The growth of human scalp hair mediated by visible red light laser and LED sources in males.

BACKGROUND AND OBJECTIVES: Low level laser therapy (LLLT) has been used to promote hair growth. A double-blind randomized controlled trial was undertaken to define the safety and physiologic effects of LLLT on males with androgenic alopecia. METHODS: Forty-four males (18-48 yo, Fitzpatrick I-IV, Hamilton-Norwood IIa-V) were recruited. A transition zone scalp site was selected; hairs were trimmed to 3 mm height; the area was tattooed and photographed. The active group received a "TOPHAT655" unit containing 21, 5 mW lasers (655 ± 5 nm), and 30 LEDS (655 ± 20 nm), in a bicycle-helmet like apparatus. The placebo group unit appeared identical, containing incandescent red lights. Patients treated at home every other day × 16 weeks (60 treatments, 67.3 J/cm(2) irradiance/25 minute treatment), with follow up and photography at 16 weeks. A masked 2.85 cm(2) photographic area was evaluated by another blinded investigator. The primary endpoint was the percent increase in hair counts from baseline. RESULTS: Forty-one patients completed the study (22 active, 19 placebo). No adverse events or side effects were reported. Baseline hair counts were 162.7 ± 95.9 (N = 22) in placebo and 142.0 ± 73.0 (N = 22) and active groups respectively (P = 0.426). Post Treatment hair counts were 162.4 ± 62.5 (N = 19) and 228.7 ± 102.8 (N = 22), respectively (P = 0.0161). A 39% percent hair increase was demonstrated (28.4 ± 46.2 placebo, N = 19; 67.2 ± 33.4, active, N = 22) (P = 0.001) Deleting one placebo group subject with a very high baseline count and a very large decrease, resulted in baseline hair counts of 151.1 ± 81.0 (N = 21) and 142.0 ± 73.0 (N = 22), respectively (P = 0.680). Post treatment hair counts were 158.2 ± 61.5 (N = 18) and 228.7 ± 102.8 (N = 22) (P = 0.011), resulting in a 35% percent increase in hair growth (32.3 ± 44.2, placebo, N = 18; 67.2 ± 33.4, active, N = 22) (P = 0.003). CONCLUSIONS: LLLT of the scalp at 655 nm significantly improved hair counts in males with androgenetic alopecia.

Clinical management with efalizumab of a patient with psoriasis and comorbid vitiligo.

Although the precise pathogenesis is not known, vitiligo appears to be an autoimmune disease involving T cell-mediated melanocyte destruction. Efalizumab, a recombinant, humanized monoclonal antibody, targets T cells, the key mediators of the immunopathogenesis of psoriasis. Although a concomitant presentation of vitiligo with psoriasis is uncommon, several cases have been reported previously in the literature. A case of a patient with vitiligo and psoriasis who was treated with efalizumab to alleviate the symptoms of psoriasis is described. Over the course of the diseases, the patient had been treated unsuccessfully with numerous therapies. The patient initiated efalizumab with a 0.7 mg/kg conditioning dose and then continued on 1 mg/kg weekly. After 2 months of efalizumab therapy, the psoriasis symptoms were reduced, and the vitiligo had visibly improved in some areas. The patient has remained on efalizumab therapy with no evidence of an exacerbation of vitiligo. The management of acute flares is also discussed. This case is illustrative of a patient with psoriasis and vitiligo who was treated successfully with efalizumab.

The role of Chlamydia pneumoniae in the etiology of acne rosacea: response to the use of oral azithromycin.

Acne rosacea is a chronic skin disorder that requires long-term therapy. Oral azithromycin has been used successfully to treat acne vulgaris. an observation that suggested an infectious agent may play an active role in the etiology of this disorder. Ten adults (not previously reported) with acne rosacea were selected to be treated with oral azithromycin. Nine of the 10 subjects received 250 mg 3 times weekly for periods ranging from 5 to 19 weeks, at which time follow-up examinations were performed on 8 of the 9 treated subjects: 1 subject was lost to follow-up. Prior to therapy. C pneumoniae antigen was detected in malar biopsy specimens in 4 of 10 subjects by immunoperoxidase technique (using monoclonal antibody to C pneumoniae). Serum antibodies against C pneumoniae were detected in 8 of 10 intent-to-treat subjects. Using polymerase chain reaction, C pneumoniae was not detected in peripheral blood mononuclear cells. The inflammatory response in tissues was characterized by a widespread infiltration of polymorphonuclear neutrophil cells, lymphocytes, and plasma cells, which support the clinical diagnosis of acne rosacea. Nine of 10 subjects treated with azithromycin showed moderate to marked improvement of their acne rosacea. No adverse reactions to azithromycin occurred. and the drug appeared to be safe and effective. These preliminary data suggest the need for further investigation with clinical trials to study long-term tolerability and efficacy and also strongly implicate C pneumoniae in the pathogenesis of acne rosacea.

Current use of anti-infectives in dermatology.

Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.

The BEST study: evaluating efficacy by selected demographic subsets.

Acne therapy often requires continuous treatment with a combination of agents. Patient satisfaction with treatment ensures proper compliance, which ultimately leads to a successful outcome. The BenzaClin (benzoyl peroxide/clindamycin topical gel) Efficacy and Satisfaction Trial (BEST) was conducted to determine changes in the degree of satisfaction after using benzoyl peroxide/clindamycin topical gel in patients with mild to moderate acne who were not satisfied with their current therapy. Reported in this subanalysis are results stratified according to selected patient demographic subsets (18 years and younger, 21-30 years; male, female; white, black, Hispanic, and Asian; and patients with mild acne). Efficacy variables included patient satisfaction, acne condition and severity, quality of life (QOL), and physician assessment of treatment response. Significant increases in patient satisfaction and improvement in acne condition were demonstrated with the use of benzoyl peroxide/clindamycin topical gel by male and female patients of the ages and races evaluated, as well as by patients with mild acne (P < or = .0001 for all patient subsets). Patients across genders and the specified age groups and races, as well as patients with mild acne, reported significant (P < .05) improvements in QOL following treatment with benzoyl peroxide/clindamycin topical gel. The majority of patients in most subsets, including those with mild acne, demonstrated marked improvements as measured by Physician Global Assessment (PGA) in response to treatment. In summary, patients who have been dissatisfied with their treatment regimen may be more satisfied with the use of this benzoyl peroxide/clindamycin topical gel regardless of age, gender, or race.