Dermatology Reports

Comparison between dutasteride and finasteride in hair regrowth and reversal of miniaturization in male and female androgenetic alopecia: a systematic review

Almuntsrbellah Almudimeegh — 2024-04-12

Nowadays androgenetic alopecia (AGA) has become a common concern of affected subjects of both sexes. Finasteride is approved by the Food and Drug Administration for the treatment of male AGA. There is no clear evidence to support the use of dutasteride in male AGA. In female AGA, the effectiveness of dutasteride and finasteride is still under debate, and there is no clear evidence to use any of them in female AGA. A systematic review was conducted to compare dutasteride and finasteride in treating both male and female AGA and their efficacy, safety, and side effects with effective dosage. The review was done using several databases including: PubMed, Ovid Medline, Google Scholar, and Cochrane, using the following search terms/key words: “Dutasteride”, “Finasteride”, “Male pattern hair loss”, “Female pattern hair loss”, “Efficacy”, “Tolerability”, “Side effects”, and “Comparison”. Articles related to the efficacy, tolerability, and side effects of dutasteride and finasteride in the treatment of male and female AGA were specifically sought, considering the doses used for each medication. The review encompassed a total of nine studies. Four randomized controlled trials, one single-arm trial, two prospective cohorts, and two retrospective cohort studies. Seven studies exclusively enrolled male participants, while only two included female participants. All groups receiving various doses of dutasteride and finasteride exhibited a significant increase in hair count compared to the placebo group. Notably, dutasteride (0.5 mg) and dutasteride (2.5 mg) were significantly more effective than finasteride (1 mg) in increasing hair counts. Furthermore, no significant difference in adverse events was observed between finasteride and dutasteride. Dutasteride is more potent than finasteride in treating AGA in both males and females. All the adverse events between finasteride and dutasteride were comparable.

Isotretinoin musculoskeletal side effects: a systematic review

Rahaf R. Almutairi — 2024-04-12

This study aimed to investigate musculoskeletal complications secondary to isotretinoin use. A systematic review was conducted, and a total of 49 studies, including analytical studies, case reports, and case series, were included in the analysis. The studies examined musculoskeletal symptoms, diagnostic findings, and treatment approaches associated with isotretinoin use. Musculoskeletal symptoms reported in the studies included lethargy, myalgia, low back pain, arthralgia, tendinopathy, and sacroiliitis. Physical examination findings and radiological findings were used to confirm the diagnoses. Treatment approaches ranged from [non-steroidal anti-inflammatory drugs (NSAIDs)] to discontinuation of isotretinoin. Some studies have explored the impact of isotretinoin dosage, treatment duration, and vitamin levels on musculoskeletal symptoms. Isotretinoin-induced sacroiliitis and [diffuse idiopathic skeletal hyperostosis (DISH)] emerged as notable musculoskeletal complications. The findings highlight the importance of monitoring patients for potential musculoskeletal side effects and implementing appropriate interventions.

CD4/CD8 double-negative mycosis fungoides: a review

Khalid Nabil Nagshabandi — 2024-04-12

Mycosis fungoides (MF) stands as the predominant form of primary cutaneous T-cell lymphoma (CTCL). It manifests a diverse array of clinical, histological, and immunophenotypic variations, each bearing distinct prognostic implications. The typical immunophenotypic profile of mycosis fungoides involves CD3+/CD4+/CD45RO+ memory T cells. Notably, the CD4- /CD8- double-negative variant of MF is a rare occurrence, observed in approximately 12% of early-stage cases and more prevalent in tumor-stage instances, often correlated with atypical clinical presentations. Despite its rarity, scant information is available about double-negative mycosis fungoides, with only a limited number of cases documented in the existing literature. This review aims to provide enhanced clarity, comprehension, and a detailed exploration of the spectrum encompassing double-negative mycosis fungoides.

