88 - Cicatricial Alopecias Flashcards
Refers to a group of idiopathic inflammatory disorders, characterized by a folliculocentric inflammatory process that ultimately destroys the hair follicle
Primary cicatricial alopecias
Can be caused by almost any cutaneous inflammatory process of the scalp skin or physical trauma, which injures the skin and skin appendages
Secondary cicatricial alopecias
Primary cicatricial alopecias are characterized by inflammatory infiltrate affecting the upper, permanent portion of the follicle referred to as the _____, and the below it, the _____ of the follicule
Infundibulum
Isthmus
The isthmus is the home of the pluripotent hair stem cells, which are found in the _____ region where the arrector pili muscle attaches to the outer root sheath
Bulge
It has been assumed that scarring hair loss is a consequence of damage to the isthmus, affecting either
Stem cells
Sebaceous glands
Lymphocytic primary cicatricial alopecias
Chronic cutaneous lupus erythematosus Lichen planopilaris Classic lichen planopilaris Frontal fibrosing alopecia Graham-Little syndrome Central centrifugal cicatricial alopecia Alopecia mucinosa Keratosis follicularis spinulosa decalvans
Neutrophilic primary cicatricial alopecias
Folliculitis decalvans
Dissecting cellulitis/folliculitis
Mixed cicatricial alopecia
Folliculitis (acne) keloidalis
Folliculitis (acne) necrotica
Erosive pustular dermatosis
No disease activity should occur on the scalp for at least _____ after which hair restoration surgery can begin
1 year
The patient has to be warned about a possible limited graft survival and disease recurrence, which seems to be higher in _____ primary scarring alopecia
Neutrophilic
_____, together with LPP, is the most common cause of inflammatory cicatricial alopecia
DLE
LPP can be divided into
Classic LPP
Graham-Little syndrome
Frontal fibrosing alopecia
Alopecic areas of _____ are often smaller, irregularly shaped and interconnected, which can lead to a reticulated clinical pattern as compared to DLE
LPP
Frontal, band-like or circumferential scarring alopecia
Alopecia of the eyebrows is also frequently seen
Frontal fibrosing alopecia
Classic LPP on the scalp, nonscarring alopecia of axillae, pubic area, and eyebrows, as well as keratosis pilaris of the trunk and extremities
Graham-Little syndrome
Small flesh-toned alopecic patches with irregular margins
“Foot prints in the snow”
Pseudopelade of Brocq
Treatment of choice for pseudopelade of Brocq
Intralesional triamcinolone in combination with topical corticosteroids
Most common form of primary cicatricial alopecia in women of African American descent
Central centrifugal cicatricial alopecia
CCCA seen in whites
Central elliptical pseudopelade
Indurated, well-demarcated, erythematous or skin-colored patches of scarring or nonscarring alpecia that can be accompanied by diffuse hair loss and alopecia of the eyebrows
Can occur idiopathically or in the setting of CTCL or MF
Alopecia mucinosa
Congenital follicular keratinizing disorders
Keratosis follicularis spinulosa decalvans
Ulerythema ophryogenes
Atrophoderma vermiculatum
A bacterial infection involving Staphylococcus aureus, in combination with hypersensitivity reaction to “superantignes” and defect in host cell-mediated immunity have all been suspected as possible pathogenic factors
Folliculitis decalvans
Multiple hairs emerging from a single, dilated, follicular orifice
Tufted folliculitis
Follicular occlusion triad
Dissecting folliculitis
Acne conglobata
Hidradenitis suppurativa
Fluctuating nodules, abscesses, and sinuses, which frequently show spontaneous discharge of pus, as well as erythematous, follicular papules and pustules
Dissecting folliculitis
Idiopathic primary cicatricial alopecia that might be triggered by trauma (shirt collars) or infection (Demodex or bacteria)
Acne keloidalis nucahe
Treatment of first choice for acne keloidalis nucahe
Intralesional triamcinoloe acetonide
alone or combined with
Topical clindamycin or oral (tetracylines) antibiotics
Umbilicated, pruritic, or painful papules that undergo central necrosis
Frontal and parietal scalp, as well as seborrheic areas of the face are most commonly affected
Acne necrotica (varioliformis)
Predominantly occurring in elderly women
Suppurative, necrotic, erosive papule or plaque
Erosive pustular dermatosis
Possible causes of secondary cicatricial alopecia
Congenital defects Trauma Inflammatory conditions Infections Neoplasms Rarely, drugs
Ectothrix infection is most commonly caused by
Microsporum spp
Epidermophyton spp
Endothrix infection is most commonly caused by
Trichophyton spp
Traumatic alopecias are usually of 3 types
Acute trauma
Prolonged traction
Pressure
Marginal traction alopecia is more commonly seen in
African American women from hair braiding and weaving procedures
Patchy traction alopecia in the frontal hairline or temples is commonly seen in
Sikh boys, whose hair is usually tight up in a “topknot”
Two forms of trichotillomania can be distinguised
Infantile or early-onset
Late-onset
