1
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Oak ASW, Yang K, Reddy SB, Elston CA, Mayo TT. Lichen planopilaris in 24 African American women. Int J Womens Dermatol 2024; 10:e141. [PMID: 38572266 PMCID: PMC10986913 DOI: 10.1097/jw9.0000000000000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Allen S. W. Oak
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Yang
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sivani B. Reddy
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carly A. Elston
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany T. Mayo
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
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2
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Yu DA, Kim SR, Cho SI, Kwon O. Endocrine and metabolic comorbidities in primary cicatricial alopecia: A nationwide population-based study. J Dermatol 2024; 51:429-440. [PMID: 38111374 DOI: 10.1111/1346-8138.17080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
Primary cicatricial alopecia (PCA) is a rare, scarring, hair loss disorder. Due to its low incidence, little is known about endocrine and metabolic comorbidities in patients with PCA. Thus, we aimed to investigate the association between PCA and endocrine and metabolic disorders. This nationwide, population-based, cross-sectional study included patients diagnosed with PCA or non-cicatricial alopecia (NCA) and normal individuals without history of alopecia registered in the Korean National Health Insurance Service database between January 1, 2011, and December 31, 2020. We calculated the odds ratios of endocrine and metabolic comorbidities of patients with PCA compared to all patients or age- and sex-matched patients with NCA or normal individuals using multivariable logistic regression models. A total of 3 021 483 individuals (mean age [SD], 38.7 [15.0] years, 1 607 380 [53.2%] men), including 11 956 patients with PCA, 601 852 patients with NCA, and 2 407 675 normal participants, were identified. Patients with PCA had an increased risk for dyslipidemia (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.06-1.24), diabetes (aOR 1.38, 95% CI 1.24-1.53), and hypertension (aOR 1.10, 95% CI 1.02-1.19) compared to matched patients with NCA. Regarding PCA subtypes, lichen planopilaris/frontal fibrosing alopecia was positively associated with hypothyroidism (aOR 2.03, 95% CI 1.44-2.86) compared to NCA. Folliculitis decalvans and dissecting cellulitis were positively associated with dyslipidemia (aOR 1.16, 95% CI 1.05-1.28 and aOR 1.16, 95% CI 1.04-1.29, respectively), diabetes (aOR 1.38, 95% CI 1.20-1.58 and aOR 1.52, 95% CI 1.32-1.74, respectively), and hypertension (aOR 1.10, 95% CI 1.00-1.20 and aOR 1.14, 95% CI 1.02-1.27, respectively). Similar trends were observed when each PCA subgroup was compared with the normal control group. This study demonstrates that patients with PCA are more likely to have endocrine and metabolic comorbidities than patients without PCA. Further research on these comorbidities may improve the understanding of PCA.
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Affiliation(s)
- Da-Ae Yu
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Ohsang Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
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3
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Li J, Ge R, Lin K, Wang J, He Y, Lu H, Dong H. Advances in the Application of Microneedles in the Treatment of Local Organ Diseases. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2306222. [PMID: 37786290 DOI: 10.1002/smll.202306222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/07/2023] [Indexed: 10/04/2023]
Abstract
In recent years, microneedles (MNs) have attracted a lot of attention due to their microscale sizes and high surface area (500-1000 µm in length), allowing pain-free and efficient drug delivery through the skin. In addition to the great success of MNs based transdermal drug delivery, especially for skin diseases, increasing studies have indicated the expansion of MNs to diverse nontransdermal applications, including the delivery of therapeutics for hair loss, ocular diseases, and oral mucosal. Here, the current treatment of hair loss, eye diseases, and oral disease is discussed and an overview of recent advances in the application of MNs is provided for these three noncutaneous localized organ diseases. Particular emphasis is laid on the future trend of MNs technology development and future challenges of expanding the generalizability of MNs.
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Affiliation(s)
- Jinze Li
- Marshall Laboratory of Biomedical Engineering, Shenzhen Key Laboratory for Nano-Biosensing Technology, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Guangdong, 518060, China
| | - Rujiao Ge
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Research Center for Bioengineering and Sensing Technology, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kai Lin
- College of Chemistry and Environmental Engineering, Shenzhen University, Guangdong, 518060, China
| | - Junren Wang
- Marshall Laboratory of Biomedical Engineering, Shenzhen Key Laboratory for Nano-Biosensing Technology, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Guangdong, 518060, China
| | - Yu He
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
| | - Huiting Lu
- Department of Chemistry, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Haifeng Dong
- Marshall Laboratory of Biomedical Engineering, Shenzhen Key Laboratory for Nano-Biosensing Technology, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Guangdong, 518060, China
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4
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Lim SH, Kang H, Heo YW, Lee WS, Lee S. Prevalence and incidence of comorbid diseases and mortality risk associated with lichen planopilaris: a Korean nationwide population-based study. Clin Exp Dermatol 2023; 48:1230-1237. [PMID: 37433080 DOI: 10.1093/ced/llad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Various comorbid diseases have been reported in patients with lichen planopilaris (LPP); however, data regarding the risks of incident diseases and mortality are lacking. OBJECTIVES To investigate the risks of incident diseases and mortality associated with LPP. METHODS This was a retrospective nationwide population-based study, using data from the National Health Insurance Service Database of Korea from 2002 to 2019. Patients aged ≥ 18 years with three or more documented medical visits for LPP were included. The adjusted hazard ratios (aHRs) for incident disease outcomes and mortality were compared with 1 : 20 age-, sex-, insurance type- and income-level-matched controls. RESULTS In total, 2026 patients with LPP and 40 520 controls were analysed. The risks of incident systemic lupus erythematosus [aHR 1.91, 95% confidence interval (CI) 1.21-3.03], psoriasis (aHR 3.42, 95% CI 2.83-4.14), rheumatoid arthritis (aHR 1.39, 95% CI 1.19-1.63), lichen planus (aHR, 10.07, 95% CI 7.17-14.15), atopic dermatitis (aHR 2.15, 95% CI 1.90-2.44), allergic rhinitis (aHR 1.29, 95% CI 1.13-1.49), thyroid diseases (hyperthyroidism: aHR 1.42, 95% CI 1.14-1.77, hypothyroidism aHR 1.19 95% CI 1.01-1.41, and thyroiditis: aHR, 1.35, 95% CI 1.08-1.69), nonmelanoma skin cancer (aHR 2.33, 95% CI 1.00-5.44) and vitamin D deficiency (aHR 1.23, 95% CI 1.03-1.47) were higher in patients with LPP. Patients with LPP had a higher mortality rate than controls (aHR 1.30, 95% CI 1.04-1.61), although the risk was not significant after adjusting for comorbidities (aHR 1.08, 95% CI 0.87-1.34). CONCLUSIONS Patients with LPP had a higher risk of various diseases following LPP diagnosis. Close follow-up is needed to optimize comprehensive patient care.
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Affiliation(s)
- Sung Ha Lim
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyun Kang
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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5
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Kurzeja M, Warszawik-Hendzel O, Rakowska A, Graczyk A, Fedorczuk D, Czuwara J, Olszewska M, Rudnicka L. Line-field confocal optical coherence tomography: A new diagnostic method of lichen planopilaris. Skin Res Technol 2023; 29:e13495. [PMID: 37881054 PMCID: PMC10576171 DOI: 10.1111/srt.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | | | - Adriana Rakowska
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Alina Graczyk
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Danuta Fedorczuk
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Poland, Warsaw, Poland
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Pinedo-Moraleda F, Tristán-Martín B, Dradi GG. Alopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists. J Clin Med 2023; 12:5004. [PMID: 37568407 PMCID: PMC10419566 DOI: 10.3390/jcm12155004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Accurately diagnosing specific variants of alopecia remains challenging for pathologists, potentially delaying appropriate therapeutic decisions by dermatologists. Issues such as limited knowledge on optimal biopsy types and processing methods add complexity. Understanding the normal histology of hair follicles and their changes throughout the follicular cycle further complicates microscopic evaluation. This paper aims to summarize these characteristics and highlight essential diagnostic clues for pathologists to confidently suggest a diagnosis, therefore playing a key role in alopecia diagnosis. Ongoing education, collaboration with dermatologists, and staying up to date on advancements is crucial for the accurate diagnosis and effective management of different types of alopecia.
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Affiliation(s)
| | - Belén Tristán-Martín
- Department of Pathology, Hospital Nuestra Señora de Sonsoles, 05004 Avila, Spain;
| | - Giulia Greta Dradi
- Department of Dermatology, Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Spain;
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7
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Treatment of Frontal Fibrosing Alopecia. Dermatol Ther 2023. [DOI: 10.1155/2023/3856674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer-assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5-alpha-reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5-alpha-reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.
