Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris

The aim of the treatment in frontal fibrosing alopecia and lichen planopilaris is to alleviate symptoms and to arrest the progression of the hair loss, since hair regrowth is not possible once the destruction of hair follicle has happened. Topical corticosteroids and tacrolimus are used to reduce inflammation, but with no clear benefit in slowing the alopecia. Intralesional corticosteroids may obtain hair regrowth in some patients, and they are especially useful in the treatment of eyebrow alopecia in frontal fibrosing alopecia. Regarding systemic treatments, the use of 5-alpha reductase inhibitors has been shown to be the most effective one to get stabilization in frontal fibrosing alopecia and even regrowth in the hairline. Hydroxychloroquine and oral immunomodulators are especially helpful as oral treatment in lichen planopilaris. Low-dose oral isotretinoin is the preferred treatment for facial papules in frontal fibrosing alopecia. The combination of oral and topical treatments is the best therapeutic choice

Frontal Fibrosing Alopecia: A Review

This article is part of the Ph.D. thesis of María Librada Porriño-Bustamante.Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review

Frontal Fibrosing Alopecia and Sunscreen Use: A Cross-sectional Study of Actinic Damage

Patients with frontal fibrosing alopecia report higher rates of sunscreen use than control subjects. However, it is not known whether the higher use of sunscreens is a cause or a consequence of the alopecia. A greater use of sunscreens should be associated with a lower incidence of signs of actinic damage. The aim of this study is to assess the presence of actinic damage in patients with frontal fibrosing alopecia. A cross-sectional study was carried out on 101 patients with frontal fibrosing alopecia and 40 control subjects. The presence of actinic damage, in the form of solar lentigines, actinic keratoses, and basal and squamous cell carcinomas, was recorded in both groups, together with sunscreen use. Trichoscopy and skin biopsy were performed on patients. Actinic damage was present more frequently in patients with frontal fibrosing alopecia (69.3%) than in control subjects (50%) (p = 0.031). Patients used sunscreens more frequently than did control subjects (83.2% vs 62.5%, p = 0.008). However, the prevalence of trichoscopic inflammatory signs, peripheral alopecia, and inflammatory infiltrate and sebaceous gland involvement in skin biopsy, were similar in patients who used sunscreens and those who did not use them. In conclusion, patients with frontal fibrosing alopecia had greater actinic damage than did control subjects, and this is hypothesized as a reason for the higher use of sunscreens among patients. Thus, use of sunscreens may not be the trigger for frontal fibrosing alopecia that dermatologists have proposed

Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp

Frontal fibrosing alopecia is characterized by the presence of a lymphocytic inflammatory infiltrate around the upper follicle and by perifollicular fibrosis, which results in the destruction of the hair follicle. Recent reports have also found the presence of those findings in clinically unaffected areas. The aim of this report is to perform a deeper analysis of the histopathological features of this apparently unaffected scalp. A cross-sectional study including 52 women with frontal fibrosing alopecia was performed. Two areas were biopsied: the frontal hairline and a normal-appearing scalp area. Sebaceous glands were reduced/absent in 80.8% of the frontal hairline samples compared to 42.3% of the “healthy scalp” samples (p = 0.001). Inflammatory infiltrate was observed in 92.3% of patients in the frontal hairline and in 86.5% of them in the “healthy scalp” area (p = 0.508), although the severity was higher in the former (p = 0.013). Follicular epithelium changes were seen in 70.6% of the frontal hairline biopsies compared to 48.1% of the “healthy scalp” biopsies (p = 0.012). Fibrous tissular changes were noted in 80.8% and 53.8% of the frontal hairline and “healthy scalp” biopsies, respectively (p = 0.003). In conclusion, the histopathological features of frontal fibrosing alopecia are shared by both affected and clinically unaffected areas

Epidemiological nevi study on students from the school of medicine of the Granada University

