Common Dermatological Disorder Research Articles

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Few most common dermatological disorders like Psoriasis, Scabies, and lichen planus are described here. Knowing the common clinical features of the diseases would help physicians to diagnose the entity correctly which would prevent mismanagement of the disorder.

A Case Report on Individualized Homeopathic Treatment of Psoriasis

Psoriasis is a chronic dermatosis characterized by an unpredictable course of remission and relapses and presence at a typical site of well-defined erythematous papules and plaques, which are surmounted with large, silvery loose scales. Psoriasis is an immune-mediated genetically determined common dermatological disorder which affects skin, nails, joints and has various systemic associations. One patient suffering from psoriasis was treated in the outpatient department of State National Homoeopathic Medical College and Hospital, Lucknow. Thorough case-taking was done, followed by analysis and evaluation of the case, was done. The patient was prescribed medicines as per homeopathic principles. The condition of the patient was assessed with the Psoriasis Area and Severity Index (PASI) score every month. Homeopathic medicine reduced the PASI score suggesting the utility of homeopathic treatment of a patient suffering from psoriasis.

Knowledge on the Use of Isotretinoin and Its Side Effects and Awareness towards Saudi FDA-Pregnancy Prevention Program among the Female Acne Patients: A Northern Saudi Study.

Background and Objectives: Acne vulgaris is one of the most common dermatological disorders among adolescents and adults in the Kingdom of Saudi Arabia (KSA). Isotretinoin is a cost-effective way of treating severe acne patients compared to other methods used for severe forms of acne management. The present study investigated the knowledge of the use of isotretinoin and its side effects among female acne patients of the reproductive age group who were on isotretinoin. This study also assessed participants' awareness of the Saudi FDA-Pregnancy Prevention Program (SFDA-PPP). Materials and Methods: The present population-based cross-sectional survey was conducted among 768 participants using a standard and validated Arabic version questionnaire. We have applied logistic regression analysis to determine the predictors for awareness of SFDA-PPP. A Chi-square test was applied to identify the factors associated with knowledge related to isotretinoin. Results: Regarding the side effects of isotretinoin, participated female acne patients were most commonly aware of dry mouth and lips (84.5%), teratogenicity (68.2%), and headache (44.8%). Nearly 60% of the participants belonged to the low knowledge category. The present study participants' knowledge was significantly associated with education status (p = 0.007), occupation (p = 0.01), and those participants who were aware of SFDA-PPP (p = 0.001). Furthermore, we explored that only 37.5% were aware of the SFDA-PPP program implemented in Saudi Arabia. The awareness of SFDA-PPP was significantly higher among those participants belonging to health sectors (Adjusted OR (95% CI) = 1.39 (1.01-1.92), p = 0.049). Conclusion: The present survey explored inadequate knowledge among reproductive age group female acne patients regarding isotretinoin uses, precautions to be followed, and side effects, especially teratogenic effects. This survey findings suggest that improving female acne patients' knowledge of isotretinoin through health promotion activities is crucial, especially by giving them precise instructions about the teratogenic effects.

Improvement of Quality of Life in Dialysis and Diabetic Patients by Skin Dryness and Pruritus Management with an Ecobiological Dermo-Cosmetic Product.

PurposeXerosis and pruritus are common chronic dermatological disorders among dialysis and diabetic patients that are frequently underdiagnosed or neglected, which can impact the quality of life of these patients. This study aimed to evaluate the efficacy and safety of a specific dermo-cosmetic product in the treatment of dry skin and pruritus associated with dialysis and diabetes.Patients and MethodsTwenty-nine dialysis patients (mean age 62 years) and 40 diabetic patients (mean age 57 years, 88% type 2) were included in two different single-center open-label uncontrolled clinical trials. All patients presented skin dryness according to the Scaling Roughness Redness and Cracks (SRRC) scale, and pruritus and/or insomnia. They applied the dermo-cosmetic product Medi-Secure Atoderm Xereane (NAOS, Laboratoire Bioderma) once or twice a day. The clinical efficacy (SRRC, pruritus, and insomnia), the skin-related quality of life (Dermatological Life Quality Index, DLQI), and the subjective efficacy were assessed at the inclusion visit and after 28 days of product application, as well as the safety.ResultsAfter 28 days of application, the product significantly reduced the SRRC global score of 83% (0.9±0.8 vs 5.1±1.2) and 66% (1.4±1.2 vs 4.2±0.5), pruritus intensity of 76% (1.1±1.3 vs 4.6±2.1) and 78% (0.9±1.7 vs 4.2±2.6), and insomnia intensity of 61% (0.9±1.3 vs 2.4±2.3) and 82% (0.9±1.7 vs 4.8±2.7) in dialysis and diabetic patients, respectively. Furthermore, the product’s application led to an improvement of the skin-related quality of life of 50% (5.4 vs 2.7; p<0.0001) in dialysis patients and 71% (6.6 vs 1.9; p<0.0001) in diabetic patients at D28. In addition, the product was greatly appreciated by all patients for its soothing, comforting, repairing, nourishing, and hydrating effects and was very well tolerated by the entire panels.ConclusionThis specific dermo-cosmetic product significantly reduces skin dryness, pruritus, and insomnia in dialysis and diabetic patients, thereby greatly improves their skin-related quality of life. By managing and avoiding bothersome symptoms associated with their disease or treatment, this ecobiological dermo-cosmetic can prevent serious complications that constitute a substantial burden on their daily life.

Compatibility of Personalized Formulations in Cleoderm™, A Skin Rebalancing Cream Base for Oily and Sensitive Skin

Inflammatory skin conditions are prevalent in the general population and are a source of much concern for those who suffer from them. Acne is an extremely common condition and can significantly impact the quality of life of affected patients. Rosacea is another common dermatological disorder that often affects the face and can present with flushing, irritated skin, and pimples. In addition to being key for acne and rosacea, inflammation can also play a role in prematurely aging skin and contributes to the formation of wrinkles. Given the prevalence and patient impact of dermatological conditions on the face, such as those previously described, there is a demand for personalized medicines to manage these conditions when commercially available options are unsuitable, unavailable, or insufficient to fully resolve the condition. When designing an appropriate personalized therapy for a patient, both the vehicle and the active pharmaceutical ingredient choices are key to the success of the treatment. Cleoderm™ is a topical cream designed for use as a vehicle for the preparation of dermatological treatments by compounding pharmacies. Its ingredient profile was specifically curated to be gentle on the skin, allowing its use as a vehicle for compounded preparations that may be applied to sensitive and affected skin. In this bracketed study, benzoyl peroxide, cyproterone acetate, estriol, metronidazole, niacinamide, progesterone, retinoic acid, spironolactone, and tranexamic acid were selected, due to their known applications for dermatological skin conditions. To evaluate the compatibility and stability of Cleoderm™ in these formulations, high-performance liquid chromatography, followed by antimicrobial effectiveness testing, were performed for 180 days. For most formulations, a beyond-use date of 180 days was observed when stored at room temperature, except for retinoic acid, which had a beyond-use date of 30 days. Through the outcomes of this study, we concluded that Cleoderm™ presents increased convenience for both the compounding pharmacist and the patient, suggesting that it is an adequate candidate vehicle for compounding different dermatological formulations with adequate stability, presenting itself as a good alternative to commercially available treatments that cannot be personalized.

Sociodemographic disparities in patch testing for commercially insured patients with dermatitis: A retrospective analysis of administrative claims data

To the Editor: Contact dermatitis (CD) is a common dermatologic disorder, and management relies on avoiding the offending agent. Chronic CD has been associated with profound psychosocial and economic impacts.1 Patch testing (PT) remains the gold standard in diagnosing allergic contact dermatitis (ACD), and a higher number of allergens tested is associated with greater diagnostic sensitivity2; thus, barriers to PT can delay diagnosis and management, increasing the burden of disease. In this study, we used a large US claims database to evaluate for sociodemographic disparities in access to PT.

