Background: Female pattern hair loss (FPHL) is the most common cause of hair loss in women, yet therapeutic responses remain highly variable. A substantial proportion of patients experience persistent hair thinning or limited hair density improvement despite standard therapies, and current guidelines provide limited guidance for managing patients with poor therapeutic response. Summary: This review summarizes the major determinants of poor therapeutic response in FPHL, including pharmacogenetic factors, metabolic and endocrine comorbidities, treatment-related barriers, and advanced follicular miniaturization. Emerging evidence suggests that androgen receptor (AR) polymorphisms may influence antiandrogen responsiveness, whereas sulfotransferase (SULT1A1) activity may affect topical minoxidil efficacy. Obesity-related insulin resistance and polycystic ovary syndrome may further impair the follicular microenvironment through hyperandrogenism and chronic inflammation. Based on current evidence, we propose a practical three-step framework for evaluating poor responders: exclusion of pseudo-nonresponse, identification of metabolic-endocrine comorbidities, and incorporation of emerging biomarkers to support individualized treatment selection. Key Messages: Poor therapeutic response in FPHL is multifactorial. Identifying the dominant contributing factor rather than simply escalating treatment intensity may facilitate precision management and improve outcomes in refractory patients.
Introduction: Extracellular vesicles (EVs), often referred to in the literature as “exosomes,” have emerged as candidate biologic mediators for hair restoration, but clinical evidence remains limited. Microinfusion of drugs into the skin (MMP®) is a tattoo device-based technique that combines microneedling with controlled intradermal delivery and may offer a reproducible way to administer scalp treatments. Methods: We performed a retrospective case series of adults with androgenetic alopecia (AGA) treated with a plant-derived EV formulation delivered through MMP®. Patients underwent 6 monthly sessions. Treatment tolerance, patient-reported outcomes, and blinded investigator assessments from standardized clinical photographs and site-matched trichoscopy were reviewed. Results: Twenty patients were included. Tolerance was favorable: 85% reported no adverse effects and 15% reported mild procedural pain. Subjectively, 95% of patients perceived improvement after six sessions, including 55% who reported marked improvement. Blinded evaluation also suggested benefit, more clearly at the clinical level than at the trichoscopic level. Mean clinical ratings indicated mild-to-marked improvement in 70% of cases, whereas mean trichoscopic ratings indicated mild-to-marked improvement in 50% and stabilization-to-mild improvement in 45%. Conclusion: In this retrospective series, plant-derived EVs delivered by MMP® were feasible, well tolerated, and associated with favorable subjective and blinded efficacy signals in patients with AGA.
Introduction:Alopecia areata (AA) is an organ-specific autoimmune disorder producing non-scarring alopecia that ranges from isolated patches to total scalp loss (alopecia totalis, AT) or loss of all body hair (alopecia universalis, AU). Although the nail unit may also be affected and is widely regarded as a poor prognostic sign, data on its prevalence and correlates in children with refractory disease remain limited. Methods:We reviewed the records of 91 children (aged 3.5-14 years) with treatment-resistant AA, defined as disease duration ≥6 months, <10% improvement in Severity of Alopecia Tool (SALT) score after ≥2 adequate courses of conventional treatment, and ≥1 established poor prognostic factor. Nail morphology, SALT score-based severity, clinical subtype, sex, disease duration, and family history of AA were recorded. Chi-square and Fisher exact tests were applied (p < 0.05). Results:Sixty-three of 91 (69.2%) children had nail involvement. Pitting was the most common finding (47/63; 74.6%), followed by leukonychia (11.1%), trachyonychia (9.5%), longitudinal ridging (3.2%), and Beau's lines (1.6%). Nail involvement was significantly associated with longer disease duration (p = 0.049) but did not correlate with sex, clinical subtype, or scalp severity (all p > 0.05). Children without a family history of AA had significantly more severe disease and a higher proportion of AT or AU (p < 0.05). Conclusion:Nail involvement was present in nearly 70% of children with treatment-resistant AA, far above rates reported in unselected cohorts. Association with disease duration but not scalp severity suggests that nail-matrix autoimmune activity may follow a partially independent course. Routine nail examination provides prognostic insights and may help guide treatment.
Introduction:Pili annulati is an autosomal dominant hair shaft disorder mapped to chromosome 12q24.33 and classified among hair shaft disorders without fragility. It is characterized by a shiny appearance with alternating light and dark bands and typically affects the scalp, as well as axillary, beard, and pubic hair. Trichoscopy reveals hair shafts with alternating white and dark bands involving approximately 50%-100% of the shaft thickness. Light microscopy and transmission electron microscopy are useful diagnostic tools for this. Case Presentation:We report a case series of 7 patients diagnosed with pili annulati via clinical and trichoscopic evaluation. Of these cases, 1 patient exhibited unusual involvement of the eyebrows and eyelashes, another presented with a distinct patch of heterochromia, and the remaining five demonstrated diffuse involvement confined to the scalp. Conclusion:Although traditionally considered a rare condition, the prevalence of pili annulati may be underestimated. Therefore, proficiency in recognizing its characteristic clinical and trichoscopic features is essential for an accurate and timely diagnosis.
Introduction Selective matrixectomy is a common intervention for painful onychocryptosis that is associated with mild-to-moderate postoperative pain. It can usually be managed effectively with non-opioid analgesics. We evaluated rates and factors associated with opioid prescribing following selective matrixectomy to guide physicians in counseling postoperative patients. Methods A retrospective cohort study was conducted using the TriNetX research network, querying for patients who underwent selective matrixectomy for onychocryptosis. Opioid prescriptions <3-days after selective matrixectomy were assessed, and Cox regression estimated hazard ratios and 95% confidence intervals for opioid prescribing, adjusting for factors associated with prolonged opioid use. Results Among 97,208 patients who underwent selective matrixectomy, 14,759 received an opioid prescription <3-days postoperatively (15.2%), declining from 24.3% during 2008-2018 to 12.8% during 2018-2025. Female sex, older age, Asian race, antidepressant use, and histories of anxiety, depression, chronic pain, migraine, osteoarthritis, and back pain were associated with lower likelihood of opioid prescribing. Black/African American race, Hispanic/Latino ethnicity, prior benzodiazepine or opioid use, and fibromyalgia were associated with higher likelihood. Conclusion Opioid prescribing following selective matrixectomy was relatively common and may be more frequent than clinically necessary. Prescribing patterns appear influenced by demographic and clinical factors, suggesting an opportunity to refine postoperative pain management strategies.
Introduction: Primary hyperhidrosis (PHH) is defined by excess sweating not attributable to medications or underlying medical conditions. It is associated with significant burden of subsequent psychiatric comorbidities, but psychiatric conditions preceding PHH diagnosis are not well characterized. We assessed associations of PHH with preceding psychiatric conditions using a matched case-control approach. Methods: Overall, 1,418 participants with PHH and 7,090 matched controls were assessed using the All of Us Research Program database. Multivariable logistic regressions calculated odds ratios and 95% confidence intervals, with Benjamini-Hochberg correction for multiple testing. Results: Subjects with PHH vs. controls had higher odds of prior diagnosis with Obsessive-Compulsive Disorder (OCD) (OR: 1.97, 95% CI: 1.29-2.94, corrected p=0.007), Restless Legs Syndrome (RLS) (OR: 1.63, 95% CI: 1.22-2.15, corrected p=0.007), Attention-Deficit/Hyperactivity Disorder (ADHD) (OR: 1.35, 95% CI: 1.07-1.69, corrected p=0.035), and insomnia (OR: 1.22, 95% CI: 1.04-1.44, corrected p=0.037). Conclusion: We found significant associations with subsequent PHH diagnosis in participants with OCD, ADHD, RLS, and insomnia. Further research into the etiologies of psychiatric conditions and PHH may better elucidate their relationship.
