Trichotillomania is a psychodermatologic disorder characterized by uncontrollable
urge to pull one's own hair. Differential diagnoses include the most common
forms of alopecia such as alopecia areata. It is usually associated with
depression and obsessive-compulsive disorder. Trichotillomania treatment
standardization is a gap in the medical literature. Recent studies demonstrated
the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of
the disease. We report the clinical case of a 12-year-old female patient who
received the initial diagnosis of alopecia areata, but presented with clinical
and dermoscopic features of trichotillomania. She was treated with the
combination of psychotropic drugs and N-acetylcysteine with good clinical
response. Due to the chronic and recurring nature of trichotillomania, more
studies need to be conducted for the establishment of a formal treatment
algorithm.
Pigmented purpuric dermatoses (PPD) include a spectrum of diseases with different
clinical aspects, but with similar histopathological features. Specific clinical
findings allow the division of PPD in variants. Schamberg's disease is the most
common. Treatment is sometimes ineffective and recurrences are common. There are
reports of patients who responded well to the use of colchicine. We report the
case of a 32-year-old woman, previously healthy, with a history of onset of
asymptomatic lesions in legs. She presented purpuric skin eruptions and brownish
stains diffusely distributed in the lower limbs. Biopsy was compatible with PPD.
We decided for the introduction of colchicine, with good clinical response. The
patient has been followed on outpatient basis for ten months without
recurrence.
Eosinophilic pustular folliculitis (EPF) or Ofuji disease is a rare dermatosis,
prone to recurrence and chronicity. The peak incidence occurs in the third
decade of life and its exact etiology remains unknown. Evidence suggests that
the expression of adhesion molecules and the production of cytokines activate
the follicular unit, but the stimulus that triggers these changes remains
unclear. The three clinical variants reported in the literature include classic
EPF, immunosuppression-associated EPF, and infancy-associated EPF. We report a
case of eosinophilic pustular folliculitis with peculiar epidemiological
characteristics, which represents a challenging therapeutic scenario.
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