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Kusano M, Ohashi T, Hiraiwa T, Hashimoto T, Yamamoto T. Scarring alopecia and nail loss in a patient with epidermolysis bullosa acquisita. J Dermatol 2024. [PMID: 38680057 DOI: 10.1111/1346-8138.17242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Misaki Kusano
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takenobu Ohashi
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoko Hiraiwa
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Rahbar Z, Cohen JN, McCalmont TH, LeBoit PE, Connolly MK, Berger T, Pincus LB. Cicatricial Pemphigoid Brunsting-Perry Variant Masquerading as Neutrophil-Medicated Cicatricial Alopecia. J Cutan Pathol 2021; 49:408-411. [PMID: 34841567 DOI: 10.1111/cup.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
A 72-year-old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy was interpreted to represent a neutrophil-mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis demonstrated linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes and plasma cells and prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting-Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil-rich form of cicatricial pemphigoid can masquerade as a neutrophil-mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil-mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ziba Rahbar
- Department of Pathology, Loma Linda University Health, Loma Linda, California
| | - Jarish N Cohen
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Philip E LeBoit
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - M Kari Connolly
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Laura B Pincus
- Department of Pathology, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
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Genedy RM, Mohamed A, El-Mulla K. Extension of separation along the follicular epithelium and follicular basement membrane in pemphigus and bullous pemphigoid. Int J Dermatol 2021; 61:422-433. [PMID: 34227115 DOI: 10.1111/ijd.15734] [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: 03/05/2021] [Revised: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The outer root sheath of hair follicle and the interfollicular epidermis are continuous and basically similar in many aspects. The expression of various basement membrane (BM) components in the upper portion of the hair follicle is similar to that of the interfollicular BM. The extension of acantholysis into the adnexal structures was highlighted in the pemphigus group of diseases. On the other hand, extension of separation down the hair follicle BM has not been studied in subepidermal autoimmune bullous dermatoses. The aim of the present work was to study the extension of separation along follicular epithelium and follicular BM in pemphigus and bullous pemphigoid. METHODS This retrospective study was conducted on pemphigus and bullous pemphigoid cases. For each case, 4-μm-thick sections stained with hematoxylin and eosin were examined for the presence of hair follicles and the extension of separation down follicular epithelium and follicular BM. RESULTS Positive extension of acantholysis down the follicular epithelium was seen in 23/27 (85.2%) of pemphigus vulgaris (PV) and 7/9 (77.8%) of pemphigus foliaceus (PF) cases with hair follicles. Follicular extension was limited to the infundibulum in PF but down the entire follicular length in PV. As for bullous pemphigoid (BP) cases, 20/26 cases (76.9%) that had hair follicles showed positive extension of the separation down the follicular BM. The cellular infiltrate detected was identical in its nature and density to that of subepidermal blister in all cases. CONCLUSIONS Extension of the separation along follicular epithelium and follicular basement membrane was observed in PV, PF, and BP without significant difference.
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Affiliation(s)
- Rasha M Genedy
- Department of Dermatology and Venereology, Alexandria University, Alexandria, Egypt
| | - Abdiwale Mohamed
- Department of Dermatology and Venereology, Alexandria University, Alexandria, Egypt
| | - Khaled El-Mulla
- Department of Dermatology and Venereology, Alexandria University, Alexandria, Egypt
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Iorizzo M, Kempf W, Rudnicka L. Scalp Erosions that Do Not Heal: The Diagnostic Value of Trichoscopy. Skin Appendage Disord 2021; 7:155-158. [PMID: 33796565 DOI: 10.1159/000513135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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