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At least 379 records · Page 21Linked to original sources
PubMedDate not supplied

Effective treatment of female androgenic alopecia with dutasteride.

Dihydrotestosterone is the main molecule responsible for androgenic alopecia. Finasteride, which reduces transformation of testosterone into dihydrotestosterone and decreases dihydrotestosterone activity, is approved for treatment of androgenic alopecia in men. We describe the case of a 46-year-old woman with androgenic alopecia, non-responsive to minoxidil, who initially benefited from finasteride. Due to only limited improvement after finasteride and persisting profound psychological distress resulting from androgenic alopecia, another 5-reductase inhibitor, dutasteride, was introduced. Clinical evaluation and trichogram were applied for assessment of dutasteride efficacy in this patient. Additionally, mean hair diameter was monitored by means of computer dermoscopy. After 6 months of therapy, significant improvement was observed and after 9 months the clinical diagnosis of androgenic alopecia could no longer be made in this patient. No side effects were observed. In conclusion, theoretical data and our experience in this case show that dutasteride might develop into a true alternative in treatment of androgenic alopecia.

5-alpha Reductase Inhibitors↗
PubMedDate not supplied

Computer-aided diagnosis of melanocytic lesions.

BACKGROUND: The clinical diagnosis of melanoma could be difficult for a general practitioner and, in some cases, for dermatologists. To enhance and support the clinical evaluation of pigmented skin lesions a computer-aided diagnosis has been introduced. MATERIALS AND METHODS: Images of melanocytic lesions (477 total, 42 melanomas and 435 melanocytic nevi) evaluated in epiluminescence microscopy and recorded with x16 magnification were selected. A training set of 22 melanomas and 218 nevi was randomized from the dataset. The test set was formed by the complement (the remaining 20 melanomas and 217 nevi). Furthermore, a set of images consisting of 31 melanomas and 103 nevi was selected to compare the discrimination capacity of three general practitioners and three dermatologists with experience in dermoscopy (2 years), and with the automatic data analysis for the melanoma early detection system (ADAM). Sensitivity and specificity were estimated for observer assessments and computer diagnosis. RESULTS: The entire dataset used to test the implementation of the diagnostic algorithms ADAM showed a good sensitivity and specificity performance. Compared with the physicians, the ADAM system showed a slightly higher diagnostic performance in terms of sensitivity and a lower one in terms of specificity. Dermatologists showed higher levels of specificity, but lower levels in terms of sensitivity, when compared with the general practitioners. CONCLUSION: Image analysis has the potential to distinguish nevi and melanomas and to support the clinical diagnosis of melanocytic lesions by the general practitioner.

Humans↗
PubMed2006

Lipedematous alopecia of the scalp.

Lipedematous scalp is a rare disorder, mainly described in adult African-American females. We report 2 adult caucasian males with lipedematous scalp associated with androgenetic alopecia. Patients were studied by dermoscopy and histopathology; they were treated with finasteride 1 mg. In our patients, lipedematous scalp affected the occipital and the vertex areas and pathologically exhibited mild edema and thickening of the adipose subcutaneous layer. At videodermoscopy, lipedematous scalp areas showed linear areas of teleangiectasia within the scalp creases, possibly caused by compression of the superficial blood capillaries by the increased volume of the subcutaneous fat layer within the thickened scalp. Finasteride at a dose of 1 mg per day for 1 year induced mild improvement of androgenetic alopecia in one patient and stabilization of the disease in the other. The lipedematous scalps remain unchanged. Lipedematous scalp is apparently a rare disease even though the condition is probably underdiagnosed. As a matter of fact, we diagnosed lipedematous scalp in our patients during a clinical examination for androgenetic alopecia, which was the patients' complaint. The association of lipedematous scalp and androgenetic alopecia in our two patients appears to be coincidental.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2006

[Basal cell carcinoma].

