Publications by authors named "Antonella Tosti"

353 Publications

Development of the Alopecia Areata Scale for Clinical Use: Results of an Academic-Industry Collaborative Effort.

J Am Acad Dermatol 2021 Aug 30. Epub 2021 Aug 30.

Janssen Global Services, LLC, PA; Eli Lilly and Company, IN.

Background: The current classification for Alopecia Areata (AA) does not provide a consistent assessment of disease severity.

Objective: To develop an AA severity scale based on expert experience.

Methods: A Modified Delphi process was utilized. An advisory group of 22 US-based AA clinical experts was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development.

Results: Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing with the adoption of the proposed scale.

Limitations: The scale is a static assessment intended to be used in clinical practice, and not clinical trials.

Conclusions: The final AA disease severity scale, anchored on extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.
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http://dx.doi.org/10.1016/j.jaad.2021.08.043DOI Listing
August 2021

Eyelash involvement in frontal fibrosing alopecia: A prospective study.

J Am Acad Dermatol 2021 Aug 14. Epub 2021 Aug 14.

Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Brazil.

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http://dx.doi.org/10.1016/j.jaad.2021.07.063DOI Listing
August 2021

Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management.

JAAD Int 2021 Dec 3;5:11-18. Epub 2021 Aug 3.

Dermatology Department, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain.

Background: The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported.

Objective: To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease.

Methods: Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms.

Results: Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more.

Limitations: The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities.

Conclusion: The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.
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http://dx.doi.org/10.1016/j.jdin.2021.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328568PMC
December 2021

Proxalutamide Reduces the Rate of Hospitalization for COVID-19 Male Outpatients: A Randomized Double-Blinded Placebo-Controlled Trial.

Front Med (Lausanne) 2021 19;8:668698. Epub 2021 Jul 19.

Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, United States.

Antiandrogens have demonstrated a protective effect for COVOD-19 patients in observational and interventional studies. The goal of this study was to determine if proxalutamide, an androgen receptor antagonist, could be an effective treatment for men with COVID-19 in an outpatient setting. A randomized, double-blinded, placebo-controlled clinical trial was conducted at two outpatient centers (Brasilia, Brazil). Patients were recruited from October 21 to December 24, 2020 (clinicaltrials.gov number, NCT04446429). Male patients with confirmed COVID-19 but not requiring hospitalization (COVID-19 8-point ordinal scale <3) were administered proxalutamide 200 mg/day or placebo for up to 7 days. The primary endpoint was hospitalization rate at 30 days post-randomization. A total of 268 men were randomized in a 1:1 ratio. 134 patients receiving proxalutamide and 134 receiving placebo were included in the intention-to-treat analysis. The 30-day hospitalization rate was 2.2% in men taking proxalutamide compared to 26% in placebo, < 0.001. The 30-day hospitalization risk ratio was 0.09; 95% confidence interval (CI) 0.03-0.27. Patients in the proxalutamide arm more frequently reported gastrointestinal adverse events, however, no patient discontinued treatment. In placebo group, 6 patients were lost during follow-up, and 2 patients died from acute respiratory distress syndrome. Here we demonstrate the hospitalization rate in proxalutamide treated men was reduced by 91% compared to usual care.
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http://dx.doi.org/10.3389/fmed.2021.668698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326462PMC
July 2021

Time of onset and duration of post-COVID-19 acute telogen effluvium.

J Am Acad Dermatol 2021 10 21;85(4):975-976. Epub 2021 Jul 21.

Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.07.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294706PMC
October 2021

Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims.

Adv Ther 2021 09 22;38(9):4646-4658. Epub 2021 Jul 22.

Yale School of Medicine, New Haven, CT, USA.

Introduction: Alopecia areata (AA) is an autoimmune disorder causing sudden, non-scarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA.

Methods: Patients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis. Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data.

Results: A total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs.

Conclusion: Patients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population. Healthcare costs incurred by patients with AA went beyond AA-related expenses. Longitudinal data are needed to better understand treatment trajectories and the disease burden in patients with AA.
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http://dx.doi.org/10.1007/s12325-021-01845-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408067PMC
September 2021

Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature.

Dermatol Ther (Heidelb) 2021 Jul 7. Epub 2021 Jul 7.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.

Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors' own experiences treating this unique patient population.
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http://dx.doi.org/10.1007/s13555-021-00574-0DOI Listing
July 2021

The Impact of Shampoo Wash Frequency on Scalp and Hair Conditions.

Skin Appendage Disord 2021 Apr 15;7(3):183-193. Epub 2021 Feb 15.

The Procter & Gamble Company, Mason, Ohio, USA.

Background: How frequently should the scalp and hair be cleansed? A dearth of objective data has led to confusion both among lay people and experts. Each extreme has potential detrimental effects: overcleaning may lead to surface damage while undercleaning may lead to buildup of harmful stimuli. This situation is complicated because both objective and subjective criteria are relevant to assess optimal cleaning.

Objectives: The objective of this work was to combine epidemiological and treatment data with both objective and subjective end points to yield clear data to guide both the consumer and expert as to optimal scalp and hair cleaning practices.

Methods: Two studies were conducted with Asian populations without any specific scalp pathologies. An epidemiological study was conducted as a function of natural wash frequency. This was combined with a controlled wash frequency study. In both cases, objective measures of hair and scalp condition were assessed. These were combined with self-assessments of all participants.

Results: In the epidemiological study, it was observed that overall satisfaction with hair and scalp condition was achieved when washing 5-6 times per week. This was consistent for both objective and subjective end points. Controlled treatment likewise showed that a daily wash regimen was superior to once per week cleansing for all end points. No objective detrimental effects to hair at this level of cleansing were observed.

Conclusions: Two different studies led to the same conclusion: higher wash frequency is both beneficial and more preferred to lower wash frequency among the Asian populations studied. Concerns related to "overcleaning" were unfounded both objectively and subjectively.
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http://dx.doi.org/10.1159/000512786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138261PMC
April 2021

Alopecia Areata: New Treatment Options Including Janus Kinase Inhibitors.

Dermatol Clin 2021 Jul 15;39(3):407-415. Epub 2021 May 15.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL 33136, USA. Electronic address:

Alopecia areata (AA) is a chronic, relapsing, autoimmune disorder characterized by patchy nonscaring hair loss. Although the pathogenesis of alopecia areata is not yet completely elucidated, loss of immune privilege in anagen stage hair follicles is widely accepted to play a key role. Several cytokines that depend on Janus kinase signaling have been identified to be involved in AA, including interleukin (IL)-2, IL-7, IL-15, IL-21, and interferon-γ, making Janus kinase inhibitors an attractive therapeutic target. Available information indicates that about 70% of patients with AA experience significant regrowth, but interruption of treatment is associated with disease recurrence.
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http://dx.doi.org/10.1016/j.det.2021.03.005DOI Listing
July 2021

Role of Scalp Health in Achieving Optimal Hair Growth and Retention.

Int J Cosmet Sci 2021 May 1. Epub 2021 May 1.

The Procter & Gamble Company, Mason, OH, USA.

We have conducted a thorough review of the literature to assess the evidence for supporting a cause-and-effect linkage between scalp condition and resultant hair condition. Over 20 epidemiological studies have been published covering a wide range of abnormal scalp conditions in which consequent impacts to the hair have been documented. A treatment study was conducted to demonstrate not only that impaired scalp condition led to impaired hair quality but that the impacts to hair are reversible upon normalization of the scalp condition. A proposed explanation involves the impact of scalp oxidative stress, which is part of the etiology of these scalp conditions as well as normal aging, in interfering with the normal keratinization of the pre-emergent hair cuticle. This perturbed cuticle impedes normal fiber anchorage and emerges more brittle and fragile than normal cuticle leading to accelerated physical degradation, mirroring the effects of chronological aging of the hair fiber. The consequences of the rapid cuticle degradation result in hair that is more vulnerable to mechanical insults and compromised overall quality.
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http://dx.doi.org/10.1111/ics.12708DOI Listing
May 2021

Hair regrowth in cicatricial alopecia: A literature review.

J Dermatol 2021 Aug 22;48(8):1113-1128. Epub 2021 Apr 22.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, USA.

