Sífilis secundaria en un paciente con VIH / Secondary Syphilis in a Patient with HIV

Introducción: La sífilis y la infección por virus de inmunodeficiencia humana comparten los mismos grupos de alto riesgo y formas de transmisión, por lo que la coinfección es común. La historia natural y las manifestaciones clínicas de la sífilis pueden modificarse por la infección concomitante por VIH, que puede progresar rápidamente desde la sífilis primaria a la sífilis terciaria. Objetivo: Describir las manifestaciones clínicas, análisis de laboratorio y tratamiento de un paciente que vive con el virus de inmunodeficiencia humana con coinfección de sífilis secundaria, una condición infrecuente. Caso clínico: Paciente de 30 años quien acude a consulta en el contexto de alopecia sifilítica a nivel del cuero cabelludo, cejas y pestañas, hipocromía en zona escrotal y perineal; la sífilis es considerada la gran simuladora, lo cual dificulta el diagnóstico y tratamiento. Se confirma el diagnóstico de sífilis secundaria. Conclusiones: Mediante un caso clínico de un paciente que vive con el virus de inmunodeficiencia humana y con coinfección de sífilis, se describe la afectación de manifestaciones clínicas poco habituales como la alopecia sifilítica en región del cuero cabelludo, cejas y pestañas, entre otras(AU)

Introduction: Syphilis and human immunodeficiency virus infection share the same high-risk groups and transmission ways; therefore, coinfection is common. The natural history and clinical manifestations of syphilis can be modified by concomitant HIV infection, which can rapidly progress from primary to tertiary syphilis. Objective: To describe the clinical manifestations, laboratory tests and treatment of a patient living with human immunodeficiency virus and co-infected with secondary syphilis, being such a rare condition. Clinical case: A 30-year-old patient attended consultation for presenting of syphilitic alopecia of the scalp, eyebrows and eyelashes, as well as hypochromia in the scrotal and perineal area; syphilis is considered as the great simulator, which makes diagnosis and treatment difficult. The diagnosis of secondary syphilis is confirmed. Conclusions: Through the clinical case of a patient living with human immunodeficiency virus and syphilis coinfection, the condition is described of unusual clinical manifestations such as syphilitic alopecia in the scalp, eyebrows and the eyelashes region, among others(AU)

Characteristics of telogen effluvium in COVID-19 in western Iran (2020)

Abstract Background: Although COVID-19 pandemic significantly induces mortality, many of the patients who recovered present other medical problems such as alopecias. Telogen effluvium is a common alopecia that is usually related to previous events such as acute febrile diseases, including COVID-19. Objective: To evaluate the characteristics of telogen effluvium in COVID-19. Method: This cross-sectional study was carried out on 526 patients with documented telogen effluvium that recovered from COVID-19. Demographic data, concurrent alopecia, associated diseases, and COVID-19 severity were recorded. Data were analyzed by appropriate statistical methods. Results: The mean age of the 526 patients (410 females, 116 males) was 30.97±9.592 years, with 7.65 ± 1.739 weeks of mean time of alopecia onset. Vitamin D deficiency (24.3%), androgenetic alopecia (78.2%), and grade III COVID-19 severity were the most common findings. Alopecia onset was significantly earlier in the younger age group, females, in hypothyroidism, and more severe coronavirus infection. Higher grade coronavirus infection was significantly seen in males, higher ages, earlier onset, and androgenic alopecia. Study limitations: Performing a single-center study and considering limited variables. Conclusion: Although Coronavirus 2 infection can be an important factor in telogen effluvium induction, other factors such as associated diseases, drug intake and emotional stress may also be involved. In the cases of early onset of alopecia, concomitant diseases such as hypothyroidism and severe coronavirus infection can occur, thus, the presence of various factors in telogen effluvium induction should be considered.

