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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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2
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Kuczara A, Waśkiel-Burnat A, Rakowska A, Olszewska M, Rudnicka L. Trichoscopy of Androgenetic Alopecia: A Systematic Review. J Clin Med 2024; 13:1962. [PMID: 38610726 PMCID: PMC11012765 DOI: 10.3390/jcm13071962] [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: 02/02/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Androgenetic alopecia, the most common cause of non-scarring hair loss, is a consequence of the gradual miniaturization of the hair follicles. In the majority of male androgenetic alopecia cases, a patient's history and clinical evaluation may be sufficient to establish the diagnosis, while for women, they should be supplemented with trichoscopy. Methods: The PubMed and Scopus databases were used to collate published studies and to analyze the most typical trichoscopic findings in patients diagnosed with androgenetic alopecia. A total of 34 articles were retrieved after exclusion. Results: The most common features identified using trichoscopy included hair diameter variability (94.07% of patients), vellus hairs (66.45%) and the peripilar sign (43.27%). Others, such as the honeycomb pattern, yellow and white dots, were less relevant. Conclusions: We concluded that hair diameter variability, vellus hairs and the peripilar sign represented valuable indicators for the diagnosis of androgenetic alopecia.
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Affiliation(s)
| | - Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008 Warsaw, Poland
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3
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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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4
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Wei K, Ni C, Huang Q, Yang K, Zhang Y, Liu Q, Sha Y, Zhang Q, Lin J, Wu W. Clinicopathological characteristics of fibrosing alopecia in a pattern distribution: a single-center, retrospective study. Int J Dermatol 2023; 62:1391-1396. [PMID: 37766670 DOI: 10.1111/ijd.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Fibrosing alopecia in a pattern distribution (FAPD) is a distinct entity of primary cicatricial alopecia (PCA), mimicking diffuse hair loss of androgenetic alopecia (AGA) with trichoscopic and histopathologic features of both AGA and lichen planopilaris (LPP). METHODS Clinical, demographic, and histopathological data of 20 FAPD patients were retrospectively collected. RESULTS All patients presented with female pattern hair loss with a median Sinclair grade of 3. Trichoscopic findings revealed hair diameter variability (20/20), perifollicular erythema (mild 7/20, moderate 11/20, severe 2/20), peripilar casts (none 2/20, mild 12/20, moderate 5/20, severe 1/20), and loss of follicular ostia (+12/20, ±7/20, -1/20). Histopathologic examination revealed perifollicular lymphocytic infiltration at the infundibulum or isthmus level and an increase of vellus-like hairs. All cases showed interface dermatitis with concentric perifollicular lamellar fibrosis and follicular scars. Infundibular or isthmic infiltration of mast cells was found. CONCLUSIONS The uniqueness of our study lies in perifollicular mast cells and discovering that the young population is at higher risk than previously thought. Clinicopathological features of FAPD were identified, filling the void of much-needed details for FAPD diagnosis tailored to the Chinese population.
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Affiliation(s)
- Kelu Wei
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunya Ni
- Department of Dermatology, Jing'an District Central Hospital, Shanghai, China
| | - Qiong Huang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai Yang
- Department of Dermatology, Jing'an District Central Hospital, Shanghai, China
| | - Yue Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingmei Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuou Sha
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiaoan Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinran Lin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenyu Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Dermatology, Jing'an District Central Hospital, Shanghai, China
- Academy for Engineering and Technology, Fudan University, Shanghai, China
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5
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Ummadi S, Stepenaskie S, Nunez SE, Konstantinov NK. Diffuse hair loss in a patient with systemic lupus erythematosus. JAAD Case Rep 2023; 40:4-7. [PMID: 37675063 PMCID: PMC10477750 DOI: 10.1016/j.jdcr.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Sahana Ummadi
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Shelley Stepenaskie
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Sharon E. Nunez
- Rheumatology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Nikifor K. Konstantinov
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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6
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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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7
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Pinedo-Moraleda F, Tristán-Martín B, Dradi GG. Alopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists. J Clin Med 2023; 12:5004. [PMID: 37568407 PMCID: PMC10419566 DOI: 10.3390/jcm12155004] [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: 07/06/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Accurately diagnosing specific variants of alopecia remains challenging for pathologists, potentially delaying appropriate therapeutic decisions by dermatologists. Issues such as limited knowledge on optimal biopsy types and processing methods add complexity. Understanding the normal histology of hair follicles and their changes throughout the follicular cycle further complicates microscopic evaluation. This paper aims to summarize these characteristics and highlight essential diagnostic clues for pathologists to confidently suggest a diagnosis, therefore playing a key role in alopecia diagnosis. Ongoing education, collaboration with dermatologists, and staying up to date on advancements is crucial for the accurate diagnosis and effective management of different types of alopecia.
