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Madarosis, milphosis, eyelash trichomegaly, and dermatochalasis

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Abstract

Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patient's emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes. Copyright © 2015. Published by Elsevier Inc.

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... The loss of hair of either or both eyebrows and eyelashes is called madarosis. 3,15 Eyebrow hypotrichosis can be categorized as primary and secondary. Primary eyebrow hypotrichosis is a physiologic condition, whereas secondary eyebrow hypotrichosis involves underlying disorders that can be subclassified as primary dermatoses, endocrinopathy, autoimmune diseases, infections, trauma, neoplasm, exogenous agents, nutritional disorders, and genodermatoses. ...
... Primary eyebrow hypotrichosis is a physiologic condition, whereas secondary eyebrow hypotrichosis involves underlying disorders that can be subclassified as primary dermatoses, endocrinopathy, autoimmune diseases, infections, trauma, neoplasm, exogenous agents, nutritional disorders, and genodermatoses. 3,[15][16][17] The etiology of eyebrow hypotrichosis is summarized in Table 1. ...
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... 32,33 Other drugs that may cause trichomegaly include cyclosporine, tacrolimus, topical prostaglandins (latanoprost, bimatoprost), topiramate, minoxidil, streptomycin, penicillamine, systemic corticosteroids (Figure 3), and zidovudine. 34 Topical prostaglandins may also prolong the anagen phase of the eyelashes. 35 The effect can be observed within the first 6 months of treatment. ...
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Drug-induced changes of hair and nails have been observed with a variety of different pharmaceutical agents, both topical and systemic. These compounds or their metabolites may interfere with hair cycling and texture, nail matrix, nail bed, nail folds, and microvasculature. Phototoxic reactions may also occur. Before initiating treatment, physicians and patients should be aware of possible adverse events to hair and nails and should know the preventive measures, if available, as quality of life can be reduced and adherence and compliance to treatment may be impaired.
... Dovepress Dovepress 48 alonso et al may be attributed to telogen effluvium caused by intake of drugs such as anticoagulants, lipid-lowering agents, antihypertensive agents (propranolol), valproate, barbiturates, bromocriptine, immunosuppressants, botulinum toxin, NSAIDs, and hormone imbalance. 1 It is known that premenopausal, perimenopausal, and postmenopausal women suffer from hypotrichosis as a consequence of hormone misbalance; under this situation, some changes in skin such as increased dryness and roughness, decreased elasticity, warts, freckles, increased wrinkles, loss and graying of head hair, and lengthening of eyebrows and eyelashes are observed. 2,3 Under these situations, extensions, masks of different types, eyelash bends, transplants, and permanent dyes are used on both eyelashes and eyebrows. ...
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Purpose: A combination of extracts, from two plant species, ie, Coffea arabica and Larrea divaricata (Jarilla) (ECOHAIR®), is being successfully used in Argentina as a cosmetic for hair recovery in androgenic and areata alopecia, and for eyelash and eyebrow growth. The objectives of this prospective study were to evaluate the capacity of Jarilla–Coffea extract gel of improving hair growth in relation to thickness, appearance of new hair, and hair length in comparison with a placebo in premenopausal and postmenopausal volunteers and to identify possible signs of ocular adverse local reactions related to the application of the gel. Volunteers and methods: An open-label, placebo-controlled, prospective study was performed in healthy premenopausal and postmenopausal women during a daily administration period of 2 months (eyebrow growth) and 3 months (eyelash growth). The thickness of hair was determined using a video microscope MedicalScope®. The appearance of new hairs and total area with hair in eyebrow and eyelash length were quantified using a photographic record with Fotofinder® (Germany). The number of volunteers presenting variation in growth of new hair and length were also recorded. Results: The product significantly increased the thickness of eyebrows (20% in 80% women) and eyelashes (19.44% in 100% of women). The gel also increased the appearance of new hairs, total area with hair, and length but there was no statistical difference between treatment and placebo. Conclusion: The gel was capable of improving growth of eyelashes and eyebrows by inducing principally hair thickening without causing local adverse effects in a high percentage of volunteers.
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... 10 Vij et al tackle the topic of disorders of the eyebrows, eyelashes, and eyelids. 11 Not only are these cosmetically and functionally important landmarks but also the pathology of these sites can be reflective of important local and systemic disease processes. This review focuses on madarosis (loss of the eyebrows or eyelashes), milphosis (eyelash loss), trichomegaly (excess growth of eyelash hair) and dermatochalasis (excess skin in the upper or lower eyelids). ...
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The primary role of eyelashes is to protect and maintain the health of the lid margin. However, the mechanisms to fulfill this role are not fully understood. Unraveling these mechanisms will stand to greatly improve the efficiency of eye care professionals' interventions in anomalies of the eyelashes. The aim of this article is to provide a review on eyelashes including highlights and new avenues for research; the biology of both the lash and its follicle; the pathophysiology and management of lash anomalies by eye care professionals; and the effect of iatrogenic factors on lashes. Using the database of Ovid MEDLINE, we reviewed studies specifically directed on human/mammalian eyelashes and key articles on current trends in scalp hair methodologies that can be applicable to lash research. The eyelash morphology, pigmentation and growth rate have been documented using techniques ranging from lash imaging to follicle immunohistochemistry. Furthermore, studies have demonstrated that the lash follicle is sensitive to many factors of the external environment, a variety of systemic/topical medications and cosmetics. Recently, aerodynamic studies using a mammalian eye model confirmed that an optimal lash length was needed so that eyelashes serve a protective role in reducing the number of particles that can reach the eye. Despite recent advances in lash research, studies are still scarce, due to the limited availability of the human lid for sampling. This review brings awareness that further research is needed with respect to eyelashes and will hopefully reduce the gap with scalp hair research.
