Dermatology practical & conceptual最新文献

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital area, with potential systemic implications.

Objective: Our aim was to elucidate its clinical characteristics and management strategies.

Methods: We conducted a retrospective observational study on adult patients with LS referred to our center between January 2022 and December 2023.

Results: Forty-six adult subjects affected with LS were enrolled in the present study. The majority of patients presented with genital involvement, but a significant subset also exhibited extragenital LS and concomitant immune-mediated disorders. Common symptoms included itching, soreness, and dyspareunia, with characteristic skin findings of erythema and atrophy. Topical corticosteroids were the mainstay of therapy, complemented by alternative treatments in refractory cases. Alternative therapeutic approaches, such as PRP (platelet rich plasma) or ADSC (adipose-tissue derived stromal/stem cell)-based strategies, were effectively employed in refractory cases, in the absence of major adverse events.

Conclusions: Our findings underscore the importance of alternative approaches in the management of LS and highlight the need for further research to elucidate its pathogenesis and optimize therapeutic interventions.

Introduction: Dermoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible to the naked eye. Trichoscopy is useful for the diagnosis and follow-up of hair and scalp disorders.

Objective: The aim of the present study was to evaluate the causes of focal non-cicatricial alopecia in Egyptian children and to assess the importance of the trichoscope in the diagnosis of each disease.

Methods: This study was done with 200 Egyptian pediatric patients aged from 2 to 18 years who suffered from focal non-cicatricial alopecia. Clinical and dermoscopic evaluations were performed on all patients, and informed consent was obtained from their parents.

Results: The most prevalent diagnoses were alopecia areata (42%) and tinea capitis (40.5%), followed by trichotillomania (8%) and tractional alopecia (7%). Congenital triangular alopecia (1.5%) and patchy androgenetic alopecia (1%) were less common. Trichoscopy revealed distinct features in alopecia areata cases, such as short vellus hair, exclamation mark hair, black dots, broken hair, pigtail hair, and upright regrowing hair. The most common trichoscopic features of tinea capitis were comma hair, corkscrew hair, broken hair, bent hair, zigzag hair, morse code hair, perifollicular scaling, and diffuse scaling. These findings contribute to understanding the etiology and clinical presentation of childhood alopecia, facilitating accurate diagnosis and appropriate management.

Conclusion: The routine use of trichoscopy in the clinical evaluation of scalp and hair disorders enhances diagnostic capabilities beyond simple clinical inspection. Trichoscopy reveals disease features that contribute to accurate diagnosis and improved management.

Introduction: Dermoscopy is an important noninvasive tool that helps to determine the stability and activity of vitiligo. Various dermoscopic findings help classify the disease as stable or unstable. This is important for the management of the disease, as surgical management requires disease stability.

Objectives: We aimed to describe the dermoscopic findings in vitiligo and to assess the frequency of various dermoscopic findings in stable and unstable vitiligo.

Methods: This was a hospital-based cross-sectional descriptive study of 100 vitiligo patients and various dermoscopic findings. Results are expressed as percentages.

Results: The most common dermoscopic findings in stable vitiligo patches were sharp border, marginal and perifollicular pigmentation, and reticulate pigment network. Findings such as polka dot appearance, starburst appearance, comet tail, and satellite lesions were seen in unstable vitiligo patches.

Conclusions: Dermoscopy is extremely helpful in determining the stability of vitiligo patches.

Introduction: Dupilumab, a monoclonal antibody targeting IL-4 receptor subunit alpha, treats atopic dermatitis (AD) and may impact alopecia areata (AA). AA involves Th1-driven immune activity, and recent studies suggest a role for Th2 pathways. Dupilumab's effects on AA are mixed, with reports of both improvement and worsening.

Objectives: This study aims to review the effects of dupilumab on AA in patients with AD, analyzing literature to understand cases of improvement or worsening and identifying contributing factors.

Methods: A literature review was conducted using articles in platforms such as PubMed, Scopus, and Web of Science written up to April 2024, focusing on studies involving AA, AD, and dupilumab. Articles were analyzed for patient demographics, disease characteristics, and responses to treatment.

Results: Out of 35 articles reviewed, 13 AA cases worsened after dupilumab (mean age 32.8; mostly males with patchy alopecia), and 38 cases showed improvement (mean age 27.6; majority females, varying AA types). Full hair regrowth occurred in 11 improved cases, while 9 had partial regrowth.

Conclusions: Dupilumab shows dual effects on AA, influenced by Th1/Th2 immune profiles. Worsening was more common in males with Th1-driven AA, while females with Th2-skewed AA saw improvement. Factors like age, disease severity, and IgE levels may affect outcomes, suggesting a need for personalized treatment approaches for AA patients with AD.

Introduction: Hair loss can happen for various reasons, including emotional stress, physical strain, certain medical issues, and nutritional gaps. When it comes to nutrition, a lack of vitamin D3 could be linked to diffuse hair loss.

Objectives: The aim was to look for the frequency of vitamin D3 deficiency with diffuse hair fall, especially in the Pakistani population.

Methods: A total of 120 patients of both sexes and all ages presenting to the Dermatology Clinic with complaints of non-scarring alopecia and loss of over 100 strands of hair within a 24-hour period (counted by patient) of any duration and positive hair pull test were advised to take serum vitamin D3. Tests and results were then analyzed by SPSS statistical software package (version 19.0 for Windows).

Results: The mean age of participants enrolled in the study was 28.56 ± 11.62 years. The majority of the patients, i.e., 77 (63.64%), were ≤30 years of age. Among the 120 patients, 17 were males and 103 were females. Mean serum vitamin D3 levels were 17.33 ± 5.43 ng/ml. 95 (79.17%) patients were found to be vitamin D3 deficient, with 37 patients having female pattern hair loss, seven patients with male pattern hair loss, seven patients with diffuse alopecia areata, and 44 patients with telogen effluvium.

Conclusions: This study concluded that there is considerable frequency of vitamin D3 deficiency in individuals with diffuse hair fall. Therefore, we recommend that there should be early recognition and treatment of this condition in these particular patients in order to reduce hair fall.

Introduction: In recent years, there has been a growing emphasis on the role of the mammalian target of rapamycin (mTOR) pathway in the pathogenesis of psoriasis. This intracellular signaling pathway is known as the main control pathway of metabolism and is of particular interest in this context.

Objectives: To investigate the importance of the mTOR pathway in the pathogenesis of plaque psoriasis.

Methods: A total of forty patients with plaque psoriasis and 40 non-psoriatic volunteers were included in this case-control study. The fasting serum levels of mTORC1 and mTORC2 in the study groups were examined by enzyme-linked immunosorbent assay.

Results: Serum levels of both mTORC1 and mTORC2 were found to be significantly lower in patients with plaque psoriasis than in controls (P = 0.001). A positive correlation was identified between serum mTORC1 and serum mTORC2 levels in patients with plaque psoriasis (p=0.001, r=0.826).

Conclusion: The lower serum levels of mTORC1 and mTORC2 complexes, which are active signaling molecules in the cell, were observed in patients with plaque psoriasis. This suggests that these levels may serve as an indicator of increased intracellular activation of these molecules. It is our opinion that agents that can effectively inhibit both mTOR complexes may be more effective in the treatment of psoriasis.