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Fijałkowska A, Kądziela M, Żebrowska A. The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review. J Clin Med 2024; 13:2419. [PMID: 38673692 PMCID: PMC11050979 DOI: 10.3390/jcm13082419] [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: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.
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Affiliation(s)
| | | | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, Haller sq. 1, 90-647 Lodz, Poland; (A.F.); (M.K.)
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2
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Perales A, Lipsker D, Cribier B, Lenormand C. Non-scarring alopecia of lupus erythematosus: A comprehensive review. Ann Dermatol Venereol 2023; 150:260-269. [PMID: 37598015 DOI: 10.1016/j.annder.2023.04.002] [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: 10/28/2022] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Although non-scarring alopecia (NSA) is a frequent clinical finding in patients with systemic lupus erythematosus (SLE), it has been poorly described in the literature. It is considered a nonspecific sign in the current classification of skin lesions of LE. The aim of this study was to give an updated overview of the spectrum of NSA in LE patients, with emphasis on the clinical significance thereof. METHOD We conducted a review of the English literature using the PubMed-Medline database using the keywords "Alopecia" + "Lupus erythematosus". Publications describing LE patients with NSA were included. RESULTS Data for 237 patients from 27 publications were analyzed. Ninety-one patients had diffuse NSA, 43 had patchy NSA, 83 had lupus hair, 3 had alopecia of dermal cutaneous LE, and 17 had alopecia of linear and annular lupus panniculitis of the scalp. Patients with diffuse/patchy NSA and lupus hair shared the following features: strong association with systemic activity of LE, subtle clinical/trichoscopic signs of inflammation, histological aspect consistent with lesions specific to cutaneous LE, high likelihood of response to SLE therapy, and absence of progression to scarring alopecia. Association with SLE was rare in patients with dermal cutaneous LE or linear and annular lupus panniculitis of the scalp, and skin-directed therapies were most often effective. One patient of each subtype progressed to scarring alopecia. DISCUSSION Diffuse/patchy NSA and lupus hair may represent a topographic variation of a single entity specific for LE. Prospective studies are warranted to further document the clinical significance of this manifestation.
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Affiliation(s)
- A Perales
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - C Lenormand
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France.
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Passeron T, King B, Seneschal J, Steinhoff M, Jabbari A, Ohyama M, Tobin DJ, Randhawa S, Winkler A, Telliez JB, Martin D, Lejeune A. Inhibition of T-cell activity in alopecia areata: recent developments and new directions. Front Immunol 2023; 14:1243556. [PMID: 38022501 PMCID: PMC10657858 DOI: 10.3389/fimmu.2023.1243556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Alopecia areata (AA) is an autoimmune disease that has a complex underlying immunopathogenesis characterized by nonscarring hair loss ranging from small bald patches to complete loss of scalp, face, and/or body hair. Although the etiopathogenesis of AA has not yet been fully characterized, immune privilege collapse at the hair follicle (HF) followed by T-cell receptor recognition of exposed HF autoantigens by autoreactive cytotoxic CD8+ T cells is now understood to play a central role. Few treatment options are available, with the Janus kinase (JAK) 1/2 inhibitor baricitinib (2022) and the selective JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) inhibitor ritlecitinib (2023) being the only US Food and Drug Administration-approved systemic medications thus far for severe AA. Several other treatments are used off-label with limited efficacy and/or suboptimal safety and tolerability. With an increased understanding of the T-cell-mediated autoimmune and inflammatory pathogenesis of AA, additional therapeutic pathways beyond JAK inhibition are currently under investigation for the development of AA therapies. This narrative review presents a detailed overview about the role of T cells and T-cell-signaling pathways in the pathogenesis of AA, with a focus on those pathways targeted by drugs in clinical development for the treatment of AA. A detailed summary of new drugs targeting these pathways with expert commentary on future directions for AA drug development and the importance of targeting multiple T-cell-signaling pathways is also provided in this review.
