RESUMO
BACKGROUND: Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA. METHODS: The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients. RESULTS: The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life. CONCLUSIONS: AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.
Assuntos
Alopecia em Áreas , Sistema de Registros , Alopecia em Áreas/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Criança , Qualidade de Vida , Idoso , Pré-EscolarRESUMO
INTRODUCTION: Pigmented eccrine poroma (PEP) is a unique variant of a benign adnexal tumor known as eccrine poroma. Distinguishing PEPs from other pigmented lesions can be challenging due to overlapping clinical and dermoscopic features. OBJECTIVES: To provide a comprehensive analysis of the dermoscopic, confocal (RCM), and histological features of PEPs. METHODS: We undertook a retrospective study of the clinical, dermoscopic, RCM and histopathological features of PEPs that were surgically excised and histopathologically recognized. Data on epidemiological, clinical, dermoscopic, RCM and histopathological features were collected from the databases of the Skin Cancer Unit, IRCCS Policlinico di Sant' Orsola, between January 2021 and May 2023. RESULTS: The study population consisted of 61 patients, including 34 females (55.7%) and 27 males (44.3%). Dermoscopic examination of 61 PEPs revealed the presence of irregular borders (55.7%), milia-like cysts (50.8%), brown pseudo-network (41%), cerebriform pattern (34.4%), comedo-like openings (29.5%), atypical vessels (26.2%), glomerular vessels (18%), fingerprint-like perifollicular structures (8.2%), dots (4.9%) and dotted vessels (4.9%). RCM imaging was collected from 11 cases and showed mostly well-defined tumor nests with small cells in 100% of cases, bright structures in the upper dermis representing melanocytes and melanophages (63.6%), dark round spaces within the tumor nests (54.5%), well-demarcated borders of the nest (45.5%) and dilated and prominent vessels in upper dermis (27.3%). Histopathological pattern analysis revealed PEP sensu stricto (PEPss) as the most frequent (54.1%). CONCLUSIONS: The distinctive dermoscopic patterns, along with the confocal features aid in the differentiation from other pigmented lesions.
RESUMO
BACKGROUND: Trichophyton rubrum and Trichophyton mentagrophytes variant interdigitalis are the most frequent etiologic agents of onychomycosis. Diagnosis of certainty requires mycological examination, which often results unfeasible. OBJECTIVES: The aim of our study is to describe pathogen specific dermoscopic features, allowing a differential diagnosis without the need for cultural examination, in order to prescribe the most appropriate treatment anyway. PATIENTS AND METHODS: We conducted an observational retrospective study on 54 patients with a culture proven diagnosis of distal subungual onychomycosis of the toenail, caused by Trichophyton rubrum or Trichophyton mentagrophytes variant interdigitalis. Using a videodermatoscope we collected data on nail colour (white, yellow, orange, brown, dark) and on dermoscopic patterns (aurora, spikes, jagged, ruin, linear edge, dots, striae). RESULTS: Fifty-four patients, with a total of 72 nails, were eligible for this study. Analysing the association between discoloration of the nail plate and type of infection (T. rubrum or T. interdigitalis), no correlation turned out to be statistically significant. Instead, significant associations between spikes and T. rubrum infection and striae and infection from T. interdigitalis were identified. Finally, a 100% specificity was identified for white colour and ruin pattern for T. rubrum infection, and brown colour, jagged border and aurora pattern for T. interdigitalis. CONCLUSIONS: Trying to find relationships between specific pathogens and dermoscopic patterns, we found out an association between spikes and striae and T. rubrum and T. interdigitalis respectively. Further larger studies are however necessary to evaluate our preliminary findings.
Assuntos
Arthrodermataceae , Onicomicose , Trichophyton , Humanos , Onicomicose/diagnóstico , Onicomicose/microbiologia , Estudos RetrospectivosRESUMO
Background: Dissecting cellulitis (DC) is a rare neutrophilic dermatosis that leads to cicatricial alopecia. Although DC and Hidradenitis suppurativa (HS) have similar characteristics, their association remains poorly understood. Objectives: In this prospective observational study, we used trichoscopy to identify subclinical signs of DC in male patients aged 18 years or older, presenting with HS. The objective of this study was to use trichoscopy to identify subclinical signs of DC in patients with confirmed diagnosis of HS. Method: In this prospective, monocentric, observational study, we used trichoscopy to identify subclinical signs of DC in male patients aged 18 years or older, presenting with HS for their initial visit at our HS outpatient clinic from February 1, 2022, to January 31, 2023. Results: Of the 23 male patients with HS, 8 (35%) had subclinical trichoscopy findings consistent with DC. The most frequent location was the vertex (6/8), and the majority of patients had early/inflammatory trichoscopic signs of DC (5/8). Additionally, patients with trichoscopic findings consistent with DC had a higher Hurley stage and the International Hidradenitis Suppurativa Severity Score System (IHS4). Among the cases with trichoscopic findings compatible with DC, the majority (6/8) were classified as having a "follicular" HS according to the Canoui-Poitrine classification. Patients were treated according to European S1 guidelines on HS. Conclusions: This is the first study to evaluate subclinical DC findings in HS patients using trichoscopy. Although the trichoscopic findings of DC are heterogeneous, the use of this non-invasive technique, in conjunction with clinical evaluation, can improve diagnostic accuracy and lead to earlier diagnosis. These findings suggest a potential association between HS and DC, indicating the need for further studies to evaluate this relationship.
