Efficacy of Calcipotriol/Betamethasone Dipropionate Fixed-Combination Aerosol Foam in the Treatment of Localized Scalp Psoriasis: A Real-Life Case Series from Switzerland.

INTRODUCTION: Scalp psoriasis is one of the most common and challenging manifestations of plaque psoriasis for general practitioners, dermatologists, and patients, as successful topical management requires the choice of effective ingredients, an appropriate formulation, and clear application instructions to patients. To date, only limited experience is available for the calcipotriol (50 µg/g)/betamethasone dipropionate (0.5 mg/g) aerosol foam formulation (Cal/BD foam) in the treatment of scalp psoriasis. METHODS: In this Swiss real-world patient case series, we asked 10 consecutive patients with active scalp psoriasis to apply the Cal/BD foam once daily before bedtime for a period of 4 weeks. Clear application and rinse-off instructions were provided. RESULTS: A total of 10 consecutive adult patients were treated between April and May 2019. Two patients suffered from mild, five from moderate, and three from severe scalp psoriasis. In eight out of the 10 patients, scalp psoriasis was the only manifestation of disease. All patients had received previous topical treatments, mainly topical corticosteroids (TCS), tar shampoo, and salicylic acid. After 4 weeks of treatment with Cal/BD foam, the scalp psoriasis improved in all 10 patients by ≥ 2 points on a 5-point severity assessment scale. Eight out of 10 patients achieved clear/almost clear skin after 4 weeks of treatment, with no further keratolytic treatments needed. Adverse events were not observed in any of the patients. Overall, patients were very satisfied with the ease of use, the efficacy, and the safety of the Cal/BD foam. CONCLUSION: Our case series confirms that Cal/BD foam is a rapid, effective, and convenient treatment for localized scalp psoriasis in a nonselected real-world patient cohort refractory to TCS or other local treatments. Clear application instructions are crucial for treatment success and cosmetic acceptance, however.

Look at Your Hair the Way You Look at Your Face: Concept of Total Facial Skin and Hair Care.

With today's increasing life expectation and quality of life, the desire to look young and beautiful plays a bigger role than ever. Aging of the hair is particularly visible. And yet, cosmetic dermatology has paid comparatively little attention to the care of the aging hair. The professional market for cosmetic interventions into the face has preceded those into the hair for a number of reasons. First, the market for facial rejuvenation has been dominated by plastic surgeons, until the fillers and botulinum toxin were introduced. Second, investigative dermatology found a profound interest in the study of skin aging, particularly as it relates to ultraviolet exposure, and exposed mechanisms at the level of the DNA and repair mechanisms, opening venues for effective preventive measures and pharmacological treatments of aging-related conditions of the skin. Finally, at the level of health professionals, the care for the skin has been overrated in relation to the hair, mostly due to economic reasons. Nevertheless, the hair represents an integral part of the face and our appearance. Moreover, the discovery of pharmacological targets and the development of safe and effective drugs for treatment of hair loss indicate strategies of the drug industry for maintenance of hair growth and quantity, while the hair care industry has become capable of delivering active compounds directed toward meeting the consumer demand for maintenance of hair cosmesis and quality. To offer patients the best outcomes toward a more youthful look, we therefore should look at the whole face including the condition of the hair for a more comprehensive approach toward a total facial skin and hair care concept.

Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?

Post-finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat either hair loss or benign prostatic hyperplasia, independent of age, dosage, or indication. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of finasteride treatment. As yet, the condition is not recognized by the medical community, although individuals who suffer from PFS present with relatively homogenous symptoms. The concept of PFS has emerged from reports of non-dermatologists, neuroendocrinological research and reflections, and uncontrolled studies of low quality and with a strong bias selection, while a significant nocebo effect among patients informed about possible side effects of finasteride is recognized. There are no predictive factors for the risk of development of PFS. Nevertheless, it has been suggested that a patient history of preexisting mental health disorder, particularly depression, may put patients at an increased risk. We report the first case of PFS in a long-standing (over 20 years) dermatotrichological practice with frequent finasteride prescription observed in a 25-year-old male following dutasteride treatment for male androgenetic alopecia. There was circumstantial evidence that PFS may represent a delusional disorder of the somatic type, possibly on a background of a histrionic personality disorder, which would explain the refractoriness of the condition and a high degree of suggestibility.

Precision Medicine and the Practice of Trichiatry: Adapting the Concept.

Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, engineering, and statistics, such as the systematic review of medical literature, meta-analysis, risk-benefit analysis, and randomized controlled trials. The limited success rate of EBM therapies suggests that the complex nature of hair loss may be inadequately served by the present levels of evidence, and that physicians treating hair loss may have fallen short of adequately researching a robust evidence to underpin their practices. Against this backdrop, the concept of precision medicine (PM) is evolving. PM refers to the customization of medical care to the patient's individual characteristics based on the patient's genetic background and other molecular or cellular analysis, while classifying patients into subpopulations that differ in their susceptibility to a particular medical condition, in the biology or prognosis of those medical conditions, or in their response to a specific treatment. With the advances in hair research, the powerful tools of molecular biology and genetics, and innovative technologies, we have the robust scientific data and tools to adapt the concept of PM to the practice of trichiatry. Finally, databases pertaining to the development and efficacy of PM must be analyzed and be used to form the basis of evidence-based personalized trichiatry.

Comparative Analysis of Efficacy, Toxicity, and Patient-Reported Outcomes in Rectal Cancer Patients Undergoing Preoperative 3D Conformal Radiotherapy or VMAT.

BACKGROUND: Locally advanced rectal cancer (LARC) patients are usually treated within a multimodal therapy regime, in which the tumor resection plays the major role. This treatment ideally includes 5-fluorouracile (5FU)-based chemoradiation (CRT) leading to significantly improved local control rates. Local therapy as radiotherapy (RT) is required to be adapted referring to side effects and efficacy. Purpose of this study is the comparison of dosimetric parameters, acute and late toxicity, and quality of life in terms of patient-reported outcome (PRO) in patients treated with VMAT or 3D conformal radiotherapy (3DCRT) for LARC. METHODS: Pelvic RT for LARC was performed with a prescription dose of 45 Gy in 1.8 Gy per fraction, 50.4 Gy in 1.8 Gy per fraction, or 50 Gy in 2 Gy per fraction. Chemotherapy included 5FU or 5FU/Oxaliplatin or Capecitabine-based RT. Acute and late toxicity were evaluated via National Institute Common Terminology Criteria for Adverse Events version (CTCAE) v4.03 and the Scoring System Late effects of Normal Tissue. Quality of life was established via EORTC QLQCR29. RESULTS: After a median follow-up of 38 months (VMAT) and 78 months (3DCRT) there was no significant difference in progression-free survival (p = 0,85) but a significant difference in overall survival (p = 0.032). Regarding dose-volume parameters, patients treated with VMAT plans had a lower V20 of the bladder than 3DCRT-treated patients (p = 0.004). VMAT plans can also reduce Dmean of the right (p = 0.002) and left (p < 0.001) femoral head. Acute side effects between the VMAT and 3DCRT patients showed no significant difference. But concerning long-term effects, VMAT-treated patients had a significant lower appearance of high grade anal incontinence (p = 0.032). Quality of life (PRO) showed no significant different between the patients except of hair loss and worrying about weight. CONCLUSION: VMAT treatment of LARC in preoperative CRT revealed a reduction of dose to organs at risk (OARs) as bladder and femoral heads. However, no changes in acute and long-term toxicity profiles were detectable. For late toxicity and quality of life data longer follow-up times are required.