed: 38946625
DOI: 10.1111/jocd.16448 -
Acta Dermatovenerologica Croatica : ADC Mar 2024Introduction Telogen effluvium (TE) is a common sequela of SARS-CoV-2 infection. Existing studies are highly heterogeneous. We aimed to assess the prevalence of TE in a...
Introduction Telogen effluvium (TE) is a common sequela of SARS-CoV-2 infection. Existing studies are highly heterogeneous. We aimed to assess the prevalence of TE in a cohort of patients with severe disease hospitalized for acute COVID-19. Methods This prospective cohort study was conducted at the University Clinic of Dermatology, part of the COVID-19 University Hospital Network throughout the pandemic. The acute phase data were extracted from electronic hospital records. Details about hair loss were obtained at two follow-up points, 3 and 6 months after hospital discharge, using telephone interviews. Results A total of 77 patients were successfully followed up, and 40 (48.8%) were male. The mean age was 55.91, SD=10,588. Overall, 68.8% of patients reported TE. Among these, 52.8% reported early onset, and 50.9% reported moderate hair loss. 11 (20.7%) reported complete hair regrowth within three months, and an additional 32 (60.3%) reported complete regrowth within six months. 4 (7.5%) patients have chronic TE. Female sex (p<0.0001), anemia (p=0.019), hypoproteinemia (p=0.037), and severe pneumonia (p=0.004) were associated with TE. Age, fever, SpO2, CRP levels, in-hospital complications, and raised D-dimers were not associated with TE. Discussion Our study confirmed a high prevalence of COVID-19-associated TE in hospitalized patients. Anemia and hypoalbuminemia were associated with TE, shedding new light on the possible pathogenesis. COVID-19-associated TE occurs earlier than classic TE and has a good prognosis in most patients. However, chronic ТЕ was reported by 7.5%. Even a small incidence of long-term sequelae during a pandemic could have substantial health consequences.
Topics: Humans; Male; COVID-19; Female; Middle Aged; Prospective Studies; Adult; Patient Discharge; Aged; Alopecia; Prevalence; Cohort Studies; SARS-CoV-2
PubMed: 38946185
DOI: No ID Found -
Acta Dermatovenerologica Croatica : ADC Mar 2024An extensive body of literature has been published regarding alopecia areata (AA) in the past 50 years. The current paper used a bibliometric analysis (BA) to identify...
BACKGROUND
An extensive body of literature has been published regarding alopecia areata (AA) in the past 50 years. The current paper used a bibliometric analysis (BA) to identify high-quality research articles using criteria such as annual citations (ACs) and journal impact factor.
OBJECTIVES
To identify and analyze the top 100 most cited articles in AA scientific literature over the past 50 years using BA methods.
METHODS
Web of Science (webOS) citation indexing database was used, on April 4th, 2023, to identify the most cited articles on AA. Articles were ranked by their ACs. Data sets were then subdivided into corresponding and senior authors, year of publication, journal and impact factor, total citations according to webOS database, ACs, affiliation, country of origin, manuscript type, design, focus, and usage count since 2013.
RESULTS
The extracted articles were published between 1975-2019. Mean total citations ranged between 67 and 578. The most cited paper was: "Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients" by Liu et al. with an AC of 26.5. Most publications were published between 1990 and 1999 (n=28). The Journal of the American Academy of Dermatology was the most published journal (25 articles). The research focus of original papers was treatment (36%), epidemiology (22%), pathogenesis (20%), basic science (16%), and diagnosis (6%).
CONCLUSION
This analysis is the first to provide detailed bibliometric characteristics, highlighting the worldwide burden and research trends in.
Topics: Alopecia Areata; Bibliometrics; Humans; Journal Impact Factor
PubMed: 38946183
DOI: No ID Found -
Pediatric Dermatology Jun 2024The management of alopecia areata (AA) in pediatric patients poses unique challenges, particularly regarding treatment discussions and decision making involving both...
