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Kim SR, Yu DA, Cho SI, Kwon O. Association of Primary Cicatricial Alopecia with Subsequent Cardiovascular Disease. J Invest Dermatol 2024; 144:1166-1169. [PMID: 37989400 DOI: 10.1016/j.jid.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Da-Ae Yu
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | | | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Republic of Korea.
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Lyakhovitsky A, Zilbermintz T, Segal Z, Galili E, Shemer A, Jaworowski B, Baum S, Hermush V, Kaplan B, Barzilai A. Exploring Remission Dynamics and Prognostic Factors in Lichen Planopilaris: A Retrospective Cohort Study. Dermatology 2024; 240:531-542. [PMID: 38574470 DOI: 10.1159/000538355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/10/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Lichen planopilaris (LPP) is a common type of primary cicatricial alopecia. Previous studies focused on the epidemiology, clinical characteristics, and treatment of LPP. A lack of knowledge regarding LPP outcomes and prognostic factors remained. METHODS To delineate the rate and timing of remission in LPP, as well as the prognostic factors for achieving remission, a retrospective cohort study was conducted. The study included 126 patients, from a single tertiary center, diagnosed with LPP between January 2010 and December 2022, who were followed up for a minimum of 6 months. RESULTS There were 89 (70.6%) women and 37 (29.4%) men included in this study. The mean age of the patients was 47.92 ± 14.2 years. The mean time from disease onset to diagnosis was 33.85 (±30) months, indicating significant diagnostic delays. The mean duration of follow-up was 34.13 ± 22.7 months. Among the cohort, 43 patients achieved complete remission (CR) during the follow-up period, whereas 83 patients did not. Of the 83 patients who did not achieve CR, 35 partially improved and 48 did not improve or worsened. The median time for achieving CR was 46 ± 18.8 months. Milder disease at presentation and comorbid lichen planus were associated with higher CR rates. CONCLUSION This study demonstrates significant diagnostic delays that should be addressed as LPP causes irreversible alopecia, suggests disease severity and comorbid lichen planus as potential prognostic factors. Further, it emphasizes the limited efficacy of current treatments and the need for prolonged treatment in patients with LPP to achieve remission.
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Affiliation(s)
- A Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zilbermintz
- Education authority, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Z Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - E Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel,
| | - A Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Jaworowski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V Hermush
- Laniado Medical Center, Adelson School of Medicine, Ariel University, Ariel, Israel
| | - B Kaplan
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - A Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Yu DA, Kim SR, Cho SI, Kwon O. Endocrine and metabolic comorbidities in primary cicatricial alopecia: A nationwide population-based study. J Dermatol 2024; 51:429-440. [PMID: 38111374 DOI: 10.1111/1346-8138.17080] [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: 09/07/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
Primary cicatricial alopecia (PCA) is a rare, scarring, hair loss disorder. Due to its low incidence, little is known about endocrine and metabolic comorbidities in patients with PCA. Thus, we aimed to investigate the association between PCA and endocrine and metabolic disorders. This nationwide, population-based, cross-sectional study included patients diagnosed with PCA or non-cicatricial alopecia (NCA) and normal individuals without history of alopecia registered in the Korean National Health Insurance Service database between January 1, 2011, and December 31, 2020. We calculated the odds ratios of endocrine and metabolic comorbidities of patients with PCA compared to all patients or age- and sex-matched patients with NCA or normal individuals using multivariable logistic regression models. A total of 3 021 483 individuals (mean age [SD], 38.7 [15.0] years, 1 607 380 [53.2%] men), including 11 956 patients with PCA, 601 852 patients with NCA, and 2 407 675 normal participants, were identified. Patients with PCA had an increased risk for dyslipidemia (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.06-1.24), diabetes (aOR 1.38, 95% CI 1.24-1.53), and hypertension (aOR 1.10, 95% CI 1.02-1.19) compared to matched patients with NCA. Regarding PCA subtypes, lichen planopilaris/frontal fibrosing alopecia was positively associated with hypothyroidism (aOR 2.03, 95% CI 1.44-2.86) compared to NCA. Folliculitis decalvans and dissecting cellulitis were positively associated with dyslipidemia (aOR 1.16, 95% CI 1.05-1.28 and aOR 1.16, 95% CI 1.04-1.29, respectively), diabetes (aOR 1.38, 95% CI 1.20-1.58 and aOR 1.52, 95% CI 1.32-1.74, respectively), and hypertension (aOR 1.10, 95% CI 1.00-1.20 and aOR 1.14, 95% CI 1.02-1.27, respectively). Similar trends were observed when each PCA subgroup was compared with the normal control group. This study demonstrates that patients with PCA are more likely to have endocrine and metabolic comorbidities than patients without PCA. Further research on these comorbidities may improve the understanding of PCA.
