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This work reports 30 cases of folliculitis decalvans (FD) in patients with dystrophic epidermolysis bullosa (DEB) among a cohort of 125 DEB patients seen between 2010 and 2021 in 2 French expert centers for the management of inherited epidermolysis bullosa. Such an association between two rare diseases cannot be fortuitous and implies a physiopathological link that we discuss in this paper. This association is a new significant fact to add to the reflexion on FD causes, suggesting that skin abnormality of DEB could act as a factor of a specific skin barrier alteration which could favor FD. Scarring alopecia with tufted folliculitis and pustules on inflamed skin at the vertex of a woman with dominant dystrophic epidermolysis bullosa.

Background: Homeostasis in the differentiation programme of sebaceous stem cells has been identified as a key step in comedogenesis and should be a target for acne-prone skin care. Objective: To report on a multicentre, year-long/real-life use study of a patented natural product containing S. marianum fruit extract proven to modulate molecular actors in the initial steps of comedogenesis. Methods: An open-label multicentric international study, with a 12 month follow-up, included 54 teenage and young adult subjects with mild to moderate facial acne. The study was aimed at reproducing a real-life use context. Results: Total lesion count mean was 88.3 at inclusion. There was a sustained, highly significant decrease over the months of clinical lesion counts (45.6% improvement after 6 months and 59.6% at 12 months) and on other efficacy markers, associated with a significant decrease in global microcomedone quantity on cyanoacrylate superficial skin surface biopsies. Importantly, the study protocol allowed the dermatologist to prescribe, if needed as in real life, any of the acne drugs registered in the acne guidelines. The exposure to these acne drugs during the whole year was calculated as a percentage of S. marianum fruit extract/352 days of use and happened to be very limited at less than 4%, which indicates a marginal contribution to the sustained clinical improvement. (Oral and local acne treatments: Lymecycline 1.46%; Doxycycline 0.24%; Adapalene 0.16% or gel association with Benzoyl peroxide 1.17%; Clindamycin 0.04%; Benzoyl peroxide 1.5%; Erythromycin 0.75%). The tolerance with daily S. marianum fruit extract long-term use was good. Limitations: The association with routine prescription acne drugs when needed, even if limited, does not allow a full evaluation of the intrinsic quantitative efficacy of S. marianum fruit extract in lesion reduction. Conclusion: This open, real-life, year-long multicentre study confirms a previous 48-week proof of concept study and qualifies the use of S. marianum fruit extract as a “field-dermo cosmetic” contributing to homeostasis of acne-prone skin in association with acne drugs.

Background Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. Objectives To enable data to be collected worldwide on FFA using common criteria and assessment methods. Methods A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. Results Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. Conclusions These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.

Background We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata. Objective To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata. Methods Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%. Results Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]). Limitations The study had low representation from Africa, South America, and Asia. Conclusion There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care.

Androgenetic alopecia (AGA) is a pathology involving the aesthetic prognosis. Hair transplantation is among best treatments. The principle of hair micro-grafts during AGA consists in taking hair from the non-androgen-dependent occipital area to transplant them with their root in the sparse androgen-dependent areas. Herein, we report 10 cases of the different types of post-transplant inflammatory complications.We included patients referred to our center by their dermatologists or hair transplant surgeons for inflammatory cicatricial alopecia or hair loss observed after the hair transplant.Ten patients (eight men and two women) were included. These patients represented 0.08% of all consultations in our center. The indication for hair transplantation was AGA in all of our patients. The technique used for the transplant was follicular unit extraction (FUE) in seven cases and follicular unit transplantation (FUT) strip in three cases. None of the patients had pathology of the scalp or an inflammatory dermatosis before the operation. The inflammatory complications found were lichen planopilaris (LPP) in seven cases, erosive pustulosis of the scalp (EPS) in two cases, and superficial folliculitis (SF) in 1 case.Our series highlight the rarity of inflammatory complications that occur after a hair transplant. We demonstrate through this work that a hair transplant can trigger inflammatory pathology a few months after the act. We show also, the importance of detecting the rough forms of lichen before an intervention, hence the interest of the systematic dermatoscopic examination during the preoperative consultation.

