Hilary E. Baldwin

Finasteride in the treatment of men with frontal male pattern hair loss

BACKGROUND Finasteride, a specific inhibitor of type II 5alpha-reductase, decreases serum and scalp dihydrotestosterone and has been shown to be effective in men with vertex male pattern hair loss. OBJECTIVE This study evaluated the efficacy of finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning. METHODS This was a 1-year, double-blind, placebo-controlled study followed by a 1-year open extension. Efficacy was assessed by hair counts (1 cm2 circular area), patient and investigator assessments, and global photographic review. RESULTS There was a significant increase in hair count in the frontal scalp of finasteride-treated patients (P < .001), as well as significant improvements in patient, investigator, and global photographic assessments. Efficacy was maintained or improved throughout the second year of the study. Finasteride was generally well tolerated. CONCLUSION In men with hair loss in the anterior/mid area of the scalp, finasteride 1 mg/day slowed hair loss and increased hair growth.

Guidelines of care for the management of acne vulgaris

Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

Acne life cycle: the spectrum of pediatric disease.

Acne is no longer simply a diagnosis based on the appearance of characteristic lesions on the skin of adolescents. The presentation of acne differs across age groups, and the population of younger pediatric patients with acne continues to grow. This article addresses the changing epidemiology and demographics of acne, with specific emphasis on the 7- to 11-year-old acne patient population; the differences and similarities between pediatric acne and adolescent acne; age-based acne epidemiology; and current perspectives on acne etiology.

The acne continuum: an age-based approach to therapy.

Acne vulgaris is classically considered a disease of adolescence. Although it most commonly occurs and has been best studied in that age group, it can develop at any time during childhood. It is important that health care practitioners recognize the manifestations of neonatal, infantile and childhood acne, as well as the differential diagnosis and best therapeutic approach in the younger child. Acneiform eruptions in infants and toddlers can occasionally be associated with scarring or with other significant disorders that may be life-threatening. In this article, the authors draw on their own clinical experience as well as the available literature to suggest an age-based approach to managing acne in children from the neonatal period through age 11 years.

Approach to pediatric acne treatment: an update.

By late adolescence, almost all individuals have experienced some degree of acne. A broad range of acne treatments has been shown to be safe and effective in adults. While still sparse, emerging data now also document similar safety and efficacy of these agents for children >12 years of age. For younger children with preadolescent acne, where data are more limited or unavailable, it seems reasonable to extrapolate from the findings of studies involving older children >12 years of age. This article reviews the latest evidence and current expert opinions on acne therapies in the pediatric age group.

Evidence-based recommendations for the management of acne fulminans and its variants

Background Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence‐based information and no clear guidelines concerning the classification and treatment of AF. Objective To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research. Methods A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5‐hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations. Results Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus. Limitations Limited evidenced‐based data and prospective studies in the literature concerning the treatment of AF is available. Conclusion These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants. Abbreviations used: AF: acne fulminans; AF‐SS: acne fulminans with systemic symptoms; AF‐WOSS: acne fulminans without systemic symptoms; ICP: intracranial pressure; IIAF‐SS: isotretinoin‐induced acne fulminans with systemic symptoms; IIAF‐WOSS: isotretinoin‐induced acne fulminans without systemic symptoms; IL‐1: interleukin 1; PAPA: pyogenic arthritis, pyoderma gangrenosum, and acne; PAPASH: pyogenic arthritis, pyoderma gangrenosum, acne, and hidranitis suppurative; PASH: pyoderma gangrenosum, acne, and hidranitis suppurative; PTCS: pseudotumor cerebri syndrome; SAPHO: synovitis, acne, pustulosis, hyperostosis, and osteitis.

The effects of culture, skin color, and other nonclinical issues on acne treatment.

The effective and safe treatment of acne vulgaris often is affected by individual patient characteristics, including skin color and cultural background. Skin of color is especially prone to hyperpigmentation, both from lesions and from irritating therapy. Clinicians also should be aware of cultural attitudes and folk remedies that may adversely affect dermatologic conditions such as acne.

Highlights of Skin Disease Education Foundation’s 42nd Annual Hawaii Dermatology Seminar

Updates on managing some of the most common dermatologic conditions for which patients seek care illuminated presentations at the Skin Disease Education Foundations 42nd Annual Hawaii Dermatology Seminar®. This educational supplement summarizes the highlights of clinical sessions presented during this CME/CE conference. Treatment of psoriasis has continued to advance, with three interleukin (IL)-17 antagonists approved by the US Food and Drug Administration (FDA) and a fourth in phase 3 trials. An authority on the use of biologics in psoriasis presents current data on the safety and efficacy of these therapies. Tumor necrosis factor (TNF) inhibitors also retain a place in the management of psoriasis, with records of long-term safety. A fourth TNF inhibitor awaits FDA approval for use in psoriasis, offering data on transmission during pregnancy and lactation. An expert on the use of this drug class presents the evidence. Topical therapies remain the cornerstone of care for many patients with psoriasis as well as those with rosacea. Our faculty update readers about new and investigational topical therapies for moderate or severe psoriasis, as well as for acne and rosacea. The current literature on monitoring patients receiving isotretinoin also is summarized. Aesthetic and cosmetic dermatology services form a sizable portion of some practices. Our faculty review data on safety of topical and procedural therapies for cellulite as well as safe injection of facial fillers.

Evidence-based update on rosacea comorbidities and their common physiologic pathways

Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities. This information may be helpful in addressing patient questions about potential systemic implications of rosacea and can serve as a candidate platform for future research to understand rosacea and improve treatments.