Hair disorders

Author(s):  
David de Berker

This chapter discusses inflammatory scalp diseases and hair shedding (telogen effluvium and pattern hair loss). Inflammatory diseases of the scalp can affect all epidermal surfaces or focus upon the follicle, with relative sparing of the interfollicular skin. Eczema and psoriasis are examples of the former; other diseases, such as lichen planopilaris or discoid lupus erythematosus, are examples of the latter. Some follicular diseases, such as the family of diseases based on alopecia areata (alopecia areata (small areas of hair loss), alopecia totalis (whole scalp), and alopecia universalis (whole body)), cause barely visible follicular inflammation which results in hair loss but no scarring. Some patients present with hair shedding or change of hair pattern as their primary complaint, with no scalp disease; this is telogen effluvium. Others present with an altered pattern of scalp hair without conspicuous shedding; this is pattern hair loss.

2020 ◽  
Vol 3 (2) ◽  
pp. 86-96
Author(s):  
Dominik Mikiel ◽  
Adriana Polańska ◽  
Aleksandra Dańczak‑Pazdrowska ◽  
Ryszard Żaba ◽  
Zygmunt Adamski

Introduction. Focal alopecia in the parietal area is one of the types of hair loss that can be found in dermatological practice. Trichoscopy is a non-invasive and easily accessible diagnostic method widely used in scalp disorders.Aim. The aim of this study was to assess the usefulness of trichoscopy in the non-invasive diagnosis of focal hair loss in adult women.Material and Methods. The study included 40 adult women. The study group consisted of 30 patients including 10 patients with alopecia areata (AA), 10 patients with discoid lupus erythematosus (DLE) and 10 with classical form of lichen planopilaris (LPP). The control group consisted of 10 healthy volunteers. Four groups of structures observed in trichoscopic examination were evaluated: hair follicle openings, hair shafts, vessels, perifollicular and interfollicular skin surface. Results. Among patients with AA the most frequently observed trichoscopic structures were: yellow dots in 100% (10/10), broken hairs in 90% (9/10), hairs resembling exclamation marks in 90% (9/10). DLE patients most often presented white / white-pink structureless areas and prominent, interfollicular scaling in 100% (10/10) and 90% (9/10) of cases, respectively. On the other hand, in the group of patients with LPP, the most frequent findings were: fine perifollicular scaling in 100% (10/10) and linear, slightly branched vessels arranged concentrically around the follicular openings - both features observed also in 100% (10/10) of cases.Conclusion. Trichoscopy as a non-invasive diagnostic method may be helpful in differentiating non-scarring and scarring alopecia in the parietal area in women. Moreover, there are some trichoscopic features typical for AA, DLE and LPP, which allow for differentiation and facilitate the diagnosis of these entities.


Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Joanna Golińska ◽  
Marta Sar-Pomian ◽  
Lidia Rudnicka

<b><i>Background:</i></b> The common inflammatory scalp diseases, such as psoriasis, seborrheic dermatitis, lichen planopilaris, discoid lupus erythematosus, contact dermatitis, or pemphigus may share similar clinical features. <b><i>Objective:</i></b> To identify and systematically review the available evidence on the accuracy of trichoscopy in inflammatory scalp disorders. <b><i>Methods:</i></b> A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 articles were included in the analysis. <b><i>Results:</i></b> The following trichoscopy features were found to show the highest specificity for the respective diseases: in psoriasis: diffuse scaling, simple and twisted red loops, red dots and globules, and glomerular vessels; in seborrheic dermatitis: atypical vessels, thin arborizing vessels, and structureless red areas; in discoid lupus erythematosus: follicular plugs and erythema encircling follicles; in lichen planopilaris: milky red areas or fibrotic patches; in contact dermatitis: twisted red loops; in pemphigus foliaceus: white polygonal structures and serpentine vessels; in pemphigus vulgaris: red dots with whitish halo and lace-like vessels; and in dermatomyositis: lake-like vascular structures. <b><i>Limitations:</i></b> Different nomenclature and variability in parameters, which were analyzed in different studies. <b><i>Conclusion:</i></b> This systemic analysis indicates that trichoscopy may be used with high accuracy in the differential diagnosis of inflammatory scalp diseases.


2022 ◽  
pp. 1-5
Author(s):  
Daniel Fernandes Melo ◽  
Paulo Müller Ramos ◽  
Matilde Iorizzo ◽  
Caren dos Santos Lima ◽  
Erica Baptista Pinto ◽  
...  

