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Fibrosing alopecia pattern distribution (FAPD) is a recently described disease, wherein the clinical, trichoscopic, and histologic characteristics of non‐scarring alopecia, such as androgenic alopecia, and lichenoid inflammatory cicatricial alopecia are reported. The lack of uniformity in the diagnostic criteria can result in FAPD overdiagnosis. The characteristic findings of loss of follicular openings on trichoscopy and fibrosis on histopathology are crucial, as they are necessary to diagnose cicatricial inflammatory lichenoid alopecias. Â Hair transplantation in FAPD can be controversial. The scarce publications in this realm do not reach a clear consensus in favor or against the surgical approach. Thus, the presence of histological lichenoid inflammatory infiltrates could make this therapeutic option less suitable. There have been few reports on hair transplantation in other lymphocytic lichenoid inflammatory alopecias, such as lichen planus pilaris (LPP) and frontal fibrosing alopecia (FFA) Â Based on those data, an algorithm for the indication of hair transplantation in FAPD is proposed. The algorithm optimizes the results of the treatment and achieves the greatest coverage of the alopecic area. [ABSTRACT FROM AUTHOR]

Bicalutamide is a selective androgen receptor antagonist. To date, it has been used orally with good efficacy results, but not in mesotherapy. In our center, we assessed whether patients undergoing bicalutamide mesotherapy showed positive responses and tolerated the local administration of bicalutamide. Six premenopausal women, with a mean age of 35.7 years and clinical diagnosis of Olsen Grade II or III female androgenetic alopecia accompanied by significant seborrhea were treated with 1 ml bicalutamide 0.5% mesotherapy. Three monthly sessions were performed. A subtle improvement in hair density was described after the third session. The overall satisfaction of the patients with the treatment was 6.3, on a scale of 1--10. Premenopausal women require several therapeutic approaches to combat severe androgenetic alopecia. Our data showed that bicalutamide mesotherapy was well tolerated and welcomed by the patients; we, therefore, provide a new tool for the management of this pathology. [ABSTRACT FROM AUTHOR]

Raynaud's phenomenon (RP) is an episodic peripheral circulatory disorder characterized by local artery spams in subjects exposed to cold or emotional stress. It is not well-established whether RP patients show an altered rheological profile, mostly due to patient classification and clinical severity. We aimed to compare the hemorheological profile in patients with primary and secondary RP with a healthy control group. Eighteen primary RP, 22 secondary RP and 22 healthy controls, were included in the study. RP patients were also divided according to the presence of digital ulcers (7 with, 33 without). Biochemical and hemorheological variables were analyzed, including glucose, triglycerides, total-cholesterol, immunoglobulins, fibrinogen, plasma viscosity, erythrocyte aggregation, erythrocyte deformability and blood viscosity. Age was higher in secondary RP as compared with primary (p = 0.049), while glucose, triglycerides IgA, IgG and plasma viscosity were higher in secondary RP than in healthy subjects (p < 0.05). RP patients with digital ulcers presented higher IgA (p = 0.012), lower erythrocyte aggregation time (p = 0.008) and a trend for higher fibrinogen levels and plasma viscosity (p = 0.064, p = 0.069, respectively). The results of the present study indicate that secondary RP patients show a mild impairment of the rheological profile that aggravates with microangiopathy severity. [ABSTRACT FROM AUTHOR]

The association between hyperhomocysteinemia (HHcy) and Raynaud's phenomenon (RP) remains a matter of debate. In 18 primary RP, 23 secondary RP and 41 controls, we investigated homocysteine (Hcy) levels along with biochemical and inflammatory parameters. The Hcy levels in both primary and secondary RP were elevated when compared with controls (p < 0.05 and p < 0.01, respectively). As age was higher in secondary RP as compared with controls (p < 0.01), both primary and secondary RP were age-matched with a corresponding control group, and with Hcy maintaining its statistical significance (p < 0.05). No differences in creatinine, B12 vitamin or folic acid were observed between groups (p > 0.05), or in the prevalence of cardiovascular risk factors (p > 0.05). When patients were classified according to presence or absence of digital ulcers, as a sign of microangiopathy severity, the former showed higher Hcy levels than the latter (p = 0.035). Our results indicate that both primary and secondary RP patients show a mild increase in Hcy levels, which is not related to age, vitamin deficiencies or impaired renal function, but is related to microangiopathy severity. Therefore the association of HHcy and RP suggest that Hcy may contribute to endothelial dysregulation, which characterizes this disease. Specific studies should be designed to elucidate the pathogenesis of HHcy in these patients. [ABSTRACT FROM AUTHOR]