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Affiliation(s)
| | - Belén Tristán-Martín
- Department of Pathology, Hospital Nuestra Señora de Sonsoles, 05004 Avila, Spain;
| | - Giulia Greta Dradi
- Department of Dermatology, Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Spain;
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8
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Larrondo J, McMichael AJ. Scarring Alopecia. Dermatol Clin 2023; 41:519-537. [PMID: 37236719 DOI: 10.1016/j.det.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.
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Affiliation(s)
- Jorge Larrondo
- Department of Dermatology, Wake Forest Baptist Health, 4618 Country Club Road, Winston-Salem, NC 27104, USA; Department of Dermatology, Clínica Alemana-Universidad del Desarrollo, Av. Vitacura 5951, Santiago, 7650568, Chile
| | - Amy J McMichael
- Department of Dermatology, Wake Forest Baptist Health, 4618 Country Club Road, Winston-Salem, NC 27104, USA.
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9
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Ho JD, Collie CJ, Spencer SA. Histopathologic Spectrum of Alopecias Seen in a Jamaican Setting. Am J Dermatopathol 2023; Publish Ahead of Print:00000372-990000000-00207. [PMID: 37377278 DOI: 10.1097/dad.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Alopecia is common in Jamaican, primarily Afro-Caribbean patients. We performed a retrospective review examining the histopathologic alopecia diagnoses over ∼5 years. Requisition forms and pathology reports were assessed. Demographic/clinical/technical/diagnostic and pathologic findings of chronicity/severity data were recorded. Three hundred thirty-eight biopsies were included. The majority were 4 mm punches, grossed horizontally. The F:M ratio was 4.8:1, mean age = 42.7 years, and mean duration of alopecia = 5.1 years. Cicatricial alopecias (CAs) predominated over non-CAs (NCAs). The top 10 diagnoses were central centrifugal CA (21.9%), folliculitis decalvans (10.9%), multifactorial alopecias (10.1%), pattern hair loss (8%), lichen planopilaris (7.1%), alopecia areata (6.2%), discoid lupus erythematosus (6.2%), nonclassifiable lymphocytic scarring alopecias (5.6%), frontal fibrosing alopecia (5.3%), and nonspecific NCAs (5%). This contrasted with other richly pigmented populations where discoid lupus erythematosus predominates. Other interesting findings included relatively frequent folliculitis decalvans and lichen planus pigmentosus in 40.9% of frontal fibrosing alopecia cases. Scarring/nonscarring clinicopathologic congruence occurred in 83.4%.Regarding histopathologic features of severity/chronicity, CAs had markedly decreased hair counts. Perifollicular fibrosis affecting retained hairs occurred in 75% of CAs, moderate to severe in >50% of these. Approximately 50% of NCA samples demonstrated advanced miniaturization (T:V ratio <2:1). In our study, relatively young women with chronic hair loss and CA are most frequently biopsied. Central centrifugal CA is the most common diagnosis. Local features of chronic/severe disease are seen microscopically. Clinical impression of scarring/nonscarring correlates well with histopathology.
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Affiliation(s)
- Jonathan D Ho
- Division of Dermatology, Department of Medicine, The University of the West Indies, Kingston, Jamaica W.I.; and
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
| | - Chico J Collie
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
| | - Sherri-Ann Spencer
- Department of Pathology, The University of the West Indies, Kingston, Jamaica W.I
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10
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases. J Clin Med 2023; 12:jcm12093259. [PMID: 37176700 PMCID: PMC10179687 DOI: 10.3390/jcm12093259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.
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Affiliation(s)
- Misaki Kinoshita-Ise
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
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11
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[Translated article] Trichoscopy: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T327-T333. [PMID: 36848957 DOI: 10.1016/j.ad.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/18/2022] [Indexed: 02/27/2023] Open
Abstract
Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.
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12
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Sosh D, Chung C, Kaffenberger J. Alopecia of the crown and midline scalp. Int J Dermatol 2023; 62:35-36. [PMID: 35717593 DOI: 10.1111/ijd.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/22/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel Sosh
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine Chung
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Kaffenberger
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Beyond the Hot Comb: Updates in Epidemiology, Pathogenesis, and Treatment of Central Centrifugal Cicatricial Alopecia from 2011 to 2021. Am J Clin Dermatol 2023; 24:81-88. [PMID: 36399228 DOI: 10.1007/s40257-022-00740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia that predominantly affects middle-aged women of African descent. Recent data suggest a multifactorial etiology of CCCA that is influenced by environmental and genetic factors. Emerging evidence regarding the genetic basis of the condition may elucidate new therapies. While topical and intralesional steroids and tetracycline antibiotics are the mainstay of treatment, refractory cases may be considered for hair transplantation. Emerging therapies using platelet-rich plasma, botanical formulas, and cosmetic procedures have shown promising results for the future management of CCA. As recent notable advances in CCCA have been achieved, this review provides an update on the epidemiology, pathophysiology, and management of CCCA.
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14
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Fernández-Domper L, Ballesteros-Redondo M, Vañó-Galván S. Trichoscopy: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:327-333. [PMID: 36574917 DOI: 10.1016/j.ad.2022.12.003] [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: 09/21/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022] Open
Abstract
Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and fibrosing frontal alopecia.
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Affiliation(s)
- L Fernández-Domper
- Servicio de Dermatología, Hospital Clínico Universitario, Valencia, España.
| | | | - S Vañó-Galván
- Unidad de Tricología, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, España; Unidad de Tricología y Trasplante Capilar, Clínica Grupo Pedro Jaén, Madrid, España
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15
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Zhang Z, Li W, Chang D, Wei Z, Wang E, Yu J, Xu Y, Que Y, Chen Y, Fan C, Ma B, Zhou Y, Huan Z, Yang C, Guo F, Chang J. A combination therapy for androgenic alopecia based on quercetin and zinc/copper dual-doped mesoporous silica nanocomposite microneedle patch. Bioact Mater 2022; 24:81-95. [PMID: 36582348 PMCID: PMC9772573 DOI: 10.1016/j.bioactmat.2022.12.007] [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: 09/20/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
A nanocomposite microneedle (ZCQ/MN) patch containing copper/zinc dual-doped mesoporous silica nanoparticles loaded with quercetin (ZCQ) was developed as a combination therapy for androgenic alopecia (AGA). The degradable microneedle gradually dissolves after penetration into the skin and releases the ZCQ nanoparticles. ZCQ nanoparticles release quercetin (Qu), copper (Cu2+) and zinc ions (Zn2+) subcutaneously to synergistically promote hair follicle regeneration. The mechanism of promoting hair follicle regeneration mainly includes the regulation of the main pathophysiological phenomena of AGA such as inhibition of dihydrotestosterone, inhibition of inflammation, promotion of angiogenesis and activation of hair follicle stem cells by the combination of Cu2+ and Zn2+ ions and Qu. This study demonstrates that the systematic intervention targeting different pathophysiological links of AGA by the combination of organic drug and bioactive metal ions is an effective treatment strategy for hair loss, which provides a theoretical basis for development of biomaterial based anti-hair loss therapy.
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Affiliation(s)
- Zhaowenbin Zhang
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Wenbo Li
- Department of Plastic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200025, PR China
| | - Di Chang
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Fudan University, Shanghai, 200433, PR China
| | - Ziqin Wei
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Endian Wang
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Jing Yu
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Yuze Xu
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Yumei Que
- Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China
| | - Yanxin Chen
- Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China
| | - Chen Fan
- Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China
| | - Bing Ma
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Yanling Zhou
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Zhiguang Huan
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Chen Yang
- Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China,Corresponding author.
| | - Feng Guo
- Department of Plastic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200025, PR China,Corresponding author.
| | - Jiang Chang
- State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China,Wenzhou Institute, University of Chinese Academy of Sciences, Zhejiang, 325000, PR China,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, PR China,Corresponding author. State Key Laboratory of High-Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, PR China.
