Platelet-Rich Plasma for Treatment of Hair Loss Improves Patient-Reported Quality of Life.

BACKGROUND: While numerous studies have demonstrated enhanced hair growth following platelet-rich plasma (PRP) treatments in patients with male and female pattern hair loss, no study has demonstrated its impact on quality of life (QoL) using a validated tool. OBJECTIVE: This prospective study aimed to assess the psychological impact of PRP treatment for hair loss. METHODS: PRP scalp injections were repeated monthly for the first 3 months, then quarterly for 1 year, and annually thereafter. HAIRDEX 48, a validated scale assessing QoL for patients with alopecia, was administered before PRP and at each visit. Scores were interpolated on a 0-100 scale: 0 representing highest QoL, 100 lowest, and compared using paired t-tests. RESULTS: Ninety-two patients receiving PRP were analyzed. Mean age was 48.2 ± 17.4 years and 55% were male. Patients had an average of 4 ± 2 treatments; most (60%) had ≥4. Thirty patients (33%) completed both pre- and post-PRP questionnaires. Prior to PRP, 61% tried minoxidil, 16% finasteride, and 1% hair transplant. Total HAIRDEX scores improved from a mean of 23.2 ± 15.4 to 19.7 ± 11.3 after 3-5 months after PRP (p < 0.001). There were also decreases in symptoms (10.0 ± 12.0 vs. 9.6 ± 10.8, p < 0.001), functioning (16.1 ± 18.1 vs. 13.3 ± 12.6, p < 0.001), and emotions domains (37.7 ± 24.1 vs. 32.2 ± 18.9, p < 0001). For stigmatization and self-confidence domains, improvements from pre-PRP were significant at 3-5 months (21.2 ± 16.8 vs. 17.4 ± 12.1; p < 0.001 and 24.8 ± 17.7 vs. 20.9 ± 15.5; p < 0.001, respectively) and >6 months (18.9 ± 13.9; p < 0.001 and19.5 ± 18.6; p = 0.008, respectively). CONCLUSIONS: PRP improves QoL and is an effective part of multimodal therapy for hair loss. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Radiofrequency Microneedling: A Comprehensive and Critical Review.

BACKGROUND: Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear. OBJECTIVE: To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in. MATERIALS AND METHODS: A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded. RESULTS: Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia. CONCLUSION: Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.

Patient safety in dermatology: a ten-year update.

OBJECTIVE: We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. METHODS: PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, infections including COVID-19, falls, laser safety, scope of practice, and electronic health records. SUMMARY: Hospitals and clinics are adopting the methods of high-reliability organizations to identify and change ineffective practice patterns. Although systems issues are emphasized in patient safety, people are critically important to effective teamwork and leadership. Advancements in procedural and cosmetic dermatology, organizational and clinical guidelines, and the revolution in information technology and electronic health records have introduced new sources of potential error. CONCLUSION: Despite the growing number of dermatologic patient safety studies, our review supports a continuing need for further studies and reports to reduce the number of preventable errors and provide optimal care.

Platelet-Rich Plasma and Stem Cells for Hair Growth: A Review of the Literature.

The prevalence of hair loss, its psychological consequences, and historically subpar treatments present a unique challenge to the physician. The current Food and Drug Administration-approved treatments for hair loss are plagued by ineffectiveness, noncompliance, and adverse effects. Recent advances in our understanding of hair physiology have fueled the development of more efficacious, minimally invasive, and safer treatment options for hair restoration including plasma-rich protein and stem cell therapy. Platelet-rich plasma, the autologous preparation of concentrated platelets in plasma, when injected into the scalp of patients with both androgenetic alopecia (AGA) and alopecia areata (AA), has been shown to increase hair count and density. The clinical findings have been supported by histologic evaluation of the scalp skin. These findings have been recapitulated in numerous randomized controlled trials. Stem cell therapy, although newer in its application in hair restoration, has also been effective for treating both AGA and AA. The isolation techniques for stem cells are varied, but regardless have shown promising results in early prospective and retrospective studies.

Dermal Microflora Restoration With Ammonia-Oxidizing Bacteria Nitrosomonas Eutropha in the Treatment of Keratosis Pilaris: A Randomized Clinical Trial.