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LETTER TO THE EDITOR - CASE LETTER Year : 2016 | Volume : 82 | Issue : 6 | Page : 700-702 Familial eyelash trichomegaly: The case of a sister and a brother Funda Tamer1, Mehmet Eren Yuksel2 1 Department of Dermatology, School of Medicine, Turgut Ozal University, Ankara, Turkey 2 Department of General Surgery, Devrek State Hospital, Zonguldak, Turkey Date of Web Publication 7-Oct-2016 Correspondence Address: Dr. Funda Tamer Department of Dermatology, School of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi No: 57, Emek, Ankara Turkey Source of Support: None, Conflict of Interest: None Check DOI: 10.4103/0378-6323.187690 How to cite this article: Tamer F, Yuksel ME. Familial eyelash trichomegaly: The case of a sister and a brother. Indian J Dermatol Venereol Leprol 2016;82:700-2 How to cite this URL: Tamer F, Yuksel ME. Familial eyelash trichomegaly: The case of a sister and a brother. Indian J Dermatol Venereol Leprol [serial online] 2016 [cited 2018 Jun 3];82:700-2. Available from: http://www.ijdvl.com/text.asp?2016/82/6/700/187690 Sir, A 16-year-old girl and her 2-year-old brother presented for clinical evaluation of long eyeleshes. The increased eyelash growth had been present since birth in both siblings [Figure 1] and [Figure 2]. The 2-year-old boy had curly and extraordinarily long eyelashes while his sister had markedly long, curly, thick, hyperpigmented eyelashes. Her brother had no complaints; however, the girl had cosmetic concerns. She stated that she had to trim her eyelashes with scissors regularly and complained of pain and itching if she did not trim them. Medical and family history were both unremarkable. Similar clinical findings were not seen in their parents and two other siblings. The patients did not take any medication regularly. Figure 1: A 16-year-old girl with eyelash trichomegaly (sister) Click here to view Figure 2: A 2-year-old boy with eyelash trichomegaly (brother) Click here to view Laboratory tests of the girl (including complete blood count, luteinizing hormone, follicle stimulating hormone, estradiol and thyroid stimulating hormone) were within normal limits. Her serum testosterone level was 0.31 ng/mL (normal range is 0.38–1.97 ng/mL). Abdominal ultrasonography revealed no abnormalities. Laboratory test results of the boy (including thyroxine, triiodothyronine, hepatitis B surface antigen, antibody against hepatitis C virus) were also within normal limits. The serum level of anti-hepatitis B surface antigen was 230.8 IU/L (reference ranges: <10 IU/L negative; >10 IU/L positive). He had also low serum follicle stimulating hormone and luteinizing hormone levels, 0.5 and 0.1 IU/L, respectively (reference ranges of follicle stimulating hormone and luteinizing hormone for men are 1.2–12.4 IU/L and 1.7–8.6 IU/L, respectively). There was no symptom of any underlying disease or associated syndrome. Our patients and their parents were informed about this rare condition. Trimming or epilation of the eyelashes was advised. Despite the fact that the boy did not have any complaints, follow-up was recommended for potential ocular side effects. Eyelash trichomegaly is an uncommon condition which describes increased length (12 mm or greater), thickness, stiffness, curling and pigmentation of the eyelashes.[1],[2] The growth cycle of eyelashes is approximately 5–6 months. It consists of anagen, catagen and telogen phases which last 30, 15 and 100 days, respectively. In addition, about 50% of eyelashes (versus 85–90% of scalp) follicles are in the anagen phase at any time. They have a low anagen to telogen ratio as compared to scalp hairs. The exact mechanism of eyelash trichomegaly remains unknown; however, immune system regulation, epidermal growth factor receptors and prostaglandins seem to have an important role in the etiopathogenesis.[2] Its true incidence remains unknown but it affects adults much more than children. Eyelash trichomegaly has been reported as an isolated feature in most cases. However, it can be accompanied by generalized acquired hypertrichosis and malar-eyebrow hypertrichosis in some patients.[1],[3] Trichomegaly of eyelashes may be familial or it may occur as a part of congenital syndromes such as Oliver–McFarlane syndrome, Cornelia de Lange syndrome and Hermansky–Pudlak syndrome.[4] Familial eyelash trichomegaly is characterized by patients whose family members have similar findings.[2] Eyelash trichomegaly has been reported with several diseases including alopecia areata, systemic lupus erythematosus, dermatomyositis, human immunodeficiency virus infection, atopic dermatitis, allergic rhinitis and uveitis. In addition, treatment with cyclosporine, tacrolimus, topical prostaglandins, topiramate, zidovudine and epidermal growth factor receptor inhibitors such as cetuximab, erlotinib, gefitinib and panitumumab may cause overgrowth of the eyelashes as a side effect.[4] It has been also suggested that patients with human immunodeficiency virus infection and allergic diseases would have long and silky eyelashes whereas epidermal growth factor receptor inhibitors would lead to coarse and tortuous eyelashes.