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Lin RR, Warp PV, Williams KN, Elman SA, Maderal AD. Sex-based differences in dermatomyositis: a retrospective study. Arch Dermatol Res 2024; 316:297. [PMID: 38819470 DOI: 10.1007/s00403-024-03104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/01/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Rachel R Lin
- University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Peyton V Warp
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Scott A Elman
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea D Maderal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Salgueiro C, Poblete MJ, Robles-Silva C, Abarzúa Á, Vera-Kellet C. Trichoscopic, oral, and periungual fold findings as activity and damage markers in dermatomyositis patients and their correlation with myositis antibodies. Arch Dermatol Res 2023; 315:1603-1613. [PMID: 36757439 PMCID: PMC9909127 DOI: 10.1007/s00403-023-02554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/11/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
There is little clarity about the clinical manifestations of dermatomyositis (DM) in the periungual folds, scalp, and oral cavity and their association with disease activity and damage. The objective of this study was to compare the prevalence of trichoscopic, oral, and periungual changes between DM and healthy patients and assess their possible association with disease activity and damage. We conducted an observational, transversal, and analytical study between 2020 and 2021. Forty DM patients were matched by sex and age with 40 healthy individuals. On the same day, all patients had a clinical evaluation of the hands, periungual folds, scalp, and oral cavity. Photographs of these areas and peripheral venous blood tests, including myositis-associated (MAAs) and myositis-specific antibodies (MSAs), were taken. Two dermatologists blinded to their diagnosis, damage, and activity levels registered the lesions. The disease activity and damage were evaluated using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). The presence of mechanic's hands, Gottron's sign, and Gottron's papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; thick tortuous capillaries in scalp; gingival telangiectasias in the oral cavity; and positive MSAs associated with severe cutaneous involvement in DM patients (Anti-TIF1g, Anti-MDA5, Anti-SAE1/2) were associated with a higher CDASI activity score. The presence of MSAs associated with intense muscle involvement in DM patients (Anti-Mi2a, Anti-Mi2b, Anti-NPX2, and Anti-SAE1/2) was related to a lower CDASI activity score. Gottron's sign and Gottron's papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; basal erythema in scalp; and gingival telangiectasias in the oral cavity were associated with a higher CDASI damage score. There are trichoscopic, oral and periungual fold findings and some myositis-specific antibodies that correlate with disease activity and damage in DM patients.
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Affiliation(s)
- Catalina Salgueiro
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4686. Macul, 7820436, Santiago, Chile
| | - María José Poblete
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4686. Macul, 7820436, Santiago, Chile
| | | | - Álvaro Abarzúa
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4686. Macul, 7820436, Santiago, Chile
| | - Cristián Vera-Kellet
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4686. Macul, 7820436, Santiago, Chile.
- Connective Tissue Diseases Unit, Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Rodríguez-Tamez G, Herz-Ruelas ME, Gómez-Flores M, Ocampo-Candiani J, Chavez-Alvarez S. Hair Disorders in Autoimmune Diseases. Skin Appendage Disord 2023; 9:84-93. [PMID: 36937160 PMCID: PMC10015649 DOI: 10.1159/000527933] [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: 08/16/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023] Open
Abstract
Alopecia is a common feature in several autoimmune diseases. With a wide spectrum of clinical presentations, it may manifest with a scarring or non-scarring nature, in a diffuse, patchy, or localized pattern. We as dermatologists have the opportunity of assessing patients with hair loss who may have an underlying undiagnosed autoimmune disorder. This review aimed to describe the main clinical, trichoscopic, and histopathological features of hair disorders associated with autoimmune diseases.
