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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 (12 weeks) telogen effluvium.

Background: The short anagen syndrome (SAS) is a rare idiopathic pediatric disorder characterized by the short duration of the anagen phase. SAS mainly affects Caucasian children. Parents complain of their child's inability to grow long hair. Topical minoxidil may be an effective treatment for SAS; however, a slow spontaneous improvement is typical. Objective: Our aim was to collect data on out cases of SAS and create an algorithm to facilitate diagnosis of SAS. Methods: A retrospective review of 25 patients with SAS was performed within the Dermatology Department of the University of Bologna. We collected data regarding symptoms, pull test, hair card test, trichoscopy, trichogram, treatments, including biotin and minoxidil, and clinical outcome. Results: Characteristic findings included parental reporting that the hair had not required a haircut, hair card test showing hairs with conical-shaped tips, and hair shafts of different diameters, with more 10%-20% of hair shafts less than 60 μm thick on trichoscopy. Trichogram revealed an increased percentage of telogen hair with normal hair shafts and tapering ends. The mean anagen-to- telogen ratio was 66:34 (normal ratio 90:10). Conclusion: We developed an algorithm to facilitate the diagnosis of this rare hair disease using clinical examination and invasive and non-invasive testing to differentiate SAS from other forms of pediatric alopecia. In conclusion, the collected data of the therapy showed that biotin alone or in combination with topical minoxidil is an effective treatment for SAS.

Background Melanonychia refers to brown-black color pigmentation due to melanin or not-melanin deposition in the nail plate. Onychoscopy allows to distinguish if the pigmentation is due by melanin or not. The main causes of non-melanic pigmentation are subungual hematoma and pigmented onychomycosis. Fungal melanonychia (FM), is rare and may present as diffuse or longitudinal pigmentation. Differential diagnosis includes melanic activation, such as ethnic-type nail pigmentation or frictional melanonychia, but also versus melanic proliferation, such as nevus or nail melanoma. Fungal melanonychia can be due a colonization by fungi with black variant or by melanin activation due to inflammation of fungal invasion. Objectives The aim of paper is to increase clinical and dermoscopic knowledge of this increasingly frequent disease. Methods In this retrospective observational study, twenty patients with dermatophytic melanonychia were collected, with available clinical and dermoscopic pictures. The diagnosis of dermatophytic melanonychia was made based on clinical manifestation and mycological examination. KOH smear was performed in all cases. For each patient, clinical data included: age, gender, type of melanonychia and involved fingers. Results This study aimed to show increased incidence of dermatophytic melanonychia and its correct management. In addition, we reviewed our collected cases and described the clinical and dermoscopic features of dermatophytic melanonychia. Conclusions The results of this study showed that physicians should keep in mind the diagnosis of this increasing disease, and that it cannot be performed relying only on clinical grounds. We would like to highlight the importance of tools as KOH examination, culture, and dermoscopy.

The field of hair disorders is constantly growing. The most important hair diseases are divided in non- cicatricial and cica- tricial ones. Non-cicatricial alopecia are more frequent than cicatricial alopecia. The first step is to obtain a good history and physical examination. Laboratory testing is often unnecessary, while trichoscopy is fundamental for all hair diseases. Scalp biopsy is strongly suggested in cicatricial alopecia and in doubtful cases. Androgenetic alopecia, alopecia areata, telogen effluvium, trichotillomania are common causes of non- cicatricial alopecia. Frontal fibrosing alopecia, discoid lupus erythematosus, lichen planopilaris, follicullitis decalvans are some of the most common forms of cicatricial hair loss. Many treatments are available, and a prompt diagnosis is very important for the prognosis. Received: 17 April 2020; Accepted: 27 October 2020

