Publications by authors named "Maryanne Senna"

48 Publications

Development of the Alopecia Areata Scale for Clinical Use: Results of an Academic-Industry Collaborative Effort.

J Am Acad Dermatol 2021 Aug 30. Epub 2021 Aug 30.

Janssen Global Services, LLC, PA; Eli Lilly and Company, IN.

Background: The current classification for Alopecia Areata (AA) does not provide a consistent assessment of disease severity.

Objective: To develop an AA severity scale based on expert experience.

Methods: A Modified Delphi process was utilized. An advisory group of 22 US-based AA clinical experts was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development.

Results: Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing with the adoption of the proposed scale.

Limitations: The scale is a static assessment intended to be used in clinical practice, and not clinical trials.

Conclusions: The final AA disease severity scale, anchored on extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.
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http://dx.doi.org/10.1016/j.jaad.2021.08.043DOI Listing
August 2021

Undiagnosed cicatricial alopecia among new patients undergoing platelet-rich plasma.

JAAD Int 2021 Jun 18;3:89-91. Epub 2021 Apr 18.

Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.jdin.2021.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362280PMC
June 2021

Characterizing the role of facial hair in gender identity and expression among transgender men.

J Am Acad Dermatol 2021 Aug 4. Epub 2021 Aug 4.

Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.07.060DOI Listing
August 2021

Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims.

Adv Ther 2021 09 22;38(9):4646-4658. Epub 2021 Jul 22.

Yale School of Medicine, New Haven, CT, USA.

Introduction: Alopecia areata (AA) is an autoimmune disorder causing sudden, non-scarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA.

Methods: Patients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis. Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data.

Results: A total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs.

Conclusion: Patients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population. Healthcare costs incurred by patients with AA went beyond AA-related expenses. Longitudinal data are needed to better understand treatment trajectories and the disease burden in patients with AA.
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http://dx.doi.org/10.1007/s12325-021-01845-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408067PMC
September 2021

Association of resilience and perceived stress in patients with alopecia areata: A cross-sectional study.

J Am Acad Dermatol 2021 Jul 9. Epub 2021 Jul 9.

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.06.879DOI Listing
July 2021

A pilot evaluation of scalp skin wounding to promote hair growth in female pattern hair loss.

Int J Womens Dermatol 2021 Jun 8;7(3):344-345. Epub 2020 Dec 8.

Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States.

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http://dx.doi.org/10.1016/j.ijwd.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243145PMC
June 2021

Subcutaneous metastasis from an atypical pulmonary carcinoid tumor.

Dermatol Online J 2021 May 15;27(5). Epub 2021 May 15.

Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, MA.

Pulmonary carcinoid tumors are uncommon neuroendocrine tumors that rarely metastasize to the skin. We report the case of a 71-year-old woman with a longstanding history of primary atypical pulmonary carcinoid tumor who presented with a new tender cutaneous nodule. Immunostaining of the nodule was consistent with metastatic atypical carcinoid tumor of the skin including positive staining for neuroendocrine markers chromogranin and synaptophysin. Dermatologists should consider cutaneous neuroendocrine metastasis when evaluating new nodules in patients with stable pulmonary carcinoid tumors or in those with concomitant concerning respiratory symptoms.
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http://dx.doi.org/10.5070/D327553613DOI Listing
May 2021

Development and validation of the Brigham Eyelash Tool for Alopecia (BELA): A measure of eyelash alopecia areata.

J Am Acad Dermatol 2021 Jul 16;85(1):271-272. Epub 2021 Mar 16.

Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.jaad.2020.06.1034DOI Listing
July 2021

Legislative update: Regulating ingredients in personal care products.

J Am Acad Dermatol 2021 Jun 16;84(6):1780-1781. Epub 2021 Feb 16.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.02.025DOI Listing
June 2021

Using deep learning for dermatologist-level detection of suspicious pigmented skin lesions from wide-field images.

Sci Transl Med 2021 02;13(581)

Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.

A reported 96,480 people were diagnosed with melanoma in the United States in 2019, leading to 7230 reported deaths. Early-stage identification of suspicious pigmented lesions (SPLs) in primary care settings can lead to improved melanoma prognosis and a possible 20-fold reduction in treatment cost. Despite this clinical and economic value, efficient tools for SPL detection are mostly absent. To bridge this gap, we developed an SPL analysis system for wide-field images using deep convolutional neural networks (DCNNs) and applied it to a 38,283 dermatological dataset collected from 133 patients and publicly available images. These images were obtained from a variety of consumer-grade cameras (15,244 nondermoscopy) and classified by three board-certified dermatologists. Our system achieved more than 90.3% sensitivity (95% confidence interval, 90 to 90.6) and 89.9% specificity (89.6 to 90.2%) in distinguishing SPLs from nonsuspicious lesions, skin, and complex backgrounds, avoiding the need for cumbersome individual lesion imaging. We also present a new method to extract intrapatient lesion saliency (ugly duckling criteria) on the basis of DCNN features from detected lesions. This saliency ranking was validated against three board-certified dermatologists using a set of 135 individual wide-field images from 68 dermatological patients not included in the DCNN training set, exhibiting 82.96% (67.88 to 88.26%) agreement with at least one of the top three lesions in the dermatological consensus ranking. This method could allow for rapid and accurate assessments of pigmented lesion suspiciousness within a primary care visit and could enable improved patient triaging, utilization of resources, and earlier treatment of melanoma.
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http://dx.doi.org/10.1126/scitranslmed.abb3652DOI Listing
February 2021

