Efficacy of Minoxidil Combined With Photobiomodulation for the Treatment of Male Androgenetic Alopecia. A Double-Blind Half-Head Controlled Trial.

BACKGROUND: Androgenetic alopecia (AGA) is a hair loss disorder that frequently affects the male population. Conventional treatment modalities are limited to minoxidil, 5α reductase inhibitors, and hair transplantation procedures. The efficacy of low-level laser therapy (LLLT), also known as photobiomodulation, in the treatment of AGA has been reported, yet little is known about the outcomes of combining photobiomodulation with other conventional therapies. OBJECTIVE: To evaluate hair growth improvement in males with AGA, during the administration of minoxidil with and without photobiomodulation, using a half-head model. STUDY DESIGN/MATERIALS AND METHODS: Twenty-one men with AGA agreed to undergo 12 minutes of low-level laser irradiation (using a modified Capellux®), followed by topical minoxidil application (1 ml of 5% solution), to the affected scalp two times per day for 6 months. The photobiomodulation devices were modified such that the left half emitted light, and the right half did not. Efficacy was assessed by blinded analyses of clinical photos and automated phototrichograms (Trichoscan®) taken before treatment and after 3 and 6 months of therapy. RESULTS: None of the study participants experienced any adverse events. All patients showed improvements in hair coverage on both sides of the scalp at 3 and 6 months. On the side with combined treatments, the number of total hairs was significantly increased after 3 (P < 0.001) and 6 months (P = 0.001). A similar increase was also observed on the minoxidil-only side, at both 3 (P < 0.001) and 6 months (P < 0.001). No statistically significant differences were detected between sides (P > 0.05). CONCLUSION: Additional improvement was not observed with the association of photobiomodulation to topical minoxidil in male AGA. Differences from previous studies that might have influenced our result include non-collimated light source, higher dosimetry, and a cohort with darker skin phototype and more severe alopecia. Lasers Surg. Med. 2021. © 2021 Wiley Periodicals LLC.

A Survey of Psychiatry Course Offerings for Fourth-Year Medical Students.

OBJECTIVE: Fourth-year course offerings seem to vary widely among psychiatry departments with some offering a wide selection while others offer little or unspecified opportunity. The purpose of this study was to learn the distribution and diversity of fourth-year medical school psychiatry courses and identify unique course offerings that may inspire other departments. METHODS: The authors compiled a list of US allopathic medical schools accredited by the Liaison Committee on Medical Education (LCME) using the LCME website. They accessed each school's website catalog and recorded all psychiatry electives available to fourth-year students listed in the catalog or the Visiting Student Application Service® (VSAS®) database. The authors calculated median published course offerings per department and categorized each course according to learning opportunity. RESULTS: The authors identified 142 fully accredited allopathic medical schools of which n = 126 listed fourth-year medical student courses on their website or through VSAS. The median number of fourth-year psychiatry course offerings per school was 6 (range, 1-22). The most frequently offered courses were inpatient psychiatry (n = 105 schools), child and adolescent psychiatry (n = 95), and consultation psychiatry (n = 84). The authors also identified unique enrichment courses in media, women's health, ethics, research, and cultural psychiatry. CONCLUSIONS: The fourth-year curriculum varies widely among institutions. Hypotheses to be tested are if prioritizing robust fourth-year rotations include improved resident readiness, improved retention of home students into the training program, improved recruitment of visiting students, increased faculty scholarly activity and career development, and improved recruitment into the subspecialties.

Development of Evaluations to Assess the Quality of Residency Program Directors.

OBJECTIVE: The objective was to develop residency program director specific evaluation tools with face validity for identifying areas of excellence and opportunities for improvement. METHODS: Investigators conducted standardized interviews with graduate medical education (GME) leadership, department chairs, program directors, and senior residents assessing their perspectives on the desirable qualities of program directors. Responses were categorized by theme to create benchmarked evaluation tools. RESULTS: Residents and faculty emphasized communication, mentorship, and role modeling. Faculty emphasized maintenance of accreditation and resident discipline, while residents emphasized wellness, approachability, and maintenance of the learning environment. The investigators then developed a 10-item assessment for residents and a similar 12-item assessment for department chairs and GME leadership with face validity. CONCLUSION: Although the responsibilities of residency training directors are numerous and variable by specialty, the investigators were able to develop valid program director evaluation tool templates that can highlight the successes and opportunities for improvement of these academicians.

