Dermatitis Cruris Pustulosa et Atrophicans: Scarring Alopecia Beyond Scalp Hair.

Dermatitis Cruris Pustulosa et Atrophicans (DCPA) was first described in 1952 in Nigeria and is nowadays regarded as a type of chronic folliculitis of tropical areas. It is often limited to the lower limbs of young adults, mostly in the second to third decades, with a unique clinical picture characterized by chronicity, relentless progression, therapy refractoriness, and permanent cicatricial changes. Trauma, occlusion, and microorganism selection contribute for its etiopathogenesis, which is deemed multifactorial but still incompletely understood. Despite its conspicuous clinical features, awareness of DCPA is apparently low, hence probably overlooked. We herein summarize the current state of knowledge regarding this distinct entity, and further present the first report in a patient from Bangladesh, and concurrently the first in Europe. Paucity of data, and unraveled definite etiology and treatment, highlight the need for further studies.

Intermammary Hidradenitis Suppurativa: Considerations on a Unique Presentation.

INTRODUCTION: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. CASE PRESENTATION: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. DISCUSSION/CONCLUSION: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

Monotonous Broom Hairs: A Feature of Trichoteiromania.

Trichoteiromania is a self-inflicted traumatic hair injury, with breaking of the hair shafts resulting from repetitive rubbing of the scalp. We describe a patient with trichoteiromania presenting with one lichenified pruriginous plaque on the scalp, associated with fracture and loss of hair shafts giving the conspicuous appearance of monotonous clusters of broom hairs under trichoscopy, which pointed to the diagnosis. As trichoteiromania can be considered a psychodermatological condition, patient education and a behavioral approach are of paramount importance in the management and prognosis of this disorder.

Neutrophils in Nail Clipping Histology: A Retrospective Review of 112 Cases.

BACKGROUND: Nail clipping histology is more sensitive than mycology for detecting nail fungi. However, in the absence of fungi, established diagnostic clues for this and other nail dystrophy causes are lacking, namely for nail psoriasis. Neutrophils have been reported in onychomycosis and nail psoriasis samples but have been insufficiently characterized. OBJECTIVES: The aim of this paper is to differentiate neutrophil-containing nail clipping samples in nail psoriasis and onychomycosis regarding histology. METHODS: We performed a 3-year retrospective review of all nail clipping test results included in our department's database and re-analyzed samples containing neutrophils. RESULTS: In total,112 neutrophil-containing nail clipping samples were accounted. Onychomycosis was the commonest diagnosis (74.1%), followed by nail psoriasis (18.8%). Onychomycosis samples had more abundant neutrophils, more often arranged in collections (60.2%) (p = 0.002) and with smaller quantities of parakeratosis, in a lamellar distribution. In nail psoriasis, neutrophils were mostly aggregated (57.1%) with parakeratosis in all samples, in increased amounts, and showing no predominant pattern. CONCLUSIONS: Neutrophils are present in both nail psoriasis and onychomycosis, warranting careful interpretation. However, less dense aggregates of neutrophils with more abundant parakeratosis are clues of nail psoriasis when all other fungal tests are negative.

Subungual Solitary Angiokeratoma Simulating a Squamous Cell Carcinoma.

Subungual angiokeratoma is extremely rare. Only 1 case is reported in the literature, presenting as a longitudinal pigmented band on a toenail. We report a case of a subungual angiokeratoma on a fingernail of a 43-year-old woman, clinically mimicking a squamous cell carcinoma. Medical imaging revealed a soft tissue tumor and erosion of the distal phalanx. Although extremely rare, solitary angiokeratomas may arise in the nail apparatus and should be added to the differential diagnosis of subungual warty tumors.

Toenail Changes in Patients with Diabetes Mellitus with and Without Onychomycosis.

BACKGROUND: Diabetes mellitus is a predisposing factor for onychomycosis (OM). A high frequency of nonfungal onychodystrophy (OD) is also alleged, although information on the prevalence of specific nail changes is scant. We evaluated the prevalence and types of nail changes in a cohort of diabetic patients with fungal and nonfungal OD. METHODS: During a 6-month period, inpatients with diabetes mellitus were screened for foot and toenail changes. Demographic, social, and clinical data were recorded, as was information concerning foot and toenail care. Fungal infection was confirmed by mycologic examination and by histologic analysis of nail clippings. RESULTS: Of the 82 patients included, 65 (79.3%) had nail changes, and 34 of these 65 patients (52.3%) were diagnosed as having OM. The most frequently observed nail signs were subungual hyperkeratosis, onycholysis, yellow discoloration, and splinter hemorrhages, each seen in more than 25% of the patients. Tinea pedis and superficial pseudoleukonychia were observed more frequently in the OM group (P < .05). Conversely, prominent metatarsal heads and history of nail trauma were more frequent in patients with nonfungal OD (P < .05). CONCLUSIONS: Physicians who care for diabetic patients should not ignore nail changes. Fungal and nonfungal OD are common and should be addressed in the global evaluation of the feet to help prevent breaks in the skin barrier and subsequent bacterial infections and ulcers.