Skin Appendage Disorders最新文献

Introduction: Eosinophilic pustular folliculitis (EPF) is a rare, non-infectious dermatosis characterized by pruritic, recurrent episodes of follicular papulopustules. Three main forms have been described: classic EPF (Ofuji disease), immunosuppression- or HIV-associated EPF, and infantile EPF. Histopathologically, eosinophilic infiltration within and around the follicular epithelium is a typical finding.

Case presentation: We report four non-infant patients with negative anti-HIV antibody results who presented with pruritic follicular papulopustules exclusively involving the scalp and face. Histopathological examination in all cases confirmed the diagnosis of EPF.

Conclusion: This case series highlights a clinical presentation of EPF with isolated scalp and facial involvement in immunocompetent adults. Although longer follow-up is required, these findings may suggest a distinct clinical pattern within the spectrum of EPF.

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: Alopecia treatments can incur significant patient costs; however, this monetary impact has yet to be characterized in scarring alopecia (SA) patients. Our study aims to characterize the financial burden of SA and its psychosocial impact.

Methods: We conducted a cross-sectional study using survey data collected by the Scarring Alopecia Foundation between December 2, 2022, and December 16, 2022. Financial burden metrics and quality of life impacts were analyzed using RStudio.

Results: A total of 1,047 individuals (97.4% female, mean age 57.8 years) completed the survey. Most patients (51.4%) spent USD 1-100 monthly on medical treatments, followed by USD 101-250 (22.8%). Annual costs for nonprescription treatments were most commonly USD 1,000. No differences were seen between general dermatologist and hair loss specialist patients. Most patients felt only somewhat supported or not supported by insurance with no difference between public and private coverage. Additionally, no financial metrics were significantly associated with differences in quality of life.

Conclusion: Regardless of provider type, patients with SA face substantial out-of-pocket costs for nonmedical items with limited insurance support. Further advocacy is needed to lessen the financial burden faced by SA patients.

Background: Hidradenitis suppurativa (HS) may be linked to behavioral factors that exacerbate inflammation, gut microbiome, and healing.

Summary: This review evaluates current evidence on the relationship between alcohol consumption and HS. Emerging studies show high incidences of alcohol and substance use disorders in HS patients. However, observational studies remain inconsistent: HS patients may experience higher alcohol-related burden, yet its association to disease progression and baseline severity remains unclear. Limitations of existing studies include self-reported exposures of alcohol, heterogeneous outcome measures, and potential confounding factors, such as stress.

Key messages: Biologic plausibility remains, as alcohol can promote dysbiosis, inflammation, and oxidative stress that may influence disease activity and healing. This review highlights the need for larger, controlled trials that determine whether the reduction or elimination of alcohol may improve HS outcomes.

Introduction: Female androgenetic alopecia (FAGA) is a frequent cause of diffuse, non-scarring hair loss in women. The trichogram is a noninvasive method for assessing follicular miniaturization, but its diagnostic accuracy compared with scalp biopsy remains uncertain.

Methods: In this retrospective, cross-sectional study, 49 women with suspected FAGA underwent trichogram and scalp biopsy on the same day. Hair shafts were classified using three approaches: (1) standard classification (terminal >0.03 mm; vellus ≤0.03 mm or thinner than the inner root sheath, per Headington's criteria); (2) T:(V+I) classification (terminal >0.06 mm, intermediate >0.03-0.06 mm, vellus ≤0.03 mm); and (3) relative diameter method, where hairs <50% of the thickest shaft were considered vellus. In all methods, a terminal-to-vellus ratio ≤3 indicated diagnosis.

Results: Standard classification yielded a sensitivity of 65.3%. When intermediate and miniaturized hairs were combined, sensitivity increased to 96%. The relative diameter method achieved 77.6%, with no significant difference from histopathology.

Conclusion: Trichogram sensitivity in FAGA improves when intermediate hairs are included or when relative shaft diameter is applied. These adaptations enhance correlation with histology and support the trichogram as a practical, noninvasive, and cost-effective diagnostic tool in clinical practice.

Introduction: Nail psoriasis significantly impairs quality of life (QoL). General dermatology instruments often lack sensitivity for specific nail-related burdens. This study aimed to validate the Turkish versions of the Nail Psoriasis Quality of Life Scale (NPQ-10) and the Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA).

Methods: This cross-sectional validation study included 71 patients (42 male, 29 female). The questionnaires were translated into Turkish following international guidelines. Reliability and validity were assessed by analyzing correlations with the Dermatology Life Quality Index (DLQI) and clinical parameters (PASI, NAPSI).

Results: The sample showed a male predominance (59.2%). DLQI scores showed a moderate positive correlation with NPQ-10 (r = 0.453) and NAPPA-QoL (r = 0.477). Patients with toenail involvement had significantly higher QoL impairment. While men had higher clinical severity scores (PASI), women reported higher stigma-related scores.

