Nada Khalil, James Carton, Carolina P. Fernandez, Neil P. Patel
Introduction: Lipedematous scalp (LS) is a rare disorder characterized by thickening of the adipose subcutaneous scalp layer without associated hair loss. To date, there have been fewer than 100 reported cases of LS. LS occurring in siblings has not been previously reported. Case Presentation: We present a 58-year-old and 63-year-old pair of black Caribbean female siblings with LS. Scalp thickness on ultrasound of the vertex in each case was 12 mm and 11 mm from skin to periosteum, respectively (normal range: 5–6 mm). Histopathological analysis in the younger sibling demonstrated prominent fat, high in the dermis around hair follicles, with follicular distortion and focal perifollicular fibrosis. Co-morbidities in the younger sibling were obesity (body mass index [BMI] 39.0), paranoid schizophrenia, and bipolar disorder; the older sibling was overweight (BMI 26.0) with co-morbidities of hypercholesterolemia, type 2 diabetes mellitus, hypomania, and migraines; both siblings were taking psychiatric medication. Conclusion: We present an unusual case of LS in a pair of female siblings, adding to the limited existing evidence that there may be a genetic role in the pathogenesis of LS. Furthermore, both siblings in this case had psychiatric co-morbidities and were taking psychiatric medication, which have not been previously identified as associations of LS.
{"title":"Lipedematous Scalp Occurring in Two Female Siblings: Further Evidence for a Genetic Role","authors":"Nada Khalil, James Carton, Carolina P. Fernandez, Neil P. Patel","doi":"10.1159/000534698","DOIUrl":"https://doi.org/10.1159/000534698","url":null,"abstract":"<b><i>Introduction:</i></b> Lipedematous scalp (LS) is a rare disorder characterized by thickening of the adipose subcutaneous scalp layer without associated hair loss. To date, there have been fewer than 100 reported cases of LS. LS occurring in siblings has not been previously reported. <b><i>Case Presentation:</i></b> We present a 58-year-old and 63-year-old pair of black Caribbean female siblings with LS. Scalp thickness on ultrasound of the vertex in each case was 12 mm and 11 mm from skin to periosteum, respectively (normal range: 5–6 mm). Histopathological analysis in the younger sibling demonstrated prominent fat, high in the dermis around hair follicles, with follicular distortion and focal perifollicular fibrosis. Co-morbidities in the younger sibling were obesity (body mass index [BMI] 39.0), paranoid schizophrenia, and bipolar disorder; the older sibling was overweight (BMI 26.0) with co-morbidities of hypercholesterolemia, type 2 diabetes mellitus, hypomania, and migraines; both siblings were taking psychiatric medication. <b><i>Conclusion:</i></b> We present an unusual case of LS in a pair of female siblings, adding to the limited existing evidence that there may be a genetic role in the pathogenesis of LS. Furthermore, both siblings in this case had psychiatric co-morbidities and were taking psychiatric medication, which have not been previously identified as associations of LS.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"85 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135092420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Lichen planopilaris (LPP) is an autoimmune disorder leading to lymphocytic cicatricial alopecia. Different agents such as hydroxychloroquine, methotrexate, cyclosporine, and mycophenolate mofetil have been tried to control hair loss with limited efficacy. JAK inhibitors are immune-modulating drugs which interfere with the JAK-STAT signaling pathway in lymphocytes and are used in treatment of inflammatory conditions such as rheumatoid arthritis and alopecia areata. Summary: Our aim was to determine effectiveness of JAK inhibitors in LPP and its clinical variant, frontal fibrosing alopecia. A literature search was conducted using PubMed, Google Scholar, and Cochrane databases. A total of 7 articles describing 35 patients were found. Although data on treatment are limited to retrospective studies and case reports, JAK inhibitors can be considered a new therapeutic option, especially in recalcitrant cases. Large prospective studies and randomized control trials are needed to provide further evidence supporting efficacy. Key Messages: Besides the fact that data on the treatment of LPP and FFA with JAK inhibitors are limited to retrospective studies and case reports, but JAK inhibitors can be considered as a new therapeutic option especially in recalcitrant cases.
