BACKGROUND AND OBJECTIVES:Chemotherapy-induced alopecia, encompassing both acute reversible alopecia and its persistent form, significantly impacts patients' quality of life but remains inadequately addressed. This study aimed to compare dermatologists' and oncologists' knowledge, attitudes, and practices regarding chemotherapy-induced alopecia, as well as their awareness of scalp cooling as a preventive intervention. PATIENTS AND METHODS:A cross-sectional survey was conducted in Israel at nine tertiary medical centers using a structured questionnaire to assess knowledge, attitudes, and practices related to chemotherapy-induced alopecia, including separately analyzed persistent chemotherapy-induced alopecia and scalp cooling. Responses from dermatologists and oncologists were compared, and factors influencing knowledge scores were identified. RESULTS:Both groups demonstrated limited knowledge. Oncologists scored higher on acute chemotherapy-induced alopecia (mean 3.88 vs. 2.74, p < 0.001), while dermatologists tended to score higher on persistent chemotherapy-induced alopecia (mean 7.85 vs. 6.92, p = 0.063). Male participants scored lower than female participants (p = 0.050). Oncologists were more familiar with scalp cooling, citing cost and logistical issues as significant barriers; dermatologists emphasized the need for proactive care and education. CONCLUSIONS:Significant knowledge gaps and differing practices between dermatologists and oncologists underscore the importance of targeted educational initiatives and interdisciplinary collaboration to improve patient care.

BACKGROUND:Longitudinal melanonychia (LM) may represent subungual melanoma (SUM), yet clinical differentiation from benign LM remains challenging. Intraoperative dermoscopy (IOD) improves diagnostic accuracy but requires specialized equipment and time. Intraoperative nail matrix examination (IONME), a direct visual inspection without magnification, may provide a simpler alternative. This study evaluated the diagnostic performance of IONME compared with histopathology and nail plate dermoscopy. METHODS:A retrospective analysis of 110 LM cases (16 SUM in situ, 94 benign LM, of which 88 were melanocytic) with documented IONME was performed. IONME patterns were classified into three morphological categories: (a) barely visible homogeneous pigmentation or none, (b) regular lines and/or homogeneous spot, and (c) irregular variegated lines. Each pattern was correlated with histopathology. Diagnostic accuracy, sensitivity, and specificity were calculated by comparing SUM in situ with benign melanocytic LM (mLM). Intra-observer agreement was assessed using Cohen's κ. RESULTS:An irregular IONME pattern was observed in 87.5% (14/16) of SUM in situ versus 21.6% (19/91) of benign mLM (p < 0.001), yielding sensitivity of 0.88 and specificity of 0.78. In comparison, nail plate dermoscopy demonstrated lower accuracy (sensitivity, 0.81; specificity, 0.55). The barely visible pattern occurred exclusively in benign LM, while the regular pattern predominated in melanocytic activation and lentigo. Intra-observer agreement for pattern classification was excellent (κ = 0.84-0.88; p < 0.001). Agreement for the presence of an irregular pattern ranged from excellent to perfect (κ = 0.94-1.00; p < 0.001). CONCLUSIONS:IONME is a simple, equipment-free intraoperative tool that improves clinicopathologic correlation, aids in distinguishing SUM in situ from benign LM, and supports patient follow-up. It can be easily incorporated into routine LM biopsy documentation.

BackgroundDutasteride, a potent 5 alpha-reductase inhibitor, has demonstrated efficacy in male pattern baldness (MPB) when administered orally, but concerns about systemic side effects limit its use. Topical formulations may offer a safer alternative. This Phase I trial evaluated the safety, local tolerability, usability, and exploratory efficacy of FOL100, a novel topical dutasteride lotion.MethodsIn this open-label, multicenter study, 79 men with mild-to-moderate MPB received FOL100 (n = 66) once daily for 24 weeks or oral finasteride (OF) 1 mg/day (n = 13). The trial was registered at ClinicalTrials.gov. Assessments included clinical safety, laboratory parameters, pharmacokinetics, hair counts via phototrichograms, hair morphology, and investigator and participant global improvement scales. Follow-up continued for 4 weeks post-treatment.ResultsIn the FOL100 group, treatment-related adverse events occurred in 10.6% of participants and were all mild and transient (mainly pruritus and erythema), with no treatment-related discontinuations. Serum dutasteride levels were undetectable in all FOL100-treated participants, and systemic dihydrotestosterone suppression was minimal and not statistically significant. Usability and tolerability ratings were consistently favorable, supporting good adherence potential. Exploratory efficacy analysis in the FOL100 group at Week 28 showed, using a bootstrap model, a significant increase in total hair count median from baseline (+11 hairs/cm2; -11.25, 27.50 Q1-Q3 range), along with improvements in follicular unit density. Global assessments by both investigators and subjects indicated stabilization or improvement in most participants. The small sample size in the OF arm precluded meaningful efficacy analysis.ConclusionsFOL100 demonstrated excellent safety, tolerability, and usability with promising signals of clinical benefit. These findings support further placebo-controlled studies to establish the therapeutic value of topical dutasteride in MPB. Trial Registration: identifier: NCT05611593ConclusionsFOL100 demonstrated excellent safety, tolerability, and usability with promising signals of clinical benefit. These findings support further placebo-controlled studies to establish the therapeutic value of topical dutasteride in MPB. Trial Registration: identifier: NCT05611593

