Clinical, dermoscopic and histopathological study of superficial scalp folliculitis

Questa tesi si basa su uno studio retrospettivo clinico, dermatoscopico e istopatologico sulle follicoliti superficiali del cuoio capelluto. Le follicoliti superficiali del cuoio capelluto rappresentato un gruppo di patologie di frequente riscontro nella pratica ambulatoriale, ma poco descritte in letteratura. La chiave per comprendere questo vasto argomento della tricologia è capire prima di tutto la sede e le caratteristiche dell’insulto infiammatorio a livello del follicolo pilifero. In base al tipo di processo infiammatorio si può così risalire al fattore scatenante ed impostare la terapia specifica per bloccare l’infiammazione prima di creare un danno permanente ai follicoli con alopecia cicatriziale. Lo scopo di questa tesi è descrivere le patologie che si presentano clinicamente come follicoliti del cuoio capelluto, identificarne le cause e le caratteristiche, per creare una classificazione standardizzata. Per ognuna delle patologie analizzate si è cercato di descrivere le peculiarità cliniche sia da un punto di vista obiettivo che soggettivo, gli strumenti necessari dal punto di vista diagnostico, nonché alcuni accenni di terapia, confrontando le nozioni già note con gli ultimi studi presenti in letteratura. Gli strumenti usati in questo studio sono stati di due tipi: non invasivo ed invasivo. Lo strumento non invasivo utilizzato è stata la dermatoscopia, una tecnica che consente di osservare ad alto ingrandimento il cuoio capelluto ed i capelli valutando le condizioni della cute e dei follicoli piliferi. Lo strumento di tipo invasivo utilizzato è stata la biopsia cutanea in sede di follicolite con relativo esame istologico. E’ anche stato effettuato l’esame colturale nella gran parte dei casi. Attraverso questo studio retrospettivo clinico, dermatoscopico e istopatologico abbiamo voluto raccogliere tutti i pazienti che si sono presentati con un quadro clinico di follicoliti superficiali del cuoio capelluto e cercare una correlazione tra la diagnosi dermatoscopica e la diagnosi istologica.This study is based on a retrospective clinical, dermoscopic and histopathology study on the superficial folliculitis of the scalp. Superficial folliculitis of the scalp represented a group of diseases frequently visited in clinical practice, but a few case reports are described in the literature. Their classification can be so difficult, especially for dermatologists without trichological experience, and since today there is no standardized classification. The key to understand this diseases is to know, first of all, the inflammatory characteristics of the infiltrate of the hair follicle. On the basis of the type of inflammatory process, it is possible to find the trigger factors and gives the specific therapy to block the inflammation before creating permanent damage to the follicles with scarring alopecia. The purpose of this study is to describe the diseases that clinically occur as scalp folliculitis, identify the causes and characteristics of the disease, and create a standardized classification. For each type of folliculitis, we tried to describe the clinical features both an objective and subjective point of view, the tools for the diagnosis and the therapy, comparing what is know in the literature. The instruments used in this study were of two types: non-invasive and invasive. The non-invasive tool used was the dermoscopy, a technique that permit to observe at high magnification the scalp and hairs, evaluating the conditions of the skin and hair follicles. The invasive instrument used was skin biopsy in the site of folliculitis with histological examination. It was also performed a culture examination in most cases. Through this clinical, dermoscopic and histopathological retrospective study, we collected all the patients who presented with a clinical aspect of superficial folliculitis of the scalp and find a correlation between the dermoscopic and histological diagnosis

Role of dynamic optical coherence tomography for in vivo investigation of nails

Introduction Nail diseases are often troubling to the patient and diagnostically challenging for dermatologists. Therefore, a nail biopsy is required in some cases although often perceived uncomfortable by the patient and potentially scarring. Non-invasive imaging techniques are of particular interest in the diagnosis of nail diseases, reducing the number of nail biopsies. Objective The main objective of this study was to describe the typical aspect of healthy nail in Dynamic OCT (D-OCT) and assess the morphological changes that occur in different affected nails. Secondary objective was to detect the main characteristics of each nail disease. Material and Methods This was an observational, retrospective study carried out in our dermatology center from January 2016 to June 2018. Consecutive patients affected by nail diseases and volunteers with healthy nail were recruited. There were no limitations in age or gender. Standardized clinical and dermoscopic images were acquired per patient. D-OCT (VivoSight®: Michelson Diagnostics, Maidstone, UK) was performed on the surface of any nail investigated at three different distances: proximal nail fold, proximal and distal part of the nail plate. In case of suspicious nail tumour, for a better identification of the lesion and its borders, more D-OCT acquisitions were executed. Results 25 nail diseases from 126 patients were evaluated and divided in six main groups: nail changes, ungual infections, ingrowing toenails, nail pigmentation, nail neoformations and inflammatory nail disorders. Mean age of our patient population was 45.7 years (range 9-87) and the majority were female (81 cases, 64.3%). Moreover, 2 healthy nails from 5 volunteers (2 men and 3 women) with a mean age of 34.4 years (range 26-56) were collected. Conclusions D-OCT allows an early diagnosis of nail disease, reduces the number of nail biopsies, helps for the biopsy site selection, detection of the nail tumours borders and for the treatment monitoring

Dermoscopy, reflectance confocal microscopy and optical coherence tomography for the diagnosis of lichen simplex chronicus localized on the scalp