Frequency, severity and related factors of androgenetic alopecia in dermatology outpatient clinic: hospital-based cross-sectional study in Turkey

Abstract: BACKGROUND: Androgenetic alopecia (AGA) is a patterned hair loss occurring due to systemic androgen and genetic factors. It is the most common cause of hair loss in both genders. In recent years, many studies investigating the relation between systemic diseases and androgenetic alopecia presented controversial results. OBJECTIVES: In this study we aimed to investigate the frequency of androgenetic alopecia, the presence of accompanying systemic diseases, the relation between body mass index and androgenetic alopecia severity and the association of hyperandrogenemia signs with androgenetic alopecia in patients who referred to our outpatient clinic. METHODS: Patients who referred to our clinic between October 2013 and May 2014 were included in the study. Diagnosis of androgenetic alopecia was made upon clinical findings. Presence of seborrhea and acne in both genders, and hirsutism in women, were examined. Age, gender, smoking habit and alcohol consumption, age of onset of androgenetic alopecia, family history, accompanying systemic diseases and abnormalities of menstrual cycle were recorded. RESULTS: 954 patients (535 women, 419 men) were included in the study. Androgenetic alopecia prevalence found was 67.1% in men and 23.9% in women. Androgenetic alopecia prevalence and severity were correlated with age in both genders (p=0,0001). Frequency of accompanying systemic diseases were not significantly different between patients with and without androgenetic alopecia (p=0,087), except for hypertension, which was significantly more frequent in men with androgenetic alopecia aged between 50 and 59 years. Study limitations: Despite the exclusion of other causes of alopecia, differentiation of Ludwig grade 1 AGA from telogen effluvium based on clinical features alone is difficult. CONCLUSIONS: In our study the rate of androgenetic alopecia was found to be higher than the other studies made in Asian and Caucasian populations.

Lichen planopilaris epidemiology: a retrospective study of 80 cases

AbstractBACKGROUND:Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: classic lichen planopilaris, frontal fibrosing alopecia and Graham-Little Piccardi-Lassueur Syndrome (GLPLS).OBJECTIVE:Description of the clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices.METHOD:A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris.RESULTS:Eighty patients were included, 73 (91,25%) were female. Prototype II was seen in 53 (66,25%) patients. Classic lichen planopilaris was seen in 62,5% of the cases. Frontal fibrosing alopecia was seen in 31% of the patients and only one patient presented Graham-Little Piccardi-Lassueur Syndrome (GLPLS). Scalp lesions were scattered throughout the scalp in 47 (58,75%) of the patients, while 24 (30%) presented mainly central scalp lesions, 29 (36,25%) presented marginal lesions and only 4 (5%) patents had vertex lesions.CONCLUSIONS:Clinical presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis.

Female Pattern Hair Loss: a clinical and pathophysiological review

AbstractFemale Pattern Hair Loss or female androgenetic alopecia is the main cause of hair loss in adult women and has a major impact on patients' quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological patterns. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal and environmental factors. In addition, response to treatment is variable. In this article, authors discuss the main clinical, epidemiological and pathophysiological aspects of female pattern hair loss.

Frontal fibrosing alopecia and lichen planopilaris in HLA-identical mother and daughter.

Frontal fi brosing alopecia (FFA) is a lymphocyte-mediated scarring alopecia thought to be a variant of lichen planopilaris (LPP). We present a 67-year-old woman with frontal fi brosing alopecia whose daughter was diagnosed to have lichen planopilaris. Both patients had identical human leukocyte antigen (HLA) D types, supporting a phenotypical relationship between the two clinical entities. Interestingly, our patient also had of autoimmune chronic atrophic gastritis, a previously unreported association.

The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia.

Background: The effectiveness of finasteride and dutasteride in women with androgenetic alopecia has been the subject of debate. Aim: To evaluate the effectiveness of finasteride and dutasteride on hair loss in women with androgenetic alopecia over a period of 3 years. Methods: From a database containing systematically retrieved data on 3500 women treated for androgenetic alopecia between 2002 and 2012 with finasteride 1.25 mg or dutasteride 0.15 mg, a random sample stratified for age and type of medication was taken to yield 30 women in two age categories: below and above 50 years, and for both medications. Hair thickness of the three thinnest hairs was measured from standardized microscopic images at three sites of the scalp at the start of the treatment and after 3 years of continuous medication intake. The macroscopic images were evaluated independently by three European dermatologists/hair experts. The diagnostic task was to identify the image displaying superior density of the hair. Results: Both age categories showed a statistically significant increase in hair thickness from baseline over the 3‑year period for finasteride and dutasteride (signed rank test, P = 0.02). Hair thickness increase was observed in 49 (81.7%) women in the finasteride group and in 50 (83.3%) women in the dutasteride group. On average, the number of post‑treatment images rated as displaying superior density was 124 (68.9%) in the finasteride group, and 118 (65.6%) in the dutasteride group. Dutasteride performed statistically significantly better than finasteride in the age category below 50 years at the central and vertex sites of the scalp. Conclusions: Finasteride 1.25 mg and dutasteride 0.15 mg given daily for 3 years effectively increased hair thickness and arrested further deterioration in women with androgenetic alopecia.

