RESUMEN
The prevalence of rosacea in skin of color (SOC) populations is estimated to be as high as 10% in some countries. Traditionally, intense pulsed light (IPL) and pulsed dye laser (PDL) have been the laser and energy-based devices (EBDs) used to treat rosacea. However, not all laser and EBDs are safe for SOC (Fitzpatrick skin types IV-VI) due to increased absorption of energy in pigmented skin and increased risk of post-inflammatory hyperpigmentation and scarring. This review summarizes the use of the top seven laser and EBDs for treating rosacea in SOC.
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Láseres de Colorantes , Terapia por Luz de Baja Intensidad , Rosácea , Pigmentación de la Piel , Rosácea/terapia , Rosácea/radioterapia , Humanos , Pigmentación de la Piel/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Terapia por Luz de Baja Intensidad/instrumentación , Terapia por Luz de Baja Intensidad/efectos adversos , Láseres de Colorantes/uso terapéutico , Tratamiento de Luz Pulsada Intensa , Terapia por Láser/métodos , Terapia por Láser/efectos adversosRESUMEN
BACKGROUND: Currently, there is only one topical medication approved by the U.S. Food and Drug Administration for alopecia, minoxidil 2.5% and 5%. With limited options, dermatologists often turn to compounding pharmacies for customized topical alopecia medications. OBJECTIVES: (1) to investigate the pricing and availabilities of compounded topical alopecia medications and (2) to investigate the delivery/mail options available. METHODS: 103 dermatological compounding pharmacies in the tri-state area were contacted. Data were collected on the prices of 11 different compounded formulations for alopecia, the highest concentration of minoxidil available, compounding accreditation status, and delivery. RESULTS: The majority (76.7% [79/103]) of pharmacies surveyed were responsive. Mean prices for 60 g or mL of medication were $70.44 for minoxidil 5%, $86.95 for minoxidil 5%/finasteride 0.5%, $159.13 for minoxidil 5%/bimatoprost 0.03%, $141.91 for minoxidil 5%/latanoprost 0.02%, $75.31 for finasteride 0.5%, $204.41 for tacrolimus 0.3%, $220.11 for tacrolimus 0.3%/minoxidil 5%/clobetasol 0.05%, $71.44 for cetirizine 1%, $74.93 for metformin 10%, $4,273.20 for tofacitinib 2%, and $1,840.42 for ruxolitinib 2%. Nearly all (93.5% [72/77]) of the pharmacies reported being able to compound minoxidil higher than the commercially available 5%, while 67.6% (50/74) were able to customize minoxidil to be made with <10% alcohol. Just over half (56.4% [44/78]) of the pharmacies were able to deliver to all tri-state areas. The mean delivery fee of pharmacies was $5.93 (n=77). Almost all of the pharmacies (98.7% [76/77]) claimed to be able to process and deliver medications within a week. If pharmacies were not located in the local vicinity, 44.6% (29/65) used a mailing service. CONCLUSION: This survey serves to expand clinicians' and patients' knowledge of the options and prices of topical compounded medications for alopecia. J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7697.
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Finasterida , Minoxidil , Estados Unidos , Humanos , Tacrolimus , Alopecia/tratamiento farmacológico , Composición de MedicamentosRESUMEN
It has been recently established that laser treatment can be combined with topical or intralesional medications to enhance the delivery of drugs and improve overall results in a variety of different dermatological disorders. The aim of this review is to evaluate the use of laser and energy-assisted drug delivery (LEADD) for the treatment of alopecia with a specific focus on ablative fractional lasers (AFL), non-ablative fractional lasers (NAFL), and radiofrequency microneedling (RFMN). A comprehensive PubMed search was performed in December 2022 for "laser-assisted drug delivery" as well as "laser" and "alopecia." The evidence regarding LEADD for alopecia treatment is limited to two specific alopecia subtypes: alopecia areata (AA) and androgenetic alopecia (AGA)/pattern hair loss (PHL). LEADD with minoxidil and platelet-rich plasma (PRP) were evaluated for efficacy in both treatments of AA and AGA. LEADD with topical corticosteroids and intralesional methotrexate were studied for the treatment of AA, while LEADD with growth factors and stem cells were studied for the treatment of AGA. Multiple RCTs evaluated LEADD for topical corticosteroids with ablative fractional lasers for the treatment of AA. There is evidence in the literature that supports the use of topical minoxidil in combination with all devices for the treatment of AGA/PHL. All the reviewed studies show a positive treatment effect with LADD; however, some trials did not find LEADD to be superior to monotherapy or microneedling-assisted drug delivery. LEADD is a rapidly emerging treatment modality for the treatment of AGA and AA.
