Alopecia Lesions Research Articles

Forehead reconstruction with a custom-made three-dimensional titanium implant in a Parry-Romberg syndrome patient.

Parry-Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues usually on only one side of the face. It is usually difficult to restore the facial contour due to skin tightness. In this case report, we report a forehead reconstruction with custom-made three-dimensional (3D) titanium implant of a Parry-Romberg syndrome patient who was treated with multiple fat grafts but had limited effect. A 36-year-old man presented with hemifacial atrophy. The disease progressed from 5 to 16 years old. The patient had alopecia on frontal scalp and received a surgery using tissue expander. The alopecia lesion was covered by expanded scalp flap done 22 years ago. Also, he was treated with fat grafts on depressed forehead 17 years ago. However, it did not work sufficiently, and there was noted depressed forehead. We planned to make 3D titanium implant to cover the depressed area (from the superior orbital rim to the vertex). During the operation, we confirmed that the custom-made 3D implant accurately fit for the depressed area without any dead spaces. Previously depressed forehead and glabella were elevated, and the forehead contour was improved cosmetically. A custom-made 3D titanium implant is widely used for skull reconstruction and bring good results. In our case, the depressed forehead of a Parry-Romberg syndrome patient was improved by a 3D titanium implant.

Avaliação dos tratamentos farmacológicos para dermatofitoses em animais de companhia

Dermatophytoses are skin infections that can be transmitted from the infected to companion animals or to humans. It is caused by keratinophilic fungi called dermatophytes. The objective of this work is to evaluate the pharmacological treatments for dermatophytoses in companion animals of the animals treated at the University Veterinary Clinic of the Pontifical Catholic University of Paraná - PUCPR Campus Toledo in the period from March 15, 2017 to August 08, 2017 and compare them to the bibliography. The agents most frequently found in this type of infection are of the genus Microsporum sp., Trichophyton sp. and Epidermophyton sp. They cause alopecia lesions, erythema, crusting and pruritus, requiring laboratory identification to confirm the diagnosis and may have long treatment or even reinfections, depending on therapeutic combinations for complete cure. It was evaluated nine cases, one case of feline species and eight cases of canine species. The most frequent lesion in cases of dermatophytosis was alopecia, allergy, pruritus and erythema. The most frequent fungal isolates in this study were Trichophyton sp. identified in eight animals of the canine species, and for the feline species Penicillium sp. a case. For the treatments used, they were mostly through shampoos containing antimicrobial and antiseptic drugs in their formulation, followed by systemic use of oclacitinib maleate, fluconazole, itraconazole, respectively. It was also observed the association of the baths with shampoo and medications of systemic use corroborating with the consulted bibliography, since the association of the topical and systemic therapies reduces the time of infection of the animal. Topical use through ointments was observed in two cases, one being in the feline where it replaced the bath with the shampoo.

Distinct immune and clinical responses to alcohol-soluble vs. salt-soluble wheat proteins in mice

Abstract Food hypersensitivity is a growing global public health problem. Wheat has been linked to distinct types of human hypersensitivities with incompletely understood mechanisms. Although wheat proteins (WP) differ in solubility, it is unknown whether alcohol-soluble (AS) and salt-soluble (SS) WP differ in their immune and disease activation properties. Here we tested the hypothesis that AS and SSWP extracted from soft-wheat will elicit distinct types of immune and clinical responses in inbred mice. Groups of BALB/cJ mice weaned onto a plant-protein free diet received IP injections with AS and SSWP (0.01 mg/mouse) along with alum. The WP-specific (S) IgE, IgG1, IgG2a, IgA and total (T) IgE responses were analyzed. Systemic anaphylaxis and mucosal mast cell degranulation response (MMCR) upon IP challenge were quantified by hypothermia shock response (HSR) and elevation of plasma mMCP-1, respectively. Mice were monitored for dermatitis and alopecia. Spleen tissue extracts were used in measuring immune-activation biomarkers. Whereas the SSWP elicited higher titers of SIgA, the ASWP elicited higher titers of SIgE, SIgG1, SIgG2a and higher TIgE levels. The ASWP elicited significantly higher HSR and MMCR. Only ASWP but not SSWP elicited dorsal neck dermatitis lesions in 44% of mice. Alopecia lesions, without inflammation, were noted in 22% of ASWP- and 33% of SSWP-injected mice. Furthermore, ASWP and SSWP elicited distinct patterns of activation of acute-phase response proteins, chemokines, cytokines, growth factors, matrix proteins and signaling proteins. These data provide the first direct evidence that WP fractions that differ in solubility elicit qualitatively distinct immune and clinical reactions in genetically identical mice.

