Clinco-pathologic Features of Alopecia in a Patient of Cronkhite-Canada Syndrome / 대한피부과학회지

Although hair loss in Cronkhite-Canada syndrome (CCS) developed frequently, its exact mechanism has not been elucidated. Thus, we attempted to investigate the histopathologic features of hair loss with scalp biopsy in one case of CSS. The patient complained of persistent diarrhea and diffuse hair loss of the scalp 1 month prior to the hospital visit. CCS has been already diagnosed through colonoscopy and medical examination. Scalp biopsy was performed to evaluate hair loss of the patient, and pathologic examination showed increased telogen hairs (anagen to telogen is 7:8) without specific dermal inflammation and miniaturization of hair follicles. The patient was treated with topical and systemic steroids, and hair loss has almost completely recovered in 5 months. In this case, we investigated the clinical and pathological features of hair loss through scalp biopsy in one case of CCS and reported them with a review of the literature.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.

Diffuse alopecia areata is associated with intense inflammatory infiltration and CD8+ T cells in hair loss regions and an increase in serum IgE level.

Background: Mechanism leading to an abrupt hair loss in diffuse alopecia areata (AA) remains unclear. Aims: To explore the characteristics of diffuse AA and possible factors involved in its pathogenesis. Methods: Clinical and laboratory data of 17 diffuse AA patients and 37 patchy AA patients were analyzed retrospectively. Serum IgE level was evaluated in all diffuse and patchy AA patients, as well as 27 healthy subjects without hair loss to serve as normal control. Univariate analysis was performed using Fisher's exact test and Wilcoxon rank-sum test. Associations between inflammatory cell infiltration and laboratory values were analyzed using Spearman rank correlation test. Results: The mean age of patients with diffuse AA was 27 years with a mean disease duration of 1.77 months. All of them presented in spring or summer with an acute onset of diffuse hair loss preceded by higher incidence of scalp pruritus. Although no statistically significant difference on the incidence of atopic disease among three groups has been found, serum IgE level in diffuse AA was higher than that in healthy controls, but was comparable to that in patchy AA group. Histopathology of lesional scalp biopsies showed more intense infiltration comprising of mononuclear cells, eosinophils, CD3 + , and CD8 + T cells around hair bulbs in diffuse AA group than in patchy AA group. Moreover, IgE level in diffuse AA patients positively correlated with intensity of infiltration by mononuclear cells, eosinophils, and CD8 + T cells. Conclusions: Hypersensitivity may be involved in pathogenesis of diffuse AA. The acute onset of diffuse AA may be related to intense local inflammatory infiltration of hair loss region and an increase in serum IgE level.

A Case of Acute Diffuse and Total Alopecia of the Female Scalp / 대한피부과학회지

Diffuse alopecia areata is the least common clinical type of alopecia, and this diffuse form lacks the characteristic hairless patches of alopecia and it begins as diffuse hair loss. Diffuse alopecia areata has been poorly characterized. In 2002, there was a suggestion to define this form of alopecia areata as acute, diffuse and total alopecia of the female scalp (ADTAFS). ADTAFS is characterized by a marked female predominance, tissue eosinophilia and a uniquely short clinical course. We report here on one case of ADTAFS.

14 Cases with Acute Diffuse Alopecia Areata / 대한피부과학회지

BACKGROUND: Acute diffuse alopecia areata (AA) was described as a unique AA which mimics anagen effluvium, or in which the initial hair loss is diffuse and followed by total denudation of scalp within several weeks or months. In spite of its peculiar clinical feature, there was neither further characterization nor known effective treatment for this form of AA. OBJECTIVE: To evaluate the characteristic clinical findings of acute diffuse AA and confirm the effect of high dose methyl prednisolone therapy. METHODS: The medical records of 13 patients with acute diffuse AA between January 2002 and April 2006 at the Department of Dermatology, Chungnam National University Hospital were reviewed. All patients were treated with high dose methylprednisolone therapy. RESULTS: Of the 13 patients who completed the study, 8 patients (61.5%) were male and 5 patients (38.5%) were female. The mean age was 29.6 years old. The progress of hair loss stopped 2.4 weeks on average after initial treatment and newly emerging hairs were recognized 4.1 weeks on average after initial treatment. 84.6% (11/13) of patients showed terminal hair growth, and 46.2% (6/13) of patients completely responded to this therapy. CONCLUSION: Acute diffuse alopecia areata can occur in male as well as in female patients. High dose methylprednisolone therapy appears to be effective in patients with rapidly progressing acute diffuse alopecia areata to prevent the progression of the disease.

