An uncommon zoonosis

In a patient with foreign‐body granulomas, dog hairs were identified as the causative agent by combing history, histopathology and highly sensitive detection of species‐specific canine mitochondrial DNA. Granulomas from human hair are well known in hairdressers. Animal hair granulomas have so far been only described in dog groomers, milkers, and shearers. To the best of our knowledge this patient represents the first described case of dog hair granulomas in a pet owner.     

发疹性毳毛囊肿1例

报告1例发疹性毳毛囊肿，患者女，32岁，因前额和两侧颞部起许多蓝灰色有脐窝的丘疹10余年就诊，曾误诊为汗管瘤和异物肉芽肿，组织病理为典型的发疹性毳毛囊肿。     

miR‐424 levels in hair shaft are increased in psoriatic patients

Objective diagnostic markers have not been in clinical use for psoriasis. In this study, we investigated the levels of miR‐424 in hair roots and hair shafts in psoriatic patients, and evaluated the possibility that miR‐424 can be a biomarker of the disease. A single hair root and five pieces of hair shafts (~5 cm in length) were obtained from the non‐lesional occiput of each individual of 26 psoriatic patients. Control hair samples were collected from nine normal subjects. Samples from 10 atopic dermatitis patients were also included as the disease control. miR‐424 levels were determined by quantitative real‐time polymerase chain reaction. Hair shaft miR‐424 levels were significantly upregulated only in patients with psoriasis compared with normal controls and those with atopic dermatitis. By receiver–operator curve analysis of hair shaft miR‐424 to distinguish psoriatic patients from normal subjects, the area under the curve was 0.77. However, relative miR‐424 levels were not correlated with disease activity markers including disease duration, body surface area and Psoriasis Area and Severity Index. Hair root miR‐424 was not useful for evaluating both diagnosis and severity of the disease. Our results indicated hair shaft miR‐424 levels may be useful as a diagnostic marker of psoriasis.     

Tumefactive foreign body giant cell reaction following high‐pressure paint injection injury: A case report and review of literature

High‐pressure paint injection injury is an uncommon but well‐described injury. The histologic features of long‐term paint injection injury with retained material are less recognized. A 46‐year‐old male presented clinically as “recurrent giant cell tumor of tendon sheath.” The right index finger demonstrated fusiform enlargement by a pigmented mass with diffuse infiltration into the soft tissue of the hand. Histologically the tumor showed multiple giant cells in a fibrotic stroma extending into the dermis. There were multiple types of foreign material including diffuse brown black pigment, weakly optically polarizing foreign material and white inclusions with a “train track” appearance. The cells were positive for CD68 and negative for S100 antigen. Further investigation revealed that the patient had a history of high‐pressure paint injection injury to his digit 6 years prior. Foreign material injected under high pressure into tissues may result in a pseudo‐neoplastic foreign body granulomatous reaction that can mimic giant cell tumor of tendon sheath. Our case demonstrates that this reaction can be florid and can have slow growth over years. A high index of suspicion, a good clinical history and careful examination can distinguish these 2 entities.     

Adverse reactions to polylactic acid injections in the periorbital area

Background Correction of aging changes and contour deformities has been addressed largely by tissue augmentation agents whose volume is injected into tissues to achieve the required result. Polylactic acid (PLA) is an agent that is injected with the aim of enhancing the host's own collagen deposition. Objective We describe the development of multiple nodules and one case of a foreign‐body granuloma formation following the administration of PLA to the face for correction of rhytides and contour deformities. Methods Four case presentations, including clinical history, injection protocol, histopathology, individual treatment, and their outcomes, are discussed with pertinent literature review. Results Four patients who received injections of PLA developed nodules that were clinically similar in size, shape, and consistency. Histopathologic examination revealed the presence of a foreign‐body granulomatous inflammatory reaction in one of the patients. Conclusion Cosmetic treatment with PLA may be complicated by disfiguring nodules that may mask a granulomatous reaction. PLA‐induced nodules and foreign‐body granulomas have proven difficult to treat. Therefore, PLA should only be injected in the infraorbital area by experienced injectors who have had appropriate training. In addition to this, PLA should be injected in a “depot” method below the muscle at a significantly diluted volume. Due to the complications encountered after the use of PLA, we feel that a cautionary warning regarding the use of PLA in this area may be prudent regardless of the abovementioned precautions.     

5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss

Background Various treatments have been attempted for female pattern hair loss (FPHL), including topical minoxidil, oral antiandrogen and finasteride. But, there is no consensus on the standard treatment options. Clinical efficacy of finasteride in treating FPHL is still in controversy, but there is a tendency to high dose finasteride, which is more effective than lower dose. Objectives The purpose of this study was to evaluate the clinical efficacy of high dose (5 mg/day) oral finasteride in normoandrogenic Asian women with FPHL. Methods Total of 87 normoandrogenic, pre and post‐menopausal women with FPHL were enrolled in this study. They were treated with oral finasteride (Proscar^®), 5 mg daily for 12 months. Efficacy was evaluated with hair density and thickness changes assessed by phototrichogram and global photographs using 7‐point scale. Results Eighty‐six patients completed 12 months of finasteride treatment schedule. One patient (1.1%) withdrew due to headache. At initial visits, mean hair density was 90 ± 22/cm² and mean hair thickness was 64 ± 11 μm. After 12 months of finasteride treatment, hair density was significantly increased to 107 ± 23/cm² (P < 0.001), and hair thickness was also significantly increased to 70 ± 9 μm (P = 0.02). In global photographs, 70 (81.4%) of the 86 patients were improved (57 were slightly, 10 were moderately and four were greatly improved). Patients without any changes were 13 (15.1%) and 3 (3.5%) patients reported slightly aggravated. Four patients (4.6%) reported adverse events (headache, menstrual irregularity, dizziness and increased body hair growth). However, these adverse events were mild and disappeared soon. Conclusions Oral finasteride, 5 mg/day, may be an effective and safe treatment for normoandrogenic women with FPHL.     

Granulomatous reaction to hyaluronic acid filler material in oral and perioral region: A case report and review of literature

The use of cosmetic fillers agents in orofacial region has become more often used for esthetic concern. Although adverse effects are rare, some patients may develop foreign body reaction to such fillers. Hyaluronic acid (HA) is a biomaterial in the spotlight, because it is normally present in several tissues of human body. The aim of this study was to report a case of a 54‐year‐old white woman with granulomatous reaction to the HA located in the lips. In addition, a review of the English‐language literature of all previously described cases of this condition in oral and perioral region was performed. The location, clinical features, symptoms, time between injection and reaction, type of treatment and treatment outcome of 17 cases were summarized. The clinical and histopathological examination along with a detailed history about this condition is very important to management of patients with nodular lesions in maxillofacial region.     

Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: A case of Fournier's gangrene caused by fish bone

Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74‐year‐old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Intraoperative findings showed dirty necrosis of soft tissue, and a splinter‐shaped foreign body was found in the perirectal region. The foreign body was thought to be the cause of the condition, and it was analyzed using Fourier transform infrared spectroscopy. We found that the foreign body was a mixture of calcium phosphate and protein, suggesting that the splinter was a bone. Moreover, during the medical interview, the patient mentioned about intake of fish around the time of onset of symptoms. Therefore, to confirm the results of the analysis, DNA was extracted from the foreign body, and genomic PCR with subsequent sequence analysis was performed. The DNA sequence was identical to that of Oncorhynchus kisutch, a salmon that is a very popular food in Japan. On the basis of these findings, we concluded that FG in this case was caused by the penetration into the rectum of an accidentally ingested fish bone. Although some cases of intra‐abdominal abscess due to accidental ingestion of fish bone have been reported, FG caused by fish bone is extremely rare.     

Skin equivalent assay: An optimized method for testing for hair growth reconstitution capacity of epidermal and dermal cells

Hair follicle reconstitution requires highly organized epithelial‐mesenchymal interactions. Skin equivalents containing the epidermal and dermal cells with hair reconstitution capacity can reproduce these processes, but have not been established. This study was conducted to develop a hair follicle‐producing three‐dimensional (3D) skin equivalent assay using neonate mouse epidermal and dermal cells. A skin equivalent comprised of mouse dermal cells (MDCs) embedded in type I collagen and overlaid with mouse epidermal cells (MECs) was used. MDCs were mixed with type I collagen and cultured for 7 days. One day after adding MECs on top, the composites were grafted onto nude mice. MDCs cultured on a two‐dimensional (2D) plate for 7 days and mixed with MECs as a negative control, and freshly isolated MDCs and MECs mixture (chamber assay) as a positive control were also grafted. Six weeks after grafting, regenerated hair follicles were analysed. Our 3D skin equivalent culture assay reproducibly regenerated hair follicles, while MDCs precultured in the 2D model with MECs did not. Compared to the chamber assay, which produced randomly oriented hair follicles, nearly all regenerated hair follicles in our assay extruded through the skin and numerous regenerated hair follicles were higher than those in the chamber assay. Several representative genes associated with hair induction showed higher expression in our assay than in the 2D model. When Wnt3a was added, the number of regenerated hairs increased. Organized hair follicle regeneration was accomplished using our assay. This approach can be applied to assess a test agent with hair growth‐promoting effects.     

Comedonal graft‐vs‐host disease: a distinct clinical expression of a lichenoid follicular GVHD

We report two cases of chronic follicular graft‐vs‐host disease (GVHD) that resemble closed and open acne‐like comedones. We propose the term ‘comedonal GVHD’ for this variant. A 47‐year‐old man presented with multiple 2–4‐mm acne‐like follicular papules in facial areas on day 82 status post bone marrow transplantation. A biopsy showed follicular infundibular dilation with keratotic plugs, hypergranulosis and vacuolar alteration (hydropic degeneration) of the basal layer, with dyskeratotic (apoptotic) keratinocytes, scattered lymphocytes and vascular ectasia of the superficial dermal plexus. We diagnosed chronic follicular lichenoid GVHD. The second patient was a 53‐year‐old female. On day 420 after transplantation, she presented with generalized dark to grayish, confluent, indurated lesions with confluent papules and unevenly distributed comedo‐like lesions. Skin biopsy showed sclerotic dermis and also dilated follicular infundibula with keratotic plugging, hypergranulosis and vacuolar alteration (hydropic degeneration) of the basal layer of the epidermis. We established the diagnosis of chronic sclerodermoid GVHD with follicular lichenoid involvement. The presence of open and closed comedones on the trunk and facial region of an adult raises several differential diagnosis but in our patients, histopathologic study demonstrated typical features of GVHD, which led to this diagnoses despite the peculiar clinical findings.     

Penis swelling due to foreign body reaction after injection of silicone

A 19‐year‐old man presented with phimosis and painful swelling of the penis four weeks after augmentation with silicone in Thailand. Histology revealed a foreign body reaction to silicone. Infectious causes were ruled out. Granulomatous foreign body reactions to silicone are common, but there are few case reports on reactions following silicone injection for penis enlargement. Foreign body reactions should be included in the differential diagnosis of penis swelling.     

A case of perforating pilomatricoma

Pilomatricoma is a rare skin neoplasm, most commonly seen in the head and neck region, and occurring in the first two decades of life. It is usually solitary and varies from 0.5 to 2 cm in diameter. Its etiology is unknown. Perforating pilomatricoma is a rare clinical variant that presents as a draining, crusted nodule or ulcer, and is reported to arise faster than the classic pilomatricoma. Herein, we report a case of 35-year-old female, who had a 4-month history of a growing mass on her leg. On physical examination, a 4-cm diameter, asymptomatic, erythematous, ulcerated mass was noted on the left anterio-lateral upper leg. The first histopathological analysis of a punch biopsy from the lesion was reported as basal cell carcinoma. Therefore, the lesion was totally excised. There were shadow cells, squamoid cells, and basaloid aggregations more prominently in the one area in the tumor. In addition, calcification, foreign body giant cells and inflammatory cells were present. Punch or excisional biopsies are preferred as a method of diagnosis for the majority of cutaneous neoplasms. If total excision is not the method of choice, multiple punch biopsies should be made from different areas in large skin tumors for correct diagnosis.     

Tinea capitis mimicking dissecting cellulitis in three children

Tinea capitis mimicking dissecting cellulitis is a rare presentation, and there is a paucity of information regarding this presentation in the literature. Three children 10‐14 years of age who presented with an unusual clinical manifestation of tinea capitis that clinically resembled dissecting cellulitis are reported. The patients were treated with systemic antifungals for 3‐4 months. Treatment success was measured according to repeat fungal cultures and clinical assessment of hair regrowth at follow‐up visits. All three patients had resolution of infection, with negative repeat fungal cultures and complete hair regrowth without scarring. These cases highlight a rare inflammatory subtype of tinea capitis that can be easily misdiagnosed and therefore improperly treated, prolonging the duration of infection.     

Distal‐type epitheloid sarcoma mimicking a wart in a child: A diagnosis not to be missed

Epithelioid sarcoma is a rare soft‐tissue tumor that occurs mainly in children and young adults. It typically presents as a subcutaneous or deep dermal mass in distal extremities. Due to its benign‐appearing clinical presentation, infrequent occurrence, and histologic similarities with other pathologies, the diagnosis of epithelioid sarcoma in its early stages can be extremely difficult and can be easily confused with benign lesions such as warts or foreign body granuloma. In this paper, we report the case of a 12‐year‐old boy with a distal‐type epithelioid sarcoma of the hand and wish to emphasize the difficulties of diagnosing this potentially lethal tumor both clinically and histologically.     

Management of dupilumab‐associated conjunctivitis in atopic dermatitis

Since September 2017, the monoclonal antibody dupilumab (Dupixent^®) has been approved in the EU for the treatment of moderate‐to‐severe atopic dermatitis. By blocking IL‐4 and IL‐13 signaling pathways, dupilumab improves both objective signs and subjective symptoms of the disease. Blocking of the IL‐4aRα subunit leads to improvement of the skin's barrier function and reduction in Th2‐mediated inflammation. While the rate of adverse events on dupilumab is generally low, mild‐to‐moderate conjunctivitis associated with redness as well as a burning and foreign body sensation has been reported in up to 28 % of patients. Treatment options include topical corticosteroids and topical calcineurin inhibitors. The present review highlights the clinical presentation of dupilumab‐associated conjunctivitis and addresses pharmacological and non‐pharmacological options available for the treatment of this clinically highly relevant condition.     

