Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles.
Objective
To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL].
Methods
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.
Results
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).
Conclusions
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.
{"title":"Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study","authors":"Abhijeet Kumar Jha MD FRCP, MD Zeeshan MD, Anupama Singh MD, DNB, Anil Kumar Singh MD, DNB, DM (Endocrinology)","doi":"10.1111/ajd.14306","DOIUrl":"10.1111/ajd.14306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.139).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 5","pages":"437-443"},"PeriodicalIF":2.2,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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).
Objectives
Our retrospective study aimed to better define prognostic subgroups among patients with CKS, which is the most common in our country.
Method
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.
Results
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.
Conclusion
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.
{"title":"Prognostic factors in Kaposi sarcoma, single centre experience","authors":"Ezgi Değerli MD, Kerem Oruç MD, Nihan Şentürk Öztaş MD, Gülin Alkan Şen MD, Şahin Bedir MD, Nebi Serkan Demirci MD, Hulusi Fuat Demirelli MD","doi":"10.1111/ajd.14309","DOIUrl":"10.1111/ajd.14309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Our retrospective study aimed to better define prognostic subgroups among patients with CKS, which is the most common in our country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 5","pages":"444-450"},"PeriodicalIF":2.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Foley MBBS, BMedSc, MD, FACD, Patrick D. Mahar MBBS, LLB, GDLP, MBA, MDerm, PhD, DMedSc, FACD, Saxon D. Smith MBBS, MHL, PhD, GAICD, FAMA, IFAAD, FACD, Monisha Gupta MBBS, MD, FACD, Nicholas Manuelpillai MBBS, BEng, BCom, MPH, David Orchard MBBS, FACD, Li-Chuen Wong MBBS, FACD, John C. Su MBBS, MEpi, FACD, Amelia James BSc, MD, Gayle Fischer MBBS, FACD, MD, Gillian Marshman MBBS, FACD, Morton Rawlin MBBS, FRACGP, Murray Turner LLB, BArts(Rec), Emma King RN, Robyn Kennedy RN, Christopher Baker MBBS, FACD, FRCP
Background
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.
Methods
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).
Results
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.
Conclusion
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.
{"title":"Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies – Considerations for paediatric patients","authors":"Peter Foley MBBS, BMedSc, MD, FACD, Patrick D. Mahar MBBS, LLB, GDLP, MBA, MDerm, PhD, DMedSc, FACD, Saxon D. Smith MBBS, MHL, PhD, GAICD, FAMA, IFAAD, FACD, Monisha Gupta MBBS, MD, FACD, Nicholas Manuelpillai MBBS, BEng, BCom, MPH, David Orchard MBBS, FACD, Li-Chuen Wong MBBS, FACD, John C. Su MBBS, MEpi, FACD, Amelia James BSc, MD, Gayle Fischer MBBS, FACD, MD, Gillian Marshman MBBS, FACD, Morton Rawlin MBBS, FRACGP, Murray Turner LLB, BArts(Rec), Emma King RN, Robyn Kennedy RN, Christopher Baker MBBS, FACD, FRCP","doi":"10.1111/ajd.14303","DOIUrl":"10.1111/ajd.14303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 6","pages":"e134-e144"},"PeriodicalIF":2.2,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sha Jin MMed, Yige Zhao MMed, Shiwen Wang MMed, Panpan Wang MMed, Chenyu Tang MMed, Mengyan Zhu MMed, Ping Wang PhD
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.
放线菌病（MF）是一种起源于记忆 T 细胞的低度恶性皮肤 T 细胞淋巴瘤。它的病程通常比较特殊，病情相对较轻。MF过去以组织驻留记忆T细胞（TRM）表型为特征，但最近的分子研究揭示了它的复杂性，使人们对其起源细胞和TRM-MF范式产生了怀疑。最近的克隆异质性研究表明，MF 可能起源于未成熟的早期前体 T 细胞。在发育过程中，肿瘤微环境（TME）会影响肿瘤细胞的表型。中性粒细胞的确切起源和发育轨迹仍然难以捉摸。明确 MF 细胞的起源对于准确诊断和有效治疗至关重要。
