BackgroundRitlecitinib, an oral JAK3/TEC family kinase inhibitor, demonstrated efficacy over 48 weeks in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study. ObjectivesThis post hoc analysis evaluated individual Severity of Alopecia Tool (SALT) score trajectories in patients who received ritlecitinib 50 mg and rolled over from Phase 2b/3 into the ongoing, open-label, Phase 3 ALLEGRO-LT study to describe long-term response patterns and associated baseline disease characteristics. MethodsPatients aged >= 12 years with >= 50% scalp hair loss received ritlecitinib 50 mg once daily in both studies. SALT score trajectories from baseline to Month 24 were used to categorise patients as early (SALT score <= 20 at Week 24 and Months 12 and 24), middle (<= 20 at Months 12 and 24) or late responders (<= 20 by Month 24) or as partial responders (maintained 30% improvement), relapsers (achieved but did not maintain 30% improvement) or non-responders (did not achieve 30% improvement). The proportions of patients achieving sustained response (achieved and maintained SALT score <= 20 at all subsequent available time points through Month 24) and complete response (SALT score 0 at >= 1 time point through Month 24) were evaluated. Multivariable logistic regression assessed variables associated with response. ResultsOf 191 patients treated with ritlecitinib 50 mg, 87 (45.5%) were responders (SALT score <= 20), 24 (12.6%) were partial responders, 24 (12.6%) were relapsers and 56 (29.3%) were non-responders. Of 87 patients categorised as responders, 81 (93.1%) sustained their clinical response and 47 (46.0%) achieved complete response. Factors associated with treatment response included female sex and less extensive and shorter duration of hair loss. ConclusionsApproximately 45% of patients were SALT score responders, with up to 11% requiring >1 year of ritlecitinib treatment to achieve response, highlighting the importance of extended treatment duration. RegistrationALLEGRO phase 2b/3 study (NCT03732807); ALLEGRO-LT study (NCT04006457).

Introduction Le ritlécitinib, inhibiteur oral de JAK3 et des kinases TEC, est efficace et sa sécurité d’emploi jusqu’à 48 semaines chez des patients atteints de pelade a été démontrée par l’étude de phase 2b/3 ALLEGRO (NCT03732807). L’efficacité à long terme du ritlécitinib définie par la proportion de patients ayant atteint des scores de sévérité «Severity of Alopecia Tool» (SALT) ≤20 et ≤10 (perte ≤20 % et ≤10 % de la chevelure) est rapportée à 24 mois dans l’étude d’extension de phase III en ouvert ALLEGRO-LT (NCT04006457) suite à l’étude ALLEGRO-2b/3. La description du score SALT sur l’ensemble de la population, y compris chez les patients n’ayant pas atteint ces seuils, est présentée ici. Matériel et méthodes L’analyse concerne les patients âgés de ≥12ans présentant une perte ≥50 % du cuir chevelu, inclus dans l’étude ALLEGRO-LT suite à ALLEGRO-2b/3 ; et ayant reçu 50mg de ritlécitinib par jour sans dose de charge au cours des deux études. La répartition des patients en fonction du score SALT (tel qu’observé) a été évaluée durant 24 mois pour la population globale. L’analyse intermédiaire a été réalisée sur des données extraites le 9 décembre 2022 (data cutoff). Résultats L’analyse incluait 191 patients. Lors de l’analyse intermédiaire, 71 patients avaient arrêté le traitement ; les causes les plus fréquentes étaient: retrait par décision du patient, événements indésirables et manque d’efficacité. On présente la distribution des patients par score SALT entre le début de l’étude et le mois 24. Tous les participants présentaient un score SALT ≥50 à l’inclusion, dont 71,2 % >90. Parmi les patients ayant un score SALT, les proportions de patients de catégorie SALT >90–100 aux mois 6, 12 et 24 étaient respectivement de 31,5 %, 22,6 % et 14,2 %. Des réductions de la proportion de patients dans les autres catégories SALT>50 ont également été observées durant les 24 premiers mois.Au mois 12, 34,2 % et 11,0 % des patients appartenaient aux catégories SALT 0-10 et>10–20, respectivement, avec 50,8 % et 10,0 % de patients dans ces catégories au mois 24. Des graphiques dynamiques de l‘évolution de la distribution du score SALT pour la population globale, selon la sévérité de la maladie et les groupes d’âge, seront présentés. Discussion Sur 24 mois, l’administration quotidienne de 50mg de ritlécitinib a réduit le nombre de patients aux scores SALT les plus élevés. Ces données reflètent la réponse au traitement au-delà des seuils des scores SALT prédéfinis et expliquent la dynamique de réponse, exprimée par catégories de score SALT. Conclusion Ces données peuvent aider les cliniciens à informer les patients et contextualiser leurs attentes sur le délai de repousse capillaire. Elles montrent également qu‘un traitement par ritlécitinib maintenu au-delà de 12 mois, résulte en une augmentation continue des taux de réponse, soulignant l’importance d’évaluer l’efficacité du traitement après un délai suffisant.

