Zoe Diana Draelos

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.

Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public

Skin cancer is less prevalent in people of color than in the white population. However, when skin cancer occurs in non-whites, it often presents at a more advanced stage, and thus the prognosis is worse compared with white patients. The increased morbidity and mortality associated with skin cancer in patients of color compared with white patients may be because of the lack of awareness, diagnoses at a more advanced stage, and socioeconomic factors such as access to care barriers. Physician promotion of skin cancer prevention strategies for all patients, regardless of ethnic background and socioeconomic status, can lead to timely diagnosis and treatment. Public education campaigns should be expanded to target communities of color to promote self-skin examination and stress importance of photoprotection, avoidance of tanning bed use, and early skin cancer detection and treatment. These measures should result in reduction or earlier detection of cutaneous malignancies in all communities. Furthermore, promotion of photoprotection practices may reduce other adverse effects of ultraviolet exposure including photoaging and ultraviolet-related disorders of pigmentation.

Hydrophobically modified polymers can minimize skin irritation potential caused by surfactant-based cleansers

The addition of hydrophobically modified polymers (HMPs) to cleansers that contain surfactants can create polymer–surfactant complexes that are less irritating to the skin than commercially available mild cleansers. Our objective was to compare the tolerability and efficacy of a test foaming liquid facial cleanser containing HMPs with a commercial liquid nonfoaming facial cleanser in women with sensitive skin.

Dyspigmentation, skin physiology, and a novel approach to skin lightening

Even facial pigmentation is considered a universal sign of youth and beauty in all cultures and at all ages in both men and women. The recent FDA concern about the safety of topical hydroquinone has provided the impetus for research into new pigment lightening alternatives in the cosmetic OTC market.

Commentary: Healthy hair and protein loss

H air is a complex protein-based fiber of significant value for the perception of human beauty. All ancient civilizations and modern societies appreciate the appearance of ‘‘healthy’’ hair, yet defining the chemical structure that correlates with the image of hair health has proved challenging for the cosmetic chemist. Khumalo et al investigated the effect of hair straightening on hair chemistry as compared to virgin black tightly curled hair. Hair relaxing, also known as lanthionization, is a chemical process whereby extremely curly hair is straightened through the use of metal hydroxides, such as sodium, lithium, potassium, or guanidine hydroxide, to change approximately 35% of the cysteine contents of the hair to lanthionine along with minor hydrolysis of the peptide bonds. Chemical relaxing can be accomplished with lye-based, lyefree, ammonium thioglycolate, or bisulfite creams. Lye-based relaxers are alkaline creams with a pH of 13 containing up to 3.5% sodium hydroxide. Other strong alkali chemicals sometimes used in place of sodium hydroxide are guanidine hydroxide and lithium hydroxide, which are known as ‘‘no-lye’’ relaxers. These relaxing kits contain 4% to 7% cream calcium hydroxide and liquid guanidine carbonate. The guanidine carbonate activator is then mixed into the calcium hydroxide cream to produce calcium carbonate and guanidine hydroxide, the active agent. Thioglycolate can also be used as an active agent in hair straightening, which is the same chemical used for permanently waving straight hair. The least damaging of all hair-straightening chemicals are the ammonium bisulfite creams. These products contain a mixture of bisulfite and sulfite in

Bimatoprost 0.03% for the Treatment of Eyebrow Hypotrichosis

BACKGROUND Eyebrow loss may have substantial negative functional and social consequences. OBJECTIVE Evaluate the safety and efficacy of bimatoprost 0.03% in subjects with eyebrow hypotrichosis. METHODS This multicenter, double-masked study randomized adult females or males with eyebrow hypotrichosis to receive bimatoprost 0.03% twice (BID) or once daily (QD) or vehicle BID for 7 months. Primary endpoint was overall eyebrow fullness at Month 7. Secondary endpoints included eyebrow fullness (mm2), darkness (intensity units), and subject satisfaction with treatment. Safety was also assessed. RESULTS At Month 7, the proportion of subjects with improvement was significantly higher in bimatoprost groups versus vehicle (both, p < .001). Improvements occurred in both bimatoprost groups versus vehicle after Month 1 and continued through follow-up; eyebrow fullness and darkness improved as early as Months 2 and 1, respectively (both, p < .001). Greater satisfaction was reported with bimatoprost versus vehicle at Month 2 and all subsequent time points. Overall, 38.1%, 42.4%, and 35.5% of subjects in the bimatoprost BID, QD, and vehicle groups, respectively, experienced ≥1 treatment-emergent adverse event (TEAE). Most frequent TEAEs were similar across groups. No skin or iris hyperpigmentation or conjunctival hyperemia occurred. CONCLUSION Bimatoprost 0.03% BID and QD is safe, well tolerated, and effective for eyebrow hypotrichosis.