Cumulative Life Course Impairment of Alopecia Areata.

Int J Trichology 2020 Sep-Oct;12(5):197-204. Epub 2020 Nov 3.

Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.

Alopecia areata (AA), an unpredictable, nonscarring hair loss, is commonly perceived as a cosmetic, rather than medical, concern. However, substantial evidence exists describing the negative impact on quality of life, as the disease affects patients personally, socially, financially, and physically. Over time, the cumulative disability may perpetuate poor confidence, social disconnection, negative coping strategies, and failure to achieve a full life potential. Here, we describe the cumulative life course impairment (CLCI) of AA by examining the complex interaction of (1) stigmatization, (2) physical and psychiatric comorbidities, and (3) coping strategies. The model aggregates existing cross-sectional data, which have previously captured disease burden only as snapshots in time. Thus, by examining cumulative effects, the CLCI model serves as a proxy for longitudinal data to better describe life course epidemiology of the disease.
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http://dx.doi.org/10.4103/ijt.ijt_99_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832162PMC
November 2020

Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.

J Am Acad Dermatol 2021 Jan 7. Epub 2021 Jan 7.

Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.12.059DOI Listing
January 2021

Hydroxychloroquine use and COVID-19 concerns among alopecia patients: A cross-sectional survey study.

Dermatol Ther 2020 11 21;33(6):e14529. Epub 2020 Nov 21.

Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1111/dth.14529DOI Listing
November 2020

A Potential Role for IL-4 and IL-13 in an Alopecia Areata-Like Phenotype: A Clinical Perspective.

J Investig Dermatol Symp Proc 2020 11;20(1):S58-S59

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Although alopecia areata (AA) has been traditionally classified as a strictly T helper type 1-mediated process, the T helper type 2 (Th2) pathway may contribute to an AA-like phenotype in some individuals. Herein, we describe three clinical cases that support the potential role of Th2 activity through the upregulation of IL-4 and IL-13 in an AA-like phenotype.
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http://dx.doi.org/10.1016/j.jisp.2020.04.008DOI Listing
November 2020

Brigham Eyebrow Tool for Alopecia: A Reliable Assessment of Eyebrow Alopecia Areata.

J Investig Dermatol Symp Proc 2020 11;20(1):S41-S44

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

There are no tools to evaluate eyebrow involvement in patients with alopecia areata. We developed and assessed the reliability of the Brigham Eyebrow Tool for Alopecia (BETA) as a quantitative evaluation of eyebrow alopecia areata. BETA uses facial landmarks of eyebrow anatomy and is calculated using surface area and density. A total of 50 eyebrow images with varying levels of hair loss were distributed to six board-certified dermatologists at three academic medical centers with standardized instructions and examples. Interrater and intrarater reliability were calculated using intraclass correlation coefficients (ICCs). BETA demonstrated high interrater (ICC = 0.88, confidence interval = 0.83-0.92 right eyebrow scores and ICC = 0.90, confidence interval = 0.85-0.94 left eyebrow scores) and intrarater (ICC = 0.90, confidence interval = 0.85-0.93 right eyebrow scores and ICC = 0.91, confidence interval = 0.87-0.94 left eyebrow scores) reliability. When measured in the same patient with varying degrees of hair loss over time, BETA demonstrated sensitivity to change. BETA is a simple and reliable objective assessment of eyebrow alopecia areata. BETA is easy-to-use and quick to calculate, making it feasible for a variety of clinical and research settings. Although developed for alopecia areata, we hope that BETA will be investigated in other etiologies of eyebrow alopecia to serve as a universal tool for monitoring disease progression, improvement, and response to treatment.
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http://dx.doi.org/10.1016/j.jisp.2020.06.001DOI Listing
November 2020

Supplement use among women experiencing hair loss.

Int J Womens Dermatol 2020 Jun 5;6(3):211. Epub 2020 Feb 5.

Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States.

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http://dx.doi.org/10.1016/j.ijwd.2020.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330448PMC
June 2020

Thermal Injury in a Patient Using a Scalp Cooling System to Prevent Chemotherapy-Induced Alopecia.

