Christina S Oh, Maria Karim, Elizabeth J Klein, Lu Yin, Daniel Gutierrez, Jerry Shapiro, Kristen Lo Sicco
All types of alopecia, including androgenetic alopecia, alopecia areata, and lichen planopilaris/frontal fibrosing alopecia, affect over half of men and women. Though a common dermatological experience, many patients with visible hair loss report significant psychological and social distress and, consequently seek treatment. Current existing therapeutic regimens have proven to be efficacious, though may result in various adverse effects and require lifelong use. Laser and light-based therapies have been emerging in the current literature as a safe and alternative treatment, but their utilization for treating alopecia is poorly understood. This review evaluates the existing evidence regarding the use of lasers in the treatment of various forms of alopecia. Overall, there has been promising evidence for potential alopecia treatment efficacy: low-level light therapy for androgenetic alopecia, fractional laser for androgenetic alopecia, and excimer laser for alopecia areata.
{"title":"Light-based therapies in the treatment of alopecia.","authors":"Christina S Oh, Maria Karim, Elizabeth J Klein, Lu Yin, Daniel Gutierrez, Jerry Shapiro, Kristen Lo Sicco","doi":"10.5070/D330564423","DOIUrl":"https://doi.org/10.5070/D330564423","url":null,"abstract":"<p><p>All types of alopecia, including androgenetic alopecia, alopecia areata, and lichen planopilaris/frontal fibrosing alopecia, affect over half of men and women. Though a common dermatological experience, many patients with visible hair loss report significant psychological and social distress and, consequently seek treatment. Current existing therapeutic regimens have proven to be efficacious, though may result in various adverse effects and require lifelong use. Laser and light-based therapies have been emerging in the current literature as a safe and alternative treatment, but their utilization for treating alopecia is poorly understood. This review evaluates the existing evidence regarding the use of lasers in the treatment of various forms of alopecia. Overall, there has been promising evidence for potential alopecia treatment efficacy: low-level light therapy for androgenetic alopecia, fractional laser for androgenetic alopecia, and excimer laser for alopecia areata.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shae Margulies, Macartney Welborn, Vladimir Vincek
Infantile perianal pyramidal protrusion is characterized by a light pink to skin-colored soft tissue protrusion that is often midline and anterior [A1]to the anus. It most commonly occurs in young females and is relatively asymptomatic. Although biopsies are not routinely done, histopathology is relatively nonspecific and can appear similar to an acrochordon. The differential diagnosis is broad and clinical misdiagnosis as condyloma can lead to unnecessary accusations of child abuse. We report a case of perianal pyramidal protrusion that was originally biopsied owing to concern of condyloma acuminatum or molluscum. This case raises awareness of this diagnosis to help avoid unnecessary procedures and prevent emotional distress that could come for families with an inaccurate diagnosis of condyloma in young children.
{"title":"Diagnosis of perianal pyramidal protrusion in infants.","authors":"Shae Margulies, Macartney Welborn, Vladimir Vincek","doi":"10.5070/D330564433","DOIUrl":"https://doi.org/10.5070/D330564433","url":null,"abstract":"<p><p>Infantile perianal pyramidal protrusion is characterized by a light pink to skin-colored soft tissue protrusion that is often midline and anterior [A1]to the anus. It most commonly occurs in young females and is relatively asymptomatic. Although biopsies are not routinely done, histopathology is relatively nonspecific and can appear similar to an acrochordon. The differential diagnosis is broad and clinical misdiagnosis as condyloma can lead to unnecessary accusations of child abuse. We report a case of perianal pyramidal protrusion that was originally biopsied owing to concern of condyloma acuminatum or molluscum. This case raises awareness of this diagnosis to help avoid unnecessary procedures and prevent emotional distress that could come for families with an inaccurate diagnosis of condyloma in young children.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanadi Alsatti, Atheel Balkhy, Bashaer H Almahdi, Amal H Abualola
Sarcoidosis is a disease characterized by immunological granuloma formation in various organs. Cutaneous manifestations occur in about 25% of patients with rare cases showing ulcerative sarcoidosis, that can be debilitating if not treated promptly. This article presents a patient with isolated ulcerative sarcoidosis and reviews existing literature. A 44-year-old woman presented with a non-healing ulcer on her right gluteal area. A skin biopsy confirmed sarcoidosis with non-necrotizing granulomas. Systemic involvement of sarcoidosis was ruled out. Treatment involved topical corticosteroids and intralesional corticosteroid injections, resulting in complete healing. This case emphasizes the importance of considering ulcerative sarcoidosis in non-healing wounds and the efficacy of corticosteroid treatment.