Estudio retrospectivo de pacientes con alopecia fibrosante frontal / Retrospective study of patients with frontal fibrosing alopecia

Introducción: La alopecia fibrosante frontal, considerada por algunos autores como un subtipo de liquen plano pilaris, corresponde a una alopecia cicatricial primaria, que se presenta en mujeres adultas y se caracteriza por el retroceso simétrico de la línea de implantación fronto temporal. Se presenta un estudio descriptivo de pacientes con Alopecía fibrosante frontal atendidos en este centro. Objetivos: Evaluar características clínicas, dermatoscópicas e histopatológicas de pacientes con alopecia fibrosante frontal. Materiales y métodos: Estudio retrospectivo de pacientes con diagnóstico clínico-histopatológico de alopecia fibrosante frontal atendidos en nuestro centro desde Julio 2010 a Octubre 2012. Resultados: Se encontraron 57 casos con diagnóstico histológico de alopecia cicatricial, de los cuales 8 (14 por ciento) se diagnosticaron como Alopecia Fibrosante Frontal. El 100 por ciento correspondieron a mujeres, el promedio de edad fue de 45 años. Sólo la mitad de los casos comenzó con la alopecia luego del climaterio. El hallazgo clínico más frecuentemente encontrado fue el retroceso de la línea de implantación frontotemporal (87,5 por ciento); y en segundo lugar la disminución difusa de densidad capilar (37,5 por ciento) y alopecia de la cola de las cejas (50 por ciento). No se reportó ningún caso asociado a liquen plano cutáneo o de mucosas. Los hallazgos más relevantes a la dermatoscopía fueron: eritema perifolicular (50 por ciento) e hiperqueratosis folicular (25 por ciento). A la histopatología, los principales hallazgos fueron el infiltrado inflamatorio linfocitario perifolicular (50 por ciento) y fibrosis concéntrica perifolicular (100 por ciento). Discusión: La Alopecia fibrosante frontalrepresenta el 14 por ciento de las alopecias cicatriciales primarias en nuestra serie. La edad al diagnóstico fue inferior a lo reportado en la literatura. El principal hallazgo clínico fue el retroceso de la línea de implantación frontotemporal...

Introduction: Frontal fibrosing alopecia, considered by some authors as a subtype of lichen planopilaris, is a scarring alopecia that usually involves adult women and is characterized by the symmetric recession of fronto-temporal hairline. Objectives: Characterize the clinical, dermoscopic and histological features of frontal fibrosing alopecia. Materials and Methods: We conducted a retrospective study of patients with clinical and histological diagnosis of Frontal Fibrosing Alopecia treated in our institution from July 2010 to October2012. Results: 8 out of 57 cases with histological diagnosis of scarring alopecia, had diagnosis of frontal fibrosing alopecia (14 percent). 100 percent were women, with mean age of 45 years. 50 percent of patients began with alopecia in the post-climacteric period. Recession of frontotemporal hair-line was the most common finding (87.5 percent), associated with reduced capillary density (37.5 percent) and loss of eyebrows (50 percent). In our study, none of the patients had other signs of lichen planus. At dermoscopy, most common finding were perifollicular erythema (50 percent) and follicular hyperkeratosis (25 percent). Most common histological findings were a perifollicular lymphocytic inflammatory infiltrate (50 percent) and perifollicular concentric fibrosis (100 percent). Discussion: Frontal fibrosing alopecia represents 14 percent of scarring alopecia in our series. Age at diagnosis was lower than reported in the literature, and only 50 percent of women presented alopecia in the postmenopausal period. The main clinical finding was the recession of frontotemporal hairline...

