Diagnostic Insights and Treatment Approaches for Dermatophytosis Affecting Vellus Hair

Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3months after treatment. All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P<.001) and group C (P<.001), respectively. In addition, the median treatment time in group C was significantly shorter than group A (P=.002). No recurrence of infection was noted during follow-up period. The three modalities were effective in the treatment of white piedra of the scalp. The most rapid response was observed with the combined use of topical and oral azoles.

Malignant melanoma is a common skin cancer among Asians. However, some features, such as tumor type and initial stages, are not comparable with those found in Western countries. We audited a large cohort of patients at a single tertiary referral hospital in Thailand to identify factors affecting the prognosis. A retrospective study was conducted of patients diagnosed with cutaneous malignant melanoma between 2005 and 2019. Details of demographic data, clinical characteristics, pathological reports, treatments, and outcomes were collected. Statistical analyses of overall survival and factors affecting survival were investigated. The study enrolled 174 patients (79 men and 95 women) with pathologically confirmed cutaneous malignant melanoma. Their mean age was 63 years. The most common clinical presentation was a pigmented lesion (40.8%), with the plantar area being the most common site (25.9%). The mean duration of onset and hospitalization was 17.5 months. The 3 most common types of melanoma were acral lentiginous (50.7%), nodular (28.9%), and superficial spreading (9.9%). Eighty-eight cases (50.6%) had concomitant ulceration. Pathological stage III was the most common (42.1%). The 5-year overall survival was 43%, and the median survival time was 3.91 years. Multivariate analysis showed that clinically palpable lymph nodes, distant metastasis, a Breslow thickness ≥ 2 mm, and evidence of lymphovascular invasion were poor prognostic factors for overall survival. In our study, most patients with cutaneous melanoma presented with a higher pathological stage. Independent factors affecting survival are palpable lymph nodes, distant metastases, Breslow thickness, and the presence of lymphovascular invasion. The overall 5-year survival rate was 43%.

Pierre Robin sequence (PRS), characterized by micrognathia, glossoptosis, cleft palate, and obstructed airways, is one of the craniofacial conditions challenging various approaches to managing compromised airways, ranging from conservative measures to invasive airway surgery. This study was conducted to identify predictive risk factors for tracheostomy in the PRS. A retrospective chart review was conducted at a tertiary referral hospital in Thailand. Children diagnosed with PRS from January 2010 to December 2021 were enrolled. Univariate and multivariate analysis methods were used to identify the risk factors. Sixty-five patients with PRS were identified in electronic medical records, but 6 were excluded. Thirteen of the remaining 59 patients underwent tracheostomy. There were no significant differences in sex, preterm gestational age, cleft palate, associated syndromes, chromosome abnormalities, or cardiac or neurological involvement between patients who received tracheostomy and those who did not. However, patients with oropharyngeal dysfunction who received tracheostomy tended to use a nasogastric tube or percutaneous gastrostomy 92.3% of the time ( P = 0.043). In addition, patients with abnormal airways from endoscopy were more likely to undergo tracheostomy (odds ratio, 2.17; 95% confidence interval [CI], 1.20-3.90). Interestingly, patients with a sum of Apgar scores at 1 and 5 minutes <15 were more likely to undergo tracheostomy (adjusted odds ratio, 9.91; 95% CI, 1.32-74.52). Furthermore, patients with at least 3 identified comorbidities were more likely to undergo tracheostomy (adjusted odds ratio, 11.34; 95% CI, 1.16-111.15). The need for tracheostomy depends on comorbidities, Apgar scores, and abnormal airway anatomy. Feeding methods can become more complex with tracheostomy. Prognostic risk factors can help guide treatment and counseling for health care workers and caregivers.

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Introduction: Hair loss is a cause of emotional and mental distress, especially in the modern age of social media. Hair loss can be classified as Cicatricial and Non-Cicatricial, based on the permanence of the damage wrought to the hair follicles. The conditions selected for evaluation in this particular study are androgenetic alopecia and telogen effluvium, owing to their higher rate of incidence and their amenable response to timely intervention.Trichoscopy aids in diagnosis, determination of biopsy site and acts as a prognostic tool. In this study, we will enumerate trichoscopic features of the scalp in androgenic alopecia (AGA) and telogen effluvium (TE) on the basis of follicular patterns, interfollicular patterns and hair signsMaterial and Methods: It is a cross-sectional and observational study is suited for estimating the prevalence of each trichoscopic feature in AGA and TE. The study was conducted in the Department of Dermatology, Venereology and Leprosy, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka. The study was conducted between January 2020 to December 2020 with sample size of 100 patients.Results: In the 100 cases of AGA and TE, 69% had AGA and 31% TE. Hair pull test was positive in 90% patients of TE. Yellow dots (69%), empty hair follicles, (65%) peripilar sign (71%), vellus hair (95%) and variation in hair shaft diameter in frontotemporal areas (98%) are the characteristic findings in AGA patients. The follicular features present in TE are peripilar sign (10%), yellow dots (29%) and vellus hair (30%). The characteristic finding is that the variation in hair – shaft diameter is prevalent in fronto-temporal (15%) and occipital areas (65%).Conclusion: The characteristic follicular features on Trichoscopy observed in AGA were peripilar sign, yellow dots and empty hair follicles. The characteristic hair shaft pattern observed was vellus hair. Variation in hair shaft diameter was more prevalent in fronto-temporal areas. TE is said to be a disease of exclusion on Trichoscopy. It is important to differentiate this condition from AGA, where-in the variation in hair shaft thickness is present in fronto-temporal areas and absent in occipital area.

