Efficacy of minoxidil for cancer treatment–induced hair loss
A retrospective review published in the Archives of Dermatological Research assessed the clinical characteristics and response to treatment of patients with endocrine therapy–induced alopecia (EIA) or persistent chemotherapy–induced alopecia (pCIA). Of 24 patients with pCIA and EIA, 87.5% of patients demonstrated moderate or significant improvement in clinical response to low-dose oral minoxidil (LDOM) or topical minoxidil. Subgroup analysis revealed that LDOM use was associated with superior results among patients with pCIA, while both oral and topical minoxidil showed comparable results among those with EIA. Patients with pCIA were more likely to present with more severe alopecia compared with patients with EIA. The authors conclude that LDOM shows promise as an effective alternative for cancer treatment–induced hair loss, especially in patients with pCIA.
DermWorld Insights and Inquiries: Malignant syphilis — History in the making
Malignant syphilis is a rare, severe form of secondary syphilis, characterized by cutaneous ulcers with central necrosis that a black-brown rupioid crust may accompany. (The term “rupioid” [from the Greek rhupos, meaning filth] is used to describe oyster or limpet shell-shaped thick keratotic lesions.) First, a point of clarification — as Vinay et al affirm: “The term ‘malignant’ has been used to describe the grotesque clinical features and is not related to the clinical event of malignancy.” Malignant syphilis has been increasingly reported in both immunocompromised and immunocompetent patients. Dermatologists should consider this diagnosis when encountering patients with an acute onset of well-defined necrotic ulcers that may be associated with rupioid crusts. Keep reading!
Most effective medications for plaque psoriasis
An article in JAMA Dermatology provided a clinical evidence synopsis of a recently published Cochrane database systemic review and meta-analysis on systemic medications used for the treatment of plaque psoriasis. In psoriasis RCTs examining efficacy eight to 24 weeks following treatment onset, the most effective drugs for psoriasis in rank order were (1) infliximab, (2) bimekizumab, (3) ixekizumab, and (4) risankizumab. There was no difference in clinical effectiveness between these four drugs. All biologic treatments showed a higher proportion of patients reaching PASI 90 than the nonbiologic systemic agents. The rank order of efficacy for the five most commonly used oral drugs for psoriasis was (1) deucravacitinib, (2) methotrexate, (3) cyclosporine, (4) apremilast, and (5) acitretin.
When considering systemic agents by class, anti–IL-17 medications showed a higher proportion of patients reaching PASI 90 compared with all other classes except anti–IL-23 medications. Among this class, bimekizumab and ixekizumab were more effective than brodalumab and secukinumab. Among IL-23 blockers, risankizumab was more effective than guselkumab, tildrakizumab, and ustekinumab. For the TNF inhibitors, infliximab was more effective than adalimumab, certolizumab, and etanercept.
Experts break down emerging treatment options for psoriasis and what they can offer patients and physicians inDermWorld.
Cardiovascular, venous thromboembolism risk associated with JAK inhibitors
A meta-analysis of 35 clinical trials with a mean follow-up duration of 4.9 months published in JAMA Dermatology assessed the risk of all-cause mortality, major adverse cardiovascular events (MACE), and venous thromboembolism (VTE) in patients with dermatologic conditions using JAK inhibitors. There was no significant difference between patients receiving JAK inhibitors and those receiving placebo/active comparator in terms of composite MACE, VTE, and all-cause mortality. Subgroup analysis of oral versus topical JAK inhibitors also did not find significant differences between patients who were exposed to JAK inhibitors and those who were not. According to the authors, short-term use of JAK inhibitors for dermatologic indications may not increase the risk of all-cause mortality, MACE, or VTE; however, long-term trials are needed to fully evaluate safety risks.
Positive patch test in patients with frontal fibrosing alopecia
A study published in Dermatitis found that of 60 patients with frontal fibrosing alopecia/lichen planopilaris (FFA/LPP), 83% of the cohort had a positive patch test, which was higher than the 2019 to 2020 North American Contact Dermatitis Group results, which demonstrated only a 69.7% patch test positivity rate. This suggests a potential increased prevalence of allergic contact dermatitis in patients with FFA/LPP. Specifically, the authors found that 36.6% of the patients with FFA/LLP had positive patch testing to cetrimonium bromide, a quaternary ammonium compound salt found in many personal care products. It was the allergen that had the highest number of positive tests in the cohort, highlighting its potential as an allergen in patients with FFA/LPP.
Contact dermatitis experts discuss key cosmetic allergens and how to investigate which product may be causing a patient’s allergic reaction. Read more in DermWorld.
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