Cicatricial alopecias (CA) describes multiple subtypes of hair loss in which the hair follicle is destroyed by an unknown inflammatory mechanism. The main goal of treatment is to stop this inflammatory process and prevent further hair loss; however, there have been occasional reports of hair regrowth following treatment in some subtypes of CA. This review aims to highlight these reports. A total of 71 cases of hair regrowth were found documented in the literature. The treatments used varied widely both between and within each subtype of alopecia. This review highlights that regrowth is possible in at least a subset of patients with cicatricial alopecia; however, the mechanism by which this occurs has yet to be elucidated.
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http://dx.doi.org/10.1111/1346-8138.15902DOI Listing
August 2021

Pathobiology questions raised by telogen effluvium and trichodynia in COVID-19 patients.

Exp Dermatol 2021 07 4;30(7):999-1000. Epub 2021 May 4.

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

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http://dx.doi.org/10.1111/exd.14352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250761PMC
July 2021

Androgenetic Alopecia in a Patient with Klinefelter Syndrome: Case Report and Literature Review.

Skin Appendage Disord 2021 Feb 7;7(2):135-138. Epub 2020 Dec 7.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Introduction: Klinefelter syndrome (KS) is defined as (a chromosomal disorder in which males have an extra X chromosome). KS presents clinically with signs of androgen deficiency including low testosterone. Androgenetic alopecia (AGA) develops as a response of the hair follicle cells to androgens in individuals with genetic predisposition.

Case Presentation: We describe a 17-year-old male patient with KS who developed AGA with a Ludwig pattern.

Conclusion: Our patient had a good response to oral minoxidil, finasteride, and low-level light therapy.
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http://dx.doi.org/10.1159/000512224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991277PMC
February 2021

Trichotillomania Incognito: Two Case Reports and Literature Review.

Skin Appendage Disord 2021 Feb 15;7(2):131-134. Epub 2020 Dec 15.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami School of Medicine, Miami, Florida, USA.

Trichotillomania is a compulsive disorder characterized by repetitive hairpulling. It is an important cause of patchy alopecia, especially in children between 9 and 13 years of age. The aim of this paper is to report 2 pediatric cases presenting with trichotillomania without patches. This condition may be extremely distressful, impacting psychosocial development of children. In these case reports, we reinforce the relevance of trichoscopy in hair disorder evaluation, which allowed early recognition to better advise and conduct these unique pediatric cases.
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http://dx.doi.org/10.1159/000512038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991471PMC
February 2021

A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata Disease Severity and Treatment Safety (GRASS).

JAMA Dermatol 2021 04;157(4):1-11

Clinical Medicine, Trinity College Dublin, Dublin, Ireland.

Importance: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata.

Objective: To generate core domains and domain items for a global network of alopecia areata patient registries.

Evidence Review: Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology, Milan, Italy, June 14, 2019.

Findings: Ninety-two core data items, across 25 domains, achieved consensus agreement. Twenty further noncore items were retained to facilitate data harmonization in centers that wish to record them. Broad representation across multiple stakeholder groups was sought; however, the opinion of physicians was overrepresented.

Conclusions And Relevance: This study identifies the domains and domain items required to develop a global network of alopecia areata registries. These domains will facilitate a standardized approach that will enable the recording of a comprehensive, comparable data set required to oversee the introduction of new therapies and harness real-world evidence from existing therapies at a time when the alopecia areata treatment paradigm is being radically and positively disrupted. Reuse of similar, existing frameworks in atopic dermatitis, produced by the Treatment of Atopic Eczema (TREAT) Registry Taskforce, increases the potential to reuse existing resources, creates opportunities for comparison of data across dermatology subspecialty disease areas, and supports the concept of data harmonization.
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http://dx.doi.org/10.1001/jamadermatol.2020.5839DOI Listing
April 2021

Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients.

J Am Acad Dermatol 2021 Jun 24;84(6):1644-1651. Epub 2021 Feb 24.

Sinclair Dermatology, Melbourne, Australia.

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.
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http://dx.doi.org/10.1016/j.jaad.2021.02.054DOI Listing
June 2021

Proxalutamide Significantly Accelerates Viral Clearance and Reduces Time to Clinical Remission in Patients with Mild to Moderate COVID-19: Results from a Randomized, Double-Blinded, Placebo-Controlled Trial.

Cureus 2021 Feb 22;13(2):e13492. Epub 2021 Feb 22.

Dermatology, Applied Biology Inc, Irvine, USA.

