Background: The prognosis of alopecia areata (AA) is difficult to predict. Few studies report long-term follow-up of AA patients. Objective: The purpose of this study is to better assess the long-term evolution of AA ...Background: The prognosis of alopecia areata (AA) is difficult to predict. Few studies report long-term follow-up of AA patients. Objective: The purpose of this study is to better assess the long-term evolution of AA and the possible relationship between disease severity and treatment response with long-term prognosis. Methods: One hundred ninety one patients with AA who presented with a new diagnosis of AA between 1983 and 1990 were subsequently contacted by phone. Patients were queried regarding current disease status, treatments, and disease course. Results: Severity of AA at first consultation ranged from mild (128 patients) to severe (63 patients). Fifty-five of 191 patients were affected by concomitant autoimmune or related inflammatory disease. Sixty-six of 191 patients were presently disease free (followup duration, 15-22 years; mean 17.74 years). These include 41 of 60 patients with S1 disease (68.3%), 22 of 68 patients with S2 disease (32.3%), 1 of 11 patients with S3 disease (9%), 1 of 14 patients with S4 disease (7.1%), and 1 of 11 patients with alopecia totalis (AT) (9.1%). Sixty-nine of 191 patients (36-1%) were presently affected by AT or alopecia universalis. There was a statistically significant tendency of severe patterns of AA to worsen over time. In children, 18 of 39 (13 with ≤S2 disease and 5 with ≥S3 disease) with AA had developed AT or alopecia universalis at long-term follow-up. In children, however, this trend was not statistically significant. Patients with severe AA who responded to topical immunotherapy seem to have a better prognosis than nonresponders. Limitations: Follow-up was only performed by phone. Conclusions: Severity of AA at time of first consultation is an important prognostic factor. Response to therapy (topical immunotherapy) may be associated with better prognosis. In children, the prognosis is worse; our study found that AA worsens over time.展开更多
OBJECTIVE: To determine whether women in the National Breast and Cervical Ca nc er Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) te st of atypical squamous cells of undetermined significan...OBJECTIVE: To determine whether women in the National Breast and Cervical Ca nc er Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) te st of atypical squamous cells of undetermined significance (ASC-US) or low-gra de squamous intraepithelial lesions (LSIL) were followed up in accordance with t he interim guidelines for management of abnormal cervical cytology. METHODS: For this study period, the guidelines for a Pap result of ASC-US or LSIL specified follow-up by Pap tests repeated every 4 to 6 months for 2 years. If a second r eport of ASC-US or LSIL was made, the patient was to have colposcopy. We analyz ed data from 10,004 women who had a result of ASC-US or LSIL followed by a seco nd ASC-US or LSIL from 1991-2000. RESULTS: As judged by the guidelines, 44%of women who had 2 low-grade abnormalities were followed up appropriately with co lposcopy. Among women with 2 ASC-US results, those aged less than 30 years were more likely to receive colposcopy than the other age groups, while women who we re aged 60 years and olde r were more likely to be followed up with a third Pap test. For each of the 4 re sult groups, American Indian or Alaska Native women had the highest percentages of a third Pap test, whereas Black or African-American women had a higher perce ntage of no follow-up. CONCLUSION: More than one half of the women studied were not followed up in accordance with the established guidelines for managing abno rmal cervical cytology. Factors such as age and race or ethnicity influence whet her women with cytologic abnormalities receive appropriate follow-up.展开更多
文摘Background: The prognosis of alopecia areata (AA) is difficult to predict. Few studies report long-term follow-up of AA patients. Objective: The purpose of this study is to better assess the long-term evolution of AA and the possible relationship between disease severity and treatment response with long-term prognosis. Methods: One hundred ninety one patients with AA who presented with a new diagnosis of AA between 1983 and 1990 were subsequently contacted by phone. Patients were queried regarding current disease status, treatments, and disease course. Results: Severity of AA at first consultation ranged from mild (128 patients) to severe (63 patients). Fifty-five of 191 patients were affected by concomitant autoimmune or related inflammatory disease. Sixty-six of 191 patients were presently disease free (followup duration, 15-22 years; mean 17.74 years). These include 41 of 60 patients with S1 disease (68.3%), 22 of 68 patients with S2 disease (32.3%), 1 of 11 patients with S3 disease (9%), 1 of 14 patients with S4 disease (7.1%), and 1 of 11 patients with alopecia totalis (AT) (9.1%). Sixty-nine of 191 patients (36-1%) were presently affected by AT or alopecia universalis. There was a statistically significant tendency of severe patterns of AA to worsen over time. In children, 18 of 39 (13 with ≤S2 disease and 5 with ≥S3 disease) with AA had developed AT or alopecia universalis at long-term follow-up. In children, however, this trend was not statistically significant. Patients with severe AA who responded to topical immunotherapy seem to have a better prognosis than nonresponders. Limitations: Follow-up was only performed by phone. Conclusions: Severity of AA at time of first consultation is an important prognostic factor. Response to therapy (topical immunotherapy) may be associated with better prognosis. In children, the prognosis is worse; our study found that AA worsens over time.
文摘OBJECTIVE: To determine whether women in the National Breast and Cervical Ca nc er Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) te st of atypical squamous cells of undetermined significance (ASC-US) or low-gra de squamous intraepithelial lesions (LSIL) were followed up in accordance with t he interim guidelines for management of abnormal cervical cytology. METHODS: For this study period, the guidelines for a Pap result of ASC-US or LSIL specified follow-up by Pap tests repeated every 4 to 6 months for 2 years. If a second r eport of ASC-US or LSIL was made, the patient was to have colposcopy. We analyz ed data from 10,004 women who had a result of ASC-US or LSIL followed by a seco nd ASC-US or LSIL from 1991-2000. RESULTS: As judged by the guidelines, 44%of women who had 2 low-grade abnormalities were followed up appropriately with co lposcopy. Among women with 2 ASC-US results, those aged less than 30 years were more likely to receive colposcopy than the other age groups, while women who we re aged 60 years and olde r were more likely to be followed up with a third Pap test. For each of the 4 re sult groups, American Indian or Alaska Native women had the highest percentages of a third Pap test, whereas Black or African-American women had a higher perce ntage of no follow-up. CONCLUSION: More than one half of the women studied were not followed up in accordance with the established guidelines for managing abno rmal cervical cytology. Factors such as age and race or ethnicity influence whet her women with cytologic abnormalities receive appropriate follow-up.