This post-hoc analysis evaluated individual Severity of Alopecia Tool (SALT) score trajectories of patients with AA treated with ritlecitinib, an oral JAK3/TEC family kinase inhibitor, in the ALLEGRO phase 2b/3 study (NCT03732807) and the ongoing, open-label, phase 3, ALLEGRO-LT study (NCT04006457) with the goal of identifying long-term responder patterns. This analysis included patients aged ≥12 years with AA with ≥50% hair loss from ALLEGRO-2b/3 who rolled-over into the ALLEGRO-LT study and who received ritlecitinib 50 mg once daily (QD). SALT score trajectories were generated for individual patients up to Week 96, who were categorized as responders (early, middle, late), partial responders, non-responders, or relapsers. The 6 comprehensive and mutually exclusive categories were based on 3 time periods (early [Baseline-Week 24], middle [Week 25-Week 48], and late [Week 49-Week 96]) and achieving SALT score ≤20 response or 30% SALT score improvement from baseline. Multivariable logistic regression assessed the impact of patient demographics and baseline disease characteristics on achieving response or non-response. Analyses are based on observed data. In total, 191 patients received ritlecitinib 50 mg QD in ALLEGRO-2b/3 and ALLEGRO-LT. Based on individual SALT score trajectories, 87 of these patients (45.5%) were responders (35 [18.3%] early, 32 [16.8%] middle, and 20 [10.5%] late responders), 24 (12.6%) were partial responders, 56 (29.3%) were non-responders, and 24 (12.6%) were relapsers. Female sex, younger age, absence of active shedding, shorter duration of scalp hair loss, and lower baseline SALT score were independent factors associated with increased likelihood of treatment response vs non-response. Over 45% of ritlecitinib-treated patients were SALT score responders, most of whom achieved response within 1 year of treatment. Approximately 10% of patients achieved response after >1 year suggesting that extended treatment may be benefit some patients. Evaluation of individual response profiles may identify patient and disease characteristics associated with treatment response.

BACKGROUND:The lack of validated and responsive outcome measures in the management of frontal fibrosing alopecia (FFA) significantly limits assessment of disease progression and treatment response over time.AIM:To understand how FFA extent and progression is currently assessed in UK specialist centres, to validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and to identify pragmatic advice to improve FFA management in clinic.METHODS:Consultant dermatologists with a specialist interest in hair loss (n = 17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images (Questionnaire 1), with assessment repeated 3 months later to assess intraindividual variability (Questionnaire 2) and 12 months later to test whether interindividual accuracy could be improved with simple instruction (Questionnaire 3).RESULTS:All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques used by our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement [intraclass coefficient (ICC) = 0.61; 95% CI 0.40-0.85], yet intrarater reliability was found to be poor with wide limits of agreement (-8.71 mm to 9.92 mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (Questionnaire 3), inter-rater reliability improved significantly, with ICC = 0.70, suggesting moderate agreement (95% CI 0.51-0.89; P < 0.001). A similar pattern was seen with temporal hairline measurements, which again improved in accuracy with instruction.CONCLUSION:We found that accuracy of measurements in FFA can be improved with simple instruction and we have validated components of the IFFACG measurement recommendations.

The societal impact of the Covid-19 pandemic is profound, with most face-to-face interaction replaced by "virtual" working/socialising. An unanticipated consequence is increased dissatisfaction with on-screen appearance, resulting in a hefty 57% uplift in interest in facial cosmetic procedures--a phenomenon dubbed the "Zoom Boom.1 " This includes interest in botulinum toxin and dermal filler injections, which had already accounted for 75% of the pre-pandemic cosmetic market-share.2 The market demand, accelerated by the surge in interest during the pandemic, should motivate an increased understanding by healthcare professionals; especially as complications will undoubtedly continue to fall at the doorstep of an already overstretched NHS.

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0 08, P = 0 7). At follow-up, three patients (14%) reported 12-month passive suicidal ideation; no patient reported 12month active suicidality. Depression and the prevalence of anxiety are high in patients with psoriasis. Suicidal ideation rates appear to be higher than the rates in the general population during the COVID-19 pandemic. However, we did not observe a significant increase in the psychological burden or shielding of our patients during the pandemic compared with previous levels. Our findings are consistent with recent research on psoriasis-related quality of life during the COVID19 pandemic and may reflect population-specific resilience mechanisms. They also highlight the importance of continued monitoring of psychiatric comorbidity in this population, independently of acute stressors. Future research should address the long-term pandemic impact on patients.

0 08, P = 0 7). At follow-up, three patients (14%) reported 12-month passive suicidal ideation; no patient reported 12month active suicidality. Depression and the prevalence of anxiety are high in patients with psoriasis. Suicidal ideation rates appear to be higher than the rates in the general population during the COVID-19 pandemic. However, we did not observe a significant increase in the psychological burden or shielding of our patients during the pandemic compared with previous levels. Our findings are consistent with recent research on psoriasis-related quality of life during the COVID19 pandemic and may reflect population-specific resilience mechanisms. They also highlight the importance of continued monitoring of psychiatric comorbidity in this population, independently of acute stressors. Future research should address the long-term pandemic impact on patients.

Rosacea has an overall female predominance; however, rhinophyma, a feature attributed to advanced rosacea, is exceedingly rare in females. The impact of this condition on quality of life can be profound. Multiple treatment modalities have been described. However fully ablative carbon dioxide (CO2) laser for moderate-severe rhinophyma has been shown to be most effective with good cosmetic outcome and high patient satisfaction. We describe a series of 7 female patients presenting with rhinophyma to a tertiary NHS laser centre and a private dermatology clinic. A retrospective case review of rhinophyma management was performed, assessing presentation, treatments and outcomes. The mean age at presentation was 47 years (27–62 years). Three patients developed rhinophyma before the age of 30 years. One patient had severe, 2 patients had moderate and 4 patients had minor rhinophyma. Four patients underwent fractional CO2 laser treatment with a good cosmetic outcome. Two further patients developed scarring following fully ablative CO2 laser. Long-term low-dose oral isotretinoin was used in 3 patients following laser treatment, to prevent relapse. One patient solely received isotretinoin with a good outcome. In our experience, females suffering with rhinophyma presented for treatment at an early age and stage of severity. Fractional or fully ablative CO2 laser alone or in combination with oral isotretinoin is a very effective treatment modality.

patients switched back to the originator biologic (rheumatology, n = 47; gastroenterology, n = 12; dermatology, n = 5). Of the 64 switch-back patients; 52% reported lack of efficacy; 27% reported injection site pain and 21% stated various other factors such as blepharitis, insomnia and hair loss as the reason for switching back. Thirty-eight patients refused the switch and remained on the originator biologic (rheumatology, n = 11; gastroenterology, n = 27). Thirty-one patients switched to an alternative biologic (rheumatology, n = 19; gastroenterology, n = 9; dermatology, n = 3). Thirty-two stopped treatment (rheumatology, n = 13; gastroenterology, n = 19). Treatment was withheld in three patients (gastroenterology, n = 2; dermatology, n = 1). Fifty-eight per cent of all eligible patients switched, resulting in a substantial annual cost saving. Dermatology achieved the most success, switching 76% of their patients. Injection site pain and a subjective lack of efficacy predominantly reported in 2019 are the main reasons for ongoing switch backs across the three specialties. Performing a thorough assessment of patients’ concerns will help in rationalizing the use of a biological agent vs. a biosimilar. There have since been further cost-effective adalimumab biosimilars launched, resulting in a quandary for healthcare professionals in light of the recent switch outcomes. This seminal review demonstrates the ongoing need for a robust critical appraisal of such biosimilars, with consideration of both clinical and cost-effective parameters, before establishing their placement in hospital treatment pathways.

