Publications by authors named "Poonkiat Suchonwanit"

64 Publications

Follicular Granular Parakeratosis: A Case Report, Literature Review, and Proposed Classification.

Skin Appendage Disord 2021 Feb 26;7(2):144-148. Epub 2021 Jan 26.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Granular parakeratosis (GP) is a distinctive acquired keratotic dermatosis that is usually presented with brownish-red hyperkeratotic papules and plaques in the intertriginous areas. Follicular involvement in GP could be either extending lesions from interfollicular epithelium or originating primarily from the follicular epithelium. The latter was named follicular GP and is considered an extremely rare condition. To our knowledge, there has been one reported case so far in the literature. We herein report the second case of follicular GP in a 52-year-old Thai man presenting with multiple tiny filiform hyperkeratotic papules on his face 2 weeks after using anti-melasma cream. We also propose a classification of GP based on its distinct clinical manifestations and histopathological findings.
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http://dx.doi.org/10.1159/000512950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991269PMC
February 2021

Comedone-Like Lesions as a Manifestation of Lichen Planopilaris beyond the Scalp: A Case Report with Dermoscopic Features and Literature Review.

Case Rep Dermatol 2021 Jan-Apr;13(1):106-113. Epub 2021 Feb 16.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Lichen planopilaris is a rare inflammatory condition that is also known as follicular lichen planus. Although the condition commonly affects the scalp, it sometimes involves the other regions of the body with a variety of clinical presentations. The involvement beyond the scalp is considered to be a generalized nature of disease process. In this report, we present a case of generalized follicular lichen planus in a 34-year-old Thai female presenting with comedone-like lesions on the trunk and extremities as well as scarring alopecia on the scalp. Dermoscopic features were also discussed.
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http://dx.doi.org/10.1159/000512711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989723PMC
February 2021

Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update.

Drug Des Devel Ther 2021 23;15:1285-1298. Epub 2021 Mar 23.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Treatment of extensive or recalcitrant alopecia areata (AA) is a major clinical challenge. Even after thorough investigation of several medications, its treatment outcomes have remained unsatisfactory. While there is no US Food and Drug Administration-approved medication for AA yet, topical immunotherapy has been a well-documented treatment option. Dinitrochlorobenzene, squaric acid dibutylester, and diphenylcyclopropenone are three substances that have demonstrated efficacy in the treatment of extensive or recalcitrant AA. Despite being commonly used, the mechanism underlying topical immunotherapy is not well-elucidated and a wide range of clinical efficacies have been reported in the literature. The aim of this review was to summarize and update the pharmacology, mechanism of action, therapeutic efficacy, and tolerability of topical immunotherapy in the treatment of AA.
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http://dx.doi.org/10.2147/DDDT.S297858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001176PMC
March 2021

Cutaneous, systemic features and laboratory characteristics of late- versus adult-onset systemic lupus erythematosus in 1006 Thai patients.

Lupus 2021 Apr 7;30(5):785-794. Epub 2021 Feb 7.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Age at disease onset may modulate systemic lupus erythematosus (SLE), but its relation to cutaneous/extracutaneous manifestation remains understudied.

Objective: To compare the cutaneous, systemic features, laboratory characteristics, and disease severity between late- and adult-onset SLE patients.

Methods: Analyses of the cutaneous, systemic involvement, laboratory investigations, SLE disease activity index 2000 (SLEDAI-2K), and disease damage were performed to compare between groups.

Results: Of 1006 SLE patients, 740 and 226 had adult- (15-50 years) and late-onset (>50 years), respectively. Among 782 with cutaneous lupus erythematosus (CLE), acute CLE (ACLE) and chronic CLE (CCLE) were more common in the adult- and late-onset SLE, respectively ( = 0.001). Multivariable logistic regression analysis demonstrated that male patients and skin signs, including papulosquamous subacute CLE, discoid lupus erythematosus, and lupus profundus, were associated with late-onset SLE (all  < 0.05). Late-onset SLE had lower lupus-associated autoantibodies, and systemic involvement (all  < 0.05). ACLE, CCLE, mucosal lupus, alopecia, and non-specific lupus were related to higher disease activity in adult-onset SLE (all  < 0.001). There was no difference in the damage index between the two groups.