Introduction: Brittle nail syndrome is characterized by dry, weak, easily breakable nails that show inelasticity, splitting and overall nail plate fragility. Objective: This paper describes in vitro and clinical studies using bovine hooves designed to assess the efficacy, compatibility and acceptability of a water-soluble nail strengthener (WSNS), containing Pistacia lentiscus and hyaluronic acid, for the treatment of patients affected by brittle nails. Methods: In the in vitro study, the WSNS was tested versus placebo and a marketed product on bovine hoof membranes, applied once daily for 14 days for evaluation of firmness, viscoelasticity and thickness before and after applications. In a clinical study, 23 female subjects affected by brittle nails were included, and the WSNS was applied once daily for 3 months. Signs and symptoms were rated by the investigators and by the participants during treatment at 28 and 84 days with different methods and dermoscopic images. Subjective efficacy was evaluated by specific questionnaires. Results: In the in vitro study, the daily application of the WSNS and marketed product led to a significant increase in firmness index. In the clinical study, the nails on the treated hand presented an improvement in nail appearance and weakness, after 28 and 84 days of WSNS application, respectively. The nails not treated showed no improvement. The WSNS was well tolerated. Conclusions: The WSNS containing Pistacia lentiscus and hyaluronic acid was shown to significantly increase nail firmness in the in vitro study. In the clinical study, WSNS significantly improved brittle nail appearance. The hydrosolubility and easy-to-apply format of WSNS were reported to be factors of a good compliance. We consider this product as an important tool to improve and reinforce the aspect of brittle nails.

Introduction Brittle nails are fragile or split nails; they affect 20% of the population and may be primary or secondary to different conditions. The aim of our studies was to evaluate the efficacy and tolerability of a new water-based nail-strengthening treatment containing hyaluronic acid and Pistacia lentiscus with daily application for a period of 1–3 months for one study (n = 30) and up to 6 months for a second study (n = 30). Methods In total, we enrolled 60 patients of both sexes with brittle and weak nails due to primary or secondary causes and evaluated the efficacy of this new product using subjective and objective methods: clinical evaluation, assessment of photographs, onychoscopy evaluation, investigator and patient global assessment, dynamic optical coherence tomography (D-OCT) and reflectance confocal microscopy (RCM). Results Studies subjects presented a statistically significant improvement in global assessment scale (GAS) scores at 14 days (GAS = 1.7 ± 0.6), 1 month (GAS = 1.4 ± 0.7) and at 3 months (GAS = 1±0.7) versus the GAS score obtained before treatment (1.9 ± 0.5) (p

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 (12 weeks) telogen effluvium. info:eu-repo/semantics/publishedVersion

Background: Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles in a pattern distribution in genetically predisposed individuals. The efficacy of conventional therapies is variable, therefore there is a need for adjuvant and newer treatment modalities to provide faster and better outcomes. Objectives: Evaluation of the efficacy and tolerability of a combined therapy: preformed growth factors vehiculated through iontophoresis in patients with androgenetic alopecia and associated telogen effluvium, to obtain faster hair regrowth. Materials and Methods: Treatment was performed between June 2018 and June 2019 on 60 patients with androgenetic alopecia and associated telogen effluvium. Each patient underwent 4 sessions in total, each session was performed every 3 weeks. Global photography and trichoscopy were collected at every session of therapy. All patients filed out a self-assessment questionnaire. Results: Results were very promising, with improvement of hair density and thickening of the hair shaft diameter in most of patients seen with both global photography and trichoscopy. All patients were satisfied of the clinical result and reported a complete reduction in hair loss. No serious adverse side effects were reported. Conclusions: The use of growth factors associated with iontophoresis technique is a useful treatment for treating and preventing androgenetic alopecia. In addition, in case of associated telogen effluvium, this technique allows for an early stop of hair shedding, especially when cosmetic procedures do not provide satisfactory results in patients.

Background: Congenital triangular alopecia (CTA) is a benign, asymptomatic, nonprogressive, localized and noncicatricial type of alopecia that is usually first noted during infancy or childhood. The pattern of hair loss is traditionally described as triangular, oval or lancet shaped with apex toward the vertex. Objectives: We present a case series of CTA located in unusual sites. Patients and Methods: We performed trichoscopy in 78 patients with CTA. From this group, we selected 10 individuals (4 males and 6 females) whose disease was not localized on the typical scalp area. Results: The alopecic area was located on the occipital region in 5 patients, the parietal region in 4 patients, at the vertex in 1. With trichoscopy, vellus hairs were detected in all patients, and evidence of empty follicles was noticed only in 3 patients. Conclusions: In contrast with the preconceived notion that all CTAs are frontotemporal, our case series points out that this disease could be localized in other scalp sites.

