Poonkiat Suchonwanit

Melasma in men

Melasma is an acquired hypermelanosis that results in localized hyperpigmentation, commonly found on the face. This condition is much more common in women than men. There are some features of melasma in men that seem to differ from those seen in women. However, there is a paucity of data on this topic. The aim of this article is to review the etiology, clinical presentation, and treatment of melasma in men. It is important for dermatologists to understand some unique aspects of melasma in this group to provide appropriate care for patients who suffer from this frustrating condition.

Bilateral Linear Lichen Planus Pigmentosus Associated with Hepatitis C Virus Infection

Lichen planus pigmentosus is a rare subtype of lichen planus. We report a first case of lichen planus pigmentosus with bilateral linear distribution associated with hepatitis C virus infection. The lesion was improved after sun avoidance and treatment of hepatitis C virus infection with a combination of interferon and ribavirin. This case stresses the importance of screening for hepatitis C virus infection as lichen planus pigmentosus can be an associated condition.

Trichoscopic clues for diagnosis of alopecia areata and trichotillomania in Asians

Trichoscopy has become a useful diagnostic tool for various hair and scalp diseases, including alopecia areata (AA) and trichotillomania (TTM), which are sometimes difficult to distinguish clinically.

Parietal scalp is another affected area in female pattern hair loss: an analysis of hair density and hair diameter

Purpose Female pattern hair loss (FPHL) is a common hair disease. However, studies of the quantitative measurement of FPHL are still limited. The aim of this study was to investigate the characteristics of hair density and hair diameter in normal women and FPHL patients, and further correlate the quantitative measurement with the clinical presentation of FPHL. Patients and methods An evaluation of 471 FPHL patients and 236 normal women was carried out according to the Ludwig classification, and analysis was performed by using a com-puterized handheld USB camera with computer-assisted software. Various areas of the scalp, including frontal, parietal, midscalp, and occipital, were analyzed for hair density, non-vellus hair diameter, and percentage of miniaturized hair. Results The hair density in normal women was the highest and the lowest in the midscalp and parietal areas, respectively. The FPHL group revealed the lowest hair density in the parietal area. Significant differences in hair density, non-vellus hair diameter, and percentage of miniaturized hair between the normal and FPHL groups were observed, especially in the midscalp and parietal areas. Conclusion The parietal area is another important affected area in FPHL in addition to the midscalp area. This finding provides novel important information of FPHL and will be useful for hair transplant surgeons choosing the optimal donor sites for hair transplantation in women.

Eruptive Tumors of the Follicular Infundibulum: An Unexpected Diagnosis of Hypopigmented Macules

BackgroundTumor of the follicular infundibulum (TFI) is considered as a rare benign neoplasm providing two distinctive clinical patterns: the solitary and the eruptive form. The clinical presentations resemble many other dermatologic conditions and require histopathological study to make a definite diagnosis.ObjectiveTo inform physicians of a clinical presentation of TFI.Case ReportWe report on a 50-year-old man who presented with multiple asymptomatic hypopigmented macules resistant to the treatments. The histopathological study was consistent with tumors of the follicular infundibulum.ConclusionHypopigmented macules are one of the more common clinical presentations in dermatological practices. It is important to include TFI in the differential diagnosis when a patient with hypopigmented lesions does not respond to the treatment based on the clinical diagnosis.

Primary Cutaneous Chrysosporium Infection following Ear Piercing: A Case Report.

Chrysosporium is a large genus of saprophytic fungi that is commonly found in the soil. Infection caused by this organism is rare in humans and typically occurs in immunocompromised patients. Primary cutaneous Chrysosporium infection is relatively rare and has been reported in a heart transplant patient. The prognosis is usually favorable, but very poor in the setting of persistent profound immunosuppression. We herein report a case of primary cutaneous Chrysosporium infection following ear piercing in an immunocompetent patient. It is important for clinicians to consider this condition in patients with slow-onset skin and soft tissue infection following cutaneous injury, even in an immunocompetent setting.

Role of janus kinase inhibitors in the treatment of alopecia areata

Alopecia areata (AA) is a common hair loss disorder worldwide with characteristic exclamation mark hairs. Although AA is self-limited, it can last for several months or even years in some patients. Currently, there is no US Food and Drug Administration-approved treatment for AA. Many off-label treatments are available but with limited efficacy. Through a better understanding of molecular biology, many targeted therapies have emerged as new alternatives for various autoimmune diseases. Various janus kinase (JAK) and signal transducer and activator of transcription (STAT) proteins form signaling pathways, which transmit extracellular cytokine signals to the nucleus and induce DNA transcriptions. By inhibiting JAK, T-cell-mediated inflammatory responses are suppressed. Increasing evidence suggests that JAK inhibitors (JAKis) are effective in the treatment of many autoimmune diseases, including AA. Among these, several studies on tofacitinib, ruxolitinib, and baricitinib in AA had been published, demonstrating promising outcomes of these agents. Unlike oral formulations, efficacy of topical forms of tofacitinib and ruxolitinib reported in these studies is still unsatisfactory and requires improvement. This review aims to summarize evidence of the efficacy and safety of JAKis in the treatment of AA.

PPAR-γ Agonists and Their Role in Primary Cicatricial Alopecia

Peroxisome proliferator-activated receptor γ (PPAR-γ) is a ligand-activated nuclear receptor that regulates the transcription of various genes. PPAR-γ plays roles in lipid homeostasis, sebocyte maturation, and peroxisome biogenesis and has shown anti-inflammatory effects. PPAR-γ is highly expressed in human sebaceous glands. Disruption of PPAR-γ is believed to be one of the mechanisms of primary cicatricial alopecia (PCA) pathogenesis, causing pilosebaceous dysfunction leading to follicular inflammation. In this review article, we discuss the pathogenesis of PCA with a focus on PPAR-γ involvement in pathogenesis of lichen planopilaris (LPP), the most common lymphocytic form of PCA. We also discuss clinical trials utilizing PPAR-agonists in PCA treatment.

A retrospective comparative study of the efficacy and safety of two regimens of diphenylcyclopropenone in the treatment of recalcitrant alopecia areata

Diphenylcyclopropenone (DPCP) is an effective topical immunotherapy for recalcitrant alopecia areata (AA), which sometimes requires prolonged treatment. We developed a new treatment protocol to shorten the duration of therapy. This study aimed to compare the efficacy and safety of the new treatment protocol with the standard treatment protocol in the treatment of recalcitrant AA. We conducted a 6-year retrospective comparative study of patients with AA who received one of the DPCP treatment protocols at our institute. Patients’ information was collected and subsequent statistically analyzed. Thirtynine patients (16 in the new treatment group and 23 in the standard treatment group) were included. There were no statistically significant differences in area of hair regrowth. Mean duration to initial hair regrowth and mean duration to significant hair regrowth in the new treatment group were significantly shorter than in the standard treatment group (P=0.002 and 0.01, respectively). Adverse effects were slightly higher in the new treatment group. The present study reveals the effectiveness and safety of the new treatment protocol, which shortens the duration of DPCP treatment and could represent an alternative regimen.

Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia.