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Alopecia Archives | Skin of Color Update | Dermatology Conference | New York City

Recommendations for Managing Lichen Planopilaris With Hydroxychloroquine During the COVID-19 Pandemic

By | COVID-19 Resources | No Comments
Recommendations Chart

Source: Journal of Drugs in Dermatology

The recommendations are noted in the article, Considerations of Managing Lichen Planopilaris With Hydroxychloroquine During the COVID-19 Pandemic, will be available in the June print issue of the Journal of Drugs in Dermatology.

Chloroquine (CQ) and hydroxychloroquine (HCQ), two well-known drugs among dermatologists, have shown their efficacy in the inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication.1,2 HCQ is found to possess a better clinical safety profile, more potency, and fewer drug–drug interactions compared to chloroquine.3 HCQ has been reported to exert efficacy in the inhibition of SARS-CoV-2 in vitro replication through diverse mechanisms. First, it interferes with the glycosylation of angiotensin-converting enzyme 2 (ACE2), resulting in a subsequent reduction in the binding efficacy between ACE2 on host cells and the SARS-CoV-2 spike protein. Second, it blocks the fusion of the virus to the host cell. Finally, it suppresses the “cytokine storm” accountable for the disease progression to acute respiratory distress syndrome (ARDS). Although studies are underway to confirm the in vivo effectiveness of HCQ in the SARS-CoV-2 infection, promising primary results have led to a shortage of the drug for dermatologic purposes, which is a real concern in the current pandemic.1

While we are amid a pandemic with the possible shortage of HCQ, dermatologists should be reminded that:

  • The anti-inflammatory effect of HCQ may improve the clinical signs of LPP; however, administration of this drug is insufficient to prevent the subclinical disease progression.9 Dermatologists may discontinue the use of HCQ in responders after 1 year with monitoring the patients for recurrence or relapse.5
  • Topical and intralesional super potent corticosteroids are recommended as the first-line treatment in localized LPP.4
  • Oral cyclosporine followed by systemic corticosteroid may be the most effective medications in LPP; however, disease relapse may be detected.10 Mycophenolate mofetil has a more favorable safety profile compared to cyclosporine11 but the immunosuppressive nature of these medications necessitates extreme caution toward their administration during COVID-19 pandemic.12
  • Acitretin (25 mg/day) may be an appropriate alternative since it has shown improvement in 66% of patients.7
  • Pioglitazone (hypoglycemic drug, 15–30 mg/day) has shown some efficacy in the treatment of LPP and can be considered as an alternative to HCQ.4
  • Tetracyclines antibiotics can also be considered as an alternative due to favorable outcomes in previous studies.13

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Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia

By | Aesthetic Dermatology, Medical Dermatology, Sessions | No Comments
Patient with Alopecia

Source: Next Steps in Derm

In this case series, JDD authors evaluate the efficacy and safety of intralesional triamcinolone acetonide injections (ILK) when used with topical minoxidil in the management of traction alopecia in 6 African American women.

Background

Traction alopecia (TA) is a form of hair loss secondary to repetitive and/or prolonged tension to a hair follicle over an extended period of time. This typically results from wearing tight hairstyles, or an acute traumatic event.1,2 As the etiology is mechanical trauma of the hair follicle, it can occur in any ethnic/racial demographic or gender. It has been observed in ballerinas, as well as Sikh Indian males, all of whom wear hairstyles that exert tension on the frontotemporal hairline. However, most cases of TA occur in women of African descent.1,3

The diagnosis of TA can be made clinically, as well as through the histological examination of a scalp biopsy. The earliest signs of TA are perifollicular erythema and pruritus with or without surrounding papules and pustules.4 The fringe sign of TA is a clinical finding characterized by the presence of retained hair along the frontal and/or temporal hairline, and it has been shown to have high sensitivity for detecting early and late disease of TA.5 On dermoscopy, one may observe reduced hair density with an absence of follicular openings in late stages, and in earlier stages an absence of hairs with preserved follicular openings outlined in brown, particularly at the periphery of the patch of affected scalp, corresponding to the pigmented basal cell layer of the follicular infundibulum that can be seen on histology.6,7 The histological findings can also vary depending on the stage of the disease. Early findings on histology include trichomalacia, normal number of terminal hairs, preserved sebaceous glands, and increased number of telogen and catagen hairs.8 Late disease findings include a decreased number of terminal hair follicles which have been replaced by fibrous tracts, vellus hairs, and retained sebaceous glands.8

Recommended treatment for traction alopecia includes the use of minoxidil and intralesional steroid injections. However, evidence-based proof of the efficacy of ILK in the improvement of TA has not been reported in the literature. In this case series, we evaluate the efficacy and safety of intralesional triamcinolone acetonide injections (ILK) when used with topical minoxidil in the management of TA in 6 African American women.