Background: Scalp psoriasis is often undiagnosed or inadequately treated. The patient himself underestimates the seriousness of this hair disease and consults too late to a dermatologist. Objectives: The aim of our study was to create a correlation between the clinical patterns and trichoscopy of scalp psoriasis such in a way to help the clinician to make the diagnosis and select the appropriate therapy. Material and methods: We gathered all patients affected of scalp psoriasis afferent to Outpatient's hair consultation of the Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, from January 2012 to December 2018. All patients were evaluated through clinical, trichoscopic examination and a skin biopsy only in doubtful cases. We quantified the severity of the disease with several objective and subjective parameters every 4months, up to 1year. We recorded therapies, outcome data and quality of life. Results: We collected 156 patients affected by scalp psoriasis, identifying seven clinical patterns with specific trichoscopical correlation. In the order of frequency, the clinical patterns were as follows: plaque psoriasis (with a prevalence of erythema, silver-white scales and twisted red loops vessels and red dots); thin scales (with silvery-white scales, simple red lines and signet red ring vessels); sebopsoriasis (with greasy scales, erythema with red dots, globules and twisted and bushy red loops at high magnification); psoriatic cap (with silver-white scales, erythema and polymorphic vascular pattern); pityriasis amiantacea (with yellowish adherent scales, erythema and simple red loops capillaries); cicatricial psoriatic alopecia (with erythema associated with yellowish, silver-white scales with twisted and bushy red loops capillaries) and pustular psoriasis (with ‘flower shape’ pustular lesions, erythema simple red loops capillaries). Conclusions: The description of different clinical patterns of scalp psoriasis and its trichoscopical correlations may help the clinician to make the diagnosis also in atypical presentations and to prescribe an adequate therapeutic regimen.

Bubble hair abnormality describes hair damage character-ized by the formation of air cavities within the cortex of the hair, due to the high temperature of water inside the shaft, that induces keratin hydrolysis and local air expansion. It is linked to excessive cosmetic treatments, in particular, pro-longed exposure of damp hair to the high temperatures (> 125 C°) of blow dryers or electric curlers, and is typically en-countered in women.

Background Fibrosing alopecia in a pattern distribution and cicatricial pattern hair loss are poorly recognized diffuse variants of lichen planopilaris (LPP). Objectives The medical features of 40 patients affected by a diffuse hair thinning associated with a long-lasting history of pruritus and erythema of the scalp and a histopathologic diagnosis of LPP were reviewed. Methods Clinical data, results of trichoscopy and histopathology, response to treatment, and follow-up were analyzed. Results There were 18 patients diagnosed with fibrosing alopecia in pattern distribution and 2 patients with cicatricial pattern hair loss. A new variant of diffuse LPP, named “lichen planopilaris diffuse pattern,” was described in 20 individuals. Limitations Low number of cases due to rarity of the diseases. Conclusion In patients complaining of a long-lasting history of scalp erythema, itching/dysesthesia, and diffuse hair thinning, it is advisable to consider diffuse variants of LPP.

INTRODUCTION: Brittle nail syndrome is characterized by dry, weak, easily breakable nails that show inelasticity, splitting and overall nail plate fragility. OBJECTIVE: This paper describes in vitro and clinical studies using bovine hooves designed to assess the efficacy, compatibility and acceptability of a water-soluble nail strengthener (WSNS), containing Pistacia lentiscus and hyaluronic acid, for the treatment of patients affected by brittle nails. METHODS: In the in vitro study, the WSNS was tested versus placebo and a marketed product on bovine hoof membranes, applied once daily for 14 days for evaluation of firmness, viscoelasticity and thickness before and after applications. In a clinical study, 23 female subjects affected by brittle nails were included, and the WSNS was applied once daily for 3 months. Signs and symptoms were rated by the investigators and by the participants during treatment at 28 and 84 days with different methods and dermoscopic images. Subjective efficacy was evaluated by specific questionnaires. RESULTS: In the in vitro study, the daily application of the WSNS and marketed product led to a significant increase in firmness index. In the clinical study, the nails on the treated hand presented an improvement in nail appearance and weakness, after 28 and 84 days of WSNS application, respectively. The nails not treated showed no improvement. The WSNS was well tolerated. CONCLUSIONS: The WSNS containing Pistacia lentiscus and hyaluronic acid was shown to significantly increase nail firmness in the in vitro study. In the clinical study, WSNS significantly improved brittle nail appearance. The hydrosolubility and easy-to-apply format of WSNS were reported to be factors of a good compliance. We consider this product as an important tool to improve and reinforce the aspect of brittle nails.

