Colombina Vincenzi

The role of scalp dermoscopy in the diagnosis of alopecia areata incognita

BACKGROUND Alopecia areata incognita is a variety of alopecia areata characterized by acute diffuse shedding of telogen hairs without typical patches. OBJECTIVE We sought to report the clinical, pathological, and dermoscopic features of alopecia areata incognita. METHODS Seventy patients with alopecia areata incognita were evaluated clinically and with videodermoscopy during the period of 2002 to 2006. Pathology was performed in 50 patients. RESULTS The presence of numerous, diffuse, round or polycyclic yellow dots, different in size and uniform in color and distribution, was a typical dermoscopic feature in all patients. Short regrowing hairs were also present. The dermoscopic findings were correlated and supported by the histologic features of the scalp specimens. LIMITATIONS Scalp biopsy was performed only in 50 patients. CONCLUSION Videodermoscopy is a first step before performing a biopsy. It can help the clinician to find the right place to take the sample, but can also avoid unnecessary biopsies.

Euxyl K 400: incidence of sensitization, patch test concentration and vehicle

The aim of this study was to verily the most suitable vehicle and concentration for testing Euxyl K 400 and its individual ingredients, and to evaluate the prevalence of sensitization to this preservative over the years in Italy. From January 1991 to October 1994. Euxyl K 400 2.5% pet, was positive in 99 patients (35 male. 64 female) out of 3455 (2.8%.). Of these, 22 out of 855 patients had a positive reaction during 1991 (2.6%), 29 out of 1037 in 1992 (2.8%), 28 out of 858 in 1993 (3.3%), and 20 out of 705 in 1994 (2.8%). 51 of the 99 patients with a reaction to Euxyl K 400 2.5% pet, showed a positive reaction to dibromodicyanobutane 0.5% pet, and 2 to phenoxyethanol 5% pet. The results of patch testing with serial dilutions of Euxyl K 400 in different vehicles indicate that water is a good vehicle for testing the preservative. However, since Euxyl K 400 is only hydrosoluble to a limited extent, the maximum concentration that can be tested using water is 0.5% and so with this concentration about 40% of sensitized patients are missed. The results of patch testing with serial dilutions of Euxyl K 400 in petrolatum demonstrate that concentrations lower than 2.5% are not suitable for detection of all sensitized patients. Euxyl K 400 in ethanol frequently causes irritant reactions without offering significant advantages in detecting sensitized patients.

Histological features of peripilar signs associated with androgenetic alopecia.

BackgroundA study of the scalp in a large cohort of volunteers with androgenetic alopecia using macrophotographs showed the presence of peripilar signs (PPS) around the hair ostia.ObjectiveThe aim of the present study was to establish the histopathological features related to PPS.DesignProspective clinicopathological study.SettingDepartment of Dermatology, University Hospital of Bologna.PatientsA group of 40 patients (21 males and 19 females) participated in the study. Macrophotographs of the scalp were taken using a Dermaphot camera and PPS were scored using a three-point scale. Hair density and PPS were clinically scored according to reference scales. Two punch biopsies from the photographed area were obtained from each subject and histological analysis was performed on vertical and horizontal sections.ObservationsClinical parameters indicated that PPS were already detectable on scalp with high hair density. Moreover, in patients with high hair density (score >4), a significant relationship was found between the PPS score and the global score for perifollicular infiltrates. Thus PPS are linked to superficial perifollicular lymphocytic infiltrates in early androgenetic alopecia.ConclusionsPPS could be the clinical signs reflecting the presence of perifollicular infiltrates.

Adalimumab-induced psoriasis of the scalp with diffuse alopecia: A severe potentially irreversible cutaneous side effect of TNF-alpha blockers

To the Editor: Anti-tumor necrosis factor (TNF) agents have revolutionized the treatment of chronic inflammatory bowel disease. Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks TNF-alpha (TNF-a) and has been successfully used in the treatment of Crohn’s disease (CD). Regimens with early use of biologic therapy are under discussion because they might alter the natural history of CD. Physicians treating patients with TNF-a blockers should be aware that possible complications of biologic therapy are not only opportunistic infections and the development of malignant tumors, but also cutaneous side effects. In the recent literature there is evidence that adalimumab may induce psoriasis in individuals who have no personal or family history of psoriasis. Clinical presentations include plaque or guttate psoriasis or palmoplantar pustulosis. We herein report two cases of severe and diffuse alopecia due to scalp psoriasis. Psoriasiform alopecia under adalimumab therapy may be severe and diffuse and, most important, irreversible. A 19-year-old woman with a 3year history of CD was started on adalimumab monotherapy (40 mg, every 2–3 weeks) after failing to respond to various therapy regimens, including mesalofalk, azathioprine, and infliximab. Three months after the initiation of adalimumab the patient observed diffuse alopecia and erythematous scaly plaques on the scalp, abdomen, trunk, and extremities. Clinical examination revealed intense erythema with exudative discharge and severe alopecia over most of the scalp (Fig. 1a). Two biopsies from the scalp showed the characteristic features of psoriasis, without any evidence of a scarring alopecia. The scalp lesions cleared with complete hair regrowth after withdrawal of adalimumab. The second patient was a 31year-old woman with a 2-year history of CD. Treatment with sulfasalazine

Contact allergens and irritants in household washing and cleaning products.

Background: Household cleaning products often contain potential allergens and irritants but allergic contact dermatitis from these products in general consumers is rarely reported in the literature.

Permanent alopecia after busulfan chemotherapy

Systemic chemotherapy is a well known cause of reversible hair loss. Busulfan chemotherapy, however, is responsible for a permanent alopecia that usually occurs in bone marrow transplant patients. We report two patients with permanent alopecia due to busulfan chemotherapy. Both patients had a diffuse alopecia characterized by greatly reduced hair density with short, thin hair. The pathology showed reduced follicular density in the absence of fibrosis, suggesting that alopecia may result either from hair follicle stem cell destruction or from acute damage to the keratinocytes of the lower portion of some follicles.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Hair casts are a dermoscopic clue for the diagnosis of traction alopecia.

FCAS was infiltrated with IL-17-positive cells, which appeared to be neutrophils. This is the first report of IL-17 expression in an urticarial lesion of a patient with FCAS. In conclusion, we hypothesize that the urticarial rash in FCAS is induced by IL-1b as a result of NLRP3 activation; IL-1b activates Th17 cells leading to IL-17-associated neutrophil recruitment into the dermis. In addition, the neutrophil infiltrate might secrete more IL-17, and cause further inflammation. The blockage of IL-1b by anakinra provides therapeutic benefit for patients with CAPS; however, long-term benefit and safety data are needed. We speculate that IL-17 might be a potential therapeutic target.

Sensitization to thimerosal in atopic children

Thimerosal is an organic mercurial compound widely used as a preservative in vaccines, eyedrops, and contact lens cleaning and storage solutions. 5 infants, 2 female and 3 male, ranging in age from 7 to 28 months and affected by atopic dermatitis (AD) diagnosed according to the Hanifin and Rajka criteria, experienced an exacerbation of their clinical condition 2–10 days after mandatory vaccinations with vaccines containing thimerosal. Cutaneous lesions of nummular eczema appeared on the trunk, limbs and face. All patients were patch tested with serial dilutions of thimerosal in petrolatum. A positive patch test reaction to thimerosal 0.1% pet. was observed in all 5 children. 3 of them also showed a positive reaction at 0.01% and 0.05% pet. Despite their thimerosal‐hypersensitivity, all children completed the entire series of mandatory vaccinations, care being taken to use different needles for injection and aspiration of the vaccine. The 2‐year follow‐up did not reveal other episodes of exacerbation of the AD after vaccination. The present study confirms the high frequency of sensitization to thimerosal in atopic children and suggests that vaccination can cause clinical symptoms in sensitized children. Nevertheless, sensitization to thimerosal does not prevent children from continuing with mandatory vaccinations.

Permanent alopecia after systemic chemotherapy: A clinicopathological study of 10 cases

Anagen effluvium due to chemotherapy is usually reversible with complete hair regrowth. However, there is increased evidence that certain chemotherapy regimens can cause dose-dependent permanent alopecia. The histological features of this type of alopecia and the mechanisms of its origin are not known yet. We discuss the histological features of 10 cases of permanent alopecia after systematic chemotherapy with taxanes (docetaxel) for breast cancer (6 patients), busulfan for acute myelogenous leukemia (3 patients), and cisplatin and etoposide for lung cancer (1 patient). All patients had moderate to very severe hair thinning, which in 4 cases was more accentuated on androgen-dependent scalp regions. Patients complained that scalp hair did not grow longer than 10 cm and showed altered texture. Paired scalp biopsies from the affected scalp areas were obtained and evaluated in serial horizontal and vertical sections. The histology of all specimens was characterized by a nonscarring pattern with a preserved number of follicular units and lack of fibrosis. The hair count revealed decreased number of terminal hairs, increased telogen hairs, and increased miniaturized vellus-like hairs with a terminal to vellus and anagen to telogen ratios of 1:1 and 3.6:1, respectively. There was increased number of fibrous streamers (stelae) in both reticular dermis and subcutis. Arao-Perkins bodies were found in the subcutaneous portions of the streamers. The histological findings of permanent alopecia after chemotherapy are those of a nonscarring alopecia similar to androgenetic alopecia. Dermatopathologists should be aware of this condition as the absence of fibrosis and the presence of miniaturized hairs may be considered as features consistent with a diagnosis of androgenetic alopecia. Hence, these cases could easily be misdiagnosed in the absence of a good clinicopathological correlation.