Placas alopécicas en una cocinera / Alopecic Plaques in a Cook

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Crecimiento concéntrico en la alopecia areata (patrón en diana) / Concentric or Targetoid Regrowth in Alopecia Areata

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Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations / Evaluación histoquímica de la destrucción de la pared del vaso y la selectividad después del tratamiento con luz pulsada intensa en las malformaciones capilares

BACKGROUND: Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES: To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS: Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS: Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS: IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS

ANTECEDENTES: Entre las distintas estrategias para intentar mejorar la eficacia en el tratamiento de las malformaciones capilares tipo mancha en vino de Oporto (MC tipo MVO) están las fuentes de luz pulsada intensa. Existen hasta la fecha pocos estudios clínicos que avalen su utilidad en el tratamiento de las MC. Además, no disponemos de estudios histológicos que objetiven los efectos de la luz pulsada en la coagulación de estos vasos anómalos. OBJETIVOS: Evaluar los efectos histológicos de la luz pulsada en las MC tipo MVO. Intentamos comparar el daño epidérmico, dérmico y de la pared de los vasos después del tratamiento con distintos parámetros de IPL. MATERIAL Y MÉTODOS: Fueron realizadas 55 biopsias postratamiento en las MC de 15 pacientes. Las muestras fueron teñidas con cloruro de nitroblue tetrazolium. RESULTADOS: Quince pacientes (edad media: 39 años) fueron inscritos en este estudio. En esta serie los pacientes con mayor daño epidérmico fueron aquellos con un fototipo más alto (>IV). Las malformaciones de color rosa pálido eran especialmente resistentes al tratamiento, incluso con altas fluencias, duraciones de pulso corto y pulsos repetidos. Los pulsos de una mayor duración fueron especialmente eficaces en malformaciones capilares violáceas. CONCLUSIONES: Los equipos de IPL ofrecen una gran cantidad de opciones de tratamiento en las MC, sin embargo necesitamos conocer mejor sus efectos para realizar abordajes más eficaces y seguros. En este estudio hemos podido observar los efectos histológicos de los distintos pulsos sobre las MC tipo MVO

A primer to natural hair care practices in black patients.

Natural hairstyles have increased in popularity in the United States among individuals of African and Afro-Caribbean descent. Dermatologists should be aware of general principles of natural hair care in this patient population, including basic hair care terminology, types of natural hairstyles, methods of washing, and product selection. A basic knowledge of natural hair care practices in black patients will assist dermatologists in the management and treatment of many conditions associated with traumatic hairstyling in this patient population.

Three cases of liver toxicity with a dietary supplement intended to stop hair loss.

Liver toxicity associated with herbal remedies and dietary supplements is an increasing concern. Several toxic hepatitis cases have been reported in the literature in association with products intended for weight loss where green tea extracts are an ingredient.Three hepatotoxicity cases are reported below in association with the use of Inneov masa capilar®, a dietary supplement intended to stop hair loss whose primary component is green tea catechins. In all of them, other potential causes of acute hepatitis were ruled out.We highlight the importance of awareness regarding these substances at history taking in order to identify and report hepatic adverse reactions secondary to apparently safe herbs as described in the present manuscript.

A review of hair care products for black individuals.

Physicians should be prepared to provide professional guidance to black individuals with both chemically treated and natural (ie, nonchemically treated) hair. Patients may seek advice from physicians if they decide to discontinue use of chemical relaxers or if they have sustained damage such as chemical burns, breakage, or hair loss from the misuse of various hair care products. Properly advising this patient population requires a basic understanding of hair morphology in black individuals as well as the unique characteristics of this hair type and the products used to address its needs. Although some products may promote healing properties, misusing or overusing them may cause adverse effects. This article will provide clinicians with a basic understanding of chemically treated and natural hair in black individuals. We also discuss hair care products that are ideal for this patient population and the potential adverse effects based on their chemical formulations.

Pubic lice: an endangered species?