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Affiliation(s)
- Da-Ae Yu
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnoseverzögerung, komorbide Hidradenitis suppurativa und die prognostische Bedeutung bakterieller Kulturen bei Folliculitis decalvans: eine Kohortenstudie. J Dtsch Dermatol Ges 2023; 21:1469-1478. [PMID: 38082530 DOI: 10.1111/ddg.15202_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 12/18/2023]
Abstract
ZusammenfassungHintergrundFolliculitis decalvans (FD) ist eine primäre neutrophile vernarbende Alopezie, die häufig zu irreversiblem Haarverlust führt. Daten zu Epidemiologie, klinischen Merkmalen, Folgen und prognostischen Faktoren sind nur eingeschränkt verfügbar.ZielDie Beurteilung einer Patientenkohorte mit FD sowie die Charakterisierung schwerer Krankheitsverläufe und prognostischer Faktoren, die eine Remission verhindern.Patienten und MethodenDiese retrospektive Kohortenstudie umfasste 192 Patienten, bei denen zwischen 2010 und 2020 an einem tertiären Zentrum eine FD diagnostiziert und die mindestens sechs Monate nachverfolgt wurden.ErgebnisseDie Diagnose wurde im Mittel um 22,2 (± 29,7) Monate verzögert gestellt. Komorbide Erkrankungen mit Okklusion der Haarfollikel waren häufig. In 45,6% der Fälle waren Bakterienkulturen positiv, am häufigsten mit Staphylococcus (S.) aureus. Schwere Krankheitsverläufe waren mit komorbider Hidradenitis suppurativa und positiver Bakterienkultur, insbesondere S. aureus, assoziiert. Bei 50,7% der Patienten kam es zu vollständiger Remission: Bei 32% innerhalb der ersten sechs Monate der Behandlung und bei 18,7% während der Nachkontrolle. Rezidive waren häufig. Negative Prognosefaktoren bezüglich der Remission waren jüngeres Alter und positive Bakterienkultur.SchlussfolgerungenEs besteht Bedarf hinsichtlich der Ausbildung von Dermatologen, um die Diagnoseverzögerung zu reduzieren. Das Screening von FD‐Patienten auf komorbide Hidradenitis suppurativa und Bakterienkulturen sind wichtig für die Behandlungsplanung.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: A cohort study. J Dtsch Dermatol Ges 2023; 21:1469-1477. [PMID: 37875786 DOI: 10.1111/ddg.15202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Folliculitis decalvans (FD) is a type of primary neutrophilic cicatricial alopecia often leading to irreversible hair loss. Data on its epidemiology, clinical features, outcomes, and prognostic factors are limited. OBJECTIVE To evaluate a cohort of patients with FD and identify characteristics of severe disease and prognostic factors which impede remission. PATIENTS AND METHODS This retrospective cohort study included 192 patients diagnosed with FD and followed for at least six months at a tertiary center between 2010 and 2020. RESULTS There was a diagnostic delay averaging 22.2 (± 29.7) months. Comorbid follicular occlusion disorders were common. Bacterial cultures were positive in 45.6% of the cases, with Staphylococcus (S.) aureus being the most common pathogen. Severe disease was associated with comorbid hidradenitis suppurativa and a positive bacterial culture, particularly S. aureus. 50.7% of patients experienced complete remission: 32% within the first six months of treatment and 18.7% later during follow-up. Relapses were frequent. Negative prognostic factors for achieving remission included younger age and a positive bacterial culture. CONCLUSIONS There is a need for the education of dermatologists to reduce the diagnostic delay. Screening FD patients for comorbid hidradenitis suppurativa and obtaining bacterial cultures is important for treatment planning.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Popa A, Carsote M, Cretoiu D, Dumitrascu MC, Nistor CE, Sandru F. Study of the Thyroid Profile of Patients with Alopecia. J Clin Med 2023; 12:jcm12031115. [PMID: 36769763 PMCID: PMC9918246 DOI: 10.3390/jcm12031115] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Thyroid hormones are required for the physiological growth and maintenance of hair follicles. We aim to study the thyroid profile of patients with alopecia. This is a narrative review. PubMed literature was searched from 2013 to 2022. We followed different types of alopecia: alopecia areata (AA), androgenic alopecia in males and females, telogen effluvium (TE), frontal fibrosing alopecia (FFA), lichen planopilaris, and alopecia neoplastica (AN). AA shares a common autoimmune background with autoimmune thyroid diseases, either sporadic or belonging to autoimmune polyglandular syndromes. Some data suggested that AA is more severe if thyroid anomalies are confirmed, including subclinical dysfunction or positive antithyroid antibodies with normal hormone values. However, routine thyroid screening for patients with AA, if the patients are asymptomatic from a thyroid point of view and they have negative personal and family history of autoimmunity, remains controversial. TE, apart from the autoimmune type, associates thyroid anomalies of a hormonal assay (between 5.7% and 17%). FFA, mostly a postmenopausal entity (however, not exclusive), associates a higher prevalence of thyroid conditions (up to 50%) than the general population. However, these might have an age-dependent pattern, thus the association may be incidental since there are a limited number of studies. Overall, alopecia remains a very challenging condition for patients and physicians; a multidisciplinary team is required to improve the outcome and quality of life. The common autoimmune background is suggestive of some types of alopecia and thyroid disorders, yet, the underlying mechanisms are still a matter of debate. AA, TE, FFA, LPP, and, potentially, female pattern hair loss have been found to be connected with thyroid entities, thus a state of awareness from a dual perspective, of trichology and endocrinology, is helpful.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila University” of Medicine and Pharmacy & “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy & “C.I. Parhon” National Institute of Endocrinology, 011461 Bucharest, Romania
- Correspondence:
| | - Dragos Cretoiu
- Department of Cellular and Molecular Biology, and Histology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy & National Institute for Mother and Child Health Alessandrescu-Rusescu, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy & University Emergency Hospital, 011461 Bucharest, Romania
| | - Claudiu-Eduard Nistor
- Department 4–Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy & Thoracic Surgery Department, “Carol Davila” Central Emergency University Military Hospital, 011461 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila University” of Medicine and Pharmacy & “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Lyakhovitsky A, Tzanani I, Gilboa S, Segal O, Galili E, Baum S, Barzilai A. Changing spectrum of hair and scalp disorders over the last decade in a tertiary medical centre. J Eur Acad Dermatol Venereol 2023; 37:184-193. [PMID: 36066315 DOI: 10.1111/jdv.18570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hair- and scalp-related disorders (HSRDs) encompass a wide range of conditions that affect people of all ages. OBJECTIVE To evaluate the workload and trends in HSRDs at an outpatient dermatological clinic in a tertiary medical centre over a 10-year period. METHODS Medical records for HSRD visits to the outpatient dermatology clinic at the Sheba Medical Center, an Israeli tertiary care center, were reviewed between 1 January, 2010 and 31 December, 2020. RESULTS There were 10,396 HSRD visits with a new-to-follow-up visit ratio of 1:1.9. The annual number of HSRD visits, as well as their proportion out of all dermatological outpatient visits, have increased from 295 (1.24%) in 2010 to 1726 (9.44%) in 2020. The patients' mean age was 35.3 years (women 39.5 years, men 28.8 years), age range 1-87 years. Over the decade, there was a growing predominance of women with an average female-to-male ratio of 2:1. The winter season accounted for 28.7% of annual visits, followed by the autumn (25.6%), summer (24.3%) and spring (21.4%). The most prevalent HSRDs included androgenetic alopecia (30.6%), alopecia areata (19.3%), telogen effluvium (15.4%), non-scarring folliculitis (15.4%), seborrheic dermatitis (14.9%), lichen planopilaris (7.1%) and folliculitis decalvans (6.6%). Androgenetic alopecia demonstrated the highest increase over the decade examined (from 17% to 32%). CONCLUSION HSRDs account for a significant percentage of visits at a tertiary dermatology outpatient clinic. The number of HSRD visits has increased annually over the past decade. The recent advancement in diagnosis and treatment may account, at least in part, for the growing burden of HSRDs within dermatological ambulatory care.
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Affiliation(s)
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Sarit Gilboa
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Institute of Pathology, Sheba Medical Center, Ramat-Gan, Israel
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KIM DC, CHOI YW, LEE ES, CHOI JW. No Association Between First Exposure to General Anaesthesia and Atopic Dermatitis in the Paediatric Population. Acta Derm Venereol 2022; 102:adv00813. [PMID: 36317588 PMCID: PMC9811282 DOI: 10.2340/actadv.v102.2738] [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] [Indexed: 11/16/2022] Open
Abstract
General anaesthesia could affect various immune responses, including Th1 and Th2 immunity, which might also affect cells that play an important role in the pathogenesis of atopic dermatitis. However, the relationship between general anaesthesia exposure and atopic dermatitis remains unknown. The aim of this study was to investigate the risk of developing atopic dermatitis after first exposure to general anaesthesia in the paediatric population (18 years or under). A retrospective cohort study, including those exposed (n = 7,681) and unexposed (n = 38,405; control participants) to general anaesthesia (1:5 ratio), was conducted using national sample cohort data from 2002 to 2015. All participants were followed up for 2 years after cohort entry. The 2-year cumulative incidences of atopic dermatitis in the exposed and unexposed groups were 2.3% and 2.2%, respectively. In the subgroup analysis by age, the cumulative incidence was not significantly different between these cohorts. The risks of atopic dermatitis were not significant in the exposed group in the univariate model (hazard ratio 1.05; confidence interval 0.88-1.24) and in the multivariate model, wherein all covariates were adjusted (adjusted hazard ratio, 1.03; 95% confidence interval 0.87-1.23). The results suggest that children's exposure to general anaesthesia was not associated with increased or decreased risk of atopic dermatitis.
