Scarring Alopecia Research Articles

Quality of life assessment and the impact of an early diagnosis and treatment in Lichen planopilaris: a systematic review.

Lichen planopilaris (LPP) and its variants, mainly frontal fibrosing alopecia (FFA), affect the hair follicles causing cicatricial alopecia with a significant negative impact on self-confidence and quality of life (QoL). This systematic review investigates the psycho-emotional impact of LPP and its variants using PRISMA guidelines. The review revealed that LPP and FFA cause significant psychological distress and impaired QoL. Higher LPP disease activity and severity were associated with higher depression, higher anxiety scores, lower quality-of-life scores, and higher scores of role limitations (physical and emotional). Additionally, facial lesions in FFA patients, especially the eyebrows involvement can be very distressing, leading to impaired self-esteem and QoL. this negative impact of active and severe LPP and FFA on QoL and self-esteem of patients causes psychiatric conditions including anxiety and depression. Therefore, an early diagnosis must be encouraged in these patients.

Clinical and Trichoscopic Patterns of Discoid Lupus Erythematosus of Scalp in Patients with Systemic Lupus Erythematosus: An Observational Study

Abstract Background: Discoid lupus erythematosus (DLE) is a specific cutaneous manifestation of systemic lupus erythematosus (SLE), which results in scarring alopecia of the scalp. Methods: A prospective cross-sectional observational study on scarring alopecia among SLE patients was done between September 2016 and August 2017. The clinical and trichoscopic patterns of scalp DLE among these patients were studied. The DLE lesions were categorised into active and inactive based on clinical features. Trichoscopy was done and photographs were obtained using a non-polarised videodermoscope. Results: There were 26 patients with scalp DLE, out of which 15 patients (57.69%) had active DLE and 11 (42.30%) had inactive DLE. The trichoscopic findings seen were structureless white areas, loss of follicular units, blue-grey dots and globules, follicular keratotic plugs and telangiectasia. The trichoscopic features seen in active versus inactive DLE were blue-grey dots and globules (93.33% vs 63.63%), structureless white areas (93.33% vs 90.90%), loss of follicular units (86.66% vs 72.72%) and follicular keratotic plugs (80% vs 45.45%), yellow dots with arborising vessels (33.33% vs 72.72%), exaggerated honeycomb pigmentation (46% vs 63.63%) and telangiectasia (66.67% vs 54.54%). Scaling (P = 0.033) and blue-grey dots (P = 0.021) were significantly higher in active and yellow dots with arborising vessels (P = 0.047) in inactive DLE. Conclusions: On comparing trichoscopic features between active and inactive DLE scaling and blue-grey dots were significantly higher in active and yellow dots with arborising vessels in inactive DLE.

Primary Cutaneous Spindle Cell B-Cell Follicle Center Lymphoma Presenting as Long-Standing Plaque of Cicatricial Alopecia: A Case Report With a Comprehensive Review of the Literature.

Primary cutaneous spindle B-cell lymphoma is an uncommon subtype of cutaneous lymphoma characterized by a distinct spindled cytology of neoplastic B cells. Despite sharing clinical, histopathological, and phenotypical similarities with primary cutaneous follicle center lymphoma, an indolent form of B-cell lymphoma, it also exhibits certain features akin to primary cutaneous diffuse large B-cell lymphoma. Notably, in rare instances, a more aggressive clinical course has been observed. This report details a rare case of primary cutaneous spindle cell B-cell follicle center lymphoma, manifested as a prolonged solitary plaque of cicatricial alopecia. In addition, we provide a comprehensive review of existing cases documented in the literature.

Neuropsychiatric involvement in systemic lupus erythematosus contributes to organ damage beyond the nervous system: a post-hoc analysis of 5 phase III randomized clinical trials

