Hair & Nails

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

In the November issue of Journal of Drugs in Dermatology (2011;10:1235-9), Dr. Eliot F. Battle Jr., gives an excellent review of "Advances in Laser Hair Removal in Skin of Color."

Dr. Battle summarizes that "Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction."

The mechanism of laser hair reduction (LHR) is based on the theory of selective photothermolysis, whereby thermal injury to a desired chromophore can be achieved with the appropriate wavelength, pulse duration, and fluence.

In LHR, the target chromophore is the pigment in the hair follicle and bulb. However, Dr. Battle notes that destruction of the non-pigmented progenitor stem cells is also required to achieve permanent hair reduction. Therefore, a modified theory of selective photothermolysis has been proposed for the mechanism of LHR where appropriate wavelengths, as well as longer pulse durations, must be used to allow heat to effectively destroy the melanocytic hair follicle and bulb, as well as the amelanotic hair follicle and stem cell. 

In darker skin types, longer wavelength lasers must be used to bypass absorption of epidermal pigment to prevent untoward side effects of dyspigmentation.

Currently the 810-nm diode and 1064-nm Nd:YAG lasers are Food and Drug Administration approved for skin types IV-VI. The Nd:YAG is inherently the safer of the two devices because of the longer wavelength; however,  long pulse durations with the diode laser with appropriate cooling have been shown to increase its safety profile.

Epidermal damage from lasers occurs when the epidermal temperature equals or exceeds 45 degrees Celsius, thus appropriate cooling mechanisms are essential for safe and effective LHR. Excessive cooling, however, can lead to dyspigmentation in darker skin.

Initiating LHR in darker skin should be done conservatively with longer wavelengths, lower fluences, and longer pulse durations. If test spots are performed, it is recommended to wait 48 hours before proceeding with therapy as patients with darker skin may manifest delayed dyspigmentation.

Patients with skin types IV-VI may also be at increased risk for paradoxical hypertrichosis. While it has been reported in most ethnic origins, those of Mediterranean and Pacific Asian descent may be particularly affected. Paradoxical hypertrichosis mainly occurs on the face and neck, and has been reported both within and outside the treatment area. While the exact cause is unknown, possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Current treatment for paradoxical hypertrichosis is laser therapy of the affected area.

The only contraindications for LHR are gold therapy and St. John’s Wort, which should be discontinued for 3 months prior to therapy. While not contraindicated, LHR is not recommended in pregnant women. 

There is no evidence supporting increased LHR side effects in patients recently receiving Accutane; however, until there is more data, it is recommended to wait 3 months after discontinuing Accutane before initiating LHR. Anti-viral prophylaxis may be taken 2-3 days prior to LHR and for 5-7 days after treatment for patients with a history of recurrent herpetic infections in the treatment area.

With each treatment, patients may expect a 10%-20% decrease in hair count, color, and diameter of the hair. In patients of darker color, a minimum of eight treatments may be required to achieve results, with treatments typically scheduled 4-8 weeks apart. 

Dr. Battle also noted that LHR not only treats unwanted hair, but also effectively diminishes inflammation and dyspigmentation from pseudofolliculitis barbae and acne keloidalis nuchae, as these conditions are due to ingrown and/or tufted coarse curled hairs in darker skin types.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

PHILADELPHIA – New findings that show T-cell activation plays a critical role in the development of alopecia areata has opened new doors to treatment.

A report last year from a genome-wide association study involving 1,054 patients with alopecia areata (AA) and more than 3,000 controls, identified eight genes strongly linked to the disease (Nature 2010;466:113-7). One of the gene’s codes for a ligand, ULBP3, appears in the dermal sheath of hair follicles in patients with AA. The ULBP3 ligand appears responsible for attracting the cluster of T cells that produce the characteristic histopathology of affected hair follicles, Angela M. Christiano, Ph.D., said at the meeting.

©Heidi Frerichs/iStockphoto.com

"Normally the hair follicle is immune privileged, but when the ULBP3 ligand is increased, T cells attack" the follicle and cause its destruction and the hair loss that is pathognomonic for AA, said Dr. Christiano, professor of dermatology and of genetics and development at Columbia University Medical Center in New York.

The ULBP3 finding led to a search for possible treatments that could interfere with the T-cell attack, guiding Dr. Christiano and her associates to the drug abatacept (Orencia). The agent suppresses T-cell activation and activity and is approved for treating rheumatoid arthritis (RA) and juvenile idiopathic arthritis. Study results reported almost a decade ago showed that abatacept worked in a mouse model of AA, she said.

Testing of a drug such as abatacept represents a new direction for AA treatment, which until now has usually been treated with agents developed for psoriasis, a strategy that has been unsuccessful.

Dr. Christiano and her coinvestigators designed a pilot study to test the efficacy of abatacept in patients with moderately severe AA, 6-12 months after diagnosis. They set these parameters because the patients will have established disease that is unlikely to spontaneously remit, but not so severe as to be too advanced to respond to T-cell based treatment.

Their planned study will randomize 56 patients to either a subcutaneous injection of abatacept or placebo at baseline, weeks 2 and 4, and then every 4 weeks for five cycles for a total treatment duration of 6 months. The study’s primary endpoint will be a 30%-40% improvement on the severity of alopecia tool after the first 6 months of treatment, and then after an additional 6 months of untreated follow-up, she said in an interview.

"I don’t think we could have been more shocked by what we found" in the genetic study, said Dr. Christiano at the meeting, sponsored by the Drug Information Association. "We fully expected to be aligned with other skin autoimmune diseases, like psoriasis." Instead, the eight genes linked to AA closely overlapped with type 1 diabetes, RA, and celiac disease, disorders that "we never considered."

But like the ULBP3 ligand found in the hair-follicle dermal sheaths of patients with AA, these autoimmune diseases also feature upregulated ligands that attract T cells to cellular targets and cause the disease: synoviocytes in RA, gut epithelial cells in celiac disease, and pancreatic islet cells in a mouse model of type 1 diabetes.

Dr. Christiano said that she had no disclosures.

PHILADELPHIA – New findings that show T-cell activation plays a critical role in the development of alopecia areata has opened new doors to treatment.

A report last year from a genome-wide association study involving 1,054 patients with alopecia areata (AA) and more than 3,000 controls, identified eight genes strongly linked to the disease (Nature 2010;466:113-7). One of the gene’s codes for a ligand, ULBP3, appears in the dermal sheath of hair follicles in patients with AA. The ULBP3 ligand appears responsible for attracting the cluster of T cells that produce the characteristic histopathology of affected hair follicles, Angela M. Christiano, Ph.D., said at the meeting.

©Heidi Frerichs/iStockphoto.com

"Normally the hair follicle is immune privileged, but when the ULBP3 ligand is increased, T cells attack" the follicle and cause its destruction and the hair loss that is pathognomonic for AA, said Dr. Christiano, professor of dermatology and of genetics and development at Columbia University Medical Center in New York.

The ULBP3 finding led to a search for possible treatments that could interfere with the T-cell attack, guiding Dr. Christiano and her associates to the drug abatacept (Orencia). The agent suppresses T-cell activation and activity and is approved for treating rheumatoid arthritis (RA) and juvenile idiopathic arthritis. Study results reported almost a decade ago showed that abatacept worked in a mouse model of AA, she said.

Testing of a drug such as abatacept represents a new direction for AA treatment, which until now has usually been treated with agents developed for psoriasis, a strategy that has been unsuccessful.

Dr. Christiano and her coinvestigators designed a pilot study to test the efficacy of abatacept in patients with moderately severe AA, 6-12 months after diagnosis. They set these parameters because the patients will have established disease that is unlikely to spontaneously remit, but not so severe as to be too advanced to respond to T-cell based treatment.

Their planned study will randomize 56 patients to either a subcutaneous injection of abatacept or placebo at baseline, weeks 2 and 4, and then every 4 weeks for five cycles for a total treatment duration of 6 months. The study’s primary endpoint will be a 30%-40% improvement on the severity of alopecia tool after the first 6 months of treatment, and then after an additional 6 months of untreated follow-up, she said in an interview.

"I don’t think we could have been more shocked by what we found" in the genetic study, said Dr. Christiano at the meeting, sponsored by the Drug Information Association. "We fully expected to be aligned with other skin autoimmune diseases, like psoriasis." Instead, the eight genes linked to AA closely overlapped with type 1 diabetes, RA, and celiac disease, disorders that "we never considered."

But like the ULBP3 ligand found in the hair-follicle dermal sheaths of patients with AA, these autoimmune diseases also feature upregulated ligands that attract T cells to cellular targets and cause the disease: synoviocytes in RA, gut epithelial cells in celiac disease, and pancreatic islet cells in a mouse model of type 1 diabetes.

Dr. Christiano said that she had no disclosures.

PHILADELPHIA – New findings that show T-cell activation plays a critical role in the development of alopecia areata has opened new doors to treatment.

