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Competing Interests: Conflicts of interest None disclosed.

Hair disorders, including central centrifugal cicatricial alopecia (CCCA), traction alopecia (TA), and acquired trichorrhexis nodosa (ATN), commonly occur in individuals with curly textured hair. Curly textured hair in individuals of African descent has unique properties and can present diagnostic and therapeutic challenges. CCCA has been linked to uterine leiomyoma and type 2 diabetes mellitus, as well as fibroproliferation. TA often presents with a fringe sign and can arise from high-tension hairstyles presumed to be protective. Trichoscopy is useful in establishing a diagnosis; perifollicular halos are more commonly seen than perifollicular erythema or scale in CCCA. In TA, miniaturized follicles, hair casts, and "flambeau sign" can be seen. Hairstyling practices likely contribute to TA and ATN; however, the data are mixed on the role of chemical relaxers and heat styling in CCCA. Unique considerations in the presentation of frontal fibrosing alopecia in curly textured hair have also been published recently. This review provides a comprehensive, up-to-date summary of these disorders with an emphasis on their unique properties, as well as considerations in hair care for curly textured hair., (© 2024 the International Society of Dermatology.)

The scalp microbiome represents an array of microorganisms important in maintaining scalp homeostasis and mediating inflammation. Scalp microbial dysregulation has been implicated in dermatologic conditions including alopecia areata (AA), dandruff/seborrheic dermatitis (D/SD), scalp psoriasis (SP) and folliculitis decalvans (FD). Understanding the impact of scalp microbial dysbiosis gives insight on disease pathophysiology and guides therapeutic decision making. Herein we review the scalp microbiome and its functional role in scalp conditions by analysis of metagenomic medical literature in alopecia, D/SD, SP, and other dermatologic disease.Increased abundance of Malassezia, Staphylococcus, and Brevibacterium was associated with SD compared to healthy controls. A higher proportion of Corynebacterium, actinobacteria, and firmicutes are present in AA patients, and lower proportions of Staphylococcus caprae are associated with worse clinical outcomes. Decreased prevalence of actinobacteria and Propionibacterium and increased firmicutes, staphylococcus, and streptococcus are associated with scalp psoriasis. Studies of central centrifugal cicatricial alopecia (CCCA) suggest scalp microbial composition contributes to CCCA's pro-inflammatory status. The most common organisms associated with FD include methicillin-resistant S. aureus and S. lugdunensis. Antifungals have been a mainstay treatment for these diseases, while other alternatives including coconut oils and shampoos with heat-killed probiotics have shown considerable potential efficacy by replenishing the scalp microbiome., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Alopecia areata (AA) is managed with prolonged medical treatments and cosmetic therapies, whose cost can be burdensome. We sought to identify the costs of AA treatment and consolidate the available data for the practicing dermatologist by performing a PubMed search of articles indexed for MEDLINE. Ten studies including approximately 16,000 patients with AA across a range of Oxford Centre for Evidence-Based Medicine Levels of Evidence were included. Studies showed that despite the limited efficacy of many AA therapies, patients incurred substantial expenses to manage their AA.

