



ORIGINAL ARTICLE Year : 2014 | Volume : 80 | Issue : 4 | Page : 306-312

Clinical features of primary cicatricial alopecia in Chinese patients



Shiling Qi, Ying Zhao, Xiaoting Zhang, Shuifeng Li, Hui Cao, Xingqi Zhang

Department of Dermatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China





Date of Web Publication 18-Jul-2014

Correspondence Address:

Xingqi Zhang

Department of Dermatology, First Affiliated Hospital of Sun Yat sen University, Guangzhou, Guangdong 510080

China

Source of Support: None, Conflict of Interest: None Check 4

DOI: 10.4103/0378-6323.136833



Abstract

Background: There have been few reports on primary cicatricial alopecias (PCR) especially from Asia (PCA). Aims: To study the clinical, pathological and dermoscopic characteristics of PCA among Chinese patients. Methods: A retrospective analysis of the clinical data of 59 patients with PCA was conducted and the dermoscopic, pathological, treatment and prognosis characteristics analyzed. Fisher's Chi-square exact test, Kruskal-Wallis and Spearman rank correlation test were performed. Results: The ratio of neutrophilic to lymphocytic cicatricial alopecias was about 1.3:1 in this group. The most frequent disorder was folliculitis decalvans. Follicular openings were absent on dermoscopy in all cases except alopecia mucinosa. Patulous follicular openings were characterisitc of alopecia mucinosa. After treatment, an increase in short vellus hairs was the earliest feature, while telangiectasia, epidermal scale, follicular hyperkeratosis, pustules and hair diameter diversity gradually decreased or even disappeared. Improvement in the areas of hair loss after treatment was seen more often in discoid lupus erythematosus, folliculitis decalvans and dissecting cellulitis than in patients with classic pseudopelade of Brocq. Nine patients (13.6%) relapsed after cessation of therapy. Female patients needed longer treatment times. Long duration, large areas of hair loss and shorter treatment courses were the major factors in relapses. Conclusions: Dermatoscopy provides a rapid, practical and useful aid for the diagnosis of PCA and also to assess disease activity. Patulous follicular openings are a specific dermoscopic sign of alopecia mucinosa. Lichen planopilaris is less common in China than in the West.

Keywords: Cicatricial/scarring alopecia, clinical features, dermoscopy, pathology

How to cite this article:

Qi S, Zhao Y, Zhang X, Li S, Cao H, Zhang X. Clinical features of primary cicatricial alopecia in Chinese patients. Indian J Dermatol Venereol Leprol 2014;80:306-12

How to cite this URL:

Qi S, Zhao Y, Zhang X, Li S, Cao H, Zhang X. Clinical features of primary cicatricial alopecia in Chinese patients. Indian J Dermatol Venereol Leprol [serial online] 2014 [cited 2020 Sep 21];80:306-12. Available from: http://www.ijdvl.com/text.asp?2014/80/4/306/136833

Introduction

A lymphocytic group (e.g. chronic cutaneous lupus erythematosus/discoid lupus erythematosus [DLE], lichen planopilaris [LPP], classic pseudopelade of brocq [PB], alopecia mucinosa [AM]) Neutrophilic group (e.g. folliculitis decalvans [FD], dissecting cellulitis/folliculitis [DC]) and A mixed group and nonspecific group according to the histopathologic features. [1]

Methods

Results

Table 1: Summary of clinical features among the PCA cases



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Figure 1: Global view (a-c), dermoscopy (d-f) and pathological features (g-i) of discoid lupus erythematosus, lichen planopilaris, classic pseudopelade of brocq



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Figure 2: Global view (a~c), dermoscopy (d~f), and pathological features (g~i) of alopecia mucinosa, folliculitis decalvans, dissecting cellulitis/folliculitis



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Table 2: Dermatoscopic features observed with handheld dermatoscope



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Table 3: Histopathologic characteristics of primary scarring alopecias



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Discussion

Table 4: Summary of the incidences of various types of cicatricial alopecia reported in literature



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References

1. Olsen EA, Bergfeld WF, Cotsarelis G, Price VH, Shapiro J, Sinclair R, et al. Summary of North American Hair Research Society (NAHRS)-sponsored workshop on cicatricial alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol 2003;48:103-10.

2. Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, Canfield D, et al. Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation. J Am Acad Dermatol 2004;51:440-7.

3. Somani N, Bergfeld WF. Cicatricial alopecia: Classification and histopathology. Dermatol Ther 2008;21:221-37.

4. Tan E, Martinka M, Ball N, Shapiro J. Primary cicatricial alopecias: Clinicopathology of 112 cases. J Am Acad Dermatol 2004;50:25-32.

5. Whiting DA. Cicatricial alopecia: Clinico-pathological findings and treatment. Clin Dermatol 2001;19:211-25.

[ PUBMED ] 6. Abal-Díaz L, Soria X, Casanova-Seuma JM. Scarring alopecia. Actas Dermosifiliogr 2012;103:376-87.

7. Griffin LL, Michaelides C, Griffiths CE, Paus R, Harries MJ. Primary cicatricial alopecias: A U.K. survey. Br J Dermatol 2012;167:694-7.

8. Trachsler S, Trueb RM. Value of direct immunofluorescence for differential diagnosis of cicatricial alopecia. Dermatology 2005;211:98-102.

9. Kumar U M, Yelikar BR.The spectrum of histopathological lesions in scarring alopecia: a prospective study. J Clin Diagn Res 2013;7:1372-6.

10. Assouly P, Reygagne P. Lichen planopilaris: Update on diagnosis and treatment. Semin Cutan Med Surg 2009;28:3-10.

11. Moure ER, Romiti R, Machado MC, Valente NY. Primary cicatricial alopecias: A review of histopathologic findings in 38 patients from a clinical university hospital in Sao Paulo, Brazil. Clinics (Sao Paulo) 2008;63:747-52.

12. Chandrawansa PH, Giam YC. Folliculitis decalvans: A retrospective study in a tertiary referred centre, over five years. Singapore Med J 2003;44:84-7.

13. Dogra S, Sarangal R. What's new in cicatricial alopecia? Indian J Dermatol Venereol Leprol 2013;79:576-90.

[ PUBMED ] 14. Sillani C, Bin Z, Ying Z, Zeming C, Jian Y, Xingqi Z. Effective treatment of folliculitis decalvans using selected antimicrobial agents. Int J Trichology 2010;2:20-3.

15. Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol 2005;53:1-37.

16. Tosti A, Torres F, Misciali C, Vincenzi C, Starace M, Miteva M, et al. Follicular red dots: A novel dermoscopic pattern observed in scalp discoid lupus erythematosus. Arch Dermatol 2009;145:1406-9.

17. 17. Tosti A, Torres F. Dermoscopy in the diagnosis of hair and scalp disorders. Actas Dermosifiliogr 2009;100 Suppl 1 :114-9.

18. Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol 2013;27:1299-303.

19. Otberg N. Primary cicatricial alopecias. Dermatol Clin 2013;31:155-66.

[ PUBMED ] 20. Rudnicka L, Olszewska M, Rakowska A, Slowinska M. Trichoscopy update 2011. J Dermatol Case Rep 2011,5:82-8.



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