A report last year from a genome-wide association study involving 1,054 patients with alopecia areata (AA) and more than 3,000 controls, identified eight genes strongly linked to the disease (Nature 2010;466:113-7). One of the gene’s codes for a ligand, ULBP3, appears in the dermal sheath of hair follicles in patients with AA. The ULBP3 ligand appears responsible for attracting the cluster of T cells that produce the characteristic histopathology of affected hair follicles, Angela M. Christiano, Ph.D., said at the meeting.

©Heidi Frerichs/iStockphoto.com

"Normally the hair follicle is immune privileged, but when the ULBP3 ligand is increased, T cells attack" the follicle and cause its destruction and the hair loss that is pathognomonic for AA, said Dr. Christiano, professor of dermatology and of genetics and development at Columbia University Medical Center in New York.

The ULBP3 finding led to a search for possible treatments that could interfere with the T-cell attack, guiding Dr. Christiano and her associates to the drug abatacept (Orencia). The agent suppresses T-cell activation and activity and is approved for treating rheumatoid arthritis (RA) and juvenile idiopathic arthritis. Study results reported almost a decade ago showed that abatacept worked in a mouse model of AA, she said.

Testing of a drug such as abatacept represents a new direction for AA treatment, which until now has usually been treated with agents developed for psoriasis, a strategy that has been unsuccessful.

Dr. Christiano and her coinvestigators designed a pilot study to test the efficacy of abatacept in patients with moderately severe AA, 6-12 months after diagnosis. They set these parameters because the patients will have established disease that is unlikely to spontaneously remit, but not so severe as to be too advanced to respond to T-cell based treatment.

Their planned study will randomize 56 patients to either a subcutaneous injection of abatacept or placebo at baseline, weeks 2 and 4, and then every 4 weeks for five cycles for a total treatment duration of 6 months. The study’s primary endpoint will be a 30%-40% improvement on the severity of alopecia tool after the first 6 months of treatment, and then after an additional 6 months of untreated follow-up, she said in an interview.

"I don’t think we could have been more shocked by what we found" in the genetic study, said Dr. Christiano at the meeting, sponsored by the Drug Information Association. "We fully expected to be aligned with other skin autoimmune diseases, like psoriasis." Instead, the eight genes linked to AA closely overlapped with type 1 diabetes, RA, and celiac disease, disorders that "we never considered."

But like the ULBP3 ligand found in the hair-follicle dermal sheaths of patients with AA, these autoimmune diseases also feature upregulated ligands that attract T cells to cellular targets and cause the disease: synoviocytes in RA, gut epithelial cells in celiac disease, and pancreatic islet cells in a mouse model of type 1 diabetes.

Dr. Christiano said that she had no disclosures.

There’s power in numbers, and why should patient advocacy be any different?

Last week, at a meeting in Philadelphia on the collection and use of clinical specimens for genetic studies, alopecia areata researcher Dr. Angela Christiano couldn’t stop praising the National Alopecia Areata Foundation, both for its financial assistance in funding her research over more than a decade, and for the group's more intrinsic aid in establishing, promoting, and populating the National Alopecia Areata Registry that provided the genetic specimens Dr. Christiano and her associates used to identify eight genes linked to the disease, study results they reported last year.

Courtesy Images from the History of Medicine Collection (NLM)

In her talk, Dr. Christiano gave some reasons why alopecia areata should have such a dynamic advocacy group. Alopecia areata, an autoimmune disorder that causes either partial or complete hair loss in otherwise healthy, young people, affects more than 5 million Americans. In addition, until recently little was know about its cause, and no evidence-based nor reliably effective treatment exists.

The genetic links that Dr. Christiano and her colleagues identified finally provide clues to what causes alopecia areata and how it might be treated. They also plan to further explore genetic links in an expanded study. Last year’s report used genetic specimens from 1,054 patients, but now the registry includes about 7,400 patients, and the researchers’ goal is to raise the total above 10,000.

The discussion at last week’s meeting made clear that patient advocacy groups can play a key role in helping researchers acquire large numbers of clinical specimens for genetic studies from patients with a variety of diseases. The Internet and social media have made patients much more informed about their conditions and have tied them into better organized networks. Alopecia areata is a disease where the payoffs from this have begun to accrue.

---Mitchel Zoler (on Twitter @mitchelzoler)

There’s power in numbers, and why should patient advocacy be any different?

