Sinclair Dermatology

Alopecia areata is a common cause of non-scaring autoimmune hair loss, associated with substantial psychosocial burden. Alopecia areata is an autoimmune disease in which loss of immune privilege in hair follicles leads to local hair follicle-associated inflammation. A chronic disease with uncertain course that is estimated to affect 2% of people over their lifetime, alopecia areata can present with a range of clinical features, from a single small round patch of hair loss to full scalp and body hair loss, and is associated with atopic, autoimmune and psychological comorbidities. Alopecia areata also has a major negative impact on quality of life, with a greater mental burden than physical burden. Since the 2010s, advances in understanding of disease pathogenesis have led to the identification of inflammatory pathways that can be successfully inhibited to produce substantial clinical responses. The therapeutic landscape has been transformed, with FDA approval of the first treatment for adults with severe alopecia areata in 2022 and for adolescents with severe alopecia areata in 2023, with multiple investigational treatments currently in phase II and phase III clinical trials.

ABSTRACTOver 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA‐approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.

Topical minoxidil, approved for the treatment of androgenetic alopecia, also has efficacy in many other hair loss disorders, its use is limited due to the need for at least daily application. Oral minoxidil, in doses below those likely to lower blood pressure (so called "low dose oral minoxidil") has increasingly been used off label to treat a variety of hair loss conditions but without any standard recommended best practices. To provide a review of how experts in hair loss use the available literature on topical and low dose oral minoxidil to educate and treat safely and effectively patients with hair loss. Dermatologists with expertise in hair disorders met by teleconference and email to review the literature and share their direct experience with topical and oral minoxidil. Provision of basic knowledge of the key aspects of the use of topical or oral minoxidil to insure safe and effective use of either in treating hair loss.

Presented on 29 May 2025: Session 25 For energy producers, enhancing operational efficiency is critical due to the high capital investments and the complex nature of operations. Asset performance management (APM) has become a vital strategy for optimising asset utilisation, reducing costs and extending the life of critical equipment. This paper explores how effective implementation of APM can significantly improve operational efficiency within the energy sector. APM integrates advanced data analytics, predictive maintenance and real-time monitoring to enable a shift from reactive to proactive maintenance strategies. This approach reduces unexpected downtimes, lowers maintenance costs and prolongs asset life by allowing early detection of potential equipment failures. However, implementing APM poses challenges, including the integration of new technologies with existing systems, the need for skilled personnel and initial capital investment. Despite these hurdles, the long-term benefits such as improved asset reliability, cost savings and enhanced efficiency justify the investment. The paper provides a basic roadmap for energy producers aiming to adopt APM, emphasising the importance of a systematic approach to maximise the benefits of this transformative technology. As the energy sector increasingly prioritises efficiency and sustainability, APM stands out as a critical tool for energy producers looking to optimise operations and maintain a competitive edge. To access the Oral Presentation click the link on the right. To read the full paper click here

ABSTRACTBackgroundAlopecia areata (AA) is a common non‐scarring alopecia. Data continue to emerge on associations with autoimmune and other conditions. Janus kinase inhibitors (JAKi) are increasingly used to treat AA.ObjectivesThe aim was to assess variation in laboratory testing in patients with AA among hair experts internationally and to compare subspecialized clinical practice to current guidelines.MethodsThirty hair experts from 14 countries and six continents contributed to develop a 24‐item survey collecting demographic information on respondents; methods of severity assessment; and laboratory testing practices in AA for mimics, contributory factors, associations, and workup for systemic therapy. The survey was distributed to a global network of expert hair specialists.ResultsOf 214 respondents, 79.9% (171/214) had special interest/expertise in hair loss disorders, and 35.5% (n = 76) were based in Europe. Most cared for both adults and children (87.9%, n = 188). For clinical assessment, almost two‐thirds (63.6%, n = 136) used the Severity of Alopecia Tool and 38% (n = 84) used the Dermatology Life Quality Index. Only 24.3% (n = 52) typically tested for alternative infectious or inflammatory diagnoses, 39.7% (n = 85) typically tested for contributory conditions such as nutritional deficiencies, and 50.9% (n = 109) typically tested for co‐existent autoimmune illnesses. Thyroid function testing was routinely performed in 73.4% (n = 157) and complete blood count (CBC) was checked in 65.9% (n = 141). Compared to conventional systemic therapy, experts were more likely to check lipid levels, creatine kinase, coagulation profiles, thrombophilia screens, tuberculosis blood testing, hepatitis B and C serology before prescribing JAKi.ConclusionsReal world practice of laboratory testing for AA by hair experts, who may see more severe or complex alopecia, is variable. Most experts routinely perform thyroid function and CBC testing. We discuss evidence for indications for testing for AA mimics, contributory factors, associated autoimmune conditions, and before systemic therapy. Further research is required to characterise the role of laboratory testing in AA.

