ABSTRACT
A case of cicatricial female pattern hair loss was reported. A 36-year-old female patient presented with gradually aggravated hair loss for more than 10 years. Skin examination showed diffuse hair thinning on the scalp, thin and soft hairs, and some pencil eraser-sized areas of focal atrichia. TrichoScan examination revealed markedly decreased hair density on the forehead, variability in hair diameter greater than 20%, and increased proportions of vellus hairs. Dermoscopic examination showed increased numbers of vellus hairs, plenty of focal atrichia areas measuring 3 - 5 mm in diameter, loss of some follicular ostia, and confluent white dots. Histopathological examination of vertical and transverse scalp sections showed predominantly distributed miniaturized hair follicles with lichenoid folliculitis around the infundibulum and isthmus, concentrically layered perifollicular fibrosis, a marked decrease in the number of hair follicles compared with healthy people of the same age, increased proportions of vellus hairs, a large number of miniaturized hair follicles and follicular streamers, and formation of follicular micro-scars. The patient was diagnosed with cicatricial female pattern hair loss. She received topical treatment with 5% minoxidil liniment once a day, and alternate treatment with topical tacrolimus ointment and clobetasol propionate ointment, as well as oral spironolactone at a dose of 20 mg twice a day and compound glycyrrhizin capsules at a dose of 50 mg thrice a day. After half a year of treatment, there was no marked aggravation of hair loss, and the follow-up continued.
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A case of fibrosing alopecia in a pattern distribution (FAPD) and its clinicopathological, dermoscopic and TrichoScan features were reported to improve the understanding of FAPD. A 23-year-old male patient presented with progressive hair loss on the forehead and top of the head for 10 years, local hair thinning and softening, and occasional scalp itching. Skin examination showed diffuse sparseness of hair from the forehead to the top of the head, frontal hairline recession, focal thinning and softening of hair, some follicular keratotic papules and perifollicular erythema on the alopecic area, with no obvious scales. TrichoScan examination revealed markedly decreased hair density and increased proportions of vellus hairs. Dermoscopy showed loss of some follicular ostia and confluent white dots. Histopathological examination of the scalp showed lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles, concentrically layered perifollicular fibrosis, hair follicle destruction, formation of follicular micro-scars, markedly increased variation in the diameter of residual follicles, and some vellus hairs. The patient was diagnosed with FAPD. FAPD is easily misdiagnosed as androgenetic alopecia, and early diagnosis and treatment are needed.
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Objective To compare diagnostic performance of traditional vertical section technique,horizontal section technique and modified Ho-Vert technique for classical lichen planopilaris.Methods Clinical data were collected from patients with classical lichen planopilaris in Department of Dermatology,The Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1st 2015 to January 1st 2019.With the help of dermoscopy,2 scalp specimens were obtained from each patient and sliced horizontally and vertically respectively by using modified Ho-Vert technique.The horizontal and vertical sections were read separately or simultaneously,and histopathological changes were observed.Results Totally,21 patients with classical lichen planopilaris were enrolled into this study,including 15 males and 6 females.Their age was 50.0 ± 13.6 years,and the average course of disease was 18 months.The patients mainly presented with muhifocal or confluent patchy hair loss,and scalp atrophy,perifollicular hyperkeratosis,loss of follicular ostia,fibrous white dots and orbit sign were observed.On the horizontal sections,lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles and follicular micro-scars could be observed in all patients,and the dermo-epidermal interface could be seen in 7 patients.On the vertical sections,lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles only could be observed in 9 patients,follicular micro-scars could be seen in 4,and the dermoepidermal interface could be observed in all patients.Moreover,the detection rates of interfollicular interface dermatitis,follicular keratotic plugs,lymphocytic infiltration around sebaceous glands,atrophy or disappearance of sebaceous glands and inflammatory infiltration around hair follicle bulbs were significantly different between the horizontal and vertical sections.In combination with clinical manifestations,7 patients could be exactly diagnosed with lichen planopilaris according to findings from horizontal sections,and 9 could be diagnosed exactly according to findings from vertical sections,while 21 could be diagnosed exactly according to histopathological findings from both horizontal and vertical sections.Conclusion With the help of dermoscopy,modified Ho-Vert technique can improve the efficacy of pathological diagnosis of classical lichen planopilaris,by multidimensionally showing histopathological changes.