{"title":"JAK Inhibitors in the Treatment of Lichen Planopilaris","authors":"Maryam Nasimi, Mahshid Sadat Ansari","doi":"10.1159/000534631","DOIUrl":"https://doi.org/10.1159/000534631","url":null,"abstract":"<b><i>Background:</i></b> Lichen planopilaris (LPP) is an autoimmune disorder leading to lymphocytic cicatricial alopecia. Different agents such as hydroxychloroquine, methotrexate, cyclosporine, and mycophenolate mofetil have been tried to control hair loss with limited efficacy. JAK inhibitors are immune-modulating drugs which interfere with the JAK-STAT signaling pathway in lymphocytes and are used in treatment of inflammatory conditions such as rheumatoid arthritis and alopecia areata. <b><i>Summary:</i></b> Our aim was to determine effectiveness of JAK inhibitors in LPP and its clinical variant, frontal fibrosing alopecia. A literature search was conducted using PubMed, Google Scholar, and Cochrane databases. A total of 7 articles describing 35 patients were found. Although data on treatment are limited to retrospective studies and case reports, JAK inhibitors can be considered a new therapeutic option, especially in recalcitrant cases. Large prospective studies and randomized control trials are needed to provide further evidence supporting efficacy. <b><i>Key Messages:</i></b> Besides the fact that data on the treatment of LPP and FFA with JAK inhibitors are limited to retrospective studies and case reports, but JAK inhibitors can be considered as a new therapeutic option especially in recalcitrant cases.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135240743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elva Dalia Rodríguez-Acosta, Diego Fernandez Nieto, Emilio Berna-Rico, Hector Ricardo Galván-García, Ruth Galit Meza-Castro, Ana Karen Rosales-Lerma, Andrea Viridiana Guerrero-Cervantes, Hassiel Aurelio Ramírez-Marín
Introduction: Alopecia areata (AA) is an autoimmune disease characterized by T cell‐mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects, pain due to intralesional injections or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308 nm excimer lamp used in a monthly basis in a double-stacked pulse manner for the treatment of AA. Methods: This was a prospective study, using 308 nm excimer lamp in a double-stacked pulse therapy for AA. The primary endpoint was the improvement in SALT score. Results: A total of 40 patients with AA were enrolled in this study. Forty (100%) patients achieved clinical response. Hyperpigmentation and erythema occurred on the treated alopecic areas of all patients but they were considered tolerable. Patients of younger age or with a smaller area of affection had a better overall treatment response. Conclusion: 308 nm excimer lamp therapy is an excellent option for single or multiple AA because it achieves a good clinical response with less adverse effects than other therapies. This therapy may be useful for low-income countries where new JAK inhibitors are not available, however, for patients with extensive hair loss, it is not as effective and thus, it may be unfit for patients with alopecia totalis and alopecia universals.