[2] Patients with eyelash trichomegaly are usually asymptomatic; thus, treatment is not necessary in most cases.[5] Nonetheless, patients can suffer from cosmetic problems. Severe cases may present with visual discomfort, mechanical ptosis and corneal ulcers as a result of trichiasis.[2] However, epilation and trimming of the long eyelashes have been reported as effective treatment options.[1] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Rossetto JD, Nascimento H, Muccioli C, Belfort R Jr. Essential trichomegaly: Case report. Arq Bras Oftalmol 2013;76:50-1. 2. Paul LJ, Cohen PR, Kurzrock R. Eyelash trichomegaly: Review of congenital, acquired, and drug-associated etiologies for elongation of the eyelashes. Int J Dermatol 2012;51:631-46. [PUBMED] 3. Almagro M, del Pozo J, García-Silva J, Martínez W, Castro A, Fonseca E. Eyelash length in HIV-infected patients. AIDS 2003;17:1695-6. 4. Vij A, Bergfeld WF. Madarosis, milphosis, eyelash trichomegaly, and dermatochalasis. Clin Dermatol 2015;33:217-26. [PUBMED] 5. Fabbrocini G, Panariello L, Cacciapuoti S, Bianca D, Ayala F. Trichomegaly of the eyelashes during therapy with epidermal growth factor receptor inhibitors: Report of 3 cases. Dermatitis 2012;23:237-8. [PUBMED] Figures [Figure 1], [Figure 2]
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Follicular mucinosis coexisting with lymphoproliferative disorders has been thoroughly debated. However, it has been rarely reported in association with inflammatory disorders. Thirteen cases have been retrieved, and those with cutaneous lymphoma or alopecia mucinosa were excluded. It was found follicular mucinosis in the setting of squamous cell carcinoma, seborrheic keratosis, simple prurigo, acne vulgaris, dextrometorphan-induced phototoxicity, polymorphous light eruption (2 cases), insect bite (2 cases), tick bite, discoid lupus erythematosus, drug-related vasculitis, and demodecidosis. Unexpectedly, our observations revealed a preponderating accumulation of mucin related to photo-exposed areas, sun-associated dermatoses, and histopathologic solar elastosis. The amount of mucin filling the follicles apparently correlated with the intensity of perifollicular inflammatory infiltrate, which was present in all cases. The concurrence of dermal interstitial mucin was found in 7 cases (54%). The concurrence of interstitial dermal mucinosis or the potential role of both ultraviolet radiation and the perifollicular inflammatory infiltrates in its pathogenesis deserves further investigations. Precise recognition and understanding of this distinctive reactive histological pattern may prevent our patients from unnecessary diagnostic and therapeutic strategies.
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Syphilitic alopecia occurs in only 4% of patients with syphilis. We present 5 cases of this uncommon manifestation and review the corresponding literature. All of the patients in our series were men aged between 31 and 46 years. The lesions, which were located mainly in the parieto-occipital area of the scalp, manifested as multiple, irregular, nonscarring patches of alopecia that adopted a characteristic patchy moth-eaten pattern. One patient initially presented diffuse alopecia with multiple erythematous scaling lesions. Immunohistochemical staining revealed the presence of numerous spirochetes in the hair follicles in the 2 patients in whom skin biopsy was performed. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.
Article
Refinements in hair transplantation techniques allow the experienced surgeon to create natural-appearing facial hair transplants. Restoring eyebrows, beards/goatees, and sideburns have all become popular procedures, and the results can be outstanding. This article provides a comprehensive review of hair grafting techniques to achieve the best results in restoring various hair-bearing areas of the face, including the eyebrows, beard/goatee, and sideburns, and repairing the alopecic scarring from prior facial plastic surgery.
Article
Abstract We report a male patient with retinitis pigmentosa, growth failure, long eyelashes, and sparse hair, which are typical signs of Oliver-McFarlane syndrome. The patient was born to healthy parents and developed night blindness at 2 years of age. Retinitis pigmentosa was diagnosed when he was 5 years old. To date, only 11 cases of Oliver-McFarlane syndrome have been documented, with the present case being the 12th overall and the first in China. Thus, the existence of typical Oliver-McFarlane syndrome in Asians was verified.
Article
After reading this article, the participant should be able to: 1. Demonstrate an anatomic approach to eyelid reconstruction. 2. Manage common and complex eyelid defects by utilizing a reconstructive strategy outlined in the article. Reconstruction of the eyelids after excision of skin cancer can be challenging. Knowledge of surgical eyelid anatomy and appropriate preoperative planning are critical in order to perform eyelid reconstruction and minimize complications and the need for reoperation. The fundamental principle for full-thickness eyelid reconstruction is based on reconstructing the subunits of the eyelid, including the anterior and posterior lamellae as well as the tarsoligamentous sling.