<b><i>Introduction:</i></b> All types of lupus erythematosus (LE) may cause hair loss. Nonscarring alopecia was correlated with systemic LE, based on its high specificity. Discoid LE can also appear as nonscarring patches in early stages. Patchy alopecia LE-specific may also mimic alopecia areata (AA) – which can co-occur with LE. The distinction is fundamental to early diagnosis and effective treatment. This study aims to analyze clinical, epidemiological, trichoscopic, and histopathological features of patients with patchy LE-specific alopecia, nonscarring type, mimicking AA. <b><i>Methods:</i></b> This is a multicentric retrospective study. We reviewed the medical records of patients with a confirmed diagnosis of LE mimicking AA. <b><i>Results:</i></b> Ten patients were included (90% female) with a mean age of 45.9 years. Clinically, 60% showed erythema and 70% presented incomplete hair loss. The most common trichoscopic findings were interfollicular arborizing vessels (90%) and scattered brown discoloration (80%). On histopathology, perivascular inflammation (85.7%), peribulbar lymphocytes (85.7%), and dermal pigment incontinence (71.4%) were present in most cases. <b><i>Discussion/Conclusion:</i></b> Trichoscopy was found as an essential first step for the patchy alopecia diagnosis, enabling to differentiate LE from AA. Putting it mildly, trichoscopy raises the suspicion that leads to a biopsy, increasing the diagnostic accuracy with better outcome for patients.


2020 ◽  
Vol 8 (3) ◽  
pp. 175-182
Author(s):  
C.R. Madubuko ◽  
B.U. Okwara

Background: Alopecia is a common condition accounting for the top ten morbidities seen in patients that present at dermatology outpatient clinics in Nigeria.Aim: This retrospective study aimed at documenting the prevalence and types of alopecia in the skin clinic at the University of Benin Teaching Hospital between December 2014 and December 2019. Methods: The medical records of all patients with alopecia attending dermatological outpatient clinic between December 2014 to December 2019 were analyzed retrospectively for this descriptive observational study. An approval for the study was obtained from the Ethics Committee of the University of Benin Teaching Hospital, Benin-city, Nigeria. The diagnosis of Hair loss was essentially clinical, confirmed where expedient with a skin biopsy. Dermatological tools like Dermoscopes were also used to boost diagnostic accuracy when necessary. The patients were also evaluated for presence of other cutaneous and systemic disorders. Results: During the 5year study period, 106 patients with hair loss (6.6%%) were observed. The youngest patient was 2months old and the oldest patient was 90years old. The males constituted 61.3% of patients observed while the females accounted for 38.7% of patients seen. The male to female ratio was 1.6:1. Discoid lupus erythematosus of the scalp, was the most common disorder 29(29.4%). Alopecia areata occurred in23(27.7%); tinea capitis in 15(14,2%); Acne keloidalis nuchae in 14(13.2%); seborrheic dermatitis10(9.4%); and folliculiltis delcavans 9(8.5%). Less commonly observed causes of alopecia included androgenetic alopecia 2(1.9%); traction alopecia 2(1.9%); lichenplanopilaris 1(0.9%) and nevus sebaceum 1(0.9%). Conclusion: There is a need for studies to further describe and proffer solutions to common causes of alopecia in our community. Keywords: Retrospective study, Alopecia, Tertiary hospital, Benin French title: Une étude rétrospective de cinq (5) ans sur l'alopécie dans un hôpital tertiaire du Sud au Nigéria Contexte général de l'étude: L'alopécie est une condition de classement courante qui explique les dix principales morbidités observées chez les patients qui se présentent dans des cliniques externes de dermatologie au Nigéria.Objectif de l'étude: Cette étude rétrospective visait à documenter la prévalence et les types d'alopécie à la clinique externe de dermatologie de l'hôpital universitaire du Bénin entre décembre 2014 et décembre 2019.Méthode de l'étude: Il s'agissait d'une étude rétrospective de patients présentant principalement une perte de cheveux. Les données ont été obtenues à partir des dossiers cliniques et des notes cliniques des patients.Résultats de l'étude: Au cours de la période d'étude de 5 ans, 106 patients sur 1 600 personnes fréquentant la clinique de la peau ont eu une perte de cheveux constituant une prévalence de 6,6%. Les patients vus étaient âgés de 2 mois à 90 ans. Plus d'hommes (61,3%) que de femmes (38,7%) ont été vus; avec un rapport de 1,6: 1. Le lupus érythémateux discoïde du cuir chevelu était le trouble le plus courant «insérer un nombre absolu» (29,4%). L'alopécie areata est survenue en «insérer le nombre absolu» 27,7%; tineacapitis en «insérer le nombre absolu» 14,2%; Acné  keloidalisnuchae en «insérer le nombre absolu» 13,2%; dermatite séborrhéique «insérer le nombre absolu» 9,4%; et folliculiltisdelcavans «insérer le nombre absolu» 8,5%. Les causes d'alopécie moins fréquemment observées comprenaient l'androgénétopécie (1,9%); alopécie de traction (1,9%); lichenplanopilaris (0,9%) et naevus sébacé (0,9%)Conclusion: Des études sont nécessaires pour décrire et proposer des solutions aux causes courantes d'alopécie dans notre communauté. Mots-clés: Alopécie, lupus érythémateux discoïde, alopéciaareata, acné keloidalisnuchae


