Italian Journal of Dermatology and Venereology最新文献

Introduction: Androgenetic alopecia (AGA), or pattern hair loss, is the most common form of hair loss worldwide. It is primarily caused by genetic and hormonal factors, particularly the action of dihydrotestosterone (DHT) on hair follicles.

Evidence acquisition: A comprehensive literature search on PubMed and Google Scholar was conducted until October 31, 2024, using keywords related to male AGA and its treatments. Relevant reviews, meta-analyses, clinical trials, and case studies in English were selected and analyzed to enhance the quality of the research. This review is based solely on existing studies and does not include new human or animal research conducted by the authors.

Evidence synthesis: This review thoroughly examined and analyzed 149 articles to provide a detailed presentation of the evidence.

Conclusions: This article examines both established and emerging therapies for AGA. We recommend initiating treatment with topical minoxidil and oral finasteride, as these are extensively researched and FDA-approved options for male AGA. For patients who do not respond well or cannot tolerate these treatments, clinicians may explore alternative therapies and approaches.

Malar bags are a common aesthetic concern characterized by swelling and puffiness in the prezygomatic space and cheek area. Various medical and surgical techniques have been developed to address this condition and restore a more youthful and rejuvenated appearance. In terms of medical therapies, non-invasive options such as topical creams containing retinoids, peptides, and hyaluronic acid have shown promise in reducing mild malar bags. These substances help improve skin texture, promote collagen production, and enhance skin elasticity, thereby reducing the appearance of swelling and puffiness. Additionally, injectable treatments such as dermal fillers have been utilized to camouflage malar bags and create a smoother contour. By strategically placing fillers in the surrounding areas, a skilled practitioner can achieve a more harmonious facial appearance. In recent years, advancements in radiofrequency have also shown promise for treating malar bags. Laser skin resurfacing procedures can help tighten the skin, stimulate collagen production, and reduce the appearance of swelling and wrinkles in the malar area. For patients seeking more lasting results, surgical techniques provide viable options. Blepharoplasty, a surgical procedure aimed at correcting eyelid issues, can be performed to remove excess skin and fat deposits in the lower eyelid, effectively addressing malar bags. Additionally, newer techniques like endoscopic surgery allow for minimal incisions and reduced scarring, making them appealing to patients concerned about visible postoperative marks. Although numerous medical and surgical techniques are available, the choice of treatment depends on factors such as the severity of the condition, patient preferences, and the expertise of the medical practitioner. In this manuscript we have made a retrospective evaluation of the medical and surgical therapies of malar bags and we report our considerations after 20 years of experience.

Gender medicine has been achieving increasing importance. Gender differences in disease depend on hormonal status and may involve functions of the skin, immune responses and metabolic pathways, and have to do also with indications and response to treatments. Psoriasis is a common chronic inflammatory immune-mediated disease. The prevalence of psoriasis in the population is balanced between males and females, but early onset psoriasis is slightly more prevalent in males, with the latter suffering from a more severe disease. In general, male and female patients receive identical drugs at equivalent dosages. However, females receive systemic treatments less frequently compared to males. Males are more satisfied with their psoriasis treatment and respond better to biologics. Females have a significant higher rate of adverse events and drug-related discontinuation rate compared to males. About conventional systemic treatments for psoriasis during pregnancy, only cyclosporine is suggested when the benefits exceed the potential side effects, whereas methotrexate is contraindicated during pregnancy and lactation and in the three months before fatherhood and motherhood. Among the biologics, only certolizumab pegol is considered safe in pregnant patients, as it does not cross the maternal-placental barrier. Therefore, it is important to consider a gender perspective in the treatment of psoriasis, including her willingness to procreate. This is a narrative review highlighting the challenges that the healthcare dermatologists may face regarding management of psoriasis in female patients.

Background: Proper identification and management of flare in atopic dermatitis (AD) is complex, especially in patients being treated with biological drug or small molecules. To date, the definition of flare is not agreed upon. Available scores such as the ADCT (AD control tool) are administered retrospectively to the patient and do not cover key aspects such as self-medication with topical steroids. In the present pilot study, we propose a daily questionnaire to be administered to the patient for proper identification of flares.

Methods: Patients under dupilumab, tralokinumab and upadacitinib filled out for all days in the first month of treatment a daily questionnaire focused on pruritus and topical steroids application. During the in-clinic visit, the physician based on the diary will assess the number and presence of: 1) increase in NRSp (numerical rating score, pruritus) score ≥4 compared to the previous day; 2) increase in topical steroid or topical calcineurin inhibitor applications ≥1 compared with the previous day. Flares were defined as worsening from the previous condition daily, meaning an increased itching or increase of steroid or calcineurin inhibitor application. Topical medication application is considered good proxy for worsening of disease that is easily recorded by the patient.

Results: Forty-seven patients completed at least 1-month questionnaires. Thirteen patients reported at least one flare, and 6 of these patients reported clinical flares (pruritus) in the first months of treatment. Most reported a single episode, while 2 patients reported 2 episodes during the first month, 1 patient reported 15 episodes during the first month, and all three of these patients were on dupilumab. Regarding dupilumab, 38% of patients experienced at least one episode of flares in the first month. 17% of patients on tralokinumab experienced flares. No patients experienced flares on upadacitinib.

Conclusions: The pilot and observational nature does not allow validation of the questionnaire-used, which therefore needs wider integration in clinical use and studies confirming its usefulness. Implementing a questionnaire such as ours that evaluates flares in clinical practice could optimize the therapeutic management of the atopic patient being treated with systemic medication whether biologic or small molecules.

Background: Alopecia areata incognita (AAI) represents a variant of alopecia areata with an absence of well-defined alopecic patches but diffuse involvement of the scalp and even if usually affected females, it may also appear in male. Little is known about AAI in men. The aim of this study was to characterize the history, clinical, trichoscopic, and histopathologic features of AAI in male patients.

Methods: All histopathologically proven male patients with AAI between April 2011 and December 2023, were included in the study. The history, clinical, trichoscopic and histopathologic features of the male patients were evaluated.

Results: Twenty-nine patients with AAI were included in the study, the mean age was 23.1. All patients had an underlying androgenetic alopecia (AGA) - Hamilton Scale: 17 (58.62%) grade IV, 9 (31.03%) grade V and 3 (10.34%) grade VI. The most common trichoscopic features included short regrowing hair (96.6%), yellow dots (89.7%) and pigtail hair (41.3%) especially seen in the occipital, parietal and frontal regions. A positive pull test with telogen roots was observed in 24.1% of the patients. Histopathological characteristics of AAI in male patients were indistinguishable from previously described features in female patients. All patients were treated with an ultra-potent topical corticosteroid under occlusion and topical 5% minoxidil twice/day or oral minoxidil, remission was established between 4-8 months after treatment initiation.

Conclusions: A thorough trichoscopic examination in cases of diffuse hair loss in male patients with AGA refractory to conventional therapy is warranted and trichoscopy-guided biopsy is necessary to confirm the diagnosis.

Prurigo nodularis (PN) is a chronic skin inflammatory condition characterized by severe, persistent itching and excoriated nodules induced by scratching. PN is strongly related to neural and immune dysfunction and negatively impacts quality of life. Treatments for PN are often off-label, highlighting the need for specifically approved agents and consensus guidelines for patient management. An Italian expert panel (including nine dermatologists) discussed four main clinical and therapeutic topics (definition and etiopathogenesis, diagnosis and staging, clinical management and therapy) based on their clinical experience and literature review. Data gaps were identified and a modified Metaplan^® method was used to determine the consensus for each topic. PN, mainly affecting middle-aged and elderly adults, is a distinct disease from atopic dermatitis (AD), despite sharing some features (e.g. itch and inflammatory pathways). Although the pathophysiology of PN remains under debate, type 2 pro-inflammatory cytokines (e.g. interleukin IL-4, IL-13 and IL-31) are key mediators of both chronic pruritus and tissue changes. According to international definition, PN is a disease characterized by chronic (at least 6 months) pruritus and signs of repeated scratching, and well-defined nodules. Dupilumab (targeting the IL-4 receptor alpha inhibitor and inhibiting both IL-4 and IL-13) and nemolizumab (an IL-31 receptor alpha inhibitor) were recently approved for the treatment of PN, showing marked efficacy and favorable safety in randomised clinical trials. PN management requires a better understanding of disease pathophysiology, with comprehensive patient care strategies. Novel targeted therapies, such as dupilumab, are essential for improving patient outcomes in PN.