International Journal of Trichology最新文献

Canities subita is a rare condition characterized by sudden hair pigmentation loss. Although its etiology is under discussion, an association with alopecia areata (AA) has been proposed. We present the case of a 60-year-old male with rheumatoid arthritis who experienced abrupt hair whitening and a large bald occipital patch. Diagnosed with canities subita with concomitant AA, treatment with baricitinib led to remarkable hair repigmentation within 8 months and repopulation of the occipital patch. This case supports the link between canities subita and AA, evidenced by similar presentations. However, only a fraction of cases copresent with alopecia, suggesting alternative etiologies. Our findings suggest baricitinib as a potential treatment, particularly in AA-associated cases of canities subita. Further research is warranted to explore the efficacy and mechanisms of baricitinib in treating this condition.

This article presents the case of a 31-year old patient with alopecia areata, who after two subsequent treatments with Janus kinase-inhibitors Baricitinib and Abrocitinib, achieved therapeutic success after using tofacitinib. This case raises the question, whether tofacitinib could be a valid treatment option for the future.

Alopecia totalis (AT) is an autoimmune condition and severe form of alopecia areata characterized by complete scalp hair loss, often posing treatment challenges, especially in pediatric patients. This case report presents a 7-year-old boy with a 2-year history of alopecia, who developed AT. The patient initially showed limited response to a combination of Wysolone (prednisolone) and methotrexate. The introduction of topical tofacitinib along with mometasone resulted in significant hair regrowth and improvement in hair density over a 4-month period. This case highlights the potential of topical Janus kinase inhibitors as a promising treatment for the pediatric patient with AT.

We have read Ramos Costa et al.'s publication "Trichoteiromania: A multicentre retrospective descriptive and analytical study of 129 cases" in the Journal of the European Academy of Dermatology, and comment on some critical issues related to the nosology, nomenclature, and methodology. The term trichoteiromania was originally coined for the rubbing of the hair due to an underlying psychiatric disorder without further specifications. Based on case observations of patients with trichoteiromania, it was later reported that in contrast to trichotillomania that represents an obsessive-compulsive disorder, the underlying disorder in trichoteiromania varies among patients. Histopathological features are unspecific, while the traumatic changes to the hair shaft are more conspicuous, and 15 min of rubbing the hair is sufficient for hair breakage. Therefore, a clear distinction must be made between trichotillomania, trichoteiromania, neurotic excoriations, factitious dermatitis, lichen simplex chronicus, and nodular prurigo of the scalp, while the dermoscopic findings provided by Ramos Costa et al. showed the mechanics of hair damage without a deeper insight into its etiology. Trichoscopy has gained disproportionate popularity for the differential diagnosis of the hair and scalp disorders since its introduction into dermatologic practice, and as a self-reliant examination technique, it can even be misleading. As a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a more comprehensive dermatological learning, to include a stringent nosological classification and nomenclature of diseases, based on a pathogenic understanding. Specifically, in trichoteiromania studies with a more detailed assessment of the psychopathological status will be of more value to determine disease management strategies, specifically approaches to psychotherapeutic, behavioral, and pharmacological interventions aimed at reducing or eliminating the hair-rubbing behavior. Regrettably, the majority of recent publications on trichoteiromania have been based on trichoscopy without any disease-relevant insights, and obviously, the editors and reviewers of the respective publishing journals have so far failed to acknowledge this major shortcoming.

