Alopecia areata (AA) is an autoimmune condition that causes non-scarring hair loss on the scalp or other hair-bearing surfaces. Various signalling molecules regulate the hair cycle and hair follicle regeneration. These include genes, growth factors, nuclear receptors, cytokines, and subcellular signalling pathways. Growth factors can cause the vascular endothelium and dermal fibroblasts to proliferate, extend the anagen phase, and delay the initiation of catagen in the hair follicle, thereby promoting hair growth. Microneedling causes the release of growth factors and has been shown to help high-molecular-weight drugs penetrate the stratum corneum and hair follicles. These recent discoveries regarding the pathogenesis of AA have resulted in the development of promising therapies. Herein, this article reviews the use of growth factors and microneedling in the treatment of AA and explores their efficacy and safety. Treatment with growth factors and microneedling appears to be highly effective for AA, with no major adverse effects, and may provide a new option for hair regeneration therapy. To support the efficacy of growth factors and microneedling for AA treatment, additional large-scale studies of patients with AA are needed.
斑秃（AA）是一种自身免疫性疾病，会导致头皮或其他生发表面出现非疤痕性脱发。各种信号分子调节毛发周期和毛囊再生。这些分子包括基因、生长因子、核受体、细胞因子和亚细胞信号通路。生长因子可促使血管内皮细胞和真皮成纤维细胞增殖，延长毛囊的生长期，延缓毛囊的衰老期，从而促进毛发生长。微针疗法可释放生长因子，并有助于高分子量药物渗透角质层和毛囊。这些有关 AA 发病机制的最新发现促进了前景广阔的疗法的开发。本文回顾了生长因子和微针疗法在 AA 治疗中的应用，并探讨了它们的有效性和安全性。使用生长因子和微针治疗 AA 似乎非常有效，且无重大不良反应，可为毛发再生疗法提供新的选择。要证实生长因子和微针治疗 AA 的疗效，还需要对 AA 患者进行更多的大规模研究。
{"title":"Growth Factors and Microneedling in Alopecia Areata: A Narrative Review","authors":"M. Almutlq, Abrar E. Bukhari","doi":"10.1159/000534636","DOIUrl":"https://doi.org/10.1159/000534636","url":null,"abstract":"Alopecia areata (AA) is an autoimmune condition that causes non-scarring hair loss on the scalp or other hair-bearing surfaces. Various signalling molecules regulate the hair cycle and hair follicle regeneration. These include genes, growth factors, nuclear receptors, cytokines, and subcellular signalling pathways. Growth factors can cause the vascular endothelium and dermal fibroblasts to proliferate, extend the anagen phase, and delay the initiation of catagen in the hair follicle, thereby promoting hair growth. Microneedling causes the release of growth factors and has been shown to help high-molecular-weight drugs penetrate the stratum corneum and hair follicles. These recent discoveries regarding the pathogenesis of AA have resulted in the development of promising therapies. Herein, this article reviews the use of growth factors and microneedling in the treatment of AA and explores their efficacy and safety. Treatment with growth factors and microneedling appears to be highly effective for AA, with no major adverse effects, and may provide a new option for hair regeneration therapy. To support the efficacy of growth factors and microneedling for AA treatment, additional large-scale studies of patients with AA are needed.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139451444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacopo Tartaglia, Stefano Piaserico, Luigi Naldi, Andrea Sechi
Background: Nail psoriasis poses challenges for effective treatment, and topical drug delivery through the nail plate is limited. A novel approach to address this challenge involves the use of ablative fractional laser as a pretreatment strategy to enhance topical drug delivery for nail psoriasis. Summary: This systematic review, conducted in accordance with PRISMA guidelines, involved an extensive literature search across PubMed/MEDLINE, EMBASE, and the Cochrane Library up to July 2023. The primary focus was on exploring studies that investigated the application of ablative laser technology to augment drug delivery for nail psoriasis. Key Messages: (1) The review included seven randomized controlled trials, all examining the combination of fractional CO2 laser with topical treatments. These trials demonstrated varying degrees of improvement in nail psoriasis. (2) Patients undergoing laser treatment reported experiencing moderate levels of pain, effectively managed through the application of topical anesthesia. (3) Commonly observed side effects included erythema, swelling, and crusting, with the Koebner phenomenon being a rare occurrence. (4) Notably, patient satisfaction levels with the combined approach of laser and topical treatments were consistently high. In conclusion, the utilization of ablative CO2-assisted laser pretreatment, when used in conjunction with topical therapy, appears to be both effective and well-tolerated for the treatment of nail psoriasis. However, the establishment of optimal parameters and treatment intervals for fractional laser therapy remains an area for further research. Standardized studies are imperative to identify the most effective strategy for enhancing topical drug delivery in the context of nail psoriasis treatment.
背景：指甲银屑病给有效治疗带来了挑战，通过甲板进行局部给药受到限制。解决这一难题的新方法是使用烧蚀点阵激光作为预处理策略，以加强甲银屑病的局部给药。摘要：本系统性综述根据PRISMA指南进行，对截至2023年7月的PubMed/MEDLINE、EMBASE和Cochrane图书馆进行了广泛的文献检索。主要重点是探索有关应用烧蚀激光技术增加指甲银屑病给药量的研究。关键信息：（1）综述包括七项随机对照试验，所有试验都研究了点阵 CO2 激光与局部治疗的结合。这些试验表明，指甲银屑病得到了不同程度的改善。(2）据报道，接受激光治疗的患者会有中等程度的疼痛感，通过局部麻醉可以有效控制疼痛。(3）常见的副作用包括红斑、肿胀和结痂，而柯布纳现象则很少发生。(4)值得注意的是，患者对激光和局部治疗联合疗法的满意度一直很高。总之，利用二氧化碳辅助烧蚀激光预处理，结合局部治疗，似乎对治疗甲银屑病既有效又耐受性良好。然而，如何确定点阵激光疗法的最佳参数和治疗间隔仍是一个有待进一步研究的领域。必须开展标准化研究，以确定在指甲银屑病治疗中加强局部给药的最有效策略。
{"title":"Ablative CO2-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review","authors":"Jacopo Tartaglia, Stefano Piaserico, Luigi Naldi, Andrea Sechi","doi":"10.1159/000535022","DOIUrl":"https://doi.org/10.1159/000535022","url":null,"abstract":"Background: Nail psoriasis poses challenges for effective treatment, and topical drug delivery through the nail plate is limited. A novel approach to address this challenge involves the use of ablative fractional laser as a pretreatment strategy to enhance topical drug delivery for nail psoriasis. Summary: This systematic review, conducted in accordance with PRISMA guidelines, involved an extensive literature search across PubMed/MEDLINE, EMBASE, and the Cochrane Library up to July 2023. The primary focus was on exploring studies that investigated the application of ablative laser technology to augment drug delivery for nail psoriasis. Key Messages: (1) The review included seven randomized controlled trials, all examining the combination of fractional CO2 laser with topical treatments. These trials demonstrated varying degrees of improvement in nail psoriasis. (2) Patients undergoing laser treatment reported experiencing moderate levels of pain, effectively managed through the application of topical anesthesia. (3) Commonly observed side effects included erythema, swelling, and crusting, with the Koebner phenomenon being a rare occurrence. (4) Notably, patient satisfaction levels with the combined approach of laser and topical treatments were consistently high. In conclusion, the utilization of ablative CO2-assisted laser pretreatment, when used in conjunction with topical therapy, appears to be both effective and well-tolerated for the treatment of nail psoriasis. However, the establishment of optimal parameters and treatment intervals for fractional laser therapy remains an area for further research. Standardized studies are imperative to identify the most effective strategy for enhancing topical drug delivery in the context of nail psoriasis treatment.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniela Baboun, Marita Yaghi, J. Keri, Brian W. Morrison
The growing demand for natural treatments has raised concerns among clinicians due to limited scientific evidence supporting their use. This review article addresses the issue by assisting dermatologists and general practitioners in recommending natural treatments for the following common nail disorders: nail brittleness, onychomycosis, periungual verrucae, paronychia, chloronychia, nail psoriasis, nail lichen planus, onychocryptosis, onycholysis, and congenital malalignment of the great toenail. One limitation is the scarcity of existing reviews on natural treatment options for nail disorders in the literature. Through a comprehensive review of existing literature, this article consolidates the available evidence on natural treatment options for these conditions. Although some natural treatments for nail disorders are supported by scientific evidence, the indiscriminate use of such remedies may lead to severe poisoning and health problems. Given the widespread and increasing use of natural treatments, clinicians play a pivotal role in educating patients about evidence-based remedies and debunking misleading claims. By doing so, clinicians can enhance patient safety and improve treatment outcomes. It is essential for healthcare professionals to be well-informed and equipped with the knowledge to differentiate between effective natural treatments and unverified claims, ensuring that patients receive appropriate care.
