BACKGROUNDAlopecia areata is a chronic disorder of the hair follicles and nails, of unknown etiology, with clear autoimmune components and genetic factors. Several therapeutic options have been suggested; however, no treatment is able to modify the disease course. Methotrexate is an immunosuppressant used in various dermatoses and recently introduced as a therapeutic option for alopecia areata.OBJECTIVESTo evaluate the efficacy and safety of methotrexate in alopecia areata.METHODSIn a retrospective, non-controlled study, we evaluated 31 patients with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, cumulative dose of methotrexate, use of systemic corticosteroids or other treatments, and drug safety.RESULTSRegrowth greater than 50% was observed in 67.7% of patients, with the best responses observed in those with <5 years of disease progression (79%), age over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving systemic corticosteroids in combination with methotrexate, 77.3% had greater than 50% regrowth, compared with 44.4% in those who used methotrexate alone. The therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 33.3% of patients with more than 50% regrowth.CONCLUSIONMethotrexate appears to be a promising and safe medication for the treatment of severe alopecia areata when used alone or in combination with corticosteroids.

In a study on scalp psoriasis of 19 patients (11 males and 8 females, 15-64 years of age, psoriasis area severity index partial score of the head ranging from 0.5 to 2.8), we came to notice that, apart from the classical criteria for the diagnosis of psoriasis which were present in all cases, in a majority of patients, sebaceous glands were extremely reduced in size. We compared findings of follicular counts and sebaceous glands with a nonpsoriatic group of individuals (n = 26). Ten cases from the psoriatic population presented with completely atrophic glands, most of the time intermingled with larger glands (P = 0.03); not a single case showed sebaceous gland atrophy in the control group. There were no statistical differences regarding total number of hair follicles (P = 0.08), terminal follicles (P = 0.15), vellus follicles (P = 0.39), and telogen follicles (P = 0.58) between the groups. Other unusual features observed in the scalp psoriasis group were dilation of infundibula in 11 cases, a papillomatous epidermal surface in 8 specimens, parakeratosis at the lips of infundibular ostia in 8 specimens, mitotic figures in 7 cases, and necrotic keratinocytes in 14 cases. We conclude that psoriasis of the scalp may present itself with unexpected microscopic findings, among them being atrophy of sebaceous glands. Further studies are necessary to clarify why this atrophy develops and if it is specific to psoriasis.

BACKGROUNDMasseter hypertrophy has been treated with botulinum toxin injections because of esthetic complaints especially in Asians.OBJECTIVESThe goal of the present study was to evaluate the efficacy of abobotulin toxin use in masseter hipertrophy treatment in Brazilians.METHODSTen Brazilian female patients with masseter hypertrophy were subjected to injections of 90U of abobotulinum toxin A applied on each side respecting the safety zone stabilished in literature and were followed up for 24 weeks.RESULTSWhen analyzing the coefficients between measures of middle and lower third of the face obtained from standardized photographs, an increase was observed, with statistical significance at 2 weeks (p=0.005) and 12 weeks (p=0.001). The progression of lower third reduction was 3.94%, 5.26%, 11.99%, and 5.47% (2, 4, 12, and 24 weeks respectively). All patients showed improvement in bruxism after treatment. Observed adverse effects were masticatory fatigue, smile limitation, and smile asymmetry.CONCLUSIONThe use of abobotulinum toxin A for masseter hypertrophy is effective in Brazilians and reached its maximum effect of facial thinning at 12 weeks. Smile limitation had a higher incidence compared to that reported in the literature and may result from risorius muscle blockage caused by toxin dissemination. Despite its side effects, 80% of the patients would like to repeat the treatment.

BACKGROUNDPermanent alopecia after bone marrow transplantation is rare, but more and more cases have been described, typically involving high doses of chemotherapeutic agents used in the conditioning regimen for the transplant. Busulfan, classically described in cases of irreversible alopecia, remains associated in recent cases. The pathogenesis involved in hair loss is not clear and there are few studies available. In addition to chemotherapeutic agents, another factor that has been implicated as a cause is chronic graft-versus-host disease. However, there are no histopathological criteria for defining this diagnosis yet.OBJECTIVEthe study aims to evaluate clinical and histological aspects in cases of permanent alopecia after bone marrow transplantation, identifying features of permanent alopecia induced by myeloablative chemotherapy and alopecia as a manifestation of chronic graft-versus-host disease.METHODSdata were collected from medical records of 7 patients, with description of the clinical features and review of slides and paraffin blocks of biopsies.RESULTSTwo distinct histological patterns were found: one similar to androgenetic alopecia, non-scarring pattern, and other similar to lichen planopilaris, scarring alopecia.CONCLUSIONThe first pattern corroborates the literature cases of permanent alopecia induced by chemotherapeutic agents, and the second is compatible with manifestation of chronic graft-versus-host disease on scalp, that has never been described yet. The results contribute to the elucidation of the factors involved in these cases, including the development of therapeutic methods

Acitretin therapy improved histological and immunohistochemical features typical of psoriasis. In psoriasis, suprapapillary plates are not thin, but the epidermal/suprapapillary thickness ratio is increased. Basal cell layer is expanded in psoriasis. Langerhans' cells were less frequent after treatment, and that finding has to be investigated further to determine its role in acitretin mechanism of action.