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Affiliation(s)
- Thierry Passeron
- University Côte d’Azur, Centre Hospitalier Universitaire Nice, Department of Dermatology, Nice, France
- University Côte d’Azur, INSERM, U1065, C3M, Nice, France
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, United States
| | - Julien Seneschal
- Department of Dermatology and Paediatric Dermatology, National Reference Centre for Rare Skin Diseases, Saint-André Hospital, University of Bordeaux, Bordeaux, France
- Bordeaux University, Centre national de la recherche scientifique (CNRS), ImmunoConcept, UMR5164, Bordeaux, France
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Dermatology and Venereology, Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- College of Health and Life Sciences, Hamad Bin Khalifa University-Qatar, Doha, Qatar
| | - Ali Jabbari
- Department of Dermatology, University of Iowa, Iowa City, IA, United States
- Iowa City VA Medical Center, Iowa City, IA, United States
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Desmond J. Tobin
- Charles Institute of Dermatology, UCD School of Medicine, University College Dublin, Dublin, Ireland
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Sarkar R, Mv P, Hinduja N, Sethy M, Kar H, Ahmed S. Refractory alopecia in lupus treated with tofacitinib - a case-based review. Clin Rheumatol 2023:10.1007/s10067-023-06632-6. [PMID: 37188961 DOI: 10.1007/s10067-023-06632-6] [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: 04/19/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
One of the common cutaneous symptoms of systemic lupus erythematosus (SLE) that may have major psychosocial effects in a female is diffuse alopecia. Although Janus kinase inhibitors have shown encouraging results in the treatment of SLE and of alopecia areata in recent studies, tofacitinib in treating refractory alopecia caused by SLE has been rarely documented. The Janus kinases (JAKs) are intracellular tyrosine kinases that play a significant role in the pathophysiology of SLE by participating in a wide range of inflammatory cascades. Here, we reported a 33-year-old SLE patient with long standing (3 years) refractory alopecia who took tofacitinib and observed a substantial increase in hair growth. This was sustained at 2-years follow-up even after tapering off glucocorticoids completely. In addition, we reviewed the literature to look for further evidence to support the use of JAK inhibitors for alopecia in SLE.
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Affiliation(s)
- Rajdeep Sarkar
- Department of General Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Prakashini Mv
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Naga Hinduja
- Department of Dermatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Mitanjali Sethy
- Department of Dermatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Hemanta Kar
- Department of Dermatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.
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5
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Ueda Y, Mizuta T, Murata S, Yokogawa N. Alopecia areata-like patchy non-scarring alopecia as an initial presentation of systemic lupus erythematosus. Rheumatol Adv Pract 2023; 7:rkad004. [PMID: 36726733 PMCID: PMC9872446 DOI: 10.1093/rap/rkad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Yoshitaka Ueda
- Correspondence to: Yoshitaka Ueda, Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. E-mail:
| | - Takahiro Mizuta
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | | | - Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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6
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Melo DF, Müller Ramos P, Iorizzo M, Lima CDS, Pinto EB, Cortez de Almeida RF, Machado CJ, Starace M. Epidemiological, Clinical, Trichoscopic, and Histopathological Features of Lupus Erythematous Mimicking Alopecia Areata: A Multicenter Retrospective Study. Skin Appendage Disord 2022; 8:236-240. [PMID: 35707286 PMCID: PMC9149462 DOI: 10.1159/000520825] [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: 09/12/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction All types of lupus erythematosus (LE) may cause hair loss. Nonscarring alopecia was correlated with systemic LE, based on its high specificity. Discoid LE can also appear as nonscarring patches in early stages. Patchy alopecia LE-specific may also mimic alopecia areata (AA) - which can co-occur with LE. The distinction is fundamental to early diagnosis and effective treatment. This study aims to analyze clinical, epidemiological, trichoscopic, and histopathological features of patients with patchy LE-specific alopecia, nonscarring type, mimicking AA. Methods This is a multicentric retrospective study. We reviewed the medical records of patients with a confirmed diagnosis of LE mimicking AA. Results Ten patients were included (90% female) with a mean age of 45.9 years. Clinically, 60% showed erythema and 70% presented incomplete hair loss. The most common trichoscopic findings were interfollicular arborizing vessels (90%) and scattered brown discoloration (80%). On histopathology, perivascular inflammation (85.7%), peribulbar lymphocytes (85.7%), and dermal pigment incontinence (71.4%) were present in most cases. Discussion/Conclusion Trichoscopy was found as an essential first step for the patchy alopecia diagnosis, enabling to differentiate LE from AA. Putting it mildly, trichoscopy raises the suspicion that leads to a biopsy, increasing the diagnostic accuracy with better outcome for patients.
