Kava induced dermatitis has been reported in previous case series, however the histology has rarely been described. This case report details an erythematous eruption associated with Kava ingestion and the associated folliculocentric sebaceous inflammation found on histological analysis.
Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles.
To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL].
The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment.
Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139).
Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.
Kaposi sarcoma (KS) is a multicentric vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). It generally concerns the elderly and immunosuppressed population. Four major clinical types of KS have been described. The most common subtype is Classical KS (CKS).
Our retrospective study aimed to better define prognostic subgroups among patients with CKS, which is the most common in our country.
Between 2014 and 2020, 43 patients with CKS were treated with local excision, radiotherapy and chemotherapy. Reviewed information included demographics, clinical features, laboratory findings, treatment responses and overall survival.
During the follow-up, eight patients (18.6%) died of CKS. The complete response rate was 46.5%, partial response and stable disease 51.2%, and progressive disease 2.3% of all patients. Gender, haemoglobin level at diagnosis, and disseminated involvement were prognostic factors affecting survival in all patients.
We confirmed that male gender, low haemoglobin levels, and disseminated involvement are associated with poor prognosis in CKS patients. It is the only Turkish study in which prognostic analysis was performed for this rare cancer.
Treatment goals have been established in Australia to facilitate the management of adults with moderate to severe psoriasis. The Australasian College of Dermatologists sought to determine if and how these adult treatment goals could be modified to accommodate the needs of paediatric and adolescent patients.
A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7–9 on a 9-point scale (1 strongly disagree; 9 strongly agree).
Consensus was achieved on 23/29 statements in round 1 and 17/18 statements in round 2. There was a high level of concordance with treatment criteria in the adult setting. The limitations of applying assessment tools developed for use in adult patients to the paediatric setting were highlighted. Treatment targets in the paediatric setting should include objective metrics for disease severity and psychological impact on the patients and their family, and be based on validated, age-appropriate tools.
While the assessment, classification and management of moderate to severe psoriasis in paediatric patients aligns with metrics established for adults, it is vital that nuances in the transition from childhood to adolescence be taken into account. Future research should focus on psoriasis severity assessment scales specific to the paediatric setting.
Mycosis fungoides (MF) is a low-grade malignant cutaneous T-cell lymphoma that originates from memory T cells. It typically follows a unique and relatively indolent disease course. MF is used to be characterized by a tissue-resident memory T cell (TRM) phenotype, although recent molecular research has revealed its complexity, casting doubt on the cell of origin and the TRM-MF paradigm. Recent clonal heterogeneity studies suggest that MF may originate from immature early precursor T cells. During development, the tumour microenvironment (TME) influences tumour cell phenotype. The exact origin and development trajectory of MF remains elusive. Clarifying the origin of MF cells is vital for accurate diagnosis and effective treatment.
Miranda Wallace1; Nancy Todes-Taylor2; Margot Whitfeld3
1Pacific Dermatology, St Leonards, New South Wales, Australia; 2St Leonards Dermatology & Laser, St Leonards, New South Wales, Australia; 3Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia
Aim: Neurogenic rosacea is a form of rosacea due to neurogenic dysregulation and is characterised by severe facial erythema, burning, stinging and pain sometimes out of proportion to the degree of flushing. It is an uncommon, and often debilitating condition with severe effect on quality of life, and often refractory to traditional rosacea therapies. The intradermal microinjection technique of injecting diluted onabotulinum toxin A into the involved facial pattern can produce a significant improvement in the degree of both flushing and pain, where other therapies have failed.
Methods: A 37-year-old female with long history of facial flushing, burning skin of the cheeks, forehead and chin and conjunctival hyperaemia, was diagnosed with a combination of neurogenic and ocular rosacea. She had previously failed therapies including topical metronidazole, brimonidine, ivermectin, oral doxycycline, beta blockers, alpha blockers, mirtazapine, amitriptyline and vascular laser therapy. In addition, patch testing was performed as well blood evaluation to rule out alternative diagnoses. The onabotulinum toxin A (1.67 units per 0.1 mL) diluted in saline, was injected using multiple sites approximately 1 cm apart, and approximately 0.05 mL per injection site, with 25 units in total used over the upper forehead, cheeks, upper lip and chin areas, which were areas most effected by erythema. An additional 14 IU onabotulinum toxin A (100 IU diluted with 2.5 mL saline) diluted was injected into the glabellar complex.
Results: Improvement of symptoms were noticed by the patient within 2 weeks of the first treatment, and a second treatment, 4 months later was requested because of its efficacy. The Rosacea-specific Quality-of-Life instrument (RosQol) showed improvement from a score of 76 to 58 four months after the first treatment.
Conclusion: Neurogenic rosacea is difficult to treat, and dilute intradermal onabotulinum toxin A, may be beneficial therapy to consider in refractory cases.
James Fuller1; Cathal O'Connor2; Michelle Murphy2
1Skin Health Institute, Melbourne, Victoria, Australia; 2South Infirmary Victoria and University Hospital, Cork, Ireland
Aim: Rosacea is a common chronic inflammatory skin disease with a complex aetiology and major psychological impact. Patients with rosacea have higher incidences of embarrassment, social anxiety, depressio
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