Last week, at a meeting in Philadelphia on the collection and use of clinical specimens for genetic studies, alopecia areata researcher Dr. Angela Christiano couldn’t stop praising the National Alopecia Areata Foundation, both for its financial assistance in funding her research over more than a decade, and for the group's more intrinsic aid in establishing, promoting, and populating the National Alopecia Areata Registry that provided the genetic specimens Dr. Christiano and her associates used to identify eight genes linked to the disease, study results they reported last year.

Courtesy Images from the History of Medicine Collection (NLM)

In her talk, Dr. Christiano gave some reasons why alopecia areata should have such a dynamic advocacy group. Alopecia areata, an autoimmune disorder that causes either partial or complete hair loss in otherwise healthy, young people, affects more than 5 million Americans. In addition, until recently little was know about its cause, and no evidence-based nor reliably effective treatment exists.

The genetic links that Dr. Christiano and her colleagues identified finally provide clues to what causes alopecia areata and how it might be treated. They also plan to further explore genetic links in an expanded study. Last year’s report used genetic specimens from 1,054 patients, but now the registry includes about 7,400 patients, and the researchers’ goal is to raise the total above 10,000.

The discussion at last week’s meeting made clear that patient advocacy groups can play a key role in helping researchers acquire large numbers of clinical specimens for genetic studies from patients with a variety of diseases. The Internet and social media have made patients much more informed about their conditions and have tied them into better organized networks. Alopecia areata is a disease where the payoffs from this have begun to accrue.

---Mitchel Zoler (on Twitter @mitchelzoler)

There’s power in numbers, and why should patient advocacy be any different?

Last week, at a meeting in Philadelphia on the collection and use of clinical specimens for genetic studies, alopecia areata researcher Dr. Angela Christiano couldn’t stop praising the National Alopecia Areata Foundation, both for its financial assistance in funding her research over more than a decade, and for the group's more intrinsic aid in establishing, promoting, and populating the National Alopecia Areata Registry that provided the genetic specimens Dr. Christiano and her associates used to identify eight genes linked to the disease, study results they reported last year.

Courtesy Images from the History of Medicine Collection (NLM)

In her talk, Dr. Christiano gave some reasons why alopecia areata should have such a dynamic advocacy group. Alopecia areata, an autoimmune disorder that causes either partial or complete hair loss in otherwise healthy, young people, affects more than 5 million Americans. In addition, until recently little was know about its cause, and no evidence-based nor reliably effective treatment exists.

The genetic links that Dr. Christiano and her colleagues identified finally provide clues to what causes alopecia areata and how it might be treated. They also plan to further explore genetic links in an expanded study. Last year’s report used genetic specimens from 1,054 patients, but now the registry includes about 7,400 patients, and the researchers’ goal is to raise the total above 10,000.

The discussion at last week’s meeting made clear that patient advocacy groups can play a key role in helping researchers acquire large numbers of clinical specimens for genetic studies from patients with a variety of diseases. The Internet and social media have made patients much more informed about their conditions and have tied them into better organized networks. Alopecia areata is a disease where the payoffs from this have begun to accrue.

---Mitchel Zoler (on Twitter @mitchelzoler)

Dr. Richard K. Scher discussed the dangers of gel nail polish, and also gave tips to share with patients on how to have a safe experience at the nail salon at the American Academy of Dermatology's Summer Academy meeting in New York.

Patients undergoing gel nail polish application at salons expose their hands to several minutes of UV light to harden the layers of polish, said Dr. Scher of Columbia University, New York. Their hands are also soaked in acetone for up to 10 minutes to dissolve the hard to remove shellac during polish changes.

In the video below, Dr. Scher offers advice and tips for patients that frequent nail salons.

Dr. Richard K. Scher discussed the dangers of gel nail polish, and also gave tips to share with patients on how to have a safe experience at the nail salon at the American Academy of Dermatology's Summer Academy meeting in New York.

Patients undergoing gel nail polish application at salons expose their hands to several minutes of UV light to harden the layers of polish, said Dr. Scher of Columbia University, New York. Their hands are also soaked in acetone for up to 10 minutes to dissolve the hard to remove shellac during polish changes.

In the video below, Dr. Scher offers advice and tips for patients that frequent nail salons.

Dr. Richard K. Scher discussed the dangers of gel nail polish, and also gave tips to share with patients on how to have a safe experience at the nail salon at the American Academy of Dermatology's Summer Academy meeting in New York.

Patients undergoing gel nail polish application at salons expose their hands to several minutes of UV light to harden the layers of polish, said Dr. Scher of Columbia University, New York. Their hands are also soaked in acetone for up to 10 minutes to dissolve the hard to remove shellac during polish changes.

In the video below, Dr. Scher offers advice and tips for patients that frequent nail salons.