The edition · Dermatology
Upadacitinib for severe alopecia areata, and a year of ruxolitinib cream in young children
Two phase 3 trials put about half of severe alopecia areata patients near full regrowth on upadacitinib, an extension study backs as-needed ruxolitinib cream in children aged 2 to 11, and melanoma risk models were tested in 43,000 Australians.
The edition in brief
Today's dermatology edition. In two replicate phase 3 trials of 1,399 adults and adolescents with severe alopecia areata, a SALT score of 20 or less at 24 weeks was reached by about 45% on upadacitinib 15 mg and 55% on 30 mg, against 1.5–3.4% on placebo, with no new safety findings. A 44-week uncontrolled extension of a phase 3 trial in 282 children aged 2 to 11 with mild-to-moderate atopic dermatitis found as-needed ruxolitinib cream was well tolerated, with clear or almost clear skin maintained in 72–80%. In an Australian cohort of about 43,000 adults over 45, six published melanoma risk models discriminated moderately (AUC 0.58 to 0.70) and most underestimated melanoma numbers. A case-control series described curly or kinked regrowth after alopecia areata as acquired pili torti that reverted in a minority. The pearl covers what to tell patients about hair that regrows differently.
As-needed ruxolitinib cream held atopic dermatitis control in children for a year
As-needed ruxolitinib cream was well tolerated over a year in children aged 2 to 11 and is an option for limited eczema where steroids are a concern.
Melanoma risk models discriminated moderately and underestimated risk in Australia
Published melanoma risk models rank risk only moderately well and need recalibration before guiding surveillance.
Curly regrowth after alopecia areata was acquired pili torti
Tell patients with severe alopecia areata that regrown hair may change texture, and that it reverts in only a minority.
Set expectations before treating severe alopecia areata
A five-minute conversation about timing, colour, texture and relapse prevents many early stops in alopecia areata treatment.
Upadacitinib regrew most of the scalp in about half of severe alopecia areata
Upadacitinib produced near-complete scalp regrowth in about half of patients with severe alopecia areata at 24 weeks; consider it where licensed, with standard JAK screening.
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