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Affiliation(s)
- Daniel Fernandes Melo
- Department of Dermatology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Paulo Müller Ramos
- Department of Dermatology and Radiotherapy, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Caren dos Santos Lima
- Department of Dermatology, State University of Pará (UEPA), Belém, Brazil
- Department of Dermatology, University Center of Pará (CESUPA), Belém, Brazil
| | | | | | - Carla Jorge Machado
- Preventive and Social Medicine Department, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Michela Starace
- Department of Specialized, Experimental and Diagnostic Medicine, Dermatology − IRCCS, Policlinico Sant'Orsola, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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He X, Duan XL, Liu JS. A Case of Neuropsychiatric Systemic Lupus Erythematosus With Hair Loss as the First Diagnostic Symptom. Front Psychiatry 2022; 13:839566. [PMID: 35633816 PMCID: PMC9137432 DOI: 10.3389/fpsyt.2022.839566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 12/02/2022] Open
Abstract
Neuropsychiatric systemic lupus erythematosus is a serious complication of systemic lupus erythematosus. A 33-year-old female patient had repeated hair loss for more than 3 years. A dermatologic examination showed several pieces of irregularly shaped hair loss patterns in the center of the patient's scalp. The systemic treatment included oral hydroxychloroquine, aspirin enteric-coated tablets and prednisone, and intrathecal injection of dexamethasone and methotrexate. The local treatment included intralesional injection of triamcinolone acetonide and lidocaine in the lesion area, 0.1% tacrolimus ointment for external use. After 2-month treatment, hair regrew in a non-scarring patchy alopecia region with no further hair loss.
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Affiliation(s)
- Xun He
- Department of Dermatology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xi-Ling Duan
- Department of Dermatology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jing-Song Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
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8
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Sharifzadeh A, Smith GP. Low rate of scalp biopsy in systemic lupus erythematosus patients and the potential for misdiagnosis. Dermatol Ther 2021; 34:e14991. [PMID: 34003558 DOI: 10.1111/dth.14991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/15/2021] [Accepted: 05/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Afsheen Sharifzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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9
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Desai K, Miteva M. Recent Insight on the Management of Lupus Erythematosus Alopecia. Clin Cosmet Investig Dermatol 2021; 14:333-347. [PMID: 33833540 PMCID: PMC8020452 DOI: 10.2147/ccid.s269288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/13/2021] [Indexed: 12/25/2022]
Abstract
Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.
