Primary cicatricial alopecia: clinical features and management.

The primary cicatricial alopecias are an uncommon, complex group of disorders that result in permanent destruction of the hair follicle, usually involving scalp hair alone. Prompt diagnosis and treatment are needed to help thwart continued hair loss and the distress that often accompanies this hair loss. Nurses can facilitate the diagnostic and treatment process and, through educational and emotionally supportive measures, have a meaningful, positive impact on the patient's well being.

Videodermoscopy in the evaluation of hair and scalp disorders.

BACKGROUND: The standard methods used to diagnose scalp and hair disorders (eg, simple clinical inspection, pull test, biopsy) vary in sensitivity, reproducibility, and invasiveness. Studies on a few entities suggest that use of dermoscopy can improve clinical accuracy, but further investigation is needed. OBJECTIVES: We sought to: (1) characterize features of several nontumoral scalp and hair conditions using videodermoscopy; and (2) assess the potential usefulness of videodermoscopy in the clinical evaluation of these conditions. METHODS: Images (x20-70 magnification) obtained with videodermoscopy from 220 patients with various scalp and hair disorders and 15 unaffected control subjects were reviewed for distinguishing features. RESULTS: Conditions evaluated included psoriasis (23), seborrheic dermatitis (26), alopecia areata (58), androgenetic alopecia (64), chronic telogen effluvium (7), trichotillomania (12), and primary cicatricial alopecia (30). Clinical features evident to the naked eye were seen in great detail when videodermoscopy was used. Novel features (eg, yellow dots in alopecia areata) were also identified. LIMITATIONS: Findings require confirmation by blinded, prospective investigation. CONCLUSIONS: Use of videodermoscopy in the clinical evaluation of scalp and hair disorders improves diagnostic capability beyond simple clinical inspection and reveals novel features of disease, which may extend clinical and pathogenetic understanding.

Update on primary cicatricial alopecias.

UNLABELLED: The cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of the hair follicle and irreversible hair loss. Destruction of the hair follicle can result from primary, folliculocentric disease or as a secondary result. This article focuses on the former, or primary cicatricial alopecias. The cause and pathogenesis of many of these disorders are largely unknown. Although unique clinicopathologic features allow for accurate diagnosis in some cases, diagnostic certainty is often elusive and reflects the limits of present understanding. Classification of the primary cicatricial alopecias on the basis of pathology provides a diagnostic and investigational framework and, it is hoped, will facilitate future enlightenment. Details of classification, etiopathogenesis, clinicopathologic features, differential diagnosis, and practical management of the primary cicatricial alopecias will be discussed. LEARNING OBJECTIVES: Upon completion of this learning activity, participants should be familiar with the following aspects of the primary cicatricial alopecias: (1) the new, consensus-issued classification scheme, (2) current understanding about etiopathogenesis, (3) salient clinicopathologic features, (4) differential diagnosis, and (5) therapeutic management.

Management of hair loss.

The management of patients with hair loss requires a customized plan. Diagnosis, prognosis, psychosocial impact, treatment options, and patient preference are key determinants. This article discusses current agents for the treatment of three commonly encountered nonscarring alopecias: male- and female-pattern hair loss, telogen effluvium, and alopecia areata. Algorithmic approaches to management are provided.

Lichen planopilaris and pseudopelade of Brocq involve distinct disease associated gene expression patterns by microarray.

BACKGROUND: Lichen planopilaris (LPP) and pseudopelade of Brocq (PPB) are two scarring alopecia diagnoses that exhibit similar clinical features. Some suggest LPP and PPB are not distinct diseases, but rather different clinical presentations in a spectrum derived from the same underlying pathogenic mechanism. OBJECTIVE: We explored the degree of similarity between LPP and PPB gene expression patterns and the potential for common and unique gene pathway and gene activity in LPP and PPB using microarrays. METHODS: Microarray analysis, using a 21K cDNA set, was performed on pairs of biopsies obtained from affected and unaffected scalp of untreated patients. Diagnosis was confirmed by histopathology. Significantly differentially expressed genes were identified by analysis of microarray results in various datasets and screened for signaling pathway involvement. Selected genes were validated by quantitative PCR and immunohistology. RESULTS: The global gene expression profiles in LPP and PPB versus comparative intra-control scalp tissue were distinguishable by significance analysis of microarrays (SAM). There was limited commonality in the gene expression profiles between LPP and PPB. Specific genes, such as MMP11, TNFSF13B, and APOL2, were identified with significantly differential expression in association with LPP versus PPB. CONCLUSIONS: Our findings may have important implications for understanding the pathogenesis of LPP and PPB at the molecular level. Results suggest LPP and PPB involve different mechanisms of disease development and should be regarded as biologically distinct cicatricial alopecia diagnoses. Genes that we have identified may be useful as markers of the respective diagnoses and may be potential therapeutic targets.

Alefacept for severe alopecia areata: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: To assess the efficacy of alefacept for the treatment of severe alopecia areata (AA). DESIGN: Multicenter, double-blind, randomized, placebo-controlled clinical trial. SETTING: Academic departments of dermatology in the United States. PARTICIPANTS: Forty-five individuals with chronic and severe AA affecting 50% to 95% of the scalp hair and resistant to previous therapies. Intervention Alefacept, a US Food and Drug Administration-approved T-cell biologic inhibitor for the treatment of moderate to severe plaque psoriasis. Main Outcome Measure Improved Severity of Alopecia Tool (SALT) score over 24 weeks. RESULTS: Participants receiving alefacept for 12 consecutive weeks demonstrated no statistically significant improvement in AA when compared with a well-matched placebo-receiving group (P = .70). Conclusion Alefacept is ineffective for the treatment of severe AA.

What can we learn from animal models of Alopecia areata?

Alopecia areata (AA) is a hair loss disease marked by a focal inflammatory infiltrate of dystrophic anagen stage hair follicles by CD4+ and CD8+ lymphocytes. Although AA is thought to be an autoimmune disorder, definitive proof is lacking. Moreover, characterization of the primary pathogenic mechanisms by which hair loss is induced in AA is limited. In this context, animal models may provide a vital contribution to understanding AA. Recent research using animal models of AA has focused on providing evidence in support of a lymphocyte-mediated pathogenic mechanism consistent with AA as an autoimmune disease. In the future, research with both humans and animal models shall likely concentrate on identifying the primary antigenic epitopes involved in AA and the genetics of AA susceptibility. With a comprehensive understanding of the key elements in AA pathogenesis, new avenues for therapeutic research and intervention will be defined.