Wickham striae on skin appendages: a helpful dermoscopic feature.

Lichen planus (LP) is a chronic inflammatory disease, clinically characterized by purpuric, itchy papules that typically spread on the trunk and extremities. Other body sites can also be affected, including mucosal membranes, nails, and the scalp. The use of dermoscopy is essential in determining the diagnosis of LP, as it may highlight pathognomonic features such as Wickham striae (WS). WS are thin, pearly white structures arranged in a reticular pattern that is observed over LP lesions and histologically correspond to epidermal hypergranulosis. WS is usually most visible on the oral mucosa but can also cover almost every active LP papule. Here, we report two cases of biopsy-proven LP that show WS on dermoscopy in two specific sites: the scalp and proximal nail fold.

White hair in alopecia areata: Clinical forms and proposed physiopathologic mechanisms.

Alopecia areata (AA) is a common form of nonscarring hair loss. It is believed to be a consequence of an immune-mediated stimulus, probably involving autoreactive T cells against antigens present in the hair follicle. The exact antigen is still unknown; however, some authors have proposed that melanogenesis-associated molecules might trigger autoimmunity. Although transient white hair regrowth is a common and well-known situation in AA, there are other types of white hair phenomena in this context, including permanent white hair regrowth, sparing of white hair in a patchy pattern, or sparing in a diffuse pattern, giving the appearance of the so-called overnight graying phenomena or canitis subita. In this review, we aim to describe the different clinical aspects of white hair in AA, as well as the proposed pathophysiologic mechanisms involved in this phenomena.

Dermoscopic Findings of Discoid Lupus Erythematosus Involving the Eyelids.

Introduction: Although facial involvement in discoid lupus erythematosus (DLE) is common, eyelid involvement is atypical. Identifying this condition is challenging due to misdiagnosis, and it is essential to avoid potential deformities of the eyelid margin. Case Presentation: We, herein, report the dermoscopic findings in 2 female patients with a confirmed diagnosis of DLE who presented eyelids involvement. Discussion/Conclusion: This study highlights the importance of performing a dermoscopy examination to help physicians obtain an early diagnosis of DLE.

Trichotillomania Incognito: Two Case Reports and Literature Review.

Trichotillomania is a compulsive disorder characterized by repetitive hairpulling. It is an important cause of patchy alopecia, especially in children between 9 and 13 years of age. The aim of this paper is to report 2 pediatric cases presenting with trichotillomania without patches. This condition may be extremely distressful, impacting psychosocial development of children. In these case reports, we reinforce the relevance of trichoscopy in hair disorder evaluation, which allowed early recognition to better advise and conduct these unique pediatric cases.

Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients.

BACKGROUND: The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. OBJECTIVE: To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. METHODS: Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. RESULTS: A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. LIMITATIONS: Retrospective design and lack of a control group. CONCLUSION: LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.

Trichoscopy findings of frontal fibrosing alopecia on the eyebrows: A study of 151 cases.

BACKGROUND: Eyebrow loss (madarosis) is a frequent sign of frontal fibrosing alopecia (FFA), and it can be the first sign of the disease. OBJECTIVE: To describe trichoscopy findings of FFA on the eyebrows. METHODS: The analysis included 151 women with histologically proven diagnosis of FFA and eyebrow loss. Trichoscopy of the eyebrow area was performed with either a FotoFinder videodermatoscope or handheld dermoscope DermLite II pro. RESULTS: The most frequent signs on trichoscopy were yellow dots (92.7%), multiple pinpoint dots (79.5%), short thin hairs/vellus (76.2%), black dots (66.2%), and dystrophic hairs (60.9%). Tapering hairs were found in 21 (13.9%) patients and dystrophic hairs in 92 (60.9%) patients. LIMITATIONS: Inner limitations of a case series (there was no comparison with healthy control individuals or patients with other hair disorders) and lack of histologic correlation to the trichoscopy findings. CONCLUSIONS: Although FFA is a scarring alopecia, the most common trichoscopy signs found in the eyebrows are usually related to noncicatricial alopecia. Therefore, in most cases, trichoscopy of the eyebrows does not resemble the trichoscopy of FFA on the scalp. Black dots, dystrophic hairs, and broken hairs are frequent signs. Occasionally, tapered hairs can be present on the eyebrows in FFA, leading to misdiagnosis of alopecia areata.

Efficacy and Tolerability of a Shampoo Containing Broad-Spectrum Cannabidiol in the Treatment of Scalp Inflammation in Patients with Mild to Moderate Scalp Psoriasis or Seborrheic Dermatitis.

INTRODUCTION: Scalp inflammation is commonly associated with scalp psoriasis or seborrheic dermatitis. It can aggravate the progression of androgenetic alopecia and cause troublesome itching and burning. Here, we evaluate the efficacy of a shampoo containing 0.075% broad-spectrum cannabidiol in 50 subjects with mild to moderate scalp psoriasis or seborrheic dermatitis. METHODS: Inflammation was assessed by evaluating the density of twisted/glomerular or arborizing vessels by trichoscopy using a 6-point scale at baseline and day 14. Symptoms of itching/burning sensation, clinical evaluation of erythema/scaling, overall tolerability, and subject satisfaction were evaluated using 10-point scales. RESULTS: There were significant reductions in arborizing vessel/twisted capillary inflammation and scaling by day 14. Severity scores reduced from 2.3 ± 0.1, 2.6 ± 0.1, and 3.6 ± 0.1, respectively, to 0.5 ± 0.05, 0.8 ± 0.05, and 0.6 ± 0.05 (all p < 0.0001). Symptom scores of itching and burning also reduced significantly from 6.9 ± 0.1 to 4.5 ± 0.1 to 1.5 ± 0.05 and 1.0 ± 0.05 (both p < 0.0001). Severity of erythema and scaling was also significantly reduced from 5.5 ± 0.1 and 7.0 ± 0.1, respectively, to 1.3 ± 0.05 and 1.6 ± 0.05 (both p < 0.0001). Tolerability and subject satisfaction were both excellent. There were no significant differences in treatment effect, tolerability, or subject satisfaction between men and women. DISCUSSION/CONCLUSION: Replacing current shampooing practices with a broad-spectrum cannabidiol-containing shampoo significantly reduces both severity and symptoms of scalp inflammation within 2 weeks, with excellent tolerability and treatment satisfaction in subjects with mild to moderate scalp psoriasis or seborrheic dermatitis.

Contact dermatitis due to masks and respirators during COVID-19 pandemic: What we should know and what we should do.

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID-19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life-threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID-19 outbreak.