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Affiliation(s)
| | | | | | | | - Sonia Chavez-Alvarez
- Dermatology Department, Facultad de Medicina, “Dr. José E. González” University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Cirino PV, Hordinsky M, McAdams B, Romiti R. Small fiber neuropathy and intractable scalp pruritus in dermatomyositis patients. SKIN HEALTH AND DISEASE 2022; 3:e173. [PMID: 36751316 PMCID: PMC9892427 DOI: 10.1002/ski2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Background Scalp pruritus is a common symptom in Dermatomyositis (DM) patients. There are indications that small nerve fibers neuropathy could be involved in this symptom, however the etiology of scalp pruritus is not fully understood. Objectives To assess epidermal nerve fiber (ENF) density of dermatomyositis patients with scalp pruritus by biopsy by confocal microscopy and immunohistochemistry with subsequent imaging analysis. Methods DM patients with severe scalp pruritus from the dermatology outpatient clinic were compared to healthy volunteers. Two 4-mm scalp skin biopsies were obtained above the right ear in the parietal region and below the occipital protuberance in the occipital region. Biopsy specimens were incubated with primary antibodies to protein gene product (PGP 9.5), calcitonin gene-related peptide (CGRP), substance P (SP) were used to visualize nerve fibers (ENF) and collagen IV was used to label the epidermal basement membrane. The number of ENFs per millimeter was counted and recorded as the mean of ± SD of counts in 16 images at two micrometer increments/sections, two from each of the samples. ENF densities were compared between groups and a multiple linear regression model was applied to associated factors with ENF density. Results Fifteen DM patients with severe scalp pruritus and 12 healthy volunteers were included in the study. The mean number of ENF/mm in occipital region of DM group was 16.0 ± 13.9 while the control group in the same region was 99.8 ± 33.1. In parietal region the number of ENF/mm of DM group was 18.0 ± 20.7 while in control group was 50.4 ± 17.4 (p < 0.001). Conclusion DM patients with pruritus could have some impairment of small nerve fiber density that could explain their recalcitrant scalp pruritus.
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Affiliation(s)
| | - Maria Hordinsky
- Department of DermatologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Brian McAdams
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Ricardo Romiti
- Department of DermatologyUniversity of São PauloSao PauloBrazil
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Castillo R, Albayda J. Refractory alopecia universalis associated with dermatomyositis successfully treated with tofacitinib. Mod Rheumatol Case Rep 2022; 6:199-202. [PMID: 35253877 PMCID: PMC11132691 DOI: 10.1093/mrcr/rxac012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022]
Abstract
Dermatomyositis (DM) and alopecia areata are two diseases characterised by aberrant interferon signalling. While patchy alopecia of the scalp is a known feature of DM, alopecia universalis, which involves hair loss over the entire body, has rarely been reported in conjunction with DM. Herein, we report the case of a 30-year-old female with DM who developed refractory cutaneous disease and alopecia universalis that were successfully treated with tofacitinib. This could suggest that concomitant severe alopecia and refractory cutaneous DM may reflect a strong baseline interferon gene signature that may predict responsiveness to janus kinase inhibitors.
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Affiliation(s)
- Rochelle Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jemima Albayda
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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El-Banna G, Fiorentino D. Update on Cutaneous Signs to Assist in the Diagnosis of Dermatomyositis. Curr Rheumatol Rep 2022; 24:156-165. [PMID: 35404005 DOI: 10.1007/s11926-022-01070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Dermatomyositis (DM) is a heterogeneous idiopathic inflammatory myopathy that can be challenging to diagnose. Learning about the cutaneous manifestations in DM can assist with prompt diagnosis as well as subgroup classification. This review highlights recent data regarding cutaneous signs in DM and their associations with myositis-specific antibodies (MSAs). RECENT FINDINGS Several novel DM skin signs have recently been reported. Novel and confirmatory data have helped to define more clearly the associations between various cutaneous manifestations and MSAs. Awareness of the diverse cutaneous phenotypes can help with the timely diagnosis of DM. As some MSAs are associated with atypical skin features and/or characteristic patterns of clinical findings, knowledge of these associations can help clinicians to recognize DM patients. Understanding how the prevalence and presentation of various cutaneous signs differ among ethnically diverse patients is a high priority for further study.
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Affiliation(s)
- Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway, Pavilion C #C-234, Redwood City, CA, 94063, USA.
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Żychowska M, Łudzik J, Witkowski A, Lee C, Reich A. Dermoscopy of Gottron's papules and other inflammatory dermatoses involving the dorsa of the hands. J Eur Acad Dermatol Venereol 2022; 36:1080-1087. [PMID: 35274387 DOI: 10.1111/jdv.18052] [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: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several inflammatory dermatoses, including dermatomyositis (DM), may present as erythematous papules or plaques on the dorsal aspects of the hands over the joints. Limited skin involvement in these entities may pose a diagnostic challenge. (Video)dermoscopy is being utilized more frequently to aid in differential diagnosis of inflammatory skin conditions. OBJECTIVE To describe the dermoscopic findings in Gottron's papules and compare with dermoscopic features of other dermatoses involving the dorsal aspects of the hands. METHODS Videodermoscopic images from patients presenting with erythematous papules or plaques on the dorsal surface of the hands were retrospectively analyzed for the presence of standardized dermoscopic parameters. RESULTS Dermoscopic images from patients with DM (n=12), psoriasis (n=19), chronic dermatitis (n=16), mycosis fungoides (n=7), lichen planus (n=5) and pityriasis rubra pilaris (n=3) were included. Gottron's papules were characterized by pleomorphic vessels (dotted vessels accompanied by thick or thin linear vessels with branches or linear curved vessels) in 66.7% of cases, arranged in unspecified pattern (91.7%), and accompanied by white or pink structureless areas (75.0%). Psoriatic plaques were characterized by dotted vessels arranged in a uniform pattern (94.7%). Vessels arranged in a ring pattern were nearly exclusively observed in psoriasis, while yellow structureless areas and erosions were more frequently present in chronic dermatitis. White lines, corresponding to Wickham striae, were specific for lichen planus. CONCLUSIONS Videodermoscopy might be of value in differentiating Gottron's papules from other dermatoses involving dorsa of the hands.
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Affiliation(s)
- M Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - J Łudzik
- Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland.,Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Witkowski
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - C Lee
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Żychowska M, Reich A. Dermoscopy and Trichoscopy in Dermatomyositis-A Cross-Sectional Study. J Clin Med 2022; 11:jcm11020375. [PMID: 35054069 PMCID: PMC8778875 DOI: 10.3390/jcm11020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND (Video)dermoscopy is a non-invasive diagnostic technique that has a well-established role in dermatooncology. In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses. So far, little is known about the (video)dermoscopic features of dermatomyositis (DM). METHODS Consecutive patients with DM were included in the study and videodermoscopic assessments of the nailfolds, scalp, and active skin lesions were performed. RESULTS Fifteen patients with DM (10 women and 5 men) were included. Capillaroscopy showed elongated capillaries (90.9%), avascular areas (81.8%), disorganized vessel architecture (81.8%), tortuous capillaries (72.7%), dilated capillaries (72.7%), and hemorrhages (72.7%). The trichoscopic findings included linear branched vessels (80.0%), linear vessels (60.0%), linear curved vessels (53.3%), perifollicular pigmentation (40.0%), perifollicular erythema (33.3%), scaling (20.0%), white (20.0%) or yellow (20%) interfollicular scales, and white (20.0%) or pinkish (13.3%) structureless areas. Polymorphic vessels of an unspecific distribution and white or pink structureless areas were frequently observed under dermoscopy in cutaneous manifestations of DM, including Gottron's papules and Gottron's sign. CONCLUSIONS Dermoscopy of the nailfolds (capillaroscopy), scalp (tricoscopy), and active cutaneous lesions may be of value in the preliminary diagnosis of DM.
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Kolla AM, Liu L, Shaw K, Shapiro J, Femia A, Lo Sicco K. A narrative review of therapies for scalp dermatomyositis. Dermatol Ther 2021; 34:e15138. [PMID: 34549494 DOI: 10.1111/dth.15138] [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: 06/08/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous DM negatively impacts quality-of-life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous DM. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified eight studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low-dose naltrexone and platelet-rich plasma, as well as two frequent and one less common therapy for cutaneous DM respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assessed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM.
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Affiliation(s)
- Avani M Kolla
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lynn Liu
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Katharina Shaw
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Alisa Femia
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
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Chanprapaph K, Fakprapai W, Limtong P, Suchonwanit P. Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls. Front Med (Lausanne) 2021; 8:683900. [PMID: 34422857 PMCID: PMC8377356 DOI: 10.3389/fmed.2021.683900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nailfold capillaroscopy (NFC) is a valuable tool to detect microcirculation abnormalities in connective tissue diseases (CTDs). However, whether the universal serial bus (USB) digital microscopy used as onychoscopy is as effective as the videocapillaroscopy in determining the diagnostic and prognostic values of CTDs remains to be determined. Objective: This study aims to investigate NFC features of systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc) patients and compare with normal controls as well as examine which feature could differentiate among CTDs. Furthermore, we aim to explore different capillaroscopic abnormalities and their association with disease activity. Methods: Nailfold images were taken from patients and healthy controls using a USB digital microscopy. Patterns on the capillary morphology, diameter, architecture, and density were recorded and compared. We further determined the NFC findings in SLE, DM, and SSc and corresponded to their respective disease activity scoring system. Results: A total of 245 participants, consisting of 54 SLE, 32 DM, and 51 SSc patients, as well as 108 controls, were enrolled. All capillaroscopic features, except for tortuous capillaries, were significantly more common in CTDs than healthy control (all p < 0.05). A multinomial logistic regression analysis revealed that bushy capillaries had significantly higher odds for both SLE and DM than SSc (OR: 4.10, 95% confidence interval (CI): 1.71-9.81, p = 0.002 and OR: 7.82, 95% CI, 2.86-21.38, p < 0.001, respectively). Elongated capillaries demonstrated significant odds for SLE compared with SSc (OR: 3.35, 95% CI: 1.005-11.20, p = 0.049), while prominent subpapillary plexus showed greater odds for SLE compared with both DM and SSc (OR: 2.75, 95% CI: 1.07-7.02, p = 0.03 and OR: 5.78, 95% CI: 2.29-14.58, p < 0.001, respectively). The presence of hemorrhage, enlarged capillaries, and the low-density index had significantly higher odds in favor of SSc than SLE. Bushy capillaries were the only pattern with a strong association for DM over SSc. The presence of enlarged capillaries indicated higher SLE severity, but no specific finding was related to DM or SSc skin scores. Conclusions: Nailfold capillaroscopic examination using a digital microscope is a valuable method for the diagnosis of SLE, DM, and SSc. Several morphologic patterns can help differentiate among CTDs; however, the prognostic significance of this method requires further investigations.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wuttidej Fakprapai
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeyachat Limtong
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Golińska J, Sar-Pomian M, Sławińska M, Sobjanek M, Sokołowska-Wojdyło M, Rudnicka L. Trichoscopy may enhance differential diagnosis of erythroderma. Clin Exp Dermatol 2021; 47:394-398. [PMID: 34388270 DOI: 10.1111/ced.14887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/15/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
There is a paucity of data concerning the usability of trichoscopy in erythrodermic patients. The objective of the study was to compare trichoscopic features in erythroderma of various etiologies. Forty-nine patients with the determined cause of erythroderma (including atopic dermatitis, mycosis fungoides, allergic contact eczema, psoriasis, Sézary syndrome, drug reactions, pityriasis rubra pilaris, dermatomyositis, actinic reticuloid, crusted scabies and pemphigus foliaceus) were included in the study. Dotted vessels were present in patients with atopic dermatitis, pityriasis rubra pilaris, mycosis fungoides, Sézary syndrome and psoriasis and absent in dermatomyositis, crusted scabies, and pemphigus foliaceus (chi-square test, p=0.016). Spermatozoon-like vessels were observed only in mycosis fungoides and Sézary syndrome (p=0.001). Whitish-pinkish structureless areas were described in all patients with mycosis fungoides, pemphigus foliaceus, actinic reticuloid, and crusted scabies (p=0.028). The type of vessels and the presence of whitish-pinkish structureless areas under trichoscopy may indicate the cause of erythroderma.
