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Background: Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris predominantly affecting postmenopausal women. We report a series of 20 cases of FFA and describe the epidemiological, clinical, dermoscopic features and progress under treatment., Patients and Methods: This was a prospective study conducted over a period of 16 months in patients seen at the dermatology department of the Hassan II University in Fez, Morocco., Results: Mean patient age was 46 years. Patients were premenopausal in 65% of cases. Dermoscopic examination revealed specific signs of the disease. Skin biopsy guided by dermoscopy confirmed the diagnosis of lichen planus pilaris in its FFA variant in all cases. Immune dysfunctions and other disorders were noted in half of the cases. Various treatments had been initiated, including topical corticosteroids, tacrolimus ointment, minoxidil 2%, hydroxychloroquine, and oral finasteride. The results were satisfactory with a decline within one year., Conclusion: FFA is increasingly widely described in premenopausal women. Dermoscopy may be used to facilitate diagnosis, guide biopsy, evaluate treatment efficacy and establish a prognosis., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Scarring alopecia resulting from burns may be difficult to treat and involves various plastic surgery techniques such as expanded scalp flaps., Observation: Herein, we report the case of a 19-year-old male patient who suffered burning of the scalp with scarring alopecia following an attack with a Taser(®) electrical gun. Given the extent and site of alopecia, we decided to create a prosthesis by means of scalp expansion. The cosmetic result was satisfactory., Discussion: Several scalp reconstruction techniques have been described for scarring alopecia, with the most widely used being expansion, scalp flaps, repeated excision and hair implants., Conclusion: The present case suggests that scalp expansion offers an effective method for the reconstruction of scarring alopecia following burns with a Taser(®) device., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Pseudocysts of the scalp are a poorly known entity. Herein we present two new cases., Case Report: Two male patients aged respectively 42 and 33 years had been presenting a small number of pseudocystic lesions on the scalp, as well as alopecia limited to the same region, for a number of years. Inflammatory episodes had occurred in certain lesions. In one case, biopsy showed an aspect typical of pseudocyst of the scalp and the lesions appeared to stabilize on treatment with doxycycline., Discussion: Pseudocysts of the scalp are also known as aseptic nodules of the scalp, a term that appears to us to be less appropriate. They form lesions involving alopecia and they may be inflammatory to various degrees. Following incision of these lesions, a deep yellow fluid liquid is released that may be shown by microbiological analysis to be sterile. Histological analysis reveals a pseudocystic wall associated with perilesional inflammatory remodelling. The cysts are frequently confused with dissecting cellulitis of the scalp, but the prognosis is more encouraging. Treatment involves surgical excision, and intralesional injections of corticosteroids or doxycycline., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: The clinical features of porphyria cutanea tarda (PCT) are usually distinctive and include blistering on sun-exposed areas, fragile skin, hypertrichosis and hyperpigmentation. Sclerodermatous changes are much less common, and may either reveal PCT or else appear later. We carried out a retrospective study of the files of six female patients presenting such lesions., Patients and Methods: Six women (age: 45 to 72 years) were referred for sclerodermatous lesions on sun-exposed areas of the upper body. In four patients, these lesions revealed PCT and in the remaining two patients they were indicative of previously treated but relapsing PCT. Four had sclerodermatous skin changes mimicking morphea of the neck and neckline, the top of the back and the face, while one presented more diffuse facial and cervical sclerosis. Associated alopecia was seen in three patients. The last patient presented isolated sclerodermiform alopecia. Associated malar hypertrichosis was seen in five cases and facial hyperpigmentation was noted in three cases. Four exhibited no blisters, cutaneous fragility, milia or photosensitivity. Histological findings were consistent with morphea or scleroderma in all cases. All patients presented abnormal liver tests: cirrhosis was present in four cases (primitive biliary cirrhosis, alcoholic cirrhosis and hepatitis C) and fatty liver in two cases. In four cases, there was excessive alcohol intake. Uroporphyrin levels were above the normal range in all cases. Local corticosteroid therapy associated with phlebotomy and/or low-dose hydroxychloroquine resulted in complete normalisation of porphyrin levels in four patients, with complete resolution of the cutaneous lesions in two patients and partial improvement in the other two., Discussion: Sclerodermatous changes are uncommon in PCT. They are not always late and secondary to the process of healing of blisters but can in fact constitute the first cutaneous symptom of the disease while revealing the underlying liver disease. Even in the absence of blisters, photosensitivity or cutaneous fragility, a diagnosis of PCT must be suspected in a setting of sclerodermatous changes distributed on the neck and face, or the neckline, or scarring alopecia, if associated with abnormal liver tests. Skin biopsy to confirm the diagnosis of scleroderma may delay the diagnosis, which is in fact based on porphyrin level. Normalization of the latter parameter under treatment allows regression of lesions., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Extraskeletal osteosarcoma is a rare mesenchymatous tumour occurring in adults aged over 50 years and is located mainly in the limbs or retroperitoneum. We report a case of metastatic extraskeletal osteosarcoma revealed by a cutaneous occipital tumour site., Case-Report: A 53-year-old woman was admitted for dyspnea and weight loss. An occipital tumour, noticed for one year by the patient, was discovered. It was freely movable on the bone, of hard consistency and responsible for alopecia. In addition to left-sided pleural effusion, a chest CAT revealed a large mass in the left lung, including areas of necrosis and calcifications with intracardiac extension. Histological examination of biopsies of the skin and of pulmonary and intracardiac lumps showed an osteosarcomatous proliferation. No primary osteosarcoma was found in the bones. A diagnosis was made of metastatic extraskeletal osteosarcoma. Intravenous chemotherapy was given followed by radiotherapy. After a six-month stabilization period, the disease progressed., Discussion: Extraskeletal cutaneous locations of osteosarcoma are extremely rare. They may comprise either the primary tumour or a metastatic lesion. In this patient, the immediately metastatic nature of the disease was a poor prognostic factor for this high-grade sarcoma.

Background: In menopausal women, rapid development of androgenetic alopecia may be associated with development of androgen-secreting tumors even in the absence of signs of virilisation. We report a case in which ovarian tumor was revealed by this condition., Observation: A 75 year-old woman menopausal from the age of 44 years had experienced hair loss over the previous three years with exacerbation over the last year. Clinical examination revealed male pattern androgenogenetic alopecia but with no signs of virilisation. Testosterone levels were 3 times the normal limit. Radiological examination confirmed the presence of an ovarian tumour and hysterectomy was performed with bilateral actomy. Histopathological examination revealed a mature cystic dysembryoma of the right ovary containing Leydig cell islets. The outcome was favourable with normalisation of hormone levels 2 months after surgery and gradual hair growth., Discussion: This case involved a woman with androgenogenetic alopecia with no signs of virilisation or of hirsutism. The clinical picture was banal, and given the patient's age, there was no justification for routine endocrine investigation. Because of recent focus on androgenogenetic alopecia, testosterone levels were checked, resulting in the discovery of an ovarian tumour containing Leydig cells. In menopausal women with recent and/or severe androgenogenetic alopecia, testosterone levels should be determined in addition to ultrasensitive TSH and ferritin.

Background: Erosive pustulosis of the scalp is a rare entity of unknown etiology mainly affecting elderly people. It is often triggered by local trauma and features chronic pustules of the scalp evolving toward scarring alopecia. Its treatment is not yet codified., Observations: Two patients (66 and 87 years old) presented with crusted and erosive pustules of the scalp following surgical removal of actinic keratosis and total skin graft. In a third patient, similar lesions appeared after hair grafting. Clinical features were consistent with the clinical pattern of erosive pustulosis of the scalp. In all three patients, oral zinc gluconate in combination with topical steroids associated resulted in significant improvement., Conclusion: An association of topical steroids and oral zinc gluconate might be an interesting therapeutic option in this chronic, often disabling affection.

Background: Folliculitis decalvans consists of recurrent patchy painful folliculitis of the scalp causing scarring alopecia. The physiopathology of this condition is still unclear, but is likely a manifestation of chronic neutrophilic bacterial folliculitis. Numerous topical and systemic treatments (corticosteroids, antistaphylococcal antibiotics) have been used with variable results. Based on the dapsone antimicrobial activity and its anti-inflammatory action especially directed to the neutrophil metabolism, we treated two patients with severe folliculitis decalvans with this drug., Case Reports: The patients were treated with dapsone at a daily dose of 75 and 100 mg, respectively for 4 to 6 months. After 1 and 2 months, pustular folliculitis progressively cleared, leaving a residual non inflammatory cicatricial alopecia. When maintaining a dapsone dosage at 25 mg/day no relapse occurred during 3 years and 1 year, respectively. No important adverse effect to dapsone was evidenced. After dapsone withdrawal, a moderate relapse of the disease with pruritus and folliculitis occurred after a few weeks in both cases. The disease relapse rapidly cleared after dapsone reintroduction at a daily dose of 25 mg., Comments: Dapsone at moderate dosage was well tolerated and rapidly effective in treating the two cases of folliculitis decalvans. A long term and low dose (25 mg daily) maintenance treatment avoided disease relapses.