Apoptose, microinflamação e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino / Apoptosis, microinflamation and expression of aryl hydrocarbon receptors in hair follicles of patients with female pattern hair loss

Alopecia de padrão feminino, ou alopecia androgenética feminina, é a principal causa de queda de cabelos em mulheres adultas, e inflige importante impacto na qualidade de vida das pacientes. Decorre da progressiva miniaturização de folículos pilosos e posterior diminuição da densidade dos fios, originando um quadro de alopecia difusa não cicatricial, com padrão clínico, dermatoscópico e histológico característicos. Apesar da elevada frequência e da relevância quanto ao impacto psicológico, sua fisiopatogenia não é ainda totalmente esclarecida, sofrendo influência de elementos genéticos, hormonais e ambientais. Além disso, a resposta ao tratamento é inconstante. Os receptores de hidrocarboneto arílico (AhR) podem ser ativados por diversos ligantes ambientais como poluentes (p. ex. dioxinas), fumaça do tabaco, radiação ultravioleta e pela ação microbiana (p.ex. Malassezia sp.), podendo exercer atividade proinflamatória, proapopótica, hormonal e carcinogênica, de acordo com o fator ativador e tecido alvo. Sua ação no folículo piloso e na alopecia de padrão feminino não foi ainda estudada. Neste trabalho, os autores avaliam a apoptose, infiltrado inflamatório e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino. Foi conduzido um estudo transversal envolvendo 17 mulheres com alopecia de padrão feminino e cinco controles. Avaliaram-se amostras de pele do couro cabeludo que foram processados para HE, técnica do TUNEL e imuno-histoquímica para receptor de hidrocarboneto arílico. As variáveis foram comparadas de acordo com o grupo de folículos (terminal versus miniaturizado) e os grupos de pacientes (alopecia versus controles)...

Female pattern alopecia, or female androgenetic alopecia, is the main cause of hair loss in adult women and causes major impact on patient´s quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological pattern. Despite the high frequency and relevance about the psychological impact, its pathogenesis is not yet fully understood, but is influenced by genetic, hormonal and environmental factors. In addition, response to treatment is incostant. In this article, authors discuss the main clinical, epidemiological and physiopathological aspects of female pattern hair loss...

Alopecia areata: aspectos imunogenéticos / Areata alopecia: immunogenetic aspects

A alopecia areata (AA) é um tipo de queda súbita de cabelos, temporária, por vezes recorrente, não cicatricial que pode afetar qualquer área portadora de pêlos; que vem sendo descrita como uma doença auto-imune. Três fatores de suscetibilidade/gravidade têm sido identificados. Alelos HLA foram os primeiros a mostrar uma forte associação com a AA e alguns alelos DQB e DR demonstraram conferir alto risco para doença em estudo de casos-controle e estudos baseados em famílias. Cluster de genes da interleucinas (IL-1), principalmente receptores antagonista da IL-1, mostrou uma forte associação com a gravidade da doença na AA e várias outras doenças inflamatórias e auto-imunes. Finalmente, a associação da AA com a síndrome de Down, a alta freqüência da síndrome poliglandular do tipo 1, devido a mutações no gene auto-imune regulador no cromossomo 21q22.3, e a associação com MX1, outro gene localizado na região da síndrome de Down do cromossomo 21. Conclui-se que existem várias hipóteses possíveis que podem elucidar a patogênese da AA e compreender a presença do infiltrado inflamatório de células imunes. Estas hipóteses podem ser classificadas em três grupos principais: 1) atividade de um terceiro fator: tal como a infecção que induziria a queda do cabelo e da resposta imune; 2) a auto-imunidade induziria à doença: o sistema imune agiria anormalmente contra um folículo capilar em funcionamento normal; 3) a doença induziria a auto-imunidade: o sistema imune agiria normalmente contra um folículo capilar que funciona anormalmente.

