Scarring Alopecia Research Articles

Optimal Treatment for Post-Surgical Cicatricial Alopecia: Autologous Hair Transplantation?

Scarring alopecia significantly impacts patients' appearance and psychological well-being. Surgery is a common cause of scarring alopecia, making positive treatment crucial for patients' overall health. To investigate the clinical efficacy of autologous follicular unit extraction (FUE) transplantation for postoperative secondary stable scarring alopecia and evaluate its effectiveness. A retrospective descriptive study was conducted, including 14 patients with postoperative secondary scarring alopecia. All patients underwent initial autologous FUE hair transplantation, and postoperative complications were monitored. Patient satisfaction surveys were also conducted. Satisfaction assessments were performed for all 14 patients. Two patients (14.3%) reported being very satisfied, 6 patients expressed satisfaction (35.7%), 4 patients reported being somewhat satisfied (28.6%), and 3 patients were dissatisfied (21.4%). Aesthetic complications included low follicular density post-transplantation, uneven density, and unnatural appearance. Solely using a single FUE hair transplantation for treating postoperative secondary scarring alopecia has limited effectiveness and may not always meet expectations, potentially requiring multiple transplantations. Further research is necessary to guide and improve follicular transplantation survival rates to ensure surgical efficacy.

Lichen Planopilaris in Children: A Systematic Review.

Lichen planopilaris (LPP) is the most common form of scarring alopecia in adults. The disease may also occur in children and adolescents. The aim of this systematic review is to evaluate clinical, trichoscopic, and histopathologic features of pediatric LPP. Therapeutic management is also discussed. The systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines by searching PubMed, Scopus, and EBSCO databases with the last search on June 18, 2024. A total of 12 studies including 20 children were analyzed. Male predominance was observed. The typical presentation of LPP in children included scarring, perifollicular erythema, scaling, and plugging; atrophy, and follicular hyperkeratotic papules, located most commonly in the vertex. The most common trichoscopic findings were scaling and blue-gray dots, perifollicular erythema, and the absence of follicular ostia. Histopathological examination revealed perifollicular fibrosis, perifollicular interface lymphocytic inflammation, pigment incontinence, cytoid bodies, and scarring in the dermis. Complete or partial response was observed in children treated with topical, intralesional, and systemic corticosteroids, methotrexate, pioglitazone, and tocilizumab. LPP is a rare cause of scarring alopecia in children. The disease should be taken into consideration in the differential diagnosis of patchy hair loss in children.

The 100 Most Cited Publications in Lichen Planopilaris: A Bibliometric Analysis

Introduction: Lichen planopilaris (LPP) is a rare scarring alopecia with poorly understood etiology, leading to challenges in both diagnosis and management. With an increasing number of studies focused on its clinical presentation, histopathology, and trichoscopic features, a comprehensive bibliometric analysis of high-impact LPP research is necessary to assess current trends and identify gaps in the literature. Methods: To analyze trends in LPP research using the top 100 most-cited articles from Web of Science. Results: The average number of citations per article was 80.4 (range: 37-289), with publication dates ranging from 1990-2021. The most cited article was Kossard’s "Progressive Frontal Scarring Alopecia in Postmenopausal Women" with 289 citations. The United States (n=47) had the most publications, followed by England (n=18) and Spain (n=14). Most articles were LOE 3 (n=34) focusing on the "Clinical and Histopathological Presentation" (n=33). Key reported trichoscopic features included perifollicular erythema, perifollicular scaling, and loss of follicular ostia. Conclusion: This bibliometric analysis highlights foundational LPP studies, emphasizing key trichoscopic features while revealing gaps in high-level evidence. It underscores the need for more rigorous research and expanded geographic diversity to enhance diagnostic markers, refine trichoscopic criteria, and improve therapeutic approaches.

Clinical and demographic characteristics of frontal fibrosing alopecia in a dermatology referral center in Bogota, Colombia: a descriptive cross-sectional study.