Introduction Lichen simplex chronicus (LSC) is characterized by lichenified plaques that occur as a result of constant scratching or rubbing of the skin. The scalp is one of the most common locations involved by this chronic condition. No data on reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (D-OCT) of LSC on the scalp exist, while the useful of dermatoscopy for the diagnosis of this disease was described in three cases. Objective The aim of this study was to evaluate features of LSC at dermoscopy, RCM and D-OCT in order to provide a rapid non-invasive bed-side diagnosis. Material and Methods This was an observational, retrospective study carried out in our dermatology center from January 2015 to September 2018. A clinical assessment, digital dermatoscope examination, RCM (VivaScope\uae 3000: Mavig GmbH, Munich, Germany) and D-OCT (VivoSight\uae: Michelson Diagnostics, Maidstone, UK) were performed in patients with suspicious LSC of scalp. The diagnosis of LSC was confirmed histologically in all cases. Results In total, 3 lesions of the scalp from 2 patients with LSC were evaluated. We show that dermatoscopy, RCM and OCT can be useful tools for the diagnosis of LSC. We also correlate the dermatoscopic, RCM and OCT signs with the pathological features observed in transversely sectioned scalp biopsies from affected scalp of these two patients. Conclusions Dermoscopy, RCM and OCT provide useful information for a rapid diagnosis of LSC of scalp and for the identification of biopsy site

Efficacious and safe management of thick scales, redness and flaky scalp condition using a specific shampoo containing urea, glycolic acid, salicylic acid, icthyol pale and laureth 9

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

Adherent Serous Crust of the Scalp: Inflammatory or Infectious Hair Disease? A Case of Scalp Eschar and Neck Lymph Adenopathy after a Tick Bite

Scalp eschar and neck lymphadenopathy after tick bite (SENLAT) is an emerging and increasingly common syndrome, primarily described in Europe..

Clinical and Instrumental Objective Evidence of the Efficacy of a New Water-Based Nail-Strengthening Solution Containing Pistacia lentiscus and Hyaluronic Acid Applied for Up to 6 Months to Improve the Appearance of Weak, 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 < 0.0001). From the Italian study at 6 months (n = 30) 76% of the patients had an improvement in their nail appearance. Reduction in nail plate roughness with improved nail resistance and decreased distal breakage were the most evident benefits, demonstrated on clinical and instrumental evaluations. No side effects were reported. All patients reported an improvement in nail appearance after using the product for 1 month, 3 months and 6 months, and had a positive opinion on the product. Conclusions: This new product is an effective, safe, and easy-to-use option for topical treatment of brittle nails and primary nail fragility and an adjuvant therapy in secondary nail fragility. Moreover, its ease of application and cosmetic qualities allow good compliance

An open clinical investigation on clinical dermatoscopy, OCT and RCM visible effects of application of a new topical product for 6 months on brittle nails and weak nails with rough surface and/or tendency to break

Introduction & Objectives Nail brittleness is a common complaint characterized by weak nails with rough surface and/or tendency to split, flake and crumble. This nail alteration can be a consequence of factors that alter the nail plate production or factors that damage the nail plate, such as cosmetics (permanent and non-permanent nail lacquers), psoriasis, lichen planus, ageing, chemotherapy, other drugs and anaemia. The aim of our study was to evaluate the effectiveness, tolerability and patient’s compliance of a new water-soluble nail lacquer with silicon and keratin synthesis booster product for brittle and weak nails. Material & Methods 30 patients of both sexes, aged >18 years, affected by nail brittleness were prescribed a new topical therapy to be applied on the affected nails once a day for 6 months. The new product is dispensed by a pencil unit with a brush and has to be applied on the entire edge of the nail, cuticle included. Periodic evaluation of treatment efficacy was performed by standardized photography and dry video-dermoscopy of the target nail at baseline (V1), after 15 days (V2), 1 month (V3), 3 months (V4) and 6 months (V5). The treatment efficacy was evaluated by the experimentator through Global and Trichoscopy Assessment Scale and by patients through a patient global assessment and a specify questionnaire. 10 patients also underwent to Optical Coherence Tomography (OCT) in order to have a further objective parameter of efficacy evaluation. Results All patients concluded the study, with marked improvement of nail weakness and appearance. No side effects were recorded. All patients judged the treatment easy to apply and effective. Conclusions This new water-soluble nail lacquer with silicon and keratin synthesis booster is an effective and safe option for the treatment of nail brittleness and damages

Una storia di lesioni bollose di lunga durata

Si presenta il caso di una paziente di 33 anni di origine marocchina che riferiva fin dall’età infantile la comparsa al minimo traumatismo di multiple piccole lesioni bollose prevalentemente agli arti inferiori con saltuario coinvolgimento del cavo orale. In anamnesi ipertensione arteriosa in terapia farmacologica, un fratello di 47 anni con manifestazioni analoghe ed una sorella di 28 anni affetta da vitiligine, entrambi residenti nel paese di origine. All’esame obiettivo si osservavano molteplici esiti ipo- ed iper-pigmentati ed alcune aree disepitelizzate frammiste a lesioni crostose prevalentemente agli arti inferiori. Erano presenti, inoltre, alcune piccole bolle flaccide a contenuto siero-ematico alla pianta dei piedi ed un marcato diradamento dei capelli. Non era documentabile un interessamento delle mucose. Le indagini biochimiche, istologiche, immunologiche ed ultrastrutturali hanno portato ad una inconsueta diagnosi