BH04 A global survey to assess practice of laboratory testing in alopecia areata by hair specialists
Authors: O’Connor Cathal , Asfour Leila , Bokhari Laita , Cotsarelis George , Cotter Chantal , Craiglow Brittany , Cutlar Lara , Dhurat Rachita , Dlova Ncoza , Doche Isabella , Donovan Jeff , Eisman Samantha , Melo Daniel Fernandes , Harries Matthew , Hordinsky Maria , Kazmi Ahmed , King Brett , Meah Nekma , Ohyama Manabu , Ovcharenko Julya , Primez Rodrigo , Piraccini Bianca Maria , Rudnicka Lidia , Corralo David Saceda , Shapiro Jerry , Sinclair Rod , Smith Blake , Starace Michela , Galvan Sergio Vano , Wang Kevin Lei , York Katherine , McDonald Ian , Wall Dmitri 
Published: June 2024

Abstract
Alopecia areata (AA) is a common, immune-mediated, nonscarring alopecia associated with increased risk of other autoimmune conditions such as thyroid disease. Risk of cardiovascular disease in AA is contentious, but is relevant in the era of Janus kinase (JAK) inhibitor therapy. Rarely, nutritional deficiency and infective disorders, such as syphilis, can mimic AA. International guidelines, including those issued by the British Association of Dermatologists, recommend that investigations are unnecessary when patients are asymptomatic for other conditions. Despite guidelines, there is diversity among experts in AA with respect to laboratory investigation, which this study aimed to describe. Thirty dermatologists specializing in hair disorders from 14 countries and six continents contributed to development of a survey to investigate variation in expert practice regarding laboratory testing in AA. The survey was distributed via Google Forms among expert hair networks globally. Of 130 dermatologists, 73.1% (n = 95) had a subspecialty interest in hair disorders. Almost all (87.7%, n = 114) saw both children and adults with AA. There was a global spread, with 41.5% (n = 54) from Europe, 23.1% (n = 30) from Asia and 13.8% (n = 18) from Africa. For one-quarter (26.4%) of respondents, hair loss disorders represented &gt; 50% of their patients. Almost two-thirds (63.8%) did not perform anthropometry, while 66.2% used the Severity of Alopecia Tool and 39.2% used the Dermatology Life Quality Index. Over half (51.5%) routinely or always performed screening bloods for coexisting autoimmune illness (e.g. thyroid disease or coeliac disease), 39.2% routinely performed screening bloods for contributory conditions (e.g. nutritional deficiencies or endocrine disease), and 18.6% routinely screen for alternative diagnoses (e.g. syphilis) in all patients with AA. Regarding the identification of comorbidities, 70.8% routinely ordered thyroid testing, 65.4% ordered full blood counts, and 46.9% requested liver function testing. Before starting conventional systemic therapy (e.g. ciclosporin or methotrexate), 80.8% ordered full blood counts, 79.2% liver function, 73.8% renal function, 66.7% hepatitis B and C serology, 57.7% HIV testing, and 53.1% lipid testing. Before starting JAK inhibitors, 89.8% ordered full blood counts, 88% liver function tests, 73.8% renal function tests, 67.7% hepatitis B and C serology, 65.4% tuberculosis testing, 62.3% lipid testing, and 56.2% HIV testing. Three-monthly monitoring was conducted by 59.4%. This study identifies that real-world practice among AA experts (who may see more severe or complex AA) is variable with respect to laboratory testing, and that a renewed discussion is warranted in this regard.