Skin Appendage Disorders最新文献

Introduction: Nail unit melanoma is a rare and potentially aggressive variant of acral lentiginous melanoma. Diagnosing amelanotic variants can be particularly challenging due to the absence of typical pigmentation. Here, we report a case of chronic onychodystrophy revealing amelanotic nail unit melanoma.

Case presentation: A 48-year-old Moroccan patient presented with chronic persistent monodactylic nail dystrophy. Dermoscopy showed subungual hyperkeratosis with an atypical vascular pattern but no pigmented structures. A biopsy of the nail unit confirmed amelanotic melanoma. Staging (PET scan, lymph node ultrasound, and bone CT) excluded metastases. Surgical management led to metacarpophalangeal amputation of the thumb.

Conclusion: This case underscores the need to consider amelanotic melanoma in patients with atypical or persistent nail lesions. Early recognition and prompt treatment can significantly affect prognosis. Monodactylous involvement with nail dystrophy, including nail plate destruction, should lead to a nail biopsy for an early and accurate diagnosis.

Introduction: The epidermis and the nervous system share a common embryologic origin from the ectoderm, which explains the coexistence of neurological and cutaneous findings in several conditions. Beyond genodermatoses, peripheral nerve disorders may influence skin appendages, including the nails and hair follicles. Lumbar disc herniation, most commonly occurring at the L4-L5 and L5-S1 levels, can result in chronic compression of nerve roots innervating the dorsal and lateral aspects of the foot. Prolonged neuropathic involvement in this region may lead to subtle but clinically relevant nail changes. This study aimed to evaluate characteristic neuropathy-associated nail alterations in patients with L5-S1 disc herniation and to highlight their potential relevance as indicators of neuropathic involvement.

Methods: This observational study included 20 patients with radiologically confirmed L5-S1 disc herniation who presented with localized thickening and discoloration of the nail plate involving the first and fifth toenails. All patients underwent dermatological and neurological examination. Onychomycosis was excluded in all cases through mycological testing.

Results: Nail changes were consistently localized to the hallux and fifth toenail. No history of trauma, fungal infection, or primary dermatological disease was identified. The anatomical distribution of the nail findings corresponded to regions innervated by the affected nerve roots.

Conclusion: Hyperkeratosis and discoloration of the first and fifth toenails in patients with L5-S1 disc herniation may reflect neuropathic influence on nail morphology. These findings may serve as clinically useful markers for identifying the level of nerve root involvement.

Introduction: Prostaglandin D2 (PGD2) is elevated in the bald scalp of men with androgenetic alopecia (AGA) and inhibits hair growth. Cetirizine, an H1-antihistamine, reduces PGD2 production and has anti-inflammatory effects, making it a potential therapeutic candidate.

Methods: Ten men aged 18-60 years with Norwood-Hamilton grade III vertex to V AGA applied 1 mL of 1% cetirizine in propylene glycol/butylene glycol daily for 16 weeks. Exclusion criteria included recent use of minoxidil, finasteride, or other antiandrogenic therapies. Hair counts in a 1 cm² tattoo-marked vertex area and blinded photographic assessments were evaluated at baseline and week 16.

Results: Nine participants completed the study. Mean hair count increased from 139.6 (SE 13.9) to 163.4 (SE 15.5), a statistically significant change (p = 0.009). Blinded global photographs showed a +2 improvement in 1 patient, +1 in two, and no change in six. Trichoscopic counts improved in all patients. No adverse events occurred.

Conclusion: Despite limitations, this report provides additional real-world data supporting cetirizine as a potential therapy in AGA. Larger randomized controlled studies with longer follow-up are needed to establish efficacy, durability, and mechanism of action.

Introduction: Acne vulgaris is a chronic skin condition affecting adolescents and adults, often prompting patients to seek complementary and alternative medicine (CAM) due to dissatisfaction with conventional treatments. CAM usage is shaped by cultural beliefs and accessibility, but data in Saudi Arabia remain limited.

