RESUMO
BACKGROUND: Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance. OBJECTIVE: We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus. METHODS: An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus. RESULTS: Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections. CONCLUSIONS: We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.
Assuntos
Líquen Plano , Doenças da Unha , Psoríase , Humanos , Qualidade de Vida , Doenças da Unha/diagnóstico , Doenças da Unha/tratamento farmacológico , Unhas , Líquen Plano/diagnóstico , Líquen Plano/tratamento farmacológico , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/tratamento farmacológicoRESUMO
Nivolumab, a fully human IgG4 immune checkpoint modulator, binds to the programmed cell death 1 (PD-1) receptor on T cells and blocks their inhibition. Thus, it increases the anticancer host immune response by allowing T cells to attack tumor cells. Although anti-PD-1 immunotherapy is typically well accepted, deregulation of immune tolerance caused by nivolumab may determine immune-related adverse events, among which skin toxicities represent the most common. We report a case of severe new-onset palmoplantar and nail psoriasis after receiving nivolumab treatment for metastatic melanoma.
Assuntos
Antineoplásicos Imunológicos , Melanoma , Psoríase , Antineoplásicos Imunológicos/efeitos adversos , Humanos , Melanoma/tratamento farmacológico , Nivolumabe/efeitos adversos , Receptor de Morte Celular Programada 1 , Psoríase/induzido quimicamente , Psoríase/diagnóstico , Psoríase/tratamento farmacológicoAssuntos
Acne Vulgar , Dermatite Atópica , Compostos Heterocíclicos com 3 Anéis , Inibidores de Janus Quinases , Humanos , Inibidores de Janus Quinases/efeitos adversos , Dermatite Atópica/tratamento farmacológico , Estudos Retrospectivos , Acne Vulgar/tratamento farmacológico , Resultado do TratamentoAssuntos
Clorexidina/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Vacinas Anti-Haemophilus/efeitos adversos , Vacinas Meningocócicas/efeitos adversos , Clorexidina/análise , Dermatite Alérgica de Contato/patologia , Vacina contra Difteria, Tétano e Coqueluche/química , Desinfetantes/efeitos adversos , Desinfetantes/análise , Vacinas Anti-Haemophilus/química , Humanos , Lactente , Masculino , Vacinas Meningocócicas/química , Vacinas Combinadas/efeitos adversosAssuntos
Antifúngicos/efeitos adversos , COVID-19/psicologia , Diagnóstico Tardio/psicologia , Dermatite Alérgica de Contato/etiologia , Fluconazol/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Tempo para o Tratamento , COVID-19/prevenção & controle , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/terapia , Dermatologia , Medo , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Dermatite Alérgica de Contato/etiologia , Eczema/induzido quimicamente , Hemangioma/tratamento farmacológico , Soluções Oftálmicas/efeitos adversos , Soluções Oftálmicas/uso terapêutico , Timolol/efeitos adversos , Timolol/uso terapêutico , Administração Tópica , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Dermatite Alérgica de Contato/prevenção & controle , Eczema/tratamento farmacológico , Emolientes/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Itália , Masculino , Metilprednisolona/uso terapêutico , Soluções Oftálmicas/administração & dosagem , Testes do Emplastro , Creme para a Pele/uso terapêutico , Timolol/administração & dosagem , Resultado do TratamentoRESUMO
Frontal fibrosing alopecia (FFA) represents a distinctive form of primary lymphocytic scarring alopecia characterized by fronto-temporal hair recession and eyebrow hair loss. While predominantly affecting postmenopausal women, FFA also occurs in women of reproductive age and men, with variations observed across different ethnic groups. Genetic predisposition, environmental factors and inflammatory pathways contribute to its pathogenesis, with evolving diagnostic criteria enhancing accuracy. FFA treatment lacks standardization, encompassing topical, systemic and physical therapies, while hair transplantation remains a temporary solution. This article reviews the current understanding of FFA, aiming to provide clinicians with updated insights for its management.
RESUMO
Herpes zoster (HZ) is a condition caused by the reactivation of varicella-zoster virus (VZV), the virus responsible for chickepox, which is the clinical manifestation of the primary infection. Congenital or acquired immune system deficiencies, as well as the physiological decline in immune response occurring in the elderly, known as immune senescence, can allow VZV reactivation and, consequently, HZ. One out of 3 people develops HZ during their lifetime. Moreover, thirty percent of the affected subjects develop post-herpetic neuralgia, the most frequent complication after HZ skin rash. Patients with dermatological conditions characterized by alteration of the immune system, such as systemic lupus erythematosus, psoriasis, atopic dermatitis, bullous diseases, and cutaneous lymphomas, are at higher risk of developing HZ and post-herpetic neuralgia, even when their disease is in remission. In the present work, we described the currently available vaccinations against HZ and provided recommendations for the vaccination against HZ in patients with dermatological diseases.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Dermatopatias , Humanos , Herpes Zoster/prevenção & controle , Itália , Vacina contra Herpes Zoster/uso terapêutico , VacinaçãoRESUMO
BACKGROUND: Telogen effluvium and androgenetic alopecia (AGA) represent the most common non scarring hair diseases. In addition to medical treatments such as finasteride and minoxidil, recommendations for telogen effluvium or AGA include oral supplementation, that can be prescribed in association or before starting medical therapies. The objective of our study was to evaluate the tolerability, efficacy and the compliance of the patient of a treatment with oral supplementation in patients affected by telogen effluvium eventually associated with grade I/II of AGA according to the Ludwig Scale. METHODS: We enrolled a total of 20 female patients affected by telogen effluvium, in 7 cases associated with grade I/II of AGA according to the Ludwig scale. Patients were asked to take a supplement containing sulfurated aminoacids (L-cystine, L-methionine, liposomal glutathione) and trace elements (zinc, copper, iron, selenium) with ubidecarenone and vitamin B5. All patients underwent the dermatological examination, photography and trichoscopy, at the first visit, after 3 months and after 6 months. RESULTS: At the end of the study, clinical healing was assessed in 14 patients while 6 patients showed good improvement. 4 patients rated moderate satisfaction; 16 patients were very satisfied of the results. Trichoscopy showed important improvement in 17 patients and only 3 patients showed a moderate improvement in the hair density and diameter. All patients tolerated very well the treatment, and none of patients needed to discontinue the assumption of the tablets. CONCLUSIONS: The results of our study demonstrate the ability of a new tablet supplement with sulfurate amino acids and trace elements ingredients to effectively and safely improve the hair growth and hair loss in patients with telogen effluvium associated with mild to moderate AGA. The supplement was found to be excellently tolerated from all the patients, safe, and easily incorporated into daily routines.
