Consensus guidelines for off-label use of oral minoxidil for hair loss
An international expert consensus statement published in JAMA Dermatology provided best-practice recommendations for the off-label use of low-dose oral minoxidil among patients with hair loss. Hair-loss specialist dermatologists from 12 countries reached consensus on 76 items, including diagnoses for which oral minoxidil may provide benefit, indications for oral versus topical minoxidil, dosing for adults and adolescents, contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation.
The experts reached strong consensus for low-dose oral minoxidil providing direct benefit for androgenetic alopecia and age-related patterned thinning (97.7% of experts for both), alopecia areata (81.4%), telogen effluvium (86%), traction alopecia (79.1%), and persistent chemotherapy-induced alopecia and endocrine therapy-induced alopecia (83.7% for both). Over 90% of experts agreed on the addition of spironolactone in biological female or transgender female patients with hirsutism, acne, or polycystic ovary syndrome (or another excess androgen syndrome).
DermWorld Insights and Inquiries: Idiopathic granulomatous mastitis joins the pantheon of erythema nodosum-associated disorders
Patients often ask me, “Doctor, is my disease rare?” I’m never quite sure how to respond — while most patients are relieved to know that they are not alone, some relish the experience of being unique. By my definition, at this point in my career, if it’s the first time I’m seeing a disorder, perhaps it is unusual. If I have encountered it several times, probably not. In the literature, idiopathic granulomatous dermatitis (IGM) is considered a rare disease. I have diagnosed IGM at least a few times. By my imprecise definition, IGM may be uncommon but not rare. There are an increasing number of reports of IGM accompanied by extramammary manifestations, notably erythema nodosum. Keep reading!
Diagnostic delays, mortality among patients with calciphylaxis
According to an article published in JAAD, time to diagnosis as well as morbidity outcomes and mortality rates among patients with calciphylaxis has steadily improved since 2006. The retrospective study included 302 adults diagnosed with calciphylaxis between Jan. 1, 2006, and Dec. 31, 2022. Results showed that a greater delay in diagnosis was associated with non-nephrogenic calciphylaxis but not nephrogenic calciphylaxis, with a median time to diagnosis of 61 days versus 33 days. However, since 2006, non-nephrogenic calciphylaxis patients have been diagnosed 13.9 days faster every year versus 4.9 days faster for nephrogenic calciphylaxis patients.
Mortality rates for nephrogenic and non-nephrogenic calciphylaxis are now 36.7% and 30.77%, respectively. According to the authors, these results underscore the need for “continued provider education to expedite diagnosis and ultimately improve morbidity and mortality in calciphylaxis patients.”
Trends in patch-test positivity to methylchloroisothiazolinone and methylisothiazolinone
A systematic review published in Dermatitis assessed the trends in patch-test positivity to methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) based on regulatory status. The analysis included data from 47 studies from 2000 to 2023, and the results showed a difference in the rate of patch-test positivity to MCI and MI among countries with and without restrictions against these allergens. The worldwide rate of test positivity to MCI and MI sharply increased in the 2010s but then decreased in Europe, Canada, and Asia when restrictions and/or bans were placed on the use of MCI and MI in personal care products. However, no regulations were implemented in the U.S., and the rate of test positivity to MCI and MI remained elevated.
Contact dermatitis experts discuss regulatory complexities of the fragrance industry and share tips for identifying and managing allergens. Read more in DermWorld.
Mpox update: Recommendations for clinicians
On Nov. 15, health officials confirmed the first reported case of clade I mpox in the United States. The CDC has issued recommendations for clinical recognition, diagnosis, testing, prevention, and surveillance of mpox. The CDC is urging clinicians to consider mpox when lesions consistent with mpox are observed in a patient, even if an alternate etiology (e.g., herpes simplex virus, syphilis) is considered more likely. Early symptoms may include fever, malaise, headache, sore throat, or cough, and (in many cases) swollen lymph nodes. People with mpox infection develop lesions that typically progress from macules to papules, vesicles, pustules, and then scabs.
[Dermatologist explains what the mpox rash looks like. Read more.]
CDC recommendations include:
Discuss mpox prevention and risk reduction strategies with all your patients traveling to countries with ongoing human-to-human transmission of clade I mpox.
Take a comprehensive sexual health history and discuss your patient’s travel plans.
Recommend vaccination with the 2-dose JYNNEOS vaccine series to applicable patients.
Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox.
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