Evaluation of hair loss

The evaluation of a patient with hair problems is a fundamental step for the correct diagnosis of disease, as it gives important information and helps in choosing the diagnostic tools that should be utilized to confirm the clinical suspicion. The evaluation includes a clinical history and patient examination and is followed by invasive and noninvasive tests. Often, the sole clinical examination permits the correct diagnosis of the hair disease and the evaluation of its severity and progression. For this reason, time should be spent to get all of the necessary anamnestic data and to carefully examine the patient. Dermoscopy (trichoscopy) will afterward add additional data that can be further increased by scalp biopsy for histopathology and/or by other more specific tests. When approaching a patient with hair problems, it is mandatory to consider the strong psychological impact of hair diseases, which are very often associated with severe emotional distress. For this reason, patients should be managed with care by spending time listening to their complaints and by explaining in detail their disease and its possible treatments. The patient will only be able to properly adhere to treatment and to obtain the best result if she/he understands her/his hair problem and its possible solutions

Drug reactions affecting the nail unit: diagnosis and management.

Several drugs may be responsible for the development of nail abnormalities, but only a few classes are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues, or the digit blood vessels. Pharmacologic agents that most frequently produce nail abnormalities include retinoids, indinavir, and cancer chemotherapeutic agents

Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents.

BACKGROUND: Recurrences (relapse or reinfection) of onychomycosis are not uncommon, with percentages reported in various studies ranging from 10% to 53%. OBJECTIVE: We sought to determine the prevalence of long-term recurrences of toenail onychomycosis caused by dermatophytes cured after systemic antifungal treatment with terbinafine (T) or itraconazole (I) and identify risk factors for recurrences. METHODS: This 7-year prospective study, started in 2000 and ended in 2007, included 73 patients periodically followed after successful treatment of toenail onychomycosis using either T, 250 mg daily (59 patients), or I, 400 mg daily, for 1 week per month (14 patients). Patients were evaluated every 6 months, with clinical and mycological evaluations being performed. RESULTS: Twelve of 73 patients (16.4%) developed a recurrence of onychomycosis a mean time of 36 months after successful treatment. These included 5 of the 14 patients (35.7%) who had taken I and 7 of the 59 (11.9%) who had taken T (P = .046). LIMITATIONS: The number of patients treated with T (59 patients) was more than that for I (14 patients). CONCLUSION: The administration of systemic T to treat the first episode of onychomycosis may provide better long-term success than I in those patients with a complete response. Other factors including the presence of predisposing factors, use of nail lacquer as a prophylactic treatment, and the dermatophyte strain isolated were not significantly related to relapse

Dermatophyte infections

Tinea corporis is an infective skin disease resulting from invasion and proliferation by the causal fungi in the stratum corneum. The fungi most commonly involved are Microsporum canis, Trichophyton rubrum, and Trichophyton mentagrophytes. It most commonly involves exposed parts of the body, but can affect any site. Typical lesions are annular in shape, with a raised scaling erythematous edge. The presence of perifollicular granulomatous papules (Majocchi\u2019s granuloma) is a definite indication for systemic treatmen

Tips for diagnosis and treatment of nail pigmentation with practical algorithm

The observation of a black-brown pigmentation of the nail is often alarming for the patient and for the clinician, as they are aware that it can be a possible clinical manifestation of melanoma of the nail apparatus. Luckily, however, nail melanoma is a much less frequent cause of brown-black nail color than other melanocytic and nonmelanocytic pigmentations, which include subungual hematoma, exogenous pigmentations, and melanonychia due to benign conditions. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide the correct management of melanonychia both in children and in adults

Today's treatments options for onychomycosis.

Onychomycosis can be cured even if fungi are sometimes difficult to eradicate; the treatment is often lengthy and requires patience. The choice of agents should be based on numerous factors including patient's age and health, causative organism, clinical type of onychomycosis, number of affected nails and severity of nail involvement. We review current and future treatments for onychomycosis. We will also consider treatment options in patients with poor prognostic factors suggesting possible treatment failure

Cicatricial alopecia

A large number of scalp disorders may destroy the hair follicles and result in cicatricial alopecia. These include diseases that primarily affect the hair follicles as well as diseases that affect the dermis and secondarily cause follicular destruction. Once established, cicatricial alopecia is a permanent condition that cannot be reversed by treatment. The differential diagnosis between the diseases that cause cicatricial alopecia requires a pathological examination. The site of biopsy is crucial for pathological diagnosis and can be better selected using dermoscopy. Current treatment options of primary cicatricial alopecia are limited as the precise mechanisms that trigger the diseases are still unknown

Treatment of nail disorders

There are several reasons that make the nail unit difficult to treat. It is necessary to wait for several months before seeing the results of treatments in nail disorders, as the nail plate grows very slowly (average nail growth is 3 mm/month in fingernails and 1-1.5 mm/month in toenails). It is very important to give the patients this information, as they may otherwise discontinue the treatment feeling it to be ineffective. Delivery of topical drugs through the nail is difficult, as vehicles utilized for enhancing penetration of drugs through the skin are not effective in the nail. Most topical drugs are therefore ineffective in the treatment of inflammatory nail disorders, since the nails are largely exposed to environmental hazards and nail disorders are commonly precipitated or worsened by physical traumas. Thus, clinicians often do not prescribe systemic treatment when the disease is limited only to the nail