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16
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Gómez-Zubiaur A, Valenzuela C, Andrés-Lencina JJ, Rodríguez-Villa A, Ricart JM. Algorithm proposal for hair transplantation in fibrosing alopecia pattern distributidon. J Cosmet Dermatol 2022; 21:5543-5545. [PMID: 35621250 DOI: 10.1111/jocd.15124] [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: 03/25/2022] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 12/27/2022]
Abstract
Fibrosing alopecia pattern distribution (FAPD) is a recently described disease, wherein the clinical, trichoscopic, and histologic characteristics of non-scarring alopecia, such as androgenic alopecia, and lichenoid inflammatory cicatricial alopecia are reported. The lack of uniformity in the diagnostic criteria can result in FAPD overdiagnosis. The characteristic findings of loss of follicular openings on trichoscopy and fibrosis on histopathology are crucial, as they are necessary to diagnose cicatricial inflammatory lichenoid alopecias. Â Hair transplantation in FAPD can be controversial. The scarce publications in this realm do not reach a clear consensus in favor or against the surgical approach. Thus, the presence of histological lichenoid inflammatory infiltrates could make this therapeutic option less suitable. There have been few reports on hair transplantation in other lymphocytic lichenoid inflammatory alopecias, such as lichen planus pilaris (LPP) and frontal fibrosing alopecia (FFA) Â Based on those data, an algorithm for the indication of hair transplantation in FAPD is proposed. The algorithm optimizes the results of the treatment and achieves the greatest coverage of the alopecic area.
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Affiliation(s)
- Alba Gómez-Zubiaur
- Trichology Unit, Instituto Médico Ricart, Madrid and Valencia, Spain.,Dermatology Service, Príncipe de Asturias Hospital, University of Alcala, Madrid, Spain
| | | | | | - Ana Rodríguez-Villa
- Trichology Unit, Instituto Médico Ricart, Madrid and Valencia, Spain.,Dermatology Service, Príncipe de Asturias Hospital, University of Alcala, Madrid, Spain
| | - Jose MarÍa Ricart
- Trichology Unit, Instituto Médico Ricart, Madrid and Valencia, Spain
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17
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Senna MM, Peterson E, Jozic I, Chéret J, Paus R. Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons. JID INNOVATIONS 2022; 2:100113. [PMID: 35521043 PMCID: PMC9062486 DOI: 10.1016/j.xjidi.2022.100113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/06/2023] Open
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary, lymphocytic cicatricial hair loss disorders. These model epithelial stem cell (SC) diseases are thought to result from a CD8+ T-cell‒dominated immune attack on the hair follicle (HF) SC niche (bulge) after the latter has lost its immune privilege (IP) for as yet unknown reasons. This induces both apoptosis and pathological epithelial‒mesenchymal transition in epithelial SCs, thus depletes the bulge, causes fibrosis, and ultimately abrogates the HFs' capacity to regenerate. In this paper, we synthesize recent progress in LPP and FFA pathobiology research, integrate our limited current understanding of the roles that genetic, hormonal, environmental, and other factors may play, and define major open questions. We propose that LPP and FFA share a common initial pathobiology, which then bifurcates into two distinct clinical phenotypes, with macrophages possibly playing a key role in phenotype determination. As particularly promising translational research avenues toward direly needed progress in the management of these disfiguring, deeply distressful cicatricial alopecia variants, we advocate to focus on the development of bulge IP and epithelial SC protectants such as, for example, topically effective, HF‒penetrating and immunoinhibitory preparations that contain tacrolimus, peroxisome proliferator-activated receptor-γ, and/or CB1 agonists.
