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November 2018 - Hair and Nail Papers - Journal Club - British Hair and Nail Society

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November 2018 - Hair and Nail Papers

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Original Article


Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up.


L Miguel-Gómez et al.


The authors’ objectives were to describe the therapeutic response in a large number of cases of FD and analyse potential prognostic factors.

They conducted a multicentre prospective study where they included 60 patients with FD who had a minimum of 5 years of follow-up.  Earlier onset was statistically associated with severity of form of the disease. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the more effective. No statistically significant prognostic factors predicting a better therapeutic response were found.  The main limitation was the sample size.


Original Article


Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia.


C Aguh et al.


The authors recruited 5 patients with biopsy-proven CCCA. Two scalp biopsy specimens were obtained from each patient; one from CCCA-affected and one from unaffected scalp. Microarray analysis was performed to determine the differential gene expression patterns. They identified upregulation of genes implicated in fibroproliferative disorders, such as keloids, atherosclerosis and fibroids, in affected scalp compared with unaffected scalp.  The limitations were small sample size and the use of whole skin tissue for analysis. 


Letter to the editor


Steroid-induced changes noted on trichoscopy of patients with frontal fibrosing alopecia.


D Saceda-Corralo et al


The authors performed a retrospective analysis of the trichoscopic images and medical records of patients with FFA. Some patients did not receive topical corticosteroids (TC) for alopecia, and others used TC frequently (at least every other day for 6 months). 

The following trichoscopic findings were less prevalent in the group of patients who used TCs frequently than those who did not: perifollicular erythema (24% vs 75%, respectively, P = .009); perifollicular brown discoloration (19% vs 67%, respectively, P = .01), peripilar casts (52% vs 92%, respectively, P > .05), and white patches (95% vs 100%, respectively, P > .05); pili torti were found in 12 lesions (71% vs 25%, respectively, P = .03), and interfollicular scaling was found in 6 lesions (10% vs 25%, respectively, P > .05). Vascular structures, such as thin arborising vessels (95% vs 42%, P < .001) and thick arborizing vessels and extravasated hemorrhages (24% vs 0%, P > .05), were more common in patients who frequently used TC than those who did not. Diffuse erythema was found in 19 lesions (67% vs 33%, P > .05). Frequent use of TC led to an absence of perifollicular erythema and enhanced interfollicular vascular structures. This pattern, called the interfollicular vessel net, was found in 21% of lesions (33% vs 0%, P < .03). In conclusion, they found frequent use of TC increases the presence of arborising vessels and vessel nets. These changes can hinder the assessment of inflammation in FFA.


Letter to the editor


Clinical, trichoscopic, and histopathologic characteristics of patients with alopecia and hypothyroidism: An observational study.


S E Leal-Osuna et al.


The authors included 15 female patients with clinical alopecia who were diagnosed with hypothyroidism in the past 6 months. Medical histories, clinical and trichoscopic findings, and histology were used to exclude other causes of alopecia. 

They found that the main characteristics of hypothyroidism-associated alopecia are diffuse alopecia including the occipital area, reduced hair shaft diameter, miniaturization, single follicular units, and whitish scale. The authors did not find histologic telogen effluvium in these patients, whereas an increased number of vellus and intermediate hairs were observed, suggesting a process of follicular miniaturization that was not absolute. The most important differential diagnosis by trichoscopy was androgenetic alopecia. By trichogram, the presence of proximal longitudinal fractures in the hair shaft along with bayonet hairs and trichoschisis in patients whose main symptom is hair loss might indicate hypothyroidism as the cause.

The limitations were the small sample size and observational study design.


Letter to the editor


Seasonal patterns in alopecia areata, totalis and universalis.


E Putterman et al


The authors sought to identify whether AA, AT, and AU flares show seasonal variation in pediatric patients and to characterize temporal patterns.

The medical records of 457 children with AA, AT, or AU diagnoses were reviewed; 336 children met criteria for inclusion, with month of onset of either the initial or a subsequent flare documented. 

Of 518 total flares, the greatest proportion occurred in November (11.4%), followed by October (11.0%) and January (10.2%). Months with the lowest proportion of flares included May (3.5%) and August (5.6%). In patients with a history of atopy, who had a total of 198 flares, the frequency of flares was highest in March (14%) and November (13%). In patients without a history of atopic, who had a total of 320 flares, frequency of flares was highest in October (13%).

The results suggest that there might be a seasonal pattern, a predilection for flares during colder months; to what degree remains unclear. 

The study is limited by its retrospective design, patient recall, and a small sample size. 


