Skin Appendage Disorders最新文献

Introduction: Off-label low-dose oral minoxidil (LDOM) is used for androgenetic alopecia (AGA) treatment, with limited safety data. We investigated LDOM adverse effects (AEs) in AGA patients.

Methods: AGA patients taking LDOM were identified (January 1, 2010-December 3, 2022). AEs and management were recorded from follow-up and emergency room visits. Fisher's exact test, logistic regression, and Benjamini-Hochberg procedure assessed significance and adjusted for multiple comparisons.

Results: Three hundred ten AGA patients were analyzed with mean age 47.5 years and 53.2% females. The average LDOM dose was lower for females vs. males. AEs were observed in 14.9% of patients, with dizziness/lightheadedness, hypertrichosis, and extremity edema being most common. Higher doses were associated with increased likelihood of dizziness/lightheadedness. Females had higher overall incidence of AEs; however, gender differences did not persist after subgroup analysis. Among patients experiencing AEs, 11.1% adjusted their dosage and 28.9% discontinued treatment.

Conclusion: A higher LDOM dose increased risk of dizziness/lightheadedness in both genders, with females more likely to experience any AE. Patients are often started at inappropriately high doses, causing AE-induced regimen changes. Therefore, we recommend a cautious approach when prescribing LDOM, starting with lower doses and gradually increasing as tolerated, and counseling female patients regarding their higher risk of AEs.

Introduction: Hair density (HD) studies of marginal traction alopecia (MTA) are few. We aimed to document the HD/cm², number of hair shafts (HS) per pilosebaceous unit (PU), and HS diameter of different grades of anterior scalp margin MTA (AMTA).

Methods: A cross-sectional descriptive study of 401 women over a 9-month period in 2023. The severity of AMTA was scored using the marginal traction alopecia severity score. Phototrichoscopic evaluation of HD/cm², HS diameter, and number of HS per PU was done on the alopecic intertemporal, right and left temporal, and the non-alopecic right temporal and intertemporal scalp sites.

Results: The HD/cm² of the non-alopecic intertemporal scalp site ranged from 282 to 519 cm² compared to that of the AMTA which ranged from 14 to 349/cm², p < 0.001. With increasing severity of AMTA, there was a significant decrease in HD: grade 1 had HD of 227.56/cm² compared to 131.22/cm² in grade 4 at the intertemporal area, p < 0.001. HS diameter ranged from 0.0087 to 0.0200 mm in grade 1 and 0.0078-0.0100 in grade 4. Single hair units were present in 100%.

Conclusion: Anterior scalp marginal alopecia results in a significant reduction of HD, hair shaft diameter, and number of hair strands. Preventative education on hair care practices and hair styles is advocated.

Introduction: Eccrine poroma is a rare benign adnexal tumor that originates from the acrosyringium of eccrine sweat ducts, typically found on palms and soles. Its occurrence in subungual location is rare, making diagnosis and treatment challenging. We present the details of subungual eccrine poroma, emphasizing its unusual presentation, dermoscopic features, and management.

Case presentation: A 36-year-old female presented with a slowly growing, asymptomatic, reddish subungual mass under the left index finger nail for the past 5 years. Onychoscopy showed a reddish-pink homogenous area with keratotic borders, reddish globules, and dotted vessels. An excisional biopsy was done, and a final diagnosis of eccrine poroma was made on histopathology, with no recurrence over 6 months of follow-up.

Conclusion: Given the rarity of subungual involvement, our case highlights the importance of considering eccrine poroma in the differential diagnosis of subungual tumors. Onychoscopy can aid in diagnosis and differentiation from other subungual masses, though a definitive diagnosis requires histopathology.

Background: Androgenetic alopecia (AGA) is the most common cause of hair loss. Currently, approved medications for AGA are topical minoxidil and oral finasteride, both of which are prescription medications which may cause side effects. Non-prescription products such as herbal extracts and over-the-counter medications have limited evidence regarding safety and efficacy; however, they may be an alternative for patients unable or unwilling to use prescription medication.

Summary: This article reviews investigator-blinded, controlled clinical trials assessing the efficacy of non-prescription monotherapies in treating AGA. A total of 13 studies were included using procyanidin, cetirizine, caffeine, Oryza sativa bran, pumpkin seed oil, rosemary oil, saw palmetto, and watercress. The available data demonstrate considerable improvements in one or more parameters: total hair density, terminal hair density and hair diameter. Procyanidin and cetirizine were investigated in more investigator-blinded, randomized controlled trials than other agents. Minimal adverse events were observed; however, more robust clinical trial and long-term safety and efficacy data are warranted.

Key message: Additional investigations through the conduct of high quality randomized, controlled trials with larger numbers of patients will help determine the effectiveness and safety of this class of compounds, either as monotherapy or as an addition to current pharmacological interventions.

Introduction: Premature greying of hair (PGH) is a cosmetic issue affecting youths, and limited research has been conducted on its prevalence and impact in the Thai population. This study aimed to investigate the prevalence, psychological impact, and associated factors of PGH.

Methods: A cross-sectional study was conducted with volunteering students aged 25 or younger from a Thai university. Participants completed a self-administered survey that included questions on PGH status, psychological effects, and associated factors, which include psychological stress, alcohol and cigarette consumption, body mass index, paternal and maternal history of PGH, exercise frequency, and diet.

Results: A total of 441 participants were included in the analysis. The prevalence of PGH was 47.17%, with an average (sd) onset age of 16.29 (3.08) years. Self-assessment revealed hair greying <25% in 89.42% of all PGH cases. Of those with PGH, 67.31% reported no psychological impact, whilst 25.00% reported self-confidence loss, and 7.69% were bullied. PGH is found to be significantly associated with maternal and paternal history of the condition (p < 0.001).

Conclusion: The results showed a high prevalence of PGH, with the majority of cases involving less than 25% hair greying and no psychological impact. PGH was found to be significantly associated with both maternal and paternal history.

Introduction: The study aimed to evaluate recent trends in public interest regarding various alopecia-associated diagnoses using Google Trends.

Method: Data generated through Google Trends for the relative search volumes (RSVs) of the following diagnostic-related terms: "Alopecia," "Alopecia areata," "Androgenetic alopecia," "Central centrifugal cicatricial alopecia," "Folliculitis decalvans," "Frontal fibrosing alopecia," "Telogen effluvium," "Traction alopecia" (disease)." Analysis has been performed worldwide from July 29th, 2018, to July 16th, 2023.

Results: Between 2018 and 2023, mean RSVs by 12-month period have remained stable for "alopecia" and "alopecia areata." "Telogen effluvium" has increased peak search during 2020-2022. "Androgenetic alopecia" and "frontal fibrosing alopecia" display an increase for the past 5 years. There were differences in geographic distribution. For alopecia areata, all the countries were from the Middle East; for telogen effluvium, eight of the top 10 countries were Latin American or Spanish speaking, and Western countries had mainly searched for frontal fibrosing alopecia.

Conclusions: Google Trends is not a real epidemiological tool. It can be only used by individuals who have access to the Internet, but it does not presume the person or the reason for the search. We observed different geographical distribution according to the disease. Infodemiology provides a better understanding of alopecia needs in different countries and continents.

Introduction: Nail involvement occurs in approximately 90% of patients with cutaneous psoriasis and in isolation in 5%-10% of patients. There is an unmet need for diagnostic and therapeutic algorithms for nail psoriasis (NP), partially due to limited number of clinical trials.

Methods: The ClinicalTrials.gov, the EU, the Australian New Zealand, and the World Health Organization International Clinical Trials Registries were queried for the term "nail psoriasis". Trial data characteristics were collected and analyzed.

Results: A total of 112 clinical trials were included, with mean trial length 46.7 weeks and mean number of participants 272.7. Medications were most often studied in 97 (86.6%) trials, followed by lasers in 7 (6.3%) trials. NP Severity Index score was the most often studied outcome measure in 91 (84.3%) trials, and only 56 (52.8%) trials assessed adverse events. Only 3 (2.83%) trials included children, and many clinical trials excluded patients aged 65+ and 85+. Results were posted for 46 (41.4%) trials with mean participant age 45.1 years, mean percentage of females of 38.3%, and 87.8% of participants being White.

Conclusion: Our findings highlight a need for clinical trials assessing efficacy and long-term therapeutic safety with a broad range of age-groups and increased representation of minorities and female patients.

Background: Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss that can affect children, adolescents, and adults. Ritlecitinib, an orally administered Janus kinase (JAK) 3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) kinase family inhibitor, is the first and currently the only treatment approved by the US Food and Drug Administration for adolescents (aged 12-17 years) with severe AA.

Summary: The ALLEGRO phase 2b-3 trial demonstrated that 25% and 50% of adolescents with a Severity of Alopecia Tool (SALT) score ≥50 at baseline achieved a SALT score ≤20 at week 24 and week 48 after receiving 50 mg ritlecitinib daily, respectively. The most common adverse events were headache, acne, and nasopharyngitis in adolescents. This review summarizes the mechanism of action, clinical trial evidence on efficacy and safety profile, factors associated with treatment response to JAK inhibitors for AA, and vaccination considerations for adolescents.

Key messages: This review aims to facilitate the risk-benefit assessment and shared decision-making between clinicians and patients and provide clinical considerations and management recommendations for ritlecitinib use in adolescents with AA.

Introduction: Mycosis fungoides (MF), the most common form of primary cutaneous T-cell lymphoma, can present with diverse clinical manifestations, including alopecia that mimics conditions such as alopecia areata (AA) and lichen planopilaris (LPP). The folliculotropic variant (FMF) poses diagnostic challenges due to overlapping clinical features, necessitating histopathological evaluation for accurate diagnosis.

Case report: A 58-year-old woman with a 21-year history of stage IB MF developed alopecic patches in the left temporoparietal region, accompanied by pruritus and trichodynia. Physical examination revealed scarring and non-scarring alopecic patches, while trichoscopy showed characteristic features of follicular involvement. Histological analysis confirmed a diagnosis of FMF, characterized by atypical lymphocytic infiltrate and follicular destruction. Treatment included maintenance of NB-UVB and isotretinoin, with the addition of monthly intralesional corticosteroid injections, resulting in symptomatic improvement.

Discussion/conclusion: This case highlights the diagnostic challenges posed by FMF mimicking AA and LPP. The overlap in clinical and trichoscopic findings underscores the necessity for histopathological evaluation to confirm FMF and differentiate it from other alopecic conditions. Early recognition and a multidisciplinary approach to treatment are crucial for improving outcomes in patients with this aggressive variant of MF.