Introduction Androgenic alopecia (AGA) is a common and chronic condition. It may impact self-esteem, self-image and quality of life. Benefit, tolerability, cosmetic acceptance and patient satisfaction are key to ensuring good treatment outcome. Aim Assessment of hair loss improvement and hair quality with AC5 in subjects with mild AGA in real life settings. Materials and methods Open-label, observational, international real-life study in 527 adult subjects with mild AGA who received AC5 (2,4-Diamino-Pyrimidine-N-Oxyde, arginine, 6-O glucose linoleate (SP94), piroctone olamine and Vichy mineralizing water) once daily for 3 months. After 3 months, investigators evaluated the impact of AC5 on hair loss and product satisfaction, and asked subjects about local tolerance; subjects assessed hair growth and quality, as well as satisfaction. Results Data from 357 subjects were evaluable for the benefit analysis; 59.9% of subjects were female; the mean age was 33.6±8.7 years. Duration of hair loss was 1.62±2.24 years. 71.3% of women had a Ludwig score of 1 and 40.8% of men had a Hamilton Norwood score of 2. At the end of study, hair loss was reduced in 89.0% of subjects; it was slightly higher in women (92.5%) than in men (83.8%). Subject satisfaction on a scale from 0 (not satisfied at all) to 10 (completely satisfied) was 7.9±1.7. Tolerance was rated good to very good by 98.6% of all subjects. Conclusion AC5 reduces mild AGA in both men and women and has a pleasant texture. AC5 was well tolerated and highly appreciated. This article is protected by copyright. All rights reserved.

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Importance A recent expert consensus exercise emphasized the importance of developing a global network of patient registries for alopecia areata to redress the paucity of comparable, real-world data regarding the effectiveness and safety of existing and emerging therapies for alopecia areata. Objective To generate core domains and domain items for a global network of alopecia areata patient registries. Evidence Review Sixty-six participants, representing physicians, patient organizations, scientists, the pharmaceutical industry, and pharmacoeconomic experts, participated in a 3-round eDelphi process, culminating in a face-to-face meeting at the World Congress of Dermatology, Milan, Italy, June 14, 2019. Findings Ninety-two core data items, across 25 domains, achieved consensus agreement. Twenty further noncore items were retained to facilitate data harmonization in centers that wish to record them. Broad representation across multiple stakeholder groups was sought; however, the opinion of physicians was overrepresented. Conclusions and Relevance This study identifies the domains and domain items required to develop a global network of alopecia areata registries. These domains will facilitate a standardized approach that will enable the recording of a comprehensive, comparable data set required to oversee the introduction of new therapies and harness real-world evidence from existing therapies at a time when the alopecia areata treatment paradigm is being radically and positively disrupted. Reuse of similar, existing frameworks in atopic dermatitis, produced by the Treatment of Atopic Eczema (TREAT) Registry Taskforce, increases the potential to reuse existing resources, creates opportunities for comparison of data across dermatology subspecialty disease areas, and supports the concept of data harmonization.

Background A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials. Objective To produce an international consensus statement on the use and utility of various treatments for AA. Methods Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus. Results In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies. Limitations The study included a comprehensive list of systemic treatments for AA but not all treatments used. Conclusion Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.

Immune checkpoint inhibitors (ICI) are new therapies used for solid and hematologic cancers.1, 2 They induce activation of CD4 and CD8 cells that target tumor cells and may target unidentified cutaneous antigens, resulting in an inflammatory process after cross-reaction with normal antigens and in immune-related adverse events.3 Skin toxicity seems to be higher with monoclonal antibody targeting the cytotoxic T-lymphocyte–associated antigen-4 (CTLA-4) compared with monoclonal antibody targeting programmed cell death protein-1 (PD-1).3 Used in combination, cutaneous immune-related adverse events would be more prevalent and more severe.3 Maculopapular rash, lichenoid reactions, pruritus, vitiligo, bullous disorders, and psoriasis exacerbation, among others, are related.3 One percent to 2% of the patients go on to have alopecia areata (AA) or universalis.3 We report 4 cases of AA after treatment with nivolumab (anti–PD-1) alone or in combination with ipilimumab (anti–CTLA-4), for metastatic melanoma and lung cancer.

