Forty-First ISSUE
August 23, 2023
Clinical Outcomes for Uptitration of Baricitinib Therapy in Patients With Severe Alopecia Areata
JAMA Dermatology
JAMA Dermatology
Severe alopecia areata? Just uptitrate it!
Alopecia areata (AA), an autoimmune hair loss disorder, is commonly treated with the JAK inhibitor baricitinib, resulting in meaningful reduction of hair loss from the scalp, eyebrows, and eyelashes in patients with severe AA. However, a subset of patients with severe alopecia areata may not respond to traditional dosing of 2 mg.
This pooled analysis of 2 phase 3 randomized controlled trials evaluated uptitration to baricitinib 4 mg for 24 weeks after non-response to standard 2 mg dosing after 52 weeks of therapy. The original RCT included a total of 1200 patients randomized 3:2:2 to receive baricitinib 4 mg, 2 mg, or placebo. Response to therapy was evaluated using the severity of alopecia tool (SALT), with scores >20 indicating severe alopecia.
What did they find?
Main Takeaway: Patients with severe alopecia areata may benefit from uptitration of dosing from 2 mg to 4 mg if they are considered non-responders after initial treatment.
Alopecia areata (AA), an autoimmune hair loss disorder, is commonly treated with the JAK inhibitor baricitinib, resulting in meaningful reduction of hair loss from the scalp, eyebrows, and eyelashes in patients with severe AA. However, a subset of patients with severe alopecia areata may not respond to traditional dosing of 2 mg.
This pooled analysis of 2 phase 3 randomized controlled trials evaluated uptitration to baricitinib 4 mg for 24 weeks after non-response to standard 2 mg dosing after 52 weeks of therapy. The original RCT included a total of 1200 patients randomized 3:2:2 to receive baricitinib 4 mg, 2 mg, or placebo. Response to therapy was evaluated using the severity of alopecia tool (SALT), with scores >20 indicating severe alopecia.
What did they find?
- Of patients initially treated with baricitinib 2 mg, 212 (62.4%) had a SALT score >20 and were uptitrated to baricitinib 4 mg
- Among patients uptitrated to 4 mg, 142 (67.0%) had a baseline SALT score of 95 to 100 (very severe AA)
- After 24 weeks of uptitrated baricitinib 4 mg, 55 (25.9%) achieved a SALT score <20
- After 24 weeks of uptitration, clinician-reported hair loss outcome scores of 0 (full coverage) or 1 (minimal gaps) increased from 19.3% (31 of 161 patients) after 52 weeks of baricitinib 2 mg to 37.9% (61 of 161 patients) for eyebrows after 24 weeks of baricitinib 4 mg and from 24.1% (33 of 137 patients) to 40.9% (56 of 137 patients) for eyelashes
Main Takeaway: Patients with severe alopecia areata may benefit from uptitration of dosing from 2 mg to 4 mg if they are considered non-responders after initial treatment.
Improving artificial intelligence−based diagnosis on pediatric skin lesions
Journal of International Dermatology
Say hi to AI!
Artificial Intelligence (AI) models have demonstrated dermatologist-level ability to detect cutaneous melanoma. However, AI models are reliant on their training data to detect melanoma, limiting generalizability. Researchers sought to determine whether the addition of pediatric training images improved AI models’ ability to detect pediatric melanoma.
Researchers trained five sets of two AI models; model A using an adult-predominant dataset only (37,662 images) and model A+P using the adult-predominant dataset plus a pediatric dataset (1,536 images). Their performances were compared using the area under the receiver operating characteristic (AUROC) curve.
What did they find?
Main takeaways: The addition of pediatric training images improved AI models’ performance in detecting pediatric melanoma, suggesting that adding data to existing datasets can improve AI generalizability across populations in dermatology.
Artificial Intelligence (AI) models have demonstrated dermatologist-level ability to detect cutaneous melanoma. However, AI models are reliant on their training data to detect melanoma, limiting generalizability. Researchers sought to determine whether the addition of pediatric training images improved AI models’ ability to detect pediatric melanoma.
Researchers trained five sets of two AI models; model A using an adult-predominant dataset only (37,662 images) and model A+P using the adult-predominant dataset plus a pediatric dataset (1,536 images). Their performances were compared using the area under the receiver operating characteristic (AUROC) curve.
What did they find?
- Models A+P detected 162.4 ± 41.1 fewer false positive pediatric melanomas compared to models A (p=0.0014), suggesting improved pediatric melanoma detection
- The average change in AUROC between models A+P and models A was +7.0±1.3% on pediatric test sets and +0.07±1.3% on adult test sets, suggesting improved performance in pediatric melanoma detection while maintaining high performance in adult melanoma detection in models A+P
- One model A+P was trained using pediatric and adult images from the same source and showed a 25.8% decrease in false positive detection of pediatric melanomas, suggesting that improvement in models A+P was not due to source recognition
Main takeaways: The addition of pediatric training images improved AI models’ performance in detecting pediatric melanoma, suggesting that adding data to existing datasets can improve AI generalizability across populations in dermatology.