XXX Italian Melanoma Intergroup National Congress | 27-29 September 2024, Rimini, Italy

Italian Melanoma Intergroup (IMI) — 2024-12-18

Abstracts from the Italian Melanoma Intergroup (IMI) XXX National Congress

A study on tumor necrosis factor-α single nucleotide polymorphisms and psoriasis vulgaris in Vietnam

Vinh Ngo Minh — 2024-04-12

This study aims to evaluate the association between tumor necrosis factor-α (TNF–α) single nucleotide polymorphisms and psoriasis vulgaris. This cross-sectional study involved 140 Vietnamese patients of Kinh ethnicity diagnosed with psoriasis vulgaris. The diagnosis of psoriasis vulgaris was based on clinical signs and symptoms. We used Sanger sequencing to analyze two single nucleotide polymorphisms (SNPs), rs1799964 and rs1799724. Data were analyzed by SPSS 25. SNP rs1799964 has the highest rate of TT genotype at 62.1%, more than double the heterozygous TC genotype at 30%, CC genotype has the lowest rate at 7.9%. CC genotype of SNP rs1799724 accounted for 90%, and no homozygous genotype TT was detected. No statistically significant association was found between both SNPs and clinical features (p>0.05). The Psoriasis Area and Severity Index (PASI) was significantly lower in patients with variant alleles (p=0.021). Our data show a significant negative association between SNP variant alleles and the disease’s severity. Studies with larger sample sizes and more biochemical indices may help identify reliably predictive markers for these SNPs.

Association between lifestyle and skin moisturizing function in community-dwelling older adults

Ryosuke Oizumi — 2024-04-05

The skin’s moisturizing function declines with age, resulting in skin dryness in around 40% of older people. Various lifestyle habits may affect the skin moisturizing function, however it is not clear which ones are particularly relevant. A cross-sectional study was conducted between September and December 2023, involving individuals aged 65 years and over. Self-administered questionnaires were employed to collect information on lifestyle habits. Stratum corneum hydration (SC hydration), as an indicator of skin hydration, was measured and analyzed using multiple regression. A total of 124 individuals participated in the study, with a mean age of 83.6 years. Daily use of moisturizer (p=0.024) and exercise level (p=0.002) demonstrated significant associations with increased SC hydration. Although not statistically significant, smoking exhibited a trend towards decreased SC hydration (p=0.173). The findings of this study suggest that, among various lifestyle habits, exercise and daily moisturizing contribute to enhanced SC hydration. These results indicate that lifestyle modifications may improve the skin moisturizing function of the elderly.

A case of Kennedy terminal ulcer in a 17th-century Italian mummy

Mirko Traversari — 2024-04-23

Giacomo Torno was born in 1539 (or 1541) in Naples. At the age of 18 he joined the Clerics Regular Theatines in San Paolo Maggiore and was welcomed on 30 October 1558. He suffered a stroke on 4 December 1608 and died 45 days later. Contemporary sources report that he appeared to be tormented by the devil during his illness, suffering from constant spasms in his arm, which caused him great discomfort. During the analysis of his mummified body, a discontinuity of the skin surface at the level of the sacrum was discovered. All morphological features indicate a wound that developed during the subject’s life. Based on historical sources, the fracture of the first coccygeal vertebra, the appearance of the lesion near death, and the shape of the lesion, suggest that this is the first recorded instance of the Kennedy terminal ulcer, identified through both direct and indirect sources.

Underrepresentation of atopic dermatitis publications in pediatric journals: a bibliometric analysis

Barak Zlakishvili — 2024-04-12

Extensive research has been published on atopic dermatitis (AD), a prevalent skin condition among pediatricians. To assess the pediatric representation in the most cited literature on AD, using bibliometric analysis. Web of Science citation indexing database was used to identify publications with “atopic” and “dermatitis” or “eczema” in their title. Results were ranked by their Annual citation (AC) and refined to the top 100 most cited articles in the non-refined pediatric category and the top five journals in the categories of general medicine, dermatology, and pediatrics, by impact factor. 28,360 publications were retrieved. The metrics were significantly higher in dermatology, compared to pediatric and general categories [(R_TC=0.899, p<.001), (R_AC=0.795, p<.001), (R_usage _count=0.639, p<.001)] and [(R_TC=0.417, p<.001), (R_AC=0.392, p<.001), (R_{usage count}=0.279, p<.001)]. This analysis is the first to highlight the underrepresentation of AD publications in the pediatric literature, which might impact the clinicians’ and patients’ level of care and AD annual societal expenditure.

The impact of COVID-19 pandemic on dermatology patients with rare skin diseases

Migena Vargu — 2024-02-02

The COVID-19 pandemic has caused a global health crisis, presenting novel challenges while worsening preexisting difficulties for individuals with rare diseases. Internationally, they have experienced disruptions in their medical care, with a lack of access to essential treatments and diagnostics. We focused on the specific challenges faced by individuals living with rare skin diseases in Albania, a country with limited healthcare infrastructure. The pandemic led to a significant decrease in our service, resulting in an 87.1% reduction in patients hospitalized in 2020 compared to 2019. Notable gender and age disparities were observed in hospitalizations, with a shift towards more male patients and a decline in younger age groups seeking medical attention. Innovative approaches such as telemedicine helped maintain care for this vulnerable patient population. Further research is required to understand the long-term impacts of the pandemic on individuals with rare skin diseases and develop strategies for their care in future emergencies.

