Areas Of Alopecia Research Articles

Knockout of p16INK4a promotes aggregative growth of dermal papilla cells.

Dermal papilla cells (DPCs) are located in the hair follicles and play an important role in hair growth. These cells have the ability to induce hair follicle formation when they display aggregative behavior. DPCs derived from the androgenetic alopecia (AGA) area undergo premature senescence in vitro, associated with p16INK4a expression. The aim of the current study was to investigate the expression of p16INK4a in aggregative and non-aggregative DPCs and the effect of p16INK4a down-regulation in these cells by adenovirus-mediated RNA interference (RNAi). DPCs were isolated and cultured from healthy human scalp. p16INK4a gene and protein were detected in aggregative and non-aggregative cells. Expression of p16INK4a in DPCs was silenced by infection with rAd5-CDKN1A-1p2shRNA. Cell fate was monitored after infection. The growth of cells was measured by MTT assay. Cell cycle was evaluated by flow cytometry (FCM). DPCs were isolated by digestion and showed aggregative behavior for six passages. The expression of p16INK4a showed a clear upward trend in non-aggregative cells when compared with aggregative group. p16INK4a expression was silenced by rAd5-CDKN1A-1p2shRNA (p<0.05). The p16INK4a-silenced cells grew more rapidly and exhibited a trend towards aggregative growth. There was an increase in the proportion of cells in G1 phase, while those in S phase were reduced after p16INK4a gene silencing (p<0.05). Our results suggest that p16INK4a plays an important role in the premature senescence and aggregative behavior of DPCs. These observations can lead to novel therapeutic strategies for treatment of AGA.

Sarcoptes scabiei (Acari: Sarcoptidae) infestation in rabbits (Oryctolagus cuniculus): A case study

Sarcoptic mange was suspected in three of five European albino rabbits (Oryctolagus cuniculus) kept for experimental purposes. Gross examination revealed multifocal areas of alopecia around the eyes, nostrils and lips. Skin snips were processed using PCR for the molecular identification of the suspected mites. Histopathology of the skin snips showed erupted epidermis and stratum corneum with an infiltration of inflammatory cells. Skin scraping examination revealed the presence of adult mites as well as eggs. Microscopic taxonomy identified the adult mites as Sarcoptes (S.) scabiei (Acari: Sarcoptidae). The results of PCR indicated a 311 bp band from all the three cases, which confirmed the S. scabiei infestation in rabbits. Sarcoptes scabiei may be a public health concernthrough direct transmission from rabbits infested with S. scabiei through handling. To the best of our knowledge, this is the first report of S. scabiei infection in rabbits from Pakistan.

Pênfigo foliáceo em um gato de oito meses de idade: possível reação cutânea adversa a fármacos?