Conclusions: Late-onset SLE had a distinct disease expression with male predominance, milder disease activity, and lower systemic involvement. Cutaneous manifestations may hold prognostic values for SLE.
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http://dx.doi.org/10.1177/0961203321991920DOI Listing
April 2021

Dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid: A comparative study of 100 patients with bullous pemphigoid and diabetes mellitus.

J Dermatol 2021 Apr 4;48(4):486-496. Epub 2021 Feb 4.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Dipeptidyl peptidase-4 inhibitor (DPP4i)-associated bullous pemphigoid (BP) has been emerging but whether it has genotype or phenotype differences from idiopathic BP (IBP) remains to be determined. We aimed to compare clinical characteristics, genetic susceptibility, laboratory features, disease activity, and outcomes between DPP4i-associated BP (DBP) and IBP occurring among patients with diabetes mellitus type 2 (T2DM). Medical records of patients diagnosed with BP and T2DM from January 2009 to December 2019 were retrospectively reviewed, and patients were categorized into DBP or IBP groups. Of 100 patients, 23 had DBP and 77 had IBP. There was no difference in the Bullous Pemphigoid Disease Activity Index score between the two groups; however, the score for urticaria and erythema was less in DBP (p < 0.001), indicating a non-inflammatory phenotype. The HLA-DQB1*03:01 allele was more commonly present in the DBP than IBP cases (odds ratio = 5.33 [95% confidence interval, 1.11-28.59], p = 0.016). The absolute eosinophil count was significantly lower in the DBP group (p = 0.002). Likewise, eosinophilic spongiosis was found less frequently in DBP cases (p = 0.005). Patients in the DBP group had a significantly higher percentage of complete remission on therapy compared to the IBP counterpart (p = 0.026) after DPP4i discontinuation. Moreover, the mean maximum dosage of prednisolone administrated per patient was significantly lower in drug-related cases (p = 0.012). In conclusion, our cohort in Thai patients with T2DM confirms the differences between phenotype and genotype characteristics of DBP and IBP. We emphasize the importance of drug discontinuation in all DPP4i-related cases because doing so may lead to a better disease outcome.
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http://dx.doi.org/10.1111/1346-8138.15778DOI Listing
April 2021

Are drug treatment strategies really effective against alopecia areata?

Expert Opin Pharmacother 2021 Feb 7;22(3):257-260. Epub 2020 Dec 7.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University , Bangkok, Thailand.

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http://dx.doi.org/10.1080/14656566.2020.1854728DOI Listing
February 2021

Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians.

Dermatol Ther (Heidelb) 2021 Feb 5;11(1):131-147. Epub 2020 Dec 5.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Introduction: Cutaneous manifestations are central to the primary diagnosis of systemic lupus erythematosus (SLE). However, information on the clinical, histopathologic, and direct immunofluorescence (DIF) features among subtypes of cutaneous lupus erythematosus (CLE), as well as longitudinal prospective observational study to evaluate the natural history and the progression to SLE, is lacking among Asians. Our objectives are to summarize the differences in the clinical, histopathologic, and DIF characteristics and serological profiles between various subtypes of CLE, and to provide its natural history and the association with disease activity in our Asian population.

Methods: A prospective observational study on CLE patients was performed between May 2016 and May 2020. Patients underwent full physical/dermatologic examination, skin biopsy for histology, and DIF. Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores and laboratory data were evaluated. Time schedule and characteristics for resolution and/or the disease progression to SLE were recorded in subsequent follow-ups.

Results: Of 101 biopsy-proven CLE patients, 25 had acute CLE (ACLE), 8 had subacute CLE (SCLE), 39 had chronic CLE (CCLE) only, 22 had CCLE with SLE, and 7 had LE-nonspecific cutaneous lesions only. Patients with exclusive CLE showed lower female preponderance, serological abnormalities, and correlation to systemic disease. However, when CLE was accompanied with any LE-nonspecific cutaneous manifestations, they were associated with high antinuclear antibody (ANA) titer, renal, hematologic, joint involvement, and greater SLEDAI score. Of 207 biopsy sections, SCLE/CCLE regardless of systemic involvement showed significantly higher percentage of superficial/deep perivascular and perieccrine infiltration than ACLE. On DIF, deposition of multiple immunoreactants was associated with higher systemic disease. Approximately 10% of CLE-only patients later developed SLE but had mild systemic involvement.

