Background: Nail unit squamous cell carcinoma (nSCC) presenting as longitudinal melanonychia is underrecognized, particularly among patients with skin of color (SOC). This review identifies patient, tumor, and human papillomavirus (HPV) characteristics. Summary: A review from peer-reviewed articles plus five institutional cases yielded 59 total cases. The majority (69.6%) were male, with a median age of 53 years. Among those with known Fitzpatrick Skin Type or race, 86.9% had SOC. Fingernails accounted for 87.7% of tumors. Longitudinal melanonychia was the only finding in 23.7% of cases, while hyperkeratosis, onychodystrophy, and verrucous changes were reported in 30.5%, 18.6%, and 15.3% of cases, respectively. The lateral nailfold was involved in 80.6% of cases. Most (81.4%) tumors were in situ at diagnosis. When performed, HPV testing was positive in 76.0% of cases, with high‑risk types (including HPV 16, 56, 58, and 59) predominating (76.9%). Key Messages: nSCC should be considered in the differential of longitudinal melanonychia, especially in patients with SOC over age 40 and a history of HPV infection presenting with lateral nailfold involvement, hyperkeratosis, onychodystrophy, or verrucous changes. Recognizing these findings may reduce diagnostic delay and allow earlier, tissue‑sparing treatment.
Introduction: Alopecia areata is an autoimmune disorder causing non-scarring hair loss that frequently affects children. Management of moderate-to-severe pediatric disease remains challenging, and systemic treatment options for younger children are limited. We evaluated clinical outcomes and tolerability of oral dexamethasone mini-pulse therapy combined with fixed-dose oral minoxidil in children younger than 12 years. Methods: This retrospective cohort study included 35 children treated with oral dexamethasone on two consecutive days weekly for 12 weeks together with oral minoxidil 2 mg/day. Clinical records from January 2021 through December 2025 were screened, and the database was locked on August 15, 2026. Only patients with at least 9 months of follow-up after their final treatment cycle were included. Response was assessed using the Severity of Alopecia Tool (SALT). Results: After the first 12-week cycle, 21/35 patients (60.0%) achieved SALT50, 9/35 (25.7%) achieved SALT90, and 4/35 (11.4%) achieved SALT100. Mean SALT decreased from 60.3 ± 21.7 to 37.0 ± 30.7, with a mean change of −23.3 ± 15.1 points. Eleven first-cycle SALT50 nonresponders underwent a second cycle; 8/11 (72.7%) achieved SALT50, 2/11 (18.2%) achieved SALT90, and none achieved SALT100. Overall, 29/35 patients (82.9%) achieved a cycle-specific SALT50 response during at least one treatment cycle; this was a cumulative proportion rather than a uniform 12-week outcome. Mild adverse events occurred in 9 patients (25.7%), most commonly hypertrichosis (11.4%). Median post-treatment follow-up was 10.4 months (IQR 9.6–11.2). Conclusion: The combined regimen was associated with clinically meaningful SALT improvement and generally mild documented adverse events. Because of the retrospective uncontrolled design, causal efficacy and the independent contribution of oral minoxidil cannot be established. Prospective controlled studies are warranted.