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Alopecia Areata , Minoxidil , Humanos , Preparaciones Farmacéuticas , Alopecia Areata/tratamiento farmacológico , Rayos Láser , CorticoesteroidesRESUMEN
The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis.
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Láseres de Gas , Enfermedades de la Uña , Onicomicosis , Psoriasis , Humanos , Onicomicosis/tratamiento farmacológico , Onicomicosis/radioterapia , Preparaciones Farmacéuticas , Antifúngicos/uso terapéutico , Enfermedades de la Uña/tratamiento farmacológico , Psoriasis/tratamiento farmacológico , Psoriasis/radioterapia , Administración Tópica , Láseres de Gas/uso terapéutico , Resultado del TratamientoRESUMEN
Traction alopecia (TA) is a type of hair loss caused by repetitive tension placed on the hair follicle. An institutional review board-approved retrospective study was conducted at a single institution located in the Bronx, New York. The review identified 216 unique patients with TA and collected information on demographics, patient presentation, history, physical exam, treatment, follow-up and disease improvement. Almost all patients identified as female (98.6%), and most were Black or African American (72.7%). Mean (SD) age was 41.3 (17.1) years (median 40â years; range 1-88). Patients reported hair loss for a mean duration of 35 (51.1) months (median 18â months; range 1-264) prior to presentation. Most patients experienced asymptomatic hair loss. Around half (49.1%) of the patients attended a follow-up, with 42.5% of these patients noting improvement in hair loss or symptoms across all visits. Duration of hair loss was not associated with improvement in hair loss at follow-up visit (P = 0.23).
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Alopecia , Tracción , Humanos , Femenino , Adulto , Tracción/efectos adversos , Estudios Retrospectivos , Población Urbana , Alopecia/diagnóstico , Alopecia/terapia , Alopecia/etiología , Folículo PilosoRESUMEN
Serious complications of cosmetic filler injections include vascular necrosis if the filler is injected into an artery. The use of a microcannula for filler injection has been reported to be safer with lower rates of vascular occlusion. We report a case of vessel infiltration that was noted prior to injection with microcannula which identifies an additional safety step for injectors. This case highlights the potential for devastating vascular occlusion with microcannula use while also demonstrating methods to identify vascular infiltration prior to filler injection. The purpose of this report is to educate and encourage injectors to inspect the introducer needle prior to any filler injection in order to avoid vascular occlusion during filler injection.
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Técnicas Cosméticas , Rellenos Dérmicos , Humanos , Técnicas Cosméticas/efectos adversos , Ácido Hialurónico/efectos adversos , Inyecciones/efectos adversos , Rellenos Dérmicos/efectos adversosRESUMEN
Alopecia is one of the most common dermatologic conditions affecting black patients, with a significantly negative impact on quality of life.1,2 Timely and accurate diagnosis is therefore critical in order to reverse or halt progression of disease.3 Unfortunately, lack of representation of skin of color (SOC) patients in the current literature may contribute to misdiagnosis as providers may be unfamiliar with the clinical spectrum of alopecia presenting in darker scalps.4 Some scarring alopecia subtypes such as Central Centrifugal Cicatricial Alopecia (CCCA) are more prevalent in certain racial groups. However, focusing solely on patient demographics and gross clinical findings may obscure accurate diagnoses. To distinguish alopecia findings in Black patients, a dedicated approach using a combination of clinical exam findings and patient history, along with trichoscopy and biopsy, is essential to prevent misdiagnosis and improve clinical and diagnostic outcomes. We present three cases of alopecia in patients of color which the initial suspected clinical diagnosis did not correspond with trichoscopic and biopsy results. We challenge clinicians to reexamine their biases and fully evaluate patients of color with alopecia. An examination should include a thorough history, clinical examination, trichoscopy, and potentially a biopsy, particularly when findings do not correlate. Our cases highlight the challenges and disparities that exist in diagnosis of alopecia in Black patients. We emphasize the need for continued research regarding alopecia in skin of color and the importance of a complete workup for alopecia to improve diagnostic outcomes.Balazic E, Axler E, Nwankwo C, et al. Minimizing bias in alopecia diagnosis in skin of color patients. J Drugs Dermatol. 2023;22(7):703-705. doi:10.36849/JDD.7117.  .