Conclusion: Our findings support that each CLE subtype has a diverse and unique character. Comprehensive understanding of the differences among CLE subtypes is important for achieving the correct diagnosis and providing appropriate disease monitoring and management.
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http://dx.doi.org/10.1007/s13555-020-00471-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859020PMC
February 2021

Trichostasis Spinulosa: A Case Report with an Unusual Presentation.

Case Rep Dermatol 2020 Sep-Dec;12(3):178-185. Epub 2020 Oct 30.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Trichostasis spinulosa (TS) is a follicular disorder characterized by the retention of multiple vellus hairs in a hyperkeratotic dilated hair follicle. TS is considered as a common disorder; however, it is often underdiagnosed due to its asymptomatic nature. Although the condition frequently affects the face or extremities, the widespread distribution of TS over the entire body has been once reported in a patient with chronic renal failure. To emphasize the infrequent presentation of TS, we herein report a 57-year-old male with an unusual location of TS.
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http://dx.doi.org/10.1159/000509993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670378PMC
October 2020

Clinical and Onychoscopic Features of Benign and Malignant Conditions in Longitudinal Melanonychia in the Thai Population: A Comparative Analysis.

Clin Cosmet Investig Dermatol 2020 19;13:857-865. Epub 2020 Nov 19.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Longitudinal melanonychia can arise from many underlying conditions, both benign and malignant. Practitioners tend to be reluctant to perform a biopsy of this condition due to procedure-related pain and the possibility of permanent nail dystrophy. Onychoscopy has become a useful tool to provide a provisional diagnosis and assist in deciding on a nail biopsy.

Objective: To investigate and differentiate the clinical and onychoscopic features of subungual melanoma (SUM)/subungual melanoma in situ (SMIS) and other benign melanocytic conditions (BM).

Materials And Methods: In this cross-sectional study, a total of 32 cases of longitudinal melanonychia were examined, and baseline characteristics were recorded. Onychoscopic pictures were taken by handheld dermoscopy with 10x and 50x magnification. A biopsy was then performed in each case, and a pathological diagnosis was obtained.

Results: Of the 32 cases, 6 were diagnosed with SMIS and 26 with BM (21 simple lentigines, 5 junctional nevi). The median age was significantly higher among the SMIS group (56 vs 31 years) (p = 0.034). Regarding onychoscopic findings, cases with SMIS were significantly associated with a greater band width percentage (p = 0.014), multicolor presentation (p = 0.005), the presence of granular pigmentation (p = 0.034), and micro-Hutchinson's sign (p = 0.015). In addition, subungual hyperkeratosis, a newly recognized onychoscopic feature, was more significantly associated with SMIS in comparison to BM (p = 0.002).

Conclusion: Onychoscopy provides useful information to aid in the differential diagnosis of longitudinal melanonychia. From our study, onychoscopy can be utilized to assist in making a decision whether to perform a biopsy in patients with longitudinal melanonychia suspicious of malignant melanocytic conditions.
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http://dx.doi.org/10.2147/CCID.S283112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683522PMC
November 2020

Characterization and classification of different female hairline patterns in the Thai population.

J Cosmet Dermatol 2021 Mar 11;20(3):890-896. Epub 2020 Aug 11.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: The hairline is an essential component of the human face. Disfigurement of the hairline may cause physical and psychological problems. Standard guidelines do not exist for female hairline designs, average values of infratemporal portion, hairline classifications, and preferences.

Aims: We aimed to study hairline characteristics in Thai females and further compare the values with previous studies in different populations. Furthermore, we aimed to introduce a comprehensive hairline classification system that allowed an easy and detailed phenotypic characterization of female hairline.

Patients/methods: Healthy Thai females aged over 18 years were included in the study. Collection of demographic data, infratemporal measurements, and standard photography was performed. All collected data were analyzed to determine the standard values of each hairline dimension for comparison to previous studies.

Results: Two hundred and twenty-nine females, with a mean age of 32.4 ± 8.6 years, participated in this study. The mean mid-frontal line was 6.45 ± 0.89 cm, which was not correlated with age. Lateral mounds, widow's peaks, and cowlicks were observed in 42.35%, 24.45%, and 1.74% participants, respectively. Our study revealed five patterns of the frontal hairline and four patterns of the temporal hairline. The mid-frontal line in Asian females trended longer than that in Caucasians, without statistical significance.

