Sleep quality in men with androgenetic alopecia.

PURPOSE: Sleep disturbances affect human health and contribute to several comorbidities. In men, androgenetic alopecia (AGA) is a common, non-scarring form of hair loss that affects a patient's self-esteem. There are limited data regarding the association between poor sleep quality and male AGA. We aimed to compare the prevalence of sleep abnormalities between male patients with AGA and controls to identify an association between the two conditions. METHODS: A case-control study on patients with AGA and age-matched controls was conducted. Participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. Patients with AGA were classified into mild, moderate, and severe subgroups according to the Hamilton-Norwood classification for stratified analyses. Data between groups and among subgroups were compared. RESULTS: Of 446 male participants, 223 (50%) were in the AGA group, and the remainder (50%) were in the control group. Multivariable logistic regression analysis revealed that hypertension (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.16-3.11, p = 0.011) and STOP-BANG score ≥ 5 (OR = 2.05, 95%CI = 1.15-3.66, p = 0.015) were associated with AGA. For subgroup analyses, ordinal logistic regression model showed a significant association between severe AGA and three sleep profiles, namely total sleep time ≤ 6 h (OR = 2.16, 95%CI = 1.02-4.57, p = 0.044), PSQI > 5 (OR = 3.72, 95%CI = 1.42-9.72, p = 0.008), and STOP-BANG score ≥ 5 (OR = 3.01, 95%CI = 1.11-8.13, p = 0.030). CONCLUSION: Our findings revealed an association between sleep disturbances and AGA, which may help guide appropriate management in these patients.

Variation of Hair Follicle Counts among Different Scalp Areas: A Quantitative Histopathological Study.

INTRODUCTION: Scalp biopsy is a standard method for the definitive diagnosis of alopecia. The hair count parameters of each scalp area remain unclear. This study aimed to determine hair count values at different scalp locations from histopathology and to establish reference values for each part of the scalp. METHODS: We obtained biopsy specimens from the frontal, vertex, temporoparietal, and occipital areas of the scalps of normal deceased subjects. All specimens were evaluated for the number of follicular units, hair counts, hair types, and stages of the hair cycle. RESULTS: In total, 240 specimens were collected from 60 cadavers. Across all scalp sites, the temporoparietal area showed the lowest mean hair count, number of follicular units, terminal and vellus hairs, and terminal-to-vellus hair ratio. The average anagen-to-telogen hair ratio was comparable across all scalp sites. This study did not observe a significant association of hair parameters with gender differences or increasing age in all scalp areas. CONCLUSIONS: The present study revealed the diversity of the hair index among different scalp areas and suggested that normal hair count values should be separately standardized on each scalp region. Our findings may provide useful reference values for the histopathological evaluation of hair disorders in Asians.

A comprehensive review of treatment options for recalcitrant nongenital cutaneous warts.

INTRODUCTION: The treatment of recalcitrant nongenital cutaneous warts has always been challenging for dermatologists as they often recur and relapse. Multiple treatment options have been investigated to improve the outcome. This review provides an overview of the current treatment modalities and summarizes the efficacy and side effects of each treatment option for recalcitrant nongenital cutaneous warts. METHODS: A PubMed search was performed through July 2019 to include all English language reports investigating the treatment for recalcitrant nongenital cutaneous warts, regardless of design. RESULTS: A total of 144 studies were included in this review. The treatment options for recalcitrant nongenital cutaneous warts can be divided into three groups: destructive treatment, immunotherapy, and cytotoxic agents. Although both destructive therapies and cytotoxic agents demonstrated high complete response rates, immunotherapy, which is a minimally invasive method, was superior in terms of the clearance of distant warts. Intralesional mumps-measles-rubella injections and purified protein derivatives currently demonstrate high efficacy with well-established clinical evidence. CONCLUSIONS: Many upcoming treatment modalities, especially immunotherapy, are promising. However, more comparative studies are required to verify the efficacy and safety profile.

A comparison of the efficacy and tolerability of three corticosteroid treatment regimens in patients with alopecia areata.