Background: Intraoperative fluoroscopy imaging during coronaroplasty or transjugular intrahepatic portosystemic shunt may induce chronic radiodermatitis. Temporary hair loss is a peculiar form of radiodermatitis following endovascular surgery of the cerebral arteries., Case Reports: Six patients (2 women, 4 men, age range: 27-47 years old) were seen for a solitary plaque of alopecia. In all of the cases, the plaque had appeared two weeks after a neuroradiologically guided embolization procedure. No other skin lesions were seen. Alopecia spontaneously and completely regressed within three to four months. However, it reappeared after a subsequent embolization (one case) but not after arteriographies (five cases)., Discussion: Five similar cases have been reported in the literature. Transient alopecia often occurs after neurologically guided endovascular surgery of the cerebral arteries. This side-effect is well known by neurosurgeons and thus, these patients are rarely referred to a dermatologist. Two differential diagnoses must be evoqued: alopecia aerata and anticonvulsant - induced alopecia. The role played as cofactor by carbamazepine which is a photosensitivant drug, is discussed.

Introduction: Androgen-producing tumors of the ovary are rare in postmenopausal women and are revealed by severe virilization. Leydig hilus cell tumors are the most frequent postmenopausal virilizing tumors. In this report, an unusual and rare cause of alopecia due to Leydig cell hyperplasia within the wall of a simple cyst and in the ovarian hilus is described., Observation: An 80 year-old woman complained of a 10-year history of severe androgenic alopecia associated with very mild facial hirsutism, without others signs of virilization. Hormonal blood levels showed markedly elevated testosterone. Computed tomographic scan of the adrenals and the ovaries revealed an enormous left ovarian cystic mass. Bilateral hystero-ophorectomy was performed. Histological examination demonstrated bilateral Leydig cell hyperplasia within the wall of the cyst and in the right ovarian hilus. Two months postoperative hormonal evaluation demonstrated dramatically decreased plasma levels of testosterone., Commentary: The clinical, X ray and histologic aspects of this case, although rare, show that the presence of virilization should lead to a search for an androgen-secreting ovarian or adrenal tumor.

Introduction: Tufted hair folliculitis is a localized scarring bacterial folliculitis due to Staphylococcus aureus. We present two cases., Observations: Both patients were in their thirties. The first had had an inflammatory sclerous lesion of the vertex for three years, and the second an alopecial scarring lesion. Clinically there were tufts of hair within or around the lesions. Staphylococcus aureus was found in biopsy samples which showed hairs or composed follicles. Prolonged treatment with oral antibiotics led to progressive limitation of the lesions., Discussion: Tufted hair folliculitis is a characteristic folliculitis of the scalp showing scar formation and the presence of Staphylococcus aureus. The review of the literature raises the question of the role of local immunity and the nature of the hair tufts: primary anomaly or secondary to Staphylococcus infection? The therapeutic attitude is not well defined but prolonged treatment with oral antibiotics can stabilize the lesions.

A typical case of loose anagen hair syndrome in a 4-year old girl is reported here. The key signs of this disease are the absence of hair cut since infancy, an easy and painless uprooting of the hairs and a 100 p. 100 anageneity of the hairs with distorted bulbs on trichograms. There is no known treatment of this anomaly. Cosmetically, the course of the disease is usually favourable, but abnormal trichograms and fragility of the hairs persist in adulthood. A brief review of the literature concerning this probably underestimated condition is presented.

In 1984, Zaun described a new type of pilary dysplasia characterized by easily pluckable hair. We were able to observe three patients with this anomaly, and this paper is an attempt at reviewing the subject on the basis of these new cases compared with those previously published. Clinical features. The major sign of the anomaly is that hairs can be pulled off in tufts easily and painlessly, and promptly grow again (our cases). In all cases reported so far the hair was blond or dark-blond; in some patients it is described as scintillating (our cases). The hair shaft is usually thin (one of our cases), but it may be of normal caliber (two of our patients). In the occipital region the hairs are entangled, dry and short (our cases). They are implanted wide apart or at normal intervals (our patients); areas of alopecia are sometimes encountered (our cases). Hair growth may be slow (one of our cases) or of normal speed (two of our cases). The eyelashes and eyebrows, as well as other body hairs, are normal in all patients (fig. 1). Microscopy. The trichogram is exclusively composed of anagenic and dystrophic roots (our cases). Pathological examination by biopsy of the scalp is characteristic: transverse and oblique sections of the follicles show that the hairs are oval, triangular or trapezoidal in shape (fig. 7). Alterations of the inner epithelial sheath are also present, including keratinization and early decomposition (fig. 8), lack of complementation (fig. 7) and fissures between the cuticle of the inner epithelial sheath and of the hair, in the keratogenic area (fig. 9). (ABSTRACT TRUNCATED AT 250 WORDS)