Erosive lichen planus of the vulva (ELPV) is a variant of classic lichen planus that is characterized by painful vulvar erosions and scarring that extends onto the vaginal mucosa. This mucosal involvement in this disease differentiates it from lichen sclerosus, in which vaginal involvement is quite rare. In this prospective cohort study, Cooper and Wojnarowska describe the clinical features and therapeutic responses of 114 adult women with ELPV, confirming that this is a disease of perimenopausal and postmenopausal women that causes significant morbidity. Patients responded well to ultrapotent topical steroids as well as to combined steroid/antifungal/antibacterial preparations. Systemic therapies, on the other hand, proved disappointing. It remains unclear whether early treatment of ELPV lessens the risk of malignancy.
Female pattern hair loss (FPHL) affects as many as 50% of women. Although topical minoxidil is effective, it is often not well accepted by patients. The efficacy of oral antiandrogen therapy is not well established. Finasteride is a 5α reductase type 2 inhibitor that is currently approved to treat male androgenetic alopecia at a dose of 1 mg/d. Not only is this drug contraindicated in women of childbearing potential, the efficacy of low-dose finasteride in FPHL is controversial. In this case series of premenopausal women, Iorizzo et al demonstrate the efficacy of a regimen of 2.5 mg/d of finasteride in combination with an oral contraceptive containing drospirenone and ethinyl estradiol.
Persistent and recurrent episodes of occupational hand eczema (OHE) may result in prolonged sick leave or even job loss. Although OHE is most common among young female workers, specific prognostic predictors of a poor prognosis remain unknown. In this cohort study, Cvetkovski et al identified 758 new cases of OHE. Patients received a questionnaire regarding OHE severity, sick leave, job loss, depression, and health-related quality of life. A follow-up questionnaire was administered 1 year later. Patients reported overall OHE improvement over the course of that year. Age younger than 25 years was a significant protective factor against poor prognosis. Patients with lower socioeconomic status were a vulnerable subgroup, having a high risk of prolonged sick leave, job change, and loss of job. Atopic dermatitis was found to be a prognostic risk factor for persistently severe or aggravated disease, but contact allergy was not.
Diffuse dermal angiomatosis (DDA) is a rare variant of reactive angioendotheliomatosis that typically presents as tender, erythematous, violaceous, indurated plaques on the lower extremities of patients with severe peripheral vascular disease. In this case report, Yang et al describe DDA involving the breast in a heavy smoker who was subsequently found to have almost complete occlusion of the subclavian artery. The lesion resolved almost completely after percutaneous arterial revascularization. The authors emphasize the need for smoking cessation as part of the therapeutic regimen.
The lesion has a reticulated erythematous indurated plaque and ulceration with scar formation. Deeper tender nodules are also present.
Botulinum toxin A has been used for 2 decades for aesthetic purposes. Dysport is a European brand of this drug commonly used for off-label dermatologic purposes. It can be injected into the glabellar area, targeting the corrugator, procerus, and part of the frontalis muscle to reduce wrinkles. In this multicenter, double-blind, placebo-controlled, randomized trial, Rzany et al treated 221 patients with moderate to severe glabellar wrinkles with either a 3- or 5-site injection pattern. The 3-site pattern involved only the glabella, while the 5-site pattern involved the glabella and 2 additional cranial sites in the central forehead. The 3 central injection sites were found to be essential for the treatment of glabellar wrinkles, and the 2 additional sites in the forehead region did not significantly improve efficacy.
This Month in Archives of Dermatology. Arch Dermatol. 2006;142(3):278. doi:10.1001/archderm.142.3.278