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The article titled "Letter to the Editor: A Review of JAK Inhibitors for Treatment of Alopecia Areata in the Military Healthcare System" discusses the challenges faced by individuals with severe refractory alopecia areata (AA) in the military health care system (MHS). The current regulations prevent the use of certain Janus kinase (JAK) inhibitors for the treatment of AA, as they are primarily intended for improving physical appearance or psychological purposes. The article presents two patient cases to highlight the difficulties in treating AA within the MHS and advocates for the inclusion of these medications in TRICARE coverage. The authors suggest implementing prior-authorization protocols and personalized consideration for active duty service members to enhance access to treatment. [Extracted from the article]

This case enforces the importance of a patient's medical history in assisting with the diagnosis of nonspecific cutaneous lesions. Also, other types of lesions occurring within a scar are reviewed. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata (AA) is a disease that manifests as patchy hair loss on the scalp and other parts of the body; severe disease may result in disfigurement, functional impairment, and significant psychological distress. This condition is understood to be caused by autoimmunity to the hair follicle and subsequent arrest of hair growth. New medications, baricitinib and ritlecitinib, belong to the Janus kinase (JAK) inhibitor family and are among the first FDA-approved treatments for severe AA. In this manuscript, we aim to answer the question: What treatment options exist for AA in the military health care system (MHS)? In doing so, we review the pathogenesis, physical and psychosocial impact of AA, conventional treatment of AA, and the efficacy and safety of baricitinib and ritlecitinib., Methods: A literature search was performed using PubMed, Embase, and Ovid for the history and pathogenesis of AA, psychosocial impact of disease, functional impairments, and current treatments. Keywords "alopecia areata," "current therapy for alopecia areata," "pathogenesis alopecia areata," "baricitinib," "ritlecitinib," "JAK inhibitor alopecia," "JAK inhibitor safety," "baricitinib efficacy," "alopecia eyelash," "alopecia nails," and "psychosocial impact of alopecia" were used for the search. The TRICARE manual was searched for guidelines applicable to the treatment of AA, DoD Instruction 6130.03 Volume 2 for medical standards for military service, and the U.S. Central Command Modification 15 for fitness of deployment to Central Command area of operations., Results: Traditional treatments such as intralesional steroids may be effective for some patients, but difficulty lies in controlling extensive or refractory disease. Janus kinase inhibitors, baricitinib and ritlecitinib, are found effective at improving severe refractory disease; baricitinib induced hair regrowth in 32.6% more patients than placebo, and ritlecitinib was found to be superior to placebo by at least 24%. Currently, there is no coverage for therapeutic treatment of hair growth in the MHS. Additionally, military members are disqualified for continued service if they require immunomodulator medications such as baricitinib and ritlecitinib. Those on immunomodulators are unable to deploy worldwide., Conclusions: Baricitinib and ritlecitinib are effective treatments for widespread, progressive, and refractory AA. Although JAK inhibitors demonstrate improved effectiveness compared to non-immunomodulator treatments, their use in the MHS for this purpose is limited., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Bedbugs are a known household scourge that also have become an increasing problem in the corporate space. These pests have adapted to the office environment, finding new harborages in which to thrive and devising new ways to obtain blood meals during the day. Bedbugs pose a considerable public health problem, and managing the epidemic will require vigilance by health care professionals as well as patient education on prevention. We present the case of a 42-year-old man with treatment-refractory pruritic papules over the bilateral posterior arms that were attributed to a bedbug infestation at his workplace.

Military pilots may be at greater risk for skin cancer, particularly melanoma. Military-specific studies are limited, but skin cancer rates in civilian pilots and aircrews have previously been examined. Risk factors for all pilots may include exposure to UV radiation (UVR) at higher altitudes, cosmic radiation, and electromagnetic energy from cockpit instruments, as well as altered sleep-wake cycles. The study of aviation-specific risk factors for skin cancer is relevant to all pilots and dermatologists who care for them.

Using potassium hydroxide (KOH) preparations in the diagnosis of superficial fungal infections is a technique that has been handed down from teacher to apprentice for more than 100 years. The technique is simple, accurate, and inexpensive; however, there is reason to believe it is falling to the wayside in favor of empiric treatment, especially in primary care settings. To continue the use of this valuable diagnostic aid, a system of teaching the KOH preparation to the next generation of physicians (ie, medical students, residents) is proposed with emphasis on facilitating the process by storing viable skin samples infected with dermatophytes for long periods of time. This technique obviates the need to find suitably infected patients before each teaching laboratory. This technique also is appropriate to refresh the skills of practicing physicians as they prepare for point-of-care testing assessments.