Platelet-rich plasma (PRP) offers anti-inflammatory and regenerative properties through angiogenesis, cell differentiation, and proliferation. Although studied in many dermatologic conditions, its efficacy is not well-understood. Our objective is to review the use and effectiveness of PRP for dermatologic conditions. A literature search was performed through PubMed and yielded 54 articles published between January 2000 and November 2021; articles written in English were reviewed. Intradermal injections were associated with increased hair density in androgenic alopecia. Successful treatment of inflammatory nail diseases with PRP has been reported. Improvement in psoriasis was described, but only two studies were available. PRP was associated with higher patient self-assessment scores of photoaging and fine lines. Treatment with PRP in melasma has been associated with improved subjective satisfaction, but not with objective measures of disease improvement. PRP can serve as a safe and potentially effective adjunct for hair loss, vitiligo, nonhealing wounds, photoaging, and acne scars. An important barrier to interpreting PRP research is lack of standardization of PRP preparation protocols, inconsistent clinical endpoints, and frequent combination treatments. However, PRP is relatively noninvasive, has a well-established safety profile, and patient satisfaction is often high as patients perceive great benefit from treatment with PRP.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Non-adherence to topical minoxidil in alopecia patients is a barrier to efficacy. Understanding patient factors associated with adherence and non-adherence may provide actionable targets to improve adherence and outcomes., Methods: Ninety-nine alopecia patients at an outpatient university dermatology specialty clinic completed a survey assessing demographics and aspects of treatment adherence. Patients currently using minoxidil additionally completed a survey grading their level of adherence. A two-sample t-test was used to compare the average age between adherent and non-adherent groups. Differences in demographics and patient factors by adherence level were evaluated using the 2-tailed &chi;2 test and Fisher's exact test., Results: Adherent patients had been using topical minoxidil for a median of 24 months when surveyed; non-adherent patients used the medication for a median of 3.5 months prior to discontinuation. A larger portion of non-adherent patients used minoxidil for fewer than 3 months (35%) compared to adherent patients (3%), P&lt;.001. The most common reason non-adherent patients discontinued therapy was no improvement (50%)., Discussion/conclusion: Non-adherent patients were less likely to use topical minoxidil for at least 3 months and often cited lack of improvement as a reason for discontinuing. Patient education and intervention prior to the 3-month mark may help improve adherence. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.6639.

Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. The diagnosis of this pathology is complex, even more in countries where it is not considered endemic. However, early suspicion and management are essential to improve survival and avoid unnecessary diagnostic and therapeutic strategies. We report a 69-year-old woman who presented a sensory-motor polyneuropathy, predominantly sensory, associated with distal neuropathic pain and bilateral vitritis. The history of her Italian father with polyneuropathy of unspecified etiology stood out. A vitreous biopsy identified amyloid substance deposits (congo red positive). These were also confirmed on a superficial peroneal nerve biopsy. During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.

Competing Interests: Conflicts of interest None disclosed.

Abstract: Primary cicatricial alopecias are inflammatory scalp conditions that may lead to permanent hair loss and severe alopecia. Frontal fibrosing alopecia is one of the most frequent etiologies of primary cicatricial alopecias. Hair transplant could be a therapeutic option.High-resolution ultrasound (US) is an imaging technique useful for evaluating scalp with adequate differentiation of the skin layers. Also, hair follicles are visualized.The objectives are present presurgical and posttransplant scalp US studies on hair transplant.Frontal fibrosing alopecia is a chronic entity that can progress to extensive irreversible alopecia. Hair transplant is a surgical option. On US, the hair follicles are visualized as thin hypoechoic lines. With Doppler color imaging, it is possible to evaluate vascularization. In this experience, we can observe the follicles of the compromised area before and after the hair transplant and the depth of the implanted follicles.In conclusion, US impresses as a promissory technique for the imaging of hair transplant. More experience is necessary for a better approach of these findings., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity., Aim: To characterize patients with AL amyloidosis in Chilean public health centers., Material and Methods: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated., Results: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%., Conclusions: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.

Background: The frequency of different types of alopecia is not clearly reported in recent studies., Objective: To analyze the frequency of the types of alopecia in patients consulting at specialist hair clinics (SHC) and to assess for global variations., Methods: Multicenter retrospective study including data from patients evaluated at referral SHC in Europe, America, Africa and Australia., Results: A total of 2,835 patients (72.7% females and 27.3% males) with 3,133 diagnoses of alopecia were included (73% were non-cicatricial and 27% were cicatricial alopecias). In all, 57 different types of alopecia were characterized. The most frequent type was androgenetic alopecia (AGA) (37.7%), followed by alopecia areata (AA) (18.2%), telogen effluvium (TE) (11.3%), frontal fibrosing alopecia (FFA) (10.8%), lichen planopilaris (LPP) (7.6%), folliculitis decalvans (FD) (2.8%), discoid lupus (1.9%) and fibrosing alopecia in a pattern distribution (FAPD) (1.8%). There was a male predominance in patients with acne keloidalis nuchae, dissecting cellulitis and FD, and female predominance in traction alopecia, central centrifugal cicatricial alopecia, FFA, TE, FAPD and LPP., Conclusion: AGA followed by AA and TE were the most frequent cause of non-cicatricial alopecia, while FFA was the most frequent cause of cicatricial alopecia in all studied geographical areas., Competing Interests: The authors declare no conflicts of interest.

