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Luo X, Ni X, Zhi J, Jiang X, Bai R. Small molecule agents against alopecia: Potential targets and related pathways. Eur J Med Chem 2024; 276:116666. [PMID: 39002436 DOI: 10.1016/j.ejmech.2024.116666] [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: 05/14/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.
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Affiliation(s)
- Xinyu Luo
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xinhua Ni
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Jia Zhi
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Xiaoying Jiang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China
| | - Renren Bai
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, PR China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, 311121, PR China.
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2
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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024; 25:735-764. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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3
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Couppoussamy KI, Devanda R. Dermoscopic Features of Dermatitis Cruris Pustulosa et Atrophicans: A Retrospective Study from a Tertiary Care Center in South India. Indian Dermatol Online J 2024; 15:801-804. [PMID: 39359285 PMCID: PMC11444451 DOI: 10.4103/idoj.idoj_855_23] [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: 11/15/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 10/04/2024] Open
Abstract
Background Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic superficial folliculitis that can cause scarring alopecia if left untreated. Hardly any studies are there describing the dermoscopic features of DCPA. Dermoscopy can be a useful tool for diagnosing DCPA in addition to clinical and histopathological features and for differentiating other conditions like superficial folliculitis, folliculitis decalvans, and pseudofolliculitis. Aims/Objectives The aim of this retrospective study was to describe the dermoscopic features of 30 patients with DCPA at a tertiary care center in South India. Materials and Methods A retrospective study of clinical and biopsy-proven cases of DCPA at a tertiary care center in South India. Results Thirty patients of DCPA of skin phototype IV or V were studied. Male preponderance of DCPA was noted in our study. Lower extremities 28 (93.3%) and upper extremities 2 (6.7%) were the common sites of involvement. The most common findings noted in dermoscopy were follicular-based pustules in 30 (100%) patients, follicular white structureless area in 16 (53.3%), perifollicular collarette of scales in 12 (40%), diffuse background dotted blood vessels in 12 (40%), and the absence of follicular orifices in 12 (40%). Other findings were yellow or hemorrhagic scales, perifollicular linear white lines, broken hair, and perifollicular dotted blood vessels. Pigmentary patterns observed were dark brown pigmentation, blue-grey globules, blue-grey dots, and accentuation of the pigmentary network. Limitations The limitations of the study were the retrospective nature of the study, the small sample size, and the lack of a comparison group. Conclusion The predominant dermoscopic features observed in our patients were follicular-based pustules, follicular white structureless areas, perifollicular collarette of scales, diffuse background dotted blood vessels, and the absence of follicular orifices. Vascular and pigmentary patterns were less commonly noted.
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Affiliation(s)
- Kanmani Indra Couppoussamy
- Department of Dermatology and STD, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Rajendra Devanda
- Department of Dermatology and STD, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India
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Samra T, Miteva M. Linear Alopecia in a Healthy Young Woman: Answer. Am J Dermatopathol 2024; 46:128-129. [PMID: 38275239 DOI: 10.1097/dad.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Tara Samra
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
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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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Starace M, Piraccini BM, Carpanese MA, Iorizzo M, Apalla Z. Folliculitis-Decalvans Like Alopecia During Treatment with EGFR Inhibitors for Lung Cancer: A Case Series of 6 Patients. Dermatol Pract Concept 2023; 13:e2023180. [PMID: 37557165 PMCID: PMC10412076 DOI: 10.5826/dpc.1303a180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Michela Starace
- Dermatology Unit - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Miriam Anna Carpanese
- Dermatology Unit - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Zoe Apalla
- Second Dermatology Department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Greece
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Ding L, DeGiovanni JC, Bogner P, Soofi Y. Giant cutaneous squamous cell carcinoma of the scalp arising in the setting of folliculitis decalvans. BMJ Case Rep 2022; 15:e247932. [PMID: 35260404 PMCID: PMC8905879 DOI: 10.1136/bcr-2021-247932] [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] [Accepted: 02/11/2022] [Indexed: 11/03/2022] Open
Abstract
Squamous cell carcinoma (SCC) is uncommon in African Americans (AAs), with an incidence of approximately 0.003%. However, it is the most common skin cancer in that patient population. In AAs, SCC typically arises in sun-protected areas and mainly affects patients older than 50 years. We report a case of giant SCC in an AA man in his 40s with long-standing folliculitis decalvans on the scalp. Three previous skin biopsies were inconclusive. A wide excision was performed and the defect was reconstructed with an anterolateral thigh free flap. Histological analysis of the resected specimen revealed a well-moderately differentiated keratinising SCC with clear cell changes, severe mixed inflammation, folliculitis and dermal scar. He was discharged 2 weeks later and has been followed up closely. Four months later, the patient presents with metastatic SCC to an occipital lymph node.
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Affiliation(s)
- Liang Ding
- Department of Pathology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jason C DeGiovanni
- Department of Otolaryngology - Head and Neck Surgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Paul Bogner
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Yousef Soofi
- Department of Pathology, State University of New York at Buffalo, Buffalo, New York, USA
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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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Rahbar Z, Cohen JN, McCalmont TH, LeBoit PE, Connolly MK, Berger T, Pincus LB. Cicatricial Pemphigoid Brunsting-Perry Variant Masquerading as Neutrophil-Medicated Cicatricial Alopecia. J Cutan Pathol 2021; 49:408-411. [PMID: 34841567 DOI: 10.1111/cup.14177] [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: 07/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
A 72-year-old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy was interpreted to represent a neutrophil-mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis demonstrated linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes and plasma cells and prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting-Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil-rich form of cicatricial pemphigoid can masquerade as a neutrophil-mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil-mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ziba Rahbar
- Department of Pathology, Loma Linda University Health, Loma Linda, California
| | - Jarish N Cohen
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Philip E LeBoit
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - M Kari Connolly
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Laura B Pincus
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
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Erosive Pustular Dermatosis of the Scalp: A Clinicopathologic Study of Fifty Cases. Dermatopathology (Basel) 2021; 8:450-462. [PMID: 34698128 PMCID: PMC8544368 DOI: 10.3390/dermatopathology8040048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 12/25/2022] Open
Abstract
Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder.
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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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Matard B, Cavelier Balloy B, Assouly P, Reygagne P. It has the Erythema of a Lichen Planopilaris, it has the Hyperkeratosis of a Lichen Planopilaris, but it is Not a Lichen Planopilaris: About the "Lichen Planopilaris-Like" Form of Folliculitis Decalvans. Am J Dermatopathol 2021; 43:235-236. [PMID: 32769552 DOI: 10.1097/dad.0000000000001758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruno Matard
- Centre Sabouraud, Hôpital Saint-Louis, Paris, France ; and
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