BACKGROUND: Topical corticosteroids (TC) and/or intralesional corticosteroids (IC) are considered first-line treatments for patch-type alopecia areata (AA). However, the efficacies of TC monotherapy, IC monotherapy, and combined topical and intralesional corticosteroids (CC) in patients with AA have never been compared. OBJECTIVE: To evaluate and compare the efficacy and tolerability of 3 corticosteroid treatments (TC, IC, and CC) in patients with AA. METHODS: A study of patients with AA who received TC, IC, or CC was conducted. Outcomes including initial hair regrowth (25% regrowth), significant hair regrowth (>80% regrowth), and adverse events were statistically compared. Cox proportional hazards regression analysis was used to identify factors that influence the treatment response. RESULTS: One hundred and forty-eight patients were eligible for analysis. The response rates of initial and significant hair regrowth were comparable among 3 treatment groups. Multivariate analysis revealed that an AA treatment duration of longer than 6 months was associated with a lower probability of significant hair regrowth. A small proportion of patients experienced adverse effects. CONCLUSION: The 3 corticosteroid treatment regimens are effective, safe, and show no significant differences in treatment outcomes. However, an AA duration longer than 6 months portends a lack of significant hair regrowth.

Topical finasteride for the treatment of male androgenetic alopecia and female pattern hair loss: a review of the current literature.

BACKGROUND: Androgenetic alopecia (AGA) is a frequently encountered dermatological concern that impacts a patient's self-esteem and quality of life. Finasteride is a selective 5-alpha reductase inhibitor that has been approved for the treatment of male AGA and the off-label use in female pattern hair loss (FPHL); however, its adverse effects may limit its use. Topical finasteride is a new formulation that aims to decrease complications caused by oral administration. OBJECTIVE: This review assesses the pharmacology, current therapeutic use, and safety of topical finasteride for the treatment of AGA and FPHL. METHODS: A PubMed search was conducted to include all English language articles on topical finasteride from January 1992 to January 2020. RESULTS: A total of 33 articles including 28 topical finasteride related articles and five AGA related articles were included in this review. Multiple studies on topical finasteride as the treatment for male AGA and FPHL showed positive results with a favorable safety profile. CONCLUSIONS: Topical finasteride is a promising therapeutic option. We emphasize the importance of continued research for the establishment of a novel therapeutic agent.

Case Report: Pityriasis Rosea-Like Eruption Following COVID-19 Vaccination.

Vaccination is one of the cornerstones in the efforts towards ending the coronavirus disease 2019 (COVID-19) pandemic. However, several adverse effects of COVID-19 vaccination have been identified. Pityriasis rosea (PR)-like eruption is a rare cutaneous complication of immunization. To the best of our knowledge, there have been no reports of PR-like eruptions following inoculation with Oxford/AstraZeneca ChAdOx1 nCoV-19 (AZD1222) vaccine. Here, we described a case of PR-like eruption that developed 14 days after Oxford/AstraZeneca vaccination in a 52-year-old Thai woman with glioblastoma. Treatment with topical 0.1% triamcinolone acetonide twice per day showed partial response after seven days. Despite this rare complication, our report highlights that the presence of PR-like eruption is not a contraindication for subsequent vaccinations.

Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata.

