[Platelet-rich plasma (PRP) for the treatment of androgenetic alopecia (AGA): a review of the current literature]

BACKGROUND

Platelet rich plasma (PRP) injections have been reported to be an effective and low side effect treatment for androgenetic alopecia (AGA). However, robust data concerning this therapy are lacking.

AIM

We address some potentially critical aspects of PRP treatment and give some reasons why study results may differ.

MATERIALS AND METHODS

In the following review we give a brief overview of the current literature and compare the results of the various trials.

RESULTS

In recent years, several clinical trials have been published that have revealed different but rather positive results, which offers hope to those affected by AGA and to physicians as well. However, the results were observed in methodologically weak trials and data from randomized controlled trials are lacking. Differences in trial designs have made it difficult to draw concrete conclusions about its clinical efficacy. Even in the studies where no hair-growth-promoting effect could be observed, the majority of subjects were at least satisfied with the result. The combination of several treatment approaches seems to lead to optimal improvement in hair growth.

CONCLUSION

There are many factors that could have influenced the results of the different studies. The results were observed in methodologically weak studies, giving reason for caution when drawing conclusions. Nevertheless, the majority of the subjects were at least satisfied with the result. Given the current low level of evidence, PRP treatments need to be further investigated in larger studies.

Letter to The Editor on ‘Evaluation of antimicrobial textiles for atopic dermatitis’

Linked article: This article is commented on by A. Wollenberg et al., p. e169 in this issue. To view this article visit https://doi.org/10.1111/jdv.15401.

Mobile teledermatology helping patients control high-need acne: a randomized controlled trial

BACKGROUND

Acne is an important health issue with a major psychological impact in addition to the physical problems it causes.

OBJECTIVES

To investigate the superiority of mobile teledermatology in the care of patients with high-need facial acne in comparison to outpatient services with particular attention to treatment efficacy, safety, and patient compliance. Further, patient satisfaction with remote care was evaluated.

METHODS

Sixty-nine consecutive patients (f: 25, m: 44, median age: 19 years, range: 13-37 years) were randomly allocated to either the teleconsultation (TCA) or the outpatient consultation (OCA) arm of the trial to receive isotretinoin treatment in weight and severity-dependent dosages over 24 weeks. Acne grading was performed by one examiner using the Global Acne Severity Scale (GEA) and the total lesion counting (TLC).

RESULTS

Due to noncompliance issues, 17 of 69 (24.6%) patients were excluded from the study, of who 10 had been assigned to the TCA (10/34; 29.4%) and 7 to the OCA (7/35; 20%). Both, in the TCA (GEA-score: ∆ = 2.25; TLC: ∆ = 89.08) and in the OCA (GEA-score: ∆ = 2.0; TLC: ∆ = 91.21) excellent and almost equivalent therapeutic outcomes were achieved. In the TCA, however, less patients experienced adverse reactions (P = 0.55). Even though additional live supervision would have been appreciated in some teledermatology cases, patients were satisfied with the mobile service and no consultation request was created.

CONCLUSION

Mobile teledermatology is an efficient, safe and well-accepted tool among patients with high-need acne constituting at least a valuable adjunct to outpatient care services. Further larger studies would be useful to confirm our findings.

Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome

OBJECTIVES

Women with polycystic ovary syndrome (PCOS) frequently suffer from metabolic disturbances, in particular from insulin resistance. Accumulating evidence suggests that vitamin D deficiency may contribute to the development of the metabolic syndrome (MS). Hence, the aim of our study was to investigate the association of 25(OH)D levels and the components of the MS in PCOS women.

METHODS

25(OH)D levels were measured by means of ELISA in 206 women affected by PCOS. Metabolic, endocrine, and anthropometric measurements and oral glucose tolerance tests were performed.