Article
We report a case of severe eyelid oedema due to Graves' ophthalmopathy (GO). The aim was to present a case report and review of the literature about eyelid oedema due to GO. The case report includes a history of patient data and literature review. The patient was offered intravenous methylprednisolone and gave consent. A dosage of 500 mg intravenous methylprednisolone once weekly for 6 weeks, followed by 250 mg intravenous methylprednisolone once weekly for 6 weeks, with a total treatment period of 12 weeks was given. Up to day, minor improvement has been observed. Severe eyelid oedema due to GO is a rare manifestation of Graves' disease. In cases of active and moderate-to-severe disease, treatment with intravenous glucorticoids is recommended alone or with orbital radiotherapy, followed by rehabilitative surgery.
Article
Hair transplantation is a continuously evolving field. The procedure was originally developed by Dr. Orentreich in 1959, but he applied it only to the androgenic alopecia. Potential applications for hair grafting extend beyond treatment of hair loss. Our study group consisted of 25 cases of 23 patients. The causes of scar resulting to hair loss were burns, operation, and trauma. The scalp strips or follicular unit extracts were harvested from occipital, posterior auricular, dog-eared scalp, adjacent scalp area, and nuchal area. The recipient sites were scalp, eyebrow, lip, and eyelid. The follow-up cases over 6 months after operation were 18 among total 25 cases. The result after hair follicle transplantation was excellent (44.4%), good (38.9%), fair (11.1%), and poor (5.6%). The hair follicle transplantation on the scar tissue is more difficult than grafting on normal tissue because the scar is accompanied by poor blood circulation and stiffness of tissue. The patients with burned scar achieved more favorable result than did others. Incision scars are deeper than burned scars, and their success rates are poor. We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result.
Article
A 58-year-old woman presented with a 2-year history of progressive hair loss involving the frontal hairline and eyebrows. She had a band of frontoparietal hairline recession and almost complete loss of eyebrows.
Article
Seborrheic dermatitis (SD) is a common skin condition seen frequently in clinical practice. The use of varying terms such as sebopsoriasis, seborrheic dermatitis, seborrheic eczema, dandruff, and pityriasis capitis reflects the complex nature of this condition. Despite its frequency, much controversy remains regarding the pathogenesis of SD. This controversy extends to its classification in the spectrum of cutaneous diseases, having being classified as a form of dermatitis, a fungal disease, or an inflammatory disease, closely related with psoriasis. Some have postulated that SD is caused by Malassezia yeasts, based on the observation of their presence in affected skin and the therapeutic response to antifungal agents. Others have proposed that Malassezia is incidental to a primary inflammatory dermatosis that resulted in increased cell turnover, scaling, and inflammation in the epidermis, similar to psoriasis. The presence of host susceptibility factors, permitting the transition of M furfur to its pathogenic form, may be associated with immune response and inflammation. Metabolites produced by Malassezia species, including oleic acid, malssezin, and indole-3-carbaldehyde, have been implicated. SD also has been traditionally considered to be a form of dermatitis based on the presence of Malassezia in healthy skin, the absence the pathogenic mycelial form of Malassezia yeasts in SD, and its chronic course. As a result, proposed treatments vary, ranging from topical corticosteroids to topical antifungals and antimicrobial peptides.
Article
Syphilitic alopecia occurs in only 4% of patients with syphilis. We present 5 cases of this uncommon manifestation and review the corresponding literature. All of the patients in our series were men aged between 31 and 46 years. The lesions, which were located mainly in the parieto-occipital area of the scalp, manifested as multiple, irregular, nonscarring patches of alopecia that adopted a characteristic patchy moth-eaten pattern. One patient initially presented diffuse alopecia with multiple erythematous scaling lesions. Immunohistochemical staining revealed the presence of numerous spirochetes in the hair follicles in the 2 patients in whom skin biopsy was performed. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.
Article
Selenium is a micronutrient. It presents a nutritional conundrum because of its twin status as an essential as well as a highly toxic trace element. Here, we report a case of acute non-intentional selenium toxicity due to increased ingestion of "paradise nuts" (Lecythis ollaria) which resulted in massive alopecia.
Article
Purpose: Demodex folliculorum and Demodex brevis are ectoparasites with an astounding prevalence of 100% in patients aged 70 years and older. Every person in this age group is estimated to carry a colony of 1000 to 2000 mites. With such a high prevalence, little attention has been paid to the mite among eye care practitioners. We demonstrate a clinical sequence in a set of case reports to identify the mite. The clinical sequence includes a clinical history of blepharitis, dry eyes, and/or ocular allergy; slit lamp examination of cylindrical dandruff; and confirmation using light microscope evaluation of epilated lashes. Case reports: Patient 1 was a 68-year-old woman who demonstrates associations with dry eyes and diabetes. Patient 2 was a 44-year-old man with uncommonly seen D. brevis present. Patient 3 was a 40-year-old woman with dry eyes and allergy, showing mite tails protruding from base of lashes. Patient 4 was a 60-year-old woman who demonstrates the association with rosacea. Patient 5 was a 53-year-old woman intermittently taking topical steroid and antibiotic combination medications, with an actual mite photographed on the surface. Conclusions: Following a clinical sequence helps identify Demodex, the underdiagnosed, undertreated, and underappreciated ocular surface disease.
