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1.
J Am Acad Dermatol ; 88(5): 1040-1050, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-31163237

RESUMO

BACKGROUND: To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression. OBJECTIVE: We sought to analyze the existing literature to examine the association between alopecia areata, anxiety, and depression. METHODS: We extracted literature from 4 databases including MEDLINE, Embase, PsychINFO, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (ie, PRISMA) reporting guidelines to finalize a list of relevant articles to be included in our systematic review and meta-analysis. There were no restrictions placed on publication year or age of participants. RESULTS: Eight studies that included 6010 patients with AA and 20 961 control individuals were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies showed a positive association with anxiety (pooled odds ratio, 2.50; 95% confidence interval, 1.54-4.06) and depression (pooled odds ratio, 2.71; 95% confidence interval, 1.52-4.82). LIMITATIONS: Publication bias may be a limitation of the study. CONCLUSION: This study suggests that patients with AA are at higher risk of both anxiety and depression. Health care professionals must be cognizant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated.


Assuntos
Alopecia em Áreas , Humanos , Alopecia em Áreas/epidemiologia , Depressão/epidemiologia , Estudos Transversais , Ansiedade/epidemiologia
2.
J Investig Dermatol Symp Proc ; 20(1): S58-S59, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33099387

RESUMO

Although alopecia areata (AA) has been traditionally classified as a strictly T helper type 1-mediated process, the T helper type 2 (Th2) pathway may contribute to an AA-like phenotype in some individuals. Herein, we describe three clinical cases that support the potential role of Th2 activity through the upregulation of IL-4 and IL-13 in an AA-like phenotype.


Assuntos
Alopecia em Áreas/imunologia , Alopecia em Áreas/metabolismo , Hipersensibilidade Alimentar/imunologia , Interleucina-13/metabolismo , Interleucina-4/metabolismo , Adolescente , Adulto , Alopecia em Áreas/complicações , Alopecia em Áreas/tratamento farmacológico , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Feminino , Hipersensibilidade Alimentar/complicações , Preparações para Cabelo/efeitos adversos , Humanos , Fenótipo , Células Th2 , Adulto Jovem
3.
Breast Cancer Res Treat ; 175(2): 267-276, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30806923

RESUMO

PURPOSE: Chemotherapy-induced alopecia (CIA) remains a distressing adverse event of cancer treatment but may be prevented by scalp cooling. The effectiveness of scalp cooling, however, is dependent on the chemotherapy regimen with successful hair preservation (i.e., < 50% hair loss) in 41-59% of women on taxane-based therapies in comparison to 16-36% on anthracycline-based therapies. Despite the potential utility, use of scalp cooling has shown a more equivocal impact on quality of life (QoL). In this review, we aim to evaluate the use of scalp cooling for CIA and quantitative QoL measures. METHODS: A systematic review of PubMed, Embase, Web of Science, and Cochrane databases for clinical studies on scalp cooling to prevent CIA published before October 29, 2018 was performed. Clinical studies with 5 or more patients that reported on a quantitative QoL measure were included and graded according to a modified five-point scale from the Oxford Centre for Evidence-Based Medicine. RESULTS: Studies meeting inclusion criteria included 4 randomized clinical trials (RCT), 8 cohort studies, and 1 cross-sectional study with 1282 unique patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30: 46%) and Breast Cancer Module (QLQ-BR23: 46%) represented the most commonly used QoL assessments. Overall, 4 (31%) of the 13 studies concluded that scalp cooling was associated with significant improvements in QoL measures; 8 (62%) determined that there was either non-significant or no improvements; and 1 (7.7%) provided a mixed conclusion. Although 2 (50%) RCT demonstrated that scalp cooling can effectively prevent CIA depending on the chemotherapy regimen, these studies did not show that successful hair preservation was associated with improved QoL measures. CONCLUSIONS: This review demonstrates that scalp cooling is not consistently associated with significant QoL improvements as assessed by EORTC QLQ-C30 and -BR23. Representing a critical limitation, more than one-third of the studies did not subcategorize QoL outcomes for successfully or unsuccessfully scalp-cooled patients but rather reported on QoL measures for all scalp-cooled patients in general. Failure to prevent hair loss in patients undergoing an expensive and potentially uncomfortable treatment likely contributes to decreased well-being, impacting the overall distribution of QoL measures in scalp cooling patients compared to controls. Future studies should incorporate validated QoL instruments specific to hair disease and classify QoL outcomes for scalp-cooled patients based on the degree of hair preservation.


