Dermatology practical & conceptual最新文献

Objectives: Alopecia areata incognita is a non-scarring autoimmune hair loss condition primarily affecting women aged 20 to 40. It is often misdiagnosed due to its resemblance to other conditions. Diagnosis relies on clinical suspicion, trichoscopic findings, and histological features. Reflectance confocal microscopy (RCM) shows promise as a non-invasive diagnostic tool for alopecia areata incognita. In this study, we aimed to explore RCM's diagnostic potential by investigating its association with trichoscopic and histopathological findings.

Methods: We conducted a prospective study with 12 female patients affected by alopecia areata incognita. Patient data, trichoscopy, and RCM were used for diagnosis. Biopsies were taken based on trichoscopic and RCM criteria. Agreement between RCM, trichoscopy, and histopathology was assessed.

Results: RCM showed substantial agreement with histopathology for fibrous tracts (92.9%). Other criteria, like infundibular ostia and inflammation, exhibited reasonable agreement (71.4% to 78.6%), with varying Kappa values. Miniaturized follicles had the lowest agreement (64.3%).

Conclusion: This study suggests that RCM holds promise as a diagnostic tool for alopecia areata incognita, offering advantages in non-invasiveness and real-time monitoring. It demonstrated substantial agreement with histopathology in identifying key features. While some discrepancies were noted, especially in detecting inflammatory infiltrates, further research may enhance RCM's sensitivity. The non-invasive nature of RCM could improve patient experiences and offer dynamic disease tracking for better treatment decisions. This technology's potential extends beyond alopecia areata incognita, presenting opportunities for more patient-friendly diagnostic procedures in trichology.

Introduction: Localized scleroderma is a rare inflammatory skin disease that causes sclerosis in the dermis and subcutaneous tissue. Oxidative stress may play a role in the etiology or be responsible for the chronicity or progression of the disease.

Objectives: We aimed to investigate the presence of oxidative stress in patients with localized scleroderma by examining thiol-disulfide balance, ischemia-modified albumin (IMA), and prolidase parameters.

Methods: Twenty patients over the age of 18 who were diagnosed with localized scleroderma both clinically and histopathologically and 20 control subjects were included in the study. Age, sex, age at disease onset, duration of the disease, and presence of accompanying systemic diseases were questioned and recorded. Lesion type and modified Rodnan and LoSSI scores were calculated through dermatological examination. CRP, sedimentation rate, total thiol, native thiol, and disulfide levels indicated by the Erel profile, IMA level, and prolidase levels were measured and compared in both the patient and control groups.

Results: Levels of native thiol (P=0.958), total thiol (P=0.979), disulfide (P=0.449), (disulfide/native thiol%) (P=0.368), (disulfide/total thiol%) (P=0.361), (native thiol/total thiol%) (P=0.368), and prolidase (P=0.121) were similar in both patient and control groups. Only IMA was significantly different. No significant relationship was found between the levels of native thiol, total thiol, disulfide, (disulfide/native thiol), (disulfide/total thiol), IMA, prolidase, and Rodnan and LoSSI scores.

Conclusion: According to the data obtained from this study, we can say that the thiol-disulfide balance is not disrupted and that prolidase levels are not affected in localized scleroderma; however, IMA is negatively affected.

Introduction: Antibiotic resistance has become a serious, severe problem worldwide. This issue does not only relate to the use of systemic antibiotics but to topical ones as well, like systemic therapies and local treatment of skin and mucosal infections. Antiseptics, an alternative to the topical treatment with antibiotics of wounds and some inflammatory dermatological conditions, tend to be microbicidal and have a broader spectrum of antimicrobial activity than antibiotics. Among these, polyhexanide (PHMB) allows for the control of the infection while avoiding the development of resistance.

Objectives: Recommendations on the rules of good clinical practice for the management of small wounds, burns and post-traumatic ulcerative wounds, impetigo or folliculitis in the initial stages, and acne.

Methods: Literature review on the principal topical therapies for small wounds, injuries, impetigo, folliculitis, and acne and a proposal of innovative, highly-tolerated treatments.

Results and conclusions: Given the abuse of topical antibiotics in dermatology, for the treatment of small wounds, injuries, localized folliculitis, impetigo, and acne, the use of alternative topical treatments like polyhexanide and Rigenase® is recommended.

Introduction: Few publications are available on eyebrow trichoscopy in patients with alopecia areata and frontal fibrosing alopecia (FFA).

Objective: To investigate the validity of using trichoscopy to examine eyebrow involvement in patients with lichen planopilaris (LPP) and FFA.

