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Waśkiel-Burnat A, Czuwara J, Blicharz L, Olszewska M, Rudnicka L. Differential diagnosis of red scalp: the importance of trichoscopy. Clin Exp Dermatol 2024; 49:961-968. [PMID: 37935061 DOI: 10.1093/ced/llad366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
Red scalp is a common complaint that may constitute a diagnostic and therapeutic challenge in daily clinical practice. Among the numerous diseases to cause diffuse scalp erythema are psoriasis, seborrhoeic dermatitis, contact dermatitis, diffuse lichen planopilaris, dermatomyositis and scalp rosacea. Accurate diagnosis is crucial for optimal treatment outcomes. Histology most frequently discriminates the underlying condition, but it requires scalp biopsy. In many cases, the combination of clinical examination and trichoscopy is sufficient for establishing the correct diagnosis. The main trichoscopic features of psoriasis are silver-white scaling, regularly distributed dotted (glomerular) vessels or twisted red loops, and punctate haemorrhages. Yellowish-white scaling and thin arborizing vessels are typical features of seborrhoeic dermatitis. Contact dermatitis is characterized by the presence of yellow exudate and polymorphic vessels, while perifollicular scaling and erythema with the lack of follicular openings are typical findings in lichen planopilaris. In scalp dermatomyositis, tortuous and arborizing vessels with interfollicular and perifollicular pigmentation may be detected. The most characteristic features of scalp rosacea are perifollicular scaling and polygonal/arborizing vessels. This review also summarizes histological features and therapeutic options for these conditions.
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Affiliation(s)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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2
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Kołcz K, Krawczyk-Wołoszyn K, Reich A, Żychowska M. Pruritus in Lichen Planopilaris and Frontal Fibrosing Alopecia-Clinical Characteristics and Dermoscopic Correlations. J Clin Med 2024; 13:4898. [PMID: 39201040 PMCID: PMC11355708 DOI: 10.3390/jcm13164898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/02/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy.
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Affiliation(s)
- Kinga Kołcz
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (K.K.); (K.K.-W.); (A.R.)
- The Doctoral School, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Karolina Krawczyk-Wołoszyn
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (K.K.); (K.K.-W.); (A.R.)
- The Doctoral School, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (K.K.); (K.K.-W.); (A.R.)
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (K.K.); (K.K.-W.); (A.R.)
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3
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Oak ASW, Yang K, Reddy SB, Elston CA, Mayo TT. Lichen planopilaris in 24 African American women. Int J Womens Dermatol 2024; 10:e141. [PMID: 38572266 PMCID: PMC10986913 DOI: 10.1097/jw9.0000000000000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Allen S. W. Oak
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Yang
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sivani B. Reddy
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carly A. Elston
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany T. Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
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Lyakhovitsky A, Zilbermintz T, Segal Z, Galili E, Shemer A, Jaworowski B, Baum S, Hermush V, Kaplan B, Barzilai A. Exploring Remission Dynamics and Prognostic Factors in Lichen Planopilaris: A Retrospective Cohort Study. Dermatology 2024; 240:531-542. [PMID: 38574470 DOI: 10.1159/000538355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/10/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Lichen planopilaris (LPP) is a common type of primary cicatricial alopecia. Previous studies focused on the epidemiology, clinical characteristics, and treatment of LPP. A lack of knowledge regarding LPP outcomes and prognostic factors remained. METHODS To delineate the rate and timing of remission in LPP, as well as the prognostic factors for achieving remission, a retrospective cohort study was conducted. The study included 126 patients, from a single tertiary center, diagnosed with LPP between January 2010 and December 2022, who were followed up for a minimum of 6 months. RESULTS There were 89 (70.6%) women and 37 (29.4%) men included in this study. The mean age of the patients was 47.92 ± 14.2 years. The mean time from disease onset to diagnosis was 33.85 (±30) months, indicating significant diagnostic delays. The mean duration of follow-up was 34.13 ± 22.7 months. Among the cohort, 43 patients achieved complete remission (CR) during the follow-up period, whereas 83 patients did not. Of the 83 patients who did not achieve CR, 35 partially improved and 48 did not improve or worsened. The median time for achieving CR was 46 ± 18.8 months. Milder disease at presentation and comorbid lichen planus were associated with higher CR rates. CONCLUSION This study demonstrates significant diagnostic delays that should be addressed as LPP causes irreversible alopecia, suggests disease severity and comorbid lichen planus as potential prognostic factors. Further, it emphasizes the limited efficacy of current treatments and the need for prolonged treatment in patients with LPP to achieve remission.
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Affiliation(s)
- A Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zilbermintz
- Education authority, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Z Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - E Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel,
| | - A Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Jaworowski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V Hermush
- Laniado Medical Center, Adelson School of Medicine, Ariel University, Ariel, Israel
| | - B Kaplan
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - A Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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5
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Özcan D, Öztürk MÖ, Özen Ö. Chronic diffuse alopecia in women: a retrospective review of histopathologic diagnoses. Int J Dermatol 2024; 63:182-187. [PMID: 37997208 DOI: 10.1111/ijd.16921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The diseases causing chronic diffuse alopecia and having similar clinical findings, namely chronic telogen effluvium, androgenetic alopecia, and the alopecia with overlapping features, should be differentiated. Recently, diffuse variants of lichen planopilaris have been described with histopathologic features of lichen planopilaris but clinically presenting with diffuse hair loss mostly in an androgenetic pattern. OBJECTIVES To determine the accurate diagnosis underlying chronic diffuse alopecia in women by evaluating histopathologic findings. PATIENTS AND METHODS The study included 32 patients with diffuse and clinically noncicatricial alopecia for at least 6 months with no identifiable etiologic factor after general medical history, review of organ systems, and appropriate laboratory tests. Two 4 mm punch biopsies, one from vertex and the other from mid-occiput, were obtained and sectioned transversely. RESULTS The median age was 30.5 years (range: 22-40 years), and the median duration of hair loss was 4 years (range: 1.5-10 years). The histopathologic diagnosis was androgenetic alopecia, chronic telogen effluvium, and overlapping alopecia in 13 (40.6%), three (9.4%), and four (12.5%) patients, respectively. In the remaining 12 (32.5%) patients, a lichenoid inflammatory reaction affecting the infundibulum and isthmus was noted, and the probable diagnosis of diffuse variant of lichen planopilaris was made. LIMITATIONS The retrospective nature and the small sample size. CONCLUSION When the clinical diagnosis is not straightforward and no etiologic factor is found, histopathologic examination is mandatory for the accurate diagnosis of the disorder leading to chronic diffuse alopecia in women.
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Affiliation(s)
- Deren Özcan
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Meryem Ö Öztürk
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Özlem Özen
- Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
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Yoo LJH, Meah N, Wall D, McDonald I. Diffuse Lichen Planopilaris Masquerading as Diffuse Alopecia Areata. Case Rep Dermatol 2024; 16:83-87. [PMID: 38529513 PMCID: PMC10963056 DOI: 10.1159/000538064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/06/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia that represents a form of follicular lichen planus. Case Presentation We describe a case of coexisting diffuse LPP and female pattern hair loss masquerading as diffuse alopecia areata in a 32-year-old female. Discussion In complex cases such as this, dermoscopy-guided vertical and horizontal biopsies from androgen sensitive and insensitive areas are helpful in increasing diagnostic yield. Prompt initiation of treatment is key to halting disease progression. Long-term follow-up is important as resolution of clinical signs does not always correlate with the absence of disease progression.
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Affiliation(s)
- Li Jie Helena Yoo
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nekma Meah
- Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Ian McDonald
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
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7
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Khutsishvili N, Rudnicka L, Ovcharenko Y, Starace M, Buchukuri I, Pataraia S, Lortkipanidze N. Trichoscopy - a valuable tool for identifying conditions mimicking androgenetic alopecia. Int J Dermatol 2024; 63:23-31. [PMID: 37950461 DOI: 10.1111/ijd.16895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Androgenetic alopecia (AGA) is the most prevalent type of hair loss in women and men. Recently, a European consensus group published guidelines for the diagnostic evaluation of AGA in men, women, and adolescents. This S1 guideline presents expert opinion-based recommendations for gender-dependent steps in the diagnostic procedure, which can easily be implemented in the daily clinical routine. For diagnosing AGA, detailed anamnesis and objective learning are not enough because there are several conditions mimicking this disease. Trichoscopy can be considered an important, non-invasive tool for diagnosing hair and scalp disorders that may have similar clinical signs to AGA.
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Affiliation(s)
| | | | | | | | - Irma Buchukuri
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
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8
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Kurzeja M, Warszawik-Hendzel O, Rakowska A, Graczyk A, Fedorczuk D, Czuwara J, Olszewska M, Rudnicka L. Line-field confocal optical coherence tomography: A new diagnostic method of lichen planopilaris. Skin Res Technol 2023; 29:e13495. [PMID: 37881054 PMCID: PMC10576171 DOI: 10.1111/srt.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | | | - Adriana Rakowska
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Alina Graczyk
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Danuta Fedorczuk
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
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9
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Tabka M, Mokni S, Frioui R, Fetoui N, Ounallah A, Sriha B, Belajouza C, Denguezli M. Rare and misdiagnosed entity fibrosing alopecia in a pattern distribution: A case report. J Cosmet Dermatol 2023; 22:2619-2621. [PMID: 36978249 DOI: 10.1111/jocd.15743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Mariem Tabka
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Sana Mokni
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Refka Frioui
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Nedia Fetoui
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Amina Ounallah
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Badreddine Sriha
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
- Pathology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | | | - Mohamed Denguezli
- Dermatology Department, Farhat Hached Hospital of Sousse, Sousse, Tunisia
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10
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Gallo G, Burzi L, Torrelli F, Quaglino P, Ribero S. Low-dose oral minoxidil in female patients with lichen planopilaris: Real-life experience. J Eur Acad Dermatol Venereol 2023; 37:e98-e100. [PMID: 35974439 DOI: 10.1111/jdv.18489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Giuseppe Gallo
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenza Burzi
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Torrelli
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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11
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Ramírez-Marín HA, Tosti A. Examining the autoimmune aspects of frontal fibrosing alopecia. Expert Rev Clin Immunol 2022; 18:1091-1094. [PMID: 35904171 DOI: 10.1080/1744666x.2022.2106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Antonella Tosti
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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12
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Starace M, Vezzoni R, Alessandrini A, Bruni F, Carpanese M, Melo DF, Piraccini BM. Tufted hairs: A bouquet of flowers in different hair diseases. J Cosmet Dermatol 2022; 21:3741-3746. [PMID: 35001495 DOI: 10.1111/jocd.14712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
Tufted hairs, an unusual hair follicle dysplasia, are characterized by several hair shafts grouped together, emerging from a single hair follicle-like "doll's hair". This clinical picture is considered characteristic of folliculitis decalvans (FD). However, the emergence of grouped hair shafts from a single follicle can also be observed in other hair disorders, even if not as a distinctive diagnostic sign. This paper aims to collect and analyze all clinical and trichoscopic features of different hair diseases with tufted hairs to find distinctive features, helping the clinician with the diagnosis.
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Affiliation(s)
- Michela Starace
- Dermatology- IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Roberta Vezzoni
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Aurora Alessandrini
- Dermatology- IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Dermatology- IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Miriam Carpanese
- Dermatology- IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Bianca Maria Piraccini
- Dermatology- IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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13
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Uchiyama M. Primary cicatricial alopecia: Recent advances in evaluation and diagnosis based on trichoscopic and histopathological observation, including overlapping and specific features. J Dermatol 2021; 49:37-54. [PMID: 34866229 DOI: 10.1111/1346-8138.16252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022]
Abstract
Primary cicatricial alopecia (PCA) is a form of alopecia in which inflammatory cells target follicles, including the bulge region containing follicular stem cells, leading to permanent alopecia. New classifications of PCA subtypes have recently been proposed, including those that account for novel trichoscopic and histopathological features of PCA, enabling greater precision in the evaluation and diagnosis of this condition. Nonetheless, diagnosis remains challenging clinically and histopathologically because the etiology of PCA is multifactorial. Inconsistent use of terminology, overlapping disease concepts, and changes in the clinical or histopathological severity of inflammation in the disease course in the same patient also make diagnosis quite challenging. The present study comprehensively reviews recent progress in diagnostic techniques, including the use of clinical, trichoscopic, and histopathological features, in evaluating each PCA subtype, containing overlapping and specific features. Elucidating the features of PCA, including those that are common to multiple subtypes as well as specific to each in both early and advanced-stage lesions, is important for accurate diagnosis. Improving the evaluation and treatment of this disease depends on having a broader clinical understanding that takes into account not only the features of the disease at a given point in time, but also the changes that occur during the entire disease course.
