A systematic review published in Dermatology and Therapy aimed to characterize the safety and use of oral minoxidil in children. Low-dose oral minoxidil was found likely to be safer than moderate or high doses for the treatment of pediatric patients with alopecia and other hair disorders.
Patients included in the study reported using minoxidil to treat hair disorders (83.9%) and hypertension (11.3%) with some accidental use (4.8%) also reported. Patients consumed a mean daily minoxidil dose of 2.5 mg or less for periods ranging from three months to five years. The most common adverse effects were hypertrichosis (12.1%), hypotension (5.6%), headache (2.1%), elevated liver function test results (1.9%), nausea (1.6%), palpitations or tachycardia (1.3%), and anemia (1.1%). No patients discontinued treatment because of adverse effects.
[Androgenetic alopecia: topical minoxidil vs. low-dose oral minoxidil. Read more.]
Daily low-dose oral minoxidil was used to treat AGA, alopecia areata, loose anagen syndrome, and other hair disorders. Most participants reported improved hair density and decreased shedding. Forty-two patients used moderate-dose oral minoxidil at doses ranging from 3 to 15 mg daily. The most common adverse events were hirsutism and hypertrichosis (66.7%), pericardial effusion (9.5%), reflex tachycardia and peripheral fluid retention (7.1%), among others. The use of high-dose oral minoxidil for hypertension, at daily doses ranging from 15.1 to 135 mg, was reported in 26 patients (96.3%). The most common adverse effects were hirsutism and hypertrichosis (77.8%), pericardial effusions (in 14.8% of patients taking 21 to 83 mg minoxidil daily), edema (in 11.1% of patients taking 20 to 50 mg minoxidil daily), and hypertensive encephalopathy (11.1%).
The researchers concluded that while the majority of patients in the moderate-dose minoxidil and high-dose minoxidil groups had severe underlying disease, this study suggests moderate and high doses of oral minoxidil may not be safe for use in children.
DermWorld Insights and Inquiries: Rounds on pityriasis rotunda
This commentary focuses on an entity that I have only rarely diagnosed yet may have profound implications — pityriasis rotunda (PR). Surrounding skin may appear ichthyotic. Dermatoscopic features demonstrate well-demarcated scales separated from each other by paler striae. The differential diagnosis includes dermatophyte infections, tinea versicolor, erythrasma, pityriasis alba, pityriasis rosea, psoriasis, parapsoriasis, cutaneous T cell lymphoma, fixed drug eruption, and nummular eczema. The most important consideration is that PR may be a paraneoplastic disorder, particularly with hepatocellular carcinoma. Keep reading!
Contact allergens in ‘clean’ children’s products
A study published in Pediatric Dermatology reviewed “clean” baby products from a popular online marketplace (Target). The study found that many of these products contained known contact allergens, including fragrance in 82% of the products, Compositae mix in 46%, cocamidopropyl betaine in 45%, glucosides in 37%, propylene glycol in 12%, and lanolin in 1%. Only 6% of the products were free of all screened allergens. Of the 33 products that claimed to be “fragrance-free” or “unscented,” 58% of them contained fragrance or botanical ingredients. According to the authors, baby products often contain known contact allergens, such as fragrance and botanical ingredients, even when labeled “clean,” “fragrance-free,” or “unscented.”
Is cumulative methotrexate associated with liver fibrosis in patients with a history of moderate-to-severe psoriasis?
A study published in the British Journal of Dermatology assessed the association of liver fibrosis with cumulative methotrexate dose and other liver fibrosis risk factors in patients with a history of moderate-to-severe psoriasis. Liver stiffness, measured by transient elastography, was evaluated in 204 patients. Depending on the liver stiffness measurement cutoff, the liver fibrosis prevalence ranged from 17% to 36%. Approximately 90% of the patients had received methotrexate; however, the cumulative methotrexate dose was not associated with continuous liver stiffness measurement values. Although the results of this study support the lack of association between cumulative methotrexate dose and liver fibrosis in patients with psoriasis, the authors suggest that physicians should consider alternative therapies in those with identified risk factors for liver fibrosis.
In its seventh year, DataDerm provides real-time data to registry participants while also providing a program to facilitate comprehensive dermatologic research. In a fourth Annual Report published in JAAD, the authors present the advances the registry has made in conjunction with OM1, the data analytics partner, as well as the current status and future plans of DataDerm. As of Dec. 31, 2022, DataDerm contained data from 14,217,738 unique patients and 53,496,428 unique patient visits. Of the 14,217,738 unique patients in DataDerm, 12,987,717 patients were entered via EHR-integrated practices.
In 2022, the DataDerm analytics team processed 14 data requests addressing topics such as demographic characteristics of patients with rare diseases, patterns of population-level medication use, and geographic trends in management of dermatologic disease. Since the 2022 Annual Report, DataDerm has supported peer-reviewed publications on topics including pyoderma gangrenosum, vitiligo, Sweet syndrome, medications for atopic dermatitis, and more. Researchers are currently utilizing data from the registry to examine the following topics for future publications: Demographic trends in the treatment of atopic dermatitis, access to specialty testing, and appropriate management of comorbidities among dermatologic patients.
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