Alopecic Nodules Research Articles

Aseptic Alopecic Nodule of the Scalp (NAAS) Simulating Hoffmann's Disease (HD), Efficacy of Intra-Lesional Corticotherapy: 03 Observations at the Bamako Dermatology Hospital (HDB)

The alopecic aseptic nodule of the scalp (NAAS) is a recently described entity known as a "pseudocyst of the scalp". It can be confused with dissecting folliculitis of the scalp (Hoffmann's disease) by certain clinical signs. We report three cases of NAAS mimicking MH with favourable evolution under doxycycline associated with intra-lesional corticotherapy. Case 1: A 36-year-old man presented with painful nodules of the scalp. Examination revealed two fluctuating subcutaneous nodules measuring 4 and 5 cm, both painful. The skin opposite the nodules was alopecic and not scarred. Case 2: A 28-year-old man presented with a scalp nodule that had been present for 3 months. Clinical examination revealed a fluctuating, painful subcutaneous nodule measuring 7cm, alopecic and non-scarring, with surrounding small patches of alopecia. In addition, inflammatory acne lesions were noted on the face. Case 3: A 33-year-old obese male smoker presented with a scalp nodule. Examination revealed a painful subcutaneous nodule measuring 3 cm, with smooth alopecic skin. Discussion: The pathophysiology of NAAS remains poorly understood, and a link with the spectrum of follicular occlusion pathologies has been suggested. Inflammatory acne was observed in two of our patients. The biopsy was non-specific; the pus came back sterile in all cases; after aspiration, the patients benefited from intra-lesional corticosteroid therapy associated with doxycycline 100mg/dr with a good evolution. Conclusion: Aseptic alopecic nodules of the scalp are clinically similar to folliculitis dissecans of the scalp. Certain clinical signs can help the practitioner to make the correct diagnosis in order to avoid aggressive treatment.

Clinico-Trichoscopic and Histopathological Findings of Aseptic and Alopecic Nodules of Scalp: A Case Series.

Clinico-Trichoscopic and Histopathological Findings of Aseptic and Alopecic Nodules of Scalp: A Case Series.

34065 Lupus panniculitis with facial hemiatrophy

A 29-year-old Hispanic woman presented with a 7-year history of facial lesions and alopecic areas on the scalp. Her initial lesions were painful nodules. In addition, the left side of her face has progressively hardened and changed in its contour. Approximately a year after onset, she developed alopecia on both sides of her scalp. At the time of presentation to us, she denied fever, arthritis, chest pain, shortness of air, and fatigue. Physical examination demonstrated facial asymmetry, erythematous indurated nodules, and plaques on the left face, as well as alopecic nodules on the scalp.

Alopecic and aseptic nodules of the scalp: an underdiagnosed entity.

Alopecic and aseptic nodules of the scalp (AANS) is an underdiagnosed entity characterized by one or more dome-shaped alopecic nodule(s) that predominantly affects young men. The singular aspect of the nodules, nonscarring alopecia, deep inflammatory infiltrate, and efficacy of doxycycline confer specificity to AANS [1]. The etiology remains unclear, but AANS might be included in a spectrum of diseases such as dissecting cellulitis of the scalp, acne conglobate, and hidradenitis suppurativa, which share the common pathogenesis: follicular occlusion, follicular rupture, then follicular infection. AANS is diagnosed based on clinicohistopathological features. The preferred treatment is doxycycline. Other options include aspiration or puncture, intralesional corticosteroid injection, and surgical excision. The prognosis is usually good, and alopecia is reversible either spontaneously or after treatment especially with doxycycline [1]. Herein, we report a case of AANS to facilitate its recognition and proper management. A 22-year-old man presented with an asymptomatic scalp mass lasting 3 weeks ([Fig. 1A]). Physical examination revealed a dome-shaped, tender, fluctuating, and alopecic nodule in the occipital region. The puncture was negative. Intraoperatively, the lesion was filled with chronic granulation tissue ([Fig. 1B]). After surgical removal of the lesion, the involved scalp was minimally excised and closed. Histopathologic examination showed a chronic inflammatory lesion along with mixed inflammatory cells in the deep dermis ([Fig. 2]). The postoperative course was uneventful over 6 months postoperatively and the hair growth in the area previously affected by the lesion was restored. Considering that only a portion of the alopecic area was excised during the excisional biopsy, we believe that alopecia was recovered spontaneously following the natural courses of the lesion. This underdiagnosed entity requires careful clinical consideration to make an accurate diagnosis and adequately manage patients. AANS should be differentiated from other scalp lesions such as inflamed trichilemmal cysts, alopecia areata, bacterial folliculitis, dissecting cellulitis of the scalp, and metastatic nodules [2].