Background:Diffuse unpatterned alopecia (DUPA) is an uncommon and incompletely characterized variant of androgenetic alopecia (AGA) marked by diffuse follicular miniaturization across the entire scalp, including the occipital region, which distinguishes it from classic patterned AGA and often precludes hair transplantation. Summary:In this review of the available literature on DUPA, we discuss its clinical presentation, diagnostic features, competing pathophysiologic hypotheses, and management considerations. Current evidence suggests DUPA typically presents with diffuse thinning across all scalp regions, with trichoscopy demonstrating widespread follicular miniaturization without features of scarring alopecia. Diagnosis remains clinical because histopathologic criteria and standardized trichometric thresholds have not been established. Important mimickers include telogen effluvium and diffuse alopecia areata, requiring careful history, examination, trichoscopy, and occasional scalp biopsy. Management is primarily medical, emphasizing stabilization rather than regrowth, and includes topical or oral minoxidil with consideration of adjunctive therapies in selected patients. Key Messages:DUPA is a diffuse, non-patterned hair loss condition affecting the entire scalp, including the occipital region, for which medical management remains the cornerstone of treatment. DUPA remains poorly defined and further clinicopathologic, trichometric, and longitudinal studies are needed to clarify major knowledge gaps, including epidemiology, pathology, diagnostic criteria, and treatment-specific outcomes.
Introduction:GLP-1 receptor agonists (GLP-1 RAs) are among the fastest-growing pharmacological classes globally. Alopecia has emerged as a clinically relevant adverse effect signal, yet pooled quantitative estimates of risk by subtype and agent are lacking. The objective of this study was to estimate the pooled risk of alopecia associated with GLP-1 RA use, stratified by subtype, agent, and follow-up duration, and to synthesize mechanistic and management evidence. Methods:PubMed/MEDLINE, Embase, Cochrane Central, Web of Science, and Scopus were searched from inception to March 31, 2026, with no language restrictions. Studies reporting alopecia outcomes in adult GLP-1 RA users were eligible, including cohort studies, pharmacovigilance disproportionality analyses, and case series (n ≥ 5). Of 1,847 identified records, 17 met eligibility criteria. Random-effects meta-analyses (DerSimonian-Laird) were performed for odds ratios (ORs) and reporting ORs (RORs). The protocol was prospectively registered in PROSPERO (CRD420261335458) and PRISMA 2020 guidelines were followed. Results:Seventeen studies encompassing 1,091,743 patient-exposures were included. The pooled OR for any non-scarring alopecia was 1.40 (95% CI: 1.33-1.48; I 2 = 0%; 3 cohort studies). Significant associations were found for telogen effluvium (aOR, 1.76; 95% CI: 1.34-2.32) and androgenetic alopecia (aOR, 1.64; 95% CI: 1.35-1.99) at 12 months; alopecia areata was not significant (aOR, 1.08; 95% CI: 0.87-1.34). Pharmacovigilance signals were highest for semaglutide (ROR, 2.46; 95% CI: 2.14-2.83) and tirzepatide (ROR, 1.73; 95% CI: 1.43-2.10). Paradoxically, 58% of patients with central centrifugal cicatricial alopecia showed improvement with GLP-1 RA use. Conclusion:GLP-1 RAs are associated with a significant 40% increased risk of non-scarring alopecia, driven by telogen effluvium and androgenetic alopecia and primarily mediated by weight loss-induced micronutrient deficiency. Semaglutide and tirzepatide carry the highest pharmacovigilance burden. Dermatologists should counsel patients proactively, optimize nutrition, and avoid premature drug discontinuation.
