Subject(s)
Dermatologic Agents/therapeutic use , Dermatology/standards , Health Services Accessibility/organization & administration , Healthcare Disparities , Medically Uninsured/statistics & numerical data , Adult , Delivery of Health Care , Dermatologic Agents/economics , Dermatology/trends , Female , Humans , Male , Medicaid/economics , Middle Aged , Needs Assessment , Outcome Assessment, Health Care , Patient Protection and Affordable Care Act , Risk Assessment , Skin Diseases/diagnosis , Skin Diseases/drug therapy , Socioeconomic Factors , United StatesABSTRACT
Alopecia areata (AA) is an autoimmune disease directed at the hair follicle. Although usually limited to patchy hair loss over the scalp (focalis), AA can present as total loss of scalp hair (totalis; AT) or as total loss of both scalp and body hair (universalis; AU). Management of AT and AU can be challenging, and although multiple treatment modalities have been explored, no therapy is currently FDA-approved. This review focuses on the evidence for current treatment options for AT and AU. The PubMed database was searched from January 1, 2000, to September 1, 2016, for clinical trials, retrospective studies, and case reports of treatments for AT and AU. A total of 40 studies were retrieved and analyzed. Therapies studied for AT/AU included: topical immunotherapy, steroids, photodynamic therapy, immunosuppressive agents, TNFα inhibitors, and other therapies, such as sulfasalazine, bexarotene, JAK inhibitors, and simvastatin/ezetimibe. Although certain treatments showed significant hair regrowth, no treatment was completely effective. The most promising therapies with the highest quality data include diphenylcyclopropenone, squaric acid dibutylester, photodynamic therapy, steroids, and cyclosporine in combination with methylprednisolone. High-quality randomized-controlled trials with large sample sizes are lacking. Unified outcome guidelines are encouraged to facilitate the comparison of future studies.
Subject(s)
Alopecia/drug therapy , Glucocorticoids/therapeutic use , Immunologic Factors/administration & dosage , Photochemotherapy , Administration, Cutaneous , Administration, Oral , Humans , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Steatocystoma multiplex is a well-recognized condition in which subjects develop dermal cysts generally inherited in an autosomal dominant fashion, though these can occur sporadically. This case report describes the successful treatment of a 51-year-old woman with steatocystomata limited to the face, who after two treatments with a fractionated ablative carbon dioxide laser remained free of cysts for three years. We conclude that this treatment should be considered as an efficient and effective treatment option for patients with steatocystoma multiplex.
Subject(s)
Carbon Dioxide/therapeutic use , Face/surgery , Laser Therapy/methods , Steatocystoma Multiplex/surgery , Face/pathology , Female , Humans , Middle Aged , Patient Satisfaction , Steatocystoma Multiplex/pathology , Treatment OutcomeABSTRACT
Secukinumab (also known as AIN-457) is a human monoclonal antibody targeting IL-17A, which has been recently FDA-approved for the treatment of moderate to severe psoriasis and psoriatic arthritis with coexistent moderate to severe plaque psoriasis based on clinical trials demonstrating excellent efficacy. This review will address the rationale for targeting the IL-23/Th17/IL-17 axis, the role of IL-17 and Th17 cells in psoriasis and other chronic inflammatory diseases, and will examine pre-clinical studies, pharmacologic properties, clinical efficacy, and the safety profile of secukinumab.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Arthritis, Psoriatic/drug therapy , Psoriasis/drug therapy , Animals , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Arthritis, Psoriatic/pathology , Dermatologic Agents/adverse effects , Dermatologic Agents/therapeutic use , Humans , Interleukin-17/antagonists & inhibitors , Psoriasis/pathology , Severity of Illness IndexABSTRACT
Objective. We report a rare case of keloidal scleroderma and provide an analysis of similar cases. Results. A 41 year-old woman presented with dark brown, indurated, exophytic nodules over the chest along with smaller hyperpigmented plaques scattered over the abdomen, with concomitant sclerodactyly. The clinical, laboratory, and pathological findings were consistent with a diagnosis of keloidal scleroderma. The patient was treated with methotrexate, resulting in reduced firmness of her plaques and no new lesions. A literature review of previously reported cases was performed using keywords including keloidal morphea, keloidal scleroderma, nodular morphea, and nodular scleroderma. In our review, the majority of patients were African American and female. 91% of cases had nodular lesions with distribution on the trunk. The majority of patients exhibited sclerodactyly and pulmonary involvement was reported in 28%1. The majority of patients were ANA positive (63%) and only 10% demonstrated anti-SCL-70 positivity. Conclusion. Keloidal scleroderma is a rare presentation, which can often be clinically confused with keloid and scar formation. Due to this being a rare variant, our knowledge of treatment options and efficacy is limited. Methotrexate could be considered as an initial treatment option for patients with progressive keloidal scleroderma.
