Breaking the cycle of hair breakage: pearls for the management of acquired trichorrhexis nodosa.

Acquired trichorrhexis nodosa (TN) is a common cause of hair loss for patients of all ethnicities. It is especially prevalent in black patients with tightly curled hair types and can present unique diagnostic and therapeutic challenges due to structural differences in these hair types and the combination of various hair care and styling practices that contribute to hair damage. While scalp biopsies can help rule out other etiologies of hair loss, there is a paucity of histologic findings in acquired TN, making this primarily a clinical diagnosis. Instead of more traditional prescription based therapies, the management of this form of hair loss emphasizes protecting the hair shaft and minimizing further damage through the development of a healthy hair care regimen. This involves appropriate selection and use of cleansing products and conditioning agents that help protect the hair from the insults of daily grooming. This paper will review the current literature on acquired TN and will provide guidelines and recommendations for management by reviewing the different types of cleansing and conditioning products that can be used to prevent and/or halt the progression of hair breakage.

Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa.

BACKGROUND: Antibiotic therapy is commonly used to treat hidradenitis suppurativa (HS). Although concern for antibiotic resistance exists, data examining the association between antibiotics and antimicrobial resistance in HS lesions are limited. OBJECTIVE: We sought to determine the frequency of antimicrobial resistance in HS lesions from patients on antibiotic therapy. METHODOLOGY: A cross-sectional analysis was conducted on 239 patients with HS seen at the Johns Hopkins Medical Institutions from 2010 through 2015. RESULTS: Patients using topical clindamycin were more likely to grow clindamycin-resistant Staphylococcus aureus compared with patients using no antibiotics (63% vs 17%; P = .03). Patients taking ciprofloxacin were more likely to grow ciprofloxacin-resistant methicillin-resistant S aureus compared with patients using no antibiotics (100% vs 10%; P = .045). Patients taking trimethoprim/sulfamethoxazole were more likely to grow trimethoprim/sulfamethoxazole-resistant Proteus species compared with patients using no antibiotics (88% vs 0%; P < .001). No significant antimicrobial resistance was observed with tetracyclines or oral clindamycin. LIMITATIONS: Data on disease characteristics and antimicrobial susceptibilities for certain bacteria were limited. CONCLUSIONS: Antibiotic therapy for HS treatment may be inducing antibiotic resistance. These findings highlight the importance of stewardship in antibiotic therapy for HS and raise questions regarding the balance of antibiotic use versus potential harms associated with antibiotic resistance.

Understanding patient experiences with scarring alopecia: a qualitative study with management implications.

INTRODUCTION: Alopecia can have a significant negative impact on patient's lives. The objective of this study is to describe some of the emotional and psychological challenges that affect women with scarring alopecia (SA). METHODS: A qualitative study design was used with open-ended, individual interviews with 10 women with biopsy-proven SA. Interviews were audio-taped, transcribed verbatim and analyzed thematically using ATLAS.ti analysis software. RESULTS: Four overarching major themes (with several subthemes) emerged including the following: the negative emotional impact of SA, difficulties with concealing hair loss, negative experiences with diagnosis/management, and the importance of support from others. Patients reported that many of these issues were under-emphasized during doctor visits. CONCLUSION: Analysis of patient responses indicated that patients with SA contend with significant emotional and psychological sequelae of their diagnosis.

All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA).

Prevalent among black women, traction alopecia (TA) is a type of hair loss that is often attributed to certain hairstyling practices. Although some of the hair care techniques common in the black community can promote ease of everyday hairstyling for black women, many of these practices have been implicated as risk factors for TA. Because of the limited literature on black hairstyling methods, hair loss in this patient population can present a diagnostic and therapeutic challenge for dermatologists. By increasing the knowledge and understanding of these practices and their risk of causing TA, clinicians can better manage this condition and stop the progression of hair loss before it becomes permanent. This information can be used to develop individualized recommendations for safer styling alternatives and improve patient education by identifying high-risk hairstyling habits. This review stratifies these hair care and styling practices into high-, moderate-, and low-risk categories, in addition to outlining a diagnostic approach for TA and detailed guidelines for conservative management.