{"title":"Assessing the Efficacy of Monthly 308 nm Excimer Lamp Double-Stacked Pulse Adjusted Therapy for Alopecia Areata","authors":"Elva Dalia Rodríguez-Acosta, Diego Fernandez Nieto, Emilio Berna-Rico, Hector Ricardo Galván-García, Ruth Galit Meza-Castro, Ana Karen Rosales-Lerma, Andrea Viridiana Guerrero-Cervantes, Hassiel Aurelio Ramírez-Marín","doi":"10.1159/000533993","DOIUrl":"https://doi.org/10.1159/000533993","url":null,"abstract":"<b><i>Introduction:</i></b> Alopecia areata (AA) is an autoimmune disease characterized by T cell‐mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects, pain due to intralesional injections or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308 nm excimer lamp used in a monthly basis in a double-stacked pulse manner for the treatment of AA. <b><i>Methods:</i></b> This was a prospective study, using 308 nm excimer lamp in a double-stacked pulse therapy for AA. The primary endpoint was the improvement in SALT score. <b><i>Results:</i></b> A total of 40 patients with AA were enrolled in this study. Forty (100%) patients achieved clinical response. Hyperpigmentation and erythema occurred on the treated alopecic areas of all patients but they were considered tolerable. Patients of younger age or with a smaller area of affection had a better overall treatment response. <b><i>Conclusion:</i></b> 308 nm excimer lamp therapy is an excellent option for single or multiple AA because it achieves a good clinical response with less adverse effects than other therapies. This therapy may be useful for low-income countries where new JAK inhibitors are not available, however, for patients with extensive hair loss, it is not as effective and thus, it may be unfit for patients with alopecia totalis and alopecia universals.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"97 1‐2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135818823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Androgenetic alopecia (AGA) is the most common form of hair loss, with negative impact on patient quality of life. Oral minoxidil is used off-label for AGA treatment. We hypothesized increased public interest in oral minoxidil for hair loss treatment following the New York Times (NYT) Article on oral minoxidil: “An Old Medicine Grows New Hair for Pennies a Day, Doctors Say.” The objective of this study was to quantify interest in oral minoxidil for hair loss treatment before and after the NYT article and help inform dermatologists about treatments of interest to their patients. Method: We performed a cross-sectional analysis of Google Trends evaluating relative prevalence of “oral minoxidil,” “minoxidil,” “hair loss,” and “Rogaine®” 2/2022–5/2023. t tests compared mean search volume and linear regression analysis quantified changes in public interest over time. Results: Oral minoxidil and minoxidil search volumes increased from 0.86 to 3.00 and 22.43 to 32.60, respectively, before and after the NYT article (both p < 0.05). Minoxidil searches continually increased by 500,000 searches per month (p < 0.001). Conclusions: There was a significant and sustained increase in Google searches for oral minoxidil after publication of the NYT article, indicating increased patient interest. Larger clinical trials are needed to provide evidence-based care to AGA patients.
{"title":"Increased Interest in Oral Minoxidil for Hair Loss Treatment Following Publication of August 2022 New York Times Article: A Google Trends Analysis","authors":"Noelle Desir, Amar D. Desai, Shari R. Lipner","doi":"10.1159/000534526","DOIUrl":"https://doi.org/10.1159/000534526","url":null,"abstract":"<b><i>Introduction:</i></b> Androgenetic alopecia (AGA) is the most common form of hair loss, with negative impact on patient quality of life. Oral minoxidil is used off-label for AGA treatment. We hypothesized increased public interest in oral minoxidil for hair loss treatment following the New York Times (NYT) Article on oral minoxidil: “An Old Medicine Grows New Hair for Pennies a Day, Doctors Say.” The objective of this study was to quantify interest in oral minoxidil for hair loss treatment before and after the NYT article and help inform dermatologists about treatments of interest to their patients. <b><i>Method:</i></b> We performed a cross-sectional analysis of Google Trends evaluating relative prevalence of “oral minoxidil,” “minoxidil,” “hair loss,” and “Rogaine<sup>®</sup>” 2/2022–5/2023. <i>t</i> tests compared mean search volume and linear regression analysis quantified changes in public interest over time. <b><i>Results:</i></b> Oral minoxidil and minoxidil search volumes increased from 0.86 to 3.00 and 22.43 to 32.60, respectively, before and after the NYT article (both <i>p</i> &lt; 0.05). Minoxidil searches continually increased by 500,000 searches per month (<i>p</i> &lt; 0.001). <b><i>Conclusions:</i></b> There was a significant and sustained increase in Google searches for oral minoxidil after publication of the NYT article, indicating increased patient interest. Larger clinical trials are needed to provide evidence-based care to AGA patients.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"230 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences. Methods: Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed. Results: A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity. Conclusion: There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.
{"title":"The Question of Adolescent and Postadolescent Acne: The Nigerian Experience","authors":"Ehiaghe Lonia Anaba, Hadiza Sani, Babawale Arabambi","doi":"10.1159/000534165","DOIUrl":"https://doi.org/10.1159/000534165","url":null,"abstract":"<b><i>Introduction:</i></b> Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences. <b><i>Methods:</i></b> Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed. <b><i>Results:</i></b> A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity. <b><i>Conclusion:</i></b> There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135221860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aditya K. Gupta, Tong Wang, Mary A. Bamimore, Shruthi Polla Ravi, Mesbah Talukder
Background: Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking. Objective: The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks. Methods: We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments’ surface under the cumulative ranking distribution (SUCRA) values and relative effects – in terms of mean difference (MD). Results: Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater (p < 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm2), PRP monotherapy (MD = 16 hairs/cm2), and microneedling monotherapy (MD = 17 hairs/cm2). Conclusion: Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.
{"title":"Relative Effects of Minoxidil 5%, Platelet-Rich Plasma, and Microneedling in Pattern Hair Loss: A Systematic Review and Network Meta-Analysis","authors":"Aditya K. Gupta, Tong Wang, Mary A. Bamimore, Shruthi Polla Ravi, Mesbah Talukder","doi":"10.1159/000534196","DOIUrl":"https://doi.org/10.1159/000534196","url":null,"abstract":"<b><i>Background:</i></b> Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking. <b><i>Objective:</i></b> The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks. <b><i>Methods:</i></b> We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments’ surface under the cumulative ranking distribution (SUCRA) values and relative effects – in terms of mean difference (MD). <b><i>Results:</i></b> Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater (<i>p</i> &lt; 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm<sup>2</sup>), PRP monotherapy (MD = 16 hairs/cm<sup>2</sup>), and microneedling monotherapy (MD = 17 hairs/cm<sup>2</sup>). <b><i>Conclusion:</i></b> Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"7 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136234269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thayane Batista Lemos, Rita Fernanda Cortez de Almeida, Sidney Frattini, Michela Starace, Daniel Fernandes Melo
Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus. It is more frequent in adult women, particularly black race. Scalp DLE has an earlier onset and a more severe clinical course in black patients compared to Caucasians. Nevertheless, studies on this population remain scarce. The aim of this study was to review the literature and summarize the most frequent trichoscopic findings of scalp DLE among patients with a higher phototype. The main trichoscopic findings of DLE on black scalp are interruption of the honeycomb pattern, reduction, or absence of pinpoint white dots, keratotic follicular plugs and peripilar casts, blue-gray dots in a speckled pattern, and large tortuous arboriform vessels. Knowledge of these and other changes enables an early diagnosis of these individuals, preventing cicatricial sequelae and reducing its impact on quality of life.
{"title":"Trichoscopy of Discoid Lupus Erythematosus in the Black Scalp: A Literature Review","authors":"Thayane Batista Lemos, Rita Fernanda Cortez de Almeida, Sidney Frattini, Michela Starace, Daniel Fernandes Melo","doi":"10.1159/000534430","DOIUrl":"https://doi.org/10.1159/000534430","url":null,"abstract":"Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus. It is more frequent in adult women, particularly black race. Scalp DLE has an earlier onset and a more severe clinical course in black patients compared to Caucasians. Nevertheless, studies on this population remain scarce. The aim of this study was to review the literature and summarize the most frequent trichoscopic findings of scalp DLE among patients with a higher phototype. The main trichoscopic findings of DLE on black scalp are interruption of the honeycomb pattern, reduction, or absence of pinpoint white dots, keratotic follicular plugs and peripilar casts, blue-gray dots in a speckled pattern, and large tortuous arboriform vessels. Knowledge of these and other changes enables an early diagnosis of these individuals, preventing cicatricial sequelae and reducing its impact on quality of life.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"9 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136233975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acne is a chronic inflammatory disease of the pilosebaceous unit with a multifactorial etiology and is one of the most common conditions treated by dermatologists and primary care physicians. Within an extensive and evolving treatment landscape, oral isotretinoin has demonstrated efficacy for treatment of severe, recalcitrant acne. Several side effects of isotretinoin have been reported, including laboratory abnormalities, mucocutaneous, and musculoskeletal effects, which may reduce compliance and patient satisfaction with treatment. In this narrative review, we aim to review the efficacy and safety profile of oral supplements or topical adjuvant therapies in mitigating isotretinoin-associated mucocutaneous and musculoskeletal side effects. Oral supplements reviewed include omega-3 fatty acids, vitamin E, folic acid and vitamin B12, antihistamines, l-carnitine, biotin, and combined oral supplements. Topical adjuvants include a hyaluronic acid, biosaccharide gum-2, and glycerine gel-cream; a nongreasy, noncomedogenic, fragrance-free moisturizing cream; dexpanthenol; trichloroacetic acid; and a combination cream. Most of the supplements and topical adjuvants demonstrated efficacy with an adequate level of supporting evidence and no reported adverse events, indicating an adequate safety profile. Patients on isotretinoin may benefit from using oral supplements and topical adjuvants to minimize primarily mucocutaneous side effects, increase adherence to treatment, and thereby improve overall outcomes.
{"title":"Use of Oral Supplements and Topical Adjuvants for Isotretinoin-Associated Side Effects: A Narrative Review","authors":"Sophia Reyes-Hadsall, Teresa Ju, Jonette E. Keri","doi":"10.1159/000533963","DOIUrl":"https://doi.org/10.1159/000533963","url":null,"abstract":"Acne is a chronic inflammatory disease of the pilosebaceous unit with a multifactorial etiology and is one of the most common conditions treated by dermatologists and primary care physicians. Within an extensive and evolving treatment landscape, oral isotretinoin has demonstrated efficacy for treatment of severe, recalcitrant acne. Several side effects of isotretinoin have been reported, including laboratory abnormalities, mucocutaneous, and musculoskeletal effects, which may reduce compliance and patient satisfaction with treatment. In this narrative review, we aim to review the efficacy and safety profile of oral supplements or topical adjuvant therapies in mitigating isotretinoin-associated mucocutaneous and musculoskeletal side effects. Oral supplements reviewed include omega-3 fatty acids, vitamin E, folic acid and vitamin B12, antihistamines, l-carnitine, biotin, and combined oral supplements. Topical adjuvants include a hyaluronic acid, biosaccharide gum-2, and glycerine gel-cream; a nongreasy, noncomedogenic, fragrance-free moisturizing cream; dexpanthenol; trichloroacetic acid; and a combination cream. Most of the supplements and topical adjuvants demonstrated efficacy with an adequate level of supporting evidence and no reported adverse events, indicating an adequate safety profile. Patients on isotretinoin may benefit from using oral supplements and topical adjuvants to minimize primarily mucocutaneous side effects, increase adherence to treatment, and thereby improve overall outcomes.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135618687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alia Abbas, Sima Amin, Adaugo Sanyi, Tiffany Mayo, Boni Elewski
Background: Nail psoriasis is a common condition that affects quality of life in individuals with psoriasis and psoriatic arthritis. Topical treatments have been shown to be effective in treating nail bed disease but not as effective in treating nail matrix diseases, which often requires intralesional corticosteroids. Objectives: The objective of this open-label study was to evaluate the efficacy of combination calcipotriol/betamethasone dipropionate foam as a treatment for nail psoriasis including nail matrix disease. Method: We report three patients with moderate to severe nail psoriasis with involvement of all ten fingernails who applied study foam nightly for 6 months. Nails were assessed using the NAPSI score evaluating both nail bed and nail matrix disease. Results: NAPSI score improved including nail matrix disease in the majority of nails. No skin irritation or unexpected adverse events occurred. Conclusions: We conclude this foam combination product could be an effective and safe treatment for fingernail psoriasis and may provide better nail matrix penetration as evidenced by improvement in nail matrix score. Further studies are needed for additional evaluation.