Introduction: Nail growth disorders may lead to functional limitations and cosmetic distress, yet evidence-based therapeutic options remain limited. Minoxidil, a vasodilatory agent widely used for androgenetic alopecia, has been proposed as a potential treatment to enhance nail growth because of its proliferative and vascular effects. This systematic review evaluated the efficacy and safety of topical minoxidil for promoting nail growth in both healthy individuals and patients with nail growth disorders. Methods: The review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, MEDLINE, Web of Science, Wiley, Google Scholar, and EBSCO identified eligible human studies reporting quantitative nail growth outcomes. Results: Three studies, including one randomized controlled trial and two non-randomized studies, met the inclusion criteria. Topical minoxidil was associated with increased nail growth compared with placebo or untreated controls. In healthy participants, twice-daily application of 5% topical minoxidil increased the mean nail growth rate from 3.91 mm/month to 4.27 mm/month after 1 month (p = 0.003). In patients with pathological nail arrest (onychomadesis), a 5% minoxidil formulation combined with vitamin E achieved an 81% clinical response rate after 12 months of treatment. Additionally, minoxidil showed a greater increase in nail growth compared to oral biotin, with a 19% versus 13% increase in longitudinal nail growth, respectively. No severe local or systemic adverse effects were reported. Conclusion: Preliminary evidence from three studies indicates that topical minoxidil may stimulate nail growth in healthy individuals and patients with nail growth disorders. Nevertheless, the limited number of included studies (n = 3), small sample sizes, and heterogeneous study designs preclude definitive clinical recommendations. More comprehensive randomized controlled trials should be conducted to prove efficacy and develop standardized treatment regimens.
Introduction:Although the association between hidradenitis suppurativa (HS) and metabolic syndrome (MetS) has been demonstrated, we aimed to investigate risk factors for MetS in patients with HS, as this topic has been addressed in only a limited number of previous studies. Methods:To compare the frequency of MetS and its components, 50 adult patients with HS and 50 age-, sex-, and body mass index (BMI)-matched controls were included in the study. Subsequently, the effects of age, sex, BMI, smoking status, and the modified Sartorius score on MetS in the patients with HS were examined using Firth's bias-reduced logistic regression analysis. Results:MetS and two of its components, namely central obesity and low high-density lipoprotein cholesterol levels, were significantly more common in the patients (62% vs. 22%, 64% vs. 28%, and 46% vs. 18%, respectively). The patients had higher rates of smoking (76% vs. 34%). Firth's logistic regression analysis showed that age (odds ratio: 1.17, 95% confidence interval: 1.05-1.43) and BMI (1.94, 1.25-4.54) were significantly associated with MetS in the patients with HS. The positive association between smoking and MetS was borderline significant (p = 0.053). Conclusion:Our findings suggest the need for proactive metabolic screening in routine HS care. Physicians should not only screen for MetS at the initial visit but also remain particularly vigilant during follow-up in older patients and those experiencing weight gain.
Background:Androgenetic alopecia (AGA) frequently occurs in both men and women and is associated with a significant quality-of-life impairment. Topical minoxidil has been demonstrated to have a variable clinical response, and the proposed efficacy of using concomitant topical tretinoin largely stems from increased minoxidil penetration and activation by the follicular sulfotransferase enzyme. Summary:This review summarizes mechanisms, safety, outcomes, and social media perspectives on the subject. Pharmacokinetic evidence demonstrates a nearly threefold increase in systemic absorption when tretinoin cream is applied before minoxidil, with researchers hypothesizing increased permeability as the cause. However, clinical data regarding combination therapy are minimal. One randomized controlled trial reported similar outcomes between dual therapy and topical minoxidil monotherapy; results from smaller investigations, however, are consistent with the potential conversion of some minoxidil nonresponders to responders when tretinoin is used. A social media analysis of 71 online posts was notable for frequently positive claims regarding the interaction, but tolerability concerns were common. Key Messages:Though current evidence does not support the first-line use of dual therapy, topical tretinoin may be considered as an adjunct in AGA, especially in patients without response to topical minoxidil. Any potential benefit, however, should be weighed against the potential for increased irritation.
