BHNS Journal Club January 2019
Modified Tangential Excision of the Nail Matrix
Martin N. Zaiac, M.D.1 ; Jorge Ocampo-Garza, M.D.
J Am Acad Dermatol. 2018
A very useful technique for nail matrix pigmented lesion biopsies with the benefit of minimal scarring compared to standard incisional biopsy techniques. The authors acknowledge that it’s a challenging technique for practitioners and offers a tip, with photos, on making it a smoother process. They propose peri-operative injection of 1ml of plain lidocaine to elevate the matrix off the underlying tissues allowing the tangential shave to take place more smoothly.
Acer E; Kaya Erdoğan H; İğrek A; Parlak H; Saraçoğlu ZN et al.
Journal of cosmetic dermatology; Dec 2018
This cross-sectional study from Turkey took 1192 volunteers ages 18-20 and looked through the socio-clinical risk factors associated with PHG such as smoking, alcohol consumption, diet preference, atopy history, and family history of PHG and Perceived Stress Scales (PSS). They acknowledge that there is global variation according to race with regards to PHG. 68% of their participants had less than 10 grey hairs on examination, the remainder, more. Greying due to vitiligo and alopecia areata were excluded. The results supported significantly higher PNG in those reporting a vegetarian diet, atopy, family history of PNG and alcohol consumption amongst women only. Smoking and PHG were not significantly related, but the authors acknowledge that the low ages of participants may be a factor in this result. They conclude that PHG may be due to a combination of environmental factors in genetically predisposed individuals.
Association between male pattern baldness and testicular germ cell tumor (TGCT): a meta-analysis.
Zhou J; Xia S; Li T; Liu R
BMC cancer; Jan 2019; vol. 19 (no. 1); p. 53
The relationship between male pattern baldness and incidence of testicular cancer remains inconclusive. This research article showcases a meta-analysis based on all eligible case-control studies from PUBMED, EMBASE and Web of science databases. This resulted in a total of 884 cases from 5 studies being examined.
Their results support that male patterned baldness has no significant correlation with TGCTs. They do claim that there was significant result showing that men with any pattern baldness have a negative association with testicular cancer.
Overall, this meta-analysis lacks self-examination and a discussion of its limitations, alongside the practical use of such knowledge.
Trichoscopic signs in systemic lupus erythematosus: a comparative study with 109 patients and 305 healthy controls.
Suchonwanit P; Udompanich S; Thadanipon K; Chanprapaph K
Journal of the European Academy of Dermatology and Venereology : JEADV; Jan 2019
Hair and scalp involvement in systemic lupus erythematosus (SLE) may manifest as scarring alopecia, non-scarring alopecia or scalp/hair shaft changes. While trichoscopic signs in chronic cutaneous lupus are well estabished, data on SLE patients with normal-looking or non-scarring scalp are limited. This study investigated the trichoscopic features of SLE patients without chronic cutaneous scalp lesions and compared the findings with normal controls to determine if any feature associated with a systemic disease. The study was undertaken with the examination of patients’ photographs by one blinded hair specialist. A 109 SLE patients and 305 healthy controls were included. The most common feature was prominent arborizing blood vessels (60.6% vs. 18.4%, P<0.001), followed by thick arborizing blood vessels (57.8% vs. 10.2%, P<0.001), black dots (47.7% vs. 2%, P<0.001), brown scattered pigmentation (5.5% vs. 0.7%, P=0.005) and blue grey speckled pigmentation (44% vs.0.3%, P500 mg/day, P=0.004 for proteinuria>1g/day). The authors conclude that trichoscopic examination is a valuable tool for SLE diagnosis and monitoring. Severe diffuse non-scarring alopecia may possibly be used as a forecast of internal lupus likely indicates active disease. This is a study that is limited with a small number of patients from a focal ethnic origin if south-east Asia, and the study acknowledges this well.
A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients.
Watanabe T; Yagata H; Saito M; Okada H; Yajima T et al.
PloS one; 2019; vol. 14 (no. 1); p. e0208118
As many breast cancer patients suffer from chemotherapy-induced hair loss this multicentre cross-sectional study aimed to provide some evidence-based data on the timeline of anthracycline / taxane induced hair loss, to help patient better psychologically prepare. This study was conducted in Japan with 1853 patients having had breast cancer within the prior 5 years were enrolled from 47 hospitals. Descriptive statistics were obtained in this study. The study was reported according to the STROBE criteria. Their response rate was 81.5%. Hair loss occurred in 99.9% of patients. The mean time from chemotherapy until hair loss was 18.0 days. Regrowth of scalp hair occurred in 98% of patients. The mean time from the completion of chemotherapy to the beginning of regrowth was 3.3 months. Two years after chemotherapy completion, the scalp-hair recovery rate was <30% in approximately 4% of patients, and this rate showed no improvement 5 years after chemotherapy.
Factors associated with onychomycosis in nail psoriasis: a multicenter study in Pakistan.
Tabassum S; Rahman A; Awan S; Jabeen K; Farooqi J et al.
International journal of dermatology; Jan 2019
Treatment of psoriatic nail disease is challenging, and dystrophic psoriatic nails can get secondarily infected with fungi. This case-control study over 2 years was conducted at three tertiary care in Pakistan. Data were collected from patients with nail psoriasis with age- and gender-matched controls. A detailed questionnaire was filled for all study participants. Nail Psoriasis Severity Index (NAPSI) scoring tool was used to assess dystrophy. Fungal infection was diagnosed via nail clippings with visualised fungal hyphae and positive culture. The most frequent fungal species identified was Candida parapsilosis in both cases and controls. A contrast to what we usually see in the UK. A total of 477 participants, 159 cases and 318 controls completed the study. Their mean age was 44 years, and one-third were female. The authors found nearly one-third of psoriatic nail patients had concomitant fungal infection. The authors remind us that screening for onychomycosis and subsequent treatment alongside treatment for the psoriasis too is imperative in order to reach better long term outcomes for these patients. Their multi-variate analysis of socio-economic data also showed that those in lower income households, doing wet-work and lack of protective footwear were more pre-disposed to getting onychomycosis. Some parts of this data may be transferrable to our population in the UK.
"It's not lupus, it's your nails!"
McCarthy S; Flynn A; Bennett M; Bourke JF
Contact dermatitis; Jan 2019; vol. 80 (no. 1); p. 67-68
This Irish centre reported on their case of a 22-year old patient initially presenting with an intermittent erythematous plaque rash present on the face and neck in a photo-distributed pattern. Initial biopsies with spongiotic dermatitis and mucin prompted a diagnosis of lupus and subsequent treatment with hydroxychloroquine, mychophenolate and prednisolone. A repeat biopsy did not confirm any lupus. Re-evaluation of the case and patch testing revealed an allergy to acrylates from her press-on artificial nails that had been overlooked in the history-taking. Her rash resolved shortly after these were discontinued. This reports highlights the importance of a generic dermatological history as well as emphasising a well known catchphrase from Dr Rodney Dawber: “ignore the nails at your peril!”