Alopecia as a systemic disease

Nanda, Sonali; Bedout, Valeria De; Miteva, Mariya

doi:10.1016/j.clindermatol.2019.07.026

Cited by 9 publications

(11 citation statements)

References 100 publications

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“…SSc involves complex interrelations between the immunological, vascular, and fibrotic elements, resulting in chronic and progressive tissue fibrosis [ 37 ]. SSc has long been considered to have no specific scalp and/or trichoscopic changes [ 38 ]. However, our study has demonstrated several trichoscopic abnormalities that corresponded well to SSc pathophysiology and were highly suggestive of SSc.…”

Section: Discussionmentioning

confidence: 99%

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Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

et al. 2021

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Background: Hair and scalp involvement is prevalent in connective tissue diseases (CTDs). Trichoscopic features may provide a diagnostic implementation and enable differentiation among CTDs; however, a direct comparison of these signs among CTD patients is lacking. Objectives: To compare trichoscopic findings in dermatomyositis (DM), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) as well as determine their distinctive features and associations with disease activity. Methods: Trichoscopic photographs were taken from DM, SLE, and SSc patients and further evaluated for hair shaft and scalp surface abnormalities. Data regarding patients’ clinical manifestations, laboratory results, and disease activity were analyzed. Results: One hundred fifty participants, consisting of 30 DM, 60 SLE, and 60 SSc patients, were included. Perifollicular red-brown pigmentation, brown scattered pigmentation, and white patches were exclusive findings in DM, SLE, and SSc, respectively (p < 0.001). A multinomial logistic regression analysis revealed that DM demonstrated higher odds for having microaneurysmal blood vessels than SLE and SSc (odds ratio [OR] = 22.22, 95% confidence interval [CI] = 1.73–285.13, p = 0.017, and OR = 15.34, 95% CI = 1.36–177.59, p = 0.029, respectively). Polymorphic vessels forming a telangiectatic network suggested SSc over SLE (OR = 12.83, 95% CI = 1.35–121.98, p = 0.026), while avascular areas were more pronounced in SSc than DM and SLE (OR = 43.24, 95% CI = 5.17–361.67, p = 0.001, and OR = 0.03, 95% CI = 0.01–0.24, p = 0.001, respectively). In a quantile regression analysis, perifollicular red-brown pigmentation, reduction in hair diameter, and the absence of thin arborizing vessels were linked to higher disease activity in DM, SLE, and SSc, respectively (all p < 0.05). Conclusions: Trichoscopy is a valuable tool possessing diagnostic and prognostic values for CTDs. Specific trichoscopic features allow adequate distinction between DM, SLE, and SSc and may help identify active disease.

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Section: Discussionmentioning

confidence: 99%

“…Thick homogenized sclerotic collagen bundles in the dermis may compromise the follicular architecture leading to hair size reduction and diffuse hair loss (Fig. 3a ) [ 38 ]. White patches located between normally arranged follicular units are a visible sign of fibrosis and microcirculation insufficiency in SSc (Fig.…”

Section: Discussionmentioning

confidence: 99%

Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

et al. 2021

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“…Diffuse non-scarring alopecia is the most frequent presentation (22-31% of patients) [16]. It resembles female-pattern hair loss or telogen effluvium, with a positive hair pull test.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The growth of depigmented fine hairs along the frontal hairline is observed during recovery. In these three clinical scenarios, hair regrowth occurs once SLE is properly controlled [16,19].…”

Section: Clinical Presentationmentioning

confidence: 99%

Hair Disorders in Autoimmune Diseases

Rodríguez-Tamez¹,

Herz‐Ruelas²,

Gómez‐Flores³

et al. 2023

Skin Appendage Disord

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Alopecia is a common feature in several autoimmune diseases. With a wide spectrum of clinical presentations, it may manifest with a scarring or non-scarring nature, in a diffuse, patchy, or localized pattern. We as dermatologists have the opportunity of assessing patients with hair loss who may have an underlying undiagnosed autoimmune disorder. This review aimed to describe the main clinical, trichoscopic, and histopathological features of hair disorders associated with autoimmune diseases.

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“…In Primary CA (PCA), inflammation specifically targets the hair follicle epithelium, whereas in secondary CA the hair follicle is damaged as part of a wider destructive process within the skin (e.g., radiation, thermal burns, etc. )—see Nanda et al [ 3 ]. Permanent alopecia may also occur in traditionally non-scarring alopecia disorders, where follicular drop out occurs in long-standing cases.…”

Section: Cicatricial Alopeciasmentioning

confidence: 99%

Scarring Alopecias: Pathology and an Update on Digital Developments

2021

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Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI).

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Alopecia as a systemic disease

Cited by 9 publications

References 100 publications

Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

Hair Disorders in Autoimmune Diseases

Scarring Alopecias: Pathology and an Update on Digital Developments

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