{"title":"Calcipotriene/Betamethasone Dipropionate Foam as a Potential Safe and Effective Treatment of Nail Psoriasis","authors":"Alia Abbas, Sima Amin, Adaugo Sanyi, Tiffany Mayo, Boni Elewski","doi":"10.1159/000533994","DOIUrl":"https://doi.org/10.1159/000533994","url":null,"abstract":"Background: Nail psoriasis is a common condition that affects quality of life in individuals with psoriasis and psoriatic arthritis. Topical treatments have been shown to be effective in treating nail bed disease but not as effective in treating nail matrix diseases, which often requires intralesional corticosteroids. Objectives: The objective of this open-label study was to evaluate the efficacy of combination calcipotriol/betamethasone dipropionate foam as a treatment for nail psoriasis including nail matrix disease. Method: We report three patients with moderate to severe nail psoriasis with involvement of all ten fingernails who applied study foam nightly for 6 months. Nails were assessed using the NAPSI score evaluating both nail bed and nail matrix disease. Results: NAPSI score improved including nail matrix disease in the majority of nails. No skin irritation or unexpected adverse events occurred. Conclusions: We conclude this foam combination product could be an effective and safe treatment for fingernail psoriasis and may provide better nail matrix penetration as evidenced by improvement in nail matrix score. Further studies are needed for additional evaluation.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"18 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136032586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vishal Gaurav, Mehul Tyagi, Chander Grover, Shukla Das
Introduction: Nail unit infestation by scabies mites (ungual scabies) is uncommon. It usually presents with distal subungual lesions, leading to recurrent and persistent disease by acting as a reservoir of infection. Periungual involvement in scabies with nail loss is rare and may lead to severe nail damage. Case Presentation: We report a 14-year-old boy on chemotherapy for acute lymphocytic leukemia (ALL) who presented with extensive scaling and crusted plaques of scabies. Nail unit revealed periungual crusted plaques with paronychia and onychomadesis involving five digits. It was associated with partial to complete nail loss. Dermoscopy of periungual crusted plaques showed greyish-white scales with brown dots and globules. A sinuous burrow with a brown-triangular structure was visualized in the web space. KOH mount from skin scrapings showed the scabies mites. Treatment of scabies led to a marked improvement. Conclusion: Though ungual scabies is generally a benign disease, proximal periungual involvement with damage to nail matrix is possible, leading to nail loss. We review manifestations of nail unit scabies reported in literature. Treatment options used and outcomes are also analyzed. The importance of nail-directed therapy in preventing relapses of scabies cannot be undermined.
{"title":"Ungual Scabies: A Case Report and Review of Literature","authors":"Vishal Gaurav, Mehul Tyagi, Chander Grover, Shukla Das","doi":"10.1159/000533881","DOIUrl":"https://doi.org/10.1159/000533881","url":null,"abstract":"<b><i>Introduction:</i></b> Nail unit infestation by scabies mites (ungual scabies) is uncommon. It usually presents with distal subungual lesions, leading to recurrent and persistent disease by acting as a reservoir of infection. Periungual involvement in scabies with nail loss is rare and may lead to severe nail damage. <b><i>Case Presentation:</i></b> We report a 14-year-old boy on chemotherapy for acute lymphocytic leukemia (ALL) who presented with extensive scaling and crusted plaques of scabies. Nail unit revealed periungual crusted plaques with paronychia and onychomadesis involving five digits. It was associated with partial to complete nail loss. Dermoscopy of periungual crusted plaques showed greyish-white scales with brown dots and globules. A sinuous burrow with a brown-triangular structure was visualized in the web space. KOH mount from skin scrapings showed the scabies mites. Treatment of scabies led to a marked improvement. <b><i>Conclusion:</i></b> Though ungual scabies is generally a benign disease, proximal periungual involvement with damage to nail matrix is possible, leading to nail loss. We review manifestations of nail unit scabies reported in literature. Treatment options used and outcomes are also analyzed. The importance of nail-directed therapy in preventing relapses of scabies cannot be undermined.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136062706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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