ObjectiveTo investigate the association between neuropsychiatric systemic lupus erythematosus (NPSLE) and SLICC/ACR damage index (SDI) items, especially non-neuropsychiatric items.MethodsBaseline data from five phase III trials (BLISS-52, BLISS-76, BLISS-SC, BLISS-NEA, EMBRACE) were analysed. NPSLE involvement was defined as NP BILAG A/B/C/D (n = 272); NP BILAG E denoted non-neuropsychiatric SLE (n = 3273). We employed multivariable logistic regression analysis adjusting for age, sex, disease duration, and ethnicity.ResultsThe median (IQR) and mean ± SD SDI scores were 0 (0–1) and 0.62 ± 1.09. Compared with the non-neuropsychiatric SLE group, NPSLE patients were more likely to develop damage (adjusted (a)OR = 2.86; 95% CI = 2.28–3.59). This held true also after suppression of the NP SDI items (aOR = 1.70; 95% CI = 1.36–2.12). Beyond the neuropsychiatric domain, NPSLE was associated with damage in the cardiovascular (aOR = 2.63; 95% CI = 1.75–3.95), musculoskeletal (aOR = 1.90; 95% CI = 1.43–2.52), and skin (aOR = 1.54; 95% CI = 1.06–2.22) SDI domains. Dissecting domains into items, NPSLE was associated with coronary artery disease (aOR = 3.08; 95% CI = 1.44–6.58), myocardial infraction (aOR = 3.11; 95% CI = 1.54–6.27), muscle atrophy (aOR = 3.34; 2.16–5.16), scarring alopecia (aOR = 1.79; 95% CI = 1.19–2.70), bowel infarction (aOR = 1.98; 95% CI = 1.20–3.26), retinopathy (aOR = 2.23; 95% CI = 1.15–4.32), and premature gonadal failure (aOR = 2.10; 95% CI = 1.11–3.90).ConclusionThe intricate association between NPSLE and damage accrual extends beyond the nervous system to also comprise the musculoskeletal, skin, and cardiovascular organ systems.

Dermoscopic Features of Dermatitis Cruris Pustulosa et Atrophicans: A Retrospective Study from a Tertiary Care Center in South India.

Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic superficial folliculitis that can cause scarring alopecia if left untreated. Hardly any studies are there describing the dermoscopic features of DCPA. Dermoscopy can be a useful tool for diagnosing DCPA in addition to clinical and histopathological features and for differentiating other conditions like superficial folliculitis, folliculitis decalvans, and pseudofolliculitis. The aim of this retrospective study was to describe the dermoscopic features of 30 patients with DCPA at a tertiary care center in South India. A retrospective study of clinical and biopsy-proven cases of DCPA at a tertiary care center in South India. Thirty patients of DCPA of skin phototype IV or V were studied. Male preponderance of DCPA was noted in our study. Lower extremities 28 (93.3%) and upper extremities 2 (6.7%) were the common sites of involvement. The most common findings noted in dermoscopy were follicular-based pustules in 30 (100%) patients, follicular white structureless area in 16 (53.3%), perifollicular collarette of scales in 12 (40%), diffuse background dotted blood vessels in 12 (40%), and the absence of follicular orifices in 12 (40%). Other findings were yellow or hemorrhagic scales, perifollicular linear white lines, broken hair, and perifollicular dotted blood vessels. Pigmentary patterns observed were dark brown pigmentation, blue-grey globules, blue-grey dots, and accentuation of the pigmentary network. The limitations of the study were the retrospective nature of the study, the small sample size, and the lack of a comparison group. The predominant dermoscopic features observed in our patients were follicular-based pustules, follicular white structureless areas, perifollicular collarette of scales, diffuse background dotted blood vessels, and the absence of follicular orifices. Vascular and pigmentary patterns were less commonly noted.

Line-field confocal optical coherence tomography: Characteristic hints for the diagnosis of scarring alopecia due to lupus erythematodes: A preliminary study.

Lupus erythematosus (LE) is an inflammatory autoimmune disease, that can affect the skin to varying degree. In particular, discoid LE (DLE) and the rare form of lupus panniculitis/profundus are associated with scarring alopecia. The heterogeneity of the clinical, dermatoscopic, and histologic presentation poses a major challenge to the clinician in the diagnosis and differential diagnosis of other forms of scarring alopecia. While noninvasive imaging techniques using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) have proven to be helpful in the diagnosis of scarring alopecia in the context of LE, this study aimed to investigate line-field confocal OCT (LC-OCT) to identify characteristic features of cicatricial alopecia in LE. Fifteen patients with cicatricial alopecia in LE were included and the most affected/inflamed areas of the scalp were prospectively examined. In analogy to histopathology and previously reported criteria in RCM, all images were evaluated according to seven established criteria and underwent descriptive analyses. LC-OCT revealed characteristic features of cicatricial alopecia, such as lymphocytic interface dermatitis (14/15; 93.3%) and basal cell vacuolization (13/15; 86.7%). The most impressive feature was the occurrence of prominent hyperreflective fibers in 14/15 patients (93.3%). LC-OCT imaging can noninvasively detect morphologic criteria such as lymphocytic and vacuolar interface dermatitis of cicatricial alopecia due to LE. In particular, the presence of hyperreflective collagen fibers appears to be a characteristic easily recognizable feature that may facilitate differential diagnosis with other forms of cicatricial alopecia. Further studies are mandatory to differentiate other forms of scarring alopecia.