The state‐of‐the‐art in the management of androgenetic alopecia: A review of new therapies and treatment algorithms

AbstractAndrogenetic alopecia is one of the most common dermatologic disorders in the daily clinical practice of dermatologists. Despite it is such a common entity, few medications are FDA‐approved for its treatment. Due to this situation dermatologists are often reluctant to try off‐label therapies. This guide's purpose is to review the current available therapies for androgenetic alopecia including those off‐label, and to propose treatment algorithms according to the published scientific research.

Recent advances for commedonal acne treatment by employing lipid nanocarriers topically

Acne is one of the most common chronic inflammatory dermatological disorder associated with multifactorial pathogenesis. Approximately 95 % of the population suffers from it at some point in their lifetime. Antibiotics, acids, benzoyl peroxide, and retinoids are the most commonly drugs used for the treatment of acne. However, conventional formulations of these drugs are associated with undesirable toxicities, inadequate penetration across stratum corneum, short retention time of the drug in the target site, and poor aqueous solubility of drugs, that limited their medicinal applications. As a consequence pharmaceutical researchers are turning towards novel drug delivery systems to overcome these limitations.With respect to their small particle size, lipid occlusive nature and unique surface characteristics, lipid nanocarriers can promote skin hydration, enhance drug permeation, improve its targeting properties and retention time on the skin, increase drug solubility and protect it from degradation, provide sustained drug release and reduce dosing frequency. The current review summarizes the better nanotechnological systems that can be used in future for better and effective treatment of acne.

Recent advances for commedonal acne treatment by employing lipid nanocarriers topically

Acne is one of the most common chronic inflammatory dermatological disorder associated with multifactorial pathogenesis. Approximately 95 % of the population suffers from it at some point in their lifetime. Antibiotics, acids, benzoyl peroxide, and retinoids are the most commonly drugs used for the treatment of acne. However, conventional formulations of these drugs are associated with undesirable toxicities, inadequate penetration across stratum corneum, short retention time of the drug in the target site, and poor aqueous solubility of drugs, that limited their medicinal applications. As a consequence pharmaceutical researchers are turning towards novel drug delivery systems to overcome these limitations.With respect to their small particle size, lipid occlusive nature and unique surface characteristics, lipid nanocarriers can promote skin hydration, enhance drug permeation, improve its targeting properties and retention time on the skin, increase drug solubility and protect it from degradation, provide sustained drug release and reduce dosing frequency. The current review summarizes the better nanotechnological systems that can be used in future for better and effective treatment of acne.

Immune Activities in Choroids of Visually Impaired Smyth Chickens With Autoimmune Vitiligo.

Vitiligo is a common dermatological disorder affecting 1–2% of the world’s population. It is characterized by postnatal, autoimmune destructions of melanocytes in the skin, resulting in patches of depigmentation. Autoimmunity in vitiligo may also affect melanocytes in non-integumental tissues, including the eyes where choroidal melanocytes are the target of the autoimmune response. The Smyth line (SL) of chicken is the only animal model that spontaneously and predictably develops all clinical and biological manifestations of autoimmune vitiligo. In SL vitiligo (SLV), destruction of epidermal melanocytes in growing feathers (GFs) involves a melanocyte-specific, Th1-mediated cellular immune response. Smyth chickens may also exhibit uveitis and vision impairment. Previous studies established a strong association between SLV and vision impairment, including similar pathology in affected eyes and GFs. To determine the presence, types, and activities of choroid infiltrating mononuclear cells, we collected eyes before, near onset, and during active SLV from sighted, partially blind, and blind SL chickens. All SL chickens with vision impairment had SLV. Immunohistochemistry and quantitative reverse transcriptase-PCR analyses revealed mononuclear cell and cytokine expression profiles in the autoimmune destruction of melanocytes in choroids that are identical to those described in GF, demonstrating the systemic nature of autoimmunity against melanocytes in SLV. In addition, we observed aberrant melanogenesis in SL eyes. The immunopathogenesis in SL vision impairment resembles human vitiligo-associated ocular diseases, especially Vogt–Koyanagi–Harada syndrome and sympathetic ophthalmia. Hence, the Smyth chicken autoimmune vitiligo model provides the opportunity to expand our understanding of spontaneous autoimmune pigmentation disorders and to develop effective treatment strategies.

