Clinical Benefits of Baricitinib Therapy According to Scalp Hair Regrowth in Patients with Severe Alopecia Areata

Objectives The present analyses report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) on the clinical benefits of baricitinib treatment on the basis of the amount of scalp hair regrowth through 52 weeks of treatment. Methods This post hoc analysis was conducted with data from patients who were treated continuously for 52 weeks with baricitinib 4 mg or 2 mg. Clinical outcomes were assessed using the Severity of Alopecia Tool (SALT) and Clinician-Reported Outcome (ClinRO) for Eyebrow (EB) and Eyelash (EL) hair. Secondary measures included the Hospital Anxiety and Depression Scale and Skindex-16 adapted for alopecia areata. At week 52, patients were classified into three subgroups: SALT ≤ 20 response, intermediate response (achieved a 30% improvement from baseline (SALT30) without a SALT score ≤ 20), or nonresponse (never achieved SALT30). The criterion of SALT30 approximates a minimal clinical meaningful response to therapy. Results At week 52, with baricitinib 4 mg treatment, the greatest (70%) improvement in EB and EL was observed in responders, but approximately 50% of patients with intermediate response and 20% of nonresponders experienced complete/nearly complete EB and EL regrowth. Improvement in emotional distress was directionally related to improvements in scalp hair regrowth, while impact on quality of life was proportionately greater for the responder subgroup. Conclusions Clinically meaningful regrowth in eyebrow and eyelash hair can occur in the absence of complete scalp hair regrowth after treatment with baricitinib. Emotional distress and quality of life improvement is most associated with obtaining a clinical meaningful improvement in scalp hair. Trial Registration Number BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, 24 September 2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, 8 July 2019

Le unghie dei piedi. Guida pratica per riconoscere le malattie e la corretta gestione

Le malattie delle unghie rappresentano un settore specialistico della Dermatologia e sono spesso poco conosciute. In particolare, le onicopatie dei piedi rappresentano oggi un campo in cui Dermatologo e Podologo collaborano al fine di garantire una gestione ottimale del paziente, che pu\uf2 cos\uec beneficiare non solo di diagnosi e terapia a livello specialistico, ma anche di trattamenti periodici da parte del Podologo. L\u2019intento di questo libro \ue8 quello di fornire al Podologo una visione ampia ma precisa delle patologie ungueali, in modo da poterle distinguere ed effettuare una pronta diagnosi differenziale per una maggior precisione diagnostico-terapeutica

Chronic paronychia: different causes and their treatment

Chronic paronychia is an inflammatory disorder that usually involves fingernails of adult women, affecting the proximal and/or lateral nail folds. It is a multifactorial disorder and, depending on the major etiological factor, can be classified into different types that will be discussed in this review. Besides the use of drugs, management of chronic paronychia requires avoidance of wet environments, chronic microtraumas and contact with irritants or allergens for at least 1-2 months after the cuticle has been restored and the condition has resolved. Clinical appearance of the periungual tissues and nails are important guidelines for treatment

Epidemiology of onychomycosis in Italy: Prevalence data and risk factor identification

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1-month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate-severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear

Biotin: overview of the treatment of diseases of cutaneous appendages and of hyperseborrhea

One of the most common micronutrient deficiencies with cutaneous findings is the vitamin B, also known as biotin, deficiency. Biotin deficiency may be due to congenital lack of biotinidase, or acquired following some conditions that interfere with its absorption, such as inflammatory bowel disorders, a diet too rich in avidin, magnesium deficiency, smoking habit and treatment with broad-spectrum antibiotics, anticonvulsants and sulfonamides. This review highlights the role of biotin in the most common skin disorders such associated with biotin deficiency and an approach to their treatment. Biotin administration may improve the treatment of hair loss when deficiency is detected on the basis of a careful patient history, clinical examination and the determination of serum biotin levels. The use of biotin is rationale in seborrheic dermatitis as the vitamin intercepts the main metabolic pathways underlying the pathogenesis of the disease. Treatment with biotin could also be useful in comedonal acne characterized by a high rate of seborrhea, and may be helpful for acne treated with topical retinoids, contributing to the control of flaking and irritation. The tolerability of biotin is excellent and there is no risk of hypervitaminosis even in the case of high doses. It is important that administration is controlled by physicians and follows a medical diagnosis and prescription. Correct doses used in dermatological conditions are safe and are not at risk of interference with laboratory tests

Minoxidil 5% (Carexidil®) soluzione cutanea per il trattamento dell'alopecia androgenetica maschile e femminile: studio clinico multicentrico in aperto

The aim of the study was to evaluate efficacy and safety of 5% Carexidil solution®, applied twice a day on the scalp, on male and female androgenetic alopecia. The 6 month-study was performed in three Italian dermatological centers. Evaluation of efficacy was performed with subjective and objective methods, including operator and patient assessments, global photography and videodermoscopy. Global photography revealed that after 6 months of treatment with 5% Carexidil solution®, androgenetic alopecia was improved in all 32 females and 16 males. Alopecia stopped to progress in 6 males. Scalp videodermoscopy confirmed the results. Some patients complained of increased hair greasiness, others complained of mild scalp itching. Two female patients developed contact sensitization to minoxidil, confirmed by patch test, 2 a mild malar-temporal hypertrichosis. All patients were satisfied by treatment and continued it after the end of the study. Our study confirms the data of the literature and the evidence coming from years of clinical experience, that twice a day topical application of 5% minoxidil solution, Carexidil ®, is effective in the treatment of male and female androgenetic alopecia, with evident efficacy already after 6 month

Dermoscopy of Subungual Exostosis: A Retrospective Study of 10 Patients

Subungual exostosis (SE), the most common nail tumor of young adults, is a benign bony proliferation of the distal phalanx occurring beneath the nail. Misdiagnosis or late diagnosis frequently occurs and no dermoscopy features of this tumor were previously outlined

Enhanced Insights into Frontal Fibrosing Alopecia: Advancements in Pathogenesis Understanding and Management Strategies

Abstract Frontal fibrosing alopecia (FFA) represents a distinctive form of primary lymphocytic scarring alopecia characterized by fronto-temporal hair recession and eyebrow hair loss. While predominantly affecting postmenopausal women, FFA also occurs in women of reproductive age and men, with variations observed across different ethnic groups. Genetic predisposition, environmental factors and inflammatory pathways contribute to its pathogenesis, with evolving diagnostic criteria enhancing accuracy. FFA treatment lacks standardization, encompassing topical, systemic and physical therapies, while hair transplantation remains a temporary solution. This article reviews the current understanding of FFA, aiming to provide clinicians with updated insights for its management