Recommendations for the use of topical, oral minoxidil
A study published in JAAD reviewed how hair loss experts use available literature on topical and low-dose oral minoxidil (LDOM) to effectively and safely treat patients with hair loss. In addition to pattern hair loss and alopecia areata, minoxidil is the primary treatment for telogen effluvium, chemotherapy-induced alopecia, loose and short anagen syndromes, and female-pattern hair loss. For hair loss limited to the central scalp or patchy hair loss, either formulation is reasonable to start with. When the entire scalp is involved, LDOM is preferred.
[Topical finasteride with minoxidil vs. topical minoxidil alone for male-pattern androgenic alopecia. Read more.]
Relative efficacy of the two options is unclear, but two trials of pattern hair loss showed no statistically significant differences in efficacy with 1 mg LDOM and 5% topical minoxidil. Multiple studies have shown that the effect on blood pressure from LDOM is minimal in most cases. The authors also discuss the side effects of both LDOM and topical minoxidil, and the use of minoxidil in children.
Sexual dysfunction with 5-alpha reductase inhibitors for androgenetic alopecia. Read more.
DermWorld Insights and Inquiries: Adding protothecosis to the protocol
As a dermatology resident at the outset of the AIDS epidemic, I quickly learned that all bets are off when diagnosing infectious diseases in immunocompromised hosts. That experience taught me to culture broadly for bacterial, atypical mycobacterial, fungal, and viral diseases when suspecting an infectious etiology in an immunosuppressed patient. Rarely (if ever) have I thought about algae — recent publications alerted me to this oversight. Davies et al. reported the first human infection with a Prototheca alga 60 years ago in a Sierra Leone barefoot rice farmer’s foot. Protothecosis presents as a localized cutaneous infection, olecranon bursitis, or disseminated disease, especially in immunocompromised patients. Keep reading!
FDA approves dupilumab for chronic spontaneous urticaria
The FDA approved dupilumab for the treatment of adults and adolescents aged 12 years and older with chronic spontaneous urticaria (CSU) who remain symptomatic despite H1 antihistamine treatment. Two phase 3 clinical trials assessed dupilumab as an add-on therapy to standard-of-care antihistamines compared to antihistamines alone.
Dupilumab demonstrated reductions in itch severity and urticaria activity compared to placebo at 24 weeks. It also increased the likelihood of well-controlled disease or complete response compared to placebo at 24 weeks. The safety data were consistent with the safety profile of dupilumab in its approved indications. The most common adverse event was injection site reactions.
Long-term effectiveness of adalimumab for the treatment of hidradenitis suppurativa
In a brief report published in JAAD, the authors evaluated the long-term, real-world effectiveness of adalimumab in hidradenitis suppurativa (HS) patients. The cohort comprised 12 males and 20 females, with a median age of 45 years. The patients received continuous 40 mg of adalimumab weekly. At baseline, 10% had moderate disease and 90% had severe disease; at the end of treatment, 40% had mild, 23.3% moderate, and 36.7% severe disease. A significant improvement was observed at 12 weeks and sustained through week 364. Clinical remission was achieved in 87.5% of patients, with remission lasting for 154 to 210 weeks.
FDA alert for compounded topical finasteride products
The FDA released an alert regarding reports of adverse events involving compounded topical finasteride products. There is currently no FDA-approved topical formulation of finasteride, and there are potential serious risks associated with its use. Some compounders and telemedicine platforms market topical formulations of finasteride either as a single active ingredient or in combination with other active ingredients, including minoxidil, to treat hair loss. There were 32 cases reported to the FDA Adverse Event Reporting System between 2019 and 2024. Adverse events included erectile dysfunction, anxiety, suicidal ideation, brain fog, depression, fatigue, insomnia, decreased libido, and testicular pain. View the FDA alert.
FDA alert for cosmetic products
The FDA has issued an alert regarding several cosmetic products marketed as gel nail polish remover that contain methylene chloride, an ingredient prohibited in cosmetics at any level. It has been shown to cause cancer in animals and is likely harmful to human health. Read more and view a list of products found to contain methylene chloride.
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