Introduction Le principe des micro-greffes capillaires au cours des alopecies androgenetiques (AAG) consiste a prelever des cheveux de la zone occipitale non androgeno-dependante pour les transplanter avec leur racine dans les zones clairsemees androgeno-dependantes. Nous rapportons ici les complications inflammatoires post-greffe observees au Centre Sabouraud dans les suites de correction d’AAG. Materiel et methodes Etude retrospective des patients ayant consulte entre 2015 et 2021 pour alopecie cicatricielle inflammatoire post-greffe de cheveux. Resultats Dix patients (âge moyen 53 ans) : 8 hommes et 2 femmes, tous greffes pour AAG, representant 0,08 % des consultations du centre. Aucune pathologie du cuir chevelu et aucune dermatose inflammatoire n’etait connue. Sept cas ont ete greffes par FUE et 3 cas par bandelettes FUT. Les complications inflammatoires etaient un lichen plan pilaire (LPP) dans 7 cas, une pustulose erosive du cuir chevelu (PECC) dans 2 cas et une folliculite superficielle dans 1 cas. Le delai moyen d’apparition des symptomes apres la greffe etait 12,4 mois (1 mois–4 ans). La greffe etait sur le vertex (8 cas), frontale (5 cas) ou temporale (3 cas). Les patients qui developpaient un LPP avaient tous une rarefaction des greffons et presentaient un erytheme avec des squames peripilaires au niveau des zones receveuses dans 3 cas. La dermatoscopie etait evocatrice de LPP dans ces 3 cas. La biopsie cutanee a confirme le diagnostic de LPP dans tous les cas. Les 2 patients qui avait une PECC presentaient des lesions pustulo-crouteuses au niveau de la zone receveuse. La dermatoscopie etait tres evocatrice du diagnostic dans 1cas et une histologie a confirme le diagnostic du 2e cas. La densite capillaire apres la greffe etait decevante chez tous les patients avec une estimation de repousse capillaire Discussion La greffe de cheveux est essentiellement pratiquee chez l’homme et la femme comme correction esthetique de l’AAG. Notre serie souligne la rarete des complications inflammatoires avec une nette predominance pour le LPP. Nos patients n’etaient pas porteurs d’un LPP ou d’une PECC avant la greffe. L’interet qui est montre par cette serie est de depister les formes frustes de lichen avant une intervention, d’ou l’interet de l’examen dermatoscopique systematique lors de la consultation preoperatoire afin de deceler la presence d’un eventuel LPP peu symptomatique qui contre-indiquerait la greffe, et en cas de doute de realiser une biopsie avec etude histologique en coupes verticales et horizontales, dans le but de confirmer ou non un LPP. La greffe capillaire pourrait egalement favoriser l’aggravation par effet Koebner d’un LPP fruste a ce jour non depiste. Pour la PECC, le role declenchant des traumatismes locaux est bien etabli et les micro-greffes en font partie.

Introduction L’alopecie frontale fibrosante (AFF) est une alopecie cicatricielle, caracterisee par une alopecie en bande de la ligne frontale et consideree comme une variante clinique du lichen plan pilaire (LPP), deux pathologies auto-immunes avec une physiopathologie proche et une etiologie inconnue. Si notre etude histologique recente a montre peu de differences entre AFF et LPP, elle a permis de preciser la nature differente des infiltrats, notamment lymphocytaires. L’objectif de cette etude est de caracteriser plus avant les sous-populations lymphocytaires telles que les cellules productrices d’IL17 ou d’IFNγ connues pour etre impliquees dans les maladies auto-immunes. Materiel et methodes Quinze patientes atteintes d’AFF, douze atteintes de LPP et douze femmes controles appariees pour l’âge (moyenne 61,9 ± 7,9 ans) ont ete inclues dans cette etude. La fibrose cutanee et l’infiltrat lymphocytaire ont ete evalues et caracterises respectivement par histologie et immunohistochimie. Les sous-populations lymphocytaires dans le sang peripherique ont ete identifiees par cytometrie en flux. Resultats Outre une fibrose perifolliculaire, une augmentation significative des cellules T CD8+ est observee dans les lesions cutanees des patients AFF et LPP par rapport aux temoins. Dans le sang, les pourcentages des lymphocytes Th17 (CD4+IL17+), des CD4 + RORdt+ productrices d’IL17 et des cellules Tc17 (CD8+IL17+) sont significativement augmentes chez les LPP par rapport aux temoins (p Discussion Ainsi, si les AFF et LPP partagent des caracteristiques histologiques, ces deux pathologies different dans le profil de leurs sous-populations lymphocytaires, avec davantage de lymphocytes Th17, Tc17, TCRgd producteurs d’IFNγ et/ou d’IL17 et de lymphocytes Treg producteurs de TNF dans les LPP par rapport aux AFF. Ces resultats suggerent que les lymphocytes Th17, Tc17, TCRgd et Treg sont des composantes cles de la physiopathologie des LPP, et a un degre moindre, des AFF, offrant ainsi de nouvelles cibles therapeutiques dans ces pathologies auto-immunes.

Introduction L’alopecie frontale fibrosante (AFF) est une alopecie cicatricielle d’incidence croissante, affectant principalement les femmes menopausees. Elle est caracterisee par une alopecie en bande de la ligne frontale. Son etiologie est inconnue. L‘histologie et la presentation clinique evoquent une forme particuliere de lichen plan pilaire (LPP) et leurs physiopathologies, proches, sont discutees dans la litterature. Afin de mieux caracteriser ces deux entites, nous avons etudie leurs aspects histologiques et analyse par immunohistochimie et cytometrie en flux, les populations cellulaires impliquees dans ces deux entites. Materiel et methodes Il s’agit d’une etude monocentrique, comparative, intergroupe, incluant : 12 femmes atteintes d’AFF d’âge median 68 ans (46–73), 12 femmes atteintes de LPP d’âge median 68 ans (46–73), 12 femmes temoins, d’âge median 54 ans (46–72), de phototype apparie. Deux biopsies cutanees de 2,5 mm etaient pratiquees pour chaque patiente dans les 3 groupes. Une biopsie etait incluse en paraffine pour l’analyse histologique et immunohistochimique, la seconde etait incubee en milieu de culture pour une analyse lymphocytaire ex vivo en cytometrie en flux. Resultats En histologie on observait un infiltrat lymphocytaire perifolliculaire significatif (p Ex vivo, ces differences etaient confirmees, avec des pourcentages de T CD8+ superieurs dans les AFF et LPP par rapport aux controles (augmentation respective de 1,7 et 1,3) avec une expression significative de CD183+ (recepteur chimiokine) sur les CD8+ et un ratio de cellules NK tres superieur (augmentation respective de 3,8 et 2) dans les AFF et LPP compares aux controles. Le ratio moyen des cellules CD4+/CD8+ etait de 2,4 (AFF) et 2,9 (LPP) ex vivo. Conclusion Nos resultats montrent de faibles differences histologiques entre AFF et LPP mais permettent de mieux preciser la nature differente des infiltrats en caracterisant certaines populations cellulaires. L’analyse fonctionnelle de ces populations pourrait ouvrir sur de nouvelles approches pharmacologiques.

