NAAF Travel Grant Awardees Report from the 2019 World Congress of Dermatology

Nov 18, 2019

NAAF provided travel grants to Drs. Margit Juhasz and Vivien Lai to attend and present their alopecia areata research at the 24th World Congress of Dermatology Meeting, June 10-15 in Milan, Italy.

Margit Juhasz, Dermatology Resident, University of California Irvine, Irvine, CA, USA

Thank you so much for awarding a Travel Grant which allowed me to attend the 2019 World Congress of Dermatology (WCD) in Milan, Italy from June 10-15, and present  my research titled “Alopecia areata getting on your nerves? How alopecic patch location may point to a neuronal etiology of disease” and “The microbiome of alopecia areata – elucidating its role in disease pathogenesis”. In addition, to this research on alopecia areata, I also presented “A novel, non-invasive imaging system to characterize metabolic changes in subcutaneous adipose tissue after cryolipolysis”, and “Identifying and characterizing basal cell carcinomas in the albino population of Tanzania”. All presentations and posters were met with great interest.

The WCD is probably the largest dermatology conference in the world and is very special in that it only occurs every four years. Dermatologists and scientists from around the world, come together and discuss research on dermatologic discoveries, novel therapies and new treatment techniques. It was inspiring to learn about the advances in disease understanding and treatment options for alopecia areata emerging from Asia, Europe, and South America. As the international medical community comes to accept the detrimental effects alopecia areata can have on patients’ lives, more and more research focuses on finding an effective, long-term treatment. Now that I have transitioned from my research fellowship to dermatology residency, I am excited to implement novel alopecia areata therapies into my practice as a future dermatologist! Thank you again.

Vivien Lai, Medical Intern and Junior Researcher, Alfred Hospital, Melbourne, Australia

I attended the 24th World Congress of Dermatology in Milan, Italy in June 2019. As a junior researcher and doctor with an interest in alopecia areata, I completed my Bachelor of Medical Science (Honors)in 2018 under the supervision of Professor Rodney Sinclair, investigating the efficacy of oral cyclosporin in patients with moderate to severe alopecia areata through a placebo-controlled randomised trial.

At the World Congress I presented three posters:

  1. Systemic Treatments for Alopecia Areata: A Systematic Review
  2. Cyclosporine for moderate to severe alopecia areata: a double-blind, randomised, placebo-controlled clinical trial of efficacy and safety
  3. Health-Related Quality of Life of Patients with Alopecia Areata

A number of systemic treatments are regularly used to treat chronic moderate to severe alopecia areata with variable evidence supporting efficacy. In our systematic review, we evaluated the evidence surrounding systemic treatments used in the management of moderate to severe alopecia areata, alopecia totalis and alopecia universalis. We found only 8 placebo-controlled randomized control trials , with no studies evaluating steroid-sparing agents. Currently, there is no systemic therapy supported by robust evidence from randomized control trials.

Our randomised placebo-controlled trial evaluated the efficacy of cyclosporin, a popular second line agent to prednisolone. Adults aged 18 to 65 years of age with moderate to severe alopecia areata were randomised in a 1:1 ratio to receive 3 months of cyclosporin (4mg/kg/day) or matching placebo. 32 participants (cyclosporin: 16; placebo: 16) were analysed. The cyclosporin group had a greater mean reduction in SALT score (14.8% versus 2.3%; p=0.23) and greater proportion of participants achieving at least a 50% reduction of SALT score (31.3% versus 6.3%; p=0.07) compared to placebo at 3 months, however this was not statistically significant. A larger sample size and longer treatment duration may detect lower response rates.

We included quality of life assessment as an important secondary efficacy endpoint due to the substantial psychological burden of disease. Few studies explore the interaction between alopecia areata  symptoms and health-related quality of life (HRQOL) using both disease-specific Alopecia Areata Symptom Impact Scale (AASIS) and generic Assessment of Quality of Life (AQoL-8D)instruments.  Participants had impaired quality of life across 6 of 8 AQoL-8D dimensions compared to Australian population norms. Mental health, self-worth and coping were most affected. Greater symptom severity and greater interference with daily functioning were strongly correlated with poorer HRQOL.

I would like to thank the National Alopecia Areata Foundation for their travel grant in allowing me to attend the World Congress. I found this experience highly valuable to both present my research and hear about the exciting innovations across a range of areas in dermatology.

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