Treatment of rosacea during pregnancy.

BACKGROUND: Exacerbation of rosacea may occur during pregnancy and there are multiple associated cases of rosacea fulminans (RF). Treatment during pregnancy poses a significant challenge as many rosacea treatments are contraindicated or have limited evidence regarding potential adverse fetal effects. OBJECTIVE: Review the pregnancy categories of various treatments and develop algorithms for treating pregnant patients with rosacea and RF. METHODS: Rosacea treatments showing efficacy in randomized controlled trials were searched through DailyMed to review pregnancy labelling. Searching the PubMed/MEDLINE database for English articles using keywords "rosacea fulminans AND pregnancy" without publishing-time restrictions yielded 8 articles. We summarized treatments used in cases of RF during pregnancy. RESULTS: Topical ivermectin was more effective than metronidazole, but has a more concerning pregnancy category. Three pregnant women with RF were treated successfully with topical metronidazole in combination with other therapies. Azithromycin is the only oral rosacea therapy that is considered safe for pregnant patients and it has been used to treat RF. CONCLUSIONS: This review highlights the challenging aspects of treating pregnant patients with rosacea, as there is limited pregnancy-related treatment efficacy and safety data. The pregnancy categories of therapeutic options are summarized. Further studies are needed to learn which therapies are effective and safe for use during pregnancy.

Hair-Loss Perceptions and Treatment Expectations in Young People of Color.

BACKGROUND: While much research has been dedicated to hair loss in older patients, little has addressed hair loss perception and treatment expectations among young people of color (POC). This study evaluates disease perceptions, willingness to utilize specific therapies, and treatment expectations in younger versus older POC with any form of hair loss. METHODS: An online survey was utilized to analyze 217 responses to 37 questions assessing perceptions of hair loss, hair care practices, and treatment expectations among others. These parameters were measured on a 1–5 Likert scale. Comparison between groups was be done using Chi-Square tests for proportions and Student t-tests. RESULTS: Included were 52 respondents between the ages of 18 and 29 (POC<30), and 36 respondents greater than 30 years of age (POC>30). The reported average hair loss in POC<30 was 67.0%, compared to POC>30 reporting 60.0% (P<0.05). Average embarrassment was 2.6 for POC<30 versus 3.4 for POC>30 (P<0.001). Average pain was 2.0 for POC<30 versus 1.8 for POC>30 (P<0.05). Average hair thinning was 3.0 for POC<30 versus 3.7 for POC>30 (P<0.001). Average willingness to use topical treatments including creams, solutions, ointments, and gels was 3.0 in POC<30 versus 3.8 in POC>30 (P<0.001). The average perceived effectiveness of topical treatments was 2.9 in POC<30 versus 3.6 in POC>30 (P<0.01). CONCLUSION: Early identification and appropriate management of young POC with hair loss may facilitate follicular rescue. This, in turn, may help reduce the negative consequences of advanced hair loss, such as embarrassment, as seen in older POC. J Drugs Dermatol. 2021;20(7):746-750. doi:10.36849/JDD.5960.

Scar tissue I wish you saw: Patient expectations regarding scar treatment.

Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80 years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

The danger of neglecting melanoma during the COVID-19 pandemic.

Due to the COVID-19 pandemic, planned medical and surgical activities are being postponed. For the dermatology community, this interruption to the healthcare system can lead to delays in the diagnosis and treatment of melanoma. Neglecting melanoma during this crisis can result in increased mortality, morbidity and healthcare costs. With the COVID-19 pandemic evolving and no clear solutions in sight, it is time for the prospective evaluation of teledermatology. However, dermatologists should be cautious and continue seeing patients with pigmented lesions in person due to the necessity of early surgical intervention.

From the Cover: Lifelong Exposure of C57bl/6n Male Mice to Bisphenol A or Bisphenol S Reduces Recovery From a Myocardial Infarction.

Bisphenol A (BPA) leaches from plastics to contaminate foodstuffs. Analogs, such as bisphenol S (BPS), are now used increasingly in manufacturing. Greater BPA exposure has been correlated with exacerbation of cardiovascular disease, including myocardial infarction (MI). To test the hypothesis that bisphenol exposure impairs cardiac healing, we exposed C57bl/6n mice to water containing 25ng/ml BPA or BPS from conception and surgically induced an MI in adult male progeny. Increased early death and cardiac dilation, and reduced cardiac function were found post-MI in BPA- and BPS-exposed mice. Flow cytometry revealed increased monocyte and macrophage infiltration that correlated with increased chemokine C-C motif ligand-2 expression in the infarct. In vitro BPA and BPS addition increased matrix metalloproteinase-9 (MMP) protein and secreted activity in RAW264.7 macrophage cells suggesting that invivo increases in MMP2 and MMP9 in exposed infarcts were myeloid-derived. Bone marrow-derived monocytes isolated from exposed mice had greater expression of pro-inflammatory polarization markers when chemokine stimulated indicating an enhanced susceptibility to develop a pro-inflammatory monocyte population. Chronic BPA exposure of estrogen receptor beta (ERß) deficient mice did not worsen early death, cardiac structure/function, or expression of myeloid markers after an MI. In contrast, BPS exposure of ERß-deficient mice resulted in greater death and expression of myeloid markers. We conclude that lifelong exposure to BPA or BPS augmented the monocyte/macrophage inflammatory response and adverse remodeling from an MI thereby reducing the ability to survive and successfully recover, and that the adverse effect of BPA, but not BPS, is downstream of ERß signaling.