The rankings are in: Minoxidil, finasteride, and dutasteride for male androgenetic alopecia
Authors of a recent meta-analysis inJAMA Dermatology compared the efficacy of monotherapy with oral and topical minoxidil, dutasteride, and finasteride in male patients with androgenetic alopecia (AGA). After examining various doses and administration routes of the three medications, the analysis showed that 0.5 mg/d of oral dutasteride has the highest probability of being the most efficacious treatment. According to the study authors, the following were most efficacious treatments in decreasing order: 5 mg/d of oral finasteride, 5 mg/d of oral minoxidil, 1 mg/d of oral finasteride, 5% topical minoxidil, 2% topical minoxidil, and 0.25 mg/d of oral minoxidil.
[What’s new in the management of AA, AGA, and CCCA? Find out in DermWorld.]
Authors of an editorial responded to the study noting that although topical minoxidil ranked higher than the lowest dose oral minoxidil, their personal experience is that oral minoxidil at doses of 1.25 mg to 5 mg are superior to topical minoxidil for treating AGA. They also called attention to the difficulty of interpreting the difference between 1 mg finasteride, 5 mg finasteride, and 0.5 mg dutasteride because the cumulative rankings do not incorporate statistical significance or quality of evidence.
Dermatologists discuss the latest clinical guidance for managing hirsutism. Read more.
DermWorld Insights and Inquiries: Bowel-associated dermatosis-arthritis syndrome (BADAS) — The story behind the acronym
Justifiably, the COVID-19 pandemic has focused the world’s attention, however, another global pandemic threatens us — obesity. According to the World Health Organization, in 2016, more than 1.9 billion people are overweight (BMI >25) and 650 million are obese (BMI >30). The ramifications are vast for patients, regarding morbidity and mortality, and society at large. Managing obesity conventionally focuses on lifestyle modification, pharmacotherapy, and bariatric surgery.
Intestinal bypass surgery for morbid obesity was first utilized in 1956. Complications such as persistent diarrhea, electrolyte deficits, hepatic failure, renal stones, gallstones, among others were numerous. A 23% incidence of polyarthritis was appreciated, as was tenosynovitis and polymyalgia. Dicken and Seehafer were the first to recognize cutaneous lesions (vesiculopustular lesions in two patients, one of whom also displayed erythema nodosum) following intestinal bypass surgery, suggesting the term “bowel bypass syndrome.” The syndrome demonstrated the histologic features of Sweet syndrome, thereby classifying it as a neutrophilic dermatosis, occurring in 20% of patients who underwent jejunoileal bypass surgery for the treatment of morbid obesity. Keep reading!
Acne and insulin resistance
A systematic review and meta-analysis published in JAADexplored whether patients with acne would have higher levels of insulin resistance. The authors analyzed 13 studies and found that acne was strongly associated with insulin resistance. Variables such as weight, age of acne onset, and sex did not significantly alter the association.
[Experts explore the underlying mechanisms of the link between the brain and the skin in DermWorld.]
Publication bias was assessed, and although some asymmetry exists, the large effect size of the last study appears to mitigate the asymmetry. The authors conclude that dermatologists should be aware of the potential relationship between acne and insulin resistance and consider whether patients may need referral to primary care for further evaluation.
President Joe Biden recently signed the Dr. Lorna Breen Health Care Provider Protection Act, a law that provides federal funding to address behavioral health and well-being among health care workers. The law is named for Lorna Breen, MD, a New York City emergency physician who died by suicide at the beginning of the pandemic.
[Experts discuss how the conversation surrounding physician mental health has changed in DermWorld.]
The law provides $135 million over three years for training health care providers on suicide prevention and behavioral health, and for awareness efforts to improve mental health among health care workers. The law establishes grants for training of health care students, residents, or health care professionals in evidence-informed strategies to reduce and prevent suicide, burnout, mental health conditions and substance use disorders.
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Grants will be available for health care providers to promote mental and behavioral health among their workforces. HHS will award these grants to health care providers, including medical professional associations, to establish or expand evidence-informed programs to promote mental and behavioral health among their employees. HHS will also conduct a study on mental and behavioral health and burnout among healthcare workers and submit policy recommendations to Congress.
What dermatologists should know about VEXAS syndrome
VEXAS syndrome (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic), an adult inflammatory syndrome, was first described in 2020. According to a review published in JAAD, 89% of published cases have documented skin involvement. Reported skin presentations include Sweet-like urticated and tender erythematous nodules, cartilaginous involvement with chondritis, cutaneous vasculitis, and periorbital angioedema, with many patients diagnosed with Sweet syndrome, relapsing polychondritis, polyarteritis nodosa, or erythema nodosum.
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