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Starace MV, Vezzoni R, Misciali C, La Placa M, Piraccini BM. If You Hear Hoof Beats, Sometimes Think Zebras. Skin Appendage Disord 2022; 8:515-519. [PMID: 36407638 PMCID: PMC9672866 DOI: 10.1159/000525048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2023] Open
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Starace M, Granger C, Carpanese MA, Alessandrini A, Bruni F, Piraccini BM. Review of the literature on the efficacy and safety of a new cosmetic topical treatment containing Pistacia lentiscus and hyaluronic acid for the treatment of nail plate damages. J Cosmet Dermatol 2022; 21:5514-5518. [PMID: 35962760 DOI: 10.1111/jocd.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/20/2022] [Accepted: 08/05/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objective of our study is the review of the literature on the efficacy and safety of a novel water-soluble nail strengthened (WSNS) containing hyaluronic acid and Pistacia lentiscus used for the improvement of nail plate diseases. MATERIALS AND METHODS We conducted literature research on PubMed/MEDLINE to identify all the studies reporting the use of hyaluronic acid and P. lentiscus in the improvements of nail alterations. RESULTS We found two reports and two posters published in the literature, accounting for 96 patients treated with WSNS containing P. lentiscus and hyaluronic acid. The 83 patients were affected by brittle nails and 13 patients by onychomycosis. CONCLUSIONS This review demonstrates that the daily application of this new product containing P. lentiscus and hyaluronic acid can be used as a cosmetic adjuvant for improving common nail diseases such as nail fragility and onychomycosis, with significant results on nail quality and appearance. Patients did not report any adverse events and its ease of application and cosmetic qualities contribute to the great compliance to treatment.
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Abbenante D, Starace MV, Leuzzi M, Chessa MA, Piraccini BM, Neri I. Branching Dilated Vessels: A Possible Trichoscopic Clue for Diagnosis of Erosive Pustular Dermatosis of the Scalp in Children. Skin Appendage Disord 2022; 8:482-485. [PMID: 36407645 PMCID: PMC9672863 DOI: 10.1159/000524650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2023] Open
Abstract
Introduction Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory scalp condition that usually affects the elderly, while only few cases have been reported in childhood. In children, it may mimic fungal or bacterial infections, especially kerion. Case Presentation We describe the usefulness of trichoscopy as a supportive diagnostic tool in 2 cases of pediatric EPDS. Discussion Clinical distinction between EPDS and different types of alopecia in children is difficult, with a significant likelihood of diagnostic errors and delay in therapy. Trichoscopy may provide a noninvasive option that can help avoid invasive diagnostic procedures in children.
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Alessandrini A, Evangelista V, Barisani A, Vaccari S, Dika E, Piraccini BM, Starace M. Recurrent microinvasive subungueal squamous cell carcinoma in an HIV patient: a case of good response to photodynamic therapy. Dermatol Pract Concept 2022; 12:e2022136. [DOI: 10.5826/dpc.1204a136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/06/2022] Open
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Chessa MA, Picciola VM, Filippi F, Patrizi A, Misciali C, Piraccini BM, Stanganelli I, Savoia F. Eruptive Non-melanoma Skin Cancers/Squamous Atypia Following Skin Surgery. Report of Two New Cases, Concise Review of the Literature With Special Emphasis on Treatment Options. Dermatol Pract Concept 2022; 12:e2022193. [PMID: 36534538 PMCID: PMC9681231 DOI: 10.5826/dpc.1204a193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Eruptive cutaneous squamous cell carcinomas (ESCC), eruptive squamous atypia (ESA) and eruptive keratoacanthomas (EKA) are different terms used to describe the occurrence of multiple cutaneous squamous neoplasms after skin surgery, laser treatment, traumas, such as tattoos, and local or systemic medical treatments. ESCC have been reported to arise at the sites of skin surgery, including the area affected by the primary tumor and split thickness skin graft (STSG) donor and recipient sites. OBJECTIVES The aim of this study is to report 2 additional cases of ESCC after skin surgery and make a critical revision of the literature, analyzing the clinical, histological features and outcomes of ESCC after cutaneous surgery. METHODS Up to August 2021, according to our systematic review of the literature, we have collected 19 published articles and a total of 34 patients, including our 2 cases. RESULTS The results of this review highlight five red flags that clinicians should consider: (i) lower and upper limbs represent the cutaneous site with the highest risk, representing 83,78% of the cases in the literature; (ii) the median time to onset of ESCC is approximately 6 weeks; (iii) primary cutaneous squamous cell carcinomas were completely excised with free margins on histologic examination in the totality of the cases of the literature, and therefore ESCC should not be considered recurrences; (iv) any surgical technique involves a risk to promote ESCC; (v) treatment of ESCC includes medical treatment, surgery or combined surgical and medical treatment. CONCLUSIONS This review highlights 5 red flags which could support clinicians in the diagnosis and management of ESCC after skin surgery.