JCO Oncol Pract 2020 08 26;16(8):522-524. Epub 2020 May 26.

Department of Dermatology, Massachusetts General Hospital, Boston, MA.

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http://dx.doi.org/10.1200/OP.20.00021DOI Listing
August 2020

Polycystic ovary syndrome in patients with hair thinning.

J Am Acad Dermatol 2020 Jul 20;83(1):260-261. Epub 2020 May 20.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.01.075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291365PMC
July 2020

Shared medical appointments for female pattern hair loss.

J Am Acad Dermatol 2021 Jan 20;84(1):180-182. Epub 2020 Apr 20.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.04.066DOI Listing
January 2021

Spironolactone for treatment of female pattern hair loss.

J Am Acad Dermatol 2020 Jul 5;83(1):276-278. Epub 2020 Apr 5.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.03.087DOI Listing
July 2020

Androgenetic Alopecia in Gender Minority Patients.

Dermatol Clin 2020 Apr 26;38(2):239-247. Epub 2019 Nov 26.

Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA. Electronic address:

Androgenetic alopecia (AGA) is the most common type of hair loss in adults and may be particularly distressing for gender minority patients, given the close relation between hair and gender expression. Furthermore, use of gender affirming hormones such as testosterone in transmen and estrogen/antiandrogens in transwomen has a direct effect on hair growth distribution and density. Clinicians should thus be knowledgeable about the effects of sex hormones on the hair growth cycle to comfortably diagnose and treat AGA in gender minority patients.
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http://dx.doi.org/10.1016/j.det.2019.10.010DOI Listing
April 2020

Frontal fibrosing alopecia preceding the development of vitiligo: A case report.

JAAD Case Rep 2020 Feb 30;6(2):154-155. Epub 2020 Jan 30.

Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.jdcr.2019.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000443PMC
February 2020

Primary cicatricial alopecia associated with systemic indolent mastocytosis.

JAAD Case Rep 2020 Feb 30;6(2):146-148. Epub 2020 Jan 30.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.jdcr.2019.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000442PMC
February 2020

Patch testing and contact allergen avoidance in patients with lichen planopilaris and/or frontal fibrosing alopecia: A cohort study.

J Am Acad Dermatol 2020 Aug 19;83(2):659-661. Epub 2020 Jan 19.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.01.026DOI Listing
August 2020

Complementary & Alternative Medicine for Alopecia Areata: A Systematic Review.

J Am Acad Dermatol 2019 Dec 20. Epub 2019 Dec 20.

Department of Dermatology, Brigham and Women's Hospital, Boston, MA. Electronic address:

Background: Despite high utilization of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear.

Objective: To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychological well-being.

Methods: PubMed and Embase were searched to identify English articles containing original data investigating CAM in human subjects with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria.

Results: Of 1,015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective non-controlled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low quality evidence for improvement of psychological and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated.

Limitations: Inconsistent or poorly reported study methodology and non-standardized outcomes limit the conclusions that can be made from these studies.

Conclusions: This work serves to inform physician management of patients with AA seeking CAM, while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.
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http://dx.doi.org/10.1016/j.jaad.2019.12.027DOI Listing
December 2019

Topical Antiandrogen Therapies for Androgenetic Alopecia and Acne Vulgaris.

Am J Clin Dermatol 2020 Apr;21(2):245-254

Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA, 02114, USA.

Androgenetic alopecia (AGA) and acne vulgaris are two conditions commonly seen by dermatologists. Androgens and the androgen receptors play an essential role in the manifestation of both conditions, and some systemic therapies function by interfering in this pathway. The use of topical antiandrogen therapies has gained traction in recent years due to their potential efficacy in treating AGA and acne vulgaris, as well as their reduced adverse effects compared with systemic drugs. This review discusses the role of androgens in skin physiology and pathology and assesses the potential efficacy and safety of three topical antiandrogen therapies in the treatment of AGA and acne vulgaris. A literature review utilizing the PubMed, US Clinical Trials, and SCOPUS databases was conducted to search for randomized clinical trials, systematic reviews, cohort studies, case reports, and other relevant published studies on the pathogenesis and treatment of each condition with topical finasteride, ketoconazole shampoo, and cortexolone 17α-propionate (C17P). The results demonstrated that topical formulations of finasteride, ketoconazole, and C17P are promising treatments for male pattern hair loss, especially topical finasteride in combination with topical minoxidil. Limited studies have shown C17P to have potential in treating acne vulgaris in both males and females. Minimal adverse effects have been reported in clinical trials for all topical therapies, although topical finasteride is still contraindicated in pregnancy. Recognizing the preliminary evidence, more peer-reviewed studies on topical antiandrogen treatments for AGA and acne vulgaris are necessary before definitive recommendations can be made regarding efficacy and safety. There is also a critical need to include more women in study populations for these treatments.
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http://dx.doi.org/10.1007/s40257-019-00493-zDOI Listing
April 2020

Development of Lichen Planopilaris-Like Alopecia following Occupational Exposure to Trichloroethylene and Tetrachloroethylene.

