A review of the treatment of male pattern hair loss

Introduction: Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. An effective treatment for hair baldness is needed.Areas covered: In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens are key role-players in disease pathogenesis. Herein the authors review the pharmacologic treatment of androgenetic alopecia, which involves 5 alpha reductase inhibitors, minoxidil and prostaglandins. Non-pharmacologic approaches are also explored.Expert opinion: Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.Abbreviations: MPHL: male pattern hair loss; AGA: androgenetic alopecia; DHT: dihydrotestosterone; 5AR: 5-alpha-reductase; VEGF: vascular endothelial growth factor; PG's: prostaglandins (PG's); PGD2R: prostaglandin D2 receptor; VPA: valproic aid; SR: Serenoa Repens; PRP: platelet-rich plasma; PDGF: platelet derived growth factor; TGF: transforming growth factor; ERK: extracellular signal-regulated kinase; PKB: protein kinase B; LLLT: low-level laser therapy; ROS: reactive oxygen species; RCT: randomized control trial; SFRP1: secreted frizzled related protein 1; DP: dermal papilla; PDE5: phosphodiesterase 5.

Skin checks in primary care.

BACKGROUND: The incidence of skin cancers in Australia continues to rise. Early detection and timely management are required. OBJECTIVE: This article presents a framework for skin examinations in primary care and outlines the various measures available to facilitate early skin cancer detection. Common characteristics of malignant cancers are also discussed. DISCUSSION: Skin cancer awareness campaigns encourage patients to see their general practitioners (GPs) for complete skin examination. GPs are expected to correctly identify benign and malignant skin lesions and understand their high risk patients. A systematic approach to the skin examination combined with knowledge and awareness of diagnostic tools can aid in the early detection of skin malignancies, and prompt escalation as necessary.

Assessing the validity and response distribution of the simplified psoriasis index in patients receiving phototherapy.

BACKGROUND/OBJECTIVES: The simplified psoriasis index (SPI) is a three-part multidimensional tool incorporating disease severity, psychosocial impact and historical course completed by the health-care professional (professional SPI, [proSPI]) or the patient (self-assessment SPI, [saSPI]). We aimed to assess the validity and response distribution of proSPI and saSPI in patients with psoriasis undergoing phototherapy. METHODS: The validity and response distribution of SPI was assessed by recording saSPI and proSPI in patients with psoriasis before and after a course of phototherapy. Recruitment ended once 100 complete data sets were available for analysis. RESULTS: Altogether 52 of the 100 patients evaluated were male and most (93) underwent narrowband UVB phototherapy. There was a close correlation between the proSPI-current severity score (proSPI-s) with the psoriasis area and severity index (PASI) score (r = 0.76, r = 0.86) before and after treatment, respectively. Although pretreatment correlation between the saSPI-current severity score (saSPI-s) and PASI was weak (r = 0.39), a more close correlation was noted at the end of treatment (r = 0.50). A moderate correlation was observed between the SPI-psychosocial impact score (SPI-p) and the dermatology life quality index (DLQI), both before and after phototherapy (r = 0.64, r = 0.73). The SPI had wide response distributions in all three domains. CONCLUSIONS: Both versions of SPI demonstrated wide response distributions and the proSPI-s in particular was shown to have good validity with PASI.

A rare case of cutaneous collagenous vasculopathy.

Cutaneous collagenous vasculopathy is a rare microangiopathy first described by Salama and Rosenthal in 2000. Several cases have been reported to date, describing distinct histological findings of thick hyaline collagenous blood vessel walls in the superficial dermis. Clinical confusion can arise with generalised essential telangiectasia. We report a case occurring in a 76-year-old woman who presented with a 2-year history of a telangiectatic rash progressing from her knees upwards. The diagnosis was confirmed on skin biopsy and treatment with pulsed dye laser was later initiated at the patient's request.