Frontal fibrosing alopecia (FFA) is a type of scarring alopecia that is characterized by a symmetrical recession of the frontal/temporal hairline. Despite growing interest in this pathology, there is scarce data on its epidemiology in Latin American countries such as Colombia. To estimate the frequency and describe the clinical manifestations and factors associated with FFA. This descriptive cross-sectional study reviewed the electronic health records of adult patients diagnosed with FFA at a referral center in the city of Bogota, Colombia, between 2018 and 2021. Of the 1506 patients diagnosed with scarring alopecia, 213 fully met the selection criteria (14.14%). Patients had a median age at diagnosis of 60 years (Q1-Q3: 49-67 years) and were more frequently female (95.31%). Concurrent eyebrow alopecia was the most frequent clinical presentation (56.34%). Perifollicular desquamation was present in 114 patients (53.52%), perifollicular erythema in 56 (26.29%), and both features simultaneously in 35 (16.43%). Sunscreen use was reported by 116 (54.46%) and facial moisturizers by 38 (17.84%), both of which have been reported as risk factors. The small sample size and the lack of racial and geographical diversity in the subjects. This study provides baseline epidemiological data in a Colombian sample. Sex, location of alopecia, and symptoms were consistent with those reported in the literature, but age at presentation, tobacco use, use of wigs, and dyes differed from those reported in other countries.

481 Pathogenic variants affecting peptidyl arginine deiminase 3 and its major substrates underlie central centrifugal cicatricial alopecia

481 Pathogenic variants affecting peptidyl arginine deiminase 3 and its major substrates underlie central centrifugal cicatricial alopecia

Clinical Profile of Patchy Alopecia: Report from a Tertiary Care Hospital of Bangladesh

Background: Patchy alopecia is a common dermatological problem worldwide with a high degree of phenotypic and genotypic variation influenced by genetic and environmental factors and is often a major source of psychological distress to patients. However, there is limited published data on patchy alopecia in Bangladesh. The purpose of this study was to evaluate the clinical pattern and prevalence of patchy alopecia in Bangladeshi patients. Materials and methods: This is a descriptive cross-sectional study which was carried out in the Department of Dermatology and Venereology of Chittagong Medical College Hospital, Bangladesh, between the periods of September 2018 to December 2019. Results: Out of 259 patients, male were 169 (65.3%) and female were 90 (34.7%) with a male to female ratio 1.8:1. The mean age of the study population was 23.73 ± 12.735 SD (Range: 1-65) years. The mean age of onset was 22.67 ± 12.735SD (Range: 0-65) years. Non Cicatricial Alopecia (NCA) were accounted 192 (74%) and rest of the 67 (26%) were Cicatricial Alopecia (CA) patients. Alopecia Areata (AA) 172 (66.4%) was the most common 192 (74%) NCA while alopecia due to Discoid Lupus Erythematosus (DLE) 34(13.1%) was the most common 67 (26%) CA. Most of the patients 158 (61%) had multiple patches. Among 259 patients, 77 (29.73%) patients had associated pruritus, 44 (16.98%) patients had scaling and 49 (18.9%) patients were atopic. Conclusion: This study finding showed that patchy hair loss results from a variety of causes. Proper identification and differentiation of pattern of patchy alopecia is necessary for early diagnosis and to design appropriate treatment and by all these means to improve the quality of life Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 27-30

Red Scalp Disease: An underdiagnosed entity.

Introduction: Red scalp disease or scalp rosacea, an inflammatory dermatosis, is frequently misdiagnosed as scarring alopecia due to nonspecific trichoscopic findings and limited case reports. While facial rosacea is well-documented, rosacea affecting extrafacial sites, such as the scalp, remains underrecognized. Accurate diagnosis is crucial to avoid unnecessary treatments and to establish appropriate prognosis. Case Report: A 70-year-old male with an asymptomatic red scalp for one year, unresponsive to topical treatments, presented to our clinic. Examination revealed diffuse erythema with papules and pustules. Trichoscopy showed vascular polygons, “caterpillar hair” vessels, linear arterial branching, and hairpin vessels. Diagnosis of scalp rosacea was made, and significant improvement was observed after two months of oral tetracycline therapy. Discussion/Conclusion: Red scalp disease is characterized by diffuse erythema, inflammatory lesions, and vascular changes. Patients often exhibit mild facial photosensitivity but may not show prominent facial rosacea symptoms. Distinct trichoscopic patterns can assist in accurate diagnosis. Early recognition and treatment with systemic antibiotics, such as tetracyclines, are crucial to prevent progression to more severe inflammation. Increased awareness among dermatologists and trichologists is essential to enhance the diagnosis and management of this condition.

