Cross-Sectional Study of Trichoscopy Features, Prevalence, Types of Hair Loss and Hair Care Practices at a Lagos Urban Market.

BACKGROUND: Hair loss studies have mostly been clinical with no trichoscopy features of the hair loss documented in Nigeria. OBJECTIVE: The objective of this study was to determine the community prevalence, types of hair loss, trichoschopy features and the risk factors for the observed hair loss types. METHODS: This was a cross-sectional descriptive study of traders (Fitz Patrick's skin types V-VI) at an urban market. The traders were clinically evaluated for hair loss. Sociodemographic, clinical and trichoscopy data were recorded using a study questionnaire. Data was analyzed using SPSS version 22.0. Statistics such as means, medians, frequencies, t-test and chi-square test were presented. Levels of significance of all tests was set at, P<0.05%. RESULTS: A total of 307 participants (32.6% male and 67.4% female) with a mean age of 42.7±12.8 years were studied. The prevalence of hair loss was 68.7% (51% in males and 77.3% in females) and the mean age of those with hair loss was 44.8±12.3 years. The pattern of hair loss was patterned, diffuse and localized in 94.3%, 3.8% and 1.9% respectively. The main types of hair loss were androgenetic alopecia (26.9%) and traction alopecia (71.7%). The prevalent hair practices were; braids and weave-on (extensions) in 78.2%, turban-like head gear in 76.9%, and chemical relaxers in 73.8%. Trichoscopy features characteristic of the observed hair loss types were documented. CONCLUSION: Hair loss is common in the community. The common hair care practices and increasing age could be contributors to hair loss.

CONTEXTE: Les études sur la perte de cheveux ont surtout été cliniques et aucune caractéristique trichoscopique de la perte de cheveux n'a été documentée au Nigeria. OBJECTIF: L'objectif de cette étude était de déterminer la prévalence communautaire, les types de perte de cheveux, les caractéristiques de la trichoscopie et les facteurs de risque pour les types de perte de cheveux observés. MÉTHODES: Il s'agissait d'une étude descriptive transversale de commerçants (types de peau V-VI de Fitz Patrick) sur un marché urbain. Les commerçants ont été évalués cliniquement pour la perte de cheveux. Les données sociodémographiques, cliniques et trichoscopiques ont été enregistrées à l'aide d'un questionnaire d'étude. Les données ont été analysées à l'aide de SPSS version 22.0. Des statistiques telles que les moyennes, les médianes, les fréquences, le test t et le test du chi-deux ont été présentées. Le niveau de signification de tous les tests a été fixé à P<0,05%. RÉSULTATS: Un total de 307 participants (32,6% d'hommes et 67,4% de femmes) avec un âge moyen de 42,7±12,8 ans ont été étudiés. La prévalence de la perte de cheveux était de 68,7 % (51 % chez les hommes et 77,3 % chez les femmes) et l'âge moyen des personnes présentant une perte de cheveux était de 44,8±12,3 ans. La perte de cheveux était structurée, diffuse et localisée dans 94,3 %, 3,8 % et 1,9 % des cas respectivement. Les principaux types de perte de cheveux étaient l'alopécie androgénétique (26,9 %) et l'alopécie de traction (71,7 %). Les pratiques capillaires prédominantes étaient les suivantes : tresses et tissage (extensions) dans 78,2 % des cas, coiffure en turban dans 76,9 % des cas et défrisage chimique dans 73,8 % des cas. Les traits trichoscopiques caractéristiques des types de perte de cheveux observés ont été documentés. CONCLUSION: La perte de cheveux est fréquente dans la communauté. Les pratiques courantes de soins capillaires et l'âge croissant pourraient contribuer à cette perte de cheveux. Mots clés: Trichoscopie, Perte de cheveux, Pratique des soins capillaires, Communauté, Africaine, Prévalence.

Onychopapilloma: its clinical, dermoscopic and pathologic features.

