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Hair loss, specifically androgenetic alopecia (AGA), is a common outpatient dermatology complaint. AGA occurs in men and women, results from the effect of dihydrotestosterone miniaturizing scalp follicles, and commonly presents with thinning of the bitemporal, frontal, and vertex scalp.

BACKGROUND Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management. OBJECTIVE Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care. METHODS Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non-profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow-up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed. RESULTS The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0-439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P

Background Minimally invasive alternative approaches to treat non-melanoma skin cancers remain limited and unproven. Objective We aim to assess the efficacy of varying combinations of anti-tumor agentsmimiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% creammwith brief cryotherapy in treating non-melanoma skin cancers. Methods This retrospective study included 690 cases of non-melanoma skin cancers in 480 patients who received a diagnosis of a basal cell carcinoma or squamous cell carcinoma during a ten-year period. During treatment period, patients applied 30 applications of one of three combinations (imiquimod/tretinoin, 5-fluorouracil/tretinoin, or imiquimod/5-fluorouracil/tretinoin) and had cryotherapy every 2 weeks. Each patient had a clinical examination at least three years post-treatment or documented treatment failure. Clearance was defined by a lack of persistence or recurrence for 3 years following the completion of treatment. The likelihood of lesion clearance was evaluated using multivariable logistic regression analysis. Results A total of 186 cases (97; basal cell carcinoma and 89; squamous cell carcinoma) in 133 patients [37% women and 63% men; median (interquartile range) age, 77 (69, 83) years] met the inclusion criteria. Multivariable logistic regression analysis adjusting for clinical and lesion variables demonstrated that, relative to the imiquimod/5-fluorouracil/tretinoin treatment approach, imiquimod/ tretinoin (odds ratio, 0.05; 95% confidence interval, 0.00-0.99) and 5-fluorouracil/tretinoin (0.02; 0.00n0.45) were associated with lower likelihoods of lesion clearance. Likewise, morpheaform basal cell carcinoma had a lower probability of clearance (0.05; 0.00n0.72). Conclusions The combination of imiquimod/5-fluorouracil/tretinoin with cryotherapy had high clearance rates and was the most effective treatment regimen. J Drugs Dermatol. 2021;20(3):260-267. doi:10.36849/JDD.5427.

Pili annulati is generally classified as a hair shaft disorder without fragility. However, increased susceptibility to weathering is common. Severe breakage due to trichorrhexis nodosa is uncommon. We report a case and review the literature on this topic.

Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted. MethodsMaterials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system. Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser). Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation. J Drugs Dermatol. 2019;18(11):1090-1096.

Psoriasis is an immune-mediated disease associated with many comorbidities, including obesity, metabolic syndrome and cardiovascular disease. Many patients seek alternatives to standard treatments. In this case report, we present a non-obese patient who was able to completely clear her psoriatic plaques by following a plant-based, anti-inflammatory diet, focusing on the consumption of nutrient-dense foods. The efficacy of this anti-inflammatory diet may lie in the overall reduction of the systemic inflammatory state associated with psoriasis. Possible mechanisms of action are explored.

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Importance Squamous cell carcinoma (SCC) is the second most common form of skin cancer, and its incidence is increasing. When surgical management is not an option, finding a safe and efficacious treatment is a challenge. Mounting evidence suggests that the human papillomavirus (HPV) is involved in the pathogenesis of some SCCs. Objective To assess whether the 9-valent HPV vaccine could be an effective treatment strategy for cutaneous SCC. Design, Setting, and Participants A woman in her 90s with multiple, inoperable cutaneous basaloid SCCs was successfully treated at a university-based outpatient dermatology clinic with a combination of systemic and intratumoral delivery of the 9-valent HPV vaccine from March 17, 2016, through February 27, 2017, and then followed up through May 21, 2018. Main Outcomes and Measures Reduction in tumor size and number after a combination of systemic and intratumoral administration of the HPV vaccine. Results All tumors resolved 11 months after the first intratumoral injection of the vaccine. The patient remained free of tumors at the end of follow-up. Conclusions and Relevance This is the first report, to our knowledge, of complete regression of a cutaneous malignant tumor after combined systemic and direct intratumoral injection of the 9-valent HPV vaccine. This report suggests that the HPV vaccine may have therapeutic utility for SCCs in patients who are poor surgical candidates, have multiple lesions, or defer surgery.