Keratosis pilaris (KP) is a common skin finding that presents as follicular hyperkeratotic papules on the proximal extremities in patients with a propensity for atopy. Although often asymptomatic, the stippled appearance is cosmetically disturbing to patients and difficult to treat as current therapies are limited in availability and efficacy. Nitric oxide (NO) has been found to be essential in basic systemic and cutaneous physiologic function, specifically in terms of its anti-microbial and anti-inflammatory properties, which evolutionarily was maintained by ammonia-oxidizing bacteria (AOB). As modern hygiene practices have improved, there has been a gradual loss of cutaneous AOB and, therefore, the availability of an important source of human physiologic NO. We propose that restoring this dermal microflora with a purified strain of AOB, Nitrosomonas eutropha (D23), may reduce the overall cutaneous inflammatory state and, thus, be a potential therapeutic option for improving the cosmetic appearance of a skin condition such as KP which is often found in association with xerosis and atopic dermatitis. Clinical trial registry number: NCT03243617

J Drugs Dermatol. 2018;17(3):285-288.

Treatment of female pattern hair loss with combination therapy.

Female pattern hair loss (FPHL) is a common nonscarring alopecia characterized by progressive loss of terminal hairs. FPHL is a major concern for women and has a high impact on quality of life. Therapeutic regimen is often challenging and requires multiple combinations of topical, systemic, and interventional therapies to control hair loss and produce satisfactory hair regrowth. This article reviews common treatments of FPHL and their efficacy.

Laser advances in the treatment of burn and traumatic scars.

The realm of scar management is constantly changing. Many factors need to be considered when developing a comprehensive treatment plan, including the nature of the scar and the patient. Scar characteristics can be divided by color, scar type and thickness, and body location. Topical and intralesional agents and light- and laserbased treatments can be used to revitalize and restore damaged skin in atrophic and hypertrophic scars. The most commonly used lasers are the pulsed-dye laser (PDL) and fractional lasers. Ideally, a combination approach using topical and intralesional medications along with pulsed-dye laser and a fractional laser should be considered in all patients wishing to undergo treatment of their hypertrophic and atrophic scars. Keloidal scars tend to be resistant to standard therapy so other modalities should be considered.

Picosecond laser with specialized optic for facial rejuvenation using a compressed treatment interval.

Studies using a 755 nm picosecond laser with a focus lens array have been reported to be effective for facial wrinkles and pigmentation. This study reports the safety and efficacy using a shorter interval of 2-3 weeks between treatments. Nineteen female subjects and one male subject, primarily Fitzpatrick skin types II and III (one skin type I), who had mild to moderate wrinkles and sun-induced pigmentation were enrolled and treated using the 755 nm PicoSure Laser with focus lens array. The skin was cleansed then wiped with an alcohol wipe prior to treatment. Lidocaine 30% ointment and/or forced air cooling could be used to increase subject comfort. Adjacent pulses, with minimal overlap (10% or less), were delivered to the full face. Subjects received four treatments, performed at 2-3-week intervals. The laser energy used was 0.71 J/cm2 . The physician administered 3-7 passes with an average total of 6,253 pulses per treatment. Follow-up visits occurred at 1 and 3 months post-last treatment at which the physician scored satisfaction and improvement and subjects scored satisfaction and likelihood to recommend to others. The most common side effects were mild swelling, pain, redness, and crusting, most of which subsided within hours of the treatment, with the latest resolving within 48 hours. This is similar to a previous reported study (Weiss et al. ASLMS 2015) where treatments were performed every 6 weeks with side effects resolving within 24 hours. At the 1 and 3 month follow-up visits, 94% (n = 19) and 93% (n = 15) of subjects scored themselves as satisfied or extremely satisfied with their overall results and 81% and 93% were likely to recommend the treatment based on global assessment, respectively. The treating physician was satisfied with 93% of subject's overall results. Three blinded evaluators were able to correctly identify the baseline from post-treatment photographs in 77% of the subjects at the 1 month follow-up and 69% of the subjects at the 3 month follow-up, on average. The average treatment pain score was 4.2 on a 1-10 scale. A compressed treatment interval expedites results without increasing side effects and resulted in a high physician and subject satisfaction rate. Lasers Surg. Med. 48:723-726, 2016. © 2016 Wiley Periodicals, Inc.

Medical and Aesthetic Treatment Across the Broad Spectrum of Ethnicities, Introduction.

The ethnic and racial composition of the US population is changing rapidly. There is a continuous rise of individuals with mixed ethnic backgrounds comprising skin of color. It is important for physicians to be comfortable addressing and treating the needs of this population, as it differs significantly from the white population.

