Dear Editor, Calcitonin gene-related peptide (CGRP) is a neuropeptide with potent vasodilatory effects and a key role in trigeminovascular signaling, underlying the pathogenesis of migraine. Consequently, the inhibition of CGRP activity has been demonstrated to reduce the incidence of acute migraine attacks. Based on this evidence, monoclonal antibodies against CGRP or its receptor have been approved by the European Medicines Agency for prevention of both episodic and chronic migraine. Among CGRP inhibitors, galcanezumab has also been authorized for the treatment of episodic cluster headache. Since the advent of CGRP inhibitors, several cases of drug-induced telogen effluvium have been reported, with incidence rates ranging from 1.10% to 7.23%. However, to the best of our knowledge, alopecia areata (AA) associated with CGRP inhibition remains undescribed in the literature. [...]

Ritlecitinib, an oral selective inhibitor of Janus kinase 3 and the TEC family of kinases, has recently been approved for the treatment of severe alopecia areata, but real-world data are still limited. The aim was to evaluate the effectiveness and tolerability of ritlecitinib 50 mg/day after 24 weeks in patients with severe alopecia areata in clinical practice. We performed an Italian observational, retrospective, multicentre study with 24 weeks of follow-up. Patients ≥ 12 years of age with severe alopecia areata (Severity of Alopecia Tool [SALT] ≥ 50) and a disease duration ≥ 6 months who were candidates for systemic therapy were enrolled. Ritlecitinib 50 mg/day was administered according to national guidelines. The primary endpoint was to evaluate the achievement of SALT ≤ 20 at week 24. Secondary endpoints included achievement of SALT ≤ 10; mean change in SALT; trichoscopic improvement; quality of life; psychological impact; efficacy in eyebrows, eyelashes, and nails; and safety profile. A total of 102 patients were included. At week 24, 40.2

Key Message Relapse during ongoing JAK inhibitor therapy is not uncommon in real-world alopecia areata management, and rescue outcomes are heterogeneous and not reliably predicted by baseline clinical features or the selected rescue approach, supporting individualized management.

Acne and acne sequelae can have an important impact on patients’ quality of life, affecting interpersonal relationships and social functioning. Acne-induced scars (AIS) and acne-induced macular hyperpigmentation (AIH), in particular, are a major concern for patients with acne, as their management is challenging and often unsatisfactory. Retinoids are considered the mainstay of acne treatment because of their action on multiple pathogenetic factors, and there is increasing evidence that they can also improve AIS and AIH. Trifarotene, a topical retinoid with selectivity for retinoic acid receptor (RAR)-γ, has undergone an extensive clinical development programme, demonstrating its efficacy in treating facial and truncal acne and improving acne sequelae. In this article, we review the main evidence supporting the use of trifarotene in patients with acne and acne sequelae and provide place-in-therapy suggestions based on the experience of the Italian Acne Board with this drug in real-life practice. Trifarotene can be used successfully, as monotherapy or in association with other treatments, in most clinical settings of acne, but it plays an essential role in patients with existing AIS and AIH, those with a clinical or personal history of scarring and those who are predisposed to AIH. Owing to its long-term efficacy and tolerability, trifarotene is also a good option as a maintenance treatment. As with other topical retinoids, patients undergoing trifarotene therapy should be given advice on how to minimise local irritation when starting treatment.

Introduction:Terra firma-forme dermatosis (TFFD) is a benign condition characterized by hyperpigmented patches that resist routine washing yet are removable with isopropyl alcohol. Observing TFFD on the scalp is an exceptional event. Case Presentation:A 9-year-old female with ectodermal dysplasia and features of diffuse alopecia areata presented with multiple brown patches on the scalp. Trichoscopic examination revealed cluster of brown dots arranged in single files forming multiple curved lines that resemble a fingerprint pattern composed of dots. The lesions were completely removed by rubbing with isopropyl alcohol-soaked gauze. Discussion:This case introduces a novel trichoscopic pattern in scalp TFFD, expanding the diagnostic spectrum of the condition. The rapid resolution with isopropyl alcohol confirms the diagnosis, underscoring the utility of trichoscopy as a noninvasive diagnostic tool in complex scalp disorders.

Purpose of the article: Baricitinib, a JAK 1/2 inhibitor, is approved for treating severe alopecia areata (AA). This study aimed to evaluate the long-term effectiveness and safety of baricitinib in a real-world setting over 52 weeks.Materials and methods: This multicenter retrospective study included 96 adult patients diagnosed with severe AA from 11 Italian Dermatology Units. All patients received 4 mg of baricitinib daily. Effectiveness was assessed using the Severity of Alopecia Tool (SALT) score, with the primary endpoint defined as achieving a SALT score <= 20 at week 52. Secondary endpoints included achieving a Clinician-Reported Outcome (ClinRO) score of 0 or 1 for eyebrow (ClinRO EB) and eyelash hair loss (ClinRO EL), with a >= 2-point improvement from baseline.Results: After 52 weeks, 61.5% of patients achieved a SALT score <= 20. Additionally, 67.6% and 69.7% of patients attained ClinRO EB and ClinRO EL scores of 0 or 1, respectively, with a >= 2-point improvement. No significant adverse safety events were reported during the study.Conclusions: The study confirms the long-term effectiveness and safety of baricitinib for severe AA in a real-world setting. These findings align with clinical trial results and reinforce baricitinib's role as a viable treatment option for severe AA.

