Scalp Involvement Research Articles

293 Ixekizumab demonstrates comprehensive psoriasis clearance in patients with moderate-to-severe psoriasis with scalp, nail, and/or palmoplantar involvement: Uncover-1, -2 trials through 5 years

Involvement of sensitive or challenging body areas is an important treatment consideration since patients with psoriasis in these areas can have disproportionately greater burden of disease. We assess comprehensive clearance by measuring the ability of ixekizumab to achieve complete skin clearance (PASI 100) up to 5 years when multiple challenging body areas (scalp, nails, palmoplantar [pp] regions) are involved. Data were integrated from UNCOVER-1 (NCT01474512) and UNCOVER-2 (NCT01597245) trials for patients with psoriasis treated with ixekizumab per label dosing.

Trichoscopy of pemphigus vulgaris in remission. A tool for treatment-cessation decision making? Preliminary results

Background One of the controversies in the treatment of Pemphigus Vulgaris (PV), is the time of treatment cessation. Scalp involvement is often the most stubborn to treatment body site and may reflect disease activity. Trichoscopy (Dermoscopy of scalp) features have not been studied in clinically “healthy-looking” skin of patients in full remission. Aims and Objectives To find out if there are any trichoscopy features in PV patients in clinical and immunologic remission, and accommodate treatment decision Methods The age and disease duration of 3 women with PV were correspondingly 62, 63, 55 and 5, 6, 15 years. Treatment at examination was 2,5 mg prednisone(Pr), for the last 22, 5 and 7 months. The 2nd patient was also taking 1 mg/kg/d of Azathioprine. Anti Desmoglein antibodies turned to negative since Oct/2017, Feb/2017, Sept/2015. Contact dermoscopy and hand lens X10 magnifier for clinical evaluation, were used. Results A red hue background, peripillar scales and tubular casts were observed by trichoscopy in the first 2 patients. Only peripilar scales on a small brown round area were the features in the 3rd patient. Treatment cessation was decided only in this patient, since casts observed in the other two patients, were considered as a consequence of outer root sheath acantholysis and a sign of disease activity Conclusions Areas of red hue skin background and movable cylindical scales (casts) around hair shafts may be observed, even in the absence of apparent scalp clinical involvement, in PV patients in remission. Since these features may drive physicians to treatment continuation, dermoscopy of the scalp is required in clinically “healthy-looking” PV patients, before a decision of treatment cessation is made. Future studies with greater number of patients, furtherly validated by long term disease course outcome, are needed

Treatment of Scalp Psoriasis.

Scalp involvement is seen in a majority of individuals with psoriasis, a chronic autoimmune skin disease with variable phenotypes. Occasionally, isolated scalp involvement is observed; and this causes significant psychosocial morbidity. Management of scalp psoriasis is difficult, in part due to the difficulty of applying topical agents and its refractory nature. Various treatment options are available with variable efficacy. Topical agents include topical steroids, keratolytics, tar and anthralin compounds, vitamin D analogues, and vitamin A derivatives. The combination treatment of topical betamethasone and calcipotriene is the most effective topical therapy. Systemic agents include conventional agents such as methotrexate, cyclosporine, and oral retinoids. Biologics offer a greater efficacy, with near complete or complete clearance of the scalp. In this article we review the published literature on adult and scalp psoriasis to highlight its treatment. Articles published in peer-reviewed journals were included for qualitative analysis of the literature, including reviews, clinical trials, case series, case reports published in the electronic database (MEDLINE/PubMed) through June 2021, cross references of respective articles, and trials from clinicaltrials.gov. J Drugs Dermatol. 2022;21(8):833-837. doi:10.36849/JDD.6498.

BH12: Frontal fibrosing alopecia affecting the glabella and lower forehead without scalp involvement

BH12: Frontal fibrosing alopecia affecting the glabella and lower forehead without scalp involvement

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis.