BACKGROUND: Increased rates of autoimmune diseases (ADs) have been reported in association with alopecia areata (AA); however, the risk factors for coexisting ADs in AA patients have been poorly investigated. OBJECTIVE: To evaluate the prevalence and factors associated with AD comorbidities in patients with AA. METHODS: This case-control study included patients diagnosed with AA between January 2000 and March 2020. Individuals with AA, both with and without concomitant ADs, were statistically compared. Variables significantly associated with coexisting ADs were identified using univariate and multivariate logistic regression analyses. Multinomial logistic regression analysis was performed to identify the specific risk factors for each concomitant AD. RESULTS: Among the 615 patients with AA, comorbid ADs were found in 76 (12.4%). Autoimmune thyroid disease (AITD) exhibited the highest frequency (n = 42, 6.8%), followed by vitiligo (n = 15, 2.4%), and systemic lupus erythematosus (SLE) (n = 12, 2.0%). Logistic regression analyses revealed that female sex (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.24-4.82; P = 0.011), nail abnormalities (OR = 2.49, 95% CI = 1.14-5.46; P = 0.023), and atopic diseases (OR = 1.98, 95% CI = 1.09-2.43; P < 0.001) were significantly associated with coexisting ADs. Regarding each concomitant AD, nail abnormalities were an associated factor for AITD (OR = 4.65, 95% CI = 1.96-7.24; P = 0.01), whereas coexisting atopic diseases were demonstrated as a predictor of vitiligo (OR = 2.48, 95% CI = 1.43-4.58; P = 0.02). Female sex (OR = 1.61, 95% CI = 1.18-4.27; P = 0.04) and family history of AD (OR = 1.85, 95% CI = 1.26-4.19; P = 0.03) were predictors of SLE. CONCLUSION: This study suggests that female AA patients with nail abnormalities and atopic diseases have increased rates of AD comorbidities. A thorough review of systems for associated factors can help physicians screen for concomitant ADs.

A Study of Botulinum Toxin A for Ultraviolet-Induced Hyperpigmentation: A Randomized Controlled Trial.

BACKGROUND: Ultraviolet (UV) exposure contributes to skin hyperpigmentation. Recently, botulinum neurotoxin type A (BoNT-A) showed a promising protective effect on UVB-induced hyperpigmentation in both in vitro and animal models. OBJECTIVE: The study aimed to investigate the preventive effect of BoNT-A against UVB-induced hyperpigmentation in human subjects. MATERIALS AND METHODS: A prospective, double-blinded, randomized controlled trial was performed in 15 healthy participants. Four separate square areas on the abdomen were randomly injected intradermally with different dilutions of BoNT-A (1:2.5, 1:5, 1:7.5) and normal saline (control). Two weeks after injection, hyperpigmented spots were induced by UVB irradiation at the experimental sites. The lightness index and hyperpigmentation scores from blinded physician and participants were evaluated. RESULTS: Fifteen participants completed the study. One week after UVB irradiation, all BoNT-A-treated sites had a significantly lower degree of hyperpigmentation than the control site in lightness index and hyperpigmentation scores from blinded physician and participants (p < .05). However, no statistically significant difference was observed between different concentrations of BoNT-A. No side effects were observed throughout the study period. CONCLUSION: Intradermal BoNT-A injection provided a protective effect from UVB-induced hyperpigmentation. It may be used for other hyperpigmentation disorders that are aggravated by UVB.

Isobutylamido thiazolyl resorcinol for prevention of UVB-induced hyperpigmentation.

BACKGROUND: Isobutylamido thiazolyl resorcinol (ITR, Thiamidol® ) has been proposed as a potent tyrosinase inhibitor. A formulation containing ITR has recently shown promising efficacy for the treatment of some hyperpigmentary conditions. OBJECTIVES: This study aimed to evaluate the efficacy and safety of ITR in the prevention of ultraviolet (UV)-induced hyperpigmentation in human skin. MATERIALS AND METHODS: We performed a randomized, single-blinded, pilot study in 30 healthy participants. One arm was randomly assigned to receive an ITR-containing product for three weeks. Three hyperpigmented spots were induced by UVB irradiation on both arms after 3 weeks of ITR application. Outcome evaluations included measuring mean lightness index (*L) obtained by colorimeter, hyperpigmentation scores by visual analog scale (VAS), and adverse effects. RESULTS: Both experimental sides showed no significant difference in terms of skin lightening after ITR application. However, the ITR-treated sides showed a statistically significant lower mean lightness index compared to control after an induction with UVB. In addition, the ITR-treated sides had an earlier improvement and resumed the normal skin color after 3 weeks post-UVB induction. A clinical evaluation by a blinded nontreating physician and subjects was more favorable on the ITR-treated side than the control side (P < .05). No significant side effect was noted. CONCLUSIONS: ITR is an effective agent in the prevention of pigmentary change from UVB irradiation and may serve as a promising agent for preventing other hyperpigmentary conditions.

