Faculty Bibliography

INTRODUCTION: Permanent skin and nail disorders resulting from cytotoxic or endocrine agents used in early stages of breast cancer such as facial skin aging and nail changes (including nail ridging, discoloration, and onycholysis) develop in 3% and 78% of patients, respectively, however their impact on quality of life (QoL) has not been reported.
Objective(s): The CHANCE study is a prospective, longitudinal study of chemotherapy-and endocrine therapy-induced hair, skin, and nail changes in women with non-metastatic breast cancer. This preliminary analysis intends to evaluate the impact of permanent skin and nail sequelae of adjuvant breast cancer therapies on patients' QoL.
Material(s) and Method(s): A target of 500 patients in 5 treatment cohorts will be followed for 3 years using standardized clinical images and objective skin biometrics. Patient-reported outcomes are assessed through QoL questionnaires at baseline, 6 months after chemotherapy completion, or one year after initiation of endocrine therapy: Skin QoL Questionnaire (SQQ) and Nail-specific QoL Questionnaire (NQQ). Higher scores correspond to worse QoL.
Result(s): Questionnaires were completed at both baseline and follow-up by 85 of 327 enrolled patients at the time of analysis. Overall worsening of QoL was found (baseline vs. follow-up: SQQ 2.89 vs. 3.19, p=.03; NQQ fingernail module 1.08 vs. 1.33, p=.003; NQQ toenail module 1.22 vs. 1.57, p=0.008). The greatest impact on skin-related QoL occurred in patients receiving cyclophosphamide+methotrexate+5-fluorouracil and on nail-related QoL occurred in patients receiving newer combination chemotherapy regimens (e.g. taxane+trastuzumab). The greatest change in NQQ subscale score occurred in fingernail emotional and toenail symptoms subscales (baseline vs. follow-up: fingernail 1.08 vs. 1.36, p=.002; toenail 1.21 vs. 1.57, p=.002).
Conclusion(s): Adjuvant therapy used in non-metastatic breast cancer result in persistent skin and nail changes that cause a negative impact on patients' QoL. Longer-term effects of anticancer therapy on QoL will be assessed with subsequent analyses

Frontal fibrosing alopecia (FFA) represents an uncommon variant of lichen planopilaris (LPP). While the histopathology of both conditions is similar, their clinical presentations are distinct. FFA exhibits progressive recession of frontal and temporoparietal hairlines, and involvement of eyebrows, beard, and body hair with loss of follicular ostia. FFA in males represents a rare subset of cases, yet reported cases are increasing. This population necessitates further evaluation to define demographics, clinical presentation, diagnostic pearls, and effective therapies.

Lichen planopilaris (LPP) is a cicatricial alopecia that often causes permanent hair loss. Pioglitazone, a peroxisome proliferator activated receptor-gamma (PPAR- γ) agonist, has demonstrated immunomodulatory properties that may offer an effective treatment modality. This retrospective analysis describes 23 patients with LPP treated with adjunctive pioglitazone. Most (18/25) demonstrated significant reduction in patient-reported symptoms and clinical signs of inflammation. No adverse effects were reported.

BACKGROUND:Approximately 40% of women experience excessive hair shedding when washing their hair. Previously, we have demonstrated that a topically applied α1 adrenergic receptor agonist can be used to contract the arrector pili muscle of the follicular unit (ie, produce "goose bumps"), increasing the force required to pluck hair by as much as 400%. Subsequently, we reported a topical cosmetic solution containing an α1 adrenergic receptor agonist that reduced hair shedding during brushing by a maximum of 77%. AIMS/OBJECTIVE:In this communication, we explore a novel mechanism to contract the arrector pili muscle. Trace amine-associated receptors (TAAR) have been shown to regulate smooth muscle tone in blood vessels, but have not been reported to be present in the skin. Here, we report on the anti-shedding efficacy of a shampoo containing a selective TAAR agonist, tyramine hydrochloride. METHODS:A single-blinded crossover study was designed to test the efficacy of the novel shampoo versus placebo in reducing hairs lost during brushing. RESULTS:In this study, the novel TAAR shampoo reduced hair shedding during brushing by 31% in a cohort of 24 women with a maximum reduction of 77%. CONCLUSIONS:A shampoo formulated with a selective TAAR agonist was demonstrated to contract the arrector pili muscle and reduce hair shedding subsequent to washing.