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Starace M, Carpanese MA, Pampaloni F, Dika E, Pileri A, Rubino D, Alessandrini A, Zamagni C, Baraldi C, Misciali C, Patrizi A, Bianchi T, Apalla Z, Piraccini BM. Management of malignant cutaneous wounds in oncologic patients. Support Care Cancer 2022; 30:7615-7623. [PMID: 35672478 PMCID: PMC9385755 DOI: 10.1007/s00520-022-07194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Neoplastic wounds may develop as a result of primary tumor growth in the skin, due to metastasis, or due to skin invasion by tumors emerging from deeper levels. Malignant wounds may present as a crater-like ulcer, or as raised nodules with a cauliflower-like appearance. They are associated with malodor, necrosis, pain, bleeding, and secondary infection. The aim of our study is to better characterize fungating wounds and their management. METHODS We retrospectively reviewed the database of the Wound Care Unit of the University of Bologna in order to identify individuals affected by neoplastic wound, between January 2019 and February 2021. RESULTS We identified 9 females and 2 males with a mean age of 63 years; all were referred by the Oncology Unit. Management differed depending on the characteristics of the patients and the ulcers. Complete healing of the wound, following the parallel complete remission of the lymphoproliferative neoplasia, was observed in one individual. Among the others, one died because of breast cancer, while cutaneous lesions in 2 individuals deteriorated after 1 year of follow-up. Remission/relapse of the ulcer following the treatment course administered for the lymphoma were observed in one patient. CONCLUSIONS Treatment of malignant fungating wounds is challenging. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. A mostly palliative treatment, focusing on maintaining the patient's quality of life, is a reasonable choice.
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Senna MM, Kwon O, Piraccini BM, Sinclair R, Ball S, Ding Y, Chen YF, Dutronc Y, King B. 33774 Baricitinib results in eyebrow and eyelash growth in patients with alopecia areata who do not achieve 20% or less scalp hair loss. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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83
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de Marsillac PF, Cortez de Almeida RF, Machado CJ, Piraccini BM, Starace M, Tosti A, Vincenzi C, Kobzei K, Iorizzo M, Alves LD, Blanco A, Coelho C, Saceda-Corralo D, D'Atri G, Benez M, Ramos PM, Baja S, Tortelly VD, Frattini S, Melo DF. Clinical, epidemiological, trichoscopic and histopathological features of linear morphea on the scalp. J Eur Acad Dermatol Venereol 2022; 36:e892-e895. [PMID: 35694874 DOI: 10.1111/jdv.18323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
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Dika E, de Biase D, Lambertini M, Alessandrini AM, Acquaviva G, De Leo A, Tallini G, Ricci C, Starace M, Misciali C, Piraccini BM. Mutational landscape in squamous cell carcinoma of the nail unit. Exp Dermatol 2022; 31:854-861. [PMID: 34951714 DOI: 10.1111/exd.14518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023]
Abstract
Squamous cell carcinoma (SCC) is the most common malignancy of the nail unit. Pathogenetic mechanisms are yet to be determined, and a deeper molecular characterization of this disease is still necessary. The aim was to obtain a molecular characterization of NU SCC samples using an NGS approach to identify the genetic drivers involved in this tumor. The presence of HPV infection was also assessed. Furthermore, the mutational status was correlated with specific clinical-pathological features for a better insight into the carcinogenesis of this uncommon tumor. We analysed twenty paraffin-embedded nail unit SCC samples from patients diagnosed with primary SCC of the nail unit by next genome sequencing. In the 20 tested samples, the neoplastic cells enrichment ranged from 10% to 50% (mean value: 25.7%). In 14/20 cases (70.0%), at least one mutation was detected; whereas in the other six cases (30.0%), no alterations were observed ('wild-type/WT cases'). Overall, a total of 23 mutations were identified in the 20 specimens. TP53 was the most mutated gene (6/20 cases, 30.0%), while cKit, GNAS, EGFR, DICER1 and CTNNB1 were observed in one sample each (5.0%). No clinical-pathological parameters (age, sex, depth of invasion-DOI, histological subtype, grading and HPV) were significantly associated with the mutational status. The nail unit SCC mutational landscape appeared to be heterogeneous, favouring the hypothesis of a complex pathogenesis and an interaction of multiple elements, including HPV infections. This wealth of information undoubtedly improves our understanding of SCC biology.
