Lynne J. Goldberg

Guest Editor for the following articles:

Jun
2015
Vol. 34. No. 2

Hair loss in patients with skin of color

Amy J. McMichael, MD | Ashley L. Semble

Hair loss in skin of color patients can vary from the very simplest of diagnoses to a unique diagnostic challenge requiring extensive knowledge of historical symptoms, haircare practices, and previous treatments. There are several disorders in the literature that are noted to be more common in patients of African descent as compared to Caucasian populations. These disorders include central centrifugal cicatricial alopecia, dissecting cellulitis, discoid lesions of lupus erythematosus, traction alopecia, seborrheic dermatitis, and hair breakage. While there is no definitive prevalence data for the various forms of hair loss in the skin of color population, it is clear that these disorders are a concern for many patients in this population along with common hair loss concerns, such as telogen effluvium and pattern hair loss. A careful detailed clinical examination, history, and potential histopathology will guide the clinician to appropriate management. Hair disorders in skin of color patients may present unique challenges to the clinician, and knowledge of accurate clinical presentation and treatment approaches is essential to providing quality care. Semin Cutan Med Surg 34:81-88 © 2015 Frontline Medical Communications

MORE
Jun
2015
Vol. 34. No. 2

Hair transplantation update

Nicole Rogers, MD, FAAD

Contemporary hair transplant surgery offers results that are natural and undetectable. It is an excellent treatment option for male and female pattern hair loss. Patients are encouraged to also use medical therapy to help protect their surgical results and prevent ongoing thinning of the surrounding hairs. The two major techniques of donor elliptical harvesting and follicular unit extraction are discussed here. Semin Cutan Med Surg 34:89-94 © 2015 Frontline Medical Communications

MORE
Jun
2015
Vol. 34. No. 2

Anatomy of the nail unit and the nail biopsy

Eckart Haneke, MD, PhD

The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, it consists of 4 epithelial components: the matrix that forms the nail plate; the nail bed that firmly attaches the plate to the distal phalanx; the hyponychium that forms a natural barrier at the physiological point of separation of the nail from the bed; and the eponychium that represents the undersurface of the proximal nail fold which is responsible for the formation of the cuticle. The connective tissue components of the matrix and nail bed dermis are located between the corresponding epithelia and the bone of the distal phalanx. Characteristics of the connective tissue include: a morphogenetic potency for the regeneration of their epithelia; the lateral and proximal nail folds form a distally open frame for the growing nail; and the tip of the digit has rich sensible and sensory innervation. The blood supply is provided by the paired volar and dorsal digital arteries. Veins and lymphatic vessels are less well defined. The microscopic anatomy varies from nail subregion to subregion. Several different biopsy techniques are available for the histopathological evaluation of nail alterations. Semin Cutan Med Surg 34:95-100 © 2015 Frontline Medical Communications

MORE
Jun
2015
Vol. 34. No. 2

Pigmented lesions of the nail unit

Beth S. Ruben, MD

Longitudinal melanonychia originates from pigmented and/or melanocytic lesions of the nail unit. It may be a less-common entity encountered in dermatologic practice, but it is often a vexing one. Lesions occurring at this location present particular problems due to the unfamiliarity with clinical assessment, their relative inaccessibility, requiring more surgical finesse, and the lack of experience with histopathologic examination. Obtaining a specimen sufficient for interpretation is one of the main impediments to successful diagnosis in this setting. Most pigmented bands are benign, due to more common entities such as melanocytic activation, lentigo, and/or a nevus; however, deciding which ones are due to melanoma is of the utmost importance and can be difficult. Some examples of melanoma at this site are amelanotic, which are more challenging to recognize clinically, and usually lead to significant delays in diagnosis. In order to provide optimal patient care in this setting, it is very important that the physician has an understanding of the unique clinical, surgical, and pathologic issues relating to diagnosis of melanocytic neoplasms at this site, and there is communication between the clinician and the pathologist. Semin Cutan Med Surg 34:101-108 © 2015 Frontline Medical Communications

MORE
Jun
2015
Vol. 34. No. 2

Inflammatory diseases of the nail unit

Adam Rubin, MD | Molly Hinshaw, MD

Inflammatory disorders of the nail unit are frequently encountered in clinical medicine and are a cause of significant morbidity. Psoriasis, lichen planus, chronic paronychia, and trachyonychia will be discussed. An approach to diagnosis and management of these disorders requires knowledge of nail unit anatomy, consideration of associated systemic manifestations, and patient education with respect to prognosis and management of factors that will maximize disease improvement. The nail unit responds with a limited number of signs to disparate clinical entities such that there is some overlap in clinical presentation between inflammatory conditions. Nail unit biopsy may therefore be useful in establishing a specific diagnosis. Semin Cutan Med Surg 34:109-116 © 2015 Frontline Medical Communications

MORE