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Cristina García-Millan,1 Ander Pino,2 Rita Rodrigues,1 Gonzalo Segurado-Miravalles,1,3 Adrián Alegre-Sánchez,1 Pedro Jaén,1,3 Eduardo Anitua2 1Grupo de Dermatología Pedro Jaén, Madrid, Spain; 2BTI Biotechnology Institute, Vitoria, Spain; 3University Hospital Ramon y Cajal, Madrid, SpainCorrespondence: Eduardo Anitua, BTI Biotechnology Institute, Jacinto Quincoces 39, Vitoria, Spain, Email eduardo@fundacioneduardoanitua.orgBackground: Although the underlying pathophysiology of sensitive skin remains unknown, it presents clinical symptoms like erythema, burning and dryness associated with other inflammatory dermatoses such as dermatitis or rosacea.Objective: The aim of the present report was to provide preliminary data about the efficacy of Endoret-Serum (ES) as an autologous therapy for the topical management of sensitive skin alterations.Materials and Methods: Five patients underwent a daily topical ES treatment that was maintained for three months. Clinical assessment was carried out using validated dermatological surveys (DLQI, IGA, Likert, PGI-I). Additionally, skin hydration measurement and high-resolution topographic and reflectance confocal imaging analysis were carried out.Results: No adverse events were observed during the treatment. At the end of the follow-up period, surveys highlighted a significant therapeutic effect compared to baseline. Skin hydration was also improved, and topographic images showed a decrease in patient’s underlying inflammatory and vascular condition.Conclusion: This preliminary report suggests that Endoret-Serum may be useful in the management of clinical symptoms derived from sensitive skin alterations.Keywords: platelet-rich plasma, growth factors, sensitive skin, topical formulation, case report

Background: Folliculitis decalvans (FD) is a rare primary neutrophilic scarring alopecia whose etiology has not been completely elucidated yet. Objective: To determine if the follicular microbiota residing in FD-affected hair follicles had a distinct microbiological signature and if an aberrant immune response was present in the pathogenesis of FD. Methods: We conducted a cross-sectional study of ten patients affected by FD. Trichoscopy-guided follicular biopsies were taken from affected and healthy scalp to identify the follicular microbiome using next-generation sequencing. We searched for microbiological biomarkers of FD-affected follicles using the linear discriminant analysis (LDA) effect size (LEfSe) tool. Additionally, peripheral blood mononuclear cells were obtained, and their cytokine production was quantified after incubation with pathogen-associated molecular patterns isolated from patients’ biopsies and compared with healthy controls. Results: β-diversity analysis showed statistically significant differences regarding bacteria comparing follicular microbiota of healthy and FD-affected hairs. Ruminococcaceae, Agathobacter sp., Tyzzerella sp. and Bacteriodales vadin HA21 family were good predictors of disease status. IL-10, TNF-α and IL-6 levels were significantly decreased in patients after incubation with various strains of bacteria compared with controls. Conclusion: FD hair follicles have a specific heterogenous follicular bacterial microbiota signature. Additionally, these patients seem to have an impaired immunological response.

Background The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. Objective To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. Methods Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. Results A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. Limitations Retrospective design and lack of a control group. Conclusion LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.

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.

5-alpha inhibitors are an effective treatment for androgenetic alopecia. Mesotherapy with dutasteride has been proposed as an effective method to improve hair loss and reducing systemic absorption.The main objective was to describe the safety profile of mesotherapy with dutasteride in real clinical practice in a large cohort of patients with androgenetic alopecia. A secondary aim was to describe the effectiveness of this treatment.A multicentric retrospective study was designed. Patients treated with at least 6 months of follow-up were included in the study. Side effects and response to the treatment were analyzed.A total of 541 patients were included. The commonest approach during the first year was to perform the treatment every 3 months. Response to the mesotherapy in monotherapy could be assessed in 86 patients (15.9%) after one year. Most of them presented clinical improvement, being a marked improvement in 33 patients (38.4%). Pain was the most frequent side effect of the treatment (246 patients, 45.5%). No serious or sexual adverse events were detected.Mesotherapy with dutasteride was effective in male and female hair loss in real clinical practice. Side effects related to the treatment were mild and self-limited. This therapy may be an effective option for select patients wishing to avoid oral treatment. J Drugs Dermatol. 2022;21(7):742-747. doi:10.36849/JDD.6610.