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Starace M, Alessandrini A, Piraccini BM. Onychodynia: a new term of painful sensation and paresthesia of the nails. J Eur Acad Dermatol Venereol 2022; 36:e809-e810. [PMID: 35648440 DOI: 10.1111/jdv.18286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
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86
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Zengarini C, Misciali C, Robuffo S, Piraccini BM, Pileri A. Who is the culprit? A Toxic epidermal necrolysis case in a patient treated with rituximab plus polatuzumab. J Eur Acad Dermatol Venereol 2022; 36:e782-e783. [PMID: 35607916 DOI: 10.1111/jdv.18261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
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87
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Zengarini C, Carpanese MA, Vara G, Conni A, Piraccini BM, Gaspari V. Analysis of serological treatment response to doxycycline versus benzathine penicillin in syphilis infections, a retrospective single-center study. Dermatol Ther 2022; 35:e15586. [PMID: 35594004 PMCID: PMC9540744 DOI: 10.1111/dth.15586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
Abstract
Doxycilicine is the second-line treatment of choice for infectious syphilis when treatment with penicillin G is not feasible. To date, difficulties in the penicillin supply chain make it necessary to evaluate and resort to antibiotic therapies which are currently considered a second-line choice. Moreover, systematic studies comparing the two treatments in affected patients are still few, and many do not consider late and indeterminate latent infections. The objective of this study was to assess the differences in the serological response of the treatment of syphilis infections with benzathine penicillin compared with doxycycline. We built an in-house database with all patients diagnosed with syphilis infection from January 2010 to January 2020 in the STD Centre of the S.Orsola-Malpighi Polyclinic of the University of Bologna, located in the North-east of Italy. We recorded all the principal independent (demographic, social status, reinfection rare, HIV infections, comorbidities, sexual behaviors, and initial TPHA values) and dependent variables (RPR values). We then extrapolated all patients treated with doxycycline (100 mg of doxycycline twice daily for 14 days for infections diagnosed within the first year and a 28 days course for infections older than 1 year or undetermined) and matched in 1:1 ratio numbers with a homogeneous group of patients treated with penicillin G (2.4 million units in a single dose intramuscularly for infections diagnosed within the first year and a cycle consisting in of 2.4 million units administered in a single dose per week for 3 weeks for infections older than 1 year or undetermined) We then analyzed the serological trends and outcomes in the primary, secondary and early latent groups versus late latent and undetermined infections. We retrieved 41 patients for each group with homogeneous initial characteristics. At the end of the 24-month observation period, a slight difference in a valid RPR reduction rate emerged, with a greater success rate emerged in patients receiving penicillin than those with doxycycline (26 vs. 22, p 0.615). Indeed, patients with latent or indeterminate syphilis treated with doxycycline appear to have a higher rate of serofast than those treated with penicillin. Linear regression analysis showed no strong correlation between the analyzed independent variables and the observed outcomes. Doxycycline had a slightly lower, though not statistically different, success rate when compared with penicillin in treating primary syphilis, but appeared to have a reduced success rate in attaining resolution in late and undetermined syphilis infection.
