Skin Appendage Disorders最新文献

[This corrects the article DOI: 10.1159/000544742.].

Background: Androgenetic alopecia (AGA) is a common pattern hair loss in which perifollicular fibrosis drives hair follicle miniaturization. Inflammatory-fibrotic cross talk centered on TGF-β/Smad, with input from Wnt/β-catenin and Notch, disrupts epithelial-mesenchymal communication and impairs regeneration.

Summary: We summarize evidence linking chronic inflammation to fibroblast/myofibroblast activation and excessive extracellular matrix deposition around hair follicles, highlight dermoscopic features that may reflect fibrotic burden, and outline a continuum between AGA and fibrosing patterned alopecias. We review anti-fibrotic strategies directed at TGF-β, Wnt/β-catenin, and Notch signaling, and how combining antiandrogenic, anti-inflammatory, and anti-fibrotic approaches could address both hormonal and structural drivers.

Key messages: Perifollicular fibrosis is integral to AGA progression and may underlie incomplete treatment responses. Dermoscopic signs such as perifollicular hyperpigmentation and whitish perifollicular structures may correlate with histologic fibrosis and merit validation. Pathway-directed anti-fibrotic agents targeting TGF-β and Wnt/Notch show anti-fibrotic activity in other organs but require AGA-specific testing.

Introduction: Alopecia areata is a non-scarring autoimmune alopecia that may arise as a paradoxical reaction during treatment with biologic agents for immune-mediated inflammatory diseases. Such paradoxical reactions are increasingly recognized with the widespread use of biologics, particularly TNF-α inhibitors.

Case presentation: We report a case series of 7 patients with multiple immune-mediated inflammatory diseases who developed alopecia areata during biologic therapy.

Conclusion: There is no consensus on the optimal management of paradoxical alopecia areata. Individualized management should be guided by disease severity, response to treatment, and patient preference. Recognizing patients at higher risk, particularly those with multiple immune-mediated inflammatory diseases, and monitoring them closely may aid in the early detection and management of paradoxical reactions.

Introduction: Darier disease (DD) is a rare genodermatosis associated with neuropsychiatric, cardiovascular, and metabolic disorders. Nail changes in DD are reported but understudied. We aimed to characterize nail changes and comorbidities in patients with DD to guide management.

Methods: We retrospectively reviewed 26 patients with DD at Weill Cornell (2010-2025), analyzing demographics, comorbidities, and clinical features. Fisher's exact tests assessed associations between comorbidities and clinical features (p < 0.05).

Results: Ten patients (38.5%) had nail changes, including V-shaped nicking (19.2%) and "candy cane" nails (longitudinal erythronychia/leukonychia) (11.5%). Nail changes preceded skin changes in 20%. Nail examination was not documented in 26.9%. Skin symptoms included pruritus (30.8%), pain (23.1%), and burning sensation (19.2%). Comorbidities included cardiovascular disease (23.1%), neuropsychiatric disease (26.9%), neuropsychiatric medication use (15.4%), and diabetes/prediabetes (19.2%). Diabetes/prediabetes correlated with burning sensation (p = 0.034) and trended toward correlation with nail changes (p = 0.055).

Discussion: Nail changes were common in patients with DD and the first sign of disease in 20%. Nail examination was lacking in >1/4 of patients, demonstrating an opportunity for education. Patients with DD had high prevalence of comorbidities and cutaneous symptoms. Therefore, active monitoring for symptoms including burning, pain, and pruritus is important, especially in patients with baseline comorbidities.

Background: Since the 1990s, when complementary and alternative medicine began receiving formal recognition in the USA, interest in Ayurveda and traditional Chinese medicine (TCM) has grown. While TCM has seen an increase in evidence-based research globally, Ayurveda remains comparatively under-researched. Although integrative approaches have shown benefits across dermatology, their role in hair disorders has received limited investigation. This study aims to review the reported clinical outcomes of Ayurvedic treatments for hair disorders.

Summary: This review analyzed sixteen studies that described an Ayurvedic treatment and reported clinical outcomes in hair disorders. Ayurvedic treatments have been reported for alopecia areata, telogen effluvium, folliculitis decalvans, and madarosis. The most common treatment regimens include a combination of oral herbal medications, topical hair oil or paste formulations, and physical scalp manipulation.

Key messages: Ayurvedic medicine encompasses a range of traditional medications and interventions that aim to decrease inflammation, increase blood circulation to the scalp, stimulate hair growth, and promote overall balance in the body. A better understanding of traditional treatments can enhance cultural competence among dermatologists, strengthen the patient-physician relationship, and improve patient outcomes. Continued research and collaboration can broaden the range of treatment options available to patients seeking alternative or integrative approaches.

Introduction: Androgenetic alopecia (AGA) is the most common form of hair loss in men and women. Our study aimed to determine the effectiveness of intradermal glucocorticosteroid microinjections in female patients with AGA. This method was intended to alleviate microinflammation.

Methods: This prospective, 4-month, randomized comparative study included 54 women with AGA. The experimental group was treated with topical application of a 5% minoxidil preparation plus three monthly sessions of intradermal microinjections of triamcinolone 5 mg/mL. The control group was treated with topical 5% minoxidil preparation.

Results: Clinical improvement was observed in 78.7% and 57.1% of the patients in the experimental and control groups, respectively (p value <0.001). The mean hair density and diameter did not differ significantly between the experimental and control groups before treatment. After treatment, hair density significantly increased in the experimental group compared to the control group, although no significant difference was found in the average diameter between the two groups.

Conclusions: This study found that combining topical minoxidil with intradermal microinjections of triamcinolone is associated with a marked increase in treatment efficacy compared with minoxidil monotherapy. Further in-depth research is required to evaluate the efficacy and safety of this combination in a wider population.