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Calidad de Vida , Pigmentación de la Piel , Humanos , Alopecia/diagnóstico , Alopecia/patología , Piel/patología , Cuero Cabelludo/patologíaRESUMEN
Although broad reviews on laser-assisted drug delivery (LADD) have been published in the past, an updated focused examination of its utility in the context of common, treatment-resistant, dermatologic conditions has not been published. This article reports a comprehensive scoping review of the potential benefits of LADD compared to laser or drug monotherapy for the treatment of 3 such conditions: scars, rhytids, and melasma. A PubMed (National Institutes of Health; Bethesda, MD) search was conducted for keywords including "laser-assisted drug delivery," "scar," "rhytid," and "melasma." Out-of-scope studies were excluded. To evaluate the efficacy of LADD for the treatment of scars, relevant articles were categorized by scar type: hypertrophic/keloid, atrophic, and hypopigmented. LADD, with both ablative and nonablative laser types, was studied in combination with corticosteroids, botulinum toxin-A (BTX-A), 5-fluorouracil, 5-aminolevulinic acid photodynamic therapy, stem cells, platelet-rich plasma, and prostaglandin analogs for the treatment of scars. Some randomized controlled trials demonstrated the efficacy of LADD, whereas others showed no significant differences in clinical outcomes but demonstrated reduced adverse effects. Regarding rhytids, laser treatment has been combined with various cosmeceuticals, including poly-L-lactic acid, topical retinaldehyde, and topical BTX-A. The studies reviewed supported the use of LADD with these drugs over monotherapy. Some studies showed that LADD was effective for the absorption of drugs such as poly-L-lactic acid and BTX-A which are often not effective topically. For melasma treatment, LADD with tranexamic acid and hydroquinone was superior in some studies, but not significantly different than monotherapy in other studies. LADD with certain drugs could be considered to treat scars, rhytids, and melasma.
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Queloide , Melanosis , Humanos , Preparaciones Farmacéuticas , Administración Cutánea , Rayos Láser , Resultado del TratamientoRESUMEN
Alopecia areata (AA) is an autoimmune disease driven by cytokine dysregulation resulting in hair loss, and recent data suggests inflammation may be occurring systemically. This systemic increase in inflammatory cytokines may increase the incidence of thrombotic events, including deep vein thrombosis, stroke, myocardial infarction, and pulmonary embolism. As the use of JAK inhibitors for AA becomes more common, it is important to further investigate this potential relationship to prevent exacerbation of such events. The purpose of this case-control study was to determine if there is an increased association between thrombotic events and alopecia areata using the All of Us database. We matched 926 patients with AA 4:1 to controls without any alopecia, and we found that there was a statistically significant increase in the incidence of venous thromboembolism (VTE) in patients with AA (p = 0.009). Multivariable conditional logistic regression was then used to estimate the odds of AA in relation to VTE, controlling for common hypercoagulable factors (atrial fibrillation, estrogen replacement, obesity, malignancy, pregnancy, and smoking history). We found that after controlling for these risk factors, there was no significant difference in the incidence in VTE between those with and without AA (OR: 1.549, CR 95% (0.862, 2.783)). While recent reports have suggested alopecia areata to be significantly associated with venous thromboembolisms, we did not observe a significant association after controlling for hypercoagulable factors.
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Alopecia Areata , Tromboembolia Venosa , Humanos , Alopecia Areata/epidemiología , Femenino , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Estudios de Casos y Controles , Masculino , Persona de Mediana Edad , Adulto , Factores de Riesgo , Incidencia , Estados Unidos/epidemiología , Anciano , Adulto JovenRESUMEN
BACKGROUND: Chemical exfoliation of the skin is a frequently utilized treatment in dermatology to improve the appearance and health of photoaged skin. Photodamaged skin is especially prone to dryness and irritation. Over-exfoliation with at-home products are partially to blame for the "epidemic" of sensitive skin affecting over half the population. Combining AHA, BHA, and PHA together creates a complementary blend that has the potential to target numerous age-related changes in the skin including the appearance of pores and smoothing skin texture, while firming skin and increasing its collagen and moisture content. OBJECTIVES: The following study tested the clinical efficacy of a triple acid blend designed specifically for sensitive skin and measured improvements in signs of photodamage and hydration levels in the skin over time. METHODS: Thirty females aged 35-60 with mild to moderate facial lines, wrinkles, sun damage, uneven skin tone/texture, dark spots, or pores were enrolled. Subjects were instructed to use the test article, DWB-EN, on a clean face at night 3 times weekly with 48 h between applications for 4 weeks. RESULTS: Statistically significant improvements were noted in all parameters of photoaging clinical assessments (wrinkles, pores, overall appearance, luminosity, visible texture, skin tone evenness, hyperpigmentation) at the end of the 4-week study period. There were no instances of skin irritation throughout the duration of this study despite half of the women having sensitive skin. CONCLUSIONS: Overall, this study demonstrated the clinical efficacy and tolerability of DWB-EN for treating photoaging in subjects with all skin types.
