Antonella Tosti

University of Miami | UM · Miller School of Medicine

Intralesional injections of triamcinolone acetonide are widely used to successfully treat several inflammatory nail conditions. This procedure is well described in adults, but less frequently reported in children and teenagers, being largely considered too invasive and fear-provoking for pediatric patients. Our report shows how this procedure is fe...

Scalp microinfusion is a promising novel drug delivery technique for hair loss treatment. We discuss the MMP® technique and review its possible use in alopecias. MMP® technique provides a small amount of drugs delivered homogeneously into the skin combined with micro-needling and can, therefore, provide optimal delivery. However, literature on this...

Introduction: Precise evaluation of changes in hair count is crucial for monitoring progression of hair loss and the effects of treatment. The focus of this study is the comparison of the various examination and assessment techniques in terms of the precision of hair count change observed in trichoscopy images. Methods: Controlled hair extractio...

Introduction: Although facial involvement in discoid lupus erythematosus (DLE) is common, eyelid involvement is atypical. Identifying this condition is challenging due to misdiagnosis, and it is essential to avoid potential deformities of the eyelid margin. Case presentation: We, herein, report the dermoscopic findings in 2 female patients with...

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most re...

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by hair loss. Patients with AA experience a range of social and emotional impacts, and the lack of effective treatments and multiple affected locations can deepen the burden of illness. The objective of the current study was to assess health-related quality of life (HRQL) am...

Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including...

Background Cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, post-infectious telogen effluvium and trichodynia have also been reported. Objective To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to other signs...

Background The current classification for Alopecia Areata (AA) does not provide a consistent assessment of disease severity. Objective To develop an AA severity scale based on expert experience. Methods A Modified Delphi process was utilized. An advisory group of 22 US-based AA clinical experts was formed to develop this AA scale. Representatives...

Antiandrogens have demonstrated a protective effect for COVOD-19 patients in observational and interventional studies. The goal of this study was to determine if proxalutamide, an androgen receptor antagonist, could be an effective treatment for men with COVID-19 in an outpatient setting. A randomized, double-blinded, placebo-controlled clinical tr...

Importance: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective: To generate core domains and domain items...

Importance: A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective: To generate core domains and domain items fo...

O prazer por desvendar o novo, compartilhar conhecimento e experiências já adquiridos e, especialmente, o amor genuíno pela docência serviram de combustível na criação desta obra, a qual, mais do que proporcionar informação médica atual e de excelência, visa trazer a experiência de grandes nomes da tricologia dos cenários nacional e internacional,...

Optical coherence tomography (OCT) is a noninvasive and in vivo real-time diagnostic approach that allows for the visualization of skin architecture and cutaneous blood vessels. OCT provides a quick and useful diagnostic imaging technique for a number of nail disorders including psoriasis, glomus tumors, and subungual myxoid cysts and is a valuable...

Frontal fibrosing alopecia (FFA), a common type of lichen planopilaris most frequently affecting postmenopausal women, is characterized by progressive loss of the eyebrows and fronto‐temporal recession1 Although FFA is a considered a scarring alopecia, the hair loss is not always irreversible and regrowth has been occasionally reported on the scalp...

Trichorhinophalangeal syndrome (TRPS) is an autosomal dominant disease characterized by trichologic, craniofacial, and musculoskeletal abnormalities. Predominant clinical features include a pear-shaped nose with bulbous tip, long philtrum, protruding ears, and sparse hair on both the scalp and the lateral third of the eyebrows. Cone-shaped epiphyse...

Lipedematous alopecia (LA) is a rare nonscarring alopecia mostly affecting middle aged women with a soft and boggy scalp.¹ The abnormal increase in the thickness of scalp subcutaneous layer is known as lipedematous scalp (LS),² and the association of both conditions was reported in less than 50 cases in the literature.³ Although these disorders gen...

Background A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high quality randomized controlled trials (RCTs). Objective To produce an international consensus statement on the use and utility of various treatments for AA. Methods Fifty hair experts from 5 contin...