Methods

A retrospective chart review was performed in patients carrying a diagnosis of TA, who were seen at an active hair disorder clinic between January 2016 and December 2017. All patients who were treated with ILK, and whose treatment progress were recorded with photographs were included. Those who used minoxidil as an adjunct treatment were also noted. The management of TA was assessed by comparing the changes in hair density along the frontotemporal hairline. All patients had been instructed to avoid tension-related hair care practices.

Discussion

This study shows that ILK, when used in conjunction with topical minoxidil, is effective in halting TA progression, and in improving frontotemporal hair density in patients with TA. Our patients reported no adverse systemic effects from the injections that are commonly associated with corticosteroids, and only one patient reported itch in the frontotemporal hairline, a symptom which is more likely a side effect of the topical minoxidil or a manifestation of the TA pathology itself.

Results

Of the TA patients seen, 6 met the criteria for our observational study. All 6 were African American females presenting for evaluation of frontotemporal hair loss, with ages ranging from 32 to 61 years. All subjects reported a history of hairstyling that exerted tension to the frontotemporal hairline at some point in their lives, whether it was recent, during childhood, or both. The clinical diagnosis of TA was established through the presence of the fringe sign. Five subjects had 3 to 4 ILK injections done at 6 to 8-week intervals, performed at a concentration of 5 mg/mL, while one subject (Subject #2) received only one treatment with ILK (Table 1) also at a concentration of 5 mg/mL. Injections were done both at the border of the hair loss in the frontotemporal hairline and extending backwards to include the normal density hair. Subjects concurrently used topical minoxidil 5% daily, and one subject (Subject #2) also took oral doxycycline. All subjects reported the cessation of all hair care practices that exert tension to the frontotemporal hairline, including tight ponytails, tight hair braiding/weaving, twisting of locks, use of scarves to tie hair down, and the use of hair gel on the frontotemporal hairline. All subjects demonstrated a visible increase in hair density along the frontotemporal hairline following their third treatment (Figure 1). None of the subjects reported any serious adverse effects from the injections. The subject that received only one ILK treatment and continued dual therapy on minoxidil and doxycycline reported itch initially, which was improved with the use of a topical steroid.

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Skin of Color Update Co-Chair Dr. Eliot Battle Shares Insights into 2019 Faculty and Topics

By | Sessions, Skin of Color Update Agenda | No Comments

Skin of Color Update Co-Chair, Dr. Eliot Battle, discusses the elite faculty lineup and topics planned this year including hair loss, keloids, rosacea, acne, lasers, aesthetic treatments, skin cancer, medical dermatology, melasma, hyperpigmentation, vitiligo, inflammatory diseases and much, much more!

Skin of Color Update 2019 (previously Skin of Color Seminar Series) is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. Attendees leave with critical annual updates and fresh practical pearls in skin of color dermatology.

Join us this year in New York City, September 7-8, 2019! Register today at https://skinofcolorupdate.com/registration-hotel-2019/

Co-Chair Dr. Alexis Shares the Exciting 2019 Program Highlights

By | Sessions, Skin of Color Update Agenda | No Comments

Skin of Color Update 2019 (previously Skin of Color Seminar Series) is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI. Attendees leave with critical annual updates and fresh practical pearls in skin of color dermatology. Earn CE in New York City with direct access to elite experts and an experience unmatched by any other event in dermatology.

Medical Updates in Skin of Color

Medical Updates in Skin of Color

By | Skin of Color Update Agenda | No Comments

During the 16th Annual ODAC Dermatology, Aesthetics and Surgical Conference, ANGELO LANDRISCINA, MD had the pleasure of taking part in the Resident Career Development Mentorship Program (a program supported by an educational grant from Sun Pharmaceutical Industries, Inc.). and was paired with Dr. Andrew Alexis, Co-Chair of the Skin of Color Update.