Currently, retrospective multicenter studies have gained particular popularity with trichologists, and become a practice of some groups of authors for cranking up the number of papers on their resumes. Multicenter collaboration can result in higher rates of patient enrolment than single-center trials, thereby generating larger studies of shorter duration, while offering the opportunity for networking. A single-center trial is conducted according to a single protocol and at a single site, while multicenter trials are conducted according to a single protocol but at different locations, and conducted by various researchers. Differences between the two include variations in sample size, time of patient recruitment, costs, presence of bias, validity, and center and investigator characteristics. However, the validity of multicenter research can be questioned. A single center with a high number of patients, interventions, and large experience is superior to a collective of a large number of centers with low number of patients, interventions, and little experience at each center. Multicenter studies are at risk of inconsistent diagnosis and heterogeneity among centers and populations. Finally, by their nature, multicenter studies rely purely on local expert opinion to generate findings. If the centers participating in the study can be shown to be representative of the group or area of knowledge under study then content validity can be assumed. The practice though of selecting centers based on networking means there is a responsibility to prove and justify the selection procedures used. Hence, how a center is chosen for its competence is defined must be somewhat arbitrary, and the results would then represent that particular group's opinions at a given point in time. In conclusion, when interpreting results from retrospective multicenter clinical research, bias and traps among the result should be detected according to who performs it, which inclusion indication criteria is involved, what the target is, and how it is carried out.

Background: The most frequent pediatric dermatophyte infection globally is tinea capitis (TC). Hair follicles have a variety of immunological defense mechanisms to stop infections from entering it. Natural-killer group 2, member D receptor ligands include unique long binding protein 3 (ULBP3) has a significant impact on the regulation of immunological reactions that are innate and adaptive.

Objectives: The objective of this study was to evaluate the serum level of ULBP3 in patients with TC, its clinical significance, relation to types of dermatophytes, disease severity, and pathogenesis.

Materials and methods: There were 60 TC patients and 30 normal subjects in this case-control study. A culture of hair samples was done on Sabouraud dextrose agar with cycloheximide to know the type of dermatophyte, and the serum level of ULBP3 was done using ELIZA.

Results: TC patients reported substantially higher plasma ULBP3 concentrations than healthy controls (P < 0.001). ULBP3 showed a clear overall difference between organisms (P = 0.001). It was noticeably greater in Trichophyton verrucosum compared to other organisms. A substantial positive correlation between the Clinical Severity Score and the ULBP3 was observed (r = 0.434 and P = 0.001).

Conclusions: Serum ULBP3 might be involved in TC pathogenesis. Moreover, ULBP3 serum level could be considered a standalone risk predictor for TC susceptibility, activity, and severity.

To pose is defined as to place in an attitude or fixed position, for the sake of effect, and the poseur as a person who inauthentically adopts a certain attitude playing a role, a fake, or an imposter. To cover their incompetence, physicians in the past had to strike a pose. The posing of today's physician has become rather that of self-performance and for commercial purposes, particularly in cosmetic medicine. Because of the elective nature and the high out-of-pocket costs of the cosmetic procedures and products, the image particularly of cosmetic surgeons and dermatologists has changed from the traditional role of doctor into one of a business person who will promote unnecessary interventions among consumers and peers. "Bluffing, puffing, and spinning" are accepted marketing practices for businesses. Selfie culture has emerged as a natural result of the development of smartphones and social media. Mannerisms and instruments of pose in medicine have been the stethoscope, dermatoscope, FotoFinder^® handpiece, microscope, syringe, human skull, and during the pandemic, undergoing COVID-19 vaccination, usually as selfie placed on Instagram or Facebook. Selfie culture has far-reaching implications for society as a whole. It has altered our understanding of privacy, blurring the line between public and private spaces, and breaking taboos in public, such as sexuality, religion, and private health issues. The World Medical Association has developed the International Code of Medical Ethics as a canon of ethical principles for the members of the medical profession worldwide defining the professional duties of physicians toward patients, other physicians and health professionals, and society as a whole. The primary duty of the physician is to promote the health and well-being of individual patients by providing competent, timely, and compassionate care in accordance with good medical practice and professionalism. The physician must always exercise independent professional judgment while maintaining the highest standards of professional conduct. The physician must refrain from intrusive or otherwise inappropriate advertising and marketing. The lure of money and celebrity cannot blind dermatologists to the limits of what they can do.