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The randomized double-blind placebo-controlled trial of intralesional botulinum toxin A injection for recalcitrant alopecia totalis and alopecia universalis
The randomized double-blind placebo-controlled trial of intralesional botulinum toxin A injection for recalcitrant alopecia totalis and alopecia universalis
(Poster reference number 5318)
Rattapon Thuangtong, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Kumpol Aiempanakit, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Sunatra Nitayavardhana, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Supenya Varothai, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Alopecia totalis and alopecia universalis are very difficult to treat and highly recurrence. Nowadays, no one find the best way to treat those diseases. Recently, the hypothesis of botulinum toxin A injection in alopecia areata may inhibit unmyelinated C fiber to release substance P and CGRP which can stop destroying of the hair follicles and show the good clinical response in cephalalgia alopecia areata. Objective: To see the efficacy of botulinum toxin A in treatment of recalcitrant alopecia totalis and alopecia universalis. Methods: Twenty cases of recalcitrant alopecia totalis and alopecia universalis were enrolled in this study. Double-blinded randomization were done. The scalp was split into two sides. One was injected with botulinum toxin A 50 units 2.5 mL intradermally (dilution 2 units/mL), another was injected with normal saline 2.5 mL. Clinical assessments were conducted by Severity of Alopecia Tool (SALT), scalp mapping, and photography. Then, the follow-up were made monthly for the period of 4 months after the treatment in order to see the terminal hair regrowth. Result: Until now, all subjects were completed the 4-month follow-up. No clinical improvement has shown. Conclusion: Alopecia areata is multifactorial disease. Botulinum toxin A cannot improve the clinical feature of recalcitrant alopecia totalis and alopecia universalis as in cephalalgia alopecia areata. Therefore, we cannot explain pathophysiology of those diseases with the same mechanism. Commercial support: None identified.
Trichotemnomania: Series of three cases
(Poster reference number 5556)
Jacinto Orgaz-Molina, MD, University Hospital San Cecilio, Granada, Spain; Husein Husein-ElAhmed, MD, University Hospital San Cecilio, Granada, Spain; Salvador Arias-Santiago, MD, PhD, University Hospital San Cecilio, Granada, Spain Background: Trichotemnomania is defined as an acquired and noninflammatory hair loss condition that the patient is raised by cutting or shaving in the context of obsessive-compulsive disorder. Clinical cases: We report 3 cases (1 male and 2 females) that have a very similar clinical presentation. The patients visited the doctor for alleged sudden hair loss on the scalp and they were accompanied by a relative, which showed frightened by the situation, unlike patients who showed a relative indifference respect their sudden hair loss. We found a generalized hair loss without signs of inflammation or scarring. In a closer examination we found that follicle openings were filled with black hair shafts and the scalp seemed to have been shaved or cut (Fig 1). No alterations were found in any nails or mucous membranes or other symptoms, except ‘‘patient 2’’ who had hair loss of upper half of his eyebrows (Fig 1B). Moreover, more inaccessible areas are more easily respected (Fig 2). Characteristically, none of them admitted the authorship of clinical; only ‘‘case 3’’ have admitted autorship after a private interview (without parents). The patient recognized that she had cut the hair herself with a haircut machine, motivated by an intrusive idea that she could not avoid. The hair pull test was negative and there were no exclamation point hairs, nor yellow dots with dermatoscopy. Histologic analysis showed no abnormalities. Discussion: Main differential diagnosis is comprised between alopecia areata, trichotillomania and trichoteiromania. Although trichotemnomania is a self-induced alopecia, patients are resistant to confess their habit. This feature is shared with trichotemnomania, in which is documented the resistance to admit the habit. These patients may be embarrassed by their appearance and habit, showing feelings of guilt. So, patients present to physician with hair loss but in fact their problem is physiciatric type: obsession and compulsive habit. Conclusion: Dermatologists should know about the existence of trichotemnomania and not feel confused in cases like these described here, in which the patient usually does not admit the mechanism of production. Trichotemnomania should be interpreted as a variant of trichotillomania with differences in the way to run the compulsion. Therefore, it should not to be confused with alopecia of organic nature, such alopecia areata, and must be managed as an epiphenomenon of psychiatric disorders. Commercial support: None identified.
The survey of hair dyeing prevalence in Korean population
(Poster reference number 5012)
Hyoseung Shin, MD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Hee Chul Eun, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Jong Hee Lee, MD, PhD, Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, South Korea; Kyu Han Kim, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Oh Sang Kwon, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Seong Jin Jo, MD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Soyun Cho, MD, PhD, Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea, South Hair graying is easily observed in healthy people, therefore it has been considered as a normal ageing process, not a medical problem. However, in Koreans, hair graying is often a big cosmetic problem because it stands out prominently against an original black hair color. For that reason, hair dyeing to cover gray hair is very common in Korea. In this study, we investigated the prevalence of hair dyeing in Korean subjects using a questionnaire and by physical examination. 1002 subjects, 522 (52.1%) men and 480 (47.9%) women, were initially recruited. The average age was 43.2 6 16.7 years (mean 6 SD). According to questionnaire responses, 649 (64.8%) of the 1002 subjects had gray hair. Of the 649 subjects with gray hair, 289 (44.1%) responded that they had dyed their hair. Dyeing behavior was significantly different between genders (P\.001). In women, 56.1% had dyed their hair, whereas only 33.2% of men had done that. An analysis by age showed that only about 20% of subjects in their twenties and thirties dyed their hair, but this increased sharply to 60% in subjects from 40 to 79 years old. The proportion then decreased to \ 20% in those aged over 80. Dyeing behavior seemed to be associated with individual subjective judgments of the extent of graying. The prevalence of hair dyeing was only 22.7% in subjects who thought that less than 20% of the scalp was involved in hair graying, but was more than 60% in subjects that thought more than 20% of the scalp was involved. This difference was significant (P\.001). In addition, women were found to dye hair more than men regardless of grayness grade. Our survey results suggest that the hair dyeing prevalence in Korea population is different depending on gender, age and extent of gray respectively. We expect these results might be useful for the studies that would develop the cosmetics or new pharmaceuticals for graying hair. Commercial support: None identified.
APRIL 2012
Two cases of elkonyxis in association with washboard nails or 20-nail dystrophy
(Poster reference number 5093)
MinSeok Cheon, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Baik-Kee Cho, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; HyunJeong Park, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; YoungBok Lee, MD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea Elkonyxis is a term that describes irregular defects in the dorsal nail plate. It is clinically characterized as a punched out lesion at the lunula that progressively moves distally with the growth of the nail. The causes of elkonyxis have been described in secondary syphilis, psoriasis, Reiter syndrome, and after trauma. It was also reported to appear in association with retinoid therapy and peritonitis in a peritoneal dialysis patient. However, this rare nail dystrophy has been rarely reported. A 68-year-old woman presented with a hemorrhagic crust on the left third finger nail, which had been injured by a door 2 months previously. On close inspection, there was a punched-out lesion at the lunula on the left third finger and there also were multiple transverse grooves with central depression on the both thumb finger nails, and left second and third finger nails that were clinically consistent with washboard nails. The cuticles of the involved nails were not observed. The patient habitually pushed back the cuticle of the finger nails and the washboard deformities were presented for 8 years. Histopathologic finding of the crusted lesion showed chronic inflammation and necrotic tissue. The elkonyxis at the left third finger improved with symptomatic treatment. A 34-year-old man presented with a dome-shaped reddish papule on the right thumb nail that had been present for 1 week and that had been sustained by impact on the corner of a desk. The patient had been diagnosed with 20-nail dystrophy with regular pits and rough surfaces on both finger and toenails for 8 years without specific. The histopathology of the specimen showed necrotic tissue on the surface and increased vascular structures, collagen bundles and inflammatory cells in the dermis that were consistent with pseudopyogenic granuloma. Herein, we report two cases of elkonyxis in association with washboard nails and 20-nail dystrophy. Commercial support: None identified.
J AM ACAD DERMATOL
AB101
(Poster reference number 5318)
Rattapon Thuangtong, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Kumpol Aiempanakit, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Sunatra Nitayavardhana, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Supenya Varothai, MD, Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Alopecia totalis and alopecia universalis are very difficult to treat and highly recurrence. Nowadays, no one find the best way to treat those diseases. Recently, the hypothesis of botulinum toxin A injection in alopecia areata may inhibit unmyelinated C fiber to release substance P and CGRP which can stop destroying of the hair follicles and show the good clinical response in cephalalgia alopecia areata. Objective: To see the efficacy of botulinum toxin A in treatment of recalcitrant alopecia totalis and alopecia universalis. Methods: Twenty cases of recalcitrant alopecia totalis and alopecia universalis were enrolled in this study. Double-blinded randomization were done. The scalp was split into two sides. One was injected with botulinum toxin A 50 units 2.5 mL intradermally (dilution 2 units/mL), another was injected with normal saline 2.5 mL. Clinical assessments were conducted by Severity of Alopecia Tool (SALT), scalp mapping, and photography. Then, the follow-up were made monthly for the period of 4 months after the treatment in order to see the terminal hair regrowth. Result: Until now, all subjects were completed the 4-month follow-up. No clinical improvement has shown. Conclusion: Alopecia areata is multifactorial disease. Botulinum toxin A cannot improve the clinical feature of recalcitrant alopecia totalis and alopecia universalis as in cephalalgia alopecia areata. Therefore, we cannot explain pathophysiology of those diseases with the same mechanism. Commercial support: None identified.
Trichotemnomania: Series of three cases
(Poster reference number 5556)
Jacinto Orgaz-Molina, MD, University Hospital San Cecilio, Granada, Spain; Husein Husein-ElAhmed, MD, University Hospital San Cecilio, Granada, Spain; Salvador Arias-Santiago, MD, PhD, University Hospital San Cecilio, Granada, Spain Background: Trichotemnomania is defined as an acquired and noninflammatory hair loss condition that the patient is raised by cutting or shaving in the context of obsessive-compulsive disorder. Clinical cases: We report 3 cases (1 male and 2 females) that have a very similar clinical presentation. The patients visited the doctor for alleged sudden hair loss on the scalp and they were accompanied by a relative, which showed frightened by the situation, unlike patients who showed a relative indifference respect their sudden hair loss. We found a generalized hair loss without signs of inflammation or scarring. In a closer examination we found that follicle openings were filled with black hair shafts and the scalp seemed to have been shaved or cut (Fig 1). No alterations were found in any nails or mucous membranes or other symptoms, except ‘‘patient 2’’ who had hair loss of upper half of his eyebrows (Fig 1B). Moreover, more inaccessible areas are more easily respected (Fig 2). Characteristically, none of them admitted the authorship of clinical; only ‘‘case 3’’ have admitted autorship after a private interview (without parents). The patient recognized that she had cut the hair herself with a haircut machine, motivated by an intrusive idea that she could not avoid. The hair pull test was negative and there were no exclamation point hairs, nor yellow dots with dermatoscopy. Histologic analysis showed no abnormalities. Discussion: Main differential diagnosis is comprised between alopecia areata, trichotillomania and trichoteiromania. Although trichotemnomania is a self-induced alopecia, patients are resistant to confess their habit. This feature is shared with trichotemnomania, in which is documented the resistance to admit the habit. These patients may be embarrassed by their appearance and habit, showing feelings of guilt. So, patients present to physician with hair loss but in fact their problem is physiciatric type: obsession and compulsive habit. Conclusion: Dermatologists should know about the existence of trichotemnomania and not feel confused in cases like these described here, in which the patient usually does not admit the mechanism of production. Trichotemnomania should be interpreted as a variant of trichotillomania with differences in the way to run the compulsion. Therefore, it should not to be confused with alopecia of organic nature, such alopecia areata, and must be managed as an epiphenomenon of psychiatric disorders. Commercial support: None identified.
The survey of hair dyeing prevalence in Korean population
(Poster reference number 5012)
Hyoseung Shin, MD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Hee Chul Eun, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Jong Hee Lee, MD, PhD, Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, South Korea; Kyu Han Kim, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Oh Sang Kwon, MD, PhD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Seong Jin Jo, MD, Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea; Soyun Cho, MD, PhD, Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea, South Hair graying is easily observed in healthy people, therefore it has been considered as a normal ageing process, not a medical problem. However, in Koreans, hair graying is often a big cosmetic problem because it stands out prominently against an original black hair color. For that reason, hair dyeing to cover gray hair is very common in Korea. In this study, we investigated the prevalence of hair dyeing in Korean subjects using a questionnaire and by physical examination. 1002 subjects, 522 (52.1%) men and 480 (47.9%) women, were initially recruited. The average age was 43.2 6 16.7 years (mean 6 SD). According to questionnaire responses, 649 (64.8%) of the 1002 subjects had gray hair. Of the 649 subjects with gray hair, 289 (44.1%) responded that they had dyed their hair. Dyeing behavior was significantly different between genders (P\.001). In women, 56.1% had dyed their hair, whereas only 33.2% of men had done that. An analysis by age showed that only about 20% of subjects in their twenties and thirties dyed their hair, but this increased sharply to 60% in subjects from 40 to 79 years old. The proportion then decreased to \ 20% in those aged over 80. Dyeing behavior seemed to be associated with individual subjective judgments of the extent of graying. The prevalence of hair dyeing was only 22.7% in subjects who thought that less than 20% of the scalp was involved in hair graying, but was more than 60% in subjects that thought more than 20% of the scalp was involved. This difference was significant (P\.001). In addition, women were found to dye hair more than men regardless of grayness grade. Our survey results suggest that the hair dyeing prevalence in Korea population is different depending on gender, age and extent of gray respectively. We expect these results might be useful for the studies that would develop the cosmetics or new pharmaceuticals for graying hair. Commercial support: None identified.
APRIL 2012
Two cases of elkonyxis in association with washboard nails or 20-nail dystrophy
(Poster reference number 5093)
MinSeok Cheon, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Baik-Kee Cho, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; HyunJeong Park, MD, PhD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; YoungBok Lee, MD, Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea Elkonyxis is a term that describes irregular defects in the dorsal nail plate. It is clinically characterized as a punched out lesion at the lunula that progressively moves distally with the growth of the nail. The causes of elkonyxis have been described in secondary syphilis, psoriasis, Reiter syndrome, and after trauma. It was also reported to appear in association with retinoid therapy and peritonitis in a peritoneal dialysis patient. However, this rare nail dystrophy has been rarely reported. A 68-year-old woman presented with a hemorrhagic crust on the left third finger nail, which had been injured by a door 2 months previously. On close inspection, there was a punched-out lesion at the lunula on the left third finger and there also were multiple transverse grooves with central depression on the both thumb finger nails, and left second and third finger nails that were clinically consistent with washboard nails. The cuticles of the involved nails were not observed. The patient habitually pushed back the cuticle of the finger nails and the washboard deformities were presented for 8 years. Histopathologic finding of the crusted lesion showed chronic inflammation and necrotic tissue. The elkonyxis at the left third finger improved with symptomatic treatment. A 34-year-old man presented with a dome-shaped reddish papule on the right thumb nail that had been present for 1 week and that had been sustained by impact on the corner of a desk. The patient had been diagnosed with 20-nail dystrophy with regular pits and rough surfaces on both finger and toenails for 8 years without specific. The histopathology of the specimen showed necrotic tissue on the surface and increased vascular structures, collagen bundles and inflammatory cells in the dermis that were consistent with pseudopyogenic granuloma. Herein, we report two cases of elkonyxis in association with washboard nails and 20-nail dystrophy. Commercial support: None identified.
J AM ACAD DERMATOL
AB101