Novel retinoid ester in combination with salicylic acid for the treatment of acne.

Retinoids (RC), alpha‐hydroxy acids (AHA), and salicylic acid (BHA) treat acne through differing mechanisms of action. It is theorized that optimal improvement can be achieved by combining the RC‐induced normalization of cellular differentiation, AHA‐induced exfoliation in hydrophilic areas, and BHA‐induced exfoliation in lipophilic areas. AHA and RC have been combined in a bioengineered molecule (AHA retinoid conjugate, or AHA‐RC) delivering both lactic acid (AHA) and RC in a manner reducing retinoid‐associated irritation.

A pilot study investigating the efficacy of botanical anti‐inflammatory agents in an OTC eczema therapy

Eczema is a frequently encountered dermatologic condition characterized by inflammation resulting in erythema, scaling, induration, and lichenification.

Defining cosmetic issues in a world of medical necessity

We are seeing a shift worldwide in organized healthcare to only cover the treatment of “medically necessary conditions.” This shift has become dramatic, most recently in the United States, as the Affordable Healthcare Act begins implementation in January 2014. In anticipation of this law going into effect, many subtle changes are occurring in private health insurance that quietly affect dermatology. For example, where I practice in North Carolina, the insurance plans offered by the college systems do not cover the treatment of acne. It is classified in the category of not medically necessary. What is one of the most common chronic conditions that college students experience? Acne. What is the most common scarring condition that college students experience? Acne. What is one of the most emotionally debilitating conditions that college students experience? Acne. Yet, acne is not covered. These same students will be required to purchase insurance under the new healthcare act, but one of the major reasons that they may seek medical care is not covered. It is the payments of the youth that are expected to sustain the healthcare costs of the mature citizens of the US. This is a rather interesting subtle redefinition of medical necessity where a medical condition, such as acne, is reclassified as cosmetic. Other shifts in acne treatment are slowly occurring, as well. At present, the only topical acne medications covered by private insurance in North Carolina are generic benzoyl peroxide/clindamycin combinations and generic adapalene cream. All acne patients must fail treatment with these two medications before prior approval is granted for other currently available acne medications. Prior approval medications carry a higher copay requiring the patient to cover a larger proportion of the drug cost. Further, most of the newer acne medications are off formulary meaning that the patient must pay cash as no insurance subsidies are provided. This is also a subtle way of reshaping acne treatment into a noncovered cosmetic condition. If the patient goes to the dermatologist to get the best treatment customized for their unique medical needs, but cannot obtain the proper medication, inadequate treatment has been provided. This is another interesting development that is slowly moving the treatment of acne from a condition representing medical necessity to a cosmetic designation. While acne is one example of how the practice of dermatology is changing, it points to an interesting philosophical question. How do we define medical necessity? If medical necessity were defined as conditions that are life threatening, then most of dermatology would be classified as cosmetic. Fortunately, the skin is a robust organ capable of rapid regeneration throughout life. While there are some rare skin conditions, such as pemphigus vulgaris and epidermolysis bullosa, that could be life threatening, the only common rapidly progressive fatal disease in dermatology is melanoma. Is it possible that melanoma could become the only insurance covered diagnosis and all others considered part of cosmetic dermatology? At present, cosmetic dermatology encompasses conditions that affect appearance and most consumers recognize that filler and toxin injections fit in this category along with liposuction and facial cosmetic surgery. The Journal of Cosmetic Dermatology publishes cutting edge research in this appearance related realm also encompassing the world of skin care products and cosmeceuticals. Would we need to redefine cosmetic dermatology, especially in the United States, when a nationwide insurance plan redefines dermatology? This is the question I have been pondering. I have been further intrigued by medical policy crafters in the United States who state that medical procedures that do not prolong life should be uncovered after age 70. For example, the treatment of basal and squamous cell carcinomas does not prolong life after age 70 according to an article published in JAMA Dermatology by Chanco-Turner (need reference). Does this then mean that nonmelanoma skin cancers are cosmetic after age 70? Certainly, one of the biggest federal health expenditures is the treatment of skin conditions, especially actinic keratoses. The treatment of actinic keratoses has always been a little controversial, as relatively few of these precancerous lesions have been documented histologically to convert to squamous cell carcinoma upon longitudinal examination. Further,