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Affiliation(s)
- Dong Chan KIM
- Department of Dermatology, Ajou University School of Medicine, Suwon
| | - Young Woong CHOI
- Department of Anesthesia, Korea Cancer Center Hospital, Seoul, Korea
| | - Eun-So LEE
- Department of Dermatology, Ajou University School of Medicine, Suwon
| | - Jee Woong CHOI
- Department of Dermatology, Ajou University School of Medicine, Suwon
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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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Mardones F, Valenzuela K. Primary cicatricial alopecia profile in Chilean population: a retrospective study. Int J Dermatol 2021; 60:1568-1569. [PMID: 34633072 DOI: 10.1111/ijd.15942] [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: 05/09/2021] [Revised: 08/22/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Felipe Mardones
- Hospital Clínico Universidad de Chile José Joaquín Aguirre, Santiago, Chile.,Clínica Universidad de los Andes, Santiago, Chile
| | - Karen Valenzuela
- Hospital Clínico Universidad de Chile José Joaquín Aguirre, Santiago, Chile
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Lee H, Kim YC, Choi JW. Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study. PLoS One 2021; 16:e0250216. [PMID: 33961663 PMCID: PMC8104430 DOI: 10.1371/journal.pone.0250216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of hair follicles. Chronic inflammatory skin diseases such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases (HDs) remains unclear. Therefore, we conducted this retrospective cohort study to evaluate the risk of subsequent HDs in patients with AA. We reviewed 3770 cases of AA and from 18,850 age, sex, and income level-matched controls from the National Health Insurance Service-National Sample Cohort. In the subgroup analysis, patients who suffered from alopecia totalis, alopecia universalis, and ophiasis were designated as patients with severe AA and patients having the disease for over a year were designated as patients with long-standing AA. As a result, we found that AA was not associated with a higher risk of heart failure, angina pectoris, or myocardial infarction. There was no significant increase in the risk of overall HD associated with AA (adjusted hazard ratio: 1.17; 95% confidence interval: 0.93-1.48; p = 0.177). Neither the severity nor the duration of AA was related to an increased risk of HDs. During the study period, AA patients did not show a significantly higher cumulative incidence of HDs than controls (log-rank p = 0.157). In conclusion, AA does not increase the risk of HD.
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Affiliation(s)
- Heera Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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12
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Kim JC, Kim YC, Choi JW. Use of hydrochlorothiazide and risk of nonmelanoma skin cancer in Koreans: a retrospective cohort study using administrative healthcare data. Clin Exp Dermatol 2021; 46:680-686. [PMID: 33215728 DOI: 10.1111/ced.14520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The incidence of skin cancer is increasing because of the ageing population and ultraviolet exposure, and previous studies have revealed that long-term use of hydrochlorothiazide (HCTZ), an antihypertensive agent, has been associated with an increased risk of nonmelanoma skin cancer (NMSC). However, the association of NMSC and HCTZ within East Asian populations is unclear. AIM To investigate the risk of NMSC in Korean subjects using HCTZ. METHODS A retrospective cohort study was conducted using the administrative healthcare data. The study enrolled 62 243 patients exposed to HCTZ with a cumulative dose of ≥ 2500 mg and 62 243 unexposed subjects matched 1 : 1 with the patients for age, sex and income level. RESULTS There was a significant difference in the cumulative incidence of NMSC between the two groups (log-rank P < 0.01). Cox regression analysis was conducted after adjusting for potential confounders, and showed the risk for NMSC in the group exposed to HCTZ was significantly higher than that of the unexposed group (hazard ratio = 1.48; 95% CI 1.03-2.13). In the subgroup analysis, the oldest age group (≥ 70 years) showed increased cumulative incidence of NMSC with statistical significance compared with the unexposed control group (log-rank P < 0.01). CONCLUSIONS In this study, we revealed that the cumulative use of HCTZ (≥ 2500 mg) could increase the risk of NMSC in Koreans, especially the older age group. Thus, HCTZ could be a risk factor for NMSC in East Asian as well as white populations.
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Affiliation(s)
- J C Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Y C Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - J W Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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