Introduction: Body-focused repetitive behaviors (BFRBs), including skin picking, onychophagia, onychotillomania, and trichotillomania, are psychodermatologic conditions characterized by repetitive self-injury. While neuropsychiatric comorbidities are common in neurofibromatosis type 1 (NF1), prevalence and quality-of-life (QoL) impact of BFRBs in these individuals are underexplored. We aimed to characterize BFRB prevalence and assess association with dermatology-related QoL in a national NF1 cohort. Methods: A voluntary online survey was distributed to NF1 registry members. Participants reported BFRBs and dermatology-related QoL using the Dermatology Life Quality Index (DLQI). Multivariable logistic regression assessed predictors of moderate-severe QoL impairment. Results: Among 143 respondents, 73.4% reported ≥1 BFRB. Skin picking was most common (55.3%), followed by onychophagia (39.8%), onychotillomania (35.2%), and trichotillomania (17.9%). Respondents with any BFRB had significantly worse QoL vs. those without (mean DLQI score 7.28 vs. 4.03; p < 0.001). Any BFRB increased odds of moderate-severe impairment (OR 4.88; p = 0.007) with higher odds per additional BFRB (OR 1.93; p < 0.001). Conclusion: We found that BFRBs are highly prevalent and independently associated with poorer QoL in NF1 patients. Screening for BFRBs during dermatologic evaluation in patients with NF1 may improve early recognition and reduce grooming-related skin and nail injury.
Background:Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a disproportionately high burden of metabolic comorbidities, including obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), dyslipidaemia, and polycystic ovary syndrome. Despite this, clinical management of HS has historically remained siloed within dermatology, with insufficient integration of cardiometabolic risk management. Summary:GLP-1 receptor agonists (GLP-1 RAs) - a drug class now established for T2DM, obesity, and cardiovascular risk reduction - have recently emerged as candidate agents for HS. A systematic review published in 2024 and two pivotal real-world studies published in 2025 provide preliminary evidence that GLP-1 RAs improve HS disease activity through both weight loss and direct anti-inflammatory mechanisms. We argue that this evidence base is already sufficient to justify a paradigm shift: GLP-1 RAs should be considered as adjunctive components of a multidisciplinary treatment strategy for HS patients with concurrent cardiometabolic disease. We propose a practical clinical framework for patient selection and monitoring and call for dedicated randomised controlled trials. Key Messages:Metabolic comorbidities are mechanistically linked to HS pathogenesis and are inadequately addressed in current clinical practice. GLP-1 RAs offer dual benefit in HS - improving both metabolic outcomes and HS disease activity. Dermatologists should screen every HS patient for cardiometabolic comorbidities and advocate for GLP-1 RA therapy in eligible patients as part of a multidisciplinary approach.
Background:Alopecia is one of the most prevalent medical conditions worldwide, and traditional therapies, such as topical minoxidil and hair transplants, are limited by pharmacological efficacy and donor-site availability. With technology evolving at a rapid pace, emerging bioengineering strategies are being developed, one of which is three-dimensional (3D) bioprinting of hair follicles. This review focuses on the materials, process, applications, and limitations of 3D printing in trichology, which aims to mimic real hair follicles to produce them de novo. Summary:This review identifies the synthetic and natural polymers currently used to make bioinks for 3D bioprinting and describes the process where cell populations - primarily dermal papilla cells - are layered to form a dermis and epidermis. The text then explores how this technology can be applied in androgenetic alopecia and full-thickness wound healing, as well as providing a template for surgical practice and an alternative to animal testing. Finally, it addresses the current limitations of this technology, such as its high maintenance cost, finding a balance between viability and printability, and the present inability to apply it to humans. Key Messages:3D bioprinting is an encouraging preclinical approach to overcoming treatment limitations for such a prevalent condition as alopecia. Its versatility would not only help in the treatment of alopecia but also in creating personalized prosthetics, guiding surgical techniques, and improving scientific research. However, while promising in a laboratory setting, further optimization of the bioink as well as cost of maintenance are required before it can be applied to clinical practice.
