Ana Rita Rodrigues-Barata

Frontal fibrosing alopecia: A multicenter review of 355 patients

BACKGROUND To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. OBJECTIVE We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. METHODS This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. RESULTS In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). LIMITATIONS The retrospective design is a limitation. CONCLUSIONS Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

N-acetylcysteine in the treatment of trichotillomania

Trichotillomania is as medical condition caused by the patient himself by pulling out of is own hair, resulting in a perceptible hair loss pattern that frequently is associated with other psychiatric processes. Generally has a chronic course in most patients, and a challenging therapeutical management. There are several available options for is treatment, but the clinical response is not satisfactory in many patients. Recently, N-acetylcisteine, a glutamate modulator, has shown efficacy in the treatment of trichotillomania and other compulsive behaviors, and is considered a new alternative in the management of this condition. We describe two patients with trichotillomania successfully treated with N-acetylcysteine. Nevertheless, further studies need to be conducted to establish the appropriate treatment regimen and to evaluate it long-term efficacy in improving this chronic condition.

Trichoscopic features of frontal fibrosing alopecia: Results in 249 patients

To the Editor: Currently, dermoscopy constitutes an essential noninvasive tool for dermatologists. It helps discern between different types of alopecia, it provides a more precise follow-up, and it can be used to identify an adequate biopsy site. Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia with a distinctive clinical pattern of progressive frontotemporal hairline recession and eyebrow loss that mainly affects postmenopausal women. The main objective of our study was to describe the trichoscopic features of FFA in a large series of patients and to correlate these findings with several relevant parameters of FFA. We performed a descriptive, retrospective, observational, multicenter study of digital trichoscopic images, obtained between 1994 and 2013, of 238 women with FFA at 12 Spanish centers. Diagnostic criteria included typical clinical signs and/or histopathologic features consistent with FFA. Images were obtained with either a nonpolarizing or a polarizing dermoscope. Two dermatologists expert in dermoscopy evaluated the images if the registered trichoscopic features of FFA (cicatricial white patches, perifollicular erythema, follicular hyperkeratosis, lonely hairs, and hair diameter diversity) and yellow dots typical of androgenetic alopecia were present on the frontotemporal hairline. Both a descriptive and an analytic study to correlate these parameters with the degree of severity and other clinical variables were performed using SPSS 15.0 software. Clinical and severity variables included female pattern hair loss (FPHL), presence or absence of menopause, FFA severity (I: 1 cm, II: 1-2.99 cm, III: 3-4.99 cm, IV: 5-6.99 cm, and V: [7 cm), and years of evolution, pruritus, trichodynia, facial papules, occipital involvement, eyebrow and eyelash loss, pubis hair loss, and body hair involvement. A bivariate analysis including trichoscopic findings and the aforementioned variables was carried out, and those variables with statistical significance in X test were included in a multivariate logistic regression analysis adjusted for age and excluding lost cases. No new dermoscopic signs were found. Descriptive dermoscopic results are listed in Table I. Both the intraobserver and interobserver agreement for the assignment of a dermoscopic pattern for each lesion were excellent (! 1⁄4 0.82, P\.001; ! 1⁄4 0.80, P\.001, respectively). The trichoscopic features that were statistically significantly associated (P \ .05) with some clinical parameters in the bivariate and multivariate logistic regression analysis are listed in Table II. Dermoscopic features of FFA have previously been described in some isolated studies. Toledo-Pastrana et al retrospectively analyzed the dermoscopic images of 79 patients with FFA. They found that 100% of the patients showed no follicular openings, 72.1% showed follicular hyperkeratosis, 66.3% showed perifollicular erythema, and 44.8% showed follicular plugs. Interestingly, they also found that perifollicular erythema was statistically associated to the activity of FFA. In our study, we correlated the dermoscopic features with another outcome: the severity of the disease in terms of extension of the hairline. Remarkably, we found that the presence of cicatricial white patches was statistically associated with the severity of FFA. This dermoscopic feature correlates with the histopathologic findings of hair follicle destruction and severe tissue fibrosis. Therefore, it

Folliculitis decalvans: a multicentre review of 82 patients

Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challenge for dermatologists.

Frontal fibrosing alopecia: clinical and prognostic classification

Frontal fibrosing alopecia (FFA) is a chronic scarring alopecia with an unpredictable evolution. There are no current classifications of this disease that may predict its prognosis.

Depression of the frontal veins: A new clinical sign of frontal fibrosing alopecia.

Fig 2. Frontal fibrosing alopecia. Histopathologic findings of a biopsy from a depressed frontal vein in a patient with frontal fibrosing alopecia. Panoramic view: intense dermal atrophy and dermal fibrosis with a dilated vascular structure in the subcutaneous tissue corresponding to the frontal vein. An erector pili muscle can be observed in the dermis. (Hematoxylin-eosin stain.) J AM ACAD DERMATOL VOLUME 72, NUMBER 6 Letters 1087

Beard alopecia areata: a multicentre review of 55 patients.

Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics.

Frontal fibrosing alopecia and cutaneous comorbidities: A potential relationship with rosacea

baseline to 40 at study end (Fig 1). Of the nonoccluded warts, 57% (22/38) showed a partial reduction in size; they were reduced by 42% in size (Fig 1). Of the occluded warts, 50% (8/16) showed a partial reduction (45% reduction) in size (Fig 1). There was no correlation between wart clearance or reduction in wart size and other variables, such as sex or age. On the satisfaction survey, 11 of 16 subjects stated that the wart treatment was tolerable or very tolerable. In addition, 7 of 16 subjects preferred this treatment over previous topical treatments or office procedures. All subjects experienced application-site reactions (eg, swelling, vesiculation, pustulation); however, these were clinically resolved during short-term follow-up at 3 to 4 weeks. No adverse effects were reported. In this study, a 2-day treatment of verruca vulgaris on the hands or fingers with ingenol mebutate gel, 0.05%, was associated with an overall 26% reduction in wart count and with a 44% reduction in wart size. Thus, ingenol mebutate may provide clinical benefits for patients with common warts. The optimal protocol for the use of ingenol mebutate in the treatment of warts will require further study.

Steroid-Induced Changes Noted On Trichoscopy Of Patients With Frontal Fibrosing Alopecia

In summary, both apremilast monotherapy and combination therapy result in favorable 52-week maintenance of therapeutic response in approximately two thirds of patients, with minimal mild-to-moderate AEs during weeks 16-52 of treatment. As such, physicians can consider using apremilast in combination with biologic or systemic agents for long-term maintenance of disease control in patients presenting with challenging psoriasis that cannot be controlled with 1 agent alone.

Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up

Background Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge. Objectives To describe the therapeutic response in a large number of cases of FD with long‐term follow‐up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response. Methods This multicenter prospective study included patients with FD who had a minimum of 5 years of follow‐up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms. Results A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found. Limitations Because FD is a rare disease, the main limitation was the sample size. Conclusions An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.