Conclusions: Measurements of the infratemporal portions in Thai females revealed no change with age, and the mid-frontal line showed no statistically significant differences between Korean and Turkish participants. The hairline classification system introduced in our study was comprehensive and would be easily applicable in clinical practice. Female hairline dimensions and patterns reported in our study could provide reference values for hairline design in hairline restoration surgery as well as assist in accurate diagnosis of hair disorders.
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http://dx.doi.org/10.1111/jocd.13642DOI Listing
March 2021

Prognostic Value of Concurrent Expression of C-MYC and BCL2 in Intravascular Large B-Cell Lymphoma: A 10-Year Retrospective Study.

Biomed Res Int 2020 22;2020:1350820. Epub 2020 May 22.

Division of Dermatology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Intravascular large B-cell lymphoma (IVLBCL) is a variant of extranodal diffuse large B-cell lymphoma (DLBCL), characterized by the presence of a B-lymphoma cell in the lumina of small blood vessels or capillaries. Due to its extremely variable clinical manifestations, IVLBCL typically results in a delayed diagnosis and poor disease prognosis. Skin biopsy, particularly random skin biopsy, has shown a potential role in the diagnosis of IVLBCL. However, information of clinicopathological features in patients with IVLBCL diagnosed by skin biopsy is limited.

Objectives: To study the clinicopathological features in relation to immunohistochemical features and to identify prognostic factors in IVLBCL patients diagnosed by skin biopsy.

Materials And Methods: Clinical characteristics; laboratory, histological, and immunohistochemical findings; and therapeutic response of all biopsy-confirmed IVLBCL patients during the years 2008-2017 were retrospectively reviewed.

Results: The mean age was 67.4 (±9.8) years. Fever was the most common presenting symptom, accounting for 64.7%. Cutaneous and bone marrow involvement was found in 23.5% and 35.3% of patients, respectively. Patients receiving R-CHOP showed more favorable therapeutic outcome. C-MYC/BCL2 double expressors showed significantly higher incidence rate to mortality compared with nondouble expressors ( = 0.042). One-year and two-year overall survival rates were 67.2% and 53.8%, respectively.

Conclusions: Skin biopsy is an effective diagnostic method for IVLBCL. Concurrent expression of C-MYC and BCL2 may be a useful prognostic indicator and should be performed in order to predict the prognosis in IVLBCL patients.
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http://dx.doi.org/10.1155/2020/1350820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273482PMC
March 2021

Topical finasteride for the treatment of male androgenetic alopecia and female pattern hair loss: a review of the current literature.

J Dermatolog Treat 2020 Jun 26:1-6. Epub 2020 Jun 26.

Department of Medicine, Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Androgenetic alopecia (AGA) is a frequently encountered dermatological concern that impacts a patient's self-esteem and quality of life. Finasteride is a selective 5-alpha reductase inhibitor that has been approved for the treatment of male AGA and the off-label use in female pattern hair loss (FPHL); however, its adverse effects may limit its use. Topical finasteride is a new formulation that aims to decrease complications caused by oral administration. This review assesses the pharmacology, current therapeutic use, and safety of topical finasteride for the treatment of AGA and FPHL. A PubMed search was conducted to include all English language articles on topical finasteride from January 1992 to January 2020. A total of 33 articles including 28 topical finasteride related articles and five AGA related articles were included in this review. Multiple studies on topical finasteride as the treatment for male AGA and FPHL showed positive results with a favorable safety profile. Topical finasteride is a promising therapeutic option. We emphasize the importance of continued research for the establishment of a novel therapeutic agent.
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http://dx.doi.org/10.1080/09546634.2020.1782324DOI Listing
June 2020

The study of hair follicle counts from scalp histopathology in the Thai population.

Int J Dermatol 2020 Aug 5;59(8):978-981. Epub 2020 Jun 5.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: The horizontal section of a scalp specimen offers an advantage over a vertical section by providing quantitative information. The reference data for hair counts in Asians, including Thais, are inconclusive. We aimed to determine the normal values of hair counts in scalp biopsy specimens in the Thai population.

Methods: A 4-mm punch biopsy was performed at the occipital area of the scalp from subjects presenting with clinically normal hair and scalp appearance. All specimens were horizontally sectioned and observed to assess the number of follicular units and hair follicles, type of hairs, and phase of the hair cycle. The results were further compared between sexes and with the pre-existing data from previous studies.