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Key Words
- 5ARI, 5α-reductase inhibitor
- AA, alopecia areata
- AGA, androgenetic alopecia
- CRH, corticotropin-releasing hormone
- EMT, epithelial‒mesenchymal transition
- FFA, frontal fibrosing alopecia
- HF, hair follicle
- IP, immune privilege
- K, keratin
- KC, keratinocyte
- LPP, lichen planopilaris
- MAC, macrophage
- MHC, major histocompatibility complex
- PCA, primary cicatricial alopecia
- PCP, personal care product
- PPAR-γ, peroxisome proliferator–activated receptor-γ
- SC, stem cell
- SP, substance P
- eHFSC, epithelial hair follicle stem cell
- α-MSH, α-melanocyte-stimulating hormone
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Affiliation(s)
- Maryanne Makredes Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Erik Peterson
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivan Jozic
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jérémy Chéret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,CUTANEON, Hamburg, Germany
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18
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Diehl KL, Erickson CP, Calame A, Cohen PR. Frontal Fibrosing Alopecia Mimicking Alopecia Syphilitica. Cureus 2022; 14:e21901. [PMID: 35265425 PMCID: PMC8898542 DOI: 10.7759/cureus.21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Frontal fibrosing alopecia is lymphocytic scarring alopecia most commonly affecting postmenopausal women. Alopecia syphilitica, an uncommon manifestation of secondary syphilis, is characterized as a nonscarring and non-inflammatory hair loss that primarily affects the scalp. Frontal fibrosing alopecia has a classic pattern of hair loss involving regression of frontotemporal hair; it also may affect the eyebrows or other sites of the body. The typical patterns of frontal fibrosing alopecia are characterized as diffuse and linear. In addition, patients with frontal fibrosing alopecia can have atypical signs and patterns of hair loss. The atypical signs and patterns of frontal fibrosing alopecia are the androgenetic-like pattern, clown alopecia pattern, cockade-like pattern, doll hairline sign, lonely hair sign, ophiasis-like pattern, pseudo-fringe sign, and upsilon pattern. We observed a woman with a traditional pattern of frontal fibrosing alopecia whose hair loss involved the frontotemporal scalp areas; however, she also had hair loss in the occipital scalp that appeared similar to the moth-eaten alopecia of alopecia syphilitica. Her rapid plasma reagin was negative and the biopsies from her frontal scalp and occipital scalp both showed scarring alopecia consistent with frontal fibrosing alopecia. Her alopecia persisted with conservative treatment, and she returned to wearing a wig. Alopecia syphilitica-like pattern of hair loss can be added to the other atypical patterns of alopecia that may potentially be observed in a patient with frontal fibrosing alopecia.
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19
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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: 7] [Impact Index Per Article: 2.3] [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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20
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Trüeb RM, Starace MVR, Piraccini BM, Rezende HD, Reis Gavazzoni Dias MF. Trichodynia Revisited. Skin Appendage Disord 2021; 7:449-453. [PMID: 34901175 PMCID: PMC8613582 DOI: 10.1159/000517463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findings. The respective studies failed to demonstrate correlations between trichodynia and quantifiable hair loss activity, nor histopathologic evidence for follicular inflammation. A symptomatic scalp is a frequent condition in specific dermatological conditions of the scalp. By definition of exclusion, we are not dealing with trichodynia in these cases. It is conceivable that neuropeptides are key players between the central nervous system and the skin immune and microvascular system. Such mechanisms would explain the noxious effects of both external stimuli and emotional distress in eliciting cutaneous nociception. Since we have begun to understand the diverse etiologies of trichodynia, and a single term does not measure up to this circumstance, it may be wiser to describe the condition depending on the type of scalp sensation and its specific disease association. Further studies are warranted into the neural/endothelial/follicular interactions both in hair growth and shedding and the psychosomatic diseases of the hair and scalp.
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Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland
| | - Michela V R Starace
- Department of Experimental, Dermatology -IRCCS Policlinico di Sant'Orsola, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Dermatology -IRCCS Policlinico di Sant'Orsola, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Centro de Ciências Médicas, Hospital Universitário Antonia Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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21
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Meyer-Gonzalez T, Bacqueville D, Grimalt R, Mengeaud V, Piraccini BM, Rudnicka L, Saceda-Corralo D, Vogt A, Vano-Galvan S. Current controversies in trichology: a European expert consensus statement. J Eur Acad Dermatol Venereol 2021; 35 Suppl 2:3-11. [PMID: 34668238 DOI: 10.1111/jdv.17601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hair disorders are one of the most common conditions within dermatology practice but, although new diagnostic tools and therapeutic options have arisen, the management of these patients still represents a major clinical challenge. OBJECTIVE This study aimed at gathering information and achieving consensus on relevant recommendations on the latest advances in alopecia, trichoscopy and hair dermocosmetics. METHODS Experts of the steering committee consulted the available evidence on trichology-related areas from the past 5 years and formulated recommendations based on the evidence and their experience. A modified two-round Delphi procedure was performed among 45 European dermatologists experts in trichology to consult their degree of agreement on twenty recommendations, using a 4-point Likert scale. Consensus was defined as >80% of participants scoring either 1 (totally agree) or 2 (agree). RESULTS In the first round of the Delphi questionnaire, 75% of the recommendations reached consensus. Those that were not agreed upon were reformulated by the steering committee and voted again after an online meeting, where consensus was achieved in all recommendations. CONCLUSIONS All recommendations reached consensus after the two-round Delphi questionnaire and may be useful in clinical practice for dermatologists. The participants agreed that besides this consensus, further clinical studies are needed to assess the benefits of the emerging tools and treatments and to clarify the controversies that still exist in the field, aiming at improving patients' quality of life.