[Not Available]. / Síndrome de Graham-Little-Piccardi-Lassueur: variante disseminada de líquen plano folicular.

Graham-Little-Piccardi-Lassueur syndrome is a rare lichenoid dermatosis. It is characterized by the triad of scarring alopecia of the scalp, alopecia of the axilla and or groin, and keratotic follicular papules of the body. The present paper reports on two cases affecting young women. Histopathological findings suggest the disorder represents a generalized form of lichen planus follicularis.

Extra-follicular cutaneous manifestations of frontal fibrosing alopecia.

Frontal fibrosing alopecia (FFA) is an inflammatory cicatricial alopecia, which is considered to be a variant of lichen planopilaris. In addition to follicular changes, FFA often presents with associated cutaneous manifestations in most patients, including lichen planus pigmentosus, implantation line hypochromia and facial papules. The objective of the present article is to provide a detailed overview of the non-follicular cutaneous clinical manifestations of FFA and discuss their impact on the diagnosis and treatment of patients with this condition.

Efficacy and Safety of Scalp Microneedling in Male Pattern Hair Loss.

Introduction: There are few reports involving scalp microneedling in MPHL patients, and in most of them, physical stimulus is associated with other therapeutic agents. The aim of this study was to evaluate the efficacy and risks of isolated scalp microneedling in MPHL patients. Methods: Thirty patients were included in this randomized single-blinded study and submitted to 4 monthly scalp microneedling sessions. Two different microneedling devices were used: roller (n = 15) and tattoo cartridge (n = 15). Scalp coverage and hair density changes were measured 4 and 16 weeks after the last session. Adverse events were observed throughout the study, and scalp biopsies were performed before and after to investigate scarring changes. Results: Four of 12 participants in the roller group and 2 of 14 participants in the tattoo cartridge group showed an improvement in clinical pictures at the first follow-up visit. Only half of these patients sustained an improvement until the last follow-up visit. No benefit in hair density was observed in either group. No reports of adverse events were made. Neocollagenesis and elastolysis were noted in scalp biopsies. Discussion/Conclusion: Isolated scalp microneedling did not show improvement in scalp coverage or hair density of MPHL participants in this study.

Scalp cooling to prevent chemotherapy-induced alopecia.

Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.

Histopathological Findings of Uncomplicated Hair Transplant for Male Androgenetic Alopecia: Can Lichen Planopilaris Features Be Present?

INTRODUCTION: Insufficient hair growth after hair transplant, as well as erythema and perifollicular scaling, may be diagnosed as lichen planopilaris and treated as such based on clinical and histopathological findings. The purpose of this study is to observe graft biopsies of patients after uncomplicated hair transplants and to discuss if histological findings are enough to diagnose lichen planopilaris. METHODS AND RESULTS: Eight patients diagnosed with androgenetic alopecia who were submitted to hair transplant were enrolled. In each of the participants, a scalp biopsy was performed in the receptor area and in the adjacent area. Biopsies were performed between 6 months and 1 year after surgery. Exams were analyzed by 3 pathologists. The t test was performed for paired observations, comparing the transplanted and the nontransplanted area for lymphocytic infiltrate and fibrosis. The significance level was considered as 5% (p < 0.05). Four of 8 participants had perifollicular lymphocytic infiltrate, from moderate to dense intensity in the recipient area. Fibrosis was seen in 6 patients. These findings were not seen in the control area. CONCLUSIONS: It is questioned whether lymphocytic infiltrate and fibrosis may be expected in patients who are submitted to normal hair transplants.

Tinea Capitis: Correlation of Clinical Aspects, Findings on Direct Mycological Examination, and Agents Isolated from Fungal Culture.

BACKGROUND: Tinea capitis (TC) is a dermatophytosis of the scalp caused by the Trichophyton and Microsporum genera. The condition can be classified according to clinical symptoms or based on mycological presentations observed on direct examination. Treatment is best determined after isolation of the causative agent, with griseofulvin indicated for Microsporum and terbinafine for Trichophyton. MATERIALS AND METHODS: This was a prospective study correlating clinical and mycological classifications with agents isolated from culture of patients seen at a tertiary hospital in São Paulo (Brazil) between May 15, 2017, and January 11, 2019. RESULTS: A total of 23 patients were treated, comprising 19 (83%) with alopecic clinical aspect (14 [60%] trichophytic and five [23%] microsporic) and 4 (17%) with kerion celsi presentation. According to the parasite invasion at the hair shaft, 9 (40%) were endothrix and 14 (60%) were ectothrix cases. Trichophyton tonsurans was isolated from culture in 14 (60%) patients and Microsporum canis in 5 (40%) patients. A statistically significant association was found for mycological classification and agent isolated from culture (P = 0.003) with associations of the endothrix form with T. tonsurans and of ectothrix with M. canis. CONCLUSIONS: The mycological classification appears to be a valid method for suggesting the etiological agent of TC.

