Retrospective Review of Folliculitis Decalvans in 23 Patients with Course and Treatment Analysis of Long-standing Cases.

BACKGROUND: To date, there is no standard treatment of folliculitis decalvans (FD), a rare type of cicatricial alopecia. OBJECTIVE AND METHODS: The records of 23 patients with FD (1998-2012) were retrospectively analyzed, with added data review on the course and treatment of long-standing cases. RESULTS: Initial management consisted mostly of intralesional triamcinolone acetonide, clobetasol lotion, and either cephalexin, minocycline, doxycycline, or tetracycline. Alternatives consisted of rifampicin, clindamycin, ciprofloxacin, and isotretinoin. Remission was achieved in weeks to months in more than half of the cases, with low occurrence of relapse. The poor responders had a protracted course of temporary improvement and multiple relapses. CONCLUSION: The majority of patients showed improvement and subsequent remission with oral antibiotics. In some patients, it took years of slow taper before the antibiotic could be discontinued. Only a few patients had recalcitrant disease, with minimal response to their initial and alternative medications.

Retrospective Review of Folliculitis Decalvans in 23 Patients with Course and Treatment Analysis of Long-standing Cases.

BACKGROUND: To date, there is no standard treatment of folliculitis decalvans (FD), a rare type of cicatricial alopecia. OBJECTIVE AND METHODS: The records of 23 patients with FD (1998-2012) were retrospectively analyzed, with added data review on the course and treatment of long-standing cases. RESULTS: Initial management consisted mostly of intralesional triamcinolone acetonide, clobetasol lotion, and either cephalexin, minocycline, doxycycline, or tetracycline. Alternatives consisted of rifampicin, clindamycin, ciprofloxacin, and isotretinoin. Remission was achieved in weeks to months in more than half of the cases, with low occurrence of relapse. The poor responders had a protracted course of temporary improvement and multiple relapses. CONCLUSION: The majority of patients showed improvement and subsequent remission with oral antibiotics. In some patients, it took years of slow taper before the antibiotic could be discontinued. Only a few patients had recalcitrant disease, with minimal response to their initial and alternative medications.

Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up.

BACKGROUND: Frontal fibrosing alopecia is a distinctive form of scarring alopecia presenting with frontal and temporoparietal recession of the hairline. Its etiology remains unknown, and there are no universal treatment guidelines. We conducted a retrospective cohort study to define the clinical findings and treatment outcomes of 62 patients with frontal fibrosing alopecia, one of the largest cohorts to date. METHODS: Data analysis from case notes was performed on 62 patients with a diagnosis of frontal fibrosing alopecia seen from January 2004 to March 2012. RESULTS: Except for one male, all patients in this cohort were females (80% post-menopausal) and mostly Caucasians (81%). Age at onset was between 18 and 81 years. While 35% reported no symptoms, the majority (65%) had itching, pain, or burning sensations. All patients had frontal hairline recession, and 81% had complete or partial loss of eyebrows. Perifollicular erythema and perifollicular hyperkeratosis occurred in 73% and 31%, respectively. Associated autoimmune connective tissue diseases were observed in 14% of patients. Reduction in symptoms and hairline stabilization were achieved in 97% of treated patients with intralesional corticosteroids. Thirty-one percent of patients were able to stop treatments and remained in remission for six months to six years. CONCLUSION: Frontal fibrosing alopecia is increasingly seen in postmenopausal women and rarely in men. Despite the limitations of a retrospective study, we conclude early intervention and treatment with intralesional triamcinolone acetonide may halt the progression of the disease; however, further controlled prospective studies are needed to establish treatment guidelines for frontal fibrosing alopecia.

Pattern hair loss in men: diagnosis and medical treatment.

Androgenetic alopecia is a common cause of hair loss in both men and women. The exact pathogenesis of androgenetic alopecia is not well understood. As the name implies, the role of androgens and genetic susceptibility predisposes to pattern hair loss due to gradual conversion of terminal hair into vellus hair. Male and female pattern hair loss are clinically distinct entities but histologically indistinguishable. The role of sex hormones in females is less understood. This article discusses current understanding of the etiopathogenesis of hair loss in men, diagnostic tests available, and its medical management.

Hair transplantation update: procedural techniques, innovations, and applications.

The advances in hair transplantation, particularly the advent of follicular unit transplantation, have greatly elevated the outcome of this procedure. Various modifications to the basic technique as well as innovations focused on the different aspects of the hair transplantation procedure have further enhanced this type of hair restoration surgery. In addition, there is ongoing expansion of the indications and applications of this procedure beyond the usual male pattern hair loss.

Pallor sign: an indicator of hemangioma in evolution.

BACKGROUND: The typical presentation of infantile hemangioma is well known and is easily recognizable. However, it may have many atypical presentations, as reported in the literature. Most of the hemangiomas are not visible at birth and become apparent at about 3 to 4 weeks of age. There are very few case reports of hemangioma presenting as a pale patch in the dermatology literature, and none of them describe the etiopathogenesis of this presentation and its clinical implications. OBJECTIVE AND CONCLUSION: We report a case of an infantile hemangioma with a trichrome presentation: an erythematous oval patch with a dark red macule at the periphery enclosed by a hypopigmented halo. A brief description of the etiopathogenesis of the pallor sign is also given.

Wigs and hairpieces: evaluating dermatologic issues.

Hair is an important feature of self-image, and hair loss can have a devastating impact on a person's pychological well-being. In recent years, there has been an explosion of research in the understanding of various hair disorders, but unfortunately there has not been a major breakthrough and not much has changed in terms of therapeutic options available to patients with extensive hair loss. As professionals, we need to understand the social significance of hair in relation to a person's outward presentation and social interactions. We must minimize the distress alopecia can cause by providing up-to-date information to enable them to prepare for and minimize the psychological consequences of hair loss.

Autosomal recessive plasma cell panniculitis with morphea-like clinical manifestation.

Two siblings had hyperpigmented indurations over the inner aspects of both thighs extending to the lower abdomen. Skin biopsy showed plasma cell panniculitis favoring a diagnosis of morphea profundus. Family history of consanguinity was present, but both parents were unaffected. To our knowledge this is the first report of autosomal recessive plasma cell panniculitis with the clinical manifestations of morphea.

Becker's melanosis: a report of 12 cases with atypical presentation.

Becker's melanosis is a distinct clinical entity. It usually presents in adolescence as a unilateral, hyperpigmented, hairy cutaneous hamartoma. We report herein 12 cases of Becker's melanosis that differ in their presentation from classical Becker's melanosis, and we believe that such presentations are not uncommon.

Phakomatosis pigmentovascularis type IIb associated with Sturge-Weber syndrome.

We describe a 23-month-old child with phakomatosis pigmentovascularis type IIb associated with Sturge-Weber syndrome. Phakomatosis pigmentovascularis type IIb is a rare cutaneous malformation characterized by the simultaneous occurrence of nevus flammeus and melanocytic nevi. A brief review of the literature is presented and classification of this rare disease is discussed.