{"title":"Cutaneous ulcers in sarcoidosis.","authors":"Hanadi Alsatti, Atheel Balkhy, Bashaer H Almahdi, Amal H Abualola","doi":"10.5070/D330464113","DOIUrl":"10.5070/D330464113","url":null,"abstract":"<p><p>Sarcoidosis is a disease characterized by immunological granuloma formation in various organs. Cutaneous manifestations occur in about 25% of patients with rare cases showing ulcerative sarcoidosis, that can be debilitating if not treated promptly. This article presents a patient with isolated ulcerative sarcoidosis and reviews existing literature. A 44-year-old woman presented with a non-healing ulcer on her right gluteal area. A skin biopsy confirmed sarcoidosis with non-necrotizing granulomas. Systemic involvement of sarcoidosis was ruled out. Treatment involved topical corticosteroids and intralesional corticosteroid injections, resulting in complete healing. This case emphasizes the importance of considering ulcerative sarcoidosis in non-healing wounds and the efficacy of corticosteroid treatment.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy. Three months post-initiation, he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft. The progressive course, lesion symmetry and location, worsening with nivolumab infusions, and biopsy findings supported the diagnosis. Hidradenitis suppurativa pathogenesis involves immune dysregulation marked by elevated IL17 and neutrophil-dominated inflammation [1]. Immune checkpoint inhibitors, including anti-PD1 agents like nivolumab, are linked to immune-related adverse events related to widespread T cell activation, potentially increasing IL17 signaling associated with HS [2,3]. Clinicians should be aware of, and observant for anti-PD1-induced HS, a rare immune-related adverse event, in patients undergoing immune checkpoint inhibitor therapy.
{"title":"Nivolumab-induced hidradenitis suppurativa: a case report.","authors":"Olivia Lamberg, Karan Pandher, Natalie H Matthews","doi":"10.5070/D330464106","DOIUrl":"https://doi.org/10.5070/D330464106","url":null,"abstract":"<p><p>We present a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy. Three months post-initiation, he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft. The progressive course, lesion symmetry and location, worsening with nivolumab infusions, and biopsy findings supported the diagnosis. Hidradenitis suppurativa pathogenesis involves immune dysregulation marked by elevated IL17 and neutrophil-dominated inflammation [1]. Immune checkpoint inhibitors, including anti-PD1 agents like nivolumab, are linked to immune-related adverse events related to widespread T cell activation, potentially increasing IL17 signaling associated with HS [2,3]. Clinicians should be aware of, and observant for anti-PD1-induced HS, a rare immune-related adverse event, in patients undergoing immune checkpoint inhibitor therapy.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minoxidil is a vasodilator medication known for its ability to promote hair growth. Although it was first introduced as an oral drug to treat hypertension, minoxidil was observed to have the important side-effect of increasing hair growth. This led to the development of a topical formulation as a 2% concentration solution for the treatment of female androgenic alopecia (AGA) and 5% for treating male AGA, which is considered as a first line U.S. Food and Drug Administration (FDA)-approved treatment for AGA in addition to oral 5-alpha-reductase inhibitor (finasteride). The mechanism by which minoxidil promotes hair growth is not fully understood but can be related to increasing blood flow owing to its vasodilator effects. Androgenic alopecia is characterized by the gradual conversion of terminal hairs into vellus hairs. Alterations in the hair cycle include reduced duration of the anagen phase and increased duration of the telogen phase, resulting in shorter hairs and eventual balding. Side effects of topical minoxidil include irritant and allergic contact dermatitis, pruritus, and facial hypertrichosis, which are more often seen with the use of 5% solutions rather than 2%. Herein, we report a 24-year-old woman who developed severe ear and face hypertrichosis after using a topical 5% minoxidil solution. She later had spontaneous resolution of her hypertrichosis three months after stopping it.