Acné queloideo de la nuca, un reto terapéutico para los dermatólogos

Acne keloidalis nuchae (AKN) is a chronic inflammatory dermatosis of the scalp that causes scarring alopecia. The etiology of AKN has been associated with an immune response vs. follicular antigens. AKN is characterized by fibrotic papules and plaques that can converge in tumor-like lesions; subclinical disease has been reported in perilesional areas, which could impact its development. Early diagnosis and treatment are essential to reduce morbidity and preserve and minimize healing. Various treatments have been established including optimal medical therapy, surgical excision, and light sources. An updated description of treatments (algorithm included) used for AKN is suggested based on the clinical lesions.

The reasons and solutions for lipsotrichia and pelada phenomenon

Abstract. According to Darwins evolution, people know that humans evolved from certain types of apes which used to have a lot of hair. In the process of evolving from apes to humans, apes hair was lost gradually. Nowadays, there is only a little bit of hair that modern humans still left, like hair on the heads and four limbs. NLM database reported an experiment that justified hair on the heads can protect human brains by reducing solar radiation. But many people, because of some reasons, like genes, immune system, and endocrine, have hair loss problems, which leads to possible damage to their brain and appearance. This paper aims to explore the way to mitigate scarring alopecia and androgenetic alopecia. The results show that people can prevent their hair by changing their life habits cleaning their scalps carefully and having a good mood. If they already get scarring alopecia, people must take medicine based on medical advice. And if people get androgenetic alopecia, they should use Minoxidil. This paper can help people with hair loss problems grow their hair back so that it can better help the brain dissipate heat.

JAK-STAT1 as therapeutic target for EGFR deficiency-associated inflammation and scarring alopecia

The hair follicle stem cell niche is an immune-privileged microenvironment, characterized by reduced antigen presentation, thus shielding against permanent immune-mediated tissue damage. In this study, we demonstrated the protective role of hair follicle-specific epidermal growth factor receptor (EGFR) against scarring hair follicle destruction. Mechanistically, disruption of EGFR signaling generated a cell-intrinsic hypersensitivity within the JAK-STAT1 pathway, which, synergistically with interferon gamma expressing CD8 T-cell and NK-cell-mediated inflammation, compromised the stem cell niche. Hair follicle-specific genetic depletion of either JAK1/2 or STAT1 or therapeutic inhibition of JAK1/2 ameliorated the inflammation, restored skin barrier function and activated the residual stem cells to resume hair growth in mouse models of epidermal and hair follicle-specific EGFR deletion. Skin biopsies from EGFR inhibitor-treated and cicatricial alopecia patients revealed an active JAK-STAT1 signaling signature along with upregulation of antigen presentation and downregulation of key components of the EGFR pathway. Our findings offer molecular insights and highlight a mechanism-based therapeutic strategy for addressing chronic folliculitis associated with EGFR-inhibitor anti-cancer therapy and cicatricial alopecia.

Efficacy and Safety of Laser Therapy and Phototherapy in Cicatricial and NonCicatricial Alopecia: A Systematic Review Study.