RESULTS

The prevalence of insufficient 25(OH)D levels (<30 ng/ml) was 72.8% in women with PCOS. PCOS women with the MS had lower 25(OH)D levels than PCOS women without these features (17.3 vs 25.8 ng/ml respectively; P<0.05). In multivariate regression analysis including 25(OH)D, season, body mass index (BMI), and age, 25(OH)D and BMI were independent predictors of homeostatic model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI; P<0.05 for all). In binary logistic regression analyses, 25(OH)D (OR 0.86, P=0.019) and BMI (OR 1.28, P<0.001) were independent predictors of the MS in PCOS women. We found significantly negative correlations of 25(OH)D levels with BMI, waist circumference, waist-to-hip ratio, systolic and diastolic blood pressure, fasting and stimulated glucose, area under the glucose response curve, fasting insulin, HOMA-IR, HOMA-beta, triglycerides, and quotient total cholesterol/high-density lipoprotein (HDL) and positive correlations of 25(OH)D levels with QUICKI and HDL (P<0.05 for all).

CONCLUSION

We demonstrate that low 25(OH)D levels are associated with features of the MS in PCOS women. Large intervention trials are warranted to evaluate the effect of vitamin D supplementation on metabolic disturbances in PCOS women.

Vulvar syringoma causing pruritus and carcinophobia: treatment by argon laser

Syringomas are benign lesions most commonly appearing around the eyelids and in malar areas, but they have also been described on other body sites. Depending on the site they may cause either aesthetic disturbance (e.g. face, neck, arms) or pruritus (e.g. vulva). This is the first report of argon laser treatment of syringoma in a patient with multiple vulvar syringomas in association with pruritus vulvae and carcinophobia.

[Venous leg ulcers: no improvement of wound healing with 685-nm low level laser therapy. Randomised, placebo-controlled, double-blind study]

INTRODUCTION

Venous leg ulcers (ulcera crurum venosa) are frequently seen in elderly patients. It has been suggested that low level laser irradiation has a biostimulative and wound healing effect; however, this has not yet been clinically verified by controlled studies.

STUDY DESIGN

The difference in size reduction of leg ulcers with and without low level laser or placebo laser treatment was measured in 44 patients randomised into two treatment groups (685-nm low level laser and placebo laser) or a control group which served to quantify the effect of laser application. All patients received standardized wound care.

OBJECTIVE

The aim of the study was to compare the effectiveness of low level laser irradiation with that of a placebo "light source". The size of the ulcers was planimetrically measured at baseline (day 1), at the end of therapy (day 28) and 2 months later (day 90). The difference in wound size was evaluated.

RESULTS

There were no statistically significant differences in reduction of wound size between the three groups, thus suggesting that low level laser light does not have any stimulatory effect on wound healing in ulcera crurum venosa.

Does the use of low-level laser influence wound healing in chronic venous leg ulcers?

OBJECTIVE

Venous leg ulcer treatment often requires months or years of regular wound care by trained staff. It has been suggested that low-level laser irradiation has a biostimulative and wound healing effect, but this has not been clinically verified by controlled studies. This study aimed to compare the effectiveness of low-level laser irradiation with that of a placebo 'light source'.

METHOD

Forty-four patients were assigned to two treatment groups (laser and placebo) or a third group (standardised treatment only) to quantify the effect of the laser therapy. Patients in all three groups received standardised wound care (disinfection, a hydrofibre dressing and compression bandaging). Ulcer size was measured at baseline (day 1), at the end of therapy (day 28) and then two months later (day 90). The relative difference in wound size was evaluated.

RESULTS

The difference in the reduction in wound size was not statistically significant in all three groups. A positive effect of using the non-laser device (placebo effect) was demonstrated in some patients.

CONCLUSION

These study results suggest that low-level laser does not stimulate wound healing in venous leg ulcers. Further controlled studies are needed to clarify the efficacy of low-level laser treatment as a wound-healing stimulant.

Nonablative laser treatment of wrinkles: meeting the objective? Assessment by 25 dermatologists

BACKGROUND

Established skin resurfacing methods causing superficial wounds and extended recovery times have become less popular since the introduction of nonablative lasers.