Psoriasis is a systemic inflammatory disorder with increased cardiovascular risk which has been partly attributed to the increased prevalence of the metabolic syndrome (MS). However, the contribution of rheological alterations to cardiovascular risk has been scarcely investigated. In 91 psoriasis patients and in 101 healthy volunteers, we determined the rheological profile (fibrinogen, blood viscosity and erythrocyte aggregation), along with lipidic and inflammatory parameters. Patients showed statistically higher BMI, waist, triglycerides, insulin, c-reactive protein (CRP), neutrophils, lower HDL-cholesterol and a higher MS prevalence (p < 0.05). When subjects with MS were excluded from the study, patients with psoriasis still showed a worse inflammatory, lipidic and rheological profile in the above-mentioned variables compared with controls without MS (p < 0.05). The logistic regression analysis revealed that abdominal obesity and fibrinogen >384 mg/dL were independent predictors of psoriasis (OR 3.75 95% CI 1.77-7.94, p < 0.001; OR 2.95 95% CI 1.14-7.64, p = 0.025), respectively. Patients on biologics, showed less inflammation and a better rheological profile than those not on biological treatment. In conclusion, patients with psoriasis show an altered rheological profile, which may contribute to increased cardiovascular risk. Although the presence of MS worsens this profile, psoriasis per se shows rheological alterations due to both inflammation and altered metabolic parameters. Anti TNF-α treatment markedly improves the rheological profile by mostly decreasing inflammation. [ABSTRACT FROM AUTHOR]

Psoriasis, a systemic immunomediated disorder, is associated with increased cardiovascular risk, although the contribution of rheological alteration to this risk has been seldom analyzed. We have determined erythrocyte deformability in 91 patients with psoriasis and in 101 sex- and age-matched control subjects by means of the Rheodyn SSD, along with hematological, biochemical and inflammatory parameters. Although psoriatic patients showed higher BMI, waist, triglyceride, C-reactive protein levels, neutrophils count and lower HDL-cholesterol (P < 0.001), no differences in the elongation index and in any of the shear stresses tested (12, 30, 60 Pa) were observed (P > 0.05). The results of the present study indicate that patients with psoriasis do not present impaired erythrocyte deformability. Therefore this rheological parameter does not seem to be involved in the higher cardiovascular risk characterizing these patients. [ABSTRACT FROM AUTHOR]

HIV-infected patients are at increased cardiovascular risk. Although several studies have analyzed the hemorheological profile in these patients, studies dealing with erythrocyte deformability are scarce. Moreover, studies have been performed in HIV patients on antiretroviral treatment which may influence this rheological parameter. We analyzed erythrocyte deformability (Elongation Index) at 12, 30 and 60 Pa by means of the Rheodyn SSD in 34 naïve HIV-infected patients (22 males and 12 females) and 34 HIV negative control subjects (24 males and 10 females). Erythrocyte indices (MCV, MCH, MCHC), reticulocytes, plasma lipids, iron, folic acid, vitamin B12 and hepatic enzymes were also determined. When compared with controls, naïve HIV-infected patients showed lower total cholesterol, iron, bilirubin and folic acid (p = 0.009, p = 0.003, p = 0.004, p = 0.004, respectively) and higher triglycerides (TG), aspartate aminotransferase (AST) and gamma glutamyl transferase (γGt) levels (p = 0.017, p = 0.042, p = 0.004, respectively). In the multivariate regression analysis, MCV, γGt and triglycerides were independent predictors of EI60. Neither erythrocyte indices nor reticulocyte count showed differences (p > 0.05). No differences in the Elongation Index at any of the shear stresses tested (12, 30, 60 Pa) were found (p > 0.05). The results of the present study indicate that naïve HIV-infected patients not on antiretroviral treatment do not present decreased erythrocyte deformability when compared with HIV negative control subjects. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is characterised by increased venous and arterial thrombotic risk. Nevertheless, how hemorheological alterations contribute to thrombotic risk remains a question of debate. We aimed to determine the rheological profile in 105 patients with SLE (24 with a thrombotic event) and 105 healthy controls. We determined blood viscosity and erythrocyte aggregation along with plasma lipids and fibrinogen. Although SLE patients showed lower blood viscosity at 230 s-1 at a native hematocrit when compared with controls (p < 0.001), differences disappeared after adjusting the hematocrit to 45% (p = 0.095). When comparing SLE patients with and without thrombotic events, no differences in any rheological parameter were found (p > 0.05), except in fibrinogen which was higher in patients with thrombosis (p = 0.013). No differences in the rheological parameters were observed when venous and arterial thrombotic events were compared, although a tendency for higher fibrinogen was observed in patients with venous thrombosis (p = 0.053). Only hematocrit, fibrinogen and triglycerides were independent predictors of native blood viscosity in the multivariate regression analysis, even after adjusting for continuous variables and for tobacco and hypertension: beta coefficient: 0.727 p < 0.001; beta coefficient: 0.152 p = 0.003 and beta coefficient: 0.133 p = 0.015, respectively. The logistic regression analysis revealed that neither increased native blood viscosity (BVn > 4.33) nor increased erythrocyte aggregation (EA1 > 7.85) increased thrombotic risk: OR 0.636, CI 0.313-3.12, p = 0.578 and OR 2.01, CI 0.77-5.20, p = 0.152, respectively. However, hyperfibrinogenemia (Fbg > 342 mg/dL) increased thrombotic risk by around three times: OR 3.44 CI 1.32-8.96, p = 0.011. Our results suggest that the role of blood viscosity and erythrocyte aggregation in thrombotic risk in SLE patients fails to demonstrate any association. [ABSTRACT FROM AUTHOR]

