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Anais Brasileiros de Dermatologia 2022Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in... (Review)
Review
Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in the early stages, but scalp biopsy is the standard exam for definitive diagnosis. Frontal fibrosing alopecia is considered a variant of lichen planopilaris, as the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate, sometimes with a lichenoid pattern. A thorough clinical examination, trichoscopy and photographic documentation are essential to assess the evolution and therapeutic response. To date, there are no validated treatments or guidelines for these diseases, but there are recommendations that vary with the individual characteristics of each patient. This article presents a comprehensive review of the literature, including an update on topics related to the diagnosis, follow-up, histopathological aspects and available treatments for lichen planopilaris and frontal fibrosing alopecia, highlighting their similarities, differences and peculiarities.
Topics: Alopecia; Humans; Lichen Planus; Scalp; Scalp Dermatoses
PubMed: 35379508
DOI: 10.1016/j.abd.2021.08.008 -
Clinical Reviews in Allergy & Immunology Dec 2021Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact... (Review)
Review
Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA.
Topics: Alopecia Areata; Humans
PubMed: 34403083
DOI: 10.1007/s12016-021-08883-0 -
Dermatologic Therapy Apr 2022Androgenetic alopecia (AGA) is the most common cause of hair loss in men, often requiring medical attention. The US FDA approved topical minoxidil and oral finasteride... (Review)
Review
Androgenetic alopecia (AGA) is the most common cause of hair loss in men, often requiring medical attention. The US FDA approved topical minoxidil and oral finasteride to treat AGA. Topical minoxidil requires a long-term application to observe improvement; oral finasteride may cause undesirable side effects. Therefore, natural products may be an alternative when patients are skeptical about these two conventional treatments. Physicians may also suggest natural products in conjunction with topical minoxidil or oral finasteride to enhance clinical outcomes. This article reviews the prospect of natural products in treating male AGA. A systematic search was conducted in PubMed, CINAHL, Scopus, Web of Science, and EMBASE (Ovid) on July 19, 2021. In addition, the bibliographies of selected articles were hand-searched to identify relevant studies. After deduplication and screening, 11 clinical studies meet the criteria for detailed review. The selected clinical studies suggest that saw palmetto, caffeine, melatonin, marine extracts, rosemary oil, procyanidin, pumpkin seed oil, and cannabidiol oil might be considered in male AGA treatment.
Topics: Alopecia; Biological Products; Finasteride; Humans; Male; Minoxidil; Treatment Outcome
PubMed: 35044013
DOI: 10.1111/dth.15323 -
Dermatologic Therapy Nov 2020Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that... (Review)
Review
Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low-level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.
Topics: Alopecia; Female; Humans; Low-Level Light Therapy; Transplantation, Autologous
PubMed: 32700775
DOI: 10.1111/dth.14055 -
American Journal of Clinical Dermatology Feb 2020Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with... (Review)
Review
Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.
Topics: Alopecia; Androgen Antagonists; Disease Progression; Female; Hair; Humans; Hyperandrogenism; Minoxidil
PubMed: 31677111
DOI: 10.1007/s40257-019-00479-x -
Journal of the European Academy of... Mar 2021The field of hair disorders is constantly growing. The most important hair diseases are divided in non- cicatricial and cicatricial ones. Non-cicatricial alopecia are... (Review)
Review
The field of hair disorders is constantly growing. The most important hair diseases are divided in non- cicatricial and cicatricial ones. Non-cicatricial alopecia are more frequent than cicatricial alopecia. The first step is to obtain a good history and physical examination. Laboratory testing is often unnecessary, while trichoscopy is fundamental for all hair diseases. Scalp biopsy is strongly suggested in cicatricial alopecia and in doubtful cases. Androgenetic alopecia, alopecia areata, telogen effluvium, trichotillomania are common causes of non- cicatricial alopecia. Frontal fibrosing alopecia, discoid lupus erythematosus, lichen planopilaris, follicullitis decalvans are some of the most common forms of cicatricial hair loss. Many treatments are available, and a prompt diagnosis is very important for the prognosis.
Topics: Alopecia; Alopecia Areata; Hair Diseases; Humans; Lichen Planus; Scalp; Trichotillomania
PubMed: 33290611
DOI: 10.1111/jdv.17079 -
Current Pediatric Reviews 2021Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. (Review)
Review
BACKGROUND
Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology.