Basal cell carcinoma (BCC) is the most common skin cancer. It tends to be locally invasive but rarely metastasizes. Dermoscopy has been reported as a useful in vivo method for the accurate clinical diagnosis of BCC. The first-line treatment for BCC is surgical excision, however, clinical trials of non-surgical treatment modalities such as topical imiquimod and photodynamic therapy have recently been published in the English literature, and are gradually being introduced into Japan. Although clinical practice guidelines for the management of BCC have been already published in several countries, original guidelines for Japan are required in light of clinical and ethnic differences.

Aminoquinolines↗
PubMed1995

The morphologic criteria of the pseudopod in surface microscopy.

BACKGROUND AND DESIGN: In vivo cutaneous surface microscopy (oil epiluminescence, dermatoscopy, and dermoscopy) has been shown to greatly enhance the clinical diagnosis of melanoma. The pseudopod is a morphologic feature seen on surface microscopy that corresponds to the radial growth of tumor in melanoma. While it is one of the most specific surface microscopic features of invasive melanoma, it has remained poorly defined. We studied 239 pigmented lesions, 80 melanomas (62 invasive and 18 in situ) and 159 randomly selected pigmented nonmelanomas. We photographed these lesions in vivo using immersion oil and a Heine Dermaphot camera (Heine Ltd, Herrsching, Germany). We then scored the lesions in a "blinded" fashion for the presence of pseudopods based on strictly defined morphologic criteria. RESULTS: We defined the morphologic criteria of the pseudopod. As defined, the pseudopod retained a 97% specificity and 23% sensitivity for invasive melanoma. No difference was seen in the mean Breslow thickness between melanomas with and without pseudopods. None of the in situ melanomas were observed to have pseudopods. CONCLUSION: We suggest morphologic criteria for a highly specific in vivo cutaneous surface microscopic feature of invasive melanoma, the pseudopod.

Humans↗
PubMed1993

[Surface microscopy of pigmented cutaneous tumors].

BACKGROUND: Clinical guidelines for the diagnosis of pigmented lesions of the skin are not always reliable. Especially the differential diagnosis between benign dysplastic nevi (Clark's nevi) and early melanomas, as well as between melanocytic and nonmelanocytic skin tumors (seborrheic keratoses, pigmented basal cell carcinomas and angiokeratomas) is often difficult. OBJECTIVE: Surface microscopy, which is performed today under various synonyms (dermoscopy, dermatoscopy, epiluminescence microscopy, incident light microscopy, skin microscopy), has been shown to provide additional features and subtle clues for the assessment of pigmented skin lesions. METHODS: The pigmented lesions are covered in vivo with a drop of immersion oil and a glass slide, and observed in incident light by using a stereomicroscope (magnification 6- to 40-fold) or a hand-held instrument called dermatoscope (magnification 10-fold). The immersion oil renders the stratum corneum translucent and allows a better observation of distinctive alterations of the dermoepidermal junction and the papillary dermis. RESULTS: The various criteria of surface microscopy (e.g. pigment network, black dots or irregular extensions) that cannot be discerned by the naked eye are summarized and discussed in detail. The diagnostic significance but also the limitations of this technique are emphasized. CONCLUSION: Surface microscopy opens up a new dimension of clinical morphology for the diagnosis of pigmented skin tumors and facilitates a more reliable assessment of the lesions.

Angiokeratoma↗
PubMed1996

Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features.

OBJECTIVES: To create a simple diagnostic method for invasive melanoma with in vivo cutaneous surface microscopy (epiluminescence microscopy, dermoscopy, dermatoscopy) and to analyze the incidence and characteristics of those invasive melanomas that had no diagnostic features by means of hand-held surface microscopes. DESIGN: Pigmented skin lesions were photographed in vivo with the use of immersion oil. All were excised and reviewed for histological diagnosis. A training set of 62 invasive melanomas and 159 atypical nonmelanomas and a test set of 45 invasive melanomas and 119 atypical non-melanomas were used. Images from the training set were scored for 72 surface microscopic features. Those features with a low sensitivity (0%) and high specificity (> 85%) were used to create a simple diagnostic model for invasive melanoma. SETTING: All patients were recruited from the Sydney (Australia) Melanoma Unit (a primary case and referral center). PATIENTS: A random sample of patients whose lesions were excised, selected from a larger database. MAIN OUTCOME MEASURES: Sensitivity and specificity of the model for diagnosis of invasive melanona. RESULTS: The model gave a sensitivity of 92% (98/107) and specificity of 71%. Of the 9 "featureless" melanomas the model failed to detect, 6 were pigmented and thin and had a pigment network. The other 3 were thicker, hypomelanotic lesions lacking a pigment network, some with prominent telangiectases, and all with only small areas of pigment. All featureless melanomas noted by the patients had a history of change in color, shape, or size. CONCLUSIONS: Surface microscopy does not allow 100% sensitivity in diagnosing invasive melanoma and therefore cannot be used as the sole indicator for excision. Clinical history is an important consideration when featureless lesions are diagnosed.