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Affiliation(s)
- J Golińska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008, Warsaw, Poland
| | - M Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008, Warsaw, Poland
| | - M Sławińska
- Department of Dermatology, Venereology and Allergology of the Medical University of Gdańsk, Smoluchowskiego 17, 80-214, 80-210, Gdańsk, Poland
| | - M Sobjanek
- Department of Dermatology, Venereology and Allergology of the Medical University of Gdańsk, Smoluchowskiego 17, 80-214, 80-210, Gdańsk, Poland
| | - M Sokołowska-Wojdyło
- Department of Dermatology, Venereology and Allergology of the Medical University of Gdańsk, Smoluchowskiego 17, 80-214, 80-210, Gdańsk, Poland
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008, Warsaw, Poland
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Golińska J, Sar-Pomian M, Rudnicka L. Diagnostic Accuracy of Trichoscopy in Inflammatory Scalp Diseases: A Systematic Review. Dermatology 2021; 238:412-421. [PMID: 34265772 DOI: 10.1159/000517516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The common inflammatory scalp diseases, such as psoriasis, seborrheic dermatitis, lichen planopilaris, discoid lupus erythematosus, contact dermatitis, or pemphigus may share similar clinical features. OBJECTIVE To identify and systematically review the available evidence on the accuracy of trichoscopy in inflammatory scalp disorders. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 articles were included in the analysis. RESULTS The following trichoscopy features were found to show the highest specificity for the respective diseases: in psoriasis: diffuse scaling, simple and twisted red loops, red dots and globules, and glomerular vessels; in seborrheic dermatitis: atypical vessels, thin arborizing vessels, and structureless red areas; in discoid lupus erythematosus: follicular plugs and erythema encircling follicles; in lichen planopilaris: milky red areas or fibrotic patches; in contact dermatitis: twisted red loops; in pemphigus foliaceus: white polygonal structures and serpentine vessels; in pemphigus vulgaris: red dots with whitish halo and lace-like vessels; and in dermatomyositis: lake-like vascular structures. LIMITATIONS Different nomenclature and variability in parameters, which were analyzed in different studies. CONCLUSION This systemic analysis indicates that trichoscopy may be used with high accuracy in the differential diagnosis of inflammatory scalp diseases.
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Affiliation(s)
- Joanna Golińska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland,
| | - Marta Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Sławińska M, Sokołowska-Wojdyło M, Sobjanek M, Golińska J, Nowicki RJ, Rudnicka L. The significance of dermoscopy and trichoscopy in differentiation of erythroderma due to various dermatological disorders. J Eur Acad Dermatol Venereol 2020; 35:230-240. [PMID: 33073390 DOI: 10.1111/jdv.16998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of a patient with erythroderma may be difficult and sometimes pose a challenge for both dermatologist and pathologist. The role of dermoscopy in this area seems to be poorly investigated. There are only a few reports, with limited number of patients, describing dermoscopic features in erythroderma of various origins. To the best of our knowledge, none of the previous studies had included trichoscopic examination. OBJECTIVES Analysis of dermoscopic and trichoscopic patterns in series of patients with erythroderma. METHODS We retrospectively analysed 28 adult patients who presented with erythroderma between May 2016 and August 2020. Demographic data, disease course and duration, previous treatment, as well as dermoscopic and trichoscopic features were analysed. RESULTS There were 9 patients (32.1%) with the diagnosis of mycosis fungoides, 8 patients (28.5%) with atopic dermatitis, 3 patients (10.5%) with Sézary syndrome and 3 patients (10.5%) with pityriasis rubra pilaris. The others were diagnosed with allergic eczema (n = 1; 3.6%), dermatomyositis sine myositis (n = 1; 3.6%), psoriasis (n = 1; 3.6%), actinic reticuloid (n = 1; 3.6%) and crusted scabies (n = 1; 3.6%). Characteristic dermoscopic/trichoscopic patterns have been observed in erythroderma due to crusted scabies, psoriasis, dermatomyositis sine myositis, Sézary syndrome and pityriasis rubra pilaris. Differentiation of mycosis fungoides and long-standing atopic dermatitis based on dermoscopy is difficult, as the overlap of vessel morphology, background colour and scale colour exists. Similarly, differentiation between AD and AE based on dermoscopy/trichoscopy seems to be impossible, and clinical background is crucial. CONCLUSION Dermoscopy and trichoscopy seem to provide additional clues in the assessment of erythrodermic patient. Depending on the underlying cause, trichoscopy or dermoscopy may be more useful.