Accuracy of a high-intensity focused ultrasound device with and without real-time visualization system in face and neck treatment of skin laxity.

BACKGROUND: Microfocused ultrasound (MFU) is a nonsurgical treatment for the improvement of skin laxity. Multiple MFU devices with and without a visualization system are commercially available. AIMS: This study aims to compare the accuracy rates of MFU on target treatment areas with and without a visualization system. PATIENTS/METHODS: A cross-sectional study was conducted using 52 dermatologists as study subjects. Each subject was asked to treat one simulated volunteer on the face and upper neck with MFU for 2 sessions using the training mode. Participants were allowed to see the ultrasound monitoring screen in one session (visualized session) and were not allowed to see the monitoring screen in the other session (nonvisualized session). One investigator evaluated the accuracy rate by monitoring real-time whether an appropriate contact between the transducer and the skin is shown on the visualization system when the energy release button is pressed. RESULTS: Higher accuracy rates were observed in the visualized session than the nonvisualized session in all treatment areas including brow, lateral orbit, infraorbital, cheek, and upper neck. The greatest difference in accuracy rates was observed when performing the treatment on the upper neck. Participants with more experiences had higher accuracy rates while performing visualization session when compared to those who had less experiences. Visualized sessions required a significantly longer treatment time. CONCLUSIONS: The utilization of MFU with visualization system increases the likelihood of proper skin contact. This in turn may give a more favorable treatment outcome and decrease the rates of complications from MFU treatment.

A clinical and histological comparison between acute cutaneous graft-versus-host disease and other maculopapular eruptions following hematopoietic stem cell transplantation: a retrospective cohort.

BACKGROUND: Prompt management of acute graft-versus-host disease (GVHD) may prevent its morbidity and mortality. Maculopapular (MP) eruption is a presenting sign of acute GVHD, but differentiation from other causes of MP rash is challenging. METHODS: A retrospective study was conducted among patients developing MP eruptions after allogeneic hematopoietic stem cell transplantation. We compared the clinical and histopathological differences between an acute cutaneous GVHD (group 1) and other MP eruptions (group 2). We also determined the clinical prognostic indicators linked to acute GVHD severity, morbidity, and mortality. RESULTS: Of 95 patients identified, 75 met the classification criteria for acute GVHD, and 25 had other MP eruptions. Palm and/or sole involvement was more frequently found (51.4% vs. 12%, odds ratio [OR] [95% confidence interval] = 7 [2.1, 23.7], P < 0.01 and 41.4% vs. 0%, OR 37.2 [2.2, 635], P < 0.01, respectively) in group 1 than in group 2. Comparing the histological features between the two groups, necrotic keratinocytes in basal and spinous layers (92.9% vs. 22.2%, OR 27 [3.5, 594.7], P < 0.01) and (85.7% vs. 33.3%, OR 9.3 [1.4, 60.8], P = 0.02, respectively), diffuse basal vacuolization (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04), lymphocyte satellitosis (71.4% vs. 0%, OR 44.3 [2.1, 936.8], P < 0.01), and subepidermal clefts (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04) were significantly more apparent in group 1. Among extracutaneous presentations, diarrhea alone and/or accompanied by hyperbilirubinemia (47.1% vs. 16%, OR 4.3 [1.4, 13.1], P = 0.03 and 27.1% vs. 0%, OR 19.3 [1.1, 332.8], P < 0.01, respectively) and newly developed transaminitis (37.1% vs. 12%, OR 3.3 [1.1, 12.6], P = 0.02) suggested the diagnosis of acute GVHD. Mucosal involvement and/or blister formation correlated with severe acute GVHD (OR 26.6 [5.4, 130.4], P < 0.01). Skin and systemic GVHD severity correlated with time to rash resolution (P = 0.03 and P = 0.04, respectively), length of hospital stays (P < 0.01 and P < 0.01, respectively), and mortality (OR 4.87 [1.4, 17.4], P = 0.02 and OR 4.6 [1.3, 16.5], P = 0.02, respectively). CONCLUSIONS: Our findings may be beneficial tools for establishing the diagnosis of acute GVHD.