Assuntos
Alopecia/prevenção & controle , Neoplasias da Mama/tratamento farmacológico , Crioterapia , Quimioterapia de Indução/efeitos adversos , Alopecia/induzido quimicamente , Alopecia/patologia , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Hidrocarbonetos Aromáticos com Pontes/efeitos adversos , Hidrocarbonetos Aromáticos com Pontes/uso terapêutico , Feminino , Humanos , Qualidade de Vida , Couro Cabeludo/patologia , Taxoides/efeitos adversos , Taxoides/uso terapêutico
4.
J Am Acad Dermatol ; 81(5): 1134-1141, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454500

RESUMO

BACKGROUND: While scalp alopecia represents a distinctive feature of chronic graft-versus-host disease (cGVHD), little is known about the clinical and histologic presentation of hair loss. OBJECTIVES: We sought to classify the clinical presentations and histologic findings of chronic hair loss in patients with cutaneous cGVHD. METHODS: A prospective cohort of 17 adult hematopoietic cell transplantation (HCT) recipients with cutaneous cGVHD was enrolled. Dermatologic examinations were performed, and punch biopsy specimens of the scalp were obtained. Biopsy specimens were analyzed with hematoxylin-eosin and immunohistochemical stains in all cases and fluorescence in situ hybridization analyses in specific cases. RESULTS: Clinically, 4 patterns of hair loss were described-patchy nonscarring (41.2%), diffuse nonscarring (11.8%), diffuse sclerotic (11.8%), and patchy sclerotic (5.9%). The location of the inflammatory infiltrate on hematoxylin-eosin-stained specimens correlated with the hair loss pattern patients had clinically, with cell populations around the bulb and bulge in nonscarring and sclerotic cases, respectively. Fluorescence in situ hybridization studies in female cGVHD patients with male donors demonstrated green Y chromosomes limited to the area of the hair follicle affected by inflammatory cells. CONCLUSION: This study describes the various clinical and histologic subtypes of long-standing alopecia in adult cGVHD patients and suggests that this alopecia may be a direct manifestation of cGVHD of the hair follicle.


Assuntos
Alopecia/etiologia , Alopecia/patologia , Doença Enxerto-Hospedeiro/complicações , Couro Cabeludo/patologia , Dermatopatias/complicações , Adulto , Idoso , Biópsia , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dermatopatias/imunologia
5.
Dermatol Surg ; 45(3): 446-457, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789503

RESUMO

BACKGROUND: Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon. OBJECTIVE: To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care. METHODS: The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy. RESULTS: In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections. CONCLUSION: As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Pessoas Transgênero , Acne Vulgar/induzido quimicamente , Acne Vulgar/cirurgia , Cicatriz/cirurgia , Face/cirurgia , Feminino , Cabelo/crescimento & desenvolvimento , Cabelo/transplante , Remoção de Cabelo , Humanos , Procedimentos de Cirurgia Plástica , Infecções Sexualmente Transmissíveis/diagnóstico , Testosterona/efeitos adversos , Testosterona/uso terapêutico , Vagina/cirurgia
9.
Skin Therapy Lett ; 23(6): 1-5, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30517778

RESUMO

Cannabinoids have demonstrated utility in the management of cancer, obesity, and neurologic disease. More recently, their immunosuppressive and anti-inflammatory properties have been identified for the treatment of several dermatologic conditions. This review thus assesses the therapeutic potential of phytocannabinoids, endoocannabinoids, and chemically synthetic cannabinoids in the management of cutaneous disease. The PubMed® and Scopus® databases were subsequently reviewed in December 2017 using MeSH and keywords, such as cannabinoid, THC, dermatitis, pruritus, and skin cancer. The search yielded reports on the therapeutic role of cannabinoids in the management of skin cancer, acne vulgaris, pruritus, atopic and allergic contact dermatitis, and systemic sclerosis. While cannabinoids have exhibited efficacy in the treatment of inflammatory and neoplastic skin conditions, several reports suggest pro-inflammatory and pro-neoplastic properties. Further investigation is necessary to understand the complexities of cannabinoids and their therapeutic potential in dermatology.

13.
Int J Dermatol ; 62(3): 376-386, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36096120

RESUMO

The clinical manifestations of parasitic diseases are well-covered in the infectious disease literature; however, cutaneous manifestations often receive limited attention. There is a need to update existing knowledge and improve reporting of disease characteristics. Given continued increases in travel and transportation, more individuals are acquiring cutaneous infections while traveling abroad. Schistosomiasis is the second most important tropical disease among returning travelers and affects more than 200 million individuals worldwide. The literature classically describes three forms of skin disease in those infected with Schistosoma: the immediate pruritic eruption of cercarial dermatitis, the urticarial response of Katayama syndrome, and the granulomatous lesions of late cutaneous schistosomiasis. Over the last two decades, more atypical presentations have been described. Travelers returning from Africa, South America, and Asia are at highest risk given these are the continents in which the parasite is endemic. This review highlights the cutaneous manifestations of schistosomiasis, with a focus on international travelers with atypical presentations. Additionally, genital schistosomiasis will be reviewed given its significant morbidity. The aim of this review is to update the current body of literature. Dermatologists and other physicians evaluating the skin should be aware of the following principles regarding schistosomal infections: (i) the importance of an early skin biopsy in making the diagnosis; (ii) the necessity of adding schistosomiasis to the differential diagnosis for zosteriform lesions; (iii) the resemblance of chronic cutaneous schistosomiasis of the genitals to sexually transmitted infections; and (iv) the need to revise definitions for early and late infection, specifically for cutaneous disease.


