New study Suggests We Don’t Vaccinated Enough - Especially our Younger Patients There is a great deal of information that must be conveyed to patients before starting JAK inhibitors. One of these is a review of infections and ways to reduce the risk of infection through vaccination. Immunization against zoster, influenza and pneumococcus are generally recommended before starting JAK inhibitors. For example, zoster is recommended at age 19 or above now by the CDC (and 50 years of age and over in the general population). Influenza is recommended yearly. Pneumococcous is now recommended at 19 an ..read more

 1 in 3 Patients Using JAK Inhibitors Will Have Some Sort of Infection Authors from Italy set out to retrospectively review infectious disease events in patients receiving JAK inhibitors over the period from July 2021 to October 2023. There were 91 patients in their study, including 85 treated with baricitinib and 6 with upadacitinib. There were no patients treated with ritlecitinib in this particular study as ritlecitinib had not been approved in Europe until Sept 2023. The authors observed 34 infectious events in 28 patients (30.8%). Five patients had multiple infectious events (5.5 ..read more

Are there any concerns about minoxidil use in patients with glaucoma? There is no good evidence to date that topical minoxidil has a major effect on ocular pressures. However, there are dozens and dozens of reports in the medical literature about eye-related side effects with minoxidil. The question then becomes - is minoxidil truly responsible for a particular side effect and if so - how common is this side effect? This is the case for minoxidil and glaucoma. Over the years, there have been grumblings that minoxidil somehow affects eye pressures in some people. Despite the grumblings, there ..read more

50 mg Acitretin Caused Hair Repigmentation after 20 months of Treatment I read with great interest a nice report by Dr Eunice Chow and Dr Thomas Salopek from the University of Alberta regarding an 80-year-old man who had remarkable hair repigmentation after using the vitamin A derivative acitretin. The man was diagnosed with a skin condition known as pityriasis rubra pilaris (PRP) and was started on acitretin 40 mg daily and then increased to 50 mg once daily. His medical history included hypertension and diabetes. His medication list also included aspirin, betamethasone valerate 0.1% cream, h ..read more

TEPEZZA (teprotumumab-trbw) Causes Hair Loss TEPEZZA (teprotumumab-trbw) is an insulin-like growth factor-1 receptor inhibitor indicated for the treatment of thyroid eye disease. Clinical studies have shown that about 13 % of patients using this drug have hair loss compared to 8% of controls. I was interested to read a report by Wang et al of side effects of TEPEZZA (teprotumumab-trbw) found in the FDA Adverse Events Reporting System database. Alopecia was ranked the sixth most common side effect and had a reporting odds ratio of 7.84 (with a confidence interval of 6.75–9.1). This study remind ..read more

Bicalutamide 50 mg more effective than Spironolactone 100 mg I was very interested to read a study from India which set out to compare the effectiveness of spironolactone and bicalutamide in the treatment of female-pattern hair loss (FPHL). The study was a retrospective study of 120 female patients 18-50 years of age who used these drugs. Group A comprised patients who were taking 100 mg of spironolactone once daily, along with 2% minoxidil and Group B comprised patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2%. Patients were analysed at approximately 24 ..read more

Higher Doses of Oral Minoxidil Increase Heart Rate I read with interest another nice study by our Brazilian colleagues. The authors set out to understand the effects of higher doses of oral minoxidil (ie above 5 mg) on blood pressure and heart rate in males. The authors studied 11 males. These males had been using 5 mg oral minoxidil for 24 weeks as part of the authors’ prior research. At 24 weeks, the dose was increased to 7.5 mg. The authors wanted to see what would happen to various hemodynamic parameters like blood pressure and heart rate in males using higher doses. The mean age of pati ..read more

Hydroxychloroquine Retinopathy and my ABCDEFG Memory Tool If you’ve followed my discussions and topics for a while now, you’ll probably have come to see that hydroxychloroquine retinopathy is something I talk about fairly often. Please consider reviewing the following links if interested. Jorge AM et al. 2023 A new study set out to identify risk factors for hydroxychloroquine retinopathy. The researchers evaluated 4,677 long-term hydroxychloroquine users. This included 83 % females and 13 % males. The mean age at the start of hydroxychloroquine treatment was 52 years. There were 125 pa ..read more

Altered Immune System Function Leads to Increased Risk of Alopecia Areata in Down Syndrome It’s well known that patients with Trisomy 21 (Down syndrome) are at increased risk for a variety of immune mediated and autoimmune mediated medical conditions. Dermatological Conditions that may be more common in Down Syndrome include: Dry Skin and Ichthyosis Keratosis pilaris Pityriasis rubra pilaris Elastosis perforans serpiginosa Seborrheic Dermatitis Palmoplantar keratoderma Psoriasis Cafe au lait macules Lumbosacacral dermal melanosis Syringomas Geographic tongue Angular c ..read more

Side Effects of Anabolic Steroids: Hair Loss Among the Topic Side Effects I work with many athletes and bodybuilders who experience hair loss from anabolic steroids. Patients often want to know the answer to a simple question “How likely is a particular side effect - like hair loss?” It can often be quite challenging to give precise estimate on the risk of a given side effect. I’ve spoken about this subject before: When a study comes out that gives me assistance in formulating these sorts of estimates, I generally take to the study. One such study was the recent study by Josué Cruz Dos Santos ..read more