BACKGROUND:Alopecia areata (AA) is an autoimmune condition leading to hair loss. Baricitinib, a Janus kinase (JAK) inhibitor, has demonstrated efficacy in controlled clinical trials, but real-world data on its long-term effectiveness and safety remain limited. OBJECTIVES:This study aimed to assess the real-life effectiveness and safety of baricitinib 4 mg daily in Italian adult patients with severe AA over a 48-week treatment period. METHODS:We conducted a 48-week retrospective, observational, multicenter study across 27 Italian university hospitals. Adult patients (18-65 years) with severe AA (Severity of Alopecia Tool [SALT] score ≥ 50) who initiated baricitinib 4 mg daily treatment between November 2022 and October 2023 were included. Effectiveness was measured by the percentage of patients achieving SALT ≤20 at week 48. Secondary outcomes included changes in mean SALT score, trichoscopic findings, patient-reported quality of life (Skindex-16, Hospital Anxiety and Depression Scale [HADS]), and Clinician-Reported Outcomes (ClinRO) for eyebrows and eyelashes. Adverse events were also documented. RESULTS:A total of 253 patients (66.8% females, mean age 40.0 ± 12.6 years) were included. By week 48, 63.2% achieved SALT ≤20, and 75.5% achieved SALT ≤30. The mean SALT score significantly decreased from 93.7 ± 14.1 at baseline to 26.5 ± 33.0 at week 48 (p < 0.001). Trichoscopic assessment showed a decline in yellow dots (97.6%-50.2%), black dots (43.5%-9.1%), and dystrophic hairs (14.6%-4.3%), whilst regrowing hairs increased (7.1%-80.2%). Skindex-16 scores improved significantly (57.1 ± 25.0 to 30.0 ± 17.8, p < 0.001), as did HADS Anxiety (8.21 ± 9.38 to 4.62 ± 4.21, p < 0.001) and HADS Depression (6.36 ± 4.55 to 3.70 ± 4.11, p < 0.001). Adverse events were reported in 9.4% of patients. CONCLUSIONS:This real-world study confirms the effectiveness of baricitinib in achieving significant hair regrowth and improving psychological well-being in severe AA patients.

Alopecia areata (AA) is a chronic autoimmune disorder causing nonscarring hair loss. Conventional AA treatments show limited efficacy, highlighting the need for more effective therapeutic options. Ritlecitinib, an oral Janus kinase 3/TEC family kinase inhibitor, demonstrated efficacy and safety in patients aged ≥ 12 years, with data available up to 48 weeks. However, real-life investigations into its effectiveness and safety are limited. This study sought to address this knowledge gap by investigating treatment outcomes among patients with AA undergoing ritlecitinib in a real-life setting. We retrospectively reviewed charts across three Italian tertiary referral centres. Compared with the ALLEGRO trial, a higher rate of Severity of Alopecia Tool score 20 responses has been observed.

BACKGROUND:Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA.METHODS:The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients.RESULTS:The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life.CONCLUSIONS:AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.

Introduction: Although well-known, tick bite alopecia is rarely reported in the literature. Case Presentations: We present five cases of alopecia of the scalp caused by tick bites. All patients were Caucasians, 2 males and 3 females, with an age ranging from 4 to 9 years (mean age: 6.3 years). Discussion: The mechanisms by which ticks cause alopecia are unknown. The saliva of ticks contains anticoagulants (heparins, heparinoids, and coumarins). The release of these anticoagulants would induce an inflammatory reaction on the scalp, with alopecia as the final clinical result.

Alopecia areata (AA) is a chronic immune-mediated disorder characterized by non-scarring hair loss that can involve any hair-bearing site (1,2). AA pathogenesis depends on dysregulation of the immune system, with interferon-gamma (iFN-gamma), interleukin-15 (iL-15), and Janus kinase (JAK) playing pivotal roles in promoting inflammation and hair follicle damage (3,4). in clinical trials, JAK inhibition has been shown to prevent and reverse hair loss in alopecia areata (5–7). Baricitinib is

Introduction: Morphea, also known as localized scleroderma, could affect the head and neck region, mainly manifesting in a linear pattern. Localized scleroderma of the scalp presenting as a circumscribed alopecic patch has been described as an unusual clinical entity. We present a new case of circumscribed morphea of the scalp. Case Report: We present the case of a 33-year-old man with a single cicatricial alopecic patch of the scalp. The main clinical, trichoscopic, and histopathological findings are described. Conclusion: We suggest considering scalp morphea in the differential diagnosis of mono-lesional cicatricial alopecia involving the scalp.