Introduction: Nail disorders encompass a wide range of conditions affecting individuals across all age-groups. The aim of the study was to evaluate the workload and trends of nail-related visits (NRVs) in a tertiary outpatient dermatology clinic over a 10-year period. METHODS:A retrospective review was conducted of all NRVs to the dermatology outpatient clinic at Sheba Medical Center between January 1, 2014, and February 29, 2024. RESULTS:A total of 9,064 NRVs were recorded among 4,241 patients, representing 4.8% of 189,481 total dermatology outpatient visits. The mean number of visits per patient was 2.1 (±2.1). Except for 2017 and 2022, the annual proportion of NRVs increased consistently, peaking at 6.8% in early 2024. Females accounted for 54% of NRVs, with a mean age of 44.9 years compared to 43.5 years in males (p < 0.001). Isolated toenail involvement was the most frequent presentation (71.8%). Infectious diseases were the most common category (63.2%), with onychomycosis representing 60.6% of all nail disorders. However, its relative frequency declined significantly over time. Other notable trends included significant rising rates of longitudinal melanonychia, acrylate-induced nail changes, and lateral ingrown nail. Pediatric and elderly NRVs rose significantly over the study period, whereas young adult representation declined. CONCLUSIONS:NRVs represent a substantial and increasingly prominent component of dermatologic outpatient care. Shifts in diagnostic patterns, most notably a decline in onychomycosis and a rise in longitudinal melanonychia and acrylate-induced nail changes, highlight the evolving epidemiology of nail disorders. .

Over the past decade, reports of difficult-to-treat, antifungal-resistant superficial fungal infections have increased markedly, raising global concern among clinicians and public health authorities. Trichophyton mentagrophytes ITS genotype VIII, more recently classified as T. indotineae, has emerged as a principal driver of this shift, with infections often presenting as inflammatory, extensive dermatophytoses that are prone to persistence and relapse despite antifungal therapy. This scoping review synthesizes literature published between 2019 and 2025 to provide a comprehensive overview of emerging trends in epidemiology, clinical features, antifungal susceptibility, molecular resistance mechanisms, and management strategies. Resistance in T. indotineae contributes not only to prolonged disease courses and recurrent infections but also to intrafamilial and community outbreaks, highlighting the species' capacity for rapid and widespread transmission. These challenges are compounded by diagnostic limitations, variable correlation between squalene epoxidase gene mutations and terbinafine susceptibility, and the continued reliance on terbinafine as a first-line systemic therapy in many regions. Together, these factors underscore the urgent need for integrated diagnostic and management approaches, combining phenotypic susceptibility testing, genotypic analysis, and careful clinical assessment. Moreover, updated treatment guidelines and coordinated public health interventions are critical to mitigate transmission, optimize therapeutic outcomes, and address the growing clinical and epidemiological burden posed by resistant T. indotineae infections worldwide.

Zusammenfassung Hintergrund und Ziele Chemotherapieinduzierte Alopezie (CIA), sowohl die akute reversible als auch die persistente Form, hat erhebliche Auswirkungen auf die Lebensqualität der Patienten, wird aber immer noch unzureichend behandelt. Diese Studie hatte das Ziel, die Kenntnisse, Einstellungen und Praktiken von Dermatologen und Onkologen im Hinblick auf die CIA sowie ihr Bewusstsein für die Kopfhautkühlung als Präventionsmaßnahme zu vergleichen. Patienten und Methoden Anhand eines strukturierten Fragebogens wurde in Israel eine Querschnittsbefragung an neun tertiären medizinischen Zentren durchgeführt, um die Kenntnisse, Einstellungen und Praktiken bezüglich der CIA, einschließlich der getrennt analysierten persistenten CIA, und der Kopfhautkühlung zu beurteilen. Die Antworten von Dermatologen und Onkologen wurden verglichen und die Faktoren, die die erzielten Scores beeinflussten, ermittelt. Ergebnisse Beide Gruppen zeigten ein begrenztes Wissen. Onkologen erzielten bei akuter CIA bessere Ergebnisse (Mittelwert 3,88 vs. 2,74, p < 0,001), während Dermatologen bei der persistenten CIA tendenziell höhere Scores erzielten (Mittelwert 7,85 vs. 6,92, p = 0,063). Männer erzielten schlechtere Ergebnisse als Frauen (p = 0,050). Onkologen waren mit der Kopfhautkühlung vertrauter und nannten Kosten und logistische Probleme als wichtige Hindernisse; Dermatologen betonten die Notwendigkeit einer proaktiven Versorgung und Aufklärung. Schlussfolgerungen Erhebliche Wissenslücken und unterschiedliche Praktiken zwischen Dermatologen und Onkologen unterstreichen die Relevanz zielgerichteter Aufklärungsinitiativen und der interdisziplinären Zusammenarbeit für die Verbesserung der Patientenversorgung.

Introduction: Chronic paronychia is a persistent inflammatory condition of the periungual tissue, often triggered by excessive hand exposure to irritants. Despite its high prevalence, treatment remains challenging, with conflicting evidence on the role of microbial colonization, particularly Candida spp., and the efficacy of antifungal and antibiotic therapies. Objectives: To assess the efficacy of topical corticosteroids combined with hand-care modifications and antimicrobial treatments in managing chronic fingernail paronychia. Methods: This retrospective study included 97 patients (mean age 54.3 ±10.6 years, 67% female) with chronic fingernail paronychia (mean disease duration 13.3 ±6.1 years). Patients initially received antifungal and/or antibacterial therapy, followed by corticosteroid-based treatment and strict hand-care modifications. Results: Microbial cultures identified Candida spp. in 95.9% and bacteria in 36.1% of cases. First-line antifungal and/or antibiotic therapy was largely ineffective (76.3% nonresponders). In contrast, second-line corticosteroid-based therapy (mean duration 4.0 ±0.7 months) led to improvement in 90.7% of cases, with 38.1% achieving complete or near-complete resolution. Hand-care modifications included minimizing prolonged contact with liquids, wearing non-powdered waterproof gloves for wet tasks, using mild fragrance-free cleansers, and applying moisturizer after handwashing. Treatment adherence, including these behavioral modifications (P<0.01) and regular topical application (P<0.001) as well as longer treatment duration (P<0.05), were significantly associated with improved outcome. Conclusions: Chronic paronychia is primarily inflammatory, with limited response to antifungals or antibiotics. Prolonged corticosteroid-based therapy combined with hand-care modifications is highly effective, emphasizing the critical role of adherence to achieving clinical improvement.

An internally validated weighted MATRIX predictive model was developed to improve biopsy decision making in patients with longitudinal melanonychia. In a tertiary-centre cohort, MATRIX demonstrated superior diagnostic performance compared with the ABCDEF criteria and the dermoscopy-specific model. These findings support MATRIX as a practical clinical tool for early detection of subungual melanoma.

Onychomycosis is a prevalent and clinically relevant complication among individuals with diabetes. It is associated with an elevated risk of secondary fungal and bacterial infections, foot ulceration, and, in advanced cases, amputation. Factors contributing to the increased prevalence of onychomycosis in this population include age, peripheral vascular disease, poor glycemic control, neuropathy, suboptimal foot hygiene, and nail trauma. While dermatophytes are the most common pathogens, diabetic patients are more prone to mixed infections involving Candida species with varying antifungal susceptibility profiles, necessitating accurate identification to guide therapy. Prompt diagnosis and early intervention are important to prevent complications. Systemic antifungals such as terbinafine and itraconazole are considered first-line therapies, particularly for moderate to severe onychomycosis. However, drug interactions, renal, hepatic, and metabolic comorbidities may necessitate individualized treatment plans. For patients with mild to moderate disease, or contraindications to oral therapy, topical agents such as efinaconazole or tavaborole offer viable alternatives. Adjunctive measures, including education on foot hygiene, prompt treatment of tinea pedis, and environmental sanitization, are important in preventing recurrence and reinfection. This review summarizes the epidemiology, diagnosis, and treatment considerations for onychomycosis in diabetic patients, emphasizing the need for individualized care to improve outcomes in this high-risk population.

BACKGROUND:Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease with limited understanding of its pathophysiology. Molecular profiling has been limited by invasiveness of sampling methods. OBJECTIVE:To analyze the molecular skin profile of adult patients with SD using tape strips. METHODS:Tape-strips obtained from facial lesions of 26 adult SD patients and 18 demographically matched healthy controls were evaluated with RNA sequencing. RESULTS:SD molecular skin fingerprint was characterized by strong and significant upregulation of interleukin (IL)23/T-helper (Th)17 and Th22 (i.e. IL23A, IL22, PI3, LL37, S100A8, S100A12), some Th1 skewing (OASL, STAT1, CXCL9), and limited Th2 modulation. A parallel downregulation of barrier markers (CLDN1/8, FA2H, ELOVL3) was also observed. LIMITATIONS:Limited representation of mild and severe SD patients. CONCLUSION:These data deepen our understanding of SD suggesting that it has robust Th17/Th22, some Th1 skewing, and minimal Th2 activation, and associated skin barrier alterations. This provides rationale for novel immunomodulatory treatment approaches for SD patients targeting IL23/Th17 and/or Th22 pathways.

This retrospective case series evaluated off-label voriconazole for distal lateral subungual onychomycosis (DLSO) unresponsive to standard therapy. Twenty-nine culture-confirmed patients who had failed terbinafine (250 mg daily × 12 weeks) and itraconazole pulses (200 mg twice daily for 1 week/month × 3) received voriconazole (200 mg twice on day 1, then 200 mg daily for 3–4 months). Assessments occurred at 2, 4, 6–9, and 12 months; the primary endpoint was combined clinical cure (≥90% nail clearance) plus mycological cure (negative KOH and culture) at 12 months. Intention-to-treat included 29 patients; per-protocol included 27 (two did not complete follow-up). In the per-protocol cohort, combined cure was 55.6% (15/27) and mycological cure 74.1% (20/27). Complete clinical cure occurred in 66.7% (18/27); 25.9% (7/27) improved markedly, 3.7% (1/27) mildly, and 3.7% (1/27) showed no improvement. Voriconazole was well tolerated and may be considered for DLSO refractory to terbinafine ± itraconazole. Antifungal stewardship remains essential.

Cutaneous fungal infections predominantly caused by dermatophytes are a global concern. These infections vary widely by region, age, and body site, with recent shifts in the pathogen distribution. This study examines the distribution and trends of superficial fungal infections in a large tertiary care center in Israel from 2019 to 2022. A retrospective analysis of 2244 patients with suspected fungal infections was performed, utilizing PCR and fungal cultures for diagnosis. Confirmed fungal infections were present in 53.0% of cases. In adults, infections predominantly affected the nails and feet, while in children, the scalp and nails were the most involved sites. Trichophyton rubrum was the most common pathogen overall, but T. tonsurans was the leading cause of scalp, face, and neck infections, as well as tinea corporis in children. T. tonsurans incidence significantly increased in adults and became the most frequent agent of upper-body tinea corporis by 2022. These findings highlight a shift in pathogen distribution, with T. tonsurans emerging as the leading cause of upper-body skin infections, underscoring the need for targeted prevention strategies and further investigation of its transmission routes.

Purpose Onychomycosis, in contrast to other routine superficial dermatophyte infections, is difficult to treat and poor outcomes are not unusual. Few guidelines for onychomycosis management have been published, and these vary considerably from region to region. To meet global antifungal stewardship (AFS) goals, there must be global management guidelines for clinicians to follow in their onychomycosis practice. We aimed to survey current practices for onychomycosis management across a variety of global regions and compare practices to published treatment guidelines, as well as to what degree the management practices may facilitate AFS practices.Materials and methods An informal literature review was performed to identify regional onychomycosis guidelines. An online survey of our colleagues was distributed to assess current onychomycosis management practices and challenges for comparison with associated regional guidelines. Guidelines and practices were reviewed for adherence to the general AFS principles.Results Our review of current practices shows that, despite guidelines, identification of the infecting species is often not obtained, and treatment provision does not strictly follow existing guidelines. Lack of laboratory access prevents diagnosis and antifungal susceptibility testing that can help provide targeted treatments and resistance surveillance. Better diagnostic methods are needed as a component to improve management decisions, and provide the reliable monitoring required for effective AFS. Broader clinical testing is needed to address knowledge gaps in onychomycosis therapy. Meeting these challenges must be a priority as antifungal resistance is quickly becoming a worldwide problem.Conclusions As a reservoir for resistant strains, onychomycosis represents a significant future medical/economic burden. Future onychomycosis guidelines must address the challenge of resource limitations experienced by clinicians, as well as the challenge of balancing the need for AFS principles with the specific needs of onychomycosis therapy.

BACKGROUND:Onychoschizia is characterized by distal nail plate splitting. Several therapeutic approaches exist, most of which are based on case reports or small non-comparative case series. OBJECTIVE:To evaluate safety and efficacy of oral biotin and pyridoxine for treating onychoschizia. PATIENTS AND METHODS:A retrospective comparative study was conducted among patients with idiopathic fingernail onychoschizia. Patients were prescribed 1 mg/day biotin, or 100 mg/day pyridoxine or both, for 3 months. Complete response (improvement of more than 90%) and partial response (improvement of more than 50%) were assessed after 6 to 9 months. RESULTS:The study included 61 patients with fingernail onychoschizia (mean age 40.5 years [range 20-68 years]). The average number of affected fingernails was 7.0 (&plusmn;2.0) per patient. The nail condition lasted 11.6 (&plusmn;4.7) years on average. The combined treatment regimen achieved significantly higher rates of complete response compared to biotin or pyridoxine alone (69.6% vs 10%, 11.1%, respectively; P values &lt; .001). Partial response (&gt;50% improvement) was achieved in an additional 30.4%, 45%, and 38.9% of patients treated with combined regimen vs biotin or pyridoxine alone, respectively. No adverse events were recorded. CONCLUSIONS:This study demonstrates that the use of biotin and pyridoxine combination is an effective treatment for fingernail onychoschizia. J Drugs Dermatol. 2025;24(2):174-177. doi:10.36849/JDD.7687R1.

Sexually transmitted dermatophyte infections are an emerging public health concern, with increasing incidence reported across multiple countries. These infections are mainly spread through direct skin-to-skin contact during sexual activity and are more commonly found in individuals with high-risk sexual practices. The likelihood of infection is heightened by frequent pubic hair grooming or regular use of shared spaces like gyms and saunas. Clinically, presentations are often severe, widespread and atypical, which may delay diagnosis or lead to misidentification. Accurate species-level identification is critical and increasingly reliant on molecular sequencing techniques, including ITS and tef1α regions, which are also valuable for strain surveillance and contact tracing. Management strategies should emphasise systemic antifungal therapy, with consideration for adjunctive topical agents or antibiotics in cases of secondary infection. Individualised treatment plans may require extended therapy durations or combination regimens to ensure clinical resolution. In addition to pharmacologic intervention, education on hygiene practices, risk of reinfection and the importance of environmental decontamination and follow-up care is essential for preventing recurrence and curbing transmission.

Background: Scalp allergic contact dermatitis (ACD) is less frequent than at other body sites, underdiagnosed due to overlapping dermatoses, and understudied. This study characterized its epidemiology, clinical features, allergen profile, lesion distribution, and preexisting scalp conditions. Methods: A retrospective cohort (Sheba Medical Center, 2009-2023) included patients with clinically relevant patch test-confirmed ACD, categorized into 3 groups: (a) symptoms only (n = 17), (b) visible lesions without preexisting scalp disorder (n = 68), and (c) visible lesions with a preexisting scalp disorder (n = 16). Demographic, clinical, and patch test data were analyzed. Results: Scalp ACD represented 3.2% of patch test referrals (n = 101); 91.1% were female (mean age = 50). Common symptoms were itching and hair shedding, erythema, and scaling were the most frequent signs. Lesions involved only the scalp in 45% and extended beyond in 55%. Diagnosis was delayed by an average of 17 months. Patients had an average of 3.45 positive allergens; 50.5% were polysensitized. Nickel sulfate (47.5%), paraphenylenediamine (32%), and methylisothiazolinone/methylchloroisothiazolinone (14%) were most frequent. Allergen patterns varied by lesion distribution and preexisting scalp conditions. Conclusions: Scalp ACD predominantly affects middle-aged women and often extends beyond the scalp. Delayed diagnosis is common. Distinct allergen patterns, frequent polysensitization, and the influence of preexisting conditions highlight the need for targeted allergen avoidance strategies.