Canine Leproid Granuloma in Mineiros City Mid-West Region of Brazil

Background: Among the bacterial dermopathy the canine leproid granuloma (CLG) is a nodular pyogranulomatous disorder that affects the skin or subcutaneous tissue mainly in the dorsal face of ear pinna, head, and extremity of members caused by Mycobacterium spp. The pathogenicity is still not well clarified regarding the causative agent, which has not yet been completely typified, but phylogenetically, it is related to Mycobacterium tilburgii, M. simiae, and M. genavense, in Brazil, by the species M. murphy. The objective of this study is to report a case of canine leproid granuloma, through cytology and histopathology, and present the therapeutic procedures until the regression of cutaneous lesion.Case: A 5-year-old Boxer breed, intac male weighing 32 kg, was assisted at the Veterinary Clinic of UNIFIMES, in Mineiros City, Mid-West Region of Brazil, GO, Brazil. The animal had 4 nodules in the ears with evolution of 30 days, with no pruritus and without previous treatment. During the physical exam, the animal had normal physiological parameters. The cutaneous lesions were characterised by papules and alopecic nodules of firm to fibroelastic consistency, with progressive increase, located in the convex face of the ears. The fine needle aspiration puncture technique (FNAP) and histopathology for a definitive diagnosis was used, allowing the differentiation between inflammatory processes, infectious and neoplastic. Furthermore, blood was collected for hemogram and biochemical analysis for the assessment of renal and hepatic functions. In cytology, the stained blades by the Diff-quick stain in the microscopic exam had elevated cellularity, with several macrophages, and bacilliform structures in the negative image. Staining was also conducted by the Ziehl-Neelsen technique, which showed the presence of alcohol-acid-resistant bacilli (AARB) inside macrophages and in the centre of granuloma. In the animal’s follow up, a punch biopsy for histopathologic was conducted. A predominance of macrophages of epithelioid appearance, which were localised in the centre of nodulations, variable quantities de-agglomerates of degenerated neutrophils, was observed. In the periphery of the lesion intense infiltrate of lymphocytes and plasmocytes was found. Based on the clinical history, in the physical exam and laboratory findings, a treatment for mycobacteriosis with oral enrofloxacin 10 mg/kg every 24 h associated to doxycycline 10 mg/kg every 24 h and rifampicin topical twice a day in the cutaneous lesions was initiated. After three months of treatment, the animal did not have collateral effects with the association of antibiotics and had a complete clinical resolution, without recurrence.Discussion: Despite that the CLG etiopathogeny is not well clarified, it is important to highlight the involvement of insects, such as flies and mosquitoes, inoculating the mycobacteria. Despite the fact that large size dogs, of breeds with short hair that are raised outdoors, have greater susceptibility to CLG and the lesions can be located specially in the face and ears, it is recommended to use complementary exams, such as cytology and histopathology, to obtain a definitive diagnosis. The CLG is a disease already reported in some regions of the Brazilian territory; however, it is believed that it is underdiagnosed, making it difficult to effectively use the therapeutic protocol.

Feline progressive histiocytosis: a retrospective investigation of 26 cases and preliminary study of Ki67 as a prognostic marker.

Feline progressive histiocytosis (FPH) is an uncommon and infrequently reported cutaneous histiocytic proliferative disorder, whose clinical presentation is solitary or multiple cutaneous nodules and papules, with late-course internal metastasis. We describe herein the clinical, epidemiologic, histologic, and immunohistochemical features of this entity, and document the outcome of FPH based on a retrospective study of 26 cases. Female and male cats were affected equally. Lesions were evident either as solitary (16 of 26 cases) or multiple (10 of 26 cases) nonpruritic and alopecic nodules or plaques, preferentially located on the legs and extremities (73%). Follow-up was complete for 19 cats, and ranged from 41 to 1,449 d. Nine died of FPH with a median overall survival of 96 d (range: 41-238 d). The disease recurred in 14 cats after surgical excision of the nodules, and the median disease-free survival was 175 d (range: 21-1,449 d). Five of the 26 cats were alive at the end of the study, and 4 had no progression of the disease. Histologically, lesions were characterized by poorly circumscribed, unencapsulated histiocytic infiltration of dermis and subcutis. Epitheliotropism was observed in 11 (42%) cats. Atypical histiocytes diffusely and consistently expressed MHC II, CD18, and Iba1. Statistically significant higher E-cadherin expression was observed in epitheliotropic cases compared to non-epitheliotropic cases. A negative correlation between overall survival and proliferation index was evident, thus suggesting Ki67 as a promising prognostic marker.

Dissecting folliculitis (dissecting cellulitis) of the scalp: a 66-patient case series and proposal of classification.

Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity. A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages. Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p<0.05). A complete remission rate of 25% was achieved by any treatment, and a rate of 37.5% was achieved with oral isotretinoin alone. DF is not uncommon in Taiwan. An association with obesity needs to be clarified.

Alopecia en placas: A propósito de un caso

Non-scarring alopecias are reversible, in which the hair follicle is altered but not completely destroyed (dots are visualized) so they have a better prognosis. It is essential to know how to differentiate the trichoscopic and trichogram characteristics of non-scarring alopecias in order to diagnose trichotillomania, since it is a diagnosis of exclusion. We describe, in this case, the differential diagnosis with: alopecia areata, tractional alopecia, tinea capitis and aseptic and alopecic nodules of the scalp or pseudocysts.

Dissecting Cellulitis of the Scalp Early Diagnosed by Color Doppler Ultrasound.

