R.P.R. Dawber

Hypertrichosis in females applying minoxidil topical solution and in normal controls

Background  Hypertrichosis has been reported more frequently in females than in males who use minoxidil topical solution (MTS) for the treatment of androgenetic alopecia (AGA). This article examines the occurrence of MTS‐induced hypertrichosis in females.

Update on detection, morphology and fragility in pili annulati in three kindreds

Background  Pili annulati is an inherited hair shaft abnormality with a wide range of clinical expression.

Monilethrix treated with oral retinoids

We report a childhood case of monilethrix in which oral etretinate was given. Clinically, the cosmetic benefit was marginal. However, of note was that there was an increase in hair length with loss of beading along the shaft of these hairs. The background scalp appearance of keratosis pilaris persisted in these areas. This suggests that the beading alone is influenced by etretinate and is not solely an artefact secondary to the hyperkeratotic condition at the follicular opening.

Alterations in the basement membrane zone in pili annulati hair follicles as demonstrated by electron microscopy and immunohistochemistry.

Background  Pili annulati is a rare autosomal dominant inherited hair shaft abnormality in which clinical examination reveals alternating light and dark bands leading to a shiny appearance of the hair. The clinically light bands are the abnormal areas due to cavities within the cortex. The pathogenesis remains unknown.

Cheveux incoiffables—diagnostic, clinical and hair microscopic findings, and pathogenic studies

Three possible mechanisms of the hair shaft abnormality in cheveux incoiffables have been investigated in nine patients. Cheveux incoiffables hairs were found to exhibit a normal distribution of cystine‐rich protein within both the cuticle and the cortex, as determined by silver methenamine ultrastructural cytochemistry. Resistance to stretching, at 65% relative humidity and constant temperature, was similar to normal controls. Resistance to bending forces was also assessed, and was equivalent in both groups. On scanning electron microscopy, all patients with cheveux incoiffables demonstrated longitudinal grooving of the hair shaft, and the hairs were triangular or heart‐shaped in cross‐section. In addition, there appeared to be minimal cuticular weathering. Even hairs of 20–30 cm length showed only minimal cuticular and cortical weathering, compared with normal hair shafts of similar length and diameter. It is possible that the reduced progressive weathering renders the hair shaft more rigid, and could serve to explain the ‘stand on end’ appearance of the hair which is typical of this condition. However, the characteristic cross‐sectional shape of the hair shaft in cheveux incoiffables may render it more rigid and resistant to bending forces. This latter theory has yet to be fully investigated.

Keratosis pilaris atrophicans in mother and daughter

We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28‐year‐old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the second reported family in the UK.

Variations in the Beading Configuration in Monilethrix

Abstract: Using information from a light microscope integrated with a computer, we quantified the variation in node and internode dimensions in monllethrix. We combined this with rate of growth measurements in individual haris to make the following conclusions. There is considerable variation of node and internode configuration within single halrs. Halrs from the same scalp, sampled at the same time show no mutual coordination of node‐internode formation, even when different growth rates are taken into account. There is no apparent correlation between the day‐night cycle and the node‐internode rhythm. The follicular expression of monilethrix appears largely independent of unifying systemic influences.

Idiopathic polydactylous longitudinal erythronychia: a newly described entity

trocoagulator. A few wounds were closed primarily, while some with exposed tendons were covered with a local flap. The lesional tissue weighed 370 g. After the surgical procedures the patient was given isotretinoin, 20 mg daily for 1 month, followed by 10 mg daily for 6 months. All wounds healed within 1 month. The appearance and function of the hands and feet improved significantly (Fig. 1b). The lesions did not recur in the following 2 years. EV was first described by Lewandowsky and Lutz in 1922. It leads to widespread viral warts from an early age. There is high risk of skin carcinomas that result from susceptibility to EV–HPV infections. Over 30% of patients will develop nonmelanoma skin cancer on sun-exposed sites in their third and fourth decades. EV is a rare autosomal recessively inherited disease with mutations either in the EVER1 or the EVER2 genes situated on chromosome 17q25. The treatment of EV is unsatisfactory. Various treatments used include physical therapies such as cryotherapy and electrocautery, laser ablation, keratolytics, topical and oral retinoids, topical cytotoxic agents such as 5-fluorouracil and podophyllotoxin, immunostimulants such as interferon, and X-irradiation. In some patients, when the above measures fail or are unsuitable, surgical excision may be a final option. Severe vegetating forms of warts are rare in EV. Our patient had severe vegetating warts causing functional disability. Treatment by shave excision gave satisfactory results without clinical recurrence for up to 2 years.

Acquired periungal arteriovenous tumour (cirsoid aneurysm)

To the Editor Acquired acral arteriovenous tumours are benign vascular proliferations. They are otherwise known as cirsoid aneurysms. Only rarely are they found around the nail. We report a 39-yearold right-handed woman who presented with a 2-year history of a painless erythematous swelling involving the proximal and lateral nailfolds of the radial aspect of her right index finger. Our patient was Caucasian and worked as a cashier. There was no specific history of trauma. She had noticed that the swelling was more prominent in a warm environment. On examination, the erythematous swelling measured 6 × 4 mm (fig. 1). It blanched on diascopy and was nonpulsatile. There was an associated nail dystrophy localized to the lateral (radial) aspect of the nail plate and distal to the swelling. The dystrophic groove contained flecks of haemorrhage but there was no pigmentation of the nailfold to suggest a melanocytic lesion. Nail clippings were negative on mycologic testing. A diagnostic biopsy was performed prior to formal excision. Surgical removal of the swelling was justified on the grounds that this would limit the development of further nail dystrophy. Histopathology showed a normal epidermis overlying a dermal proliferation of thickand thin-walled vessels varying in calibre consistent with an arteriovenous tumour or cirsoid aneurysm (fig. 2a,b). The defect was left to heal by secondary intention and did so by 6 weeks. Acral arteriovenous tumours are benign vascular proliferations comprising a mixture of small-calibre arterial and venous channels. 1 They may be located about the head or extremities. 2

Erythrokeratoderma variabilis: case report and review of the literature

We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low‐sedating H1antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.