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Affiliation(s)
- M Sławińska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sokołowska-Wojdyło
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - J Golińska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - R J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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14
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Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses. J Am Acad Dermatol 2019; 81:1319-1329. [DOI: 10.1016/j.jaad.2019.05.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 01/14/2023]
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15
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Abstract
Alopecia is a skin condition of great social and psychologic impact. Primary alopecia originates from the hair follicles and usually does not have systemic manifestations; however, secondary alopecia can affect the hair follicles in the setting of systemic diseases, medications, and external trauma. Connective tissue diseases, granulomatous diseases, bullous diseases, infections, and tumors are some of the systemic diseases that will be covered in this review. Trichoscopy is a useful noninvasive tool that can help with the diagnosis in the office and can guide the selection of the optimal site for the scalp biopsy. Histopathology is the ultimate tool for the diagnosis in most cases of secondary alopecia and can be performed on vertical and horizontal sections. In most cases, treating the underlying condition is the single most important strategy, but topical treatments for the alopecia are also applied.
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Affiliation(s)
- Sonali Nanda
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria De Bedout
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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16
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Suchonwanit P, Udompanich S, Thadanipon K, Chanprapaph K. Trichoscopic signs in systemic lupus erythematosus: a comparative study with 109 patients and 305 healthy controls. J Eur Acad Dermatol Venereol 2019; 33:774-780. [DOI: 10.1111/jdv.15421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/14/2018] [Indexed: 12/17/2022]
Affiliation(s)
- P. Suchonwanit
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - S. Udompanich
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - K. Thadanipon
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
- Section for Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - K. Chanprapaph
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
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17
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Vastarella M, Gallo L, Cantelli M, Nappa P, Fabbrocini G. An Undetected Case of Tinea Capitis in an Elderly Woman Affected by Dermatomyositis: How Trichoscopy Can Guide to the Right Diagnosis. Skin Appendage Disord 2019; 5:186-188. [PMID: 31049345 DOI: 10.1159/000495805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022] Open
Abstract
Dermatomyositis (DM) is an autoimmune disease that primarily affects the skin and muscles, but may also have a systemic involvement. The frequency of scalp involvement in DM varies from 28 to 82% and is often encountered as part of a DM flare. However, it frequently presents as a treatment-resistant disease, and patients reporting no improvement with conventional therapies require further investigation. We report a case of tinea capitis (TC) in a 79-year-old woman affected by DM with scalp involvement which did not respond to conventional therapies. Thanks to trichoscopy we could detect "comma hairs," "zigzag hairs," and "pigtail hairs" at scalp examination, made the right diagnosis of TC, and instituted the best treatment without delay.
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Affiliation(s)
- Maria Vastarella
- Dermatology Division, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lucia Gallo
- Dermatology Division, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Cantelli
- Dermatology Division, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paola Nappa
- Dermatology Division, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Division, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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18
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Doutre MS. [What's new in internal medicine?]. Ann Dermatol Venereol 2018; 145 Suppl 7:VIIS24-VIIS31. [PMID: 30583754 DOI: 10.1016/s0151-9638(18)31286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's new in internal medicine will be dedicated to three topics: i) inflammatory myopathies constituting a heterogenous group of diseases whose clinical manifestations, immunological abnormalities, treatment response and outcomes vary widely; ii) alterations of gut microbiota contributing to the occurrence or development of a range of conditions, including autoimmune diseases for which further work is necessary to understand the correlation of dysbiosis with these diseases; iii) the reciprocal relationship between obesity, metabolic syndrome, atherosclerosis and autoimmune diseases. New data concerning systemic sclerosis, cutaneous vasculitis, adult Still's disease, autoantibodies anti DFS70, Epstein Barr virus and autoimmune diseases were also highlighted.
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Affiliation(s)
- M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burget, 33000 Bordeaux, France.
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19
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Horizontal and vertical sections of scalp biopsy specimens from dermatomyositis patients with scalp involvement. J Am Acad Dermatol 2018; 78:1178-1184. [DOI: 10.1016/j.jaad.2018.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
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