Alopecia Areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration (FDA). The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology (SIDeMaST) proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.

Nail psoriasis affects 50–79% of patients with skin psoriasis and up to 80% of patients with psoriatic arthritis, and can also represent a negative prognostic factor in individuals with plaque psoriasis. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies alone, and relapse is common. Among different systemic agents, secukinumab, a fully human monoclonal antibody targeting interleukin (IL)-17A, is the only antibody supported by a trial specifically conducted in patients with nail psoriasis (the TRANSFIGURE trial) and has the longest follow-up available to date. In this setting, secukinumab is characterized by the highest efficacy at week 16. This review analysed the different therapeutic options for nail psoriasis, focusing on new treatments that have shown promising results in this field.

Background: Alopecia areata is a nonscarring hair loss that usually causes round patches of baldness, but alopecia areata incognita (AAI) and diffuse alopecia areata (DAA) can cause a diffuse and acute pattern of hair loss. Objective: To analyze the clinical, trichoscopic, histological, and therapeutic features of AAI and DAA. Methods: The study was designed to include data of patients with histological diagnosis of AAI and DAA enrolled in our Hair Disease Outpatient Consultations. Results: DAA had a greater involvement of the parietal and anterior-temporal regions, while AAI manifested itself mainly in the occipital-parietal regions. The most frequent pattern was empty yellow dots, yellow dots with vellus hairs, and small hair in regrowth, but the presence of pigtail hair was found almost exclusively in those with AAI. In cases of DDA, the finding of dystrophic hair and black dots was more frequent. The most frequent trichoscopic sign in both diseases was the presence of empty yellow dots, which, however, were described in a higher percentage in cases of DAA. The diseases have a benign course and are responsive to topical steroid therapy. Conclusions: Trichoscopy is very important for the differential diagnosis between the 2 diseases and to select the best site for biopsy. In the presence of diffuse hair thinning, these entities must be considered.

Background Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak. Objective To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit. Methods Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data. Results From 2005 to 2017, we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In six cases, eyebrow alopecia preceded hair loss. Non-inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and 'lonely hair'. Scalp lichen plano-pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short-term treatment with systemic or intralesional corticosteroids followed by therapy with 5α-reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy. Conclusions Frontal fibrosing alopecia not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.

Dandruff is a common condition, generally due to seborrheic dermatitis (SD) and occasionally to scalp psoriasis (SP), which is characterized by accumulation of scales, oily, red and flaky scalp, often accompanied by itch. The aim of our study was to evaluate the cleansing efficacy and tolerability of a new shampoo (Psorisdin Shampoo®) containing urea, glycolic acid, salicylic acid, ichthyol pale and laureth 9 compared to a nonspecific shampoo. A total of 10 subjects (4 males and 6 females, 18–60 years) with mild–moderate scalp inflammation with redness, itching and flaking, due to SP and/or SD, were included in this open clinical study. The treatment efficacy was assessed by comparison of global photography and trichoscopy pictures, evaluating the presence of scales and erythema on the scalp, the number and morphology of capillaries and verifying disease evolution, severity of symptoms and presence of scalp irritation/itch. The use of this medicated shampoo resulted in an important improvement of patient’s scalp and hair clinical appearance and was well tolerated, with disappearance of scalp irritation and itching in almost all patients, showing higher cleansing and soothing property than a nonspecific shampoo. The effect of the tested shampoo was maintained over time, even after 5 days since the last wash.

