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Commonly referred to as secondary dermatological treatments, conditions such as alopecia areata (AA), female pattern hair loss (FPHL), and frontal fibrosing alopecia (FFA) can be associated with anxiety, depression, and in severe cases. It is often associated with suicidal thoughts. 1 Partly due to the psychological burden, treatment options remain limited, and most treatments lack solid evidence from high-quality research.2 Although the recent introduction of Janus kinase (JAK) inhibitors represents a potential paradigm shift in therapeutic approaches, the clinical situation remains uncertain.
The advent of JAK inhibitors, such as baricitinib and lightrecitinib, has brought new hope to patients suffering from AA. These drugs target inflammatory cytokines involved in the development of AA, particularly those that signal through the JAK/STAT pathway. However, existing management guidelines do not incorporate these new treatments, leaving gaps in knowledge regarding their practical application in dermatology clinics.
Research purpose and method
To better understand current prescribing practices for hair loss among UK dermatologists, a survey of members of the British Hair and Nail Society (BHNS) was conducted. This study aimed to evaluate treatment approaches used for mild to moderate AA, severe AA (including alopecia totalis and alopecia universalis), FPHL, and FFA. Participants were asked about their clinical practice, treatment preferences, and how the COVID-19 pandemic has impacted service delivery. 4
Data were collected through an online survey distributed from July to December 2022, with a response rate of 40%. Data analysis utilized descriptive statistics to highlight trends in treatment practices.
result
The survey revealed that 38% of respondents experienced a disruption in care delivery due to the pandemic, primarily due to increased demand in general dermatology. The majority (69%) practice in dedicated hair clinics, reflecting a commitment to professional care. Of note, researchers found that while the median number of new patients in AA and FFA remained consistent before and after COVID-19, referrals to FPHL increased. .
The study states that for mild to moderate AA, topical corticosteroids have emerged as the most commonly prescribed first-line treatment, followed by intralesional corticosteroids and oral corticosteroids. . Of note, 82% of dermatologists reported that intralesional corticosteroids were the most effective option. For severe AA, researchers have found that oral corticosteroids are the first-line treatment, but concerns about side effects have limited their use. JAK inhibitors were also used primarily in private practice.
The study found overwhelming support for topical minoxidil as a first-line treatment for FPHL, with 84% of respondents using it. Interestingly, oral minoxidil was perceived as the most effective treatment by 42% of participants, despite its limited availability in NHS settings. It reflects the rise.
This study found that a variety of approaches were used for FFA management, with topical and intralesional corticosteroids being the most commonly used first-line treatments. However, the researchers said the effectiveness of these treatments remains uncertain, reflecting a broader problem of insufficient evidence in the literature.
discussion
This study highlights that there is moderate consensus regarding the management of mild to moderate AA, favoring topical and intralesional corticosteroids. However, the lack of strong evidence for different treatments results in variability in practice. In particular, the lack of availability of JAK inhibitors on the NHS may limit clinician experience and willingness to implement these treatments.
The diverse treatment strategies for FFA reflect the uncertainty surrounding effective treatments in this field. Many clinicians report using multiple treatments simultaneously, likely due to insufficient evidence for any single agent.
conclusion
This study provided insight into the actual prescribing practices of UK dermatologists for common hair loss conditions. With the recent introduction of JAK inhibitors, a change in the treatment paradigm may be imminent if these treatments gain NHS approval. The results of this study are intended to support clinician decision-making as well as inform policy makers about the place of new high-cost treatments in the hair loss treatment landscape.
As dermatologists grapple with the complexities of hair loss management, continued research and data collection are needed to improve treatment protocols, ensure equitable care, and improve patient outcomes in this emotionally charged field. essential, the study says.
References
McBeth AE, Holmes S, Harries M, et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol. 2022;187(1):73-81. doi:10.1111/bjd.21055Messenger AG, McKillop J, Farrant P, et al. British Association of Dermatologists Alopecia Areata Management Guidelines 2012. Br J Dermatol. 2012;166(5):916-926. doi:10.1111/j.1365-2133.2012.10955.xKwon O, Senna MM, Sinclair R, et al. Efficacy and safety of baricitinib in patients with severe alopecia areata over 52 weeks of continuous treatment in two phase III trials (BRAVE-AA1 and BRAVE-AA2). J Clin Dermatol. 2023;24(3):443-451. doi:10.1007/s40257-023-00764-wFrewen J, Alsaadi D, Asfour L, et al. There is a prescribing pattern among UK dermatologists for the treatment of alopecia areata, female pattern hair loss and frontal fibrosing alopecia. JEADV Clinical Practice. 2024; 1-10. doi: 10.1002/jvc2.495
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