Background The entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into type II pneumocytes is dependent on a modification of viral spike proteins by transmembrane protease serine 2 (TMPRSS2) expressed on the surface of human cells. TMPRSS2 is regulated by the androgen receptor, hence, SARS-CoV-2 infectivity is indirectly dependent on androgenic status and phenotype. Previously, we have reported that men affected by androgenetic alopecia (AGA) are overrepresented in severe coronavirus disease 2019 (COVID-19). Additionally, we have reported that men taking antiandrogenic drugs, e.g., 5-alpha-reductase inhibitors (5ARis), are less likely to have severe COVID-19. Here we aimed to test whether the androgen receptor antagonist, Proxalutamide, would be a beneficial treatment for subjects with SARS-CoV-2 infection. Methods Male and female subjects were recruited to a double-blinded, randomized, prospective, investigational study of Proxalutamide for the treatment of COVID-19. Mild to moderate, non-hospitalized subjects, who were confirmed positive for SARS-CoV-2, were treated with either Proxalutamide 200 mg/day or placebo. Endpoints for the study were remission time (days) and the percentage of subjects confirmed negative for SARS-CoV-2 on Day 7 after treatment. A negative SARS-CoV-2 test was defined by concentration-time (Ct)>40 determined by real-time reverse transcription-polymerase chain reaction (rtPCR). Results Two-hundred thirty-six (2360 subjects were included in the study (108 female, 128 male); 171 were randomized to the Proxalutamide arm and 65 were in the placebo group. On Day 7, SARS-CoV-2 became non-detectable with rtPCR (cT>40) in 82% of the subjects in the Proxalutamide group versus 31% in the placebo group (p < 0.001). The average clinical remission time for patients treated with Proxalutamide was 4.2 ±5.4 days versus 21.8 ±13.0 days in the placebo arm (p < 0.001). Conclusion Proxalutamide significantly accelerated viral clearance on Day 7 in mild to moderate COVID-19 patients versus placebo. Further, the time to clinical remission was significantly reduced in patients treated with Proxalutamide versus placebo.
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http://dx.doi.org/10.7759/cureus.13492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899267PMC
February 2021

Occipital fibrosing alopecia.

Int J Dermatol 2021 Feb 20;60(2):e44-e45. Epub 2020 Dec 20.

Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

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http://dx.doi.org/10.1111/ijd.15335DOI Listing
February 2021

Efficacy and Tolerability of a Shampoo Containing Broad-Spectrum Cannabidiol in the Treatment of Scalp Inflammation in Patients with Mild to Moderate Scalp Psoriasis or Seborrheic Dermatitis.

Skin Appendage Disord 2020 Nov 19;6(6):355-361. Epub 2020 Oct 19.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Introduction: Scalp inflammation is commonly associated with scalp psoriasis or seborrheic dermatitis. It can aggravate the progression of androgenetic alopecia and cause troublesome itching and burning. Here, we evaluate the efficacy of a shampoo containing 0.075% broad-spectrum cannabidiol in 50 subjects with mild to moderate scalp psoriasis or seborrheic dermatitis.

Methods: Inflammation was assessed by evaluating the density of twisted/glomerular or arborizing vessels by trichoscopy using a 6-point scale at baseline and day 14. Symptoms of itching/burning sensation, clinical evaluation of erythema/scaling, overall tolerability, and subject satisfaction were evaluated using 10-point scales.

Results: There were significant reductions in arborizing vessel/twisted capillary inflammation and scaling by day 14. Severity scores reduced from 2.3 ± 0.1, 2.6 ± 0.1, and 3.6 ± 0.1, respectively, to 0.5 ± 0.05, 0.8 ± 0.05, and 0.6 ± 0.05 (all < 0.0001). Symptom scores of itching and burning also reduced significantly from 6.9 ± 0.1 to 4.5 ± 0.1 to 1.5 ± 0.05 and 1.0 ± 0.05 (both < 0.0001). Severity of erythema and scaling was also significantly reduced from 5.5 ± 0.1 and 7.0 ± 0.1, respectively, to 1.3 ± 0.05 and 1.6 ± 0.05 (both < 0.0001). Tolerability and subject satisfaction were both excellent. There were no significant differences in treatment effect, tolerability, or subject satisfaction between men and women.

