Diffuse Non-scarring Alopecia Research Articles

A report on neglected case of systemic lupus erythematosus presenting by Degos’ skin disease and diffuse non-scarring alopecia with dramatic response to treatment

A report on neglected case of systemic lupus erythematosus presenting by Degos’ skin disease and diffuse non-scarring alopecia with dramatic response to treatment

A Neglected case of Systemic lupus erythematosus presenting by Degos’ skin disease and diffuse non-scarring alopecia with dramatic response to treatment, clinically and dermoscopy.

A Neglected case of Systemic lupus erythematosus presenting by Degos’ skin disease and diffuse non-scarring alopecia with dramatic response to treatment, clinically and dermoscopy.

Recurrent pruritic polymorphic lesions associated with weight loss

A 40-year-old man presented with a 2-year history of recurrent pruritic lesions without complete regression associated with weight loss of 33 kg, watery diarrhea, and hyporexia. Physical examination revealed polymorphic lesions composed of erythematous-brown papules, plaques, and macules with a scaly-crusted surface (Fig 1), some with necrotic appearance and excoriations on the face, upper and lower limbs (Fig 2), ankles (Fig 3) and trunk, abdomen, and perianal region in addition to diffuse nonscarring alopecia, onychoschizia, and angular cheilitis.

Clinicopathologic Characteristics and Response to Treatment of Persistent Chemotherapy-Induced Alopecia in Breast Cancer Survivors

Alopecia induced by classic chemotherapy affects up to 65% of patients and is usually reversible. However, there are increasing reports of persistent chemotherapy-induced alopecia (pCIA), especially for patients treated with taxane-containing chemotherapy regimens. To analyze the clinicopathologic characteristics and response to treatment of patients with pCIA after chemotherapy for breast cancer. In this case series, a retrospective evaluation was performed of patients with a diagnosis of pCIA after chemotherapy for breast cancer in 4 specialist hair clinics from November 1, 2011, to February 29, 2020. Clinical, trichoscopic, and histopathologic characteristics and treatment outcomes were analyzed. For patients who presented with diffuse alopecia or diffuse rarefaction of hair over the midfrontal scalp with widening of the central part line and preservation of the frontal hairline, the Sinclair scale (grades 1-5, where 1 indicates normal hair density and 5 indicates the most severe stage of hair loss, with little or no hair in the centroparietal region) was used to assess severity. One hundred patients (99 women [99%]; mean age at presentation, 54.0 years [range, 29.0-74.1 years]) were included. Most patients had diffuse nonscarring alopecia (n = 39), female pattern hair loss (n = 55), or male pattern hair loss (n = 6). Six patients developed cicatricial alopecia. Taxane-containing regimens were used for most patients (92 [92%]) and were associated with more severe alopecia than regimens that did not contain taxanes (median Sinclair grade, 4 [IQR, 3-5] vs 2 [IQR, 2-2.5]; P < .001). A total of 76 of 86 patients (88%) had trichoscopic signs indistinguishable from those of androgenetic alopecia. Of 18 patients who had biopsies, 14 had androgenetic alopecia-like features, 2 had cicatricial alopecia, and 2 had features of both. Both topical and oral minoxidil, sometimes combined with antiandrogen therapy, were associated with an improvement in hair density (median Sinclair grade, 4 [IQR, 3-5] before treatment vs 3 [IQR, 2-4] after treatment; P < .001). This case series outlines previously unreported features of pCIA in patients with breast cancer, including a trichoscopic description. Cosmetically significant regrowth was achieved for a significant proportion of patients with topical or systemic treatments, suggesting that pCIA may be at least partly reversible.

Case Report: Reversal of Long-Standing Refractory Diffuse Non-Scarring Alopecia Due to Systemic Lupus Erythematosus Following Treatment With Tofacitinib

The Janus kinases (JAKs) are intracellular tyrosine kinases involved in a broad variety of inflammatory cascades participating in the pathogenesis of systemic lupus erythematosus (SLE). Diffuse non-scarring alopecia is one of the most frequent cutaneous manifestations in SLE, resulting in devastating psychosocial consequences. Although recent studies have shown promising outcomes of the JAK inhibitors in SLE treatment, the efficacy of tofacitinib in diffuse non-scarring alopecia due to SLE has never been reported. Here we present a 29-year-old SLE patient with a 10-year history of refractory severe diffuse non-scarring alopecia who experienced dramatic hair regrowth with tofacitinib. Furthermore, we have made a systematic review regarding the potential effectiveness of tofacitinib in systemic and cutaneous lupus erythematosus. To the best of our knowledge, this is the first case study depicting an SLE patient with refractory alopecia who experienced impressive hair regrowth with the JAK1/3 inhibitor tofacitinib therapy, which contributes to expanding the field of possible uses of tofacitinib in SLE patients with difficult-to-treat cutaneous involvement, including severe alopecia.