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Affiliation(s)
- Masaki Uchiyama
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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14
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Issa NT, Tosti A. Trichoscopy for the Hair Transplant Surgeon-Assessing for Mimickers of Androgenetic Alopecia and Preoperative Evaluation of Donor Site Area. Indian J Plast Surg 2021; 54:393-398. [PMID: 34984075 PMCID: PMC8719970 DOI: 10.1055/s-0041-1739245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.
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Affiliation(s)
- Naiem T. Issa
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
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15
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Jerjen R, Pinczewski J, Sinclair R, Bhoyrul B. Clinicopathological characteristics and treatment outcomes of fibrosing alopecia in a pattern distribution: A retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 35:2440-2447. [PMID: 34415628 DOI: 10.1111/jdv.17604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fibrosing alopecia in a pattern distribution (FAPD) is a primary cicatricial alopecia considered a subtype of lichen planopilaris (LPP). OBJECTIVE The clinical and histopathological features, and treatment response of 24 female patients with FAPD were evaluated. METHODS Demographic, clinical, histopathological and treatment data of patients with FAPD were retrospectively collected. RESULTS Twenty-four women were included (mean age 60.7 years). The mean Lichen Planopilaris Activity Index score was 1.50, and the median Sinclair grade was 3. Twelve patients had diffuse alopecia in the centroparietal region, four had frontal accentuation and eight had vertex accentuation of hair loss. Eight had associated loss of facial hair. Predominant trichoscopic features included hair shaft diameter variability (100%), perifollicular erythema and/or scaling (95%) and loss of follicular ostia (95%). Histopathological examination revealed features of scarring alopecia with interface changes in follicular epithelia mainly targeting terminal and intermediate hairs, and less frequently, vellus hairs. Treatment with hair growth-promoting, anti-inflammatory and anti-androgen agents arrested disease progression in 14 patients and resulted in hair regrowth in two patients. Six patients had progression of their hair loss in spite of treatment. LIMITATIONS Referral bias to a specialist hair clinic, retrospective design and small sample size. CONCLUSIONS We present clinicopathological features of FAPD which can aid in the diagnosis of this insidious scarring alopecia. Our findings suggest a more favourable outcome if treatment is initiated in early stages of the disease.
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Affiliation(s)
- R Jerjen
- Sinclair Dermatology, East Melbourne, VIC, Australia
| | | | - R Sinclair
- Sinclair Dermatology, East Melbourne, VIC, Australia
| | - B Bhoyrul
- Sinclair Dermatology, East Melbourne, VIC, Australia
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16
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Golińska J, Sar-Pomian M, Rudnicka L. Diagnostic Accuracy of Trichoscopy in Inflammatory Scalp Diseases: A Systematic Review. Dermatology 2021; 238:412-421. [PMID: 34265772 DOI: 10.1159/000517516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The common inflammatory scalp diseases, such as psoriasis, seborrheic dermatitis, lichen planopilaris, discoid lupus erythematosus, contact dermatitis, or pemphigus may share similar clinical features. OBJECTIVE To identify and systematically review the available evidence on the accuracy of trichoscopy in inflammatory scalp disorders. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 articles were included in the analysis. RESULTS The following trichoscopy features were found to show the highest specificity for the respective diseases: in psoriasis: diffuse scaling, simple and twisted red loops, red dots and globules, and glomerular vessels; in seborrheic dermatitis: atypical vessels, thin arborizing vessels, and structureless red areas; in discoid lupus erythematosus: follicular plugs and erythema encircling follicles; in lichen planopilaris: milky red areas or fibrotic patches; in contact dermatitis: twisted red loops; in pemphigus foliaceus: white polygonal structures and serpentine vessels; in pemphigus vulgaris: red dots with whitish halo and lace-like vessels; and in dermatomyositis: lake-like vascular structures. LIMITATIONS Different nomenclature and variability in parameters, which were analyzed in different studies. CONCLUSION This systemic analysis indicates that trichoscopy may be used with high accuracy in the differential diagnosis of inflammatory scalp diseases.
