Use of Hydroxychloroquine in Hair Disorders.

Hydroxychloroquine (HCQ) is an antimalarial that is utilized to treat a range of dermatologic and autoimmune disorders. With its ability to alter immunologic mechanisms, it has been used to slow or halt the progression of hair loss in conditions secondary to autoimmune dysfunction. Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and alopecia areata (AA) are hair disorders with underlying autoimmune components and no standardized treatment guidelines. We summarized the available literature on the use of HCQ to treat LPP, FFA, and AA. For all three conditions, HCQ showed variable efficacy from halted hair loss to no improvement. While patients did show success with HCQ treatment, there were no clear treatment patterns. Regimens ranged from HCQ monotherapy to combination treatments with other agents like steroids. Overall, HCQ should certainly be considered by clinicians as a treatment option for patient suffering from these hair disorders. While there is no standardized treatment, incorporation of HCQ should take into consideration individual patient characteristics, clinical judgment, and risks of side effects.

Hydroxychloroquine (HCQ) is an antimalarial drug that acts on the immune system. Lichen planopilaris, frontal fibrosing alopecia, and alopecia areata are all disorders that result in hair loss secondary to immune dysfunction. HCQ has been used to treat these conditions, so publications addressing HCQ use for such hair loss disorders were collected, and the findings were summarized. Overall, HCQ showed mixed efficacy but can be a successful treatment option for some patients. Various treatment patterns were seen from using only HCQ to combination therapy plans with HCQ and steroids, for example. Treating these hair loss conditions can be challenging, and while there are no standardized guidelines, HCQ should be considered in the treatment arsenal for patients.

The psychologic impact of loose anagen syndrome and short anagen syndrome.

Loose anagen syndrome (LAS) and short anagen syndrome (SAS) are congenital hair disorders presenting with reduced hair length with or without hair thinning. We conducted a non-validated online questionnaire of self-identified familial participants in a Facebook support group to assess psychologic symptoms, including anxiety, depression, low self-esteem, sadness, insecurity, worry, frustration, and body dysmorphia, in patients and their caregivers. Of 163 total respondents, negative psychologic symptoms were reported in 44.2% (38/89) of LAS patients, 48.3% (43/89) of LAS caregivers, 56.8% (42/74) of SAS patients, and 47.2% (35/74) of SAS caregivers. Our data indicate that both LAS and SAS have strong psychologic, emotional, and social impacts on affected children and their caregivers.

Hormonal Contraceptives and Dermatology.

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.

Oral minoxidil treatment for hair loss: A review of efficacy and safety.

BACKGROUND: Although topical minoxidil is an effective treatment option for hair loss, many patients are poorly compliant because of the necessity to apply the medication twice a day, undesirable hair texture, and scalp irritation. OBJECTIVE: In recent years, oral minoxidil at low dose has been proposed as a safe alternative. This study reviewed articles in which oral minoxidil was used to treat hair loss to determine its efficacy and safety as an alternative to topical minoxidil. METHODS: PubMed searches were performed to identify articles discussing oral minoxidil as the primary form of treatment for hair loss published up to April 2020. RESULTS: A total of 17 studies with 634 patients were found discussing the use of oral minoxidil as the primary treatment modality for hair loss. Androgenetic alopecia was the most studied condition, but other conditions included telogen effluvium, lichen planopilaris, loose anagen hair syndrome, monilethrix, alopecia areata, and permanent chemotherapy-induced alopecia. LIMITATIONS: Larger randomized studies comparing the efficacy/safety of different doses with standardized objective measurements will be needed to clarify the best treatment protocol. CONCLUSION: Oral minoxidil was found to be an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations.

Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis.

Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.

Novel drug delivery approaches for the management of hair loss.

Introduction: Alopecia is a common clinical complaint for patients and often a source of significant psychological distress. The goal of therapy is to stop hair loss and encourage regrowth. Many treatment modalities are available and novel drug delivery approaches are needed to maximize results and minimize potential side effects.Areas covered: Many novel drug delivery approaches for the management of hair loss have been developed in recent years. This review summarizes all therapeutic modalities used to enhance drug penetration into the scalp including microneedling, laser-assisted, radio-frequency, sonophoresis, iontophoresis. Advantages and developments in nanoparticles drug delivery approaches are also discussed.Expert opinion: When considering novel drug delivery approaches for alopecia, physicians should consider the intended target and etiology of hair loss.

Thrombospondin-1 Mediates Axon Regeneration in Retinal Ganglion Cells.

Neuronal subtypes show diverse injury responses, but the molecular underpinnings remain elusive. Using transgenic mice that allow reliable visualization of axonal fate, we demonstrate that intrinsically photosensitive retinal ganglion cells (ipRGCs) are both resilient to cell death and highly regenerative. Using RNA sequencing (RNA-seq), we show genes that are differentially expressed in ipRGCs and that associate with their survival and axon regeneration. Strikingly, thrombospondin-1 (Thbs1) ranked as the most differentially expressed gene, along with the well-documented injury-response genes Atf3 and Jun. THBS1 knockdown in RGCs eliminated axon regeneration. Conversely, RGC overexpression of THBS1 enhanced regeneration in both ipRGCs and non-ipRGCs, an effect that was dependent on syndecan-1, a known THBS1-binding protein. All structural domains of the THBS1 were not equally effective; the trimerization and C-terminal domains promoted regeneration, while the THBS type-1 repeats were dispensable. Our results identify cell-type-specific induction of Thbs1 as a novel gene conferring high regenerative capacity.