Journal Digest: May 20

The American Journal of Dermatopathology: Onychocytic Matricoma: A Clinical, Dermoscopic, and Pathological Analysis of 14 Cases

Perrin et al’s analysis focused on onychocytic matricoma (OCM), a rare benign nail tumor originating from the nail matrix epithelium, and is the largest case series to date, analyzing 14 cases. OCM usually presents as longitudinal xanthopachyonychia or leukopachyonychia, which can mimic melanoma or subungual squamous cell carcinoma, causing diagnostic challenges. Dermoscopic findings included free-edge thickening, white clods, and filiform hemorrhages. Histologically, OCM shows thickened nail plates with round-to-oval spaces filled with serous fluid, blood, and cornified cells, and can be categorized into acanthotic and papillomatous subtypes. Perrin et al emphasized the importance of histopathological examination and the use of LEF-1 staining to differentiate OCM from other subungual lesions like seborrheic keratosis and onychocytic carcinoma.¹

Clinical, Cosmetic and Investigational Dermatology: Congenital Triangular Alopecia: A Case of Effective Response with 5% Topical Minoxidil in a Male Adolescent

Congenital triangular alopecia (CTA) is a rare, non-scarring hair loss disorder marked by a triangle or lancet-shaped patch of alopecia, commonly seen in children aged 2 to 9 years. Sutisna et al’s case study reported the successful treatment of a 14-year-old male with CTA using 5% topical minoxidil. Initially misdiagnosed with alopecia areata, the patient displayed a well-defined triangular alopecia patch on the right frontotemporal scalp. Following 8 months of twice-daily application of 5% minoxidil, the patient experienced significant hair regrowth with dense terminal hairs, confirmed by trichoscopy. According to the authors, their data aligns with limited reports suggesting that minoxidil can stimulate hair regrowth in CTA, providing a potential treatment option for CTA. Despite the benign nature of CTA and its typical resistance to other treatments, Sutisna et al noted that their study suggests the potential efficacy of minoxidil for patients with CTA.²

International Journal of Women’s Dermatology: Use of Systemic Therapies for Vulvar Lichen Sclerosus and Vulvovaginal Lichen Planus: A Survey Study of Dermatologists and Gynecologists

Vulvar lichen sclerosus (VLS) and vulvovaginal lichen planus (VLP) typically require potent corticosteroids as first-line treatment, although many cases are refractory and need systemic therapies. Richardson et al’s study surveyed 71 clinicians (76% gynecologists, 22% dermatologists) worldwide to assess systemic therapy usage. Results demonstrated that 31% of respondents used systemic treatments for VLS and 47% for VLP, with dermatologists more frequently prescribing them. Steroids and methotrexate were the most common systemic agents. Severe itch or pain refractory to topicals was the primary reason for systemic therapy use, despite concerns about adverse effects and inadequate training among some gynecologists. Limitations included the survey's self-reported nature and potential non-representativeness. According to the study authors, their data emphasizes the need for prospective research and clinician education on systemic therapies for optimizing VLS and VLP management.³

Experimental Dermatology: Dose Escalation of Biologic Treatment in Patients With Moderate-to-Severe Psoriasis in Japan

Tada et al’s study investigated dose escalation of interleukin (IL) inhibitors among Japanese patients with psoriasis (PsO) using data from the Japan Medical Data Center. The study included 982 patients treated with various IL inhibitors: brodalumab (BRO), guselkumab (GUS), ixekizumab (IXE), risankizumab (RIS), secukinumab (SEC), and ustekinumab (UST). Dose escalation, defined as a ≥20% increase in average daily dose, was most common with UST (44.4% at 12 months) and IXE (37.2%), while it was minimal for SEC (3.4%) and nonexistent for GUS and RIS. Adjusted odds of dose escalation for UST were significantly higher compared to other IL inhibitors. RIS had the lowest escalation rates, suggesting superior efficacy at standard doses. The study author’s findings highlighted the variability in dose escalation across IL inhibitors, suggesting an unmet need in PsO treatment.⁴

References

1. Perrin C, Coutts M, Boukari F, Ambrosetti D. OnychocyticMatricoma: a clinical, dermoscopic, and pathological analysis of 14 cases. Am J Dermatopathol. 2024;46(5):259-270. doi:10.1097/DAD.0000000000002674
2. Sutisna FD, Gondokaryono SP, Dwiyana RF, Effendi RMRA, Tache N, Anandita R. Congenital triangular alopecia: a case of effective response with 5% topical minoxidil in a male adolescent. Clin Cosmet Investig Dermatol. 2024;17:1147-1151. https://doi.org/10.2147/CCID.S458753
3. Richardson C, Kassels A, Elsensohn A, Akinshemoyin Vaughn OL, Kraus C. Use of systemic therapies for vulvar lichen sclerosus and vulvovaginal lichen planus: a survey study of dermatologists and gynecologists. Int J Womens Dermatol. 2024;10(2):e146. Published 2024 Apr 18. doi:10.1097/JW9.0000000000000146
4. Tada Y, Soliman AM, Ishii K, et al. Dose escalation of biologic treatment in patients with moderate-to-severe psoriasis in Japan. Exp Dermatol. 2024;33(5):e15067. doi:10.1111/exd.15067