Current standards in the diagnostics and therapy of hair diseases – hair consultation

Hair and scalp diseases present an extensive diagnostic and therapeutic task. Treating them is often a challenge for the physician in daily practice. Unclear diagnoses, chronic conditions with long‐lasting therapies and the uncertainty of the patient may often lead to unsatisfying situations for both the patient as well as the doctor. The complaints can be divided into (1) hair loss, (2) increased hair growth and (3) abnormal hair quality. A structured history and the objectification of the clinical findings with the help of standardized diagnostic methods and score systems or classifications enable a diagnosis in most patients already at the first visit. Moreover, such structured processes strengthen the treatment satisfaction and compliance of both the patient and the therapist. In the meantime, diagnostic measures and clinical practice guidelines are available for the most common hair disorders. Expertise in basic psychosomatic care and an empathetic approach to the fears and concerns as well as practical advice for the daily contact with hair disorders should be integrated as separate elements in the management of hair diseases; in most cases they are gratefully welcomed by the patients. The aim of this article is to provide the physician with a guideline for the structured management of a hair patient. An overview of recent new developments and the currently available clinical practice guidelines for diagnosis and therapy of hair disorders is presented.     

Clinical updating study at 3 years on 278 patients treated by modern artificial hair implant technique (automatic biofibre®)

In this study, we report our multicentric experience of synthetic medical certified polyamide hair implants in male androgenetic, female menopausal, and chronic alopecia. Biofibre hair implantation was performed by means of a standardized, mini‐invasive technique followed by regular postoperative care along 3 years. From May 2015, 278 patients were enrolled and 253 completed the trial; 202 men (79.9%) versus 51 women (20,1%). The average age was 43(± 4.29); 179 patients (70.1%) had taken previous treatments for alopecia. We evaluated efficacy (as judged by Hamilton scale grading, covered area percent, surgeon, and patient's subjective evaluation) and safety (as judged by adverse events). The overall scalp surface restored with artificial hair (mm² spaced) and pre‐postoperative general customers' satisfaction (by Hamilton scale grading) are reported, showing a significant (98,14%) subjective and objective improvement of the self‐image. Twenty‐two cases (8.75%) declared minor side effects generally counteracted by topical or short course systemic antibiotic and anti‐inflammatory treatment. The average number of implanted fibers was 2,295 (SD 2.805; SE 200.9) ranging from 300 to 16,000. The average duration of pain and tenderness at the implant area was 2.2 days (SD 4.096; SE 0.2933) ranging from 1 to 20 days. A diagrammatic comparison of the Hamilton scale grading before and after the trial showed a dramatic improvement with the majority of the patients being in Hamilton grade II after implantation.     

Trichothiodystrophy and fragile hair: the distinction between diagnostic signs and diagnostic labels in childhood hair disease

Background Hair typically becomes fragile when there are structural abnormalities and/or a reduction in the sulphur‐containing amino acids cystine or methionine. This finding in the setting of a neuroectodermal complaint is usually labelled trichothiodystrophy (TTD). The spectrum of features within this diagnostic grouping tests the validity of using sulphur‐deficient hair as a central characteristic. Objectives To determine what diagnoses were found within a group of subjects with fragile hair and whether low cystine or methionine were relevant central characteristics. Methods We examined cases referred to us from 12 U.K. centres for hair microscopy over 10 years where hair fragility or clinical characteristics raised the possibility of TTD. All samples underwent amino acid analysis. This was achieved through cation exchange chromatography coupled with spectrophotometric quantification. Results Twenty‐five patients (11 male, 14 female) with a mean age of 11 years (0·3–37) were evaluated. Nineteen patients had features of hair damage. Of these, five patients had abnormalities on microscopy only and four patients had microscopic changes and tiger‐tail pattern but normal amino acid content. The remaining 10 patients had reduced cystine content, two of whom also had low methionine. All but one had the tiger‐tail pattern. Among the wide range of phenotypes there were only three cases matching a diagnosis of TTD. Conclusions Our data suggest that clinically apparent fragile hair in childhood is only rarely associated with a diagnosis of TTD. The tiger‐tail change is sensitive but not wholly specific to TTD. We propose that the term trichothiodystrophy be limited in its use to define sulphur‐deficient hair rather than as a diagnostic term in a heterogeneous and incoherent multisystem disorder, where sulphur‐deficient hair is one feature.