Early clinical response to 5-fluorouracil 0.5% and salicylic acid 10% topical solution in the treatment of actinic keratoses of the head: an observational study

Background Actinic keratosis is one of the most common dermatological disorders. A new topical solution, constituted by 0.5% 5-fluorouracil and 10% salicylic acid (Actikerall, Almirall) has been introduced in the treatment pipeline of hyperkeratotic actinic keratoses of the head and neck. Patients and methods We analyzed in an observational prospective clinical study the short-term treatment effectiveness of 5-fluorouracil and salicylic acid on face and scalp actinic keratoses of grade 1 and 2 of 40 patients. Efficacy assessment was performed by clinical dermatological examination, collecting color photographs, calculating AKASI score, and by means of dermoscopy for each target lesion at every visit. Results AKASI score decreased from an initial score of 3.3 to a final score of 0.9. At week 4, we were able to record a complete clearance of 50% of the treated lesions and a partial clearance of 28%. At the end of 12 weeks, 84% of the total lesions showed complete clearance, while 8% had partial clearance. Conclusions 5-fluorouracil and salicylic acid topical solution is effective in the treatment of mild to moderate actinic keratoses. In the future, further studies are needed to evaluate the chance of adjusting drug dosage according to patients' and actinic keratoses features.

Stress and Quality of Life in Psoriasis

Introduction Psoriasis is a common dermatological disorder characterized by silvery-white, scaly, and erythematous plaques with or without pruritus. It is an immensely stressful condition, hampering the quality of life with significant psychological morbidity. Objective To assess the level of stress and quality of life among the patients with psoriasis. Methods A nonexperimental descriptive study design was used. Sixty participants were enrolled from Dermatology OPD, PGIMER, Chandigarh, by a purposive sampling technique during October to January 2021. An interview schedule, comprising (a) sociodemographic and clinical profile, (b) Perceived Stress Scale (PSS), (c) Patient Health Questionnaire-4 to assess anxiety (PHQ-4), (d) Patient Health Questionnaire-9 to assess depression (PHQ-9), (e) Patient Global Assessment (PtGA) Scale to assess severity of illness (PtGA), and (f) Dermatology Life Quality Index (DLQI), was used for data collection. Data were collected by a telephonic interview as per the interview schedule. At the end of the interview, patients were asked to send the pictures of affected body parts, which were then assessed by the dermatologist using the Investigator’s Global Assessment (IGA) Scale. Data analysis was done with descriptive and inferential statistics using the Statistical Package for Social Sciences (SPSS version 23). Results Most of (86.7%) the participants reported a moderate level of stress (PSS) and 65% described moderate effect on the quality of life. The assessment of the severity of illness on IGA depicted that 36.7% of participants had mild, 28.3% had moderate, and 26.7% had severe psoriasis. Mild to moderate depression (PHQ-9) was screened in about 25% of the participants. A significant correlation was found between stress, quality of life, anxiety, and depression (&lt;0.001). The severity of psoriasis was significantly correlated with quality of life, anxiety, and depression. Conclusion The study results concluded that the presence of a significant level of stress has a considerable effect on the quality of life among the patients with psoriasis. Thus, it is recommended to assess and address the psychological issues along with medical management for the comprehensive management of patients with psoriasis.

