Allergen immunotherapy (AIT) is the only disease-modifying treatment for IgE-mediated allergic disorders, including allergic rhinitis and asthma, with established long-term clinical efficacy and immunological tolerance induction.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and significant impairment of quality of life. In severe or chronic cases, AD can present with diverse atypical phenotypes, among which prurigo nodularis (PN)-like lesions are clinically challenging due to their recalcitrance to conventional therapies. Patients with severe AD are also at an increased risk of comorbid immune-mediated diseases, such as alopecia areata (AA), a non-scarring hair loss disorder driven by aberrant immune responses. Ivarmacitinib, a highly selective oral Janus kinase 1 (JAK1) inhibitor, has been approved by the National Medical Products Administration (NMPA) of China for moderate-to-severe atopic dermatitis (April 2025) and alopecia areata (June 2025). Herein, we report a case of a 28-year-old male patient with a long-standing history of AD who developed generalized PN-like lesions and concurrent AA (with a 2-year disease duration) and androgenetic alopecia (AGA). Conventional therapies including topical corticosteroids and antihistamines failed to yield satisfactory outcomes. Following treatment with ivarmacitinib (8 mg once daily), the patient showed rapid improvements in skin lesions, pruritus, and hair regrowth. This case suggests that ivarmacitinib may be beneficial for complex AD phenotypes with comorbid immune-mediated hair loss.

Introduction Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder increasingly recognized as a systemic immune-mediated condition. Previous studies examining AA-associated autoimmune diseases were limited by narrow disease scope, single-country cohorts, or lack of bidirectional and sex-stratified analyses. This study comprehensively evaluated over 50 autoimmune conditions in AA patients, performed bidirectional analyses exploring temporal relationships, and conducted sex-stratified assessments to identify gender-specific risk. Methods We conducted a retrospective cohort study using the TriNetX Global Health Research Network, incorporating de-identified electronic health records from over 120 million patients worldwide. Adults with AA were 1:1 propensity score-matched with controls (n=69,259) based on demographics and comorbidities. Over 50 autoimmune and inflammatory disorders were assessed using Cox proportional hazards models. Reverse analyses and sex-stratified cohorts were performed. Sensitivity analyses tested robustness through temporal restrictions, recent data periods, and stricter diagnostic criteria. Results AA was strongly associated with endocrine, rheumatologic, dermatologic, gastrointestinal, hepatic, neurologic, and systemic autoimmune diseases. Highest hazard ratios included cutaneous lupus erythematosus (HR=9.843), systemic lupus erythematosus (HR=5.807), vitiligo (HR=3.844), lichen planus (HR=3.627), and Addison's disease (HR=3.847). Reverse analyses demonstrated that lichen planus (HR=6.205), cutaneous lupus erythematosus (HR=5.579), and vitiligo (HR=4.505) markedly increased AA risk. Females with AA had higher risks of thyroid, rheumatologic, and cutaneous autoimmune disorders, while males showed higher vitiligo risk. Conclusions AA was associated with increased risk of multiple autoimmune and inflammatory diseases in both directions. These findings support considering AA as a clinically visible marker of increased autoimmune susceptibility and may justify targeted evaluation for thyroid and connective tissue disorders, particularly in females with AA, as well as clinical awareness of AA risk in patients with autoimmune skin diseases.

Objectives: Alopecia areata (AA) is a widespread autoimmune condition causing non-scarring hair loss, significantly affecting the quality of life. Despite its prevalence, data on diagnostic and treatment efficacy and the quality of patient care in Poland remain unstudied. The aim of this study was to assess the current clinical approaches to the diagnosis and management of alopecia areata by dermatologists in Poland and to highlight the challenges encountered by Polish patients. Methods: A cross-sectional study was conducted regarding dermatologists and AA patients in Poland. The data were gathered from distinct proprietary surveys: an original questionnaire for doctors, and DLQI, CDLQI, AAPPO, WPAI+CIQ:AS, and SF-36 questionnaires for patients. Results: The study included 100 dermatologists and 252 patients from Poland. The study revealed that the care provided to patients with alopecia areata is inadequate and lacks a comprehensive approach, despite the negative disease impact on patients' quality of life. A number of physicians do not follow the diagnostic and treatment guidelines. Despite the registration of next-generation treatments like Janus kinase inhibitors, access to these medications remained limited until recently. Conclusions: Alopecia areata in Poland poses significant diagnostic, therapeutic, and psychosocial challenges. While clinical practice largely aligns with international recommendations, notable gaps remain in the use of validated severity tools, psychosocial assessment, and access to advanced therapies. The recent reimbursement of ritlecitinib represents a breakthrough, bringing Polish care in line with global standards. However, optimal management requires not only pharmacological advances but also interdisciplinary strategies integrating psychological support, patient advocacy, and public education to reduce stigma and improve overall quality of life for affected individuals.

