Genotyping of the rs1800440 Polymorphism in CYP1B1 Gene and the rs9258883 Polymorphism in HLA-B Gene in a Spanish Cohort of 223 Patients with Frontal Fibrosing Alopecia.

The pathogenesis of frontal fibrosing alopecia has been linked to specific genetic variants. CYP1B1 codes for a component of the cytochrome p450 machinery that is involved in the metabolism of xenobiotic oestrogens. The study of the prevalence of polymorphisms in this gene may help to understand their role in the development of frontal fibrosing alopecia. The aim of this study is to describe the frequency of genetic variations in the alleles HLA-B*07:02 and CYP1B1 in patients with frontal fibrosing alopecia. A cross-sectional study was designed to evaluate blood samples from patients with frontal fibrosing alopecia who attended the Dermatology Department at University Hospital Ramón y Cajal (Madrid, Spain), in search of the polymorphisms rs9258883 and rs1800440 in the alleles HLA-B*07:02 and CYP1B1, respectively. A total of 223 patients were included in the study. Among the 83.8% of patients who carried the rs9258883 polymorphism in HLA-B*07:02, 58.7% were heterozygous for this variant and it was not present in 14.8% of the cases. The majority of patients with frontal fibrosing alopecia lacked the protective rs1800440 polymorphism in CYP1B1 (75.2%). This suggests a relevant role of this variant in development of frontal fibrosing alopecia. The genetic approach to this condition might influence patient prognosis and therapy options.

Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia in real clinical practice.

BACKGROUND: Dutasteride has been proposed as an effective therapy for frontal fibrosing alopecia (FFA). OBJECTIVES: We sought to describe the therapeutic response to dutasteride and the most effective dosage in FFA compared with other therapeutic options or no treatment. METHODS: This was a retrospective observational study including patients with FFA with a minimum follow-up of 12 months. Therapeutic response was evaluated according to the stabilization of the hairline recession. RESULTS: A total of 224 patients (222 females) with a median follow-up of 24 months (range 12-108 months) were included. The stabilization rate for the frontal, right, and left temporal regions after 12 months was 62%, 64%, and 62% in the dutasteride group (n = 148), 60%, 35%, and 35% with other systemic therapies (n = 20), and 30%, 41%, and 38% without systemic treatment (n = 56; P = .000, .006, and .006, respectively). Stabilization showed a statistically significant association with an increasing dose of dutasteride (88%, 91%, and 84% with a weekly treatment of 5 or 7 doses of 0.5 mg [n = 32], P < .005). Dutasteride was well tolerated in all patients. LIMITATIONS: Limitations included the observational and retrospective design. CONCLUSIONS: Oral dutasteride was the most effective therapy with a dose-dependent response for FFA in real clinical practice compared with other systemic therapies or no systemic treatment.

Prescribing Habits for Androgenic Alopecia among Dermatologists in Spain in 2019-2020: A Cross-Sectional Study.

BACKGROUND: In 2017, we carried out a cross-sectional study with the aim of describing androgenic alopecia (AGA) prescription habits among dermatologists who practice in Spain. Three years later, we repeated this study with the aim of describing the current situation and comparing it with previous data. MATERIAL AND METHODS: Descriptive cross-sectional study using online questionnaires autocompleted by dermatologists working in Spain. RESULTS: The responses of 243 dermatologists were analyzed. The most common treatments prescribed for MAGA were topical minoxidil (100%), oral finasteride (92.6%), oral dutasteride (75.7%), and oral minoxidil (50.6%). For premenopausal female AGA (FAGA), the most common treatments were topical minoxidil (99%), oral contraceptives (75%), nutricosmetics (71%), and oral minoxidil (67.9%). Lastly, the most common treatments prescribed in patients with postmenopausal FAGA were topical minoxidil (99.2%), oral finasteride (79%), oral durasteride (71.6%), and oral minoxidil (63%). CONCLUSIONS: In conclusion, AGA is the most frequent alopecia in the trichology clinic. The most common treatments prescribed in male AGA (MAGA) and postmenopausal FAGA were topical minoxidil and oral finasteride, while in premenopausal FAGA, topical minoxidil, oral contraceptives, and nutricosmetics were most commonly prescribed. In the past three years, oral dutasteride and oral minoxidil have increased drastically among the most prescribed therapies for MAGA, premenopausal FAGA, and postmenopausal FAGA.

A case of atypical disseminated herpes simplex virus 1 with hepatitis in a liver transplant recipient: the need for dermatologic evaluation.

Disseminated herpes simplex virus (HSV) is mainly seen in immunocompromised individuals. Atypical lesions can be present in both primary infection and reactivation disease. Compared with the general population, inmunocompromised hosts are at greater risk of increased persistency and severity of clinical manifestations, including severe systemic involvement such as esophagitis, meningitis, and hepatitis. Herein, we report the case of a liver transplant recipient with atypical disseminated herpes simplex virus-1 complicated by HSV-related hepatitis. Dermatological consultation and histological assessment were crucial for a correct diagnosis and treatment.

Treatment of gingival pigmentation with a 755-nm alexandrite picosecond laser.

Hyperpigmentation of the gums can be associated to several etiological factors. Although it is physiological in most cases it can cause esthetic concerns in some patients. The objective of our study was to evaluate the clinical efficacy and patient satisfaction with the treatment of gingival hyperpigmentation with picosecond alexandrite laser of 755 nm. We selected two patients with gingival hyperpigmentation on the anterior face of the upper and lower gums of years of evolution. Malignancy, drug ingestion, exposure to tobacco and underlying genetic and endocrine alterations were ruled out. Clinical photographs were taken before treatment and 2 weeks after the procedure. In both cases, anterior gingival areas were depigmented with satisfaction. The patients did not complain of severe pain or discomfort. Two weeks after the procedure the gingiva showed almost complete depigmentation. In conclusion, the 755-nm alexandrite picosecond laser seems to be safe and effective for the esthetic treatment of gingival hyperpigmentation.

Low-level light-assisted photodynamic therapy using a wearable cap-like device for the treatment of actinic keratosis of the scalp.

BACKGROUND: Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. METHODS: In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. RESULTS: In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. CONCLUSION: PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.

Hormonal and Gynecological Risk Factors in Frontal Fibrosing Alopecia: A Case-Control Study.

INTRODUCTION: Frontal fibrosing alopecia (FFA) is a condition that likely involves an interplay of autoimmune, hormonal, and environmental factors in its pathogenesis. There is a lack of comparative studies demonstrating the presence of hormonal background differences in FFA patients compared to the general population. MATERIALS AND METHODS: A single-center case-control study was designed, including 104 female FFA patients and 208 controls. Patients and controls were interviewed, and extensive data regarding their gynecological and hormonal background were recorded. RESULTS: One hundred four cases and 208 age-matched controls were included in the study. A significant difference of 2 years in the age of menopause was detected with a consistent mean increase in fertile life for the control group of 1.7 years. After the multivariate analysis, we found previous intake of tamoxifen to be a risk factor for the development of FFA (OR 14.89). The only protective factor identified was the previous use of an intrauterine device (IUD) (OR 0.22). CONCLUSIONS: An earlier menopause and tamoxifen intake might promote or maintain FFA, while the use of an IUD might protect from developing FFA. Our results support the previously proposed hypothesis of an underlying hormonal mechanism in the etiopathogenesis of FFA and point out low-estrogen environments as an ideal condition for FFA development.