Skin Appendage Disorders最新文献

Introduction: Androgenetic alopecia (AGA) is a type of hair loss that often manifests as male or female pattern baldness. In women, AGA resembling male pattern baldness can occur in conditions of hyperandrogenism, such as congenital adrenal hyperplasia or ovarian and adrenal tumors, which are exceedingly rare, occurring in approximately 0.2% of cases.

Case presentation: We report a 62-year-old female exhibiting hair loss and hirsutism that began over a decade ago. The medical examination reveals hirsutism on the face, abdomen, and chest, and hair loss in the fronto-parieto-occipital region, with a male pattern distribution consistent with grade VII on the Hamilton scale. Trichoscopy revealed loss of follicular openings, single follicular units, miniaturized hairs, and perifollicular brown halo. Laboratory tests indicated a total testosterone level of 10.15 ng/mL. An abdominal CT scan revealed bilateral adrenal adenomas, which were subsequently treated with laparoscopic radical adrenalectomy.

Conclusion: In postmenopausal women, a new-onset state of hyperandrogenism may lead to virilizing symptoms, such as male pattern alopecia, when testosterone levels exceed 5 nmol/L, necessitates immediate investigation to exclude an androgen-producing tumor, which typically normalizes swiftly within weeks post-surgery, while symptoms of androgen excess gradually diminish following the normalization of testosterone levels, as observed in our case. Identifying the cause of hyperandrogenism is crucial for treatment. Surgery remains the primary option for postmenopausal women with virilizing symptoms and androgen excess.

Introduction: Primary cicatricial alopecias (PCAs) cause permanent hair loss and psychosocial distress. Management involves anti-inflammatory and hair growth-promoting therapies. A combination of tacrolimus, clobetasol, and minoxidil (TCM) may offer synergistic benefits by targeting distinct inflammatory pathways while increasing background hair density for improved camouflage. This study evaluates the safety and efficacy of TCM use in PCA patients.

Methods: We conducted a retrospective chart review of PCA patients aged 18+ years treated with TCM between January 1, 2009, and May 31, 2025. Outcomes included inflammatory activity on trichoscopy, scalp symptoms, provider- and patient-reported disease status, and objective hair measurements. Descriptive statistics were performed using SAS v9.4.

Results: Eighty-two patients (80.5% female, mean age 61.5) were included, most commonly with frontal fibrosing alopecia or lichen planopilaris. TCM was typically prescribed as a compounded solution used 1-2 times/day for an average of 24.5 months. Adverse effects included worsened itch/burning (6.1%), hypertrichosis (4.9%), scalp irritation/dryness (4.8%), and atrophy (3.7%); most (62.2%) experienced no adverse effects. Provider-assessed inflammation and disease status improved or stabilized in 69.5% and 76.9%, respectively. Objective hair measurements also improved.

Conclusions: TCM is well tolerated and, used alone or in conjunction with other therapies, appears to be effective. Improvements were seen in provider-reported outcomes and objective hair measurements.

Background: Chemotherapy-induced alopecia (CIA) significantly impacts patients' quality of life. While low-dose oral minoxidil (LDOM) shows promise in treating CIA after chemotherapy completion, its safety and efficacy when given during active chemotherapy remain unclear. This review examined existing literature on CIA pathogenesis, minoxidil's mechanism of action, and LDOM efficacy to explore its potential use during chemotherapy.

Summary: Recent retrospective studies demonstrated LDOMs good tolerability in cancer patients post-chemotherapy, with minimal adverse effects. Scalp cooling, the only Food and Drug Administration-cleared intervention to mitigate CIA, is thought to reduce chemotherapeutic delivery to the hair follicles, whereas minoxidil, a vasodilator, increases blood flow to the follicle. Despite these differing mechanisms, preclinical studies suggest potential benefits of LDOM during chemotherapy. One study demonstrated a protective effect of subcutaneous minoxidil against cytarabine-induced alopecia, while another showed faster regrowth with systemic minoxidil administered concurrently with paclitaxel. LDOM may, therefore, exert benefits through mechanisms beyond vasodilation, potentially by its impact on the hair cycle. Studies on topical minoxidil during chemotherapy show variable results, possibly due to poor adherence or variations in application practices - limitations LDOM could address.