Efficacy and safety of isotretinoin in comparison to methotrexate in the patients suffering from moderate-to-severe plaque psoriasis: A prospective cohort study

Background: Psoriasis is a common dermatological disorder with both inflammatory and genetic etiology. In India, the incidence of psoriasis is on the verge of rise. Very less data is available on the efficacy of isotretinoin versus methotrexate in patients suffering from plaque psoriasis. Aims and Objective: In this prospective cohort study, we aimed at comparing the efficacy and safety of systemic isotretinoin with systemic methothotrexate in patients suffering from moderate to severe plaque psoriasis in a tertiary care medical college hospital in eastern India. Materials and Methods: It was a prospective cohort study conducted in the dermatology and pharmacology department of Burdwan Medical College between December 1, 2020, and August 31, 2021, on 60 patients suffering from moderate to severe plaque psoriasis. Patients receiving methotrexate and isotretinoin as systemic therapy of psoriasis from the dermatology outpatient department at the time of the study constituted the methotrexate and isotretinoin group, respectively. Each group had 30 patients. Psoriasis area severity index (PASI) score and dermatology life quality index (DLQI) score were utilized for evaluation of improvement in disease severity and quality of life, respectively. Different laboratory parameters and patients reported side effects were noted for evaluation of safety. Results: Fifty-eight patients completed the study (28 patients from methotrexate group and 30 patients from isotretinoin group). Both drugs were effective in managing psoriasis. 100% patients in the methotrexate group and 89.28% patients in the isotretinoin group had reached the threshold for a minimal response (25% reduction from baseline PASI score after 12 weeks of treatment). The mean percentage reduction in PASI score was 70.23±6.78 and 52.78±7.34 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Methotrexate was more effective in improving quality of life. The mean percentage reduction in DLQI score were 60.02±5.04 and 28.49±4.84 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Isotretinoin group showed fewer patient-reported side effects and lower fluctuation of laboratory parameters. Conclusions: Methotrexate is more efficacious than isotretinoin in disease remission and improving quality of life in patients suffering from mild to moderate plaque psoriasis. Isotretinoin is safer than methotrexate.

Efficacy of intradermal injection of tranexamic acid and ascorbic acid versus tranexamic acid and placebo in the treatment of melasma: A split-face comparative trial.

Background and AimsMelasma is a common dermatologic disorder characterized by symmetrical hyperpigmented lesions on the face. Although various therapeutic options are available for melasma, its treatment remains challenging. The present study evaluated the safety and efficacy of intradermal microinjection of tranexamic acid (TA) plus ascorbic acid in treating melasma lesions compared with TA and placebo.MethodsFrom September 2019 to May 2020, 24 patients with symmetrical melasma were enrolled in a prospective, double‐blind, split‐face, randomized controlled clinical trial. Each patient received 50 mg/ml TA and 50 mg/ml ascorbic acid for one side of the face (A) and 50 mg/ml TA and placebo for the other side (B) every 2 weeks for 12 weeks. The Melasma Area and Severity Index (MASI) score, Physician Global Assessment, and pain were measured at baseline and at 4, 8, 12, and 24 weeks. Statistical analysis was done using SPSS software version 16, and data were reported as mean ± standard deviation or median and interquartile range. χ 2 and Fisher's exact tests were used to test differences between the groups.ResultsBoth groups experienced a significant decrease in MASI scores compared with the baseline. The MASI score was significantly less in the intervention group than the placebo group at the 8th and 12th weeks. However, burning pain was significantly more prominent in the intervention group.ConclusionIntradermal injection of ascorbic acid combined with TA can be beneficial in treating melasma. Currently, there are numerous treatment modalities for melasma. However, the results still vary, and satisfactory outcomes are yet to be reached.

Common Dermatologic Disorders in Down Syndrome: Systematic Review.