Background: The common inflammatory scalp disorders share similar clinical manifestations, and patient work up require invasive, undesirable diagnostic procedures like biopsy to ensure correct diagnosis. Optical coherence tomography (OCT) is a noninvasive high-resolution imaging modality that has found a valuable tool to assist in the diagnose and...

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guid...

Unfortunately, the co-author name was incorrectly published as "Jose L. López-Esterbaranz" instead of 'Jose L. López-Estebaranz" in the original article. The correct version of author name is updated here.The original article has been corrected.

Background/objectives: Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and lichen planopilaris (LPP). The existing literature on FAPD and current understanding of the epidemiology, pathogenesis, clinical features, diagnosis, and treatmen...

Patients often have a number of questions regarding changes in their hair. This chapter contains the most common questions patients ask as well as the answers to these questions. The chapter discusses basic information about hair growth and loss; age-related hair problems; effect of nutrition and lifestyle choices on hair; specific diagnoses includ...

Scalp itch is a common cause of complaint in the dermatological setting and also accompanies many of the scalp disorders. When possible, the first step to treat scalp pruritus is to find the underlying cause. A thorough evaluation must comprehend a complete interrogatory, clinical, and trichoscopical evaluation and sample taking when necessary.

The new drugs in the development of AGA include PGF2 analogs, a PGD2 receptor antagonist, Wnt pathway activators, an androgen receptor antagonist, a topical JAK inhibitors, and topical finasteride. While many of these have already shown efficacy compared to placebo, none have shown superiority to topical minoxidil; however, they may still have futu...

When treating patients with scalp diseases, it is essential to be able to evaluate treatment response. Treatment response will allow further decision-making such as increasing or decreasing treatment dose, changing the treatment vehicle, changing therapy, or adding adjuvant treatments. Sometimes, hair disorders have multifactorial causes, so respon...

In many patients presenting with hair loss, diagnosis can be made (or at least suspected) through a detailed history and clinical examination. In doubtful cases, some diagnostic tools such as trichoscopy and trichogram may help to confirm diagnosis and, many times, avoid invasive methods, such as a cutaneous biopsy. When a biopsy is needed, trichos...

Telogen effluvium represents one of the most common causes of hair loss. The treatment of telogen effluvium primarily relies on treating the underlying cause if it can be identified. Nutritional supplements are often prescribed even when there are no associated vitamin or oligoelement deficiencies. Education, reassurance, and shampooing are also ve...

Alopecia areata is a complex immune-mediated disease that targets anagen hair follicles. Therapeutic strategies must be directed as either immunosuppressive or immunomodulating and may consist of monotherapy or combination therapy and should be different depending on patient’s age, extent, and chronicity of the disease. The physician must discuss m...

Hair dyes and hair relaxers are hair care products commonly used to change hair color and shape, respectively. Very popular among patients, these products may be self-applied as a home care treatment or by a professional hair stylist at the hair salon. These products can cause adverse reactions, particularly after improper use. In this chapter, we...

Many strategies exist to improve hair volume in patients with thinning hair, providing options for various types and severity of hair loss. The most complete form of camouflage is a wig, which can provide total hair replacement. Many different types of wigs exist, varying in the degree of natural appearance, price, and durability. Hair extensions a...

Conditions of the hair and scalp can be genetic or the result of infection, hormone imbalance, medication, trauma, or underlying primary disease. Regardless, they often cause significant psychological distress and sometimes physical discomfort, though much can be done to treat these complaints. Hair and Scalp Treatments focuses on therapy of hair a...

Fillers are frequently used in aesthetic medicine and, although usually safe, complications can occur. Vascular occlusion leading to tissue necrosis is a rare but severe complication. Alopecia after hyaluronic acid injection has been recently reported, being a vascular compromise the most probable physiopathological mechanism. The trichoscopic find...