{"title":"Diffuse face and ear hypertrichosis caused by 5% topical minoxidil in an adult woman with spontaneous resolution.","authors":"Fares A Alkhayal, Ali A Alkinani","doi":"10.5070/D330464117","DOIUrl":"10.5070/D330464117","url":null,"abstract":"<p><p>Minoxidil is a vasodilator medication known for its ability to promote hair growth. Although it was first introduced as an oral drug to treat hypertension, minoxidil was observed to have the important side-effect of increasing hair growth. This led to the development of a topical formulation as a 2% concentration solution for the treatment of female androgenic alopecia (AGA) and 5% for treating male AGA, which is considered as a first line U.S. Food and Drug Administration (FDA)-approved treatment for AGA in addition to oral 5-alpha-reductase inhibitor (finasteride). The mechanism by which minoxidil promotes hair growth is not fully understood but can be related to increasing blood flow owing to its vasodilator effects. Androgenic alopecia is characterized by the gradual conversion of terminal hairs into vellus hairs. Alterations in the hair cycle include reduced duration of the anagen phase and increased duration of the telogen phase, resulting in shorter hairs and eventual balding. Side effects of topical minoxidil include irritant and allergic contact dermatitis, pruritus, and facial hypertrichosis, which are more often seen with the use of 5% solutions rather than 2%. Herein, we report a 24-year-old woman who developed severe ear and face hypertrichosis after using a topical 5% minoxidil solution. She later had spontaneous resolution of her hypertrichosis three months after stopping it.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supravenous and perivenous distribution of a benign pigmented purpuric eruption.","authors":"Yoshihiro Matsudate","doi":"10.5070/D330464123","DOIUrl":"https://doi.org/10.5070/D330464123","url":null,"abstract":"","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa C Leeolou, Peter A Young, Iesha L Ticknor, Jinping Lai, Ricardo T Paniagua, Robert L Burns
Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.
{"title":"A rapidly-growing friable nodule on the cheek.","authors":"Melissa C Leeolou, Peter A Young, Iesha L Ticknor, Jinping Lai, Ricardo T Paniagua, Robert L Burns","doi":"10.5070/D330464116","DOIUrl":"https://doi.org/10.5070/D330464116","url":null,"abstract":"<p><p>Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syphilis is a sexually transmitted infection with manifestations that can mimic other diseases, leading to misdiagnosis. Annular syphilis is a rare atypical secondary syphilitic lesion that seldomly involves the face. Human immunodeficiency virus (HIV) coinfection can increasingly lead to atypical manifestations of syphilis and complicate the diagnosis. Herein, we describe a 29-year-old man with a diagnosis of annular secondary syphilis and HIV coinfection. He had clinical manifestations of annular erythematous papules and plaques with white scales at the edges, distributed and scattered on the face, neck, and upper back. The skin lesions went undetected on several visits and were misdiagnosed owing to similarities with other dermatoses. Serological examination showed positive Treponema pallidum particle agglutination assay and venereal disease research laboratory test titer 1/512, confirming syphilis infection. Results from the histopathological examination supported the diagnosis of secondary syphilis. Positive anti-HIV rapid test results indicated concurrent HIV infection. He was treated for syphilis and given antiretroviral therapy, and showed a good response as demonstrated by improvement of the lesions and serological titers. This case highlights the importance of recognizing the possibility of annular secondary syphilis and HIV coinfection which can have atypical manifestations.
