Clinical and laboratory evaluation of AIDS trichopathy

Alopecia areata associated with abacavir therapy

Abacavir is a nucleoside reverse-transcriptase inhibitor that has been approved for use in combination with other retroviral agents in the treatment of HIV infection. Common adverse reactions include headache, fatigue, nausea, and rash. A fatal hypersensitivity reaction may occur in 5% of patients receiving abacavir; therefore, screening for HLA-B5701 should be performed before starting abacavir. Alopecia areata (AA) is infrequently reported in HIV-infected patients. Certain underlying conditions have been associated with AA, including a decreased CD4:CD8 ratio related to the progression of HIV infection, some opportunistic infections, and syphilis. Several antiretroviral drugs, such as zidovudine, indinavir, indinavir/ritonavir, lopinavir/ritonavir, and atazanavir/ritonavir have been implicated in the development of AA. At present, the occurrence of AA has not been associated with abacavir use. We cannot exclude that the use of abacavir and the development of AA could be coincidental. Nevertheless, patients given abacavir should be monitored for hair loss and the drug discontinued promptly if such signs appear.

Loose anagen hair syndrome in black-haired Indian children

Loose anagen hair syndrome (LAHS) is an uncommonly reported autosomal dominant hair disorder with incomplete penetrance that primarily affects children but is occasionally seen in adults. LAHS is characterized by the ability to easily and painlessly extract unsheathed anagen hairs from the scalp with gentle traction. The hair is sparse and does not grow long. Usually the hairs are not fragile and do not have areas of breakage. Initially it was considered a rare, sporadic condition found predominantly in young white girls with blonde hair. Because autosomal dominant inheritance has been reported, it was suspected that the condition might be equally common in boys but was probably underdiagnosed.

Morphological and immunological changes in the skin of autopsied women with AIDS

Acquired immunodeficiency syndrome (AIDS) is characterized by decreased immunity, making a patient more susceptible to opportunistic infections which can have cutaneous manifestations. The aim of this study was to evaluate the local immunity of the skin through morphological and immunohistochemical analysis. Skin samples of 52 women, 27 without AIDS and 25 with AIDS, autopsied in an academic referral hospital in Brazil were evaluated. The autopsy reports and medical records were reviewed, and histochemical Hematoxylin-eosin, Picrosirius red, and Verhoeff stains as well as morphometric (Image J and KS-300 Kontron-Zeiss) and immunohistochemical (S-100 and anti-IgA) analyses of the skin were performed. Women with AIDS presented a thinner epidermis than women without AIDS (33.33 [12.00-317.66] vs 67.42 [12.00-530.02] μm; p < 0.001), with a lower number of epithelial cell layers (4.00 [2.00-11.00] vs 4.00 [2.00-16.00]; p < 0.001), a smaller cell diameter (12.92 [6.00-28.87] vs 24.32 [6.00-33.12] μm; p < 0.001), and a lower number of Langerhans cells (LC) (12.58 [0.00-81.74] vs 31.44 [0.00-169.77] LC/mm(2); p < 0.001). The dermis contained more collagen fibers (8.20 % [2.40-19.40] vs 6.30 % [0.40-13.90]; p < 0.001). Some of these parameters were negatively correlated with viral load and positively correlated with the number of CD4+ T-lymphocytes. We conclude that a decrease of the local skin immunity in women with AIDS may contribute to the development of skin lesions.

Worldwide diversity of hair curliness: a new method of assessment

BACKGROUND

For many years, cosmetic scientists have attempted to measure the physical features of human hair, such as its shape and colour, as these can be artificially modified using cosmetic products. With regard to hair shape, previous anthropologic studies have emphasized its variability within and between human ethnic groups. Many studies have broadly distinguished three ethnic human subgroups: African, Asian, and Caucasian. Such a broad classification cannot account for the great complexity of human biological diversity, resulting from multiple, past or recent mixed origins. The verbal description of hair shape ranges from the classic to the more sophisticated, with terms such as straight, wavy, curly, frizzy, kinky, woolly, helical, etc. Although these descriptions evoke a global appearance, they remain confusing as their definitions and limits are unclear. Assessments are therefore required to more accurately define such verbal attributes.

OBJECTIVE

The work reported here attempts to address the following issues: (i) to define hair types according to specific shape criteria through objective and simple measurements; and (ii) to define such hair types without referring to human ethnicity.

METHODS

Measurements of four parameters related to hair curliness (curve diameter, curl index) or kinking of the hair (numbers of waves, numbers of twists) were performed on hair from 2449 subjects from 22 different countries. Principal components analysis and hierarchical ascendant classification were used to identify homogeneous groups of hair and to determine key variables for the assignment of group membership. Finally, a segmentation tree was prepared in order to establish simple rules for predicting group membership of new subjects.