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8
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Muacevic A, Adler JR, O’Connell C, Mann C. Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study. Cureus 2023; 15:e34169. [PMID: 36843712 PMCID: PMC9950001 DOI: 10.7759/cureus.34169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Background Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) is scarring alopecias with limited evidence supporting their treatment options. We investigated the use of low-dose naltrexone (3 mg oral daily) as adjunctive therapy in the treatment of FFA and LPP. Methods A single-center, uncontrolled open-label prospective study was performed, with 26 patients who took low-dose naltrexone for one year included in the per-protocol analysis. Both patient-reported (pruritus and burning/pain) and physician-assessed (erythema, scale, and scalp involvement) outcomes were analyzed. Results There were decreases in erythema and scale for the overall longitudinal outcomes using linear mixed effects model analysis. However, only erythema had a significant decrease at 12 months compared with baseline. Mean erythema decreased by 0.93 at 12 months compared with baseline on a 0-3-point scale (p<0.0001, 95% mean CI [-1.32, -0.53]). There was no statistically significant difference comparing 12 months to baseline for the other outcomes including pruritus, burning/pain, and scalp involvement. Limitations include the possibility of spontaneous stabilization, concurrent medications, a small sample size with limited racial diversity, and mild subjective symptoms at baseline. Conclusion Our study supports further investigation of oral low-dose naltrexone as adjunctive therapy in the treatment of FFA and LPP if there is prominent erythema, and possibly scale.
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9
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Zhou Y, Jia L, Zhou D, Chen G, Fu Q, Li N. Advances in microneedles research based on promoting hair regrowth. J Control Release 2023; 353:965-974. [PMID: 36549392 DOI: 10.1016/j.jconrel.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Alopecia is the most common and difficult-to-treat hair disorder. It usually brings a significant psychological burden to the patients. With the growing popularity of alopecia, the study of alopecia has gained more attention. Currently, only minoxidil and finasteride have been approved by the FDA for the treatment of alopecia, but the efficacy has always been unsatisfactory. As a new form of transdermal drug delivery, microneedles have been widely used in the treatment of alopecia and have proven to be effective. Microneedles delivery can improve the efficiency of local drug delivery and patients' compliance, which can achieve better therapeutic effects on hair-related diseases. Therefore, microneedles have gained much attention in the field of alopecia and hair regrowth promotion in recent years. This review summarizes the last decade of research on the microneedles delivery design for the treatment of alopecia or promotion of hair regrowth and provides a comprehensive evaluation of this field.
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Affiliation(s)
- Yanjun Zhou
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Luan Jia
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Di Zhou
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Gang Chen
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China
| | - Qiang Fu
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, PR China.
| | - Ning Li
- School of Traditional Chinese Materia Medica, Key Laboratory for TCM Material Basis Study and Innovative Drug Development of Shenyang City, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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Reversible hair loss in a patient with cicatricial alopecia: A case of regrowth associated with pioglitazone use. JAAD Case Rep 2022; 28:21-23. [PMID: 36090197 PMCID: PMC9459670 DOI: 10.1016/j.jdcr.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang EHC, Monga I, Sallee BN, Chen JC, Abdelaziz AR, Perez-Lorenzo R, Bordone LA, Christiano AM. Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways. PNAS NEXUS 2022; 1:pgac111. [PMID: 35899069 PMCID: PMC9308563 DOI: 10.1093/pnasnexus/pgac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
The primary forms of cicatricial (scarring) alopecia (PCA) are a group of inflammatory, irreversible hair loss disorders characterized by immune cell infiltrates targeting hair follicles (HFs). Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and centrifugal cicatricial alopecia (CCCA) are among the main subtypes of PCAs. The pathogenesis of the different types of PCAs are poorly understood, and current treatment regimens yield inconsistent and unsatisfactory results. We performed high-throughput RNA-sequencing on scalp biopsies of a large cohort PCA patients to develop gene expression-based signatures, trained into machine-learning-based predictive models and pathways associated with dysregulated gene expression. We performed morphological and cytokine analysis to define the immune cell populations found in PCA subtypes. We identified a common PCA gene signature that was shared between LPP, FFA, and CCCA, which revealed a significant over-representation of mast cell (MC) genes, as well as downregulation of cholesterogenic pathways and upregulation of fibrosis and immune signaling genes. Immunohistological analyses revealed an increased presence of MCs in PCAs lesions. Our gene expression analyses revealed common pathways associated with PCAs, with a strong association with MCs. The indistinguishable differences in gene expression profiles and immune cell signatures between LPP, FFA, and CCCA suggest that similar treatment regimens may be effective in treating these irreversible forms of hair loss.
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Affiliation(s)
- Eddy H C Wang
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - Isha Monga
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - Brigitte N Sallee
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - James C Chen
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - Alexa R Abdelaziz
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - Rolando Perez-Lorenzo
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
| | - Lindsey A Bordone
- Department of Dermatology, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA
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12
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Youssef A, Al-Mahdy DA, Sayed RH, Choucry MA, El-Askary H. A Comprehensive Review of Natural Alternatives for Treatment of Alopecia with an Overview of Market Products. J Med Food 2022; 25:869-881. [PMID: 35796701 DOI: 10.1089/jmf.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alopecia or hair loss is a widespread issue that has significant effects on personal well-being for both genders nationally and internationally. In addition, alopecia causes extreme emotional stress and negatively impacts the psychological health and self-esteem of cancer patients suffering from chemotherapy-induced alopecia. Unfortunately, available synthetic medications are costly, invasive, or have extreme adverse effects. On the contrary, natural and herbal hair loss products are widely available in the local and international markets in variable pharmaceutical forms with different mechanisms of action, namely, androgen antagonists, nutritional supplements, vasodilators, and 5α-reductase inhibitors or dihydrotestosterone blockers. Thus, it is of great importance to encourage researchers to investigate these natural alternatives that can act as potent therapeutic agents having diverse mechanisms of action as well as limited side effects. Currently, natural remedies are considered a fast-rising pharmaceutical segment with demand from a wide range of consumers. In this study, we present a review of reported herbal remedies and herb combinations recommended for hair loss and their mode of action, along with an overview of available market products and formulations, their composition, and declared effects. In addition, a general outline of the different forms of alopecia, its causes, and recommended treatments are mentioned as well. This was all done with the aim of assisting further studies with developing standardized natural formulations for alopecia as many were found to lack standardization of their bioactive ingredients and efficiency confirmation.
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Affiliation(s)
- Alaa Youssef
- Department of Pharmacognosy, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Dalia A Al-Mahdy
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Rabab H Sayed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mouchira A Choucry
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.,Department of Pharmacognosy, Faculty of Pharmacy and Drug Technology, Egyptian Chinese University (ECU), Cairo, Egypt
| | - Hesham El-Askary
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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13
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Watson VE, Faniel ML, Kamili NA, Krueger LD, Zhu C. Immune-mediated alopecias and their mechanobiological aspects. Cells Dev 2022; 170:203793. [PMID: 35649504 PMCID: PMC10681075 DOI: 10.1016/j.cdev.2022.203793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
Alopecia is a non-specific term for hair loss clinically diagnosed by the hair loss pattern and histological analysis of patient scalp biopsies. The immune-mediated alopecia subtypes, including alopecia areata, lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia, are common, significant forms of alopecia subtypes. For example, alopecia areata is the most common autoimmune disease with a lifetime incidence of approximately 2% of the world's population. In this perspective, we discuss major results from studies of immune-mediated alopecia subtypes. These studies suggest the key event in disease onset as the collapse in immune privilege, which alters the hair follicle microenvironment, e.g., upregulation of major histocompatibility complex molecules and increase of cytokine production, and results in immune cell infiltration, inflammatory responses, and damage of hair follicles. We note that previous studies have established that the hair follicle has a complex mechanical microenvironment, which may regulate the function of not only tissue cells but also immune cell infiltrates. This suggests a potential for mechanobiology to contribute to alopecia research by adding new methods, new approaches, and new ways of thinking, which is missing in the existing literature. To fill this a gap in the alopecia research space, we develop a mechanobiological hypothesis that alterations in the hair follicle microenvironment, specifically in the mechanically responsive tissues and cells, partially due to loss of immune privilege, may be contributors to disease pathology. We further focus our discussion on the potential for applying mechanoimmunology to the study of T cell infiltrates in the hair follicle, as they are considered primary contributors to alopecia pathology. To establish the connection between the mechanoimmunological hypothesis and immune-mediated alopecia subtypes, we discuss what is known about the role of T cells in immune-mediated alopecia subtypes, using the most extensively studied AA as our model.
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Affiliation(s)
- Valencia E Watson
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Makala L Faniel
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Loren D Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Cheng Zhu
- Wallace H. Coulter Department of Biomedical Engineering, USA; Bioengineering PhD Program, USA; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA.
