Michela Starace

Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis.

Background  Distal subungual onychomycosis and traumatic onycholysis are the most common causes of toenail abnormalities, and differential diagnosis is often impossible without mycology.

Onychomatricoma : First description in a child

Abstract:  Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4‐year‐old girl.

Dermoscopy of non-skin cancer nail disorders.

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.

Short Anagen Syndrome

Abstract:  Short anagen syndrome (SAS) is a recently described disease, but is rarely reported in the literature probably because of its under‐recognized status. It is characterized by the inability to grow long hair because of an idiopathic short anagen phase. The condition is not associated with hair shaft fragility or hair unruliness. The patients complain of abnormally short scalp hair and report that they never had a haircut. The condition is benign and most of the reported cases had no associated systemic diseases or skin disorders. Hair length tends to improve spontaneously after puberty. The main differential diagnoses include loose anagen hair syndrome (LAS).

Videodermoscopy: A Useful Tool for Diagnosing Congenital Triangular Alopecia

Abstract:  Congenital triangular alopecia, despite its name, usually presents in children between 3 and 6 years of age, but adult patients have been reported. It is not uncommon for triangular alopecia to be misdiagnosed as alopecia areata and treated for such. This is especially true when a lesion of triangular alopecia presents in an area of the scalp other than the typical fronto‐temporal hairline or later in adulthood. Videodermoscopy may serve as a useful tool to perform the right diagnosis as it can highlight signs not seen by the unaided eye and may be able to spare the patient from a biopsy.

A new dermoscopic finding in healthy children.

Methods. Dermoscopic images were obtained from 19 participants, ages 5 months to 14 years, with no prior diagnosis of hair or scalp disease, during the period January 2004 to May 2008. Images were acquired using a computerized polarized-light videodermoscopy system (FotoFinderdermoscope; Teachscreen Software, Bad Birnbach, Germany), with a water interface solution (Eau Thermale Avène, Paris, France), at magnifications ranging from 20 to 70. Two patients were reevaluated 3 years after their initial examination. An additional patient was examined within the same day, before and after shampoo of the scalp. Bacterial and fungal cultures were obtained from 2 subjects.

Alopecia areata (AA) and treatment with simvastatin/ezetimibe: Experience of 20 patients.

To the Editor: We read with great interest the prospective pilot study that evaluated the effectiveness of simvastatin/ezetimibe (Vytorin, Merck and Co, Kenilworth, NJ) in patients with alopecia areata (AA) and reported a statistically significant association between being on therapy and stable remission of the disease. We obtained different results with the same treatment using a different protocol. In 2012, after ethics committee approval, we started a prospective study with simvastatin/ezetimibe in 20 patients older than 18 years, with AA totalis/universalis or involvement of the scalp greater than 70% (Table I). These patients had previously undergone 1 or more treatments without satisfying results. Inclusion criteria included interruption of any local or systemic treatments for AA at least 20 days before enrollment. Patients were given simvastatin/ezetimibe 40 mg/ 10 mg daily for 6 months. During this study, the patients were visited every 8 weeks and global photography and blood tests were performed, together with assessment of tolerability of the drugs. At the end of the 6-month treatment period, 17 (85%) patients completed the study and 3 (15%) patients dropped out, 1 for personal reasons and 2 because they were not satisfied by the results. Fourteen of 17 (82%) patients had no hair regrowth, 2 (12%) had a transient diffuse hair regrowth followed by total hair loss in 1 month during the treatment period, and 1 (6%) patient had a patchy hair regrowth of pigmented hair (\20%), which was not considered cosmetically acceptable. Side effects were observed in 3 patients (15%), who reported mild headache or muscle cramps that did not interrupt treatment. In conclusion, we did not obtain any result with simvastatin/ezetimibe therapy in severe AA. Our study has some limitations, ie, the small number of patients enrolled and the absence of a control group. But the complete failure of therapy

Tinea capitis mimicking folliculitis decalvans

We report on an adult patient with tinea capitis caused by Microsporum canis, who presented with diffuse alopecia and follicular pustules, mimicking folliculitis decalvans. Examination of the scalp showed severe alopecia with prominent involvement of the frontal and vertex scalp: the skin was markedly erythematous with pustules and brownish crusts. Videodermoscopy revealed visible follicular ostia, numerous pustular lesions and several comma hairs. Fluconazole 150 mg a week for 8 weeks associated with ketoconazole shampoo cleared the inflammatory lesions and produced complete hair regrowth.

Corkscrew Hair: A Trichoscopy Marker of Tinea Capitis in an Adult White Patient

tion between the frequency of dermoscopic pattern and age group (P = .002 for all). Furthermore, the peas-in-a-pod and fibrillar patterns were significantly prevalent in the youngerthan-20-years group (P < .001) and the 20-to-39-years group (P = .046), respectively, and less prevalent in the older-than59-years group (P = .046 and P = .03, respectively). Meanwhile, the nontypical pattern was significantly prevalent in the older-than-59-years group (P < .001) and less prevalent in the younger-than-20-years group (P = .005). There were no significant differences in the frequencies of parallel furrow and latticelike patterns between age groups. Parallel ridge, reticular, globular, and homogeneous patterns were regarded as unsuitable for statistical analysis because of the small sample size.

Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study

Longitudinal melanonychia might be difficult to differentiate and the use of dermoscopy can be useful for the preoperative evaluation and management decision.