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Traction alopecia (TA) is common, but histopathologic criteria for TA have not been objectively defined. Determine whether the pauci-follicular unit (PFU) can be used as a diagnostic criterion for TA. Compared to a normal follicular unit (NFU), the PFU is a noninflamed follicular unit with an intact sebaceous gland but fewer than 2 follicles. A retrospective review of 25 cases of TA and 25 cases of "normal scalp" was performed. Data included all follicles (by size and phase), sebaceous glands, and total follicular units. Comparing data (traction vs normal), we found a significantly higher number of PFUs in cases of TA (median 6 vs 0, P <.001), which can be used as a helpful and easily recognizable diagnostic tool in diagnosing cases of TA. Comparison to other forms of alopecia was not performed. The number of PFUs in an alopecia biopsy can be used to establish the diagnosis of TA. [ABSTRACT FROM AUTHOR]

In this current review, research spanning the last decade (such as transcriptomic studies, phenotypic observations, and confirmed comorbidities) has been synthesized into an updated etiology of hair loss and applied to the new cosmeceutical paradigm of hair rejuvenation. The major etiological components in scalps with hair loss are denoted as the 'big eight strikes', which include the following: androgens, prostaglandins, overactive aerobic metabolism of glucose, bacterial or fungal over-colonization, inflammation, fibrosis, metabolism or circulation problems, and malnutrition. The relevance of the 'big eight' to nine categories of hair loss is explained. In cases of androgenetic alopecia or female pattern hair loss, both elevated DHT and increased frequency of androgen receptors lead to problems with the metabolism of glucose (sugar), redox imbalance, disruption to the electron transport chain, and PPAR-γ overactivity (the latter is unique to androgenetic alopecia, where the reverse occurs in other types of hair loss). These etiological factors and others from 'the big eight' are the focal point of our hypothetical narrative of the attenuative mechanisms of commercial cosmeceutical hair serums. We conclude that cosmeceuticals with the potential to improve all eight strikes (according to published in vitro or clinical data) utilize bioactive peptides and plant compounds that are either flavonoids (isoflavones, procyanidins, flavanols, and flavonols) or sterols/triterpenes. It is noteworthy that many therapeutic interventions are generic to the multiple types of hair loss. Lastly, suggestions are made on how scalp and hair health can be improved by following the cosmeceutical approach. [ABSTRACT FROM AUTHOR]

We present a retrospective case series on the use of Hughes flap in managing acquired cicatricial lower lid retraction. This was a multicentre, retrospective case series. Data was collected from medical records across different sites within Australia (Adelaide, Melbourne, and Sydney) and New Zealand (Hamilton). Fourteen patients were identified. The aetiology of cicatricial lower lid retraction included previous lid lesion excision and reconstruction, eyelid trauma, orbital fracture repair, orbital radiotherapy, and lateral canthal dystopia from previous lid surgeries. 4/14 (29%) cases had undergone other surgery to correct the retraction prior to the Hughes flap. Pre-operative lagophthalmos due to lower lid retraction was noted in 11/14 (79%) cases with a median 2 mm (range: 1–5 mm). Exposure keratopathy was present in 7/14 (50%) cases. There were no peri-operative complications during Hughes flap reconstruction. One patient had post-operative upper eyelid retraction that did not require any further intervention. One patient had persistent lagophthalmos and exposure keratopathy that is being managed conservatively. One patient had wound dehiscence and further lid retraction following flap division, which required further surgery. Median length of follow-up was 15 months (range: 0.5–84 months). At final review, improvement or resolution of symptoms was seen in 13/14 (93%) cases. A Hughes flap is an effective surgical technique for the management of cicatricial lower lid retraction. [ABSTRACT FROM AUTHOR]