Alopecia androgenética femenina: etiología y diagnóstico / Female androgenetic alopecia: etiology and diagnosis

La alopecia de patrón femenino es un problema clínico cada día más frecuente en las mujeres. El cuadro clínico de la alopecia androgenética femenina (FAGA) típica comienza con una específica “pérdida difusa de cabellos de las regiones parietal y frontovertical respetando la línea de implantación frontal”. Ludwig llamó a este proceso “rarefacción”. En la clasificación de Ludwig se describieron tres grados o tipos progresivos de FAGA. Grado I o mínimo, grado II o moderado y grado III o intenso. Ludwig también describió la alopecia androgenética femenina de patrón masculino que debe ser subclasificada de acuerdo con la graduación de Ebling; es decir, FAGA.M desde grado I a V. Generalmente se observa en mujeres con nivelesde testosterona elevados o con hipersensibilidad del órgano diana a esta hormona. La FAGA.M puede observarse en cuatro situaciones: síndrome de persistencia de la adrenarquía, alopecia por tumor suprarrenal u ovárico, alopecia posmenopáusica y alopecia involutiva. Hay otras propuestas de clasificación como la Olsen que considera la alopecia de patrón femenino de dos tipos: de comienzo precoz o tardío y cada unode ellos con o sin exceso de andrógenos. El diagnóstico debe efectuarse con la historia clínica, exploración con el “signo del arrancamiento”, signo de la tracción”, trichoscan®, tricoscopía, test del lavado y tricograma, y con test bioquímicos, especialmente determinaciones androgénicas. Como en el varón, la alopecia femenina causa importantes problemas psicológicosa la mujer, siendo la depresión el síntoma más constante. Con frecuencia se asocia a efluvio telogénico crónico y alopecia frontal fibrosante.

Female pattern hair loss is a clinical problem which every day is more common in women. The clinical picture of typical female androgenetic alopecia (FAGA) begins with a specific “diffuse loss of hair from the parietal or frontovertical areas with an intact frontal hair implantation line”. Ludwig called this process “rarefaction”. In the Ludwig’s classification three degrees or progressive type of FAGA were described: grade I or minimal, grade II or moderate and grade III or severe. Ludwig also described female androgenetic alopecia of male pattern that should be sub- classified according to Ebling’s degrees; that is to say, FAGA.M from grade I to V. It is usually seen in women with increased testosterone levels, or with a hypersensitivity of the target organ to this hormone. FAGA.M may be present in four situations: persistence adrenarche syndrome, alopecia due to an adrenal or an ovarian tumor, post-hysterectomy and as an involutive alopecia. There were other proposal of classification as the most recent Olsen’s classification of female pattern hair loss (FPHL) with two types: of early and late onset and in each one with or without androgens excess. Diagnosis must be made by clinical history, clinical examination with the “pull-out sign”, “tug sign”, trichoscan®, trichoscopy, wash test and trichograms and laboratory test, especially androgenic determinations. FPHL causes important psychological problems in women, being depression the most constant symptom. Frequently, FPHL is associated with chronic telogen effluvium and frontal fibrosing alopecia.

Trasplante capilar en una paciente con alopecia fibrosante frontal asociada con liquen escleroatrófico de vulva / Hair transplantation in a patient with frontal fibrosing alopecia associated with lichen scleroatrophicus vulvae

La alopecia fibrosante frontal (AFF) puede representar una variedad del liquen plano pilaris. Se presenta una paciente con AFF asociada con liquen escleroatrófico de vulva que fue tratada con finasteride (1 mg/día) y aplicaciones tópicas de minoxidil a 2% dos veces al día. Se le efectuaron microtrasplantes de pelo en la zona alopécica frontal y frontoparietal, con resultado excelente que se mantiene 6 años después. Los microtrasplantes capilares pueden ser considerados una alternativa terapéutica no convencional.

Alopecia difusa na mulher / Diffuse hair loss in women

Os autores realizaram estudo retrospectivo, a partir da análise do prontuário de 291 mulheres com diagnóstico de Alopecia Difusa, de um total de 3.103 pacientes do sexo feminino, atendidas em clínica privada, no período de janeiro a outubro de 1991. Foram analisados dados epidemiológicos e prováveis fatores associados. A incidência de alopecia na mulher foi maior na clínica privada (11,4%) do que no Serviço de Dermatologia do HEC (2,6%). A Alopecia Difusa ocorreu como forma clínica mais comum, tanto em consultório privado (84,1%) como no HEC (71,4%). A faixa etária predominante foi dos 21 aos 40 anos (73,6%). Das causas prováveis relacionadas as mais freqüentes foram: stress/depressäo 76(26.1%); drogas 37(12,7%); dieta 33(11,3%); hiperfluxo menstrual 27(9,3%); pós parto 27(9,3%); anemia 18(6,2%)