Discussion/conclusion: Replacing current shampooing practices with a broad-spectrum cannabidiol-containing shampoo significantly reduces both severity and symptoms of scalp inflammation within 2 weeks, with excellent tolerability and treatment satisfaction in subjects with mild to moderate scalp psoriasis or seborrheic dermatitis.
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http://dx.doi.org/10.1159/000510896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706496PMC
November 2020

Paraneoplastic pemphigus with cicatricial nail involvement.

Cutis 2020 Oct;106(4):E4-E6

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Florida, USA.

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http://dx.doi.org/10.12788/cutis.0098DOI Listing
October 2020

Platelet-Rich Plasma in the Treatment of Alopecia Areata: A Review.

J Investig Dermatol Symp Proc 2020 11;20(1):S45-S49

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA.

Platelet-rich plasma (PRP) is an autologous preparation of plasma with concentrated platelets containing various growth factors and cytokines that enhance the body's inherent capacity to repair and regenerate hair follicles. A few studies and case reports support the use of PRP for the treatment of alopecia areata (AA). Further large-scale studies are needed to evaluate the efficacy of PRP as monotherapy or in association with other therapeutic modalities for AA. Although PRP is relatively safe and potentially effective, there is no standardized protocol or recommendations for the number of PRP sessions required to treat and maintain hair growth.
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http://dx.doi.org/10.1016/j.jisp.2020.05.002DOI Listing
November 2020

Advances in Stem Cell-Based Therapy for Hair Loss.

CellR4 Repair Replace Regen Reprogram 2020 2;8. Epub 2020 Sep 2.

Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.

Objective: Hair loss is a quite common condition observed in both men and women. Pattern hair loss also known as androgenetic alopecia is the most common form of hair loss that is thought to affect up to 80% of Caucasian men and up to 40% of Caucasian women by age of 70, and it can have quite devastating consequences on one's well-being, including lower self-esteem, depression and lower quality of life. To date there have only been 2 FDA approved medications, minoxidil and finasteride, but their effects are often unsatisfactory and temporary, in addition to having various adverse effects. Stem cell-based therapies have recently received lots of attention as potential novel treatments that focus on reactivating hair follicle stem cells and in this way enhance hair follicle growth, regeneration and development. Stem cell-based therapy approaches include stem cell transplant, stem cell-derived conditioned medium and stem cell-derived exosomes.

Materials And Methods: A combination of following key words was utilized for a PubMed search: cell-based therapy, hair loss, alopecia, hair regrowth; abstracts were screened and included based on the content relevant to hair loss and stem-cell based therapy.

Results: Preclinical research utilizing these approaches has blossomed in the past decade along with a more limited number of clinical studies, overall demonstrating very promising findings.

Conclusion: However, stem cell-based therapies for hair loss are still at their infancy and more robust clinical studies are needed to better evaluate their mechanisms of action, efficacy, safety, benefits and limitations. In this review, we provide the resources to the latest preclinical studies and a more detailed description of the latest clinical studies concerning stem cell-based therapies in hair loss.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508456PMC
September 2020

The Alopecia Areata Consensus of Experts (ACE) study part II: Results of an international expert opinion on diagnosis and laboratory evaluation for alopecia areata.

J Am Acad Dermatol 2021 Jun 12;84(6):1594-1601. Epub 2020 Sep 12.

Duke Dermatology Clinic-Clinic 3K, Durham, North Carolina.

Background: We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata.

Objective: To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata.

Methods: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%.

Results: Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]).

Limitations: The study had low representation from Africa, South America, and Asia.

Conclusion: There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care.
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http://dx.doi.org/10.1016/j.jaad.2020.09.028DOI Listing
June 2021

Thymol-Induced Chemical Leukoderma Successfully Treated with 308-Nanometer Excimer Laser.

Skin Appendage Disord 2020 Jul 2;6(4):244-246. Epub 2020 Jun 2.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami - Miller School of Medicine, Miami, Florida, USA.

Introduction: Chemical leukoderma (CL) is an acquired depigmenting disorder caused by repeated exposure to chemical compounds. Thymol is a phenol derivative used as a preservative or antiseptic in many commercially available products. Here, we present the second reported case of CL caused by a thymol-containing compound.