Background: The frequency of different types of alopecia is not clearly reported in recent studies. Objective: To analyze the frequency of the types of alopecia in patients consulting at specialist hair clinics (SHC) and to assess for global variations. Methods: Multicenter retrospective study including data from patients evaluated at referral...

Glomus tumors are painful, benign perivascular neoplasms of the glomus body affecting the nail apparatus. Although diagnosis can be made clinically using Love's and Hildreth's tests, imaging is required to distinguish glomus tumors from other subungual vascular lesions. Clinical diagnosis is complicated when the nail has no visible abnormalities.¹...

The term retronychia originated in 1999 (1) and a first series of cases was published in 2008. (2) A disturbance in the continuous longitudinal nail growth (3) leads to an upward and backward nail displacement with posterior embedding. Several nail plates pile up beneath the proximal nail fold (PNF) generating paronychia and granulation tissue. Rep...

Introduction Patch testing is the gold standard for evaluating allergic contact dermatitis (ACD), yet current interpretation methods are limited by their subjectivity and possible variability between observers. Optical coherence tomography (OCT) imaging enables noninvasive in vivo skin visualization and holds promise as an objective method of patch...

Since the initial description of frontal fibrosing alopecia (FFA) in 1994, increasingly more cases of FFA have been reported in literature. Although clear epidemiologic data on the incidence and prevalence of FFA is not available, it is intriguing to consider whether FFA should be labeled as an emerging epidemic. A medline trend analysis as well as...

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatm...

Fiberglass dermatitis is a common form of occupational irritant contact dermatitis. Individuals experience a negative reaction to fiberglass fragments because of mechanical irritation. This review comprehensively analyzes the information in the existing literature on fiberglass dermatitis. Recognizing the different environmental risks factors for a...

Alopecia areata is a common form of non-scaring type of hair loss. It is believed to be a consequence of an immune-mediated stimulus, probably involving autoreactive T-cells against antigens present in the hair follicle. The exact antigen is still unknown; however, some authors have proposed that melanogenesis-associated molecules might trigger aut...

Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies....

Background Lichen planopilaris (LPP) is a rare inflammatory lymphocyte‐mediated disease of the scalp considered to have an autoimmune pathogenesis. Objectives To identify the prevalence of medical comorbidities in patients with classic LPP (CLPP) and frontal fibrosing alopecia (FFA). Methods The medical records of 206 LPP patients and 323 control...

Background/Objectives Short anagen syndrome is a hair cycle disorder usually diagnosed in early childhood and characterized by short hair length due to short duration of the anagen phase. The objective was to review the presentation and demographic characteristics of short anagen syndrome and compare them with the most common differential diagnosis...

The word trachyonychia means rough nails. Trachyonychia can present in opaque and shiny variants. This is referred to as opaque trachyonychia and shiny trachyonychia. The diagnosis of trachyonychia is clinical and a nail unit biopsy is not required Trachyonychia is a benign disease that may regress spontaneously. The most common causes of trachyony...

The nail plate is a fully keratinized structure produced by the germinative epithelium of the nail matrix. As it grows, the nail plate emerges from the proximal nail fold and progresses distally lying across and adhering to the nail bed. As the nail plate approaches the tip of the digit, it detaches from the underlying tissues at the level of the h...

The Structure, Biology & Hair Curl, Colour, and Luster Session included two invited presentations and three selected from submitted abstracts. These presentations taken together highlight current progress in linking follicle biology to the tensile/physical properties of hair. They show progress in understanding the development of the hair fiber, an...

Dermatophytoma was first described in 1998 to complicate toenail infections and is characterized by fungal elements compacted into a fungal ball.¹ Clinically, it appears as a dense white or yellow linear or round white patch within the nail plate. Cutting back the overlying nail plate reveals a hyperkeratotic mass that can be easily removed because...

There are a wide variety of hair and nail disorders which occur in the pediatric population. These disorders can cause significant distress to children and their parents, but also can present a diagnostic challenge for the clinician. This chapter assists the clinician by providing a detailed overview of the most common and uncommon hair and nail di...