Keraunoparalysis or transient weakness in limbs following a lightning strike has been well described in literature. Many times, neurosurgeons encounter patients with paraparesis secondary to trauma in the setting of a lightning strike. In these cases, it becomes imperative to find out the true cause behind such weakness in lower limbs because the prognosis differs significantly depending on the etiology. We report a case of keraunoparalysis affecting both lower limbs in a 50-year-old male, where he recovered within 48 hours of the impact. As far as our knowledge is concerned, this is the first case of keraunoparalysis reported from India. We also review the available literature and discuss the physics of lightning, its mechanism, other clinical presentations, and management strategy in the light of our case. These patients must be investigated for other possible causes of paraparesis secondary to trauma and keraunoparalysis should rather be a diagnosis of exclusion, only to be confirmed on imageology. Awareness regarding similar cases will make neurosurgeons notice this entity early, avoiding unnecessary investigation, and hence they will be able to prognosticate in the most efficient manner.
Article
Parry-Romberg syndrome is a rare condition characterized by progressive, hemifacial atrophy, hair loss, enophthalmos, retinal vasculopathy occasionally associated with hemicranial pain syndrome (secondary trigeminal neuralgia). The cause of the condition is unknown; however, substantial evidence suggests that vasculopathy plays a significant role in the genesis of the neurologic damage and facial lipodystrophy. Herein describes a case of Parry-Romberg syndrome treated with repetitive botulinum type A toxin injections, with almost complete resolution of severe chronic pain.
Article
: Acquired cutis laxa (ACL) is a rare connective tissue disorder that affects the skin elastic fibers, resulting in the loss of elasticity. In 50% of cases, this condition is associated with other diseases, particularly plasma-cell dyscrasias. This report describes a case of ACL with unusual clinical and histopathological characteristics. A 29-year-old man presented with diffuse erythematous plaques that had first appeared 5 months previously. Examination revealed multiple flaccid erythematous plaques on his trunk, neck, and skinfolds. Immunophenotyping of bone marrow aspirate revealed 7% of monoclonal plasma cells with lambda light chain expression. Skin biopsy histology revealed foci of interstitial granulomatous reaction. Weigert stain showed a loss of elastic fibers in the dermis, areas with thickened fibers and elastophagocytosis. Immunohistochemistry was positive for CD68. The cutaneous findings enabled an early diagnosis of IgG lambda monoclonal gammopathy to be made. Microscopic examination revealed an interstitial granulomatous reaction and severe alterations in the elastic fibers that varied in intensity in the different biopsies. Curiously, little has been mentioned in the literature regarding the presence of an interstitial granulomatous reaction in ACL. It is our belief that this reaction is secondary to the degenerative process of the elastic fibers.
Article
Linear morphea en coup de sabre is a localized form of morphea that presents as paramedian face or frontal scalp depression. The histopathology of alopecia in linear morphea is typically characterized by sclerosis and a reduction in the number of follicular units. We present a 26-year-old Caucasian female with a 1.5-year history of linear morphea and alopecia with unique atrophic follicular remnants on scalp biopsy. Transverse and vertical sections of biopsy specimens showed dense, dermal sclerosis with marked eccrine gland atrophy and replacement of much of the adipose by collagenous tissue. All sebaceous glands had disappeared, but erector pili muscles persisted. Numerous vertical, columnar and epithelial structures were present at the sites of formerly viable hair follicles. Transverse sections of these atrophic follicular remnants had a resemblance to telogen follicles but were microscopically different. The morphology of these follicular remnants indicates an end-stage process or permanent alopecia. Similar follicular remnants have been reported in chemotherapy-induced permanent alopecia but not in alopecia secondary to morphea or other cicatricial alopecias. We discuss the significance of these findings and their relationship to other forms of cicatricial or permanent alopecia based on the literature and case review.
Article
  It is well known that gradual loss of elastic fibers and skin relaxation cause the aging process, but whether changes in the orbicularis oculi muscle may contribute to the aging of the upper eyelid is not known. The aim of the present study was to use histopathologic examination to investigate whether the orbicularis oculi contributes to upper eyelid aging.   Full-thickness upper eyelids, which were removed during blepharoplasty using en bloc resection, were stained with hematoxylin-eosin and examined. Eleven patients with oriental eyelid, 14 patients with bilateral dermatochalasia, and 2 patients with facial nerve palsy and contralateral dermatochalasia were included in this study.   Patients ranged in age from 21 to 73 years (median age, 55.8 years). Histologic results revealed that changes in the aging upper eyelid were mainly in the skin and subcutaneous layers with large masses of deranged elastic fibers in the papillary dermis, which was characterized as solar elastosis.   Our study revealed that the entire orbicularis oculi muscle layer remained morphologically intact with aging. Moreover, our findings suggests that a minimally invasive surgical approach with muscle sparing in upper blepharoplasty in selected patients could yield good results in terms of cosmetic outcomes and upper eyelid function while minimizing postoperative complications.
Article
Madarosis is window of diagnosis to various diseases and disorders. Though the patient presents to the dermatologist or the ophthalmologist for the treatment of this disease, a consultation with various other departments is necessary for the accurate diagnosis and treatment of this condition. Madarosis occurs in leprosy frequently but its occurrence as a presenting manifestation of leprosy has seldom been reported. Here, we are presenting a case of lepromatous leprosy who presented with bilateral madarosis only with no obvious skin lesions of leprosy.