Introduction Hormonal intrauterine devices (H-IUD) are contraceptives designed to exert predominantly local effects through the intrauterine release of levonorgestrel, a progestin that inhibits endometrial growth. Methods We conducted a single-center retrospective chart review comparing adult patients (>18 years) using hormonal IUDs with patients using copper IUDs as controls. Cohorts were propensity score–matched by age, race, and ethnicity. Diagnoses of TE (ICD-10 L65) and AGA (ICD-10 L64) were assessed. Comparative analyses between groups were performed using Fisher exact tests, with P < 0.05 considered statistically significant. For each cohort, we assessed alopecia subtype and temporal relationship to IUD placement (before versus after insertion), relevant comorbidities (including polyendocrine metabolic ovarian syndrome, thyroid disease, hyperprolactinemia, and uterine fibroids), and laboratory abnormalities at diagnosis (low ferritin levels and high testosterone levels). Results We identified 47 patients with H-IUDs (mean age, 40.6 ± 9.8 years) and 21 patients with Cu-IUDs (mean age, 42.0 ± 10.5 years). The occurrence of AGA was significantly higher in the H-IUD group than in the Cu-IUD group at 44.7% compared to 33.3% (P = 0.01), whereas no significant difference in TE prevalence was observed between groups (P = 0.89). All patients in the H-IUD group developed either AGA or TE after IUD insertion. In contrast, in the Cu-IUD control group, a significant association was observed between alopecia subtype and temporal relationship to IUD placement, with AGA more commonly preceding insertion and TE occurring more frequently after insertion (P = 0.043). Low ferritin levels at the time of diagnosis were identified in 5 patients in the Cu-IUD group with TE. In the H-IUD group, low ferritin levels were observed in 9 patients, including 6 with TE and 3 with AGA. Conclusion Our cohort study finds that H-IUD, unlike Cu-IUDs, was temporally associated with the development of AGA and TE. Although causality cannot be established, clinicians should consider H-IUDs as a potential contributing factor in patients presenting with new-onset hair loss after insertion.
Background : Black women experience a disproportionate burden of hair loss disorders, which may be linked to cultural hair care practices. Early recognition and referral are critical to prevent irreversible scarring alopecia. Hair care professionals (HCPs) are uniquely positioned to identify early signs of hair loss due to frequent client interactions and established trust. Summary : We conducted a systematic literature review to evaluate HCPs’ knowledge, attitudes, and referral practices regarding hair loss in Black women. Of 916 records, four studies met inclusion criteria. Two survey studies found that a third of HCPs serving African American clientele would refer their clients to dermatologists for management of hair loss. In a study among South African HCPs, a targeted educational intervention was effective at improving identification of hair loss disorders and in recognizing the need for dermatological consultation. Another educational intervention for HCPs serving African American clientele increased HCPs' likelihood to refer clients with CCCA to dermatologists and at earlier stages of disease. Key Messages : HCPs show variable knowledge on hair loss in Black women and inconsistent referral practices. Brief educational interventions may increase recognition and referral. Strengthening collaboration and integrating dermatologic education into cosmetology training may improve early detection and reduce disparities.
Rosacea is an inflammatory skin disease characterized by facial erythema, telangiectasia, and follicular-based papules. In Fitzpatrick skin types III-VI, clinical features may present more subtly, leading to delayed or missed diagnoses. Global prevalence estimates in these populations remain uncertain. This study aimed to evaluate the distribution and ethnoracial reporting in rosacea randomized controlled trials (RCTs) conducted between 2000 and 2025. Eighty Phase 2 and 3 trials completed from 2000 to 2025 were identified through ClinicalTrials.gov, PubMed, and web searches. Data extracted included race, ethnicity and geographic distribution. Only 15,938 of the 24,149 participants across 80 trials had reported racial data. Of those reported, 63.5% (n = 15,329/24,149) were white, 1.2% (n = 290/24,149) Black, 0.7% (n = 184/24,149) Asian, 0.1% (n = 26/24,149) American Indian or Alaskan Native, and 0.1% (n = 30/24,149) Native Hawaiian or Other Pacific Islander. Multi-racial participants comprised 0.2% (n = 41/24,149), while 34.0% (n = 8,201/24,149) had race unknown/unreported. Race was reported in 48.7% (n = 39/80) of trials and ethnicity was reported in 35.0% (n = 28/80), with 15.7% (n = 3,796/24,149) Hispanic/Latino participants. Ethnoracial representation in rosacea RCTs remains limited, with over half of studies omitting demographic data. Enhanced inclusion and standardized reporting of ethnoracial information are needed to ensure that studies reflect real-world populations. Greater diversity in trial participation will improve understanding of rosacea across skin tones, promote earlier diagnosis in underrecognized groups, and support generalizable treatment outcomes.
