Skin Appendage Disorders最新文献

Introduction: Scarring alopecias (SAs) cause permanent hair loss and psychological distress. With no FDA-approved SA treatments, patients face significant barriers to care. Despite promising evidence supporting the use of Janus kinase inhibitors (JAKi) to treat SAs, access remains limited. This study aimed to assess the demographic profile, psychosocial burden, treatment experiences, and barriers to care among patients with SA.

Methods: An IRB-approved online survey was distributed to adults (≥18 years) with a self-reported SA diagnosis via the Scarring Alopecia Foundation (SAF) listserv and at the April 2025 SAF Conference. Wilcoxon-Mann-Whitney U tests and χ² tests were performed using SAS v9.4.

Results: Among 294 respondents (98.0% female, mean age 61, 81.3% White), common diagnoses included frontal fibrosing alopecia (66.3%), lichen planopilaris (41.5%), and central centrifugal cicatricial alopecia (12.6%). Only 37.5% reported well-controlled symptoms; 78.9% experienced SA-related depression or anxiety. JAKi awareness was high (71%), but use was low (30%), with significant differences based on gender, region, income, and education. Barriers to treatment access included provider reluctance (46%), insurance denial (18%), and high cost (16%).

Conclusions: SA patients face significant psychosocial distress and barriers to accessing therapies. Improving equitable access to care requires enhanced provider education, broader insurance coverage, and stronger patient assistance programs.

Introduction: Pityriasis amiantacea (PA), also known as pseudotinea amiantacea, is a scalp disorder characterized by adherent scales surrounding hair tufts, with an unclear etiopathogenesis potentially linked to inflammatory scalp diseases such as psoriasis, seborrheic dermatitis, and atopic dermatitis.

Methods: This retrospective multicenter study analyzed the epidemiology, clinical presentation, trichoscopic features, and management of 76 pediatric patients diagnosed with PA across 22 centers.

Results: Pruritus was the hallmark symptom, and scarring alopecia was rare in pediatric patients. Regarding trichoscopy, recognizing the vascular patterns is demonstrated to be valuable for severe or unresponsive cases. In our study, monotherapy using topical steroid treatment generally led to favorable outcomes, suggesting that PA may be less aggressive in children due to earlier diagnosis and less severe inflammation.

Conclusion: This study highlights the importance of recognizing PA in pruritic scalp conditions in pediatric patients, suggesting effective management strategies that can improve quality of life despite the psychosocial impact of the disease.

Introduction: Onychotillomania is a body-focused repetitive behavior disorder characterized by compulsive trauma to the nail unit. While manual manipulation is well recognized, oral-induced mechanisms remain undocumented. We describe a novel subset involving frictional trauma from the teeth, which we term onychotillomania dentata.

Case presentation: An 11-year-old female presented with a 1-year history of progressive thumbnail dystrophy. Clinical history revealed a habitual behavior occurring predominantly at night: inserting the thumbs into the mouth and rubbing the nail plates against the lower incisors in a repetitive anteroposterior motion. The patient described the behavior as soothing and unconscious. Signs of concomitant onychophagia were also present. Examination demonstrated central nail plate concavity, lamellar splitting, periungual erythema, and localized subungual hyperkeratosis. Dermoscopy revealed lamellar onychoschizia, linear furrows, and compact subungual debris. Behavioral counseling was initiated, including thumb guards during sleep and positive reinforcement strategies. Oral n-acetylcysteine (600 mg every 12 h) was prescribed as adjunctive therapy. Referral to pediatric psychodermatology was recommended for behavioral assessment and initiation of habit-reversal training.

Conclusion: Onychotillomania dentata represents a previously undescribed pattern of nail trauma within the broader spectrum of onychotillomania. While classical onychotillomania typically results from manual manipulation, onychotillomania dentata is distinguished by repetitive oro-digital friction. Clinical features include central concavity, lamellar splitting, and linear furrows along the axis of mechanical trauma. Diagnosis often relies heavily on clinical morphology and dermoscopy, especially as many patients may deny their behavioral habit. Early recognition is crucial to avoid misdiagnosis and unnecessary treatment. Additionally, chronic mechanical friction may pose a risk of dental damage, including enamel erosion. Management involves behavioral modification strategies, pharmacologic support when appropriate, and interdisciplinary psychodermatologic care.