Background Nail apparatus melanoma is an uncommon tumor and there are few studies focused on its dermoscopic features. Objective the aims of our study was to evaluate the diagnostic accuracy of dermoscopy in nail apparatus melanoma. A diagnostic algorithm for adult patients with suspected nail apparatus melanoma is proposed. Methods We collected nail apparatus melanoma dermoscopic images of patients with a proven histopathology from 2008 until 2015. Clinical and dermoscopic images were blindly examined by 2 dermatologists and correlations between histopathological aspects and dermoscopic features were investigated. Results We retrospectively collected nail apparatus melanoma dermoscopic images associated to a proven histopathology of 23 Caucasian patients. Only cases with available both pre-operative dermoscopic images and bioptic specimens were included. 17 women and 6 men were included. The mean age at diagnosis was 63 years (range 18–92). Conclusion we created an algorithm to indicate the correct way to follow an adult patient with suspected nail apparatus melanoma. This algorithm may ameliorate management in case of suspected nail apparatus melanoma and possibly facilitate an early diagnosis. This article is protected by copyright. All rights reserved.

A simple clue to diagnose frontal fibrosing alopecia

PSORIASI OF THE NAILS IS VERY COMMON, AFFECTING UP TO 80% OF PATIENTS WITH SKIN LESIONS, AND ALSO OCCURRING AS ISOLATED NAIL DISEASE. NAIL PSORIASIS IS MORE COMMON IN PATIENTS WITH SEVERE DISEASE AND IN THOSE WITH PSORIATIC ARTHOPATHY AND IS CONSIDERED BY THE NAIL DYSTROPHIES, AND OFTEN FRUSTATED BY PREVIOUS INEFFECTIVE OR POORLY TOLERATED TREATMENTS. COMBINATION OF TOPICAL DRUGS AND PRODUCTS WITH DIFFERENT MODE OF ACTION AND MODALITY OF APPLICATION IS PROBABLY THE BEST WAY TO OBTAIN IMPROVEMENT OF NAIL PSORIASIS, IN ORDER TO TARGET BOTH NAIL BED AND NAIL MATRIX SYMPTON. THE COMBINED TREATED WITH TOPICAL TAZAROTENE AND UREA CONTANING NAIL LACQUER IS A VALID THERAPEUTIC OPTION IN THESE PATIENTS

Nail dermoscopy is becoming more and more frequently utilized for the diagnosis of nail disorders. It can be performed with handy dermoscope or with a video dermoscope, which allows magnifications of up to 200. Nail dermoscopy requires a good knowledge of nail anatomy and physiology and the pathogenesis of nail diseases: we have to know which part of the nail we have to look at! The nail is in fact not visible as a whole at one time, but its different parts should be observed, moving the lens back and forth and transversally. All nail disorders can be observed by dermoscopy. However, except for some diseases in which the technique really adds a lot to clinical examination, in most of the cases, nail dermoscopy only permits a better visualization of symptoms already evident to the naked eye. Dermoscopic features of nail signs are always very interesting and surprising, and may help in our understanding of nails.

The hair is formed by two parts: a visible part, the shaft, and a non-visible part, the hair follicle. The latter is further divided into upper segment, or permanent, and a lower segment, or dynamic, for the changes they have during the follicular cycle. The follicular cycle causes the production of the hair from the follicle, and it is not continuous but cyclic, with a succession of the three stages: growth (anagen), regression (catagen), and resting (telogen)

Myiases often emulate other disease symptoms eliciting wrong diagnoses and delaying proper treatment of infestations. The case we reports give us the opportunity to discuss the occurrence of myiasis in developed countries then focusing on suggestions for an effective infestation diagnosis.

Nail dermoscopy is becoming more and more frequently utilized for the diagnosis of nail disorders. It can be performed with handy dermoscope or with a video dermoscope, which allows magnifications of up to 200. Nail dermoscopy requires a good knowledge of nail anatomy and physiology and the pathogenesis of nail diseases: we have to know which part of the nail we have to look at! The nail is in fact not visible as a whole at one time, but its different parts should be observed, moving the lens back and forth and transversally. All nail disorders can be observed by dermoscopy. However, except for some diseases in which the technique really adds a lot to clinical examination, in most of the cases, nail dermoscopy only permits a better visualization of symptoms already evident to the naked eye. Dermoscopic features of nail signs are always very interesting and surprising, and may help in our understanding of nails.

EPDS is a rare disease that does not seem restricted to an age group, but rather to a precipitating event that involves the scalp, most commonly a mechanical trauma. The clinical histo- ry is therefore mandatory to suspect the diagnosis, which is suggested by chronic scalp erosions leading to skin atrophy and scarring.