RESUMO
INTRODUCTION: Superficial folliculitis of the scalp (SFS) is a common complaint in clinical practice, and initial presentation may be difficult to differentiate as they may appear very similar to each other. OBJECTIVES: The aim of this thesis is to describe the pathologies that occur clinically as folliculitis of the scalp, identify their causes and characteristics and create a standardized classification. METHODS: This is a retrospective clinical, dermoscopic and histopathological study over 10 years of dermatologic consultations. Only individuals with a confirmed diagnosis of SFS (updated diagnostic criteria or biopsy) were included. RESULTS: In this review, we describe the various clinical features of different causes of SFS in ninety-nine cases and divided into infectious due to fungus, bacteria, or virus and inflammatory conditions such as rosacea, acneiform eruption and Ofuji syndrome. CONCLUSIONS: The clinician must differentiate SFS from other underlying scarring disorders to prevent poorer outcomes. We created an algorithm to help the clinician reach a proper diagnosis.
RESUMO
BACKGROUND: Very few reports have described trichoscopic patterns of allergic scalp contact dermatitis (ASCD), which is usually an exclusion diagnosis on hair disorders. Trichoscopy is a simple, diffused method for investigating scalp diseases and may help to establish the characteristic findings of ASCD. METHODS: A retrospective chart review was conducted on patients who visited the outpatient hair consultation at the Department of Experimental, Diagnostic, and Specialty Medicine of the University of Bologna, Italy, from January 2020 to September 2021. The inclusion criteria were based on the previous diagnosis of ASCD, patch test positivity; recover after allergen suspension and absence of other scalp diseases besides androgenetic alopecia on the patients in use of topical minoxidil. All trichoscopic features were described. RESULTS: ASCD was observed in 12 patients. The allergens were as follows: topical minoxidil (58.33%), p-phenylenediamine (PFD) (33.33%), wig, nickel, methylchloroisothiazolinone, and methylisothiazolinone (MCI/MI-Kathon CG) in one patient each, with multiple positive patients. Scales were classified as diffuse, patchy, white, and yellowish, and vascular patterns were classified as arborizing vessels, twisted red loops, simple red loops, bushy red loops, red dots, and globules besides atypical vessels. The main findings were erythema (100%), white scales (100%), arborizing vessels (91.2%), and simple red loops (91.2%). CONCLUSIONS: Trichoscopy is a useful tool to help on the diagnosis of ASCD.
Assuntos
Dermatite Alérgica de Contato , Couro Cabeludo , Humanos , Minoxidil/uso terapêutico , Estudos Retrospectivos , Projetos Piloto , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , AlérgenosRESUMO
BACKGROUND: Telogen effluvium (TE) is a common cause of non-cicatricial hair loss with no treatment-standardized protocol. The aim of our study was to evaluate the efficacy, tolerability, and patient compliance of a treatment with an oral supplement based on arginine, l-cystine, zinc and B
Assuntos
Alopecia em Áreas , Cistina , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Vitaminas/efeitos adversos , Zinco/efeitos adversos , Arginina/uso terapêutico , Compostos OrgânicosRESUMO
Eyelashes and eyebrows have different functions, ranging from practical purposes such as protecting the eye apparatus from external hazards to the definition of our facial expression. For this reason, their loss could have both functional and psychological impact on patients' quality of life. Complete or partial loss can occur any time during life, and identifying the cause is mandatory to establish a correct and prompt treatment. The aim of this paper is to create a practical guide for the management of the most common causes of madarosis to the best of our knowledge.
RESUMO
INTRODUCTION: The diagnostic delay in nail melanoma (NM) has been repeatedly emphasized. It may be related to both clinical misinterpretations and to errors in the bioptic procedure. OBJECTIVES: To assess the efficacy of histopathologic examination in different diagnostic biopsies in NM. METHODS: We retrospectively investigated the diagnostic procedures and histopathologic specimens referred to the Laboratory of Dermatopathology for the clinical suspicion of NM from January 2006 to January 2016. RESULTS: Eighty-six nail histopathologic specimens were analyzed consisting in 60 longitudinal, 23 punch and 3 tangential biopsies. A diagnosis of NM was performed in 20 cases, benign melanocytic activation in 51 cases and melanocytic nevi in 15 patients. Longitudinal and tangential biopsy were diagnostic in all cases, regardless of the clinical suspicion. Nail matrix punch biopsy instead was not diagnostic in most of the cases (13/23 specimens). CONCLUSIONS: In the presence of an NM clinical suspicion, longitudinal biopsy is recommended (lateral or median) because it provides exhaustive information on the characteristics of melanocytes morphology and distribution in all the components of the nail unit. Tangential biopsy, recently encouraged by expert authors due to the optimal surgical outcome, in our experience gives incomplete information on tumor extension. Punch matrix biopsy gives limited evidence in the diagnosis of NM.
RESUMO
INTRODUCTION: Digital ulcers represent a current public health issue, due to the relevant difficulties in their management and their tendency to become chronic, non-healing lesions. OBJECTIVES: Our case series represents an opportunity to discuss the main comorbidities of digital ulcers and to present an evidence-based treatment protocol that has proved highly effective in our clinical practice. METHODS: We collected the clinical data about clinical features, associated diseases and diagnostic therapeutical procedures of 28 patients with digital ulcers referred to our Wound Care Service at S. Orsola-Malpighi Hospital. RESULTS: Digital ulcers were divided into 5 categories, based on the causative agent: peripheral artery disease: 5/16 females and 4/12 males, diabetes-associated wounds: 2/16 females and 1/12 males, mixed wounds: 4/12 males, pressure wounds: 3/16 females and 2/12 males, and immune-mediated diseases associated with wounds: 6/16 females and 1/12 males. Each group received specific management, based on the characteristics of the ulcer and the underlying comorbidities. CONCLUSIONS: The clinical evaluation of digital wounds requires a thorough knowledge of their aetiopathogenesis. A multidisciplinary approach is necessary to achieve a precise diagnosis and correct treatment.