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Zengarini C, Piraccini BM, La Placa M. Lichen Ruber Planus occurring after SARS-CoV-2 vaccination. Dermatol Ther 2022; 35:e15389. [PMID: 35174595 PMCID: PMC9111831 DOI: 10.1111/dth.15389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 12/03/2022]
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Zengarini C, Misciali C, Ferrari T, Dika E, La Placa M, Piraccini BM, Baraldi C. Disseminated herpes zoster in an immune‐competent patient after
SARS‐CoV
‐2 Vaccine (
BNT162b2
Comirnaty, Pfizer). J Eur Acad Dermatol Venereol 2022; 36:e622-e623. [PMID: 35429051 PMCID: PMC9114886 DOI: 10.1111/jdv.18154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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Bardazzi F, Viviani F, Filippi F, Carpanese MA, Piraccini BM, Abbenante D. The legs: An underestimated difficult-to-treat area of psoriasis. Dermatol Ther 2022; 35:e15485. [PMID: 35383406 DOI: 10.1111/dth.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
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Piraccini BM, Starace M, Rubin AI, Di Chiacchio NG, Iorizzo M, Rigopoulos D. Onychomycosis: Recommendations for Diagnosis, Assessment of Treatment Efficacy, and Specialist Referral. The CONSONANCE Consensus Project. Dermatol Ther (Heidelb) 2022; 12:885-898. [PMID: 35262878 PMCID: PMC9021334 DOI: 10.1007/s13555-022-00698-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical signs may overlap with other dermatoses. The treatment may be challenging, as it should be patient-tailored. Methods An online survey was conducted among European Nail Society (ENS) members to provide recommendations on the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in non-specialized clinical environments, as well as recommendations for patient referral. Results DLSO diagnosis is predominantly based on clinical aspects, and microscopy and fungal culture are commonly employed to establish the diagnosis. Assessment of clinical features is the main method for DLSO follow-up, and the main criterion to define cure is a combination of mycologic cure and clinical cure. The most commonly selected treatments for onychomycosis include oral antifungals, topical antifungals, and nail debridement. According to the nail experts, predisposing factors of DLSO to be evaluated include concurrent tinea pedis diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to be evaluated for DLSO diagnosis should include subungual hyperkeratosis, white-yellow-orange subungual scales, and absence of salmon-pink coloration. Recommendations for clinical signs that should be evaluated to confirm treatment effectiveness include normal appearance and color of the nail, reduction or absence of scales under the nail, and absence of onycholysis. Recommendations for specialist referral include lack of treatment effectiveness, need of additional therapies, concurrent presence of other diseases or comorbidities, severe DLSO, and presence of a dermatophytoma or involvement of the nail matrix. Conclusions According to the surveyed nail experts, after evaluating clinical signs and predisposing factors for DLSO, the diagnosis should include subungual hyperkeratosis, nail color (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there is treatment failure, concomitant diseases/comorbidities, presence of a dermatophytoma or involvement of the nail matrix, or involvement of several/all nails, referral should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00698-x.