OBJECTIVES

To evaluate the clinical efficacy of a nonablative 1450-nm diode laser system.

METHODS

Nine patients (Fitzpatrick skin type II-IV) with periorbital wrinkling class I-II were treated three times at 3-weekly intervals with a 1450-nm diode laser. Clinical outcome was determined by 25 independent dermatologists evaluating standardized photographs taken before treatment and 1 month after treatment.

RESULTS

The patients were satisfied with the procedure, and reported a mild to moderate improvement in all cases. Among 25 dermatologists, only two provided ratings which were significantly in favour of a positive treatment effect.

CONCLUSIONS

Nonablative laser treatment subjectively satisfies patients but does not convince objective judgement.

[Verrucae vulgares. Treatment with 585 nm flashlamp pumped pulsed dye laser]

BACKGROUND AND OBJECTIVE

Various approaches have been taken in the management of verrucae vulgares, but a treatment of choice has not been established.

PATIENTS/METHODS

Over a period of 12 months, 99 Patients with recalcitrant or untreated verrucae vulgares on their hands or feet (2:1) were treated with a 585 nm flashlamp pumped pulsed dye laser (FPDL) every 2 to 4 weeks. Laser parameters were: energy density 8 J/cm2, spot size 7 mm, pulse duration 450 microseconds. No topical measures were employed during the course of laser treatment.

RESULTS

93 patients finished the study, as 6 were lost to follow-up. Up to 8 laser treatments led to 63% total remission and 22% partial remission, 15% did not respond to this type of management. Relapses were not found in a follow-up period of 2 to 6 months.

CONCLUSIONS

FPDL is efficient for the removal/reduction of verrucae vulgares and does not requires less patient compliance than other treatment options.

Finasteride increases anagen hair in men with androgenetic alopecia

BACKGROUND

The growth of scalp hair is a cyclical process of successive phases of growth (anagen) and rest (telogen). In previous clinical trials in men with androgenetic alopecia, treatment with finasteride increased scalp hair counts in a defined area (i.e. increased hair density).

OBJECTIVES

The current study used a phototrichogram methodology to assess the effect of finasteride on the phases of the hair growth cycle.

PATIENTS/METHODS

Two hundred and twelve men, age 18-40 years, with androgenetic alopecia were randomized to receive finasteride 1 mg daily or placebo for 48 weeks. At baseline and at 24 and 48 weeks, macrophotographs were taken to measure total and anagen hair count in a 1-cm(2) target area of the scalp.

RESULTS

At baseline, mean total and anagen hair counts in the finasteride group were 200 and 124 hairs, respectively (% anagen = 62%) and the anagen to telogen ratio was 1.74 (geometric mean). In the placebo group, the respective values were 196 and 119 hairs (% anagen = 60%) and 1.57. At week 48, the finasteride group had a net improvement (mean +/- SE) compared with placebo in total and anagen hair counts of 17.3 +/- 2.5 hairs (8.3% +/- 1.4%) and 27.0 +/- 2.9 hairs (26% +/- 3.1%), respectively (P < 0.001). Furthermore, treatment with finasteride resulted in a net improvement in the anagen to telogen ratio of 47% (P < 0.001). In this study, treatment with finasteride 1 mg day(-1) for 48 weeks increased both total and anagen hair counts, and improved the anagen to telogen ratio.

CONCLUSIONS

These data provide direct evidence that finasteride 1 mg daily promotes the conversion of hairs into the anagen phase. These data support that finasteride treatment results in favourable effects on hair quality that contribute to the visible improvements in hair growth observed in treated patients.

"Pseudocyst of the auricle", othematoma and otoseroma: three faces of the same coin?

