Melatonin and the Human Hair Follicle.

BACKGROUND: Melatonin, a pleiotropic hormone, affects the physiological processes including that of the hair follicle. We seek to identify the scientific evidence to support the potential benefits of melatonin in human hair growth. OBJECTIVE: To summarize the evidence on the association between melatonin and hair health, denoted by hair growth. METHODS: A literature review using 3 databases (PubMed, Google Scholar, and Cochrane) identified studies investigating the relationship between melatonin and hair loss (2022). The following search terms were used: (hair OR hair loss OR alopecia OR hair growth OR effluvium OR scalp) and (melatonin). Two independent reviewers screened studies for inclusion criteria, and data collection included demographics, melatonin intervention, study type, and effects on hair. RESULTS: A total of 11 human studies were identified with evidence of melatonin use in subjects with diagnosed alopecia (2,267 patients; 1,140M). Eight of the studies reviewed observed positive outcomes after topical melatonin use in subjects with androgenetic alopecia (AGA). Most studies report improved scalp hair growth (n=8), density (n=4), and hair shaft thickness (n=2) among melatonin users compared with controls. Effective topical melatonin dosage appears to be 0.0033% or 0.1% solution applied once-daily for 90 to 180 days vs 1.5 mg twice-daily oral melatonin supplementation for 180 days. CONCLUSION: There is evidence to support melatonin use to facilitate scalp hair growth, particularly in men with AGA. Further studies should include more patients and investigate the mechanism of action. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.6921.

Inflammatory Vulvar Dermatoses (Part I).

Vulvar disease is common, and urologists are often the first providers to see patients with a vulvar skin condition. Primary vulvar dermatoses can be localized to the anogenital area or a manifestation of more diffuse cutaneous disease. Additionally, secondary dermatoses can develop from exogenous agents and inflammatory vaginitis. Vulvar conditions are challenging to diagnose due to location and different types of skin and mucosal epithelium involved. Herein, we provide an overview of noninfectious inflammatory vulvar dermatoses (part I) and benign and malignant vulvar neoplasms (part II), grouped by morphologic findings. We include diagnostic evaluation, workup, and management of these conditions.

Vulvar Neoplasms (Part II).

Vulvar disease is common, and urologists are often the first providers to see patients with a vulvar skin condition. Primary vulvar dermatoses can be localized to the anogenital area or a manifestation of more diffuse cutaneous disease. Additionally, secondary dermatoses can develop from exogenous agents and inflammatory vaginitis. Vulvar conditions are challenging to diagnose due to location and different types of skin and mucosal epithelium involved. Herein, we provide an overview of noninfectious inflammatory vulvar dermatoses (Part I) and benign and malignant vulvar neoplasms (Part II), grouped by morphologic findings. We include diagnostic evaluation, workup, and management of these conditions.

Characterization of Residual Facial Dermatitis during Dupilumab Therapy: A Retrospective Chart Review to Delineate the Potential Role of Expanded Series Patch Testing.

OBJECTIVE: We sought to determine the incidence of RFDD in patients receiving dupilumab and the rate of resolution of RFDD after expanded series patch testing (ESPT) and allergen avoidance. METHODS: This is a retrospective chart review of 80 patients with atopic dermatitis who were evaluated for RFDD after treatment with dupilumab. Expanded series patch testing findings and response to allergen avoidance were assessed in the subset of patients with RFDD who subsequently underwent ESPT while continuing to receive dupilumab. RESULTS: Forty-nine patients (61.3%) experienced facial dermatitis before initiating dupilumab. Thirty-five patients (43.8%) experienced RFDD after starting dupilumab. Of the 14 patients with RFDD who received ESPT, 92.9% had 1 or more relevant positive patch test results, with 50% of such patients being mostly to completely clear of facial dermatitis after allergen avoidance. Importantly, 50.6% of the positive reactions to allergens were not included on the North American Contact Dermatitis Group Core 80. CONCLUSIONS: Many patients with RFDD benefit from patch testing and subsequent allergen avoidance. Expanded series patch testing should be offered to patients who experience RFDD after beginning dupilumab therapy to ensure that such patients have eliminated any exogenous component of their dermatitis, such as concomitant allergic contact dermatitis.

