Skin Appendage Disorders最新文献

Introduction: Trichotillomania (TTM) is a body-focused repetitive disorder linked to psychiatric comorbidities. Comprehensive studies mapping its associations with a range of conditions remain limited. This study examines TTMs associations with psychiatric, neurodevelopmental, substance-related, reproductive, and social factors using a national database.

Methods: We performed a case-control study using the All of Us Research Program database. TTM cases (n = 40) were matched to controls (n = 400) based on age, sex, and ethnicity. Multivariate logistic regression was used to examine associations with comorbidities and lifestyle factors, controlling for demographic variables.

Results: TTM was significantly associated with obsessive-compulsive disorder (odds ratio [OR] 18.3), borderline personality disorder (OR 15), anxiety disorders (OR 10.2), alcohol abuse (OR 6.13), depression (OR 5.89), and vitamin D deficiency (OR 4.2) (all p < 0.01). Other significant associations included fatigue, social anxiety, post-traumatic stress disorder, ADHD, and difficulty running errands alone.

Conclusion: Our findings highlight the strong association between TTM and a wide range of psychiatric and behavioral conditions, emphasizing the need for integrated treatment strategies addressing both psychiatric and physical aspects.

Introduction: Knowledge of the structure and function of existing nail clinics remains limited. Sharing this knowledge from nail experts who run these clinics can readily support newly trained nail clinicians in setting up their nail clinics.

Method: We surveyed members of the Council for Nail Disorders (CND) to learn about the structure and practices of their nail clinics. Of the practicing CND members in any membership class, we analyzed responses from those who have nail clinics.

Results: Of the 79 practicing CND members, 38 responded (48.1% response rate), of whom 25 (65.8%) had a nail clinic. Analysis of these 25 responses revealed that 52% of nail clinics were relatively new (operating <5 years). The majority (72%) were in academic settings. Medical trainees were being taught in 64% of clinics. Nail clinics were directed by either one (64%) or multiple clinicians. All experts reported using clinical photographs in their routine care for nail patients, and 96% used dermoscopy. Additionally, 96% performed punch and tangential shave biopsies, and 88% performed matrixectomy. Access to a pathologist(s) with nail expertise was available in 84% of clinics.

Conclusion: Our findings characterize the current practices of nail clinics directed by CND members, serving as a guide for clinicians looking to establish their own.

Introduction: Palmoplantar pustulosis (PPP) is a common chronic recurrent skin disease characterized by sterile pustules on the palms and soles of the feet. Most patients with PPP have a rash that improves during pregnancy due to the influence of estrogen and progesterone, but relatively few have an exacerbation of the rash during pregnancy.

Case introduction: Here, we show a female patient diagnosed with PPP, whose rash worsened during pregnancy and gestation. Her lesions were painful and cracked, interfering with normal walking and sleep, and was poorly treated with hormonal ointments and ultraviolet light. She gave birth to a healthy baby boy at 39 weeks plus 4 days of gestation after regular monitoring and stopped breastfeeding at 6 months of age and then presented to the outpatient clinic. For sterile pustules, we choose tofacitinib at a dosage of 5 mg b.i.d. Three months after taking the medication, the pustules on her hands and feet had mostly disappeared. Follow-up showed that the condition remained stable without recurrence.

Conclusion: Aggravation of PPP during pregnancy is relatively rare. Tofacitinib, as an oral JAK inhibitor, is effective in the treatment of PPP exacerbated during pregnancy, but the risk to mother and child is unknown, and the relationship between tofacitinib and pregnancy outcome should be further investigated.

Introduction: Alopecia areata (AA) is a difficult to treat and appearance altering disorder affecting up to 2% of people during their lifetime. Understanding current management trends will help in improving patient outcomes. The aim of this study was to determine the impact of comorbid disorders and demographic factors on the management of AA and determine the influence of previously discovered genetic factors in different ethnic groups.

Methods: We used the All of Us controlled dataset (version 7) and examined electronic health record and genomic data from 206,173 participants in a retrospective cross-sectional study conducted in outpatients in the USA.

Results: We found that AA patients with comorbid atopic dermatitis, psoriasis, and vitiligo were more likely to have been prescribed topical corticosteroids. Patients that were not of European/Caucasian ancestry were less likely to be prescribed any type of corticosteroid. We also found that specific genetic variations (single nucleotide polymorphisms) that increased or decreased risk in European/Caucasian participants did not necessarily have the same effect in other ethnicities (Hispanics and blacks).

Conclusion: This work has helped uncover the state of AA care within the USA and has identified access to healthcare inequities in different ethnic populations.

Introduction: Nail involvement in pemphigus (NIP) was considered as a rare finding and a predictor factor of the severity of pemphigus. The diagnosis of NIP can be challenging, as it can be mistaken for other nail disorders. The aim of our study was to provide an overview of NIP, with a focus on the dermoscopy role to detect these nail changes.

Methods: A monocentric prospective study was performed from January 2018 to December 2022, investigating clinically and with a dermoscope NIP.

