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Background Dutasteride has been proposed as an effective therapy for frontal fibrosing alopecia (FFA). Objectives We sought to describe the therapeutic response to dutasteride and the most effective dosage in FFA compared with other therapeutic options or no treatment. Methods This was a retrospective observational study including patients with FFA with a minimum follow-up of 12 months. Therapeutic response was evaluated according to the stabilization of the hairline recession. Results A total of 224 patients (222 females) with a median follow-up of 24 months (range 12-108 months) were included. The stabilization rate for the frontal, right, and left temporal regions after 12 months was 62%, 64%, and 62% in the dutasteride group (n = 148), 60%, 35%, and 35% with other systemic therapies (n = 20), and 30%, 41%, and 38% without systemic treatment (n = 56; P = .000, .006, and .006, respectively). Stabilization showed a statistically significant association with an increasing dose of dutasteride (88%, 91%, and 84% with a weekly treatment of 5 or 7 doses of 0.5 mg [n = 32], P Limitations Limitations included the observational and retrospective design. Conclusions Oral dutasteride was the most effective therapy with a dose-dependent response for FFA in real clinical practice compared with other systemic therapies or no systemic treatment.

Background Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge. Objectives To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response. Methods This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms. Results A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found. Limitations Because FD is a rare disease, the main limitation was the sample size. Conclusions An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

Resumen Introduccion A pesar de que los unicos farmacos con indicacion aprobada en nuestro pais para la alopecia androgenica (AGA) son minoxidil topico y finasterida oral, es comun la utilizacion de numerosas terapias fuera de indicacion, provocando una gran variabilidad en el manejo de estos pacientes. El objetivo principal de este trabajo fue describir los habitos de prescripcion de los dermatologos en Espana en AGA masculina (MAGA) y AGA femenina (FAGA). Material y metodos Estudio descriptivo transversal mediante cuestionarios digitales autocumplimentados por dermatologos que ejercen en territorio espanol. Resultados Se incluyeron las respuestas de un total de 241 dermatologos. En MAGA los tratamientos mas utilizados fueron en este orden: minoxidil topico (98%), finasterida oral (96%), nutricosmeticos (44%), finasterida topica (37%), dutasterida oral (33%), plasma rico en plaquetas (14%) y laser de baja potencia (8%). En FAGA premenopausica: minoxidil topico (98%), anticonceptivos orales (81%), nutricosmeticos (72%), acetato de ciproterona (58%), finasterida oral (39%), finasterida topica (39%), espironolactona (27%), plasma rico en plaquetas (20%), dutasterida oral (20%), flutamida oral (18%) y laser de baja potencia (7%). En FAGA posmenopausica: minoxidil topico (98%), finasterida oral (84%), nutricosmeticos (68%), finasterida topica (50%), dutasterida oral (35%), plasma rico en plaquetas (21%), espironolactona (16%), acetato de ciproterona (16%), flutamida oral (9%) y laser de baja potencia (9%). Como limitaciones de nuestro estudio, no se incluyeron terapias novedosas para AGA como minoxidil oral o microinyecciones de dutasterida. Conclusiones Los agentes terapeuticos mas utilizados en MAGA y FAGA posmenopausica por los dermatologos en Espana fueron minoxidil topico, finasterida oral y nutricosmeticos, mientras que en FAGA premenopausica fueron minoxidil topico, anticonceptivos orales y nutricosmeticos.

Background Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methods Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. Results The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. Conclusions The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Frontal fibrosing alopecia (FFA) is a scarring alopecia characterized by recession of the frontotemporal hairline and loss of the eyebrows.To design and validate a scoring system to assess the severity of FFA.The Frontal Fibrosing Alopecia Severity Score (FFASS) was developed; criterion validity was assessed by the Investigator's Global Assessment, and construct validity was evaluated by the convergence of other measures of severity (the Patient's Global Assessment], the rest of the clinical features, the Lichen Planopilaris Activity Index, and quality of life measures (Dermatology Life Quality Index and Hospital Anxiety Depression Scale). Intraobserver and interobserver reliability were determined.In total, 103 female patients were included. The FFASS showed significant correlation to the Patient's Global Assessment, occipital involvement, and the Lichen Planopilaris Activity Index. Intraobserver reliability was completed for 31 subjects and showed good correlation (intraclass correlation coefficient, 0.86; 95% confidence interval, 0.7-0.95; P .001). Interobserver reliability showed excellent correlation (intraclass correlation coefficient, 0.97; 95% confidence interval, 0.95-0.99; P .001).The study was performed at a single institution, and only female patients were assessed.The FFASS is a statistically validated scale and a reliable measure of FFA severity, and it can be used in clinical practice and future research studies as an assessment tool.

Background Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. Objective To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. Methods This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. Results Overall, 55 male patients with a mean age of 39.1 years (range 20–74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. Conclusions According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Background Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challengefor dermatologists.Objective To describe the epidemiology, comorbidities, clinical presentation, diagnostic !ndings and therapeuticoptions in a large series of patients with FD.Methods This retrospective multicentre review includes patients diagnosed with FD based on clinical and histopatho-logic !ndings. The clinical severity was determined by the maximum diameter of the largest alopecic patch (slight

This cohort study evaluates the association between frontal fibrosing alopecia and health-related quality of life.

Background Frontal fibrosing alopecia (FFA) is a chronic scarring alopecia with an unpredictable evolution. There are no current classifications of this disease that may predict its prognosis. Objective To analyze the differences in clinical presentation and evolution of FFA patients and to create a clinical and prognostic classification Methods We conducted a retrospective analytical study of FFA patients. Clinical characteristics of frontal hairline recession were used as the sorting variable between patterns of presentation. A cohort of 106 patients homogenously treated with oral dutasteride and topical corticosteroid was followed 12 months. Results In all, 242 female patients with a mean age of 61.4 years were included. Patients were classified in three clinical patterns (118 (48.8%) patients as pattern I (linear), 109 patients (45%) as pattern II (diffuse) and 15 patients (6.2%) as pattern III (double-line)). Stabilization was achieved in 37.3% of the 106 patients treated with oral dutasteride and topical corticosteroid. Pattern III patients had less hairline recession and eyebrow involvement at the diagnosis and after treatment. Limitations Retrospective design. Conclusions FFA patients can be classified in three different clinical patterns with different prognosis. Pattern III patients have the best prognosis, while pattern II patients have the worst prognosis. This article is protected by copyright. All rights reserved.

Methylisothiazolinone (MI), along with Kathon™ CG (methylchloroisothiazolinone/MI), are widely used preservatives to prevent bacterial overgrowth in aqueous solutions of various types of cosmetic, household, and industrial products. Because of its high sensitising power and widespread use, MI is currently one of the most common causes of allergic contact dermatitis, both in our private lives and in the occupational field. As it was thought that MI had less sensitivity capacity, it started to be commercialised separately, and a new epidemic of sensitisation to these preservatives has been observed in recent years. MI should be included separately in the standard patch testing series. Also, the use of isothiazolinones should be revised, and legislative measures from the competent authorities should be implemented in order to resolve this problem.

Background To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. Objective We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. Methods This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. Results In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). Limitations The retrospective design is a limitation. Conclusions Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

Desde el siglo V a.C. Hipócrates ya describía las afectaciones ungueales, las cuales luego se relacionaban con enfermedades sistémicas o adquiridas. Los médicos de medicina del trabajo se deben preparar para detectar las afectaciones por factores externos. Sin embargo son pocos los casos publicados sobre patología ungueal de origen ocupacional. Nuestra revisión consiste en brindar conocimientos básicos sobre esta asignatura. Desde su definición, función y la descripción de su anatomía. La patología ungueal la clasificaremos según: a) anomalías de: la forma, de la adhesión, de la coloración, superficie, infección; b) según el mecanismo de acción que se producen o c) según el tipo de ocupación. Al adquirir estos conocimientos podremos establecer posteriores pautas de prevención eficaces.From the V century B.C. Hippocrates described the damages in the nails, which then were related to systemic diseases or acquired. As physicians we must prepare work to detect the effects caused by external factors. However, few published cases of occupational origin nail pathology. Our review is to provide basic knowledge on this subject. From its definition, function and description of the anatomy. The nail pathology classify as: a) anomalies: the way of accession, coloration, surface, infection, b) according to the mechanism of action that occur oc) by type of occupation. By acquiring this knowledge we can establish effective prevention guidelines later.