OBJECTIVE
To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata.
METHODS
The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles.
RESULTS
AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss, generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show "exclamation point hairs" and "yellow dots". Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA, including conservative treatment, and topical, oral, and injectable medications.
CONCLUSION
AA is an autoimmune disease with a heterogeneous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.
Topics: Alopecia Areata; Autoimmune Diseases; Child; Combined Modality Therapy; Humans
PubMed: 32351186
DOI: 10.2174/1573396316666200430084825 -
Journal of the American Academy of... Aug 2023Hair loss is devastating to the patient, but the diagnosis and treatment of alopecia are also difficult for primary care providers and even dermatologists. Given recent... (Review)
Review
Hair loss is devastating to the patient, but the diagnosis and treatment of alopecia are also difficult for primary care providers and even dermatologists. Given recent advances in the field, there has never been a more pressing time to reevaluate and improve upon the significant clinical skills needed to accurately diagnose and treat our patients with hair loss. This CME activity on alopecia is designed to (1) educate dermatologists in a simple, succinct fashion on the identification of, and the distinction between, the diverse types of hair loss and (2) discuss how to manage them.
Topics: Humans; Alopecia; Clinical Competence
PubMed: 37591559
DOI: 10.1016/j.jaad.2023.05.048 -
Journal of the American Academy of... Dec 2021Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and... (Review)
Review
BACKGROUND/OBJECTIVES
Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and lichen planopilaris. The existing literature on FAPD and current understanding of the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of this disease are reviewed.
METHODS
PubMed searches were performed to identify all articles discussing FAPD. The references of articles were used to identify additional articles.
RESULTS
A total of 15 articles were found describing FAPD in a total of 188 patients (164 women and 24 men; average age, 53.8).
CONCLUSIONS
FAPD affects the androgen-dependent scalp and is typically associated with hair follicle miniaturization. The scalp affected by FAPD shows features of both lichen planopilaris and AGA, and FAPD may possibly represent an exaggerated inflammatory response to damaged hair follicles, triggered by AGA. Physical examination and trichoscopic evidence of follicular inflammation and, occasionally, fibrosis are important to identify the condition, and a dermoscopy-guided biopsy can confirm the diagnosis. Unless recognized, clinicians may misdiagnose FAPD as AGA associated with seborrheic dermatitis. Data on treatment modalities are limited; however, based on pathogenesis, combined therapy with anti-inflammatory and hair growth-promoting agents is warranted.
Topics: Alopecia; Female; Fibrosis; Hair Follicle; Humans; Lichen Planus; Male; Middle Aged; Scalp
PubMed: 31926219
DOI: 10.1016/j.jaad.2019.12.056 -
Journal of the American Academy of... Nov 2021Androgenetic alopecia (AGA) is a well-known cause of hair loss in adults but is an under-recognized cause of hair loss in children and adolescents. We reviewed the... (Review)
Review
OBJECTIVES
Androgenetic alopecia (AGA) is a well-known cause of hair loss in adults but is an under-recognized cause of hair loss in children and adolescents. We reviewed the existing literature regarding androgenetic alopecia in the pediatric/adolescent population.
METHODS
PubMed searches were performed to identify all articles discussing AGA in a pediatric/adolescent population published up to December 2018.
RESULTS
We identified 7 articles discussing androgenetic alopecia in patients aged younger than 18. One of these articles was a review containing data from 3 conference abstracts, which were also included in the analysis. A total of 655 cases of androgenetic alopecia were found.
LIMITATIONS
Data are limited to retrospective reviews and case reports/series.
CONCLUSION
AGA in the pediatric population is not uncommon, but its incidence and prevalence are unknown. It is associated with a strong family history of AGA and can typically be diagnosed clinically by physical examination and trichoscopy. Topical minoxidil, although not approved, has been used with success. Other treatment modalities are poorly studied in children.
Topics: Adolescent; Alopecia; Child; Finasteride; Humans; Incidence; Minoxidil; Retrospective Studies
PubMed: 31415838
DOI: 10.1016/j.jaad.2019.08.018