{"title":"Natural Treatment Options for Nail Disorders","authors":"Daniela Baboun, Marita Yaghi, J. Keri, Brian W. Morrison","doi":"10.1159/000534629","DOIUrl":"https://doi.org/10.1159/000534629","url":null,"abstract":"The growing demand for natural treatments has raised concerns among clinicians due to limited scientific evidence supporting their use. This review article addresses the issue by assisting dermatologists and general practitioners in recommending natural treatments for the following common nail disorders: nail brittleness, onychomycosis, periungual verrucae, paronychia, chloronychia, nail psoriasis, nail lichen planus, onychocryptosis, onycholysis, and congenital malalignment of the great toenail. One limitation is the scarcity of existing reviews on natural treatment options for nail disorders in the literature. Through a comprehensive review of existing literature, this article consolidates the available evidence on natural treatment options for these conditions. Although some natural treatments for nail disorders are supported by scientific evidence, the indiscriminate use of such remedies may lead to severe poisoning and health problems. Given the widespread and increasing use of natural treatments, clinicians play a pivotal role in educating patients about evidence-based remedies and debunking misleading claims. By doing so, clinicians can enhance patient safety and improve treatment outcomes. It is essential for healthcare professionals to be well-informed and equipped with the knowledge to differentiate between effective natural treatments and unverified claims, ensuring that patients receive appropriate care.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138599543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Werner Druck, Basel Medien AG, Dimitrios Rigopoulos – National, Dr Manuel Gea Gonzalez, Mexico City, Mexico, James Q. Del Rosso, Aditya K. Gupta, M. Hordinsky, Bryan C. Markinson, Andrew G. Messenger, J. Shapiro, R. Godse, M. P. P. Dany, S. Tamazian, PA Pittsburgh, J. Wan, M. Baltimore, M. Jen, A. I. P. P. Rubin, Espinoza-González, E. M. N.A. Carmona Hernandez, N. Okwundu, WA Kennewick, C. Ogbonna, A. McMichael, P. Kakizaki, L. A. Contin, M. Barletta, São Paulo, C. Machado, N. E. Trupiano, K. Z. Young, T. M. Benitez, J. Mervak, Ann Arbor, Cortez de Almeida, R. F. Melo, R. Janeiro, L. Drake, Ma Boston, J. M. I. Han, S. Boston, FL MAMiami, A. Mostaghimi, K. Huang, Guimerá Martin-Neda, La Laguna, A. K. Leroy, R. F. Cortez de Almeida, D. L. Obadia, Rio, A. Nwosu, M. Miteva, N. Kluger, P. R. Lindsø Andersen, Køge
{"title":"Contents 2023, Vol. 9","authors":"Werner Druck, Basel Medien AG, Dimitrios Rigopoulos – National, Dr Manuel Gea Gonzalez, Mexico City, Mexico, James Q. Del Rosso, Aditya K. Gupta, M. Hordinsky, Bryan C. Markinson, Andrew G. Messenger, J. Shapiro, R. Godse, M. P. P. Dany, S. Tamazian, PA Pittsburgh, J. Wan, M. Baltimore, M. Jen, A. I. P. P. Rubin, Espinoza-González, E. M. N.A. Carmona Hernandez, N. Okwundu, WA Kennewick, C. Ogbonna, A. McMichael, P. Kakizaki, L. A. Contin, M. Barletta, São Paulo, C. Machado, N. E. Trupiano, K. Z. Young, T. M. Benitez, J. Mervak, Ann Arbor, Cortez de Almeida, R. F. Melo, R. Janeiro, L. Drake, Ma Boston, J. M. I. Han, S. Boston, FL MAMiami, A. Mostaghimi, K. Huang, Guimerá Martin-Neda, La Laguna, A. K. Leroy, R. F. Cortez de Almeida, D. L. Obadia, Rio, A. Nwosu, M. Miteva, N. Kluger, P. R. Lindsø Andersen, Køge","doi":"10.1159/000535260","DOIUrl":"https://doi.org/10.1159/000535260","url":null,"abstract":"","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138620500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Atluri, D. De, T. Shih, Caitlyn B. Dagenet, Rahul Masson, Khiem A Tran, Vivienne Ng, Jennifer L. Hsiao, Vivian Y Shi
Introduction: Hidradenitis suppurativa (HS) is a chronic skin condition that often requires acute care during periods of flares, with many patients visiting the emergency department over 5 times before receiving a proper diagnosis. However, little is known about emergency medicine (EM) providers’ experiences and knowledge of HS management. Methods: In this study, an anonymous survey was distributed to EM providers to identify knowledge and practice gaps in HS care. Results: The results showed that most respondents lacked confidence in HS diagnosis and management, especially in knowing available treatment options and managing patients with moderate to severe HS. Attendings were more confident than non-attendings in diagnosing and managing HS, and providers who saw more HS patients per month were more confident in referring patients to appropriate specialists. Over 80% of respondents referred HS patients to dermatology, which is an important initial step in HS management. Conclusion: The study highlights the importance of educating EM providers in HS recognition, timely referral to dermatology, and initial management to improve quality of life among patients and mitigate disease progression.