Assuntos
Dermatite , Esquistossomose , Dermatopatias Parasitárias , Dermatopatias , Humanos , Esquistossomose/diagnóstico , Esquistossomose/epidemiologia , África , Pele , Viagem
14.
JAMA Dermatol ; 156(11): 1246-1247, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32822454

RESUMO

Clinical Question: Who should receive human papillomavirus (HPV) vaccination? Bottom Line: Catch-up vaccination is now recommended for all persons through age 26 years. For persons aged 27 through 45 years, clinicians and patients should now jointly decide whether HPV vaccination is appropriate. Routine HPV vaccination at age 11 or 12 years (or as early as age 9 years) continues to be recommended.


Assuntos
Medicina Baseada em Evidências/normas , Vacinação em Massa/normas , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Comitês Consultivos/normas , Centers for Disease Control and Prevention, U.S./normas , Criança , Feminino , Humanos , Esquemas de Imunização , Masculino , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Estados Unidos/epidemiologia , Adulto Jovem
15.
Dermatol Clin ; 38(2): 209-218, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115130

RESUMO

Sexual and gender minorities have unique risk factors that may increase their risk of developing skin cancer. In particular, sexual minority men report a higher prevalence of skin cancer (including both keratinocytes carcinomas and melanoma), higher rates of indoor tanning, and overall poorer sun protection behaviors. Sexual and gender minorities also have high rates of alcohol and tobacco use, and infection with human immunodeficiency virus and human papillomavirus, which may increase overall risk of developing skin cancer in these populations. In this review, we discuss the evidence surrounding skin cancer and associated risk factors among sexual and gender minorities.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Infecções por Papillomavirus/epidemiologia , Fatores de Risco , Procedimentos de Readequação Sexual , Fumar/epidemiologia , Banho de Sol/estatística & dados numéricos , Estruturas Criadas Cirurgicamente
16.
Dermatol Clin ; 38(2): 239-247, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115134

RESUMO

Androgenetic alopecia (AGA) is the most common type of hair loss in adults and may be particularly distressing for gender minority patients, given the close relation between hair and gender expression. Furthermore, use of gender affirming hormones such as testosterone in transmen and estrogen/antiandrogens in transwomen has a direct effect on hair growth distribution and density. Clinicians should thus be knowledgeable about the effects of sex hormones on the hair growth cycle to comfortably diagnose and treat AGA in gender minority patients.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Alopecia/terapia , Fármacos Dermatológicos/uso terapêutico , Finasterida/uso terapêutico , Folículo Piloso/transplante , Terapia com Luz de Baixa Intensidade , Minoxidil/uso terapêutico , Pessoas Transgênero , Alopecia/epidemiologia , Alopecia/metabolismo , Androgênios/metabolismo , Androgênios/uso terapêutico , Estrogênios/metabolismo , Estrogênios/uso terapêutico , Humanos , Procedimentos de Readequação Sexual , Minorias Sexuais e de Gênero , Transplante de Tecidos , Transplante Autólogo
17.
Am J Clin Dermatol ; 21(2): 245-254, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31832993

RESUMO

Androgenetic alopecia (AGA) and acne vulgaris are two conditions commonly seen by dermatologists. Androgens and the androgen receptors play an essential role in the manifestation of both conditions, and some systemic therapies function by interfering in this pathway. The use of topical antiandrogen therapies has gained traction in recent years due to their potential efficacy in treating AGA and acne vulgaris, as well as their reduced adverse effects compared with systemic drugs. This review discusses the role of androgens in skin physiology and pathology and assesses the potential efficacy and safety of three topical antiandrogen therapies in the treatment of AGA and acne vulgaris. A literature review utilizing the PubMed, US Clinical Trials, and SCOPUS databases was conducted to search for randomized clinical trials, systematic reviews, cohort studies, case reports, and other relevant published studies on the pathogenesis and treatment of each condition with topical finasteride, ketoconazole shampoo, and cortexolone 17α-propionate (C17P). The results demonstrated that topical formulations of finasteride, ketoconazole, and C17P are promising treatments for male pattern hair loss, especially topical finasteride in combination with topical minoxidil. Limited studies have shown C17P to have potential in treating acne vulgaris in both males and females. Minimal adverse effects have been reported in clinical trials for all topical therapies, although topical finasteride is still contraindicated in pregnancy. Recognizing the preliminary evidence, more peer-reviewed studies on topical antiandrogen treatments for AGA and acne vulgaris are necessary before definitive recommendations can be made regarding efficacy and safety. There is also a critical need to include more women in study populations for these treatments.


Assuntos
Acne Vulgar/tratamento farmacológico , Alopecia/tratamento farmacológico , Antagonistas de Androgênios/uso terapêutico , Administração Tópica , Humanos
18.
J Cosmet Dermatol ; 19(6): 1494-1498, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31553137

RESUMO

BACKGROUND: In gender minority patients, electrolysis and laser hair removal may be necessary to reduce facial and body hair in individuals seeking a more feminine appearance and/or modified gender expression. These procedures may also be required preoperatively for some gender-affirming surgeries. AIMS: To identify (a) the frequency of unwanted facial and body hair, (b) the use of various hair removal methods, and (c) associated barriers to care in gender minority patients. METHODS: An online-based patient survey was distributed via social media on Facebook® , YouTube® , and Instagram® in fall 2018. Respondents were at least 18 years old and self-identified as a gender minority. RESULTS: In total, 991 responses were recorded with a completion rate of 77%. Considering excess hair, 84% of transwomen on feminizing hormone therapy (FHT: estrogen and anti-androgen therapy), 100% of transwomen not on FHT, and 100% of nonbinary individuals on FHT reported excess facial/body hair. Laser hair removal (18%) and electrolysis (17%) had similar rates of use in this cohort and were more commonly reported for nonsurgical gender-affirming purposes than preoperative preparation. Cost was the most frequently cited barrier to care. CONCLUSION: As the majority of transwomen and nonbinary people on feminizing hormone therapy had persistent excess facial/body hair, routine use of gender-affirming hormones is not sufficient to fully eliminate unwanted hair. There remains a critical need to advocate for more comprehensive insurance coverage for laser hair removal and electrolysis in gender minority patients.


Assuntos
Remoção de Cabelo/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hipertricose/terapia , Cobertura do Seguro/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Idoso , Face , Feminino , Remoção de Cabelo/economia , Remoção de Cabelo/psicologia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Hipertricose/economia , Hipertricose/psicologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários/estatística & dados numéricos , Pessoas Transgênero/psicologia , Estados Unidos , Adulto Jovem
19.
JAMA Dermatol ; 156(5): 561-565, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32211825

RESUMO

Importance: Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective: To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting: Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy's medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures: Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results: A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance: Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.


Assuntos
Remoção de Cabelo/economia , Cobertura do Seguro/estatística & dados numéricos , Minorias Sexuais e de Gênero , Pessoas Transgênero , Estudos Transversais , Feminino , Identidade de Gênero , Remoção de Cabelo/métodos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/economia , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Estados Unidos
20.
J Cosmet Dermatol ; 18(6): 1765-1766, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30985070

RESUMO

BACKGROUND: Gender-related price inequalities for over-the-counter dermatologic products such as shampoos and conditioners, razors, deodorants, and lotions remain prevalent in the marketplace. This trend has also been found to apply to topical minoxidil, a common treatment for male and female pattern hair loss. OBJECTIVE: We sought to identify the gender-related price discrepancies of facial moisturizers, which are routinely recommended by dermatologists. METHODS: Three online retailers (Amazon, Target, and Walmart) were surveyed for available facial moisturizers in October 2018. Facial moisturizers were classified as men's, women's, or gender-neutral based on three specific marketing variables: language, container color/graphics, and container curvature/shape. RESULTS: In total, 110 facial moisturizers were included in this analysis. Of the 54 facial moisturizers evaluated for men, 47 (87%) contained the word "men" within the marketing language, while only three of 56 (5.4%) facial moisturizers targeted at women were explicitly labeled "for women." No statistically significant difference was found between the number of facial moisturizers listed as fragrance-free, SPF-containing, anti-aging, or those labeled as sensitive, hypoallergenic, or dermatologist recommended between the two groups. However, facial moisturizers marketed to women were on average $3.09 more per ounce than those marketed to men. A two-tailed t test revealed a statistically significant difference between the price per ounce of facial moisturizers for men ($6.20) and those for women ($9.29) (P = 0.013). CONCLUSION: Facial moisturizers marketed to women were found to be significantly more expensive than comparable facial moisturizers marketed to men.


Assuntos
Marketing/estatística & dados numéricos , Sexismo/economia , Creme para a Pele/economia , Face
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