Carcinoma basocelular de couro cabeludo x alopecia frontal fibrosante: desafio diagnóstico e terapêutico / Basal cell carcinoma of the scalp x frontal fibrosing alopecia: diagnostic and therapeutic challenge

O carcinoma basocelular é considerado a neoplasia mais comum do mundo, tem como principal fator de risco a radiação ultravioleta, pode aparecer em todo o corpo incluindo couro cabeludo. A alopecia frontal fibrosante é uma alopecia cicatricial primária, variante do líquen planopilar. A associação entre as duas patologias não tem relato prévio na literatura. Neste caso apresenta-se paciente feminina, pós-menopausa, atendida por queixa de queda de cabelo, com diagnóstico histopatológico de alopecia frontal fibrosante e carcinoma basocelular de couro cabeludo. A distinção das margens tumorais para exérese completa da neoplasia é complexa apenas pela dermatoscopia e exame físico, devido á presença de áreas de atrofia em comum. Então se optou pela cirurgia micrográfica de Mohs para delimitação histopatológica de margens.

BCC is considered the most common neoplasia in the world, it can appear throughout the body including the scalp. Frontal fibrosing alopecia is a primary scarring alopecia, variant of lichen planopilaris. The association between the two pathologies has not been previously reported in the literature. In this case it is presented a brazilian female patient complaining of hair loss, with histopathological diagnosis of AFF and scalp BCC. The distinction of tumor margins for neoplastic excision is complex only by dermoscopy and physical examination, due to areas of common atrophy. So Mohs micrographic surgery was chosen for histopathological delimitation of margins.

Trasplante de cabello en el liquen plano pilar / Hair transplant in lichen planopilaris

El liquen plano pilar es una variante clínica del liquen plano, que afecta al cuero cabelludo donde su estadio final provoca una alopecia cicatrizal, que se acompaña en general, de un gran impacto negativo en la calidad de vida del enfermo. Hasta la fecha existe una gran escasez de estudios publicados, que informen tratamientos quirúrgicos. OBJETIVO: se evalúa la eficacia del trasplante de cabello bajo la técnica FUE (extracción de unidades foliculares) y determinar directrices para óptimos resultados. MATERIAL Y MÉTODO: se presenta una mujer con LPP de siete años de evolución. Después de una biopsia de cuero cabelludo y una sesión terapéutica, se procedió a un trasplante. Fueron realizados controles fotográficos a los dos, cuatro y seis meses para determinar éxito-fracaso. RESULTADO: se observó un crecimiento de cabello a partir de los 2-3 meses, sin cicatrices visibles en el área donante. CONCLUSIÓN: la técnica FUE es un proceso bien tolerado y seguro para mejorar la pérdida de cabello en un LPP, que histológicamente muestra una falta de inflamación (estadio cicatrizal). Esta técnica merece en nuestra opinión, más estudios a futuro.

BACKGROUND: lichen planopilar is a clinical variant of lichen planus, which affects the scalp and in the final stage which causes scarring alopecia, entailing a significant impact on quality of life. To date no shortage of published studies reporting surgical treatments. OBJECTIVE: effectiveness on hair transplant FUE technique and determine guidelines for optimum results is evaluated. MATERIAL AND METHOD: a woman with LLP seven years of evolution is presented. After scalp biopsy and a therapeutic meeting, he underwent a transplant. Photographic controls the 2.4 and six months were performed to determine success. RESULT: hair growth was observed after 2-3 months without visible scars in the donor area. CONCLUSION: technique FUE was a well tolerated and safe process to improve hair loss in LPP histologically shows a lack of inflammation (scarring stage).

Clinical features of primary cicatricial alopecia in Chinese patients.

Background: There have been few reports on primary cicatricial alopecias (PCR) especially from Asia (PCA). Aims: To study the clinical, pathological and dermoscopic characteristics of PCA among Chinese patients. Methods: A retrospective analysis of the clinical data of 59 patients with PCA was conducted and the dermoscopic, pathological, treatment and prognosis characteristics analyzed. Fisher’s Chi‑square exact test, Kruskal‑Wallis and Spearman rank correlation test were performed. Results: The ratio of neutrophilic to lymphocytic cicatricial alopecias was about 1.3:1 in this group. The most frequent disorder was folliculitis decalvans. Follicular openings were absent on dermoscopy in all cases except alopecia mucinosa. Patulous follicular openings were characterisitc of alopecia mucinosa. After treatment, an increase in short vellus hairs was the earliest feature, while telangiectasia, epidermal scale, follicular hyperkeratosis, pustules and hair diameter diversity gradually decreased or even disappeared. Improvement in the areas of hair loss after treatment was seen more often in discoid lupus erythematosus, folliculitis decalvans and dissecting cellulitis than in patients with classic pseudopelade of Brocq. Nine patients (13.6%) relapsed after cessation of therapy. Female patients needed longer treatment times. Long duration, large areas of hair loss and shorter treatment courses were the major factors in relapses. Conclusions: Dermatoscopy provides a rapid, practical and useful aid for the diagnosis of PCA and also to assess disease activity. Patulous follicular openings are a specific dermoscopic sign of alopecia mucinosa. Lichen planopilaris is less common in China than in the West.

