Androgenic pattern presentation of scarring and inflammatory alopecia

Abstract

EditorAlopecia often frustrates clinicians and patients because of the lack of clear aetiology and treatment options. Androgenic alopecia, in particular, is a challenge because of the perceived obvious diagnostic clinical presentation. This 'classic presentation' is exemplified by the frequency with which the diagnosis is often made using only the physical exam. In this report, we sought to determine how often the clinical diagnosis was supported by the histological diagnosis.A search was preformed on our dermatopathology database from 2007 to July of 2009. The search was preformed without identification of patient data except for any clinical history that was provided by the physician for pathologist use. Submitted tissue samples were limited to those from dermatologists trained by ACGME accredited dermatology residency programmes. Samples were collected based on two criteria with (i) those listing only non-scarring and non-inflammatory alopecias in the clinical impression and (ii) those listing non-scarring (a) (b) (c) (d) Figure 2 Clinical features: (a) webbed fingers, pseudosyndactyly and nail dystrophy; (b) poikiloderma on the neck; (c) whitish plaques on oral mucosa; (d) skin atrophy with 'cigarette-paper'-like wrinkling on the dorsa of the hands. LETTERS TO THE EDITOR 979 ª 2010 The Authors JEADV 2010, 24, 974-985 Journal compilation ª

Problems in pattern alopecia

“…Also, evaluation of hair loss based on physical exam alone may lead to an incorrect diagnosis. For example, scarring and inflammatory alopecias can have distributions that mimic the classic “patterns” of FPHL 4 …”

“…Pattern is a critical clinical finding in most alopecias, as it is in other dermatologic diseases. However, pattern presentation of alopecia has caused much confusion in clinical practice 4 . This is akin to the morphologic mimics that confound other dermatologic conditions, such as mycosis fungoidies presenting as psoriasis.…”

Cicatricial alopecia: What’s new in etiology?

“…The progress has been hindered by a poor understanding of the course of the disease, its incoherent and not precise description in the literature, absence of final molecular markers for any of the recognized form of the cicatricial alopecia, and finally because of an unpredictable and incomplete response to the treatment. 10,14,15 …”

“…The cells are located at the site of the arrector pili muscle attachment, in the outermost layer of the hair root, that is, hair bulb. 9,10 An abnormal immune response that destroys eHFSCs, probably plays a role in the etiology of cicatricial alopecia. It is believed that hair follicles can be the gate to the microbial invasion on the mammal skin.…”

“…In fact, the current classification of primary cicatricial alopecia is mainly based on the predominating cells of the inflammatory infiltrate. 1,[10][11][12] These disorders are divided into: lymphocytic, neutrophilic, mixed, or non-specific.…”