Key messages: Given the psychological impact of CIA and limited treatments, investigation of LDOM's safety and efficacy when initiated during chemotherapy is warranted.

Introduction: Instruction in nail procedures is limited in dermatology residency programs. Cadaveric-based educational sessions can help bridge the gap in nail procedure knowledge and confidence in residency education. This study evaluates a combined didactic and hands-on cadaveric workshop for two cohorts of second- and third-year dermatology residents at a single institution (2023 and 2025).

Methods: Second- and third-year dermatology residents completed a pre-survey prior to the session to assess their comfort and confidence with nail procedures prior to completing a didactic nail surgery lecture and subsequent nail procedure cadaveric training. Participants completed a post-survey within a week after the nail cadaver lab training to re-assess their experience and confidence.

Results: Participants demonstrated significant post-intervention improvements in comfort with nail procedures, including instruments needed to perform nail procedures, postoperative care, nail matrix biopsies, and nail avulsions, with confidence in complete and partial nail avulsions doubling. All residents endorsed the session's effectiveness and recommended repeating it for future dermatology residents.

Conclusion: These findings highlight nail procedure cadaveric training as a reproducible, scalable intervention to address gaps in procedural dermatology education and enhance residents' skills in nail surgery.

Introduction: Hair shaft disorders include congenital or acquired conditions characterized by structural abnormalities of the hair. Trichonodosis, or knotted hair, is a rare disorder characterized by the presence of knots along the hair shaft. It can occur spontaneously or be induced by mechanical forces.

Case presentation: An 8-year-old girl presented with short, fine, curly hair since birth. Physical examination revealed diffusely curly scalp hair with visible breakage. Trichoscopy and light microscopy showed knotted hair segments, cortical fractures, and variation in hair shaft thickness. A diagnosis of spontaneous trichonodosis was made. Treatment with topical minoxidil and gentle hair care led to improved hair length and strength over 2 years.

Conclusion: We propose that spontaneous trichonodosis with congenital onset and no mechanical triggers suggest a genetic predisposition. Although treatment options are limited, topical minoxidil may provide therapeutic benefit.

Introduction: Angiokeratomas are benign vascular tumors that typically present as a hyperkeratotic, red-brown to black papule on the lower extremities. Angiokeratomas in the subungual location are rare, with few reported cases in the literature.

Case presentation: We present three biopsy-proven cases of subungual angiokeratomas with novel clinical features: involvement of the nail bed, clinically mimicking nodular melanoma, and involving a broad age range, with the youngest patient reported at 25 years old. Symptoms included tenderness and bleeding, while the clinical presentations ranged from evenly to irregularly pigmented nodule(s). Histopathology revealed morphologic findings; characteristics of angiokeratoma include multiple dilated vascular spaces within the superficial dermis and overlying epidermal hyperplasia.

Conclusion: This case series expands the known clinical presentations of nail unit angiokeratomas and emphasizes the importance of including subungual angiokeratoma in the differential diagnosis of pigmented, nodular lesions of the nail unit.

Introduction: Patients suffering from androgenetic alopecia may experience obsessive behaviors on observing their own scalp.

Case presentation: This article describes a series of three cases of young men presenting with an unusual, seemingly compulsive behavior related to mild scalp psoriasis and a family history of androgenetic alopecia. Contrary to the typical goal of psoriasis treatment, these patients exhibit an intense fixation on scalp scales containing embedded hairs. They actively avoid dislodging these scales during routine hygiene or therapeutic efforts, fearing that their removal might accelerate hair loss. The cases involve young men (aged 24, 19, and 22) with significant anxiety about hair loss, which manifests as a meticulous and repetitive manipulation of their scalps to preserve these specific scales.