Background Frontal fibrosing alopecia (FFA) is a cicatricial alopecia mostly affecting the frontotemporal hairline. Its aetiology and associated factors remain unclear. Objective and methods An observational, cross-sectional and descriptive study was conducted in France and Germany to identify demographic and health characteristics associated with the severity of FFA. Results Of 490 included patients, 95% were female, of which 84% were postmenopausal. Age at onset of FFA symptoms ranged between 15 and 89 years, but diagnosis was frequently delayed up to 24 years. Lichen Planopilaris Activity Index scores were low (median 1.8, IQR 1.0 to 3.5). Thyroid function disorders were reported in 13% of men and 35% of women. Abnormal blood lipid levels were found in 42% of tested men and 47% of women. In the bivariate analyses, LPPAI scores were negatively correlated with abnormal testosterone (rs = -0.775) and oestrogen values (rs = -0.664), regular use of face cleaning products (rs = -0.465), hair colourants (rs = -0.679) and hairspray (rs = -0.500). Conclusions The most common comorbidity was thyroid disease, with proportions higher than in the European population, possibly reflecting a role of thyroid hormones in FFA pathogenesis. The association of abnormal testosterone and oestrogen values with lesser disease activity needs to be explored in further studies. Our correlation analyses do not support a role of leave-on cosmetic products in the pathophysiology of FFA.

Folliculitis decalvans (FD) is a chronic inflammatory disease of unknown aetiology. Although Staphylococcus aureus, frequently found on lesional skin, is thought to play a causal role, the importance of its involvement remains controversial. To examine the role of S aureus, we compared superficial and subepidermal microbiota in 20 FD patients who had S aureus on lesional skin and in 20 healthy controls using culture techniques and genomic identification, before and after an anti-staphylococcal treatment; we also screened for S aureus virulence factors. When present on lesional skin, S aureus colonized non-lesional and subepidermal skin in 80% of cases. These data imply a break in the epidermal barrier integrity and that an abnormal non-lesional skin microbiota persists in FD. S aureus had no superantigenic toxin in 31% of cases and no toxin specificity. Clinical improvement obtained in most cases upon treatment was associated with the disappearance of S aureus in all studied areas, with an incomplete restoration of normal microbiota and a significant increase in negative bacterial samples. This persistent unbalanced, subepidermal microbiota may act as a reservoir of abnormal flora and explain the chronicity of FD, suggesting new avenues of research to restore normal microbiota.