Background:Dissecting cellulitis is a chronic primary scarring alopecia characterized by pustules, nodules, abscesses, and sinus tracts that progress to permanent hair loss. Its prevalence is low, and reports in pediatric populations are scarce. Summary:This review aims to expand current understanding of dissecting cellulitis in pediatric population, highlighting it as a potential differential diagnosis at this age group to enable early diagnosis and prevent complications. A literature review was conducted using PubMed, Google Scholar, and SciELO, employing English and Spanish terms: "dissecting cellulitis," "children," "pediatrics," and "perifolliculitis capitis abscedens et suffodiens," covering publications from 1999 to 2025. Dissecting cellulitis is an uncommon disease in pediatric patients. Its pathogenesis is multifactorial, and it is clinically characterized by papules and pustules that evolve into nodules, abscesses, and fistulous tracts, leading to disfiguring scars and alopecia. Diagnosis is primarily clinical, supported by trichoscopy and histopathological examination. Differential diagnosis with other conditions is crucial to prevent its irreversible course. Although no standardized treatment protocol exists, multiple therapeutic options have been successfully employed in pediatric cases. Key Messages:Recognizing that dissecting cellulitis can occur in pediatric patients is essential to achieve early diagnosis and treatment, thereby preventing irreversible sequelae with significant psychosocial impact.
Introduction: Onychogryphosis has been associated with chronic foot injury and vascular disease. We evaluated whether onychogryphosis is associated with increased 5-year risk of lower extremity complications. Methods: Using TriNetX Research Network patients with onychogryphosis were propensity score matched 1:1 to controls for age, sex, race, obesity, type II diabetes, chronic kidney disease, and smoking. Cox proportional hazards models estimated 5-year hazard ratios (HRs) for lower extremity complications, with subgroup analyses for diabetes and peripheral artery disease (PAD). Results: After matching (174,537 per cohort), onychogryphosis was associated with increased 5-year risk of foot/toe amputation procedures (HR 2.798, 95% CI: 2.516-3.111), ulcer (HR 2.108, 95% CI: 2.023-2.196), cellulitis (HR 1.743, 95% CI: 1.685-1.803), osteomyelitis (HR 1.673, 95% CI: 1.583-1.769), and gangrene (HR 1.485, 95% CI: 1.382-1.597) (all p < 0.0001). Associations remained significant in diabetes and PAD restricted analyses. Conclusion: Onychogryphosis was associated with substantially increased 5-year risk of major lower extremity complications in a large matched cohort, with consistent findings among patients with type II diabetes and PAD. Identification of onychogryphosis should prompt focused lower extremity assessment and brief risk screening with a low threshold for vascular or primary care referral in high-risk patients.
Introduction:Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with obesity and a high burden of psychiatric comorbidity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and metformin are commonly prescribed for metabolic disease and have anti-inflammatory effects, prompting interest in their use among patients with HS. However, recent reports have raised concerns regarding potential psychiatric adverse effects of GLP-1RAs. We evaluated psychiatric outcomes following GLP-1RA versus metformin initiation among adults with HS. Methods:We conducted a retrospective cohort study within the NIH All of Us Research Program (Controlled Tier v8) using a new-user, active-comparator design. Adults with HS were identified using validated SNOMED concepts. Incident users of GLP-1RAs were compared with incident users of metformin after a 365-day washout. The primary outcome was the first psychiatric diagnosis within 12 months of treatment initiation. Stabilized inverse probability of treatment weighting (IPTW) was used to control for confounding. Effect estimates included 12-month cumulative risks, risk differences (RD), risk ratios (RR), and IPTW-weighted Cox proportional hazards models. Results:The weighted analytic cohort included 77 GLP-1RA users and 233 metformin users. At 12 months, psychiatric diagnoses occurred in 61.3% of GLP-1RA users versus 51.1% of metformin users (RD + 10.2 percentage points; RR 1.20; 95% CI: 0.95-1.52). The hazard ratio for time to first psychiatric diagnosis was 1.26 (95% CI: 0.90-1.78). Divergence between groups occurred primarily within the first 90 days after initiation. Conclusion:Among adults with HS, GLP-1RA initiation was associated with a modest, nonsignificant increase in psychiatric diagnoses compared with metformin. These findings are hypothesis-generating and warrant further investigation.
