There are no data to support the use of finasteride in women with androgenic alopecia. Pregnant women should not be exposed to finasteride either by use or by handling crushed tablets because of the risk of hypospadias developing in a male fetus.
Bimatoprost (Latisse) is a prostaglandin analog available as a 0.03% ophthalmic solution to treat hypotrichosis of the eyelashes. Mechanism of action is unknown. Treatment consists of nightly application to the skin of the upper eyelid margins at the base of the eyelashes using a separate disposable applicator for each eyelid. Contact lenses should be removed prior to bimatoprost application. Side effects include pruritus, conjunctival hyperemia, skin pigmentation, and erythema of the eyelids. Although iris darkening has not been reported with applications confined to the upper eyelid skin, increased brown iris pigmentation, which is likely to be permanent, has occurred when bimatoprost ophthalmic solution was instilled onto the eye for glaucoma.
Eflornithine (Vaniqa) is an irreversible inhibitor of ornithine decarboxylase, which catalyzes the rate-limiting step in the biosynthesis of polyamines. Polyamines are required for cell division and differentiation, and inhibition of ornithine decarboxylase affects the rate of hair growth. Topical eflornithine has been shown effective in reducing facial hair growth in approximately 30% of women when applied twice daily for 6 months of therapy. Hair growth was observed to return to pretreatment levels 8 weeks after discontinuation. Local adverse effects include stinging, burning, and folliculitis.
The treatment of melanoma is discussed in Chapter 54.
Alitretinoin (Panretin) is a topical formulation of 9-cisretinoic acid that is approved for the treatment of cutaneous lesions in patients with AIDS-related Kaposi’s sarcoma. Localized reactions may include intense erythema, edema, and vesiculation necessitating discontinuation of therapy. Patients who are applying alitretinoin should not concurrently use products containing DEET, a common component of insect repellant products.
Bexarotene (Targretin), a member of a subclass of retinoids that selectively binds and activates retinoid X receptor subtypes, is available both in an oral formulation and as a topical gel for the treatment of cutaneous T-cell lymphoma. Teratogenicity is a significant risk for both systemic and topical treatment with bexarotene, and women of childbearing potential must avoid becoming pregnant throughout therapy and for at least 1 month following discontinuation of the drug. Bexarotene may increase levels of triglycerides and cholesterol; therefore, lipid levels must be monitored during treatment.
Vismodegib (Erivedge) and sonidegib (Odomzo) are oral hedgehog pathway inhibitors for the treatment of metastatic basal cell carcinoma or locally advanced basal cell carcinoma in adults who are not candidates for surgery or radiation. They are highly effective in patients with basal cell nevus syndrome. The recommended dosage of vismodegib is 150 mg daily and sonidegib is 200 mg daily. The most common adverse effects include dysgeusia and ageusia, alopecia, fatigue, and muscle spasms.
Baseline serum creatine kinase and creatinine levels prior to initiating therapy and during treatment may be indicated for significant musculoskeletal symptoms.
Hedgehog pathway inhibitors are embryotoxic, fetotoxic, and teratogenic in animals. Pregnancy status of females of reproductive potential must be verified within 7 days prior to initiating therapy. Exposure may occur through seminal fluid.