A comprehensive evaluation of safety and awareness in eyebrow microblading: a cross-sectional study

Yahya Argobi — 2024-04-23

The importance of eyebrows in facial aesthetics has long been recognized, and eyebrows restoration is carried out by carefully depositing pigments into the epidermis. This cosmetic procedure is known as microblading, and it is very popular because of the progress made on social media platforms. This study was designed to determine the awareness of eyebrow microblading, complication and laser removal in general population of Saudi Arabia. This was a cross-sectional study conducted in four different regions in Saudi Arabia (Asir, Qasim, Jawf, and Eastern province), from June 2023 to December 2023. Only females were included, and an online questionnaire was distributed. A convenient non-probability sampling method was adopted to gather data from participants. Data analysis was performed using SPSS version 21. A total of 705 participants were included in the study, with the majority, 281 (39.9%), falling into the age group >35 years, and the mean age was 29.1±11.9 years. The study revealed a moderate level of awareness (65%) among participants regarding eyebrow microblading. However, alarming gaps regarding hygiene practices in microblading setups still exist. Notably, facing complications during the surgery was identified as a statistically significant factor associated with a higher level of awareness (p=0.049). Of the participants, 17.4% had undergone eyebrow microblading with friends being the source of advice for 39.5% of them. More than 60% of microblading recipients chose laser removal, and varying degrees of pleasure and satisfaction were reported. Eyebrow microblading is a successful cosmetic procedure with aesthetic advantages. However, this study also emphasizes the necessity for extensive public education regarding microblading, including its associated risks, restrictions, and appropriate practices. Stringent laws and licensing for certified professionals are also deemed essential to ensure safe and ethical practices.

Treatment satisfaction among patients with psoriasis in Saudi Arabia

Mahdi Aldhafiri — 2024-04-15

Psoriasis, affecting 2% of the population, burdens individuals physically and emotionally, with adherence challenges (39-73%). Treatment ranges from topical to systemic therapy, including biologics. Although biologic therapy improves clinical outcomes, side effects lead 50% of severe cases to prefer topical treatment. This study evaluates patient satisfaction in Saudi Arabia with various psoriasis treatments, offering insights and addressing the crucial aspect of satisfaction in management. This cross-sectional study, using an electronic questionnaire aligned with prior research, included Saudi adults with psoriasis undergoing topical, biological, or phototherapy treatment. Exclusions encompass non-treatment recipients and participants outside Saudi Arabia. A total of 314 psoriasis patients receiving treatment were included, the most reported type being plaque psoriasis. The most reported sites of psoriasis included scalp. 70.1% of the patients received topical treatment, 36.3% received systematic treatment, and 18.2% used phototherapy. The participants showed an intermediate satisfaction level, the highest for systematic treatments followed by phototherapy and the lowest for topical treatments. Male gender, plaque psoriasis, and lack of disease follow-up were associated with poor satisfaction levels.

A case of symmetrical subepidermal calcified nodules on the eyelids

Yoko Shimada — 2024-04-15

Dear Editor, Subepidermal calcified nodules (SCNs) are typically asymptomatic, solitary, and idiopathic cutaneous calcinosis. We report a case with two SCNs with a symmetrical distribution, where a single nodule was located on the medial aspect of each of the bilateral upper eyelids in a teenage male. [...]

Dermoscopy of Riehl’s melanosis: a case report and a short review of the literature

Benedetta Sonego — 2024-07-04

Riehl’s melanosis (RM) is a pigmentary disorder more common in individuals with dark skin phototypes. It is considered a form of pigmented contact dermatitis. In this paper, we present a case of RM due to the rubber component of a work facial mask, in which dermoscopy and patch test were the most important tools to help physicians diagnose. In addition, we reviewed the main dermoscopic clues that may be useful in differential diagnosis with other facial pigmentary disorders.

