Onychotillomania: clinicopathologic correlations.

Onychotillomania represents an unusual dermatosis affecting the nail unit. The term refers to 'neurotic picking at a nail until it is permanently altered'. It can be difficult for dermatologists to diagnose, as typically patients will deny the self-destructive behavior and the clinical features may mimic other inflammatory conditions affecting the nail unit. Aside from the difficulty in establishing the diagnosis clinically, the histopathologic features of onychotillomania are nonspecific. With this limited knowledge, dermatopathologists could have difficulty in correlating the clinical and histopathologic features and determining the correct diagnosis. Establishing the diagnosis is critical, as onychotillomania is sometimes associated with major depression and obsessive-compulsive disorder, and can be a clue to uncovering these debilitating psychiatric disorders. Here we present two cases of onychotillomania and emphasize the clinical-pathological confrontation necessary to secure the diagnosis.

An unusual variant of confluent and reticulated papillomatosis masquerading as tinea versicolor.

BACKGROUND: Confluent and reticulated papillomatosis (CARP), also known as Gougerot-Carteaud syndrome, is a rare disorder. It usually presents as hyperkeratotic brown papules that coalesce into plaques with a reticulated periphery on the central trunk of young adults. Confluent and reticulated papillomatosis is most often clinically confused with tinea versicolor and usually does not respond to therapy with antifungals. Minocycline is the treatment of choice. OBSERVATIONS: Four cases of CARP with the unusual presentation of hypopigmented lesions masquerading as tinea versicolor in dark-skinned (Fitzpatrick skin types IV-V) patients are presented. All cases exhibited characteristic features of CARP on biopsy results and responded to minocycline of several months' duration. Two of the cases were also treated with adjuvant topical tazarotene. CONCLUSIONS: The hypopigmented variant of CARP in dark-skinned patients makes the clinical differentiation from tinea versicolor extremely challenging. Physicians encountering darkly pigmented individuals with hypopigmented plaques unresponsive to antifungals should have a high clinical suspicion for the hypopigmented variant of CARP.

A review of the effects of hypnosis on the immune system in breast cancer patients: a brief communication.

In order to make a recommendation about the use of hypnosis as adjuvant therapy in the treatment of breast cancer, 2 studies assessing the immunological effects of hypnosis in patients with early stage breast cancer were evaluated: (a) an experiment that taught hypnotic guided-imagery therapy to patients and (b) one that provided participants with home visits and autogenic training. Both investigations demonstrated improvement in depression and increased natural killer (NK) cell counts after 2 months of hypnosis treatment. However, neither study determined the clinical significance of hypnosis in the setting of cancer, and therefore future experiments are needed to relate the immune-mediated effects of hypnosis to hard clinical outcomes like survival rates.