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Starace M, Orlando G, Iorizzo M, Alessandrini A, Bruni F, Mandel VD, Awatef K, Cabo H, Fabbrocini G, Hanane B, Lanssens S, Lobato-Berezo A, Mernissi FZ, Paoli J, Patrí A, Sabban ENC, Sławińska M, Sobjanek M, Zaar O, Pellacani G, Piraccini BM. Clinical and Dermoscopic Approaches to Diagnosis of Frontal Fibrosing Alopecia: Results From a Multicenter Study of the International Dermoscopy Society. Dermatol Pract Concept 2022; 12:e2022080. [PMID: 35223189 PMCID: PMC8824238 DOI: 10.5826/dpc.1201a80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction: Frontal fibrosing alopecia (FFA) is a form of primary lymphocytic scarring alopecia characterized by a progressive recession of the fronto-temporal hairline. Although the clinical presentation of FFA is very typical, biopsy for histopathological examination is still recommended to confirm the diagnosis. Currently, a growing number of skin and mucosal inflammatory diseases are diagnosed with modern noninvasive techniques such as dermoscopy without the necessity of a biopsy.
Objectives: The International Dermoscopy Society (IDS) aimed to test the ability of its members to diagnose classic FFA through clinical and dermoscopic parameters and to compare acquired data to the largest cohort studies published since 1994.
Methods: This is an observational, cross-sectional study describing patient demographics, clinical presentation and diagnostic tools used in a sample of FFA patients collected by IDS members. A literature search was then performed using Pubmed to review studies reporting more than 100 cases.
Results: IDS members submitted 188 cases demonstrating a predominant female population (98.4%). In 71.8% of the cases, the clinical presentation and the trichoscopic findings allowed for the diagnosis. Out of 24 revised studies, 13 showed that clinical and trichoscopic features were decisive for the diagnosis in almost all cases.
Conclusions: Demographic and clinical data of our cohort were mostly comparable to previous reported data on FFA. The relevant role of the clinical and trichoscopic features in diagnosing FFA was confirmed by our study and the reviewed literature. Trichoscopy could be considered a worldwide-acknowledged non-invasive technique for the diagnosis of FFA.
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Zengarini C, Guglielmo A, Giovani M, Preci C, Dika E, Piraccini BM, Pileri A. Estimating the incidence of Covid-19 skin manifestations on the general population in a territorial setting. J Eur Acad Dermatol Venereol 2022; 36:e415-e417. [PMID: 35080272 DOI: 10.1111/jdv.17970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
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Starace M, Vezzoni R, Alessandrini A, Bruni F, Carpanese M, Melo DF, Piraccini BM. Tufted hairs: A bouquet of flowers in different hair diseases. J Cosmet Dermatol 2022; 21:3741-3746. [PMID: 35001495 DOI: 10.1111/jocd.14712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
Tufted hairs, an unusual hair follicle dysplasia, are characterized by several hair shafts grouped together, emerging from a single hair follicle-like "doll's hair". This clinical picture is considered characteristic of folliculitis decalvans (FD). However, the emergence of grouped hair shafts from a single follicle can also be observed in other hair disorders, even if not as a distinctive diagnostic sign. This paper aims to collect and analyze all clinical and trichoscopic features of different hair diseases with tufted hairs to find distinctive features, helping the clinician with the diagnosis.
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Sous D, Starace MV, Chen L, Nieman EL, Anadkat MJ, Piraccini BM, Coughlin CC. Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series. Skin Appendage Disord 2022; 8:31-33. [PMID: 35118126 PMCID: PMC8787582 DOI: 10.1159/000519016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. CASE PRESENTATION We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. DISCUSSION/CONCLUSION For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.