UNLABELLED: The incidence of pubic lice infestations is estimated to be between 1.3% and 4.6%, with an average incidence of 2% worldwide. It is also estimated that 70% to 80% of adults now remove pubic hair in part or entirety, using a variety of methods. It is hypothesized that the destruction of this pubic hair habitat may account for the falling incidence of pubic lice and may possibly lead to its eradication or atypical presentation. AIM: To report the changing incidence of pubic lice infestation from our unit over the last 10 years and assess its association, if any, with pubic hair removal of any kind. METHODS: Assessment of medical records and questionnaires were used to identify the incidence of hair removal and pubic lice infestation over a 10-year period. Data were anonymized and analyzed to identify any correlation. RESULTS: A significant and strong correlation between the falling incidence of pubic lice infections and increase in pubic hair removal was observed, with a Pearson correlation r value of 0.9686 (95% confidence intervals, 0.88-0.992). The P value is less than 0.0001. CONCLUSIONS: The increased incidence of hair removal may lead to atypical patterns of pubic lice infestations or its complete eradication as the natural habitat of this parasite is destroyed.

Shave frequency and regimen variation effects on the management of pseudofolliculitis barbae.

BACKGROUND: Pseudofolliculitis barbae (PFB) is an inflammatory condition of the face with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, all of which develop in response to shaving. Prevalent in African American men, a limited amount of data have been published on the shave outcomes as they relate to clinically measurable responses and patient satisfaction scoring. The primary purpose of this study is to evaluate the impact of a daily shaving regimen and advanced shaving products on exacerbation of lesions and symptoms in patients with PFB. METHODS: Ninety African American men were randomized to 1 of 3 treatment groups shaving 2 to 3 times per week with standard products (control group), shaving daily with standard products (daily standard group) or shaving daily with advanced products (daily advanced). The number of pustules, papules, ingrown hairs, and investigator's assessment of severity and subjective symptoms of itching and burning/stinging were assessed at baseline, week 6, and week 12. The response to treatment was also assessed by the investigator and the subject at weeks 6 and 12. Secondary measures including questionnaires regarding baseline shave practices were also correlated with outcomes variables. RESULTS: There were no significant differences noted between the 3 groups for papule (P=.32) or pustule (P=.46) count for the 12-week study. However, there was a significant mean papule reduction from baseline detected for both the control and daily advanced groups. In addition, compared to baseline, there was a significant reduction in ingrown hairs for the control group, and a directional reduction in ingrown hairs for the daily advanced group. There were significant group differences between the control group and both daily shaving groups, with the control group seeing significantly fewer ingrown hairs (P=.005 for control vs daily standard group and P=.04 for control vs daily advanced group). There were no significant group differences among the 3 groups for investigator-graded severity (P=.43) and response to treatment (P=.51). There was a significant perceived improvement in the response to treatment (P=.007) and itching (P=.002) for the daily advanced group vs the control group.

Premature hair graying.

Hair pigmentation and graying are important topics for the understanding of the physiology of aging; the differentiation of stem cells; and the mechanisms underlying disease processes such as progeroid syndromes, vitiligo, and hypothyroidism. Although hair graying, or canities, is a common process occurring in people as they age, an unknown percentage of individuals experience premature graying from familial inheritance or pathologic conditions. We review the physiology of hair pigmentation and the mechanism underlying physiologic graying, and we explore the etiology of pathologic causes of premature graying, pathologies associated with premature graying, and the limited available treatment options for hair graying.

Evaluation of efficacy, safety and effects on symptoms of androgenization of a generic oral contraceptive containing chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg.