Cystic swellings of the choncha of the ear without serious inflammation are routine findings for otolaryngologists. They are frequently diagnosed as othematoma or otoseroma and may be caused by traceable traumas or microtraumas. "Pseudocyst of the auricle" is defined as intracartilaginous cavity lacking epithelial lining. Thus, according to previous reports "pseudocysts" are supposed to occur due to chondromalacia within the cartilage. We recently observed four cases of "pseudocyst of the auricle" characterized by non-inflammatory, merely painless swellings on the anthelix part of the ears without history of any previous trauma. Incisional biopsies were taken from the dorsal side of the concha and freed 2 to 2.5 ml of viscous serous fluid. Histopathological examination of biopsy specimens showed regular epidermis overlying normal reticular dermis and perichondrium as well as regular cartilage in all patients. In the fourth patient the biopsy, additionally, revealed a tiny intracartilaginous cavity measuring 1 x 4 micrometers in diameter. Histopathologically "pseudocysts of the auricle" are reported to represent small intracartilaginous hollows lacking epithelial linings. Following previous descriptions they are located within the cartilage of the concha of the ear. Because of the small size of the intracartilaginous cavity they are unable to contain more than a few microliters of fluid. Therefore cystic swellings of the auricle containing comparatively large amounts of serous liquid must be located outside the cartilage. In this context the concept of "pseudocyst of the auricle" as reported, can only be seen as the third face of a coin that shows othematoma on the one and otoseroma on the other side.

[Porokeratosis Mibelli gigantea: case report and literature review]

Porokeratos of Mibelli is a rare inherited disorder of epidermal keratinization, whose pathogenesis is not fully understood. The common clinical feature is a erythematous plaque surrounded by a hyperkeratotic border. The histopathologic hallmark is a parakeratotic cornoid lamella. An unusual case of porokeratosis gigantea, a morphological variant of classical porokeratosis of Mibelli, is reported. The pathogenesis, taking in account especially the clonal hypothesis and premalignant nature of porokeratosis, is discussed.

Ex vivo quality-switched ruby laser irradiation of cutaneous melanocytic lesions: persistence of S-100-, HMB-45- and Masson-positive cells

AIM

To assess changes in human pigmented melanocytic skin lesions after quality-switched ruby laser (QSRL) irradiation.

METHODS

Investigations were performed ex vivo on 21 melanocytic pigmented lesions (10 nevus cell nevi, 2 pigmented dermal nevi, 4 congenital nevi, 3 lentigo maligna lesions, 2 superficial spreading melanomas) immediately after surgical excision. A total of 42 biopsy specimens was obtained for comparative investigations before and after QSRL impact. Electron microscopy was performed in 3 lesions.

RESULTS

Hematoxylin-eosin stainings showed selective vacuolization of pigmented structures (melanin granules, melanophages, pigmented melanocytes, pigmented keratinocytes) immediately after QSRL irradiation due to selective photothermolysis. Cryosections stained with nitroblue tetrazolium chloride featured minimal thermal damage of the surrounding tissue proving the high selectivity of QSRL light. Immunohistochemical techniques employing anti-S-100, HMB-45 antimelanoma antibody and Fontana-Masson staining revealed selective photothermal damage (vacuolization) of basal melanin granules, pigmented basal melanocytes and epidermal keratinocytes, as well as pigmented superficial dermal melanocytes. Deeper melanocytes and nests of nonpigmented melanocytes persisted unaltered and retained their S-100 and HMB-45 positivity. Masson's staining revealed persisting dermal melanophages. Electron microscopy showed specific damage of both keratinocytes and melanocytes with numerous melanosomes and confirmed the light-microscopic findings. Deeper dermal melanocytes containing only few melanin granules remained unaltered.

CONCLUSION

In pigmented lesions extending into the dermis, deeper pigmented melanocytic cells (nevus cells) persist throughout a single course of QSRL exposure. Nonpigmented melanocytic cells remain totally unaffected by QSRL irradiation. Therefore QSRL therapy of melanocytic nevi and congenital nevi should only be performed in controlled studies. Long-term results have to be evaluated before recommendations can be given.