In recent years, the application of various light and laser devices in the treatment of different types of alopecia has been established. This systematic review aims to assess the efficacy and safety of laser therapy and phototherapy in cicatricial and non-cicatricial alopecia. A comprehensive search was conducted on PubMed, Scopus, Science Direct, and Google Scholar. Articles were evaluated across four subgroups: alopecia areata, androgenic alopecia, telogen effluvium, and cicatricial alopecia. Included studies were published in English or Persian between January 2010 and September 2023, focusing on interventional, cohort, or case series research that achieved a minimum score of 75% on the EBL checklist. Exclusion criteria encompassed animal and in vitro studies, review articles, case reports, duplicated or irrelevant research, as well as studies that did not meet the designated EBL score. Editorial letters and case studies were also excluded. Initially, 965 records were collected, resulting in the inclusion of 58 studies in the final review: 26 on alopecia areata, 26 on androgenic alopecia, five on cicatricial alopecia, and one on telogen effluvium. Narrow-band ultraviolet B, 308-nm excimer laser, and psoralen ultraviolet A therapy showed varying effectiveness; specifically, the excimer laser was notably effective for patients with shorter disease duration. In androgenic alopecia, erbium-glass and thulium lasers effectively increased hair density but showed a gradual decline posttreatment. Low-level light/laser therapy also increased hair density and diameter and exhibited potential benefits when used alongside minoxidil, but did not significantly enhance outcomes in telogen effluvium treatment. Light/laser therapy can serve as an additive treatment for cicatricial alopecia, particularly lichen planopilaris, but has limited efficacy in treating telogen effluvium. Overall, light/laser therapies exhibit a significant positive effect on increasing hair density and diameter across various alopecia types.

Cross-sectional study to evaluate the utility of elastic tissue staining in primary cicatricial alopecia

Background and aimsDiagnosing end-stage primary cicatricial alopecia (PCA) on routine histology is challenging since the major diagnostic feature (inflammatory infiltrate) may be minimal or absent. This study aimed to assess...

Association of lichen planopilaris with cardiovascular and metabolic disorders: A systematic review and meta-analysis.

Lichen planopilaris (LPP) is among the most common types of immune-mediated scarring alopecia. Observational studies have reported conflicting findings regarding the association of LPP with different comorbidities. We conducted a systematic review and meta-analysis to elucidate the association between LPP and different cardiovascular and metabolic disorders. We systematically searched four electronic databases-PubMed, Web of Science, Embase, and Cochrane Library-for relevant studies published from their inception to August 1, 2024. A random-effects model was used to perform a pooled analysis and calculate odds ratios or incidence rate ratios with 95% confidence intervals. The meta-analysis included 10 case-controls studies involving 7,516 patients with LPP and 64,719,097 controls. The results demonstrated no significant association between LPP and hypertension, diabetes mellitus, or hyperlipidemia. The pooled analysis results also revealed that patients with LPP did not have significantly higher risks of obesity and heart failure than did controls. All pooled analyses revealed high levels of heterogeneity across the studies, but no significant publication bias was detected. LPP is not significantly associated with most cardiovascular and metabolic disorders, including hypertension, diabetes mellitus, hyperlipidemia, obesity, and heart failure.

Low-Level Laser and LED Therapy in Alopecia: A Systematic Review and Meta-Analysis.

Low-level laser/LED therapy (LLLT) has been described as a treatment option for alopecia, but no study has comprehensively reviewed its efficacy in multiple alopecia types. To review and evaluate LLLT for various alopecia types. A systematic search of PubMed/MEDLINE, Embase, and CENTRAL was conducted to identify studies assessing the effect of LLLT on patients diagnosed with alopecia. Prespecified outcome measure was the change in hair density. Meta-analysis was performed to calculate the standardized mean difference in hair density before and after LLLT compared with placebo. Thirty-eight studies were included that described 3,098 patients with androgenetic alopecia (2,930/3,098), scarring alopecia (49/3,098), alopecia areata (50/3,098), telogen effluvium (17/3,098), and chemotherapy-induced alopecia (32/3,098). The mean change in hair density increased significantly in androgenetic alopecia patients after LLLT for 4 to 26 weeks compared with placebo (<20 weeks: SMD = 1.14; 95% CI [0.51-1.78]; p = .000; I2 = 88.26%; >20 weeks: SMD = 1.44; 95% CI [0.97-1.91]; p = .000; I2 = 80.81%). Change in hair density was reported in 5 studies evaluating other alopecia types; however, statistical information was insufficient for meta-analysis. LLLT is a promising treatment option for patients with androgenetic alopecia, but future studies are needed to better understand its efficacy in other alopecia types.

