A new treatment of alopecia induced by palbociclib: Topical cetirizine.

INTRODUCTION: Recently CDK4/6 inhibitors have been introduced for the treatment of hormone positive breast cancer resistant to endocrine therapy. Among their side effects, alopecia is often reported being associated to patients' distress and depressive symptoms. CASE REPORT: We report the case of a 70-year-old woman affected by breast cancer in treatment with Palbociclib, who developed alopecia.Management and Outcome: We prescribed a topical solution with cetirizine. Global photography, trichoscopy and trichogram were assessed. All evaluations demonstrated alopecia improvement. DISCUSSION: Currently, no treatment options for CDK 4/6 inhibitors induced alopecia have been proposed. Herein, we report the use of topical cetirizine.

Alopecia areata treated with dimethyl fumarate: A case series.

Alopecia areata is an autoimmune condition leading to non-scarring hair loss. Clinically, several presentations ranging from single or few small patches to complete hair loss are documented. The management of alopecia areata is challenging and all available treatments do not ensure a long-term remission to assess the safety and efficacy of systemic dimethyl fumarate in alopecia areata patients not responding to other systemic treatments. After obtaining informed consent, we administered off-label dimethyl fumarate to 10 adult patients with alopecia areata, for a period ranging from 4 to 37 weeks. Medical information for each patient and the severity of alopecia tool (SALT) score before and after dimethyl fumarate administration were recorded. During the treatment, 50% of patients (5 patients out of 10) had a slight improvement of hair regrowth; it was mainly as partial hair regrowth (ranging from 8% to 32%) and only one patient (10%) achieved > 50% terminal hair regrowth. Authors conclude that dimethyl fumarate is not advisable as a treatment of alopecia areata, also considering the risk of fumaric acid esters toxicity.

Isoradiotopic response of discoid lupus after radiotherapy: A case report and review of the literature.

Radiotherapy is frequently associated with a great number of collateral effects, which can affect the skin and its appendages. In addition to more common side effects, like radiodermatitis, other cutaneous conditions are less known and often they are underdiagnosed. Among these, isoradiotopic response is one of the rare radiotherapy-associated phenomena. This term refers to the appearance of a secondary dermatosis in a previously irradiated district. The term was used for the first time by Shurman et al. to describe a case of lichen ruber planus arising in the genital area after radiotherapy for squamous cell carcinoma. The pathologic mechanism is not completely clear, but a few hypotheses have been proposed. Alterations in the local lymphatic drainage, in the nervous system and the immune microenvironment have all been called into play (the immunocompromised district theory). We present the case of a male patient that developed discoid lupus on a previously irradiated cutaneous area and review the literature, highlighting the numerous possible manifestations of this phenomenon.

A new combination of molecules for the treatment of androgenetic alopecia and telogen effluvium: a double-blind randomized, monocentric, placebo-controlled study.

BACKGROUND: Androgenetic alopecia (AGA) is the most frequent form of alopecia. Telogen effluvium (TE) is a common form of diffuse hair loss mainly observed in women. The aim of our study was to evaluate the efficacy of a topical trichological treatment containing a new combination of molecules for the treatment of AGA and TE. METHODS: In-vitro tests were performed analyzing different combinations and concentrations of arginine, zinc and a third enzymatically neutral substance called AA on human follicles dermal papillae cells. These tests evaluated the capability of inhibiting the 5α-reductase (5-AR) enzyme and the 5-AR gene expression. We also performed an in-vivo study. Forty individuals affected by AGA and TE were divided into two groups. One group was administered a combination of zinc and arginine (lotion A), whilst the other placebo (lotion B). Therapy duration was 23 consecutive weeks. Follow-up examinations and pull tests occurred at baseline, after 6 weeks and at the end of the therapy. On 20 randomly selected patients we also performed noninvasive phototrichograms. RESULTS: In-vitro tests showed that the combination had a strong statistically significant inhibitory activity on 5-AR of dermal papillae cells. Number of hairs removed by pull-test significantly decreased at T0, T1 and T2 in patient treated with lotion A. We also observed an increase in the percentage of anagen hair and a decrease in telogen hairs. Concerning phototrichograms, all objective parameters evaluated showed better results in the lotion A group when compared with the placebo group. CONCLUSIONS: Based on our results, the combination of arginine and zinc tested in our study could represent a good therapeutic option for the treatment of AGA and TE and it might represent a valid alternative to finasteride.