Article
Hair follicle cells have a high turnover. A caloric deprivation or deficiency of several components, such as proteins, minerals, essential fatty acids, and vitamins, caused by inborn errors or reduced uptake, can lead to structural abnormalities, pigmentation changes, or hair loss, although exact data are often lacking. The diagnosis is established through a careful history, clinical examination of hair loss activity, and hair quality and confirmed through targeted laboratory tests. Examples of genetic hair disorders caused by reduced nutritional components are zinc deficiency in acrodermatitis enteropathica and copper deficiency in Menkes kinky hair syndrome.
Article
Purpose: Epidermal growth factor receptor (EGFR) inhibitors and kinases are commonly used in the treatment regimen of various solid tumors including non-small cell lung, colorectal, head and neck, breast, and pancreatic cancers. The aim of this study is to describe common ocular adverse effects associated with EGFR inhibitor treatment, outline successful management options, and provide data on intermediate-term follow-up of these patients. Methods: A retrospective chart review was performed of all patients presenting to the ophthalmology clinic with an adverse ocular effect while on an EGFR inhibitor. Duration of EGFR inhibitor treatment, symptoms, diagnosis, and treatment information were collected. Statistical analyses were done to ascertain differences in adverse effects based on duration and type of EGFR inhibitor treatment using the Fisher exact test. Results: The two most common EGFR inhibitors in this group of patients were erlotinib and cetuximab. The most common adverse ocular effects for patients on EGFR inhibitors were dysfunctional tear syndrome (DTS), followed by blepharitis and eyelash changes (trichomegaly and trichiasis). Two patients had epithelial defects (corneal abrasions). There was no significant difference in adverse effects based on specific EGFR inhibitor medication or duration of treatment. Almost all patients were successfully managed with treatment regimens that we have outlined in this paper. Intermediate-term follow-up (range 6-17 months) showed a persistence of DTS and eyelash changes. Conclusion: We present what is, to our knowledge, the largest reported cohort of patients with ocular toxicities from EGFR inhibitors--the spectrum of eye toxicities, their management, and the intermediate-term follow-up of patients with eye toxicities. Awareness of this information is important for oncologists and oncology nurses to facilitate proper counseling and management/referral of patients developing eye toxicity while on EGFR inhibitors.
Article
Eyelash trichomegaly is defined as eyelashes which are found to be of increased length, thickness, and pigmentation. This unique finding can be present at birth as part of a variety of congenital syndromes or as a benign familial trait. There are also acquired conditions and drugs that are known to cause these changes. Case reports and clinical studies in the medical literature concerning eyelash trichomegaly were investigated and summarized to compile a comprehensive review of the etiology of eyelash trichomegaly. Previously published reviews and studies that report on the finding of increased generalized hair growth and which do not specifically mention eyelashes were not included. Trichomegaly of the eyelashes may occur as a key feature among rare congenital syndromes, develop in association with certain acquired diseases, or present as an intended or treatment-related adverse drug effect. Eyelash trichomegaly may be present from birth or manifest later in life in association with acquired diseases or drug therapy. The relevance of this finding may be benign, however eyelash trichomegaly in some individuals can be a symptom for immune dysfunction or a clinical measure of response to drug therapy.
Article
Background: Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye condition that affects both children and adults. It is common in all ethnic groups and across all ages. Although infrequent, blepharitis can lead to permanent alterations to the eyelid margin or vision loss from superficial keratopathy (abnormality of the cornea), corneal neovascularization, and ulceration. Most importantly, blepharitis frequently causes significant ocular symptoms such as burning sensation, irritation, tearing, and red eyes as well as visual problems such as photophobia and blurred vision. The exact etiopathogenesis is unknown, but suspected to be multifactorial, including chronic low-grade infections of the ocular surface with bacteria, infestations with certain parasites such as demodex, and inflammatory skin conditions such as atopy and seborrhea. Blepharitis can be categorized in several different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis. Second, categorization is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic blepharitis), and posterior, or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis and stratifies anterior and posterior blepharitis. Objectives: To examine the effectiveness of interventions in the treatment of chronic blepharitis. Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. Selection criteria: We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Data collection and analysis: Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. Main results: There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Authors' conclusions: Despite identifying 34 trials related to treatments for blepharitis, there is no strong evidence for any of the treatments in terms of curing chronic blepharitis. Commercial products are marketed to consumers and prescribed to patients without substantial evidence of effectiveness. Further research is needed to evaluate the effectiveness of such treatments. Any RCT designed for this purpose should separate participants by type of condition (e.g. staphylococcal blepharitis or MGD) in order to minimize imbalances between groups (type I errors) and to achieve statistical power for analyses (prevent type II errors). Medical interventions and commercial products should be compared with conventional lid hygiene measures, such as warm compresses and eyelid margin washing, to determine effectiveness, as well as head-to-head to show comparative effectiveness between treatments. Outcomes of interest should be patient-centered and measured using validated questionnaires or scales. It is important that participants be followed long-term, at least one year, to assess chronic outcomes properly.