{"title":"Annular secondary syphilis with HIV coinfection that resembles other dermatoses.","authors":"Nabila Kirtti Pradipta, Devi Artami Susetiati, Hafidzah Nurmastuti, Retno Danarti, Satiti Retno Pudjiati","doi":"10.5070/D330464109","DOIUrl":"https://doi.org/10.5070/D330464109","url":null,"abstract":"<p><p>Syphilis is a sexually transmitted infection with manifestations that can mimic other diseases, leading to misdiagnosis. Annular syphilis is a rare atypical secondary syphilitic lesion that seldomly involves the face. Human immunodeficiency virus (HIV) coinfection can increasingly lead to atypical manifestations of syphilis and complicate the diagnosis. Herein, we describe a 29-year-old man with a diagnosis of annular secondary syphilis and HIV coinfection. He had clinical manifestations of annular erythematous papules and plaques with white scales at the edges, distributed and scattered on the face, neck, and upper back. The skin lesions went undetected on several visits and were misdiagnosed owing to similarities with other dermatoses. Serological examination showed positive Treponema pallidum particle agglutination assay and venereal disease research laboratory test titer 1/512, confirming syphilis infection. Results from the histopathological examination supported the diagnosis of secondary syphilis. Positive anti-HIV rapid test results indicated concurrent HIV infection. He was treated for syphilis and given antiretroviral therapy, and showed a good response as demonstrated by improvement of the lesions and serological titers. This case highlights the importance of recognizing the possibility of annular secondary syphilis and HIV coinfection which can have atypical manifestations.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mycosis fungoides (MF) is characterized by a clonal proliferation of skin-homing mature T cells with special predilection for involving the epidermis. Folliculotropic and syringotropic MF typically present with erythematous papules, patches, and plaques, with punctate accentuation that is folliculocentric in the former. We report a 67-year-old woman, with an extensive history of allergic contact dermatitis, who was referred to the Mohs surgery clinic with a large pink plaque extending from the nasal bridge to the right upper medial cheek concerning for basal cell carcinoma. An outside punch biopsy showed benign basaloid follicular neoplasm. The patient was found to also have indurated erythematous plaques of the bilateral upper arms and erythematous scaly patches of bilateral arms and legs, abdomen, lateral trunk, buttocks, and groin. Owing to concern for possible cutaneous lymphoma, punch biopsies were performed which revealed the diagnosis of folliculotropic and syringotropic MF. Of note, folliculotropic and syringotropic MF are often, but not uniformly, characterized by a more aggressive disease course. This case highlights the importance of a high index of suspicion and awareness of all clinical and histopathologic pitfalls to avoid misdiagnosis of MF.
{"title":"Folliculotropic and syringotropic mycosis fungoides mimicking basal cell carcinoma.","authors":"Claudia Quarshie, Brittney DeClerck, Jenny C Hu","doi":"10.5070/D330464115","DOIUrl":"https://doi.org/10.5070/D330464115","url":null,"abstract":"<p><p>Mycosis fungoides (MF) is characterized by a clonal proliferation of skin-homing mature T cells with special predilection for involving the epidermis. Folliculotropic and syringotropic MF typically present with erythematous papules, patches, and plaques, with punctate accentuation that is folliculocentric in the former. We report a 67-year-old woman, with an extensive history of allergic contact dermatitis, who was referred to the Mohs surgery clinic with a large pink plaque extending from the nasal bridge to the right upper medial cheek concerning for basal cell carcinoma. An outside punch biopsy showed benign basaloid follicular neoplasm. The patient was found to also have indurated erythematous plaques of the bilateral upper arms and erythematous scaly patches of bilateral arms and legs, abdomen, lateral trunk, buttocks, and groin. Owing to concern for possible cutaneous lymphoma, punch biopsies were performed which revealed the diagnosis of folliculotropic and syringotropic MF. Of note, folliculotropic and syringotropic MF are often, but not uniformly, characterized by a more aggressive disease course. This case highlights the importance of a high index of suspicion and awareness of all clinical and histopathologic pitfalls to avoid misdiagnosis of MF.</p>","PeriodicalId":11040,"journal":{"name":"Dermatology online journal","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}