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14
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Senna MM, Peterson E, Jozic I, Chéret J, Paus R. Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons. JID INNOVATIONS 2022; 2:100113. [PMID: 35521043 PMCID: PMC9062486 DOI: 10.1016/j.xjidi.2022.100113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/06/2023] Open
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary, lymphocytic cicatricial hair loss disorders. These model epithelial stem cell (SC) diseases are thought to result from a CD8+ T-cell‒dominated immune attack on the hair follicle (HF) SC niche (bulge) after the latter has lost its immune privilege (IP) for as yet unknown reasons. This induces both apoptosis and pathological epithelial‒mesenchymal transition in epithelial SCs, thus depletes the bulge, causes fibrosis, and ultimately abrogates the HFs' capacity to regenerate. In this paper, we synthesize recent progress in LPP and FFA pathobiology research, integrate our limited current understanding of the roles that genetic, hormonal, environmental, and other factors may play, and define major open questions. We propose that LPP and FFA share a common initial pathobiology, which then bifurcates into two distinct clinical phenotypes, with macrophages possibly playing a key role in phenotype determination. As particularly promising translational research avenues toward direly needed progress in the management of these disfiguring, deeply distressful cicatricial alopecia variants, we advocate to focus on the development of bulge IP and epithelial SC protectants such as, for example, topically effective, HF‒penetrating and immunoinhibitory preparations that contain tacrolimus, peroxisome proliferator-activated receptor-γ, and/or CB1 agonists.
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Key Words
- 5ARI, 5α-reductase inhibitor
- AA, alopecia areata
- AGA, androgenetic alopecia
- CRH, corticotropin-releasing hormone
- EMT, epithelial‒mesenchymal transition
- FFA, frontal fibrosing alopecia
- HF, hair follicle
- IP, immune privilege
- K, keratin
- KC, keratinocyte
- LPP, lichen planopilaris
- MAC, macrophage
- MHC, major histocompatibility complex
- PCA, primary cicatricial alopecia
- PCP, personal care product
- PPAR-γ, peroxisome proliferator–activated receptor-γ
- SC, stem cell
- SP, substance P
- eHFSC, epithelial hair follicle stem cell
- α-MSH, α-melanocyte-stimulating hormone
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Affiliation(s)
- Maryanne Makredes Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Erik Peterson
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ivan Jozic
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jérémy Chéret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,CUTANEON, Hamburg, Germany
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15
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Shahidi-Dadras M, Asadi Kani Z, Dadkhahfar S, Zartab H, Rakhshan A. The presence of mast cells in lichen planopilaris and discoid lupus erythematosus of the scalp; a quantitative study. J Cutan Pathol 2022; 49:448-453. [PMID: 35103345 DOI: 10.1111/cup.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/04/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Histopathologic differentiation of Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) as the two common causes of primary cicatricial alopecias remains challenging. METHOD We performed a histopathologic study on a case series of LPP and DLE specimens to investigate the number, distribution, and morphology of mast cells as indices for differentiation of these two entities. H & E investigation and Giemsa staining for the detection of mast cells was performed. RESULT A total of 74 cases comprising 50 cases of LPP and 24 cases of DLE, were assessed. The mean mast cell count and percentage were significantly higher in LPP group (P <0.001). Mean degranulated mast cell count and the mean intact mast cell count were also significantly higher in LPP patients (P <0.001). Most of the specimens, 58 (78.4%), showed both perifollicular and perivascular distribution of mast cells without significant diffrence between two groups. The morphology of mast cells was predominantly round-oval in 85.5%, predominantly fusiform in 13.5% with more frequent fusiform morphology in DLE group. CONCLUSION The mast cell count detected by Giemsa staining could assist pathologists in distinguishing between LPP and DLE. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Zahra Asadi Kani
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran
| | - Hamed Zartab
- Center for Research & Training in Skin Diseases & Leprosy, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azadeh Rakhshan
- Skin research center, Shahid Beheshti university of medical sciences, Tehran, Iran.,Department of pathology, Shohada-e-Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Vikhe Patil K, Mak KHM, Genander M. A Hairy Cituation - PADIs in Regeneration and Alopecia. Front Cell Dev Biol 2021; 9:789676. [PMID: 34966743 PMCID: PMC8710808 DOI: 10.3389/fcell.2021.789676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 02/04/2023] Open
Abstract
In this Review article, we focus on delineating the expression and function of Peptidyl Arginine Delminases (PADIs) in the hair follicle stem cell lineage and in inflammatory alopecia. We outline our current understanding of cellular processes influenced by protein citrullination, the PADI mediated posttranslational enzymatic conversion of arginine to citrulline, by exploring citrullinomes from normal and inflamed tissues. Drawing from other stem cell lineages, we detail the potential function of PADIs and specific citrullinated protein residues in hair follicle stem cell activation, lineage specification and differentiation. We highlight PADI3 as a mediator of hair shaft differentiation and display why mutations in PADI3 are linked to human alopecia. Furthermore, we propose mechanisms of PADI4 dependent fine-tuning of the hair follicle lineage progression. Finally, we discuss citrullination in the context of inflammatory alopecia. We present how infiltrating neutrophils establish a citrullination-driven self-perpetuating proinflammatory circuitry resulting in T-cell recruitment and activation contributing to hair follicle degeneration. In summary, we aim to provide a comprehensive perspective on how citrullination modulates hair follicle regeneration and contributes to inflammatory alopecia.
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Affiliation(s)
- Kim Vikhe Patil
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Kylie Hin-Man Mak
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Genander
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
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17
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Uchiyama M. Primary cicatricial alopecia: Recent advances in evaluation and diagnosis based on trichoscopic and histopathological observation, including overlapping and specific features. J Dermatol 2021; 49:37-54. [PMID: 34866229 DOI: 10.1111/1346-8138.16252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022]
Abstract
Primary cicatricial alopecia (PCA) is a form of alopecia in which inflammatory cells target follicles, including the bulge region containing follicular stem cells, leading to permanent alopecia. New classifications of PCA subtypes have recently been proposed, including those that account for novel trichoscopic and histopathological features of PCA, enabling greater precision in the evaluation and diagnosis of this condition. Nonetheless, diagnosis remains challenging clinically and histopathologically because the etiology of PCA is multifactorial. Inconsistent use of terminology, overlapping disease concepts, and changes in the clinical or histopathological severity of inflammation in the disease course in the same patient also make diagnosis quite challenging. The present study comprehensively reviews recent progress in diagnostic techniques, including the use of clinical, trichoscopic, and histopathological features, in evaluating each PCA subtype, containing overlapping and specific features. Elucidating the features of PCA, including those that are common to multiple subtypes as well as specific to each in both early and advanced-stage lesions, is important for accurate diagnosis. Improving the evaluation and treatment of this disease depends on having a broader clinical understanding that takes into account not only the features of the disease at a given point in time, but also the changes that occur during the entire disease course.
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Affiliation(s)
- Masaki Uchiyama
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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18
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Moattari CR, Jafferany M. Psychological Aspects of Hair Disorders: Consideration for Dermatologists, Cosmetologists, Aesthetic, and Plastic Surgeons. Skin Appendage Disord 2021; 8:186-194. [PMID: 35707291 PMCID: PMC9149398 DOI: 10.1159/000519817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022] Open
Abstract
Hair loss disorders may cause considerable distress to patients. Although many do not pose a significant medical risk, the sociocultural importance of hair is substantial. Often the extent of hair loss does not correlate to the impact on psychosocial function, thus necessitating an individualized approach. Hair loss disorders are interrelated with mental health and at times exert significant psychological percussions, and therefore, providers should address both medical and psychological aspects of treatment. This review contains a discussion of the impact on quality of life of common hair loss disorders and the psychological approaches that providers may utilize to improve care. The incorporation of psychodermatology and psychotrichology in dermatology and psychiatry residency programs is of vital importance. Dermatology and psychiatry liaison clinics may prove useful in the treatment of these patients.
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Affiliation(s)
- Cameron R. Moattari
- College of Medicine, State University of New York Downstate Health Sciences University, New York City, New York, USA
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
- *Mohammad Jafferany,
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19
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Shahidi Dadras M, Rakhshan A, Dadkhahfar S, Barat T. The role of interleukin-17 (IL-17) in the pathogenesis of discoid lupus erythematosus and lichen planopilaris: is immunohistochemistry for IL-17 a promising way to differentiate these entities? Int J Dermatol 2021; 61:647-652. [PMID: 34530493 DOI: 10.1111/ijd.15885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/27/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Interleukin-17 (IL-17) is a pro-inflammatory mediator which its excess secretion by immune cells is found in many chronic autoimmune diseases. This survey is aimed to compare the amount and pattern of distribution of IL-17 positive cells in lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) which are of the most frequent causes of primary cicatricial alopecia (CA). METHODS Biopsies of lesional scalp skin from adult LPP (n = 30), DLE patients (n = 19), and control scalp skin (n = 18) were analyzed by immunohistochemistry (IHC) method using rabbit polyclonal antibody against IL-17. Cells stained positive for IL-17 and their pattern of distribution were assessed and compared between these groups. RESULTS The mean of IL-17 positive cell counts per high power field (HPF) in both LPP and DLE groups was significantly higher in comparison with the control group (both p < .0001). The LPP group had higher values of IL-17 positive cell counts per HPF (47.56 ± 13.37) compared to the DLE group (22.21 ± 11.06) (p < .0001). More than 30 IL-17 positive cell counts in IHC have a sensitivity of 90% and a specificity of 78% for differentiating LPP from DLE. CONCLUSIONS Our findings suggest that IL-17 is effective in the pathogenesis of DLE and LPP and its role is more prominent in LPP. IL-17 positive cells in IHC can distinguish DLE from LPP with satisfactory sensitivity and specificity.
