Skin Appendage Disorders最新文献

Background: In humans, apocrine glands are generally associated with chemical signaling and body odor. Their presence in the scalp is poorly documented, commonly being associated with benign and malignant tumors. If apocrine glands are consistently present in the normal scalp or become apparent only under pathological circumstances remains unclear. Moreover, their potential physiological role in relation to the hair follicle and microbiome modulation has yet to be fully elucidated.

Summary: The role of scalp apocrine glands is often considered rudimentary and may be underestimated. However, the higher excretions of urea and potassium compared to eccrine glands suggest a potential role in the removal of metabolic waste products and electrolyte balance. Additionally, the openings of apocrine ducts drain into the hair follicle, mixing with follicular contents and sebum before reaching the skin's surface. This highlights a possible close interaction between the apocrine glands and microbiome. Furthermore, given the anatomical and functional association between follicular units and apocrine glands, it is likely that they participate in the pathogenesis of follicular occlusion diseases.

Key messages: This article aimed to review existing research on scalp apocrine glands, clarifying this underexplored topic and highlighting them as a potentially relevant component of scalp physiology and pathology.

Introduction: Alopecia areata (AA), a chronic autoimmune condition with variable severity of clinical presentation, affects patients' quality of life (QoL). In Italy, a lack of awareness and standardized practices contributes to inconsistent patient care.

Methods: This study aimed to develop a consensus on the diagnosis, management, and treatment of AA among Italian dermatologists, using the Delphi technique. Twenty dermatologists participated in the tailored Delphi. The questionnaire covering diagnosis, management, and treatment approach, was developed by a steering committee and validated by five validators before administration. Statements were evaluated on a 5-point Likert scale, with consensus defined as ≥70% agreement.

Results: All statements achieved the agreement threshold in the first round. Key practices were the need for comprehensive diagnostic evaluation, trichoscopy use, and assessment of autoimmune comorbidities. Management approaches emphasized empathetic communication, QoL assessment, and multidisciplinary collaboration. Treatment strategies prioritized individualized approaches based on the Severity of Alopecia Tool score, disease activity, and patient-specific factors. Systemic therapies were recommended with SALT ≥50 and active/worsening disease.

Conclusions: The study proposes a framework for standardizing AA care in Italy, with attention to patient-centered and personalized approaches. This work provides practical guidance for improving diagnostic and management of AA, while addressing its psychosocial impact.

[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.