Pressure alopecias: A review.

Pressure-induced alopecias (PAs) are an infrequent group of scarring and nonscarring alopecias that occur after ischemic obstruction of capillaries that leads to circumscribed areas of hair loss. Initially described after prolonged surgeries or immobilization, type 1 PA occurs after sustained external pressure to the skin, mainly the scalp prominences. Alopecia induced by cosmetic procedures, referred in this review as type 2 PA, is reported with increased frequency in literature and predominantly emerges from pressure exerted by the volume of injectables. It is important to differentiate type 2 PA from vascular occlusion-induced alopecia because they represent distinct entities. Clinically, PA may present with erythema, swelling, and tenderness; however, alopecia might be the sole manifestation. Crusts and ulceration are associated with a worse outcome and a higher risk of scarring alopecia. Prompt diagnosis is paramount to prevent complications. Trichoscopy, although considered nonspecific, may provide relevant clues for an accurate diagnosis. Hair regrows in most cases, but prognosis depends on ischemia severity and timely treatment with reperfusion therapies or mobilization. Treatment of hair loss is usually not necessary because the disease in most cases is self-limited and reversible. The role of topical minoxidil and corticosteroids remains unknown.

Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication.

Surgical facelifts and noninvasive techniques such as mesotherapy, hyaluronic fillers and botulinum toxin, among other procedures are widely used nowadays to reverse skin ageing and achieve rejuvenation effects. Secondary alopecia due to cosmetic procedures is a rare side effect and is poorly described in the literature. The mechanisms in which hair loss develops after an aesthetical procedure or surgical technique are not well known. The development of secondary scarring alopecia or non-scarring alopecia depends upon the interaction between different external factors, the individual host response and the extent of damage to the hair follicle anatomy. Current knowledge hints at the type of substance used, pressure to hair structures and vasculature due to the materials used, previously unknown or unaware hair disorder, and poor surgical techniques to be the main factors contributing to the development of secondary alopecia. Physicians and patients must be aware of all the substances used for the procedures and be attentive to any change in hair density or hair loss. Clinicians must have a low threshold to take biopsies if the risk of scarring alopecia may occur. Herein, we review the clinical, trichoscopic, histopathological findings and potential pathophysiological mechanisms of hair loss due to different aesthetic procedures.

Evidence-based treatment for gynoid lipodystrophy: A review of the recent literature.

Gynoid lipodystrophy (GLD) is a structural, inflammatory, and biochemical disorder of the subcutaneous tissue causing alterations in the topography of the skin. Commonly known as "cellulite," GLD affects up to 90% of women, practically in all stages of the life cycle, beginning in puberty. It is a clinical condition that considerably affects the patients' quality of life. It is a frequent reason for consultation, although the patients resort to empirical, improvised, nonevidence-based treatments which discourage and can be a source of frustration not only because of the lack of results but also due to the complications derived from those treatments. In this article, a panel of experts from different specialties involved in the management of this clinical skin disorder presents the results of a systematic literature search and of the consensus discussion of the evidence obtained from different treatments currently available. The analysis was divided into topical, systemic, noninvasive, and minimally invasive treatments.

A case series and a review of the literature on foreign modelling agent reaction: an emerging problem.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.