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Affiliation(s)
| | - Azadeh Rakhshan
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of pathology, Shohada-e-Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tara Barat
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Svigos K, Yin L, Fried L, Lo Sicco K, Shapiro J. A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris. Am J Clin Dermatol 2021; 22:681-692. [PMID: 34347282 DOI: 10.1007/s40257-021-00630-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts.
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Affiliation(s)
- Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lu Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren Fried
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.
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21
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Abstract
Alopecia is a dermatologic condition in which sudden or gradual loss of hair occurs on 1 or more areas of the body, most commonly the scalp. Hair loss can be acute or chronic in nature as a result of underlying inflammation, autoimmune processes, stressors, chemotherapy, or hairstyling practices. Alopecia can have substantial psychological consequences, having a negative impact on the quality of life in affected patients. The ability to both recognize and distinguish these condition holds great significance not only in providing adequate and timely treatment to improve outcomes but also meeting patient needs.
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Affiliation(s)
- Taylor A Jamerson
- University of Michigan Medical School, 1050 Wall Street, Apartment 2D, Ann Arbor, MI 48105, USA
| | - Crystal Aguh
- Department of Dermatology, Johns Hopkins University School of Medicine, 10710 Charter Drive, Shared Suite 420, Baltimore, MD 21044, USA.
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22
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A Cell Membrane-Level Approach to Cicatricial Alopecia Management: Is Caveolin-1 a Viable Therapeutic Target in Frontal Fibrosing Alopecia? Biomedicines 2021; 9:biomedicines9050572. [PMID: 34069454 PMCID: PMC8159142 DOI: 10.3390/biomedicines9050572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Irreversible destruction of the hair follicle (HF) in primary cicatricial alopecia and its most common variant, frontal fibrosing alopecia (FFA), results from apoptosis and pathological epithelial-mesenchymal transition (EMT) of epithelial HF stem cells (eHFSCs), in conjunction with the collapse of bulge immune privilege (IP) and interferon-gamma-mediated chronic inflammation. The scaffolding protein caveolin-1 (Cav1) is a key component of specialized cell membrane microdomains (caveolae) that regulates multiple signaling events, and even though Cav1 is most prominently expressed in the bulge area of human scalp HFs, it has not been investigated in any cicatricial alopecia context. Interestingly, in mice, Cav1 is involved in the regulation of (1) key HF IP guardians (TGF-β and α-MSH signaling), (2) IP collapse inducers/markers (IFNγ, substance P and MICA), and (3) EMT. Therefore, we hypothesize that Cav1 may be an unrecognized, important player in the pathobiology of cicatricial alopecias, and particularly, in FFA, which is currently considered as the most common type of primary lymphocytic scarring alopecia in the world. We envision that localized therapeutic inhibition of Cav1 in management of FFA (by cholesterol depleting agents, i.e., cyclodextrins/statins), could inhibit and potentially reverse bulge IP collapse and pathological EMT. Moreover, manipulation of HF Cav1 expression/localization would not only be relevant for management of cicatricial alopecia, but FFA could also serve as a model disease for elucidating the role of Cav1 in other stem cell- and/or IP collapse-related pathologies.
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23
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Lawson CN, Bakayoko A, Callender VD. Central Centrifugal Cicatricial Alopecia: Challenges and Treatments. Dermatol Clin 2021; 39:389-405. [PMID: 34053593 DOI: 10.1016/j.det.2021.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia diagnosed in women of African descent. Although the etiology was originally attributed exclusively to hairstyling practices common among women of African descent, more recent research on CCCA supports the concept that there are several contributing factors, including variants in gene expression, hair grooming practices that increase fragility on the hair follicle, and associations with other systemic conditions. Treatment of CCCA involves a combination of patient counseling and education on alternative hairstyles, medical therapies, and procedural methods when necessary.
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Affiliation(s)
- Christina N Lawson
- Dermatology Associates of Lancaster, 1650 Crooked Oak Drive, Suite 200, Lancaster, PA 17601, USA.
| | - Awa Bakayoko
- Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Valerie D Callender
- Callender Dermatology and Cosmetic Center, 12200 Annapolis Road, Suite 315, Glenn Dale, MD 20769, USA
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24
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Cardoso CO, Tolentino S, Gratieri T, Cunha-Filho M, Lopez RFV, Gelfuso GM. Topical Treatment for Scarring and Non-Scarring Alopecia: An Overview of the Current Evidence. Clin Cosmet Investig Dermatol 2021; 14:485-499. [PMID: 34012282 PMCID: PMC8126704 DOI: 10.2147/ccid.s284435] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/25/2021] [Indexed: 12/22/2022]
Abstract
Alopecia is a clinical condition related to hair loss that can significantly affect both male and female adults' quality of life. Despite the high market demand, only few drugs are currently approved for alopecia treatment. Topical formulations still bring drawbacks, such as scalp irritation with frequent use, and low drug absorption to the site of action, which limits the efficacy. The most recent research points out that different formulation technology could circumvent the aforementioned flaws. Such technology includes incorporation of drugs in rigid or deformable nanoparticles, strategies involving physical, energetical and mechanical techniques, such as iontophoresis, sonophoresis, microneedling, and the use of solid effervescent granules to be hydrated at the moment of application in the scalp. In this paper, the progress of current research on topical formulations dedicated to the treatment of alopecia is reviewed and discussed.
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Affiliation(s)
- Camila O Cardoso
- Laboratory of Food, Drugs, and Cosmetics (LTMAC), University of Brasilia, Brasília, 70910-900, DF, Brazil
| | - Seila Tolentino
- Laboratory of Food, Drugs, and Cosmetics (LTMAC), University of Brasilia, Brasília, 70910-900, DF, Brazil
| | - Tais Gratieri
- Laboratory of Food, Drugs, and Cosmetics (LTMAC), University of Brasilia, Brasília, 70910-900, DF, Brazil
| | - Marcilio Cunha-Filho
- Laboratory of Food, Drugs, and Cosmetics (LTMAC), University of Brasilia, Brasília, 70910-900, DF, Brazil
| | - Renata F V Lopez
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14040-903, SP, Brazil
| | - Guilherme M Gelfuso
- Laboratory of Food, Drugs, and Cosmetics (LTMAC), University of Brasilia, Brasília, 70910-900, DF, Brazil
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25
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Dominguez-Santas M, Fernandez-Nieto D, Diaz-Guimaraens B, Suarez-Valle A, Jimenez-Cauhe J, Saceda-Corralo D. Avelumab-induced lichen planopilaris, a novel association. Int J Dermatol 2021; 60:e414-e416. [PMID: 33826153 DOI: 10.1111/ijd.15595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Ana Suarez-Valle
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Juan Jimenez-Cauhe
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
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26
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Desai K, Miteva M. Recent Insight on the Management of Lupus Erythematosus Alopecia. Clin Cosmet Investig Dermatol 2021; 14:333-347. [PMID: 33833540 PMCID: PMC8020452 DOI: 10.2147/ccid.s269288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/13/2021] [Indexed: 12/25/2022]
Abstract
Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.
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Affiliation(s)
- Karishma Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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27
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Mikiel D, Polańska A, Żaba R, Adamski Z, Dańczak-Pazdrowska A. Suitability of high-frequency ultrasonography (20 MHz) in evaluation of various forms of primary cicatricial alopecia in relation to trichoscopy - pilot study. Skin Res Technol 2021; 27:774-784. [PMID: 33751668 DOI: 10.1111/srt.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary cicatricial alopecia is a potentially irreversible process of hair loss, in which for proper diagnosis a skin biopsy is necessary. Searching for new, non-invasive diagnostic methods may shorten the time for final diagnosis, initiating appropriate treatment and reduce the need for biopsy. The aim of this study was to evaluate the usefulness of high-frequency ultrasonography (HF-USG) as a diagnostic method in patients with primary scarring alopecia and to compare it with trichoscopy. MATERIALS AND METHODS The study covered a total of 44 adults: 8 with classic lichen planopilaris (LPP), 11 with discoid lupus erythematosus (DLE), 14 with frontal fibrosing alopecia (FFA), and 11 healthy volunteers. Each patient underwent physical and trichoscopic examination which was the base for qualification for active/inactive stage of the disease. Then, HF-USG was performed using a probe with a frequency of 20 MHz. In HF-USG images, the following elements were evaluated and measured: entrance echo (EE), follicular structures (FS), dermal background (DB), and dermal/subdermal border (D/SB). RESULTS Inactive phase was characterized by significantly lower number/lack of FS compared to the active phase of scarring alopecia. HF-USG of active LPP/FFA presented cigar-like shaped FS, while inactive stage pronounced D/SB forming saw-like pattern. Active DLE in HF-USG were associated with focal, doubled EE and widened FS with a tendency to create hypoechogenic wide, structureless bands within the skin. In inactive DLE, there was no specific pattern of D/SB or rarely puzzle-like pattern. CONCLUSION HF-USG images differ depending on the phase of the disease and the type of scarring alopecia, similarly to trichoscopic examination.
