Dermoscopic findings and comparison of usefulness of longitudinal versus transversal sections in the histological diagnosis of alopecia X.

BACKGROUND: A combination of dermoscopic and histological findings may provide useful information for the diagnosis of hair follicle diseases. However, there are no studies on dermoscopic-histopathological correlations in dogs affected by alopecia X, and comparison of longitudinal versus transversal sectioning of skin biopsy specimens in the assessment of this hair loss disorder has not been thoroughly investigated. HYPOTHESIS/OBJECTIVES: The aim of this study was to correlate dermoscopic and histological features using both longitudinal and transversal sectioning of skin biopsy samples to gain additional information for the diagnosis of alopecia X. ANIMALS: Nineteen Pomeranian dogs affected by alopecia X and five healthy Pomeranians as controls. MATERIALS AND METHODS: Dermoscopic-histological correlation was performed within the diseased group, whereas histological comparisons against controls. The demographic and clinical characteristics also were related to the histological findings. RESULTS: The dermoscopic findings revealed scattered, thinned, short hairs mixed with amorphous keratoseborrhoeic-like material (follicular plugging), perifollicular and intrafollicular scaling, and hyperpigmentation varying from pinpoint black spots to a diffuse texture. Dermoscopic findings correlated with histological findings for selected qualitative and quantitative findings. The usefulness of transversal sections was demonstrated in accurately determining the hair follicular density and counts, growth arrest phases and in identifying mineralisation of hair follicle basement membrane when compared to the longitudinal. Conversely, no correlations between histological findings and demographic and clinical characteristics were detected. CONCLUSIONS AND CLINICAL RELEVANCE: These data provide evidence of the usefulness of dermoscopic evaluation as an accessory diagnostic tool and of transversal sections of skin biopsies as complementary to the diagnosis of alopecia X.

Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options.

Keratosis pilaris is a common skin disorder comprising less common variants and rare subtypes, including keratosis pilaris rubra, erythromelanosis follicularis faciei et colli, and the spectrum of keratosis pilaris atrophicans. Data, and critical analysis of existing data, are lacking, so the etiologies, pathogeneses, disease associations, and treatments of these clinical entities are poorly understood. The present article aims to fill this knowledge gap by reviewing literature in the PubMed, EMBASE, and CINAHL databases and providing a comprehensive, analytical summary of the clinical characteristics and pathophysiology of keratosis pilaris and its subtypes through the lens of disease associations, genetics, and pharmacologic etiologies. Histopathologic, genomic, and epidemiologic evidence points to keratosis pilaris as a primary disorder of the pilosebaceous unit as a result of inherited mutations or acquired disruptions in various biomolecular pathways. Recent data highlight aberrant Ras signaling as an important contributor to the pathophysiology of keratosis pilaris and its subtypes. We also evaluate data on treatments for keratosis pilaris and its subtypes, including topical, systemic, and energy-based therapies. The effectiveness of various types of lasers in treating keratosis pilaris and its subtypes deserves wider recognition.

Role of bath psoralen plus ultraviolet A in early-stage mycosis fungoides.

BACKGROUND: Psoralen plus ultraviolet (UV) A (PUVA) radiation is the preferred treatment for folliculotropic mycosis fungoides (MF) and MF refractory to narrowband (NB) UVB radiation. However, systemic PUVA has many unfavorable side effects and contraindications. Bath PUVA has been found to be a suitable alternative in patients with psoriasis, but data on MF are sparse. OBJECTIVE: The purpose of the study was to evaluate the effectiveness of bath PUVA in the treatment of folliculotropic MF and NB-UVB-refractory early-stage MF. METHODS: The study group included 26 patients of average age 44 years attending a tertiary medical center in 2004 through 2012, 14 with folliculotropic type and 12 with NB-UVB-refractory early-stage MF who were not amenable for oral PUVA. Treatment consisted of 0.2 mg/L 8-methoxypsoralen bath 3 times weekly followed by UVA irradiation at 0.3 J/cm(2) with fixed increments every second session. RESULTS: A complete clinical response was achieved in 62% of patients after an average of 33 weeks and a cumulative radiation dose of 158 J/cm(2). LIMITATIONS: This was a relatively small series. CONCLUSION: Bath PUVA is a good treatment option for superficial folliculotropic MF and NB-UVB-refractory early-stage MF.