Psoriasis is associated with a higher risk of liver diseases. We investigated the impact of hepatic steatosis (European cohort) and hepatic inflammation (United States cohort) on subclinical atherosclerosis. In the European cohort (n = 76 psoriasis participants and 76 controls), nonalcoholic fatty liver disease, assessed by the sonographic hepatorenal index, was more prevalent in psoriasis than in controls (61% vs. 45%; P = 0.04). Participants with psoriasis with nonalcoholic fatty liver disease had a higher prevalence of subclinical atherosclerosis (ultrasonographic presence of plaque in femoral or carotid arteries) than participants with psoriasis without nonalcoholic fatty liver disease (61% vs. 23%; P = 0.006) and controls with nonalcoholic fatty liver disease (61% vs. 32%; P < 0.05). Sonographic hepatorenal index was a determinant of subclinical atherosclerosis in psoriasis (OR = 3.5; P = 0.01). In the United States cohort (n = 162 participants with psoriasis who underwent positron emission tomography and coronary computed tomography angiography), those with high hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake had higher noncalcified (1.3 [0.49 mm2] vs. 1.0 [0.40 mm2]), fibrofatty (0.23 [0.15 mm2] vs. 0.11 [0.087 mm2]), and lipid-rich necrotic core (4.3 [2.3 mm2] vs. 3.0 [1.7 mm2]) coronary burden (all P < 0.001). Hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake associated with noncalcified (β = 0.28; P < 0.001), fibrofatty (β = 0.49; P < 0.001), and lipid-rich necrotic core (β = 0.28; P = 0.003) burden. These results show the downstream cardiovascular effects of subclinical liver disease in psoriasis. pre-print 723 KB

Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent.In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test.In all patients we observed a global reduction in the number of AK lesions (71%; p 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment.PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.

FAT1, which encodes a protocadherin, is one of the most frequently mutated genes in human cancers1-5. However, the role and the molecular mechanisms by which FAT1 mutations control tumour initiation and progression are poorly understood. Here, using mouse models of skin squamous cell carcinoma and lung tumours, we found that deletion of Fat1 accelerates tumour initiation and malignant progression and promotes a hybrid epithelial-to-mesenchymal transition (EMT) phenotype. We also found this hybrid EMT state in FAT1-mutated human squamous cell carcinomas. Skin squamous cell carcinomas in which Fat1 was deleted presented increased tumour stemness and spontaneous metastasis. We performed transcriptional and chromatin profiling combined with proteomic analyses and mechanistic studies, which revealed that loss of function of FAT1 activates a CAMK2-CD44-SRC axis that promotes YAP1 nuclear translocation and ZEB1 expression that stimulates the mesenchymal state. This loss of function also inactivates EZH2, promoting SOX2 expression, which sustains the epithelial state. Our comprehensive analysis identified drug resistance and vulnerabilities in FAT1-deficient tumours, which have important implications for cancer therapy. Our studies reveal that, in mouse and human squamous cell carcinoma, loss of function of FAT1 promotes tumour initiation, progression, invasiveness, stemness and metastasis through the induction of a hybrid EMT state., info:eu-repo/semantics/published

Chilblain-like lesions (CLL) were described early on the coronavirus disease 2019 (COVID-19) pandemic as red-to-violet macules, plaques, or nodules typically appearing at the distal aspects of toes.1 Although increasing evidence suggests they are COVID-19-related,2 it is not supported by analytic controlled studies.

Background The effect of biologics on the risk for cardiovascular disease in patients with psoriasis is still unclear despite their widespread use. Objective The objective of this study was to examine the impact of licensed biological therapies on imaging and biomarkers of cardiovascular disease risk in patients with psoriasis by a systematic review and meta-analysis of placebo-controlled trials. Methods A comprehensive search of studies published before 1 June 2020 was performed in Medline-Ovid, EMBASE, and CENTRAL using a predefined strategy to identify relevant articles. Results Five studies were included for the final examination, and two studies were included in the meta-analysis. We did not find a significant reduction in aortic vascular inflammation in patients treated with adalimumab compared with those who received placebo at weeks 12–16. There was no beneficial effect on imaging biomarkers (aortic vascular inflammation or flow-mediated dilatation) of cardiovascular disease risk in patients exposed to biological therapies (adalimumab and secukinumab) compared with those exposed to placebo, except for ustekinumab showing a reduction in aortic vascular inflammation at week 12 but not at week 52 after the open-label extension period. The strongest reduction in blood-based cardiometabolic risk biomarkers was observed with adalimumab (CRP, TNF-α, IL-6, and GlycA) and phototherapy (CRP and IL-6) compared with that observed with placebo. Conclusions Randomized controlled trials show that ustekinumab reduces aortic vascular inflammation and that TNF-α inhibitors and phototherapy reduce CRP and IL-6. These surrogate marker findings require randomized controlled trials evaluating cardiovascular events to inform clinical practice.