Introduction Depuis la publication princeps rapportant l’efficacite du methotrexate (MTX) seul ou associe a 20 mg/j de prednisone (1), 16 etudes ouvertes ont ete publiees. La meta analyse qui les a integrees (2) a estime un taux de repousse complete de 35 % (IC95 % = 25–48 %), (44 % chez les adultes) et un taux de repousse > 50 % de 63 % (IC95 % = 54 % > 71 %) (69 % chez les adultes). Materiel et methodes Etude multicentrique randomisee en double aveugle comportant 2 phases : Phase 1 (M0 a M6) : randomisation : MTX : 20 a 25/semaine po versus placebo. Phase 2 (M6 a M12) : les patients ayant obtenu une repousse > 25 % (evaluee par 3 experts independants) restaient dans leur groupe de randomisation jusqu’a M12. Les autres patients etaient a nouveau randomises MTX + prednisone 20 mg/j puis 15 mg/j versus MTX + placebo. Criteres d’inclusion pelade totale ou universelle evoluant sans repousse depuis au moins 6 mois malgre des traitements anterieurs. L’evaluation de la repousse a M12 etait realisee par les investigateurs, les patients et par 3 experts independants. Resultats Un total de 89 patients d’âge moyen 38,6 ± 14,3 ans ont ete inclus, dont 66 provenaient d’un centre specialise dans la pathologie du cuir chevelu. La duree mediane d’evolution de la pelade etait de 5,8 ans [1,7–12,5]. Le taux de repousse complete a M12 chez les patients ayant obtenu une repousse > 25 % a M6 et etant restes dans leur groupe de randomisation initial (critere de jugement principal) etait de 1/45 (MTX) versus 0/44 (placebo). Le taux de repousse complete (evaluee par 3 experts independants) chez les patients re-randomises a M6 variait de 12 % a 38 % (MTX + prednisone) versus 12 % (MTX + placebo) et le taux de repousse > 50 % etait de 50 % (MTX + prednisone) versus 12 % (MTX + placebo). Aucun effet secondaire (ES) grave n’a ete observe. Le taux d’ES a M6 etait de 45 % dans le bras MTX (nausees, fatigue) versus 16 % dans le bras placebo (fatigue). Le taux d’ES a M12 des patients re-randomises dans les bras MTX + prednisone etait de 38 % a 44 % (diabete, prise de poids). L’appreciation de la repousse par les patients, les investigateurs et les experts etaient tres concordante : R = 0,96, R = 0,81, R = 0,89. Conclusion Cette etude confirme l’efficacite du MTX dans les formes les plus severes de pelades (totales et universelles d’evolution chronique ayant resiste a des traitements anterieurs), surtout lorsqu’il est associe a de faibles doses de prednisone. L’efficacite legerement moindre que celle rapportee dans la meta-analyse recente est vraisemblablement liee a un biais de selection puisque 70 % des malades ont ete inclus par un centre tertiaire. La combinaison avec une corticotherapie a faible dose ne semble pas augmenter la frequence des ES de maniere importante.

Introduction La cause de la folliculite decalvante (FD) est inconnue. Bien que Staphylococcus aureus soit suppose jouer un role, l’importance de son implication reste debattue. Pour etudier le role de S. aureus dans la FD, nous avons evalue (1) la prevalence de S. aureus dans le compartiment sous epidermique de patients chez qui S. aureus a ete trouve en peau lesionnelle par ecouvillonnage ; (2) les variations de la prevalence de S. aureus a la surface de la peau et dans le compartiment sous epidermique apres un traitement anti-staphylococcique ; (3) la composition du microbiote superficiel et sous epidermique avant et apres un traitement anti-staphylococcique ; (4) une eventuelle specificite toxinique de S. aureus ; (5) la prevalence de S. aureus dans les narines et en peau non lesionnelle. Patients et methodes Nous avons compare le microbiote superficiel et sous epidermique chez 20 patients qui avait S. aureus en peau lesionnelle et chez 20 sujets sains avec des techniques de culture et de genomique bacterienne (PCR + spectrometrie de masse) avant et apres un traitement par rifampicine et clindamicine de 10 semaines). Chaque souche de S. aureus a fait l’objet d’une etude des toxines. Resultats Nos donnees de genomique bacterienne chez les temoins ont montre, pour la premiere fois avec une methode non culture dependante, la composition du microbiote sous epidermique du cuir chevelu normal. Ce dernier etait compose presque exclusivement de P. acnes et de staphylocoques coagulase negative. Quand il etait present en peau lesionnelle, S. aureus colonisait la peau non lesionnelle et sous epidermique dans 80 % des cas. Ces donnees suggerent une barriere epidermique alteree et un desequilibre persistant du microbiote en peau non lesionnelle dans la FD. S. aureus n’avait pas de toxine super-antigenique dans 31 % des cas, ni de specificite toxinique. L’amelioration clinique obtenue dans la plupart des cas sous traitement etait associee avec : la disparition de S. aureus dans toutes les zones etudiees, une tendance a la resilience du microbiote, une augmentation significative des prelevements bacteriens negatifs, un microbiote superficiel et sous epidermique anormal. Discussion Ces donnees suggerent que la FD est due a une rupture de la composition normale du microbiote qui conduirait a une inflammation avec alteration de la barriere epidermique et invasion sous epidermique par les bacteries opportunistes. Les antibiotiques seraient efficaces en reduisant la charge bacterienne au-dessous du seuil qui declenche la reponse inflammatoire mais ne parviendraient pas a restaurer une flore normale du fait de la persistance d’un microbiote sous epidermique desequilibre. Ce dernier, couple a un « effet reservoir » de cette flore sous epidermique pathogene pourrait expliquer l’indefinie chronicite de la FD. Conclusion Ce scenario suggere de nouvelles recherches pour restaurer le microbiote normal.

