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Aboalola D, Aouabdi S, Ramadan M, Alghamdi T, Alsolami M, Malibari D, Alsiary R. An Update on Alopecia and its Association With Thyroid Autoimmune Diseases. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:54-59. [PMID: 38187080 PMCID: PMC10769472 DOI: 10.17925/ee.2023.19.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 01/09/2024]
Abstract
Alopecia is comorbid with several illnesses, including various autoimmune conditions such as thyroid disease. Leukocyte-mediated inflammation of hair follicles in alopecia was first described over a century ago. However, the high prevalence of the role of thyroid autoimmune disease in the pathogenesis of alopecia has only recently come to light, together with a strong association between the two. Therefore, this review focuses on articles published between 2011 and 2022 on alopecia's association with thyroid autoimmune disease, and the mechanism behind it. In addition, it highlights the link between alopecia and thyroid cancer, as patients with alopecia have increased risk of thyroid cancer. In conclusion, this comprehensive, focused, scoping review will serve as a reference highlighting recent information on alopecia, exploring its association with thyroid autoimmune diseases.
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Affiliation(s)
- Doaa Aboalola
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Sihem Aouabdi
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Majed Ramadan
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Tariq Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Mona Alsolami
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Dalal Malibari
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
| | - Rawiah Alsiary
- King Abdullah International Medical Research Center, Jeddah, Western Region, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Western Region, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Western Region, Saudi Arabia
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Smith SDB, Woddor N, Cassarino DS, Chen W, Clemetson N, Nava VE. Central Centrifugal Cicatricial Alopecia Associated With PDL1 Loss and Increased Expression of Caspase 3: A Case Series. Am J Dermatopathol 2023; 45:418-422. [PMID: 37074004 DOI: 10.1097/dad.0000000000002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
ABSTRACT Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that disproportionately affects patients with skin of color. Genetic studies have revealed that approximately 30% of CCCAs are associated with peptidyl arginine deiminase 3 misfolding mutations. Patients with CCCA usually have a poor prognosis with progressive and permanent hair loss. To further characterize CCCA, we evaluated the inflammatory milieu, PDL1, and caspase 3 expression. The data support the idea of CCCA being a CD4-predominant T-cell process. The loss of PDL1 and increase in caspase 3 expression raises the possibility of involvement of the PD1/PDL1 pathway in CCCA.
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Affiliation(s)
- Shane D B Smith
- Department of Pathology, The George Washington University, Washington, DC
| | - Navitha Woddor
- Department of Pathology, The George Washington University, Washington, DC
| | - David S Cassarino
- Department of Pathology, Southern California Permanente Medical Group, Los Angeles, CA
| | - Wen Chen
- Department of Pathology, The George Washington University, Washington, DC
- Department of Pathology, Veterans Affairs Medical Center, Washington, DC; and
| | - Nashay Clemetson
- Department of Medicine, Dermatology, Veterans Affairs Medical Center, West Palm Beach, FL
| | - Victor E Nava
- Department of Pathology, The George Washington University, Washington, DC
- Department of Pathology, Veterans Affairs Medical Center, Washington, DC; and
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Pathoulas JT, Flanagan KE, Walker CJ, Collins MS, Ali S, Pupo Wiss IM, Cotsarelis G, Milbar H, Huang K, Mostaghimi A, Scott D, Han JJ, Lee KJ, Hordinsky MK, Farah RS, Bellefeuille G, Raymond O, Bergfeld W, Ranasinghe G, Shapiro J, Lo Sicco KI, Gutierrez D, Ko J, Mirmirani P, Mesinkovska N, Yale KL, Goldberg LJ, Tosti A, Gwillim EC, Goh C, Senna MM. A multicenter descriptive analysis of 270 men with frontal fibrosing alopecia and lichen planopilaris in the United States. J Am Acad Dermatol 2023; 88:937-939. [PMID: 36396001 DOI: 10.1016/j.jaad.2022.10.060] [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: 02/16/2022] [Revised: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- James T Pathoulas
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly E Flanagan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Chloe J Walker
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya S Collins
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaheir Ali
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabel M Pupo Wiss
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - George Cotsarelis
- Department of Dermatology, University of Pennsylvania, Pennsylvania, Pennsylvania
| | - Heather Milbar
- Department of Dermatology, University of Pennsylvania, Pennsylvania, Pennsylvania
| | - Kathie Huang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Deborah Scott
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jane J Han
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen J Lee
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maria K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gretchen Bellefeuille
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ora Raymond
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | | | - Jerry Shapiro
- Department of Dermatology, NYU Langone Health, New York, New York
| | | | - Daniel Gutierrez
