Lightning-Storm Periungual Capillaries in a Patient with Complex Regional Pain Syndrome Type I.

INTRODUCTION: Complex regional pain syndrome (CRPS) is characterized by chronic pain out of proportion to injury following trauma. CRPS most commonly results after crush-type injury to the hand and may be associated with various cutaneous symptoms believed to be driven by vasomotor instability. Existing reports in the literature have employed a range of methodologies to describe and evaluate cutaneous and vascular changes in CRPS, though there exists no current gold standard for diagnosis. CASE PRESENTATION: Here, we report a 71-year-old male with a 10-year history of CRPS who presented with abnormal capillaries on onychoscopy, demonstrating a "lightning-storm" pattern. CONCLUSION: Previous studies have shown increased blood flow to the cutis in the early stage of CRPS, yet diminished cutaneous flow during the later stages. However, one study showed increased nail capillary diameter in patients with later stage CRPS. Due to a variety of reported clinical characteristics and a nonspecific clinic presentation, both the recognition and diagnosis of CRPS is difficult. Nail fold capillaroscopy may be a useful and accessible tool for evaluating patients with CRPS.

An Open-Label Evaluator Blinded Study of the Efficacy and Safety of a New Nutritional Supplement in Androgenetic Alopecia: A Pilot Study.

Objective: To evaluate the effectiveness of a novel oral supplement, Forti5®, containing green tea extract, omega 3 and 6 fatty acids, cholecalciferol, melatonin, beta-sitosterol, and soy isoflavones, and in the management of subjects with androgenetic alopecia. Design: A prospective case series of 10 subjects. Setting: Open-label, evaluator-blinded, proof-of-concept study. Participants: Ten adult subjects with androgenetic alopecia completed the study. Subjects were not allowed to use oral or topical hair growth products in the 24 weeks preceding the study or during the study. The nutritional supplement was administered at a dosage of two tablets daily for 24 weeks. Measurements: Clinical evaluations were performed at baseline and at 24 weeks. Efficacy was evaluated using hair mass index measured by cross section trichometer, terminal hair count measured with dermoscopy and Investigator Global Photography Assessment. Results: Overall 80 percent of subjects (8/10) were rated as improved after 24 weeks of supplementation (mean change of +1.4 equivalent to slightly-to-moderately increased). Forty percent of subjects (4/10) were rated as moderately improved (2+), and 10 percent (1/10) were rated as greatly improved (3+). There was a significant improvement in terminal hair count (mean increase of 5.9% or 4.2 more terminal hairs in the area examined, p=0.014) and in Hair Mass Index (mean increase of 9.5% or 4.5 higher Hair Mass Index, p=0.003). Conclusion: These preliminary results indicate that Forti5® a novel nutritional supplement that contains cholecalciferol, omega 3 and 6 fatty acids, melatonin, antioxidants, and botanical 5-alpha reductase inhibitors, may be a useful adjunct in the treatment of androgenetic alopecia.

Topical application of the Wnt/ß-catenin activator methyl vanillate increases hair count and hair mass index in women with androgenetic alopecia.

BACKGROUND: Activation of the WNT/ß-catenin pathway has emerged as a potential therapeutic target in androgenetic alopecia (AGA). Methyl vanillate (MV) - a safe plant-derived ingredient - has been recently shown to activate the WNT/ß-catenin signaling. Objectives Two distinct substudies were conducted. First, we designed a 6-month, uncontrolled, open-label clinical study to investigate whether topically applied MV may increase hair count and hair mass index (HMI) in female AGA. Second, we conducted a molecular study on the effect of MV on WNT10B mRNA expression in scalp biopsies of women with AGA. METHODS: A total of 20 Caucasian women (age range: 25-57 years) with AGA (Sinclair grade 1-2) were included. The research product was an alcohol-free formulation supplied in the form of a spray containing 0.2% MV as the active ingredient. RESULTS: In the clinical study, hair count and HMI were found to increase at 6 months by 6% (P < 0.01) and 12% (P < 0.001), respectively, compared with baseline. No participant discontinued treatment due to adverse effects, and the overall patient satisfaction was good. At the molecular level, the topical application of the research product resulted in a 32% increase in WNT10B mRNA expression levels in the temporal scalp area (P < 0.001). CONCLUSION: Our pilot data suggest that topical MV can increase hair count and HMI by inducing WNT10B expression in the scalp, potentially serving as a novel treatment strategy for female AGA.