16 - 88 - CICATRICIAL ALOPECIAS

Question 1

refers to a group of idiopathic inflammatory diseases, characterized by a folliculocentric inflammatory process that ultimately destroys the hair follicle

Answer 1

Primary cicatricial alopecia

Question 2

can be caused by almost any cutaneous inflammatory process of the scalp skin or by physical trauma, which injures the skin and skin appendages

Answer 2

Secondary cicatricial alopecias

Question 3

Regardless of whether a cicatricial alopecia is primary or secondary in nature, all scarring alopecias are characterized clinically by?

Answer 3

*** loss of follicular ostia **
* pathologically by a replacement of hair follicles with fibrous tissue

Question 4

Primary cicatricial alopecias are characterized by an inflammatory infiltrate affecting what parts of the hair follicle?

Answer 4

upper, permanent portion of the follicle referred to as the infundibulum, and below it, the isthmus of the follicle

Damage to the bulge area and the sebaceous gland with the isthmus may result in an incomplete hair cycle and can be associated with chronic follicular inflammation and foreign-body reaction

Question 5

home of pluripotent hair stem cells, which are found in the bulge region where the arrector pili muscle attaches to the outer root sheath

Answer 5

isthmus

Question 6

cells responsible for the** renewal of the upper part of the hair follicle and sebaceous glands,** and for the restoration of the lower cyclical component of the follicles at the onset of a new anagen period

Answer 6

Pluripotent hair follicle stem cells

Question 7

It has been assumed that scarring hair loss is a consequence of damage to what part of the hair follicle, affecting either stem cells or sebaceous glands

Answer 7

isthmus

Question 8

Primary cicatricial alopecia usually affects what parts of the scalp

Answer 8

central and parietal scalp before progressing to other sites of the scalp

Question 9

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Erosive pustular dermatosis

Answer 9

Mixed

Question 10

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Dissecting cellulites/folliculitis (perifolliculitis abscedens et suffodiens)

Answer 10

Neutrophilic

Question 11

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Question 12

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Keratosis follicularis spinulosa decalvans

Answer 12

Lymphocytic

Question 13

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Folliculitis (acne) necrotica

Answer 13

mixed

Question 14

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Folliculitis decalvans

Answer 14

neutrophilic

Question 15

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Alopecia mucinosa

Answer 15

lymphocytic

Question 16

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Folliculitis (acne) keloidalis

Answer 16

mixed

Question 17

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Central centrifugal cicatricial alopecia

Answer 17

lymphocytic

Question 18

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Classic pseudopelade of Brocq

Answer 18

lymphocytic

Question 19

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Graham-Little syndrome

Answer 19

lymphocytic

Question 20

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Frontal fibrosing alopecia

Answer 20

lymphocytic

Question 21

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Classic lichen planopilaris

Answer 21

lymphocytic

Question 22

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Lichen planopilaris

Answer 22

lymphocytic

Question 23

Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:

Chronic cutaneous lupus erythematosus (discoid lupus erythematosus)

Answer 23

lymphocytic

Question 24

Question 25

scalp biopsy recommendations on cicatricial alopecia

Answer 25

* One **4-mm punch biopsy **including **subcutaneous tissue** should be taken from a clinically active area, processed for **horizontal** sections and stained with hematoxylin and eosin. **Elastin (acid alcoholic orcein), mucin, and periodic acid–Schiff stains** may provide additional diagnosis-defining information. * **A second 4-mm punch biopsy from a clinically active disease**-affected area should be cut **vertically** into 2 equal pieces. ## Footnote One half provides tissue for transverse cut routine histologic sections, and the other half can be used for direct immunofluorescence studies.