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Affiliation(s)
- Dominik Mikiel
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Skin Diseases, Provincial Hospital in Poznan, Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Verzì AE, Lacarrubba F, Dall'Oglio F, Micali G. Association of Frontal Fibrosing Alopecia with Facial Papules and Lichen Planus Pigmentosus in a Caucasian Woman. Skin Appendage Disord 2020; 6:379-383. [PMID: 33313056 DOI: 10.1159/000509407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Frontal fibrosing alopecia (FFA) is a lymphocytic primary cicatricial alopecia typically involving the frontotemporal hairline. It may be associated with the presence of facial papules (FP) that clinically appear as noninflammatory, monomorphic, white-yellowish papules. Lichen planus pigmentosus (LPPigm) is characterized by the presence of asymptomatic grayish pigmented macules, predominantly in sun-exposed and flexural areas. Case Report A 58-year-old, Caucasian, phototype III woman presented with a symmetrical, band-like, frontotemporal alopecia with regression of the hairline; bilateral eyebrow loss; diffuse, symmetrical hyperpigmentation of the face; and some asymptomatic, flesh-colored, monomorphic papules on the chin. Based on clinical, dermoscopic, and histological findings, the diagnosis of FFA associated with FP and LPPigm was established. Discussion/Conclusion The peculiarity of our report is represented by the triple association of FFA, FP, and LPPigm in a Caucasian skin type III woman, as it has been rarely reported. Clinicians should be aware of this association also in subjects with phototype ≤III, as its recognition may be useful for diagnostic and prognostic purposes: the observation of LPPigm of the face may suggest to check for early FFA, and in case of FFA associated with FP, a poorer FFA prognosis may likely be expected.
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Kurzeja M, Czuwara J, Walecka I, Olszewska M, Rudnicka L. Features of classic lichen planopilaris and frontal fibrosing alopecia in reflectance confocal microscopy: A preliminary study. Skin Res Technol 2020; 27:266-271. [PMID: 32743819 DOI: 10.1111/srt.12940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Classic lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary lymphocytic cicatricial alopecia. In patients with ambiguous clinical presentation, reflectance confocal microscopy (RCM) a new noninvasive skin imaging technique, could be a helpful diagnostic tool. The aim of our study was to describe the characteristic features of classic LPP and FFA using RCM. MATERIALS AND METHODS Ten patients with classic lichen planopilaris and two with frontal fibrosing alopecia were examined with RCM. RESULTS Lichenoid inflammatory infiltrate around the hair follicle was observed in three cases of classic LPP and FFA (3/12; 25.0%). Extensive perifollicular fibrosis was seen in nine patients (9/12; 75.0%) with classic LPP and FFA. An increased number of white, ill-defined, coarse dermal fibers at the level of the superficial dermis were visible in seven cases (7/12; 58.3%). Moreover, dilated blood vessels were present in seven patients with classic LPP and FFA (7/12; 58.3%). CONCLUSION Summing up, reflectance confocal microscopy allows to visualize major key diagnostic features of classic lichen planopilaris and frontal fibrosing alopecia in the real time. The value of RCM examination in scarring alopecia needs to be further evaluated, but it appears to be a useful adjuvant tool for the initial diagnosis of classic LPP and FFA.
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Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology Centre of Postgraduate Medical Education/CSK MSWIA, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Larkin SC, Cantwell HM, Imhof RL, Torgerson RR, Tolkachjov SN. Lichen Planopilaris in Women: A Retrospective Review of 232 Women Seen at Mayo Clinic From 1992 to 2016. Mayo Clin Proc 2020; 95:1684-1695. [PMID: 32753140 DOI: 10.1016/j.mayocp.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the clinicopathologic findings, comorbidities, and treatment outcomes of women with lichen planopilaris (LPP). METHOD In this retrospective review of women with LPP at Mayo Clinic from 1992 to 2016, we searched for scarring alopecia in all female patients aged 1 to 100 years from January 1, 1992, through December 31, 2016. Men were excluded from this study to more accurately determine the association of hormonal factors in LPP pathogenesis. Two hundred thirty-two patients were included as they met diagnostic criteria for LPP based on clinicopathologic correlation, with 217 having confirmatory biopsies. RESULTS We identified 232 women with LPP (mean age, 59.8 years). Of those, 92.7% (215) presented with hair loss; 23.7% (55) had preceding inflammation; 30.6% (71) had thyroid disease, including hypothyroidism (23.2%; 54); and 9.4% (22) had vitamin D deficiency. Incidence of depression and anxiety was 45.7% (106) and 41.8% (97), respectively. History of total abdominal hysterectomy/bilateral salpingo-oophorectomies and hormone replacement therapy was found in 16.8% (39) and 16.4% (38), respectively. Lichen planus at other body sites occurred in 16.4% (38) of patients; and 53.2% (123) had slowing of disease progression or disease stabilization, often requiring combination therapies. In those who achieved slowing or stabilization of disease, mean time to recurrence was 1.8 year. The mean time to remission was 1.1 year. CONCLUSION The typical LPP patient is a 60-year-old female with vertex scarring alopecia who presents with burning, erythema, inflammation, and scale. Almost half of patients will have comorbid autoimmunity. As previously reported, LPP is associated with thyroid disease. We also found higher rates of depression, anxiety, nutritional deficiencies, and skin cancer than reported in the general population.
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Affiliation(s)
| | | | - Reese L Imhof
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN
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31
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Del Duca E, Ruano Ruiz J, Pavel AB, Sanyal RD, Song T, Gay-Mimbrera J, Zhang N, Estrada YD, Peng X, Renert-Yuval Y, Phelps RG, Paus R, Krueger JG, Guttman-Yassky E. Frontal fibrosing alopecia shows robust T helper 1 and Janus kinase 3 skewing. Br J Dermatol 2020; 183:1083-1093. [PMID: 32215911 DOI: 10.1111/bjd.19040] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia with unclear pathogenesis and a progressive course. The disease has a major impact on patients' quality of life and there is a lack of effective treatment to halt disease progression. METHODS We profiled lesional and nonlesional scalp biopsies collected in 2017 from patients with FFA (n = 12) compared with scalp biopsies from patients with alopecia areata (AA) (n = 8) and controls (n = 8) to evaluate gene and protein expression, including the primary outcome (CXCL9). We determined significant differences between biomarkers using a two-sided Student's t-test adjusting P-values by false discovery rate. RESULTS Significant increases were seen in CD8+ cytotoxic T cells, CD11c+ dendritic cells, CD103+ and CD69+ tissue-resident memory T cells in FFA and AA vs. control scalp (P < 0·05), with corresponding significantly upregulated granzyme B mRNA, particularly in FFA (P < 0·01). In AA, cellular infiltrates were primarily concentrated at the bulb, while in FFA these were mainly localized at the bulge. FFA demonstrated significant upregulation of T helper 1/intereferon (IFN) (IFN-γ, CXCL9/CXCL10), the Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway (STAT1, JAK3) and fibrosis-related products (vimentin, fibronectin; P < 0·05), with no concomitant downregulation of hair keratins and the T-regulatory marker, forkhead box P3, which were decreased in AA. The stem cell markers CD200 and K15 demonstrated significantly reduced expression only in FFA (P < 0·05). CONCLUSIONS These data suggest that follicular damage and loss of stem cells in FFA may be mediated through immune attack in the bulge region, with secondary fibrosis and reduced but still detectable stem cells. JAK/STAT-targeting treatments may be able to prevent permanent follicular destruction and fibrosis in early disease stages.
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Affiliation(s)
- E Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - J Ruano Ruiz
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - A B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R D Sanyal
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Song
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Gay-Mimbrera
- Department of Dermatology, University of Córdoba, Córdoba, Spain.,Immune-Mediated Inflammatory Skin Diseases Research Group, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - N Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - X Peng
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - R G Phelps
- Department of Pathology, Division of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Paus
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - E Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Aslani FS, Sepaskhah M, Bagheri Z, Akbarzadeh-Jahromi M. Value of CD123 Immunohistochemistry and Elastic Staining in Differentiating Discoid Lupus Erythematosus from Lichen Planopilaris. Int J Trichology 2020; 12:62-67. [PMID: 32684677 PMCID: PMC7362963 DOI: 10.4103/ijt.ijt_32_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. Patients and Methods: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. Results: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). Conclusion: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.
