Finasteride-Induced Neuropsychiatric Reactions
Mayer Brezis
Braun School of Public Health & Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Finasteride, widely prescribed for androgenetic alopecia and increasingly obtained online, has been associated with persistent neuropsychiatric adverse effects, including depression, anxiety, cognitive impairment, and suicidality. This Mini Review examines the strength of evidence supporting a causal relationship between finasteride and these reactions, evaluates the drug’s benefit–risk balance in cosmetic use, and discusses implications for clinical practice and regulation. Evidence from experimental, clinical, and epidemiological studies across multiple countries fulfills key Bradford–Hill criteria for causality, including temporality, consistency, biological plausibility, and reversibility, with reports of persistent symptoms after drug discontinuation. Mechanistically, inhibition of 5α-reductase reduces neurosteroid synthesis—particularly allopregnanolone—affecting mood regulation, neurogenesis, and neuroinflammatory pathways. Regulatory agencies have responded by updating safety warnings, and some countries now require formal informed consent prior to prescription.
Although finasteride demonstrates short-term efficacy for hair loss, evidence for long-term benefit is limited, while meta-analytic data suggest an approximately 50% relative increase in depression risk. Given the baseline prevalence of depression, this translates into a clinically meaningful absolute risk, with rare but grave outcomes including suicide. Because alopecia is a cosmetic condition with alternative management options, application of the precautionary principle is warranted. Clinicians should ensure comprehensive disclosure of potential neuropsychiatric harms, screen for prior mood disorders, and engage in genuine shared decision-making. In light of persistent adverse effects, limited long-term efficacy data, and broader public health costs, avoidance of finasteride for hair loss and strengthened regulatory oversight should be seriously considered.
DOI: 10.29245/2767-5092/2026/1.1212 View / Download PdfDermatologists’ Role in Interdisciplinary Care for Obsessive-Compulsive Disorder and Body-Focused Repetitive Behaviors
Mary C. Swaim and Tony A. Slieman*
Department of Biomedical and Anatomical Sciences, NYIT College of Osteopathic Medicine at Arkansas State University, P.O. Box 119, State University, AR 72467.
Obsessive-compulsive disorder (OCD) and body-focused repetitive behaviors (BFRBs) are becoming increasingly prevalent in dermatology. Patients presenting with cutaneous concerns may have underlying psychiatric conditions, such as excoriation disorder, trichotillomania, and onychophagia. Despite up to 12% of the population meeting BFRB criteria, these disorders frequently go undetected due to stigma, underreporting, and a primary focus on cutaneous symptoms. Data suggest a substantial overlap in clinical presentation, neurobiology, genetics, and interventions among obsessive-compulsive spectrum disorders. Affected individuals experience elevated risks of comorbid anxiety, depression, and additional compulsive disorders. Dermatologists are uniquely positioned as the first to detect sequelae of these conditions, including alopecia, excoriations, nail deformities, and secondary infections. Validated screening tools, along with dermoscopy and full-body skin examinations, can aid in earlier detection. Treatment interventions for BFRBs remain inconsistent, with behavioral therapies showing more promising results and pharmacologic interventions demonstrating variable efficacy. This review synthesizes the current knowledge of OCD and BFRBs, including their relevance in dermatology and the importance of interdisciplinary collaboration. Increasing awareness and strengthening the dermatology-psychiatry partnership allows practitioners to address both the physical and psychological manifestations accompanying these conditions, ultimately leading to better treatment outcomes.
DOI: 10.29245/2767-5092/2026/1.1210 View / Download PdfCommentary: Resonance-Induced Therapeutic Technique for Skin Cancer Cells
DOI: 10.29245/2767-5092/2026/1.1201 View / Download PdfAhmed M. Al-Jumaily* and Hassan Liaquat
Institute of Biomedical Technologies, Auckland University of Technology
The Dermatologist’s Role in Long-Term Surveillance of Burn Scars for Malignancy
Richard J. Moraga
Rosalind Franklin University of Medicine & Science, North Chicago IL 60064.