Results: Ninety specimens were collected from 90 subjects. The average number of total hairs, terminal hairs, vellus hairs, and follicular units per 4-mm punch scalp skin were 20.5 ± 5.2, 18.2 ± 4.1, 2 (range 0-7), and 9.1 ± 1.6, respectively. The mean ratio of terminal to vellus hair was 8.9:1 and of anagen to telogen hair was 91.9:7.9. There were no gender differences in any of the parameters and no correlations with changing age. Compared to other Asian populations, Thais and Taiwanese showed intermediate values between Iranians and Koreans; when compared to other ethnic groups, hair density in Asians showed lower than Caucasians and Hispanics but was comparable to Africans.

Conclusion: This study established reference values of scalp horizontal sections in the Thai population; this will be helpful for clinicians and researchers to evaluate hair disorders.
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http://dx.doi.org/10.1111/ijd.14989DOI Listing
August 2020

Diagnostic and prognostic values of cutaneous manifestations in COVID-19.

Dermatol Ther 2020 07 2;33(4):e13650. Epub 2020 Jun 2.

Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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http://dx.doi.org/10.1111/dth.13650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267114PMC
July 2020

A comparison of the efficacy and tolerability of three corticosteroid treatment regimens in patients with alopecia areata.

J Dermatolog Treat 2020 Jun 9:1-6. Epub 2020 Jun 9.

Faculty of Medicine, Division of Dermatology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Topical corticosteroids (TC) and/or intralesional corticosteroids (IC) are considered first-line treatments for patch-type alopecia areata (AA). However, the efficacies of TC monotherapy, IC monotherapy, and combined topical and intralesional corticosteroids (CC) in patients with AA have never been compared. To evaluate and compare the efficacy and tolerability of 3 corticosteroid treatments (TC, IC, and CC) in patients with AA. A study of patients with AA who received TC, IC, or CC was conducted. Outcomes including initial hair regrowth (25% regrowth), significant hair regrowth (>80% regrowth), and adverse events were statistically compared. Cox proportional hazards regression analysis was used to identify factors that influence the treatment response. One hundred and forty-eight patients were eligible for analysis. The response rates of initial and significant hair regrowth were comparable among 3 treatment groups. Multivariate analysis revealed that an AA treatment duration of longer than 6 months was associated with a lower probability of significant hair regrowth. A small proportion of patients experienced adverse effects. The 3 corticosteroid treatment regimens are effective, safe, and show no significant differences in treatment outcomes. However, an AA duration longer than 6 months portends a lack of significant hair regrowth.
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http://dx.doi.org/10.1080/09546634.2020.1773384DOI Listing
June 2020

Asian Hair: A Review of Structures, Properties, and Distinctive Disorders.

Clin Cosmet Investig Dermatol 2020 24;13:309-318. Epub 2020 Apr 24.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Asian hair is known for its straightness, dark pigmentation, and large diameter. The cuticle layer in Asians is thicker with more compact cuticle cells than that in Caucasians. Asian hair generally exhibits the strongest mechanical properties, and its cross-sectional area is determined greatly by genetic variations, particularly from the gene. However, knowledge on Asian hair remains unclear with limited studies. This article aimed to review and summarize the characteristics and properties of Asian hair. It also aimed to discuss hair disorders including linear lupus panniculitis and pseudocyst of the scalp that occur distinctively in Asian populations.
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http://dx.doi.org/10.2147/CCID.S247390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187942PMC
April 2020

UV308 excimer lamp phototherapy for the treatment of alopecia areata: A randomized, self-controlled study.

Photodermatol Photoimmunol Photomed 2020 Sep 28;36(5):405-407. Epub 2020 May 28.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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http://dx.doi.org/10.1111/phpp.12570DOI Listing
September 2020

Cutaneous manifestations in COVID-19: Lessons learned from current evidence.

J Am Acad Dermatol 2020 Jul 24;83(1):e57-e60. Epub 2020 Apr 24.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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http://dx.doi.org/10.1016/j.jaad.2020.04.094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194618PMC
July 2020

Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date.

