Skin Appendage Disorders最新文献

Introduction: Hidradenitis suppurativa (HS) is an auto-inflammatory disease characterized by recurrent painful nodules, abscesses, tunnels, and scarring, commonly seen in intertriginous body surfaces; however, an additional ulcerative phenotype has not been described and represents a specific clinical phenotype of the disease requiring special therapeutic considerations.

Case presentation: We report 4 patients with a previously undescribed, ulcerative phenotype of HS that did not respond to standard treatment but were healed with surgery. These lesions present as large, deep-dermal, erythematous, well-defined ulcers that are exquisitely tender.

Conclusion: This phenotype necessitates recognition by the clinician as a rapid path to combined pharmacologic and surgical management is crucial for the patient.

Introduction: Terra firma-forme dermatosis (TFFD) is a benign condition characterized by hyperpigmented patches that resist routine washing yet are removable with isopropyl alcohol. Observing TFFD on the scalp is an exceptional event.

Case presentation: A 9-year-old female with ectodermal dysplasia and features of diffuse alopecia areata presented with multiple brown patches on the scalp. Trichoscopic examination revealed cluster of brown dots arranged in single files forming multiple curved lines that resemble a fingerprint pattern composed of dots. The lesions were completely removed by rubbing with isopropyl alcohol-soaked gauze.

Discussion: This case introduces a novel trichoscopic pattern in scalp TFFD, expanding the diagnostic spectrum of the condition. The rapid resolution with isopropyl alcohol confirms the diagnosis, underscoring the utility of trichoscopy as a noninvasive diagnostic tool in complex scalp disorders.

Introduction: Hyperhidrosis is a chronic condition of excessive sweating with a significant impact on quality of life. Although recent therapeutic advances have expanded treatment options, clinical trial data may lack generalizability due to underrepresentation of diverse populations. This study examined geographic distribution, racial/ethnic representation, and demographic reporting trends in randomized controlled trials (RCTs) for hyperhidrosis.

Methods: A search of ClinicalTrials.gov in November 2024 identified completed phase 2 and 3 interventional RCTs for hyperhidrosis from 2005 to 2024. Demographics were extracted from trial registries and associated PubMed publications. Race and ethnicity were categorized per US Census definitions, and geographic representation was analyzed by continent.

Results: Thirty-two RCTs with 4,904 participants were included. Most were US-based (62.5%) and only 53.1% reported race/ethnicity. Among reported participants, 55.1% were White, 10.3% Black, 4.1% Asian, and 13% Hispanic/Latino. Race/ethnicity was unknown or unreported for 28.5% of participants. Reporting improved over time (race: 30-63.6%; ethnicity: 20-50%), while geographic diversity declined.

Conclusion: Nearly half of hyperhidrosis RCTs failed to report race/ethnicity, and participant diversity remains limited despite improvements. Limited racial/ethnic and geographic diversity undermines the generalizability of trial findings and highlights the need for more inclusive study designs.

Introduction: Hyperhidrosis is a chronic dermatologic condition that significantly impacts quality of life. While research has expanded in recent years, bibliometric analyses exploring publication trends remain limited. This study examined the 100 most-cited articles from 2015 to 2025 to assess research priorities.

Methods: A Scopus search was conducted on January 2, 2025, using the terms "hyperhidrosis", "primary hyperhidrosis", "secondary hyperhidrosis", and "excessive sweating". Non-English, abstract-only, and non-hyperhidrosis focused articles were excluded. Two reviewers screened and identified the 100 most-cited publications. Data were analyzed for publication year, authorship, country, study design, journal, and topic focus. The Oxford Centre for Evidence-Based Medicine Level of Evidence (LoE) framework was used to assess study quality.

Results: The majority (76%) of highly cited articles were published between 2015 and 2019. Randomized controlled trials (20%), cohort studies (18%), and case-control studies (16%) were the most common study types. Using LoE assessment, 33% of studies were level 1 (high-quality evidence). Research on treatments (55%) dominated, followed by quality of life (12%) and outcome measures (11%). The USA led in publication output.

Conclusion: This bibliometric analysis identifies evolving research priorities toward minimally invasive treatments and patient-centered outcomes, providing direction for future research and improvements in clinical practice.

Introduction: People with alopecia areata (AA) experience stigma, but little is known about how this affects healthcare interaction (HCI). We aim to explore the relationship between stigma and HCI in AA.

Methods: A cross-sectional survey of 500 members of the National Alopecia Areata Foundation was performed. Survey items related to stigma and HCI were summed and sorted into low, medium, and high tertiles. Multinomial logistic regressions were performed to control for demographic and clinical factors.

Results: Respondents (n = 500) were white (80.0%), female (86.2%), and insured (96.0%), with a plurality earning over USD 100,000 annually (34.2%). Participants in the high-stigma subgroup were more likely to be in the low-HCI subgroup (relative risk ratio [RRR]: 2.22; 95% CI: 1.31-3.76; p = 0.003), in comparison to participants in the low- or moderate-stigma subgroups (RRR for both: 0.45; p < 0.05). This relationship was independent of demographics and clinical characteristics. However, data are from a population with limited socioeconomic diversity and high baseline healthcare engagement.