Background: Pemphigus foliaceus is an autoimmune skin disease whose the occurrence in feline clinic is uncommom. The etiology is unknown in most cases. Althought it is a rare condition in cats, pemphigus foliaceus can be induced by drugs. It may affect both adult and old cats with no sexual or racial predilection and diagnosis is based on animal historical, clinical examination and skin histopathology. Moreover, the treatment consists in immunosuppressive-based drugs. This paper describes a pemphigus foliaceus case in an eight-month-old kitten, probably due a cutaneous adverse drug reaction.Case: A 8-month-old, neutered male mongrel cat with crusted lesions located on face was examinated at the Veterinary Hospital. The owners reported that they had adopted the patient two months before the clinical presentation suggesting that this background was unknown. The cat was treated in a local veterinary clinic with antibiotics and anti-inflammatory for rhinotracheitis and herpetic dermatitis on face due to the occurrence of sneezing and crusted pruriginous dermatitis. The kitten presented erosions, purulent exudation and crusts on pinnae, nasal and supra ocular areas, paronychia with purulent exudate and alopecia at distal portion of the tail. Supplementary exams such as skin scraping, cytology and fungal culture were performed to rule out other agents and confirm the diagnosis. The parasitological and fungal examination resulted negative despite the fact that cytological exam showed coccoid bacteria. Complete blood count and biochemical profile showed no alteration and the test for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) resulted negative. Histological changes were consistent with intra-epidermal pustular subcorneal with acantholysis dermatitis. An immunosuppressive dose of prednisolona was prescribed for 15 days. After this time, the crusted lesions were substituted by alopecia areas. Every 20 days the corticosteroid dose was reduced by half and after 90 days, the patient showed repilation in all regions previously affected during 545 days whithout treatment.Discussion: Pemphigus foliaceus is usually an idiopathic disease but in some cases it may be induced by drugs and infectious or parasitic agents. Previous reports described that animals younger than 1 year-old and older than 17 year-old can be affected. However, the disease occurrence is rare in young cats. The age of onset of symptoms was early considering that the literature describes 5 years of age as an average for the starting of the disease. Pemphigus foliaceus is considered a pustular disease. However, pustule is rarely reported in cats in contrast with crusted lesions which are the most common clinical sign. The body regions affected were the same as reported in the literature with the addition of systemic signs as anorexia and lethargy. Fungal culture and parasitological examination should always be performed in cats with clinical evidence to discharge other agents. Diagnosis is made by skin histopathology in which acantholytic cells are the main characteristic. The importance of the differential diagnosis and skin biopsy regardless of age enabled the diagnosis and therapeutic success. It is suggested that Pemphigus foliaceus was of pharmacodermic etiology because of the age of the patient, a history of administration of unknown antimicrobial medication and the lack of recurrence of clinical manifestations after 545 days of the end of glucocorticoid treatment

Pythiosis in dogs in the semiarid region of Northeast Brazil

ABSTRACT: We describe the epidemiological, clinical and pathological features of five cases of pythiosis in dogs in northeast semiarid. The disease occurred in dogs with age between one and three years, females and males of different breeds. The dogs were created in urban areas, but were occasionally taken to the countryside and then had contact with wetlands. The main clinical signs were weight loss, vomiting, diarrhea and tenesmus. Macroscopically there were intestinal wall thickening with irregular firm masses with yellowish granular areas interspersed with a whitish tissue, involving the duodenum, colon and rectum, extending to the lymph nodes and pancreas, and the vagina and liver. In the skin there were areas of alopecia and irregular ulcerations, some containing small cavitations with serosanguineous secretion. Microscopically there were pyogranulomatous inflammation and in one case also there were eosinophilic necrosis associated with negative images tubuliformes by hematoxylin and eosin, strongly stained by GMS and weakly by PAS. Hyphae were strongly marked by immunohistochemistry with polyclonal anti-Pythium insidiosum. The disease occurs sporadically in dogs in the semiarid Northeast, however should be included in the differential diagnosis of chronic diseases and proliferative aspect of the gastrointestinal system, and front skin lesions of difficult treatment.

Th1/Th2 PB balance and CD200 expression of patients with active severe alopecia areata.

Th1/Th2 peripheral blood balance and CD200 expression in patients with severe alopecia areata (SAA) in the active stage were investigated. Fifty patients with active SAA, 50 patients with stable SAA and 50 healthy controls were continuously selected and expression of Th1/Th2 of peripheral T lymphocytes, and peripheral B lymphocytes was detected by flow cytometry; RT-PCR was used to detect the expression of the PBMC CD200 mRNA and the expression of CD200 in hair follicles of alopecia area was detected by immunohistochemically staining; ELISA was used to detect expression levels of serum LFN-γ and serum interleukin (IL)-10. The expression of CD200 in patients with alopecia areata in active phase on CD3+ T lymphocytes and CD19+ B lymphocytes was significantly lower (P<0.05) than those in stable phase and of the control group. CD200 expression in patients with alopecia areata in stable phase on T lymphocytes was greatly lower than that of the control group (P<0.05). However, the comparison of expression of CD200 in patients with alopecia areata in stable phase on B lymphocytes with the control group were statistically non-significant. The level of the expression of CD200 mRNA in active phase was obviously lower than those of the other two groups and the difference was statistically significant (P<0.05); the moderate positive and strong positive percentage of CD200 in the active phase was significantly lower than those of the other two groups. Positive expression rate of CK15 among the three groups were compared with each other; the differences had no statistical significance. The level of LFN-γ in the active phase had obviously increased while the IL-10 level decreased significantly (P<0.05). In conclusion, the level of expression of CD200 on peripheral blood and hair follicle outer root sheath of patients with SAA was decreased. This may be associated with the imbalance of the Th1/Th2 equilibrium.

