María José García-Hernández

Alopecia Areata, Stress and Psychiatric Disorders: A Review

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.

Alopecia areata: psychiatric comorbidity and adjustment to illness

Background Decades ago, alopecia areata (AA) was regarded as a well‐known example of psychosomatic disease. The poor development of measurement methods and criteria for the classification of psychiatric disorders at that time was probably partly to blame for the lack of methodologic validity of some studies.

Sebaceus naevi: a clinicopathologic study

Objective To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study.

Congenital Triangular Alopecia (Brauer Nevus)

Abstract: Congenital triangular alopecia is manifested at 3 to 5 years of age by unilateral or, less frequently, bilateral patches of alopecia in the frontotemporal region. At this age the differential diagnosis is important, particularly as regards alopecia areata. Only about 47 cases have been reported, probably because the lesion is benign and nonprogressive. In 6200 patients seen in index visits, we found 7 with triangular alopecia, a frequency of 0.11%. We believe that males do not require treatment because of the later development of androgenic alopecia, but in women, surgical treatment is successful.

Psychological features of androgenetic alopecia

Objective To evaluate the psychological features of subjects with male (MAGA) and female androgenetic alopecia (FAGA).

Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under 26 years old.

Background  Finasteride is a 5α‐reductase inhibitor that has proved to be an effective treatment for men with androgenetic alopecia.

Occupational contact dermatitis from anethole in food handlers.

Case no. I. A 39-year-old woman presented with dermatitis on both hands, which had resisted treatment for 20 years, and clearly worsened at work, where she cooked traditional Seville cakes. Lesions spread up the forearms, and rhinitis and blepharitis ocurred whenever she entered the cake factory. Her lgE level was normal. Patch tests with the GEIDC standard series, fragrances, plants, cake ingredients (flour, yeast, sugar, honey, salt, anise oil and sesame) were performed, with a + + reaction only to anise oil (5% o.o.) at 2 and 4 days. Anethole, the main component of anise oil, gave a + + reaction in the patient at 5% pet. on D2 and D4.

Ofuji papuloerythroderma in an elderly woman with atopic erythroderma.

To the Editor A 9-year-old Caucasian girl was referred to our clinic for hyperpigmented macules on her face and body. Four years previously subcutaneous nodules that had appeared on her knees and the occipital area were diagnosed as Schwannomas histologically. The ‘brownish’ skin lesions on her face, legs and sacral area, present since birth, were thought to be café-au-lait macules and the diagnosis was neurofibromatosis. The nodules that were not excised had curiously disappeared over time. Later, her mother became concerned when more macular lesions appeared on her arms and legs and the girl was referred to us. When questioned, the child complained of bone pain, occasional pruritus and urticaria. Physical examination revealed light pinkish-brown macules with tiny telangiectatic vessels close to the periphery of the lesions, the biggest ones on the sacral and right preauricular area, measuring 8 cm and 5 cm in diameter, respectively (figs 1 and 2). These ‘congenital’ lesions were warmer than the adjacent normal skin and neither the normal (dermographism) nor the lesional (Darier’s sign) skin urticated on stroking. The lesions did fade slightly with diascopy. The newly appearing lesions were smaller tan macules with few or no telangiectasia and were not warm. There were two new subcutaneous lesions on the left elbow. The liver was slightly enlarged on palpation and ultrasonographically. There was no splenomegaly or lymphadenopathy. Serum levels of liver transaminases and alkaline phosphatase were slightly above normal limits. Two per cent basophilia was noted on the peripheral blood smear. The results of the other laboratory tests and imaging studies, including biochemical analyses, protein electrophoresis, blood coagulation tests, hepatitis serology, cranial magnetic resonance imaging, chest X-rays, bone scan, bone marrow aspiration and biopsy were within the normal limits. A 24-h urine collection for methylimidazoleacetic acid was within normal limits. Because of the lack of permission from the parents, bone and liver biopsies were not performed. Histopathological examination of the macule on the sacral area showed hyperpigmentation in the basal layer, superficial perivascular inflammatory infiltrate with scattered spindle-shaped mast cells and telangiectatic dermal vessels (figs 3 and 4). A diagnosis of telangiectasia macularis eruptiva perstans (TMEP) was suspected. The most frequent site of organ involvement of mastocytosis is the skin. TMEP is generally agreed to be cutaneous mastocytosis, an uncommon variant of urticaria pigmentosa. 1 It appears most frequently in adults and only rarely affects young children or infants. Systemic involvement is more common in adult forms of mastocytosis. 2 Systemic signs and symptoms depend on the specific organ system affected. Bone pain in the legs of our patient was the only complaint that can be considered a systemic manifestation of mastocytosis, and it is

Is Aberrant Mammary Tissue a Marker for Chronic Alcoholism or Kidney-Urinary Tract Malformations?

Background: Numerous publications describe the relationship between aberrant mammary tissue (AMT) and kidney-urinary tract malformations, individual/ familial alcoholism and sense organ disorders. Patients and Methods: We investigated these possible associations and reviewed 72 cases observed in our Department during the past 3 years: 30 men and 42 women, 17 of them with bilateral AMT (7 men and 10 women) and 25 patients from 9 families. Diagnosis was made according to Kajawa’s classification. A detailed family history was performed asking for individual or familial alcoholism, especially in the mother, in addition to blood tests and ultrasonographic examination of the abdomen and the kidneys. Results: We only found 1 family history of alcoholism in 3 families, but in the father, never in the mother or the affected subject. No congenital/ hereditary nephrourinary defects or sense organ disorders were found. Conclusions: We believe that in our population AMT is not a marker for alcoholism, kidney-urinary malformations nor sense organ disorders.

Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain

Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge.