COL 0·5% cream and MAL-PDT are safe and effective for treating SFC.

Early-onset effluvium secondary to COVID-19: Clinical and histologic characterizationTo the Editor: As telogen effluvium (TE) is the most common manifestation of postacute COVID-19 syndrome, we read with keen interest the publication by Abrantes et al 1 reporting the clinical characteristics of 30 patients with post-COVIDe19 acute TE. We would like to commend the authors and bring some other elements to this relevant discussion.TE is a heterogeneous condition that can be elicited by multiple stimuli. 2 Headington 3 proposed 5 functional types of TE based on alternations in particular phases of the follicular cycle. Infections are thought to induce TE through the mechanism of immediate anagen release. According to this model, an acute inflammatory state converts the follicles from anagen to catagen, leading to the shedding of telogen hairs around 90 days after the infection. Interestingly, the median time for the onset of hair shedding observed by Abrantes et al 1 was 45 days after infection; in the most precocious case, it started 18 days after COVID-19.This early onset was also observed in 2 multicentric studies. Moreno-Arrones et al 4 evaluated 214 cases of acute TE after COVID-19 and noted the onset of hair shedding, on average, 57.1 days after the infection. Starace et al 5 observed early onset especially when TE was associated with trichodynia. In these cases, the latency from the infection to hair shedding occurred at an average of 3 (range, 2-7.5) weeks. 5 We recently assessed 203 hospitalized patients with confirmed COVID-19, of whom 11 (5.4%) reported hair loss with onset early during hospitalization, \30 days after the infection. Seven of them were assessed using trichoscopy, a trichogram, and a histologic evaluation. The detailed information of these cases is presented in Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/p254jbh356/1).Clinically, all the cases presented a positive pull test result. Trichoscopy did not reveal broken hairs, anisotrichosis, or yellow dots, but it did reveal some empty follicles. The trichogram obtained from the vertex revealed[10% dystrophic anagen hairs (Fig 1) and [20% telogen hairs in all the cases. Histologically, there was predominance of anagen terminal follicles, no relevant miniaturization ([10%), and no cases showing [25% telogen follicles. No

The fingernail growth rate (NGR) is approximately 3 mm/month and varies according to sex, age, labour activities, systemic diseases, seasonality, dominant hand and trauma. 1 The slow growth of nails may have functional and cosmetic impact, such as nail fragility and delayed renewal of the nail plate. 2 Few studies have evaluated pharmacological interventions to increase NGR.

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BackgroundA skin field cancerization is a cutaneous area with subclinical changes resultant from chronic sun exposure, with a higher predisposition to development of pre-neoplastic and neoplastic lesions. So far, there are no well-defined objective parameters that can indicate their degree of activity.ObjectivesTo describe and compare morphometric aspects and expression of factors related to apoptosis and cell proliferation in actinic keratosis (AK), in both photoexposed and photoprotected epidermis.MethodsA cross-sectional study of patients with actinic keratosis in the forearms, biopsied at two points: the actinic keratosis and the axillary region. The biopsies of the actinic keratosis, perilesional area, and axilla were evaluated through keratinocyte intraepithelial neoplasia (KIN), and immunohistochemistry of p53, survivin, and Ki67. Nuclear morphometry of basal layer cells was performed through digital image analysis: entropy, area, perimeter, Ra, fractal dimension, circularity, color intensity, and largest diameter.ResultsThere were 13 patients included and 38 actinic keratosis biopsied. In morphometry, 1039 nuclei were analyzed, of which 228 represented axillary skin, 396 demonstrated actinic keratosis, and 415 represented the perilesional area to the actinic keratosis. There was a significant difference (p < 0.05) in all variables tested for the topographies evaluated. A significant correlation was identified between nucellar morphometric elements, KIN, proliferation markers, and apoptosis. Joint patterns of p53, Ki67, and KIN discriminated the topographies sampled.Study limitationsThis was a cross-sectional study with a small number of patients.ConclusionsThere are patterns of proliferation, resistance to apoptosis, and different cellular morphometrics between photoprotected skin and photoexposed skin. The joint expression of p53, Ki67, and KIN can characterize skin field cancerization activity.