- Department of Dermatology, NYU Langone Health, New York, New York
| | - Justin Ko
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Paradi Mirmirani
- Department of Dermatology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Natasha Mesinkovska
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Katerina L Yale
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Lynne J Goldberg
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts
| | - Antonella Tosti
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Eran C Gwillim
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Carolyn Goh
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Umar S, Kan P, Carter MJ, Shitabata P, Novosilska M. Lichen Planopilaris Responsive to a Novel Phytoactive Botanical Treatment: A Case Series. Dermatol Ther (Heidelb) 2022; 12:1697-1710. [PMID: 35674981 PMCID: PMC9276860 DOI: 10.1007/s13555-022-00749-3] [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: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Lichen planopilaris (LPP) is characterized by chronic scarring alopecia that is progressive and typically refractory to therapy. Current drug treatments are suboptimal and not applicable for long-term use because of the high potential for adverse effects, warranting safer and more effective treatment alternatives. METHODS Based on our previous success in treating a patient with central centrifugal cicatricial alopecia using a topical botanical formulation (Gashee), we reviewed records of four patients with biopsy-proven LPP treated with the topical formulation alone or in combination with its oral preparation. Three patients had failed previous treatment with intralesional steroid injections, topical minoxidil, tacrolimus, and clobetasol. Physical examination and photographic documentation were also used as outcome measures. Treatment duration with the botanical formulations ranged from 6 weeks to 9.5 months. RESULTS All patients showed overall improvement in surrogate indicators of LPP activity as evidenced by the disappearance of symptoms (pruritus, tenderness, scalp irritation, and hair shedding), improvement in hair growth, and reduction in redness. All reported a high satisfaction level and no adverse effects. CONCLUSIONS Patients with treatment-refractory LPP responded to a novel botanical treatment. To the best of our knowledge, this is the first published report of LPP responding to a plant-based natural treatment. Further evaluation of this treatment in a controlled trial with a larger number of patients is warranted.
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Affiliation(s)
- Sanusi Umar
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. .,Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA. .,Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA.
| | - Petrina Kan
- Department of Molecular Biology, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Paul Shitabata
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.,Dermatopathology Institute, Torrance, CA, USA
| | - Myroslava Novosilska
- Department of Dermatology and Oncology, Aesthetic Medical Clinic Myroslava Novosilska, Lviv, Ukraine
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Pathoulas JT, Flanagan KE, Su MY, Elmariah SB, Zhan Y, Walker CJ, Burns LJ, Manatis-Lornell A, Penzi L, Miller DD, Hordinsky MK, Senna MM. A Prospective Pilot Study of NB-UVB Treatment in Lichen Planopilaris. J Am Acad Dermatol 2022; 87:703-705. [DOI: 10.1016/j.jaad.2022.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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6
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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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7
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Abstract
This article focuses on the assessment and treatment of patients with primary cicatricial alopecia and provides new information regarding the genetics and pathophysiology of this group of diseases.
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Affiliation(s)
- Maria Hordinsky
- Department of Dermatology, University of Minnesota, 516 Delaware Street Southeast, MMC 98, Minneapolis, MN 55455, USA.
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8
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Bertolini M, McElwee K, Gilhar A, Bulfone‐Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Exp Dermatol 2020; 29:703-725. [DOI: 10.1111/exd.14155] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Kevin McElwee
- Monasterium Laboratory Münster Germany
- Centre for Skin Sciences University of Bradford Bradford UK
- Department of Dermatology and Skin Science University of British Columbia Vancouver British Columbia Canada
| | - Amos Gilhar
- Laboratory for Skin Research Rappaport Faculty of Medicine Technion‐Israel Institute of Technology Haifa Israel
| | - Silvia Bulfone‐Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
| | - Ralf Paus
- Monasterium Laboratory Münster Germany
- Centre for Dermatology Research University of Manchester and NIHR Manchester Biomedical Research Centre Manchester UK
- Dr. Philip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
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9
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Aslani FS, Sepaskhah M, Bagheri Z, Akbarzadeh-Jahromi M. Value of CD123 Immunohistochemistry and Elastic Staining in Differentiating Discoid Lupus Erythematosus from Lichen Planopilaris. Int J Trichology 2020; 12:62-67. [PMID: 32684677 PMCID: PMC7362963 DOI: 10.4103/ijt.ijt_32_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. Patients and Methods: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. Results: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). Conclusion: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.
