RESUMO
BACKGROUND: In frontal fibrosing alopecia (FFA), scalp alopecia dominates the clinical picture. However, eyebrow loss and hair loss in other body sites may also occur; this has been documented clinically, but rarely histopathologically. We describe the clinicopathological findings of 13 cases of FFA, with histopathologic data from the scalp, eyebrow, and body hair. METHODS: Thirteen patients with a diagnosis of FFA, seen between 2006 and 2008, were included. Scalp biopsies were performed in all patients for histology and direct immunofluorescence (DIF). Biopsy specimens for histology were taken from the eyebrow in 6 patients and from the upper limb in 5 patients. RESULTS: All 13 patients were female, 11 of whom were postmenopausal. The median age at onset of alopecia was 57 years. Clinical examination revealed a band of frontal hairline recession in all patients. Eyebrow loss was present clinically in all patients, with loss of body hair in 10 of 13. Histopathologic examination of the scalp, eyebrow, and upper limb skin biopsy specimens showed similar features, including a marked reduction in the number of hair follicles and a perifollicular lymphoid cell infiltrate with perifollicular fibrosis. Direct immunofluorescence was negative in all cases. LIMITATIONS: Not all patients consented to biopsies of the eyebrows or upper limbs. CONCLUSION: Eyebrow and peripheral body hair loss is not uncommon in FFA-a finding that is likely underreported. We have demonstrated that alopecia of the upper limbs in FFA is indeed common and, histopathologically, shows features of lichen planopilaris and scarring, similar to findings in the scalp and eyebrows. Consequently, the process of lichen planopilaris with scarring alopecia is generalized rather than localized only to the frontal scalp and eyebrows.
Assuntos
Alopecia/patologia , Fibrose/patologia , Líquen Plano/patologia , Pele/patologia , Adulto , Distribuição por Idade , Idoso , Alopecia/diagnóstico , Alopecia/epidemiologia , Biópsia por Agulha , Estudos de Coortes , Diagnóstico Diferencial , Progressão da Doença , Sobrancelhas/patologia , Feminino , Fibrose/diagnóstico , Fibrose/epidemiologia , Testa/patologia , Humanos , Imuno-Histoquímica , Incidência , Líquen Plano/diagnóstico , Líquen Plano/epidemiologia , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Retrospectivos , Medição de Risco , Couro Cabeludo/patologia , Índice de Gravidade de Doença , Reino Unido , Extremidade Superior/patologiaRESUMO
BACKGROUND: Patients with chronic actinic dermatitis (CAD) frequently have positive patch or photopatch tests. In our previous study (period 1987-1992), the most prominent contact allergen was the sesquiterpene lactone mix (36% of patients with CAD). OBJECTIVE: To assess whether contact allergy profiles in CAD patients between 2000 and 2005 have changed in respect to our previous data (1987-1992). PATIENTS AND METHODS: Fifty CAD patient records from 2000 to 2005 for patch and photopatch testing were retrospectively analysed and data were compared with that from 86 patients seen between 1987 and 1992. RESULTS: Thirty-two (64%) and 64 (74%) patients had positive patch or photopatch tests in 2000-2005 and 1987-1992, respectively. The allergen profile has altered. A decline in sesquiterpene lactone mix positive reactions was noted: 29 (36%) patients were positive in 1987-1992 and 10 (20%) patients in 2000-2005, but this was not significant (P = 0.08). Reactions to non-fragrance consumer allergens (i.e. p-phenylenediamine and preservatives) had risen from 7 reactions (1987-1992) to 21 reactions in 13 individuals (2000-2005) (P < 0.001). Of these allergens, p-phenylenediamine was the most common (12%; P = 0.004). CONCLUSIONS: A significant rise in positive patch tests to non-fragrance consumer allergens, particularly p-phenylenediamine, was seen in CAD patients in 2000-2005. We speculate this alteration of allergen profile may be partly due to changes in exposure patterns.
Assuntos
Dermatite de Contato/imunologia , Dermatite Fotoalérgica/imunologia , Tolerância Imunológica , Fenilenodiaminas/imunologia , Feminino , Humanos , Lactonas/imunologia , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Transtornos de Fotossensibilidade/imunologia , Estudos Retrospectivos , Sesquiterpenos/imunologia , Raios Ultravioleta/efeitos adversosRESUMO
BACKGROUND: Ciclosporin (CsA) is an effective treatment for several inflammatory dermatoses, including psoriasis and eczema. In contrast to transplantation medicine, dermatologists do not routinely use CsA blood concentrations to guide therapy. OBJECTIVE: To determine the range of CsA levels at 2 hours after dosing (C2 levels) and whether these C2 levels had any relationship to clinically relevant parameters, such as CsA dose, serum creatinine, blood pressure, PASI (psoriasis area and severity index) or DLQI (dermatology life quality index). METHODS: A total of 18 patients on CsA maintenance therapy (cohort 1) and eight patients commencing on CsA (cohort 2) were included in the study. In cohort 1, CsA blood concentrations were measured at 2 hours post-dose on one occasion only, while in cohort 2, C2 levels were performed at baseline and at 4, 8 and 12 weeks after commencing CsA treatment. RESULTS: In cohort 1, a significant relationship between C2 levels and PASI was found. However, no relationship was found between C2 levels and CsA dose, blood pressure, or serum creatinine. In cohort 2, higher C2 levels were associated with lower PASI scores (p <0.05) and DLQI scores at 4 weeks (p = 0.014). CONCLUSION: We suggest that C2 levels may be beneficial in patients who are not responding well to CsA treatment in the loading phase.
Assuntos
Ciclosporina/sangue , Fármacos Dermatológicos/sangue , Monitoramento de Medicamentos , Psoríase/tratamento farmacológico , Adulto , Idoso , Pressão Sanguínea , Creatinina/sangue , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemRESUMO
Occupational irritant contact dermatitis (ICD), a non-immunological cutaneous inflammatory response to a workplace substance, comprises a major portion of occupational dermatoses in industrialized societies, resulting in considerable social and economic implications. The sheer morphological variety of ICD presents a diagnostic and classification challenge; ideotypes identified to date include acute, chronic and cumulative irritant dermatitis, delayed acute irritant dermatitis, irritant reaction, pustular irritant dermatitis, suberythematous irritation, sensory irritation, friction dermatitis and airborne dermatitis. Hand dermatitis is the most frequent manifestation of occupational ICD. This article reviews the various types of ICD, the epidemiological data available to date, risk factors, pathophysiology, diagnosis and management of ICD, emphasizing occupational issues.