Introduction: MMP® (the Portuguese acronym for microinfusão de medicamentos na pele [i.e., microinfusion of drugs into the skin]) is a novel drug delivery technique that uses microneedling to infuse drugs into the skin. Scalp microinfusion is a promising intervention for hair loss.

Aim: The aim of the study was to evaluate the efficacy and safety of microinfusion of dutasteride with the MMP® technique compared with microinfusion of saline solution (placebo) in men with androgenetic alopecia (AGA). This is the first study that compared microinfusion with MMP® using dutasteride versus placebo for the treatment of AGA.

Methods: A prospective, multicenter, controlled clinical trial was conducted in eight (8) adult male patients with AGA. Three applications of dutasteride or placebo (saline solution 0.9%) using the MMP® were made every 30 days. Photos pre- and posttreatment were analyzed by three blinded dermatologists and the patient. Efficacy and safety were evaluated.

Results: No statistical difference in the clinical assessment was found between the groups. However, patient self-assessment reported marked improvement in the vertex area in the dutasteride group.

Conclusion: Dutasteride microinfusion using the MMP® technique is effective in treating male AGA. Microneedling with MMP® without any medication is effective in treating male AGA.

Introduction: Digital mucous cysts (DMCs) are benign lesions commonly involving the distal interphalangeal joint and proximal nail folds. Although recurrence is common, surgical excision remains the most effective treatment. This study assessed the recurrence rate of DMCs following surgical excision with autografting of the overlying skin.

Methods: This was a retrospective, observational, and descriptive study based on photographic and medical record review of 29 patients treated between 2008 and 2024, with a minimum follow-up of 6 months and a mean follow-up of 74.4 months. The surgical procedure involved excision of the DMC, autografting of the overlying skin, and application of Brown's dressing for 10 days to ensure sustained local pressure. Recurrence was defined as clinical reappearance of the cyst.

Results: The cohort had a mean age of 61 years, with 89.7% being female. The recurrence rate was 6.9% (2/29), with both recurrences occurring early (at 3 and 10 months). Notably, no recurrences were observed in toe lesions, despite their high proportion (12/29 cases).

Conclusion: Surgical excision followed by autografting of the overlying skin and application of Brown's dressing resulted in a low recurrence rate. Sustained local pressure appears to promote fibrosis, contributing to long-term cyst resolution.

Introduction: Considering the growing recognition of the association between hidradenitis suppurativa (HS) and spondyloarthritis, this study addresses a gap in clinical practice in HS consultation: the absence of a validated arthritis screening tool.

Methods: Drawing on interdisciplinary collaboration between dermatology and rheumatology, we assayed a modified version of the PURE-4 tool: patient and dermatologist Psoriatic Arthritis Uncluttered Screening Evaluation-5 (p- and dPURE-5), adapted to reflect clinical features relevant to this population.

Results: Of 214 HS patients, 125 (58.4%) were male, with a median age of 42 years (IQR 30-49). Buttock involvement was observed in 64 patients (29.9%) and was more common in males (35.7%) than in females (21.6%) (p = 0.26). Of the 214 patients, 82 (38.3%) answered negatively to all questions, while 118 (55.6%) answered positively to at least one question in the pPURE-5 but were later dismissed by the trained dermatologist after a more detailed interview. Finally, 14 patients (6.5%) were referred to Rheumatology due to a positive dPURE-5. Of these, 2 (14.3%) were diagnosed with inflammatory chronic arthritis, yielding a positive predictive value of 14.3%.

Conclusion: To conclude, the PURE-5 questionnaire appeared valuable for guiding anamnesis and facilitating rheumatology referrals. Even so, there is still a need for new and validated screening tools for detecting arthritis in the HS population.

Introduction: Phyma of the nose, or rhinophyma, is considered a diagnostic clinical phenotype of rosacea. Rarely, phyma manifestations may be present on the chin (gnathophyma), ear (otophyma), forehead (metophyma) and eyelids (blepharophyma). The purpose of this paper was to present a case of rhino-metophyma and to review the literature on the topic.