{"title":"Perspectives of Emergency Medicine Physicians on Hidradenitis Suppurativa Care","authors":"S. Atluri, D. De, T. Shih, Caitlyn B. Dagenet, Rahul Masson, Khiem A Tran, Vivienne Ng, Jennifer L. Hsiao, Vivian Y Shi","doi":"10.1159/000535189","DOIUrl":"https://doi.org/10.1159/000535189","url":null,"abstract":"Introduction: Hidradenitis suppurativa (HS) is a chronic skin condition that often requires acute care during periods of flares, with many patients visiting the emergency department over 5 times before receiving a proper diagnosis. However, little is known about emergency medicine (EM) providers’ experiences and knowledge of HS management. Methods: In this study, an anonymous survey was distributed to EM providers to identify knowledge and practice gaps in HS care. Results: The results showed that most respondents lacked confidence in HS diagnosis and management, especially in knowing available treatment options and managing patients with moderate to severe HS. Attendings were more confident than non-attendings in diagnosing and managing HS, and providers who saw more HS patients per month were more confident in referring patients to appropriate specialists. Over 80% of respondents referred HS patients to dermatology, which is an important initial step in HS management. Conclusion: The study highlights the importance of educating EM providers in HS recognition, timely referral to dermatology, and initial management to improve quality of life among patients and mitigate disease progression.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138623066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Pityriasis amiantacea (PA) is a rare presentation characterized by the presence of extensive adherent scaling that tightly encircles and affixes tufts of hairs secondary to inflammatory or infectious dermatoses. However, the occurrence of PA as a consequence of leukaemia cutis has not been previously reported. Case Report: A 32-year-old man with B-cell acute lymphoblastic leukaemia (B-ALL) presented with severe scalp scaling and hair loss for 2 months. Examination revealed extensive, tightly adherent scales encircling and binding down hairs, along with haemorrhagic crusts. Skin examination showed nontender, partially blanchable papules forming ill-defined plaques, giving a cobblestone appearance. Trichoscopy revealed white crusts, tufting, and micro-haemorrhages. Scalp biopsy confirmed precursor B-ALL infiltration. He was diagnosed with PA with secondary cutis verticis gyrata due to leukaemia cutis and referred to a haemato-oncologist for further management. Discussion: Leukaemia cutis is a rare condition where leukaemia cells infiltrate the skin, often associated with acute myeloid leukaemia and ALL. It can lead to secondary verticis gyrata. The co-occurrence of PA and cutis verticis gyrata is rare and previously unreported, highlighting the need for increased awareness among clinicians.