RESULTS AND CONCLUSIONS

This study has shown that it is possible to classify the various hair types found worldwide into eight main groups. The approach involves objective descriptors of hair shape, and is more reliable than traditional methods relying on categories such as curly, wavy, and kinky. Applied to worldwide human diversity, it avoids reference to the putative, unclear ethnic origin of subjects. Briefly, a straight hair type I is just that, and whether it originates from a Caucasian or an Asian subject is not at issue. The hair types defined here also more adequately reflect the large variation of hair shape diversity around the world, and may possibly help to trace past mixed origins amongst human subgroups.

Alterações dermatológicas em crianças com Aids e sua relação com categorias clínico-imunológicas e carga viral

FUNDAMENTOS: Desde o início da epidemia da Aids as dermatoses têm sido freqüentemente descritas em pacientes com essa doença, com relatos de casos atípicos e estudos de séries de pacientes adultos; no entanto, há poucas publicações sobre alterações cutâneas em pacientes pediátricos com Aids. OBJETIVOS: Estudo prospectivo para avaliar a presença de dermatoses em 40 pacientes pediátricos com Aids. MÉTODOS: Quarenta pacientes, com idade inferior a 13 anos e portadores de Aids, foram estudados por um período de seis meses para avaliação de: número de alterações dermatológicas; suas características clínicas; distribuição conforme as categorias clínico-imunológicas e o valor da carga viral. RESULTADOS: A prevalência de dermatoses foi de 82,4%, na primeira consulta, e, no acompanhamento longitudinal, 92,5% dos pacientes tiveram alterações dermatológicas, com proporção de cinco diagnósticos por doente. As crianças com classificação clínico-imunológica grave e carga viral acima de 100.000 cópias/ml apresentaram maior número de alterações dermatológicas quando comparadas àquelas das categorias clínico-imunológicas leves. A proporção de diagnósticos por paciente na categoria clínica C foi de 6,8 e na A de 3,6; na categoria imunológica grave, de sete, e na leve de 3,7; e na carga viral > 100.000 de 7,3, e na < 100.000 de 4,2 (todos com significância estatística). CONCLUSÃO: As dermatoses foram freqüentes nas crianças com Aids e ocorreram em maior número nos pacientes pertencentes às categorias graves. A elevada freqüência de alterações da pele nos pacientes pediátricos com a doença indica ser imprescindível sua avaliação dermatológica minuciosa e freqüente.

Update on cutaneous manifestations of HIV infection

The skin is affected in virtually all patients with HIV infection. Many articles and several books have been published that deal with these disorders for a number of reasons. First, cutaneous disease may serve as the initial or only problem that the patient suffers for much of the course of the HIV infection. Second, serious opportunistic infections may present for the first time in the skin, so that a skin lesion may be a harbinger of the patient's having a life-threatening illness. Third, skin disorders in these patients may appear unusual and hence may not be accurately diagnosed by clinical inspection alone. Furthermore, response to treatment may be poorer than expected. Thus, skin diseases in the HIV-infected patient are important and, in some cases, may be the most debilitating element of the patient's condition.

Loose anagen syndrome and loose anagen hair

Loose anagen syndrome, or loose anagen hair, is a recently described condition of unknown etiology that may be under-recognized. The typical patient is a child with sparse fine hair that can easily be pulled out. The diagnosis is confirmed by microscopic examination of firmly pulled hairs, many of which are in the anagen phase but lacking an inner and outer root sheath and demonstrating a ruffled cuticle. Some presentations of alopecia areata may be confused with this condition, but the pull test analysis serves to differentiate them. A variety of theories have been postulated to explain the pathophysiology of loose anagen syndrome. In some cases, there is an autosomal dominant pattern of inheritance. In most cases, this condition spontaneously improves with age.

Clinical and histopathologic features of hair loss in patients with HIV-1 infection

BACKGROUND

Hair loss is common in patients with HIV-1 infection, and in black patients this loss may be associated with straightening. Possible causes are frequently present in patients with HIV-1. These causes include chronic HIV-1 infection itself and recurrent secondary infections, nutritional deficiencies, immunologic and endocrine dysregulation, and exposure to multiple drugs. However, histopathologic features have rarely been reported in these patients.

OBJECTIVE

The objective was to evaluate the changes in the hairs of a group of these patients and to identify the light microscopic and ultrastructural changes in the hairs and the histologic changes in the scalp.

METHODS

Hair plucks and pulls with scanning electron microscopy of the hairs were done on 10 patients with late-stage HIV-1 infection. In addition, scalp biopsy specimens were examined in both vertical and transverse sections.

RESULTS

All patients had telogen effluvium. Numerous apoptotic or necrotic keratinocytes were seen in the upper external root sheath follicular epithelium in addition to a mild to moderate perifollicular mononuclear cell infiltrate often containing eosinophils. Variable dystrophy of the hair shafts was also a consistent feature.

CONCLUSION

Although telogen effluvium is a common response to a wide spectrum of biologic stresses, the presence of apoptotic or necrotic keratinocytes within the upper end of the external root sheath epithelium and dystrophy of hairs may be markers of hair loss in patients with HIV-1 infection.