Is fractional CO2 laser combined with PRP more efficacious than fractional CO2 laser alone for the treatment of stretch marks?
Dermatologic Surgery
Is fractional CO2 laser combined with PRP more efficacious than fractional CO2 laser alone for the treatment of stretch marks?
Dermatologic Surgery
PRP and fractional CO2...a match made in heaven?
Striae distensae (SD), AKA stretch marks, are a common skin finding. While the pathogenesis of SD is not completely understood and there are currently no gold standard treatment options, fractional ablative CO2 laser therapy and platelet-rich plasma (PRP) are popular cosmetic treatment options. This prospective, randomized study compared the efficacy of CO2 laser alone (n=30) versus combined fractional CO2 laser followed by PRP injection (n=30) for the treatment of SD.
What did they find?
Limitations: The study’s sample size was small and only included Egyptian women with Fitzpatrick skin photo-type III and IV.
Main Takeaways: Striae distensae treated with combined fractional CO2 laser and PRP was associated with greater improvement, increased patient satisfaction, and increased dermal collagen and elastic fiber deposition compared to CO2 laser alone.
Striae distensae (SD), AKA stretch marks, are a common skin finding. While the pathogenesis of SD is not completely understood and there are currently no gold standard treatment options, fractional ablative CO2 laser therapy and platelet-rich plasma (PRP) are popular cosmetic treatment options. This prospective, randomized study compared the efficacy of CO2 laser alone (n=30) versus combined fractional CO2 laser followed by PRP injection (n=30) for the treatment of SD.
What did they find?
- The combined treatment showed improvement in 40% of patients compared to 10% with the laser only (p = 0.007)
- Mean improvement in the combined treatment group (60.33 土 26.49) was significantly higher than the laser only group (43.80 土 27.43) (p = 0.001)
- Mean patient satisfaction was significantly higher with the combined treatment (57.83 土 24.62) than with laser only (43.83 土 26.38) (p = 0.001)
- Histopathological findings:
- Initial assessment: epidermis loss of rete ridges, and mostly fine dermal elastic fibers.
- Post-treatment: the combined group demonstrated epidermal rete ridges, thin, randomly arranged collagen/elastin fibers in papillary dermis, and increased collagen bundles in the reticular dermis compared to the fractional CO2 laser alone
Limitations: The study’s sample size was small and only included Egyptian women with Fitzpatrick skin photo-type III and IV.
Main Takeaways: Striae distensae treated with combined fractional CO2 laser and PRP was associated with greater improvement, increased patient satisfaction, and increased dermal collagen and elastic fiber deposition compared to CO2 laser alone.
Fight aging, one face mask at a time!
Carboxytherapy is the subcutaneous injection or transdermal application of CO2; it is used for skin rejuvenation, increasing vascular perfusion, and treatment of peripheral arteriopathies. Researchers wanted to evaluate the efficacy of a CO2-emitting face mask for improving photodamaged skin. In a prospective study, 35 females (35-65 years, skin types I-VI) with mild-to-moderate photoaging applied a facial carboxy mask for 10 weeks: 3x/week during week 1, 1x/week during weeks 2-4, no treatment weeks 5-6, 1x/week during week 7, and no treatment weeks 8-10. The skin was evaluated at baseline, 4 weeks, and 10 weeks.
What did they find?
Main takeaway: CO2-emitting topical face masks may have anti-aging properties and may improve overall skin appearance.
Carboxytherapy is the subcutaneous injection or transdermal application of CO2; it is used for skin rejuvenation, increasing vascular perfusion, and treatment of peripheral arteriopathies. Researchers wanted to evaluate the efficacy of a CO2-emitting face mask for improving photodamaged skin. In a prospective study, 35 females (35-65 years, skin types I-VI) with mild-to-moderate photoaging applied a facial carboxy mask for 10 weeks: 3x/week during week 1, 1x/week during weeks 2-4, no treatment weeks 5-6, 1x/week during week 7, and no treatment weeks 8-10. The skin was evaluated at baseline, 4 weeks, and 10 weeks.
What did they find?
- Skin elasticity improved after week 4 (-26%) and week 10 (-28%), indicating improvements in skin firmness and sagging (p<0.001)
- Improvements noted in luminosity, radiance, tactile roughness, visual roughness, and erythema all improved significantly at week 4 and continued into week 10
- Significant improvement in overall facial appearance after week 10 of treatment by investigator assessment (12%, p<0.002) and subject assessment (34%, p<0.001)
Main takeaway: CO2-emitting topical face masks may have anti-aging properties and may improve overall skin appearance.