JAAD

Clinical Pearl

Hair cross-sectioning in uncombable hair syndrome: An easy tool for

complex diagnosis

Vincenzo Piccolo, MD,Antonietta Cirocco, MD, Teresa Russo, MD,

Bianca Maria Piraccini, MD, PhD, Michela Starace, MD, PhD, Andrea Ronchi, MD, and Giuseppe Argenziano, MD, PhD

The authors propose the atraumatic and noninvasive hair shaft cutting with subsequent histopathologic examination of the hair cross section to diagnose Uncombable Hair Syndrome (UHS). This technique can show the characteristic longitudinal grooves in the hair shaft as well as the triangulated appearance that is diagnostic of this condition. It is cost-effective, easy, and noninvasive.

JEADV

Review Article

Mohs micrographic surgery for nail unit tumours: an update

and a critical review of the literature

M. Lambertini,* B.M. Piraccini, P.A. Fanti, E. Dika

This article provides a review of the current literature on the use of Mohs micrographic surgery (MMS) to treat malignant neoplasms such as Bowen’s disease, squamous cell carcinoma, melanoma, basal cell carcinoma, keratoacanthoma, carcinoma cuniculatum and benign neoplasms such as onychomatricoma and glomus tumour.

Over all, there is a lack of case–control studies that confront the outcome of MMS versus other surgical techniques for the treatment of nail tumours. Most of the reports refer to single centre experiences that describe their results. By reviewing the current literature and from the authors own experience, MMS represents a successful surgical option for nail tumours in the term of tissue conservation, preserving the nail unit functionality with clearing of malignant tumours. The authors believe that MMS is a valid technique for the treatment of nail SCC, especially for cases where there is no radiographic evidence of bone invasion. In regards to Bowen’s disease (BD) and keratoacanthoma (KA), if applicable the treatment with MMS can be considered at the first approach. The recurrences of both tumours are better treated with conventional surgery. For benign tumours such as glomus tumor and onychomatrichoma, MMS can reduce the risk of recurrences, avoiding annoying symptomatology for the patients.

In the authors experience, the conservative approach with functional surgery involving the excision of the whole nail unit is a good option for the treatment of non-invasive nail unit melanoma (Mis, stage Ia) to prevent possible recurrences and metastasis.

JEADV

Original Article

Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease

 P. Moya Alvarado, E.Roe Crespo, F.Z. Munoz-Garza, A. Lopez-Ferrer, A. Laiz Alonso, E. Vilarrassa Rull, J. Casademont i Pou, L. Puig Sanz

The aim of this prospective study is to describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO (psoarisis) and asymptomatic PsA (psoriatic arthritis). Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand.

Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368).

The authors conclude that enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints more frequently than has been described. Likewise, there is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations, both clinical and ultrasonographic. Patients with subclinical enthesopathy present a larger thickening of the proximal structures of the nail apparatus. The authors suggest further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

JEADV

Original Article

Alitretinoin can be a good treatment option for idiopathic recalcitrant trachyonychia in adults: an open-label study

K. Shin, T.-W. Kim, S.-M. Park, H.-J. Lee, H. Jin, H.-S. You, W.-H. Shim, G.-W. Kim, H.-S. Kim, H.-C. Ko, B.-S. Kim, M.-B. Kim

This study evaluates the efficacy and safety of oral alitretinoin for idiopathic recalcitrant trachyonychia. A total of 21 adult patients with 210 nails affected by idiopathic recalcitrant trachyonychia were evaluated in this open-label prospective study. All patients took 30 mg of alitretinoin daily for at least 3 months. Clinical outcomes were assessed using the Physician Global Assessment (PGA) scale (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at baseline and 1, 3 and 6 months after treatment. After 1, 3 and 6 months of treatment, 74.3% (123/210), 98.1% (206/210) and 99.2% (119/120) of nails showed clinical improvement, respectively; 0% (0/210), 22.9% (48/210) and 69.2% (83/120) were completely free from nail abnormalities. The mean PGA score at baseline was 3.4, decreasing significantly to 2.7, 1.3 and 0.7 at 1, 3 and 6 months following treatment, respectively. Headache was reported by 28.6% (6/21) of patients, leading to withdrawal in 9.5% (2/21). Flushing and dry eyes were reported by 9.5% (2/21) and 4.8% (1/21), respectively. No serious adverse events were reported.

