Safety of minoxidil for hair disorders in pediatric patients
A retrospective review published in the International Journal of Dermatology evaluated the safety of systemic minoxidil, as either low-dose oral or sublingual, in 63 children aged 0-12 years with hair disorders. Two-thirds of patients were treated for alopecia areata and eight patients for loose anagen syndrome.
[What’s new in pediatric dermatology? Read more in DermWorld.]
Most patients started at a dose of 0.1 mg once daily, with dosage up-titrated according to treatment response. The average maximum dose concentration of minoxidil was 12.45 ng/kg, with a treatment duration range of three to 65 months. The mean duration of treatment was 14.6 months. Mild hypertrichosis was the most common side effect, although none of the side effects required discontinuation or dose adjustment. While low-dose oral minoxidil and sublingual minoxidil were well tolerated, the authors find that future prospective studies that objectively measure the efficacy and optimum dose concentration should be considered.
Does low-dose oral minoxidil affect blood pressure, heart rate? Read more inDermWorld Weekly.
DermWorld Insights and Inquiries: Telangiectasias: When is it TEMPI time?
For the medical dermatologist, telangiectasis requires a thoughtful approach to diagnosis. Where are the lesions distributed (generalized, mucosal, periungual)? Are they linear or mat-like? Are they associated with other lesions (pigmented macules, spider angiomas)? Is the patient symptomatic (flushing, diarrhea, shortness of breath, arthralgias, etc.)? The differential diagnosis is long and depends on the answers to these questions. Generalized telangiectasias without any symptoms may be essential telangiectasias or cutaneous collagenous vasculopathy. Periungual telangiectasias are characteristic of autoimmune diseases (lupus, dermatomyositis, and scleroderma). When mat-like and mucosal, CREST syndrome and hereditary hemorrhagic telangiectasia are the two main differential diagnoses. When seen with spider angiomas, high estrogen states such as liver disease or pregnancy must be considered. An association with pulmonary or gastrointestinal symptoms may suggest carcinoid syndrome or mastocytosis (telangiectasia macularis eruptiva perstans). Keep reading!
DermWorld Young Physician Focus:
Revisiting physician mental health
My initial instinct is to recoil from suggestions that physicians themselves should somehow be responsible for fixing their own burnout. The solution to physician burnout is not found in mandated lectures on the subject, nor in a one-off pizza party or yoga session; the solution to burnout is not for the lone physician to simply become more resilient. The house of medicine is in turmoil, and whether we realize it or not, we reflect that. Physicians bear the burden of ever-increasing regulatory requirements which often do not improve patient care, while simultaneously being graded on satisfaction scores that do not correlate with quality of care. Day to day, we are subject to so many metrics — benchmarks that are outside of our personal control, detract from our time with patients, and may not be medically relevant. These things eventually contribute to a loss of our sense of meaning in work and subsequent physician burnout. Read more from DermWorld Young Physician Advisor Bridget McIlwee, DO, FAAD.
Monkeypox: Recognizing minimal cutaneous involvement or systemic symptoms
Classically, patients with monkeypox develop cutaneous lesions following prodromal symptoms. However, in this current outbreak, patients not uncommonly develop few cutaneous lesions, often localized to the anogenital region, with minimal preceding symptoms. Authors of an article published in JAMA Dermatology note that patients have presented in an atypical manner during this outbreak. Few or single cutaneous lesions may precede instead of mild systemic symptoms. Lesions may be asymptomatic, painful, or minimally pruritic.
[Visit the Academy’s monkeypox resource center for information on recognizing infection, resources on treatment and pain, and a registry to collect information on dermatologic manifestations of the disease.]
The authors list the following atypical clinical features of monkeypox during this outbreak:
Few or isolated minimally symptomatic (painful or pruritic) cutaneous lesions
Anal pain and bleeding without skin lesions
Anogenital lesions without further body site involvement
Lesions at different stages of development (asynchronous)
Absence of prodromal period or minimal constitutional symptoms
Is there an association of VTE with AD and treatment with JAK inhibitors?
A systematic review and meta-analysis published in JAMA Dermatology explored whether patients with atopic dermatitis (AD), particularly those taking JAK inhibitors, have an increased risk for venous thromboembolism (VTE). A total of 466,993 participants were included, and the meta-analysis found no significant association of AD with incident VTD (incidence rate of VTE, 0.23 events/100 patient-years).
Overall, three of 5,722 patients with AD (0.05%) who were receiving treatment with JAK inhibitors experienced VTE compared with one of 3,065 patients with AD (0.03%) receiving placebo or dupilumab. The incidence rate of VTE was 0.15 and 0.12 events per 100 patient-years in participants with AD receiving JAK inhibitors and placebo, respectively. The findings were similar in four unique JAK inhibitors (abrocitinib, baricitinib, upadacitinib, and SHR0302). The authors conclude the currently available evidence does not detect an increased risk of VTE associated with AD or treatment with JAK inhibitors, although future real-world, long-term data are warranted.
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