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Affiliation(s)
- T Meyer-Gonzalez
- Trichology Unit, Dermatology Service Hospital Dr. Gálvez, Malaga, Spain
| | - D Bacqueville
- Pierre Fabre Laboratories, Centre R&D Pierre Fabre Toulouse, Toulouse, France
| | - R Grimalt
- Department of Dermatology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - V Mengeaud
- Pierre Fabre Laboratories, Centre R&D Pierre Fabre Toulouse, Toulouse, France
| | - B M Piraccini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - D Saceda-Corralo
- Trichology Unit, #TricoHRC Research Group, Dermatology Service, IRYCIS, Ramon y Cajal Hospital, University of Alcala, Madrid, Spain
| | - A Vogt
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - S Vano-Galvan
- Trichology Unit, #TricoHRC Research Group, Dermatology Service, IRYCIS, Ramon y Cajal Hospital, University of Alcala, Madrid, Spain
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22
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Distinctive age distribution and hair loss pattern putatively highlighting uniqueness of Japanese cases of fibrosing alopecia in a pattern distribution. J Dermatol 2021; 49:106-117. [PMID: 34536235 DOI: 10.1111/1346-8138.16155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/08/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023]
Abstract
Fibrosing alopecia in a pattern distribution (FAPD) is a unique entity which presents clinicopathological characteristics of both male/female pattern androgenetic alopecia (AGA) and lichen planopilaris (LPP). This entity was first reported in 2000 and its criteria was recently proposed. Etiopathogenesis of FAPD has been speculated to be immunological destruction involving miniaturized hair follicles but still remains elusive. To date, few Asian FAPD cases have been reported in the literature. In this study, Japanese FAPD cases were identified based on the aforementioned criteria and analyzed to delineate clinicopathological characteristics. By retrospectively revisiting medical records and clinical photographs, 24 Japanese cases comprising 17 women and seven men were diagnosed as FAPD. All male patients had disease onset by their early 30s, whereas most female patients had developed the condition in middle age or later. Their initial diagnoses prior to the diagnostic confirmation of FAPD were mostly LPP. Based on the clinical phenotypes, the cases were categorized into AGA and LPP types. These subtypes were characterized by foremost trichoscopic and histopathological findings of AGA or LPP, respectively. Unlike previously reported cases, our patients tended to manifest hair loss in both vertex and frontal to mid-scalp with minimal regression of anterior hairline, manifesting unique "parachute" pattern, which has been reported as a representative characteristic of East Asian AGA in the literature. Anti-inflammatory therapies seemed to be effective to deter hair loss but insufficient to achieve improvement. Further accumulation of the cases is necessary; however, these findings may provide additional pathophysiological insights into FAPD and highlight uniqueness of the etiology and clinical phenotype of Japanese FAPD putatively influenced by racial predispositions.
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Affiliation(s)
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
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23
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Özcan D, Vural AT, Özen Ö. Two cases of fibrosing alopecia in a patterned distribution after coronavirus disease 2019. Indian J Dermatol Venereol Leprol 2021; 87:848-850. [PMID: 34491674 DOI: 10.25259/ijdvl_204_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Deren Özcan
- Department of Dermatology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Ayşe Tunçer Vural
- Department of Dermatology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Özlem Özen
- Department of Pathology, Faculty of Medicine, Başkent University, Ankara, Turkey
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24
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Tsiogka A, Laimer M, Ahlgrimm-Siess V. Trichoscopy-assisted hair pull test: A helpful adjunct to trichoscopy for diagnosing and managing alopecias. Australas J Dermatol 2021; 62:e602-e605. [PMID: 34309870 PMCID: PMC9292700 DOI: 10.1111/ajd.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Aikaterini Tsiogka
- Faculty of Medicine, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Laimer
- Department of Dermatology and Allergology, University Hospital and Paracelsus Private Medical University, Salzburg, Austria
| | - Verena Ahlgrimm-Siess
- Department of Dermatology and Allergology, University Hospital and Paracelsus Private Medical University, Salzburg, Austria
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25
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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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26
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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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27
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Bhoyrul B. A simple technique to distinguish fibrosing alopecia in a pattern distribution from androgenetic alopecia and concomitant seborrheic dermatitis. J Am Acad Dermatol 2021; 86:163-165. [PMID: 33440218 DOI: 10.1016/j.jaad.2020.12.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/20/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia.