Examining disease prevalence for species of conservation concern using non‐invasive spatial capture–recapture techniques

Summary Non‐invasive techniques have long been used to estimate wildlife population abundance and density. However, recent technological breakthroughs have facilitated non‐invasive estimation of the proportion of animal populations with certain diseases. Giraffes Giraffa camelopardalis are increasingly becoming recognized as a species of conservation concern with decreasing population trajectories across their range in Africa. Diseases may be an important component impacting giraffe population declines, and the emerging ‘giraffe skin disease’ (GSD), characterized by the appearance of wrinkled skin and alopecic lesions on the limbs, neck and chest of infected giraffe, may hinder movement causing increased susceptibility to predation. We examined the prevalence of GSD in Tanzania's Ruaha National Park over a 4‐month period in 2015, using photographic capture–recapture surveys via road‐based transects. We divided the study area into five circuitous survey units, each approximately 100 km in length ( = 99·22 km, SD = 3·72), and surveyed for giraffes for 4 months. From these surveys, we developed a data base of spatially explicit giraffe photographs. We processed these photographs for individual identification and fitted spatial capture–recapture models to predict the spatial configuration of giraffe abundance and GSD prevalence within the study area. Our results indicated that >86% of the giraffe population showed signs of GSD and that the disease was more prevalent in the northern and north‐eastern portion of Ruaha National Park. Synthesis and applications. Our research shows that data from non‐invasive surveys can be used in spatial capture–recapture (SCR) models to estimate the proportion of a population affected by a visible disease. Researchers and conservationists can use SCR models to better examine the variation in parameters associated with these populations such as sex, age class, movement, and encounter rate, which may be linked to the prevalence of the disease, while incorporating broad spatial and temporal dimensions of the population in such areas. We discuss the implications of this research for conservation of threatened species with an emphasis on disease ecology and vulnerability to predations, and more broadly, for wildlife conservation.

Non-dermatophyte Dermatoses Mimicking Dermatophytoses in Humans

Human dermatophytic cutaneous infections usually present as single or multiple slowly progressing annular erythemato-squamous lesions with a tendency to central healing on the hairless skin. In the intertriginous regions (feet, inguinal, axillar, submammary), dermatophytic colonisations and infections manifest as whitish, slightly hyperkeratotic, pruritic and sometimes fissurated lesions. On the scalp, dermatophytic infections commonly lead to single or multiple more or less inflammatory and alopecic lesions. On the plantar and palmar aspects of the feet and hand, dermatophytosis presents as an eczema-like chronic dermatosis. Abscess-like lesions may occur due to zoophilic dermatomycosis. Dermatophytic infections of the nails reveal ill-defined whitish-yellowish colorations of the distal end or the lateral aspects of the nails, sometimes combined with partial nail embrittlement or even complete destruction. Despite the ubiquity of dermatophytic skin infections and their usually highly typical clinical features, a differential diagnosis has to be considered, in particular when treatment is not efficient or when treatment resistance occurs. This review presents the differential diagnosis in terms of frequency as well as the diagnostic methods permitting the distinction of annular, intertriginous, alopecic, palmoplantar, abscess-like and onychodystrophic lesions.