Evaluation of the Environmental Risk Factors and Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study

Introduction: Lichen planopilaris (LPP) is an uncommon cicatricial alopecia clinically characterized by follicular hyperkeratosis, perifollicular erythema, and permanent hair loss. The association of LPP with certain underlying diseases and environmental factors has been evaluated but there are limited data about this association. This study was designated to evaluate the environmental risk factors and comorbidities in LPP patients. Method: This case-control study was performed on LPP patients referred to two dermatology referral centers from 2019 to 2022. A group of non-LPP healthy individuals referring for cosmetic concerns was recruited as control group. Data collection was performed using two questionnaires: a general questionnaire, including demographic information, comorbidities, environmental risk factors, and disease-related information, and the lichen planopilaris activity index (LPPAI) questionnaire. Results: One hundred LPP patients as case group were compared with 100 healthy people without LPP as control group. Unemployment, history of major stressful events, thyroid disorder, history of hair dyeing, using face soaps, taking supplements, postmenopausal status, and family history of LPP or other types of alopecia had significant relationship with LPP (all p values <0.05). Conclusion: LPP has associations with environmental and non-environmental risk factors and, also, genetic component.

Evidence of IL-17-secreting mast cells in scalp lesions of folliculitis decalvans points to new therapeutic targets in recalcitrant lesions.

Folliculitis decalvans (FD) is a chronic neutrophilic scarring alopecia which exact pathogenesis remains unknown. The recent report on the successful use of a novel anti-IL17 biologic agent in FD and the presence of IL-17-secreting mast cells in other types of scarring alopecias point to a distinct pathogenic mechanism in this disease. Our aim was to study and correlate the expression of IL-17 and mast cells in lesional and non-lesional FD scalp, using immunohistochemical techniques. Increased expression in IL-17 and mast cells was found in lesional scalp compared to non-lesional scalp areas (p<.05). A significant positive correlation between IL-17 and Mast cell Tryptase immunolabeling in non-lesional scalp (r=.64) highlights the role of IL-17-secreting mast cells in "normal-appearing" sites of FD. These findings suggest that targeting both IL-17 and mast cells may be potentially beneficial to better control the chronic inflammatory status of the disease specially in recalcitrant cases of FD.

Vitamin D deficiency in non-scarring and scarring alopecias: a systematic review and meta-analysis.

Numerous studies have linked vitamin D deficiency (VDD) to the pathogenesis of various alopecia disorders. This study aimed to investigate whether patients with alopecia are more likely to have VDD or lower vitamin D levels than controls, and the prevalence of VDD among patients with certain alopecia disorders. Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception until September 2024. Studies that reported data allowing for the calculation of odds ratios, mean differences, or correlation coefficients related to vitamin D levels and alopecia were included, while studies without a confirmed diagnosis of alopecia or those involving patients taking vitamin D supplements were excluded. It was found that 51.94% of patients with alopecia areata (AA), 50.38% of patients with female pattern hair loss (FPHL), 47.38% of patients with male androgenic alopecia (MAGA), 53.51% of patients with telogen effluvium (TE), and 38.85% of patients with primary scarring alopecia had VDD. Compared to controls, AA patients had a pooled odds ratio (OR) of VDD of 2.84 (95% confidence interval: 1.89-4.26, I2 = 84.29%, p < 0.01) and a pooled unstandardized mean difference (UMD) of vitamin D levels of -8.20 (-10.28 - -6.12, I2 = 74.25%, p < 0.01) ng/mL. For FPHL patients, a pooled OR of VDD of 5.24 (1.50-18.33, I2 = 81.65%, p < 0.01) and a pooled UMD of vitamin D levels of -15.67 (-24.55 - -6.79, I2 = 91.60%, p < 0.01) ng/mL were found. However, for MAGA, a pooled VDD OR of 4.42 (0.53-36.61, I2 = 88.40%, p < 0.01), and a pooled UMD of vitamin D levels of -2.19 ng/mL (-4.07 - -0.31 ng/mL, I2 = 7.64%, p = 0.37) were found. For TE patients, pooled UMD of vitamin D levels of -5.71 (-10.10 - -1.32) ng/mL were found. People with alopecia frequently have VDD; however, only in patients with AA or FPHL was the association of VDD and decreased vitamin D levels statistically significant compared to control. The findings indicate screening for vitamin D could benefit patients with AA or FPHL, potentially addressing vitamin D deficiency. Further study on vitamin D supplementation as a treatment for alopecia is recommended.