Drug Des Devel Ther 2020 2;14:951-959. Epub 2020 Mar 2.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

The currently approved treatment for female pattern hair loss (FPHL) includes topical minoxidil administration; however, this treatment fails to achieve hair regrowth in some patients. Finasteride, a selective 5α-reductase inhibitor (5-ARI), may be considered as an alternative treatment. However, because of its potential teratogenic effects, clinical studies and use of finasteride for FPHL are limited. In this review, we aim to summarize the literature regarding the pharmacology, clinical efficacy, and adverse effects of oral finasteride for the treatment of FPHL and to provide novel therapeutic options including topical finasteride and dutasteride, a new generation 5-ARI, for the treatment of FPHL.
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http://dx.doi.org/10.2147/DDDT.S240615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060023PMC
February 2021

A comprehensive review of treatment options for recalcitrant nongenital cutaneous warts.

J Dermatolog Treat 2020 Mar 11:1-18. Epub 2020 Mar 11.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

The treatment of recalcitrant nongenital cutaneous warts has always been challenging for dermatologists as they often recur and relapse. Multiple treatment options have been investigated to improve the outcome. This review provides an overview of the current treatment modalities and summarizes the efficacy and side effects of each treatment option for recalcitrant nongenital cutaneous warts. A PubMed search was performed through July 2019 to include all English language reports investigating the treatment for recalcitrant nongenital cutaneous warts, regardless of design. A total of 144 studies were included in this review. The treatment options for recalcitrant nongenital cutaneous warts can be divided into three groups: destructive treatment, immunotherapy, and cytotoxic agents. Although both destructive therapies and cytotoxic agents demonstrated high complete response rates, immunotherapy, which is a minimally invasive method, was superior in terms of the clearance of distant warts. Intralesional mumps-measles-rubella injections and purified protein derivatives currently demonstrate high efficacy with well-established clinical evidence. Many upcoming treatment modalities, especially immunotherapy, are promising. However, more comparative studies are required to verify the efficacy and safety profile.
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http://dx.doi.org/10.1080/09546634.2020.1737635DOI Listing
March 2020

Evaluation of Hair Density and Hair Diameter in the Adult Thai Population Using Quantitative Trichoscopic Analysis.

Biomed Res Int 2020 10;2020:2476890. Epub 2020 Feb 10.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

The data of hair density and hair diameter in the Asian population, especially in Thais, are limited. We aimed to evaluate hair density and hair diameter of members of the Thai population at different scalp sites and to determine the effect of sex and aging as well as to compare the results with those in groups of other ethnicities. Healthy Thais whose hair examination findings were normal were evaluated. Two hundred and thirty-nine subjects participated in this study, of whom 79 were male and 160 were female. Hair density and hair diameter were analyzed at four different scalp sites using quantitative trichoscopic analysis. The highest hair density in Thais was observed in the vertex area. Hair densities at four different scalp sites were significantly different from one another; only hair density at the vertex site showed no significant difference from that in the occipital area. In contrast, hair diameter did not show any statistically significant differences for the different sites. We observed decreased mean hair density with increasing age and found statistically significant differences between participants in their 20s and those in their 60s, while hair diameter remained consistent. Comparing our results with a previous study in other ethnicities, the hair densities in Asians are generally lower. In conclusion, hair density in the Thai population varies at different scalp sites. Aging is a factor in declining hair density. Asians have a lower hair density compared to Caucasian and African populations.
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http://dx.doi.org/10.1155/2020/2476890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035527PMC
November 2020

Response to: "Comment on: 'Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses'".

J Am Acad Dermatol 2020 05 19;82(5):e171. Epub 2020 Jan 19.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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http://dx.doi.org/10.1016/j.jaad.2020.01.022DOI Listing
May 2020

Darier's Disease: Report of a Case with Facial Involvement.

Case Rep Dermatol 2019 Sep-Dec;11(3):327-333. Epub 2019 Dec 10.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Darier's disease is a relatively rare autosomal dominant genodermatosis with a defect in the desmosomal attachment due to a mutation in the gene. The condition is characterized by multiple hyperkeratotic papules predominantly in seborrheic areas on the head, neck, and trunk, with less frequent involvement of the oral mucosa. Histopathologically, the lesions reveal suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells. Facial involvement in Darier's disease is one of the common presenting features. However, it has been once reported in a severe, chronic form as leonine facies in a long-standing case. To raise awareness of facial involvement in Darier's disease, we herein report a 65-year-old female patient with prominent facial lesions.
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http://dx.doi.org/10.1159/000504925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940465PMC
December 2019

A Comparison of Azathioprine and Mycophenolate Mofetil as Adjuvant Drugs in Patients with Pemphigus: A Retrospective Cohort Study.