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Affiliation(s)
- Fatemeh Sari Aslani
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Sepaskhah
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh-Jahromi
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Randolph MJ, Salhi WA, Tosti A. Lichen Planopilaris and Low-Level Light Therapy: Four Case Reports and Review of the Literature About Low-Level Light Therapy and Lichenoid Dermatosis. Dermatol Ther (Heidelb) 2020; 10:311-319. [PMID: 32060796 PMCID: PMC7090134 DOI: 10.1007/s13555-020-00359-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.
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Affiliation(s)
| | - Waleed Al Salhi
- Department of Dermatology, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA.
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34
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Gambichler T, Kronenberg C. Unusual hair loss pattern in Graham-Little syndrome coexistent with palmoplantar pustular psoriasis. J Dermatol 2020; 47:e116-e117. [PMID: 32056288 DOI: 10.1111/1346-8138.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Harries M, Hardman J, Chaudhry I, Poblet E, Paus R. Profiling the human hair follicle immune system in lichen planopilaris and frontal fibrosing alopecia: can macrophage polarization differentiate these two conditions microscopically? Br J Dermatol 2020; 183:537-547. [PMID: 31883384 DOI: 10.1111/bjd.18854] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is traditionally regarded as a variant of lichen planopilaris (LPP) based on histological features. Distinct clinical presentation, demographics and epidemiology suggest that differing pathogenic factors determine the final phenotype. OBJECTIVES To map the hair follicle immune system in LPP and FFA by systematically comparing key inflammatory markers in defined hair follicle compartments. METHODS Lesional scalp biopsies from LPP and FFA and healthy controls were stained with the following immunohistochemical markers: CD1a and CD209, CD4, CD8, CD56, CD68, CD123, CXCR3, forkhead box (FOX)P3, mast cell tryptase and cKit. Macrophage polarization was explored using CD206, CD163, CD86, receptor for advanced glycation end products (RAGE), interleukin (IL)-4 and IL-13 on paired lesional and nonlesional LPP and FFA samples. RESULTS Increased numbers of CD8+ , CXCR3+ and FOXP3+ T cells and CD68+ macrophages were identified in the distal hair follicle epithelium and perifollicular mesenchyme in both LPP and FFA compared with controls. In both LPP and FFA, total and degranulated mast cells and CD123+ plasmacytoid dendritic cells were increased in the perifollicular mesenchyme adjacent to the bulge and infundibulum, whereas numbers of CD1a+ and CD209+ dendritic cells were significantly reduced in the infundibulum connective tissue sheath. However, only with CD68 staining was a significant difference between LPP and FFA identified, with greater numbers of CD68+ cells in LPP samples. Furthermore, the identified macrophage polarization markers downregulated CD86 and upregulated CD163 and IL-4 expression in lesional LPP compared with FFA samples. CONCLUSIONS This comparative immunopathological analysis is the first to profile systematically the hair follicle immune system in LPP and FFA. Our analysis highlights a potential role of macrophages in disease pathobiology and suggests that macrophage polarization may differ between LPP and FFA, allowing microscopic differentiation. Linked Comment: Kinoshita-Ise. Br J Dermatol 2020; 183:419-420.
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Affiliation(s)
- M Harries
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester, U.K.,Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - J Hardman
- Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - I Chaudhry
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, U.K
| | - E Poblet
- Department of Pathology, University General Hospital of Murcia, Murcia, Spain
| | - R Paus
- Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, U.S.A
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36
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Chéret J, Piccini I, Hardman-Smart J, Ghatak S, Alam M, Lehmann J, Jimenez F, Erdmann H, Poblet E, Botchkareva N, Paus R, Bertolini M. Preclinical evidence that the PPARγ modulator, N-Acetyl-GED-0507-34-Levo, may protect human hair follicle epithelial stem cells against lichen planopilaris-associated damage. J Eur Acad Dermatol Venereol 2020; 34:e195-e197. [PMID: 31774585 PMCID: PMC7154684 DOI: 10.1111/jdv.16114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J Chéret
- Monasterium Laboratory GmbH, Münster, Germany.,Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - I Piccini
- Monasterium Laboratory GmbH, Münster, Germany
| | - J Hardman-Smart
- Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, UK
| | - S Ghatak
- Monasterium Laboratory GmbH, Münster, Germany
| | - M Alam
- Monasterium Laboratory GmbH, Münster, Germany.,Mediteknia Skin & Hair Lab, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - J Lehmann
- Monasterium Laboratory GmbH, Münster, Germany
| | - F Jimenez
- Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Mediteknia Dermatology Clinic, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | | | - E Poblet
- Department of Pathology, University General Hospital of Murcia, Murcia, Spain
| | | | - R Paus
- Monasterium Laboratory GmbH, Münster, Germany.,Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, and NIHR Biomedical Research Centre, Manchester, UK
| | - M Bertolini
- Monasterium Laboratory GmbH, Münster, Germany
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Batra P, Sukhdeo K, Shapiro J. Hair Loss in Lichen Planopilaris and Frontal Fibrosing Alopecia: Not Always Irreversible. Skin Appendage Disord 2020; 6:125-129. [PMID: 32258058 DOI: 10.1159/000505439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction We present 2 cases in which typically irreversible lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) showed signs of reversal. Case Presentation A 27-year-old Caucasian man presented with hair loss and intense pruritus on the vertex scalp for 4 years with biopsy-proven LPP and having failed multiple pharmacologic modalities. Six months after adding oral tofacitinib and later dapsone, he demonstrated reduced scalp visibility, evidence of crown and vertex hair regrowth, and elimination of itch. A 45-year-old premenopausal Hispanic woman presented with eyebrow loss for 3.75 years and hair loss for 9 months with biopsy-proven FFA. After beginning oral finasteride and hydroxychloroquine, triamcinolone injections, and topical minoxidil, she initially worsened over 11 months but subsequently improved over 6 months, demonstrating hair and eyebrow regrowth, reduction in glabella-hairline distance, and new absence of frontal hair line hyperkeratosis and inflammation. Discussion/Conclusion Cicatricial alopecia involves inflammation with JAK-STAT upregulation. We report a positive clinical response in LPP to tofacitinib, a JAK1/3 inhibitor, and dapsone, an anti-neutrophilic agent. FFA is believed to involve autoimmune and/or hormonal processes. Here we report a positive clinical response to androgenic and immune modulators.
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Affiliation(s)
- Prag Batra
- Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Kumar Sukhdeo
- Department of Dermatology, New York University School of Medicine, New York, New York, USA.,Pilaris Dermatology, New York, New York, USA
| | - Jerry Shapiro
- Department of Dermatology, New York University School of Medicine, New York, New York, USA
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Experimentally Induced Epithelial-Mesenchymal Transition of Human Hair Follicle Stem Cells as a Model of Scarring Alopecia Ex Vivo. Methods Mol Biol 2020; 2154:143-152. [PMID: 32314214 DOI: 10.1007/978-1-0716-0648-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Primary cicatricial alopecia is characterized by a permanent "scarring" alopecia. This condition is characterized by the irreversible loss of hair follicles (HF) as a result of apoptosis and epithelial-mesenchymal transition (EMT) of epithelial stem cells localized in the HF bulge.We here report the procedure for experimentally induced EMT in healthy human epidermal stem cells (eSCs) using full-length HF organ culture ex vivo. The present model can be used to recapitulate the complex processes observed in scarring alopecia patient tissues, to further investigate the mechanisms involved in EMT transformation of HFeSCs, and to test substances that could prevent and/or rescue HFeSCs from EMT for the management of scarring alopecias.
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39
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Okwundu N, Ekpo F, Ghafferi J, Fivenson D. Uncommon presentation of lichen planopilaris during paclitaxel chemotherapy: Case report. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_44_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raffi J, Suresh R, Agbai O. Clinical recognition and management of alopecia in women of color,. Int J Womens Dermatol 2019; 5:314-319. [PMID: 31909150 PMCID: PMC6938875 DOI: 10.1016/j.ijwd.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/24/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022] Open
Abstract
Certain types of alopecia, such as traction alopecia, discoid lupus erythematosus, and central centrifugal cicatricial alopecia, occur more commonly in African-American individuals than in those of other ethnicities. Both intrinsic hair qualities and hair care practices play a role. Lower baseline tensile strength, hair density, and growth rates, as well as the use of high-tension hairstyles and chemical relaxers may contribute to alopecia in this group. Alopecia can also occur as a result of discoid lupus erythematosus, which involves chronic lymphocytic infiltration and eventual scarring of the hair follicle. Lichen planopilaris is a less common cause of scarring alopecia that can appear clinically similar to other forms of cicatricial alopecia. Lastly, although not classically associated with hair loss, recent evidence indicates that seborrheic dermatitis may play a role in shedding and alopecia. Recognizing and differentiating these alopecic subtypes clinically and histopathologically is important for prompt diagnosis and treatment. This article is based on a chapter in Ethnic Skin and Hair, and intended as a supplemental article to “Current and Emerging Treatment Strategies for Hair Loss in Women of Color.”