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Affiliation(s)
- Joanna Golińska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland,
| | - Marta Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Abstract
This article focuses on the assessment and treatment of patients with primary cicatricial alopecia and provides new information regarding the genetics and pathophysiology of this group of diseases.
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Affiliation(s)
- Maria Hordinsky
- Department of Dermatology, University of Minnesota, 516 Delaware Street Southeast, MMC 98, Minneapolis, MN 55455, USA.
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18
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Teixeira MS, Gavazzoni Dias MFR, Vilar EAG, Pantaleão L, Jourdan RFR, Ekelem C, Rochael MC. Histopathological differential diagnosis of frontal fibrosing alopecia and fibrosing alopecia in a pattern distribution. Br J Dermatol 2021; 185:1069-1070. [PMID: 34157130 DOI: 10.1111/bjd.20592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- M S Teixeira
- Department of Dermatology, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
| | - M F R Gavazzoni Dias
- Department of Dermatology, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
| | - E A G Vilar
- Department of Pathology of the Fluminense Federal University, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
| | - L Pantaleão
- Department of Pathology of the Fluminense Federal University, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
| | - R F R Jourdan
- Department of Dermatology, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
| | - C Ekelem
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - M C Rochael
- Department of Pathology of the Fluminense Federal University, Antonio Pedro University Hospital, Niteroi, RJ, Brazil
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19
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Dubin C, Glickman JW, Del Duca E, Chennareddy S, Han J, Dahabreh D, Estrada YD, Zhang N, Kimmel GW, Singer G, Chowdhury M, Zheng AY, Angelov M, Gay-Mimbrera J, Ruano Ruiz J, Krueger JG, Pavel AB, Guttman-Yassky E. Scalp and serum profiling of frontal fibrosing alopecia reveals scalp immune and fibrosis dysregulation with no systemic involvement. J Am Acad Dermatol 2021; 86:551-562. [PMID: 34044102 DOI: 10.1016/j.jaad.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a progressive, scarring alopecia of the frontotemporal scalp that poses a substantial burden on quality of life. Large-scale global profiling of FFA is lacking, preventing the development of effective therapeutics. OBJECTIVE To characterize FFA compared to normal and alopecia areata using broad molecular profiling and to identify biomarkers linked to disease severity. METHODS This cross-sectional study assessed 33,118 genes in scalp using RNA sequencing and 350 proteins in serum using OLINK high-throughput proteomics. Disease biomarkers were also correlated with clinical severity and a fibrosis gene set. RESULTS Genes differentially expressed in lesional FFA included markers related to Th1 (IFNγ/CXCL9/CXCL10), T-cell activation (CD2/CD3/CCL19/ICOS), fibrosis (CXCR3/FGF14/FGF22/VIM/FN1), T-regulatory (FOXP3/TGFB1/TGFB3), and Janus kinase/JAK (JAK3/STAT1/STAT4) (Fold changes [FCH]>1.5, FDR<.05 for all). Only one protein, ADM, was differentially expressed in FFA serum compared to normal (FCH>1.3, FDR<.05). Significant correlations were found between scalp biomarkers (IL-36RN/IL-25) and FFA severity, as well as between JAK/STAT and fibrosis gene-sets (r>.6; P <.05). LIMITATIONS This study was limited by a small sample size and predominantly female FFA patients. CONCLUSION Our data characterize FFA as an inflammatory condition limited to scalp, involving Th1/JAK skewing, with associated fibrosis and elevated T-regulatory markers, suggesting the potential for disease reversibility with JAK/STAT inhibition.