Combined isobutylamido thiazolyl resorcinol and low-fluence Q-switched Nd: YAG laser for the treatment of facial hyperpigmentation: A randomized, split-face study.

BACKGROUND: Isobutylamido thiazolyl resorcinol (ITR) is a novel anti-tyrosinase recently shown to be effective in the treatment of hyperpigmentation. Low-fluence Q-switched Nd:YAG 1064-nm laser (LFQS) has proven to be effective for various hyperpigmentary conditions. However, there is no study on the efficacy and safety of combined ITR and LFQS treatment. OBJECTIVES: To compare the efficacy and safety of combined ITR and LFQS with LFQS monotherapy for facial hyperpigmentation. MATERIALS AND METHODS: Patients with symmetrical facial hyperpigmentation were treated with five sessions of once weekly LFQS on the whole face. One side was randomly treated with ITR and the other side received a placebo cream for 12 weeks. Patients were followed for 8 weeks after the last laser treatment. Relative lightness index (RL*I), Facial Hyperpigmentation Severity Score on the malar area (FHSSm ), patient satisfaction, recurrence, and adverse events were recorded. RESULTS: Twenty-four patients completed the study. Both sides demonstrated significant reductions of mean RL*I and mean FHSSm from baseline (P < .01). At the 4th week, the ITR-treated side showed more improvement of mean RL*I than the placebo-treated side (62.5% vs 47.3% improvement, P < .05). The mean FHSSm on the ITR-treated was reduced at a significantly higher percentage than the placebo-treated side (54.4% vs 40.2% reduction, P < .05). Partial recurrence was observed on both sides. No serious side effects were noted. CONCLUSION: Combined ITR and LFQS therapy was more superior than LFQS monotherapy in the treatment of facial hyperpigmentation. ITR may serve as adjuvant for patients with such condition.

The study of hair follicle counts from scalp histopathology in the Thai population.

BACKGROUND: The horizontal section of a scalp specimen offers an advantage over a vertical section by providing quantitative information. The reference data for hair counts in Asians, including Thais, are inconclusive. We aimed to determine the normal values of hair counts in scalp biopsy specimens in the Thai population. METHODS: A 4-mm punch biopsy was performed at the occipital area of the scalp from subjects presenting with clinically normal hair and scalp appearance. All specimens were horizontally sectioned and observed to assess the number of follicular units and hair follicles, type of hairs, and phase of the hair cycle. The results were further compared between sexes and with the pre-existing data from previous studies. RESULTS: Ninety specimens were collected from 90 subjects. The average number of total hairs, terminal hairs, vellus hairs, and follicular units per 4-mm punch scalp skin were 20.5 ± 5.2, 18.2 ± 4.1, 2 (range 0-7), and 9.1 ± 1.6, respectively. The mean ratio of terminal to vellus hair was 8.9:1 and of anagen to telogen hair was 91.9:7.9. There were no gender differences in any of the parameters and no correlations with changing age. Compared to other Asian populations, Thais and Taiwanese showed intermediate values between Iranians and Koreans; when compared to other ethnic groups, hair density in Asians showed lower than Caucasians and Hispanics but was comparable to Africans. CONCLUSION: This study established reference values of scalp horizontal sections in the Thai population; this will be helpful for clinicians and researchers to evaluate hair disorders.

Asian Hair: A Review of Structures, Properties, and Distinctive Disorders.

Asian hair is known for its straightness, dark pigmentation, and large diameter. The cuticle layer in Asians is thicker with more compact cuticle cells than that in Caucasians. Asian hair generally exhibits the strongest mechanical properties, and its cross-sectional area is determined greatly by genetic variations, particularly from the ectodysplasin A receptor gene. However, knowledge on Asian hair remains unclear with limited studies. This article aimed to review and summarize the characteristics and properties of Asian hair. It also aimed to discuss hair disorders including linear lupus panniculitis and pseudocyst of the scalp that occur distinctively in Asian populations.

Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date.

The currently approved treatment for female pattern hair loss (FPHL) includes topical minoxidil administration; however, this treatment fails to achieve hair regrowth in some patients. Finasteride, a selective 5α-reductase inhibitor (5-ARI), may be considered as an alternative treatment. However, because of its potential teratogenic effects, clinical studies and use of finasteride for FPHL are limited. In this review, we aim to summarize the literature regarding the pharmacology, clinical efficacy, and adverse effects of oral finasteride for the treatment of FPHL and to provide novel therapeutic options including topical finasteride and dutasteride, a new generation 5-ARI, for the treatment of FPHL.

Evaluation of Hair Density and Hair Diameter in the Adult Thai Population Using Quantitative Trichoscopic Analysis.

The data of hair density and hair diameter in the Asian population, especially in Thais, are limited. We aimed to evaluate hair density and hair diameter of members of the Thai population at different scalp sites and to determine the effect of sex and aging as well as to compare the results with those in groups of other ethnicities. Healthy Thais whose hair examination findings were normal were evaluated. Two hundred and thirty-nine subjects participated in this study, of whom 79 were male and 160 were female. Hair density and hair diameter were analyzed at four different scalp sites using quantitative trichoscopic analysis. The highest hair density in Thais was observed in the vertex area. Hair densities at four different scalp sites were significantly different from one another; only hair density at the vertex site showed no significant difference from that in the occipital area. In contrast, hair diameter did not show any statistically significant differences for the different sites. We observed decreased mean hair density with increasing age and found statistically significant differences between participants in their 20s and those in their 60s, while hair diameter remained consistent. Comparing our results with a previous study in other ethnicities, the hair densities in Asians are generally lower. In conclusion, hair density in the Thai population varies at different scalp sites. Aging is a factor in declining hair density. Asians have a lower hair density compared to Caucasian and African populations.

Frontal fibrosing alopecia in Asians: a retrospective clinical study.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia and predominantly occurs in postmenopausal women. The condition is increasing in prevalence worldwide. However, there is a paucity of information regarding FFA in Asians because of a lack of published literature. We aimed to describe the demographics, clinical and trichoscopic features, and treatment outcomes of FFA in Asian patients. METHODS: We conducted a retrospective clinical study including patients diagnosed with FFA. Data regarding demographics, clinical and trichoscopic findings, and treatment outcomes were collected. The data were analyzed using descriptive statistics. RESULTS: Fifty-six Thai patients with FFA met the inclusion criteria. There were 54 females (96.4%) and two males (3.6%), and the average age of disease onset was 51.3 ± 6.3 years. All patients presented with frontotemporal hairline recession, and 49 patients (87.5%) experienced eyebrow loss. Trichoscopy in 35 patients revealed follicular dropout, perifollicular erythema, and lonely hair in 35 (100%), 29 (82.8%) and 26 patients (74.2%), respectively. Disease stabilization was superiorly observed in patients treated with a combination of topical corticosteroids and hydroxychloroquine or finasteride (79.3% and 73.3%, respectively). CONCLUSION: Our study presents the largest series of FFA in Asians and reports mixed clinical patterns between Caucasian and African patients. Combination therapy of topical corticosteroids and hydroxychloroquine or the use of topical corticosteroids and finasteride may halt the progression of FFA in Asians.

A Case Report of Idiopathic Follicular Hyperkeratotic Spicules and Literature Review.

Follicular hyperkeratotic spicules is a rare skin disorder that is usually associated with multiple myeloma. The condition typically presents with tiny hyperkeratotic spicules in follicular distribution and predominantly on the face. To our knowledge, there has been one reported case of this condition without underlying disease. We herein report the second case of idiopathic follicular hyperkeratotic spicules in a 54-year-old Thai woman presenting with multiple follicular horn-like spicules on her face and neck.