El Kathon CG constituye el nombre comercial de una mezcla de isotiazolinas: Metilcloroisotiazolinona y Metilisotiazolinona. Es un conservante muy utilizado, sobre todo en la industria cosmética, aunque en los últimos años también se ha impuesto su presencia en productos de limpieza de uso doméstico y actualmente a concentraciones más altas en preparados de uso industrial como aceites de corte, emulsiones de látex, pinturas al temple, aceites para motores Diesel, etc. Por su alto poder sensibilizante y amplia utilización, constituye actualmente una de las causas más frecuentes de alergia de contacto por preservativos, tanto en nuestra vida privada, como en el ámbito profesional. Objetivos: Estudiar la capacidad sensibilizante del Kathon CG y su relación con el desarrollo de eczema de contacto alérgico de origen profesional. Métodos: Estudio observacional descriptivo, a través de la revisión de las historias clínicas de los pacientes vistos en el Servicio de Dermatología Laboral del Instituto Nacional de Medicina y Seguridad en el Trabajo durante los años 2008-2012; 1520 pacientes fueron evaluados y estudiados mediante pruebas epicutáneas para descartar una posible dermatosis profesional. Se registraron los casos de sensibilización al Kathon CG y se analizaron las siguientes variables: genero, edad, grupo profesional, localización de las lesiones cutáneas, relevancia y relación profesional. El análisis estadístico se realizó con el programa SPSS 15.0. Resultados: Se observó sensibilización al Kathon CG en 88 pacientes (5,8%), correspondiendo un 42% a sensibilizaciones de origen profesional. Conclusiones: La alergia de contacto profesional por Kathon CG constituye actualmente es un problema de alta prevalencia. Ante un paciente con positividad a este alérgeno hay que interrogar siempre por su profesión.Kathon CG is the tradename for a mixture of isothiazolines: methylchloroisothiazolinone and methylisothiazolinone. It is a widely used preservative, especially in the cosmetic industry, although in recent years is presence have also been imposed in cleaning products for household use and, at higher concentrations in industrial preparations such as cutting oils, latex emulsions, paints, oils for diesel engines, etc. Because of its high sensitizing power and widespread use, is currently one of the most common causes of allergic contact dermatitis, both in our private lives, as in the occupational field. Objectives: To study the sensitizing capacity of Kathon CG and its relation to the development of allergic contact dermatitis of occupational origin. Methods: We performed a retrospective study by reviewing the medical records of patients seen at the Department of Occupationsal Dermatology at the Instituto Nacional de Medicina y Seguridad en el Trabajo, during the years 2008-2012. In that period, 1520 patients were evaluated and studied by patch testing, to rule out an occupational skin condition. We recorded cases of sensitization to Kathon CG and analyzed the following data: gender, age, occupational group, location of skin lesions, relevance and occupational origin. Statistical analysis was performed using SPSS 15.0. Results: We observed sensitization to Kathon CG in 88 patients (5.8%), and 42% were of occupational origin. Conclusions: Occupational contact allergy to Kathon CG is currently a problem of high prevalence. In patients with sensitization to this allergen, we should always ask about their occupation.

Soft tissue augmentation is one of the most frequent techniques in cosmetic dermatology. Nowadays, there are a high number of available materials. Nonanimal hyaluronic acid (HA) is one of most useful fillers for lip augmentation and for treating nasolabial folds, marionette lines, and the dynamic wrinkles of the upper face.To evaluate the type and management of undesirable effects of nonanimal reticulated or stabilized HA observed in our cosmetic unit in the past 3 years.The consecutive patients using HA attending to our clinic in the past 3 years were divided into 3 categories, according to the time of presentation of the adverse reactions: immediate, early, and late-onset complications. All patients were treated.Twenty-three patients presented to our clinic complaining of complications after soft tissue augmentation with HA. Ten patients presented immediate-onset complications, 8 showed early-onset complications, and 5 cases complaint of late-onset complications. Treatment of the first group consisted of hyaluronidase injection, massage, and topical antibiotics. Early- and late-onset complications were treated with intralesional triamcinolone acetonide. All patients improved, with the exception of a woman with recurrent granulomas.Generally, undesirable effects of HA (immediate, early, or late onset) are not frequent, and when present, they improve if treated properly. Physicians need to be aware of these possible adverse events in order to establish proper treatment and prevent scarring or other sequelae.