Cicatricial ectropion can be corrected by invasive surgical modalities such as full-thickness skin graft, lateral tarsal strip procedure, etc., which are associated with donor site morbidity and additional scars. Use of autologous fat graft (AFG) in treatment of burn scars has previously shown encouraging clinical results as to skin color, texture, and softness. We aim to introduce the use of AFG for the correction of mild to moderate grades of cicatricial ectropion of the lower eyelid in adult patients. This was a prospective, interventional, non-comparative, pilot study including 5 patients with a cicatricial ectropion of grade I-III. All these patients underwent a pre-injection workup to assess anatomical outcomes (grade of ectropion, vertical palpebral aperture (VPA), lagophthalmos, and eyelid retraction), functional outcomes (dry eye status) and aesthetic outcome (change of scar color, thickness, pain, and consistency). At 6-months follow-up assessment, all patients had improvement in grade of ectropion, significant improvement in VPA and eyelid retraction, and almost complete resolution of lagophthalmos in all the three patients who had pre-injection lagophthalmos. There was a significant improvement in scar color, thickness and consistency on Visual Analogue Score (VAS) with no donor site or systemic complications after the procedure but mild pain on day 1 post-injection at the donor site AFG transfer of cicatricial ectropion not only eludes the need of a invasive surgery but provides satisfactory correction with stable outcome with an overall improvement in texture of the scar and has low risk. [Display omitted] [ABSTRACT FROM AUTHOR]

In this current review, research spanning the last decade (such as transcriptomic studies, phenotypic observations, and confirmed comorbidities) has been synthesized into an updated etiology of hair loss and applied to the new cosmeceutical paradigm of hair rejuvenation. The major etiological components in scalps with hair loss are denoted as the ‘big eight strikes’, which include the following: androgens, prostaglandins, overactive aerobic metabolism of glucose, bacterial or fungal over-colonization, inflammation, fibrosis, metabolism or circulation problems, and malnutrition. The relevance of the ‘big eight’ to nine categories of hair loss is explained. In cases of androgenetic alopecia or female pattern hair loss, both elevated DHT and increased frequency of androgen receptors lead to problems with the metabolism of glucose (sugar), redox imbalance, disruption to the electron transport chain, and PPAR-γ overactivity (the latter is unique to androgenetic alopecia, where the reverse occurs in other types of hair loss). These etiological factors and others from ‘the big eight’ are the focal point of our hypothetical narrative of the attenuative mechanisms of commercial cosmeceutical hair serums. We conclude that cosmeceuticals with the potential to improve all eight strikes (according to published in vitro or clinical data) utilize bioactive peptides and plant compounds that are either flavonoids (isoflavones, procyanidins, flavanols, and flavonols) or sterols/triterpenes. It is noteworthy that many therapeutic interventions are generic to the multiple types of hair loss. Lastly, suggestions are made on how scalp and hair health can be improved by following the cosmeceutical approach.

A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy result was interpreted to represent a neutrophil‐mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis showed linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes, and plasma cells, as well as prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting–Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil‐rich form of cicatricial pemphigoid can masquerade as a neutrophil‐mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil‐mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid. [ABSTRACT FROM AUTHOR]

Abstract Utilization of the Hotz‐Celsus technique with standing sedation and local nerve blocks in cattle provides adequate correction of cicatricial entropion.

Karishma Desai, Mariya Miteva Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USACorrespondence: Karishma DesaiDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Ave., RMSB Building Room 2023C, Miami, FL, 33136, USATel +1 305 243-5523Fax +1 305 243-5810Email kdesai66@med.miami.eduAbstract: 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.Keywords: discoid, hair loss, cicatricial, scarring, non-scarring

BackgroundAcquired alopecia of the lower legs may occur secondary to friction due to socks, footwear, or both on the lower extremities. There is scant literature that reports on this phenomenon.Methods and MaterialsWe describe 5 patients who presented with alopecia of their lower legs induced by socks, footwear, or both.Methods and Materials: We reviewed PubMed for the following terms: ankle alopecia, friction alopecia, frictional alopecia, lower extremity alopecia, non-scarring leg alopecia, and sock alopecia. We also reviewed papers containing these terms and their references.ResultsAcquired frictional alopecia of the lower extremities is often an asymptomatic condition found incidentally on physical examination. The condition can persist for many years despite removal of the source of friction.ConclusionThe incidence of acquired frictional alopecia of the lower extremities may be greater than reflected in previously published reports. It is a non-scarring subtype of alopecia that was noted as an incidental finding during the patient’s dermatology appointment.

