International Journal of Dermatology最新文献

Acquired progressive kinking of the hair (APKH) is an underrecognized hair disorder characterized by a gradual change in hair texture, often manifesting as increased curliness, frizziness, and darkening of the shafts. While various systemic triggers and congenital conditions can induce similar phenotypes, a subset of cases-particularly those involving the frontal and temporal scalp in young males-appears to be linked to androgen-mediated mechanisms. This narrative review focuses on the androgen-dependent phenotype of APKH, integrating clinical, trichoscopic, and histopathological findings and presenting a representative case. We also propose a conceptual framework for distinguishing between androgen-dependent and non-androgen-dependent subtypes. A detailed analysis of all published cases meeting criteria for androgen-sensitive APKH is provided, highlighting patterns of progression, diagnostic clues, and therapeutic implications. Recognizing this presentation as a potential early manifestation of androgenetic alopecia may inform clinical decisions and prompt timely intervention.

Background: Primary cicatricial alopecias (PCA) are rare inflammatory disorders that irreversibly destroy hair follicles, making early, accurate diagnosis crucial.

Objective: The aim of this study is to describe line field confocal optical coherence tomography (LC-OCT) features of major PCA subtypes and assess its potential role in diagnosis and disease monitoring.

Methods: Twenty-five patients with PCA (lichen planopilaris [LPP], frontal fibrosing alopecia [FFA], folliculitis decalvans [FD], discoid lupus erythematosus [DLE], dissecting cellulitis of the scalp [DCS]) underwent LC-OCT imaging with vertical, horizontal, and 3D acquisitions of clinically and trichoscopically selected lesions. Images were independently evaluated to identify both shared and subtype-specific patterns.

Results: In active lesions of LPP/FFA (n = 15), infundibular hyperkeratosis with hyper-reflective keratinous sleeves was observed in 14/15 (93.3%), perifollicular bright inflammatory aggregates in 7/15 (46.6%), and dilated dermal vessels in 9/15 (60.0%). DLE (n = 4) was characterized by periadnexal inflammation, basal vacuolar alteration, and a continuous hyper-reflective junctional band in 4/4 (100%), dermal hyporeflective bands compatible with mucin in 2/4 (50.0%), and follicular plugs in 2/4 (50.0%). FD (n = 4) demonstrated tufted follicles with markedly dilated infundibula in 3/4 (75.0%), pustule-like hyporeflective cavities in 2/4 (50.0%), and periadnexal inflammatory infiltrates in 3/4 (75.0%). DCS (n = 2) showed superficial abscess-like lobulated hyporeflective cavities with perifollicular inflammatory clusters in 2/2 (100%) and follicular fusion with hair tufting in 1/2 (50.0%). In end-stage cicatricial areas, LC-OCT demonstrated follicular dropout with loss of sebaceous glands, dermal sclerosis forming a stellate pattern, and a flattened, hyper-reflective dermal-epidermal junction in all 25/25 cases (100%).

Conclusions: LC-OCT identifies shared scarring signatures as well as distinct patterns among PCA subtypes, and it supports targeted biopsy site selection. Moreover, it provides a noninvasive tool for real-time assessment of disease activity that is complementary to trichoscopy and histopathology.

Trichoblastic carcinoma (TBC) is a rare cutaneous malignancy that arises de novo or from the malignant transformation of a preexisting trichoblastoma. Although surgery is the most common treatment, the analysis of outcomes and recurrence rates between Mohs micrographic surgery (MMS) and traditional excision is limited. We analyzed the outcomes of MMS and traditional excision for TBC based on published recurrence and metastasis data. In May 2024, a systematic review was conducted utilizing PubMed, Scopus, Embase, and Web of Science databases to identify articles addressing TBC treatment with excision and/or MMS. Thirty-one articles were included, yielding 128 patients and 128 surgical operations. Approximately 9.5% (2/21) of cases treated with MMS recurred after follow-up, compared to 8.4% (9/107) of cases resected with traditional excision. Our study suggests that both MMS and traditional excision are comparably effective options for TBC, with similar recurrence rates. The choice of surgical modality may depend on the need for tissue sparing in sensitive anatomical locations. The limited data available underscore the need for further comparative studies to establish the optimal surgical approach.

A man in his 70s presented with chronic, diffuse annular plaques on his trunk and limbs. These dermatologic manifestations, together with skin biopsy, bone marrow smear and flow cytometry of the bone marrow sample, finally led to a diagnosis of acute myeloid leukemia (AML). For patients with diffuse annular lesions which do not improve with conventional treatment for eczema, the skin manifestations of leukemia and the bone marrow tests should be considered.