16 - 88 - CICATRICIAL ALOPECIAS Flashcards
refers to a group of idiopathic inflammatory diseases, characterized by a folliculocentric inflammatory process that ultimately destroys the hair follicle
Primary cicatricial alopecia
can be caused by almost any cutaneous inflammatory process of the scalp skin or by physical trauma, which injures the skin and skin appendages
Secondary cicatricial alopecias
Regardless of whether a cicatricial alopecia is primary or secondary in nature, all scarring alopecias are characterized clinically by?
*** loss of follicular ostia **
* pathologically by a replacement of hair follicles with fibrous tissue
Primary cicatricial alopecias are characterized by an inflammatory infiltrate affecting what parts of the hair follicle?
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
home of pluripotent hair stem cells, which are found in the bulge region where the arrector pili muscle attaches to the outer root sheath
isthmus
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
Pluripotent hair follicle stem cells
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
isthmus
Primary cicatricial alopecia usually affects what parts of the scalp
central and parietal scalp before progressing to other sites of the scalp
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Erosive pustular dermatosis
Mixed
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Dissecting cellulites/folliculitis (perifolliculitis abscedens et suffodiens)
Neutrophilic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Keratosis follicularis spinulosa decalvans
Lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Folliculitis (acne) necrotica
mixed
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Folliculitis decalvans
neutrophilic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Alopecia mucinosa
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Folliculitis (acne) keloidalis
mixed
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Central centrifugal cicatricial alopecia
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Classic pseudopelade of Brocq
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Graham-Little syndrome
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Frontal fibrosing alopecia
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Classic lichen planopilaris
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Lichen planopilaris
lymphocytic
Identify if lymphocytic, neutrophilic or mixed cicatricial alopecia:
Chronic cutaneous lupus erythematosus (discoid lupus erythematosus)
lymphocytic
scalp biopsy recommendations on cicatricial alopecia
- 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.
One half provides tissue for transverse cut routine histologic sections, and the other half can be used for direct immunofluorescence studies.
most common cause of inflammatory cicatricial alopecia
DLE, together with lichen planopilaris (LPP)
management and treatment of DLE
* 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
Lichen planopilaris can be divided into 3
- classic LPP
- Graham-Little syndrome,
- frontal fibrosing alopecia (FFA)
characterize Graham-Little syndrome
LPP of the scalp, noncicatricial of the eyebrows, axilla, and groin, and keratosis pilaris
frontal fibrosing alopecia (FFA) typically affects what population
postmenopausal women
Some of the most common drugs that cause lichenoid drug eruption
gold, antimalarials, and captopril
most likely drugs to cause lichenoid drug eruption
quinine and thiazide diuretics
characterized by a frontal, band-like or circumferential scarring alopecia
FFA
- 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
First-line treatment for moderately active classic LPP lesions
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
Pseudopelade of Brocq (PPB) usually affects what areas of the scalp?
vertex and occipital area of the scalp
- 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
the most common form of primary cicatricial alopecia in women of African descent.
CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA
Tufted folliculitis is typically found in what condition
Folliculitis Decalvans
- 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.
follicular occlusion triad
- dissecting folliculitis
- acne conglobata
- hidradenitis suppurativa
permanent hair loss is caused by various other scalp conditions not related to the hair follicle
secondary cicatricial alopecias
Ectothrix infection are most commonly caused by what spp?
Microsporum spp. (especially Microsporum canis) and Epidermophyton spp.
Endothrix infections are most commonly caused by what spp?
Trichophyton spp. (especially T. tonsurans subspecies sulfureum)
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
Favus
- deep, highly inflammatory fungal infection of the scalp
- It presents as a highly suppurative, boggy, nodular, deep folliculitis with fistulas and pus secretion
kerion
can occur after a patient was unconscious and completely immobile for a certain length of time
PRESSURE ALOPECIA