Letter to the editor


Onychodystrophy in Sézary syndrome.


F M Damasco et al.


The authors conducted a retrospective analysis of 535 patients with CTCL. They identified 59 patients with SzS. Nineteen patients met the inclusion criteria: diagnosis of SzS, available clinical photographs, and complete clinical data.

The nail manifestations included paronychia (12/19, 63.2%), leukonychia (8/19, 42.1%), onycholysis (8/19, 42.1%), trachyonychia (6/19, 31.6%), subungual hyperkeratosis (5/19, 26.3%), splinter hemorrhages (5/19, 26.3%), onychauxis (5/19, 26.3%), yellow nail discoloration (4/19, 21.1%), distal yellow-brown discoloration (4/19, 21.1%), distal notching nail (3/19, 15.8%), onychoschizia (3/19, 15.8%), onychomadesis (2/19, 10.5%), longitudinal melanonychia (1/19, 5.7%), and anonychia (1/19, 5.7%). The presence of paronychia and leukonychia had never before been described as nail manifestations in patients with SzS. They observed that some types of nail changes were present in all 19 patients with SzS. They did not find a correlation between the number of years with SzS and degree of onychodystrophy.


Therapeutic Pearl


Fluorescent tattoos as anatomic markers to track trichologic responses


K Sukhdeo


Current localisation methods rely on either triangulated measurement from anatomic landmarks or skin tattoing. Fluorescent tattoos are an alternative permanent skin marking technique. On subsequent visits the florescent tattoo is visualised with a Wood’s lamp before use of marking pen to create a temporary superimposed dot. With room lights raised, the location is identified for examination by trichoscopy. The marking pen ink is then removed after the examination.


Therapeutic Pearl


Platelet-rich plasma for the treatment of lichen planopilaris.


A Kumar


PRP is injected intradermally by using an insulin BD syringe (31 gauge). The author has detected significant hair thickening after 4 sessions 3 weeks apart.





Review Article


Imaging technique for the diagnosis of onychomatricoma.


E. Cinotti et al.


The authors’ objective was to evaluate current literature on imaging techniques for the diagnosis of onychomatricoma in order to understand how this technology can help the preoperative diagnosis. They searched in the Cochrane Skin Group Specialised library, Medline, Embase and LILACS databases all studies evaluating imaging technique for the diagnosis of noychomatricoma up to February 2018. They found that Dermoscopy, reflectance confocal microscopy, optical coherence tomography, ultrasonography and magnetic resonance could be useful.


Original Article


Onychopapillomas: a 68-case series to determine best surgical procedure and histologic sectioning.


C. Delvaux et al.


This study had three objectives: to review the clinical and hisopatholgical features of all onychopapillomas (OP) diagnosed in their department; to identify the most accurate histological technique; and to determine the most effective surgical procedures by examining recurrence rates and complications over the long term.

The author conducted a retrospective analysis of all patients with OP diagnosed in their department between January 2007 and March 2017. The clinical findings and type of surgery were recorded and the slides were reviewed by a dermatopatholosit with expertise in nail disease.

They included 68 patients. The histological interpretation was more difficult for the transverse sections than for the longitudinal ones (29.4% vs. 2.2%).  The pathological diagnosis of OP was typical in 30.6%, suggestive in 51.6%, slightly suggestive in 12.9% and not contributive in 4.8%. 50 patients had a mean follow‐up of 50 months. 38% recovered completely and 20% recurred. 42% had mild to moderate sequelae. They found that classical longitudinal excision with careful removal of the lesion from the inferior face of the nail plate seemed to be the most accurate surgical technique. They observed a recurrence rate of 20%. This was more frequent when a tangential longitudinal excision was performed.





Review Article


Alopecia areata: a review of disease pathogenesis


F. Rajabi et al.


The authors’ searched MEDLINE and Scopus for articles related to alopecia areata, with a particular emphasis on its pathogenesis.

The main theory of alopecia areata pathogenesis is that it is an autoimmune phenomenon resulting from a disruption in hair follicle immune privilege. What causes this breakdown is an issue of debate. Some believe that a stressed hair follicle environment triggers antigen presentation, while others blame a dysregulation in the central immune system entangling the follicles. Evidence for the latter theory is provided by animal studies, as well investigations around the AIRE gene.

Different immune‐cell lines including plasmacytoid dendritic cells, natural killer cells and T cells, along with key molecules such as interferon‐γ, interleukin‐15, MICA and NKG2D, have been identified as contributing to the autoimmune process.


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