Immunosuppressant-induced cutaneous drug reactions in solid organ transplant recipients

Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. We analyzed these manifestations' prevalence and their association with immunosuppressants in transplant recipients from a Brazilian tertiary center. Among 532 SOTRs followed at our dermatology clinic, 60 (11.3%) developed some cutaneous adverse reactions to the immunosuppressants, with a median age at transplantation of 50.5 years and a median life span posttransplantation of seven years. Acneiform eruption was the most common drug reaction found (21 patients, 30.4%), followed by diffuse non-scarring alopecia (16 patients, 23.1%), lymphedema (10 patients, 14.5%), gingival hyperplasia (7 patients, 10.1%), hypertrichosis (6 patients, 8.7%) and sebaceous hyperplasia (9 patients, 13.1%). Adequate immunosuppression is an essential prerequisite for successful organ transplantation. In the immediate post-transplant period, significant immunosuppression is needed, but after that, the complications of excessive immunosuppression outweigh the risk of organ rejection. SORTs may present with a broad spectrum of inflammatory and cosmetic findings due to immunosuppressants that can impair life quality.

Nineteenth-Century Homeopathic Materia Medica Texts Predict Source Materials Whose Physiological Actions Influence Thyroid Activity.

The homeopathic materia medica contains hundreds of thousands of observations collected over the course of two centuries. It includes both clinical observations of potentized medicines and observations of the actions of potentized medicines on healthy subjects (provings). This current study was undertaken to determine the degree to which observations within the materia medica were associated with the physiological mechanisms for thyroid activity-inhibiting substances in their undiluted state. Four specific symptoms for iodine deficiency were selected to describe the hypothyroid state: (1) generalized aggravation by or sensitivity to cold; (2) chronic painless hoarseness; (3) goiter; (4) painless diffuse non-scarring alopecia. Symptom representation for the four selected symptoms within the homeopathic materia medica was compared for 2 halogen inhibitors, for 3 substances that influence thyroid hormone target tissues, for 6 substances known or suspected to increase thyroid-stimulating hormone or decrease thyroid hormone levels, and for 11 substances not known to inhibit thyroid activity. To avoid knowledge bias, only those compilations of materia medica whose publication dates preceded the discoveries of crucial aspects of thyroid physiology were used as source materials for investigation. Homeopathic medicines derived from 11 substances with mechanisms for inhibition of thyroid activity were more likely to exhibit selected symptoms than the medicines derived from the 11 substances without known physiological mechanisms for thyroid activity inhibition. The difference between groups was analyzed via the Mann-Whitney non-parametric U test and was statistically significant to p < 0.01. After observations obtained from provings alone were removed from analysis, the difference remained significant to p < 0.01. Only the two halogen inhibitors of iodine (bromine and fluoric acid) and one of the influencers of thyroid hormone target tissue (calcium carbonate) were significantly goitrogenic. With respect to thyroid activity inhibition, there is a statistically significant association between observations recorded within the homeopathic materia medica and the expected physiological mechanisms for the corresponding undiluted substances.

A novel PLEC nonsense homozygous mutation (c.7159G\u2009>\u2009T; p.Glu2387*) causes epidermolysis bullosa simplex with muscular dystrophy and diffuse alopecia: a case report

BackgroundEpidermolysis bullosa simplex with muscular dystrophy (EBS-MD; OMIM #226670) is an autosomal recessive disease, characterized mainly by skin blistering at birth or shortly thereafter, progressive muscle weakness, and rarely by alopecia. EBS-MD is caused by mutations in the PLEC gene (OMIM *601282), which encodes plectin, a structural protein expressed in several tissues, including epithelia and muscle. We describe a patient affected with EBS-MD and diffuse alopecia in which we identified a novel pathogenic mutation by PCR amplification of all coding exons and exon–intron boundaries of PLEC gene, followed by bidirectional Sanger sequencing.Case presentationThe patient, a 28-year-old female and only child of consanguineous healthy parents, was born after uneventful pregnancy. At 2 days of age, she developed skin and oral mucosal blistering, accompanied by voice hoarseness. On physical examination as an adult, we observed diffuse non-scarring alopecia on the scalp, onychodystrophy (pachyonychia) in all 20 nails, dental decay, mild dysphonia, and severe muscle atrophy mainly affecting the extremities. Neurological examination showed profoundly diminished reflexes. Mutation analysis revealed the patient to be homozygous for the novel PLEC nonsense mutation − c.7159G > T (p.Glu2387*) − located in exon 31. Thismutation predicts the lack of expression of the full-length plectin isoform.ConclusionThe present case appears to be the second association of EBS-MD with diffuse alopecia, both cases having different mutations involving PLEC exon 31. It remains to be elucidated whether diffuse alopecia results from PLEC mutations and/or from environmental factors.

A tricky case of hair loss in a child: Trichoscopy saves the day

Dear Editor, A 7-year-old, otherwise healthy Indian girl presented with asymptomatic sparsening of hair on the sides and posterior scalp of 6 months duration. The parents reported no improvement with oral iron and multivitamin supplements taken for 3–4 months, betamethasone, and 2% minoxidil lotion applied for 2–3 months, and three doses of weekly oral fluconazole 50 mg. Examination revealed numerous coalescing patches of nonscarring alopecia, with the left parieto-occipital scalp being more involved [Figure 1]. There was mild scalp scaling but no visible broken hair shafts or exclamation-point hair. Hair pull test was negative. A 10% potassium hydroxide (KOH) mount preparation of hair shafts from multiple areas was negative for fungal elements. Specimen was also sent for fungal culture. Provisionally, differential diagnoses of noninflammatory tinea capitis (TC), diffuse alopecia areata (AA), and trichotillomania (TTM) were considered. Trichoscopy using a hand-held dermoscope (Heine Delta® 20T) under polarized light (×10) revealed several “comma,” and “corkscrew” hairs in addition to few black dots and focal scale-crust. A dead head louse was also detected incidentally, however, no nits were visualized [Figure 2]. In the absence of defining trichoscopic features of AA or TTM, and the unmissable presence of typical trichoscopic features of TC, the patient was treated with oral terbinafine (125 mg/day) and 2% ketoconazole shampoo. Our diagnosis of TC was reaffirmed when the fungal culture reported growth of Trichophyton violaceum. The child achieved complete clinical cure by the 6th week of treatment initiation. The utility of trichoscopy is being increasingly recognized in the diagnosis of alopecia in children. The dermoscopic features of various causes of alopecia, including AA, TTM and TC are now well-recognized.[1] The trichoscopic features of TC vary in inflammatory and noninflammatory variants. While the typical black-dot tinea is characterized black dots and short broken hair, inflammatory variant shows additional features such as erythema, scaling, pustules and follicular scale-crusts. Though black dots and broken hair are non-specific findings that can also be seen in AA and TTM, presence of comma, corkscrew and zig-zag hairs are specific to TC.[23] “Comma hair,” observed in both endothrix and ectothrix-infections appear as slightly curved hair shafts, fractured close to the scalp surface and result from hyphal invasion of the hair shaft.[23] Corkscrew and zigzag hair represent variations of the comma hair.[23] The trichoscopic hallmarks of AA are exclamation mark hairs and yellow dots,[4] while TTM shows broken hair shafts of uneven length, follicular hemorrhage, trichoptilosis, tulip hair, flame hair, and other specific features, which were absent in our patient.[5]Figure 1: Patchy-to-diffuse hair loss in a 7-year-old girl; more prominent on the left side of the scalpFigure 2: Trichoscopy [Polarized, 10×] showing multiple comma hairs (green arrows), corkscrew hairs (red arrows), in addition to black dots and focal scale crust. A dead head louse was seen incidentally (Yellow circle)The clinical pattern of alopecia was not very typical of TC in our patient, with diffuse nonscarring alopecia, minimal inflammation, and a negative hair pluck test. A negative KOH rendered the diagnosis tricky. Fungal culture, the gold standard of diagnosis of TC, takes approximately 4 weeks for growth of dermatophytes. The correct diagnosis was initially suggested by trichoscopy that showed characteristic comma and corkscrew hairs, which allowed us to start the treatment early. The diagnosis of TC was later confirmed by a positive fungal culture. With this report, we wish to highlight the utility of dermoscopy as a quick, simple and noninvasive technique in the differential diagnosis of nonscarring alopecia in children and as an aid in instituting the optimal treatment without delay. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature.

