Natasha Mesinkovska’s research while affiliated with University of California, Irvine and other places

Background Etrasimod, an oral, selective sphingosine 1‐phosphate 1, 4 and 5 receptor modulator approved for the treatment of ulcerative colitis, has been studied in immune‐mediated inflammatory diseases, including alopecia areata (AA). Objectives To evaluate the efficacy and safety of etrasimod in adults with moderate to severe AA. Methods This Phase 2, randomized, double‐blind, placebo‐controlled trial included patients (aged ≥18 years) with moderate to severe AA, defined as a Severity of Alopecia Tool (SALT) score of ≥25. Patients were sequentially enrolled into two cohorts. Cohort 1 included patients (SALT score of ≥50) randomized 2:1 to etrasimod 2 mg or placebo. Cohort 2 included patients (SALT score ≥25 to <95) randomized 4:1:2 to etrasimod 3 mg, 2 mg or placebo. Patients completed a 24‐week double‐blind and 28‐week open‐label extension period. The primary endpoint was percent change from baseline (%CFB) in SALT score at Week 24. Safety was monitored throughout the trial. Results Eighty patients were randomized to etrasimod 2 mg ( n = 31), 3 mg ( n = 25) or placebo ( n = 24). At Week 24, least squares mean (SE) percent changes from baseline in SALT score for the etrasimod 2 mg, 3 mg and placebo groups were −13.8 (8.6), −21.4 (6.9) and 0.35 (8.9), respectively. The least squares mean difference (95% CI; P value) in SALT score %CFB of etrasimod 2 mg and 3 mg versus placebo was −14.1 (−38.9 to 10.6; p = 0.2579) and − 21.8 (−44.4 to 0.9; p = 0.0592), respectively; statistical superiority was not achieved. The proportions of patients achieving ≥30%, ≥50% or ≥75% improvement in baseline SALT score at Week 24 were generally numerically higher in etrasimod groups versus placebo. Treatment‐emergent adverse events occurred in 67.7%, 80.0% and 78.3% of patients receiving etrasimod 2 mg, 3 mg and placebo, respectively, by Week 24. Conclusions Etrasimod did not meet the primary and secondary efficacy endpoints, but efficacy was numerically higher with etrasimod than with placebo. The etrasimod clinical programme for AA has been discontinued. Etrasimod was well tolerated, and its safety profile was consistent with other etrasimod studies to date. Trial Registration ClinicalTrials.gov : NCT04556734.

Scalp health is essential for healthy hair growth and may be affected by intrinsic or extrinsic factors. Reactive oxygens species are key contributors to aging and can have a detrimental impact on scalp health. Oxidative stress on the scalp is thought to be a factor in developing dandruff. We present consensus statements on scalp barrier health and its effects on hair through a systematic literature search and expert panel discussion. Three dermatologists with extensive experience in hair were selected to form a panel that formulated consensus statements that would best capture the current understanding of scalp health. The consensus statements developed and presented in this manuscript highlight the current literature and broader discussion surrounding scalp health and its impact on hair and dandruff. It also highlights the often-overlooked effects of scalp conditions on hair health and growth. Through our research, we found that there has been minimal emphasis on scalp health in the setting of dandruff, with most studies focusing on other inflammatory diseases such as psoriasis and atopic dermatitis. Here, we review the clinical importance of focusing on the impact of the scalp barrier condition on hair health. J Drugs Dermatol. 2025;24:2(Suppl 1):s3-7.

Dandruff and seborrheic dermatitis are associated with a disrupted scalp barrier that contributes to irritation, pruritus, and flaking of the scalp. The flaking and itch associated with dandruff can significantly impact an individual's self-esteem and quality of life. While the exact pathogenesis of dandruff is still not completely understood, scalp barrier health and its microbiome are thought to play significant roles in disease propagation. Five expert dermatologists with extensive experience in hair, dandruff, and seborrheic dermatitis were selected to participate in discussions that would result in five consensus statements focused on scalp barrier health and dandruff. Results of a systematic literature search and expert panel discussion are presented. These consensus statements aim to reflect expert opinions on the current understanding of scalp health in the context of dandruff and seborrheic dermatitis. The panel addressed challenges to promote scalp health, improve patient comfort, and prevent flares during dandruff management and maintenance. The presented consensus statements urge reframing our current understanding of dandruff and seborrheic dermatitis treatment by refocusing attention on global scalp and hair health. J Drugs Dermatol. 2025;24:2(Suppl 1):s8-14.