espanolLa pandemia causada por el coronavirus SARS-Cov2 ha puesto a prueba a las organizaciones sanitarias, sus equipos directivos y gestores, y por supuesto a todos los profesionales que las integran, asi como a los equipos de soporte. Una crisis sanitaria de estas dimensiones se podria considerar inimaginable, pero cuando acontece con esta magnitud es fundamental que emerja un liderazgo efectivo, un liderazgo capaz de resolver con inmediatez e imaginacion todos los problemas no previstos que se originan. En esas circunstancias es preciso contar con un liderazgo agil, coherente y adaptado a las necesidades mas inmediatas que se producen para dar respuesta al gran impacto sociosanitario en la poblacion, al aumento desmedido de pacientes que requieren atencion inmediata de forma simultanea, con la gravedad de un proceso desconocido para muchos de ellos, alta demanda de camas en Cuidados Intensivos y Hospitalizacion especifica, hiperdemanda de atencion en la Urgencia, asi como enfrentarse a situaciones de miedo al tener que manejar una enfermedad provocada por un virus desconocido con alta tasa de infectividad y mortalidad no habitual en nuestro entorno. Los profesionales necesitan establecer vias de comunicacion fiable, constante y adaptada a la nueva situacion. Los lideres durante la pandemia han de adaptarse rapidamente a la mayor crisis sanitaria conocida en el sistema sanitario espanol desde hace muchos anos y tienen que asumir retos constantes para dar respuestas rapidas y eficientes a las situaciones criticas que se viven en el dia a dia. EnglishThe pandemic caused by the SARS-Cov2 coronavirus has represented a test for healthcare organizations, their executive and management teams, and of course all professionals included, as well as their support teams. A healthcare crisis of these dimensions could be considered unimaginable; but when it occurs at such an extent, the emergence of an effective leadership becomes essential: a leadership able to solve immediately and with imagination all those non-foreseen problems that might arise. In these circumstances, it is necessary to have an agile and consistent leadership, adapted to the more immediate needs that appear, in order to address the major sociosanitary impact on the society, the disproportionate increase in patients requiring immediate care simultaneously, with the severity of a condition unknown for many of them, high demand on beds in Intensive Care and specific Hospitalization, hyper demand of Emergency care, as well as to face frightening situations when having to manage a disease caused by an unknown virus with a high infectivity and mortality rate, not usual in our setting. Professionals need to establish reliable communication routes, which are constant and adapted to the new situation. During the pandemic, leaders must adapt in a fast way to the greater healthcare crisis known in the Spanish Health System for many years, and they must accept constant challenges in order to give fast and efficient answers to the critical situations occurring in daily life.

Background: Cutaneous squamous skin cell carcinoma (SCC) is the second most frequent type of non- melanoma skin cancer and the second cause of death by skin cancer in caucasian population. However, at present it is difficult to predict patients with worst SCC prognosis. Objective: To identify proteins whose expression level could predict SCC infiltration in SCC arising from actinic keratosis (AC). Methods: A total of 20 biopsies of 20 different patients were studied, 10 were from SCC-AK samples and 10 from normal skin. Early infiltrated SCC-AK were selected on histological examination and to determine the expression of proteins fresh skin samples were processed by 2DE-electrophoresis Results: The expression levels of three proteins namely alpha-hemoglobin, heat shock protein (Hsp)-27 and 70 were significantly increased in SCC-AK samples with respect to normal control skin. However, only the expression level of Hsp70 protein positively correlated with the level of SCC-AK dermis infiltration. Immnunohistological examination suggested that the increased expression of Hsp70 proteins seems to mainly occur in the keratinocytes cytoplasm. The increased cytoplasmic Hsp70 expression in SCC-AK was confirmed by Western-blot experiments. Conclusion: Cytoplasmic expression of Hsp70 could be potential biomarker of early infiltration of SCC arising from an AK. Keywords: actinic keratosis, cutaneous squamous cell carcinoma; cytoplasm, skin cancer; heat shock protein.

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.

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.

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

Several types of discontinuities and defects may be present on a weld, thus leading to a considerable reduction of its resistance. Therefore, ensuring a high welding quality and reliability has become a matter of key importance for many construction and industrial activities. Among the non-destructive weld testing and inspection techniques, the time-of-flight diffraction (TOFD) arises as a very safe (no ionising radiation), precise, reliable and versatile practice. However, this technique presents a relevant drawback, associated to the appearance of speckle noise that should be addressed. In this regard, this paper presents a new, intelligent and automatic method for weld inspection and analysis, based on TOFD, image processing and neural networks. The developed system is capable of detecting weld defects and imperfections with accuracy, and classify them into different categories.