Feasibility of Clinical and Laboratory Diagnostic Approach to Chronic Female Diffuse Alopecia in Dermatologic Outpatient Clinic / 대한피부과학회지

BACKGROUND: Various kinds of disease can cause chronic diffuse hair loss in females such as female pattern hair loss and chronic telogen effluvium etc, but differential diagnosis between these diseases are so sophisticated that an easy and feasible diagnostic approach to chronic female diffuse alopecia has not yet been established. OBJECTIVE: The purpose of this study is to differentiate chronic female diffuse alopecia through several clinical and laboratory methods, which, can be tried easily in a short time with little doctor and assistants input in the ordinary dermatologic outpatient clinic. METHODS: We examined 187 female patients with a chief complaint of chronic diffuse hair loss and/or decreased hair density for more than 6 months. History taking, detailed patient's questionnaire, physical examination including hair pull test and hormonal test or skin biopsy were performed. RESULTS: Common age of onset was 20~29 years (62 cases, 33.1%) and below 19 years old (41 cases, 21.9%). A family history of similar alopecia including female pattern hair loss was seen in 50% (91 cases) and the father was the most common relative (61 cases). Crash diet restriction for weight reduction was the most common aggravating factor (14 cases, 16.1%) of hair loss and seborrheic dermatitis was the most common associated disease (24 cases, 12.8%). The serum ferritin level was lower than normal in 61 cases (40.7%) and serum copper and zinc were decreased in 22 cases (14.7%) respectively. The result of presumptive diagnosis by our checklists were as follows: female pattern hair loss (149 cases, 83.2%), diffuse alopecia areata (13 cases, 7.3%), chronic telogen effluvium (6 cases, 3.4%), and polycystic ovarian syndrome (3 cases, 1.7%). CONCLUSION: Female pattern hair loss might be the most common disease in chronic diffuse alopecia in females and a decrease of the serum ferritin level was most frequently observed. Further study about diagnostic methods such as transverse section of skin biopsy and phototrichogram will be needed for a more accurate final diagnosis.

A Case of Diffuse Alopecia Induced by Syringoma / 대한피부과학회지

Diffuse alopecia due to occult syringoma of the scalp has rarely been reported but the authors of the cases presented different opinions about which one is the primary event between the two conditions and if the syringoma is true or a reactive ductal proliferation. We have found a case whose diffuse alopecia is believed to be due to true syringoma of the scalp. A 43-year old woman showed simultaneous and gradual development of diffuse alopecia and multiple papular elevations on the face and neck adjoining the frontal and temporal hair lines. Histopathology of the scalp and the facial papular elevations all revealed typical syringomatous infiltrations with epithelial comma-tails and sclerotic stroma. All of the clinicopathological findings supported that the diffuse alopecia of the patient was due to the occult syringoma of the scalp.

Diffuse alopecia of a Female with Polycystic Ovarian Disease / 대한피부과학회지

A 19 year old female patient presented with diffuse alopecia as her chief medical complaint. A clinical examination revealed hirsutism limited only to the on midline lower abdomen with elevated DHEA-S(dehydroepiandrosterone sulfate) and total testosterone levels. Polycystic ovarian disease (PCOD) was diagnosed during the treatment with dexamethasone and spironolactone, which was effective to improve her alopecia. We believe that, with increasing, concerns about hair conditions of teen-age girls there should be increasing chances for dermatologists to care for patients of PCOD first before other specialities in medicine.