Placa eritemato descamativa / Erythematous Scaly Plaque

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Characteristics of healthy and androgenetic alopecia scalp microbiome: Effect of Lindera strychnifolia roots extract as a natural solution for its modulation.

OBJECTIVE: The human scalp harbours a vast community of microbiotal mutualists. Androgenetic alopecia (AGA), the most common form of hair loss in males, is a multifactorial condition involving genetic predisposition and hormonal changes. The role of microflora during hair loss remains to be understood. After having characterized the scalp microbiota of 12 healthy male subjects and 12 AGA male subjects (D0), the aim of this investigation was to evaluate the capacity of Lindera strychnifolia root extract (LsR) to restore a healthy bacterial and fungal scalp microflora after 83 days (D83) of treatment. MATERIAL AND METHODS: The strategy used was based on high-throughput DNA sequencing targeting the encoding 16S ribosomal RNA for bacteria and Internal Transcribed Spacer 1 ribosomal DNA for fungi. RESULTS: Test analysis of relative abundance comparing healthy and AGA subjects showed a significant increase of Cutibacterim acnes (P < 0.05) and Stenotrophomonas geniculata (P < 0.01) in AGA subjects. AGA scalp condition was also associated with a significant (P < 0.05) decrease of Staphylococcus epidermidis relative abundance. A lower proportion of Malassezia genus in samples corresponding to AGA scalps and an increase of other bacterial genera (Wallemia, Eurotium) were also noted. At the species level, mean relative abundance of Malassezia restricta and Malassezia globosa were significantly lower (P < 0.05) in the AGA group. Eighty-three days of treatment induced a significant decrease in the relative abundance of C. acnes (P < 0.05) and S. geniculata (P < 0.01). S. epidermidis increased significantly (P < 0.05). At the same time, LsR treatment induced a significant increase in the proportion of M. restricta and M. globosa (P < 0.05). CONCLUSION: Data from sequencing profiling of the scalp microbiota strongly support a different microbial composition of scalp between control and AGA populations. Findings suggest that LsR extract may be a potential remedy for scalp microbiota re-equilibrium.

OBJECTIF: Le cuir chevelu humain abrite une vaste communauté microbienne. L'alopécie androgénétique (AGA), la forme la plus courante de perte de cheveux chez l'homme, est une pathologie multifactorielle impliquant une prédisposition génétique et des changements hormonaux. Le rôle de la microflore lors de la chute des cheveux reste à comprendre. Après avoir caractérisé le microbiote du cuir chevelu de 12 hommes sans alopecie et 12 hommes porteur d'une alopécie, (J0), l'objectif de cette étude était d'évaluer la capacité de l'extrait de racine de Lindera strychnifolia (LsR) à restaurer une microflore bactérienne et fongique saine du cuir chevelu après 83 jours (D83) de traitement. MATÉRIEL ET MÉTHODES: La stratégie utilisée était basée sur un séquençage d'ADN à haut débit ciblant l'ARN ribosomal 16S codant pour les bactéries et l'ADN ribosomal de l'espaceur transcrit interne 1 pour les champignons. RÉSULTATS: Une augmentation significative de Cutibacterim acnes (P < 0,05) et Stenotrophomonas geniculata (P < 0,01) chez les sujets AGA a ete note a J0 comparativement aux sujets non alopecique. L'état du cuir chevelu AGA était également associé à une diminution significative (P < 0,05) de l'abondance relative de Staphylococcus epidermidis. Une plus faible proportion du genre Malassezia dans les échantillons correspondant aux cuirs chevelus AGA et une augmentation d'autres genres bactériens (Wallemia, Eurotium) ont également été notées. Au niveau des espèces, l'abondance relative moyenne de Malassezia restricta et Malassezia globosa était significativement plus faible (P < 0,05) dans le groupe AGA. Quatre-vingt-trois jours de traitement ont induit une diminution significative de l'abondance relative de C. acnes (P < 0,05) et S. geniculata (P < 0,01). S. epidermidis a augmenté de manière significative (P < 0,05). Dans le même temps, le traitement LsR a induit une augmentation significative de la proportion de M. restricta et M. globosa (P < 0,05). CONCLUSION: Les données de séquençage soutiennent fortement une composition microbienne différente du cuir chevelu entre les populations témoin et AGA. Les résultats suggèrent que l'extrait de LsR peut être un remède potentiel pour le rééquilibre du microbiote du cuir chevelu.

Outbreak of Trichophyton soudanense causing tinea capitis in an orphanage in Myanmar.