Case Presentation: A 48-year-old woman presented with a 4-month history of depigmentation of the nail folds of all ten fingers. This occurred after 1 month of twice-daily application of a thymol-containing compound intended for the removal of gel nails. No improvement was noted after the product was discontinued. There was no family history of vitiligo or other autoimmune disorders. On physical exam, depigmentation of all ten proximal and lateral nail folds was seen, with accentuation on Wood's lamp exam. Partial re-pigmentation was achieved after 32 treatments with 308-nm excimer laser.

Discussion: A thorough history and physical exam are instrumental in differentiating CL from other causes of depigmentation. Avoidance of the offending agent is an essential part of management. It is important to note that many cosmetic products are not tightly regulated by the FDA. Excimer laser is an effective treatment for CL with a favorable side-effect profile.
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http://dx.doi.org/10.1159/000507899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445539PMC
July 2020

How to Optimize Trichoscopy for Evaluation of Scalp Vessels.

Skin Appendage Disord 2020 Jul 25;6(4):216-219. Epub 2020 May 25.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Introduction: Trichoscopy greatly facilitates clinical diagnosis in patients with hair loss and may decrease the necessity for histopathological examination. Structures which may be revealed by trichoscopy include hair shafts, hair follicle openings, the perifollicular epidermis, and cutaneous microvessels. Cutaneous microvessels revealed in trichoscopy may vary in type and number depending on the scalp area, type of the disease, and its activity. Firm direct pressure (diascopy) might result in their blanching, but as of yet, there are no studies on the types of vessels that do or do not blanch on applying pressure.

Methods: We studied interfollicular twisted loops in 16 cases of biopsy-confirmed scalp psoriasis and 37 cases of arborizing vessels in normal subjects and seborrheic dermatitis patients.

Results: We observed that all arborizing red line vessels blanched on applying pressure. Instead, the vast majority of twisted and simple loops, despite their vascular nature, did not blanch on performing diascopy.

Conclusion: In the light of these findings, diascopy of vascular changes in hair loss patients might provide additional clues for a proper diagnosis, especially in differentiating scalp psoriasis, seborrheic dermatitis, and discoid lupus erythematosus.
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http://dx.doi.org/10.1159/000508166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445543PMC
July 2020

Hormonal Contraceptives and Dermatology.

Am J Clin Dermatol 2021 Jan;22(1):69-80

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA.

Hormones play a significant role in normal skin physiology and many dermatologic conditions. As contraceptives and hormonal therapies continue to advance and increase in popularity, it is important for dermatologists to understand their mechanisms and dermatologic effects given the intricate interplay between hormones and the skin. This article reviews the dermatologic effects, both adverse and beneficial, of combined oral contraceptives (COCs), hormonal intrauterine devices (IUDs), implants, injections, and vaginal rings. Overall, the literature suggests that progesterone-only methods, such as implants and hormonal IUDs, tend to trigger or worsen many conditions, including acne, hirsutism, alopecia, and even rosacea. Therefore, it is worthwhile to obtain detailed medication and contraceptive histories on patients with these conditions. There is sufficient evidence that hormonal contraceptives, particularly COCs and vaginal rings, may effectively treat acne and hirsutism. While there are less data to support the role of hormonal contraceptives in other dermatologic disorders, they demonstrate potential in improving androgenetic alopecia and hidradenitis suppurativa.
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http://dx.doi.org/10.1007/s40257-020-00557-5DOI Listing
January 2021

Aromatase inhibitor-induced hair loss in two adolescents.

Pediatr Dermatol 2020 Nov 1;37(6):1125-1127. Epub 2020 Sep 1.

Department of Dermatology and Cutaneous Surgery, University of Miami Hospital, Miami, Florida, USA.

Hair loss and thinning are possible complications in those undergoing endocrine therapies with aromatase inhibitors. Alopecia in pediatric patients undergoing endocrine therapy has not been previously reported. We describe two adolescents, 14 and 16 years of age, who developed androgenetic alopecia following treatment with anastrozole for idiopathic short stature. Accordingly, the possible adverse event of alopecia should be considered in the pediatric population undergoing treatment with aromatase inhibitors.
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http://dx.doi.org/10.1111/pde.14339DOI Listing
November 2020

Erythematous Papules Involving the Eyebrows in a Patient with a History of Rosacea and Hair Loss.

Skin Appendage Disord 2020 Jun 1;6(3):190-193. Epub 2020 Apr 1.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

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http://dx.doi.org/10.1159/000506749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325210PMC
June 2020
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