For energy producers, enhancing operational efficiency is critical due to the high capital investments and the complex nature of operations. Asset performance management (APM) has become a vital strategy for optimising asset utilisation, reducing costs and extending the life of critical equipment. This paper explores how effective implementation of APM can significantly improve operational efficiency within the energy sector. APM integrates advanced data analytics, predictive maintenance and real-time monitoring to enable a shift from reactive to proactive maintenance strategies. This approach reduces unexpected downtimes, lowers maintenance costs and prolongs asset life by allowing early detection of potential equipment failures. However, implementing APM poses challenges, including the integration of new technologies with existing systems, the need for skilled personnel and initial capital investment. Despite these hurdles, the long-term benefits such as improved asset reliability, cost savings and enhanced efficiency justify the investment. The paper provides a basic roadmap for energy producers aiming to adopt APM, emphasising the importance of a systematic approach to maximise the benefits of this transformative technology. As the energy sector increasingly prioritises efficiency and sustainability, APM stands out as a critical tool for energy producers looking to optimise operations and maintain a competitive edge.

Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of invasive infections caused by Aspergillus fumigatus to inform the first FPPL. The pre-specified criteria of mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence were used to search for relevant articles between 1 January 2016 and 10 June 2021. Overall, 49 studies were eligible for inclusion. Azole antifungal susceptibility varied according to geographical regions. Voriconazole susceptibility rates of 22.2% were reported from the Netherlands, whereas in Brazil, Korea, India, China, and the UK, voriconazole susceptibility rates were 76%, 94.7%, 96.9%, 98.6%, and 99.7%, respectively. Cross-resistance was common with 85%, 92.8%, and 100% of voriconazole-resistant A. fumigatus isolates also resistant to itraconazole, posaconazole, and isavuconazole, respectively. The incidence of invasive aspergillosis (IA) in patients with acute leukemia was estimated at 5.84/100 patients. Six-week mortality rates in IA cases ranged from 31% to 36%. Azole resistance and hematological malignancy were poor prognostic factors. Twelve-week mortality rates were significantly higher in voriconazole-resistant than in voriconazole-susceptible IA cases (12/22 [54.5%] vs. 27/88 [30.7%]; P=.035), and hematology patients with IA had significantly higher mortality rates compared with solid-malignancy cases who had IA (65/217 [30%] vs. 14/78 [18%]; P=.04). Carefully designed surveillance studies linking laboratory and clinical data are required to better inform future FPPL.

Abstract Monitoring the Earth is undertaken in numerous geometric and physical reference frames and coordinate reference systems. Analysis often requires transformation of coordinates between these frames. As the accuracy of positioning and geospatial data improves, the use of gridded data to describe the quantities used in these coordinate transformations is increasing. Rectangular grids also provide an efficient means of disseminating other geodetic data. IAG Commission 1 Working Group 1.3.1 in association with the Open Geospatial Consortium (OGC) have developed a Geodetic data Grid eXchange Format (GGXF) for quantifying and disseminating gridded geodetic data. GGXF was developed in conjunction with a functional model for crustal deformation (FMCD) including support for time-dependent changes, but has been designed to support any type of regularly-gridded geodetic data including but not limited to geoid models, offsets between reference frames (of one, two or three dimensions), velocity grids, tidal surfaces, etc. The purpose of GGXF is to provide a single comprehensive, efficient distribution format through which producers can disseminate gridded geodetic data and users can exchange and apply this information. This paper presents an overview of the GGXF format.