The management of alopecia areata (AA) in pediatric patients poses unique challenges, particularly regarding treatment discussions and decision making involving both patients and their families. This commentary presents findings from unpublished research on treatment-discontinuation discussions between AA patients and their treating providers, shedding light on the hopes, expectations, and disappointments of individuals with severe AA. The study explored patient and guardian satisfaction with these discussions, emphasizing the importance of addressing psychosocial concerns, facilitating contact with support groups, and demonstrating empathy. The role of dermatologists in conversations about treatment, prognosis, and quality of life is examined, emphasizing the need for honesty, empathy, and realistic expectations. The authors propose a patient-centered approach to initiating and guiding discussions, focusing on understanding the impact of AA on patients and their families and collaboratively deciding on treatment options. The mantra: 'I need to understand how this is affecting all of you, so we can decide together what to do next' is central to this proposed approach. Special considerations for different scenarios are discussed, highlighting the importance of individualized care and effective communication. Overall, the commentary emphasizes the significance of actively listening, acknowledging emotions, and prioritizing patient and family goals to optimize care for pediatric AA patients.
PubMed: 38943289
DOI: 10.1111/pde.15684 -
Clinics in Dermatology Jun 2024Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem...
Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem cells and follicular fibrosis. Follicular stem cells are crucial in skin healing after chemical peeling and other resurfacing procedures. Although there is a possible association of FFA with a history of facial and scalp surgical procedures, there is no information on the safety of cosmetic procedures in patients with FFA. We report five patients with FFA who experienced unusual and complicated outcomes after undergoing a deep chemical peel (phenol and croton oil). As the prevalence of FFA continues to increase globally, it is essential to raise awareness about the potential incompatibility of this dermatologic disorder with specific cosmetic procedures, such as deeper peels and other resurfacing modalities.
PubMed: 38942154
DOI: 10.1016/j.clindermatol.2024.06.024 -
Journal of the European Academy of... Jun 2024Alopecia areata (AA) carries a psychological burden for patients beyond hair loss. However, quality-of-life measurement tools such as EQ-5D used in clinical trials may...
IMPORTANCE
Alopecia areata (AA) carries a psychological burden for patients beyond hair loss. However, quality-of-life measurement tools such as EQ-5D used in clinical trials may not adequately capture the burden of AA, the perceived stigmatization or the psychosocial impact of AA.
OBJECTIVE
To investigate the potential association between disease severity and the degree of social isolation, perceived stigmatization, anxiety and depression, alcohol consumption and work absenteeism using multiple PRO measures in patients with AA.
DESIGN, SETTING AND PARTICIPANTS
Using the Danish Skin Cohort, the study included adult patients diagnosed with AA. The study included multiple PRO measures, including Skindex-16, EQ-5D-5L, Work Productivity and Activity Impairment (WPAI), Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Alopecia Areata Symptom Impact Scale (AASIS). The questionnaires were dispatched to the patients in January 2023. The severity of AA was determined based on scalp involvement using a modified Alopecia Areata Scale. Multiple multivariate linear regressions were conducted using Skindex-16, AASIS and WPAI, while multivariate logistic regressions were applied to HADS, AUDIT-C and EQ-5D-5L.
RESULTS
A total of 376 patients were included, of which 177 (47%) had severe disease, 41 (11%) had moderate disease, 94 (25%) had mild disease, and 64 (17%) were in remission. The median age of patients was 55 (IQR, 47-66 years) and most were female (70%). Skindex-16 and AASIS were the only PRO measures able to distinguish between severity. For these scores, moderate and severe diseases, female sex, and involvement of eyebrows increased the score and negatively impacted patient quality of life.
CONCLUSION AND RELEVANCE
The results indicate the importance of using the proper tool for the intended measurement of quality of life and that factors such as the severity of AA, as well as female sex and involvement of the eyebrows, may potentially increase the psychosocial burden of AA.
PubMed: 38940661
DOI: 10.1111/jdv.20211 -
Annals of Agricultural and... Jun 2024Photobiomodulation with the use of light-emitting diodes (LEDs) seems to be a promising option for long COVID. This retrospective study evaluates the efficiency of LED...
