Isabella Doche

Background: Alopecia areata (AA) is an autoimmune disease characterized by patchy or complete nonscarring hair loss on the scalp, face, and/or body, leading to substantial impairment in health‐related quality of life (HRQOL). Real‐world data on the impact of AA on HRQOL are limited in Brazil. Objectives: To investigate the demographics, clinical characteristics, and HRQOL among Brazilian patients with AA. Methods: A cross‐sectional survey of dermatologists and their adult patients with AA was conducted from March–June 2024 in Brazil. Data included demographics, clinical characteristics, SKINDEX‐AA, and EQ‐5D‐5L scores. Bivariate analyses compared patients with < 50% vs. ≥ 50% scalp hair loss (SHL). Results: Among 279 patients, 198 had < 50% SHL and 81% ≥ 50% SHL. Full‐time employment was lower among patients with ≥ 50% vs. < 50% SHL (51.3% vs. 67.5%; p = 0.0089). Those with ≥ 50% SHL had a longer time since diagnosis (mean [SD], 1445.4 [2413.6] vs. 713.2 [1314.0] days; p = 0.0043), more frequent disease worsening (slow, 21.0% vs. 14.1%; p = 0.0027; rapid, 11.1% vs. 4.5%; p = 0.0027), and significantly lower percentage of scalp hair regrowth (mean [SD], 31.8 [18.5] vs. 46.1 [34.6]; p = 0.0300). Hair loss across other body sites was more common in patients with ≥ 50% SHL. Mean (SD) SKINDEX‐16 AA scores were higher in patients with ≥ 50% vs. < 50% SHL (overall, 63.4 [15.7] vs. 34.2 [21.9], p = 0.0001; emotions, 83.0 [19.2] vs. 44.1 [28.0], p < 0.0001; functioning, 67.4 [29.6] vs. 35.6 [27.7], p = 0.0017), whereas EQ‐5D‐5L scores did not differ significantly. Limitations: This study utilized a convenience sample, sampling was based on the next “ n ” eligible patients, and the study data were self‐reported and may be subject to recall bias. Conclusions: In Brazil, more extensive SHL was associated with more severe AA and greater HRQOL impairment, as measured by SKINDEX‐16 AA. These findings underscore the importance of timely diagnosis and access to efficacious therapies, particularly for those with more severe AA.

INTRODUCTION Alopecia areata (AA) has a major psychological impact, yet Brazilian data on patients’ and caregiver´s quality of life (QoL) are lacking. We aim to assess QoL in patients with AA and their caregivers and identify clinical and socioeconomic correlates. METHODS A cross-sectional study including 118 patients (83 adults, 35 children/adolescent) aged ≥4 years with active scalp AA and 58 caregivers was performed at a tertiary dermatology center (2022-2024). QoL was evaluated with DLQI, CDLQI and FDLQI. Disease severity was scored with SALT II. Sociodemographic and clinical data were analyzed using parametric and nonparametric tests (p ≤ 0.05). RESULTS Participants were predominantly female (63.6%) and of mixed race (53.5%), with mean age of 27.6 years. Mean SALT II was 33.9%. Multifocal (39.3%) AA predominated. QoL impact was moderate in adults (median DLQI 6; IQR 3–10) and mild in youth (median CDLQ 5; IQR 2–8), but greater among caregivers (median FDLQI 9; IQR 6–14). Patient-caregivers QoL scores correlatedly positively (Rho = 0.48, p < 0.001). Dermatologic comorbidities worsened QoL in both groups. CONCLUSION AA exerts substantial psychosocial burden on whole family. Caregivers experience higher impairment than patients, underscoring the need for family-centered interventions in Latin America.

Introduction: Alopecia areata is a non-scarring autoimmune alopecia that may arise as a paradoxical reaction during treatment with biologic agents for immune-mediated inflammatory diseases. Such paradoxical reactions are increasingly recognized with the widespread use of biologics, particularly TNF-α inhibitors. Case Presentation: We report a case series of 7 patients with multiple immune-mediated inflammatory diseases who developed alopecia areata during biologic therapy. Conclusion: There is no consensus on the optimal management of paradoxical alopecia areata. Individualized management should be guided by disease severity, response to treatment, and patient preference. Recognizing patients at higher risk, particularly those with multiple immune-mediated inflammatory diseases, and monitoring them closely may aid in the early detection and management of paradoxical reactions.

Introduction: Pityriasis amiantacea (PA), also known as pseudotinea amiantacea, is a scalp disorder characterized by adherent scales surrounding hair tufts, with an unclear etiopathogenesis potentially linked to inflammatory scalp diseases such as psoriasis, seborrheic dermatitis, and atopic dermatitis. Methods: This retrospective multicenter study analyzed the epidemiology, clinical presentation, trichoscopic features, and management of 76 pediatric patients diagnosed with PA across 22 centers. Results: Pruritus was the hallmark symptom, and scarring alopecia was rare in pediatric patients. Regarding trichoscopy, recognizing the vascular patterns is demonstrated to be valuable for severe or unresponsive cases. In our study, monotherapy using topical steroid treatment generally led to favorable outcomes, suggesting that PA may be less aggressive in children due to earlier diagnosis and less severe inflammation. Conclusion: This study highlights the importance of recognizing PA in pruritic scalp conditions in pediatric patients, suggesting effective management strategies that can improve quality of life despite the psychosocial impact of the disease.