Oral minoxidil vs. topical minoxidil for male androgenetic alopecia
A double-blind, placebo-controlled randomized trial published in JAMA Dermatology evaluated the efficacy of low-dose oral minoxidil versus topical minoxidil in treating patients with androgenetic alopecia. Participants were randomized into two groups: oral minoxidil, 5 mg daily and topical placebo solution; or 1 mL of topical minoxidil, 5% twice daily and oral placebo for 24 weeks. After 24 weeks, no significant difference in hair density was observed between the two groups, with both oral and topical minoxidil demonstrating comparable levels of improvement regarding hair density on the hairline and vertex. The oral minoxidil group had a higher rate of hypertrichosis (49% vs. 25%) and headache (14%). According to the study authors, oral minoxidil is well-tolerated but does not demonstrate superiority over topical minoxidil in treating male patients with androgenetic alopecia.
A review of spironolactone for androgenetic alopecia. Read more.
DermWorld Insights and Inquiries: Nailing the diagnosis of the BAP1 tumor predisposition syndrome
I never imagined that I would be writing another commentary on onychopapillomas (Ops) so soon. The initial commentary was devoted to rare malignant Ops. Unsurprisingly, additional reports of malignant Ops have been reported. What else could warrant another commentary? The observation that multiple Ops appear to be associated with the BAP1-tumor predisposition syndrome (BAP1-TPDS). It is easy to miss the diagnosis of BAP1–TPDS. Clinically, lesions often appear banal, with no reason to remove or biopsy them. Unless there is a detailed family history noting associated malignancies, the syndrome may not be recognized. Are there any clinical clues that may alert the dermatologist to consider the diagnosis of BAP1-TPDS? Keep reading!
Clotrimazole-betamethasone dipropionate for nonfungal skin conditions
Authors of a research letter published in JAMA Network Open characterized prescribing of clotrimazole-betamethasone to identify potential physician knowledge gaps and improve patient treatment. Clotrimazole-betamethasone prescriptions were more frequently associated with non-dermatologist visits: family practice or internal medicine physicians (40.7%) followed by obstetricians-gynecologists (13.6%). The authors suggest this may potentially reflect the “lack of awareness that the medication contains a high-potency corticosteroid and poses potential harms associated with indiscriminate use, including adverse effects and resistance selection pressure.”
With increasing resistance to antifungal therapies, here’s what dermatologists need to know about managing dermatophytosis. Read more.
Only 3.5% of patients saw a dermatologist and few received topical antifungal monotherapy (1.1%), oral antifungals (2.6%), or diagnostic testing (15%). Fungal diagnosis was most frequent among enrollees who saw a podiatrist (77%); for each remaining physician encounter type, fewer than 45% of patients received a fungal diagnosis. The authors recommend that physicians confirm fungal diagnoses using potassium hydroxide with microscopy, fungal culture, or DNA-based techniques, or refer patients to a dermatologist.
Oral melatonin in patients with recalcitrant melasma
Authors of an article published in the International Journal of Dermatology presented data from seven patients with recalcitrant melasma treated with oral melatonin. All patients previously received treatment with either topical creams, including topical combination cream, chemical peels, or oral tranexamic acid without significant improvements. After a four-week washout period, all patients received daily 3-mg melatonin tablets and used sunscreen for 12 weeks. All patients reported lightening of pigmentation with an improvement in the Melasma Area and Severity Index scores from baseline. The authors concluded that while additional research is needed, oral melatonin may be a well-tolerated off-label treatment for patients with recalcitrant melasma.
Reddit analysis reveals JAK inhibitor questions among AD patients
Authors of an article published in the Journal of Drugs in Dermatology used data from Reddit to examine patients’ views on treating atopic dermatitis (AD) with JAK inhibitors. Posts primarily comprised of inquiries about general experiences and side effects, revealing some unlisted effects such as depression, delayed wound healing, and gynecomastia. Many posts addressed usage instructions, specifically several concerning the shingles vaccine, highlighting a need for clearer physician guidance. The authors concluded that physicians can identify medication knowledge gaps on social media and should provide resources to correct inaccurate views among patients and users.
From "slugging" to snail mucin: Dermatologists discuss popular social media trends impacting the skin. Read more.
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