Patients diagnosed with juvenile-onset systemic lupus erythematosus (JSLE) often have skin and oral lesions as part of their presentation. These mucocutaneous lesions, as defined by the American College of Rheumatology (ACR) in 1997, include malar rash, discoid rash, photosensitivity and oral ulcers. It is therefore essential to recognize mucocutaneous lesions to accurately diagnose JSLE. The mucocutaneous lesions can be divided into those with classical histological features (LE specific) and those strongly associated with and forming part of the diagnostic spectrum, but without the classical histological changes of lupus (LE nonspecific). A malar rash is the most commonly associated LE specific dermatological presentation. This skin manifestation is an acute form and also correlates with disease activity. Subacute (polycyclic or papulosquamous lesions) and chronic (discoid lesions) forms, whilst showing classical histological changes supportive of lupus, are less commonly associated with systemic lupus and do not correlate with disease activity. The most commonly associated skin lesions without classical lupus changes are cutaneous vasculitis, oral ulcers and diffuse non-scarring alopecia. These signs frequently relate to disease activity. An understanding of cutaneous signs and symptoms of lupus in children is important to avoid delay in diagnosis. They will often improve as lupus is adequately controlled and their reappearance is often the first indicator of a disease flare.

Phenytoin induced alopecia &amp; Lupus: a case report

Drugs are capable of producing a wide spectrum of hair ioss ranging from barely detectable shedding to irreversible baldness. Drug-induced alopecia is usually described as a diffuse non-scarring alopecia which is reversible upon withdrawal of the drug. Usually antimitotic agents cause hair loss. Hair loss is reported secondary to some anticonvulsant agents. Other drugs like anti-hypertensives salicylates or non-steroidal analgesics anticoagulants and antithyroid drugs oral contraceptives cimetidine retinoids amphetamines bromocriptine and levodopa and some hypocholesterolaemic and a few psychotropics may cause alopecia. Some anticonvulsants such as phenytoin rarely can cause alopecia. Diagnosis of drug-induced alopecia remains difficult. The only way to confirm It Is to see If an improvement occurs after discontinuation of administration of the suspected drug.nbsp

Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

Autoimmune Disease and Hair Loss

Once systemic disease is in remission, it is prudent to recognize the importance of alopecia in the patient's overall sense of well-being and quality-of-life clinical outcome. Scarring alopecia (scalp discoid lupus erythematosus) can be the presenting manifestation of lupus in more than half of affected individuals. Diffuse nonscarring alopecia in lupus is usually responsive to treatment of the systemic disease. Severe, often intractable burning pruritus of the scalp is a frequent complaint in dermatomyositis. Lichen planopilaris may mimic other autoimmune forms of scarring alopecia. Alopecia can also be caused by medications used to treat systemic autoimmune disease and fibromyalgia.

A Novel Dermato-Pulmonary Syndrome Associated With MDA-5 Antibodies

Melanoma differentiation-associated protein 5 (MDA-5) is a novel autoantibody frequently characterized by interstitial lung disease and a distinct cutaneous phenotype with palmar papules, ulceration, and rash. Virtually all patients have underlying dermatomyositis, but many lack the characteristic clinical myopathy associated with it. In the setting of amyopathic disease, the absence of clinically available biomarkers or clear pathologic diagnosis can complicate effective prognostic and therapeutic intervention. Until recently the presence of MDA-5 antibody associated dermato-pulmonary syndrome was described only in Asian populations. We present 2 cases of MDA-5-associated dermato-pulmonary syndrome and provide a comprehensive review of available literature.