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Envejecimiento de la Piel , Humanos , Envejecimiento de la Piel/efectos de los fármacos , Envejecimiento de la Piel/efectos de la radiación , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Quimioexfoliación/efectos adversos , Quimioexfoliación/métodos , Piel/efectos de los fármacos , Piel/efectos de la radiación , Combinación de Medicamentos , Cara , Glicolatos/administración & dosificación , Glicolatos/efectos adversos , Glicolatos/farmacologíaRESUMEN
Alopecia areata (AA), depression, anxiety, and decreased quality of life are highly associated in the literature. It has been noted that there is an increased risk of substance use in those with AA to help cope with the psychological burdens and perceived stigmatization. This study aims to explore the relationship between substance use disorder (SUD) and scarring/non-scarring alopecia using the All of Us database. Of the 9,385 patients with alopecia, 8.4% had SUD of any kind. Multivariable regression revealed that alopecia is a potential protective factor against SUD when controlling for other covariates of significance, with a decreased odds of 0.73. Substance use disorder prevalence was not different between scarring and non-scarring alopecia. This may be the result of patients fearing exacerbation of hair loss, or due to increased mental health and community support in patients with alopecia. Dermatologists and primary care providers should continue to promote psychotherapy and community support to patients whose diagnosis of alopecia has a negative psychosocial impact.
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Alopecia Areata , Alopecia , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Adulto , Estudios de Casos y Controles , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Estados Unidos/epidemiología , Alopecia/epidemiología , Alopecia/psicología , Prevalencia , Alopecia Areata/epidemiología , Alopecia Areata/psicología , Alopecia Areata/diagnóstico , Alopecia Areata/complicaciones , Calidad de Vida , Adulto Joven , Anciano , Cicatriz/psicología , Cicatriz/epidemiología , Cicatriz/etiología , Cicatriz/diagnóstico , AdolescenteRESUMEN
BACKGROUND: Ultraviolet light, visible light, infrared light, and pollution are a few examples of environmental factors that exacerbate the formation of reactive oxygen species (ROS) that cause damage to skin cells' DNA, proteins, and lipids. By supplementing the skin with antioxidants, we can help neutralize ROS formed by these extrinsic factors before they can damage the skin. AIMS: This prospective open-label study explores the safety and efficacy of this novel topical formulation of antioxidants (vitamin C, astaxanthin, fermented turmeric, and vitamin E) designed to fight free radical damage and improve overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin. PATIENTS/METHODS: This single-center clinical study evaluated the efficacy of twice-daily application of the test article (Asta C™ Vitamin C Age Defense Serum, Dr. Whitney Bowe Beauty) in 32 subjects for 12 weeks. Healthy female subjects aged 35-60 with mild to moderate fine lines, wrinkles, and hyperpigmentation/uneven skin tone were enrolled in this study. Fitzpatrick skin types I-VI, all skin types (dry, normal, combination, oily), and subjects with sensitive skin were included. RESULTS: All subjects demonstrated improvement in overall skin quality (face, neck, and chest) by the end of the 12-week study period. One hundred percent of subjects demonstrated improvement in the appearance of fine lines at Week 12. CONCLUSIONS: Overall, the current clinical study demonstrates that Asta C™ is safe, well-tolerated, and effective in improving overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin.