导言：毛囊角化症（Pityriasis amiantacea，PA）是一种罕见的病症，其特征是继发于炎症或感染性皮肤病的广泛附着性鳞屑，紧紧包裹和粘附着一簇簇毛发。然而，因皮肤白血病而出现 PA 的病例此前却未见报道。病例报告：一名 32 岁的男子患有 B 细胞急性淋巴细胞白血病（B-ALL），2 个月来出现严重的头皮脱屑和脱发。检查发现大量紧密附着的鳞屑包裹并束缚着头发，同时伴有出血结痂。皮肤检查显示，患者头皮上有不发软、部分发白的丘疹，形成界限不清的斑块，外观呈鹅卵石状。三镜检查发现白色结痂、丛生和微出血。头皮活检证实了前体B-ALL浸润。他被诊断为因白血病引起的PA伴继发性脊髓灰质炎，并被转诊至血液肿瘤科接受进一步治疗。讨论白血病是一种罕见的白血病细胞浸润皮肤的疾病，通常与急性髓性白血病和ALL有关。它可导致继发性脊髓灰质炎。PA 和脊髓灰质炎同时出现的情况非常罕见，以前也未见报道，这就凸显出临床医生需要提高对这种疾病的认识。
{"title":"Co-Occurrence of Pityriasis Amiantacea and Cutis Verticis Gyrata Secondary to Leukaemia Cutis of the Scalp","authors":"Ankur Lal, Sushant Agrawal, Vishal Gaurav","doi":"10.1159/000535081","DOIUrl":"https://doi.org/10.1159/000535081","url":null,"abstract":"Introduction: Pityriasis amiantacea (PA) is a rare presentation characterized by the presence of extensive adherent scaling that tightly encircles and affixes tufts of hairs secondary to inflammatory or infectious dermatoses. However, the occurrence of PA as a consequence of leukaemia cutis has not been previously reported. Case Report: A 32-year-old man with B-cell acute lymphoblastic leukaemia (B-ALL) presented with severe scalp scaling and hair loss for 2 months. Examination revealed extensive, tightly adherent scales encircling and binding down hairs, along with haemorrhagic crusts. Skin examination showed nontender, partially blanchable papules forming ill-defined plaques, giving a cobblestone appearance. Trichoscopy revealed white crusts, tufting, and micro-haemorrhages. Scalp biopsy confirmed precursor B-ALL infiltration. He was diagnosed with PA with secondary cutis verticis gyrata due to leukaemia cutis and referred to a haemato-oncologist for further management. Discussion: Leukaemia cutis is a rare condition where leukaemia cells infiltrate the skin, often associated with acute myeloid leukaemia and ALL. It can lead to secondary verticis gyrata. The co-occurrence of PA and cutis verticis gyrata is rare and previously unreported, highlighting the need for increased awareness among clinicians.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139226075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Vitamins have gained popularity among physicians and patients for purported benefits to hair, skin, and nail health. Safe and efficacious therapies for nail disorders, many of which are chronic conditions, are needed. Summary: We conducted a literature review of studies assessing the efficacy of oral, topical, and intralesional vitamin/vitamin derivatives for the treatment of nail disorders, including yellow nail syndrome, brittle nail syndrome, onychomycosis, habit-tic nail deformity, periungual/subungual verruca, and nail psoriasis. Forty-nine articles were reviewed. There is good evidence to support the use of topical tazarotene and vitamin D analogs for nail psoriasis treatment. We found overall limited evidence for treatment of other nail disorders with vitamin/vitamin derivatives, and further research is needed to support their use. Key Messages: Besides topical tazarotene and vitamin D analogs for nail psoriasis treatment, there is limited evidence for treatment of nail disorders with topical, oral, and intralesional vitamin/vitamin derivatives.