Atrichia with Papular Lesions: Importance of Histology at an Early Disease Stage.

We report the case of a 5-year-old girl born from consanguineous parents, presenting with alopecia universalis since the age of 8 months, without papules or cysts over the scalp or body. The goal of this paper is to emphasize the relevance of histopathology for the early diagnosis of atrichia with papular lesions in children with alopecia universalis, in settings where genetic testing may not be available.

The Use of Direct Immunofluorescence in Frontal Fibrosing Alopecia.

BACKGROUND: Frontal fibrosing alopecia (FFA) differs from lichen planopilaris (LPP) in many clinical aspects, but histology fails to distinguish between these entities. Direct immunofluorescence (DIF) is a diagnostic technique used for autoimmune diseases, including those affecting skin and hair. OBJECTIVE: To characterize DIF patterns in patients with FFA. METHOD: Data was collected retrospectively from FFA cases presenting to the Centre de Santé Sabouraud Hair Clinic in Paris from November 2013 to November 2014. RESULTS: Of 149 patients with FFA, 44 cases underwent DIF. Thirteen cases showed positive results with DIF. Patterns characteristic of LPP and lupus erythematosus were observed, with nearly half showing nonspecific staining. CONCLUSION: DIF patterns in patients with FFA were variable. This diagnostic technique should be used with caution in cases of cicatricial alopecia, particularly FFA.

Pili Annulati and Trichorrhexis Nodosa in the Same Patient: Cause or Coincidence?

PURPOSE: To determine the relationship between pili annulati (PA) and acquired trichorrhexis nodosa (TN) seen in the same patient, considering the two main theories evoked by previous studies: greater stiffness of darker PA bands or associated cuticular damage. PROCEDURES: Light microscopy of hair shafts from different regions of the patient's scalp. RESULTS: TN was not superimposed to dark bands of PA. CONCLUSIONS: Greater stiffness of darker PA bands was excluded as the cause of hair breakage. Hair breakage in PA patients might be related to cuticular abnormalities, as previously reported. Because weathering of long thin chemically treated hairs is extremely common, coincidence cannot be completely ruled out in this case.

Patchy Traction Alopecia Mimicking Areata.

Acute traction alopecia is a diagnostic challenge when the external factor is not suspected or admitted. We report two female patients with non-scarring patchy alopecia resulting from traction of video-electroencephalogram electrodes in which the clinical diagnosis of alopecia areata was suspected. Associated diffuse hair disorders might be implicated in these cases. The correct diagnosis of traction alopecia is important in order to avoid unnecessary treatments.

Scalp cooling to prevent chemotherapy-induced alopecia

Abstract Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.

Alopecia areata: an evidence-based treatment update.

BACKGROUND: There is no cure for alopecia areata, nor is there any universally proven therapy that induces and sustains remission. Treatment choices are frequently based on disease duration, extent, and activity as well as the age of the patient. OBJECTIVE: Our objective was to review all randomized controlled studies on the treatment of alopecia areata. METHODS: We performed a search in the biomedical literature database PubMed, and used the terms 'alopecia areata treatment' and article type 'randomized controlled trials'. RESULTS: Following this algorithm, we reviewed, analyzed, and reported on 29 trials that examined the efficacy of anthralin, antidepressants, biologics, calcineurin inhibitors, corticosteroids (topical and systemic), minoxidil, prostaglandin analogs, sensitizers, and a miscellaneous group of topical and oral drugs with less scientific evidence (aromatherapy, photodynamic therapy, azelaic acid, garlic gel, bexarotene, triiodothyronine, inosiplex, and total glucosides of paeony). CONCLUSION: Using the American College of Physicians Guideline grading system, our assessment is that the majority of published randomized controlled studies of alopecia areata are only of moderate quality. A number of treatments were found to be effective, for example, topical and oral corticosteroids and the sensitizing agents diphenylcyclopropenone and dinitrochlorobenzene; however, most studies had major limitations that hinder the interpretation of these results.