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Affiliation(s)
- Jodie Raffi
- University of California, Irvine School of Medicine, Irvine, CA, United States
- University of California, San Francisco Department of Dermatology, San Francisco, CA, United States
- Corresponding author at: University of California, Irvine School of Medicine, Irvine, CA, United States.
| | - Raagini Suresh
- University of California, San Francisco Department of Dermatology, San Francisco, CA, United States
| | - Oma Agbai
- University of California, Davis Department of Dermatology, Sacramento, CA, United States
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Jordan CS, Chapman C, Kolivras A, Roberts JL, Thompson NB, Thompson CT. Clinicopathologic and immunophenotypic characterization of lichen planopilaris and central centrifugal cicatricial alopecia: A comparative study of 51 cases. J Cutan Pathol 2019; 47:128-134. [PMID: 31605498 DOI: 10.1111/cup.13592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 08/12/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of the study was to compare the histopathologic and immunophenotypic features of central centrifugal cicatricial alopecia (CCCA) and lichen planopilaris (LPP) to better characterize and differentiate these two clinical entities. CCCA remains an ill-defined and still-unsettled histologic entity and many hair loss experts regard CCCA to be histologically indistinguishable from LPP. Given the overlapping histologic features of these two lymphocyte-predominant cicatricial alopecias, and the lack of consensus regarding the significance of proposed distinctions, dermatopathologists face difficulty in providing clinicians and patients certainty with a definitive diagnosis of CCCA vs LPP. METHODS We performed a retrospective review of 51 scalp biopsies of patients with either the clinical diagnosis of CCCA (27 cases) or LPP (24 cases). Clinical information, histologic features of hematoxylin-eosin-stained sections, and a panel of immunohistochemical markers were evaluated on scalp biopsies. Tested parameters were quantified, and statistical analysis was performed. RESULTS Our study found no differences on either histologic assessment or immunophenotypic characterization between cases of classic LPP and CCCA. CONCLUSION The conclusion of this study is that the inflammatory infiltrates in CCCA and LPP are not only histologically similar but also immunophenotypically indistinguishable.
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Affiliation(s)
| | | | | | | | | | - Curtis T Thompson
- Department of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon.,CTA Lab, Tigard, Oregon
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Cheng JB, Sedgewick AJ, Finnegan AI, Harirchian P, Lee J, Kwon S, Fassett MS, Golovato J, Gray M, Ghadially R, Liao W, Perez White BE, Mauro TM, Mully T, Kim EA, Sbitany H, Neuhaus IM, Grekin RC, Yu SS, Gray JW, Purdom E, Paus R, Vaske CJ, Benz SC, Song JS, Cho RJ. Transcriptional Programming of Normal and Inflamed Human Epidermis at Single-Cell Resolution. Cell Rep 2019; 25:871-883. [PMID: 30355494 PMCID: PMC6367716 DOI: 10.1016/j.celrep.2018.09.006] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022] Open
Abstract
Perturbations in the transcriptional programs specifying epidermal differentiation cause diverse skin pathologies ranging from impaired barrier function to inflammatory skin disease. However, the global scope and organization of this complex cellular program remain undefined. Here we report single-cell RNA sequencing profiles of 92,889 human epidermal cells from 9 normal and 3 inflamed skin samples. Transcriptomics-derived keratinocyte subpopulations reflect classic epidermal strata but also sharply compartmentalize epithelial functions such as cell-cell communication, inflammation, and WNT pathway modulation. In keratinocytes, ~12% of assessed transcript expression varies in coordinate patterns, revealing undescribed gene expression programs governing epidermal homeostasis. We also identify molecular fingerprints of inflammatory skin states, including S100 activation in the interfollicular epidermis of normal scalp, enrichment of a CD1C+CD301A+ myeloid dendritic cell population in psoriatic epidermis, and IL1βhiCCL3hiCD14+ monocyte-derived macrophages enriched in foreskin. This compendium of RNA profiles provides a critical step toward elucidating epidermal diseases of development, differentiation, and inflammation. Cheng et al. report single-cell RNA sequencing of normal and inflamed human epidermis, revealing a discrete set of specialized keratinocytes that exhibit a distinct composition at different anatomic sites. Myeloid dendritic cells and macrophages also vary sharply with epidermal anatomic site and inflammation, indicating dynamic programming of antigen-presenting cells.
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Affiliation(s)
- Jeffrey B Cheng
- Department of Dermatology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Alex I Finnegan
- Department of Physics, Carl R. Woese Institute of Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Paymann Harirchian
- Department of Dermatology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jerry Lee
- Department of Dermatology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Sunjong Kwon
- Department of Biomedical Engineering, OHSU Center for Spatial Systems Biomedicine, Portland, OR, USA
| | - Marlys S Fassett
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Ruby Ghadially
- Department of Dermatology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Bethany E Perez White
- Department of Dermatology and Skin Tissue Engineering Core, Northwestern University, Chicago, IL, USA
| | - Theodora M Mauro
- Department of Dermatology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thaddeus Mully
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Esther A Kim
- Department of Plastic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Hani Sbitany
- Department of Plastic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Isaac M Neuhaus
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Roy C Grekin
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Siegrid S Yu
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Joe W Gray
- Department of Biomedical Engineering, OHSU Center for Spatial Systems Biomedicine, Portland, OR, USA
| | - Elizabeth Purdom
- Department of Statistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ralf Paus
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK; Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Jun S Song
- Department of Physics, Carl R. Woese Institute of Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Raymond J Cho
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.
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Whittle C, Castro A, Larrondo J. Images in Scalp Ultrasound Before and After Hair Transplant in Frontal Fibrosing Alopecia. Ultrasound Q 2019; 37:87-89. [PMID: 31725066 DOI: 10.1097/ruq.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Primary cicatricial alopecias are inflammatory scalp conditions that may lead to permanent hair loss and severe alopecia. Frontal fibrosing alopecia is one of the most frequent etiologies of primary cicatricial alopecias. Hair transplant could be a therapeutic option.High-resolution ultrasound (US) is an imaging technique useful for evaluating scalp with adequate differentiation of the skin layers. Also, hair follicles are visualized.The objectives are present presurgical and posttransplant scalp US studies on hair transplant.Frontal fibrosing alopecia is a chronic entity that can progress to extensive irreversible alopecia. Hair transplant is a surgical option. On US, the hair follicles are visualized as thin hypoechoic lines. With Doppler color imaging, it is possible to evaluate vascularization. In this experience, we can observe the follicles of the compromised area before and after the hair transplant and the depth of the implanted follicles.In conclusion, US impresses as a promissory technique for the imaging of hair transplant. More experience is necessary for a better approach of these findings.
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Affiliation(s)
| | - Alex Castro
- Pathology Department, Clínica Alemana, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo
| | - Jorge Larrondo
- Dermatology Unit, Clínica Alemana de Santiago, Santiago, Chile
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Secchin P, Quintella DC, Paula NÁDO, Andrade LCDS, Sodré CT. Clinical-histopathological profile of the frontal fibrosing alopecia: a retrospective study of 16 cases of a university hospital. An Bras Dermatol 2019; 94:416-421. [PMID: 31644613 PMCID: PMC7007022 DOI: 10.1590/abd1806-4841.20197797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 04/14/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in postmenopausal women with alopecia of the frontal-temporal hairline. OBJECTIVES To describe the clinical, dermatoscopic, and histopathological characteristics and the treatment used in patients who have frontal fibrosing alopecia at the Alopecia Outpatient Clinic in a university hospital. METHODS Retrospective descriptive study performed by reviewing medical charts and biopsies of the scalp. RESULTS Sixteen patients were analyzed, all of them female, 93.75% of them postmenopausal, and 56.25% brown-skinned. All had frontal alopecia (100%), followed by temporal alopecia (87.5%) and madarosis (87.5%). On dermatoscopy, perifollicular erythema and tubular scales were found as a sign of disease activity. Of the patients, 68.75% had associated autoimmune diseases, including lupus, thyroid disease and vitiligo. Of the 13 biopsies from 8 patients, 10 showed microscopic aspects compatible with frontal fibrosing alopecia. Laboratory tests did not show major abnormalities and minoxidil was the most used treatment. STUDY LIMITATION Data collection limited by the study's retrospective design associated to flaws while filling in the medical charts and absence in standards to the collection and processing of the pathology and histopathological examination. CONCLUSIONS A demographical, clinical, and histopathological description of 16 patients diagnosed with frontal fibrosing alopecia, which remains a challenging disease, of unknown origin, and frequently associated with autoimmune diseases. This study reinforces literary findings. However, more research is needed to establish the pathogenesis and effective treatments.