Premature hair graying (PHG) is the early loss of natural hair color, influenced by genetic, biological, and environmental factors. This review discusses the significant psychological impacts of PHG and explores its underlying mechanisms, related health conditions, and available treatments. The review examines the roles of genetics, oxidative stress, and lifestyle factors such as smoking and diet in premature graying. It also considers associated medical conditions and current and emerging treatment options. This overview aims to improve understanding of PHG and its broader implications.

Introduction: Cutaneous infections pose ongoing challenges to standard treatments due to resistance and limited efficacy. Photodynamic therapy (PDT) emerges as a promising supplement or an alternative to address complicated cases. In this review, we comprehensively review PDT's safety and efficacy in treating cutaneous infections. Evidence acquisition: A PubMed systematic review with search terms for PDT treatment, hair, skin, and nail infections. Evidence synthesis: There were a total of 43 studies on the use of PDT in cutaneous infections which discussed the treatment of viral (N.=20), bacterial (N.=11), fungal (N.=9), and protozoal (N.=3) infections. There is evidence for using PDT, mostly 5-aminolevulinic acid (5-ALA) and methyl aminolevulinate (MAL), in the treatment of cutaneous infections. Most evidence for viral infections involved treatment with 5-ALA PDT in condyloma acuminatum (CoAc), verruca vulgaris, and molluscum contagiosum. In bacterial infections, 5-ALA and MB PDT have been used to achieve complete remission in refractory Pseudomonas and atypical mycobacteria infections without recurrence. In onychomycosis, MAL PDT achieved a 40.9% cure rate and MB PDT showed a 77.8-100% cure rate with no reports of recurrence. Parasitic infections, such as leishmaniasis have also been successfully treated with both 5-ALA and MAL PDT. Conclusions: PDT is a promising treatment option for cutaneous infections, with growing evidence for its utility in treating cutaneous bacterial, viral, fungal, and parasitic infections, particularly those that fail standard treatments. Side effects were mostly limited to localized pain with good outcomes and low recurrence rates.

Importance The results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking. Objective To create an expert consensus statement for LDOM prescribing for patients with hair loss. Evidence Review The current literature on the pharmacological properties, adverse effect profile, and use of LDOM for patients with hair loss was reviewed. Topics of interest were identified, and a modified Delphi consensus process was created. A total of 43 hair loss specialist dermatologists from 12 countries participated in a modified Delphi process. Consensus was reached if at least 70% agreed or strongly agreed on a 5-point Likert scale. Findings Over 4 survey rounds, 180 items in the first round, 121 items in the second round, 16 items in the third round, and 11 items in the fourth round were considered and revised. A total of 76 items achieved consensus including diagnoses for which LDOM may provide direct or supportive benefit, indications for LDOM compared to topical minoxidil, dosing for adults (18 years and older) and adolescents (aged 12 to 17 years), contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation. Pediatric use and dosing items for children younger than 12 years, and LDOM titration protocols fell short of consensus. Conclusions and Relevance This international expert consensus statement regarding the off-label prescribing of LDOM for patients with hair loss can help guide clinical practice until more data emerge. Hair loss experts with experience treating pediatric patients were underrepresented on this expert panel. Future research should investigate best practices for LDOM use in pediatric patients. Other critical topics for further investigation include the comparative efficacy of topical minoxidil vs oral minoxidil, the safety of oral minoxidil for patients with a history of allergic contact dermatitis to topical minoxidil, the long-term safety of LDOM, and the use of other off-label forms of minoxidil, such as compounded formulations of oral minoxidil and sublingual minoxidil. As additional evidence-based data emerge, these recommendations should be updated.