BACKGROUND: Onychopapilloma is a benign tumour of the nail bed and distal matrix and commonly presents as longitudinal erythronychia, longitudinal leukonychia or longitudinal melanonychia. Because onychopapilloma is rare, its clinical characteristics and dermoscopic findings have not been well investigated in Asia. OBJECTIVES: This study aimed to investigate the clinical characteristics and dermoscopic and pathologic findings of onychopapilloma in Korea. METHODS: We retrospectively reviewed the medical records and clinical/dermoscopic photographs of 39 patients diagnosed with onychopapilloma in the Pusan National University Hospitals (Busan and Yangsan) for 11 years (2010-2021). RESULTS: Among 39 patients, 23 (59.0%) were men, and 16 (41.0%) were women. The mean age was 46.1 (16-77) years. All lesions were single, and most of them were located on the fingers (92.3%), especially the thumb (66.7%). The most common clinical feature was longitudinal erythronychia (56.4%), and the most common dermoscopic finding was distal subungual hyperkeratosis (100%). We found two new dermoscopic features: macrolunula and trailing lunula along the longitudinal band. Among 18 patients who underwent surgical excision, only 6 (33.3%) showed typical acanthosis and papillomatosis on the nail bed. CONCLUSIONS: We found that Asian onychopapilloma has similar clinicodermoscopic findings to the Caucasian one, that is to say, longitudinal erythronychia and distal subungual hyperkeratosis were the most common nail change and dermoscopic finding, respectively. We propose two new dermoscopic features of onychopapilloma: macrolunula and trailing lunula along the longitudinal band.

Sub-macroscopic skin presentation of acromegaly and effect of pituitary tumor surgery: A study using dermatoscopy and ultra-high-frequency ultrasound.

Objective: Excessive growth hormone and insulin-like growth factor 1 contribute to cutaneous changes in acromegaly. We investigated the sub-macroscopic skin manifestation of acromegaly patients and explored its reversibility upon hormone reduction after pituitary adenoma surgery. Design: Prospectively cohort study. Methods: We enrolled 26 patients with acromegaly and 26 patients with non-functioning pituitary adenomas undergoing pituitary adenomectomy at Peking Union Medical College Hospital from July 2021 to March 2022. Skin presentations were evaluated by dermatoscopy and ultra-high-frequency ultrasound before and after surgery. Results: Skin thickening, follicular plugs, perifollicular pigmentations, perifollicular orange haloes, red structureless areas, increased hair shafts, honeycomb-like pigmentations, widened dermatoglyphics, dilated appendage openings, excessive seborrhea, hyperhidrosis, enlarged pores, and acne-like lesions were commonly occurring in acromegaly patients, and their incidences were higher than the controls (P<0.05). At 3-month follow-up after surgery, the thickness of skin reduced (4.0 ± 0.4 to 3.7 ± 0.4, P=0.007), the incidences of hyperhidrosis (92.3% to 69.2%, P=0.035) and acne-like lesions (53.8% to 26.9%, P=0.048) declined, and the severity of multiple cutaneous lesions improved. Patients with surgical endocrine remission (53.8%) had greater declines in the thickness of skin than those without remission. Patients with improvement of >1 skin lesions were younger (P=0.028) and had higher baseline GH levels (P=0.021) than those with improvement of ≤1 skin lesion. Conclusions: Dermatoscopy and ultra-high-frequency ultrasound provided augmented visual examination of the cutaneous changes in acromegaly. Some of the skin lesions could improve or reverse after pituitary surgery. Baseline GH levels, age, and endocrine remission were correlated with skin improvement at 3-month follow-up.

Diagnostic accuracy and safety of short-term teledermoscopic monitoring of atypical melanocytic lesions.