BACKGROUND: This prospective noninterventional study assessed the contraceptive efficacy, safety and the effects on signs of androgenization of the generic oral contraceptive containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol (CMA/EE) in a real-world setting. STUDY DESIGN: A total of 1440 women were investigated during a six-cycle period by 229 gynecological practices throughout Germany. RESULTS: The adjusted Pearl index was 0.136 (unadjusted: 0.271). Of 463 patients with cycle irregularities at baseline, 83.4% had regular cycles after six cycles. Likewise, 74.1% of 162 patients with spotting or breakthrough bleeding at baseline were free from these symptoms at the end of study. The percentage of patients with dysmenorrhea decreased significantly from baseline (36.5%) to visit 3 after six cycles (12.3%; p=.0001), with a significant reduction in the use of pain medication (p<.0001). Additionally, the number of patients with skin and hair problems was significantly reduced (skin: 56.3% at baseline, 19.6% after six cycles; hair: 45.7% at baseline, 13.4% after six cycles; p=.001). CMA/EE was well tolerated by the patients, and 89.44% of the gynecologists were satisfied with the treatment. CONCLUSION: Generic CMA/EE exhibits very good contraceptive efficacy, cycle control and dysmenorrhea reduction. Furthermore, treatment with generic CMA/EE led to a favorable reduction of skin and hair problems in our study.

Pitfalls of mapping a large Turkish consanguineous family with vertical monilethrix inheritance.

Monilethrix, a rare autosomal dominant disease characterized by hair fragility and follicular hyperkeratosis, is caused by mutations in three type II hair cortex keratins. The human keratin family comprises 54 members, 28 type I and 26 type II. The phenotype shows variable penetrance and results in hair fragility and patchy dystrophic alopecia. In our study, Monilethrix was diagnosed on the basis of clinical characteristics and microscopic examination in a family with 11 affected members. Haplotype analysis was performed by three Simple Tandem Repeat markers (STR) and KRT86 gene was sequenced for the identification of the disease causing mutation. In the results of this, autosomal dominant mutation (E402K) in exon 7 of KRT86 gene was identified as a cause of Moniltherix in the large family from Turkey.

Determinants of uptake of surgical treatment for trachomatous trichiasis in North Ethiopia.

BACKGROUND: Surgery for trachomatous trichiasis prevents blindness. However people still decline surgery despite the availability of services in nearby health facilities. OBJECTIVES: To assess what proportion of cases of trichiasis had surgical treatment and to investigate the determinants of uptake of surgery. METHODS: Eight villages in Enebse Sarmidir district of Amhara Region-Ethiopia were randomly selected and all self-reported cases of trichiasis were approached. Both operated and un-operated trichiasis cases were interviewed using structured questionnaires. RESULT: The study employed a case control study design with patients with untreated trichiasis being cases (135) and those operated, controls (141). The main reasons given for not having surgery were burden of household tasks, indirect cost of surgery, lack of companion and fear of surgery. Uptake of surgery was found to rise with duration of illness (Chi Square for trend = 26.62, P < 0.05). Longer walking distance (more than one hour) to the nearby health facility was a negative predictor of uptake of surgical treatment (adjusted odd ratio 0.31, 95% confidence interval 0.15-0.67). CONCLUSION: Behavior change communication interventions targeted on early uptake of surgery are very important. Village-based surgical service provision may be worthwhile in settings of high blinding trachoma burden.

Azithromycin prevents recurrence of severe trichiasis following trichiasis surgery: STAR trial.

PURPOSE: Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threatening recurrence is unknown. This randomized, clinical trial determined if treating trichiasis surgical patients with oral azithromycin compared to usual care (topical tetracycline) resulted in a reduction in severe recurrence of trichiasis to one year. METHODS: In a rural, trachoma hyperendemic district in Ethiopia, 1452 trichiasis patients age 18 or older presenting for surgery were randomly allocated to azithromycin, single 1 gram dose, versus topical tetracycline twice per day for six weeks. The outcome was recurrent severe trichiasis, defined as lashes touching the cornea, or more than 5 lashes touching the globe, to one year. RESULTS: Patients randomized to receive azithromycin had significantly fewer severe recurrences, 4.2/100 person years overall, compared to those randomized to topical tetracycline, 7.9/100 person years (p < 0.01). CONCLUSIONS: A single dose of azithromycin has been shown to reduce severe post-surgical trichiasis recurrence rates to one year and should become standard post surgical treatment.