Author(s):  
Krishnendra Varma ◽  
Ujjwal Singh ◽  
Manu Kataria

<p class="abstract"><strong>Background:</strong> Many patients of alopecia are encountered in daily practice with diagnostic dilemma. Trichoscopy is a sensitive, non-invasive tool which aids in clinical diagnosis.</p><p class="abstract"><strong>Methods:</strong> An observational study performed in adult patients with alopecia attending R.D. Gardi Medical College, Ujjain, over a period of one year. Trichoscopy was performed using a Dinolite digital microscope with both polarized and non polarized modes.<strong></strong></p><p class="abstract"><strong>Results:</strong> 269 patients of alopecia (257 non cicatricial, 12 cicatricial) aged 18-50 years were enrolled. The diagnosis was made after detailed history and clinical examination. 173 (64.3%) males and 96 (35.7%) females. 45.4% patients were diagnosed to have alopecia areata in which yellow dots were the most common trichoscopic finding observed in 88.5% patients. 37.2% patients were diagnosed with androgenetic alopecia with hair diameter diversity &gt;20% observed in all the patients. 9.3% patients were diagnosed to have telogen effluvium with short vellus hair seen in 64% patients. 3.7% of the patients were diagnosed to have seborrheic dermatitis with arborizing vessels being the most common finding seen in 90% patients. 2.9% patients were diagnosed with lichen planopilaris in which loss of follicles and peritubular white casts were seen in all the cases. 0.9% patients were diagnosed to have discoid lupus erythematosus with hyperkeratotic follicular plugging seen in all the cases. Overall yellow dots were the most common trichoscopic findings seen in 61% cases.</p><p class="abstract"><strong>Conclusions:</strong> Trichoscopy is a reliable diagnostic tool in hair and scalp disorders. Hence trichoscopic evaluation should be done in every case of alopecia.  </p><p class="abstract"> </p>


Author(s):  
Dadapeer H. J. ◽  
Anupama Y. G. ◽  
Sushma D. M.

<p><span>Discoid lupus erythematosus (DLE) is the most common chronic form of cutaneous lupus. It is characterised by persistent scaly, disk-like plaques on scalp, face and ears that may cause pigmentary changes, scarring and hair loss. </span><span class="apple-converted-space"><span>Squamous cell carcinoma can</span></span><span> rarely arise within a longstanding DLE plaque<span class="apple-converted-space"> </span>in the skin. It presents as an enlarging warty<span class="apple-converted-space"> </span>growth or ulcer. We report a case of squamous cell carcinoma which developed on lesion of discoid lupus erythematosus within a short period of time.</span></p>


2014 ◽  
Vol 6 (2) ◽  
pp. 69-72
Author(s):  
Ljubka Miteva ◽  
Valentina Broshtilova ◽  
Robert A. Schwartz

Abstract A 22-year-old woman with a 3-year history of discoid lupus erythematosus presented with two circumscribed patches of non-scarring alopecia, clinically simulating alopecia areata. Histopathological analysis of scalp lesions revealed discoid lupus erythematosus. Based on the clinical history, physical examination, and histological and immunological findings, we distinguished our case from a true combination of alopecia areata and typical chronic discoid lupus erythematosus.


2014 ◽  
Vol 11 (3) ◽  
pp. 273-275
Author(s):  
S Jain

Pseudopelade of Brocq is a clinical syndrome comprising of scarring alopecia and fibrosis in which distinct pathological features are absent. It is not a specific disease, rather a pattern of cicatricial alopecia. However, if a definitive diagnosis of DLE (discoid lupus erythematosus), LPP (Lichen planopilaris) or any other condition can be made on the basis of clinical, histopathological or immunofluorescent features, then this term cannot be used. Here we report the case of a 20 year old young male who presented to us with complaints of loss of scalp hair for 2 years which were associated with mild itching. The condition is as such rare in prevalence and hence we report the same in view of its unique presentation. DOI: http://dx.doi.org/10.3126/hren.v11i3.9652 Health Renaissance 2013;11(3):273-275


2021 ◽  
Vol 79 (2) ◽  
pp. 155-158
Author(s):  
Cleide Garbelini-Lima ◽  
Gabriela Evangelista de Almeida ◽  
Sidharta Quércia Gabdelha ◽  
Andrea Cavalcante de Souza ◽  
Mara Lúcia Gomes de Souza ◽  
...  

Scalp involvement with hair loss is common in systemic lupus erythematosus. Discoid lupus erythematosus may cause scarring alopecia, characterized by well-delimited erythematous plaques with scales, follicular hyperkeratosis and atrophy, which is considered a trichological emergency. Early diagnosis and treatment are necessary in order to prevent permanent hair loss. We describe a 44 years’ old female patient with systemic lupus erythematosus for 4 years, with multiple areas of occipitoparietal alopecia, erythematous plaques, atrophy, scales and some bloody crusts. Trichoscopy, histopathology and direct immunofluorescence led to the diagnosis of discoid lupus erythematosus. After 9 months treatment with thalidomide there was complete hair regrowth.


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