1/121. Diffuse alopecia with stem cell folliculitis: chronic diffuse alopecia areata or a distinct entity? A 34-year-old woman presented with an 8-year history of slowly progressive diffuse nonscarring alopecia with loss of hair density. scalp biopsy specimens showed increased miniaturized follicles and an asymmetric wedge-shaped lymphocytic infiltrate concentrated on the stem cell-rich region at the point of entry of sebaceous ducts and at bulge-like regions of multiple follicles. Several hair bulbs emerging at the stem cell compartment also were inflamed, but the hair bulbs in the deeper dermis and subcutis were spared. I speculate whether these findings may represent a stem cell folliculitis similar to the reaction pattern previously observed in graft versus host disease and in androgenetic alopecia. The additional presence of peribulbar lymphocytic inflammation could indicate that the patient had a variant of alopecia areata. The clinical presentation of a slowly progressive diffuse alopecia without progression to clinically recognizable alopecia areata and the prominent lymphocytic inflammation involving the stem cell compartment may prompt a reexamination of similar cases currently classified as chronic diffuse alopecia areata. The concept that lymphocytes can inhibit stem cell function without destroying the stem cells themselves needs consideration. ( info) |
2/121. Simultaneous onset of alopecia areata and idiopathic thrombocytopenic purpura: A potential association? alopecia areata (AA) has been associated with a variety of autoimmune diseases. Immune thrombocytopenic purpura (ITP) is an autoimmune disease marked by isolated thrombocytopenia. We present a young girl with the simultaneous onset of AA and ITP. To the best of our knowledge, this association has not previously been reported. We hypothesize that ITP may be one of many autoimmune diseases associated with AA via antibodies that cross-react between platelet membrane glycoproteins and follicular glycoproteins. ( info) |
| keratoconus is a progressive non-inflammatory corneal ectasia. alopecia areata is complete loss of hair patches on the hairy areas of the body in association with some ocular manifestations such as cataract, or disorders of the conjunctiva, iris, lens, choroid and retina pigment epithelium. A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years. The possible association of keratoconus with multisystem autoimmune disease is discussed. ( info) |
| A 12-year-old boy with common variable immunodeficiency (CVI) who developed severe alopecia is presented. His sister also had alopecia and recurrent infections and died of lung infection at the age of 7 years. The loss of hair in both children was total; the pathology of a scalp skin biopsy specimen was typical for alopecia areata. The boy was subjected to clinical and immunologic evaluation and the results were compatible with common variable immunodeficiency. ( info) |
5/121. Postoperative pressure-induced alopecia: report of a case and discussion of the role of apoptosis in non-scarring alopecia. We report a case of postoperative pressure induced alopecia in a 21-year-old black female after multiple intraoperative procedures. The histopathology is distinctive and demonstrated features in common with trichotillomania and alopecia areata, including the presence of pigment casts, catagen follicles, melanophages and apoptotic bodies. External hair manipulation is considered the primary event in the etiology of pigment casts, however, our present case demonstrated numerous pigment casts despite a complete lack of evidence of external hair manipulation. We performed pattern analysis and in situ end-labeling in 19 cases of non-scarring alopecia. Pigment casts were seen in postoperative alopecia (1 case), alopecia areata (1 case) and trichotillomania (5 cases). These forms of alopecia have in common the sudden termination of the anagen phase of the hair cycle. When the anagen portion of the hair cycle is prematurely disrupted hairs enter into catagen. Pigment casts may represent a non-specific reaction pattern of follicles that are suddenly transformed from anagen to catagen. We therefore propose that hair manipulation is not uniquely responsible for the formation of pigment casts. The primary pathophysiology resulting in the formation of pigment casts more correctly reflects the sudden termination of the anagen phase of the hair cycle. ( info) |
6/121. Double-lined frontoparietal scleroderma en coup de sabre. We describe a rare case of double-lined frontoparietal scleroderma en coup de sabre. The relationship to the distribution following the lines of Blaschko is discussed. In addition, we present a genetic hypothesis which is based on a mosaic state induced by postzygotic mosaicism. A patient with scleroderma en coup de sabre has a mosaic state for genes which predispose to susceptibility for linear scleroderma. ( info) |
7/121. Systematized porokeratotic eccrine and hair follicle naevus: report of a case and review of the literature. We report a unique case of a congenital keratinocytic naevus associated with severe alopecia, onychodysplasia and palmoplantar involvement in a 13-year-old girl. The lesions, consisting of scaly, spinous and verrucous papules and plaques, mainly followed Blaschko's lines and have remained unchanged since birth. The predominant histopathological picture was that of a column of parakeratosis overlying the eccrine ostia and hair follicles. This is the first case of a systematized keratinocytic naevus characterized by histopathology of eccrine and hair follicle porokeratosis and a widespread bilateral involvement. This may be a distinct entity to be included in the differential diagnosis of linear, hyperkeratotic dermatoses. We suggest its classification as systematized porokeratotic eccrine and hair follicle naevus. ( info) |
8/121. alopecia areata with features of loose anagen hair. A child with alopecia areata (AA) presented initially with clinical features of loose anagen hair (LAH) and had features consistent with LAH on microscopic hair analysis. However, a scalp biopsy specimen demonstrated peribulbar inflammatory infiltrates characteristic of AA. We suggest that AA may mimic LAH clinically and a scalp biopsy may help in making the correct diagnosis. ( info) |
9/121. Clinical evolution of alopecia areata with a male androgenetic alopecia pattern to sisaipho. We report the case of a 16-year-old boy who developed an advanced alopecia areata (AA) type male androgenetic alopecia (MAGA). In 6 months he lost his frontal hair line and showed a sisaipho pattern of alopecia. It probably represents a rare evolution of AA in a wave-like form. ( info) |
10/121. alopecia areata and coeliac disease: no effect of a gluten-free diet on hair growth. BACKGROUND: An association between alopecia areata (AA) and coeliac disease has recently been reported. AIM: The aim of this paper was to evaluate the possible effect of a gluten-free diet (GFD) on the new growth of hair in 5 alopecic patients with CD. methods: CD was diagnosed in 5 patients with AA (universalis in 3 cases and patchy in 2 cases). The diagnosis of CD was based on serological and histological standard criteria. RESULTS: In all patients the GFD resolved CD clinically, serologically and histologically but had no effect on the course of alopecia. CONCLUSION: AA and CD, when associated, present different responses to a GFD and have an independent course. ( info) |