Down syndrome (DS) has been associated with cardiovascular, gastrointestinal, and immune-related abnormalities. Several dermatologic conditions, including hidradenitis suppurativa, have also been found to be associated with DS. The objective of this study was to characterize the prevalence, presentation, and unique features of dermatologic disorders associated with DS. Electronic searches of EMBASE (via Ovid), MEDLINE (via Ovid), and Web of Science databases were conducted on December 14, 2020. Observational studies including case reports of patients with DS presenting with concomitant primary dermatologic disorder were included. This systematic review captured 40 observational studies and 99 case reports, including 10 observational studies that examined the prevalence of common skin disorders in patients with DS. The most common dermatologic conditions reported includes atopic dermatitis (8 studies, n=180; 19.7% mean prevalence), hidradenitis suppurativa (15, n=478; 3.2%), ichthyosis (4, n=16; 4.7%), lichen nitidus (6, n=6; 1.1%), psoriasis (21, n=65; 4.8%), alopecia areata (27, n=253; 7.4%), vitiligo (8, n=40; 4.4%), onychomycosis (3, n=198; 24.7%), calcinosis cutis (14, n=15), connective tissue nevi (6, n=6), dermatofibroma (3, n=3), melanoma (3, n=3), syringomas (14, n=182; 21.2%), and elastosis perforans serpiginosa (19, n=24; 0.5%). Our results indicate an increased prevalence of common cutaneous disorders in patients with DS, particularly infectious, inflammatory, autoimmune, and connective tissue conditions. Current guidelines for the screening, general management, and use of systemic immunomodulatory agents in this patient population are lacking. Patients with DS would benefit from screening for dermatologic disorders not otherwise regularly performed for earlier diagnosis and treatment. PROSPERO International Prospective Register of Systematic Reviews CRD42021226295; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226295.

Topical dapsone in the treatment of acne: a systematic review.

Acne is one of the most common dermatological disorders. Initial therapies for acne include topical retinoids, benzoyl peroxide, and topical clindamycin. However, patients who fail initial therapies may benefit from alternative topicals, including dapsone gel. To analyze the current literature studying the efficacy of topical dapsone in the treatment of acne. PubMed, Embase, and Cochrane Library were systematically searched for clinical trials examining the efficacy of topical dapsone in the treatment of acne. Fourteen studies were included in the analysis. Dapsone monotherapy showed a treatment success rate of 40.1-69.4% for dapsone gel 5% and 29.8-47.0% for dapsone gel 7.5% when used for 12-16 weeks. In all studies, inflammatory lesions decreased by a larger percentage than noninflammatory or total lesions. Dapsone gel was also studied in combination with various other acne treatments, including doxycycline, oral isotretinoin, benzoyl peroxide, and topical retinoids. While mild treatment-related adverse effects, most commonly consisting of skin irritation, occurred in 2.0-75.0% of participants, no major treatment-related adverse effects were reported. Limitations of the study include variable treatment regimens making it difficult to compare results across studies. Additionally, adverse effects and skin irritation were reported differently, and potential selection biases exist in the randomized trials. Dapsone gel offers a safe and promising alternative therapy for patients with difficult to treat acne or those who experience adverse effects to first-line therapies.

Determination of Anti-Dandruff and Hair Growth Promoting Activity of combined coconut oil extract of Marking Nut

Dandruff, a most common dermatological disorder, is an unpleasant, chronic and pruritic scalp condition which may leads to hair loss also. This study attempted to know the activity of an herbal formulation against a dandruff causing organism Malassezia furfur which was cultured and identified from human dandruff sample and also performed the hair growth activity. Marking nuts were extracted with coconut oil and its anti-malassezial activity was evaluated based on diffusion dependent assays. Extract showed effective results comparable to a standard drug. In vivo hair growth stimulating activity for the extract was tested on denuded dorsal skin of 5-week old mice against the controls and the standard drug minoxidil. The parameters used to evaluate hair growth were hair growth completion time, hair length, hair weight, and hair follicle length and hair density. The present results provides insights on the use of Marking nuts extract for antimalassezial activity and hair rejuvenation in traditional practices.

