Skin Appendage Disorders最新文献

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.

Introduction: Psoriasis is a chronic, immune-mediated skin disease that affects approximately 125 million people worldwide. Psoriatic arthritis (PsA), a complex chronic inflammatory arthritis, is classified as part of the spondyloarthritis spectrum, along with primary ankylosing spondylitis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis.

Case presentation: We report 2 cases of patients with arthropathy who were referred by a rheumatologist. Thorough physical examination of the skin and nails revealed no psoriatic changes. However, despite the absence of scalp-related complaints, a diagnosis of psoriasis was established based on trichoscopic findings.

Conclusion: Cases in which patients with PsA have even mild cutaneous psoriatic lesions are common, making the diagnosis easier. The 2 cases described above highlight the role of trichoscopy and emphasize the importance of collaboration between dermatologists and rheumatologists. When rheumatologists investigate possible causes of arthritis and consider PsA as a differential diagnosis, referring the patient to a dermatologist is important. On the other hand, in cases of scalp psoriasis, if arthropathy is present, the patient should consult a rheumatologist to determine whether joint involvement is caused by another rheumatologic condition. In clinical practice, scalp psoriasis is frequently observed as an independent condition, and its presence does not exclude the possibility of other coexisting pathologies.

Introduction: Onychomycosis is the most common nail disorder in dermatology. Treatment can be challenging due to factors related to the pathogen and the patient's health status. Therapeutic options include topical and oral antifungals; while oral agents offer higher cure rates, they also present drawbacks such as prolonged treatment duration and potential adverse effects, with liver toxicity being the most frequently reported. Previous reviews highlight a scarcity of studies addressing the actual frequency of liver enzyme alterations during therapy.

Methods: This retrospective study analyzed medical records from 313 patients treated at the Dermatology Clinic of a tertiary hospital. Changes in hepatic transaminases (aspartate aminotransferase, aspartate aminotransferase/TGO, and alanine aminotransferase, alanine aminotransferase/TGP) were evaluated in patients with a confirmed diagnosis of onychomycosis undergoing treatment with systemic antifungals.

Results: Among 229 patients, 22 (9.6%) exhibited elevated hepatic transaminase levels. Oral antifungals demonstrated an overall favorable safety profile, with a low rate of transaminase elevation and no cases of hepatotoxicity. Patients with multiple comorbidities and concomitant medication use were more likely to present laboratory abnormalities, suggesting a possible cumulative effect on hepatic metabolism.

Conclusion: In a real-world tertiary hospital setting, where most patients carried multiple comorbidities and were on continuous medications, oral antifungals for onychomycosis demonstrated a reassuring hepatic safety profile. The low incidence of enzyme alterations, all reversible after drug withdrawal, supports the continued use of systemic therapy in appropriately selected patients, reinforcing that comorbidities alone should not preclude oral antifungal treatment when clinically indicated.

Introduction: Follicular mucinosis (FM) is characterized by mucin deposition within hair follicles and sebaceous glands, sometimes causing irreversible alopecia. In adults, it is often secondary to cutaneous T-cell lymphoma (CTCL), particularly the folliculotropic mycosis fungoides (FMF) variant. Extensive scalp involvement is rare and may mimic inflammatory or infectious disorders, delaying diagnosis.

Case presentation: A 64-year-old woman presented with progressive diffuse alopecia, suppurative scalp nodules, comedones, leonine facies, and multiple erythematous plaques. Initial biopsies elsewhere suggested tuberculoid leprosy, and multidrug therapy produced no improvement. Trichoscopy showed nonspecific signs suggestive of dissecting cellulitis, but histopathology revealed mucinous follicular destruction and a perifollicular lymphocytic infiltrate with immunophenotypic features of CTCL. Large-cell transformation was present in 10% of the infiltrate. Staging confirmed advanced FMF with secondary FM. Treatment with brentuximab vedotin achieved partial hair regrowth and skin improvement.

Conclusion: This case describes an unusual presentation of FMF, in which diffuse alopecia with suppurative nodules was the first manifestation of secondary FM. Brentuximab vedotin may have a therapeutic role in mucinous alopecia in this context.

Introduction: Dyskeratosis congenita (DC) is a rare inherited telomere biology disorder characterized by mucocutaneous and systemic manifestations. There are limited descriptions of hair involvement.

Case presentation: We present the case of a 19-year-old male from a consanguineous family, diagnosed with DC, who exhibited classical dermatological and hematological features, as well as distinctive trichoscopic findings, including scattered irregular black dots, pigtail hairs, S-shaped and zigzag hairs, and microscopic evidence of cuticular abnormalities, including ruffled surfaces, flat fractures, and trichoptilosis.

Conclusion: This case highlights the under-recognized spectrum of hair pathology in DC, supporting the role of telomere dysfunction in impairing hair follicle homeostasis and structural integrity.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are an innovative class of medications primarily used to manage type 2 diabetes and obesity. These agents not only improve glycemic control but also promote significant weight loss and reduce cardiovascular risk.

Summary: GLP-1RAs are associated with various dermatologic effects, including injection-site reactions and immune-mediated responses such as hypersensitivity, urticaria, and bullous pemphigoid. "Ozempic face," a term describing facial fat loss, has gained media attention due to its cosmetic implications. Additionally, hair loss, particularly in the form of telogen effluvium, has been observed, potentially linked to rapid weight loss from GLP-1RA use. Emerging evidence also highlights the therapeutic potential of GLP-1RAs in enhancing wound healing and treating inflammatory skin conditions like psoriasis.

Key messages: With the increasing use of GLP-1RAs for weight management, clinicians should remain alert to dermatologic side effects and consider appropriate dermatologic consultations when needed. Further research is essential to optimize the safe and effective use of GLP-1RAs, ensuring therapeutic benefits are maximized while minimizing adverse dermatologic outcomes.

Introduction: Oral minoxidil, used off-label for androgenetic alopecia, has been linked to alcohol hangover symptoms. We examined changes in alcohol consumption before and after low-dose oral minoxidil (LDOM) initiation.

Methods: Using Epic's Cosmos database (2010-2024), we analyzed alcohol consumption 6 months pre- and post-minoxidil in patients with recorded data. A two-sample z test compared average daily alcohol intake.

Results: Among 21,971 patients, demographics and minoxidil dosing were similar between groups. Average alcohol consumption was unchanged pre- versus post-LDOM (0.264 vs. 0.260 drinks/day, p = 0.72).

Conclusion: LDOM does not significantly affect alcohol consumption, suggesting minimal impact on hangover symptoms. Prospective studies are needed, but patients can be reassured about the low likelihood of symptom exacerbation.