First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans.

BACKGROUND: The cause of folliculitis decalvans (FD) remains unknown. We hypothesized that a bacterial biofilm could be involved in its pathogenesis. OBJECTIVE: To assess the presence or not of a bacterial biofilm in the hair roots of the scalp in FD. PATIENTS AND METHODS: Hairs plucked from four patients and three controls were examined by field emission scanning electron microscopy (FESEM) and confocal laser scanning microscopy (CLSM). RESULTS: Bacterial communities organized as biofilms were observed both by FESEM and CLSM in the under infundibular part of hair follicles in all patients and in two of the three controls. In patients and controls, these biofilms were formed exclusively of bacilli of comparable shapes. CONCLUSION: This pilot study provides the first evidence of the presence of bacterial biofilms in the infra infundibular part of human scalp hair follicles. These biofilms were detected both in FD patients and controls, suggesting their ubiquity as a commensal biofilm with a possible pathogenic shift in FD.

Orange palpebral spots.

We report 27 cases of adults (23 females/4 males, average age 53 years old) presenting yellow-orange pigmented symmetric spots in the internal part of their superior eyelids, different from xanthelasma. Most of them were not aware of their orange palpebral spots (OPS). A systematic observation of adults showed OPS on 15 out of 326 patients. Laboratory investigation carried out in 11 patients did not show particular results except a high level of vitamin E or of total carotenoids in single cases and of beta-cryptoxanthin in 5 cases attributed to the high consumption of citrus fruit during winter. In 9 out of the 10 biopsies performed, high-situated fat cells were observed in the reticular dermis, and Fontana pigments (+) in the superficial dermis and sometimes basal keratinocytes. In 1 case yellow-brown autofluorescent microgranular deposits that may correspond to lipofuscin were identified in the superficial dermis. The origin of OPS remains unclear; more than high-situated adipocytes colored by carotenoids, lipofuscin deposit could explain this color, easily visible due to the thinness of the skin in this part of the body. Identifying OPS avoids being mistaken about other pathologies, but further investigations are necessary to understand this entity better.

[Postmenopausal frontal fibrosing alopecia: 20 cases]. / Alopécie fibrosante frontale post ménopausique: 20 cas.

INTRODUCTION: Postmenopausal frontal fibrosing alopecia is a scarring alopecia that has been recently described by Kossard in 1994 and rarely reported in the literature. OBSERVATIONS: We have conducted a retrospective clinical and histological study of a series of 20 cases of postmenopausal frontal fibrosing alopecia. The results, in agreement with those in the literature, revealed the stereotyped nature of this entity. DISCUSSION: All the clinical and histological data suggest that postmenopausal frontal fibrosing alopecia is a clinical form of lichen planopilaris occurring in elderly women. As with lichen planopilaris its physiopathology is unknown. However, in analogy with other lichen-like dermatoses, a lymphocyte T-mediated autoimmune reaction appears to play a predominant part in its genesis.

[Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients]. / Traitement des pelades étendues par bolus de méthylprednisolone. Etude ouverte chez 66 malades.

INTRODUCTION: Treatment of alopecia areata is a difficult challenge. Some European publications have shown encouraging results with high dose pulse corticosteroid therapy in extensive plurifocal alopecia areata. We undertook a prospective open study between January 2000 and December 2001 using repeated pulse each month, with the aim of identifying the effects of this repetition and underlining the best indications. PATIENTS AND METHODS: Sixty-six patients aged 9 to 60 years old presenting an extensive alopecia areata exceeding 30% of the scalp surface (n=47), alopecia totalis (n=8), alopecia universalis (n=8), ophiasic alopecia (n=3), for less than 12 months entered this study. The administered treatment was methylprednisolone 500 mg/d during 3 days or 5 mg/kg twice per day during 3 days in children. These pulses were repeated after 4 and 8 weeks, then a second series was carried out or not according to cases. The main evaluation criterion was the percentage of new terminal hair appearing on the bald areas, appreciated by clinical and photographic evaluation at 3 and 6 months. RESULTS: Ophiasic alopecia areata did not respond to treatment. A quarter of patients presenting universal alopecia had a good response (higher than 80 p. 100) followed by a relapse in half the cases. Half of the patients presenting alopecia totalis had a good response, which was maintained three times out of four. Multifocal alopecia areata seems the best indication since the patients under study presented a good response in 63.8 p. 100 of cases (78 p. 100 when it was a first episode and 90.5 p. 100 if the treatment had been started in less than 3 months before). The repetition of the pulses did not appear to increase the number of responders. CONCLUSION: This study provides the best indication of pulse methylprednisolone therapy: first recent episode of extensive plurifocal alopecia areata. These results are less convincing in long term history or other forms of alopecia areata.