Treatment of permanent chemotherapy-induced alopecia with low dose oral minoxidil.

Chemotherapy-induced alopecia is a well-established cause of major distress to patients. Permanent chemotherapy-induced alopecia (PCIA) is the absence of or incomplete hair regrowth lasting longer than 6 months after the cessation of chemotherapy and it does not respond to standard treatments of scalp cooling or topical minoxidil. The increasing numbers of reports of PCIA highlight the need for research into an effective treatment. We report a case of a 39 year-old woman with cosmetically significant regrowth after continuous therapy with oral minoxidil.

Atypical chronic sterile paronychia leading to tissue and joint space destruction in a patient with thromboangiitis obliterans.

We report the case of a patient with severe thromboangiitis obliterans (Buerger's disease) and untreated paronychia which eroded into the digital joint space causing acrolysis of digits and significant soft tissue and joint destruction.

A prospective study of the use of cryosurgery for the treatment of actinic keratoses.

BACKGROUND: Actinic keratoses are the most common actinic lesions on Caucasian skin. Cryosurgery with liquid nitrogen is commonly used to treat actinic keratoses, but there have been few studies examining the true rate of cure in everyday dermatologic practice. AIM: To determine prospectively the true efficacy of cryosurgery as a treatment for actinic keratoses in everyday dermatologic practice. METHODS: A prospective, multicentered study (a subsidiary study of a photodynamic therapy trial) was performed. Patients with untreated actinic keratoses greater than 5 mm in diameter on the face and scalp were recruited. Eligible lesions received a single freeze-thaw cycle with liquid nitrogen given via a spray device and were reviewed 3 months thereafter. Each center used their preferred freeze time. The only treatment criterion was complete freezing of actinic keratoses and a 1-mm rim of normal skin. Treated lesions were assessed as complete response or noncomplete response. The influence of the duration of freeze, cosmetic outcomes, and adverse events were examined. RESULTS: Ninety adult patients from the community with 421 eligible actinic keratoses were recruited. The overall individual complete response rate was 67.2%[SEM = +/-3.5%; 95% confidence interval (CI) = 60.4-74.1%]. Complete response was 39% for freeze times of less than 5 s, 69% for freeze times greater than 5 s, and 83% for freeze times greater than 20 s. Cosmetic outcomes were good to excellent in 94% of complete response lesions. The main adverse events were pain, stinging, and burning during treatment, and hypopigmentation after healing. CONCLUSIONS: Cryosurgery is an effective treatment for actinic keratoses. The true complete response rate is significantly lower than that previously reported. The freeze duration influences successful treatment. Adverse events are mild and well tolerated.

Short anagen hair with persistent synchronized pattern of scalp hair growth.

Unlike other mammals that molt hair seasonally, human beings have scalp hair follicles that exhibit an asynchronized pattern of cycling, with the growth and subsequent shedding of each hair being independent of others around it. This mosaic cycling behavior is established early and continues throughout life. We describe a boy who continues to have a synchronized pattern of hair growth and shedding, and a short anagen duration at 4 years of age. He appears to never have established the expected asynchronized pattern of hair growth.

Reactive angioendotheliomatosis in the setting of antiphospholipid syndrome.

A 31-year-old man with systemic lupus erythematosus and antiphospholipid syndrome developed erythematous purpuric plaques distributed over the lower chest, abdomen and upper thighs. Biopsy of lesional skin revealed intravascular proliferation of endothelial cells with associated microthrombi formation. The histological pattern was consistent with reactive angioendotheliomatosis, a rare reactive pattern seen associated with disparate medical conditions. The pathogenesis of the reactive angioendotheliomatosis in our patient was suspected to be related to his procoagulant state; thrombi formed despite a therapeutic international normalized ratio while on warfarin. His lesions began to resolve with the cessation of warfarin and commencement of subcutaneous enoxaparin, oral clopidogrel and oral aspirin. The skin biopsy findings were pivotal in influencing the change of therapy in this patient and decreasing his immunosuppression.

Chronic telogen effluvium in a man.

Chronic telogen effluvium is a recently described condition, in which there is persistent excessive hair shedding. Hairs are replaced as quickly as they shed, so patients never become bald. This condition is found primarily in women. We describe chronic telogen effluvium in a man; the diagnosis may have only become obvious because of his long hair.