Background: Alopecia areata (AA) is a chronic autoimmune disorder characterized by non-scarring hair loss, with limited treatment options for severe disease. Although Janus kinase inhibitors have recently been approved, safety concerns remain, highlighting the need for alternative targeted therapies. Biologics that modulate immune cell activity may offer novel therapeutic avenues in AA.

Summary: A review of peer-reviewed case reports, case series, and clinical trials evaluating immune cell-targeting biologics for AA, including rituximab, abatacept, alefacept, efalizumab, nivolumab, aldesleukin. Rituximab (anti-CD20) achieved complete remission in 1 patient with alopecia universalis. Abatacept (CTLA4-Ig) reduced mean SALT score by 71% in responders, though no response occurred in patients with extensive disease. Alefacept (anti-CD2 fusion) showed no significant improvement over placebo in a clinical trial, yet case reports documented up to 100% regrowth. Efalizumab (anti-CD11a) failed to improve SALT in a phase II trial, but individual cases achieved 70-100% regrowth. Nivolumab (PD-1 inhibitor) produced complete regrowth maintained beyond 1 year in a single case. Aldesleukin (low-dose IL-2) did not yield statistically significant efficacy in a clinical trial; however, a pilot study reported all patients experiencing hair regrowth along with improvements in quality of life. Across studies, adverse events were mild, with no serious events reported.

Key messages: (1) Biologics targeting B and T cells demonstrated moderate efficacy overall, suggesting that B-cell depletion and T-cell modulation may be viable strategies in AA, although better targets are needed to improve efficacy. (2) Abatacept showed partial regrowth in multiple patients, while alefacept, efalizumab, and aldesleukin were largely ineffective in controlled trials, despite several case-level responses. (3) Rituximab and nivolumab achieved complete regrowth in isolated cases, but evidence remains anecdotal.

Introduction: Frontal fibrosing alopecia (FFA) has been associated with hair cosmetic habits, yet causality and frequency-dependent effects remain uncertain. This study aimed to evaluate the association between hair care habits and FFA.

Methods: An analytical case-control study was conducted including 115 FFA patients and 112 matched controls, evaluated at the Hospital Italiano de Buenos Aires between 2015 and 2024. Participants reported current hair washing frequency, cosmetic hair practices, leave-in-product use, and sunscreen use; FFA cases also reported habits 5 years before symptom onset. Logistic regression models were performed.

Results: Decreasing hair washing frequency was associated with progressively higher odds of FFA (adjusted OR 18.7 for washing ≤1 time/week compared with daily washing). In dichotomized models, daily washing remained protective (adjusted OR 0.31; p = 0.012). Cosmetic hair procedures ≥2/year and leave-in product use ≥1/week significantly increased risk (adjusted OR 2.39 and 4.98, respectively). Sunscreen use showed no association with FFA in any model.

Conclusion: Frequent cosmetic procedures and leave-in product use were associated with higher odds of FFA, whereas daily washing was protective. These findings underscore the potential contribution of cumulative exposure to cosmetic substances in FFA pathogenesis and highlight modifiable behavioral factors warranting further study.

Introduction: Prior studies suggest that androgenetic alopecia (AGA) may increase cardiovascular and metabolic disease risk, but findings have been inconsistent due to methodological limitations, reliance on self-reported data, and small sample sizes. This study aimed to evaluate the association between AGA and cardiometabolic outcomes using large-scale clinical data.

Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network to evaluate cardiometabolic outcomes, including abdominal obesity, dyslipidemia, hypertension, and diabetes mellitus, in 30,282 propensity-matched male patients (aged 18-45 years) diagnosed with AGA compared to 30,282 controls from general screening encounters. Outcomes were analyzed up to 5 years post-diagnosis using risk ratios (RRs), risk differences, and Kaplan-Meier survival analysis.

Results: Patients with AGA demonstrated significantly lower risks of abdominal obesity (RR: 0.53; 95% confidence interval [CI]: 0.45-0.61), dyslipidemia (RR: 0.63; 95% CI: 0.60-0.67), hypertension (RR: 0.59; 95% CI: 0.54-0.65), and diabetes mellitus (RR: 0.43; 95% CI: 0.36-0.51) compared to controls. Kaplan-Meier analysis confirmed a reduced hazard for diabetes mellitus (hazard ratio: 0.44; 95% CI: 0.37-0.52).

Conclusion: AGA diagnosis was not associated with increased cardiometabolic risk. The observed risk reduction may reflect healthcare-seeking behaviors rather than a biological relationship.

Introduction: Pincer nail deformity (PND) involves excessive transverse nail plate over-curvature which pinches up distal nail bed and causes pain. Conventional surgical options are invasive with high complication risks. We treated pincer nails with a simplified, reproducible technique.

Methods: Records of PND patients treated over 7 years with a simplified technique were retrospectively analyzed. After confirming the absence of any distal bony abnormality, lateral 1/5th-1/6th of the nail plate was avulsed on both sides, with chemical matricectomy of the lateral matrix horn. Thereafter, the distal one-third nail plate was avulsed to relieve traction on the pinched nail bed, not typically included in earlier techniques. This dual approach targeted both the causative (broad matrix) and resultant (distal traction) components of PND.

Results: Records of 11 patients (15 great toenails) with symptomatic PND, without distal osteophytes, treated with this technique were analyzed. A mean follow-up of 28.6 ± 30.95 months with complete symptomatic relief and maintained nail flattening was seen. Patient-rated cosmetic outcomes were good (13), fair (3), or poor (1). Complications recorded were secondary infection (1), severe dystrophy (1), mild dystrophy (2), and malalignment (2).

Conclusion: This simplified surgical technique for PND is easy to learn and perform, and offers long-term effectiveness with minimal complications for PND without distal osteophytes.