Methods: In this case-control study, 109 patients with eyebrow involvement in LPP and FFA (cases) and with acquired hair disorders of the eyebrows (controls) were included.

Results: Trichoscopy was highly specific and sensitive for the diagnosis of LPP and FFA. Trichoscopic features significantly associated with LPP were peripilar scaling, peripilar pigmentation, broken hairs, peripilar white halos, diffuse empty follicles, and vellus hair. Localized peripilar erythema and empty follicles were significantly associated with the diffuse form of LPP and the zigzag type of FFA. Yellow dots, dystrophic hairs, hair regrowth in different directions, and diffuse empty follicles were associated with LPP activity and FFA severity.

Limitations: The retrospective nature of the statistical analysis.

Conclusions: Trichoscopy is a valid tool for evaluating eyebrow involvement in LPP and FFA. Thus, it could help increase the diagnostic accuracy and predict the prognosis of eyebrow hair loss at an early stage.

Introduction: Cutaneous chondroid syringoma (CS) is a rare benign mixed skin tumor originating from sweat glands. Despite its rarity, accurate diagnosis and management are crucial due to its potential for malignant transformation.

Objective: This study aimed to provide comprehensive insights into the main features of cutaneous CS, encompassing its epidemiology, clinical presentation, and particularly, dermoscopic findings.

Methods: A systematic review was conducted to identify relevant literature on CS up to November 2023. Data extraction included clinical and histopathological characteristics from case reports and small case series.

Results: The systematic review identified 347 unique CS cases, predominantly benign. Clinical features included a predilection for the head and neck region, with variations in morphology observed. Dermoscopic patterns, although limited, revealed recurrent features aiding diagnosis. Malignant CS cases constituted a notable subset, exhibiting distinct clinical and histopathological features.

Conclusion: Cutaneous chondroid syringoma presents with characteristic clinical and histopathological features, necessitating comprehensive diagnostic approaches. Dermoscopy emerges as a valuable tool, although further research is needed to establish definitive patterns. Treatment primarily involves wide local excision, with collaboration among clinicians essential for optimal management. Future studies are warranted to address existing knowledge gaps and enhance understanding of this rare skin neoplasm.

Introduction: Systemic Lupus Erythematosus is a pleiotropic autoimmune disease with common skin involvement. To date, only one study has investigated tattoos safety in SLE patients.

Objective: We performed a single-center study to evaluate the development of local and systemic complications after tattooing in a cohort of systemic lupus erythematosus (SLE) patients. Furthermore, we tried to identify SLE patients who had expressed the will to get a tattoo and why they decided not to.

Methods: Consecutive SLE patients were asked to complete a questionnaire about tattoos, including their number, features, and side effects. Open questions were proposed to non-tattooed patients to describe why they did not have tattoos.

Results: One hundred ninety-two SLE patients were enrolled [M/F 21/171; median age 41 years (IQR 18)]. Almost 50% of them had at least one tattoo. Seven patients (7.4%) referred adverse reactions to tattoos; interestingly, only one patient experienced a systemic reaction, specifically the occurrence of self-limiting lymphadenopathy. The main reason for not getting a tattoo was the diagnosis of SLE.

Conclusions: Our results suggest the safety of tattoos in SLE patients, as demonstrated by a low prevalence of mild adverse events.

Introduction: Morphea, also known as localized scleroderma, is a rare fibrosing inflammatory disease of unknown pathogenesis.

Objectives: Although the genetic basis for morphea is important, reports on the evaluation of Toll-like receptors (TLR) in this disease is quite limited. We aimed to evaluate TLR expression levels and serum IL-6, IL-17A, TGF-β1, FGF, and VEGF levels in patients with morphea and compare these results with healthy controls.

Methods: The expression levels of TLRs in the lesional and non-lesional adjacent skin of patients with morphea and in normal skin of healthy controls were evaluated by RT-PCR, whereas serum levels of IL-6, IL-17A, TGF-β1, FGF, and VEGF were evaluated by ELISA.

Results: Based on our findings, TLR1 gene expression increased 34.3-fold in the lesional skin of patients with morphea. In addition, IL-6, IL-17A, TGF-β, FGF, and VEGF were found to be higher in the blood samples of the patient group than in the healthy group.

Conclusion: TLRs are important parts of the pathogenesis of morphea, and a better understanding of them will lead to more directed, effective treatments. We believe that this study will be important for pioneering TLR-targeted therapeutic approaches in the treatment of morphea in the future.