Quality-switched ruby laser treatment of solar lentigines and Becker's nevus: a histopathological and immunohistochemical study

OBJECTIVE

A histopathological and immunohistochemical study was initiated to assess changes in benign human pigmented skin lesions after quality switched ruby laser (QSRL) irradiation.

METHOD

A total of 196 solar lentigines on 8 patients' forearms were irradiated in vivo, 13 biopsies were taken. Hematoxylin-eosin staining and immunohistochemical techniques using anti-S-100 and Fontana-Masson stainings, as well as cryosections stained with nitroblue tetrazolium chloride (NBTC), were employed for the evaluation of the specimens.

RESULTS

Immediately after QSRL impact selective photothermal damage (vacuolization) of all pigmented epidermal and basal melanocytes, keratinocytes, superficial dermal melanocytes and melanophages could be observed in solar lentigines. Cryosections stained with NBTC featured minimal thermal damage of the surrounding tissue. One Becker's nevus was also exposed to the QSRL, biopsies were taken before and immediately after QSRL exposure. In this lesion, superficially located pigments were selectively damaged, but a fair amount of pigmented cells in adnexal structures persisted throughout this single course of QSRL treatment. Recurrence of lentigines was not observed. In Becker's nevus, following initial fading of the lesion, clinically reactive hyperpigmentation occurred 4 weeks later.

CONCLUSION

We found that pigmented lesions featuring a moderate amount of pigment exclusively in and around the basal cell layer, like solar (actinic) lentigo, can be successfully removed by a single QSRL exposure selectively damaging epidermal and basal pigmented structures. Further investigations concerning QSRL treatment of dermally pigmented skin lesions have to be initiated.

Q-switched ruby laser application is safe and effective for the management of actinic lentigo (topical glycolic acid is not)

A study was designed to evaluate the effectiveness of single q-switched ruby laser exposure to erase actinic lentigo. A peeling fluid containing glycolic acid designed to treat lentigines was evaluated comparatively. Ten female patients presenting with actinic lentigines on the forearms and dorsal aspects of their hands were treated with the q-switched ruby laser on the right side. Single ruby laser irradiation of actinic lentigines on the dorsal aspects of forearms and hands caused transient crusting due to exfoliation of the epidermal surface, which generally lasted for 2 weeks. Four weeks after treatment total fading of the lesions was evident. Topical application of peeling fluid applied on the left forearms caused burning sensations, local irritation and superficial scaling but could not clear the lentigines. A single course of q-switched ruby laser exposure is safe and efficient for the management of actinic lentigines, as it completely clears these obvious signs of aging. Topical treatment of lentigines using a commercial peeling solution leads to moderate or severe irritation and is ineffective.

Different treatment modalities for the management of a patient with the nevoid basal cell carcinoma syndrome

Nevoid basal cell carcinoma (BCC) syndrome is a genetically linked disorder characterized by multiple BCCs associated with various skeletal abnormalities and sometimes with mental retardation. Because of the large number of lesions, treatment of BCCs in these patients may be extremely difficult. The value of different therapeutic options was assessed in a patient with multiple, disfiguring nevoid BCC syndrome. Surgical excision and split-skin grafting was used to remove three larger tumors. Photodynamic therapy led to healing of flat lesions; small papules within the treated areas, however, did not respond to this type of management. Three nodular BCCs treated with intralesional application of interferon alfa-2b were markedly reduced in size. Still, complete healing could not be achieved. Nodular lesions vaporized with the CO2 laser disappeared and showed no recurrence after 2 years of follow up. Our experience indicates that CO2 laser vaporization of BCCs allows the treatment of a large number of lesions in a single session, and is indicated when surgical treatment is not feasible for all lesions. Photodynamic therapy with 5-amino-levulinic acid may be a valid therapeutic option for flat lesions only. Intralesional application of interferon alfa-2b removes papular lesions of small size.