Nilontinib induced keratosis pilaris atrophicans.

Keratosis pilaris (KP) is a disorder of follicular keratinization that is characterized by keratin plugs in the hair follicles with surrounding erythema. A 46-year-old man with chronic myelogenous leukemia (CML) was started on nilotinib, a second generation tyrosine kinase inhibitor (TKI). Two months later the patient noticed red bumps on the skin and patchy hair loss on the arms, chest, shoulders, back, and legs. Cutaneous reactions to nilotinib are the most frequent non-hematologic adverse effects reported. However, it is important to distinguish KP-like eruptions from more severe drug hypersensitivity eruptions, which can necessitate discontinuing the medication. Also, it is important to classify the cutaneous eruptions in patients on TKI according to the morphology instead of labeling them all as "chemotherapy eruption" to be able to better manage these adverse effects.

Angioinvasive opportunistic filamentous mycoses in immunocompromised patients.

Immunocompromised individuals are at greater risk for disseminated fungal infections. Immunocompromised individuals in the community have increased because of medical advances, thereby increasing the incidence and prevalence of opportunistic mycoses. The following case series illustrates the importance of having a high clinical suspicion for skin manifestations concerning for deep fungal infections.

Incorporating research and academics into the profession in dermatology.

Each year, the dermatology landscape evolves, and the breadth of medical information available to physicians continues to grow at a rapid pace. With the constant pressure of increasing patient volume and health care demands, many physicians find themselves with less time to participate in research, education, and staying up to date with the current literature. There are various practice settings that a dermatologist can work in, including practices that have been acquired by privately held organizations, academic institutions, private practices, and academic-private practices. Despite these different practice settings, dermatologists can contribute to the research and development of all aspects of the field, especially dermatologic surgery. With an increasing number of patients using the Internet, including the use of social media for medical information, dermatologists must be at the forefront of disseminating accurate and evidence-based information.

The Association of Academic Cosmetic Dermatology: improving cosmetic dermatology education through collaboration, research, and advocacy.

Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Rise of stem cell therapies in aesthetics.

Stem cells have the ability to self-renew and differentiate into other cell types, which forms the foundation for their use in regenerative medicine and cosmetic dermatology. Adipose-derived stem cells have proven particularly attractive in aesthetics given their relative ease of collection and abundance. Stem cells have been employed for the treatment of androgenetic alopecia and skin rejuvenation with promising results, but their incorporation into cosmeceuticals is still in its infancy. Despite promising preclinical data and small clinical studies, additional randomized, controlled trials and standardization of treatment are needed to truly understand the place of stem cells in the aesthetics arena. We review the current literature and discuss current controversies and debates.

Noninvasive Correction of the Aging Forehead.

Aging of the face is a continuous and dynamic process that occurs due to changes in layers including skin, muscle, fat, and bone. There is an increasing patient preference toward nonsurgical techniques and procedures that require minimal downtime in all aspects of cosmetic surgery. The mainstay of treatment involves the administration of injectable fillers for temple volumization, eyebrow reshaping and forehead contouring, and neuromodulation to reduce the appearance of dynamic rhytids. Surgical and nonsurgical procedures can be used in combination in order to maximize periorbital rejuvenation. This article focuses on nonsurgical rejuvenation of the brow and periorbital complex.

Congenital syphilis: early- and late-stage findings of rhagades and dental anomalies.

Congenital syphilis occurs via vertical transmission when Treponema pallidum crosses the placenta after the 16th week of gestation. Manifestations of congenital syphilis vary from asymptomatic infection to stillbirth. We present a case of congenital syphilis in a Vietnamese orphan who presented with rhagades, hearing deficit, and abnormal dentition after adoption in the United States. He demonstrated both early- and late-stage findings of congenital syphilis. He is presumed to be 5 years old, and it is uncertain if he received treatment. Upon arrival to the United States, his rapid plasma reagin test was negative, but his fluorescent treponemal antibody-absorption test was positive, so no further treatment was recommended. It is possible that other late congenital syphilis stigmata may develop in his later years. The Centers for Disease Control recommends screening all pregnant women for syphilis at the beginning of prenatal care. Clinicians should be made aware of the manifestations of congenital syphilis, especially when caring for international orphans and children born to mothers who lacked prenatal care.