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Alopecia areata (AA) is an autoimmune disease directed at the hair follicle. Although usually limited to patchy hair loss over the scalp (focalis), AA can present as total loss of scalp hair (totalis; AT) or as total loss of both scalp and body hair (universalis; AU). Management of AT and AU can be challenging, and although multiple treatment modalities have been explored, no therapy is currently FDA-approved. This review focuses on the evidence for current treatment options for AT and AU. The PubMed database was searched from January 1, 2000, to September 1, 2016, for clinical trials, retrospective studies, and case reports of treatments for AT and AU. A total of 40 studies were retrieved and analyzed. Therapies studied for AT/AU included: topical immunotherapy, steroids, photodynamic therapy, immunosuppressive agents, TNFα inhibitors, and other therapies, such as sulfasalazine, bexarotene, JAK inhibitors, and simvastatin/ezetimibe. Although certain treatments showed significant hair regrowth, no treatment was completely effective. The most promising therapies with the highest quality data include diphenylcyclopropenone, squaric acid dibutylester, photodynamic therapy, steroids, and cyclosporine in combination with methylprednisolone. High-quality randomized-controlled trials with large sample sizes are lacking. Unified outcome guidelines are encouraged to facilitate the comparison of future studies.

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Background Physicians are beginning to use finasteride as treatment for hair loss, hirsutism, and various other dermatologic conditions in women. However, the reported efficacy and use of finasteride in the female population varies widely. The purpose of this study is therefore to better define the efficacy and use of finasteride in women and identify research gaps that require further investigation. Methods A systematic review of the current literature describing finasteride use in women. Results A total of 2,683 patients participated in 65 studies involving finasteride use in women published between January 1997 and July 2017. Most randomized controlled trials (RCTs) evaluated finasteride use in women with hirsutism (48.7%) or female pattern hair loss (34.7%). RCTs recommend finasteride treatment for women with hirsutism or polycystic ovarian syndrome. Meanwhile, other forms of hair loss were studied such as alopecia, lichen planopilaris, and frontal fibrosing alopecia, but no RCTs evaluating finasteride therapy were identified. Other prospective and retrospective studies report that finasteride may improve hair loss in women with female pattern hair loss or frontal fibrosing alopecia. Overall, doses of oral finasteride ranged from 0.5 to 5 mg/day, in females aged 6–88, over a duration of 6–12 months (57.6%), as monotherapy (88.9%), and for continuous use (96.4%). Conclusion The studies reviewed highlight the finasteride dosage, length of treatment, and candidate conditions that can benefit from finasteride therapy. Future long‐term studies are necessary to fully assess the therapeutic mechanisms and potential consequences of finasteride use and to optimize treatment protocols.

Angiokeratomas can present therapeutic challenges, especially in cases of extensive lesions, where traditional surgical methods carry high risks of scarring and hemorrhage. Argon, pulsed dye (PDL), neodymium-doped yttrium aluminum garnet (Nd:YAG), copper vapor, potassium titanyl phosphate, carbon dioxide, and erbium-doped yttrium aluminum garnet (Er:YAG) lasers have emerged as alternative options. To review the use and efficacy of lasers in treating angiokeratomas. A PubMed search identified randomized clinical trials, cohort studies, case series, and case reports involving laser treatment of cutaneous angiokeratomas. Twenty-five studies were included. Quality ratings were assigned using the Oxford Centre for Evidence-Based Medicine scheme. Several laser modalities are effective in treating multiple variants of angiokeratomas. Vascular lasers like PDL, Nd:YAG, and argon are the most studied and of these, PDL offers the safest side effect profile. Nd:YAG may be more effective for hyperkeratotic angiokeratomas. Combination treatment with multiple laser modalities has also demonstrated some success. Lasers are a promising treatment option for angiokeratomas, but current use is limited by the lack of treatment guidelines. There are limited high quality studies comparing laser treatments to each other and to non-laser options. Additional studies are needed to establish guidelines and to optimize laser parameters.

A man in his 70s with a 4-year history of stage IV chronic lymphocytic leukemia (CLL) presented with a 12-month history of an asymptomatic skin eruption. His CLL had been in remission for 2 years after treatment with fludarabine and rituximab before he relapsed and underwent 6 cycles of RCHOP treatment (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). During his CLL relapse, he developed cutaneous nodules on his face that then spread diffusely. The patient denied fevers, arthralgias, bone pain, polydipsia, or polyuria. Physical examination revealed multiple 0.5-to 1.5-cm reddish-brown firm papules and nodules on his cheeks, torso, buttocks, and extensor surfaces of his extremities (Figure, A), sparing his eyelids, palms, soles, and mucous membranes. Triglyceride levels were mildly elevated at 211 mg/dL; otherwise the patient's lipid levels were normal (to convert triglycerides to millimoles per liter, multiply by 0.0113). A biopsy of a representative papule on the thigh was performed, and a routine hematoxylin-eosinstained section (Figure, B) and CD68 immunohistochemically stained section (Figure, C) are shown. Findings of CD1a and S100 stainings were negative.

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Malignant melanoma arising in OCT is a rare disease with poor prognosis. The current mainstay treatment is surgical. Potential benefits of targeted therapy, immunotherapy, and chemotherapy remain to be determined. A limitation of this study is that these melanomas have only been published in case reports.