Epidemiological and Trichoscopic Study of Patchy Scalp Alopecia in Children in Delta Egypt

Abstract Background Alopecia represents a distressing problem among children and has a severe psychological impact on the affected patients and their parents. Objective To investigate the clinical presentations of patchy hair loss and analysis of their prevalence and trichoscope features in children in delta Egypt. Methods The study was done on 374 patients aged from 0-18 years (231 males, 143 females) with patchy hair loss who were subjected to detailed history taking, dermatological examination as regard the patch of alopecia, scalp skin, nails, teeth, in addition to trichoscopic examination. The obtained demographic and clinical data of the included patients were tabulated and statistically analyzed. Results Mean age 7.77 years, 231 (61.8%) male patients and 143 (38.2%) female patients. Hair loss in children in this study is largely non-cicatricial causes; specifically alopecia areata, followed by infectious causes; specifically scaly tinea capitits (141 patients). The total number of patients having non-infectious alopecia was 206 patients. Alopecia areata was present in 147 patients (39.3%), toxic alopecia (post folliculitis) (12.6%), trichotillomania (2.1%), and congenital alopecia. Male preponderance in cicatricial alopecia, toxic alopecia (post folliculitis) and infectious disease groups versus female preponderance in non-cicatricial alopecia, alopecia areata, trichotillomania, patchy traction alopecia. The age groups with the largest numbers of children were those school age children aged five to ten years representing (50.5%). Alopecia presented from rural areas represents (72.5%). Trichoscope examination have confirmed the dermatologic clinical diagnosis of patchy alopecia in 368 patients. Conclusion The largest number of children presenting with patchy alopecia in Delta Egypt were those of school age children aged five to ten years, living in rural areas. Hair loss in children is largely due to alopecia areata followed by tinea capitits. Detection of specific trichoscopic features of each disease is mandatory for the accurate diagnosis and proper differentiation of -sometimes- confusing cases of hair and scalp disorders.

Clinicopathologic features, demographics, disease burden, and therapeutics in alopecic sarcoidosis: a case series and systematic review.

Alopecic sarcoidosis is an uncommon cutaneous manifestation of sarcoidosis. Scarring and nonscarring alopecic sarcoidosis have been reported; however, information on the epidemiology, systemic disease associations, and treatment efficacy is limited. To address these gaps, we conducted a retrospective chart review and systematic literature review of alopecic sarcoidosis cases. Full-text English publications from PubMed, Scopus, and Google Scholar from inception to August 2023 were analyzed. Treatment evidence quality was assessed using the modified Oxford Centre for Evidence-Based Medicine rating scale. Three patients with biopsy-proven alopecic sarcoidosis were included as a case series, all demonstrating systemic sarcoidosis and 2 requiring multiple therapies. Among 1778 search results, 60 articles representing 77 cases of alopecic and scalp sarcoidosis were included. Patients were categorized into 4 distinct alopecic subgroups. Black patients constituted the majority of all subgroups. Extracutaneous sarcoidosis burden was high across all alopecic subgroups, with ocular disease appearing overrepresented. Topical and oral corticosteroids were the main treatments. Though scarring alopecia patients had poor outcomes despite receiving immunomodulators/cx, limited data suggest potential efficacy of tumor necrosis factor-alpha inhibitors. This study has a small sample size. Our findings underscore the importance of evidence-based strategies for improving alopecic sarcoidosis management. Prompt diagnosis and systemic evaluation, especially for scarring alopecia, are essential for timely intervention to optimize patient outcomes.

Early-Onset Graham-Little-Piccardi-Lasseur Syndrome with Cutaneous Lichen Planus – A Rare Case Report and Review of Literature

Graham-Little-Piccardi-Lasseur syndrome (GLPLS) is a rare condition characterized by lichen planopilaris with scarring alopecia of the scalp and nonscarring alopecia of the axilla, groin, and pubis with keratosis pilaris. It usually affects middle-aged women more than men. The onset of scarring alopecia is usually reported in middle age. We report a case of GLPLS from South India, having early onset of alopecia in childhood, associated with cutaneous lichen planus.