Psoriatic involvement in areas of the body such as nails, palms and soles (palmoplantar), and scalp is associated with dramatically negative effects on quality of life relative to involvement elsewhere in the body. Although numerous evidence-based studies demonstrate the efficacy of biologics for overall skin clearance in moderate-to-severe plaque psoriasis (including tumor necrosis factor α [TNFα] inhibitors and interleukin [IL]-17A, IL-12/IL-23, IL-23, IL-17F, and IL-17A/F inhibitors), large, randomized, placebo-controlled clinical studies of psoriasis with nail, palmoplantar, and scalp involvement are needed to better inform decision-making in clinical practice. Moreover, biologic failure caused by drug ineffectiveness is a common occurrence in patients who do not respond, lose response, or are intolerant to treatment. Brodalumab is a fully human IL-17 receptor A antagonist that demonstrates high rates of skin clearance among the latest generation of biologic therapies for treatment of moderate-to-severe psoriasis. This review summarizes current literature on the efficacy of brodalumab and other therapies in difficult-to-treat psoriasis including psoriasis in difficult-to-treat locations (such as psoriasis with nail, palmoplantar, or scalp involvement) and psoriasis in patients whose disease did not respond to other biologics.

Irregular treatment leading to pituitary and scalp involvement in metastatic breast cancer.

Irregular treatment leading to pituitary and scalp involvement in metastatic breast cancer.

A real-world, non-interventional, prospective study of the effectiveness and safety of apremilast in bio-naïve adults with moderate plaque psoriasis treated in the routine care in Greece - the 'APRAISAL' study.

Real-world data in patients with moderate psoriasis treated with apremilast is limited. To evaluate the effectiveness and safety of apremilast in bio-naïve patients with moderate psoriasis in real-world clinical settings. This was a 52-week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast ≤7 days before enrollment. Missing data were imputed using the last observation carried forward method. A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52-week DLQI ≤ 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52-week Kaplan-Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. Apremilast is a safe and effective treatment for bio-naïve patients with moderate psoriasis and specific psoriasis manifestations.

Scalp involvement in Dermatomyositis

Scalp involvement is common in patients with dermatomyositis (DM), however it is an understudied manifestation that has been poorly described.

Atypical presentation of the World Health Organization Grade 1 meningioma: A case report

Meningiomas are the most common benign neoplasm of the brain whereas ectopic presentation, although reported, is rare. Among these ectopic tumors, there are a group of purely intraosseous meningiomas, which usually are diagnosed differentially from common primary osseous tumor such as fibrous dysplasia and osteoid osteoma. The World Health Organization (WHO) Grade 1 meningioma with an involvement of scalp, calvarial bone, dura, and brain seen rarely. This type of atypical presentation of the WHO Grade 1 meningioma rarely documented. The main theories to justify the unusual topography appear to be embryological remains of neuroectodermal tissue or cellular dedifferentiation. Surgical treatment seems the best curative option. Meningioma with bony involvement could be very aggressive tumor, need to prepare accordingly for surgery.

Is cutaneous microbiota a player in disease pathogenesis? Comparison of cutaneous microbiota in psoriasis and seborrheic dermatitis with scalp involvement.

Background Knowledge about cutaneous microbiota in psoriasis vulgaris and seborrheic dermatitis is limited, and a comparison of microbiota in the two diseases was not yet previously undertaken. Aims/Objectives This study aimed to compare the scalp lesional and non-lesional microbiota in psoriasis vulgaris and seborrheic dermatitis with that in a healthy control group. Methods Fifty samples were taken with sterile swabs from patients' and controls' scalps, and 16S rRNA gene sequencing analyses were performed. Results Alpha and beta diversity analyses showed that bacterial load and diversity were significantly increased in psoriasis vulgaris and seborrheic dermatitis lesions compared to the controls. As phyla, Actinobacteria decreased and Firmicutes increased, while as genera, Propionibacterium decreased; Staphylococcus, Streptococcus, Aquabacterium, Neisseria and Azospirillum increased in lesions of both diseases. Specifically, Mycobacterium, Finegoldia, Haemophilus and Ezakiella increased in psoriasis vulgaris and Enhydrobacter, Micromonospora and Leptotrichia increased in seborrheic dermatitis lesions. Mycobacterium, Ezakiella and Peptoniphilus density were higher in psoriasis vulgaris compared to seborrheic dermatitis lesions. The bacterial diversity and load values of non-lesional scalp in psoriasis vulgaris and seborrheic dermatitis lay between those of lesional areas and controls. Limitations The small sample size is the main limitation of this study. Conclusion Higher bacterial diversity was detected in lesions of both psoriasis and seborrheic dermatitis compared to the controls, but similar alterations were observed when the two diseases were compared. Although these differences could be a result rather than a cause of the two diseases, there is a need to analyze all members of the microbiota and microbiota-host interactions.

