Although soft-tissue fillers are a popular choice for minimally invasive rejuvenation of the face, physicians should be aware of the serious potential adverse effects, recognize their presentations, and have appropriate treatments readily available.

Tofacitinib citrate is a Janus kinase 1/3 inhibitor approved for the treatment of rheumatoid arthritis, but it has recently been used to treat alopecia areata (AA). 1-3 In this study, investigators searched the medical records of the Cleveland Clinic for any patients with confirmed AA who were treated with oral tofacitinib (Xeljanz; Pfizer) using a standardized, systematic treatment regimen. Methods | A standard departmental treatment protocol was developed prior to this review. Treatment with tofacitinib citrate was initiated at 5 mg twice daily, and all other AA therapies were ceased. The daily dosage was increased, as allowable by insurance coverage, by 5 mg per month until the treating physician noted first signs of hair regrowth and then held the medication at that dose. The Cleveland Clinic Foundation Institutional Review Board approved this retrospective medical record review and waived the patient informed consent requirement. The review took place from May 1, 2016, to June 1, 2016. Scalp hair loss was calculated from visit to visit by the same treating physician (M.P. or W.B.) using the validated Severity of Alopecia Tool (SALT) 4 score, which can range from 0% to 100%; the higher the score, the greater the amount of scalp hair loss. In all, patients were treated by 2 different physicians (M.P. and W.B.

To investigate medical and environmental risk factors for central centrifugal cicatricial alopecia (CCCA), the most common type of scarring alopecia in African American women.Design: A population study involving a quantitative cross-sectional survey of risk factors for CCCA. Survey results are then correlated with a clinical evaluation for CCCA using a standardized, previously published central scalp alopecia photographic scale.Setting: Two African American churches and a health fair for African American women in Cleveland, Ohio.Participants: A total of 326 African American women who participated in the hair study.Main Outcome Measures: Prevalence of CCCA in the general African American population and risk factors associated with CCCA.Results: Of the 326 responders, 28% received a grade of 2 or higher using a standardized, previously pub-lished central scalp alopecia photographic scale, a score consistent with clinically evident central hair loss. Advanced central hair loss with clinical signs of scarring (grade Ն3) was seen in 59% of these respondents and was interpreted as clinically consistent with CCCA. Diabetes mellitus type 2 was significantly higher in those with CCCA (P=.01), as were bacterial scalp infections (P=.045) and hair styles associated with traction (eg, from braids and weaves) (P =.02). Conclusions:Our survey results suggest that there is a high prevalence of central hair loss among African American women. Hair styles causing traction as well as inflammation in the form of bacterial infection may be contributing to the development of CCCA. The increase in diabetes mellitus type 2 among those with CCCA is in line with the recent theory that cicatricial alopecia may be a manifestation of metabolic dysregulation.

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Acral melanocytic neoplasms often pose diagnostic difficulty. Preferentially expressed antigen in melanoma (PRAME) expression and loss of p16 expression have diagnostic utility in melanocytic tumors. We examined PRAME and p16 expression in 30 acral melanocytic neoplasms (n = 11 nevi; n = 2 dysplastic nevi; n = 7 Spitz nevi; n = 10 acral melanomas). PRAME was scored as % positive nuclei: negative = 0%; 1% to 25% = 1+; 25% to 50% = 2+; 50% to 75% = 3+, or positive: 75% to 100% = 4+. p16 expression was defined as retained (homogeneous or checkerboard) or lost (complete or partial/regionally). PRAME expression was negative in all benign, dysplastic, and Spitz nevi. Conversely, all acral melanomas were diffusely (4+) positive for PRAME expression. p16 expression was retained in all benign acral nevi (8/11 homogeneous, 3/11 checkerboard), completely lost in one dysplastic nevus, and retained in all acral Spitz nevi (3/7 homogeneous, 4/7 checkerboard). p16 was retained in five of 10 acral melanomas (3/10 homogeneous; 2/10 checkerboard), and negative in five of 10 acral melanomas (absent in 3/10, partially lost in 2/10). Our data suggest that 4+ PRAME expression is highly sensitive and specific in the setting of acral melanomas and is a more predictive diagnostic tool compared with p16 immunohistochemistry.