Dermatosis del adolescente / Skin disease in teenagers

Durante la adolescencia se producen cambios importantes en la piel que son motivo de consulta frecuente al especialista. Estos son producidos por múltiples factores, dentro de los cuales están los hormonales, inmunológicos, psicológicos y los psicosociales. Las dermatosis más frecuentes son: el acné, en sus distintas formas clínicas, que afecta a más del 90 por ciento de los adolescentes en distintos grados de severidad; la dermatitis seborreica; las alopecias no cicatriciales; hiperhidrosis y dishidrosis. Además, este grupo etáreo está presentando con mayor frecuencia complicaciones cutáneas por realizar arte corporal (perforaciones, tatuajes, entre otros). Estas dermatosis deben ser conocidas por los médicos generales y especialistas, porque los adolescentes son una población muy vulnerable psicológicamente y muchas de estas enfermedades van en detrimento de su calidad de vida. Las enfermedades cutáneas infecciosas (virales, bacterianas y parasitarias) que también comprometen a los adolescentes se analizarán en el capítulo sobre Infecciones Cutáneas.

Adolescent skin undergoes significant changes that may lead to frequent specialized consultation. These changes can be due to a number of factors such as physiological, hormonal and psychosocial changes. The most common skin diseases are acne in its various clinical forms which is suffered by over 90 per cent of teenagers at different levels of severity, seborreic dermatitis, non scarring alopecia, hyperhydrosis and dishydrosis and the skin complications originated by Body Art (tattooing, piercing, scarring andbranding), that are on the increase in this age group. General practitioners and specialist should be aware ofthese skin conditions since teenagers are psychologically vulnerable and many of these diseases have a negative effect on their lives. The infectious skin diseases (viral, bacterial an parasitic) which also affect adolescent will be reviewed in the Chapter related to skin infections.

Occurring Scarring Alopecia after Appropriate Treatments of Kerion Celsi / 대한의진균학회지

Kerion celsi is an inflammatory dermatophytosis of the scalp which is characterized by an acute suppurative process caused mainly by zoophilic dermatophytes. Systemic corticosteroid can be added to systemic antifungal treatment for reducing scarring alopecia, but focal cicatricial changes are unavoidable in a severe case. We report a case of kerion celsi caused by T. mentagrophytes, zoophilic dermatophyte, in a 7-year-old girl. This patient had localized painful erythematous crusted plaques with multiple inflammatory pustules on the scalp. Although she was initially treated with antifungal agent and systemic corticosteroid, focal scarring alopecia occurred eventually. Eventually, the cicatricial change was corrected surgically after two and a half years in spite of timely and appropriate treatment.

A Case of Tufted Hair Folliculitis / 대한피부과학회지

Tufted hair folliculitis is an inflammatory disorder of the scalp characterized by a peculiar tufting of hair within areas of scarring alopecia. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles sparing the hair root level. Within areas of inflammation, several follicles converge toward a common follicular duct with a widely dilated opening. The cause of tufted hair folliculitis is unknown, and the therapeutic approach is problematic. We present herein a patient with a 28-year history of recurrent and progressive tufted hair folliculitis. A 33-year-old man was referred to our department for the treatment of chronic and relapsing inflammatory lesions of the scalp. The clinical examination revealed a circumscribed area of 15cm length and 10cm width on the occipital area of the scalp which was characterized by hair tufting and exudates. Histopathologic findings were typical for tufted hair folliculitis. We believe that hair tufting is a secondary phenomenon which may occur in several inflammatory diseases of the scalp.

A Case of Tufted Folliculitis / 대한피부과학회지

We report a case of tufted folliculitis which developed in a 33-year-old woman. Tufted folliculitis is a rare condition, characterized by a peculiar tufting of hair within areas of scarring alopecia. Histologically, it is characterized by a superficial folliculitis that involves several follicles opening into a common ostium from which multiple hairs come out. Some pathogenetic mechanisms have been proposed to explain the development of tufted folliculitis, but exact mechanism has not been found. Up to now, about 22 reports have been reported, and most of them were cases of westerners is has been reported only once in Korea. So, we report herein a Korean woman with tufted folliculitis of scalp.

A case of postmenopausal frontal fibrosing alopecia / 대한피부과학회지

Postmenopausal frontal fibrosing alopecia is a recently described, rare scarring alopecia. The disease is characterized by progressive frontal recession in postmenopausal women with clinical features of a fibrosing alpecia. The histologic findings are indistinguishable from those seen in lichen planopilaris. Postmenopausal frontal fibrosing alopecia is especially rare in Asian women. We describe a typical case of postmenopausal frontal fibrosing alpecia in a Korean woman with clinical and histologic features.