Rheological blood behavior in primary Sjögren's syndrome (SS) has been scarcely investigated. We evaluated the rheological profile (blood viscosity, plasma viscosity, erythrocyte deformability, erythrocyte aggregation, erythrocyte aggregation time and erythrocyte disaggregation threshold) along with fibrinogen, high-sensitive C reactive protein, plasma lipids, immunoglobulins, total proteins and erythrocyte sedimentation rate in 22 patients with primary SS (2 males, 20 females, aged 58±9 years) and in 22 healthy volunteers (3 males, 19 females, aged 57±5 years). Patients showed statistically higher plasma viscosity, erythrocyte sedimentation rate and G immunoglobulin (IgG) levels and lower total cholesterol than controls (p = 0.006, p = 0.023, p = 0.034, p = 0.036, respectively). Three patients with extraglandular involvement showed the highest plasma viscosity values: 1.98 cP, 1.70 cP and 1.65 cP, respectively. No differences were observed for the other rheological parameters analyzed. In a multivariate regression analysis, only fibrinogen, triglycerides and IgG were independent determinants for plasma viscosity values (beta coefficient: 0.335; p = 0.001; beta coefficient: 0.242; p = 0.019; beta coefficient: 0.660; p < 0.001, respectively). Our results indicate that patients with primary SS show increased plasma viscosity, mostly related with IgG levels without other alterations in the rheological profile. Further research with a larger sample size achieved by multicenter studies would be desirable. [ABSTRACT FROM AUTHOR]

The relationship between rheological alterations and systemic sclerosis (SSc) is not well established. We have determined in 27 patients with SSc (4 male, 21 female ) aged 59±14 years and in a well matched control group the whole rheological profile, i.e. blood viscosity (BV), plasma viscosity (PV), erythrocyte aggregation (EA), erythrocyte deformability (ED) along with fibrinogen (Fbg), C-reactive protein (CRP), lipids, and erythrocyte indices. Patients show higher Fbg, PV and EA (P<0.01) and lower ED (P<0.01). A negative significant correlation was found between ED and inflammation markers, both CRP (P<0.05) and Fbg (P<0.01), indicating that decreased ED seems to be related to inflammatory changes at microcirculatory levels. In addition, patients with anticentromere antibodies show significantly lower ED than those without (P<0.05). The clinical significance of this observation needs to be clarified, deserving further research. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is characterised by increased venous and arterial thrombotic risk. Although antiphospholipid antibodies (APAs) have been shown to be related with thrombotic tendency in these patients, in more than 40% of them, thrombosis occurs without the presence of such antibodies. We analysed the association of venous and arterial thrombotic events with acquired (anticardiolipin antibodies (ACAs) and lupus anticoagulant (LA)) and inherited (antithrombin (AT), protein C (PC), protein S (PS) deficiencies, factor V Leiden and the prothrombin G20210A mutation), thrombophilic risk factors in 86 SLE patients and 89 healthy controls. Patients showed a higher significant percentage of ACAs titres IgG>41 GPL u/ml and LA than controls (P=0.009; P<0.001, respectively), although no differences in AT, PC, PS deficiencies, factor V Leiden and prothrombin G20210A mutation was observed (P>0.05). When patients with and without thrombosis were compared, those with thrombosis showed a statistically higher percentage of ACAs IgG>41 GPL u/ml and LA (P=0.048; P=0.001, respectively), OR 4.33; 95% CI 1.01–18.50 and OR 11.57; 95% CI 3.28–40.75, respectively. When venous and arterial thrombotic events were considered separately, the presence of LA constituted a risk factor for arterial thrombosis (P=0.010), OR 11.33; 95% CI 1.86–68.89, as well as for venous thrombosis (P=0.005), OR 10.15; 95% CI 2.12–48.64, while ACAs IgG>41 GPL u/ml on their own, were not associated with arterial or venous thrombosis (P=0.142, P=0.233, respectively). In addition inherited thrombophilic risk factors AT, PC, PS deficiencies, factor V Leiden and PT G20210A mutation do not seem to increase thrombotic risk in SLE patients. [ABSTRACT FROM AUTHOR]