An update on pachydermodactyly and a report of three additional cases

Pachydermodactyly is a benign condition characterized by symmetrical, painless, diffuse swelling of the skin on the lateral aspects of the proximal interphalangeal joints of the fingers. Histopathological examination shows epidermal hyperplasia, an increase of dermal collagen bundles and a slightly increased number of fibroblasts. We report three adolescent males with pachydermodactyly. We also review 20 published cases, and discuss the differential diagnosis, clearly distinguishing pachydermodactyly from 'true' and 'false' knuckle pads.

Multinucleate cell angiohistiocytoma: treatment with argon laser

Multinucleate cell angiohistiocytoma mainly affects middle-aged women, and usually presents as grouped reddish-brown papules. Histopathological features include the presence of multinucleate cells in the reticular dermis, and numerous dilated dermal vessels. The lesions are benign, and may persist for years. Treatment is needed for cosmetic reasons. We report the successful use of the argon laser to treat two patients who had multinucleate cell angiohistiocytoma.

[Pacemaker erythema with telangiectasis ]

Pacemaker erythema is a rare, irreversible side effect of cardiac pacemakers, clinically characterized by epifocal teleangiectatic erythema. Histology reveals teleangiectatic vessels in the superficial dermis and a slight perivascular infiltrate. We report on three patients presenting with pacemaker erythema following either pacemaker or defibrillator implantation. The pathogenesis of this histopathologically uncharacteristic lesion is unknown. In contrast to peri- or postoperative pacemaker infections, physical irritation can be considered a possible triggering mechanism. Allergic reactions to the implanted material have been ruled out by negative patch test results.

Human eccrine hamartoma of the forearm-antebrachial organ of the ringtailed lemur (Lemur catta). A possible phylogenetic relationship?

A 31-year-old woman presented with a clinically otherwise unsuspicious area of profuse sweating on her right forearm. Without triggering agents, sweating attacks producing a clear, serous fluid were observed daily. Histopathologic examination of a biopsy specimen showed hyperplastic eccrine glands with pale, stippled cytoplasm characteristic of eccrine hamartoma. No explanation, however, has been given for the fact that several authors observed eccrine hamartomas in the same anatomical location. Adolescent lemurs of the species catta (ringtailed lemur) are equipped with a pair of antebrachial cutaneous glands located on the volar surface of the wrist. They exude a clear secretion enabling them to "brachial branch mark" their territories. Histopathologic findings in the ringtailed lemur's antebrachial organ show characteristics of both apocrine and eccrine glands. In contrast to normal apocrine glands, however, the antebrachial organs of ringtailed lemurs reach the epidermis directly and are not connected to hair follicles. According to the "biogenetic law" of Ernst Haeckel, stating that ontogeny has to be seen as a short and incomplete repetition of phylogeny, a human fetus passes all evolutional stages from a single cell via amphibians and mammals to a human being. Thus, the antebrachial organ of the ringtailed lemur may be the "phylogenetic explanation" for eccrine hamartomas of the forearm in humans. The histopathologic findings of the antebrachial organ and of eccrine hamartomas are in accordance with this hypothesis.

[Notalgia paresthetica, "posterior pigmented pruritic patch" and macular amyloidosis. Three stages of a disease]

We report on nine cases of notalgia paresthetica, a cutaneous condition that has rarely been described in the dermatological literature and is characterized by localized pruritus, burning and hyperesthesia and/or paresthesia on the back. Histological and immunohistochemical studies have not clarified the pathogenesis of this disease. Several factors might be involved in various cases, including increased cutaneous innervation and neuropathy. The so-called posterior pigmented pruritic patch and macular amyloidosis may be considered as progressive evolutional stages of notalgia paresthetica.

[Eccrine hamartoma of the sweat glands simulating localized unilateral hyperhidrosis]

We report on the case of a 31-year-old woman who presented with localized unilateral hyperhidrosis on her lower right arm. Histological features showed a hamartoma of the eccrine sweat glands. Because she was afraid of being overweight, the patient took an appetite depressant. Under this self-medication complete cessation of the localized hyperhidrosis was observed.