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28
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Fernandez-Flores A, Hermosa-Gelbard A, Novo-Lens R. Lichen-planopilaris-like scarring pattern in a patient with alopecia and pityriasis rubra pilaris. J Cutan Pathol 2020; 48:133-139. [PMID: 32949041 DOI: 10.1111/cup.13879] [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: 03/16/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
Pityriasis rubra pilaris (PRP) is an erythematous-desquamative dermatitis that is sometimes associated with non-scarring alopecia. Despite the fact that the disease can be disfiguring, scarring alopecia has rarely been described in this disease. Here, we present a 69-year-old woman who developed an erythrodermic episode of PRP associated with telogen effluvium that left an area of persistent alopecia of the scalp and resulted in hair loss in the eyebrows. The biopsy of that area of the scalp demonstrated a scarring alopecia with lichen-planopilaris-like features. Despite this histopathology, the alopecia responded well to treatment. This finding expands the context in which lichen planopilaris features can be found and demonstrates their good prognosis under early treatment.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain.,Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | - Angela Hermosa-Gelbard
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Dermatology Department, Hospital Universitario Quirón San José, Madrid, Spain.,Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Raquel Novo-Lens
- Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
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29
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Panchaprateep R, Ruxrungtham P, Chancheewa B, Asawanonda P. Clinical characteristics, trichoscopy, histopathology and treatment outcomes of frontal fibrosing alopecia in an Asian population: A retro-prospective cohort study. J Dermatol 2020; 47:1301-1311. [PMID: 32710515 DOI: 10.1111/1346-8138.15517] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
Frontal fibrosing alopecia (FFA) is a distinctive lymphocytic scarring alopecia with rapid increase in prevalence. Most FFA series are retrospectively reported from Caucasians with only few from Asians. The objective of this study was to characterize the clinical, trichoscopic and histopathological findings as well as treatment outcomes. This was a retro-prospective cohort study of patients diagnosed with FFA from 1 January 2010 to 1 November 2019. All patients were asked to present for re-examination. Clinical, trichoscopic, histopathological and laboratory data were recorded. A questionnaire was used to investigate hair care, hairstyle and facial skin care compared with age-matched normal controls. Multivariate analysis was performed in order to clarify factors associated with severity. All 58 FFA patients were female, of whom 27.6% were premenopausal, 37.7% had a history of surgical menopause, 13.8% had thyroid diseases, 69% had eyebrow loss and 32.8% facial papules. On physical examination, 10.3% showed linear pattern, 46.6% diffuse pattern and 43.1% pseudo-fringe sign. Concomitant lichen planopilaris was found in 25.9%, lichen planus pigmentosus in 24.1% and female pattern hair loss in 48.3%. The most common trichoscopic characteristics in the frontal hairline were lack of follicular ostia (91.4%), perifollicular scales (79.3%) and perifollicular erythema (63.8%). Up to 90% of patients reported FFA as improved or stable after receiving antiandrogen (finasteride or dutasteride) or antimalarial with topical treatment. Multivariate analyses revealed that facial lentiginous macules and trichoscopic perifollicular erythema at the frontal area were FFA severity-associated factors. "Front puff" Thai hairstyle was associated with FFA, while sunscreens and other cosmetic products were not. In conclusion, diffuse and pseudo-fringe sign pattern are common in Asian FFA. The most common autoimmune systemic comorbidity is thyroid disease, while common concomitant dermatological diseases are female pattern hair loss, lichen planopilaris and lichen planus pigmentosus. Antiandrogens or antimalarial plus topical treatment are the most useful therapy.
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Affiliation(s)
- Ratchathorn Panchaprateep
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pariya Ruxrungtham
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bussabong Chancheewa
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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