Conclusion: This behavior may fall within the spectrum of body-focused repetitive behaviors. This observation underscores the importance for dermatologists to thoroughly question patients about underlying anxieties and specific scalp manipulation behaviors, especially in young men with a familial history of alopecia, to facilitate more effective clinical management.

Introduction: Hidradenitis suppurativa (HS) disproportionately affects historically underrepresented populations, with social determinants of health (SDoH) contributing to disparities in access to care, specialty services, and medication access. This study aimed to evaluate healthcare utilization in HS, stratified by race, to better understand the role of SDoH.

Methods: A cross-sectional analysis using the All of Us database was conducted using variables including surgical procedures, healthcare utilization, biologic use, and pertinent comorbidities (diabetes, obesity, smoking, sepsis). Survey data assessed socioeconomic factors and healthcare access. Chi-square tests were used (p < 0.005); analyses were performed in RStudio 4.1.2.

Results: Among 2,265 patients with HS (40.26% African American, 77.48% female), African American patients had higher rates of emergency department visits, diabetes, complex surgeries, and inability to afford medications (all p < 0.01). White patients had more outpatient visits and delays in care due to anxiety (p < 0.0005 and p < 0.026, respectively).

Conclusions: Racial disparities in HS healthcare utilization reflect the impact of SDoH, with African American patients experiencing greater disease burden. Early identification of high-risk patients and targeted interventions are essential to promote equitable care.

Introduction: Central centrifugal cicatricial alopecia (CCCA) is a progressive scarring alopecia. No disease activity scale exists, making assessment of therapeutic intervention difficult. This study introduces the CCCA Clinical Assessment Tool (C-CAT), a novel scale that quantifies symptom severity to facilitate tailored treatment and track disease progression.

Methods: A retrospective review of patients with CCCA was assessed on degree of pruritus, erythema, pain, disease progression, and scalp resistance, each scored from 0 to 2, over the course of a minimum of 6 months of therapy.

Results: Eighty-two patients were included. The average initial C-CAT score was 3.4, consistent with mild to moderate disease activity. After 6 months of treatment, 88% of patients had improvement in score, with 48% of all patients achieving remission. Intralesional kenalog injections and topical clobetasol were the most commonly used therapies. Patients required an average of 3.6 different treatments to achieve therapeutic response.

Conclusion: The C-CAT provides a structured, quantitative method to assess CCCA severity, which facilitates tracking of disease improvement for the majority of patients with targeted therapy. While the subjective nature of some C-CAT components may lead to inter-rater variability, this tool promotes personalized, symptom-based treatment and supports clinicians and patients in understanding this complex condition.

Background: Hair loss (HL) is a prevalent condition worldwide; it can affect both males and females of different age groups. Despite the availability of many conventional treatment options, these might be linked to causing different side effects, leading to a growing interest in natural and herbal remedies (HRs). This review aims to investigate the efficacy and safety of various HRs for HL and examine the current scientific evidence behind them.

Summary: A literature search used several studies to identify relevant studies published up to March 2024. The search terms included HL, alopecia, HRs, and names of specific herbs such as rosemary, saw palmetto, onion juice, Korean red ginseng, pumpkin seed oil, azelaic acid, olive oil, coconut oil, henna, honey, rice bran extract, Ashwagandha, and amla. Studies have suggested potential benefits in promoting hair growth and treating various forms of HL. These remedies were found to be effective in different conditions, including androgenetic alopecia, telogen effluvium, and alopecia areata, through various mechanisms of action, including 5α-reductase inhibition, increased microcapillary blood flow, antioxidant effects, and modulation of the hair growth signaling pathways.

Key messages: Natural and HRs show promise in treating HL. However, many of these studies have limitations such as lack of long-term follow-up, small sample sizes, and short treatment durations. Due to this variation in the quality of evidence, further well-designed randomized trials with larger sample sizes are required to confirm the efficacy of these HRs.