Article
Cutis laxa is a rare disorder of elastic tissue resulting in loose, redundant, hypoelastic skin. Both acquired and inherited forms exist, some of which have significant systemic manifestations. Here, we review the various forms of cutis laxa, with focus on the inherited forms. Recent molecular studies have provided many new insights into the causes of cutis laxa and revealed greater genetic heterogeneity than previously appreciated.
Article
Acitretin, a metabolite of the aromatic retinoid etretinate, has been utilized successfully in the treatment of psoriasis since the late 1980s. Of the oral retinoids available, etretinate and acitretin are the most likely agents to induce various dose-dependent hair changes, but to our knowledge this is the first reported case of acitretin-induced poliosis. Additional cutaneous findings included skin atrophy and stickiness. Here we report a case of full body acitretin-induced poliosis with concurrent alopecia in a patient with psoriasis. A proposed mechanism for the poliosis is also presented here. Closer examination of retinoid-induced hair changes is needed in order to help physicians better counsel their patients regarding the adverse effects of acitretin and to expand the current knowledge on hair follicle biology.
Article
Cutis laxa (CL) is a rare connective tissue disorder characterized by loosely hanging skin folds. Histopathology reveals degenerative changes in the dermal elastic fibers, although loss of elastin can also occur in alveolar walls, blood vessels, and other organs. The coexistence of autoimmune diseases and monoclonal gammopathies is rare but well documented in the literature. Here we report an unusual case of cutis laxa (CL) preceding the development of serologic evidence of systemic lupus erythematosus (SLE) and a diagnosis of multiple myeloma (MM) by seven and eleven years respectively.
Article
The lax eyelid syndrome was described by Van den Bosch and Lemij as an uncommon disorder seen in non-obese elderly people and characterised by chronic ocular surface irritation symptoms and a "floppy upper eyelid". The authors present some new features of the lax eyelid syndrome. The authors report five patients, belonging to a younger age group, who presented with premature laxity of all the eyelid tissues. This caused medial and lateral canthal dystopia and eyelid malposition including ptosis, entropion and ectropion. Initial surgical correction was often followed by recurrence after some time. The authors highlight the differences between lax eyelid syndrome, cutis laxa, floppy eyelid syndrome and the blepharochalasis syndrome and suggest that lax eyelid syndrome can be thought of as "progeria" or premature ageing of the eyelid tissues to distinguish it clearly from these other conditions.
Article
Alopecia areata (AA) is a nonscarring hair loss disorder with a 2% lifetime risk. Most patients are below 30 years old. Clinical types include patchy AA, AA reticularis, diffuse AA, AA ophiasis, AA sisiapho, and perinevoid AA. Besides scalp and body hair, the eyebrows, eyelashes, and nails can be affected. The disorder may be circumscribed, total (scalp hair loss), and universal (loss of all hairs). Atopy, autoimmune thyroid disease, and vitiligo are more commonly associated. The course of the disease is unpredictable. However, early, long-lasting, and severe cases have a less favorable prognosis. The clinical diagnosis is made by the aspect of hairless patches with a normal skin and preserved follicular ostia. Exclamations mark hairs and a positive pull test signal activity. Dermoscopy may reveal yellow dots. White hairs may be spared; initial regrowth may also be nonpigmented. The differential diagnosis includes trichotillomania, scarring alopecia, and other nonscarring hair loss disorders such as tinea capitis and syphilis.
Article
The purpose of the present study is to describe a case of severe, psoriasiform blepharitis by means of a case report and literature review. A 44-year-old man developed chronic blepharitis and tearing months after bilateral cataract surgery. Exam showed diffuse quad-eyelid erythema, discharge, edema, madarosis, and scale. He also had insufficient tear drainage due to bilateral upper eyelid cicatricial punctal atresia with bilateral lower eyelid punctal stenosis. Biopsy of the lower eyelids exhibited psoriasiform hyperplasia. Topical 0.1% tacrolimus achieved improvement but caused some subjective eye irritation. Psoriasiform dermatitis manifesting on the eyelids is rare, may be associated with insufficient tear drainage, and may respond favorably to 0.1% tacrolimus.
Article
There is no gold standard for a definite diagnosis of atopic dermatitis. For the time being, several lists of diagnostic criteria have been proposed, some of them in actual use. The Millennium Criteria have been proposed to diagnose atopic dermatitis and to differentiate it from atopiform dermatitis. Our aim was to further refine the Millennium Criteria into a manageable set that can differentiate between atopic and atopiform dermatitis and other entities. The hereby refined Millennium Criteria will be compared with the UK Working Party Criteria and the Hanifin & Rajka Criteria. Data of 210 included patients were used. After multiple logistic regression, a minimum set of five criteria was identified as best discriminators: (i) typical morphology; (ii) early age of onset; (iii) Dennie-Morgan fold; (iv) historical and (v) actual flexural involvement. The refined Millennium Criteria were constituted from these criteria. When comparing the different list for validity in diagnosing atopic dermatitis, the refined Millennium Criteria showed a sensitivity of 81.8% and a specificity of 98.8% compared to a sensitivity of 97.7% and specificity of 72.9% of the UK Criteria and a sensitivity of 100% and specificity of 48.8% of the Hanifin & Rajka Criteria. This refinement and validity study shows that the refined Millennium Criteria are a valid tool to diagnose atopic and atopiform dermatitis in a hospital-based setting and therefore could be incorporated in clinical practice and trials.