Artículo original [ES] Dentro de la Medicina Laboral las dermatosis ocupacionales suponen entre el 30-60% del total de enfermedades profesionales y, dentro de ellas el 80-90% son dermatitis de contacto. Este alto número no se ve reflejado en datos oficiales debido a que en muchas ocasiones, al ser condiciones de rápida resolución o de escasa repercusión sistémica, no son declaradas. En relación a las dermatitis de contacto, la forma más frecuente en el entorno laboral es la forma alérgica y la que preferentemente se declara, al ser un proceso que en muchas ocasiones constituye motivo de incapacidad. Para el abordaje diagnóstico y correspondiente asociación con el entorno de trabajo es imprescindible realizar una historia clínica laboral completa junto con la descripción de las lesiones, y la utilización de métodos diagnósticos distintos a los de otros procesos no cutáneos, como son las pruebas de parche (patch test) o pruebas epicutáneas. Constituyen un método simple, accesible y seguro para llegar al diagnóstico de las dermatitis alérgicas de contacto. Incluyen una batería estándar, propia de un país donde se trabaja, ampliada de baterías específicas en relación con el perfil, las tareas y los productos manipulados por el trabajador. La prevención en el trabajo es el único tratamiento etiológico para la sustitución y control de los riesgos laborales relacionados con las dermatosis profesionales. [EN] In occupational medicine, occupational dermatoses account for 30 to 60% of the total amount of occupational diseases and, within 80 to 90% of them correspond to contact dermatitis. This high number is not reflected in official data because in most cases, as conditions of rapid resolution or low systemic impact, they are not declared. Regarding contact dermatitis, the most common type in the workplace is the allergic type, which preferably is declared, because often results in disability. For the correct diagnosis and association with the work environment is essential to make a full history of the patient’ occupational background,correct description of the skin lesions, and the use of diagnostic methods other than those of non-cutaneous processes, such as patch testing. They provide a simple, accessible and safe method for the diagnosis of allergic contact dermatitis. They include a standard national baseline series, proper of the country where the patient works, and additional extended series, specific to the occupation performed by the worker. Prevention at work is the only etiological treatment for replacement and control of occupational hazards associated with occupational skin diseases. No

espanolEl Kathon CG constituye el nombre comercial de una mezcla de isotiazolinas: Metilcloroisotiazolinona y Metilisotiazolinona. Es un conservante muy utilizado, sobre todo en la industria cosmetica, aunque en los ultimos anos tambien se ha impuesto su presencia en productos de limpieza de uso domestico y actualmente a concentraciones mas altas en preparados de uso industrial como aceites de corte, emulsiones de latex, pinturas al temple, aceites para motores Diesel, etc. Por su alto poder sensibilizante y amplia utilizacion, constituye actualmente una de las causas mas frecuentes de alergia de contacto por preservativos, tanto en nuestra vida privada, como en el ambito profesional. Objetivos: Estudiar la capacidad sensibilizante del Kathon CG y su relacion con el desarrollo de eczema de contacto alergico de origen profesional. Metodos: Estudio observacional descriptivo, a traves de la revision de las historias clinicas de los pacientes vistos en el Servicio de Dermatologia Laboral del Instituto Nacional de Medicina y Seguridad en el Trabajo durante los anos 2008-2012; 1520 pacientes fueron evaluados y estudiados mediante pruebas epicutaneas para descartar una posible dermatosis profesional. Se registraron los casos de sensibilizacion al Kathon CG y se analizaron las siguientes variables: genero, edad, grupo profesional, localizacion de las lesiones cutaneas, relevancia y relacion profesional. El analisis estadistico se realizo con el programa SPSS 15.0. Resultados: Se observo sensibilizacion al Kathon CG en 88 pacientes (5,8%), correspondiendo un 42% a sensibilizaciones de origen profesional. Conclusiones: La alergia de contacto profesional por Kathon CG constituye actualmente es un problema de alta prevalencia. Ante un paciente con positividad a este alergeno hay que interrogar siempre por su profesion. EnglishKathon CG is the tradename for a mixture of isothiazolines: methylchloroisothiazolinone and methylisothiazolinone. It is a widely used preservative, especially in the cosmetic industry, although in recent years is presence have also been imposed in cleaning products for household use and, at higher concentrations in industrial preparations such as cutting oils, latex emulsions, paints, oils for diesel engines, etc. Because of its high sensitizing power and widespread use, is currently one of the most common causes of allergic contact dermatitis, both in our private lives, as in the occupational field. Objectives: To study the sensitizing capacity of Kathon CG and its relation to the development of allergic contact dermatitis of occupational origin. Methods: We performed a retrospective study by reviewing the medical records of patients seen at the Department of Occupationsal Dermatology at the Instituto Nacional de Medicina y Seguridad en el Trabajo, during the years 2008-2012. In that period, 1520 patients were evaluated and studied by patch testing, to rule out an occupational skin condition. We recorded cases of sensitization to Kathon CG and analyzed the following data: gender, age, occupational group, location of skin lesions, relevance and occupational origin. Statistical analysis was performed using SPSS 15.0. Results: We observed sensitization to Kathon CG in 88 patients (5.8%), and 42% were of occupational origin. Conclusions: Occupational contact allergy to Kathon CG is currently a problem of high prevalence. In patients with sensitization to this allergen, we should always ask about their occupation.