The management of acquired hypertrichosis (HT) is based on the search of the causes and subsequent specific treatment. However, simultaneous hair removal is important. No single method for hair removal is appropriate for all patients and skin areas. Treatment options are actually limited and clinical results are often unsatisfactory. Ornithine decarboxylase 1 (ODC1), an enzyme present in hair follicles, is considered as a potential target to inhibit hair growth. Only eflornithine hydrochloride, an inhibitor of ODC1, showed to be partially effective in the management of acquired HT.

Alopecia areata (AA), an autoimmune disease with a relapsing-remitting course, represents the second cause of non-scarring alopecia worldwide and is associated with several comorbidities, notably atopic dermatitis (AD). In particular, AD is related to its more severe forms alopecia totalis (AT) and alopecia universalis (AU) [Nat Rev Dis Primers. 2017;3:17011]. Considering that AA has been classified as T helper 1-driven disease, whereas AD is the prototypical T helper 2 (Th2)-driven skin disorder, recent studies suggest that these forms may underlie a different chemokine expression resulting in a Th2 skewing as a key pathomechanism that could explain this association [JAMA Dermatol. 2015 May;151(5):522-8]. Several reports showed that dupilumab, a fully human monoclonal antibody targeting the interleukin 4α receptor and thus downregulating Th2 response, led to an improvement of AA associated with AD; most of these patients were females with AT or AU, early-onset AD, and atopic comorbidities [Exp Dermatol. 2020 Aug;29(8):726-32]. We report here a case to further support this hypothesis.

BACKGROUND:Hidradenitis suppurativa (HS) is a chronic, inflammatory disease that presents with nodules, abscesses and fistulae affecting the apocrine gland-bearing skin. Since few years, ultrasonography is used to better characterize HS skin lesions but comparison between clinical and sonographic scores has been made only in small series of patients. To assess concordance between clinical and sonographic scores in a larger cohort of HS patients.METHODS:We conducted a retrospective observational study on 140 HS patients comparing two clinical score systems, Hurley and HS-Physical Global Assessment (PGA), with two ultrasonographic scores, sonographic score of hidradenitis suppurativa (SOS-HS) and ultrasonographic HS-PGA, a novel ultrasound scoring system set up by our group. We used the weighted Cohen's Kappa statistic (k) to evaluate the agreement.RESULTS:Agreement between Hurley staging and SOS-HS was found in 61.4% of patients (weighted kappa 0.477), while agreement between clinical and ultrasonography HS-PGA scores was found in 35% of patients (weighted kappa 0.278), both findings suggesting a substantial disagreement.CONCLUSIONS:Our study demonstrated a relevant disagreement between clinical and ultrasonography scores. Ultrasonography discovered non-clinically evident HS lesions, notably fistulae. Taken together, the above findings may support the view, previously suggested in expert panel reports, on the higher sensitivity of ultrasonography compared to clinics in HS.

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle that usually involves specific anatomic areas which are partially occluded, have a higher density of eccrine and apocrine sweat glands and a higher pH. These characteristics could promote the superinfection of certain group of bacteria. We aimed to describe the bacteria that can be isolated from hidradenitis lesions and to establish a correlation between bacteriological results and clinical data. METHODS: We prospectively enrolled forty-six patients presenting purulent or seropurulent discharge. Sixty samples were performed using swabs, which were deeply introduced in the lesions. RESULTS: Fifty-two percent of cultures resulted positive and fifteen bacterial species were isolated. The more prevalent species were Proteus mirabilis and Staphylococcus aureus. Samples from advanced cases were more likely to yield a positive bacterial growth. CONCLUSIONS: In our study the rate of positive cultures increased in more severe stages of the disease, thus bacterial superinfection of established lesions may contribute to maintain chronic inflammation. We could not find statistically significant correlation with the sampled anatomic area or specific group of bacteria. Larger prospective studies should be performed.

BACKGROUND: The psychological impact of acne is comparable to that experienced by patients with severe diseases; however, most of the people does not consider acne as a true disease. We evaluated beliefs, sources of information and knowledge about acne in Italian adolescents and their mothers. METHODS: This survey was carried out in 2327 acne patients and their mothers (4654 subjects) by means of a self-administered questionnaire. The questionnaire was based on ten questions: seven questions for the patients and three questions for their mothers. RESULTS: All the 2327 patients and their mothers completed the survey. Approximately 75% of patients declared that acne has a negative influence on their self-esteem and relationships; furthermore, 87% of patients stated that acne limits their social life. Finally, 65% of patients declared that they are under treatment, but only in 20% of cases the treatment was prescribed by a dermatologist. The mothers considered pollution. wrong diet and hyperseborrhea as the most important etiological factors. They considered the treatment suggested by a cosmetologist and contraceptive pill as the best one; only 8% of mothers reported that they regularly took their children to the dermatologist. CONCLUSIONS: In order to improve the treatment and the quality of life in acne patients, there is a need to improve awareness about this disease and its causes and to highlight the role and importance of dermatologists.