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Affiliation(s)
- Karishma Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Gupta M, Sharma A, Bhargava S, Abdelmaksoud A, Goldust M. Uncommon presentation of alopecia areata, severe psoriasis, and poliosis: A case report. Dermatol Ther 2020; 33:e14033. [DOI: 10.1111/dth.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mrinal Gupta
- DNB Dermatology Consultant Dermatologist Treatwell Skin Center Jammu India
| | | | | | | | - Mohamad Goldust
- University of Rome G. Marconi Rome Italy
- Department of Dermatology University Hospital Basel Basel Switzerland
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11
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Thompson CT, Kolivras A. Alopecia areata-like pattern: A new unifying concept. J Cutan Pathol 2020; 48:351-355. [PMID: 32894601 DOI: 10.1111/cup.13864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Curtis T Thompson
- CTA Pathology, Portland, Oregon, USA.,Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon, USA.,Department of Pathology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Athanassios Kolivras
- Département inter-hospitalier de Dermatologie, Saint-Pierre, Brugmann and HUDERF University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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12
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Foo HL, Lee JSS, Wang ECE. Discoid lupus erythematosus precipitated by topical diphencyprone immunotherapy for alopecia areata. JAAD Case Rep 2020; 6:747-750. [PMID: 32715069 PMCID: PMC7369523 DOI: 10.1016/j.jdcr.2020.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Hui Ling Foo
- National Skin Centre, National Healthcare Group, Singapore
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13
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Comment on “Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses”. J Am Acad Dermatol 2020; 82:e169. [DOI: 10.1016/j.jaad.2019.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/22/2022]
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Is there an association between alopecia areata and systemic lupus erythematosus? A population-based study. Immunol Res 2020; 68:1-6. [DOI: 10.1007/s12026-020-09115-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses. J Am Acad Dermatol 2019; 81:1319-1329. [DOI: 10.1016/j.jaad.2019.05.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 01/14/2023]
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Abstract
Alopecia is a skin condition of great social and psychologic impact. Primary alopecia originates from the hair follicles and usually does not have systemic manifestations; however, secondary alopecia can affect the hair follicles in the setting of systemic diseases, medications, and external trauma. Connective tissue diseases, granulomatous diseases, bullous diseases, infections, and tumors are some of the systemic diseases that will be covered in this review. Trichoscopy is a useful noninvasive tool that can help with the diagnosis in the office and can guide the selection of the optimal site for the scalp biopsy. Histopathology is the ultimate tool for the diagnosis in most cases of secondary alopecia and can be performed on vertical and horizontal sections. In most cases, treating the underlying condition is the single most important strategy, but topical treatments for the alopecia are also applied.
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Affiliation(s)
- Sonali Nanda
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria De Bedout
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Udompanich S, Chanprapaph K, Suchonwanit P. Linear and Annular Lupus Panniculitis of the Scalp: Case Report with Emphasis on Trichoscopic Findings and Review of the Literature. Case Rep Dermatol 2019; 11:157-165. [PMID: 31543767 PMCID: PMC6738250 DOI: 10.1159/000500848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022] Open
Abstract
Linear and annular lupus panniculitis of the scalp (LALPS) is a unique subset of lupus panniculitis, which results in non-scarring alopecia along the Blaschko line of the scalp in an otherwise healthy young patient. Numerous cases have been reported around the world, but data on their trichoscopic findings and correlations with the underlying pathology is sparse. We hereby present a case of 23-year-old male with LALPS and further describe his trichoscopic findings as well as their correlations with histopathological features.
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Affiliation(s)
- Siriorn Udompanich
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Suchonwanit P, Udompanich S, Thadanipon K, Chanprapaph K. Trichoscopic signs in systemic lupus erythematosus: a comparative study with 109 patients and 305 healthy controls. J Eur Acad Dermatol Venereol 2019; 33:774-780. [DOI: 10.1111/jdv.15421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/14/2018] [Indexed: 12/17/2022]
Affiliation(s)
- P. Suchonwanit
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - S. Udompanich
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - K. Thadanipon
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
- Section for Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - K. Chanprapaph
- Division of Dermatology Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
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Concha JSS, Werth VP. Alopecias in lupus erythematosus. Lupus Sci Med 2018; 5:e000291. [PMID: 30397497 PMCID: PMC6203010 DOI: 10.1136/lupus-2018-000291] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/15/2018] [Accepted: 09/02/2018] [Indexed: 11/04/2022]
Abstract
Several patterns of hair loss can occur in lupus erythematosus (LE). Alopecias which show histological characteristics of LE are LE-specific, and include discoid LE (DLE), diffuse or patchy hair loss in acute LE, subacute cutaneous LE, and rarely tumid LE. Lupus hair in SLE is a poorly characterised entity and may be a form of telogen effluvium. Alopecia areata can coexist with LE and may mimic DLE. Non-lupus alopecias such as telogen effluvium and anagen effluvium have a myriad of causes which include disease flares, drugs and stress in the setting of LE. The latest validated Systemic Lupus International Collaborating Clinics classification criteria for SLE includes non-scarring alopecia as a criterion; therefore, recognising the aetiology of hair loss in the setting of LE is crucial in classifying a patient to have systemic disease.