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

Background Follicular hyperkeratosis along with hyperplasia of the follicular and inter-follicular epithelia are major histopathological characteristics of Hidradenitis Suppurativa (HS). The presence of an occasional thickening of lesional skin in some Folliculitis Decalvans (FD) patients and histological similarities between FD and HS led us to look for epidermal hyperplasia and follicular hyperkeratosis in FD patients. Patients and method We performed a retrospective histological analysis of 26 patients with FD. Objective We sought to find out whether the presence of hyperplasia of the inter-follicular epidermis and of the follicular epithelia could be verified in FD, with reference to the work of Von Laffert et al. concerning HS. Results The main quantitative and qualitative data were: follicular hyperkeratosis (77%), hyperplasia of the inter-follicular epidermis (92%) with a psoriasiform aspect (88%), atrophy of the follicular epithelia (85%), plasma cells in infiltrate (92%) in large quantities (42%), follicular microcysts (60%), atrophy of the sebaceous glands (85%), polytrichia (54%). Conclusion Epidermal hyperplasia, sometimes psoriasiform, and follicular microcysts, are significant histological signs of FD, which have been ignored until now although they seem very common.

Background The cause of folliculitis decalvans (FD) remains unknown. We hypothesized that a bacterial biofilm could be involved in its pathogenesis. Objective To assess the presence or not of a bacterial biofilm in the hair roots of the scalp in FD. Patients and methods Hairs plucked from four patients and three controls were examined by field emission scanning electron microscopy (FESEM) and confocal laser scanning microscopy (CLSM). Results Bacterial communities organized as biofilms were observed both by FESEM and CLSM in the under infundibular part of hair follicles in all patients and in two of the three controls. In patients and controls, these biofilms were formed exclusively of bacilli of comparable shapes. Conclusion This pilot study provides the first evidence of the presence of bacterial biofilms in the infra infundibular part of human scalp hair follicles. These biofilms were detected both in FD patients and controls, suggesting their ubiquity as a commensal biofilm with a possible pathogenic shift in FD.

Introduction Les hommes alopeciques representent une population a risque pour le cuir chevelu face aux effets de l’exposition solaire. L’objectif de cette etude observationnelle, multicentrique, internationale etait de decrire les signes cliniques cutanes observes sur le cuir chevelu de sujets de 3 tranches d’âge presentant des alopecies importantes et de proposer une echelle de scorage clinique du photovieillissement du cuir chevelu. Materiel et methodes Cent quarante-trois hommes ayant une alopecie de stade ≥ IV (Norwood Hamilton) ont ete inclus en France, Italie et Espagne. Ils etaient repartis en 3 groupes d’âge : 30–50 ans ( n = 48), 51–70 ans ( n = 47), + de 71 ans ( n = 48). Le type et le nombre de lesions sur le cuir chevelu ont ete evalues par les investigateurs selon 3 grandes categories : (1) neoplasmes (carcinomes cutanes et keratoses actiniques) ; (2) atrophie/inflammation ; (3) pigmentation/lesions vasculaires. Selon la severite dermatologique de la lesion en rapport avec la photo-exposition, un poids a ete affecte permettant de calculer un score clinique global de photovieillissement du cuir chevelu. Les signes subjectifs tels que picotement, prurit et tiraillements ont ete recueillis en utilisant une echelle visuelle analogique. Le scorage global photographique du photovieillissement du cuir chevelu a ete realise par 7 experts a partir de macro-photos standardisees du cuir chevelu, selon une echelle de 0–4 (0 : absent, 1 : leger, 2 : modere, 3 : severe, 4 : tres severe). Resultats L’âge moyen des sujets selon les 3 groupes etait de 40 ± 5,8 ans, 62 ± 6,1 ans, 77 ± 5,5, avec plus de 40 % de sujets ayant une alopecie importante de niveau VI et VII. Pour toutes les lesions etudiees, leur incidence a augmente avec l’âge. Les lesions les plus frequemment observees etaient les keratoses actiniques, l’atrophie, les croutes, la desquamation, les pseudocicatrices stellaires, les varices papillaires/hemangiomes seniles, l’hyperpigmentation, les lentigines, les keratoses seborrheiques et les telangiectasies. Le signe subjectif le plus frequemment ressenti etait le prurit, surtout dans les groupes d’âge > 60 ans (27–30 % des sujets). Le score clinique global calcule (score max. mesure = 59) etait correle de maniere significative avec le scorage global photographique du photovieillissement. Discussion Ces premiers resultats confirment que chez les sujets masculins alopeciques, l’incidence des lesions associees a la photo-exposition augmente avec l’âge. Une correlation entre l’intensite et la duree de la photo-exposition et le nombre et le type de signes cliniques est en cours d’analyse. Conclusion Cette etude met en evidence que chez des hommes presentant une alopecie importante (stade > IV), le nombre de lesions cutanees du cuir chevelu augmente avec l’âge. Notre methode originale de cotation des lesions du cuir chevelu est correlee avec le scorage global du photovieillissement du cuir chevelu.

Androgenetic alopecia (AGA) is the most common hair loss disorder, affecting both men and women. Due to the frequency and the often significant impairment of life perceived by the affected patients, competent advice, diagnosis and treatment is particularly important. As evidence-based guidelines on hair disorders are rare, a European consensus group was constituted to develop guidelines for the diagnostic evaluation and treatment of AGA. This S1 guideline for diagnostic evaluation of AGA in men, women and adolescents reviews the definition of AGA and presents expert opinion-based recommendations for sex-dependent steps in the diagnostic procedure.