The genetic basis of pigmentation in alopecia areata.

Alopecia areata (AA) is a common hair loss disorder characterized by discrete, well demarcated areas of non-scarring terminal hair alopecia, with the calculated lifetime risk of ~2%. In past decades, linkage and GWA studies have implicated dozens of susceptibility genes/loci that are linked to the development of AA. Fischer et al performed a genome-wide CNV analysis of 585 AA patients and 1,340 controls in a European population. This is the first genome-wide study of CNV to be performed in AA samples, and the association finding in the MCHR2 gene region further underscores the potential role of pigmentation in AA development.

Resistance of Transplanted Hair Follicles to the Onslaught of Diffuse Alopecia Areata

A 55-year-old man who previously underwent a successful hair transplantation for androgenetic alopecia now presents with rapid onset hair loss over the anterior to mid-scalp areas during a 2-month period. The alopecic area noticeably extended diffusely from anterior hairline to scalp vertex while rows of previously transplanted hair follicles appeared intact. Further dermoscopic features and a scalp biopsy were consistent with alopecia areata incognita. This patient was subsequently successfully treated with intralesional steroid injections. This case report is the first demonstrating the relative resistance of transplanted hair follicles to the process of alopecia areata when compared with local indigenous hairs. Prior to this, a few reports have demonstrated the use of hair transplantation to treat stable areas of alopecia areata resistant to medical treatment with mixed results but at least some initial success. This could be related to the local irritation and inflammatory response resultant from needling during hair transplantation that causes a degree of scarring and fibrosis around each transplanted graft, hence lending a protective barrier to an autoimmune-based T-lymphocyte attack on hair bulbs and subsequent increased survival of transplanted hair follicles. This unexpected observation provides new avenues for investigation into alopecia areata pathophysiology and further supports hair transplantation as a viable option for patients with stable, localized alopecia areata that is recalcitrant to other modalities.

Multisystemic eosinophilic epitheliotropic disease in a horse in Brazil

ABSTRACT: Equine multisystemic eosinophilic epitheliotropic disease (MEED) is a rare disease, characterized by eosinophilia and eosinophilic infiltration of several organs. A 5-year-old horse presented pruritus, areas of alopecia, and moderate eosinophilia. The horse was treated with corticosteroids and antibiotics without substantial improvement; and after the disease progressed to fever, diarrhea, gastric reflux and progressive weight loss. Due to poor prognosis the horse was euthanized. Necropsy revealed poor body condition, multiple to coalescing foci of alopecia, with epidermal ulcerations and crusts on the head and distal parts of the limbs. The proximal duodenum was enlarged, with 3 intraluminal nodules. Histopathological evaluation revealed eosinophilic granulomas in the skin, oral mucosa, duodenum, pancreas, and mesenteric lymph nodes, which were associated with infiltrates of eosinophils, lymphocytes, macrophages, multinucleated giant cells, and occasional plasma cells, along with fibrovascular connective tissue proliferation. MEED should be included in the differential diagnosis of horses with skin lesions concomitant with clinical signs of gastrointestinal illness.

A Case of Alopecia Areata Mimicking Trichotillomania

ABSTRACT Alopecia areata (AA) is a common dermatological disease characterized by patchy areas of nonscarring alopecia. Sometimes, differentiating patchy AA from trichotillomania (TTM) can be difficult. We report a case of AA mimicking TTM. How to cite this article Shukla D, Vishwanath T, Agrawal S, Dhurat R, Sharma A. A Case of Alopecia Areata Mimicking Trichotillomania. Int J Dermoscop 2017;1(1):35-37.