Dissecting cellulitis of the scalp (DC) is a chronic inflammatory condition of the scalp that ultimately leads to scarring alopecia. A healthy 19-year-old male presented with a solitary, soft, alopecic nodule that had appeared 1 year before. A color Doppler ultrasound examination showed a hypodermal anechoic fluid collection in the left parietotemporal region of the scalp, connected to the base of widened hair follicles, and presented inner echoes suggestive of debris, as well as several fragments of hair tracts. A diagnosis of DC was made and an epidermal or trichilemmal cyst was ruled out. This case shows the importance of color Doppler ultrasound for supporting the diagnosis at an early stage or with an unusual presentation of DC.

Alopecic and Aseptic Nodules of the Scalp/Pseudocyst of the Scalp: Clinicopathological and Therapeutic Analyses in 11 Korean Patients

Background: Alopecic and aseptic nodule of the scalp (AANS) is a rare disease entity first reported in 1992 as pseudocyst of the scalp (PCS). Controversy exists regarding the histopathology and etiology of reported cases. Objective: We performed this study to analyze the clinical and histopathologic features of AANS/PCS in Korean patients. Methods: A retrospective review of medical records from 2008 to 2013 at Inje University Busan Paik Hospital was performed. Results: Eleven patients were enrolled. All patients were male, and their mean age was 21.6 years. Most patients had a solitary nodule (10/11) located predominantly on the vertex. The mean nodule size was 20 mm. Inflammatory cell infiltration in the deep dermis was a histologic feature of AANS/PCS. Eight patients showed granulomatous infiltration. All patients were treated with short-term antibiotics and intralesional steroid injection. Conclusion: Our results suggest that dermatologists should consider AANS when diagnosing an alopecic nodule on the scalp.

Cellulite disséquante du cuir chevelu : étude rétrospective de 7 cas confirmant l’efficacité de l’isotrétinoïne per os

Dissecting cellulitis of the scalp (DCS) is a rare and long-standing disease and its aetiopathogenesis remains unclear. Various therapeutic alternatives exist. We attempted to assess the efficacy of oral isotretinoin in a series of patients. Seven cases of DCS followed and treated by one of the authors at the Sabouraud Centre in the Saint-Louis Hospital between 2007 and 2013 were retrospectively studied and the efficacy of oral isotretinoin was evaluated. The seven patients included were males aged between 22 and 39 years, with alopecic nodules on the occiput (two cases) or the top of the vertex (five cases). Most patients were given oral isotretinoin at a dosage of 0.75mg/kg/day for at least nine months. The outcome was satisfactory with complete healing of the lesions and good regrowth in all cases. Follow-up after recovery lasted between 16 and 42 months. Based on published studies and the results of the present study, oral isotretinoin at a dose of 0.75mg/kg/day may be proposed as first-line treatment for DCS.

Immunohistochemical profile of multicentric cutaneous epitheliotropic T-cell lymphoma with generalised lymphadenopathy in a Holstein-Friesian cow: a case report

Cutaneous epitheliotropic T-cell lymphoma with progression to superficial and internal lymph nodes and the spleen was diagnosed in a two-year-old Holstein-Friesian cow. The skin lesions included multiple hypotrichous to alopecic nodules, often with ulceration, which first appeared three months after calving and progressed quickly to cover the entire body. The cow was euthanized one month later. The ELISA test excluded bovine leukaemia virus infection. Histologically in the epidermis, the formation of Pautrier&amp;rsquo;s microabscesses and in the dermis, dense neoplastic infiltration with mild folliculotropism was observed. Similar neoplastic cells were present in the histological sections of lymph nodes and spleen. Immunohistochemical analysis was performed using CD3, CD79&amp;alpha;cy, HLA-DR, WC1-N3 and Ki67 antibodies. Immunophenotyping results (CD79&amp;alpha;cy&amp;ndash;, CD3+, WC1-N3&amp;ndash;) confirmed the &amp;alpha;&amp;beta; T-cell origin of neoplastic cells. The mean Ki67 index among neoplastic cells was 15.3%. On the basis of the immunohistochemical and histopathological results, the first case in Poland of cutaneous epitheliotropic T-cell lymphoma in a cow was confirmed. Additionally, MHC class II expression on approximately 10.4% of lymphoma cells was associated with a poor clinical prognosis. However, the up-regulation of MHC class II expression on accompanying cells suggested tumour immune surveillance, an antigen-specific immune response or immunosuppression. However, further investigations are needed to confirm these suspicions. &amp;nbsp;

Leishmania-Like Protozoan Associated with Dermatitis in Cattle

A Leishmania sp.-like organism was found in the skin of a naturally infected 8-mo-old Red Dane female calf (Bos taurus) from Zimbabwe. There were multiple alopecic nodules, particularly on the face and udder. The nodules were up to 5 cm in diameter and larger ones were ulcerated and hemorrhagic. Numerous Leishmania-like amastigotes were seen in the skin lesions. Ultrastructurally, the organisms were oval to elongated (2-2.5 microm long), had a nucleus, a kinetoplast, and a flagellum. To our knowledge, this is the first report of Leishmania-like organisms found in an animal from Zimbabwe.