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Affiliation(s)
- Pedro Secchin
- Dermatology Sector, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Danielle Carvalho Quintella
- Discipline of Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
- Service of Anatomic Pathology, Hospital Federal de Bonsucesso, Rio de Janeiro (RJ), Brazil
| | | | | | - Celso Tavares Sodré
- Discipline of Dermatology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
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45
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Conic RRZ, Piliang M, Bergfeld W, Atanaskova-Mesinkovska N. Association of Lichen Planopilaris With Dyslipidemia. JAMA Dermatol 2019; 154:1088-1089. [PMID: 29998306 DOI: 10.1001/jamadermatol.2018.1749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rosalynn R Z Conic
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Natasha Atanaskova-Mesinkovska
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Dermatology, University of California Irvine
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Papanikou S, Xydeas-Kikemenis A, Nicolaidou E, Chatziioannou A, Rigopoulos D, Stratigos A, Chasapi V. Social Status May Interfere in the Prognosis of Frontal Fibrosing Alopecia in Female Patients: An Observational Study. Skin Appendage Disord 2019; 5:355-358. [PMID: 31799262 DOI: 10.1159/000501888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Frontal fibrosing alopecia (FFA) is a cicatricial alopecia whose incidence has greatly increased worldwide over the last years. The main purpose of the study was to investigate the possible association of the social status of FFA patients with the prognosis of the disease. Methods A total of 100 female patients with FFA, monitored at Andreas Sygros Hospital, Athens, Greece, during the last 3 years, were recruited in this observational study. The age of the women ranged from 29 to 92 years with a mean age of 61.2 years (SD = 10.3); 97% of them were Greek, with skin type II and III. Results In total, 46% of the patients were intermediate graduates, and 42% had received tertiary education; 82% were married and 21% had 1 child. The duration of the disease ranged from 0.5 to 20 years with a mean duration of 5.2 years. In 53% of the women, the frontal hairline recession was <1 cm, in 26% it was 1-2 cm, and in 15% it was 3-4.99 cm. Overall, 55.6% of patients were professionals, 26% were technicians and associate professionals, 23% were office workers, 9% were service and sales workers, and 13% were at elementary occupations. The severity of the disease was higher in lower-educated patients, who belong to the category of unskilled or with elementary occupation. Conclusions Women with high educational level and social status are more likely to be diagnosed earlier, resulting in sufficient therapeutic response.
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Affiliation(s)
- Sofia Papanikou
- Department of Dermatology and Venereology NHS, Andreas Sygros Hospital, Athens, Greece
| | | | - Electra Nicolaidou
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiro Chatziioannou
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Stratigos
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Chasapi
- Department of Dermatology and Venereology NHS, Andreas Sygros Hospital, Athens, Greece
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Syringotropic Lichen Planus: A Potential Histopathologic Mimicker of Syringotropic Mycosis Fungoides. Am J Dermatopathol 2019; 41:e50-e53. [PMID: 30371514 DOI: 10.1097/dad.0000000000001295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Perieccrine inflammation may be observed in several different dermatoses, but true permeation of the secretory coil by lymphocytes (lymphocytic syringotropism) is a rather uncommon finding, usually observed in mycosis fungoides (MF-syringotropic MF). Rare cases of syringotropic lichen striatus and lymphocytic autoimmune hidradenitis showing a similar pattern have been described as well. We describe an exceptional case of lichen planus (LP) characterized by marked lymphocytic syringotropism with focal hyperplasia of the eccrine epithelium. Histopathology was characterized by the combination of features of conventional LP, prominent permeation of the secretory portion of the eccrine glands by reactive lymphocytes, and focal involvement of a hair follicle. Syringotropic LP may be regarded as a histologic mimicker of syringotropic MF, thus representing a potential diagnostic pitfall.
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48
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Shalbaf M, Alase AA, Berekmeri A, Md Yusof MY, Pistolic J, Goodfield MJ, Edward S, Botchkareva NV, Stacey M, Vital EM, Wittmann M. Plucked hair follicles from patients with chronic discoid lupus erythematosus show a disease-specific molecular signature. Lupus Sci Med 2019; 6:e000328. [PMID: 31413850 PMCID: PMC6667780 DOI: 10.1136/lupus-2019-000328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/26/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE When faced with clinical symptoms of scarring alopecia-the standard diagnostic pathway involves a scalp biopsy which is an invasive and expensive procedure. This project aimed to assess if plucked hair follicles (HFs) containing living epithelial cells can offer a non-invasive approach to diagnosing inflammatory scalp lesions. METHODS Lesional and non-lesional HFs were extracted from the scalp of patients with chronic discoid lupus erythematosus (CDLE), psoriasis and healthy controls. RNA was isolated from plucked anagen HFs and microarray, as well as quantitative real-time PCR was performed. RESULTS Here, we report that gene expression analysis of only a small number of HF plucked from lesional areas of the scalp is sufficient to differentiate CDLE from psoriasis lesions or healthy HF. The expression profile from CDLE HFs coincides with published profiles of CDLE from skin biopsy. Genes that were highly expressed in lesional CDLE corresponded to well-known histopathological diagnostic features of CDLE and included those related to apoptotic cell death, the interferon signature, complement components and CD8+ T-cell immune responses. CONCLUSIONS We therefore propose that information obtained from this non-invasive approach are sufficient to diagnose scalp lupus erythematosus. Once validated in routine clinical settings and compared with other scarring alopecias, this rapid and non-invasive approach will have great potential for paving the way for future diagnosis of inflammatory scalp lesions.
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Affiliation(s)
- Mohammad Shalbaf
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Adewonuola A Alase
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anna Berekmeri
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Md Yuzaiful Md Yusof
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Jelena Pistolic
- Genomics Core Facility, European Molecular Biology Laboratory, Heidelberg, Germany
| | | | - Sara Edward
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Natalia V Botchkareva
- Centre for Skin Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Martin Stacey
- Faculty of Biological Sciences, School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Edward M Vital
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Miriam Wittmann
- Leeds Institue of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
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Abstract
The treatment of hair loss is a challenge for all dermatologists. New medications are needed due to lack of efficacy of many treatments or their side-effect profile. This article discusses the most recent literature updates on the use of retinoids in frontal fibrosing alopecia, platelet-rich plasma in androgenetic alopecia, and JAK inhibitors in alopecia areata.
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Affiliation(s)
- Leopoldo Duailibe Nogueira Santos
- Santa Casa of São Paulo School of Medicine, Rua Doutor Cesário Motta Júnior 61, São Paulo, SP 01221-020, Brazil; Municipal Public Servant Hospital of São Paulo, Rua Castro Alves 60, São Paulo, SP 01532-000, Brazil; University of Taubaté, Av. Granadeiro Guimarães 270, Taubaté, SP 12020-130, Brazil; The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 530 First Avenue, Suite 7R, New York, NY 10016, USA
| | - Jerry Shapiro
- Municipal Public Servant Hospital of São Paulo, Rua Castro Alves 60, São Paulo, SP 01532-000, Brazil.
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50
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Kanti V, Röwert-Huber J, Vogt A, Blume-Peytavi U. Cicatricial alopecia. J Dtsch Dermatol Ges 2019; 16:435-461. [PMID: 29645394 DOI: 10.1111/ddg.13498] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022]
Abstract
In the classification of the North American Hair Research Society, primary cicatricial alopecias (PCA) are divided into four groups according to their prominent inflammatory infiltrate: PCAs with lymphocytic, neutrophilic, mixed or nonspecific cell inflammation pattern. The hair loss can begin subclinically and progress slowly so that the exact onset of the disease is often difficult to determine. The diagnosis is often delayed. While most forms of cicatricial alopecia can be clearly diagnosed based on clinical presentation in the acute disease stage, diagnosis can be challenging in the subacute, early or late disease stages. At first presentation, a detailed patient history and dermatological examination of the body, including trichoscopy, should be performed. In clinically unclear cases, a biopsy should be performed. Due to the scarcity of primary cicatricial alopecia, there is little evidence on the efficacy of the various therapies. The aims of treatment are to stop or at least delay hair loss and progression of the scarring process, reduce clinical inflammation signs as well as to alleviate subjective symptoms. Hair re-growth in already scarred areas should not be expected. Anti-inflammatory treatment with topical corticosteroids class III to IV and / or with intracutaneous intralesional triamcinolone acetonide injections can be considered in most of the primary cicatricial alopecias. The choice of systemic therapy depends on the type of predominant inflammatory infiltrate and includes antimicrobial, antibiotic or immunomodulating/immunosuppressive agents. Psychological support and camouflage techniques should be offered to the patients.
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Affiliation(s)
- Varvara Kanti
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Joachim Röwert-Huber
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
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