Summary Background More and more we are seeing depilatory mechanisms based on IPL technology and used at home. As far as we know, these appliance have not undergone either safety or efficacy testing. Aims The aim of the study was to compare tolerance and efficacy of two depilation methods a medical device in-home-use IPL (E-One) and hot wax. Materials & Methods Axillae of 63 persons were treated by either IPL (intense pulsed light) or hot wax for 49 weeks. Tolerance was assessed clinically by a dermatologist and efficacy by an independent blinded photographic assessment. Results Tolerance of the two methods is reasonably good with better results for the IPL treatment. IPL treatment is also much more efficient. Conclusion This study confirmed good tolerance and excellent efficacy of this first one medical device used at home. Taking into consideration the mechanical action of the IPL and our experience, other cutaneous appliances (against wrinkles (or aging), hyperpigmentation. etc.) could be considered after optimization of the technical parameters.

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

In this study, we report 14 cases of androgenetic alopecia (AGA) in men treated by autologous platelet rich plasma (PRP). Each patient had several injections of non-activated PRP (PRPn) on the sclap. The quantitative assessment of hair density was performed by hair count with TrichoScan and the cosmetic assessment by Canfield stereotaxic system (Standardized photographs seen by 3 independent assessors). A slight improvement of hair density was observed in 11 cases while a cosmetic improvement on the vertex was noticed only in 2 cases according to 3 assessors.

Background: Nearly 10% of lupus erythematosus (LE) are drug induced. More than 60 different drugs are involved in iatrogenic LE. We report herein 3 cases of terbinafine-induced LE. Observations: Three patients receiving terbinafine for a suspected dermatophytic infection developed a subacute cutaneous LE, within 7 weeks following terbinafine introduction. The patients’ medical history included sicca syndrome, lung carcinoma and Kikuchi disease, respectively. Clinical remission occurred within 15 weeks following terbinafine withdrawal. Discussion: Sixteen cases of terbinafine-induced LE have been previously reported, including 13 women. The median age was 54 years. Prior autoimmunity was reported in 10 cases, including 5 pre-existing LE. The median delay between terbinafine introduction and LE onset was 5 weeks. The median time until clinical recovery following terbinafine withdrawal was 8 weeks. Conclusion: Terbinafine should be prescribed only in patients with proven dermatophytosis. We recommend cautious monitoring in patients with pre-existing autoimmunity. The diagnosis of terbinafine-induced LE should lead to the immediate and definitive withdrawal of the drug.

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women. Patients diagnosed with androgenetic alopecia may undergo significant impairment of quality of life. Despite the high prevalence and the variety of therapeutic options available, there have been no national or international evidence-based guidelines for the treatment of androgenetic alopecia in men and women so far. Therefore, the European Dermatology Forum (EDF) initiated a project to develop an evidence-based S3 guideline for the treatment of andro-genetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists as well as general practitioners with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

More and more we are seeing depilatory mechanisms based on IPL technology and used at home. As far as we know, these appliance have not undergone either safety or efficacy testing.The aim of the study was to compare tolerance and efficacy of two depilation methods a medical device in-home-use IPL (E-One) and hot wax.Axillae of 63 persons were treated by either IPL (intense pulsed light) or hot wax for 49 weeks. Tolerance was assessed clinically by a dermatologist and efficacy by an independent blinded photographic assessment.Tolerance of the two methods is reasonably good with better results for the IPL treatment. IPL treatment is also much more efficient.This study confirmed good tolerance and excellent efficacy of this first one medical device used at home. Taking into consideration the mechanical action of the IPL and our experience, other cutaneous appliances (against wrinkles (or aging), hyperpigmentation. etc.) could be considered after optimization of the technical parameters.

Background: Alopecic and aseptic nodules of the scalp (AANS) is a new entity reported first in Japan as ‘pseudocyst of the scalp’. Only retrospective studies have been published. Objectives: To describe the clinicopathological features of AANS (pseudocyst), to evaluate the response to doxycycline and to compare the results to those obtained from patients with dissecting cellulitis of the scalp (DCS). Methods: Fifteen patients with AANS and 7 with DCS were prospectively included. A puncture and a biopsy were made. Patients were treated with doxycycline (100 mg/day) for 3 months. Results: AANS affects predominantly young (mean age 29.7 years), Caucasian (11/15), male (14/15) patients. The main location of the nodules was the occiput. The associated alopecia was nonscarring. Material from the puncture was aseptic. The histopathology showed a deep granuloma in 7 of 14 patients and a nonspecific inflammation in 7 patients. After 3 months, 8 patients were cured and 3 had a good response. Conclusions: The singular aspect of the nodules, the nonscarring alopecia, the deep inflammatory infiltrate and the efficacy of doxycycline confer specificity to AANS.

ejd.2013.2221 Auteur(s) : Marie Tauber1, Nathalie Beneton2, Pascal Reygagne3, Herve Bachelez1, Manuelle Viguier1 manuelle.viguier@sls.aphp.fr 1 Department of Dermatology, 2 Department of Dermatology, Centre Hospitalier du Mans, France 3 Centre Sabouraud, Hopital Saint-Louis, Paris VII Denis-Diderot University, 1 avenue Claude-Vellefaux, 75475 Paris Cedex 10, France Drug-induced autoimmunity is a rare, well-identified side effect, essentially reported with tumor necrosis factor (TNF) blockers, [...]

