Maria Caterina Fortuna

Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10‐year follow‐up

Finasteride 1 mg is indicated for the treatment of men with androgenetic alopecia (AGA). However, more than 5 years efficacy and safety has not been previously reported. To assess the efficacy over 10 years in different age groups of men with AGA. 118 men, between 20 and 61 years, with AGA receiving finasteride (1 mg/day), were enrolled in this uncontrolled study. Efficacy evaluation was assessed with standardized global photographs at T0,T1,T2,T5,T10. Statistical analysis was made using frequency tables and evaluating the chi‐square index with its p‐value. Better improvements are observed in patients older than 30 years (42.8% aged between 20 and 30 years did not improve also after 10 years) or with higher AGA grades (58.9% for AGA grade IV and 45.4% for AGA grade V had the first improvement just after 1 year). In 21% of cases, the treatment continuation beyond 5 years provided better results. Side effects were referred by 6% of the patients; nevertheless, some of them went on with treatment because of the great results. In our opinion, the result after the first year can help in predicting the effectiveness of the treatment. Its efficacy was not reduced as time goes on; in fact, a big proportion of subjects unchanged after 1 year, improved later on, maintaining a positive trend.

Androgenetic alopecia: a review

PurposeAndrogenetic alopecia, commonly known as male pattern baldness, is the most common type of progressive hair loss disorder in men. The aim of this paper is to review recent advances in understanding the pathophysiology and molecular mechanism of androgenetic alopecia.MethodsUsing the PubMed database, we conducted a systematic review of the literature, selecting studies published from 1916 to 2016.ResultsThe occurrence and development of androgenetic alopecia depends on the interaction of endocrine factors and genetic predisposition. Androgenetic alopecia is characterized by progressive hair follicular miniaturization, caused by the actions of androgens on the epithelial cells of genetically susceptible hair follicles in androgen-dependent areas. Although the exact pathogenesis of androgenetic alopecia remains to be clarified, research has shown that it is a polygenetic condition. Numerous studies have unequivocally identified two major genetic risk loci for androgenetic alopecia, on the X-chromosome AR⁄EDA2R locus and the chromosome 20p11 locus.ConclusionsCandidate gene and genome-wide association studies have reported that single-nucleotide polymorphisms at different genomic loci are associated with androgenetic alopecia development. A number of genes determine the predisposition for androgenetic alopecia in a polygenic fashion. However, further studies are needed before the specific genetic factors of this polygenic condition can be fully explained.

Videodermoscopy Scalp Psoriasis Severity Index (VSCAPSI): A useful tool for evaluation of scalp psoriasis

The standard methods used to diagnose scalp psoriasis vary in sensitivity, reproducibility, and invasiveness. Videodermoscopy can be used to explore microcirculatory modifications in skin diseases. Psoriasis presents three pathognomonic vascular patterns: red dots, hairpin vessels and red globular rings. Our aim was to create a videodermoscopy scalp psoriasis severity index (VSCAPSI) for evaluation of scalp psoriasis, especially mild and moderate forms that often are not clinically appreciable. VSCAPSI takes into account the area of the scalp affected by psoriasis, the presence and morphology of vascular patterns, the erythema and desquamation. Videodermoscopy images obtained between November 2009 to June 2010 from 900 participants with various scalp and hair disorders were reviewed for distinguishing features. During the 2010 Italian congress on psoriasis, in order to assess the reproducibility and efficacy of the VSCAPSI, 146 dermatologists were asked to evaluate 16 videodermoscopy images of scalp psoriasis using the VSCAPSI. Of the 900 patients, 85 new cases of scalp psoriasis were diagnosed. The other 815 patients were found to be suffering from different scalp and hair diseases. Of 146 dermatologists, 28 did not recognize erythema, 15 desquamation and 7 the vascular patterns. The VSCAPSI provides important evidence for early diagnosis, differential diagnosis, for follow-up and screening.

Conditions simulating androgenetic alopecia.

Androgenetic alopecia is a common form of hair loss, characterized by a progressive hair follicular miniaturization, caused by androgen hormones on a genetically susceptible hair follicle, in androgenic‐dependent areas. Characteristic phenotype of androgenetic alopecia is also observed in many other hair disorders. These disorders are androgenetic‐like diseases that cause many differential diagnosis or therapeutic error problems. The objective of this review was to systematically analyse the greatest number of conditions that mimic the AGA pattern and explain their disease pathogenesis.