Article
Cutis laxa is a rare skin disorder characterized by wrinkled, redundant, inelastic and sagging skin due to defective synthesis of elastic fibers and other proteins of the extracellular matrix. Wrinkled, inelastic skin occurs in many cases as an acquired condition. Syndromic forms of cutis laxa, however, are caused by diverse genetic defects, mostly coding for structural extracellular matrix proteins. Surprisingly a number of metabolic disorders have been also found to be associated with inherited cutis laxa. Menkes disease was the first metabolic disease reported with old-looking, wrinkled skin. Cutis laxa has recently been found in patients with abnormal glycosylation. The discovery of the COG7 defect in patients with wrinkled, inelastic skin was the first genetic link with the Congenital Disorders of Glycosylation (CDG). Since then several inborn errors of metabolism with cutis laxa have been described with variable severity. These include P5CS, ATP6V0A2-CDG and PYCR1 defects. In spite of the evolving number of cutis laxa-related diseases a large part of the cases remain genetically unsolved. In metabolic cutis laxa syndromes the clinical and laboratory features might partially overlap, however there are some distinct, discriminative features. In this review on metabolic diseases causing cutis laxa we offer a practical approach for the differential diagnosis of metabolic cutis laxa syndromes.
Article
To determine the presence, degree, and extent of lymphatic, elastic, and collagen fiber alterations in dermatochalasis (DC) specimens. Case control study of patients with DC compared with age-, gender-, and site-matched controls. A total of 25 eyelid specimens were studied; 15 of these were blepharoplasty specimens (experimental) and 10 were entropion/ectropion specimens of patients without DC (controls). The number and maximal dilation of lymphangiectasia was measured by light microscopy, immunohistochemistry with lymphatic marker D2-40, and elastic tissue content by Verhoeff-van Gieson histochemistry. The number of macrophages was compared between patients with DC and controls in CD68 immunostained specimens. Lymphatic density, edema, and inflammation. Dermatochalasis eyelid specimens showed increased lymphangiectasia density (5.6 vs. 2.4 lymphatics/high power field; P<0.05), maximal lymphatic dilation (127 vs. 51.5 μm; P<0.05), loss of elastic fibers (2.2 vs. 8.9 fibers/high power field; P<0.05), and greater disruption of collagen networks and edema compared with controls (increased stromal collagen bed of 752 vs. 269 μm; P<0.05; increased intercollagen space of 32.5 vs. 11.8 μm; P<0.05). Macrophages were present in greater quantities in DC specimens (28.6 vs. 11.9 macrophages/high power field; P<0.05). Patients with DC show an increase in number and maximal dilation of lymphatic vessels in conjunction with widely spaced collagen bundles. This finding coexists with loss of elastic fibers, components known to be essential to the structure and function of the lymphatic system. Governed by macrophages, the pathogenesis of DC may begin with subclinical inflammation leading to elastolysis and secondary lymphostasis. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Article
Eyebrow positions differ in many ways. They vary in shape, thickness, length, and distance between the eyebrows, making the face more or less harmonious. When a large distance exists between the eyebrows and the medial brow is slanting downward, the glabellar area is larger, giving the face an awkward appearance. To correct this deformity, the authors propose using two Z-plasties to allow transposition of flaps in the region of the medial brow. The Z-shaped flap is outlined at the medial third of the brow, in the glabellar region, with the eyebrow centered in the lower portion of the "Z" and the hairless skin in the upper portion. The flaps then are transposed and sutured. Transposition of the flaps, lifting the brow flap to the glabellar region, results in horizontal positioning of the medial and central third of the eyebrow. The proposed transpositioning of "Z" flaps in this region corrects this type of deformity of the medial and central portions of the eyebrows, with an aesthetically satisfactory result.
Article
Hypertrichosis or alopecia of the eyelashes is associated with various diseases or may be drug induced. Although neither increase nor loss of eyelashes is life threatening, eyelash disorders can be psychologically disturbing. However, as control of eyelash growth and the underlying mechanisms of eyelash hypo- or hypertrichosis are largely obscure, available therapy is limited. To improve this situation, we sought to establish a pragmatic, well-defined mouse model for the study and pharmacological investigation of eyelash follicle biology.   We took a morphometric approach to establish an eyelash model using female C57BL/6J mice by comparing with pelage hairs and highlighting the differences. We next applied a hypertrichosis-triggering agent and investigated its effect using the model. In eyelashes, a synchronized growth cycle was observed after morphogenesis but was completed earlier than pelage hairs. Exogen was strictly regulated and occurred in every cycle in the eyelash. Otherwise, general morphological features of mouse eyelashes (shafts, follicles, morphogenesis and growth cycle) were comparable with those of pelage hairs. The eyelash growth-stimulatory agent in humans, bimatoprost, significantly extended the duration of anagen, resulting in more and longer eyelashes, but there was no evidence of follicle neogenesis. This study shows that mouse eyelashes offer an excellent in vivo model for the quantitative and qualitative analysis of eyelash morphology, development, growth cycle, exogen and pharmacological modulation. This model will help to elucidate the unknown molecular controls of eyelash growth, and to develop novel drugs to treat eyelash disorders.