Seborrheic dermatitis (SD), a common dermatosis associating hyperseborrhea, erythema, itching, and dandruff, has frequent scalp involvement. Malassezia furfur infection seems to play an important role in the condition's etiopathology. Treatment of SD usually consists of corticosteroids or antifungals, such as ketoconazole. The aim of this multicenter, randomized, investigator-blinded, parallel-group pilot study was to evaluate the efficacy and safety of clobetasol propionate shampoo 0.05% after different short-contact application times compared with its vehicle and ketoconazole foaming gel 2% in the treatment of SD of the scalp. For 4 weeks, 55 subjects received one of the following treatments twice weekly: clobetasol propionate shampoo for 2.5, 5, or 10 minutes; clobetasol propionate vehicle for 10 minutes; or ketoconazole foaming gel for 5 minutes before rinsing off. Efficacy criteria included total severity score (TSS) and individual scores of signs such as itching and global improvement. Safety included reporting of burning, overall tolerance, and adverse events. Results showed that an application of clobetasol propionate for 5 and 10 minutes provided a similar mean percentage decrease of TSS, and the mean percentage decrease of TSS for all active groups was significantly superior to that of the vehicle (P.01). Overall and local safety were good for all treatment groups. The present pilot study demonstrated that a short-contact application of clobetasol propionate shampoo is effective and safe in the treatment of SD of the scalp.

Background Alopecia areata (AA) is an autoimmune disorder targeting the hair follicle, more frequently observed in patients with Pso, RA or IBD. While high amount of TNF is found in the hair follicle at the AA acute phase, TNF blockers have not demonstrated efficacy in its treatment. On the other hand, cases of AA occurring during TNF blockade have been reported. Objectives To characterize the clinical features and the associated symptoms of AA occurring during TNF blockade and its outcome; to study the relationship between TNF blockade and occurrence of AA. Methods From January 1 st 2011 to December 31 th 2012, French physicians prescribing TNF blockers (dermatologists, rheumatologists, gastroenterologists) were regularly asked, via their respective academic societies, to report all cases of AA appeared during anti-TNF therapy. Diagnosis of AA should be certified by a dermatologist. Results Twenty-five patients were included (15 men, mean age: 39.4 years): 10 Pso (2 with associated PsA), 5 AS, 4 RA, 4 Crohn’s diseases (1 associated with AS) and 2 ulcerative colitis. Eight patients (32%) had a personal or family autoimmune background (AA and/or vitiligo). Six patients (24%) had previously received biotherapy (anti-TNF or efalizumab) without developing AA, with a mean exposure duration of 5.8 months (mo). The TNF blocker prescribed at the time of AA onset was infliximab (INF) (n=9), adalimumab (ADA) (n=8) or etanercept (ETA) (n=8). The mean duration of exposure was 23.7 mo (1-89) (INF: 17.9; ADA: 16; ETA: 38 mo). The underlying inflammatory disorder was completely controlled in all patients, except 2. Clinical presentation of AA was mostly plaque-type of the scalp or the beard (n=21; 84%). Concomitantly, 7 patients (28%) developed vitiligo, psoriasiform eruptions or Hashimoto’s thyroiditis. TNF blockers were stopped after AA onset in 11 cases and maintained in 14 cases. Among those who stopped the treatment, 3 (27%) had a worsening or stability of AA, whereas 8 patients (73%) had a partial or complete remission. Among those who maintained it, 4 (28%) had an unfavorable evolution while 9 patients improved (72%). One patient relapsed from AA after switching from ETA to ADA but healed again 2 weeks after stopping ADA. Mean follow-up duration was 27 mo. Conclusions Occurrence of AA during TNF blockade may be considered as an incidentally autoimmune manifestation in patients with immune-mediated inflammatory disorders or as a new autoimmune-induced side effect of TNF blockers. This latter hypothesis is supported by the concurrent development of autoimmune symptoms in one quarter of our patients, a delay of onset after exposure to TNF blockers similar to the ones of other autoimmune-induced side effects and the relapse of AA after TNF blocker restart in one patient. Clinicians should be aware that AA might occur in patients receiving anti-TNF treatment. Withdrawal of treatment should not be systematic, especially if AA presentation is mild. Disclosure of Interest None Declared