Lauren C. Strazzulla

Regulation of bone and cartilage by adenosine signaling.

There is growing recognition that bone serves important endocrine and immunologic functions that are compromised in several disease states. While many factors are known to affect bone metabolism, recent attention has focused on investigating the role of purinergic signaling in bone formation and regulation. Adenosine is a purine nucleoside produced intracellularly and extracellularly in response to stimuli such as hypoxia and inflammation, which then interacts with P1 receptors. Numerous studies have suggested that these receptors play a pivotal role in osteoblast, osteoclast, and chondrocyte differentiation and function. This review discusses the various ways by which adenosine signaling contributes to bone and cartilage homeostasis, while incorporating potential therapeutic applications of these signaling pathways.

Alopecia areata: An appraisal of new treatment approaches and overview of current therapies

Many therapies are available for the treatment of alopecia areata, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission. When making management decisions, clinicians must first stratify patients into pediatric versus adult populations. Disease severity should then be determined (limited vs extensive) before deciding the final course of therapy. The second article in this continuing medical education series describes the evidence supporting new treatment methods, among them Janus kinase inhibitors. We evaluate the evidence concerning the efficacy, side effects, and durability of these medications. An overview of conventional therapy is also provided with new insights gleaned from recent studies. Finally, future promising therapeutic options that have not yet been fully evaluated will also be presented.

Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis

Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result-at least in part-from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.

An Update on Kaposi’s Sarcoma: Epidemiology, Pathogenesis and Treatment

Kaposi’s sarcoma is an angioproliferative neoplasm which has undergone considerable epidemiologic change since the original description by Moritz Kaposi in the late 1800s. This opportunistic neoplasm gained widespread notoriety within the US during the height of the AIDS epidemic, where it was frequently found co-occurring with opportunistic infections. With the advent of modern antiretroviral therapies, as well as an increasing number of individuals on immunosuppression for autoimmune disease or organ transplantation, the landscape of the immunocompromised individual has changed. It is now important for clinicians to be mindful of Kaposi’s sarcoma manifesting in a growing variety of clinical contexts.

Image Gallery: Treatment of refractory alopecia universalis with oral tofacitinib citrate and adjunct intralesional triamcinolone injections

DEAR EDITOR, A young man with alopecia universalis (top) refractory to methotrexate was started on tofacitinib (a Janus kinase inhibitor), which may promote hair regrowth in severe alopecia areata (AA). This was combined with monthly injections of corticosteroids into the eyebrows and scalp – a common therapy for AA – which, like Janus kinase inhibitors, reduces inflammation around hair follicles. After 10 months of tofacitinib treatment combined with triamcinolone injections (2 5 mg mL ) into the eyebrows from the start of treatment, and into the scalp starting after 7 months of treatment, the patient achieved near complete regrowth (bottom). His nails remained dystrophic with mild improvement. No adverse effects were observed. L .C . STRAZZUL LA L . AV I L A K . LO S I C CO J . SHA P I RO The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, U.S.A. Correspondence: Jerry Shapiro. E-mail: jerry.shapiro@nyumc.org

Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases

Alexander H. Fischer, MD, MPH, Daniel B. Shin, PhD, Joel M. Gelfand, MD, MSCE, and Junko Takeshita, MD, PhD, MSCE Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and the Department of Dermatology and the Department of Biostatistics Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

Association of clinicopathological features of melanoma with total naevus count and a history of dysplastic naevi: a cross-sectional retrospective study within an academic centre

High naevus count (HNC) (≥ 50 naevi) and presence of dysplastic naevi (DN) are risk factors for malignant melanoma (MM); however, MMs also occur in patients with low naevus count (LNC) (< 50 naevi) and in patients without DN. Little is known about differences between MMs in these groups.

An Overview of the Biology of Platelet-Rich Plasma and Microneedling as Potential Treatments for Alopecia Areata

Platelet-rich plasma and microneedling have been investigated recently as potential therapeutic options for the treatment of hair disorders. Evidence from laboratory studies indicates that these treatments enhance growth factor production that in turn facilitates hair follicle development and cycling. Several small studies and case reports have presented encouraging findings regarding the use of these treatments for alopecia areata. Future investigations will be needed to validate these therapeutic techniques for patients with alopecia areata and further refine which subtypes of the disease these methods are best indicated for.