Acute hair loss on the limbs in frontal fibrosing alopecia: a clinicopathological study of two cases

Abstract

References1 Gazerani P, Pedersen NS, Drewes AM, Arendt-Nielsen L. Botulinum toxin type A reduces histamine-induced itch and vasomotor responses in human skin. Br J Dermatol 2009; 161:737-45. 2 Wallengren J. Neuroanatomy and neurophysiology of itch. Dermatol Ther 2005; 18:292-303. 3 Koshi EB, Short CA. Placebo theory and its implications for research and clinical practice: a review of the recent literature. Pain Pract 2007; 7:4-20. 4 Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol 2007; 143:980-2. 5 Heckmann M, Heyer G, Brunner B, Plewig G. Botulinum toxin type A injection in the treatment of lichen simplex: an open pilot study. J Am Acad Dermatol 2002; 46:617-19. 6 Sotiriou E, Apalla Z, Panagiotidou D, Ioannidis D. Severe post-herpetic neuralgia successfully treated with botulinum toxin A: three case reports. Acta Derm Venereol (Stockh) 2009; 89:214-15. 7 Yuan RY, Sheu JJ, Yu JM et al. Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology 2009; 72:1473-8. 8 Krämer HH, Angerer C, Erbguth F et al. Botulinum toxin A reduces neurogenic flare but has almost no effect on pain and hyperalgesia in human skin. J Neurol 2003; 250:188-93. 9 Tugnoli V, Capone JG, Eleopra R et al. Botulinum toxin type A reduces capsaicin-evoked pain and neurogenic vasodilatation in human skin. Pain 2007; 130:76-83. 10 Gazerani P, Pedersen NS, Staahl C et al. Subcutaneous botulinum toxin type A reduces capsaicin-induced trigeminal pain and vasomotor reactions in human skin. Pain 2009; 141:60-9. 11 Wallengren J, Sundler F. Cutaneous field stimulation (CFS) in treatment of severe localized itch. Arch Dermatol 2001; 137:1323-5.

Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement

“…To date, FP have been described as a sign of lichenoid inflammation of facial vellus hair follicles [1,2,3]. Histologic features presented herein, in association with the previously described good response to oral isotretinoin, suggest that prominent sebaceous lobules with dilated ducts associated with an abnormal elastic framework are the main explanation for the formation of FP in the context of FFA.…”

“…Since then, several features have been associated with FFA, such as glabellar red dots [2], body hair involvement [3], lichen planus pigmentosus (LPPigm) [4], depression of the frontal veins [5], and facial papules (FP) [6]. The disease is now regarded by many authors as a generalized skin condition [7].…”

Distinct Trichoscopic Features of the Sideburns in Frontal Fibrosing Alopecia Compared to the Frontotemporal Scalp

“…In some cases, hair loss of the eyebrows, eyelashes, trunk, upper and lower extremities [1], moustache and beard area, and sideburns can also occur [2,3,4]. Exclusive involvement of the sideburns in FFA was reported by us in a single case; however, it may be more prevalent [2].…”

Frontal Fibrosing Alopecia

“…Classical diffuse LPP somewhere else on the scalp has been stated in organization with FFA in one sixteenth percent [2,3,9,15]. Whereas scalp LPP is especially a complaint of terminal pigmented hairs, it's been suggested that in FFA, vellus and intermediate hairs square measure affected preferentially, [8,19] though this has not been confirmed in an added gain information of [7] ironically, most terminal pigmented hairs on the scalp square measure unaffected in FFA, with handiest these on the hairline involved. Symptoms also will be less frequent in FFA [3,9,19] (3-55%) than in LPP (60-70%) [18].…”

“…As good as eyebrows, eyelashes could also be lost [2,3] and involvement of facial vellus hairs will overtimes end in tiny flesh colored facial papules [4][5][6]. Limb and flexural hair are on the whole affected, more commonly without a related signs or rash [7,8]. The condition now not solely influences postmenopausal females as a small however growing number of instances had been suggested in premenopausal females and in guys [9].…”