Background/Objectives: Children with juvenile idiopathic arthritis (JIA) frequently develop additional autoimmune conditions during follow-up, yet the clinical and diagnostic profile of this comorbid subgroup is incompletely characterised in single-centre paediatric series. We aimed to describe the prevalence, clinical pattern, and diagnostic features of autoimmune comorbidities in a seven-year cohort of children with JIA monitored at a single tertiary paediatric centre, and to document the diagnostic protocols applied for each comorbidity. Methods: We conducted a retrospective descriptive observational study of 103 consecutive children with JIA classified according to the ILAR 2001 criteria and monitored at the Paediatric Rheumatology Unit of St. Mary Children's Emergency Hospital, Iași, Romania, between 2017 and 2023, with the year 2020 excluded by design owing to the institutional reorganisation during the early COVID-19 pandemic. Autoimmune comorbidities were ascertained from medical records using ICD-10 coding and confirmed by subspecialty evaluation. The diagnostic approach for each comorbidity is reported in detail. Continuous variables are described using mean ± standard deviation, and categorical variables as frequencies (%). No inferential analysis was performed on predictor variables; the study is exploratory and hypothesis-generating. Results: Autoimmune comorbidity was identified in 21 of 103 children (20.4%; 95% confidence interval [CI] 13.1-29.5%), the JIA-AID subgroup. Patients were predominantly female (17 of 21, 81.0%) and aged over 12 years (10 of 21, 47.6%). Autoimmune thyroiditis was the most frequent comorbidity, present in 10 of 21 cases (47.6%) when the euthyroid, hypothyroid, and vitiligo-associated forms were combined, followed by inflammatory bowel disease (4 of 21, 19.0%), alopecia areata (4 of 21, 19.0%), localised scleroderma (2 of 21, 9.5%), and coeliac disease (1 of 21, 4.8%). Three patients (14.3%) had polyautoimmunity, defined as two or more autoimmune diagnoses in addition to JIA. The HLA-B27-positive enthesitis-related arthritis subtype, although small in absolute numbers, was over-represented within the JIA-AID subgroup: 5 of 7 HLA-B27-positive ERA patients (71.4%; 95% CI 29.0-96.3%) carried a coexisting autoimmune diagnosis, compared with 16 of 96 patients in the remainder of the cohort (16.7%; 95% CI 9.8-25.6%); the predominant comorbidity in this subtype was inflammatory bowel disease. Conclusions: Autoimmune comorbidity affected approximately one in five children with JIA in this single-centre cohort, with autoimmune thyroiditis and inflammatory bowel disease as the most frequent associations and a notable concentration of comorbidity within the HLA-B27-positive enthesitis-related arthritis subtype. These descriptive observations are hypothesis-generating and support the case for proactive multidisciplinary screening in selected subgroups. Prospective registry-based studies with explicit exposure classification and standardised functional outcomes will be needed to confirm the patterns reported here.

Diffuse unpatterned alopecia (DUPA) is an uncommon and incompletely characterized variant of androgenetic alopecia (AGA) marked by diffuse follicular miniaturization across the entire scalp, including the occipital region, which distinguishes it from classic patterned AGA and often precludes hair transplantation.

Autoimmune thyroid diseases (AITDs), including Hashimoto's thyroiditis (HT) and Graves' disease (GD), affect approximately 2-5% of the global population. They are the most common organ-specific autoimmune disorders worldwide. Growing epidemiological and immunological evidence indicates that AITDs frequently coexist with immune-mediated dermatological diseases. These include atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo, and chronic spontaneous urticaria (CSU). Targeted immunotherapies have become central to the treatment of many immune-mediated skin diseases. Although these therapies are designed to act on specific immune pathways, they may also exert broader systemic immunomodulatory effects. However, thyroid function and thyroid autoantibodies are not routinely assessed in patients with immune-mediated dermatological conditions. This is also true for some patients with known or suspected AITDs. In this narrative review, we summarize the immunological overlap between cutaneous inflammation and autoimmune thyroid disease. We also discuss thyroid-related evidence for IL-4Rα inhibitors, IL-17 inhibitors, JAK inhibitors, IL-12/23 inhibitors, and immune checkpoint inhibitors (ICIs). Current evidence suggests that ICIs have the strongest established association with thyroid dysfunction. In contrast, the thyroid-related effects of dupilumab and ustekinumab are supported mainly by rare case reports. IL-17 inhibitors and selective IL-23p19 inhibitors may theoretically attenuate thyroid inflammatory pathways. However, this possibility has not yet been confirmed in clinical studies. Based on the available evidence, we propose a risk-stratified approach to thyroid surveillance across targeted immunotherapies. Routine thyroid monitoring is most strongly supported for ICIs. For patients at increased thyroid risk, selective assessment of thyroid function and thyroid autoantibodies may also be considered during treatment with dupilumab or ustekinumab. For oral JAK inhibitors, monitoring may be particularly relevant before treatment, during therapy, and after discontinuation because of the potential for immune rebound. Prospective studies are needed to define which patient subgroups would benefit most from thyroid surveillance during targeted immunotherapy.