Dermatophilosis in sheep raised under rotational grazing systems on irrigated pastures in the Brazilian semiarid region

ABSTRACT: Seventeen outbreaks of dermatophilosis are reported from three farms affecting Santa Inês and Santa Inês x Dorper sheep that were reared in irrigated areas with rotational grazing at a stocking rate of 50 to 100 sheep per hectare, in the Brazilian semiarid region. Most outbreaks occurred after rains and affected sheep of different ages, with morbidity rates of 0.77% to 31%. Clinical signs were dermatitis with crusts that stood out easily and left areas of alopecia. Dermatophilus congolensis was isolated in cultures in 5% sheep blood agar by means of Haalstra’s method. Histologically, the epidermis showed extensive multifocal areas of ortho and parakeratotic hyperkeratosis with intracorneal microabscesses and presence of D. congolensis. Sheep affected were isolated from the flocks and they recovered after treatment with 70,000IU of procaine penicillin G and 70mg of dihydrostreptomycin sulphate per kg of bodyweight. Dermatophilosis is a frequent endemic disease in rotational grazing systems with irrigated pastures and high stocking rates, which occurs with higher frequency after rains and can be controlled efficiently through isolation of the affected sheep, followed by application of a single dose of penicillin and streptomycin.

Case 1: Seizures and Rashes Do Run in the Family

A term female infant is born by spontaneous delivery at 40 2/7 weeks’ gestational age with a birthweight of 3,560 g (50th percentile) and a head circumference of 34.5 cm (50th percentile) to a 25-year-old primigravida. The parental history and the course of the present pregnancy are unremarkable. The infant is born by spontaneous normal vaginal delivery. Her Apgar scores are 8 and 10 at 1 and 5 minutes, respectively. At the age of 43 hours, tonic-clonic movements of the right hand and leg are observed, during which she is completely conscious. The physical examination reveals an erythematic rash on the lower abdomen and lower limbs, which appear and fade (Fig 1), and a small area of alopecia on the right parietal side of the head (Fig 2). The rest of the physical examination findings are normal. Under a presumed diagnosis of neonatal seizures, both basic and extended investigations are undertaken, including infectious, metabolic, hematologic, and endocrinologic tests. Broad-spectrum antibiotics and acyclovir are initiated. The focal seizures worsen, become generalized, and are accompanied by episodes of apnea, deep desaturation, and bradycardia. They cease after second-line levetiracetam is added to the initial phenobarbital treatment. A single dose of pyridoxine (vitamin B6) is also given, with no change in the clinical condition. Figure 1. Nonspecific erythematic rash on lower limbs and lower abdomen at presentation. Figure 2. Small area of alopecia on the right parietal side of the head at presentation. The complete blood cell count and the C-reactive protein levels are normal, as are the blood and cerebrospinal fluid (CSF) chemistries. Blood gases, basic …

Natural infection by Microsporum canis in a capuchin monkey

ABSTRACT: This paper described a case of a capuchin monkey (Sapajus libidinosus) with non-pruritic skin lesions. During the physical examination, multifocal areas of alopecia with crusts, erythema and scaling compatible with dermatophytosis were reported on the right fore and hind limbs and on tail. Fungal culture findings revealed a diagnosis of dermatophytosis due to Microsporum canis. The animal was successfully treated with itraconazole. This is the first report of a dermatophytosis case in S. libidinosus and the first description of an effective treatment in this species.

Adalimumab-related alopecia in a patient affected by psoriasis

Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered.

Non-dermatophyte Dermatoses Mimicking Dermatophytoses in Animals.

Dermatophytoses in animals are fungal diseases of the skin caused by dermatophyte fungi of the genus Microsporum or Trichophyton. Because the infection is generally follicular, the most common clinical sign is one or many circular areas of alopecia with variable erythema, scaling and crusting, and the primary differential diagnoses are follicular infections, such as bacterial folliculitis and demodicosis. Although dermatophyte folliculitis or ringworm is the most commonly observed lesion of dermatophytoses in animals, other presentations may be observed according to the host species and the dermatophyte involved: dermatophyte folliculitis or ringworm, scaling and crusting in dermatophytosis due to Microsporum persicolor, nodule in case of kerion or mycetoma, matted hairs, seborrheic dermatosis or miliary dermatitis in cats, generalized exfoliative dermatoses in dogs, cats and horses, superficial non-follicular pustules, papules and macules in the Devon Rex cat, pruritic dermatophytoses in dogs, cats and horses, and onychomycosis in dogs, cats and horses. Since manifestations of dermatophytosis are highly variable, particularly in the cat, dermatophytosis should be considered in case of any annular, papular, nodular or pustular dermatoses, alopecic or not, sometimes pruritic, and nodular dermatoses as well.

