BH04 A global survey to assess practice of laboratory testing in alopecia areata by hair specialists
Bibliographic record
Abstract
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 > 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".