Central centrifugal cicatricial alopecia is associated with keloid scarring in Black women: A retrospective chart review

Central centrifugal cicatricial alopecia is associated with keloid scarring in Black women: A retrospective chart review

Acne Keloidalis Nuchae: A Multicenter Retrospective Study of 142 Hispanic Patients.

Acne keloidalis nuchae (AKN) is a primary cicatricial alopecia with mixed infiltrate. It is more common in Africans or persons of African descent. Our objective was to describe the epidemiology and clinical and trichoscopic presentations of AKN in a large series of Hispanic patients. This was a retrospective study from 10 different dermatological centers in Argentina, Colombia, Mexico, and Peru. Patients with a clinical diagnosis of AKN treated by 12 dermatologists experienced in trichology from 2018 to 2022 were included. The Umar classification system was used to determine severity. We identified 142 patients with AKN: 98% were male (n=140) with a mean age of 32 years; 108 patients had a previous history of trauma to the nuchal area (76%, P < 0.001); and 48 were positive for a history of acne (33.8%, P = 0.021). Patients with >50 months of evolution were mainly classified in classes III and IV compared to patients with an evolution of <50 months (30%, n=9 vs. 14%, n=15; P = 0.019; respectively). AKN should be considered in the differential diagnosis in the Hispanic population. Advanced stages of the disease are correlated with chronic evolution.

Non-invasive Assessment and Management of Folliculitis Decalvans by Trichoscopy and Reflectance Confocal Microscopy.

Folliculitis decalvans (FD) is a rare scarring alopecia mainly affecting middle-aged men, characterized by recurring episodes of follicular pustules, crusts, erythema, tufted hairs, and scars. This study investigates the effectiveness of reflectance confocal microscopy (RCM) compared to trichoscopy for diagnosing and monitoring FD. The study involved 24 Caucasian patients diagnosed with FD. Patients were examined using trichoscopy and RCM, with a focus on specific features like erythema and inflammatory cell distribution. A subgroup of 16 patients was followed up after 3 months of therapy. The reproducibility of RCM and trichoscopy was assessed using Cohen Kappa Test. RCM and trichoscopy consistently detected features such as tufted hairs, pustules, and perifollicular fibrosis. However, RCM provided more detailed insights into inflammatory activity and types of fibrosis, often overlooked by trichoscopy. It showed a reduction in vessels and inflammatory cells, which trichoscopy failed to detect. The concordance between RCM evaluations was excellent, indicating high reproducibility. RCM is effective in diagnosing and monitoring FD, offering detailed insights into inflammation and fibrosis. It complements trichoscopy, especially in aspects where trichoscopy is limited, such as precise measurement of inflammation. The study suggests that combining RCM with trichoscopy could enhance the accuracy of diagnosis and monitoring of FD, leading to tailored therapeutic approaches. Further studies with larger sample sizes and longitudinal designs are recommended to confirm these findings.

Scalp microbiome: a guide to better understanding scalp diseases and treatments.

The scalp microbiome represents an array of microorganisms important in maintaining scalp homeostasis and mediating inflammation. Scalp microbial dysregulation has been implicated in dermatologic conditions including alopecia areata (AA), dandruff/seborrheic dermatitis (D/SD), scalp psoriasis (SP) and folliculitis decalvans (FD). Understanding the impact of scalp microbial dysbiosis gives insight on disease pathophysiology and guides therapeutic decision making. Herein we review the scalp microbiome and its functional role in scalp conditions by analysis of metagenomic medical literature in alopecia, D/SD, SP, and other dermatologic disease.Increased abundance of Malassezia, Staphylococcus, and Brevibacterium was associated with SD compared to healthy controls. A higher proportion of Corynebacterium, actinobacteria, and firmicutes are present in AA patients, and lower proportions of Staphylococcus caprae are associated with worse clinical outcomes. Decreased prevalence of actinobacteria and Propionibacterium and increased firmicutes, staphylococcus, and streptococcus are associated with scalp psoriasis. Studies of central centrifugal cicatricial alopecia (CCCA) suggest scalp microbial composition contributes to CCCA's pro-inflammatory status. The most common organisms associated with FD include methicillin-resistant S. aureus and S. lugdunensis. Antifungals have been a mainstay treatment for these diseases, while other alternatives including coconut oils and shampoos with heat-killed probiotics have shown considerable potential efficacy by replenishing the scalp microbiome.