Chronic burn scars represent a unique dermatologic substrate characterized by persistent inflammation, altered immune surveillance, and long-term structural skin changes that may predispose patients to cutaneous malignancy. Squamous cell carcinoma arising in burn scars, often referred to as Marjolin’s ulcer, is a well-documented but frequently delayed diagnosis associated with aggressive behavior and poor outcomes. While acute burn management is typically overseen by burn specialists and reconstructive surgeons, long-term surveillance of healed burn scars often falls outside structured care pathways. Dermatologists are uniquely positioned to identify early malignant transformation within burn scars due to their expertise in skin cancer recognition and longitudinal outpatient follow-up. This mini-review summarizes the epidemiology and pathophysiology of burn scar–associated malignancy, highlights clinical features suggestive of malignant transformation, and proposes a dermatology-centered framework for surveillance and early intervention. Increased awareness of burn scars as oncogenic risk sites may improve diagnostic timeliness and patient outcomes.
DOI: 10.29245/2767-5092/2026/1.1211 View / Download PdfTrigeminal Trophic Syndrome
Caroline Thorup Ladegaard1*, Henrik Frank Lorentzen1, Mathias Tiedemann Svendsen1,2
1The Department of Dermatology and Allergy, Odense University Hospital, Denmark
2Department of Clinical Research, University of Southern Denmark, Denmark
Trigeminal Trophic Syndrome (TTS) is a rare, well-documented neurocutaneous condition characterized by the triad of paresthesia, analgesia, and ulcerations caused by self-manipulation, most commonly affecting the ala nasi. It typically arises following injury to the trigeminal nerve, either centrally or peripherally.
We report the case of a 75-year-old woman who developed TTS following a cerebral stroke. Initially, her symptoms were misinterpreted as a psychiatric disorder, but the diagnosis of TTS was ultimately made based on the combination of prior trigeminal nerve injury and the classical symptom triad. This case highlights the diagnostic challenges of TTS and emphasizes the need to consider neurological etiologies in patients with atypical facial ulcerations.
DOI: 10.29245/2767-5092/2025/4.1206 View / Download PdfMelanin Fluorescence as a Bridge in the Theranostics of Malignant Melanomas
DOI: 10.29245/2767-5092/2025/4.1209 View / Download PdfDieter Leupold
Formerly LTB Lasertechnik Berlin GmbH, D-12489 Berlin, Germany.
Family-Wide Infection with Microsporum canis Following Exposure to a Domestic Cat
Anne Stockmann1, Lisbeth Lützen2, Karen M. T. Astvad3, Kristin Bergmann4, Sebastian V. Svendsen1,5, Mathias T. Svendsen1,5
1The Department of Dermatology and Allergy, Odense University Hospital, Denmark
2Department of Clinical Microbiology, Vejle Hospital, Denmark
3Bacteria, Parasites & Fungi, Statens Serum Institute, Copenhagen, Denmark
4The Department of Dermatology and Venereology, Aarhus University Hospital, Denmark
5Department of Clinical Research, University of Southern Denmark, Denmark
Tinea capitis is a superficial dermatophyte infection affecting the hair and scalp. The zoophilic dermatophyte Microsporum canis is one of the most frequent causes of both tinea capitis and tinea corporis in humans, particularly in children.
We present a case report involving whole-family transmission of M. canis due to close contact with a neighbor’s cat. All five children in the household developed scaly scalp lesions consistent with tinea capitis, while the parents exhibited only mild cutaneous involvement. Skin scrapings and hair samples from all family members were collected and analyzed using PCR, confirming M. canis in all family members.
The children were successfully treated with oral griseofulvin, while the parents responded well to topical ketoconazole shampoo.
This case highlights the importance of clinical awareness of tinea capitis, as early diagnosis and treatment are essential to prevent chronic hair changes and limit further transmission. Additionally, treatment of the infected animal under veterinary supervision is crucial to avoid reinfection.