Stevens-Johnson induced by imiquimod 5% cream: a case report

Ilaria Trave — 2024-04-19

Imiquimod 5% cream is an approved treatment for actinic keratoses, superficial basal cell carcinomas, and anogenital warts. Severe systemic side effects associated with imiquimod 5% cream are rare, although a few cases of erythema multiforme and Stevens-Johnson syndrome have been described. We present a case of Stevens-Johnson syndrome associated with topical treatment with imiquimod of two superficial basal cell carcinomas.

Toxic epidermal necrolysis induced by COVID-19

Duaa Alahmadi — 2024-01-30

Toxic epidermal necrolysis (TEN) is a life-threatening acute mucocutaneous syndrome. It is characterized by keratinocyte necrosis and apoptosis, which affect more than 30% of the body’s surface. TEN is most commonly due to an altered immunological response to specific drugs, infections, and malignancies, or it can be idiopathic. The combination of TEN and COVID-19 can have a fatal outcome if not recognized and promptly treated. Therefore, fast reporting of such cases will draw doctors’ attention to quick and right intervention. In this article, we present a 66-year-old patient with a clinical presentation of toxic epidermal necrolysis along with a coexisting COVID-19 infection. To our knowledge, this is the first case of TEN in a patient diagnosed with SARS-CoV-2 infection in Saudi Arabia.

Neutrophilic urticarial dermatosis without systemic disease: case report

Sukaina Al Haddad — 2024-01-30

Neutrophilic urticarial dermatosis (NUD) is an uncommon and not well-understood disease. We report a 24-year-old female with the persistent presence of pruritic and painful urticarial plaques unresponsive to conventional treatment. Histopathologically, it demonstrates a perivascular and interstitial neutrophilic infiltrate with leukocytoclasia without evidence of vasculitis or dermal edema consistent with neutrophilic urticarial dermatosis. Further investigations to rule out underlying autoimmune, autoinflammatory and genetic systemic disease were negative. Furthermore, the cutaneous eruption was resistant to multiple therapeutic interventions, including colchicine and dapsone treatment, and showed a significant response to treatment with anakinra, interleukin-1 receptor antagonist. Based on literature review, the case reported here is the second case with clinical and pathologic features of NUD without systemic disease and the first case of NUD that showed resistance to colchicine and dapsone treatment, with adequate response to anakinra.

Exploring the connection between hidradenitis suppurativa and erythema nodosum: a case report

Mitchell Hanson — 2024-02-08

Erythema nodosum (EN) is inflammation of subcutaneous fat. Etiologies include autoimmune diseases, drugs, infections, pregnancy, malignancy, and idiopathic origins. A 37-year-old female with a history of recurrent cellulitis and type II diabetes presented with worsening swollen lumps on upper extremities for four months during a Hurley Stage III hidradenitis suppurativa (HS) flare. Exam revealed multiple erythematous pustules and warm indurated nodules over diffuse edema on the upper extremities. Lesions were refractory to trimethoprim/sulfamethoxazole, cefalexin, clindamycin, and levofloxacin. Routine blood labs, ESR, and ANA were unremarkable. EN was diagnosed. Trimethoprim/sulfamethoxazole, saturated solution potassium iodide (SSKI), and ibuprofen were prescribed. At the three-week follow-up, EN completely resolved the issue except for one lesion. Literature review revealed one case of EN manifestation in association with HS but was complicated by Beçhet’s syndrome. We propose HS as an underlying cause of EN and SSKI an effective treatment for EN and HS.

“Sorting hat” flap as a modification of the classic A-T flap

Giulio Gualdi — 2024-02-07

This article presents a case study of a novel modification of the A-T flap, known as “Sorting Hat” flap, employed in dermatologic surgery for facial reconstruction. In the treatment of an 89-year-old male’s squamous cell carcinoma lesion on the forehead, the “Sorting Hat” flap, introduced as an innovative alternative, eliminates the need for Burrow triangles and relies on flap shape for inconspicuous scarring and favorable cosmetic outcomes.

Chronic mucocutaneous candidiasis due to signal transducer and activator of transcription 1 mutation in a Saudi patient: a case report

Abdullah Alakeel — 2024-07-03

Chronic mucocutaneous candidiasis (CMC) is a primary immunodeficiency condition caused by a genetic abnormality that increases the risk of recurrent and persistent skin, nail, and mucous membrane infections with Candida species, typically Candida albicans. Signal transducer and activator of transcription 1 (STAT1) gene mutation is a genetic trigger that causes CMC, which increases the risk of infections, multisystem disorders, and cancer susceptibility. We describe the first case of a Saudi female patient with clinical features of CMC with an underlying (STAT1) gene mutation.

