A review of spironolactone for androgenetic alopecia
In a study published inJAAD, the authors reviewed 12 studies in which participants used spironolactone for androgenetic alopecia. Spironolactone was the sole therapy for 23% of the participants while the rest used the drug in combination with topical minoxidil, oral minoxidil, low-level laser therapy, or iron supplementation.
Doses of spironolactone ranged between 25 and 200 mg for a duration of six month to four years. With the monotherapy, about half of patients achieved improvement in follicular density and hair loss. Spironolactone was ineffective at doses less than 100 mg; rather, improvement was reported after at least 12 months of 100 to 200 mg daily.
What has research revealed about the pathogenesis of androgenetic alopecia, alopecia areata, and CCCA as well as new potential therapeutics? Find out in DermWorld.
DermWorld Insights and Inquiries: Alarming but benign – The enigma of acute hemorrhagic edema of infancy
“The patient, a fat baby thriving on its mother’s milk, was suddenly attacked by purpura, urticaria, and localized edema, lasting about ten days. There were only systemic symptoms from the result of pain. At first the bowels were obstinately constipated, possibly from an edema of the intestinal walls sufficient to inhibit peristalsis, but not of enough intensity to cause colic or hemorrhages as is observed in Henoch’s purpura. … Why a healthy, breast-fed baby should develop purpura, urticaria, and swollen joints and recover so quickly, I am unable to explain.”
The quotation is from Irving Snow’s 1913 publication which is considered the first description of acute hemorrhagic edema of infancy (AHEI, aka Finkelstein disease Seidlmayer syndrome, or post-infectious cockade purpura). AHEI is a rare, predominantly cutaneous leukocytoclastic vasculitis, typically diagnosed in children younger than 2 years of age, with a male: female ratio of 2 to 1. Varanaki et al are on point with this observation: “Its rapid onset and the dramatic character of skin lesions cause parental and also health care provider anxiety.” Keep reading!
What are the long-term clearance rates for actinic keratosis interventions?
In a review and meta-analysis published in JAMA Dermatology, photodynamic therapy with aminolevulinate demonstrated the most favorable risk ratio (RR, 8.06) for complete clearance compared with placebo and the highest risk ratio for lesion-specific clearance (RR, 5.08).
Significant long-term efficacy, defined as at least 12 months, was also seen for imiquimod 5% (RR, 5.98), photodynamic therapy with methyl aminolevulinate (RR, 5.95), and cryosurgery (RR, 4.67). The long-term efficacy of fluorouracil was inconclusive due to a lack of studies meeting inclusion criteria.
FDA issues safety warning for JAK inhibitors that treat inflammatory conditions
Based on a completed review of a large, randomized safety clinical trial, the U.S. Food and Drug Administration (FDA) has concluded there is an increased risk of serious heart-related events such as heart attack or stroke, cancer, blood clots, and death with the arthritis and ulcerative colitis medicine(s) tofacitinib (Xeljanz® and Xeljanz XR®). This trial compared tofacitinib with tumor necrosis factor (TNF) blockers in patients with rheumatoid arthritis. The trial’s final results also showed an increased risk of blood clots and death with the lower dose of tofacitinib. A 2019 FDA safety announcement, based upon earlier results from this trial, reported an increased risk of blood clots and death only seen at the higher dose.
The FDA is requiring new and updated black box warnings for two other JAK inhibitors: Baricitinib (Olumiant®) and upadacitinib (Rinvoq®). These two JAK inhibitors have not been studied in trials similar to the large safety clinical trial with tofacitinib, so the risks have not been adequately evaluated. However, since they share mechanisms of action with tofacitinib, the FDA considers that these medicines may have similar risks as seen in the tofacitinib safety trial.
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