No abstract

Female pattern hair loss is the most common cause of hair loss in women and one of the most common problems seen by dermatologists. This hair loss is a nonscarring alopecia in which loss occurs on the vertex scalp, generally sparing the frontal hairline. Hair loss can have significant psychosocial effects on patients, and treatment can be long and difficult. The influence of hormones on the pathogenesis of female pattern hair loss is not entirely known. The purpose of this paper is to review physiology and potential hormonal mechanisms for the pathogenesis of female pattern hair loss. We also discuss the current hormonal and hormone-modifying therapies that are available to providers as they partner with patients to treat this frustrating issue.

IMPORTANCE Allogeneic hematopoietic cell transplant (alloHCT) is known to increase the risk for keratinocyte carcinoma. The extent to which host characteristics, including pigmentary phenotype and UV radiation exposure, contribute is unknown.OBJECTIVE To identify and validate independent risk factors for keratinocyte carcinoma after alloHCT, including those associated with the transplant and the host.

Current guidelines recommend triple antithrombotic therapy (TT) consisting of warfarin, aspirin, and a P2Y12 inhibitor following an anterior ST elevation myocardial infarction (STEMI) complicated by extensive wall motion abnormalities. This recommendation, however, is based on data collected before percutaneous coronary intervention (PCI) became the standard of care for the treatment of STEMI. We designed a retrospective study of patients who received PCI for anterior STEMI over an 8-year period to compare rates of thromboembolic and bleeding events between patients receiving dual antiplatelet therapy (DAPT) and those receiving TT, including warfarin. Patients were included if the predischarge echocardiogram showed extensive wall motion abnormality and an ejection fraction ≤35%. Patients with known left ventricular thrombus were excluded. A total of 124 patients met the criteria, with 80 patients in the DAPT group and 44 in the TT group. The median age was 58 years in the TT group and 64 years in the DAPT group (P < 0.04), with an average ejection fraction of 31%. Thromboembolic events occurred in 4 patients (5%) in the DAPT group compared with 3 patients (6.8%) in the TT group (P = 0.70). Bleeding occurred in 2 patients in the DAPT group and 4 patients in the TT group (2.5% in DAPT vs. 9.1% in TT group, P = 0.18). No differences in rates of clinical embolism or left ventricular thrombus were found. Our data support recent findings that warfarin may not be indicated for patients following PCI for anterior STEMI, even when significant wall motion abnormalities and reduced ejection fraction ≤35% are present.A cute thromboembolic events due to left ventricular thrombus (LVT) formation, particularly in patients with reduced ejection fraction (EF), remain a risk for patients surviving an anterior ST elevation myocardial infarction (STEMI) (1). Th e reported incidence of LVT formation and subsequent embolization varies based on the timing of the echocardiographic examination and the diagnostic, anticoagulation, and reperfusion strategies utilized in managing the initial presentation but is noted to range from 0 to as high as 86% (1-9). Warfarin as a prophylactic strategy is therefore utilized and suggested in guidelines based on data derived from pooled results of studies done before catheter-based treatment of STEMI was prominent (10, 11). A recent report by Le May et al has suggested that warfarin treatment might be unnecessary in patients managed by primary PCI and dual antiplatelet therapy (DAPT) (12). Th e potential adequacy of DAPT alone was also shown in a small study that showed no advantage to a triple therapy (TT) regimen involving aspirin, a P2Y12 inhibitor, and warfarin when compared with DAPT with aspirin and a P2Y12 inhibitor in preventing LVT and systemic embolism (13). Given the uncertain benefi t and known bleeding risk associated with TT (14), we conducted a retrospective analysis spanning 8 years to compare the rates of LVT formation and thromboembolic events in patients with STEMI with EF ≤35% mana...

Although most cases of extramammary Paget's disease (EMPD) are localized to the intraepidermal, the extensive subclinical extension can lead to high rates of marginal recurrence with wide local excisions and topically destructive treatments. Recurrence rates of EMPD treated with Mohs micrographic surgery (MMS) without immunohistochemical staining are better but variable. Here, we describe our multidisciplinary approach for treating large EMPD tumors of the anogenital region involving critical anatomy using MMS for peripheral margin clearance (moat method) and intraoperative CK7 immunostaining. Our clinical pearls for the management of anogenital EMPD are based on 53 multidisciplinary cases treated at the author's institution between 2014 and 2020.