Trichoscopy activity scale for folliculitis decalvans

Abstract

The pathogenesis of bromoderma is still under debate. Some authors have proposed that halogenodermas belong to the group of hypersensitivity reactions. 1,3,5 However, accumulation of the halogenide seems to play a pivotal role leading to a rather toxic inflammatory reaction provoked by the elimination of bromine through the eccrine and sebaceous glands. 1,3,5 Indeed, bromides show slow elimination rates and both bromoderma and bromism may persist for weeks after drug withdrawal. 9 Diagnosis of bromoderma is primarily based on the clinical features and history of bromine intake. 1,2,5 Histology is rather unspecific but helpful in excluding other differential diagnoses. However, pseudo-hyperchloraemia is a typical laboratory finding, which is due to the method used for serum chloride assessment. Since the electric charge of chloride and bromide is the same, enhanced serum bromide is detected by an increase in chloride. 5 Treatment mainly relies on the withdrawal of the offending drug. 2,4,6 In addition, diuretics, such as furosemide and ethacrynic acid, could be administered because of their activity in accelerating bromide excretion through the kidneys. 9,10 Local therapies include topical corticosteroids and antiseptic measurements. 2,4,6 Our case highlights that bromoderma has still to be considered as a side effect of therapeutic interventions utilizing bromide-containing agents. Funding sources: None.

The Role of Trichoscopy in Keratosis Follicularis Spinulosa Decalvans: Case Report and Review of the Literature

“…Bleeding, pain, and burning sensation can be referred by the patient [25]. Trichoscopic features change according to the inflammatory activity, and they are tufted hairs, perifollicular erythema, perifollicular hemorrhages, follicular pustules, yellow tubular scaling, and yellow crusts [26].…”

Reflectance Confocal Microscopy Applied to Folliculitis Decalvans: Preliminary Results of a Multicenter Study

“…Fourteen patients (9 males and 5 females) affected by FD with a median age of 37 years (range 22-45 years) were enrolled. Dermoscopic evaluation was performed following the "trichoscopy activity scale" features described by Saceda-Corralo et al [9]. The presence of "red patterns," namely, perifollicular erythema, and perifollicular hemorrhages was disclosed in most of the lesions evaluated, while "yellow structures" such as yellow tubular scaling and yellow crusts were observed at a less percentage.…”

“…The role of trichoscopy (dermoscopy of hair and scalp) as an auxiliary tool in the diagnosis of hair diseases is widely recognized. Recently, Saceda-Corralo et al [9] associated trichoscopic findings of FD with inflammatory activity of the disease, investigating its early stage and giving complementary insights to the trichoscopic features previously described by Fernández-Crehuet et al [6] regarding the extension of cicatricial patches of alopecia in the advanced course of FD [5,6]. Although we considered "trichoscopic activity scale" in the evaluation of our lesions, it was difficult to create a perfect match between trichoscopic and confocal criteria, since RCM offers an in vivo image with a cellular detailed resolution more similar to histology, pointing out some interesting considerations.…”

“…For each patient, clinical and dermatoscopic images of active lesions were acquired and recorded with the use of digital dermatoscopic devices (Dermaview DUAL, Tre T Medical snc, Cicciano, Italy). Trichoscopic features were evaluated according to the "trichoscopy activity scale" delineated by Saceda-Corralo et al [9] in order to assess the inflammatory activity of the disease. RCM images were obtained with Viva-Scope ® 1500 (Caliber, New York, USA, distributed in Europe by MAVIG GmbH, Munich, Germany).…”

“…Trichoscopic criteria predictive of disease severity and inflammatory activity have been recently proposed, suggesting a role for this noninvasive practice in the clinical management of the disease [9]. Reflectance confocal microscopy (RCM) is an in vivo noninvasive technique useful not only for the detection of skin tumors but also for identifying morphological and vascular changes in several inflammatory dermatoses [10,11].…”