Chigger mites of the genus Ericotrombidium (Acariformes: Trombiculidae) attacking pets in Europe

Diversity of chigger mites causing trombiculiasis of domestic animals and humans in Europe is greatly underestimated. A number of reports on the attacks of “harvest mite” (Neotrombicula autumnalis) could be based on misidentified chiggers from other species and genera. In this study descriptions of two cases of trombiculiasis are presented, which constitute the first report on the pets’ parasitism by the chigger genus Ericotrombidium in Europe. The species Ericotrombidium ibericense is for the first time reported in Portugal as a causative agent of the trombiculiasis entailed extensive alopecic lesions and pruritus in a cat. Ericotrombidium geloti is for the first time reported as a cause of canine trombiculiasis in Crimea. Presence of other Ericotrombidium species on man and domestic animals is highly probable in countries of the Mediterranean basin.

Pinnal lesions caused by actinic dermatosis and Spilopsillus cuniculi infestation in a cat

Summary A six-year-old neutered male shorthaired cat, mainly white-haired, presented in February for persistent, erythematous and alopecic lesions on the pinnae. Close dermatological examination showed the presence of several fleas, Spilopsyllus cuniculi , solidly attached to the skin. Histological examination of pinnal lesions showed microscopical lesions of actinic keratosis associated with a dermal inflammatory infiltrate consistent with S . cuniculi bites. Therapeutic approach was based on systemic insecticide (spinosad) combined with a topical repellent (geraniol) and solar eviction. Fleas could be aggravating or even predisposing factors to solar-induced skin lesions although they could simply be coincidental.

Dermatophytosis caused by Trichophyton mentagrophytes var. erinacei in a dog: a case report

Trichophyton mentagrophytes var. erinacei is rarely isolated from dogs with dermatophytosis. It is a zoophilic dermatophyte transmitted by hedgehogs and, in contrast to other dermatophyte species, is characterised by a severe suppurative and inflammatory response known as kerion. A 5-year-old male mongrel dog was referred to the Veterinary Teaching Hospital with a 2-week history of a localised pruritic and suppurative alopecic lesion on the scrotum. Routine blood tests, peripheral blood smears, multiple skin scrapings and bacteriological culture did not reveal any abnormalities. However, Trichophyton mentagrophytes var. erinacei was isolated from a fungal culture. The presence of hedgehogs around the daily walking areas of the dog suggested the possibility of direct or indirect contact of the dog with hedgehogs. Fungicidal treatment was implemented with oral itraconazole (5 mg/kg once daily) and topical application of clotrimazole (twice daily) for a month. The scrotal lesion healed completely and hair grew back within a month. No recurrence occurred during a 4 month follow-up. T. mentagrophytes var. erinacei should be included in the differential diagnosis of suppurative scrotal skin lesions of dogs, which have come into possible contact with hedgehogs.

Congenital Stigmatıc Alopecıas Associated with Occult Spinal Dysraphısm

Spinal dysraphism is one of the most frequent malformations, and is defined as a spectrum of congenital anomalies characterized by an incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine.Both the skin and nervous tissue anomalies which originate from ectoderm may occur simultaneously. It can be occult or cystic. Occult forms (occult spinal dysraphism) are characterized by skin-covered lesions without exposed neural tissue. The diagnosis of the occult spinal disraphism is usually made based on a suspicion of the midline paraspinal skin lesions, mostly localized in the lumbosacral area such as subcutaneous lipomas, dermal sinuses, tails, sacral dimple, localized hypertrichosis, hyperpigmented lesions, hemangioma, mongolian spot, pigmentary nevus, and aplasia cutis congenita. Here we described four male babies with occult spinal dysraphism associated with unusual alopecic scalp lesions.