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Affiliation(s)
- Fatemeh Sari Aslani
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Sepaskhah
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh-Jahromi
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Affiliation(s)
- Kevin J. McElwee
- Centre for Skin Sciences University of Bradford Bradford UK
- Department of Dermatology and Skin Science University of British Columbia Vancouver BC Canada
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Leonard M. Miller School of Medicine Miami FL USA
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11
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Harries M, Hardman J, Chaudhry I, Poblet E, Paus R. Profiling the human hair follicle immune system in lichen planopilaris and frontal fibrosing alopecia: can macrophage polarization differentiate these two conditions microscopically? Br J Dermatol 2020; 183:537-547. [PMID: 31883384 DOI: 10.1111/bjd.18854] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is traditionally regarded as a variant of lichen planopilaris (LPP) based on histological features. Distinct clinical presentation, demographics and epidemiology suggest that differing pathogenic factors determine the final phenotype. OBJECTIVES To map the hair follicle immune system in LPP and FFA by systematically comparing key inflammatory markers in defined hair follicle compartments. METHODS Lesional scalp biopsies from LPP and FFA and healthy controls were stained with the following immunohistochemical markers: CD1a and CD209, CD4, CD8, CD56, CD68, CD123, CXCR3, forkhead box (FOX)P3, mast cell tryptase and cKit. Macrophage polarization was explored using CD206, CD163, CD86, receptor for advanced glycation end products (RAGE), interleukin (IL)-4 and IL-13 on paired lesional and nonlesional LPP and FFA samples. RESULTS Increased numbers of CD8+ , CXCR3+ and FOXP3+ T cells and CD68+ macrophages were identified in the distal hair follicle epithelium and perifollicular mesenchyme in both LPP and FFA compared with controls. In both LPP and FFA, total and degranulated mast cells and CD123+ plasmacytoid dendritic cells were increased in the perifollicular mesenchyme adjacent to the bulge and infundibulum, whereas numbers of CD1a+ and CD209+ dendritic cells were significantly reduced in the infundibulum connective tissue sheath. However, only with CD68 staining was a significant difference between LPP and FFA identified, with greater numbers of CD68+ cells in LPP samples. Furthermore, the identified macrophage polarization markers downregulated CD86 and upregulated CD163 and IL-4 expression in lesional LPP compared with FFA samples. CONCLUSIONS This comparative immunopathological analysis is the first to profile systematically the hair follicle immune system in LPP and FFA. Our analysis highlights a potential role of macrophages in disease pathobiology and suggests that macrophage polarization may differ between LPP and FFA, allowing microscopic differentiation. Linked Comment: Kinoshita-Ise. Br J Dermatol 2020; 183:419-420.
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Affiliation(s)
- M Harries
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester, U.K.,Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - J Hardman
- Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - I Chaudhry
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, U.K
| | - E Poblet
- Department of Pathology, University General Hospital of Murcia, Murcia, Spain
| | - R Paus
- Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, U.S.A
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12
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27 TH Fondation René Touraine Annual SCIENTIFIC MEETING 2019: Skin Appendages - Developmental and Pathophysiological Aspects. Exp Dermatol 2019; 28:1353-1367. [PMID: 31854035 DOI: 10.1111/exd.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Kanti V, Constantinou A, Reygagne P, Vogt A, Kottner J, Blume‐Peytavi U. Frontal fibrosing alopecia: demographic and clinical characteristics of 490 cases. J Eur Acad Dermatol Venereol 2019; 33:1976-1983. [DOI: 10.1111/jdv.15735] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022]
Affiliation(s)
- V. Kanti
- Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Constantinou
- Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | | | - A. Vogt
- Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Kottner
- Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - U. Blume‐Peytavi
- Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
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14
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Medical therapy for frontal fibrosing alopecia: A review and clinical approach. J Am Acad Dermatol 2019; 81:568-580. [PMID: 30953702 DOI: 10.1016/j.jaad.2019.03.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited, and the literature on treatment modalities consists mostly of case reports and cohort studies. OBJECTIVES In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management. METHODS A literature search for "frontal fibrosing alopecia" on PubMed returned 270 items. In this review, only studies with treatment regimens and reported outcomes were considered. The majority of studies found were case reports and retrospective cohort studies. Response to therapy was assessed by reported ability to slow or arrest hair loss. RESULTS Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies with the most positive treatment responses (88%, 181/204 for intralesional steroids and 88%, 158/180 for 5α-reductase inhibitors). Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation. LIMITATIONS Lack of placebo control studies and uniform outcome measures. CONCLUSION The natural course of FFA is variable. Recession of the frontal hairline might stabilize regardless of treatment. However, early intervention is encouraged in active disease because hair loss is presumed permanent and treatment could modify the disease course.