Assuntos
Alopecia em Áreas , Cosméticos , Oligoelementos , Humanos , Feminino , Cabelo , Suplementos NutricionaisRESUMO
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
BACKGROUND: Solid organ transplant recipients are at increased risk for skin cancers due to immune-suppressive therapies. However, little is known about the risk and the characteristics of neoplasms in heart transplant recipients (HTRs). The aim of this study is to delineate the incidence of different skin tumors in HTRs and to correlate it with the incidence of other malignancies, including solid tumors and hematological neoplasms. METHODS: Patients who underwent to HTRs between January 1991 and November 2021 were retrieved. Clinical data on immunosuppressive therapies, skin tumors, solid and hematological neoplasms were obtained. HTRs with skin tumors were included in group A, while patients with no evidence of skin tumors during the follow-up were included in group B. RESULTS: One hundred and eight patients were retrieved. A significant increase in solid tumors was observed in group A, while no significant difference in hematological neoplasms was detected between the two groups. CONCLUSIONS: HTRs with skin tumors showed a significantly higher incidence of solid neoplasms. In most of the cases the skin tumor preceded the onset of the solid neoplasm, suggesting that the skin tumor could represent a 'marker' of immunosuppression eventually leading to the development of an internal malignancy.
Assuntos
Transplante de Coração , Neoplasias Hematológicas , Neoplasias Cutâneas , Transplantados , Humanos , Transplante de Coração/efeitos adversos , Neoplasias Hematológicas/complicações , Tolerância Imunológica , Terapia de Imunossupressão/efeitos adversos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologiaRESUMO
OBJECTIVES: The present analyses report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) on the clinical benefits of baricitinib treatment on the basis of the amount of scalp hair regrowth through 52 weeks of treatment. METHODS: This post hoc analysis was conducted with data from patients who were treated continuously for 52 weeks with baricitinib 4 mg or 2 mg. Clinical outcomes were assessed using the Severity of Alopecia Tool (SALT) and Clinician-Reported Outcome (ClinRO) for Eyebrow (EB) and Eyelash (EL) hair. Secondary measures included the Hospital Anxiety and Depression Scale and Skindex-16 adapted for alopecia areata. At week 52, patients were classified into three subgroups: SALT ≤ 20 response, intermediate response (achieved a 30% improvement from baseline (SALT30) without a SALT score ≤ 20), or nonresponse (never achieved SALT30). The criterion of SALT30 approximates a minimal clinical meaningful response to therapy. RESULTS: At week 52, with baricitinib 4 mg treatment, the greatest (70%) improvement in EB and EL was observed in responders, but approximately 50% of patients with intermediate response and 20% of nonresponders experienced complete/nearly complete EB and EL regrowth. Improvement in emotional distress was directionally related to improvements in scalp hair regrowth, while impact on quality of life was proportionately greater for the responder subgroup. CONCLUSIONS: Clinically meaningful regrowth in eyebrow and eyelash hair can occur in the absence of complete scalp hair regrowth after treatment with baricitinib. Emotional distress and quality of life improvement is most associated with obtaining a clinical meaningful improvement in scalp hair. TRIAL REGISTRATION NUMBER: BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, 24 September 2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, 8 July 2019.
RESUMO
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
Nail melanoma in children is rarely reported in the literature, and all of the published cases were diagnosed in dark-skinned phototypes or in Asians. We report two cases of in situ nail matrix melanoma presenting as longitudinal melanonychia (LM) in fair-skinned children of Italian origin. Nail plate dermatoscopy revealed a brown background with lines of irregular color, spacing, and thickness in both cases. Histopathology of the excised lesions showed melanoma in situ. Clinical, dermatoscopic, and pathological criteria that permit clear differentiation of benign melanocytic activation or proliferation from nail matrix melanoma are not established for children. The presence of a pigmented band of a single nail in a child usually represents a problem for clinicians, because the clinical and dermatoscopic features that are considered possible indicators of nail unit melanoma in adults are frequently observed in benign melanocytic hyperplasia and nevi in children. There is therefore the need to find parameters useful for clinical and dermatoscopic diagnosis in childhood nail pigmentation and to reach a consensus on management of children with a band of LM.