We report an outbreak of Trichophyton soudanense causing tinea capitis and corporis in an orphanage in Myanmar. The thirty orphan children were suspected to have anthropophilic tinea but zoonotic tinea could not be excluded as all children were playing with stray dogs. Direct mycological examinations of hair and scalp samples showed filaments but culture assays remained sterile. We revealed T. soudanense as the infectious agent by PCR amplification of extracted fungal DNA and further sequencing of the PCR products. Children were successfully treated by terbinafine and reinfection was prevented by hygiene measures. This case report shed the light on T. soudanense infection on another continent than Africa and on the significant help of PCR identification.

Syphilis: A Contemporary Clinicopathologic Assessment.

Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.

Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man.

A 32-year-old man was referred to our clinic for evaluation of abnormal liver function tests and concurrent proteinuria. Physical examination revealed a maculopapular rash, involving the trunk and palms, and multiple 'moth-eaten' patches of alopecia. After a prolonged diagnostic work-up a hepatitis with concomitant nephrotic syndrome due to secondary syphilis was diagnosed. Treatment with benzylpenicillin led to complete clinical recovery. Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.

Folliculitis decalvans-like pustular plaques on the limbs sparing the scalp.

Folliculitis decalvans is a neutrophilic cicatricial alopecia characterised by progressive pustular folliculitis. Folliculitis decalvans is seen as a condition usually limited exclusively to the scalp and rarely affects the limbs. We present a case of a 63-year-old man with a 3-year history of progressive pustular folliculitis with inflammatory patches and central scarring alopecia on both forearms and a circumscribed patch on his right lower leg. His presentation, clinical course and isolation of Staphylococcus aureus together with the histopathological findings all supported a folliculitis decalvans-like pustular folliculitis limited to the limbs. Biopsies revealed follicular pustules, gross interfollicular fibrosis with plasma cells and concentric perifollicular fibrosis with lymphocytes, all features seen with folliculitis decalvans. The positive response to antibiotics combined with topical corticosteroids mirrored the response seen with scalp folliculitis decalvans. In contrast to the previously reported cases, the patient had no evidence of folliculitis decalvans on the scalp.

Investigation on Microecology of Hair Root Fungi in Androgenetic Alopecia Patients.

BACKGROUND: This study focused on the differences in hairy root fungal microecology between androgenetic alopecia patients and healthy individuals. METHODS: Light microscopy was used to observe the morphology of hairy roots. Morphological observations were also performed in the positive specimens using scanning electron microscopy and transmission electron microscopy. The high-throughput sequencing method was used to detect the fungal microecology of hairy roots at different sites. Moreover, the comparison of fungal loads of Malassezia in different group and scalp area were tested by PCR. RESULTS: The fungi in the hair root observed by optical microscopy are mainly Malassezia yeast. The positive rate of Malassezia in the hair loss group (60%) was higher than that in the control group (40%). The detection efficiency of Malassezia examined by scanning electron microscopy was higher than that by light microscopy. Results acquired from high-throughput molecular sequencing of fungi suggested that Ascomycota was the dominant species, whereas in the occipital hair roots of the control group Basidiomycota was the dominant species in the hair loss group. Malassezia followed by Trichosporon were the most abundant fungal genera. The changes in abundance at the top and occipital region of the control group were more significant than those of the genus Fusarium, followed by Epicoccum and Malassezia. The load of Malassezia located on calvaria in the alopecia group was significantly higher than that in the control group. In the alopecia group, the load of Malassezia on the scalp was higher than that on the occipital region. The load of Malassezia globosa and Malassezia restricta in the hair loss group was higher on calvaria and occipital areas. CONCLUSION: Malassezia had a positive correlation with the incidence of androgenic alopecia.

Microbiome in the hair follicle of androgenetic alopecia patients.

Androgenetic alopecia is the most common form of hair loss in males. It is a multifactorial condition involving genetic predisposition and hormonal changes. The role of microflora during hair loss remains to be understood. We therefore analyzed the microbiome of hair follicles from hair loss patients and the healthy. Hair follicles were extracted from occipital and vertex region of hair loss patients and healthy volunteers and further dissected into middle and lower compartments. The microbiome was then characterized by 16S rRNA sequencing. Distinct microbial population were found in the middle and lower compartment of hair follicles. Middle hair compartment was predominated by Burkholderia spp. and less diverse; while higher bacterial diversity was observed in the lower hair portion. Occipital and vertex hair follicles did not show significant differences. In hair loss patients, miniaturized vertex hair houses elevated Propionibacterium acnes in the middle and lower compartments while non-miniaturized hair of other regions were comparable to the healthy. Increased abundance of P. acnes in miniaturized hair follicles could be associated to elevated immune response gene expression in the hair follicle.