A clinician's guide to cutaneous T-cell lymphoma presenting as recalcitrant eczematous dermatitis in adults.

Cutaneous T-cell lymphoma (CTCL) encompasses a group of low-grade, non-Hodgkin lymphoma, including mycosis fungoides and Sézary syndrome. Diagnosis of CTCL can be challenging given the prolonged, gradual onset and shared characteristics with many benign inflammatory skin diseases. In this case series, we describe four unique cases of patients with chronic, recalcitrant eczematous dermatitis who presented for a patch-test consultation and were ultimately diagnosed with CTCL. In particular, we highlight clinical pearls to aid in distinguishing CTCL from inflammatory dermatoses and describe the diagnostic strategy to help dermatologists arrive at the diagnosis of CTCL at earlier stages of the disease.

Idiopathic pure sudomotor failure: A review and two cases.

Idiopathic pure sudomotor failure (IPSF) is a rare disease characterized by acquired impairment in total body sweating despite exposure to heat or exercise. Its etiology is unknown but thought to involve defective cholinergic receptors on eccrine sweat glands. This article reviews the epidemiology, pathophysiology, presentation, and management of IPSF. Additionally, we report two cases of IPSF treated with multimodal therapy, including stacked antihistamine regimens and omalizumab, resulting in symptom improvement. This is the first report of treatment of IPSF with omalizumab, although its benefit is uncertain and requires further study.

Catamenial Hyperpigmentation: A Review.

BACKGROUND: Changes in skin pigmentation patterns related to the fluctuation of estrogen receptors and progesterone receptors during menstruation, also known as catamenial hyperpigmentation, have been reported in several studies. OBJECTIVE: We sought to summarize the literature on catamenial skin hyperpigmentation and menses-induced exacerbations of skin pigmentation disorders. METHODS: We searched PubMed/MEDLINE and the Cochrane Skin database with the search terms menses and pigment, estrogen and pigment, progesterone and pigment, and hyperpigmentation and menses, then assessed the relevant literature on skin diseases related to nonpathological menstruation. RESULTS: The most commonly reported primary catamenial hyperpigmentation disorders are postinflammatory hyperpigmentation (PIH) after laser therapy and ultraviolet sensitivity (UV). The most reported chronic skin pigmentation exacerbated by menses is melasma. The literature detailing catamenial hyperpigmentation is limited to cross-sectional studies, experimental studies, surveys, review articles, case reports, and small trials, leading to a lower level of evidence. CONCLUSION: Our review of the literature revealed that the most common catamenial hyperpigmentation is melasma. We also found a reported higher risk of PIH after laser therapies and UV sensitivity. Estrogen and progesterone are two of the major factors responsible for catamenial hyperpigmentation of the skin. Generally, the changes happen in the luteal phase of the menstrual cycle when the serum levels of sex hormones are at their peak. Although the exact balance of influence is controversial, most recent studies indicate that estrogen has a more prominent role than progesterone in inducing hyperpigmentation.

Pediatric contact allergens in the neonatal intensive care unit.

OBJECTIVE: The degree of neonatal exposure to potentially sensitizing agents on neonatal intensive care units (NICUs) and the process by which personal care products are selected for use in the NICU are poorly documented. STUDY DESIGN: We evaluated personal care products used in three NICUs for potentially sensitizing agents. We interviewed NICU staff to analyze how products are selected and approved for use. RESULTS: Twenty-four personal care products were evaluated. 75% contained one or more potential contact allergen, with fragrances being most common. Staff preference, brand loyalty, cost, and small product size were often considered when approving NICU products. CONCLUSIONS: The prevalence of potentially sensitizing agents in the products indicates a need for improvement in the evaluation and acquisition process of over-the-counter products used for neonatal skin care. The involvement of dermatology in this process may be beneficial.

Work-life balance among female dermatologists.