Oxidative Stress Biomarkers and Adenosine Deaminase over the Alopecic Area of the Patients with Alopecia Areata.

Alopecia areata (AA) is an autoimmune, T-cell mediated, and chronic inflammatory disorder. The pathological mechanisms of disease are unclear, but oxidative stress may be involved. To our knowledge, no studies have examined the oxidative stress levels or biomarkers within the lesional area and skin surface in patients with AA. Similarly, adenosine deaminase (ADA) has not been characterized in AA. Therefore, we aimed to define ADA levels and the factors involved in oxidative stress from scalp-scrapes of patients with AA. Case-control study. A total of 60 patients (30 diagnosed AA patients and 30 healthy controls) were included in the study. ADA as well as oxidative stress factors, including malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) were analyzed from scalp-scrapes in both groups and quantified by spectrophotometry. Activities of SOD (p=0.000), CAT (p=0.033), and ADA (p=0.004) as well as levels of GSH (p=0.000) and MDA (p=0.032) in patients with AA were higher than the controls statistically significant. Based on these results, factors associated with oxidative stress were elevated in AA patient scalp-scrapes compared to controls and may have a defined role the disease pathogenesis. Alterations in the activities of antioxidant enzymes from AA patient scraping samples may be a local effect of elevated oxidative stress levels. In this disease, oxidative stress may affect not only hair follicle but also any layers of the skin.

FIBROXANTOMA ATÍPICO – TUMOR RARO SOBRE CICATRIZ DE QUEIMADURA

O fibroxantoma atípico (FXA) é um cancro cutâneo relativamente raro que surge mais frequentemente como lesão única, de crescimento rápido, em áreas fotoexpostas de indivíduos idosos. Apesar de apresentar características de agressividade a nível histológico, nomeadamente pleomorfismo e elevado índice mitótico, o prognóstico tende a ser favorável. Apresentamos o caso de uma mulher de 62 anos, com área de alopécia cicatricial no couro cabeludo secundária a queimadura na infância, que desenvolve nesse local e em cerca de um ano, uma lesão tumoral vegetante. O exame anatomopatológico com imunohistoquímica da biopsia incisional foi sugestivo de FXA. Realizou-se a excisão radical com encerramento por duplo retalho de transposição oposto, obtendo-se controlo local da neoplasia. Os mecanismos envolvidos no desenvolvimento do FXA não estão bem esclarecidos, mas a exposição crónica à radiação ultravioleta será um dos factores primordiais. Outros factores considerados são a radioterapia e a imunossupressão. As cicatrizes de queimadura foram descritas apenas esporadicamente.

Right Laparoscopic Adrenalectomy in a Bitch

Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudalvena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma.Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC,we recommended the execution of total right adrenalectomy execution. The videosurgery used four accesses arranged in the right hypogastric region; the diameters were 10 (two), 5, and 3mm. The adrenal gland was carefully dissected with the aid of laparoscopic forceps; during the intraoperative period, there was a small laceration of the abdominal phrenic vein that resulted in bleeding, which was overcome with two titanium clips. The dog had an excellent recovery, and the teamdischarged it 48 h after the procedure. The signs of hyperadrenocorticism disappeared about two weeks after surgery. One year after having the procedure, the animal remainswell and has no signs of tumor recurrence or Cushing’s syndrome.Discussion: The choice laparoscopic approach provided less invasiveness in surgical access, reduced animal convalescence, and provided image magnifcation for the more accurate dissection of the adrenal gland. Some reports that middle-aged to older bitches were the most predisposed to present adrenal neoplasm-dependent HAC, and generally, in unilateral form, characteristics which are presented in this report. Among the clinical signs and observed in this report, are polydipsia, polyphagia, tachypnea, alopecia, and skin hyperpigmentation. That recommended the low-dose dexamethasone suppression test to diagnose Cushing’s syndrome and the endogenous ACTH test to distinguish hypophysary from adrenocorticotrophic HAC. The same tests were performed in the case reported here, as these are also important to establish the fnal diagnosisand refer the total adrenalectomy realization. In the current case report, access to the right hypogastric region using four videosurgery portals provided good surgical access. Towards the hospital convalescence time, the animal was discharged early, just 48 h post-operatively; remission of HAC clinical signs occurredwithin three weeks, and the survival alreadyreached 12 months.To the best of the authors’ knowledge, this is the frst successful case of total right adrenalectomy without caudal vena cava invasion via the laparoscopic route as treatment for adrenocortical carcinoma in the national literature.Keywords: adrenal gland, neoplasm, videosurgery, dogs.

