Part II: The treatment of primary and secondary Raynaud's phenomenon

Raynaud phenomenon (RP) presents with either primary or secondary disease, and both have the potential to negatively impact patient quality of life. First-line management of RP should include lifestyle modifications in all patients. Some patients with primary RP and most with secondary RP require pharmacologic therapies, which may include calcium channel blockers, topical nitrates, phosphodiesterase 5 inhibitors, or endothelin antagonists. Additional approaches to treatment for those with signs of critical ischemia or those who fail pharmacologic therapy include botulinum toxin injection and digital sympathectomy. Herein, we describe in detail the treatment options for patients with RP as well as provide treatment algorithms for each RP subtype.

Part I: Epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon

Raynaud's phenomenon (RP) is a relatively common disease with both primary and secondary forms. It is well understood as a vasospastic condition affecting the acral and digital arteries, resulting in characteristic, well-demarcated color changes typically in the hands and feet in response to cold or stress. Secondary RP (SRP) has been described in association with a variety of rheumatologic and nonrheumatologic diseases, environmental exposures, and/or medications. While both primary RP and SRP may impact the quality of life, SRP may lead to permanent and potentially devastating tissue destruction when undiagnosed and untreated. It is therefore crucial for dermatologists to distinguish between primary and secondary disease forms early in clinical evaluation, investigate potential underlying causes, and risk stratify SRP patients for the development of associated autoimmune connective tissue disease. The epidemiology, pathogenesis, and clinical presentation and diagnosis of both forms of RP are described in detail in this review article.

Examining the Potential for Koebnerization and Disease Precipitation in Cicatricial Alopecias

The treatment of primary scarring alopecias is challenging and patients may be susceptible to koebnerization. This predisposes cicatricial alopecia patients to worsening of their disease following procedural treatments or interventions. Research and recommendations surrounding the risk for koebnerization within scarring alopecias is extremely limited. Using a comprehensive literature review, we summarized the risks of procedures in potentially koebnerizing alopecias. We evaluated the risk not only with procedural treatments, but also with common elective cosmetic procedures and potentially trauma-inducing hairstyling techniques. Although additional studies are needed to better elucidate the risks of procedural treatments within primary scarring alopecia, we believe this review of the current evidence and expert insight will benefit healthcare providers and patients alike to help guide treatments in this challenging patient population. J Drugs Dermatol. 2023;22(1):29-34. doi:10.36849/JDD.6849.

Experience of a Single Academic Center Using IL-1 Inhibition for Rare Dermatologic Conditions

Evidence-based literature regarding management of rare and severe dermatologic disease is limited. Canakinumab and anakinra, two therapeutics used for inhibiting IL-1 pathways, have seen increased utilization for treatment of refractory dermatoses. We sought to better characterize the breadth of dermatologic conditions for which these medications could be utilized.

A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris

Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts.

Frontal fibrosing alopecia: cutaneous associations in women with skin of color

Frontal fibrosing alopecia (FFA) was first described as a progressive recession of the frontal hairline in postmenopausal women. Since its initial description, recognition and understanding of FFA has expanded. The condition is now defined as a patterned, symmetric, frontotemporal scarring alopecia that is considered to be histopathologically indistinguishable from lichen planopilaris. Numerous case reports and series have suggested clinical variants of and associations with FFA. In addition to reviewing the literature on FFA's associations, this article includes a case series of 5 women with skin of color (Hispanic and black) who presented with various cutaneous findings in association with FFA, including lichen planus pigmentosus (LPP), facial papules, and eyebrow loss. Recognition of the conditions that can occur in association with FFA in individuals with skin of color is important in further expanding our knowledge and understanding of FFA as a disease entity.