背景：维生素据称对头发、皮肤和指甲健康有益，因此受到医生和患者的欢迎。指甲疾病中有许多是慢性病，需要安全有效的治疗方法。摘要：我们对口服、外用和鞘内维生素/维生素衍生物治疗指甲疾病（包括黄甲综合征、脆甲综合征、甲癣、习惯性甲畸形、甲周/甲下疣和甲银屑病）的疗效进行了文献综述。共审查了 49 篇文章。有充分证据支持使用外用他扎罗汀和维生素 D 类似物治疗甲癣。我们发现使用维生素/维生素衍生物治疗其他指甲疾病的证据总体有限，需要进一步研究以支持其使用。关键信息：除了外用他扎罗汀和维生素D类似物治疗指甲银屑病外，使用外用、口服和鞘内维生素/维生素衍生物治疗指甲疾病的证据也很有限。
{"title":"Vitamins for the Management of Nail Disease: A Literature Review","authors":"Kaya L. Curtis, Shari R. Lipner","doi":"10.1159/000534972","DOIUrl":"https://doi.org/10.1159/000534972","url":null,"abstract":"Background: Vitamins have gained popularity among physicians and patients for purported benefits to hair, skin, and nail health. Safe and efficacious therapies for nail disorders, many of which are chronic conditions, are needed. Summary: We conducted a literature review of studies assessing the efficacy of oral, topical, and intralesional vitamin/vitamin derivatives for the treatment of nail disorders, including yellow nail syndrome, brittle nail syndrome, onychomycosis, habit-tic nail deformity, periungual/subungual verruca, and nail psoriasis. Forty-nine articles were reviewed. There is good evidence to support the use of topical tazarotene and vitamin D analogs for nail psoriasis treatment. We found overall limited evidence for treatment of other nail disorders with vitamin/vitamin derivatives, and further research is needed to support their use. Key Messages: Besides topical tazarotene and vitamin D analogs for nail psoriasis treatment, there is limited evidence for treatment of nail disorders with topical, oral, and intralesional vitamin/vitamin derivatives.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139246522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Gout is a depositional, inflammatory disorder that is rarely reported to affect the nail unit. Cases of gout involving the nail unit are likely under-recognized and therefore underreported. We present two cases of tophaceous gout affecting the nail unit and a literature review of the various presentations. Summary: Five cases of gout were identified to affect the nail unit. In all cases, these presented as white hyperkeratotic papulonodules with associated nail dystrophy. Chalky discharge was seen in three of the five cases. Nine cases were identified to have demonstrated pseudocarcinomatous changes that histopathologically mimic squamous cell carcinoma (SCC). Literature review highlights a range of findings including subclinical deposits of uric acid in the nail, onychoschizia, onychorrhexis, and Beau’s line. Key Messages: Physicians should be aware of the subtle and nonspecific clinical findings of gout, which may be easily misconstrued for other pathological entities.
{"title":"Gout Affecting the Nail Unit: Report of Two Cases and Literature Review","authors":"Jeffery Z. Hu, N. Jellinek, Molly A. Hinshaw","doi":"10.1159/000534668","DOIUrl":"https://doi.org/10.1159/000534668","url":null,"abstract":"Background: Gout is a depositional, inflammatory disorder that is rarely reported to affect the nail unit. Cases of gout involving the nail unit are likely under-recognized and therefore underreported. We present two cases of tophaceous gout affecting the nail unit and a literature review of the various presentations. Summary: Five cases of gout were identified to affect the nail unit. In all cases, these presented as white hyperkeratotic papulonodules with associated nail dystrophy. Chalky discharge was seen in three of the five cases. Nine cases were identified to have demonstrated pseudocarcinomatous changes that histopathologically mimic squamous cell carcinoma (SCC). Literature review highlights a range of findings including subclinical deposits of uric acid in the nail, onychoschizia, onychorrhexis, and Beau’s line. Key Messages: Physicians should be aware of the subtle and nonspecific clinical findings of gout, which may be easily misconstrued for other pathological entities.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139251160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. A. Guerrero-González, N. D. Di Chiacchio, Francisco Macedo Paschoa, N. D. Di Chiacchio
Introduction: Bowen’s disease is a squamous cell carcinoma in situ, the most common malignancy of the nail unit. Presenting more frequently in the fingernails, common risk factors include ionizing radiation, oral exposure to arsenic or pesticides, dyskeratosis congenita, and quite commonly diverse subtypes of HPV. We report the first case of multiple periungual pigmented Bowen’s disease in a pediatric patient. Case Presentation: A healthy 13-year-old boy presented with a 9-month history of a pigmented erythematous patch on the proximal nail fold of his 3rd right finger without associated symptoms. A punch biopsy was taken, and the diagnosis of Bowen’s disease was made. The patient received photodynamic therapy and three cycles of imiquimod without response, and two new lesions appeared on the first and second right fingers. Surgical removal was performed on all lesions. A polymerase chain reaction detected an HPV type 16. Discussion/Conclusion: Multiple periungual Bowen’s disease is rare, with the most frequent risk factors being HPV infection and chronic immunosuppression. Less than 10% of the cases present as longitudinal melanonychia. To date, there are no previous reports of multiple pigmented periungual Bowen’s disease. HPV-induced Bowen’s disease is usually present in adults aged between 22 and 89 years as persistent verrucae. In this case, koilocytosis and the fact that all lesions appeared on the right hand are suggestive of HPV infection.