Aging in a polluted world

Stories abound of persons residing in the rural areas of Greece living to the age of 112. These stories have given rise to an investigation of how the Mediterranean diet might lead to long life. Some have wondered if it is the diet of locally grown olive oil rich in essential fatty acids that decreases the incidence of heart disease in these Grecians. Others have wondered if the consumption of homegrown tomatoes and cucumbers rich in antioxidant carotenoids, lycopene, and selenium provide superior antioxidants. Some might say that Greek ouzo does it all! Perhaps all of these suppositions are incorrect and the rural nature of life is the secret, as with city dwelling comes cars and with cars comes pollution. Is avoidance of pollution the key to aging gracefully? Pollution results from all types of combustion whether it is internal combustion engines, coal burning power plants, incineration of garbage, or cigarette smoke. All of these activities result in the formation of reactive oxygen species, which include singlet oxygen (O2), superoxide anion/hydroperoxyl radical (O2 • / HO2 ), ozone (O3), aliphatic alkoxyl radical (RO ), alkylperoxyl radical (ROO), and hypochlorous acid (HOCl). Fortunately, humans have evolved a number of antioxidant protective mechanisms to live in a world of oxidative trauma. These include the ability to consume nutrients that are capable of donating an electron to neutralize a reaction oxygen species. The primary antioxidants in the body are vitamins E and C, but the consumption of flavonoids, which are polyphenolic derived botanical compounds, may also improve the body’s antioxidant capabilities. It might be said that aging is synonymous with slow cumulative oxidative insults to the human body. However, one area where the body has few protective mechanisms is in the detoxification of nanoparticle pollution. Nanoparticles are also produced as part of the burning process and are highly reactive due to their small size and large surface area per unit mass carrying organic chemicals and metals that localize in the mitochondria and generate reactive oxygen species. Nanoparticles can carry polycyclic aromatic hydrocarbons that can activate xenobiotic metabolism converting them to quinones. Quinones are redox-cycling chemicals that produce reactive oxygen species within the body and by penetrating skin appendages. It is interesting to note that Vierkotter found that increased exposure to soot and traffic particles was associated with 20% more pigmentation on the forehead and cheeks (JID 2010; 130: 2719–2726). Krutmann linked this to melanocyte proliferation from polycyclic aryl hydrocarbons bound to the surface of combustion derived nanoparticles (JID 2008; 128: S220). This phenomenon is further accelerated by exposure to nanoparticles generated by cigarette smoking (Vierkotter JID 2010; 130: 2719–2726). These observations provide an interesting connection between city pollution and an aged skin appearance. City nanoparticle pollution may also have an effect on telomeres, which determine the number of times a given cell can divide and replicate. Telomeres are found at the end of eukaryotic chromosomes formed from thousands of TTAGGG repeats designed to protect the ends of the chromosomes from degradation. With each cell division, 100–200 telomere base pairs are lost and when the telomere reaches a critical length, the cell can no longer divide entering a state of replicative senescence or apoptosis. Thus, the telomere serves as a mitotic clock controlling cell longevity, but preventing unregulated cell proliferation characteristic of cancer. It is this telomere regulated cellular senescence that leads to aging of the skin. Interestingly, telomeres are very sensitive to oxidative stress as the G (guanine) is changed to 8-oxyguanosine by reactive oxygen species. Reactive oxygen species also accelerate telomere loss, and antioxidants appear to prevent telomere loss in keratinocytes. It is noteworthy that in spite of all the wonderful achievements of modern medicine, we may be prematurely aging our skin and bodies by exposure to the by-products of modern society in the form of pollution. No diet or cosmetic cream can quench the reactive oxygen species created by nanoparticle pollution. Perhaps the answer to aging gracefully is too simple. Life in a healthy rural environment with clean air may be the solution to longevity.