Capillaroscopy: a new application for the evaluation of vascular side-effects induced by chemotherapy.

BACKGROUND: Cancer survivors are rising up, but this better survival is accompanied by possible treatments side-effects. In particular, cardiovascular effects are commonly reported, even if vascular damage is not necessarily connected to clinical manifestations. Periungual microcircle evaluation through capillaroscopy could identify asymptomatic patients with high risk of cerebro-cardio-vascular disease. The aim of this pivotal study was to evaluate videocapillaroscopy in patients who undergo chemotherapy, in order to understand if it could represent in future a prognostic tool to predict the risk of cardio-cerebro-vascular events. METHODS: We conducted an open-label, uncontrolled study. Patients affected by solid tumors were enrolled. Each subject underwent a clinical evaluation and a videocapillaroscopic examination. RESULTS: We selected 25 patients. Mean age was 55.48 years. Time interval between the start of chemotherapy and capillaroscopy: average 41 months. From our analysis it emerges that ectasia and hemorrhages could be a possible marker of capillary insult caused by chemotherapy. CONCLUSIONS: Our study showed the presence of capillaroscopic features that may be peculiar in chemotherapy-induced endothelial damage. The individuation of capillaroscopic alteration specific for chemotherapy-induced endothelial injury could be an important tool to identify patients with high cardiovascular risk.

Treatment of facial actinic keratoses with a cream containing octatrienoic acid: a multicenter clinical experience.

BACKGROUND: Actinic keratosis (AKs) are premalignant skin lesions characterized by high rate of transformation in squamous cell carcinoma if not treated. Preclinical published data on parrodiene-derivative 2,4,6-octatrienoic acid, encourages us to study and to evaluate the effect of a topical product containing it in patients affected by mild to moderate actinic keratosis. METHODS: Seventy subjects with at least 1-3 clinically diagnosed actinic keratosis lesions, non-hyperkeratotic, non-hypertrophic, localized on the face (I-II degree actinic keratosis) were enrolled in the study. The product was applied twice/day for 60 consecutive days. RESULTS: After 60 days of treatment, a significant improvement in lesions occurred as shown by the decrease in the AKESA Score (P<0.05). Moreover, octatrienoic acid containing cream induced a 90% response rate (63/70 patients P<0.5; 95% confidence interval) with 20% complete remission (14/70 patients, P<0.05). Compared to baseline, a significant number of patients reported improvement of each AKESA sub-score after 60 days of treatment: skin thickness improved in 46 patients (P<0.0001), erythema in 21 patients (P<0.0001) and atrophy in 57 patients (P<0.0348). The average pigmentation score significantly decreased from 1.50 to 0.79 (P<0.05). CONCLUSIONS: The results of the study, confirmed also by self-assessment, allow us not only to state that the use of topical octatrienoic acid was effective and well tolerated for topical treatment of AKs leading to overall clinical improvement in approximately 90% of subjects treated for 60 days.

Androgenetic alopecia: a review.

PURPOSE: Androgenetic alopecia, commonly known as male pattern baldness, is the most common type of progressive hair loss disorder in men. The aim of this paper is to review recent advances in understanding the pathophysiology and molecular mechanism of androgenetic alopecia. METHODS: Using the PubMed database, we conducted a systematic review of the literature, selecting studies published from 1916 to 2016. RESULTS: The occurrence and development of androgenetic alopecia depends on the interaction of endocrine factors and genetic predisposition. Androgenetic alopecia is characterized by progressive hair follicular miniaturization, caused by the actions of androgens on the epithelial cells of genetically susceptible hair follicles in androgen-dependent areas. Although the exact pathogenesis of androgenetic alopecia remains to be clarified, research has shown that it is a polygenetic condition. Numerous studies have unequivocally identified two major genetic risk loci for androgenetic alopecia, on the X-chromosome AR/EDA2R locus and the chromosome 20p11 locus. CONCLUSIONS: Candidate gene and genome-wide association studies have reported that single-nucleotide polymorphisms at different genomic loci are associated with androgenetic alopecia development. A number of genes determine the predisposition for androgenetic alopecia in a polygenic fashion. However, further studies are needed before the specific genetic factors of this polygenic condition can be fully explained.