Introducción: El número y características de los nevus melanocíticos son el principal factor de riesgo para Melanoma y han sido considerados marcadores y precursores de esta patología. En la etiología de estos nevus se han involucrado factores genéticos y ambientales (exposición a radiación ultravioleta). Nuestro grupo ha realizado numerosos estudios acerca de nevus en diferentes grupos etarios excepto en adultos jóvenes. Objetivos: Conocer el número y características de los nevus en una población universitaria y establecer la relación entre dichos nevus con factores genéticos y ambientales, para extraer conclusiones y modelos preventivos del cáncer de piel. Materiales y Métodos:Se diseño un estudio observacional de los nevus, en la población estudiantil de la Universidad de Granada, en 333 sujetos, entre 18 y 25 años, se recogieron datos personales, actitud hacia el bronceado, antecedente de quemadura solar en el último año y se hizo una exploración clínica completa. Resultados: Encontramos un numero medio de nevus comunes de 100,46 en mujeres y 107 en hombres, siendo mayor en sujetos con IMC >25, localizados principalmente en tronco (36,15%), con un tamaño predominante menor de 2mm (66,43 en mujeres y 64,79 en hombres). El 74,7% de la muestra prefiere estar bronceados, con un 40,8% de antecedente de quemadura solar en el último año. Además los estudiantes con fototipo mas bajo presentaron menos quemaduras solares (r= - 0,269 p< 0,0001). Conclusiones: A diferencia de lo que ocurre en otros grupos etarios, el número de nevus no está asociado a la edad, sexo ni antecedentes personales de quemadura solar. La presencia de quemadura solar es elevada en este grupo de individuos al igual que ocurre en otros grupos etarios. Es llamativa la relación existente entre el IMC y el número de nevus.Introduction: The number and characteristics of melanocytic nevus are the main risk factor for melanoma, and they have been considered trendsetter and precursor of this pathology. Various genetic and environmental (exposure to the ultraviolet radiation) factors have been involved in the etiology of these nevus. Our group has executed numerous studies about nevus in different groups of age, except in young adults. Objectives: Get to know the number and characteristics of the nevus in a university population, and establish the relationship between those nevus with genetic and environmental factors, in order to draw conclusions and extract preventive models of skin cancer. Materials and Methodology: An observational study of the nevus was designed in a student population of the University of Granada, 333 individuals, between 18 and 25 years old. Personal data was collected as well as the attitude towards suntan, sunburn history in the last year and a complete clinic exploration was performed. Results: It was found that an average number of common nevus of 100,46 in women and 107 in men, being higher in individuals with BMI >25, located mainly in the trunk (36,15%, with a prevailing smaller size than 2mm (66,43 in women and 64,79 in men). 74,7% of the sample studied prefers to be suntanned, and 40,8% has sunburn history in the last year. Besides these facts, the students with lower phototype showed less sunburn (r= - 0,269 p< 0,0001). Conclusions: In contrast with what happens to other age groups, the number of nevus is not associated to the age, sex, or to personal sunburn history. Sunburn is high in this group of individuals, the same which occurs in other age groups. The most striking aspect of this study is the relationship between BMI and the number of nevus

Urticarial vasculitis: a retrospective study of 20 cases and diagnostic-therapeutic protocol

La urticaria vasculitis es una enfermedad crónica que se caracteriza por episodios urticariales o de angioedema que puede asociarse a niveles bajos de complemento. Hemos realizado un estudio descriptivo retrospectivo que incluye a 20 pacientes con urticaria vasculitis diagnosticados en los últimos 5 años donde analizamos los síntomas más frecuentes y los tratamientos que se han empleado. A continuación se ha diseñado un protocolo diagnóstico-terapéutico de Urticaria Vasculitis para orientar el manejo de estos pacientes, en el que se incluye una breve definición de esta entidad así como las enfermedades y fármacos a los que se puede asociar.The urticarial vasculitis is a chronic disease characterized by urticarial or angioedema episodes that may be associated with low levels of complement. We conducted a retrospective study including 20 patients with urticaria vasculitis diagnosed in the last 5 years where we analyze the most common symptoms and treatments that have been used. Then there has been a diagnostic and therapeutic protocol Urticaria Vasculitis which helps the management of these patients which includes a brief definition of illness and disease and drugs that may be associated

A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia.

Frontal fibrosing alopecia has been related to some autoimmune diseases, but the association with rosacea is not clear. The objective of this study was to analyse the prevalence of rosacea in a group of patients with frontal fibrosing alopecia. A cross-sectional study, including 99 women with frontal fibrosing alopecia and 40 controls, was performed, in which clinical, dermoscopic and hormonal data were analysed. Women with frontal fibrosing alopecia presented a higher prevalence of rosacea than the controls did (61.6% vs. 30%, p = 0.001), especially those with severe grades of alopecia (77.8% in grade V vs. 33.3% in grade I, p = 0.02). Binary logistic multivariate analysis showed that perifollicular erythema (odds ratio (OR) 8.5; 95% confidence interval (95% CI) 1.73-42.30), higher body mass index (OR 1.16; 95% CI 1.01-1.34) and lower progesterone levels (OR 0.15; 95% CI 0.028-0.89) were associated with a higher risk of rosacea in patients with frontal fibrosing alopecia. In conclusion, patients with frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls. Perifollicular erythema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibrosing alopecia

Adalimumab Treatment for SAPHO Syndrome

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