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15
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Affiliation(s)
- Jouni Uitto
- From the Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Philadelphia
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16
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Sundberg JP, Shen T, Fiehn O, Rice RH, Silva KA, Kennedy VE, Gott NE, Dionne LA, Bechtold LS, Murray SA, Kuiper R, Pratt CH. Sebaceous gland abnormalities in fatty acyl CoA reductase 2 (Far2) null mice result in primary cicatricial alopecia. PLoS One 2018; 13:e0205775. [PMID: 30372477 PMCID: PMC6205590 DOI: 10.1371/journal.pone.0205775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
In a large scale screen for skin, hair, and nail abnormalities in null mice generated by The Jackson Laboratory’s KOMP center, homozygous mutant Far2tm2b(KOMP)Wtsi/2J (hereafter referrred to as Far2-/-) mice were found to develop focal areas of alopecia as they aged. As sebocytes matured in wildtype C57BL/NJ mice they became pale with fine, uniformly sized clear lipid containing vacuoles that were released when sebocytes disintegrated in the duct. By contrast, the Far2-/- null mice had sebocytes that were similar within the gland but become brightly eosinophilic when the cells entered the sebaceous gland duct. As sebocytes disintegrated, their contents did not readily dissipate. Scattered throughout the dermis, and often at the dermal hypodermal fat junction, were dystrophic hair follicles or ruptured follicles with a foreign body granulomatous reaction surrounding free hair shafts (trichogranuloma). The Meibomian and clitoral glands (modified sebaceous glands) of Far2-/- mice showed ducts dilated to various degrees that were associated with mild changes in the sebocytes as seen in the truncal skin. Skin surface lipidomic analysis revealed a lower level of wax esters, cholesterol esters, ceramides, and diacylglycerols compared to wildtype control mice. Similar changes were described in a number of other mouse mutations that affected the sebaceous glands resulting in primary cicatricial alopecia.
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Affiliation(s)
- John P. Sundberg
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- * E-mail:
| | - Tong Shen
- West Coast Metabolomics Center, University of California, Davis, California, United States of America
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, Davis, California, United States of America
- Biochemistry Department, King Abdulaziz University, Jeddah, Saudi-Arabia
| | - Robert H. Rice
- Department of Environmental Toxicology, University of California, Davis, California, United States of America
| | | | | | - Nicholas E. Gott
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Louise A. Dionne
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | | | | | - Raoul Kuiper
- Department of Laboratory Medicine, The Karolinska Institute, Stockholm, Sweden
| | - C. Herbert Pratt
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
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17
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Affiliation(s)
- Leena Alahmari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rawan Almesned
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alhumidi
- Department of Pathology, College of Medicine, Riyadh, Saudi Arabia
| | - Abdullah Alkhalifah
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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18
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Zampella JG, Kwatra SG, Alhariri J. Correlation of clinical and pathologic evaluation of scarring alopecia. Int J Dermatol 2018; 58:194-197. [PMID: 30187916 DOI: 10.1111/ijd.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/03/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. METHODS A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. RESULTS The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64-24.18]; P < 0.001), and this increased with age. CONCLUSIONS These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.
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Affiliation(s)
- John G Zampella
- Department of Dermatology, Center for Men's Health, New York University, New York, NY, USA
| | - Shawn G Kwatra
- Johns Hopkins Department of Dermatology, Baltimore, MD, USA
| | - Jihad Alhariri
- Johns Hopkins Department of Dermatology, Baltimore, MD, USA
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