INTRODUCTION AND OBJECTIVE
Photobiomodulation with the use of light-emitting diodes (LEDs) seems to be a promising option for long COVID. This retrospective study evaluates the efficiency of LED irradiation in the treatment of TE in the course of long COVID in patients with and without androgenetic alopecia.
MATERIAL AND METHODS
A retrospective single-centre chart review of patients with post-COVID hair loss was performed. 140 patients enrolled to the study were divided into four groups depending on the type of alopecia and treatment: 1) telogen effluvium with LED therapy (TE LED+), 2) telogen effluvium without LED therapy (TE LED-), 3) telogen effluvium and androgenetic alopecia with LED therapy (TE+AGA LED+), and 4) telogen effluvium and androgenetic alopecia without LED therapy (TE+AGA LED-). Clinical and trichoscopic parameters were compared.
RESULTS
After 12 weeks, cessation of hair loss and a negative hair pull test were more common in TE LED+ and TE+AGA LED+ in comparison to the patients without LED therapy (p<0.001, p=0.035, respectively). An increased number of thick hairs and an increased number of hairs within follicular units were more common in patients treated with LED irradiation, regardless of the type of alopecia, compared to the patients without LED therapy.
CONCLUSIONS
The study revealed that LED therapy is safe, well tolerated and seems to be a promising therapeutic option for TE in patients with long COVID. It can be used as adjuvant therapy leading to faster reduction of hair loss, enhancing hair regrowth as well as hair shaft thickness and density.
Topics: Humans; Alopecia; Retrospective Studies; Female; Middle Aged; COVID-19; Male; Adult; SARS-CoV-2; Low-Level Light Therapy; Aged; Hair; Treatment Outcome; Phototherapy
PubMed: 38940108
DOI: 10.26444/aaem/177238 -
Clinical and Translational Radiation... Jul 2024Preoperative radiosurgery (SRS) of brain metastases (BM) aims to achieve cavity local control with a reduction in leptomeningeal relapse (LMD) and without additional...
PURPOSE
Preoperative radiosurgery (SRS) of brain metastases (BM) aims to achieve cavity local control with a reduction in leptomeningeal relapse (LMD) and without additional radionecrosis compared to postoperative SRS. We present the final results of a prospective feasibility trial of linac-based stereotactic radiosurgery (SRS) prior to neurosurgical resection of a brain metastasis (PREOP-1).
METHODS
Eligibility criteria included a BM up to 4 cm in diameter for elective resection. The primary endpoint was the feasibility of delivering linac-based preoperative SRS in all patients prior to anticipated gross tumour resection. Secondary endpoints included rates of LMD, local control and overall survival. Exploratory endpoints were the level of expression of immunological and proliferative markers.
RESULTS
Thirteen patients of median age 65 years (range 41-77) were recruited. Twelve patients (92 %) received preoperative radiosurgery and metastasectomy and one patient went directly to surgery and received postoperative SRS, thus the primary endpoint was not met. The median time between referral and preoperative SRS was 6.5 working days (1-10) and from SRS to neurosurgery was 1 day (0-5). The median prescribed dose was 16 Gy (14-19) to a median planning target volume of 12.7 cm (5.9-26.1). Five patients completed 12-month follow-up after preoperative SRS without local recurrence or leptomeningeal disease. The patient who received postoperative FSRT developed LMD after six months. There was one transient toxicity (grade 2 alopecia) and nine patients have died from extracranial causes. Patients reported significant improvement in motor weakness at 6 months (P = 0.04). No pattern in changes of marker expression was observed.
CONCLUSION
In patients with large brain metastasis without raised intracranial pressure, linac-based preoperative SRS was feasible in 12/13 patients and safe in 12/12 patients without any surgical delay or intracranial complications.
PubMed: 38938931
DOI: 10.1016/j.ctro.2024.100798 -
JAAD Case Reports Jul 2024
PubMed: 38938699
DOI: 10.1016/j.jdcr.2024.05.008