Atherothrombotic events are significant factors of mortality and morbidity in patients with systemic lupus erythematosus (SLE). The extent that rheological factors may be involved in these events in these patients has not been established. We measured the following rheological parameters in 86 patients with SLE, of whom 16 had suffered venous and/or arterial thrombotic events, and in 86 healthy controls: fibrinogen (Fbg), plasma viscosity (PV), blood viscosity at 230 s-1 both at native haematocrit (BVn 230 s-1) and corrected to 45% (BVc 230 s-1), erythrocyte aggregation at stasis (AE0) and at 3 s-1 (AE1), aggregation time (Ta), aggregation index at 10 s (AI10), disaggregation threshold (γD), and erythrocyte deformability (ED). In addition glucose, total cholesterol (T-Chol), triglycerides (TG), haematocrit (Hct) and Body Mass Index (BMI) were determined. SLE Disease Activity Index (SLEDAI) was also assessed. The patients showed a significant increase in BMI (P=0.030), TG (P<0.001), PV (P=0.007), AE0 (P=0.005), AE1 (P=0.006), AI10 (P=0.024), γD (P=0.001), Fbg (P=0.050); and a significant decrease in Ta (P<0.001), Hct (P<0.001) and BVn 230 s-1 (P=0.003). When patients with SLEDAI10 were compared, the latter had lower Hct (P=0.041) and lower BVn 230 s-1 (P=0.017) than those with less SLEDAI. No significant differences were found in any of the parameters analysed on comparing patients who had suffered a thrombotic event with those who had not. Our results suggest that, although patients with SLE have moderate rheological changes, these do not seem to be responsible for the increase in the thrombotic tendency in these patients. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is associated with an increased thrombotic risk, although the prothrombotic mechanisms are not clearly defined. Alterations in blood rheology, specially increased erythrocyte aggregation has been suggested to play an important role in the development of thrombotic events in patients with Behçet's disease. In order to ascertain whether any rheological parameter could be involved in the pathogenesis of thrombotic events in Behçet's disease we have determined plasmatic lipids, fibrinogen, hematocrit, erythrocyte aggregation (Myrenne aggregometer), erythrocyte deformability (Rheodyn SSD), blood viscosity (Brookfield viscosimeter), plasma viscosity (Fresenius capillary viscosimeter) and erythrocyte indexes in Behçet's patients with a non‐active disease when sampling, and a well matched control group. The patient group was made up of 40 Behçet's patients (20 male, 20 female aged 43±12 years) and the control group comprised 70 healthy volunteers (24 male, 46 female aged 45±13 years). Twelve of the 40 Behçet's patients have had a previous documented history of deep vein thrombosis at least six months before entering the study, and the other 28 did not. When patients and controls were compared, patients showed a statistically higher fibrinogen level (p=0.002), plasma viscosity (p=0.003), blood viscosity (p=0.021) and erythrocyte aggregation (p=0.049), the other rheological parameters not being statistically significant. No differences were observed in the rheological parameters when patients with and without a previous thrombotic episode were compared. Our results suggest that rheological alterations do not seem to play any role in the development of thrombotic events in patients with Behçet's disease. [ABSTRACT FROM AUTHOR]

We report on a 19-year-old girl with upper extremity deep vein thrombosis after catheter indwelling whose thrombophilic study disclosed the coexistence of factor V Leiden and the prothrombin G20210A mutation, The family study identified five other members who were also heterozygous for both mutations. This is the first case of upper extremity deep vein thrombosis with the co-inheritance of both genetic defects. It provides further evidence that thrombophilic defects mostly require additional triggering factors to induce a thrombotic event and suggests that in young patients with this venous thrombotic location, a thrombophilic search should be performed even when there are other acquired thrombotic risk factors. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 60-year old woman who was referred for evaluation of an asymptomatic pigmented lesion located on her lower left gingival mucosa.