BACKGROUND: Short-term dermoscopic monitoring (STDM) of atypical melanocytic lesions (AML) after 3.0-4.5 months can be used to detect featureless melanomas without performing countless unnecessary excisions of nevi. Recently, short-term teledermoscopic monitoring (STTM) was incorporated into the STDM clinical routine at Sahlgrenska University Hospital in Gothenburg, Sweden. Follow-up images for STTM were taken by an assistant nurse with subsequent teledermoscopic assessment by a dermatologist. OBJECTIVES: The purpose of this study was to evaluate the diagnostic accuracy and safety of STTM. METHODS: In this retrospective observational study, data from electronic health records of patients with teledermoscopically monitored AMLs were explored. The number of changed and excised AMLs and their histopathological diagnoses were recorded. The excised AMLs were categorized into three subgroups according to when they changed and were excised: (i) following STTM, (ii) after planned long-term follow-up or (iii) after unplanned long-term follow-up. RESULTS: A total of 686 patients with 883 AMLs were monitored with STTM. Sixty-two AMLs (7.0%) were excised following STTM, 14 (1.6%) after planned long-term follow-up and 10 (1,1%) after unplanned long-term follow-up. Twenty-one melanomas were detected using STTM, three after planned long-term follow-up and three after unplanned long-term follow-up. All melanomas were in situ (n = 20) or thin and non-ulcerated (n = 7; median Breslow thickness 0.4 mm, range 0.3-0.8 mm). The sensitivity for the diagnosis of melanoma by means of STTM with the option of additional planned follow-up was 88.9%, and the specificity was 93.9%. The number of AMLs needed to monitor in order to detect one melanoma with the STTM routine was 32.7, and the number needed to excise was 3.2. CONCLUSIONS: STTM of AMLs was safe and allowed for high diagnostic accuracy. All detected melanomas were in situ or thin and non-ulcerated. Furthermore, a considerable number of unnecessary excisions were spared.

Outcomes of dermoscope-guided surgical procedures in primary care: case-control study.

INTRODUCTION No research has been found regarding outcomes of dermoscope-guided surgical procedures in primary care. AIM To establish whether outcomes of dermoscope-guided procedures performed in primary care settings differ from outcomes for similar procedures, performed without the use of a dermoscope. METHODS A retrospective case-control study design was used. All records of dermoscope-guided procedures performed over a 6-month period were retrieved. For each study procedure, the record of the most recent control procedure without dermoscopy guidance performed on a sex-and-age matched patient was retrieved from before we began performing dermoscope-guided procedures. Primary outcomes were: local inflammation and infections within 2 weeks' post procedure; relapse in 6 months; and obvious scars in 6 months. Pain affecting activities of daily living in the first week after the procedure was the secondary outcome. RESULTS Records of 39 dermoscope-guided procedures and 39 control procedures were retrieved. No significant difference in local inflammation and infections in 2 weeks was found; relapse in 6 months after the study procedures was significantly lower for dermoscope-guided than control procedures (risk ratio (RR): 0.22; 95% confidence interval (CI): 0.05-0.95), and there were fewer obvious scars for dermoscope-guided procedures than control procedures (RR: 0.52; 95% CI: 0.32-0.83), with the number of small lesions (<4 mm) leaving scars in study procedures particularly less than that for control procedures (RR: 0.30; 95% CI: 0.13-0.67). There was no difference in the secondary outcome of pain affecting activities of daily living in the first week following the procedure. CONCLUSION In primary care, dermoscope-guided procedures achieved better outcomes than similar procedures without dermoscope guidance. Performing dermoscope-guided procedures in primary care might lower medical costs.

Diagnostic accuracy of dermatofluoroscopy in cutaneous melanoma detection: results of a prospective multicentre clinical study in 476 pigmented lesions.

BACKGROUND: Early detection is a key factor in improving survival from melanoma. Today, the clinical diagnosis of cutaneous melanoma is based mostly on visual inspection and dermoscopy. Preclinical studies in freshly excised or paraffin-embedded tissue have shown that the melanin fluorescence spectra after stepwise two-photon excitation, a process termed dermatofluoroscopy, differ between cutaneous melanoma and melanocytic naevi. However, confirmation from a larger prospective clinical study is lacking. OBJECTIVES: The primary end point of this study was to determine the diagnostic accuracy of dermatofluoroscopy in melanoma detection. Secondary end points included the collection of data for improving the computer algorithm that classifies skin lesions based on melanin fluorescence and the assessment of safety aspects. METHODS: This was a prospective, blinded, multicentre clinical study in patients with pigmented skin lesions (PSLs) indicated for excision either to rule out or to confirm cutaneous melanoma. All included lesions underwent dermoscopy and dermatofluoroscopy in vivo before lesions were excised and subjected to histopathological examination. RESULTS: In total, 369 patients and 476 PSLs were included in the final analysis. In 101 of 476 lesions (21·2%) histopathology revealed melanoma. The observed sensitivity of dermatofluoroscopy was 89·1% (90 of 101 melanomas identified), with an observed specificity of 44·8%. The positive and negative predictive values were 30·3% and 93·9%, respectively. No adverse events occurred. CONCLUSIONS: Dermatofluoroscopy is a safe and accurate diagnostic method to aid physicians in diagnosing cutaneous melanoma. Limitations arise from largely amelanotic or regressing lesions lacking sufficient melanin fluorescence.

