Clinical and Experimental Dermatology最新文献

Folliculitis decalvans (FD) is a chronic neutrophilic scarring alopecia, the exact pathogenesis of which remains unknown. A recent report on the successful use of a novel anti-interleukin (IL)-17 biologic agent to treat FD and the presence of IL-17-secreting mast cells in other types of scarring alopecias point to a distinct pathogenic mechanism in this disease. Our aim was to study and correlate the expression of IL-17 and mast cells in lesional and nonlesional scalp areas of patients with FD, using immunohistochemical techniques. There was significantly greater expression of IL-17 and mast cells in lesional compared with nonlesional scalp areas (P < 0.05). We also found a significantly positive correlation between IL-17 and tryptase-immunolabelled mast cells in nonlesional scalp (r = 0.64), highlighting the role of IL-17-secreting mast cells in 'normal-appearing' sites of FD. These findings suggest that novel treatments targeting both IL-17 and mast cells may be potentially beneficial in controlling the chronic inflammatory status of FD, especially for patients with recalcitrant FD.

Background: Female pattern hair loss (FPHL) is common and has a negative impact on quality of life. FPHL is more challenging to treat than male pattern hair loss, with minoxidil being the gold standard treatment. Several studies have used 17α-estradiol solution for treating FPHL with variable results, either alone or combined with minoxidil.

Objectives: To study the safety and efficacy of topical 17α-ethinylestradiol 0.01% combined with minoxidil 2% in comparison with minoxidil 2% in the treatment of FPHL.

Methods: Forty-three women with FPHL were recruited to this randomized controlled study and were asked to blindly apply twice daily six puffs of a spray-on solution containing either 17α-ethinylestradiol 0.01% combined with minoxidil 2% (EMX group) or minoxidil 2% alone (MX group). Treatment continued for 6 months. Clinical and trichoscopic assessments were performed at baseline and at the end of the treatment.

Results: At the end of the treatment period, both groups showed signs of improvement. Improvement parameters were better for the EMX group vs. the MX group, but this was not statistically significant. More patients in the EMX group experienced menstrual irregularities. Limitations include the limited number of patients and follow-up period. Also, the effects of estradiol were not studied on a cellular or molecular levels and systemic absorption of both medications was not determined.

Conclusions: The use of a 0.01% 17α-ethinylestradiol with a 2% minoxidil solution in the treatment of FPHL does not seem to offer a statistically significant advantage compared with minoxidil alone and may carry a higher risk of associated menstrual irregularities.

Tarnish tattoo is a form of localized cutaneous argyria resulting from the deposition of silver into the skin following exposure to silver jewellery in fresh piercings. This report presents the clinical presentation, diagnosis and management of four female patients with tarnish tattoos on the nose and ear from wearing silver jewellery. All four patients wore silver studs or rings immediately following the piercing. Two of the four patients underwent treatment with nanosecond Q-switched 1064-nm Nd:YAG laser and Q-switched alexandrite 755-nm lasers, with minimal improvement. Tarnish tattoos are an under-recognized side-effect of wearing silver jewellery in fresh piercings. The blue-grey discoloration from tarnish tattoos can be challenging to treat with nanosecond Q-switched lasers.

Background: Tumour necrosis factor α (TNF-α) inhibitor (TNFi)-induced psoriasiform eruptions are a well-known phenomenon among adults. However, data are limited regarding this reaction in children.

Objectives: To describe in paediatric patients with inflammatory bowel disease (IBD) the clinical characteristics of TNFi-induced psoriasiform eruptions and the outcomes of various therapeutic options.

Methods: We reviewed the medical charts of paediatric patients (aged < 18 years) with IBD who developed TNFi-induced psoriasiform eruptions during 2006-2022.

Results: Among 454 patients with IBD treated with TNFis, 58 (12.8%) were diagnosed with TNFi-induced psoriasiform eruptions, of whom 51 were included in the study. The female to male ratio was 1 : 1.3. The median age at skin eruption was 14.11 [interquartile range (IQR) 12.11-16.05] years. The median elapsed time to eruption appearance was 15.00 months (IQR 7.00-24.00) after initiation of the treatment. All 51 patients were treated with topical steroids and 17 (33%) needed systemic treatment (phototherapy, methotrexate or acitretin). Sixteen of 51 patients (31%) needed to stop TNFi treatment because of an intractable eruption. Female patients, patients with inflammatory alopecia and patients who were treated with methotrexate or phototherapy were more prone to stop TNFis.

Conclusions: TNFi-induced psoriasiform eruptions are common in paediatric patients with IBD. The eruption may appear months or even years after treatment initiation. Almost one-third of the described patients had to replace their treatment because of a recalcitrant cutaneous eruption. This indicates that a multidisciplinary approach is required.

Cutaneous melanoma in situ (MIS), also known as 'stage 0 melanoma', is a collection of malignant melanocytes in the epidermis and epithelial adnexa, without evidence of microinvasion to the papillary dermis. Distinct histological subtypes include lentigo maligna (LM), superficial spreading (SS) MIS and acral lentiginous (AL) MIS. LM is the most common subtype, usually diagnosed later in life (median age at diagnosis of 66-72 years) and associated with cumulative ultraviolet radiation exposure. SS MIS is associated with intense episodes of sun exposure and is more common on the trunk and extremities. AL MIS is seen in nonhair-bearing skin. AL MIS, although rare (0.6% of MIS in England), is found in a higher proportion in more pigmented skin types compared with other MIS subtypes. Most international studies between 1990 and 2019 report rising incidence for MIS. US data show a decline in the incidence of LM between 2015 and 2019. For 2013-2019 in England, the recorded incidence of LM is plateauing, whereas that of other MIS is rising. Definitive diagnosis of MIS is by histological examination of biopsied skin with immunohistochemistry but can be supported with dermoscopy and reflectance confocal microscopy. Surgical treatment (excision or Mohs micrographic surgery) is the gold standard. Depending on MIS subtype, other options such as cryotherapy, topical imiquimod, radiotherapy or watchful waiting may be appropriate. The latest 5-year net-survival rates in England between 2013 and 2015 are 98.6% for AL MIS and exceed 100% for all other MIS. This review summarizes the aetiology, pathogenesis, epidemiology, diagnosis and management of MIS.