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Dondi A, Sperti G, Gori D, Guaraldi F, Montalti M, Parini L, Piraccini BM, Lanari M, Neri I. Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature. Eur J Pediatr 2022; 181:3577-3593. [PMID: 35948654 PMCID: PMC9365226 DOI: 10.1007/s00431-022-04585-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
UNLABELLED COVID-19 can present with a range of skin manifestations, some of which specific of the pediatric age. The aim of this systematic literature review was to determine the type, prevalence, time of onset, and evolution of cutaneous manifestations associated with COVID-19 in newborns, children, and adolescents, after excluding multisystem inflammatory syndrome in children (MIS-C). PubMed, Tripdatabase, ClinicalTrials, and Cochrane Library databases were searched using an ad hoc string for case reports/series and observational studies, published between December 2019 and February 2022. Study quality was assessed using the STROBE and CARE tools. Seventy-three (49 case reports/series and 24 studies) out of 26,545 identified articles were included in the analysis. Dermatological lesions were highly heterogeneous for clinical presentation, time of onset, and association with other COVID-19 manifestations. Overall, they mainly affected the acral portions, and typically presented a favorable outcome. Pseudo-chilblains were the most common. CONCLUSIONS Mucocutaneous manifestations could be the only/predominant and early manifestation of COVID-19 that could precede other more severe manifestations by days or weeks. Therefore, physicians of all disciplines should be familiar with them. WHAT IS KNOWN • A variety of cutaneous manifestations have been reported in association with COVID-19. • Urticaria, maculopapular, or vesicular rashes can occur at any age, while chilblains and erythema multiforme are more common in children and young patients. WHAT IS NEW • Skin lesions related to SARS-CoV-2 infection often show a peculiar acral distribution. • Mucocutaneous lesions of various type may be the only/predominant manifestation of COVID-19; they could present in paucisymptomatic and severely ill patients and occur at different stages of the disease.
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Melo DF, Lima CDS, Piraccini BM, Tosti A. Trichotillomania: What Do We Know So Far? Skin Appendage Disord 2022; 8:1-7. [PMID: 35118122 PMCID: PMC8787581 DOI: 10.1159/000518191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 01/03/2023] Open
Abstract
Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.
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Sechi A, Zengarini C, Piraccini BM, Alessandrini A, Bruni F, Patrizi A, Naldi L, Starace M. Treatment of retronychia: A systematic review and suggested treatment algorithm. Dermatol Ther 2021; 35:e15251. [PMID: 34877747 DOI: 10.1111/dth.15251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 11/21/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Retronychia is an inflammatory disorder typical of the great toes characterized by arrested nail growth, ingrowth of the nail plate into the proximal nail fold and paronychia. There is no standardized treatment for retronychia, and its management should be weighed based on the severity stage, treatment modality, and clinical outcome. In this paper, a systematic review of the literature was performed to assess all published data regarding the treatment of retronychia. A total of 231 patients from 24 studies were included in the analysis. Conservative management was adopted in mild-intermediate forms, consisting of medical (topical or intralesional high-potency corticosteroids) and podiatric treatment (taping, clipping back the onycholytic plate, orthosis), leading to a global cure rate of 41.2%, with no reported side effects. Non-conservative management, that is, chemical or surgical avulsion of the nail plate, proved resolutive in 71.2% of cases. Surgical avulsion of the nail plate produced the highest cure rate (78.2%), but was burdened by 9.6% of long-term sequelae, mainly nail dystrophies. A decision-making algorithm was designed to give clinicians treatment indications based on the severity stage of retronychia, treatment invasiveness, and possible clinical outcomes.
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Starace M, Iorizzo M, Sechi A, Alessandrini AM, Carpanese M, Bruni F, Vara G, Apalla Z, Asz-Sigall D, Barruscotti S, Camacho F, Doche I, Estrada BD, Dhurat R, Gavazzoni MF, Grimalt R, Harries M, Ioannidis D, McMichael A, Melo DF, Oliveira R, Ovcharenko Y, Pirmez R, Ramot Y, Rudnicka L, Shapiro J, Silyuk T, Sinclair R, Tosti A, Vano-Galvan S, Piraccini BM. Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management. JAAD Int 2021; 5:11-18. [PMID: 34368790 PMCID: PMC8328568 DOI: 10.1016/j.jdin.2021.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported. OBJECTIVE To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease. METHODS Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. RESULTS Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more. LIMITATIONS The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. CONCLUSION The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.
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Zengarini C, Pileri A, Salamone FP, Piraccini BM, Vitale G, La Placa M. Subacute cutaneous lupus erythematosus induction after SARS-CoV-2 vaccine in a patient with primary biliary cholangitis. J Eur Acad Dermatol Venereol 2021; 36:e179-e180. [PMID: 34807495 PMCID: PMC9011449 DOI: 10.1111/jdv.17827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
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