Unusual forms of alopecia areata in a Trichology Unit.

BACKGROUND: Alopecia areata (AA) occurs with the apparition of asyntomatic non inflamatory alopecia plaques without scars. We distinguish several variants which are divided into two groups: typical forms (AA in single or multiple plaques) and atypical forms (by its presentation, evolution or paradoxical regrowth). OBJETIVES AND METHODS: We describe the cases of AA treated in our Trichology Unit between January 2000 and December 2011. RESULTS: We obtained 488 cases of AA. 114 (23.36%) were unusual form of AA or had paradoxical regrowth. The most common unusual form of AA was sisaipho type (7.37%), followed by AA for black and blonde hair (5.32%), atypical diffuse forms (4.30%), androgenetic alopecia type and (3.89%) and AA rectangular occipital (0.68%). Furthermore, we found nine cases of paradoxical regrowth (1.84%). CONCLUSIONS: Atypical variants of AA in our series are less than 25% of all cases, although it should be noted that since it is a specialized unit, we may be making a selection bias to be more difficult to diagnose cases or poor outcome.

Three cases of Lipschutz vulval ulceration.

A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.

Latanoprost in the treatment of eyelash alopecia in alopecia areata universalis.

OBJECTIVES: The aim of this study was to test the efficacy of latanoprost in eyelash alopecia areata (AA). DESIGN: This study is a 2-year prospective, non-blinded, non-randomized, bilateral eyelash alopecia controlled study. SETTING: The setting of this study was Trichology Unit, Virgen Macarena University Hospital, Seville, Spain. PATIENTS: We conducted a survey of 54 subjects with AA universalis treated with the protocol of the Trichology Unit of our Department. Control group comprised 10 subjects who received injections of 0.5 mg/cm(2) of triamcinolone acetonide (TAC) in their eyebrows and 1 mg/cm(2) of TAC injections in affected scalp. The treatment group included 44 subjects who received the same treatment as the control group in scalp and eyebrows but they also applied a drop of latanoprost 0.005% (50 microg/mL) ophthalmic solution in their eyelid margins every night. Subjects were reviewed every 3 months for 2 years. RESULTS: Forty subjects finished the study and four subjects were lost to follow-up. In the treatment arm of this study, the course was well tolerated and uncomplicated. Both investigators and patients evaluated the regrowth. The results we obtained were: complete regrowth in 17.5%, moderate regrowth in 27.5%, slight regrowth in 30% and without response in 25%. Moderate and total regrowth constituted a cosmetically acceptable response. The therapy was continuous and the response remained without any side effects. No patients had cosmetically acceptable eyelash regrowth in the control group. CONCLUSIONS: Latanoprost may be an effective drug in the treatment of eyelash AA because it induces acceptable responses (total and moderate) in 45% of the patients. A formal, blinded prospective unilateral controlled study will permit further understanding about this promising therapeutic agent for eyelash AA.

Evaluación histológica e inmunohistoquímica secuencial de marcadores de proliferación y apoptosis durante el tratamiento de la psoriasis con anti-factor de necrosis tumoral; (infliximab) / Sequential Histological and ImmunohistochemicalAssessment of Proliferation and ApoptoticMarkers During Treatment of Psoriasiswith Antitumor Necrosis Factor α (Infliximab)

Introducción y objetivos. La psoriasis es una enfermedad inflamatoria cutánea de naturaleza inmunológica mediada por citoquinas de tipo Th1. El tratamiento con anticuerpos anti-factor de necrosis tumoral α (TNF-α) (infliximab) ha proporcionado respuestas clínicas significativas; sin embargo, los mecanismos implicadosen la curación no están bien aclarados. El objetivo del presente trabajo es evaluar las variaciones de la histología y en la expresión de marcadores de proliferación y apoptosis, en biopsias cutáneas secuenciales de pacientes con psoriasis tratados con in fliximab. Material y métodos. Se estudiaron biopsias de piel (sana y lesionada) de 3 pacientes afectados de psoriasis generalizada moderada-grave (índice de área y gravedad de la soriasis [PASI]: 35 de media) tratados con infusiones por vía intravenosa de infliximab (5 mg/kg) en las semanas 0, 2 y 6. Las biopsias se realizaron en los días 0, 14 y 28, y fueron procesadas para estudio histológico convencional e inmunohistoquímico con marcadores de apoptosis–TP53, BCL-2 y anticaspasas 3 y 8– y de proliferación celular –Ki67–. Resultados. El tratamiento con infliximab se asoció con una significativa mejoría clínica en los 3 pacientes (PASI medio: 21,6 a los 14 días y 13,9 a las 6 semanas), que se correlacionó con la desaparición progresiva de las lesiones histológicas, con disminución de la proliferación epidérmica. Sin embargo, no observamos imágenes de apoptosis ni obtuvimos positividad con los anticuerpos anticaspasas. La expresión de TP53 disminuyó a las2 semanas del inicio del tratamiento, siendo similar a la piel normal a los 28 días. Conclusiones. La respuesta clínica e histológica de la psoriasis con infliximab no se asoció a un incremento significativo en los marcadores de apoptosis evaluados (AU)