Results: Our study included 32 patients, among them 6 patients with NIP. The mean age was 53 years. The average duration of the disease at presentation was 4.5 months. Five patients (83%) had pemphigus vulgaris and 1 patient was diagnosed with paraneoplastic pemphigus. In 5 cases (83%), the disease was severe, with 4 cases having frequent exacerbations (66.7%). The average number of nails involved was 9. In 3 cases, only the fingernails were involved. The nail lesions were concomitant to the mucocutaneous lesions in half our cases. Onycholysis and subungual hemorrhage were the most frequent dermoscopic findings (83%). Paronychia and dyschromia were seen in 4 patients. In 3 cases, cuticular loss and onychomadesis were seen.

Conclusion: Dermoscopic features such as subungual hemorrhage, onycholysis, and paronychia can help distinguish pemphigus-related nail changes from other conditions.

Introduction: Treatment of acne scars includes laser therapies, microneedling, chemical peels, and dermal fillers. Herein, we sought to assess the efficacy and safety of heterologous type I collagen injections (HT1Cs) on atrophic acne scars.

Methods: One hundred milligrams of HT1C were injected beneath each atrophic acne scar on patients with atrophic acne scars graded as 2, 3, or 4 according to the Goodman and Baron's acne scar grading system. Patients underwent four treatment sessions at 2-week intervals, and they were evaluated for up to week 52, using the above-mentioned grading system and a 0-10 visual analogue scale (VAS).

Results: 30 patients (9 males: 21 females; median [range] age 32 [18-50] years) were enrolled in the study. At baseline, 10 (33%), 17 (57%), and 3 (10%) patients presented with grade 2, 3, and 4 scaring. At 3-month follow-up, 7 (23%), 16 (53%), 4 (13%), and 3 (10%) of patients presented with grade 1, 2, 3, and 4 scaring, respectively. At the same visit, physicians rated the mean improvement as 6.8, while patients rated it slightly higher at 7.2. The observed improvements were sustained up to 12 months. The mean patients' satisfaction rate at 3 months was 7.4. No major adverse events were reported throughout the entire duration of the follow-up period.

Conclusion: The results of the present study highlight the efficacy, sustainability, and safety of HT1C injections in treating atrophic acne scars.

Background: Upadacitinib, a selective Janus kinase (JAK) 1 inhibitor, has demonstrated promising efficacy in alopecia areata (AA), particularly in patients unresponsive to conventional therapies. As JAK inhibitors gain prominence, understanding upadacitinib's role in AA management is critical.

Summary: This scoping review synthesizes data from 24 publications, including 64 AA patients treated with upadacitinib (15-45 mg daily). Most patients experience substantial or complete hair regrowth within 1-4 months. The most common AA subtypes include alopecia universalis (n = 28), ophiasis (n = 15), and alopecia totalis (n = 8). Upadacitinib was generally well tolerated, with mild adverse events such as transient acneiform eruptions, leukopenia, and creatine phosphokinase elevations. Many patients with comorbid autoimmune conditions, such as atopic dermatitis (59.4%) and inflammatory bowel disease, also reported improvement. Despite these promising findings, limitations include small cohort sizes, variability in prior treatments, and reliance on case reports. Two ongoing studies are underway: a US Phase 3 clinical trial (M23-716) assessing long-term efficacy and safety, and a real-world observational study in China (NCT06573593) comparing upadacitinib with other JAK inhibitors. These studies underscore the need for larger, controlled trials to establish standardized treatment protocols and long-term safety outcomes.

Key messages: (i) Upadacitinib demonstrates good efficacy in treating AA. (ii) Its safety profile supports potential off-label use. (iii) Larger studies are essential to validate current findings and optimize management.

Introduction: Central centrifugal cicatricial alopecia (CCCA) is a primary scarring alopecia predominantly affecting black women. Autoimmune mechanisms, including antinuclear antibody (ANA) positivity, have been hypothesized to contribute to its pathogenesis but remain underexplored.

Method: Using the TriNetX database (2004-2024), we identified black women with CCCA and controls with other primary scarring alopecias. Patients were propensity score matched by current age and age at diagnosis. We compared the prevalence of ANA positivity and autoimmune comorbidities before and after alopecia diagnosis. Statistical significance was defined as an adjusted p value <0.05.

Results: Among 5,811 CCCA patients and matched controls, CCCA patients were more likely to have positive ANA (11.8% vs. 2.0%, p < 0.001) and systemic lupus erythematosus (SLE) post-diagnosis (0.9% vs. 0.3%, p = 0.007). They were less likely to have type 1 diabetes pre-diagnosis (2.9% vs. 4.8%, p = 0.007) and post-diagnosis (0.8% vs. 1.3%, p = 0.024). No significant differences were found in other autoimmune diseases.

Conclusion: CCCA patients had higher prevalence of ANA positivity and SLE, supporting potential autoimmune involvement. However, screening for other autoimmune diseases in asymptomatic CCCA patients may not be necessary. Further research is needed to clarify the interplay between autoimmune and metabolic pathways in CCCA.

Background: Eyebrows are a distinct facial feature and any shift in their appearance impacts self-perception of external beauty attributes. There may be loss of hairs, or changes in pigment and texture due to primary or secondary causes.

Summary: A surge in demand for microblading in recent years, majorly for aesthetic value, has driven curiosity and requests for the procedure. This has translated to subjective dissatisfaction with cosmetic outcomes while also increasing the risk of complications and immunogenically driven adverse events.

Key messages: Understanding the nuances of the technique and undertaking basic precautions will enable safe and desirable results in this common procedure.