Dr. Alexis lectured on new developments in the treatment of skin of color focusing on two prevalent conditions: hyperpigmentation and central centrifugal cicatricial alopecia (CCCA). Below are Dr. Landriscina’s takeaways and pearls from this lecture.

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Skin of Color Update CCCA

Pearls from Primary Cicatricial Alopecias in Black Women

By | Sessions, Skin of Color Update Agenda | No Comments

Hair Apparent: A Multi-Part Series on Hair Disorders – Part II

Dermatology residents from throughout the Washington DC area recently convened at a recent hair disorders symposium, where distinguished experts in the field of hair disorders discussed the evaluation, work-up, and treatment of a wide variety of alopecias and scalp disorders. A treasure trove of clinical pearls was shared along the way, and the attendees learned a host of new strategies to apply to the management of hair loss, which is both widely prevalent and frequently undertreated. Attend Skin of Color Update in to learn more or continuing reading below.

This post is the second of a multi-part series that summarizes salient points from each of the lectures, as well as strategies that residents can add to their alopecia armamentarium.

 

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Hair disorders skin of color update

Clinical Approach to Hair Loss in Pediatric Patients

By | Skin of Color Update Agenda | No Comments

Physicians from throughout the Washington DC area recently convened at a hair disorders symposium, where distinguished experts in the field of hair disorders discussed the evaluation, work-up, and treatment of a wide variety of alopecias and scalp disorders. A treasure trove of clinical pearls was shared along the way, and the attendees learned a host of new strategies to apply to the management of hair loss, which is both widely prevalent and frequently undertreated.

This is an excerpt from a multi-part series on Next Steps in Dermatology that summarizes salient points from each of the lectures, as well as strategies that physicians can add to their alopecia armamentarium.

This post is devoted to Dr. Leslie Castelo-Soccio’s lecture, “Clinical approach to hair loss in pediatric patients.” Dr. Castelo-Soccio is a pediatric dermatologist as well as the Dermatology Section’s Director of Clinical Research at Children’s Hospital of Philadelphia. She is an expert in alopecia as well as genetic skin disease. Her lecture provided an incredibly useful roadmap for residents learning to navigate the following aspects of caring for the pediatric alopecia patient…

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alopecia lichen Planus pigmentosus

Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women

By | SOC Manuscripts | No Comments

The association of frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPPigm) is rare. Prior reports suggest that FFA and LPPigm are on the same spectrum of disease, and a diagnosis of LPPigm may predict the future development of FFA. We aim to further characterize the association between FFA and LPPigm by reviewing the clinical cases of seven African American women. Seven patients with FFA were diagnosed clinically by recession of frontotemporal hairline and confirmed by histopathologic examination showing lymphocyte-mediated cicatricial alopecia. LPPigm was diagnosed by clinical evaluation alone based on the characteristic morphology, color, and distribution of the lesions. It is difficult to distinguish whether halted progression of FFA was due to the success of the treatment regimen or spontaneous stabilization of disease over time. Our case series supports the theory that FFA and LPPigm likely exist on the same spectrum of disease. Our observations demonstrate a likely positive correlation between FFA and LPPigm.

Prior studies suggested that LPPigm may be a herald sign for FFA, predicting the future onset of frontotemporal hair loss, though there has been at least one reported case of an individual simultaneously developing FFA and LPPigm. Our results do not support the hypothesis that LPPigm is a herald sign for FFA, but do support the theory that FFA and LPPigm likely exist on the same disease spectrum. Our findings parallel that of another case series which noted that there was no obvious trend pertaining to order of FFA and LPPigm development (Figure 1). A patient with one variant of lichen planus, either FFA or LPPigm, is likely at a higher risk to develop another variant of lichen planus. FFA patients with Fitzpatrick skin type III-V may be more likely to develop LPPigm because this condition commonly presents in darker skin types. Although few studies have previously reported on FFA with concomitant LPPigm, none of these studies specifically focused on the manifestation of this phenomenon in African American women. This is particularly worth investigating, as LPPigm, when it occurs, has a strong predilection for darker skin types, and FFA is most commonly found in women.

Source: J Drugs Dermatol. 2018;17(4):397-400.

Laura N. Uwakwe MD, Leah A. Cardwell MD, Emily H. Dothard MD, Bernice I. Baroudi BS, and Amy J. McMichael MD

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