Case presentation: A 74-year-old Caucasian male with a history of inflammatory rosacea, complained of marked nasal and frontal skin thickening. Based on clinical, ultrasound, and histopathological examination, the diagnosis of rhino-metophyma was formulated. A literature review from 2000 to 2024 revealed 14 cases of rhinophyma associated with other localizations: 7 cases of rhino-otophyma, 4 of rhino-gnathophyma, and 3 of rhino-metophyma. Reported cases of isolated extranasal phyma were 21: 10 of gnathophyma, 9 of otophyma, and 2 of metophyma. Overall, patients with involvement of the nose and extranasal phyma were predominantly males with a male:female ratio 6:1, while among extranasal localizations the male:female ratio was 1.1:1.

Conclusion: The diagnosis of rhinophyma is clinical and in the majority of cases quite easy, less for the isolated phymas in extranasal localizations. Little is also known about the management of these forms, and more studies on the prevalence of extranasal localizations and their therapeutic management would be desirable.

Introduction: Nail changes have been described in syphilis in all stages. However, they can be subtle and easy to miss. At the same time, they are valuable indicators towards underlying pathology as nail is a useful "window to systemic disease." Onychoscopic features of nail syphilis have not been described in detail.

Case report: We describe 3 patients (n = 60 nails) with secondary syphilis with involvement of 29/60 (48.3%) nails. Most common clinical nail findings were onychorrhexis (13, 37%), followed by distal onycholysis (10, 28%). Other findings included subungual hyperkeratosis, onychomadesis, Beau's lines, nail plate atrophy, paronychia, and periungual ulceration. Onychoscopic involvement was seen in 32/60 (53.3%) nails. Features observed on onychoscopy were onychorrhexis (13/60) and distal onycholysis (including erosive onycholysis) (12/60). Distinctive features on onychoscopy included alternate white and red lines, longitudinal erythematous bands, and ulcerative onycholysis.

Conclusion: Nail involvement in syphilis, particularly the onychoscopic findings, has been under-reported. Varying terminologies have been used over the years as per the literature review. We propose that nail syphilis is best classified based on the site of involvement within the nail unit. Onychoscopy aids the detection of changes which may be missed on clinical examination.

Introduction: Although platelet-rich plasma (PRP) is a widely used treatment for androgenetic alopecia (AGA), the impact of patient age on treatment efficacy remains underexplored.

Method: This retrospective study evaluated PRP outcomes in 57 AGA patients treated at NYU Langone Health, stratified into four age cohorts. Changes in trichometric hair density and width were measured from initial to final follow-up visits. Statistical significance and linear regression testing were determined using ANOVA and Rank-Based ANCOVA, respectively.

Results: While overall changes in density and width did not differ significantly across age groups, younger patients trended toward greater density gains. Furthermore, greater baseline hair width was predictive of smaller improvements in width, and significant interactions between age and the number of PRP sessions suggested that older individuals may require a greater number of treatments to attain results comparable to those seen in younger cohorts. Additionally, improvements in hair density were positively associated with the number of adjunctive therapies, as patients who received more concurrent treatments experienced greater gains. PRP was well tolerated across all age groups.

Conclusion: These findings highlight the potential impact of patient age on PRP efficacy, informing counseling and treatment planning.

Introduction: Central centrifugal cicatricial alopecia (CCCA) is a primary scarring alopecia with unclear etiology. Emerging evidence suggests an association with metabolic dysregulation, including altered protein levels in affected scalp tissue and increased insulin resistance. This study investigated potential associations between CCCA and metabolic dysfunction using a large, multicenter database.

Method: Using the TriNetX database, we analyzed 2,482 black women with CCCA and 2,482 propensity score-matched controls with other primary scarring alopecias (2004-2024). Metabolic disorders and laboratory values were compared (Benjamini-Hochberg-adjusted p < 0.0042).

Results: CCCA patients showed no differences in incidence of type 2 diabetes (19.7% vs. 19.5%, p = 0.591), prediabetes (17.8% vs. 21.0%, p = 0.265), obesity (30.9% vs. 38.5%, p = 0.054), or metabolic syndrome (1.4% vs. 1.2%, p = 0.404) compared to controls. CCCA patients had lower hypertension incidence (39.7% vs. 49.5%, p < 0.0001), higher HDL (58.0 vs. 55.5 mg/dL, p = 0.0016), and lower triglyceride (96.4 vs. 106.3 mg/dL, p = 0.0001) values.

Conclusion: We found that CCCA was not associated with most metabolic disorders. Thus, metabolic screening in CCCA patients should be individualized based on history and review of systems. Future research exploring genetic, inflammatory, and autoimmune pathways in CCCA pathogenesis is needed.