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Competing Interests: Conflicts of interest Dr Lo Sicco has been an investigator for Regen Lab and is an investigator for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Dr Shapiro is an investigator and consultant for Pfizer and is a consultant for Lilly. Dr Garshick reports consulting fees from AbbVie and Horizon Therapeutics. Dr Karagounis has no conflicts of interest to declare.

LDOM has enhanced treatment options for female AGA, yet its combined efficacy with therapies such as spironolactone, finasteride, or dutasteride remains inadequately explored. This study aims to compare the efficacy and safety of LDOM in combination with spironolactone versus LDOM with finasteride or dutasteride in women with AGA. Our analysis revealed that both combination therapies produced similar improvements in hair growth and had comparable safety profiles. Although the LDOM with finasteride/dutasteride group showed a greater average increase in hair width and density, these differences were not statistically significant. These results endorse the use of LDOM in combination with either spironolactone or finasteride/dutasteride for female AGA, and underscore the necessity for further research to validate these findings and assess long-term treatment outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The widespread adoption of glucagon-like peptide-1 (GLP-1) agonists in treating type 2 diabetes mellitus (T2DM) and obesity has sparked investigations into their impact on hair health, an area characterized by diverse conjectures. Some propose potential risks such as disrupted hair growth cycles or premature androgenetic alopecia (AGA), while others suggest benefits linked to improved insulin sensitivity and enhanced scalp blood circulation. However, despite these theoretical underpinnings, clinical evidence linking GLP-1 agonists to hair loss remains sparse. The necessity for vigilant patient monitoring and collaborative efforts cannot be overstressed in comprehensively addressing any potential consequences of GLP-1 agonist therapy on hair health as their use continues to expand., (© 2024 the International Society of Dermatology.)

Competing Interests: Conflicts of interest Dr Shapiro is a consultant for Aclaris Therapeutics, Incyte, and Replicel Life Sciences. Drs Shapiro and Lo Sicco have been investigators for Regen Lab and are investigators for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Authors Raval, Nohria, Desai, Mourtzanakis, and Buontempo have no conflicts to disclose.

Competing Interests: Dr Sicco has been an investigator for Regen Lab and is an investigator for Pfizer and is a consultant for Pfizer and Aquis. Dr Shapiro is an investigator and consultant for Pfizer and is a consultant for Lilly. Authors Nohria, Desai, Sikora, and Anyanwu and Dr Caplan have no conflicts of interest to declare.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: None disclosed.

Competing Interests: Dr Shapiro is a consultant for Aclaris Therapeutics, Incyte, and Replicel Life Sciences. Drs Shapiro and Lo Sicco have been investigators for Regen Lab and are investigators for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Drs Desai, Nohria, Alhanshali, and Buontempo have no conflicts of interest to declare.

Alopecia areata (AA) has long been considered a challenging clinical condition, with dermatologists traditionally employing corticosteroids and immunosuppressants in search of effective solutions. The introduction of Janus kinase inhibitors (JAKi), specifically the Food and Drug Administration (FDA) approval of baricitinib, marked a significant breakthrough in the treatment of AA. Clinical trials have shown promising results with baricitinib, and reports of relapse after initial success are scarce. We present a unique case of a 30-year-old male with severe patch-type AA who initially responded well to baricitinib treatment but later experienced a relapse despite continued treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Desai et al.)

Competing Interests: None.

Background: The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is aprospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) inpatients with newly diagnosed mycosis fungoides (MF)., Objectives: To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB)staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures., Methods: In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centresin 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review., Results: The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smallerpercentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariateanalysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA,20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs.T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%,while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improvedsignificantly both in patients with responsive disease and in those with stable disease., Conclusions: Disease characteristics such as presence of plaques and FMF influence physician treatment choices,and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, futuretreatment guidelines for early-stage MF need to address these issues., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Dr Shapiro is a consultant for Lilly, Replicel Life Sciences, Thirty Madison, and DS Laboratories. Drs Shapiro and Lo Sicco have been investigators for Regen Lab and are investigators for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Authors Desai and Nohriahave no conflicts of interest to declare.

Background: Janus kinase inhibitor (JAKi) therapy has revolutionized the treatment landscape for alopecia areata (AA); however, access may be limited by a lack of insurance coverage and high out-of-pocket costs., Objective: We aimed to evaluate real-world patient experiences regarding access to JAKi therapy., Methods: We conducted an online patient-centered survey using the National Alopecia Areata Foundation listserv., Results: In total 784 individuals initiated our survey, and 600 completed it in full (76.5%). While more non-White patients considered obtaining JAKi therapy, more White patients reported the use of this medication class. In total, 74.2% lacked insurance coverage or had partial coverage for JAKi, and 52% expressed dissatisfaction with available coverage. However, 52.9% reported delays in starting medication due to insurance approval processes, contributing to worsened AA and related stress. In total, 35% of patients did not try to obtain JAKi therapy due to concerns about costs, and 18.2% discontinued therapy due to financial barriers. Also, 19.8% of patients reported utilizing financial savings to pay for medication, and 55.2% reported using a copay assistance card. Further, 12.2% reported forgoing other necessities to pay for AA expenses., Limitations: Our results are limited by the subjective nature of survey studies. The recency of FDA approval for JAKi therapy may also influence patients' perceptions of access to care., Conclusion: Patients with AA face significant barriers when trying to obtain JAKi therapy, and existing racial inequities may be exacerbated by these barriers. Further advocacy work is needed to improve access to care., Competing Interests: The authors made the following disclosures: K.L.S. has been an investigator for Regen Lab and is an investigator for Pfizer. He is a consultant for Pfizer and Aquis. J.S. is an investigator and consultant for Pfizer and is a consultant for Lilly. For other authors, there is no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.)