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Affiliation(s)
- Josef Symon Salgado Concha
- Corporal Michael J Crescenz VAMC, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Corporal Michael J Crescenz VAMC, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Cutaneous and systemic lupus erythematosus (SLE) commonly involves the hair and scalp. Alopecia can result from direct activity of disease on the scalp or from the state of physical stress in the form of telogen effluvium. Discoid lupus erythematosus and lupus panniculitis/profundus are known to cause scarring alopecia, while accumulation of recent studies has shown that non-scarring alopecia in SLE may have different subtypes, comprising lupus erythematosus-specific and lupus erythematosus-nonspecific changes on histology. This review aims to summarize the clinical pattern, trichoscopic, histopathological, and direct immunofluorescence features of different types of alopecia in cutaneous and systemic lupus erythematosus, as well as exploring their relationship with SLE disease activity.
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Waśkiel A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Trichoscopy of alopecia areata: An update. J Dermatol 2018; 45:692-700. [DOI: 10.1111/1346-8138.14283] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Waśkiel
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
| | - Adriana Rakowska
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
| | - Mariusz Sikora
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
| | | | - Lidia Rudnicka
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
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22
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Rebora A, Ciccarese G, Drago F. Postfebrile telogen effluvium: hair fall after Rickettsia conorii infection. GIORN ITAL DERMAT V 2017; 154:94-95. [PMID: 28704990 DOI: 10.23736/s0392-0488.17.05643-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Alfredo Rebora
- DI.S.Sal, Section of Dermatology, San Martino University Hospital and Institute for Tumor Research and Care, University of Genoa, Genoa, Italy
| | - Giulia Ciccarese
- DI.S.Sal, Section of Dermatology, San Martino University Hospital and Institute for Tumor Research and Care, University of Genoa, Genoa, Italy -
| | - Francesco Drago
- DI.S.Sal, Section of Dermatology, San Martino University Hospital and Institute for Tumor Research and Care, University of Genoa, Genoa, Italy
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23
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Kwiatkowska M, Rakowska A, Walecka I, Rudnicka L. The diagnostic value of trichoscopy in systemic sclerosis. J Dermatol Case Rep 2016; 10:21-25. [PMID: 27900061 DOI: 10.3315/jdcr.2016.1225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/08/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND/OBJECTIVES Systemic sclerosis is a connective tissue disease, which is characterized by fibrosis of the skin and internal organs, presence of specific antibodies and vascular involvement. Capillaroscopy is a useful method for the diagnosis and follow-up of patients with systemic sclerosis. Trichoscopy is a rapid, non-invasive technique, which has become a standard procedure in differential diagnosis of scalp and hair diseases. The aim of this study was to assess whether trichoscopy may be applied in imaging microvessels in patients with systemic sclerosis. METHODS The study included 17 patients with systemic sclerosis, and 31 healthy patients. In every patient 10 trichoscopy images were taken with Fotofinder II. RESULTS In patients with systemic sclerosis trichoscopy of the frontal scalp area revealed polymorphic microvessels in 64,7% of patients, spider vessels (76,4%), capillary loops (52,9%), arborising vessels (41,1%) and avascular areas (35,2%). In healthy individuals these features were observed in polymorphic microvessels 6,4% of patients, spider vessels 6,4%, capillary loops 100%, arborising vessels 16,1%, avascular areas 9,6%, respectively. CONCLUSIONS In conclusion, the presence of polymorphic vessels in frontal area in trichoscopy is characteristic for systemic sclerosis.
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Affiliation(s)
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland; ; Department of Neuropeptides, Mossakowski Medical Research Centre, Warsaw, Poland
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