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Shen L, Zhang Y, Lin J, Wu W. Patchy alopecia in the central posterior occipital region. BMJ 2024; 385:e078418. [PMID: 38901861 DOI: 10.1136/bmj-2023-078418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Linxia Shen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinran Lin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenyu Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Dermatology, Jing'an District Central Hospital, Shanghai, China
- Academy for Engineering and Technology, Fudan University, Shanghai, China
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Corona-Rodarte E, Cano-Aguilar LE, Baldassarri-Ortego LF, Tosti A, Asz-Sigall D. Pressure alopecias: A review. J Am Acad Dermatol 2024; 90:125-132. [PMID: 37454698 DOI: 10.1016/j.jaad.2023.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Pressure-induced alopecias (PAs) are an infrequent group of scarring and nonscarring alopecias that occur after ischemic obstruction of capillaries that leads to circumscribed areas of hair loss. Initially described after prolonged surgeries or immobilization, type 1 PA occurs after sustained external pressure to the skin, mainly the scalp prominences. Alopecia induced by cosmetic procedures, referred in this review as type 2 PA, is reported with increased frequency in literature and predominantly emerges from pressure exerted by the volume of injectables. It is important to differentiate type 2 PA from vascular occlusion-induced alopecia because they represent distinct entities. Clinically, PA may present with erythema, swelling, and tenderness; however, alopecia might be the sole manifestation. Crusts and ulceration are associated with a worse outcome and a higher risk of scarring alopecia. Prompt diagnosis is paramount to prevent complications. Trichoscopy, although considered nonspecific, may provide relevant clues for an accurate diagnosis. Hair regrows in most cases, but prognosis depends on ischemia severity and timely treatment with reperfusion therapies or mobilization. Treatment of hair loss is usually not necessary because the disease in most cases is self-limited and reversible. The role of topical minoxidil and corticosteroids remains unknown.
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Affiliation(s)
- Eduardo Corona-Rodarte
- Department of Dermatology, Instituto Dermatológico de Jalisco José Barba Rubio, Zapopan, Mexico.
| | | | | | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Asz-Sigall
- Trichology Clinic, Department of Dermatology, Hospital General "Dr. Manuel Gea González," Mexico City, Mexico.
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Vashisht D, Neema S, Yadav A, Sinha A, Radhakrishnan S. Trichoscopy of pressure-induced alopecia and alopecia areata: A comparative study. Int J Trichology 2022; 14:17-20. [PMID: 35300106 PMCID: PMC8923146 DOI: 10.4103/ijt.ijt_46_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/17/2020] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
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4
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Tortelly VD, Melo DF, Ghedin BS, Lima CDS, Garcia TU, Barreto TDM. Pressure-Induced Alopecia: Presence of Thin Hairs as a Trichoscopic Clue for the Diagnosis. Skin Appendage Disord 2019; 6:48-51. [PMID: 32021863 DOI: 10.1159/000504233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
Pressure-induced alopecia (PA) is an unusual pattern of circumscribed hair loss that occurs after ischemic changes on the scalp. Trichoscopic findings described in the literature are scarce, nonspecific, and include black dots, broken hairs, circle hairs, and erythema. However, we report 3 cases of PA in which trichoscopy also showed many vellus and thin hairs. Possibly, the maintenance of these hair shafts may be explained by the more superficial insertion of their bulbs on the skin and/or their lower metabolic rates, making them suffer less from local hypoxia. Therefore, the authors suggest that these relevant signs should be added as a clue for the diagnosis of PA in doubtful cases.
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Affiliation(s)
- Violeta Duarte Tortelly
- Department of Dermatology, Marcílio Dias Hospital, Rio de Janeiro, Brazil.,Department of Dermatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Fernandes Melo
- Department of Dermatology, Marcílio Dias Hospital, Rio de Janeiro, Brazil.,Department of Dermatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Thais Ura Garcia
- Department of Dermatology, Marcílio Dias Hospital, Rio de Janeiro, Brazil
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Asz-Sigall D, Iñigo-Gomez K, Ortega-Springall MF, Vega-Memije ME, Arenas R, Tosti A. Alopecia Secondary to Hyaluronic Acid Embolization: Trichoscopic Findings. Skin Appendage Disord 2019; 5:396-400. [PMID: 31799272 PMCID: PMC6883453 DOI: 10.1159/000502262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022] Open
Abstract
Fillers are frequently used in aesthetic medicine and, although usually safe, complications can occur. Vascular occlusion leading to tissue necrosis is a rare but severe complication. Alopecia after hyaluronic acid injection has been recently reported, being a vascular compromise the most probable physiopathological mechanism. The trichoscopic findings in this entity have not been described yet. A case report of a 30-year-old female who developed this complication following a hyaluronic acid injection as well as the description of the trichoscopic findings are presented in this report.
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Affiliation(s)
- Daniel Asz-Sigall
- Oncodermatology and Trichology Clinic, National University of Mexico, Mexico City, Mexico
| | - Karla Iñigo-Gomez
- Dermatology Department, “Dr. Manuel Gea Gonzalez” General Hospital, Mexico City, Mexico
| | | | | | - Roberto Arenas
- Micology Section, “Dr. Manuel Gea Gonzalez” General Hospital, Mexico City, Mexico
| | - Antonella Tosti
- Dermatology Department, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
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Kunapareddy J, White C, Davis C, Nousari C. A unique case of pressure-induced alopecia following EEG monitoring. Pediatr Dermatol 2018; 35:e345-e347. [PMID: 30187955 DOI: 10.1111/pde.13657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a unique case of pressure-induced alopecia (PIA) in a 11-year-old boy following the use of electroencephalogram (EEG) electrodes on the scalp for 4 days. PIA is caused by localized ischemia leading to vascular congestion and discrete, often circumscribed patches of hair loss within 3-28 days of pressure interface. The synchronous conversion of follicles from anagen to catagen or telogen phase is the most distinctive finding of PIA. PIA is a nonscarring alopecia which often resolves over time without treatment.
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Affiliation(s)
| | - Chris White
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, Illinois
| | - Cindy Davis
- Broward Health Medical Center, Fort Lauderdale, Florida
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Sano DT, Kakizaki P, Anzai A, Donati A, Valente NYS, Romiti R. Headband pressure alopecia: clinical, dermoscopy, and histopathology findings in four patients. Int J Dermatol 2017; 57:237-239. [PMID: 29265341 DOI: 10.1111/ijd.13841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela T Sano
- Department of Dermatology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Priscila Kakizaki
- Department of Dermatology, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - Alessandra Anzai
- Department of Dermatology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Aline Donati
- Department of Dermatology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Neusa Y S Valente
- Department of Dermatology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
| | - Ricardo Romiti
- Department of Dermatology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
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