Methodology: A cross-sectional study was carried out in Al-Ahsa (2024-2025) through an online questionnaire targeting Saudi adults (≥18 years) diagnosed with acne vulgaris.

Results: Among 322 respondents, most were aged 18-25 (64.0%) and female (67.1%). Traditional treatments were previously used by 70.5%, mostly topical medications (67.7%), but only 30.3% reported satisfaction. CAM awareness was found in 53.1%, and 44.4% had previously used CAM, primarily nutritional supplements (35.8%). CAM use was significantly associated with age and prior traditional treatment. Side effects were reported by 23.8%, mainly redness (82.5%). Side effects had a higher rate among traditional treatment users. Satisfaction with CAM was significantly linked to acne duration, and history of traditional treatment, though only 19.6% reported satisfaction. In the regression model, older age, adequate acne-related information, and experiencing side effects significantly increased CAM use, while experiencing side effects and family history predicted lower satisfaction with CAM.

Conclusion: The study revealed moderate CAM use among acne patients, with nutritional supplements being the most common, with limited satisfaction and some reported side effects. Overall satisfaction with CAM remained low, emphasizing the need for better guidance and integration of safe, evidence-based alternative therapies in acne care.

Introduction: Onychomatricoma (OM) is a rare benign fibroepithelial tumor of the nail that originates from the nail matrix and the nail bed. It presents as a solitary lesion and leads to thickening of the nail plate, yellowish longitudinal bands, leuko-xanthonchia, transverse overcurvature, and splinter hemorrhages.

Case presentation: We report a 50-year-old woman with complaint of some changes in the shape and color of her thumbnails. On her dermatologic examination, leuko-xanthonchia extending from the distal nail to the lunula, irregularity on the lunula, and erythematous and whitish bands on the lunula were found on her left and right thumbnail. Both lesions were treated surgically. The histopathological evaluation of both lesions was consistent with OM. The BAP1 gene was reported as likely pathogenic.

Conclusion: OM commonly affects a single nail. The involvement of multiple nails should not be considered a reason to exclude the diagnosis of OM. Multi-nail dystrophies should be considered in case of presence of multiple lesions. In cases with multiple OM, evaluation for a BAP1 mutation should be considered.

Introduction: Social media is widely used by adolescents and hair products are frequently promoted on these platforms. However, little is known about marketing strategies or potential dermatologic risks.

Methods: We analyzed the first 100 TikTok and 50 Instagram posts using the hashtags "#teenhaircare," "#tweenhaircare," and "#hairtok" (10/05/2025-10/15/2025). Eligible posts were English language, ≤2 years old, and promoted hair products or routines intended for adolescents (aged 9-18). Posts were coded for promoter type, marketing strategy, product category, claims, hair type, and ingredients.

Results: Influencers comprised 44.7% of creators, and brands accounted for 19.3%. Common marketing strategies included colorful packaging (50.7%) and "natural/clean" labeling (27.3%). Key claims included "shiny hair" (34%) and "damage repair" (26.7%). Most products (82%) contained allergens/irritants such as fragrance, sulfates, silicones, or parabens. Only 2.6% of posts were created by dermatologists and only 6% targeted afro-ethnic hair types.

Conclusion: Marketing of adolescent hair products on social media is dominated by influencers with minimal dermatologist oversight. Many promoted products contain allergens or irritants that may contribute to contact dermatitis. Dermatologists should inquire about hair-care practices during adolescent visits and advocate for improved oversight of influencer marketing.

Introduction: Alopecia treatment can improve patients' quality of life, but slow hair regrowth makes progress difficult to detect. Trichoscopic measurements (TMs; hair density, hairs/cm²; hair caliber, µm) provide an objective method for monitoring treatment response. Artificial intelligence (AI) enables trichoscopic analysis without hair clippings. This study examines the perspectives of alopecia patients regarding AI-driven trichoscopy.