Alopecia Areata Progression Index, a Scoring System for Evaluating Overall Hair Loss Activity in Alopecia Areata Patients with Pigmented Hair: A Development and Reliability Assessment

Background: No scoring systems to evaluate overall hair loss activity in alopecia areata (AA) have been established. Objective: We sought to develop a measurement tool (Alopecia Areata Progression Index, AAPI) for the evaluation of overall hair loss activity in AA patients with pigmented hair. Methods: The scalp surface area was divided into 4 quadrants. In each quadrant, hair loss activity was scored on the basis of the percentage of alopecic area, clinical findings associated with hair loss. The AAPI was measured in 17 patients with different severities of AA. Results: Interobserver and intraobserver reliabilities were assessed by 4 investigators. A significant correlation of the total AAPI was found among the 4 investigators. In addition, intraobserver reliability was excellent, and interobserver reliability was statistically reliable. Conclusion: The AAPI seems to represent a system capable of truly quantifying overall hair loss activity in AA patients with different severity, demonstrating trustworthy interobserver and intraobserver reliability.

A Comparative Study of Oral Cyclosporine and Betamethasone Minipulse Therapy in the Treatment of Alopecia Areata.

BackgroundVarious systemic agents have been assessed for the treatment of alopecia areata (AA); however, there is a paucity of comparative studies.ObjectiveTo assess and compare cyclosporine and betamethasone minipulse therapy as treatments for AA with regard to effectiveness and safety.MethodsData were collected from 88 patients who received at least 3 months of oral cyclosporine (n=51) or betamethasone minipulse therapy (n=37) for AA. Patients with ≥50% of terminal hair regrowth in the alopecic area were considered responders.ResultsThe responder of the cyclosporine group was 54.9% and that of the betamethasone minipulse group was 37.8%. In the cyclosporine group, patients with mild AA were found to respond better to the treatment. Based on the patient self-assessments, 70.6% of patients in the cyclosporine group and 43.2% of patients in the betamethasone minipulse group rated their hair regrowth as excellent or good. Side effects were less frequent in the cyclosporine group.ConclusionOral cyclosporine appeared to be superior to betamethasone minipulse therapy in terms of treatment effectiveness and safety.

Onychodystrophy and Scarring Alopecia in Epidermolysis Bullosa Acquisita: ACase Based Review of the Literature

Introduction: Epidermolysis bullosa acquisita is a rare, autoimmune subepidermal bullous disease. Besides blisters appearance which heals with scars and milia cysts formation, nails undergo different changes: onychomadesis, onycholysis, onychorrhexis and matrix destruction. Case report: We present the case of a 59 years old patient, which showed multiple blisters, erosions, crusts located on the elbows, knees, hands, and feet; some lesions healed and formed hypo or hyperpigmented. scars in the evolution. On the scalp were observed areas of scar alopecia. In the oral cavity there were extensive erosions, painful dysphagia to both solid and liquid food, which in time contributed to significant weight loss. To the fingers and toes, the patient underwent nail loss, these being to be replaced with scar tissue. The only remaining nails are at the fourth and fifth fingers of both hands, but also those showing lesions of onycholysis and onychorrhexis leading to a thin epidermal nail. Conclusions: Our case report is the third case described in the literature. Onychomadesis manifestations and nail absence, although rare, complete the cutaneous manifestations of Epidermolysis bullosa acquisita.