Guidelines for the management of androgenetic alopecia (2010) Ryoji TSUBOI, Satoshi ITAMI, Shigeki INUI, Rie UEKI, Kensei KATSUOKA, Sotaro KURATA, Takeshi KONO, Norimitsu SAITO, Motomu MANABE, Masashi YAMAZAKI, GUIDELINES PLANNING COMMITTEE FOR THE MANAGEMENT OF ANDROGENETIC ALOPECIA Department of Dermatology, Tokyo Medical University, Tokyo, Department of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, Department of Dermatology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Department of Dermatology, School of Medicine, Kitasato University, Sagamihara, Kurata Clinic, Beppu, Department of Dermatology, Nippon Medical School, Tokyo, and Department of Dermatology, Akita University Graduate School of Medicine, Akita, Japan

Chromoblastomycosis is a subcutaneous mycosis for which there is no treatment of choice but rather, several treatment options, with low cure rates and many relapses. The choice of treatment should consider several conditions, such as the causal agent (the most common one being Fonsecaea pedrosoi), extension of the lesions, clinical topography and health status of the patient. Most oral and systemic antifungals have been used; the best results have been obtained with itraconazole and terbinafine at high doses, for a mean of 6 – 12 months. In extensive and refractory cases, chemotherapy with oral antifungals may be associated with thermotherapy (local heat and/or cryosurgery). Limited or early cases may be managed with surgical methods, always associated with oral antifungal agents. It is important to determine the in vitro sensitivity of the major causal agents to the various drugs, by estimating the minimum inhibitory concentration, as well as drug tolerability and drug interactions.

Chromoblastomycosis is a subcutaneous mycosis for which there is no treatment of choice but rather, several treatment options, with low cure rates and many relapses. The choice of treatment should consider several conditions, such as the causal agent (the most common one being Fonsecaea pedrosoi), extension of the lesions, clinical topography and health status of the patient. Most oral and systemic antifungals have been used; the best results have been obtained with itraconazole and terbinafine at high doses, for a mean of 6 – 12 months. In extensive and refractory cases, chemotherapy with oral antifungals may be associated with thermotherapy (local heat and/or cryosurgery). Limited or early cases may be managed with surgical methods, always associated with oral antifungal agents. It is important to determine the in vitro sensitivity of the major causal agents to the various drugs, by estimating the minimum inhibitory concentration, as well as drug tolerability and drug interactions.

Neuropathic itch treated with oral cannabinoids: A case series

This review adds to a series of reviews looking at primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Antifungals have been suggested as a treatment for chronic rhinosinusitis. To assess the effects of systemic and topical antifungal agents in patients with chronic rhinosinusitis, including those with allergic fungal rhinosinusitis (AFRS) and, if possible, AFRS exclusively. The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 17 November 2017. Randomised controlled trials (RCTs) with at least a two-week follow-up period comparing topical or systemic antifungals with (a) placebo, (b) no treatment, (c) other pharmacological interventions or (d) a different antifungal agent. We did not include post-surgical antifungal use. We used the standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the significant adverse effects of hepatic toxicity (systemic antifungals). Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse effects of gastrointestinal disturbance (systemic antifungals) and epistaxis, headache or local discomfort (topical antifungals). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included eight studies (490 adult participants). The presence of nasal polyps on examination was an inclusion criterion in three studies, an exclusion criterion in one study and the remaining studies included a mixed population. No studies specifically investigated the effect of antifungals in patients with AFRS.Topical antifungal treatment versus placebo or no interventionWe included seven studies (437 participants) that used amphotericin B (six studies; 383 participants) and one that used fluconazole (54 participants). Different delivery methods, volumes and concentrations were used.Four studies reported disease-specific health-related quality of life using a range of instruments. We did not meta-analyse the results due to differences in the instruments used, and measurement and reporting methods. At the end of treatment (one to six months) none of the studies reported statistically significant differences between the groups (low-quality evidence - we are uncertain about the result).Two studies reported disease severity using patient-reported symptom scores. Meta-analysis was not possible. At the end of treatment (8 to 13 weeks) one study showed no difference and the second found that patients in the placebo group had less severe symptoms (very low-quality evidence - we are very uncertain about the result).In terms of adverse effects, topical antifungals may lead to more local irritation compared with placebo (risk ratio (RR) 2.29, 95% confidence interval (CI) 0.61 to 8.62; 312 participants; 5 studies; low-quality evidence) but little or no difference in epistaxis (RR 0.97, 95% CI 0.14 to 6.63; 225 participants; 4 studies, low-quality evidence) or headache (RR 1.26, 95% CI 0.60 to 2.63; 195 participants; 3 studies; very low-quality evidence).None of the studies found a difference in generic health-related quality of life (one study) or endoscopic score (five studies) between the treatment groups. Three studies investigated CT scan; two found no difference between the groups and one found a significant decrease in the mean percentage of air space occluded, favouring the antifungal group.Systemic antifungal treatment versus placebo or no treatmentOne study (53 participants) comparing terbinafine tablets against placebo reported that there may be little or no difference between the groups in disease-specific health-related quality of life or disease severity score (both low-quality evidence). Systemic antifungals may lead to more hepatic toxicity events (RR 3.35, 95% CI 0.14 to 78.60) but fewer gastrointestinal disturbances (RR 0.37, 95% CI 0.04 to 3.36), compared to placebo, although the evidence was of low quality.This study did not find a difference in CT scan score between the groups. Generic health-related quality of life and endoscopic score were not measured.Other comparisonsWe found no studies that compared antifungal agents against other treatments for chronic rhinosinusitis. Due to the very low quality of the evidence, it is uncertain whether or not the use of topical or systemic antifungals has an impact on patient outcomes in adults with chronic rhinosinusitis compared with placebo or no treatment. Studies including specific subgroups (i.e. AFRS) are lacking.

Objective: To determine the efficacy of Trichoscopy in diagnosing telogen effluvium (TE) at a tertiary care Hospital. Methodology: This cross-sectional study was conducted in Dermatology department, PNS Shifa Hospital, Karachi from December 2022 to May 2023. Overall 100 individuals with clinically confirmed telogen effluvium of either gender were included. Individuals with TE underwent trichoscopic imaging of the frontal, vertex, temporal, and occipital scalp using the HEINE DELTA 20T dermoscope without liquid media. High-resolution images and videos were captured and independently evaluated by two expert dermatologists to ensure diagnostic utility. The SPSS version 26 statistical analysis program was used for data entry and analysis. Results: The mean age of the patients was 32.7 ± 8.4 years, with mean disease duration of 4 ± 2 months. Among the 100 patients, 47 (47%) were men, and 53 (53%) were women. Perifollicular scaling (95%) was the most frequent trichoscopic finding in our study, followed by hair diameter diversity (48%), vellus hair (42%), perifollicular pigmentation (33%), and yellow spots and scalp discoloration (27%). Trichoscopic findings in telogen effluvium showed significant differences between frontal and occipital regions. Vellus hair, HDD, yellow dots, perifollicular pigmentation and Perifollicular scaling were significantly more common in the frontal area, while scalp discoloration was significantly higher in the occipital region (p=&lt;0.05). Conclusion: Trichoscopy has proven to be an effective, non-invasive diagnostic tool for identifying telogen effluvium. Comparing trichoscopic findings between the frontal and occipital regions helps differentiate telogen effluvium from androgenetic alopecia, enabling early and accurate diagnosis while minimizing the need for invasive procedures.

Objective Androgenic alopecia (AGA) is a genetic, non-scarring hair loss disorder influenced by peripheral androgens, affecting patients’ appearance, and quality of life. This study compared the effects of 5% minoxidil, platelet-rich plasma (PRP), and their combination on hair count, telogen/anagen ratio, and vellus hair in AGA patients. Material and methods This retrospective study included AGA patients treated at the dermatology department. Dermoscopic images taken before and 6 months after treatment with the Molemax device were analyzed using Tricoscan software. Demographic data, disease characteristics, and previous treatments were recorded. Staging followed the Ludwig and Hamilton–Norwood classifications. Patients were categorized into three groups: Group I (5% minoxidil), Group II (PRP), and Group III (combined therapy). Results The study included 45 patients (53.3% female; mean age 27.8 ± 8.6 years). Groups II and III showed significant improvement in hair count, density, terminal hair count, and anagen ratio (p < 0.05). Vellus hair count and density significantly decreased in Group III (p < 0.05). Patient-reported improvement did not differ significantly among groups (p > 0.05). Conclusion PRP improves hair growth parameters in AGA and is more effective when combined with minoxidil, especially in reducing vellus hair. These results support PRP’s role in AGA treatment.

Tinea capitis is a common and, at times, difficult to treat, fungal infection of the scalp. This article aimed to provide an update on the evaluation, diagnosis, and treatment of tinea capitis. A PubMed search was performed in Clinical Queries using the key term "tinea capitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article. Patents were searched using the key term "tinea capitis" at www.freepatentsonline.com. Tinea capitis is most often caused by Trichophyton tonsurans and Microsporum canis. The peak incidence is between 3 and 7 years of age. Non-inflammatory tinea capitis typically presents as fine scaling with single or multiple scaly patches of circular alopecia (grey patches); diffuse or patchy, fine, white, adherent scaling of the scalp resembling generalized dandruff with subtle hair loss; or single or multiple patches of well-demarcated area (s) of alopecia with fine-scale, studded with broken-off hairs at the scalp surface, resulting in the appearance of "black dots". Inflammatory variants of tinea capitis include kerion and favus. Dermoscopy is a highly sensitive tool for the diagnosis of tinea capitis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wetmount preparation and fungal culture. It is desirable to have mycologic confirmation of tinea capitis before beginning a treatment regimen. Oral antifungal therapy (terbinafine, griseofulvin, itraconazole, and fluconazole) is considered the gold standard for tinea capitis. Recent patents related to the management of tinea capitis are also discussed. Tinea capitis requires systemic antifungal treatment. Although topical antifungal therapies have minimal adverse events, topical antifungal agents alone are not recommended for the treatment of tinea capitis because these agents do not penetrate the root of the hair follicles deep within the dermis. Topical antifungal therapy, however, can be used to reduce transmission of spores and can be used as adjuvant therapy to systemic antifungals. Combined therapy with topical and oral antifungals may increase the cure rate.

In July 2009, a pandemic influenza (H1N1) (pdm H1N1) virus epidemic emerged rapidly in Phitsanulok, Thailand. Adult cases of community-acquired pneumonia (CAP) were prospectively examined for pdm H1N1 virus infections by real-time PCR in a tertiary hospital in Phitsanulok from July to November 2009. Twenty-four cases of pdm H1N1 virus-associated CAP were confirmed, and their clinical features including bacterial infection, severity of disease, course of admission, treatment, and outcome were investigated. The median age of these cases was 39.5 years. Most cases appeared to be primary viral pneumonia, but only one case was positive for a urinary pneumococcal antigen. The median time from the onset of illness to admission was 4 days. All 24 patients received oseltamivir after admission. Twelve (50.0%) were defined as having severe CAP and 9 (37.5%) were diagnosed with acute respiratory distress syndrome (ARDS). During the study period, pdm H1N1 virus infections frequently caused severe CAP among young adults because of the delayed initiation of antiviral therapy. Of the 9 ARDS patients, 3 died of ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii. Implementation of infection control targeting this pathogen is required in tertiary hospitals in Thailand.

Aim Pelvic organ prolapse (POP) primarily affects older women, with limited data on premenopausal cases, especially among Asians. Severe pelvic floor symptoms, including urinary, bowel, and sexual dysfunction, remain understudied in this population. This study aimed to describe symptom severity and treatment outcomes in premenopausal POP patients. Methods A retrospective cohort study was conducted on premenopausal POP patients at a university hospital over six years. The Pelvic Floor Bother Questionnaire (PFBQ) assessed symptom severity, and treatment outcomes were evaluated over two years. Data were presented as counts with percentages or means with standard deviations. Results Among 87 women (mean age 44.8 ± 4.9 years), 12 (13.8%) had stage I, 47 (54.0%) stage II, 24 (27.7%) stage III, and 4 (4.6%) stage IV POP. Common comorbidities included dyslipidemia (13.8%), diabetes mellitus (11.5%), and thyroid disease (10.3%). Six patients had connective tissue diseases or nerve damage. Premenopausal women accounted for approximately 5.6% (87 out of 1,567) of all new POP cases in this population. The most bothersome symptoms were prolapse bulging (83.9%), urinary frequency (58.6%), and urgency (49.4%). Treatment included pelvic floor muscle training (10%), pessary use (28%), and surgery (62%). Vaginal hysterectomy with pelvic floor repair was most common, with 8 colpocleisis cases. Symptom improvement at two years was highest after surgery (90.1%), followed by pessary (82.6%) and pelvic floor training (68.3%). Conclusion This study highlights the burden of POP and pelvic floor symptoms in Thai women, emphasizing the need for tailored management strategies.