Background and objectives. Psoriasis is an inflammatory skin disease of immunologic nature that is mediated by T-helper-1 cytokines. Clinical response to treatment with antitumor necrosis factor (TNF) –α antibodies (infliximab) has been significant; however, the mechanisms for clearance of lesions have not been elucidated. The aim of the present study was to assess variations in the histology and expression of proliferation and apoptotic markers in sequential skin biopsies of patients with psoriasis treated with infliximab. Material and methods. We studied skin biopsies (of lesioned and healthy skin) from 3 patients with extensive moderate-to-severe psoriasis (mean psoriasis area and severity index [PASI] score, 35) treated with intravenous infliximab infusions (5 mg/kg) at weeks 0, 2, and 6. Biopsies were taken on days 0, 14, and 28, and were processed for conventional histological and immunohistochemical study. The apoptotic markers used were TP53, B-cell lymphoma 2 protein, anticaspase 3, and anticaspase 8. The cell proliferation marker used was Ki67. Results. Treatment with infliximab was associated with a significant clinical improvement in 3 patients (mean PASI score, 21.6 at 14 days and 13.9 at 6 weeks), which correlated with the progressive disappearance of histological lesions with a decrease in epidermal proliferation. However, apoptosis was not observed, and the samples tested negative for anticaspase antibodies. Expression of TP53 decreased 2 weeks after starting treatment, and was similar to that in normal skin at 28 days. Conclusions. Clinical and histological response of psoriasis to infliximab was not associated with a significant increase in the apoptotic markers assessed (AU)

[Sequential histological and immunohistochemical assessment of proliferation and apoptotic markers during treatment of psoriasis with antitumor necrosis factor alpha (infliximab)]. / Evaluación histológica e inmunohistoquímica secuencial de marcadores de proliferación y apoptosis durante el tratamiento de la psoriasis con anti-factor de necrosis tumoral alpha (infliximab).

BACKGROUND AND OBJECTIVES: Psoriasis is an inflammatory skin disease of immunologic nature that is mediated by T-helper-1 cytokines. Clinical response to treatment with antitumor necrosis factor (TNF) alpha antibodies (infliximab) has been significant; however, the mechanisms for clearance of lesions have not been elucidated. The aim of the present study was to assess variations in the histology and expression of proliferation and apoptotic markers in sequential skin biopsies of patients with psoriasis treated with infliximab. MATERIAL AND METHODS: We studied skin biopsies (of lesioned and healthy skin) from 3 patients with extensive moderate-to-severe psoriasis (mean psoriasis area and severity index [PASI] score, 35) treated with intravenous infliximab infusions (5 mg/kg) at weeks 0, 2, and 6. Biopsies were taken on days 0, 14, and 28, and were processed for conventional histological and immunohistochemical study. The apoptotic markers used were TP53, B-cell lymphoma 2 protein, anticaspase 3, and anticaspase 8. The cell proliferation marker used was Ki67. RESULTS: Treatment with infliximab was associated with a significant clinical improvement in 3 patients (mean PASI score, 21.6 at 14 days and 13.9 at 6 weeks), which correlated with the progressive disappearance of histological lesions with a decrease in epidermal proliferation. However, apoptosis was not observed, and the samples tested negative for anticaspase antibodies. Expression of TP53 decreased 2 weeks after starting treatment, and was similar to that in normal skin at 28 days. CONCLUSIONS: Clinical and histological response of psoriasis to infliximab was not associated with a significant increase in the apoptotic markers assessed.

Angiosarcoma de cuero cabelludo secundario a radioterapia / Radiotherapy-induced scalp angiosarcoma

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[Trichothiodystrophy: PIBIDS syndrome]. / Tricotiodistrofia: síndrome PIBIDS.

Trichothiodystrophy comprises a heterogeneous group of autosomal recessive entities. This fact gives rise to different interrelated neuroectodermal disorders. From a structural point of view these features are the result of the low tissue sulfur content. We report a case of trichothiodystrophy initially classified as Tay syndrome that based on clinical features, complementary exams as well as on the disease evolution was labelled as PIBIDS syndrome.