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Quality-of-life impairment is not related to disease activity in lichen planopilaris and frontal fibrosing alopecia. Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are chronic lymphocytic cicatricial alopecias (CAs) with unclear etiopathogenesis. At least one non-scalp lesion was present in 67.5% ( I n i = 25) of all patients; 8.1% ( I n i = 3) with LPP and 59.4% ( I n i = 22) with FFA. [Extracted from the article]

The presence of perifollicular lymphocytic inflammation and perifollicular fibrosis in 64% and 48% of non-lesional areas, respectively, points to a more generalized inflammatory process affecting the scalp in FD. Evidence for lymphocytic inflammation in non-lesional scalp of folliculitis decalvans: an observational study of 25 patients 2 The apparent lack of inflammation around sebaceous glands in lesional scalp is probably related to the loss of these structures due to inflammation. [Extracted from the article]

GLO:3NZ/01mar21:jdv16919-fig-0001.jpg PHOTO (COLOR): 1 (a,b) Clinical images of multiple irregular blue-coloured flat lesions on the vertex scalp of two patients with folliculitis decalvans. Dermatologists and general physicians should be aware of these benign lesions in the scalp of patients with FD in order not to misdiagnose them as malignant melanocytic lesions. Folliculitis decalvans (FD) is a neutrophilic primary scarring alopecia characterized by chronic inflammation and intense fibrosis. [Extracted from the article]

Competing Interests: None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Background: The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported., Objective: To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease., Methods: Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms., Results: Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more., Limitations: The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities., Conclusion: The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium., Competing Interests: Dr Tosti is a consultant for DS Laboratories, Monat Global, Almirall, Tirthy Madison, Eli Lilly, Leo Pharmaceuticals, Bristol Myers Squibb, and P&G. Drs Starace, Lorizzo, Sechi, Alessandrini, Carpanese, Bruni, Vara, Apalla, Asz-Sigall, Barruscotti, Camacho, Doche, Estrada, Dhurat, Gavazzoni, Grimalt, Harries, Ioannidis, McMichael, Melo, Oliveira, Ovcharenko, Pirmez, Ramot, Rudnicka, Shapiro, Silyuk, Sinclair, Vano-Galvan, and Piraccini have no conflicts of interest to declare., (© 2021 Published by Elsevier Inc on behalf of the American Academy of Dermatology, Inc.)

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic scarring alopecias affecting primarily the scalp. Although both diseases may share some clinical and histopathological features, in the last decade, FFA has become an "epidemic" particularly in Europe, North and South America with unique clinical manifestations compared to LPP, thus, raising the idea that this disease may have a different pathogenesis. Symptoms such as scalp burning, pruritus or pain are usually present in both diseases, suggesting a possible role for nerves and neuropeptides in the pathogenesis of both diseases. Based on some previous studies, neuropeptides, such as substance P (SP) and calcitonin gene-related peptide (CGRP), have been associated with lipid metabolism and many chronic inflammatory disorders. In this study, we asked if these neuropeptides are associated with LPP and FFA scalp lesions. Alteration in the expression of SP and CGRP in affected and unaffected scalp skin from patients with both diseases was found with examination of sections using immunohistochemical techniques and confocal microscopy. We then quantitatively assessed and compared SP and CGRP expression from control, LPP and FFA scalp biopsies. Although LPP and FFA share similar histopathologic findings, opposite results were found in affected and unaffected scalp in the ELISA tests, suggesting that these diseases may have different pathogenic mechanisms. We also found presence of histopathological inflammation irrespective of evident clinical lesions, which raises the possibility that both diseases may be more generalized processes affecting the scalp., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocyte-mediated scarring alopecias which clinically affect primarily the anterior and mid-scalp. However, unaffected scalp areas have not yet been investigated in a systemic manner. In this study, we assessed histopathologic changes in affected and unaffected scalp in both diseases and healthy control subjects and compared these findings with clinical signs and scalp symptoms. We have demonstrated that "normal-appearing" scalp that is devoid of clinical lesions of LPP and FFA showed lymphocytic perifollicular inflammation around the isthmus/infundibulum areas in 65% of biopsy specimens, perifollicular fibrosis in 15% and mucin deposits in 7.5% of the cases. None of these findings were found in control samples. No direct correlation was found between the degree of histopathological inflammation, scalp symptoms and clinical lesions in the corresponding affected scalp areas. This preliminary study suggests that both diseases may be more generalized processes which affect the scalp and therefore need systemic or total scalp therapy., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

There has been a resurgence of syphilis in the last decade. Although alopecia is not a common manifestation of the disease, the "moth-eaten" pattern is considered patognomonic. However, diffuse hair loss, termed essential alopecia, sometimes can be the only sign of syphilis infection and mimic other conditions, such as alopecia areata and telogen effluvium. We describe three patients with syphilis in whom the pattern of alopecia was not typical. Although clinical, histopathological, and trichoscopic examinations may share some similar findings with other hair diseases, the inclusion of syphilis in the differential diagnosis of hair loss causes is fundamental to a correct screening and diagnosis.

Intralesional corticosteroid (IL-CS) injections have been used to treat a variety of dermatological and nondermatological diseases. Although an important therapeutic tool in dermatology, a number of local side effects, including skin atrophy, have been reported following IL-CS injections. We recently noticed that a subset of patients with steroid-induced atrophy presented with ivory-colored areas under trichoscopy. We performed a retrospective analysis of trichoscopic images and medical records from patients presenting ivory-colored areas associated with atrophic scalp lesions. In this paper, we associate this feature with the presence of steroid deposits in the dermis and report additional trichoscopic features of steroid-induced atrophy on the scalp, such as prominent blood vessels and visualization of hair bulbs.

Psoriasis is a relatively frequent inflammatory dermatosis. Scarring alopecia due to scalp psoriasis was first reported in 1972, but few reports have been written since then, showing that this is a very rare complication of a common disorder. We report a young Brazilian woman with longstanding scalp psoriasis, which progressed to scaring alopecia.

Background: Frontal fibrosing alopecia is considered a particular clinical form of lichen planopilaris that primarily involves the scalp hair over the frontal hairline. Concomitant involvement of vellus at different body sites has recently been reported. To our knowledge, this is the first report on the involvement of facial vellus by effects of the inflammatory process. Unlike the usual noninflammatory clinical presentation of vellus involvement over other body areas, facial vellus involvement can lead to surface changes that may be recognized both by patients and dermatologists., Observations: Four patients with typical clinical features of frontal fibrosing alopecia presented with noninflammatory follicular papules over the face, most often inside the temporal area, and described as "roughness" by the patients. Histologic samples showed lichen planopilaris features involving the facial vellus., Conclusions: The new concept of frontal fibrosing alopecia as a generalized disease is important for treatment planning and research. Dermatologists must learn to recognize facial surface changes and discuss these with the patients, who may attribute this roughness to aging or hormonal changes associated with menopause. Further studies are needed to determine the prevalence of this involvement in patients with frontal fibrosing alopecia.