The face has not been considered a common site of fixed drug eruption, and the authors lack dermatoscopic studies of this condition on the subject. The authors sought to characterize clinical and dermatoscopic features of 8 cases of an eruptive facial postinflammatory lentigo. The authors conducted a retrospective review of 8 cases with similar clinical and dermatoscopic findings seen from 2 medical centers in 2 countries during 2010-2014. A total of 8 patients (2 males and 6 females) with ages that ranged from 34 to 62 years (mean: 48) presented an abrupt onset of a single facial brown-pink macule, generally asymmetrical, with an average size of 1.9 cm. after ingestion of a nonsteroidal antiinflammatory drugs that lasted for several months. Dermatoscopy mainly showed a pseudonetwork or uniform areas of brown pigmentation, brown or blue-gray dots, red dots and/or telangiectatic vessels. In the epidermis, histopathology showed a mild hydropic degeneration and focal melanin hyperpigmentation. Melanin can be found freely in the dermis or laden in macrophages along with a mild perivascular mononuclear infiltrate. The authors describe eruptive facial postinflammatory lentigo as a new variant of a fixed drug eruption on the face.

Purpose: The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion., Methods: We performed retrospective analyses on a cohort of 302 septic shock patients., Results: When we divided patients according to the presence of hyperlactatemia, 34% evolved without hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O(2) saturation values, and required lower norepinephrine doses. The potential inclusion of hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%., Conclusions: Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The paper aims to present the case of a progressive and unilateral cranial polyneuropathy due to perineural spread of cutaneous squamous cell carcinoma. This is a case of a 73 year old man with a history of squamous cell carcinoma in the right temporal region that was removed in 1992. In May 2000 he first presented pain and numbness in the distribution of the first branch of right trigeminal nerve and weakness of the ipsilateral frontal muscle. Later on he presented right ophthalmoplegia, and damage of lower cranial nerves, leading to dysphagia and respiratory distress. He was admitted in March 2001 for a gastrostomy for feeding, when ataxia and recurrence of the right temporal lesion ensued. After three examinations with MRI, the fourth study showed meningeal carcinomatous and a metastatic lesion in the brainstem. Histopathologic examination demonstrated dermal and perineural invasion by squamous cell carcinoma. The necropsy also showed meningeal, perineural and endoneural infiltration of atypical epidermal cells and a pons mass composed of the same cells. We conclude that the perineural spread of the cutaneous carcinoma is an exceptional cause of cranial neuropathy, however it must be ruled out in patients with progressive and unilateral cranial neuropathy. In these cases, when no radiological abnormalities are noted, a biopsy may be performed on the peripheral branches of the cranial nerve to confirm the diagnosis.

The ability of strains of the Arthrinium genus to inhibit microbial development has been previously described. In the present work different periods of mutagenic treatment using ultraviolet light, and of nitrosoguanidine treatment, on strains of Arthrinium were investigated. With nitrosoguanidine treatment the survival rate ranged from 2.17 to 8.78%. Mutant strains were only obtained with a higher antibiotic production in comparison with the wild-strain, when the mutagenic agent was UV light.

This paper is the first report in the literature of the presence of virus-like particles in the conidia and hypha of Arthrinium aureum. These particles, detected with an electron microscope, are spherical and 52 nm in diameter.

Modifications in the antibiotic capacity of Arthrinium strains when they were developed in culture media of various compositions were studied. The culture media used were 2% malt extract agar, Czapek-Dox agar, Sabouraud dextrose agar, oatmeal agar, Yoshimura's medium, mixed medium of salts, modified phytone agar, malt extract-yeast extract agar, potato dextrose agar, and Wickerham's medium. The inhibition values were compared with those obtained when the strains were developed in Wickerham's medium. The media which enhanced the production of inhibitory substances were potato dextrose agar and 2% malt extract agar.

