Female-pattern hair loss: Effect of bicalutamide on minoxidil-induced hypertrichosis
In an article published in JAAD, authors identified 35 patients with female pattern hair loss who experienced improvement of oral minoxidil-induced hypertrichosis after starting or titrating up the dose of oral bicalutamide, a pure nonsteroidal androgen receptor inhibitor.
Hypertrichosis occurred at a mean dose of 1.5 mg/day of minoxidil. All patients started bicalutamide at 10 mg/day. The mean dose that resulted in improvement of hypertrichosis was 14.4 mg/day after a mean of 3.4 months of treatment. The authors concluded that adding bicalutamide to oral minoxidil may reduce minoxidil-induced hypertrichosis, which occurs in up to 24% of patients.
What has research revealed about the pathogenesis of androgenetic alopecia, alopecia areata, and CCCA? Find out inDermWorld.
DermWorld Insights and Inquiries: Speculating on spicules — Our incomplete knowledge of trichodysplasia spinulosa
For inexplicable reasons, there are certain differential diagnoses that I find particularly satisfying, one being disorders responsible for facial follicular spicules: follicular mucinosis, pityriasis folliculorum (Demodex folliculorum), follicular hyperkeratotic spicules (myeloma immunoglobulin or cryoglobulin), follicular porokeratosis, trichostasis spinulosa (vellus hairs), keratosis pilaris, lichen planopilaris, lichen spinulosus, and trichodysplasia spinulosa. Clinical-pathologic correlation will usually allow for a precise diagnosis. This commentary will focus on trichodysplasia spinulosa. Keep reading!
DermWorld Young Physician Focus: I’m not the enemy
As we complete another trip around the sun, and another year living through a once-in-a-century pandemic, health care workers everywhere are more resigned than rejoicing. At the start of the pandemic, we were lauded as heroes, provided with discounts, and applauded from balconies. However, as the pandemic has dragged on, people have become increasingly frustrated with changing guidelines and media sensationalism, leading to mistrust of public health messaging. Though my outpatient dermatology office is just a microcosm of the health care sector, I have found patients to be less trusting and sometimes more disgruntled; I am sure I am not alone in this experience. Read more from DermWorld Young Physician Advisor Jenna O'Neill, MD, FAAD.
Congress addresses impending Medicare cuts
President Biden has signed legislation that steps back from the cliff of an estimated 10% cut in Medicare physician payment in 2022.
The bill mitigates the cuts physicians were facing next year by increasing payments in the 2022 Medicare Physician Fee Schedule by 3%, phasing in the 2% sequestration cut, and preventing an additional 4% cut that had been facing physicians due to PAYGO budget rules until 2023. While this bill represents an improvement over the significant cuts originally slated for 2021, it does not fully address the concerns within the medical community.
Here’s a snapshot of the relief from previously scheduled cuts in 2022:
3% increase in the Medicare physician payment schedule for 2022 (0.75% less than in 2021)
Phased in reinstatement of the Medicare sequester:
Full relief from the 2% sequester cut for the first three months (Jan. 1, 2022 – March 31, 2022)
1% sequester reinstatement (April 1, 2022 – June 30, 2022)
Full 2% sequester reinstatement through the end of 2022
Elimination of the 4% PAYGO budget rules and any further PAYGO cuts through 2022
Based on initial analysis from the American Academy of Dermatology Association (AADA), dermatologists will experience incremental reductions from current levels that begin at 0.75% and reach 2.75% by July 1, 2022.
Preserving the stability of Medicare physician payment is a top AADA priority and has been a major focus of our advocacy efforts throughout the year. We worked through direct lobbying efforts, coalitions, the annual Legislative Conference, and grassroots efforts to ensure the dermatology perspective was heard.
While Congress has taken steps to address the concerns of the medical community, there’s more work to be done and the AADA and the house of medicine will continue our focused advocacy efforts seeking a long-term fix to the Medicare program.
Is phototherapy an effective treatment for atopic dermatitis?
An article published in the Cochrane Database of Systematic Reviews found that compared to placebo or no treatment, NV-UVB may improve physician-rated signs and patient-reported symptoms after 12 weeks without a difference in withdrawal due to adverse events.
Thirty-two trials with 1,219 randomized participants were included in the review, with an equal number of males and females. The authors found that there may be a larger reduction in physician-assessed signs and patient-reported itch with narrowband ultraviolet B (NB-UBV) compared to placebo after 12 weeks of treatment. The number of participants with moderate to greater global improvement may be higher as well.
When comparing NB-UVB with ultraviolet A1, they found no evidence of a difference in physician-assessed signs and patient-reported itch after six weeks, although they judged the evidence to be very low certainty. The comparison between NB-UVB and psoralen plus ultraviolet A (PUVA) was also judged as very low certainty. There was no evidence of a difference in physician-assessed signs or a difference in marked improvement or complete remission after six weeks.
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