Background:Hidradenitis suppurativa (HS) is a debilitating skin disease marked by recurrent abscesses and chronic inflammation. Immune checkpoint inhibitors (ICIs) are widely used oncologic treatments that can provoke immune-mediated effects. The ICI potential to precipitate HS onset or influence HS disease activity remains uncharacterized. We aim to characterize the timing, clinical features, severity, and outcomes of HS in this context. Methods:Scoping review according to PRISMA guidelines was conducted. Studies were identified through PubMed and MEDLINE searches and were eligible if they reported at least 1 case of HS onset or worsening in the setting of ICI therapy. Results:Five publications comprising 13 patients were included. Pembrolizumab was the most frequently used ICI (46.2%). Eight individuals (61.5%) had pre-existing HS, of whom 3 (37.5%) experienced flares during therapy. Five patients (38.5%) developed new-onset HS after ICI initiation, within 2-4 months. Treatment approaches varied and included topical and systemic therapies for HS. Four patients (30.8%) experienced complete resolution of HS lesions following ICI discontinuation. Conclusions:ICI therapy may precipitate new-onset HS or exacerbate pre-existing disease in a subset of patients. Increased clinical vigilance and early dermatologic involvement may support timely diagnosis, optimize management, and preserve continuity of oncologic care.
Introduction:Alopecia areata (AA) has a major psychological impact, yet Brazilian data on patients' and caregiver's quality of life (QoL) are lacking. We aimed to assess QoL in patients with AA and their caregivers and identify clinical and socioeconomic correlates. Methods:A cross-sectional study including 118 patients (83 adults, 35 children/adolescents) aged ≥4 years with active scalp AA and 58 caregivers was performed at a tertiary dermatology center (2022-2024). QoL was evaluated with DLQI, CDLQI, and FDLQI. Disease severity was scored with Severity of Alopecia Tool (SALT) II. Sociodemographic and clinical data were analyzed using parametric and nonparametric tests (p ≤ 0.05). Results:Participants were predominantly female (63.6%) and of mixed race (53.5%), with mean age of 27.6 years. Mean SALT II was 33.9%. Multifocal (39.3%) AA predominated. QoL impact was moderate in adults (median DLQI 6; IQR 3-10) and mild in youth (median CDLQ 5; IQR 2-8) but greater among caregivers (median FDLQI 9; IQR 6-14). Patient-caregivers QoL scores correlated positively (Rho = 0.48, p < 0.001). Dermatologic comorbidities worsened QoL in both groups. Conclusion:AA exerts substantial psychosocial burden on whole family. Caregivers experience higher impairment than patients, underscoring the need for family-centered interventions in Latin America.
Introduction:Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit associated with recurrent flares, which significantly impair quality of life. Carbon dioxide (CO2) laser deroofing is a tissue-sparing technique that may offer effective symptom control with low recurrence. Our study describes the clinical characteristics and outcomes of an Asian cohort who underwent CO2 laser deroofing for HS. Methods:This retrospective study included patients who underwent clinic-based CO2 laser deroofing for HS lesions between November 2017 and December 2024 at a single institution. Results:A total of 43 procedures were performed on 30 patients (57% male; median age: 22.0 years [IQR: 17.0-33.8 years]). The cohort included mainly Chinese (53.3%) and Indian (33.3%) patients. At surgery, 51.2% had Hurley stage II disease, 25.6% had stage III disease, and 23.3% had stage I disease. Most patients (95.3%) were concurrently treated with tetracyclines. The axilla was the most treated site (63%). Recurrence occurred in 9.3% of procedures, for which one required abscess aspiration. Other complications included minor bleeding (23.3%), hypergranulation (7.0%), and infection (4.7%). Conclusion:CO2 laser deroofing is a simple, effective, and minimally invasive treatment for HS lesions. It offers low recurrence and complication rates and is feasible in an outpatient setting for Asian populations.