DT01 The DECIDE education programme: precision education for nondermatologists D. Rutkowski, L. Asfour, C. Welsh, B. Quinn and M. Singh The Dermatology Centre, SRFT, Manchester, U.K.; University of Manchester, Manchester, U.K.; and Health Innovation Manchester, Manchester, U.K. U.K. dermatology has been struggling to cope with the yearon year growth in two-week-wait (TWW) referrals (27– 30%). This is compounded by a shortage in the specialist workforce and a significant gap in effective education strategies for nondermatologists. Lack of standardized national undergraduate dermatology teaching and changes in nondermatologist postgraduate training pathways have contributed to the current situation (Yaakub A, Cohen S, Singh M, Goulding JMR. Dermatological content of U.K. undergraduate curricula: where are we now? Br J Dermatol 2017; 176: 829–37). Supporting referring nondermatologists to address knowledge gaps and apply accurate decision-making skills is fundamental to addressing these challenges if we are to improve outcomes for patients. Through TWW data analysis, a syllabus for a short-contact, high-impact continuing professional development (CPD) programme called DECIDE Dermatology was developed for two clinical commissioning groups (CCGs). Applying flipped classroom, blended learning methodology participants completed online cases, a 1-day workshop and 10 consultation reflections (from their practice up to 4 months post-workshop attendance). Health economic outcomes were measured through a mixed-method approach: quantitative data comparing TWW referrals and prescribing patterns 6 months preand postprogramme completion plus qualitative thematic analysis of participants’ case reflections. Ninety-eight clinicians representing 54 general practices participated in DECIDE in early 2019. CCG1 commissioned the CPD programme for all 39 practices and CCG2 for 14/32 practices. Results 6 months after programme completion demonstrated a positive impact on volume of referrals. CCG1 had a slowing of growth of TWW referrals from 20% to 6% (2017–18 pre-education vs. 2019–20 posteducation). CCG2 had a slowing of growth of TWW referrals from 38% (nonparticipating practices) vs. 10% (participating practices). Both CCGs have had a consistent 40% reduction in prescribing of inappropriate therapies for skin lesions in the posteducation period. Thematic analysis of 220 consultations identified significant behaviour change in the participants (improved accuracy in decision-making, holistic care, service use and shared decision-making). ‘I undressed the whole patient and found a skin cancer: the dermatologist confirmed it was a melanoma. . .the way I was made to think about my decisions changed my practice, not just for skin but everything.’ This study demonstrates that CPD embedded in pedagogy can directly improve health economic outcomes. We need to take a population-based precision approach to the design of education activities for nondermatologists if we are to provide benefits to our patients, clinicians and, as a consequence, the healthcare system.

193 Dear Editor, Folliculitis decalvans (FD) is a rare scalp disorder characterized by cicatricial alopecia, hair‐tufting, and pustule formation.[1] Staphylococcus aureus appears to be crucial in FD pathogenesis and may result from an abnormal host response to the bacterium.[1] Targeting S. aureus with prolonged/multiple antibiotics is the mainstay of therapy.[1] The World Health Organization’s Global Antimicrobial Surveillance System recently highlighted the increasing antimicrobial resistance, with S. aureus being one of the most commonly reported resistant bacteria.[2]

Linked article: F. Amatore et al. J Eur Acad Dermatol Venereol 2019; 33: 464–483. https://doi.org/10.1111/jdv.15340