복합 유형의 탈모 증상을 나타내는 환아 치험 1례

Objectives This clinical study is aimed to examine the effects of herbal medication and pharmacopunture on child with different types of alopecia. Methods 13 year old girl was treated with Hominis placenta pharmacopuncture microneedle therapy system and Ganoderma lucidum pharmacopuncture mesotherapy on the alopecia lesion for 20 months. Herbal medication, meridian pharmacopuncture therapy and physiotherapy were also used to reduce physical symptoms. Results The patient had a relapse of hair loss with changing alopecia types, but eventually alopecia has been resolved and maintained throughout the Korean medicine treatment. Conclusions This study shows the effect of the Korean medical treatments for a pediatric patient with alopecia. And more research is needed to study about patients with different types of alopecia.

Histopathological insights into hair loss in Cronkhite–Canada syndrome: Diffuse anagen‐telogen conversion precedes clinical hair loss progression

Cronkhite-Canada syndrome (CCS) is a rare disorder characterised by gastrointestinal polyposis and ectodermal changes, represented by extensive alopecia. Detailed histopathological investigations of alopecic lesions in two female CCS patients with severe hair loss revealed a marked increase in telogen hair follicles with no sign of loss or of the minaturisation or atrophy of hair follicle structures and the absence of inflammatory change, despite severe inflammation in the gastrointestinal tract. These findings suggested that hair regrowth can be expected without systemic corticosteroids, if they are not necessary for treatment of the gastrointestinal tract, and that anagen-telogen transition is an early event preceding clinical hair loss in CCS.

Alopecia areata possibly induced by autoimmune reaction in a patient with human T‐cell lymphotropic virus‐1‐associated myelopathy

A 38-year-old female patient suffered from alopecia areata totalis followed by human T-cell lymphotropic virus-1-associated myelopathy (HAM). These two diseases have recently been considered to be related to cell-mediated autoimmune reactions. Immunohistochemistry revealed accumulation of CXCR3+ CD8+ T cells around hair bulbs in alopecic lesions. Furthermore, flow cytometric analysis showed the elevated frequency of CD8+ human leukocyte antigen DR+ -activated T cells at the initial time and declined at the hair regrowth phase with HAM. CD4+ CD25+ adult T-cell leukemia/lymphoma cells were elevated at hair loss phase and decreased after improvement of hair loss. These results suggest that autoreactive and cytotoxic CD8(+) T cells induce not only alopecia areata but also HAM in ATL patients. This case highlights that the autoimmune reactions may play an important role in the pathogenesis of alopecia areata and HAM.

Trichorhinophalangeal syndrome with low expression of TRPS1 on epidermal and hair follicle epithelial cells

Trichorhinophalangeal syndrome (TRPS) is an autosomal-dominant congenital hair loss disease characterized by sparse and slow-growing scalp hair, craniofacial and skeletal abnormalities, pear-shaped nose, thin upper lip, brittle and thin toenails, and bilateral brachydactyly of the big toes. We report a case of TRPS1 exhibiting these clinical features with a novel heterozygous single nucleotide substitution in exon 3 of the TRPS1 gene. By immunohistochemical analysis of a biopsied specimen of the patient's alopecia lesion, we found for the first time that the expression level of TRPS1 was markedly reduced in the epidermis and the outer root sheath of hair follicles as compared to a normal subject. In addition, higher expression of phospho-Stat3 was found consequent to the loss of TRPS1 in the outer root sheath.

Multiple aplasia cutis congenita lesions located along Blaschko's lines in a patient with tetralogy of Fallot-A

Aplasia cutis congenita (ACC) is a congenital absence of skin, and a single alopecic lesion on the scalp is the most common form. We present a case of ACC with tetralogy of Fallot-A. Differetial diagnosis included Adams-Oliver syndrome and nevus psiloliparus. Interestingly, our patient showed multiple ACC lesions, which were located along Blaschko's lines. As far as we know, our case is the third case of ACC with tetralogy of Fallot-A. Also, this is the first case of ACC associated with Blaschko's lines.