BACKGROUND: Female dermatologists often face the challenges of balancing a rewarding medical career with duties of home life and childrearing. Excessive responsibility at home or work can introduce barriers to balance and prove detrimental to the health and wellness of the physician. OBJECTIVE: We aim to perform a needs assessment through a series of survey questions with regard to home and work responsibilities and impacts on mental health. METHODS: Survey participants were selected from the Women's Dermatologic Society through an e-mail invitation with a link to an anonymous survey tool and a paper questionnaire at the Women's Dermatologic Society Forum in February 2019 in Dallas, Texas. The survey included 20 questions with regard to household responsibilities, child care, clinical responsibilities, specialty education, and impacts on personal time, sleep, and overall sense of well-being. There were a total of 127 respondents. RESULTS: Eighty-five percent of physicians in our cohort are currently married. A large percent of respondents utilized hired household help in the form of nannies to perform chores. Spousal contribution was emphasized in this cohort and often highlighted as an important factor in maintaining home life duties. CONCLUSION: The professional women in our cohort may be balancing work and life at the expense of personal physical and mental health with little time to exercise and fewer hours of sleep per night.

Validating Responsiveness of a Quality-of-Life Instrument for Allergic Contact Dermatitis.

BACKGROUND: Although many generic dermatological quality-of-life (QoL) instruments exist, none have been specifically designed for patients with allergic contact dermatitis (ACD). In the preceding publication-Validating a Quality-of-Life Instrument for Allergic Contact Dermatitis-we developed and validated a QoL instrument specific to the ACD population. OBJECTIVE: The aim of this study was to assess whether this ACD-specific QoL instrument appropriately captures change in QoL after patch testing in ACD patients. METHODS: One hundred individuals completed the previously validated 17-item QoL survey plus 2 global questions and the Skindex-29 before patch testing. Two months after patch testing and allergen avoidance, the participants repeated the same questionnaires. We used statistical methods to evaluate the capacity of the ACD questionnaire to measure change in QoL in comparison with the Skindex-29. CONCLUSIONS: The novel ACD-specific questionnaire was more sensitive to change in QoL than the generic Skindex-29. Eleven of the original 17 items were found to capture change in QoL, and of the 3 domains (emotions, symptoms, functioning), the emotional aspect of the disease was most burdensome and responsive to change 2 months after patch testing. Providers can reliably use this index to assess changes in QoL over time.

The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review.

BACKGROUND: It is unclear whether the type 2 T helper cell-specific immunosuppressive action of dupilumab interferes with patch testing. OBJECTIVES: We sought to evaluate the reliability of patch testing on dupilumab and the contribution of allergic contact dermatitis (ACD) to complex dermatitis in patients with residual dermatitis on dupilumab. METHODS: This is a retrospective chart review of 48 patients with atopic dermatitis (AD) who were treated with dupilumab. We compare the results of patch tests performed before and after the initiation of dupilumab and the prevalence of comorbid ACD in patch-tested individuals. RESULTS: A minority of patch test reactions were "lost" on dupilumab (13/125; 10.4%). Five of 13 lost reactions occurred in individuals with documented immunodeficiency. Thirty-two of 35 patch-tested patients (91.4%) had comorbid ACD; 92.3% of individuals patch tested on dupilumab experienced further clinical improvement with allergen avoidance. LIMITATIONS: This is a nonrandomized study in a small cohort of patients. The clearance of dupilumab was assessed by subjective patient reports. CONCLUSIONS: Dupilumab does not appear to exert a dampening effect on patch test results. AD with comorbid ACD was highly prevalent and allergen avoidance resulted in significant improvement in residual dermatitis that had not resolved without dupilumab therapy.

Another Candle on the Cake: The American Contact Dermatitis Society Reaches Its 30th Year.

The year 2019 marks the 30th anniversary of the American Contact Dermatitis Society (ACDS). The work of inaugural ACDS members and the 3 decades of camaraderie, collaboration, education, and investigation of contact dermatitis that followed the inception of the ACDS are celebrated in this historical account.