A Pilot Study Characterization of the Scalp Microbiome in Central Centrifugal Cicatricial Alopecia Shows Shift in &lt;i&gt;Corynebacterium&lt;/i&gt;

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Aberrant fibrosis in central centrifugal cicatricial alopecia (CCCA) is thought to be driven by persistent low-grade inflammation, but the source of inflammation is unclear. Alterations in the scalp microbiota may contribute to inflammation and thus provide a target for therapeutic intervention. We sought to compare the bacterial and fungal cutaneous scalp microbiota in patients with CCCA versus controls. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Six patients with CCCA and seven controls were sampled at the vertex scalp. 16S rRNA sequencing of V3-V4 region and internal transcribed spacer amplicon sequencing was used to compare bacterial and fungal microbiomes. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A significantly higher relative abundance of &lt;i&gt;Corynebacterium&lt;/i&gt; was noted in patients with CCCA versus controls. No significant difference in scalp fungal or bacterial microbiota composition was observed. &lt;b&gt;&lt;i&gt;Limitations:&lt;/i&gt;&lt;/b&gt; V3-V4 sequencing can be limited in detection of major skin bacterial species. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; CCCA is characterized by a distinct bacterial microbiome community and high relative abundances of &lt;i&gt;Corynebacterium&lt;/i&gt;. Future studies should characterize the relationship between &lt;i&gt;Corynebacterium&lt;/i&gt; and scalp inflammation and the role it may play in the progression of CCCA.

Efficacy and safety of a novel weekly topical metformin loaded peel-off-mask in the treatment of melasma: a split face, placebo-controlled study.

Melasma is a widely common condition that intractably affects the patient's quality of life. Metformin is a cheap, well tolerated, and relatively safe medication that is widely prescribed for the treatment of Diabetes. Topical metformin has shown promising results in treating melasma, as well as several other dermatological conditions such as acne and recalcitrant central centrifugal cicatricial alopecia. to study the efficacy and safety of a once weekly topical metformin 30% loaded peel-off mask in treating of melasma. Twenty female patients with melasma were recruited for the application of a metformin mask and placebo mask to either side of the face once weekly for 12 weeks. Hemi-MASI was calculated at baseline, at each visit, and 12 weeks after the end of treatment. At baseline, the hemi-MASI score matched between both metformin and placebo sides (708±2.62 & 7.08±2.62 respectively (p = 1). At the end of the active treatment period, the metformin side showed a significantly better improvement in hemi-MASI score in comparison to placebo (68%±0.23 improvement on the metformin side in contrast to 20%± 0.176 on the placebo side). Although scores decreased 3 months after stopping the active treatment (52%±0.23 improvement on the metformin side compared to the placebo side 15%±0.197), they were still significantly better than the baseline. No adverse effects were reported. Topical metformin loaded peel-off mask can be a promising, safe, and effective treatment for melasma. Although applied once weekly, metformin peel-off mask shows comparable efficacy to previously reported daily usage formulations.

Isotretinoin as a promising option in the treatment of facial papules of frontal fibrosing alopecia.

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by hairline recession, pruritus, and facial papules (FP). Various therapies are used to stabilize disease activity and induce remission. However, FP of FFA is resistant to treatment in many cases. In this review, we searched the PubMed and Google Scholar databases to screen the published literature on treatment options for FP in the context of FFA. Overall, 12 studies were included in this review. Available literature suggests a noticeable improvement in resistant-to-treatment FP in FFA patients with oral isotretinoin. The available evidence is limited and is derived from retrospective studies and case reports/series. Systemic isotretinoin can be considered a promising therapeutic regimen for treating resistant-to-treatment FP of FFA patients. However, more extensive, well-designed studies are necessary for confirmatory evidence.

Cutaneous ultrasound in the diagnosis and assessment of inflammatory activity in tinea capitis

AbstractIntroductionAlthough the diagnosis of tinea capitis is mainly microbiological, the risk of evolution towards cicatricial alopecia in the most severe cases requires empirical treatment based on physical examination and complementary examinations.MethodsTwo patients were evaluated by physical examination, cutaneous ultrasound and microbiological examination.ResultsUltrasound showed follicular widening and increased vascularization in Doppler mode. In one of them, the finding of severe inflammatory activity led to the indication of oral corticotherapy.DiscussionCutaneous ultrasound could play a role not only in supporting the clinical diagnosis but that it may even guide the indication of treatment in the presence of severe inflammation that sometimes may not manifest itself clinically.ConclusionCutaneous ultrasound may constitute an additional test of considerable usefulness in the diagnosis and evaluation of inflammatory activity in cases such as the ones presented, fast, non‐invasive and of high accessibility.

Association Between Natural Hair Color, Race, and Alopecia.