Introducción. La presencia de problemas de juego entre los adolescentes y jóvenes es un dato preocupante en distintos países. La mayoría de los estudios se han centrado en analizar características individuales, factores de personalidad y comorbilidad con otros trastornos, echándose en falta investigaciones que describan las características familiares de los jóvenes jugadores. Objetivos. Este estudio analiza el perfil y los antecedentes de juego de una muestra de jóvenes jugadores patológicos y compara las características del funcionamiento familiar de éstos con una muestra control. Metodología. Diseño cuasi-experimental con contraste de medias mediante t de Student entre una submuestra de 47 jóvenes jugadores y 47 sujetos de una submuestra control. Resultados. Los resultados sugieren un perfil de juego con inicio adolescente a las máquinas tragaperras y juego impulsivo altamente sensible a la recompensa así como percepciones familiares con un buen nivel de funcionamiento pero en las que la adaptabilidad y la delimitación entre subsistemas parental y filial están deterioradas. Las familias de los jóvenes jugadores con antecedentes son percibidas como más creativas que las que no los tienen. Conclusiones. Se sugieren importantes implicaciones prácticas a partir de los recursos familiares y el cambio de juego entre los miembros. Introduction. The presence of problem gambling among adolescents and young people is an issue of concern in different countries. Most studies have focused on analyzing individual characteristics, personality factors and comorbidity with other disorders, and only a few studies have focused on describing the family characteristics of young gamblers. Objectives. This study analyzes the profile and gambling antecedents of a sample of young pathological gamblers and compares the characteristics of family functioning of these with a control sample. Methods. Quasi-experimental design with contrast medium Student t between a subsample of 47 young gamblers and 47 subjects of control subsample. Results. The results suggest a profile of early beginnings with slot machines and an impulsive pattern of gambling highly sensitive to game reward and family perceptions with a good level of functioning but where adaptability and delimitation between parental and filial subsystems are damaged. Families of young gamblers with gambling antecedents are perceived as more creative than those who do not. Conclusions. It suggests important practical implications empowering family resources and changing the game between members. Departamento de Educación y Psicología Social Versión del editor

Background Objective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. Objectives To determine the feasibility of implementation of a dermatology OSCE in the medical school. Methods Five stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). Results A total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. Limitations Testing a small sample of voluntary students may hinder generalization of our study. Conclusions OSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology.

[Background]: Alopecia areata is a T‐cell‐mediated autoimmune disease with an unknown etiopathogenesis. Gut microbiota has been revealed as a key modulator of systemic immunity., [Objective]: To determine whether patients affected by alopecia universalis present differences in gut bacteria composition compared with healthy controls and investigate possible bacterial biomarkers of the disease., [Methods]: We conducted a cross‐sectional study that involved 15 patients affected by alopecia universalis and 15 controls. Gut microbiome of the study subjects was analysed by sequencing the 16SrRNA of stool samples. We searched for bacterial biomarkers of alopecia universalis using the linear discriminant analysis effect size (LEFse) tool., [Results]: In total, 30 study subjects (46.6% female; mean [SD] age, 40.1 [9.8] years) were enrolled. Neither alpha (Shannon diversity index 5.31 ± 0.43 vs. 5.03 ± 0.43, P 0.1) or beta diversity (ADONIS P value: 0.35) of gut microbiota showed statistically significant differences between cases and controls. In patients affected with alopecia, we found an enriched presence (LDA SCORE > 2) of Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis. A predictive model based on the number of bacterial counts of Parabacteroides distasonis and Clostridiales vadin BB60 group correctly predicted disease status in 80% of patients (AUC 0.804 (0.633–0.976), P 0.004)., [Conclusion]: Alopecia universalis does not seem to affect broadly gut microbiota structure. Bacterial biomarkers found associated with the disease (Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Eggerthellaceae, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis) should be further studied as they could be involved in its pathophysiology or be used as diagnostic tools., A donation from Novartis to the Hospital Ramon y Cajal Dermatology Department was used for financial support of statistical analysis and data management services.

The objective of our study was to describe the effectiveness and safety of oral dutasteride (OD) for male androgenetic alopecia in real clinical practice. A retrospective, monocentric, and descriptive study was designed. Male patients with androgenetic alopecia that had received OD for at least 12 months were included. Three or less capsules of 0.5 mg per week were considered low doses. Therapeutic response was assessed by comparison of pre- and post-treatment (at month 12) clinical images by three independent dermatologists with expertise in hair disorders, using a four-point scale (worsening, stabilization, mild improvement or marked improvement). In all, 307 patients with a mean age of 35.3 years (range 18-79) were included. Eight patients (2.6%) required the discontinuation of the drug due to decreased libido (n = 4), gynecomastia (n = 2), mood disorder (n = 1) and erectile dysfunction (n = 1). All these AE resolved after stopping the medication. No AE were detected in patients receiving low doses of OD. The effectiveness was evaluated in the subgroup of 42 patients (13.7%) who received OD in monotherapy: 38 patients improved (90%), 10 of them (23.8%) presenting a marked improvement, 4 patients (9.5%) were stable and none patient worsened. In conclusion, OD is an effective treatment for male androgenetic alopecia in real clinical practice, presenting a good safety profile, especially at lower doses.