espanolDesde el siglo V a.C. Hipocrates ya describia las afectaciones ungueales, las cuales luego se relacionaban con enfermedades sistemicas o adquiridas. Los medicos de medicina del trabajo se deben preparar para detectar las afectaciones por factores externos. Sin embargo son pocos los casos publicados sobre patologia ungueal de origen ocupacional. Nuestra revision consiste en brindar conocimientos basicos sobre esta asignatura. Desde su definicion, funcion y la descripcion de su anatomia. La patologia ungueal la clasificaremos segun: a) anomalias de: la forma, de la adhesion, de la coloracion, superficie, infeccion; b) segun el mecanismo de accion que se producen o c) segun el tipo de ocupacion. Al adquirir estos conocimientos podremos establecer posteriores pautas de prevencion eficaces. EnglishFrom the V century B.C. Hippocrates described the damages in the nails, which then were related to systemic diseases or acquired. As physicians we must prepare work to detect the effects caused by external factors. However, few published cases of occupational origin nail pathology. Our review is to provide basic knowledge on this subject. From its definition, function and description of the anatomy. The nail pathology classify as: a) anomalies: the way of accession, coloration, surface, infection, b) according to the mechanism of action that occur oc) by type of occupation. By acquiring this knowledge we can establish effective prevention guidelines later.

Patch testing is a method for diagnosing allergic contact dermatitis, and the best way to differentiate it from irritant contact dermatitis (1). As part of the Spanish Contact Dermatitis Society baseline series, the thin-layer rapiduse epicutaneous test, known as TRUE Test® (TT), is widely used (2–4). With the aim of studying the diagnostic capacity of expired TRUE Test® panels, a prospective study on consecutive patients attending our occupational dermatology department during February 2013 was conducted. In all patients, three TRUE Tests® with different expiry dates (2011, 2012, and 2013) were applied. Also, according to the clinical history and occupation of each patient, patch testing with a specific series was performed. Patients signed an informed consent form before the study was performed. The patches were removed on D2, and readings were performed on D2 and D3. During the study period, a total of 11 patients were patch tested with three TRUE Tests® with different expiry dates: 2011, 2012, and 2013. In 9 of 11 patients, the same positive reactions, with identical intensities, were observed in the three TRUE Tests® (Fig. 1). In the remaining 2 patients, the same positive reactions were observed in the TRUE Tests® with expiry dates in 2012–2013, and negative results were obtained in the TRUE Test® in with an expiry date in 2011 (Table 1).

ejd.2012.1846 Auteur(s) : Ana Rita Rodrigues Barata rita.rodrigues.md@gmail.com, Francisco Camacho-Martinez Department of Dermatology and Venereology, Hospital Universitario Virgen Macarena, Av Dr Fedriani s/n 41009 Sevilla, Spain A 56-year-old woman with no relevant personal or medical history was treated in our dermatology department over a long period for female pattern hair loss. She had been on treatment with finasteride 2.5 mg daily and minoxidil 5% twice daily for several years with a [...]