Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology. AIM: To identify possible environmental and hormonal factors related to FFA. METHODS: We conducted a multicentre case-control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease. RESULTS: For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06-2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06-2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11-2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05-2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07-3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11-23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7-80.9) or antiageing creams (OR = 1.84; 95% CI 1.04-3.23). CONCLUSIONS: FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.

Hair and scalp evaluation: the trichogram.

Hair and scalp evaluation techniques can be classified into 3 categories: noninvasive methods (clinical history, general examination, inspection and palpation of the hair and scalp, photography, dermoscopy, etc.); semi-invasive methods (the trichogram); and invasive methods (biopsy). In this article, we provide a practical guide on how to evaluate hair and scalp conditions in the dermatology office.

Annular erythematous papules in the neckline.

A 45-year-old woman with personal history of hypertension presented with an erythematous lesion in the neckline for a year and with a progressive growth. A physical examination revealed an annular lesion with erythematous papules in the edge. Histological exam showed phagocytosis of elastic fibers by multinucleated cells compatible with annular elastolytic giant-cell granuloma. The patient did not present any other associated systemic manifestation. Treatment with tacrolimus 0.1 percent ointment was prescribed with a very good response after two months.

A new case of extensive congenital erosions and vesicles healing with reticulate scarring.

Congenital erosions and vesicles that heal with reticulate scarring comprise a new entity first described in 1985 in 3 girls aged 3, 5 and 6 years. Two years later, an 8-year-old boy in whom the skin lesions were accompanied by neurological disorders was described, as in one of the patients described in the 1985 study. In 1990, similar findings were reported in a neonate, and recently the 7th case has been reported in the American literature. We describe an 8-month-old infant born with cutaneous lesions that subsequently formed reticulate scars peculiar to this clinical entity, which is characterized by variable clinical and histological expression.

Familial multiple cutaneous leiomyomas.

BACKGROUND: Leiomyomas are rare, benign tumors that originate from the arrector muscle of hair follicles (cutaneous leiomyoma, piloleiomyoma), the tunica dartos of the scrotum and the mammillary muscle of the nipple (genital leiomyoma), and the smooth muscle of blood vessels (angioleiomyoma). OBSERVATIONS: We describe 6 members of a single family with mostly painful papulonodular cutaneous lesions on the limbs, trunk and face. Histological examination of sections stained with hematoxylin-eosin and Masson trichromic stain confirmed the diagnosis of leiomyoma. All affected women had also uterine myoma. CONCLUSION: Our observations support the concept that this entity is an autosomally inherited disorder.