Conclusion: The Turkish versions of NPQ-10 and NAPPA are valid and reliable instruments. They capture specific physical and psychosocial burdens of nail psoriasis more accurately than general tools, particularly regarding toenail involvement and stigma. Incorporating these tools into practice is recommended.

Introduction: Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrate remarkable efficacy for weight management, emerging pharmacovigilance data suggest an increased hair loss risk, particularly with newer agents. This study investigated the prevalence, risk factors, and clinical impact of hair shedding in GLP-1 RA users in Saudi Arabia.

Methods: A cross-sectional survey was conducted between September 2024 and January 2025 of current and former GLP-1 RA users. Participants with preexisting hair loss were excluded from the study. Hair shedding prevalence, associated factors, and the impact on treatment discontinuation were assessed using validated questionnaires. Multivariate logistic regression was used to identify independent predictors.

Results: Among 152 eligible participants (87.5% female, median body mass index 32.1 kg/m²), 70.4% (n = 107) reported hair shedding after GLP-1 RA initiation, which was markedly higher than the 3-7% reported in clinical trials. Tirzepatide users had the highest prevalence (76.7%), followed by semaglutide (64%) and liraglutide (54.5%). Hair shedding was significantly associated with female sex (92.5% vs. 75.6% in males, p = 0.009), greater magnitude of weight loss (82.7% prevalence with ≥15% weight loss vs. 40% with <5%, p = 0.002), and medication discontinuation (63.6% vs. 40% in non-shedders, p = 0.013). Multivariable analysis confirmed independent associations with increasing weight loss (OR 1.79, 95% CI: 1.19-2.76, p = 0.006) and female sex (OR 3.57, 95% CI: 1.20-11.11, p = 0.023). Critically, 39.7% of the affected patients cited hair shedding as their reason for discontinuation, although 37.7% reported resolution after stopping treatment. The median weight loss was 15.9% [IQR 8.69-22.5], with 53.3% achieving ≥15% reduction.

Conclusion: Hair shedding affects seven out of ten GLP-1 RA users in real-world settings, representing a ten-fold higher prevalence than that reported in registration trials. This under-recognized phenomenon during GLP-1 RA therapy significantly affects treatment adherence, particularly among women who achieve substantial weight loss. Proactive counseling and nutritional optimization strategies are essential to maintain treatment persistence.

Introduction: Hidradenitis suppurativa (HS) disproportionately affects ethnoracial minority populations, particularly Black and Hispanic individuals. However, representation in randomized controlled trials remains limited. We aim to assess ethnoracial representation and reporting in HS trials conducted over the past 5 years.

Methods: Phase 2 and 3 trials completed between 2019 and 2025 were identified via ClinicalTrials.gov. Trials with results and publications were included. Participant ethnoracial data were extracted, and PubMed supplemented missing data.

Results: Among the 17 trials included in analysis, 76.2% (n = 2,652) of participants were white, 13.0% (n = 451) Black/African American, 6.0% (n = 210) Asian, 1.9% (n = 66) more than one race, 1.0% (n = 36) American Indian or Alaska Native, and 0.1% (n = 4) Native Hawaiian or other Pacific Islander. A total of 5.2% (n = 181) were Hispanic/Latino, although only 58.8% (n = 10) of trials reported these data. Of remaining participants, 1.8% (n = 63) were recorded as "unknown/not reported." Geographically, all 17 (100%) trials had site locations in North America, 70.6% (n = 12) of trials had a site location in Europe, 41.2% (n = 7) in Australia, 41.2% (n = 7) in Asia, 11.8% (n = 2) in South America, and 5.9% (n = 1) in Africa.

Conclusions: We found improved reporting of race and ethnicity in global HS clinical trials, yet Black and Hispanic/Latino patients remain underrepresented. Additionally, a lack of trials conducted in Africa, Asia, and South America could explain the lack of a global representation in participant demographics. Future trials should conduct stratified analyses to evaluate efficacy across global populations.

Introduction: Poroma and porocarcinoma (PC) are rare adnexal tumors with overlapping clinical features, making accurate diagnosis challenging.

Methods: We retrospectively analyzed 46 histologically confirmed cases (37 poroma, 9 PC) diagnosed at a single center between 2010 and 2023, comparing demographic, clinical, and histopathological characteristics.

Results: Poroma lesions were mainly located on the lower extremities, while PCs predominated on the trunk. Ulceration and bleeding were significantly more frequent in PCs. Among poromas, 24.3% involved the palmoplantar region; all volar lesions were skin-colored to pink-red and had higher clinical diagnostic accuracy than non-volar lesions.

Conclusion: Lesion location, morphology, and color are key in evaluating adnexal tumors. Ulceration and bleeding should raise suspicion for PC, emphasizing the need for careful clinical assessment.