Survey of Dermatology Practitioners' Opinions and Prescribing Habits of Oral Minoxidil for the Treatment of Androgenetic Alopecia

BACKGROUND

Utilization of low-dose oral minoxidil has increased in recent years in association with several clinical studies that have shown its efficacy in treating androgenetic alopecia (AGA).  Objective: To assess dermatology providers' attitudes and recommendation behaviors of oral minoxidil for the treatment of AGA.

METHODS

An online survey gauging the professional opinions, prescribing behaviors, and use of oral minoxidil was sent using the Orlando Dermatology Aesthetic and Clinical Conference email listserv which included multiple levels of dermatology practitioners including MD/DOs, NPs, and PAs across the United States.

RESULTS

Overall, the survey was sent to 2200 providers, and 201 (9.1%) responses were collected. 81% (n=139) of respondents supported the use of oral minoxidil for AGA. Support varied significantly (P=.03) by providers' number of years in practice with those in practice for greater than 30 years with the least amount of support. 92% of respondents (130, n=141) reported feeling comfortable prescribing oral minoxidil, and 83% (116, n=140) found oral minoxidil to be better than its topical formulation. 78% (108, n=139) felt their patients were satisfied with their results, and 89% (124, n=140) felt oral minoxidil was well tolerated by their patients.

CONCLUSIONS

This study found that most prescribers use oral minoxidil as a treatment for AGA and find it to be an effective and tolerable option for patients. Support for oral minoxidil was significantly impacted by providers' years in practice. J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7519.

A review of hair removal modalities in pediatric patients: Ethical and clinical considerations

Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.

Severe reactive infectious mucocutaneous eruption mimicking drug-induced epidermal necrolysis triggered by norovirus

Reactive infectious mucocutaneous eruption (RIME) is an eruptive mucositis with varying degrees of cutaneous involvement presumed to be due to an immunologic response to various infectious pathogens. Most reported cases occur after a prodromal upper respiratory illness. We present a patient with a particularly severe case mimicking drug-induced epidermal necrolysis found to be triggered by asymptomatic norovirus infection, a virus not previously reported in association with RIME.

Assessment of racial and ethnic differences of atopic dermatitis severity and treatment patterns in a diverse outpatient cohort in the United States: a retrospective observational study

Previous population-based studies in the United States found racial/ethnic differences of atopic dermatitis (AD) severity and treatment patterns. It is unclear whether these differences are from differences of disease characteristics or disparities. To examine racial/ethnic differences in severity and treatment patterns in a diverse outpatient patient cohort of AD patients (n = 833). There were no significant associations of highest-reported body surface area (BSA; Fisher's exact test, P = 0.19 and P = 0.44) or physician's global assessment (PGA; P = 0.63 and P = 0.57) with race or ethnicity; nor interactions of race/ethnicity with gender or age as predictors of BSA or PGA. Asian and multiracial/other patients were more likely than White or Black patients to use topical calcineurin inhibitors (Chi-square, P = 0.01). Dupilumab use differed by race (Multiracial/other = 35.0%; White = 20.1%; Asian = 15.7%; Black = 13.6%; Chi-square, P = 0.03), but not ethnicity (P = 0.88). Use of oral corticosteroids (Chi-square, P = 0.74), immunosuppressants (P = 0.98) or GABAergics (P = 0.16) or NBUVB (P = 0.42) did not differ by race. There were no interactions of race/ethnicity with gender or age as predictors of treatment use. Similar treatment patterns were observed across racial/ethnic groups. Though, topical calcineurin inhibitors were more commonly used in Asian and multiracial/other patients; dupilumab use was more common in multiracial/other patients.

Erythrodermic Bullous Pemphigoid in Skin of Color Treated With Dupilumab

Bullous pemphigoid (BP) is an autoimmune blistering disease that typically presents with pruritic, tense bullae in elderly patients.1 Several recognized presentations deviate from the classic bullous eruption, and erythrodermic BP, in particular, is thought to be a rare phenomenon. Herein, we present a case of erythrodermic BP in an African American male who initially presented with erythroderma in the absence of tense bullae. There have been no reports on erythrodermic BP in skin of color to our knowledge. The patient rapidly improved after treatment was started with dupilumab. He developed classic tense bullae seen in BP once dupilumab was discontinued.Sanfilippo E, Gonzalez Lopez A, Saardi KM. Erythrodermic bullous pemphigoid in skin of color treated with dupilumab. J Drugs Dermatol. 2023;22(7):685-686. doi:10.36849/JDD.7196. &nbsp.

313 Assessment of racial differences of atopic dermatitis characteristics in a diverse outpatient cohort in the United States

Atopic dermatitis (AD) can present differently across racial groups. To promote equality and consistency, dermatologists and other providers should properly recognize the heterogeneous manifestations of AD across racial groups. Yet, little is known about differences in how the commonly different features of AD occur by race. We assessed racial differences in the proportions of select key features of AD. The healthcare claims database from a large metropolitan tertiary care medical centre was queried for patients with physician-diagnosed AD using International Classification of Disease, Tenth Revision and Clinical Modification codes L20.x. Medical records were reviewed for demographics, comorbidities and documentation of Hanifin-Rajka criteria. The frequency of each criterion was evaluated by race (White, Black, Asian and Multiracial–Other). Overall, 766 patients with AD were included in the study; 374 (48.8%) were White, 284 (37.1%) Black, 89 (11.6%) Asian and 19 (2.5%) multiracial/other, 558 (68.2%) were female, 50 (6.1%) were age <18 years, 456 (55.7%) age 18–49 years and 313 (38.2%) age ≥50 years. Compared to White patients, Black patients had significantly higher proportions of personal (81.4% vs. 57.3%) and family (63.3% vs. 42.2%) history of atopic disease, perifollicular accentuation (60.6% vs. 36.9%) and xerosis on physical exam (84.2% vs. 73.9%)(P ≤ 0.03 for all). Multiracial/other patients had elevated proportions of a history of dry skin (81.3%), xerosis on physical exam (86.7%) and elevated Immunoglobulin E levels (75.0%). Black and multiracial/other patients had food hypersensitivity compared to White patients (50.0% and 71.4% vs. 35.1%, P = 0.04). There were marginally significant differences in the proportion of early-age AD onset (56.9% vs. 41.8%, P = 0.07) and anterior neck fold involvement (42.6% vs. 25.3%, P = 0.06) in Asian compared to White patients. There were no significant racial differences in the likelihood of other Hanifin-Rajka criteria, including pruritus, flexural dermatitis, chronic dermatitis, ichthyosis, nipple eczema, hand/foot dermatitis, immediate skin reactivity, subcapsular cataracts, cutaneous infections, pruritus when sweating, intolerance to wool/lipid solvents, environmental/emotional factors worsening AD, or white dermatographism. Our results suggest there are racial differences in AD characteristics even within a single region. These differences may be attributable to population-differences in genetics, environmental exposures, skincare practices etc. Future research is needed to understand the mechanisms and treatment responses of these heterogeneous AD presentations.

Assessment of the validity of international classification of disease tenth revision codes for atopic dermatitis

Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.