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with...

Background: Although alopecia areata is a common disorder, it has no FDA approved treatment and evidence-based therapeutic data is lacking. Objective: To develop guidelines for the diagnosis, evaluation, assessment, response criteria and endpoints for alopecia areata. Methods: Literature review and expert opinion of a group of dermatologists s...

Background: Mexican mestizo population has a pluriethnic mixture of Amerindian, European and African ancestry, predominant in most Latin American countries. Until now, there are no reports about hair characteristics in this population, necessary to define normal values, for hair diseases evaluation and comparison among other ethnic groups. Method...

Background: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia that affects the frontotemporal hairline, eyebrows and body hair. OCT is a non-invasive imaging technique useful in understanding skin architecture and vascularization. Objective: To describe structural and vascular findings in FFA using OCT. Methods: This was a case-contro...

We report a case of acute psoriasiform contact dermatitis of the forehead and scalp related to the use of a low-laser light cap. The patient had a positive patch test to dimethylol dihydroxyethyleneurea (DMDE), methylisothiazolinone, kathon CG, and cobalt. We believe that DMDE in the fabric of the cap was responsible for the allergic contact dermat...

This chapter presents a descriptive study that aims to evaluate dermoscopic features observed in short coated healthy dogs and compare these findings with those observed in short coated dogs affected by pattern alopecia diagnosed by clinical and dermatopathological examination. This study also aims to validate the use of dermoscopy using histopatho...

IntroductionHair shedding is a common consequence of the normal hair cycle that changes with internal and external factors. Female pattern hair loss (FPHL) is difficult to assess in terms of shedding severity as the conscious perception of hair shedding varies according to each individual, and most utilized methods are semi-invasive or very time co...

There are an estimated 32 million people with onychomycosis in the United States alone, making it the most common nail disease seen and treated, but also quite misunderstood. With the sole focus of this book devoted to onychomycosis, the reader is provided with insight into the diagnosis and management of this nail infection. Onychomycosis includes...

Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory confirmati...

Background: Nail psoriasis is a painful and disfiguring nail disease that often leads to invasive biopsies. Dermoscopy of the hyponychium can be useful in the diagnosis showing twisted coiled vessels. Structural features of nail psoriasis have been described with optical coherence tomography (OCT). Objectives: To investigate vascular features of...

Postfinasteride syndrome (PFS) is a term recently coined to characterize a constellation of reported undesirable side effects described in postmarketing reports and small uncontrolled studies that developed during or after stopping finasteride treatment, and persisted after drug discontinuation. Symptoms included decreased libido, erectile dysfunct...

Opinion statement Preservatives serve the necessary purpose of preventing microbial contamination and maintaining cosmetic product integrity and safety; however, there are limitations to their use. Preservatives, including formaldehyde (FA) and formaldehyde releasers (FRPs), isothiazolinones, iodopropynyl butylcarbamate (IPBC), methyldibromoglutaro...

This case report describes resolution of nail changes of systemic amyloidosis after bone-marrow transplantation in a patient with multiple myeloma. Article Information Corresponding Author Kate E. Oberlin, MD, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami School of Medicine, 1600 NW 10th Ave, RMSB...

Frontal fibrosing alopecia (FFA) is a rare dermatologic disease that causes scarring and hair loss and is increasing in prevalence worldwide. FFA patients typically present with hair loss in the frontal scalp region and eyebrows which may be associated with sensations of itching or burning. FFA is a clinically distinct variant of lichen planopilari...

Introduction: Toenail onychomycosis is a common disease in which treatment options are limited and treatment failures and disease recurrence are frequently encountered. It usually requires many months of treatment, and recurrence may occur in more than half of the patients within 1 year or more after the infection has been eradicated. Data on long...

Background: Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed. Objective: The aim was to quantify patch test results from providers evaluating US children. Methods: The study is a retrospective analysis of deidentified...