{"title":"Phenotypic heterogeneity of mycosis fungoides cells leads to the difficulties in determining tumour origin","authors":"Sha Jin MMed, Yige Zhao MMed, Shiwen Wang MMed, Panpan Wang MMed, Chenyu Tang MMed, Mengyan Zhu MMed, Ping Wang PhD","doi":"10.1111/ajd.14304","DOIUrl":"10.1111/ajd.14304","url":null,"abstract":"<p>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.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 5","pages":"e114-e116"},"PeriodicalIF":2.2,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Miranda Wallace<sup>1</sup>; <span>Nancy</span> <span>Todes-Taylor</span><sup><span>2</span></sup>; Margot Whitfeld<sup>3</sup></p><p><sup><i>1</i></sup><i>Pacific Dermatology, St Leonards, New South Wales, Australia;</i> <sup><i>2</i></sup><i>St Leonards Dermatology & Laser, St Leonards, New South Wales, Australia;</i> <sup><i>3</i></sup><i>Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia</i></p><p><b>Aim:</b> 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.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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.</p><p><b>Conclusion:</b> Neurogenic rosacea is difficult to treat, and dilute intradermal onabotulinum toxin A, may be beneficial therapy to consider in refractory cases.</p><p><span>James Fuller</span><sup><span>1</span></sup>; Cathal O'Connor<sup>2</sup>; Michelle Murphy<sup>2</sup></p><p><sup><i>1</i></sup><i>Skin Health Institute, Melbourne, Victoria, Australia;</i> <sup><i>2</i></sup><i>South Infirmary Victoria and University Hospital, Cork, Ireland</i></p><p><b>Aim:</b> 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
米兰达-华莱士（Miranda Wallace）1；南希-托德斯-泰勒（Nancy Todes-Taylor）2；玛格特-惠特菲尔德（Margot Whitfeld）31澳大利亚新南威尔士州圣莱昂纳兹太平洋皮肤科；2澳大利亚新南威尔士州圣莱昂纳兹皮肤科&激光；3澳大利亚新南威尔士州悉尼圣文森特医院皮肤科：神经源性红斑痤疮是一种由于神经源性调节失调引起的红斑痤疮，其特征是严重的面部红斑、烧灼感、刺痛和疼痛，有时与潮红程度不成比例。这种病症并不常见，通常会使人衰弱，严重影响生活质量，传统的红斑痤疮疗法往往难以奏效。在其他疗法无效的情况下，采用皮内微注射技术，将稀释的奥博毒素 A 注射到受累的面部纹路中，可以显著改善潮红和疼痛的程度：一名 37 岁的女性，长期面部潮红，脸颊、前额和下巴皮肤灼热，结膜充血，被诊断为神经源性红斑痤疮和眼部红斑痤疮。她曾接受过多种治疗，包括甲硝唑外用药、溴莫尼丁、伊维菌素、口服多西环素、β受体阻滞剂、α受体阻滞剂、米氮平、阿米替林和血管激光治疗，但均无效。此外，还进行了斑贴试验和血液评估，以排除其他诊断。用生理盐水稀释的A型伊诺保妥适（1.67单位/0.1毫升）在多个部位注射，间隔约1厘米，每个注射部位约0.05毫升，在上额、脸颊、上唇和下巴部位共使用了25个单位，这些部位是受红斑影响最严重的部位。此外，还在睑板腺复合体注射了 14 IU 奥那布林毒素 A（100 IU，用 2.5 mL 生理盐水稀释）：结果：患者在第一次治疗后的两周内发现症状有所改善，由于疗效显著，4 个月后又要求进行第二次治疗。酒糟鼻生活质量测试（RosQol）显示，第一次治疗后四个月，患者的生活质量从 76 分下降到 58 分：James Fuller1; Cathal O'Connor2; Michelle Murphy21Skin Health Institute, Melbourne, Victoria, Australia; 2South Infirmary Victoria and University Hospital, Cork, IrelandAim: 酒渣鼻是一种常见的慢性炎症性皮肤病，病因复杂，对患者的心理影响很大。与其他人群相比，红斑痤疮患者的尴尬、社交焦虑、抑郁和生活质量（QoL）下降的发生率较高。在互联网聊天论坛和社交媒体平台盛行的今天，患者可以使用未经证实的资源匿名研究酒渣鼻，这使他们在希望改善生活质量的过程中很容易受到错误信息和阴谋论的影响。我们旨在评估网上与酒渣鼻相关的错误信息的内容：2023 年 1 月，我们使用 "红斑痤疮"、"错误信息 "或 "虚假信息 "或 "阴谋论 "等词对 PubMed 进行了正式审查，并使用这些词的组合对谷歌进行了非正式搜索。从每次谷歌搜索的前 10 页中收集图片和直接引文形式的信息。此外，还在 Twitter、Facebook、Instagram 和 TikTok 等社交媒体上进行了更多有针对性的搜索：搜索中发现的错误信息主要包括：将红斑痤疮误认为成人痤疮；关于红斑痤疮只发生在老年人或皮肤色素较浅的人身上的错误说法；导致红斑痤疮的错误原因，如化妆品或饮食；以及误导性的 "治疗方法"，其中一些方法可能会导致潜在的红斑痤疮恶化：结论：酒糟鼻患者可能会依赖网络社交媒体和互联网平台上由同龄人产生的信息，这是因为酒糟鼻会对患者造成严重的心理影响，而且酒糟鼻是无法治愈的。依赖网络论坛可能会给患者带来负面影响，因为虚假信息传播迅速，且缺乏监控或验证，令人不安。皮肤科医生必须了解网上流行的大量红斑痤疮错误信息，并准备好用证据来反驳它们，以优化患者护理。
{"title":"Rosacea","authors":"","doi":"10.1111/ajd.14288","DOIUrl":"10.1111/ajd.14288","url":null,"abstract":"<p>Miranda Wallace<sup>1</sup>; <span>Nancy</span> <span>Todes-Taylor</span><sup><span>2</span></sup>; Margot Whitfeld<sup>3</sup></p><p><sup><i>1</i></sup><i>Pacific Dermatology, St Leonards, New South Wales, Australia;</i> <sup><i>2</i></sup><i>St Leonards Dermatology & Laser, St Leonards, New South Wales, Australia;</i> <sup><i>3</i></sup><i>Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia</i></p><p><b>Aim:</b> 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.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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.</p><p><b>Conclusion:</b> Neurogenic rosacea is difficult to treat, and dilute intradermal onabotulinum toxin A, may be beneficial therapy to consider in refractory cases.</p><p><span>James Fuller</span><sup><span>1</span></sup>; Cathal O'Connor<sup>2</sup>; Michelle Murphy<sup>2</sup></p><p><sup><i>1</i></sup><i>Skin Health Institute, Melbourne, Victoria, Australia;</i> <sup><i>2</i></sup><i>South Infirmary Victoria and University Hospital, Cork, Ireland</i></p><p><b>Aim:</b> 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","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 S1","pages":"120-121"},"PeriodicalIF":2.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethics and Professionalism","authors":"","doi":"10.1111/ajd.14280","DOIUrl":"10.1111/ajd.14280","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 S1","pages":"45-46"},"PeriodicalIF":2.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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