Evidence for lymphocytic inflammation in non‐lesional scalp of folliculitis decalvans: an observational study of 25 patients

Doche, Isabella; Hordinsky, Maria; Valente, Neusa Yuriko Sakai; Sotto, Mírian Nacagami; Miotto, Isadora Zago; Rebeis, Marina Mattos; Rivitti-Machado, M C

doi:10.1111/jdv.17649

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…Histologically, peri‐ and intrafollicular neutrophils with mixed acute and chronic inflammation with follicular damage are more intense in the upper dermis 2 . As in our case, lymphocytic inflammation around the isthmus with histiocytes and plasma cells can also be seen, which may be indicative of early or subtle stages of FD 3 . On the other hand, classical and evolved FD clinical presentation usually includes tufted hairs, and diffuse dermal scarring may be seen on histology.…”

Section: Figuresupporting

confidence: 58%

Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum?

2022

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Section: Figuresupporting

confidence: 58%

Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum?

2022

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“…However, clinically in FD, the inflammation is not necessarily restricted in the central scalp and centrifugally expanded. Eyebrows and/or eyelashes, the common predilection sites of KFSD are rarely affected in FD 22 . Through trichoscopy, follicular tufts in KFSD consisted of two to eight hairs in our study, while five to 20 or more are more commonly seen in FD 20 .…”

Section: Discussionmentioning

confidence: 48%

“…Eyebrows and/or eyelashes, the common predilection sites of KFSD are rarely affected in FD. 22 Through trichoscopy, follicular tufts in KFSD consisted of two to eight hairs in our study, while five to 20 or more are more commonly seen in FD. 20 When KFSD evolves into a lymphocyte-dominant infiltrate, the inflammation pattern is similar with LPP.…”

Section: Discussionmentioning

confidence: 54%

Clinicopathologic and trichoscopic features of keratosis follicularis spinulosa decalvans: A case series study

Lan,

Qiao,

Sun

et al. 2023

The Journal of Dermatology

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Keratosis follicularis spinulosa decalvans (KFSD) is a rare X‐linked hereditary disorder characterized by the triad of follicular hyperkeratosis‐photophobia‐alopecia. The clinical heterogeneity makes the diagnosis difficult. To investigate the clinicopathologic and trichoscopic features of KFSD and to further clarify the essential requisites for the diagnosis, we conducted a retrospective study of patients with KFSD. The clinical information, histologic features, and trichoscopic findings were evaluated. Eight patients were from seven separate families. Two females were mother and daughter from the same family and the other six patients were male and represented sporadic cases. The average age of onset of alopecia was 21.25 years. Involvement of the scalp hairs leading to progressive scarring alopecia on the midline of the scalp with variable degrees of inflammation was the pathognomonic feature. It typically began after puberty. Vellus hair–associated follicular hyperkeratosis affected all of the patients. However, photophobia was not a constant feature. Histopathologic examination revealed disorders of the hair follicle with an acute‐chronic inflammatory response. Follicular changes including fused infundibulum, the protrusion of the outer root sheath into the follicular canal, and a dilatation of the follicles at the isthmus level caused by the occlusion of keratin were observed. The trichoscopic features included perifollicular scaling, tufted hairs, and loss of follicular openings. In conclusion, terminal hair involvement, either scalp hairs, eyebrows, or eyelashes, and the hyperkeratosis of the follicle of vellus hairs is the diagnostic basis of KFSD. We hypothesize that follicular changes in histopathology are the primary event that trigger variable inflammation and further follicular destruction.

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“…Furthermore, another recent non-trichoscopy-guided NAS biopsy study of 25 patients with FD found an association between FD and PIILIF-like features in NAS, including perifollicular infundibula-isthmic lymphocytic inflammation (in 64%) and fibrosis (in 48%). 15 Consequently, PIILIF may be a precursor of both AKN and FD. We also propose that the entities thus far reported as FD-LPP phenotypes 16–18 are likely FD-associated with scalp-wide PIILIF, which in the vicinity of an FD lesion is compounded by the FD-induced alopecia.…”

Section: Discussionmentioning

confidence: 99%

Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias

Umar,

Ton,

Carter

et al. 2023

CCID

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Purpose Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies. Patients and Methods This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed. Results Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44–51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis. Conclusion PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.

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Evidence for lymphocytic inflammation in non‐lesional scalp of folliculitis decalvans: an observational study of 25 patients

Cited by 4 publications

References 10 publications

Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum?

Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum?

Clinicopathologic and trichoscopic features of keratosis follicularis spinulosa decalvans: A case series study

Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias

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