Evaluation of the prevalence of musculoskeletal conditions in consecutive patients with skin psoriasis: a descriptive cross-sectional study.

The association between psoriatic arthritis (PsA) and psoriasis is well known, but some have suggested that other musculoskeletal (MSK) conditions might also be more common in patients with skin psoriasis compared with the general population. The aim of our study was to describe the prevalence of a large panel of MSK conditions, in consecutive patients with psoriasis according to skin phenotype. This was a cross-sectional study. We consecutively included 148 patients, consulting for their skin psoriasis, in the dermatology department of a tertiary hospital, Hospital Cochin in Paris, France. After the scheduled consultation with a dermatologist, a rheumatologist conducted a dedicated face-to-face interview to collected data, included demographics, comorbidities, information about the psoriasis, the MSK conditions and their treatments. Of the 148 patients, 122 (82%) had at least one MSK condition. The most common condition was mechanical back pain, present in 98 (66%) patients. Nineteen (13%) patients had spondyloarthritis (SpA), of which 95% had PsA. For all MSK conditions, the dominant psoriasis phenotype was psoriasis vulgaris. The prevalence of the other phenotypes of psoriasis differed by disease. In SpA patients, the three predominant psoriasis phenotypes were: psoriasis vulgaris (82%), scalp involvement (76%) and inverse psoriasis (65%). For all MSK diseases, the prevalence was higher than expected in the general population. Our data suggest that skin psoriasis is associated with different MSK diseases, and not only PsA.

Pityriasis lichenoid-like mycosis fungoides

Sir, Mycosis fungoides is a primary cutaneous T–cell lymphoma, secondary clonal proliferation of mature skin-homing T cells, mostly CD4-positive, with a predilection for involving the epidermis. It is an indolent lymphoma that progresses over several years and represents 50% of primary cutaneous T-cell lymphomas [1]. Its clinical presentation is variable, thus leading to several clinical variants. Herein, we describe a rare variant of mycosis fungoides: pityriasis lichenoid-like mycosis fungoides. A 45-year-old female was referred to our department with a papular rash evolving for the last year without regression. The patient had a history of breast carcinoma in complete remission for two years. A clinical examination revealed erythematous, scaly, non-itchy papules covering the entire body but sparing the face (Figs. 1 and 2). There was no scalp involvement or associated lymphadenopathy. Based on the clinical presentation, the suggested diagnosis was pityriasis lichenoid. A histological examination revealed Pautrier’s microabscesses, atypical lymphocyte infiltration along the basal layer and papillary dermis, and prominent epidermotropism (Fig. 3). There was pilotropism without mucin. Besides, hyperkeratosis with focal parakeratosis and perivascular infiltrate were noted. An immunohistochemical analysis revealed infiltrates of T cells expressing CD3, CD2, CD5, and a predominance of CD4-positive T cells in the epidermis compared to CD8-positive T cells. CD7 and CD30 were, however, negative. These findings were consistent with pityriasis lichenoid-like mycosis fungoides. The patient was classified as a IB stage and received UVB phototherapy with good progress.

Elderly Male: An Immune-Compromise Sufficient Enough to Have Hemorrhagic Varicella.

Elderly Male: An Immune-Compromise Sufficient Enough to Have Hemorrhagic Varicella.

Evaluation of Therapeutic Effect of Unani Formulation in Scalp Psoriasis: A Case Series Study

Introduction: Psoriasis is considered one of the most chronic inflammatory disorders of the skin which affects almost about 2% world’s population. Their prevalence is low among the Asian and African populations. It is a multifactorial disease that primarily affects the skin and later on joints. Plaques in the case of psoriasis are thick and scaly due to abnormal keratinisation and abnormal keratinisation is most commonly seen in the case of scalp involvement. The scalp is the most common region affected in psoriasis that’s why effective therapeutic regimens are essential for the management of scalp psoriasis. Scalp psoriasis is characterised by the presence of reddish and scaly patches which can spread to the neck, forehead, and behind the ears.Objectives: Evaluation of Unani formulation as local application and Qushta Sadaf (calcium) as oral preparation in patients with scalp psoriasis.Method: The observational clinical study was carried out on patients with scalp psoriasis. Patients are advised to apply Unani formulation over the scalp and calcium supplements once a day for 5 weeks. The assessment of efficacy was evaluated by a decrease in subjective parameters.Results: The result was encouraging.Conclusion: The applied Unani formulation as local application and calcium as oral preparations were found to be effective and safe in the management of scalp psoriasis. However further studies are needed to be carried out for a longer time with a larger sample size to rule efficacy of the Unani formulation.

Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

Background: Hair and scalp involvement is prevalent in connective tissue diseases (CTDs). Trichoscopic features may provide a diagnostic implementation and enable differentiation among CTDs; however, a direct comparison of these signs among CTD patients is lacking. Objectives: To compare trichoscopic findings in dermatomyositis (DM), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) as well as determine their distinctive features and associations with disease activity. Methods: Trichoscopic photographs were taken from DM, SLE, and SSc patients and further evaluated for hair shaft and scalp surface abnormalities. Data regarding patients’ clinical manifestations, laboratory results, and disease activity were analyzed. Results: One hundred fifty participants, consisting of 30 DM, 60 SLE, and 60 SSc patients, were included. Perifollicular red-brown pigmentation, brown scattered pigmentation, and white patches were exclusive findings in DM, SLE, and SSc, respectively (p < 0.001). A multinomial logistic regression analysis revealed that DM demonstrated higher odds for having microaneurysmal blood vessels than SLE and SSc (odds ratio [OR] = 22.22, 95% confidence interval [CI] = 1.73–285.13, p = 0.017, and OR = 15.34, 95% CI = 1.36–177.59, p = 0.029, respectively). Polymorphic vessels forming a telangiectatic network suggested SSc over SLE (OR = 12.83, 95% CI = 1.35–121.98, p = 0.026), while avascular areas were more pronounced in SSc than DM and SLE (OR = 43.24, 95% CI = 5.17–361.67, p = 0.001, and OR = 0.03, 95% CI = 0.01–0.24, p = 0.001, respectively). In a quantile regression analysis, perifollicular red-brown pigmentation, reduction in hair diameter, and the absence of thin arborizing vessels were linked to higher disease activity in DM, SLE, and SSc, respectively (all p < 0.05). Conclusions: Trichoscopy is a valuable tool possessing diagnostic and prognostic values for CTDs. Specific trichoscopic features allow adequate distinction between DM, SLE, and SSc and may help identify active disease.

An Open-Label Pilot Study to Investigate Safety and Efficacy of Fixed Combination Tazarotene 0.045% and Halobetasol Propionate 0.01% Lotion for the Treatment of Scalp Psoriasis.

Up to 80% of individuals with plaque psoriasis have scalp involvement, which can have a significant impact on the quality of life of affected individuals. Despite advancements in psoriasis therapeutics, management of scalp involvement remains a challenge. This12-week, open-label pilot study assessed the safety and efficacy of fixed combination tazarotene 0.045% and halobetasol propionate 0.01% lotion for the treatment of patients with mild-to-moderate plaque psoriasis with scalp involvement. Among 20 patients who were followed through 12 weeks, there were significant improvements in the primary endpoint (Investigator&rsquo;s Global Assessment (IGA)) and most secondary endpoints (Psoriasis Scalp Severity Index (PSSI), body surface area (BSA), and scalp IGA (sIGA)). Treatment was well-tolerated. Further placebo-controlled double-blinded study for confirmation of our results is recommended. J Drugs Dermatol. 2021;20(11): 1191-1194. doi:10.36849/JDD.0102.

S2445 When Recurring Infections Mask an Atypical Presentation of Inflammatory Bowel Disease