Rubella virus vaccine-induced granulomas: a case in children with ataxia-telangiectasia

Florine Le Lay — 2024-04-11

Ataxia telangiectasia (AT) is a rare autosomal recessive primary immunodeficiency disorder (PID) resulting from a mutation in the ATM gene involved in DNA repair. We describe the case of a young girl with cutaneous granulomas that developed after childhood vaccinations. Immunohistochemistry revealed granulomas induced by the rubella virus vaccine. This finding raises the question of the safety of live rubella vaccine strains in immunocompromised children.

Giant clear cell acanthoma: a case report and a review of the literature

Antonio Luca Cucchiara — 2024-04-12

Clear cell acanthoma (CCA) is an uncommon benign epidermal tumor of unknown origin and etiology. It is often solitary, and the presence of multiple CCAs in the same individual is rare. Typically, it presents as a slowly growing plaque or nodule located on the legs with a peripheral scaling collarette. Diagnosis is primarily based on clinical and histopathological findings, with dermoscopy enhancing diagnostic accuracy. The differential diagnosis includes various skin tumors and inflammatory dermatoses. The preferred treatment is surgical excision, as these lesions do not regress spontaneously. We describe a case of a large CCA on the right thigh associated with multiple small nodular lesions scattered across the legs.

Eosinophilic fasciitis and breast cancer: a case report highlighting recurrence signals

Vincenzo Maione — 2024-02-09

Eosinophilic Fasciitis (EF) poses a diagnostic challenge owing to its uncommon occurrence and aetiology that remains poorly understood. We report a case of a 79-year-old woman with a prolonged history of breast cancer exhibiting EF with concomitant pelvic metastases. This case underscores EF's potential as an indicator signaling a potential resurgence of cancer, highlighting its significance as a red flag of disease recurrence.

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder nodule successfully treated with laser Co2 ablation: a case report and literature review

Corrado Zengarini — 2024-02-06

This case report describes an 83-year-old patient with a history of non-melanoma skin cancer who presented with a violaceous, painless nodule on the neck. Dermoscopic examination and subsequent biopsy revealed a Small/Medium CD4+ T-cell lymphoproliferative disorder (SMPLPD) of the skin. Although excision was initially recommended, the patient opted for treatment with CO2 laser ablation. The procedure had some minor complications but resulted in successful healing. SMPLPDs are a rare skin condition with limited treatment data, and this case suggests that CO2 laser ablation with minimal margins could be a viable alternative for selected patients, reducing bleeding and promoting second-intention healing for small nodules. However, more extensive follow-up data for SMPLPD cases are needed to understand long-term outcomes better.

Resolution of paraneoplastic palmoplantar keratoderma after treating mixed serous neuroendocrine tumor of the pancreas: a case report and literature review

Hend M. Alotaibi — 2024-02-06

Palmoplantar keratodermas (PPKs), also known as ‘keratosis palmaris et plantaris’, are a heterogeneous group of disorders characterized by abnormal thickening of the epidermal skin of the palms and soles leading to hyperkeratosis. It could be acquired or hereditary. Acquired PPK often occurs as a paraneoplastic syndrome as well as a stigma of other dermatoses. We report a rare case of paraneoplastic PPK secondary to mixed neuroendocrine tumor of the pancreas with complete remission after surgical excision of the cancer.

Suspect dyskeratotic neoformations in a 7-year-old child with keratitis-ichthyosis-deafness syndrome: diagnostic, surgical and wound care management

Alvise Montanari — 2024-04-16

Keratitis-ichthyosis-deafness syndrome (KID) is a rare genetic disorder characterized by the triad of hyperkeratosis, ichthyosis, and congenital prelingual sensorineural deafness, with less than 100 cases described in the literature. In addition to many other extra-cutaneous manifestations, these patients are burdened by two principal increased risk factors involving the skin: the risk of developing infections and the risk of developing malignant skin tumors, especially Squamous Cell Carcinoma and Trichilemmal tumors. We present the case of a 7-year-old girl with a unique genetic variant described to date, who developed four dyskeratotic neoformations. Since the dermatoscopic examination was not sufficient to exclude malignancy, excisional and punch biopsies were used. Nonetheless, healing was challenging, with wound dehiscence and infection onset. Ad hoc wound care management resorting to negative pressure therapy and advanced medical honey-based dressings was necessary to achieve complete wound healing.