Iron deficiency and diffuse nonscarring scalp alopecia in women: More pieces to the puzzle

Iron deficiency and diffuse nonscarring scalp alopecia in women: More pieces to the puzzle

Diffuse Nonscarring Alopecia of Scalp: An Indicator of Early Infantile Scurvy?

An infant with diffuse nonscarring alopecia of scalp and radiologic features of scurvy responded dramatically to oral vitamin C therapy. The characteristic cutaneous manifestations of scurvy are usually not seen in infancy. The manifestations of initial stage of scurvy that are not related to collagen synthesis, as in the present case, should alert to the possibility of this potentially fatal condition.

Approach to the adult female patient with diffuse nonscarring alopecia

Alopecias are traditionally categorized by the presence or absence of scarring and by a diffuse or localized pattern. A common clinical conundrum is that of a woman presenting with the chief complaint of diffuse, nonscarring hair loss. We review the 4 main diagnostic possibilities for this clinical scenario: (1) female pattern hair loss (androgenetic alopecia), (2) acute and chronic telogen effluvium, (3) diffuse alopecia areata, and (4) loose anagen syndrome. We also outline our approach to the individual patient, emphasizing the pertinent history, physical examination, and appropriate diagnostic testing. This approach usually allows the clinician to make a definitive diagnosis or limited differential diagnosis and to offer the patient therapeutic options. (J Am Acad Dermatol 2002;47:809-18.) Learning objective: At the completion of this learning activity, participants should be familiar with the diagnostic possibilities in evaluating diffuse, nonscarring hair loss in women.

The Role of Magnetic Resonance Imaging in the Diagnostic Evaluation of Dermatomyositis

<h3>REPORT OF A CASE</h3> A 50-year-old white woman presented to our clinic for evaluation of a photosensitive skin eruption of 15 months' duration. The patient described a burning sensation after sun exposure, followed by persistent erythema. She practiced strict sun avoidance for several months before presenting to a local dermatologist. An evaluation revealed mild diffuse nonscarring alopecia, a positive antinuclear antibody titer (1:320), and a negative SSA/SSB titer. Laboratory studies revealed normal creatinine phosphokinase and aldolase values and a white blood cell count of 26×10⁹/L. A diagnosis of systemic lupus erythematosus was rendered, and treatment with hydroxychloroquine sulfate (Plaquenil) (200 mg twice daily) was initiated. The patient's eruption progressed, and mild dysphagia developed, with a 4.5-kg weight loss over the following 3 months. Her history revealed that she had undergone a partial colectomy followed by chemotherapy with fluorouracil and local irradiation for colon cancer (classification, Duke's B) 2

Mixed connective tissue disease syndrome

Fifteen patients with epidermal nuclear staining on direct immunofluorescence of normal skin and high titer serum antibody to ribonuclease-sensitive extractable nuclear antigen (ENA) had diffuse nonscarring and focal alopecia, abnormal pigmentation, swollen hands with sclerodactyly, and chronic cutaneous lupus erythematosus (LE) as the most common dermatologic features. Direct immunofluorescence of normal, unexposed skin revealed a particulate ('speckled') epidermal nuclear staining pattern in all 15 patients and subepidermal immunoglobulin deposits in 5. Ribonucleoprotein antibodies in high titer are associated with this characteristic type of epidermal nuclear staining. These findings provide easily detectable markers for a less aggressive subset of LE characterized by distinctive clinical and laboratory features consistent with mixed connective tissue disease.

Mixed Connective Tissue Disease Syndrome

• Fifteen patients with epidermal nuclear staining on direct immunofluorescence of normal skin and high titer serum antibody to ribonuclease-sensitive extractable nuclear antigen (ENA) had diffuse nonscarring and focal alopecia, abnormal pigmentation, swollen hands with sclerodactyly, and chronic cutaneous lupus erythematosus (LE) as the most common dermatologie features. Direct immunofluorescence of normal, unexposed skin revealed a particulate ("speckled") epidermal nuclear staining pattern in all 15 patients and subepidermal immunoglobulin deposits in 5. Ribonucleoprotein antibodies in high titer are associated with this characteristic type of epidermal nuclear staining. These findings provide easily detectable markers for a less aggressive subset of LE characterized by distinctive clinical and laboratory features consistent with mixde connective tissue disease. (<i>Arch Dermatol</i>113:583-587, 1977)