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BACKGROUND: Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses in dermatology. AIMS: The aim of this review is to increase awareness of the several applications of pentoxifylline in the field of dermatology. METHODS: A comprehensive PubMed search was conducted in May 2022 using the following phrases "dermatology" AND "pentoxifylline." Our search period spanned 34 years from 1988 to 2022. All available literature was reviewed. Reference lists of identified articles were included. Studies were excluded if they were not in English and if the study was out of scope. Eighty-one articles were included in this review. RESULTS: Pentoxifylline has been used to treat various dermatological conditions including peripheral vascular disease, vasculitis and vasculopathies, chilblains, pigmented purpuric dermatosis, granuloma annulare, necrobiosis, keloids, lichen sclerosis et atrophicus, scars, radiation-induced fibrosis, vitiligo, alopecia areata, leishmaniasis, and leprosy. CONCLUSIONS: Pentoxifylline's use in dermatology is growing. However, there are limited larger studies and randomized control trials on the use of pentoxifylline in dermatology and more investigation is needed to evaluate its use for many dermatologic conditions. Pentoxifylline's unique mechanism of action as well as its good tolerability, cost-effectiveness, and minimal drug interactions make it a convenient primary or adjunctive option in many dermatological conditions.
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Granuloma Anular , Pentoxifilina , Vasculitis , Humanos , Pentoxifilina/efectos adversos , Claudicación Intermitente/tratamiento farmacológico , Granuloma Anular/tratamiento farmacológico , Cicatriz/tratamiento farmacológicoRESUMEN
BACKGROUND: Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. AIMS: The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments. PATIENTS/METHODS: A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review. RESULTS: Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. CONCLUSIONS: Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.
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Melanosis , Ácido Tranexámico , Humanos , Femenino , Adulto Joven , Adulto , Ácido Tranexámico/efectos adversos , Hidroquinonas/efectos adversos , Administración Tópica , Resultado del Tratamiento , Melanosis/tratamiento farmacológico , Melanosis/patologíaRESUMEN
BACKGROUND: Alopecia is a common chief complaint and is challenging to treat. As such, regenerative treatments to promote hair growth are an emerging area of research. Exosomes, which are extracellular vesicles involved in cell communication, homeostasis, differentiation, and organogenesis, have been shown to play a central role in hair morphogenesis and regeneration with potential for use as alopecia treatment. AIMS: This review summarizes and assesses the body of literature surrounding exosomes as regenerative therapeutics for alopecia and identifies areas for improvement in future research. METHODS: A review was conducted using a comprehensive list of keywords including "exosome," "alopecia," and "hair loss" on PubMed, EMBASE, and Google Scholar databases published from inception to February 2022. Reference lists of identified articles were included. 47 studies were included. Clinical trial databases were searched using the term "exosome"; however, no trials relevant to hair growth were identified. RESULTS: Our updated and comprehensive review details the history of exosome use in medicine, postulated underlying mechanisms in treating hair loss, and current clinical studies. Preclinical studies demonstrate clear benefits of exosome therapeutics in regenerative medicine and for hair loss treatment. Clinical trials demonstrate safety of exosome use in medicine, but data showing efficacy and safety of exosome therapy for alopecia are lacking. We identified several gaps in knowledge required for effective clinical translation including safety, exosome source, and optimal treatment delivery mechanism and dosage. CONCLUSION: Exosomes are on the horizon as an exciting therapeutic for the treatment of alopecia. Further studies and clinical trials are required.
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Exosomas , Terapia por Luz de Baja Intensidad , Alopecia/terapia , Cabello , Humanos , RegeneraciónRESUMEN
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders and the use of proton-pump inhibitors has become the mainstay of treatment for many patients. While these are the most effective medications for the management of GERD, there are several side effects that patients may experience with their use. This autobiographical case report describes the development of iron-deficiency anemia (IdA) with chronic use of omeprazole. The patient was a 35-year-old male with a history of essential hypertension and GERD who was taking omeprazole 40 mg daily for 3 years for the management of reflux symptoms. He developed some mild exercise intolerance and began noticing an affinity for unusual smells, including gasoline and dust, which prompted an evaluation. Lab work demonstrated IdA to 8.3 g/dl, which was not corrected by oral iron supplementation. Sources of gastrointestinal bleeding, Helicobacter pylori infection, and other hypersecretion syndromes were ruled out. IV iron response was transient and only after 8 months of discontinuation of omeprazole did the anemia correct on its own. Omeprazole has increasingly become recognized as a cause of IdA, but only three clinical case reports have been documented in the literature. At least two mechanisms may be involved, and the discontinuation of omeprazole may correct the anemia in 2 months in mild cases, but up to 8 months in more severe cases. The presence of an abnormal propensity for unusual smells, similar to pica as seen in other IdAs, was a unique feature of this case and should prompt evaluation.