Koebner phenomenon in alopecia areata: rapid appearance after trichogram. Implications for the pathogenesis and therapy.

Anecdotical experiences indicate that Koebner phenomenon (KP) can also be observed in alopecia areata (AA). The present short report gives an account of what has been observed in some patients with remitting-relapsing AA in multiple patches, in whom the phenomenon was accidentally caused by perilesional Trichogram. The almost immediate appearance of relapses of the disease (1-7 days) and their evolution can be useful to understand the physiopathology of AA and and emphasize the compelling need for a rapid and appropriate diagnosis and treatment in the acute phase of AA, even with the active participation of the patient adequately trained. The method of trichogram should be reserved for cases in which non-invasive methods such as the Pull Test or Trichoscopy are not sufficient to verify the activity of the disease.

Tonic pupil following the use of dermatoscope.

Adie's tonic pupil is a benign condition supposed to be due to a damage of the parasympathetic innervation of the eye. It may cause considerable anxiety in the patient and lead to extensive but futile investigations. Here, we describe a 34-year-old dermatologist who developed a tonic pupil just after she had started to use intensively a 6 light-emitting diode dermatoscope. We hypothesize that frequent, repetitive exposures of one eye to intense light might fatigue the pupillary reflex and trigger the appearance of a tonic pupil.

Prevention of nosocomial infection during dermoscopy?

BACKGROUND: Dermatoscopes are applied directly to cutaneous or mucocutaneous surfaces with immersion fluid (IF) such as oil or alcohol to reduce light reflection. Recently, Staphylococcus aureus has been isolated from dermatosopes that used mineral oil as the IF. Thus, dermatoscopes might be a potential source of nosocomial infection. OBJECTIVE: In this study we propose the use of an alcohol-based antibacterial gel to reduce nosocomial infection transmission while optimizing optical resolution during dermatoscopic examination. MATERIALS AND METHODS: Aerobic bacterial cultures were performed on three dermatoscopes used in an outpatient setting after routine examination of 31 patients with an alcohol-based antibacterial gel as IF. RESULTS: There was no bacterial growth after using the antibacterial gel with the dermatoscopes. The optical resolution for the antibacterial gel appeared equal to the 'dermatoscopy oil' and superior to alcohol wipes. CONCLUSIONS: Alcohol-based antibacterial gel appears to inhibit bacterial colonization while offering excellent optical resolution during dermoscopic examination. The use of alcohol-based IF appears to obviate the risk of nosocomial infections.

Dermatoscope as vector for transmissible diseases - no apparent risk of nosocomial infections in outpatients.

PURPOSE: To determine nonpathogenic and potentially pathogenic bacterial growth isolated from dermatoscopes of dermatologists using oil as contact medium in the daily routine at two outpatient sections in Switzerland. METHODS: We investigated the microbiologic colonization of dermatoscopes (Dermatoskop Delta 10, Heine Optotechnik, or Dermogeniusbasic, Rodenstock) during routine use in the outpatient sections of the Departments of Dermatology at the University of Basel and Kantonsspital Aarau. 112 swabs (4 from Aarau, 108 from Basel) taken under standardized conditions were microbiologically worked up in the same laboratory. Oil (101) and 63% isopropyl alcohol (11) were used as contact medium. RESULTS: 39 of 112 swabs showed no bacterial growth. 73 of 112 showed growth of nonpathogenic bacteria (skin flora). Additionally to the cultivation of nonpathogenic bacteria, 3 swabs showed growth of oxacillin-sensitive potentially pathogenic Staphylococcus aureus. Of 11 swabs taken after using 63% isopropyl alcohol as a contact medium, 6 revealed no bacterial growth and 5 showed the growth of skin flora. CONCLUSIONS: The potential risk of nosocomial infection related to the routine use of dermatoscopes in outpatients is small, and the use of oil as a contact medium for dermatoscopy to enhance the optical quality seems to be unproblematic.