The nail and ageing

Para la ciencia podológica/podiátrica es muy importante conocer los cambios de la lámina ungueal en el anciano debido a su de alta frecuencia. Los cambios de la uña asociados al envejecimiento incluyen un crecimiento ungueal más lento, modificaciones en el espesor de la uña, alteraciones en la superficie, alteraciones en su configuración y cambios en el color. Estas alteraciones son muy comunes debido al insuficiente aporte sanguíneo a zonas distales, pero también a los microtraumas de repetición y a la dificultad de estos individuos gerontes en el cuidados de las uñas de sus pies. El envejecimiento predispone al desarrollo o al empeoramiento de diversas enfermedades, como las onicomicosis, las uñas quebradizas, la onicogrifosis, la paquioniquia, las uñas encarnadas, etc. Todas estas patologías pueden acontecer a cualquier edad, pero en la vejez hay una frecuencia más alta de su incidencia.For podiatric science is very important to know nail changes in old people because of their high frequency. Nail changes associated with ageing include slower growth rate, thickness modifications, surface alterations, configuration abnormalities and color changes. They are most commonly due to impaired blood supply, but also to chronic microtrauma and difficulty for elderly people to take care of their nails. Ageing predisposes to the development or to the worsening of different diseases, such as onychomycosis, brittle nails, onychogryphosis, pachionychia, pincer nails. These may occur at any age, but in old age there is a higher frequency of incidence

Ciclopirox 8% HPCH Nail Lacquer in the Treatment of Mild-to-Moderate Onychomycosis : A Randomized, Double-Blind Amorolfine Controlled Study Using a Blinded Evaluator

This was a randomized, controlled, parallel-group clinical trial with a blinded evaluator, designed to compare the efficacy and safety of the nail lacquer P-3051 with amorolfine 5% in the treatment of mild-to-moderate toenail onychomycosis. Patients were treated for 48 weeks with P-3051 daily, or twice weekly with amorolfine 5%. Out of 120 evaluable patients, 60 (50.0%) received P-3051 and 60 (50.0%) amorolfine 5%. At baseline, the two groups were homogeneous in terms of race, pathogens, number of affected toenails and severity of the infected target nail area. The statistical superiority of P-3051 versus amorolfine was achieved after 48 weeks (treatment success: 58.3% for P-3051 vs. 26.7% for amorolfine, p < 0.001; complete cure: 35.0% for P-3051 vs. 11.7% for amorolfine, p < 0.001). Mycological cure at week 48 was achieved in all patients treated with P-3051 compared to 81.7% of patients treated with amorolfine (p < 0.001). Moreover, fungal eradication by P-3051 was statistically superior at week 24. The results of this study, and of a previous pivotal study versus the insoluble formulation of ciclopirox 8%, led to consider P-3051 as the gold standard for the topical treatment of mild-to-moderate onychomycosis.Peer reviewe

Considerations for Management of Longitudinal Melanonychia During the COVID-19 Pandemic: An International Perspective

To the editor: 34 Longitudinal melanonychia (LM) is the presenting sign of nail unit melanoma (NUM) in 2/3 35 of cases and is therefore among the most important conditions managed by dermatologists. In 36 normal times, referral for LM would prompt an expedited appointment for clinical 37 examination and dermoscopy.1 However, due to SARS-CoV-2, dermatologists have been 38 asked to reconsider “urgent/emergency” conditions. The COVID-19 pandemic has propelled 39 physicians to unexpectedly adopt telemedicine without adequate guidance for managing LM 40 patients

Treatments options for alopecia

Introduction: Hair disorders have a very high social and psychological impact. Treatment is often frustrating and time-consuming both for the patients and the clinicians and requires special skills and expertise. Areas covered: This paper aims to provide an overview of available treatments for the most common forms of alopecia in adults (androgenetic alopecia [AGA], alopecia areata and cicatricial alopecias) after reviewing the literature in PubMed, Google Scholar and ClinicalTrial.gov. Expert opinion: Before starting treatment, it is very important to confirm diagnosis and discuss patient's expectations. Treatment of hair disorders requires time and first results are usually visible a few months after beginning of therapy. Treatment of most hair disorders is mostly not evidenced-based as randomized controlled trials are available only for AGA

Updates in treatment and impact of nail psoriasis

Nail psoriasis is an inflammatory disorder without a potential scarring outcome, but the nail signs, even the milder ones, can cause discomfort to patients and severely affect their quality of life. Nail psoriasis may be associated with psoriatic arthritis and when it starts during infancy, it may be a predictor of a more severe disease course in adulthood. All these issues contribute to the high economic burden of psoriasis. Nail psoriasis is notoriously difficult to treat, even though new treatments are in continuous development. This paper provides an update on new treatments and address the current gaps in care of nail psoriasis. A better understanding of the disease pathogenesis and more 'real-life' studies will definitely be helpful to improve treatment results. A lower level of heterogeneity should be advisable among trials when evaluating nail psoriasis. Moreover, the relationship between nail psoriasis and psoriatic arthritis should be the focus of unbiased studies in order to better define the real risk that nail psoriasis patients have to develop arthritis

Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment

Frontal fibrosing alopecia (FFA), first described by Kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective involvement of the frontotemporal hairline and eyebrows. Since the original description, an increasing number of cases have been reported worldwide and the clinical aspects of the disease have been better characterized. However, the pathogenesis is still unknown and several hypotheses have been made about possible triggering factors, including hormones, neurogenic inflammation, smoking, UV filters, and ingredients in leave-on facial products. A genetic basis has also been hypothesized as the disease can occur in siblings and members of the same family. Besides its pathogenesis, research is also focused on treatment; FFA is a chronic condition and at present there is no validated or approved treatment for this disorder. Commonly prescribed topical treatments include corticosteroids, minoxidil, and calcineurin inhibitors. Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, and retinoids. Intralesional triamcinolone acetonide is also utilized, especially for the eyebrows. Other possible treatments include pioglitazone, naltrexone, tofacitinib, and lasers

Emerging drugs for alopecia areata: JAK inhibitors

Introduction: Alopecia Areata is a common form of non-scarring hair loss that usually starts abruptly with a very high psychological impact. Due to the still not completely understood etiopathogenesis, at present there is no treatment that can induce a permanent remission and there is no drug approved for the treatment of this disorder. Areas covered: Leading existing treatment are briefly overviewed and then ongoing research on Janus Kinases Inhibitors is discussed, reviewing trials with oral and topical formulations so as new opportunities for other forms of alopecia, such as cicatricial alopecia. Expert opinion: JAK inhibitors represent a promise among alopecia treatments, but further studies are needed on long term safety. There is still no validated dosage for alopecia areata and the vehicles used for topical formulations seem not yet ideal in terms of skin penetration and reduced systemic absorption. Hopefully several studies are ongoing and we hope, in the near future, that JAK inhibitors will become part of the armamentarium to treat alopecia areata patients in terms of safety and costs