Competing Interests: Dr Lo Sicco has been an investigator for Regen Lab and is an investigator for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Dr Shapiro is an investigator and consultant for Pfizer and is a consultant for Lilly. Dr Femia receives royalties from UpToDate; she reports consulting fees from Octagon Therapeutics and Timber Pharmaceuticals. Dr Garshick reports consulting fees from AbbVie and Horizon Therapeutics. The authors have no conflicts of interest to declare.

Competing Interests: The authors made the following disclosures: K.L.S. has been an investigator for Regen Lab and is an investigator and consultant for Pfizer. K.L.S. is a consultant for Aquis and is on the board of directors for the Scarring Alopecia Foundation. L.D.K. is a consultant for Janssen and is on the board of directors at Skin of Color Society. A.N., D.D., M.M.S., R.S.F., L.B., C.A., E.J.K., N.M., and D.C. have no conflict of interest to declare.

Background: Low dose oral minoxidil (LDOM) is a preferred treatment for alopecia due to ease of use and efficacy. While LDOM is typically well tolerated, patients may experience a temporary increase in hair shedding starting treatment, colloquially regarded as "dread shed". One proposed method to combat this is to overlap therapies by maintaining use of topical minoxidil when initiating LDOM., Objective: To evaluate the impact of maintaining topical minoxidil when initiating LDOM on "dread shed"., Methods: We performed a retrospective chart review of patients seen at New York University Langone Health Dermatology from January 1, 2008 to August 1, 2023 prescribed LDOM., Results: A total of 115 patients met inclusion criteria, of whom 37 maintained use of topical minoxidil when initiating LDOM. Six patients experienced "dread shed" when initiating LDOM, 2 of whom overlapped therapies. We did not find that overlapping therapies had a significant impact on decreasing rates of "dread shed"., Limitations: Limitations include retrospective design, sample size, and subjective patient-reported assessment of hair shedding., Conclusions: A total of 5.2% of patients experienced dread shed, which is lower than previously reported in literature. Maintaining topical minoxidil during LDOM initiation does not significantly impact "dread shed". This remains a significant side effect deserving of further research., Competing Interests: Dr Lo Sicco has been an investigator for Regen Lab and is an investigator for Pfizer. Dr Lo Sicco is a consultant for Pfizer and Aquis. Dr Shapiro is an investigator and consultant for Pfizer and is a consultant for Lilly., (© 2024 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.)

Competing Interests: Conflicts of interest Dr Lo Sicco is a current investigator for Pfizer. She is a consultant for Pfizer and Aquis. Dr Garshick reports consultant fees from Horizon Therapeutics, Abbvie, BMS and Kiniksa. Drs Karagounis, Betensky, Klein, Karim, Liu, and Carli Needle, Ambika Nohria, Jessica Gjonaj, and Jinal Shah have no conflicts of interest.

The incidence of allergic contact dermatitis (ACD) due to personal care products is rising in parallel with increasing product availability and consumer interest. Hair products specifically represent a significant source of potential allergens, including preservatives, surfactants, emulsifiers, fragrances, adhesives, and dyes. ACD due to hair care products can present as dermatitis in the distinctive "rinse-off" distribution, involving the neck, eyelids, and lateral face in addition to the scalp. Herein, the authors review ingredients in hair care products that can cause ACD and practical tips for allergen identification.

Introduction: Surgery is an option for symptom palliation in patients with metastatic gastric cancer. Operative outcomes after palliative interventions are largely unknown. Herein, we assess the trends of surgical palliation use for patients with gastric cancer and describe outcomes of patients undergoing surgical palliation compared to nonsurgical palliation., Methods: Patients with clinical Stage IV gastric cancer in the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation were selected. We identified factors associated with palliative surgery. Survival differences were assessed by Kaplan-Meier estimate, Cox proportional hazard regression, and log rank test., Results: Six thousand eight hundred twenty nine patients received palliative care for gastric cancer. Most patients (87%, n = 5944) received nonsurgical palliation: 29% radiation therapy, 57% systemic treatment, and 14% pain management. The number of patients receiving palliative care increased between 2004 and 2015; however, use of surgical palliation declined significantly (22% in 2004, 8% in 2015; P < 0.001). Median overall survival (OS) for the cohort was 5.65 mo (95% confidence interval 5.45-5.85); 1-year and 2-year OS were 24% and 9%, respectively. Older age at diagnosis and diagnosis between 2004 and 2006 were significantly associated with undergoing surgical palliation. Patients who underwent surgical palliation had significantly shorter median OS and a 20% higher hazard of mortality than those who received nonsurgical palliation., Conclusions: Patients with metastatic gastric cancer experience very short survival. While palliative surgery is used infrequently, the observed association with shorter median OS underscores the importance of careful patient selection. Palliative surgery should be offered judiciously and expectations about outcomes clearly established., (Copyright © 2022 Elsevier Inc. All rights reserved.)