Algorithms↗
PubMed2005

The spectrum of Spitz nevi: a clinicopathologic study of 83 cases.

OBJECTIVE: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features. DESIGN: Eighty-three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n = 11), pigmented Spitz nevus (PSN, n = 14), Reed nevus (RN, n = 16), or atypical Spitz nevus (ASN, n = 14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz-Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached. SETTING: University dermatology and pathology departments and general hospital pathology departments. PATIENTS: A sample of subjects with excised melanocytic lesions. MAIN OUTCOME MEASURE: Frequency of dermoscopic patterns within the different histopathologic subtypes of Spitz nevi. RESULTS: Overlapping clinical, dermoscopic, and histopathologic findings were observed among PSN, RN, and PSRN, thereby justifying their inclusion into the single PSRN diagnostic category. Asymmetry was the most frequent indicator of histopathologic ASN (79%; n = 11); in only 4 cases did dermoscopic asymmetry show no histopathologic counterpart, and in those cases the discrepancy was probably the result of an artifact of the gross sampling technique carried out with no attention to the dermoscopic features. CONCLUSIONS: Among Spitz nevi, histopathologic distinction between PSN and RN is difficult, not reproducible, and may be clinically useless. A simple clinicopathologic classification of these neoplasms might therefore be structured as CDSN, PSRN, and ASN. Asymmetry should be assessed using both dermoscopic and histopathologic analysis, and reliability in histopathologic diagnosis may be enhanced by the simultaneous evaluation of the corresponding dermoscopic images.

Adolescent↗
PubMed2006

Dermoscopic patterns of acral melanocytic nevi and melanomas in a white population in central Italy.

OBJECTIVE: To investigate the dermoscopic features of acral melanocytic lesions in a white population in central Italy. DESIGN: Retrospective review. SETTING: University dermatology department. PATIENTS: Six hundred fifty-one Italian subjects, ranging in age from 6 months to 78 years. MAIN OUTCOME MEASURES: We retrospectively investigated all digital dermoscopic images of acral melanocytic lesions included in our database from January 1996 to May 2005. RESULTS: We retrieved digital images of 723 benign acral melanocytic lesions in 641 patients (235 males and 406 females; mean age, 26.5 years) and of 10 acral melanomas in 10 patients (7 males and 3 females; mean age, 65 years). Individual lesions were located on the soles (n=520), fingers (n=146), and palms (n=67). Among acral nevi, the parallel furrow (42.1%) was the most common pattern, followed by the latticelike (14.9%), nontypical (13.7%), fibrillar (10.8%), homogeneous (9.3%), globular (5.4%), and reticular (2.1%) patterns. The frequency of distribution of the latticelike, nontypical, fibrillar, and homogeneous patterns significantly differed (P<.001, P=.03, P<.001, and P=.03, respectively) between anatomical sites. Also, 13 acral nevi (1.8%), mainly located on the fingers, showed a new combined pattern (transition pattern) consisting of a brownish black network associated with a parallel furrow or latticelike pattern. All 10 acral melanomas showed a multicomponent dermoscopic pattern. CONCLUSIONS: In our series of acral nevi, we observed 8 dermoscopic patterns, with varying distribution by anatomical site. Identification of a specific pattern is highly suggestive of the benign or the malignant nature of any given acral melanocytic lesion.

Adolescent↗