Chronic diffuse alopecia in women: a retrospective review of histopathologic diagnoses.

INTRODUCTION: The diseases causing chronic diffuse alopecia and having similar clinical findings, namely chronic telogen effluvium, androgenetic alopecia, and the alopecia with overlapping features, should be differentiated. Recently, diffuse variants of lichen planopilaris have been described with histopathologic features of lichen planopilaris but clinically presenting with diffuse hair loss mostly in an androgenetic pattern. OBJECTIVES: To determine the accurate diagnosis underlying chronic diffuse alopecia in women by evaluating histopathologic findings. PATIENTS AND METHODS: The study included 32 patients with diffuse and clinically noncicatricial alopecia for at least 6 months with no identifiable etiologic factor after general medical history, review of organ systems, and appropriate laboratory tests. Two 4 mm punch biopsies, one from vertex and the other from mid-occiput, were obtained and sectioned transversely. RESULTS: The median age was 30.5 years (range: 22-40 years), and the median duration of hair loss was 4 years (range: 1.5-10 years). The histopathologic diagnosis was androgenetic alopecia, chronic telogen effluvium, and overlapping alopecia in 13 (40.6%), three (9.4%), and four (12.5%) patients, respectively. In the remaining 12 (32.5%) patients, a lichenoid inflammatory reaction affecting the infundibulum and isthmus was noted, and the probable diagnosis of diffuse variant of lichen planopilaris was made. LIMITATIONS: The retrospective nature and the small sample size. CONCLUSION: When the clinical diagnosis is not straightforward and no etiologic factor is found, histopathologic examination is mandatory for the accurate diagnosis of the disorder leading to chronic diffuse alopecia in women.

Granuloma annulare with alopecia areata in a 6-year-old girl: a case report.

BACKGROUND: Dermatologic signs and symptoms can be the manifestations of a single disease or different diseases, and it is proven that some are associated with one another. These connections are not fully understood, but the answer lies in the pathophysiology of each disease. CASE PRESENTATION: We report the case of a 6-year-old Middle-Eastern girl who presented with two skin lesions on the dorsum of her foot, along with scaling of her soles and palms, face skin discoloration, and areas of patchy alopecia on her scalp. She was diagnosed as a case of acute onset of granuloma annulare with alopecia areata and dermatitis. The treatment regimen for the patient's scalp consisted of topical minoxidil and betamethasone and three sessions with 1-month intervals of triamcinolone acetonide intralesional injections, which demonstrated modest effectiveness in treating alopecia areata. CONCLUSION: Granuloma annulare is a benign inflammatory illness with no known cause that might be difficult to cure. The clinical course and prognosis might vary greatly depending on the disease subtype, and associating symptoms and diseases, such as alopecia areata, should be considered.

Sarcoidosis Coexisting With Distinct Forms of Alopecia on the Scalp: A Case Series.

ABSTRACT: Sarcoidosis is an idiopathic multisystem inflammatory disease that can affect virtually any part of the body. Often, it can initially present solely in the skin. Histologically, it is characterized by noncaseating, 'naked' granulomas in the dermis and subcutaneous tissue. Clinically, sarcoidosis is often referred to as a 'mimicker' of many other pathologic processes because of its wide array of presentations. Occasionally, sarcoidosis can present in the scalp as both a scarring and nonscarring alopecia. There are countless reports of sarcoidosis mimicking various other alopecias including acne keloidalis nuchae, discoid lupus erythematosus, frontal fibrosing alopecia, lichen planopilaris, and alopecia areata totalis. In this case series, we present 2 novel cases of sarcoidosis not just clinically mimicking other forms of alopecia but occurring in conjunction with a separate and histologically distinct primary alopecia.

Association between the first exposure to general anesthesia and alopecia areata.

Alopecia areata (AA) is an autoimmune cutaneous disorder reported to be related to various immunologic diseases and psychiatric disorders. Some AA patients report the onset of patchy hair loss after surgeries under general anesthesia (GA). However, no large-scale studies have been conducted on the relationship between AA and GA. Thus, we aimed to evaluate whether exposure to GA is associated with an increased risk of AA. In this retrospective study, we analyzed a population exposed to GA. These individuals were compared to unexposed controls, matched by age, sex, income level, and comorbidities (propensity score matching, 1:2 ratio), from the national sample cohort from January 1, 2002, to December 31, 2015. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the risk of AA associated with GA using Cox proportional hazard regression. As a result, the risk of AA occurrence was significantly higher in the GA-exposed group after adjusting confounding factors (adjusted HR 1.22, 95% CI 1.07-1.43, P = 0.005). The cumulative incidence of AA was higher in the GA-exposed group (log-rank P = 0.005). The risk of AA increased with GA exposure time. However, the type of surgery and the method of anesthesia did not impact the risk of developing AA. Thus, in conclusion, exposure to GA was associated with a higher risk of developing AA.

Milia-like calcinosis cutis in Down syndrome: a new case with a review of the literature.

We report an 11-year-old girl who presented with white papules on the dorsal and palmar region of the hands bilaterally. The parents reported that the lesions had appeared four months before and some had resolved spontaneously. The girl was suffering from celiac disease, Down syndrome, and alopecia areata treated with topical corticosteroids. At the first visit, the girl presented with alopecia areata, corticosteroid acne, and a dozen white papules located on the hands. On dermoscopy, a whitish structureless area was seen. Histological examination showed the presence of calcium deposits without tissue damage, thus confirming the diagnosis of milia-like idiopathic calcinosis cutis. At 6-month follow up, the lesions had completely disappeared. Milia-like idiopathic calcinosis cutis is a benign cutaneous disorder consisting of calcium deposits in an apparently undamaged dermis and is typically associated with Down syndrome. Up to a quarter of patients have coexisting syringomas. The milia-like papules tend to self-resolve as patients reach adulthood, so a wait-and-see approach is recommended.

CAN SKIN BE A MARKER FOR INTERNAL MALIGNANCY? EVIDENCE FROM CLINICAL CASES.

Although there are many single case reports on paraneoplastic dermatoses in the literature, there are very rare articles containing multiple cases. A retrospective study was performed to examine paraneoplastic dermatoses and accompanying malignancies based on skin manifestations and appropriate diagnostic evaluations. We recorded outcomes, current conditions, and surgical/oncologic treatments. Analysis revealed paraneoplastic dermatoses in 17 patients with various skin lesions, i.e. eczematous dermatitis, vasculitis, subacute cutaneous lupus erythematosus, pruritus, chronic urticaria/angioedema, alopecia areata, flushing, bullous pemphigoid, dermatomyositis, and localized scleroderma (morphea). They were associated with different solid and hematologic malignancies (3 gastric, 2 prostate, 2 bladder, 2 thyroid, and 2 lymphoma), along with 1 case each of the following: lung, hepatocellular, esophageal, endometrial, kidney, and multiple myeloma. The majority of skin lesions gradually regressed after malignancy treatment. To our knowledge, our three cases of paraneoplastic eczematous dermatitis are the first to be associated with gastric, prostate and endometrial cancer. Additionally, we report a case of a patient with alopecia areata of the beard associated with thyroid cancer. Early malignancy detection based on skin markers makes early introduction of surgical/oncologic therapy possible and usually leads to skin lesion regression while reducing revolving door visits to specialists and the (financial) burden on the healthcare system.

Laparoscopic Extirpation of Adrenal Gland Ganglioneuroma Incidentally Diagnosed during Evaluation for Patchy Alopecia Areata in an Adolescent Boy.

OBJECTIVE: We present a 17-year-old boy with an incidentally diagnosed left adrenal ganglioneuroma during the diagnostic workup of alopecia areata. CLINICAL PRESENTATION AND INTERVENTION: Laboratory investigations revealed vitamin D deficiency. Laparoscopic adrenalectomy was performed and ganglioneuroma was confirmed histologically. At follow-up, the vitamin D supplements improved the vitamin D levels followed by a gradual regression of alopecia areata. However, it recurred 18 months later despite the normal levels of serum vitamin D and no tumor recurrence. CONCLUSION: Further studies should reveal the relationship between alopecia areata and ganglioneuroma as well as the role of vitamin D in alopecia areata.

Cancer risk by the subtype of alopecia.

The cancer risk in patients with alopecia areata (AA) or alopecia totalis (AT)/alopecia universalis (AU) remains unknown. In this study, national statistical data were used to study the association between these forms of alopecia and the risk of cancer. We enrolled 668,604 patients who were treated for alopecia from 2007 to 2014, and age- and sex-matched control subjects. AA and AT/AU patients had slightly higher overall cancer risks (hazard ratio (HR), 1.043; 95% confidence interval (CI), 1.022-1.065 and HR, 1.07; 95% CI, 1.013-1.129, respectively) than controls, after adjusting for confounding factors. The risks of oral cavity, esophagus, liver, biliary tract, pancreas, larynx, lung, kidney, breast, cervix, ovary, uterus, testis, nerve, and skin cancers; and lymphoma, multiple myeloma, and leukemia, were not increased in alopecia patients. In AA or AT/AU patients, the only increased risk was that of thyroid cancer. In AA patients alone, the risks of bladder and prostate cancers were increased. Thus, the cancer risks varied by the alopecia subtype. Careful monitoring is needed to explore if the actual risks of thyroid, bladder, and prostate cancers are increased in alopecia patients.

Cutaneous and Mucosal Manifestations Associated with Celiac Disease.

Celiac disease (CD) is an immune-mediated, gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, with dermatitis herpetiformis (DH) being the best characterized. These associated conditions may be the clue to reaching the diagnosis of CD. Over the last few years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in the absence of gastrointestinal symptoms, should give rise to an appropriate screening method for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated with CD and the possible mechanisms involved.

When your patient's parent asks: "My child's alopecia areata is not getting better. Should he or she get tested for celiac disease?"

The relationship between alopecia areata and celiac disease has been suspected for more than 20 years. For a particular individual with alopecia areata, the risk of coexisting celiac disease and the potential benefit of a gluten-free diet on hair loss or regrowth is known. Despite this limited information, patients often aske dermatologists whether they should undergo celiac disease testing or begin a gluten-free diet. We reviewed all available studies of the relationship between alopecia areata and celiac disease to provide guidance to practicing clinicians.

Hemorrhagic Ischemic Retinal Vasculitis and Alopecia Areata as a Manifestation of HLA-B27.

A 12-year-old Indian boy presented with acute and severe vision loss in his right eye. He was being treated for scalp alopecia areata and rashes behind the ears and above the brow. The eye examination revealed unilateral hemorrhagic retinal vasculitis. The lab work was normal except for a positive HLA-B27 result. The patient was treated with intravitreal bevacizumab (Avastin; Genentech, South San Francisco, CA) and systemic immunosuppression. The retinal vasculitis improved with treatment, but visual acuity only mildly improved. The alopecia areata also improved with systemic immunosuppression. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:60-63.].