Limited epidemiologic data has suggested direct associations between hair pigment, race, and incidence of alopecia areata (AA). Here, we examine the relationship between natural hair color, race, and the lifetime risk alopecia. In this case-control study, we included UK Biobank patients of all races and self-reported hair color with diagnoses of AA, androgenetic alopecia (AGA), or scarring alopecia (SA). Multivariable logistic regression was used to detect differences in lifetime risk. Findings reveal a significantly increased risk of AA among individuals with black hair compared to dark brown hair (OR 1.71 [95% CI 1.22-2.38], p < 0.001). Those with red or blonde hair showed a decreased risk of AA (0.74 [0.56-0.97]; 0.62 [0.41-0.95], p < 0.05). No racial differences in AA prevalence were observed among individuals with black hair. Darker hair colors may be associated with a higher risk of AA, lighter hair colors with a lower risk, and differences in hair color could contribute to previously noted racial variations in AA incidence, potentially influencing dermatologists' perspectives on the disease's epidemiology.

Genetic association between asthma and alopecia areata: A two-sample Mendelian randomization study.

Many patients with asthma experience alopecia areata (AA) in their lives. However, it is unclear whether asthma causes or results from AA. Our objective was to investigate the genetic causal relationship between asthma and AA. Two-sample Mendelian randomization (MR) was used to assess the causal relationship between asthma and AA based on the largest publicly available genome-wide association study summary statistics. Androgenetic alopecia (AGA) and cicatricial alopecia (CA) were chosen as the control groups for AA. The main estimates were obtained using inverse variance weighting meta-analysis (IVW), Mendelian randomization-Egger (MR-Egger), maximum likelihood estimation, and the weighted median. Sensitivity analyses were conducted using Cochran's Q test, MR-Egger, and leave-one-out methods. Lastly, we conducted a reverse MR analysis to evaluate the possibility of reverse causation. Genetically, asthma is associated with an increased risk of AA, while the association between genetically predicted AGA or CA and asthma was negative. The risk of AA increased by 1.86 times in patients with asthma under the IVW method (OR=1.86, 95% CI=1.31-2.629, p<0.001). The reverse MR analysis did not find evidence supporting reverse causality from three phenotypes of alopecia to asthma. Sensitivity analyses yielded consistent causal estimates. This study suggests that asthma is causally associated with AA. The findings deepen our understanding of the role of asthma in the pathology of AA, which emphasizes the potential for opening a new vista for the prevention and diagnosis of AA.

Trichotillomania: A case report and review of the literature

Trichotillomania is a form of impulsive disorder characterized by repetitive, deliberate, and irresistible pulling of one’s own hair resulting in traumatic alopecia that is commonly seen in children. It has a fluctuating course that waxes and wanes in association with a stressful or emotional event. It produces non-scarring alopecia at the onset and if not addressed on time, it may lead to permanent scarring alopecia. In this article, we report a case series of trichotillomania with a review of the literature. Key words: Trichotillomania, Alopecia, Bezoar, Hair loss in children

BH16 Central centrifugal cicatricial alopecia and fibroproliferative disorders: exploring the association with uterine leiomyomas

BH16 Central centrifugal cicatricial alopecia and fibroproliferative disorders: exploring the association with uterine leiomyomas

Revisiting Scalp Tissue Expander In Indonesia: Restoration Of Cicatricial Alopecia

Background: Scalp alopecia from burn injuries significantly impacts physical appearance and psychological well-being, often leading to social phobia. Tissue expanders have been effective in reconstructive surgeries, offering advantages in restoring hair-bearing scalp areas with excellent color and texture match. However, comprehensive algorithms for their use, particularly in Indonesia, are lacking. Case Presentation: A 10-year-old girl with cicatricial alopecia on the right lateral, frontal, and vertex of the scalp from a burn injury sought reconstructive surgery due to teasing from peers. A 400 mL round silicone expander was implanted and gradually expanded over five weeks. Reconstruction surgery advanced the expanded flap towards the frontal area, improving her hairline. Despite minor necrosis at the flap’s distal margin, which healed by secondary intention, the outcome was favorable. Discussion: This case demonstrates the effectiveness of tissue expanders in scalp reconstruction. Benefits include improved cosmetic outcomes and decreased donor site morbidity, though complications such as infection and alopecia in the expanded tissue require careful management. The underutilization of tissue expanders in Indonesia may be due to lack of insurance coverage and limited local availability. Conclusion: Scalp tissue expansion is a beneficial technique for reconstructing scalp defects, especially in burn-induced alopecia. Wider adoption in regions with limited advanced modalities could significantly benefit patients.

Successful Allogeneic Hair Transplantation in a Patient With Extensive Cicatricial Alopecia.

Successful Allogeneic Hair Transplantation in a Patient With Extensive Cicatricial Alopecia.