Question 26

most common cause of inflammatory cicatricial alopecia

Answer 26

DLE, together with lichen planopilaris (LPP)

Question 27

management and treatment of DLE

Answer 27

*** Hydroxychloroquine 200 to 400 mg** daily in adults or** 4 to 6 mg/kg** in children is highly effective at managing. * A baseline ophthalmologic examination and complete blood count is required before the therapy is started * Bridge therapy with **oral prednisone (1 mg/kg) tapered over the first 8 weeks** of treatment might be helpful in adult patients with rapidly progressive disease. * In limited or slowly progressive DLE, **intralesional triamcinolone acetonide **should be used at a concentration of **10 mg/mL every 4 to 6 weeks,** alone or in addition to oral therapy. * Intralesional triamcinolone acetonide can be used with or without topical class I or class II corticosteroids. * Oral acitretin and isotretinoin have also shown some effectiveness at managing

Question 28

Lichen planopilaris can be divided into 3

Answer 28

1. classic LPP 2. Graham-Little syndrome, 3. frontal fibrosing alopecia (FFA)

Question 29

characterize Graham-Little syndrome

Answer 29

LPP of the scalp, noncicatricial of the eyebrows, axilla, and groin, and keratosis pilaris

Question 30

frontal fibrosing alopecia (FFA) typically affects what population

Answer 30

postmenopausal women

Question 31

Some of the most common drugs that cause lichenoid drug eruption

Answer 31

gold, antimalarials, and captopril

Question 32

most likely drugs to cause lichenoid drug eruption

Answer 32

quinine and thiazide diuretics

Question 33

characterized by a frontal, band-like or circumferential scarring alopecia

Answer 33

FFA ## Footnote * In some cases, a few hairs are spared in the original frontal hairline. * Follicular hyperkeratosis and perifollicular erythema may be found in a band-like pattern in the frontal hairline. * Alopecia of the eyebrows is also frequently seen in FFA

Question 34

First-line treatment for moderately active classic LPP lesions

Answer 34

intralesional triamcinolone acetonide at a concentration of 10 mg/mL every 4 to 6 weeks or in combination with topical class I or class II corticosteroids

Question 35

Pseudopelade of Brocq (PPB) usually affects what areas of the scalp?

Answer 35

**vertex** and **occipital** area of the scalp ## Footnote * It presents with small **flesh-toned alopecic patches with irregular margins.** This pattern has been described as **“foot prints in the snow.”** * PPB can also present as a **noninflammatory**, **centrifugally spreading, patch of alopecia,** which might be seen as a variant of central centrifugal cicatricial alopecia (CCCA) in whites. * **Follicular hyperkeratosis and perifollicular or diffuse erythema are mostly absent. ** * Clinically, the features **may overlap with LPP**

Question 36

the most common form of primary cicatricial alopecia in women of African descent.

Answer 36

CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA

Question 36

Tufted folliculitis is typically found in what condition

Answer 36

Folliculitis Decalvans ## Footnote * but can also occur in other cicatricial inflammatory alopecias * Tufted folliculitis is characterized by multiple hairs (5 to 15) emerging from a single, dilated, follicular orifice.

Question 37

follicular occlusion triad

Answer 37

* dissecting folliculitis * acne conglobata * hidradenitis suppurativa

Question 38

permanent hair loss is caused by various other scalp conditions not related to the hair follicle

Answer 38

secondary cicatricial alopecias

Question 38

Ectothrix infection are most commonly caused by what spp?

Answer 38

Microsporum spp. (especially Microsporum canis) and Epidermophyton spp.

Question 39

Endothrix infections are most commonly caused by what spp?

Answer 39

Trichophyton spp. (especially T. tonsurans subspecies sulfureum)

Question 40

Question 41

specific type of tinea capitis characterized by patelliform scales (scutula), which are sulfuric-yellow concretions of hyphae and skin debris in the follicular orifices and exhibit a distinct malodorous smell

Answer 41

Favus

Question 42

* deep, highly inflammatory fungal infection of the scalp * It presents as a highly suppurative, boggy, nodular, deep folliculitis with fistulas and pus secretion

Answer 42

kerion

Question 43

can occur after a patient was unconscious and completely immobile for a certain length of time

Answer 43

PRESSURE ALOPECIA