Alopecia sifilítica de cejas y pestañas / Syphilitic Alopecia of the Eyebrows and Eyelashes

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Extensive tinea capitis and corporis in a child caused by Trichophyton verrucosum.

A 3-year-old boy presented with multiple lesions of tinea corporis with dermatophytids, and subsequent inflammatory lesions with alopecia on the scalp. At the beginning, topical clobetasone butyrate was prescribed. The infection was diagnosed as dermatophytosis on the basis of positive direct microscopy and fungal culture. The etiological agent was isolated from all sampled sites and identified as Trichophyton verrucosum. Clonal nature of the infection was confirmed by random amplified polymorphic DNA (RAPD) analysis. The child lived in close vicinity of cattle. He was successfully treated with itraconazole.

A case report of tinea capitis in infant in first year of life.

BACKGROUND: Tinea capitis is a cutaneous fungal infection common among 3 to 7 year old children but it is rare in the first year of life. CASE PRESENTATION: We present a case of a 12-month-old infant with erythematous scalp lesions combined with hair loss. He was suspected of dermatophytosis and mycological analysis of all suspected lesions was performed. Clinical features and culture results confirmed tinea capitis caused by Microsporum canis. The infant patient was treated with griseofulvin for 2 months. However, 15 days later at the end of treatment he presented with a single vesicle positive for M. canis. Griseofulvin therapy continued for another month. After 3 months of follow-up, no recurrence was observed. CONCLUSIONS: In infant, sometimes tinea capitis is misdiagnosed and underreported because it is similar to other scalp pathologies. Therefore, if erythematous scalp lesions are present, they must be examined from a mycological point of view to inform the differential diagnosis. Once diagnosed, treatment of tinea capitis can pose a dilemma because different factors may influence the choice between equally effective therapies (i.e. safety, age, formulation, cost). This case report suggests that it is important to establish an accurate diagnosis and  treatment for this dermatophytosis to avoid recurrences or therapeutic failures, especially in infants.

Systemic photodynamic therapy in folliculitis decalvans.

Folliculitis decalvans (FD) is classified as a primary neutrophilic cicatricial alopecia, and is estimated to account for approximately 10% of all cases of primary cicatricial alopecia. The role of dysfunctional immune activity and the presence of bacteria, particularly Staphylococcus aureus, appear pivotal. We describe a 26-year-old man with a 4-year history of FD that was recalcitrant to numerous systemic and topical therapies, whose disease was virtually cleared during a follow-up of 25 months following a course of treatment with systemic photodynamic therapy (PDT) using ultraviolet light (100-140 J/cm2 ) with porfimer sodium 1 mg/kg as monotherapy. This is the first report of the use of systemic PDT as a treatment for FD. Systemic PDT has potent antibacterial effects with little or no resistance. In addition, systemic PDT provides local immunomodulation and improved scar healing. Significant adverse effects following systemic PDT with appropriate aftercare are rare. This case demonstrates that systemic PDT is a useful therapy option in the treatment of recalcitrant FD.

Alopecia as unique clue to syphilis in a patient.

Alopecia is an uncommon manifestation of syphilis, simulating other common forms of hair-loss, but representing a crucial complaint for the patient, who might by converse have not noticed other signs and symptoms of the disease. Esthetic issues undervaluation might prolong illness, and postpone appropriate treatment. A 42-year-old patient, HIV negative, presented with a 2-month history of progressive generalized thinning of the hairs and small non-scarring irregular alopecia patches of the parietal-occipital areas of the scalp. The patient was under sertraline hydrochloride therapy for a recent diagnosis of bipolar disorder, and expressed the concern that the drug was causing the hair-loss. Accurate anamnesis and visiting of the patients revealed asymptomatic pale pink speckles of the trunk and limbs, and a bilateral psoriasis-like palmo-plantar hyperkeratosis, suggestive of secondary syphilis, further confirmed by serology. Specific antibiotic treatment healed all skin and scalp manifestations, but also the moodiness disorders, which allowed complete psychiatric drug dismissing. Skilled expertise and careful patient's examination are the clue to recognize minimal signs of serious systemic disease, such as syphilis, considered disappeared for decades. The risk of minimizing esthetic complaints, such as hair-loss can deceive a not trained eye, or escape in busy daily practice. Physicians should maintain a high level of clinical suspicion to contain the disease burden, especially among heterosexual apparently not at risk patients.