DOI: 10.29245/2767-5092/2025/3.1202 View / Download PdfWidespread Dermatophytosis in A Ukrainian Patient with AIDS: A Case Report
DOI: 10.29245/2767-5092/2025/3.1203 View / Download PdfFrederik Bloch Mangaard1*, Ileana Codruta Vasilescu2, Lisbeth Lützen3, Karen Marie Thyssen Astvad4, and Mathias Tiedemann Svendsen1,5
1Department of Dermatology and Allergy Center, Odense University Hospital, Denmark
2Department of Pathology, Odense University Hospital, Denmark
3Department of Clinical Microbiology, Lillebælt Hospital, Vejle, Denmark
4Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen
5Department of Clinical Research, University of Southern Denmark, Denmark
Erythema Multiforme–Like Hypersensitivity Reaction with Pustules: A Clinical Clue to Coccidioidomycosis
DOI: 10.29245/2767-5092/2025/2.1200 View / Download PdfMiranda L. Yousif MD MPH1, Stefanie Nguyen MS MMS1, Jordan Ward MD1,2, Margaret Kessler MD FAAD21,2,3
1 University of Arizona College of Medicine-Phoenix
2 Banner University Medical Center
3 Medical Dermatology Specialists
Successful Use of Combination 5% Fluorouracil and 0.005% Calcipotriene Cream for Peri-Anal HSIL and SCCIS in an HIV-Positive Patient
Monika Bapna B.S1, Emily S. Ruiz2, Catherine Pisano M.D2
1Georgetown University School of Medicine, Washington, DC, USA
2Brigham and Women’s Hospital, Boston, MA, USA
Purpose:
The management of multifocal perianal high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma in situ (SCCIS) remains challenging, especially in immunosuppressed populations such as individuals with HIV. Current treatments are often invasive and associated with high recurrence rates. This case report explores the use of combination 5% fluorouracil and 0.005% calcipotriene cream (5FU/C) as a non-invasive therapeutic alternative for recurrent perianal HSIL and SCCIS.
Methods:
We present a case of a 57-year-old HIV-positive male on antiretroviral therapy with recurrent HSIL and SCCIS involving the perianal, gluteal, perineal, and inguinal regions. After failing multiple surgical excisions, the patient was treated with 5FU/C cream applied topically twice daily for 8 days.
Results:
The patient experienced a strong inflammatory response and discontinued therapy prior to the recommended 10-day course. However, at 1-month follow-up, there was complete clinical resolution of external lesions. Four months later, internal recurrence was detected via digital rectal exam and high-resolution anoscopy, but external lesions remained clear. Biopsies confirmed HSIL without invasive disease.
Conclusion:
This case illustrates the potential of 5FU/C as a non-invasive treatment option for extensive external HSIL and SCCIS in immunocompromised patients. While external lesion resolution was achieved, internal disease recurrence at 4 months after 5-FU/C treatment emphasizes the importance of comprehensive internal evaluation. These findings support further investigation of 5FU/C as an adjunct or alternative to surgical treatment in the multidisciplinary management of anal neoplasia.
DOI: 10.29245/2767-5092/2025/2.1199 View / Download PdfThe Cost of Relief: Financial and Educational Impacts on Atopic Dermatitis Care
1Michaela N. Crawford, 2Victoria S. Jiminez, 3Tiffany T. Mayo
1School of Medicine, Meharry Medical College
2School of Medicine, University of Alabama at Birmingham
3Department of Dermatology, University of Alabama at Birmingham 500 22nd Street South, Floor 3, Birmingham, AL 35233
Atopic Dermatitis (AD) affects those of all ages and demographics. AD is known to be cumbersome and financially taxing, significantly affecting patients’ quality of life (QoL). The purpose of this study is to assess the financial implications across various socioeconomic backgrounds and community types from the patient perspective within a single institution in the Southeastern U.S. A cross-sectional survey was administered to those ≥18 years old diagnosed with AD. Patients self-reported information on their socioeconomic status (SES), education level, affordability, expenses related to their AD, and factors affecting their QoL. In our cohort of sixty-four patients, we found that one in five patients have been unable to afford treatment at some point. This finding is not confined to the lowest income group, but rather all groups have experienced affordability difficulty. It is clinically significant that patients chose financial burden, transportation and access to medical care as one of their top three factors that decreased their QoL. We also found that the understanding of disease and treatment options may not be based on education level. Understanding the socioeconomic impact of disease facilitates ber resource allocation and knowledge of how we can better serve the evolving patient population.
DOI: 10.29245/2767-5092/2025/2.1198 View / Download Pdf