Introduction: Pyoderma gangrenosum (PG) is an uncommon and severe extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD) with head or scalp involvement being exceeding rare. About one-third of presentations can be precipitated by skin trauma or infection, otherwise known as pathergy. These ulcers develop acutely, may not correlate with IBD activity, and can predate IBD diagnosis. Here we present an atypical presentation of PG in the setting of newly-diagnosed IBD. Case description/methods: A 35-year-old male with prior diagnosis of recurrent, diffuse soft tissue infections presented for management of presumed sepsis due to soft tissue infection. Two weeks prior to presentation, patient developed painful and purulent left lower extremity ulcer followed by worsening of facial and scalp ulcerations (Fig A-C). Patient reported prior diagnosis of facial folliculitis 1 year ago triggered by a stressor event that resolved but then had recurrence 3 months prior to this encoutner. Skin biopsy was unremarkable and was managed with IV antibiotics due to suspected infection. CT abdomen and pelvis during that admission showed circumferential sigmoid and rectal wall thickening concerning for colitis, but patient did not pursue further outpatient work up. Since being discharged from prior hospitalization, the patient experienced ongoing melenic stools. Prior to hospital transfer, patient was febrile to 39.4˚C, WBC count of 33k/ul and hemoglobin of 6.1g/dl for which endoscopy was performed showing diffuse erosive gastritis. Wound cultures grew staphylococcal aureus, and he was started on IV antibiotics. Initial concerns for IBD were based on imaging, ulcer concerning for PG, and three-year history of diarrhea elicited after admission. Laboratory work up is summarized in Table 1. Sigmoidoscopy showed cobblestoning with non-bleeding mucosal ulcerations and sigmoid colon biopsies demonstrated severely active colitis (Fig D,E). Skin biopsy was concerning for PG with superimposed infection. Patient was started on steroid therapy with improvement of diarrhea and inflammatory markers. Patient was discharged on oral steroids and planned follow up for initiation of biologic therapy. Discussion: This patient received a new diagnosis of IBD almost solely based on his presenting dermatological findings. This individual initially presented with recurrent skin wounds, however, eliciting further history of recurrent diarrhea, shifted the work up beyond infectious etiologies to earlier diagnosis and treatment of PG and IBD.Table 1.: Laboratory Data Depicting Patient Hospital Course.Figure 1.: Figure A and B: An extensive, necrolytic ulceration with an irregular, violaceous and undermined borders of the left lower extremity Figure C: Diffuse ulcerated lesions of the head and scalp Figure D and E: Endoscopy image of rectosigmoid mucosa with ulcerations, congestion, erythema, granularity and loss of vascularity.

Hist-P-05 - A rare primary subcutaneous panniculitis-like T-cell lymphoma with scalp involvement associated with lupus panniculitis

Hist-P-05 - A rare primary subcutaneous panniculitis-like T-cell lymphoma with scalp involvement associated with lupus panniculitis

Patient satisfaction with calcipotriol/betamethasone dipropionate cutaneous foam for the treatment of plaque psoriasis: The LION real-life multicenter prospective observational cohort study.

Topical treatment is the mainstay for mild or moderate psoriasis, but patients are generally little satisfied. Calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam has shown to improve signs and symptoms in plaque psoriasis patients. This study assessed patient's satisfaction with Cal/BD foam in a real‐life Italian dermatological clinical practice. A multicenter, 4‐week observational prospective cohort study enrolled, in 17 Italian dermatology clinics, adult patients with plaque psoriasis on the body and/or scalp. Treatment satisfaction was assessed by 9‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9), preference over previous treatments by Patient Preference Questionnaire (PPQ), and change in disease state by Psoriasis Area Severity Index (PASI). Overall 256 patients were eligible, with a mean (SD) age of 55.6 (15.4) years, 59.4% were males. Psoriasis severity was mild in 52.0% of patients, moderate in 43.3%, and severe in 4.7%. Scalp involvement was present in 36.7% of patients. Previous antipsoriatic treatments had been received by 80.5% of patients. TSQM‐9 median (25th–75th percentile) scores were 83.3 (66.7–88.9) for effectiveness, 77.8 (66.7–88.9) for convenience, and 78.6 (64.3–92.9) for global satisfaction. Mean (SD) PASI value decreased from 7.3 (4.8) to 2.1 (2.7) after 4 weeks. More than 90% of patients previously treated for psoriasis evaluated the Cal/BD foam more effective, easier to use and better tolerated compared to previous topical treatments at PPQ. This observational study provides real‐life evidence of a high level of satisfaction with effectiveness and convenience of the Cal/BD foam in a cohort of plaque psoriasis patients, with an objective improvement in PASI.

25602 Improvements and response achievement in PASI subscale domains for head scaling and erythema in apremilast-treated patients with moderate to severe plaque psoriasis of the scalp: Results from the STYLE study

Background: Up to 80% of patients with psoriasis have scalp involvement. Apremilast 30 mg BID (APR) demonstrated efficacy in the phase 3 STYLE study of moderate-to-severe scalp psoriasis. We report a post hoc analysis of the head scaling and head erythema PASI subscale domains.