RESUMEN
Importance: Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS. Objective: To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS. Evidence Review: A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis. Findings: Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies. Conclusions and Relevance: This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.
Asunto(s)
Remoción del Cabello , Hirsutismo , Síndrome del Ovario Poliquístico , Femenino , Humanos , Terapia Combinada , Remoción del Cabello/métodos , Hirsutismo/terapia , Hirsutismo/etiología , Terapia por Láser/métodos , Terapia por Luz de Baja Intensidad/métodos , Metformina/uso terapéutico , Metformina/administración & dosificación , Fototerapia/métodos , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/terapia , Resultado del TratamientoAsunto(s)
Adalimumab/efectos adversos , Antiinflamatorios/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Penfigoide Ampolloso/inducido químicamente , Productos Biológicos/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Humanos , Masculino , Penfigoide Ampolloso/diagnóstico , Adulto JovenAsunto(s)
Síndrome de Hipersensibilidad a Medicamentos , Eosinofilia , Exantema , Preparaciones Farmacéuticas , Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Síndrome de Hipersensibilidad a Medicamentos/tratamiento farmacológico , Síndrome de Hipersensibilidad a Medicamentos/etiología , Eosinofilia/inducido químicamente , Eosinofilia/diagnóstico , Eosinofilia/tratamiento farmacológico , Exantema/inducido químicamente , Exantema/diagnóstico , Exantema/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/efectos adversosRESUMEN
Hydroxychloroquine is an age-old drug whose use as an immunomodulatory agent with a low side-effect profile continues to expand. We present a review of this drug including recently updated prescribing recommendations and a summary of its clinical application in dermatology. A maximum daily dose of 5.0 mg/kg based on actual body weight and no greater than 400 mg is advised in order to reduce the risk of retinopathy, which is potentially permanent and has an estimated prevalence of 7.5% at 5 years on standard dosing. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended; however, closer monitoring should be considered in the setting of existing retinopathy, a cumulative dose > 1000 g or renal dysfunction. Hydroxychloroquine is now considered to be safe in pregnancy, and routine glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not required. Smoking can significantly decrease its efficacy although the reason is still uncertain. Hydroxychloroquine appears to also demonstrate antineoplastic and cardioprotective benefits.
Asunto(s)
Hidroxicloroquina/uso terapéutico , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Piel/tratamiento farmacológico , Dermatología , Relación Dosis-Respuesta a Droga , Humanos , Tamizaje Masivo , Monitoreo Fisiológico , Retina/efectos de los fármacos , Enfermedades de la Retina/prevención & control , Medición de RiesgoAsunto(s)
Adenocarcinoma/tratamiento farmacológico , Anilidas/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Liquen Plano/inducido químicamente , Neoplasias Pulmonares/tratamiento farmacológico , Penfigoide Ampolloso/inducido químicamente , Piridinas/efectos adversos , Adenocarcinoma/secundario , Anciano , Femenino , Humanos , Liquen Plano/patología , Neoplasias Pulmonares/patología , Penfigoide Ampolloso/patologíaAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutáneas/diagnóstico , Tobillo , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Emtricitabina/uso terapéutico , Pie , Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Humanos , Linfedema/etiología , Masculino , Persona de Mediana Edad , Oxazinas , Piperazinas , Piridonas , Sarcoma de Kaposi/complicaciones , Sarcoma de Kaposi/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Respuesta Virológica Sostenida , Tenofovir/uso terapéutico , Carga ViralRESUMEN
Cytomegalovirus (CMV) infection represents a major cause of morbidity and mortality in immunocompromised hosts. Skin ulceration is a rare manifestation of tissue-invasive disease, with the anogenital region being the most typical site of involvement. We present a case of CMV ulceration on the right leg occurring 16 years following renal transplantation and 1 year after adjuvant radiotherapy for a Marjolin ulcer at this site. We suggest radiotherapy may provide a mechanism for local reactivation of the virus in the skin of seropositive patients.
Asunto(s)
Carcinoma de Células Escamosas/radioterapia , Infecciones por Citomegalovirus/diagnóstico , Úlcera de la Pierna/virología , Neoplasias Cutáneas/radioterapia , Receptores de Trasplantes , Anciano , Anticuerpos Antivirales/sangre , Carcinoma de Células Escamosas/cirugía , Cicatriz/patología , Citomegalovirus/inmunología , Humanos , Huésped Inmunocomprometido , Inmunoglobulina G/sangre , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Masculino , Radioterapia Adyuvante , Neoplasias Cutáneas/cirugíaRESUMEN
An increased expression of interleukin-23 has been observed in patients with pyoderma gangrenosum, leading to the use of ustekinumab as a therapeutic option. We report the successful use of ustekinumab in three patients with treatment-resistant pyoderma gangrenosum of varying clinical presentations.
Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Piodermia Gangrenosa/tratamiento farmacológico , Ustekinumab/uso terapéutico , Adulto , Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Enfermedad Crónica , Quimioterapia Combinada , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Persona de Mediana Edad , RetratamientoRESUMEN
Inflammatory myofibroblastic tumor (IMT) rarely occurs as a primary cutaneous lesion. We report a case of cutaneous IMT in an 8-year-old girl presenting with an ulcerated nodule on the cheek. Although cutaneous IMT poses a diagnostic challenge because of its rarity, excision of the lesion is likely to be curative.
Asunto(s)
Neoplasias Faciales/patología , Neoplasias de Tejido Muscular/patología , Neoplasias Cutáneas/patología , Niño , Neoplasias Faciales/cirugía , Femenino , Humanos , Neoplasias de Tejido Muscular/cirugía , Neoplasias Cutáneas/cirugíaRESUMEN
We report a case of a 65-year-old marathon runner who presented with painful plaques, which were worse in cold weather and progressed to ulceration. A punch biopsy revealed vascular endothelial hyperplasia and an appearance consistent with reactive angioendotheliomatosis (RAE), a rare, but benign disorder of the skin. Subsequent investigations resulted in the diagnosis of type I cryoglobulinemia; the lesions resolved completely following treatment of the underlying disorder with lenalidomide.
Asunto(s)
Crioglobulinemia/complicaciones , Hemangioendotelioma/complicaciones , Neoplasias Cutáneas/complicaciones , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Crioglobulinemia/diagnóstico , Hemangioendotelioma/tratamiento farmacológico , Hemangioendotelioma/patología , Humanos , Lenalidomida , Masculino , Carrera , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Talidomida/análogos & derivados , Talidomida/uso terapéuticoRESUMEN
A 28-year-old Costa Rican woman presented with a 6-year history of an asymptomatic progressive localized livedo racemosa on her limbs. Histological examination revealed a lymphocytic vasculitis targeting the arterioles in the deep dermis. In addition, a distinct hyalinised fibrin ring was noted at the periphery of the vessel lumen. These findings were consistent with the recently described entity known as lymphocytic thrombophilic arteritis. An extensive array of investigations did not show any underlying systemic disease, and the patient has remained in good health without treatment.