Plaque inflammatoire alopéciante du cuir chevelu : mode de révélation atypique d’une tularémie

Tularaemia is a rare arthropod-borne zoonotic infection with 20 to 70 new cases being seen each year in France. Cutaneous ulceration and regional lymphadenopathy are the classical dermatological signs. Diagnosis of atypical forms is more complex.A 48-year-old woman was admitted for an erythematous papular alopecic lesion of the scalp accompanied by fever, chills and cervical lymphadenopathy. Initial antibiotic therapy for 20 days with amoxicillin clavulanate was ineffective. The patient's history included an episode of hunting in the forest three days before the onset of signs. Finally, serology led to the diagnosis of tularaemia. Combined levofloxacin and doxycycline resulted in regression of the scalp lesion and lymph node disorder.The existence of alopecia and location on the scalp did not initially suggest a diagnosis of tularaemia to us. The clinical presentation was highly suggestive of impetigo with satellite lymphadenopathies. However, resistance to antibiotics and the absence of inflammation militated against this diagnosis, and other possible diagnoses such as a tick-borne lymphadenopathy (TIBOLA), borreliosis and tularaemia were discussed. The most common clinical presentation of tularaemia is ulceroglandular tularaemia, which predominates in 80% of cases. The inoculation chancre at the point of initial infection is most often located in the upper limbs.An inflammatory plaque on the scalp with alopecia may reveal tularaemia, a potentially fatal disease resulting from inoculation.

Survivin, p53, MAC, Complement/C3, fibrinogen and HLA-ABC within hair follicles in central and centrifugal cicatricial alopecia

Context:Central centrifugal cicatricial alopecia (CCCA; originally entitled follicular degeneration syndrome, or hot comb alopecia) was first described in African American women utilizing hot combs and/or strong chemical hair care products.Case Report:A 67 year old African American female was evaluated for the presence of alopecic areas occurring on the scalp vertex, and spreading centrifugally. The alopecic lesions appeared as diffuse patches, including atrophic small areas surrounding individual hair follicles.Patients and Methods:Skin biopsies for hematoxylin and eosin examination, as well as for direct immunofluorescence and immunohistochemistry analyses were performed.Results:hematoxylin and eosin staining demonstrated histopathologic findings of premature desquamation of the inner root sheath and eccentric thinning of the follicular epithelium, supporting the diagnosis of CCCA. Direct immunofluorescence revealed strong depositions of Complement/C3, fibrinogen and kappa light chains around the hair follicles. Immunohistochemistry demonstrated increased expressions of HLA-ABC (as in African American patients with insulin independent diabetes mellitus). We also detected positive p53, bcl-2 and MAC staining in the hair follicle areas.Conclusions:Follicular degeneration syndrome may have an important immunological component previously not described, and multicolor immunofluorescence may be useful in establishing an early diagnosis.

Ichthyosiform mycosis fungoides with alopecia and atypical membranous nephropathy

We describe here a rare case of variant of mycosis fungoides (MF): ichthyosiform MF with alopecia and atypical membranous nephropathy. The diagnosis was made based on the following findings: generalized ichthyosis-like eruption, alopecia, enlarged superficial lymph nodes, proteinuria, and hematuria, the histological features of the skin biopsy from both ichthyotic and alopecic lesions with immunohistochemical staining, and the renal biopsy examination with immunofluorescence. The histological examination of ichthyotic and alopecic lesions displayed a predominant infiltration of atypical lymphocytes in the upper dermis with the characteristics of epidermotropism and folliculotropism. Immunohistochemical studies demonstrated that most infiltrated atypical lymphocytes were CD3, CD4, and CD45RO positive, whereas negative for CD5, CD7, CD20, CD30, and CD56. A renal biopsy examination revealed atypical membranous nephropathy with deposition of immunoglobulin G (IgG), IgM, IgA, C1q, and C3. In this case atypical membranous nephropathy was involved, which is very uncommon and has never been presented in the literature to date. Although ichthyosiform MF usually features a relatively favorable course, diffuse alopecia and the renal involvement in this case might indicate aggressive disease and poor prognosis.

