Assuntos
Alopecia em Áreas , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.
RESUMO
This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.
Assuntos
Dermoscopia/métodos , Doenças da Unha/diagnóstico , Transtornos da Pigmentação/diagnóstico , Consenso , Diagnóstico Diferencial , Humanos , Masculino , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
Relatado caso de paciente de 62 anos de idade que desenvolveu massa nodular erosiva no aparelho ungueal após trauma em caçada, diagnosticada como melanoma amelanótico doaparelho ungueal. Esta lesão é frequentemente diagnosticada erroneamente, permanecendo sem tratamento adequado por longos períodos. As taxas de erro diagnóstico são descritas como sendo de até 85% nos casos em que o médico não possui especialização em dermatologia.
This article describes the case of a 62-year-old patient who developed an erosive nodular mass on the nail apparatus after receiving a trauma during a hunting incident. The lesion was initially diagnosed as an amelanotic melanoma of the nail apparatus, illustrating the fact that this type of lesionis often misdiagnosed ? up to 85% of the time if the physician lacks dermatological expertise ?and remains untreated for prolonged periods.