Conclusion: People with AA who experience high stigma are less likely to interact with the healthcare system, which cannot be explained by demographics or clinical factors. Stigma and HCI may be related in a dose-dependent manner, and future investigation is needed to support access to care.

Introduction: Frontal fibrosing alopecia is a type of alopecia diagnosed predominantly clinically. A glabellar skin biopsy provides important findings in cases of diagnostic uncertainty, such as red dots, representing the presence of a perifollicular lymphocytic inflammatory infiltrate affecting the vellus hairs.

Case presentation: A 74-year-old patient with 10 months of progressive frontal hair loss was observed upon examination to show alopecia with a "fringe sign," consistent with a type III pattern of frontal fibrosing alopecia. Ice pick scarring was observed on the glabella. Trichoscopy revealed annular brown pigmentation, peripilar erythema, and hair splayed in different directions. Histopathologically, these lesions corresponded to thickened collagen fibers, predominantly perifollicular, generating conical retraction. 5-alpha reductase inhibitors, oral minoxidil, and high-potency topical corticosteroids are indicated, halting disease progression.

Conclusion: Frontal fibrosing alopecia has multiple non-capillary findings that support the diagnosis. Therefore, a more complete clinical and trichoscopic description of facial areas such as the glabella will help us correlate these findings with patient severity and prognosis.

Introduction: Nonattendance to dermatology appointments can disrupt continuity of care and may lead to worse outcomes among patients. Factors related to nonattendance among Hidradenitis suppurativa (HS) patients have not been adequately explored.

Methods: This case-control study at an HS subspecialty clinic in the southeastern USA explores patient characteristics and encounter variables predictive of nonattendance using demographic, employment, health insurance, and distance to clinic data using both univariable and mixed-model multivariable logistical regression.

Results: Return visits, Black and unknown race, disabled and unemployed status, Medicaid insurance, current smoking or former smoking status, and living 1-2 h, or 2-3 h away from clinic were found to be significant predictors of nonattendance on the multivariable regression model.

Conclusions: These findings highlight the role social determinants of health play in dermatological care access and the need for increasing accessibility to continued care among certain HS patient populations.

Introduction: Onychomycosis presents significant therapeutic challenges, with high recurrence rates and the need for prolonged treatment adherence. While previous studies have explored the contamination risks of cosmetic nail polishes, little is known about the microbiological safety of antifungal nail polishes used in onychomycosis treatment.

Methods: This study investigated potential contamination in antifungal nail polish bottles containing ciclopirox olamine 8% (CO) and amorolfine 5% (AM) used by patients diagnosed with onychomycosis confirmed by mycological exams. After treatment, applicators were analyzed using Sabouraud and Mycosel^® culture media.

Results: Of the 67 randomly selected nails treated, 100% showed positive direct mycological examination, and 49% had fungal growth in culture. However, none of the 67 applicators (49 CO and 18 AM) exhibited fungal growth.

Conclusion: The study findings suggest that antifungal nail polishes do not act as contamination reservoirs, likely due to their inherent antifungal properties. Nonetheless, patients should be educated on proper hygiene to minimize cross-contamination risks.

Introduction: Severity of alopecia areata (AA) has been commonly defined by clinician assessment of scalp hair loss. Our aim was to characterize patient-reported factors beyond scalp hair loss that contribute to AA severity while modifying for socioeconomic factors.

Methods: Patients with AA were recruited to take a survey. Multivariable linear regression was performed to evaluate lifetime AA severity while adjusting for socioeconomic variables, current AA severity at the time of survey, and patient-reported disease burden.

Results: Patient-reported AA severity was associated with scalp hair loss (OR: 4.19, 95% CI: [1.35-13], p = 0.013), facial hair loss (OR: 3.55, 95% CI: [1.75-7.21], p < 0.001), increased financial burden (OR: 2.41, 95% CI: [1.21-4.8], p = 0.013), and greater emotional burden (OR: 2.96, 95% CI: [1.48-5.93], p = 0.002), while presence of comorbidities were linked to less severe AA (OR: 0.38, 95% CI: [0.17-0.84], p = 0.017).

Conclusion: Survey population was homogeneous and may not reflect the general community with AA. Self-reported data may introduce recency or recall bias. Scalp and facial hair loss, along with emotional and financial burdens, correlate with increased patient-reported AA severity. This suggests factors beyond scalp hair loss should be considered when assessing AA severity.

Background: Nail surgery complications have not been addressed thoroughly.

Summary: This review aimed to provide a robust literature review of nail surgery complications by identifying relevant data using a search of PubMed. It examines various complications, including general complications such as bleeding and infection; specific nail complications such as nail dystrophy; and common complications associated with specific nail procedures.

Key messages: This literature reviews better familiarizes dermatologists who perform nail procedures with relevant complications.