Topical Minoxidil Adherence in Patients With Alopecia

BACKGROUND

Non-adherence to topical minoxidil in alopecia patients is a barrier to efficacy. Understanding patient factors associated with adherence and non-adherence may provide actionable targets to improve adherence and outcomes.

METHODS

Ninety-nine alopecia patients at an outpatient university dermatology specialty clinic completed a survey assessing demographics and aspects of treatment adherence. Patients currently using minoxidil additionally completed a survey grading their level of adherence. A two-sample t-test was used to compare the average age between adherent and non-adherent groups. Differences in demographics and patient factors by adherence level were evaluated using the 2-tailed χ2 test and Fisher's exact test.

RESULTS

Adherent patients had been using topical minoxidil for a median of 24 months when surveyed; non-adherent patients used the medication for a median of 3.5 months prior to discontinuation. A larger portion of non-adherent patients used minoxidil for fewer than 3 months (35%) compared to adherent patients (3%), P<.001. The most common reason non-adherent patients discontinued therapy was no improvement (50%).

DISCUSSION/CONCLUSION

Non-adherent patients were less likely to use topical minoxidil for at least 3 months and often cited lack of improvement as a reason for discontinuing. Patient education and intervention prior to the 3-month mark may help improve adherence. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.6639.

New Razor Technology Improves Appearance and Quality of Life in Men With Pseudofolliculitis Barbae

Pseudofolliculitis barbae (PFB) consists of ingrown hairs leading to papules, pustules, and discomfort. This prospective, 12-week clinical study aimed to assess the appearance of males with razor bumps and shaving irritation when using a new razor technology with 2 blades separated by a bridge feature (SkinGuard [Procter & Gamble]). The impact on participants' shave-related itching, burning, and stinging severity, as well as quality of life (QOL), also was assessed. In men with PFB, shaving with the test razor at least 5 times per week over a 12-week period improved the appearance and QOL of males with razor bumps and shaving irritation compared with baseline.

Bitemporal Scalp Hair Loss: Differential Diagnosis of Nonscarring and Scarring Conditions

BACKGROUND: Bitemporal hair loss can be a diagnostic challenge because several entities may affect this region of the scalp, including both scarring and nonscarring conditions. Although traction alopecia is the most common cause of bitemporal hair loss, no studies to date have outlined all of the potential causes. OBJECTIVE: We sought to review nonscarring and scarring conditions that have a clinical presentation of bitemporal hair loss, including traction alopecia, telogen effluvium, female pattern hair loss, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, and seborrheic dermatitis. METHODS: A Google Scholar and PubMed literature search were conducted for this review. The keywords used in the search included the following: "traction alopecia", "telogen effluvium", "androgenic alopecia", "androgenetic alopecia", "female pattern hair loss", "alopecia areata", "frontal fibrosing alopecia", "central centrifugal cicatricial alopecia", and "seborrheic dermatitis". The scope of our search included all research articles published from 1957 to February 2019. In total, 94 articles regarding non-scarring and scarring hair loss were selected and included according to topic relevance. Exclusion criteria included articles that did not address the epidemiology and/or clinicopathologic or dermatoscopic findings of non-scarring and scarring forms of alopecia. Inclusion criteria included articles that addressed a clinical presentation of bitemporal hair loss; or addressed epidemiology, clinical presentation, dermatoscopic findings, and/or treatment. RESULTS: Bitemporal hair loss is a common and often distressing condition with a broad differential. CONCLUSION: Clinicians must be aware of the potential causes of bitemporal hair loss. Prompt diagnosis is essential to prevent further hair loss, especially in scarring conditions.

Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia

Traction alopecia (TA) is a form of hair loss caused by continuous and prolonged tension to the hair, most commonly seen in Black/African American women and children who wear hairstyles that pull excessively at the frontotemporal hairline. Dermatologists have recommended the use of intralesional triamcinolone acetonide injections (ILK) to decrease the inflammatory process, however, evidence-based proof is lacking in the literature. In this case series, we evaluate the effectiveness and safety of ILK in the TA management of 6 African American women. A retrospective chart review was done of patients with a diagnosis of TA, who were treated with ILK at an academic dermatology clinic, yielding 6 patients. Management of TA was assessed by comparing the photographs for changes in hair density along the frontotemporal hairline. ILK with a concentration of 5 mg/mL, was administered in areas of low hair density along the frontotemporal hairline at 6 to 8-week intervals, for 3 successive visits. All subjects demonstrated visible increase in hair density along the frontotemporal hairline following their first or second treatment, and no severe adverse effects were observed or reported. The use of ILK is currently an effective and safe method of treating TA, particularly in the early to mid-stages. Common adverse effects are pain, and subsequent transient atrophy at the injection site. The transient atrophy is not an indication to stop treatment. Avoidance of treating dented areas is sufficient to allow it to revert. Patient education is pivotal in the prevention and management of TA. It is imperative that dermatologists caution against grooming practices that exert tension on the hairline. J Drugs Dermatol. 2020;19(2)128-130. doi:10.36849/JDD.2020.4635

Sweat and Hair: Online Interventions for Improving Physical Activity in African-American Women

Objective

To evaluate the efficacy of an informational website in improving patient knowledge on hair care and exercise.

Design

Pre- and post-exposure surveys, focusing on exercise and hair care practices, were administered to subjects after 1 h of browsing a dermatologist-designed hair care and exercise website.

Setting

Winston Salem State University, a historically Black university in North Carolina, USA.

Participants

22 African-American women (AAW) aged between 18 and 54 years.

Measurements

The outcome measures of the study include patient demographics, hair care practices, knowledge of hair/care disorders, exercise habits, and website feedback.

Results

There were 22 women enrolled in the study with 95% identifying as African-American. The average age was 28 ± 12 years. A total of 80% (16/20) of subjects reported exercising less than 150 min per week, and 36% of these patients reported modifying their hairstyle to accommodate physical activity. 85% learned new information about hair and scalp disorders from the educational material on the website, and 81% had increased understanding of their hair health. 91% reported that they would return to the website.

Conclusion

An informational website can be an effective tool to educate AAW on hair and scalp disease, as well as appropriate hair care practices and fitness goals.

Topical Antiandrogen Therapies for Androgenetic Alopecia and Acne Vulgaris

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.

A new somatic-type delusional disorder subtype: delusion inversus

The interplay between psychiatric and dermatologic conditions has been recognized for decades as evidenced by the widely accepted classification system of psychocutaneous disorders: (1) primary dermatologic disorder with psychiatric sequelae, (2) primary dermatologic disorder exacerbated by stress, (3) primary psychiatric disorder with dermatologic sequelae, and (4) miscellaneous. However, there is minimal literature regarding dermatologic patients who demonstrate a preoccupation with a more severe cutaneous disorder despite evidence confirming a diagnosis of a minor, treatable skin condition. These patients are a hybrid of the first and fourth categories and should be classified under a new entity known as delusion inversus. These patients have a primary dermatologic condition; however, they believe their condition to be more severe and malignant than it is, despite evidence to the contrary. Their beliefs are pathological and analogous to delusion disorder somatic type. Given the scarcity of data concerning delusion inversus, the epidemiology, diagnosis, and management of the disorder as described in this review is extrapolated from reported cases of delusion disorder and delusion disorder somatic-type. Often these patients will present to a non-psychiatric, outpatient clinic for medical care. Thus, it is imperative that dermatologists are able to identify the condition and manage the patient appropriately.

Atopic dermatitis in adolescents with skin of color

Atopic dermatitis (AD) is a common chronic inflammatory dermatosis of childhood that typically improves during adolescence but can be lifelong. Black children are at 6-times greater risk for severe AD than white children, and AD may lead to a greater negative impact on quality of life (QOL) in patients with skin of color. For these reasons, it is important for dermatologists to consider the various issues associated with AD that adolescents with skin of color may face. We present management strategies for AD in this patient population.