Methods: We conducted an IRB-approved survey study and chart review of 101 patients at the NYU Langone hair clinic undergoing AI-driven trichoscopy. Pre- and post-visit surveys measured self-perceived alopecia severity and quality-of-life impact before and after reviewing TMs with their dermatologist. Opinions regarding AI-driven trichoscopy were assessed via Likert scales. Demographics, medical history, and clinician-assessed severity were extracted from medical charts.

Results: Most participants were female (74.3%), white (73.3%), and had nonscarring alopecia (89%). After reviewing TMs, 33.7% of participants reported feeling less bothered by their alopecia, 39.6% perceived reduced severity, and 54.5% noted increased treatment motivation. Among follow-up patients, concordance between patient and physician assessments of interval change in hair loss improved after viewing TMs (p = 0.0075). Patients endorsed enhanced alopecia care and greater confidence in treatment recommendations with the use of AI-driven trichoscopy.

Conclusion: Patients with alopecia generally view AI-driven trichoscopy favorably, noting improved quality of care and greater motivation to continue therapy.

Background: Sudden diffuse hair whitening (canities subita) is exceptionally rare in childhood and may mimic congenital pigment dilution syndromes.

Case presentation: We describe a 17-month-old girl who developed abrupt hair depigmentation during hospitalization for septic shock. Clinical examination, trichoscopy, and light microscopy confirmed diffuse alopecia areata and achromotrichia. Hematologic and immunologic investigations were normal. Spontaneous repigmentation occurred within 3 months.

Conclusion: This case - 1 of the youngest reported - highlights systemic stress as a potential trigger for pediatric canities subita associated with diffuse alopecia areata and underscores the importance of distinguishing it from congenital silvery hair syndromes, which carry markedly different prognostic and therapeutic implications.

Introduction: The diagnosis of nail unit squamous cell carcinoma (nSCC) remains challenging due to variable clinical presentations and nonspecific features. Dermoscopy offers a promising noninvasive adjunct to improve diagnostic accuracy, but dermoscopic features of nSCC are not well standardized nor summarized.

Methods: We systematically reviewed dermoscopic features of keratinocyte-derived nail tumors to identify structures and patterns that differentiate nSCC from other lesions. Databases were searched from inception to March 2025. Studies reporting dermoscopic structures/patterns of benign and malignant keratinocyte-derived nail tumors, and onychomatricoma, were included. A sub-analysis assessed the diagnostic performance of specific features in differentiating nSCC from other keratinocyte-derived nail tumors.

Results: From 1,159 articles screened, 83 studies met inclusion criteria, with 10 distinct nail tumors identified. Features such as heterogeneous and brown longitudinal melanonychia, white/yellow scale, structureless areas, glomerular vessels, and ulceration were more frequently reported in nSCC. In a sub-analysis of diagnostic value of specific dermoscopic features, subungual hyperkeratosis was significantly associated with nSCC compared to onychomatricoma.

Conclusions: While underscoring ongoing diagnostic challenges of nSCC, this study also provides a framework for future prospective multicenter research aiming to establish reliable, standardized dermoscopic criteria. Such efforts are essential to improve early detection and enhance patient outcomes for those affected by nSCC.

Introduction: Pyogenic granuloma development following plaster cast immobilization is rare, with only 17 reported cases previously.

Case presentation: Here, we present a case of the youngest patient to date, an 11-year-old male, who developed a pyogenic granuloma on his left thumbnail after cast immobilization for a left wrist and elbow fracture. His fracture was complicated by wound infection, ulnar nerve injury, and avascular necrosis. Following cast removal, a pyogenic granuloma developed on his left thumbnail that was recalcitrant to treatment with timolol, and surgical resection was recommended. Additionally, he had onychomadesis of all nails on his left hand.

Conclusion: This case highlights an association between pyogenic granuloma development and plaster cast immobilization in pediatric patients.