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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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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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[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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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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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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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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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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