{"title":"Multiple-Digit Pigmented Bowen’s Disease Induced by Human Papillomavirus in an Immunocompetent Child","authors":"G. A. Guerrero-González, N. D. Di Chiacchio, Francisco Macedo Paschoa, N. D. Di Chiacchio","doi":"10.1159/000534734","DOIUrl":"https://doi.org/10.1159/000534734","url":null,"abstract":"Introduction: Bowen’s disease is a squamous cell carcinoma in situ, the most common malignancy of the nail unit. Presenting more frequently in the fingernails, common risk factors include ionizing radiation, oral exposure to arsenic or pesticides, dyskeratosis congenita, and quite commonly diverse subtypes of HPV. We report the first case of multiple periungual pigmented Bowen’s disease in a pediatric patient. Case Presentation: A healthy 13-year-old boy presented with a 9-month history of a pigmented erythematous patch on the proximal nail fold of his 3rd right finger without associated symptoms. A punch biopsy was taken, and the diagnosis of Bowen’s disease was made. The patient received photodynamic therapy and three cycles of imiquimod without response, and two new lesions appeared on the first and second right fingers. Surgical removal was performed on all lesions. A polymerase chain reaction detected an HPV type 16. Discussion/Conclusion: Multiple periungual Bowen’s disease is rare, with the most frequent risk factors being HPV infection and chronic immunosuppression. Less than 10% of the cases present as longitudinal melanonychia. To date, there are no previous reports of multiple pigmented periungual Bowen’s disease. HPV-induced Bowen’s disease is usually present in adults aged between 22 and 89 years as persistent verrucae. In this case, koilocytosis and the fact that all lesions appeared on the right hand are suggestive of HPV infection.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139257979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Aparício Martins, B. Figueira Vilela, Joana Cabete
Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a diagnostic delay of 7–10 years. A later diagnosis is associated with development of local sequelae and systemic comorbidities, as well as a reduced response to medical treatment. The aim of this study was to analyze the time required for HS diagnosis and investigate factors associated with diagnostic delay. Method: A retrospective observational study was conducted based on clinical records from HS patients followed at a tertiary hospital, with diagnosis between January 2006 and December 2022. Results: A total of 285 patients were included. The mean diagnostic delay was 10.1 years, and there was no difference in time to diagnosis during the considered period. A diagnostic delay of more than 5 years was significantly associated with an earlier onset of symptoms, location on breasts and thighs, follicular phenotype, and with cardiovascular and psychiatric comorbidities. Smoking and body mass index ≥25 kg/m2 were also associated with a longer diagnostic delay. A personal history of acne and a greater disease severity were associated with an earlier diagnosis. Conclusions: This study reveals the lack of improvement in the diagnostic delay in HS and highlights its association with atypical clinical manifestations and systemic comorbidities, scarcely reported in literature.
{"title":"Diagnostic Delay in Hidradenitis Suppurativa: Still an Unsolved Problem","authors":"I. Aparício Martins, B. Figueira Vilela, Joana Cabete","doi":"10.1159/000534845","DOIUrl":"https://doi.org/10.1159/000534845","url":null,"abstract":"Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a diagnostic delay of 7–10 years. A later diagnosis is associated with development of local sequelae and systemic comorbidities, as well as a reduced response to medical treatment. The aim of this study was to analyze the time required for HS diagnosis and investigate factors associated with diagnostic delay. Method: A retrospective observational study was conducted based on clinical records from HS patients followed at a tertiary hospital, with diagnosis between January 2006 and December 2022. Results: A total of 285 patients were included. The mean diagnostic delay was 10.1 years, and there was no difference in time to diagnosis during the considered period. A diagnostic delay of more than 5 years was significantly associated with an earlier onset of symptoms, location on breasts and thighs, follicular phenotype, and with cardiovascular and psychiatric comorbidities. Smoking and body mass index ≥25 kg/m2 were also associated with a longer diagnostic delay. A personal history of acne and a greater disease severity were associated with an earlier diagnosis. Conclusions: This study reveals the lack of improvement in the diagnostic delay in HS and highlights its association with atypical clinical manifestations and systemic comorbidities, scarcely reported in literature.","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139265799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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