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Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.

Background: Scalp biopsy provides worthwhile diagnostic clues to diagnose the noncicatricial or cicatricial type of alopecia. Although a pair of vertically and horizontally sectioned pathology samples would be ideal, the diagnostic yield of vertical (V) or transverse (T) sectioning in different types of cicatricial and non-cicatricial alopecia is not studied. Also, when a single biopsy is submitted and/or the sample is not large enough for a combined V and T sectioning from a single specimen (such as HoVert technique), the decision to make the most appropriate sectioning would be challenging, specifically depending on the type of alopecia suspected clinically. Methods: A prospective study included 194 patients with two 4 mm-punch biopsies, one was sectioned vertically and the other horizontally. The V and T diagnoses were compared with the final diagnosis. The kappa coefficient of agreement, sensitivity, specificity, likelihood ratio (LR), diagnostic odd ratio (DOR) and concordance were estimated. Results: The most common types of alopecia were lichen planopilaris (62, 31%), androgenic alopecia (36, 18%) and central centrifugal cicatricial alopecia (26, 13%). The perifollicular inflammatory cell types, presence of pigmented cast and sebaceous hyperplasia were adequately detected in the in T (p

Introduction: Cicatricial alopecia (CA) is a group of disorders that lead to permanent hair loss due to irreversible damage to hair follicles. The aim of this study is to examine clinical and demographic characteristics of patients diagnosed with primary lymphocytic cicatricial alopecia (PLCA).Methods: Patients admitted to our outpatient clinic between 2000 and 2010 and who were diagnosed with PLCA were retrospectively evaluated for demographic characteristics, dermatologic findings, personal and family history, histopathologic results, therapeutic options given to the patients, and patient responses to the treatments.Results: Thirty-six patients were included in this study. Histopathological examination of scalp hair samples revealed that findings were concordant with lichen planopilaris (LPP) in 26 patients, discoid lupus erythematosus (DLE) in 7 patients, pseudopelade de Brocq (PB) in 3 patients. The main first-line treatment most commonly reported was intralesional corticosteroid injection (ILCS, n=16, 44.4%), which was followed by hydroxychloroquine (n=10, 28%). Nineteen of the 36 patients responded to the first-line treatments, whereas 17 patients needed another treatment. Treatments that patients were most likely to respond to were hydroxychloroquine and ILCS for LPP patients; hydroxychloroquine for DLE patients; hydroxychloroquine, systemic corticosteroid, and topical corticosteroid treatments for PB patients.Conclusion: PLCA is an entity widely observed in middle-aged women and is mostly encountered in the form of LPP. In the current study, patients most likely benefited from ILCS and hydroxychloroquine treatments.

Shani Golan, Gilad Rabina, Shimon Kurtz, Igal Leibovitch Division of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose and design: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed.Participants: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial.Methods: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period.Main outcome measure: In this study, the prevalence of glaucoma in individuals withectropion or entropion was the main outcome measure.Results: A total of 227 patients (57% men, mean age: 79.2years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications.Conclusion: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients. Keywords: cicatricial, lamella, review