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Affiliation(s)
- Celina Dubin
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob W Glickman
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ester Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Dermatology, University of Magna Graecia, Catanzaro, Italy
| | - Sumanth Chennareddy
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Han
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dante Dahabreh
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeriel D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ning Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace W Kimmel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giselle Singer
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mashkura Chowdhury
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew Y Zheng
- Macaulay Honors College at City University of New York (CUNY) Hunter College, New York, New York
| | - Michael Angelov
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jesús Gay-Mimbrera
- Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - Juan Ruano Ruiz
- Department of Dermatology, Reina Sofia University Hospital, Cordoba, Spain
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
| | - Ana B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Engineering, The University of Mississippi, Oxford, Mississippi.
| | - Emma Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory of Investigative Dermatology, Rockefeller University, New York, New York.
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20
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Trüeb RM, Gavazzoni Dias MFR, Dutra Rezende H. Comment on Follicular Inflammation and Fibrosis in Pattern Hair Loss. Skin Appendage Disord 2021; 7:159-160. [PMID: 33796566 DOI: 10.1159/000513089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Universidade Federal Fluminense, Centro de Ciências Médicas, Hospital Universitário Antonia Pedro, Rio de Janeiro, Brazil
| | - Hudson Dutra Rezende
- Department of Dermatology, Alvaro Alvim School Hospital, Campos dos Goytacazes, Rio de Janeiro, Brazil
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21
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Alessandrini A, Bruni F, Piraccini B, Starace M. Common causes of hair loss – clinical manifestations, trichoscopy and therapy. J Eur Acad Dermatol Venereol 2021; 35:629-640. [DOI: 10.1111/jdv.17079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Alessandrini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - F. Bruni
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - B.M. Piraccini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - M. Starace
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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22
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Orlando G, Starace M, Alessandrini A, Baraldi C, Bruni F, Piraccini BM. Commentary on: “Cicatricial pattern hair loss is not a variant of lichen planopilaris”. J Am Acad Dermatol 2020; 83:e415-e416. [DOI: 10.1016/j.jaad.2020.04.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
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23
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Bhoyrul B. Cicatricial pattern hair loss is not a variant of lichen planopilaris. J Am Acad Dermatol 2020; 83:e413-e414. [DOI: 10.1016/j.jaad.2020.03.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
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24
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Focal and diffuse fibrosing alopecias: Classical lichen planopilaris, frontal fibrosing alopecia, fibrosing alopecia with a pattern distribution, cicatricial pattern hair loss, and lichen planopilaris diffuse pattern. JAAD Case Rep 2020; 6:403-410. [PMID: 32382630 PMCID: PMC7200203 DOI: 10.1016/j.jdcr.2020.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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25
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Vañó-Galván S, Trindade de Carvalho L, Saceda-Corralo D, Rodrigues-Barata R, Kerkemeyer KL, Sinclair RD, Hermosa-Gelbard Á, Moreno-Arrones ÓM, Jimenez-Cauhe J, Bhoyrul B. Oral minoxidil improves background hair thickness in lichen planopilaris. J Am Acad Dermatol 2020; 84:1684-1686. [PMID: 32289397 DOI: 10.1016/j.jaad.2020.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sergio Vañó-Galván
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain.
| | | | - David Saceda-Corralo
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
| | - Rita Rodrigues-Barata
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
| | | | | | - Ángela Hermosa-Gelbard
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
| | - Óscar M Moreno-Arrones
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
| | - Juan Jimenez-Cauhe
- Trichology Unit, #TricoHRC Research Group, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
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26
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Randolph MJ, Salhi WA, Tosti A. Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis. Dermatol Ther (Heidelb) 2020; 10:311-319. [PMID: 32060796 PMCID: PMC7090134 DOI: 10.1007/s13555-020-00359-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.
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Affiliation(s)
| | - Waleed Al Salhi
- Department of Dermatology, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA.
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