Bacteria, filamentous fungi and yeasts were subjected to the action of Lavandula officinalis, Melissa officinalis and Rosmarinus officinalis essences in a steam phase, using a microatmospheric technique. Due to the methodology employed, L. officinalis essence was more active in filamentous fungi than the other essential oils studied. All three essences possessed a similar degree of activity against the micro-organisms tested, though a relatively higher activity was seen in the case of M. officinalis.

Analysis of the chemical composition of hyphae, conidia and chlamydospores of Arthrinium aureum enabled all sample constituents of > 23 kD molecular weight to be detected. Sulphur, chlorine, potassium and calcium were present in the hyphae and condia of A. aureum, and sulphur, potassium and calcium in the chlamydospores.

The relationship involving the presence of sterile hyphae in moulds and their inhibitory activity on 34 micro-organisms was investigated. From the results it was evident that antimicrobial activity varied when morphological changes were observed in the cultures.

The Present work reports the study of the distribution of keratinophilic fungi isolated from 39 samples of soil collected in Brittany, France. Keratinophilic fungi were isolated from 35 (92.3%) of the samples studied. The most frequently found species wereFusarium moniliforme, Penicillium viridicatum and an unidentified species ofAcremonium. The other fungi isolated were members of the generaChrysosporium, Gliocladium, Mucor, Trichoderma andTrichophyton.

The aim of this study was to determine the growth aspects of Arthrinium strains in the presence of several nitrogen sources. The addition of tryptone, peptone or soybean peptone to the culture medium stimulated larger colony diameters in most of the isolates.

Electron microscopic observations of structures in Arthrinium aureum, which have not previously been described, are presented and discussed. Considerable attention is given to cytoplasmic inclusions, especially nuclei, mitochondria and Woronin bodies.

The influence which the addition of certain mineral salts has on the inhibiting activity of strains belonging to the Arthrinium genus was studied. The salts employed were AgNO3, FeCl2, MnCl2 and CuSO4, in concentrations of 10, 50, 100, 150 and 200 mg/l, in the presence of Bacillus subtilis, Enterobacter cloacae, Staphylococcus aureus, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, Candida albicans and Aspergillus niger. For B. subtilis and S. aureus greater inhibition was observed after the addition of FeCl2 (200 mg/l) and MnCl2 (10 mg/l). E. coli showed a greater sensibility in the presence of AgNO3 (200 mg/l) and CuSO4 (150 mg/l). Inhibition before Enterobacter cloacae and Serratia marcescens was not increased by the addition of any of the salts. The addition of MnCl2 at 10 mg/l concentration to the basal medium showed a considerable increase of inhibitory activity over Klebsiella pneumoniae and Candida albicans. Activity for Aspergillus niger decreased when any of the salts were added to the medium.

A family is described with the following features: 1) Two propositi, a male and a female, with congenital absence of gluteal muscles and with spina bifida occulta. 2) Both parents and two apparently normal siblings with sacral spina bifida occulta. 3) Two siblings of the propositi who died soon after birth, one with anencephaly and the other with a probable spina bifida. Two alternative hypotheses for the etiology of these malformations are suggested: first, the muscular defect could be caused by an autosomal recessive gene independent of the open neural-tube defects; second, both types of malformations could be due to the same autosomal recessive gene. Then compensatory muscular changes which allow the propositi to walk are discussed.

Pharmacologic data are presented on 39 children treated for osteomyelitis with one of the following antibiotics: methicillin, dicloxacillin, cephaloridine, or cefazolin. The concentrations of drug in pus and bone were correlated with serum concentrations, with the susceptibilities of Staphylococcus aureus strains isolated from the patients, and with the degree of drug protein-binding. The penetration of the antibiotics into pus and bone was similar for the two penicillins and for the two cephalosporins despite the disparate protein-binding affinities of these drugs. The agents attained concentrations in tissues that were at least several fold, and often more than tenfold, greater than the MIC and MBC values of the S. aureus stains. These data provide a basis for selection of antimicrobial agents for treatment of osteomyelitis.

Levels of Cephaloridine and Cefazoline were measured in serum, pus and bone in 20 patients with chronic osteomyelitis and the efficiency of these drugs in the treatment of osteomyelitis was evaluated.