Alopecia areata (AA) is a common hair loss disorder worldwide with characteristic exclamation mark hairs. Although AA is self-limited, it can last for several months or even years in some patients. Currently, there is no US Food and Drug Administration-approved treatment for AA. Many off-label treatments are available but with limited efficacy. Through a better understanding of molecular biology, many targeted therapies have emerged as new alternatives for various autoimmune diseases. Various janus kinase (JAK) and signal transducer and activator of transcription (STAT) proteins form signaling pathways, which transmit extracellular cytokine signals to the nucleus and induce DNA transcriptions. By inhibiting JAK, T-cell-mediated inflammatory responses are suppressed. Increasing evidence suggests that JAK inhibitors (JAKis) are effective in the treatment of many autoimmune diseases, including AA. Among these, several studies on tofacitinib, ruxolitinib, and baricitinib in AA had been published, demonstrating promising outcomes of these agents. Unlike oral formulations, efficacy of topical forms of tofacitinib and ruxolitinib reported in these studies is still unsatisfactory and requires improvement. This review aims to summarize evidence of the efficacy and safety of JAKis in the treatment of AA.

No abstract

Solar lentigines are common pigmentary lesions. Q-switched lasers are effective treatment options but postinflammatory hyperpigmentation (PIH) is common in darker skin. The objective of the study is to compare the efficacy and safety in solar lentigines of Asian skin treated by Q-switched potassium titanyl phosphate (KTP) 532-nm nanosecond laser vs. KTP 532-nm picosecond laser for the treatment of solar lentigines in Asians. Thirty patients with at least 2 solar lentigines on the upper extremities were enrolled. A total of 30 paired lentiginous lesions were randomly treated with a single treatment of either Q-switched KTP 532-nm nanosecond laser vs. KTP 532-nm picosecond laser. In terms of efficacy, mean luminance score was evaluated at baseline, at 6th, and 12th week. Degree of pigment clearance was assessed by a blinded physician and the patients. Satisfaction score was rated by patients using visual analogue scale. Adverse events were also recorded. Twenty-eight patients completed the study. Both lasers showed significant improvement in mean luminance score from baseline (p < 0.05). Likewise, there was no significant difference in pigment clearance between two lasers either assessed by physician or patients. However, patients' satisfaction score was significantly higher with the picosecond laser (p = 0.014). Adverse events and pain were not different between groups. Q-switched KTP 532-nm nanosecond laser and KTP 532-nm picosecond laser are safe and effective for treating solar lentigines in Asians. Based on cost-effectiveness, Q-switched KTP 532-nm nanosecond laser remains the main treatment while KTP 532-nm picosecond laser can be considered as a treatment option.

Background. Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. Materials and Methods. This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties’ measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. Results. The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (P<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (P<0.05). Skin surface lipid was also found to be significantly higher in SD group (P<0.05). However, there were no differences in skin surface pH (P=0.104) and roughness (P=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (P<0.05). Conclusion. Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.

A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited. This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand. The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital. From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02). M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.

Fibrosing alopecia in a pattern distribution (FAPD) is a relatively new entity in the family of cicatricial alopecia. It has been categorized as a member of the lichen planopilaris (LPP) group due to its similarity in clinical and histopathological presentation. Nonetheless, the disease earns its own entity due to its lichenoid inflammation exclusively involving miniaturized hair and area of involvement mimicking pattern hair loss which differentiates itself from other types of LPP or pattern hair loss. Since its first introduction by Zinkernagel and Trüeb in 2000, there have been only few case reports and series of FAPD. We herein report a case of FAPD in a postmenopausal woman who had progressive hair loss over the course of 10 years.

Background: A recent report suggested potential of high-intensity focused ultrasound in improving UVB-induced hyperpigmentation in patients with Fitzpatrick skin type IV, but reports regarding its efficacy in other hyperpigmented conditions including melasma are lacking.Objectives: To investigate efficacy and safety of high-intensity focused ultrasound for the treatment of melasma in Asians.Methods: Each side of the face of 25 melasma patients was randomized to receive 3monthly sessions of high-intensity focused ultrasound treatment or serve as control.Lightness index, Melasma Area and Severity Index of malar area (MASI m ) by blinded dermatologists, self-evaluated improvement and satisfaction scales by patients, and side effects were assessed every 4 weeks for 20 weeks.Results: Twenty-one patients with Fitzpatrick skin type III and IV completed the study. There was a greater reduction of relative lightness index and MASI m after treatment in high-intensity focused ultrasound-treated side. However, there were no statistically significant differences between both sides. More than 50% improvement on treatment side was rated in 11 patients (52.4%). Side effects were minimal. None had worsening of melasma. Conclusions:High-intensity focused ultrasound may be an adjuvant for treatment of melasma. Further studies with larger sample size and proper parameter settings are recommended to determine its efficacy.

Background and Objectives: Microfocused ultrasound with visualization (MFU-V) has been approved for the treatment of skin laxity on several areas including the eyebrows, neck, and submental area. This study aims to determine the efficacy of MFU-V for the treatment of abdominal skin laxity using two different treatment protocols. Study Design/Materials and Methods: Thirty female patients with abdominal skin laxity were enrolled. Each side of the abdomen was randomly assigned to receive a single session of single-plane MFU-V treatment (4.5 mm) or dualplane MFU-V treatment (4.5 and 3.0 mm). Improvement scores (0-10) were assigned by a blinded physician and patients at 1, 3, and 6 months after treatment. Results: Twenty-eight female patients completed the study. The physician-evaluated mean improvement scores in single-plane treatment were 3.03 (±1.26), 3.43 (±1.35), and 2.18 (±0.86) at 1-, 3-, and 6-month follow-up, respectively. For dual-plane treatment, the scores were 3.11 (±1.23), 3.39 (±1.34), and 2.02 (±0.79). There was no statistically significant difference between single-and dual-plane treatment at each time point. A similar pattern of improvement was observed in patient-rated mean improvement scores. Patients who had undergone childbirth had significantly higher physician and patient-rated mean improvement scores than those who had not in both single-and dual-plane treatments. In addition, a significant reduction of mean waist circumference was observed in patients who had undergone childbirth. The median pain scores were 5.25 for single-plane treatment and 4.29 for dual-plane treatment (P = 0.20). Conclusion: Both single-and dual-plane MFU-V treatments showed comparable efficacies in treating abdominal skin laxity. The effect is more pronounced in patients who had undergone childbirth. Lasers Surg. Med.