Propionibacterium (Cutibacterium) granulosum Extracellular DNase BmdE Targeting Propionibacterium (Cutibacterium) acnes Biofilm Matrix, a Novel Inter-Species Competition Mechanism.

Acne vulgaris is the most common dermatological disorder worldwide affecting more than 80% of adolescents and young adults with a global prevalence of 231 million cases in 2019. The involvement of the skin microbiome disbalance in the pathophysiology of acne is recognized, especially regarding the relative abundance and diversity of Propionibacterium acnes a well-known dominant human skin commensal. Biofilms, where bacteria are embedded into a protective polymeric extracellular matrix, are the most prevalent life style for microorganisms. P. acnes and its biofilm-forming ability is believed to be a contributing factor in the development of acne vulgaris, the persistence of the opportunistic pathogen and antibiotic therapy failures. Degradation of the extracellular matrix is one of the strategies used by bacteria to disperse the biofilm of competitors. In this study, we report the identification of an endogenous extracellular nuclease, BmdE, secreted by Propionibacterium granulosum able to degrade P. acnes biofilm both in vivo and in vitro. This, to our knowledge, may represent a novel competitive mechanism between two closely related species in the skin. Antibiotics targeting P. acnes have been the mainstay in acne treatment. Extensive and long-term use of antibiotics has led to the selection and spread of resistant bacteria. The extracellular DNase BmdE may represent a new bio-therapeutical strategy to combat P. acnes biofilm in acne vulgaris.

Oxidant and antioxidant status in patients with female pattern hair loss with varying severity

Background Female pattern hair loss (FPHL), also known as female androgenic alopecia, is a common dermatological disorder with a multifactorial pathogenesis. Oxidative status has been implicated in the pathogenesis of several skin diseases, including FPHL. Aim This study was aimed to investigate the levels of oxidative stress biomarkers in patients with FPHL with varying severities. Patients and methods The study involved 56 patients with FPHL and 46 healthy controls. Diagnosis was based on clinical examination and trichoscopic evaluation. Patients were grouped into three subgroups as follows: mild, moderate, and extensive. Oxidative stress was examined by measuring plasma levels of catalase (CAT), superoxide dismutase, total antioxidant capacity, and malondialdehyde (MDA). Results Plasma levels of MDA in FPHL were significantly higher as compared with that of the controls, whereas activities of the antioxidant enzymes superoxide dismutase and CAT were lower. Moreover, total antioxidant capacity was also low in patients with FPHL as compared with that of the controls. Higher MDA levels in the extensive FPHL subgroup as compared with that of the mild and moderate subgroups were also observed. Furthermore, in the extensive FPHL subgroup, a significant negative correlation was observed between MDA and CAT levels. Conclusion The data suggest that oxidative stress plays a key role in FPHL progress, which accelerates hair loss by causing microinflammation and fibrosis. The recognition of the effect of androgens and associated factors on the hair follicle cycle is essential for the development of new and effective treatment methods and may be employed as a biomarker index to assess the disease’s activity and to monitor its treatment.

A Recalcitrant Case of Eosinophilic Pustular Folliculitis

Eosinophilic Pustular Folliculitis (EPF) or papulooerythroderma of Ofuji (PEO) is a rare dermatosis that presents with recurrent pruritic follicular papules and pustules that can involve the entire skin surface sparing the skin folds. This can be accompanied with elevated IgE levels and eosinophils. Diagnosis has been challenging due to its ability to mimic several common dermatologic disorders, such as acne and contact dermatitis. Literature has described the first line of therapy to be oral and topical indomethacin, however, success has been variable, and reports have been anecdotal. Until this day, there is yet to be standard guidelines for approach to diagnosis and management of this condition. In this article, we report a case of a 29 year-old female of Chinese descent who presented with papules on bilateral malar and nasal areas recalcitrant to topical corticosteroids. She demonstrated success with the use of a monthly regimen of isotretinoin after a perplexing diagnostic dilemma.