Photopneumatic therapy for the treatment of keratosis pilaris.

BACKGROUND: Current treatment options for keratosis pilaris (KP) are limited and are often found to be unsatisfactory to patients. OBJECTIVE: Pilot study to determine if photopneumatic therapy (PPx) can improve the erythema and skin texture in KP. METHODS: Ten patients with KP were treated with one session of PPx on the upper arm and then evaluated one month later for treatment efficacy. RESULTS: Average investigator-assessed improvement was 27% in erythema and 56% in skin texture roughness. Average patient self-reported improvement was 52% in erythema and 53% in skin texture. The mean satisfaction score was 6.3 on a scale of 1 to 10 (median 7.5) and 8 out of 10 participants reported they would choose to receive PPx for their KP again in the future. LIMITATIONS: Small number of patients, short follow-up period, and lack of blinding of the examiner and the patients making recall bias possible. CONCLUSIONS: One treatment of PPx improved both the erythema and redness associated with KP over at least a one month period.

[Erythema annulare centrifugum Darier. Successful therapy with topical calcitriol and 311 nm-ultraviolet B narrow band phototherapy]. / Erythema anulare centrifugum Darier. Erfolgreiche Therapie mit topischem Calcitriol und UVB-Schmalspektrumbestrahlung.

Erythema annulare centrifugum is an acute dermatosis of unclear etiology, which presents with annular erythematous lesions with marginal scale. Therapeutically, systemic and topical glucocorticosteroids are used primarily. We treated a patient with large lesions in the area of the thighs resistant to a therapy with topical glucocorticosteroids, with topical calcitriol in combination with 311 nm ultraviolet B narrow band phototherapy. After four weeks of treatment the skin lesions had cleared nearly completely without any side effects. The combination topical vitamin D3-analogue calcitriol and 311 nm ultraviolet B narrow band phototherapy was effective and can be regarded as a useful alternative to glucocorticosteroids for erythema annulare centrifugum.

[Scabies triggering Darier's disease]. / Skabies als Triggerfaktor des M. Darier.

An increased incidence of scabies has been noted in many countries. Difficulties may arise when unrecognized infestations trigger or aggravate other dermatological disorders. We present an instructive case of Darier's disease, which did not respond to appropriate therapy regimens due to constant triggering by an undetected underlying scabies infestation. In this case, a 44-year-old Italian man presented with typical symptoms of Darier's disease. In addition, the patient reported massive pruritus, which is rather uncommon in this disorder. The disease proved recalcitrant to established treatment regimens resulting in excessive treatment costs. We confirmed the diagnosis of Darier's disease by histopathological analysis, and, in addition, detected arthropod fragments in the upper epidermis. Systemic ivermectin and topical allethrin followed by acitretin and PUVA-bath therapy resulted in rapid improvement of the debilitating pruritus as well as alleviation of the symptoms of Darier's disease.

Induction of Darier-White disease with UVB radiation in a clinically photo-insensitive patient.

Combination UVA/UVB radiation and UVB radiation alone have been shown to induce the lesions of Darier-White disease. However, 6% of patients with Darier-White disease claim that sunlight ameliorates their condition. We performed an unblinded, side-by-side controlled trial of UVB, UVA, and combination UVB/UVA phototherapy in a patient with historically photoameliorated Darier-White disease to determine whether phototherapy was beneficial, to determine whether phototherapy-related heat was detrimental, and to confirm, with appropriate controls, the action spectrum of the disease. Phototherapy with radiation in the UVB but not UVA spectrum evoked Darier-White disease in this patient, both clinically and histologically. UVB radiation was capable of inducing Darier-White disease in vivo in spite of a history of photoamelioration, whereas UVA radiation alone and the heat associated with phototherapy in our protocol had no effect on the disease.

[Kyrle disease]. / Morbus Kyrle.

In the group of perforating skin diseases with transepithelial elimination the hyperkeratosis follicularis et parafollicularis in cutem penetrans is very rare. By means of casuistics the clinical and histological features are discussed. Re-PUVA as a feasible therapy variant was performed.