Skin Appendage Disord 2019 Nov 26;5(6):374-378. Epub 2019 Jul 26.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Background: We report a case of acute and severe lichen planopilaris (LPP)-like alopecia in a 35-year-old male construction worker following occupational exposure to trichloroethylene (TCE) and tetrachloroethylene (PCE).

Case Report: Two weeks after initiating ground-intrusive construction at a previous dry-cleaning facility site, the patient developed sudden scalp pruritus and associated patchy hair loss. As subsequent scalp biopsies revealed LPP, he was started on hydroxychloroquine at 200 mg twice daily and clobetasol solution once daily. Despite treatment, the patient's hair loss rapidly progressed to involve >95% of his scalp within 3 years. An official "work clean" policy report revealed high-concentration exposure to TCE and PCE.

Conclusion: Although causation cannot be proven, the close temporal relationship and rapid progression of LPP-like alopecia in an atypical patient demographic support a strong correlation between chemical exposure to TCE/PCE and scarring hair loss.
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http://dx.doi.org/10.1159/000501173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883445PMC
November 2019

Excess hair, hair removal methods, and barriers to care in gender minority patients: A survey study.

J Cosmet Dermatol 2020 Jun 25;19(6):1494-1498. Epub 2019 Sep 25.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.

Background: In gender minority patients, electrolysis and laser hair removal may be necessary to reduce facial and body hair in individuals seeking a more feminine appearance and/or modified gender expression. These procedures may also be required preoperatively for some gender-affirming surgeries.

Aims: To identify (a) the frequency of unwanted facial and body hair, (b) the use of various hair removal methods, and (c) associated barriers to care in gender minority patients.

Methods: An online-based patient survey was distributed via social media on Facebook , YouTube , and Instagram in fall 2018. Respondents were at least 18 years old and self-identified as a gender minority.

Results: In total, 991 responses were recorded with a completion rate of 77%. Considering excess hair, 84% of transwomen on feminizing hormone therapy (FHT: estrogen and anti-androgen therapy), 100% of transwomen not on FHT, and 100% of nonbinary individuals on FHT reported excess facial/body hair. Laser hair removal (18%) and electrolysis (17%) had similar rates of use in this cohort and were more commonly reported for nonsurgical gender-affirming purposes than preoperative preparation. Cost was the most frequently cited barrier to care.

Conclusion: As the majority of transwomen and nonbinary people on feminizing hormone therapy had persistent excess facial/body hair, routine use of gender-affirming hormones is not sufficient to fully eliminate unwanted hair. There remains a critical need to advocate for more comprehensive insurance coverage for laser hair removal and electrolysis in gender minority patients.
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http://dx.doi.org/10.1111/jocd.13164DOI Listing
June 2020

Histologic and clinical cross-sectional study of chronic hair loss in patients with cutaneous chronic graft-versus-host disease.

J Am Acad Dermatol 2019 Nov 24;81(5):1134-1141. Epub 2019 Aug 24.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

Background: While scalp alopecia represents a distinctive feature of chronic graft-versus-host disease (cGVHD), little is known about the clinical and histologic presentation of hair loss.

Objectives: We sought to classify the clinical presentations and histologic findings of chronic hair loss in patients with cutaneous cGVHD.

Methods: A prospective cohort of 17 adult hematopoietic cell transplantation (HCT) recipients with cutaneous cGVHD was enrolled. Dermatologic examinations were performed, and punch biopsy specimens of the scalp were obtained. Biopsy specimens were analyzed with hematoxylin-eosin and immunohistochemical stains in all cases and fluorescence in situ hybridization analyses in specific cases.

Results: Clinically, 4 patterns of hair loss were described-patchy nonscarring (41.2%), diffuse nonscarring (11.8%), diffuse sclerotic (11.8%), and patchy sclerotic (5.9%). The location of the inflammatory infiltrate on hematoxylin-eosin-stained specimens correlated with the hair loss pattern patients had clinically, with cell populations around the bulb and bulge in nonscarring and sclerotic cases, respectively. Fluorescence in situ hybridization studies in female cGVHD patients with male donors demonstrated green Y chromosomes limited to the area of the hair follicle affected by inflammatory cells.

Conclusion: This study describes the various clinical and histologic subtypes of long-standing alopecia in adult cGVHD patients and suggests that this alopecia may be a direct manifestation of cGVHD of the hair follicle.
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http://dx.doi.org/10.1016/j.jaad.2019.03.031DOI Listing
November 2019
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