Dermatol Ther (Heidelb) 2020 Feb 21;10(1):179-189. Epub 2019 Dec 21.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital-Mahidol University, Bangkok, Thailand.

Introduction: Azathioprine (AZA) and mycophenolate mofetil (MMF) are both first-line steroid-sparing agents used for the treatment of pemphigus in combination with a corticosteroid, but few studies to date have directly compared these two combination treatment modalities. The aim of this study was to compare the efficacy and safety of each of these agents as adjuvant therapy with the corticosteroid prednisolone for the treatment of pemphigus, using standardized outcome parameters.

Methods: This was a retrospective study of patients with pemphigus who received corticosteroid therapy in combination with either AZA or MMF at the Autoimmune Blistering Skin Diseases Clinic of Ramathibodi Hospital (Bangkok) between January 2007 and July 2017. The treatment response was evaluated using early [end of the consolidation phase (ECP)] and late endpoints [complete remission (CR) on therapy, CR off therapy and immunological remission]. Cumulative steroid use, relapse rate and adverse events in each treatment group were also compared.

Results: Of the 62 patients with pemphigus included in the study, 37 were treated with prednisolone plus AZA as adjuvant (AZA group) and 25 patients were treated with prednisolone plus MMF as adjuvant (MMF group). The majority of patients in both treatment groups reached the ECP (AZA group 88.2%; MMF group 71.4%; between-group difference not statistically significant at p = 0.156); the median time required to achieve this early endpoint was also comparable (p = 0.362). A high percentage of patients in both the AZA and MMF groups attained CR on therapy (AZA 73%; MMF 72%). The total number of patients who achieved CR on and off therapy were comparable in the two groups (p = 0.933 and p = 0.690, respectively). However, the median time for patients to achieve CR on therapy was significantly shorter for those on MMF than for those on AZA (7.3 vs. 12.5 months; p = 0.019), and the cumulative steroid dose required for patients to achieve CR both on and off therapy was significantly lower in the MMF group than in the AZA group (p = 0.007 and p = 0.043, respectively).

Conclusion: While corticosteroid in combination with either AZA or MMF is an effective therapeutic regimen for the treatment of pemphigus, MMF demonstrates a shorter time to achieve CR on therapy and has a significantly higher steroid-sparing effect.
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http://dx.doi.org/10.1007/s13555-019-00346-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994636PMC
February 2020

Fibrosing Alopecia in a Pattern Distribution: A Case Report and Literature Review.

Case Rep Dermatol 2019 Sep-Dec;11(3):297-302. Epub 2019 Oct 16.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Fibrosing alopecia in a pattern distribution (FAPD) is a relatively new entity in the family of cicatricial alopecia. It has been categorized as a member of the lichen planopilaris (LPP) group due to its similarity in clinical and histopathological presentation. Nonetheless, the disease earns its own entity due to its lichenoid inflammation exclusively involving miniaturized hair and area of involvement mimicking pattern hair loss which differentiates itself from other types of LPP or pattern hair loss. Since its first introduction by Zinkernagel and Trüeb in 2000, there have been only few case reports and series of FAPD. We herein report a case of FAPD in a postmenopausal woman who had progressive hair loss over the course of 10 years.
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http://dx.doi.org/10.1159/000503681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873076PMC
October 2019

A Case Report of Idiopathic Follicular Hyperkeratotic Spicules and Literature Review.

Case Rep Dermatol 2019 Sep-Dec;11(3):278-285. Epub 2019 Oct 2.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Follicular hyperkeratotic spicules is a rare skin disorder that is usually associated with multiple myeloma. The condition typically presents with tiny hyperkeratotic spicules in follicular distribution and predominantly on the face. To our knowledge, there has been one reported case of this condition without underlying disease. We herein report the second case of idiopathic follicular hyperkeratotic spicules in a 54-year-old Thai woman presenting with multiple follicular horn-like spicules on her face and neck.
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http://dx.doi.org/10.1159/000503272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6872986PMC
October 2019

Frontal fibrosing alopecia in Asians: a retrospective clinical study.

Int J Dermatol 2020 Feb 11;59(2):184-190. Epub 2019 Oct 11.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailands.

Background: Frontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia and predominantly occurs in postmenopausal women. The condition is increasing in prevalence worldwide. However, there is a paucity of information regarding FFA in Asians because of a lack of published literature. We aimed to describe the demographics, clinical and trichoscopic features, and treatment outcomes of FFA in Asian patients.

Methods: We conducted a retrospective clinical study including patients diagnosed with FFA. Data regarding demographics, clinical and trichoscopic findings, and treatment outcomes were collected. The data were analyzed using descriptive statistics.

Results: Fifty-six Thai patients with FFA met the inclusion criteria. There were 54 females (96.4%) and two males (3.6%), and the average age of disease onset was 51.3 ± 6.3 years. All patients presented with frontotemporal hairline recession, and 49 patients (87.5%) experienced eyebrow loss. Trichoscopy in 35 patients revealed follicular dropout, perifollicular erythema, and lonely hair in 35 (100%), 29 (82.8%) and 26 patients (74.2%), respectively. Disease stabilization was superiorly observed in patients treated with a combination of topical corticosteroids and hydroxychloroquine or finasteride (79.3% and 73.3%, respectively).

Conclusion: Our study presents the largest series of FFA in Asians and reports mixed clinical patterns between Caucasian and African patients. Combination therapy of topical corticosteroids and hydroxychloroquine or the use of topical corticosteroids and finasteride may halt the progression of FFA in Asians.
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http://dx.doi.org/10.1111/ijd.14672DOI Listing
February 2020

Linear and Annular Lupus Panniculitis of the Scalp: Case Report with Emphasis on Trichoscopic Findings and Review of the Literature.

Case Rep Dermatol 2019 May-Aug;11(2):157-165. Epub 2019 Jun 6.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Linear and annular lupus panniculitis of the scalp (LALPS) is a unique subset of lupus panniculitis, which results in non-scarring alopecia along the Blaschko line of the scalp in an otherwise healthy young patient. Numerous cases have been reported around the world, but data on their trichoscopic findings and correlations with the underlying pathology is sparse. We hereby present a case of 23-year-old male with LALPS and further describe his trichoscopic findings as well as their correlations with histopathological features.
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http://dx.doi.org/10.1159/000500848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738250PMC
June 2019

Eyebrow growth pattern analysis in patients with eyebrow hypotrichosis after receiving topical treatment: A retrospective study.

J Cosmet Dermatol 2020 Jun 21;19(6):1404-1408. Epub 2019 Sep 21.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Differences in growth patterns among the various parts of the eyebrow have been observed.

Aims: We aimed to investigate changes in the hair density and diameter and analyze the eyebrow growth pattern of each eyebrow part (head, body, and tail) in patients with eyebrow hypotrichosis over a 24-week course of topical treatment.

Patients/methods: A retrospective study of 48 patients who received treatment with bimatoprost 0.01% was conducted. Patient demographic data were collected; measurements of hair density and diameter in the different parts of the eyebrow were collected and statistically evaluated.

Results: The tail of the eyebrow revealed the lowest baseline eyebrow density and diameter. Significant changes in eyebrow density (P = .01) and diameter (P = .01) were first detected in the tail at 4 and 16 weeks of treatment, respectively. The head and body showed a comparable growth pattern.

Conclusions: This study confirms the previous observations that hair density, diameter, pattern of growth, and hair growth cycle vary according to their anatomical location within the eyebrow. A better understanding of eyebrow growth pattern could provide the precise pathomechanism of eyebrow hypotrichosis leading to a standardized treatment protocol.
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http://dx.doi.org/10.1111/jocd.13167DOI Listing
June 2020

Minoxidil and its use in hair disorders: a review.

Drug Des Devel Ther 2019 9;13:2777-2786. Epub 2019 Aug 9.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Minoxidil was first introduced as an antihypertensive medication and the discovery of its common adverse event, hypertrichosis, led to the development of a topical formulation for promoting hair growth. To date, topical minoxidil is the mainstay treatment for androgenetic alopecia and is used as an off-label treatment for other hair loss conditions. Despite its widespread application, the exact mechanism of action of minoxidil is still not fully understood. In this article, we aim to review and update current information on the pharmacology, mechanism of action, clinical efficacy, and adverse events of topical minoxidil.
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http://dx.doi.org/10.2147/DDDT.S214907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938PMC
April 2020