The study is limited by a small number of participants and lack of a control group. This is the first study which evaluates the efficacy and safety of oral alitretinoin for the treatment of idiopathic recalcitrant trachyonychia. The results suggest that oral alitretinoin can be a good treatment option for adult patients with recalcitrant trachyonychia.

The authors suggest a comparative, randomized, placebo controlled study with a larger number of patients is needed to confirm the effectiveness of oral alitretinoin for idiopathic trachyonychia.

JEADV

Short Report

Serum androgens and prostate-specific antigen levels in androgenetic alopecia: is there a difference between frontal and vertex baldness?

A. Lis-Swiezty,* H. Arasiewicz, I. Ranosz-Janicka, L. Brzezinska-Wcisło

The authors’ objective was to investigate potential pathophysiological differences between frontal and vertex balding that might have the impact on the incidence of prostate carcinoma (PCa). Serum concentrations of testosterone (T), dihydrotestosterone (DHT) and prostate-specific antigen (PSA) were measured in 88 subjects with androgenetic alopecia (AGA), sixty patients with frontal baldness and 28 patients with vertex baldness. The subgroups did not differ significantly in age, BMI and as regards age of AGA onset, duration of AGA and co morbidities. The mean value of DHT in serum of the men with vertex baldness was higher than those in the men with frontal baldness with statistical significance (P < 0.05). The groups did not show significant differences in mean value of serum T and PSA levels, and DHT/T ratio. No correlation was found between the serum PSA level and serum androgen levels as well as DHT/T ratio. The authors concluded vertex baldness may signal higher exposures to circulating DHT and serum PSA level cannot serve as surrogate diagnostic marker of increased androgenic activity in men with AGA. They feel the ability to observe significant results might have been limited by small sample size.

BJD

Research Letter

Perinevoid alopecia: a case report and literature review

Hiromi Kimura, Kotaro Nagase, Yutaka Narisawa

The authors describe development of alopecia around a pigmented nevus on the scalp of a 22 year old patient. Histology showed dense inflammatory infiltrate composed of lymphocytes around the nevus, hair bulb and inside of the hair matrix. The authors postulated that the immune cells around the naevi led to an attack on the peripheral hair follicles similar to autoimmune destruction of melanocytes in a halo nevus. Complete hair regrowth was seen within 2 months after the whole naevi were excised. Co-existence of AA with a nevus is very rare; only 24 cases from 19 studies had been identified in literature.

CED

Original article

A pilot split‐scalp study of combined fractional radiofrequency microneedling and 5% topical minoxidil in treating male pattern hair loss

A.‐J. Yu, Y.‐J. Luo, X.‐G. Xu, L.‐L. Bao, T. Tian, Z.‐X. Li, Y.‐X. Dong, Y.‐H. Li

This is a randomized, controlled, split-scalp trial to evaluate the efficacy and safety of combined fractional radiofrequency microneedling (FRM) and 5% topical minoxidil in the treatment of male pattern hair loss. 19 Chinese men were enrolled in this trial and received monotherapy with 5% topical minoxidil twice daily to one half of the scalp, while on the other half of the scalp the treatment with twice-daily 5% topical minoxidil was combined with five sessions of FRM at 4-week intervals. Mean hair count and hair thickness, global assessment by the investigators, subject self-assessment and adverse effects were assessed. After 5 months of treatment, mean hair count increased from 44.12 ± 21.58 to 73.14 ± 25.45 on the combined-therapy side and from 46.22 ± 18.77 to 63.21 ± 19.22 on the monotherapy side, while mean hair thickness increased from 53 ± 13 µm to 71 ± 15 µm and from 52 ± 16 µm to 66 ± 14 µm, respectively. Compared with the monotherapy side, the combined therapy side had a higher degree of improvement in both hair count (P = 0.01) and hair thickness (P = 0.02). No serious AEs were encountered during the treatment term. Well tolerated pain (average pain score of 3.63 ± 1.38), transient pinpoint bleeding and mild erythema which resolved within 24 h were observed during the FRM treatment. Eight patients reported dandruff on the drug-applied area of the scalp.

The authors concluded combined treatment with fractional radiofrequency microneedle and 5% topical minoxidil could be an effective and safe treatment option for male pattern hair loss.