Background/UNASSIGNED:The frequency of different types of alopecia is not clearly reported in recent studies. Objective/UNASSIGNED:To analyze the frequency of the types of alopecia in patients consulting at specialist hair clinics (SHC) and to assess for global variations. Methods/UNASSIGNED:Multicenter retrospective study including data from patients evaluated at referral SHC in Europe, America, Africa and Australia. Results/UNASSIGNED:A total of 2,835 patients (72.7% females and 27.3% males) with 3,133 diagnoses of alopecia were included (73% were non-cicatricial and 27% were cicatricial alopecias). In all, 57 different types of alopecia were characterized. The most frequent type was androgenetic alopecia (AGA) (37.7%), followed by alopecia areata (AA) (18.2%), telogen effluvium (TE) (11.3%), frontal fibrosing alopecia (FFA) (10.8%), lichen planopilaris (LPP) (7.6%), folliculitis decalvans (FD) (2.8%), discoid lupus (1.9%) and fibrosing alopecia in a pattern distribution (FAPD) (1.8%). There was a male predominance in patients with acne keloidalis nuchae, dissecting cellulitis and FD, and female predominance in traction alopecia, central centrifugal cicatricial alopecia, FFA, TE, FAPD and LPP. Conclusion/UNASSIGNED:AGA followed by AA and TE were the most frequent cause of non-cicatricial alopecia, while FFA was the most frequent cause of cicatricial alopecia in all studied geographical areas.

BACKGROUND:Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited, and the literature on treatment modalities consists mostly of case reports and cohort studies. OBJECTIVES/OBJECTIVE:In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management. METHODS:A literature search for "frontal fibrosing alopecia" on PubMed returned 270 items. In this review, only studies with treatment regimens and reported outcomes were considered. The majority of studies found were case reports and retrospective cohort studies. Response to therapy was assessed by reported ability to slow or arrest hair loss. RESULTS:Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies with the most positive treatment responses (88%, 181/204 for intralesional steroids and 88%, 158/180 for 5α-reductase inhibitors). Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation. LIMITATIONS/CONCLUSIONS:Lack of placebo control studies and uniform outcome measures. CONCLUSION/CONCLUSIONS:The natural course of FFA is variable. Recession of the frontal hairline might stabilize regardless of treatment. However, early intervention is encouraged in active disease because hair loss is presumed permanent and treatment could modify the disease course.

Importance/UNASSIGNED:Persistent alopecia occurs in a subset of patients undergoing chemotherapy, yet the quality of life (QOL) of these patients and their response to therapy have not been described in a large patient cohort. Objective/UNASSIGNED:To characterize the clinical presentation of patients with persistent chemotherapy-induced alopecia (pCIA) or endocrine therapy-induced alopecia after chemotherapy (EIAC) and their QOL and treatment outcomes. Design, Setting, and Participants/UNASSIGNED:A retrospective multicenter cohort of 192 women with cancer treated with cytotoxic agents who received a clinical diagnosis of persistent alopecia (98 with pCIA and 94 with EIAC) between January 1, 2009, and July 31, 2017, was analyzed. All patients were from the dermatology service in 2 comprehensive cancer centers and 1 tertiary-care hospital. Data on demographics, chemotherapy regimens, severity, clinical patterns, and response to hair-growth promoting agents were assessed. Data from the Hairdex questionnaire were used to assess the QOL of patients with alopecia. Main Outcomes and Measures/UNASSIGNED:The clinical presentation, response to dermatologic therapy, and QOL of patients with pCIA were assessed and compared with those of patients with EIAC. Results/UNASSIGNED:A total of 98 women with pCIA (median age, 56.5 years [range, 18-83 years]) and 94 women with EIAC (median age, 56 years [range, 29-84 years]) were included. The most common agents associated with pCIA were taxanes for 80 patients (82%); the most common agents associated with EIAC were aromatase inhibitors for 58 patients (62%). Diffuse alopecia was predominant in patients with pCIA compared with patients with EIAC (31 of 75 [41%] vs 23 of 92 [25%]; P = .04), with greater severity (Common Terminology Criteria for Adverse Events, version 4.0, grade 2) among patients with pCIA (29 of 75 [39%] vs 12 of 92 [13%]; P < .001). A negative emotional effect was reported by both groups. After treatment with topical minoxidil or spironolactone, moderate to significant improvement was observed for 36 of 54 patients with pCIA (67%) and for 32 of 42 patients with EIAC (76%). Conclusions and Relevance/UNASSIGNED:Persistent chemotherapy-induced alopecia is frequently more severe and diffuse when compared with EIAC, and both groups of patients experienced a negative effect. A modest benefit was observed with dermatologic therapy. Additional studies are warranted to develop effective strategies for prevention and effective therapy for pCIA and EIAC.