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Objective@#To compare diagnostic performance of traditional vertical section technique, horizontal section technique and modified Ho-Vert technique for classical lichen planopilaris.@*Methods@#Clinical data were collected from patients with classical lichen planopilaris in Department of Dermatology, The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 1st 2015 to January 1st 2019. With the help of dermoscopy, 2 scalp specimens were obtained from each patient and sliced horizontally and vertically respectively by using modified Ho-Vert technique. The horizontal and vertical sections were read separately or simultaneously, and histopathological changes were observed.@*Results@#Totally, 21 patients with classical lichen planopilaris were enrolled into this study, including 15 males and 6 females. Their age was 50.0 ± 13.6 years, and the average course of disease was 18 months. The patients mainly presented with multifocal or confluent patchy hair loss, and scalp atrophy, perifollicular hyperkeratosis, loss of follicular ostia, fibrous white dots and orbit sign were observed. On the horizontal sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles and follicular micro-scars could be observed in all patients, and the dermo-epidermal interface could be seen in 7 patients. On the vertical sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles only could be observed in 9 patients, follicular micro-scars could be seen in 4, and the dermo-epidermal interface could be observed in all patients. Moreover, the detection rates of interfollicular interface dermatitis, follicular keratotic plugs, lymphocytic infiltration around sebaceous glands, atrophy or disappearance of sebaceous glands and inflammatory infiltration around hair follicle bulbs were significantly different between the horizontal and vertical sections. In combination with clinical manifestations, 7 patients could be exactly diagnosed with lichen planopilaris according to findings from horizontal sections, and 9 could be diagnosed exactly according to findings from vertical sections, while 21 could be diagnosed exactly according to histopathological findings from both horizontal and vertical sections.@*Conclusion@#With the help of dermoscopy, modified Ho-Vert technique can improve the efficacy of pathological diagnosis of classical lichen planopilaris, by multidimensionally showing histopathological changes.
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Objective@#To analyze dermoscopic features of blue nevi.@*Methods@#Clinical and dermoscopic data were collected from patients with confirmed blue nevi in the Department of Dermatology and Venereology, Wuxi People′s Hospital from January 2008 to May 2018, and analyzed retrospectively. Chi-square test was used to analyze differences between groups.@*Results@#Totally, 65 patients with 66 skin lesions were enrolled into this study. A total of 23 skin lesions were subjected to dermoscopy, which showed homogeneous pattern in 20 (87.0%) lesions, pseudo-pigment network pattern in 2 (8.7%) lesions, and cerebriform pattern in 1 (4.3%) lesion, and the homogeneous pattern was more common than the other patterns (χ2 = 8.79, P < 0.05) . Under the dermoscope, 10 lesions were monochromatic (43.5%) , 11 were dichromatic (47.8%) , and 2 were multichromatic (8.7%) . Scar-like hypopigmentation was observed in 4 lesions (17.4%) , and vascular structures were observed in 5 (21.7%) , including punctate vessels in 4 (17.4%) and linear irregular vessels in 1 (4.3%) . Papillary hyperplasia was observed in 2 lesions (8.7%) . Additionally, pigmentation around lesions, white streaks, dots/globules, blotches, comedo-like openings were observed in 1 lesion (4.3%) each.@*Conclusions@#Blue homogeneous pattern is the most common dermoscopic feature of blue nevi. Pseudo-pigment network pattern, cerebriform pattern, scar-like hypopigmentation, multiple vascular patterns, papillary hyperplasia, white streaks, dots/globules, blotches, comedo-like openings can also be observed in blue nevus lesions.
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Objective To investigate the clinical features of patients with hypertriglyceridemia-induced acute pancreatitis (HTGP) and the influence of hypertriglyceridemia on severity or progress of acute pancreatitis.Methods By retrospective analysis,45 patients with HTGP and 184 patients with acute biliary pancreatitis (ABP) were studied.Age,gender,medical history,severity and complications were recorded and analyzed.Results Compared to ABP group,HTGP patients were significantly younger,more patients were observed in the diabetes,obesity and pregnancy.The hospitalization days in the HTGP group were much longer than that in the ABP group.The number of patients with severe acute pancreatitis (SAP) in the HTGP group were significantly higher than that in the ABP group (11/45 vs 20/184).The Ranson scores in the HTGP group were significantly higher than ABP group (2.58 ± 1.78 vs 1.98 ± 1.26).The number of HTGP patients with respiratory failure,renal failure,circulatory failure and systemic inflammatory response syndrome (SIRS) were higher than that in ABP patients.More HTGP patients had acute peripancreatic fluid collection (APFC),pancreatic pseudocysts and pancreatic necrosis than ABP patients.The mortality in IITGP group was higher than that in ABP group.Conclusions HTGP patients are younger,have more comorbidities and complications,with a trend towards more severe disease.To improve the prognosis are crucial in treatment of HTGP.
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Objective To observe the clinical efficacy of peppermint oil capsules combined with domperi-done in the treatment of bile reflux gastritis(BRG)after gastric surgery.Methods Totally 47 patients with BRG after gastric surgery were treated with peppermint oil capsule (0.9g,tid)and domperidone(10mg,tid).Each patient's gas-troscopic manifestations and histopathology were rechecked after 4 weeks.The efficacy was observed on the improve-ment of symptoms and gastric mucosal injury,and on the reduction of bile reflux.Results 42 patients attained satis-factory therapeutic effect with the total efficiency rate of 89.4%.No adverse effects during the treatment period. Conclusion Peppermint oil capsules combined with domperidone shows better efficacy in treatment of BRG after gastric surgery.