Unusual patterns of presentation of frontal fibrosing alopecia: A clinical and trichoscopic analysis of 98 patients

3. Chalmers TC, Smith H Jr, Blackburn B, et al. A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981;2:31-49. 4. Harries MJ, Sun J, Paus R, et al. Management of alopecia areata. BMJ. 2010;341:c3671. 5. Alkhalifah A, Alsantali A, Wang E, et al. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62:177-188.

Chemotherapy‐induced alopecia management: Clinical experience and practical advice

Chemotherapy‐induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment‐related aspects such as drug dose, administration regimen, and exposure to X‐rays, but also patient‐related characteristics. To the best of our knowledge, no guidelines are available about CIA management.

A preliminary study on topical cetirizine in the therapeutic management of androgenetic alopecia

Abstract Background: Androgenetic alopecia (AGA) is a common form of scalp hair loss that affects up to 50% of males between 18 and 40 years old. Several molecules are commonly used for the treatment of AGA, acting on different steps of its pathogenesis (Minoxidil, Finasteride, Serenoa repens) and show some side effects. In literature, on the basis of hypertrichosis observed in patients treated with analogues of prostaglandin PGF2a, it was supposed that prostaglandins would have an important role in the hair growth: PGE and PGF2a play a positive role, while PGD2 a negative one. Objective: We carried out a pilot study to evaluate the efficacy of topical cetirizine versus placebo in patients with AGA. Patients and methods: A sample of 85 patients was recruited, of which 67 were used to assess the effectiveness of the treatment with topical cetirizine, while 18 were control patients. Results: We found that the main effect of cetirizine was an increase in total hair density, terminal hair density and diameter variation from T0 to T1, while the vellus hair density shows an evident decrease. The use of a molecule as cetirizine, with no notable side effects, makes possible a good compliance by patients. Conclusion: Our results have shown that topical cetirizine 1% is responsible for a significant improvement of the initial framework of AGA.

Klinische, histologische und trichoskopische Korrelate bei Erkrankungen der Kopfhaut

Die dermatoskopische Untersuchung von Kopfhaut und Haar wird als Trichoskopie bezeichnet. Das einfache und nichtinvasive diagnostische Verfahren ist ein praktisches, überall einsetzbares Instrument zur Diagnose und Verlaufsbeobachtung von Haar- und Kopfhaut-Erkrankungen. Die Trichoskopie macht morphologische Strukturen sichtbar, die mit dem bloßen Auge nicht zu erkennen sind, und liefert dem Kliniker eine Reihe dermatoskopischer Befunde, die er für die Differenzialdiagnose benötigt. Die Beobachtungen in der Trichoskopie lassen sich in interfollikuläre und follikuläre Muster unterteilen. Kürzlich wurde zudem als Mischform die Kategorie des follikulär-interfollikulären Musters eingeführt. Einige dieser Muster sind spezifisch für eine einzelne Erkrankung der Kopfhaut, andere kommen bei mehreren vor. Bisherige Studien deuten darauf hin, dass der Einsatz der Trichoskopie die klinische Untersuchung verbessern kann; hierzu sind jedoch weiterführende Untersuchungen erforderlich. Die vorliegende Übersichtsarbeit beschreibt den aktuellen Kenntnisstand zu den trichoskopischen Merkmalen der häufigsten Kopfhaut-Erkrankungen und ihre jeweiligen histopathologischen und klinischen Korrelate.

Setting reference values in trichology

In clinical trichology, reference values are often arbitrary. The difficulty in setting them up depends mostly on the presence of the androgenetic alopecia (AGA) genotype in subjects with clinically unapparent forms. Prepubertal children, who lack 5α‐reductase (a real indicator of the AGA phenotype), might provide reference values independent from AGA. We verified whether the vertex/occiput ratios (V/O) of hair density and the V/O of hair diameter are suitable parameters.

A case of Scalp Rosacea treated with low dose doxycycline and probiotic therapy and literature review on therapeutic options

Rosacea is a common chronic inflammatory disorder showing a wide range of clinical features such as telangiectasia, erythema, papules, and pustules primarily involving the central part of face (forehead, cheeks and nose) although extra facial manifestation have been described. We describe a case of rosacea with predominant scalp involvement successfully treated with a 8‐week‐course of doxycycline 40 mg once a day and probiotic therapy twice a day (Bifidobacterium breve BR03, Lactobacillus salivarius LS01 1 × 109 UFC/dose).