Leishmaniasis in a dog native to Colorado

A 1-year-old 32.5-kg (71.5-lb) sexually intact male foxhound-Treeing Walker Coonhound cross was evaluated because of a 2.5-month history of dermatologic lesions, weight loss, and diarrhea. Physical examination revealed muscle wasting, lymphadenopathy, and multifocal pruritic dermatologic lesions of alopecia, thickening, erythema, and follicular casting. Hematologic and serum biochemical analyses revealed nonregenerative anemia, mono-cytosis, hypercalcemia, hyperproteinemia, and hyperglobulinemia. Proteinuria was identified on urinalysis. Hepatomegaly, splenomegaly, and diffuse abdominal lymphadenomegaly were detected on abdominal ultrasonography. A diagnosis of leishmaniasis was confirmed by ELISA detection of serum antibodies against Leishmania spp, a high serum indirect fluorescent antibody titer (1:1,024) against Leishmania infantum, amplification of Leishmania DNA on PCR assay of a whole blood sample and a lymph node aspirate, and histologic identification of suspected Leishmania amastigotes in skin specimens. In addition, the dog had a low CD4+:CD8+ lymphocyte ratio of 1:1. The dog was euthanized because of the severity of leishmaniasis and poor prognosis. This dog was from a litter of 10 puppies that included 4 stillborn puppies, 2 puppies that died as neonates, and 1 littermate that was euthanized at 1 year of age because of a high serum antibody titer against Leishmania spp. Eventually the foxhound dam was euthanized because of a high serum antibody titer against Leishmania spp. The dog had been raised with an unaffected littermate, its sire, and an unrelated Treeing Walker Coonhound female that were seronegative for Leishmania infection. Although vertical disease transmission was suspected, it is possible that L infantum is now endemic in Colorado. Leishmaniasis should be considered in dogs with scaly dermatoses.

Alopecia areata in Eringer cows

Alopecia areata is a hair loss disorder in humans, dogs and horses with a suspected autoimmune aetiology targeting anagen hair follicles. Alopecia areata is only sporadically reported in cows. Recently, we observed several cases of suspected alopecia areata in Eringer cows. The aim of this study was to confirm the presumptive diagnosis of alopecia areata and to define the clinical phenotype and histopathological patterns, including characterization of the infiltrating inflammatory cells. Twenty Eringer cows with alopecia and 11 Eringer cows without skin problems were included in this study. Affected cows had either generalized or multifocal alopecia or hypotrichosis. The tail, forehead and distal extremities were usually spared. Punch biopsies were obtained from the centre and margin of alopecic lesions and normal haired skin. Histological examination revealed several alterations in anagen hair bulbs. These included peri- and intrabulbar lymphocytic infiltration, peribulbar fibrosis, degenerate matrix cells with clumped melanosomes and pigmentary incontinence. Mild lymphocytic infiltrative mural folliculitis was seen in the inferior segment and isthmus of the hair follicles. Hair shafts were often unpigmented and dysplastic. The large majority of infiltrating lymphocytes were CD3(+) T cells, whereas only occasional CD20(+) lymphocytes were present in the peribulbar infiltrate. Our findings confirm the diagnosis of T-cell-mediated alopecia areata in these cows. Alopecia areata appears to occur with increased frequency in the Eringer breed, but distinct predisposing factors could not be identified.

A Surgical Approach for Stable Lesions of Linear Scleroderma

A 29-year-old Japanese woman presented with alopecia lesions in her occipital region and was diagnosed as linear scleroderma. Topical steroids along with psoralen and UVA light therapy were applied, but the lesion persisted. A surgical approach was therefore selected to treat the lesion. The resection was successful without any recurrence for 1 year. Sclerotic lesions on the exposed areas can cause cosmetic disfigurement, and surgery may be a useful modality for treating stable linear scleroderma.