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      Scalp Psoriasiform Contact Dermatitis with Acute Telogen Effluvium due to Topical Minoxidil Treatment

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          Abstract

          Topical minoxidil, the only approved treatment for female pattern hair loss (FPHL), has been associated with scalp allergic contact dermatitis (ACD). We report the case of 2 female patients who developed ACD from minoxidil solution with severe telogen effluvium and psoriasiform scalp dermatitis. Scalp dermoscopy was useful to identify the psoriasiform vascular pattern, whereas patch testing made it possible to differentiate the cause of sensitization. In one case, minoxidil was the sole cause of scalp dermatitis, while in the other patient it was only the vehicle, thus permitting the patient to continue the treatment for FPHL.

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          Videodermoscopy in the evaluation of hair and scalp disorders.

          Colombina Vincenzi, Margaret Ross, Antonella Tosti (2006)
          The standard methods used to diagnose scalp and hair disorders (eg, simple clinical inspection, pull test, biopsy) vary in sensitivity, reproducibility, and invasiveness. Studies on a few entities suggest that use of dermoscopy can improve clinical accuracy, but further investigation is needed. We sought to: (1) characterize features of several nontumoral scalp and hair conditions using videodermoscopy; and (2) assess the potential usefulness of videodermoscopy in the clinical evaluation of these conditions. Images (x20-70 magnification) obtained with videodermoscopy from 220 patients with various scalp and hair disorders and 15 unaffected control subjects were reviewed for distinguishing features. Conditions evaluated included psoriasis (23), seborrheic dermatitis (26), alopecia areata (58), androgenetic alopecia (64), chronic telogen effluvium (7), trichotillomania (12), and primary cicatricial alopecia (30). Clinical features evident to the naked eye were seen in great detail when videodermoscopy was used. Novel features (eg, yellow dots in alopecia areata) were also identified. Findings require confirmation by blinded, prospective investigation. Use of videodermoscopy in the clinical evaluation of scalp and hair disorders improves diagnostic capability beyond simple clinical inspection and reveals novel features of disease, which may extend clinical and pathogenetic understanding.
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            The Koebner phenomenon.

            Lior Sagi, Henri Trau (2011)
            The Koebner phenomenon is one of the most well-known entities in dermatology. It was first described by Heinrich Koebner in 1876 as the formation of psoriatic lesions in uninvolved skin of psoriatic patients after cutaneous trauma. This isomorphic phenomenon is now known to involve numerous diseases, among them vitiligo, lichen planus, and Darier disease. The pathogenesis of the Koebner phenomenon is still obscure but may involve cytokines, stress proteins, adhesion molecules, and autoantigens. This contribution reviews the clinical manifestations of Koebner phenomenon, its provocative factors, suggested pathogenesis mechanisms, and the various skin conditions that exhibit this unique response.
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              Positive lymphocyte transformation test in a patient with allergic contact dermatitis of the scalp after short-term use of topical minoxidil solution.

              Tobias Hagemann, Brigitte Schlütter-Böhmer, Jean-Pierre Allam … (2005)
              Topical 2,4-diamino-6-piperidinopyrimidine-3-oxide (minoxidil) solution has been widely used for the treatment of androgenetic alopecia for over 15 years now and the substance is currently approved for this indication in 2% and 5% formulation. Typical side effects of this topical treatment include irritative dermatitis going along with pruritus, erythema, scaling and dryness, which occur especially at the onset of the therapy. In some cases, allergic contact dermatitis or exacerbation of seborrheic dermatitis has been reported. While most of the patients with allergic contact dermatitis described in the literature showed a positive sensitization to the vehicle substance propylene glycol evaluated by patch testing, reactions to the active ingredient minoxidil are rare. Here, we report a case of allergic sensitization to minoxidil, which we evaluated and differentiated from an irritative reaction by a combination of patch testing and lymphocyte transformation test. The differentiation of allergic and irritative adverse effects and the identification of the causative allergen are of major relevance for the proceeding and adjustment of the therapy. Patients with sensitizations against propylene glycol are candidates for preparations with alternative solvents but can proceed treatment with minoxidil. In contrast, patients with allergies to the active ingredient itself are no longer candidates for treatment with minoxidil and should undergo alternative therapeutic options.
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                Author and article information

                Journal
                Journal ID (publisher-id): SAD
                Journal ID (pmc): SAD
                Journal ID (doi): 10.1159/issn.2296-9160
                Title: Skin Appendage Disorders
                Publisher: S. Karger AG
                ISSN (Print): 2296-9195
                ISSN (Electronic): 2296-9160
                Publication date Subscription-year: 2015
                Publication date (Print): February 2016
                Publication date (Electronic): 19 November 2015
                Volume: 1
                Issue: 3
                Pages: 141-143
                Affiliations
                Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
                Author notes
                *Colombina Vincenzi, Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, IT-40138 Bologna (Italy), E-Mail colombina.vincenzi@unibo.it
                Author information
                https://orcid.org/0000-0002-6894-3350
                Article
                Publisher ID: 441622 Pmcid ID: PMC4857811 Other ID: Skin Appendage Disord 2015;1:141-143
                DOI: 10.1159/000441622
                PMC ID: PMC4857811
                PubMed ID: 27172052
                SO-VID: 60db2080-17f4-470b-9872-33ec5af4471c
                Copyright © © 2015 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 25 September 2015
                Date accepted : 08 October 2015
                Page count
                Figures: 2, References: 5, Pages: 3
                Categories
                Subject: Novel Insights from Clinical Practice

                ScienceOpen disciplines: Oncology & Radiotherapy,Pathology,Surgery,Dermatology,Pharmacology & Pharmaceutical medicine
                Keywords: Hair loss,Propylene glycol,Contact dermatitis,Scalp,Telogen effluvium,Psoriasis,Minoxidil
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Pathology, Surgery, Dermatology, Pharmacology & Pharmaceutical medicine
                Keywords: Hair loss, Propylene glycol, Contact dermatitis, Scalp, Telogen effluvium, Psoriasis, Minoxidil

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