Introduction: Cicatricial alopecias are a group of disorders characterized by hair follicle destruction with the consequence of permanent hair loss. The current study was conducted to evaluate the epidemiological and clinicopathological characteristics of cicatricial alopecia in Libyan community. Methods: Thirty-one patients with confirmed diagnosis of cicatricial alopecia by biopsy and tricoscopy during Jan 2018 to Dec 2019 were included in this study. Data were collected by filling a pre-designed questionnaire by all included patients. Descriptive statistics were used for analyzing the results. Chi-squared test was performed to test the relationship between different variables using SPSS 22. Results: Out of 31 cases, 16.1% of patients suffered from lichen planopilaris (LPP), 25.8% discoid lupus erythematosus (DLE), 6% Folliculitis decalvans, 6.45% pseudopelade of brocq, and 16.12% Frontal fibrosing alopecia. Conclusions: Cicatricial alopecia was found to affect mainly middle-aged individuals, particularly females. Early diagnosis and treatment can decrease the burden of this concern.

Purpose: To assess the long-term outcomes of segmental entropion correction using anterior lamellar recession (ALR) with mucous membrane graft (MMG)., Methods: Prospective interventional study of 16 patients (mean age, 35.3 ± 16.3 years; 10 females) with severe segmental cicatricial entropion, managed using ALR and MMG. Outcome measures include eyelid and eyelash status, changes in the ocular surface, visual acuity, and cosmetic appearance at a minimum nine months of follow-up., Results: Of 16 patients (16 eyelids), 11 had Stevens-Johnson Syndrome (SJS) and five had chemical injury. The most common location of entropion was medial (87.5%) followed by central and lateral. All patients had severe entropion with trichiatic eyelashes. Anatomical success was 87.5% (14/16) at six weeks of follow-up. Residual trichiasis was managed with a repeat ALR with MMG in one and eyelash resection in the other eyelid. The etiology-wise success rates were 90% in SJS and 80% in chemical injury. At the final mean follow-up of 14.8 months, entropion was corrected in 100% of eyelids. None of the patients had cosmetic concerns. Ocular surface symptomatology and visual acuity improved in 87.5% of patients and 40% of eyes, respectively., Conclusion: Anterior lamellar recession with lid margin mucous membrane grafting successfully repairs the severe segmental cicatricial entropion without raising any cosmetic concerns., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aimed to determine the incidence of hair loss among U.S. active component service women, describe the types of hair loss, and summarize potential racial and ethnic disparities of hair loss among service women over the last 12 years. Estimates of traction alopecia among service members have been difficult, as there are no specific diagnosis codes for traction alopecia in the International Classification of Diseases, 9th and 10th revisions (ICD-9/ICD-10). A prior study on the prevalence of alopecia among female active component service women between 2010 and 2019 reported that 2.7% had traction alopecia diagnoses. That estimate may not be accurate, as the previous study used the ICD-9 code 704.01 (alopecia areata) and ICD-10 code Q84.0 (congenital alopecia), which are not fully representative of traction alopecia cases in administrative health records. This study used ICD-9/ICD-10 diagnostic codes 704.0 (ICD-9), L63, L64, L65, and L66 (ICD-10) to define cases of alopecia. The study population included female active component service members in the U.S. Army, Navy, Air Force, and Marine Corps between January 1, 2010 and December 31, 2022. The overall incidence rate of alopecia was 804.4 per 100,000 person-years. Non-Hispanic Black and Hispanic female active component service members had the highest incidence rates among all races and ethnicities, at 1,138.7 and 1,013.6 per 100,000 person-years, respectively. Non-Hispanic Black female active component service members were more than twice as likely to be diagnosed with alopecia compared to non-Hispanic White female active component service members.

Background: Eyebrow is the main contouring line of the face. That is why any eyebrow defect, especially if resulting from burn, disturbs the whole esthetic portrait and causes psychological trauma and lack of confidence. Eyebrow-hair transplantation is considered as the management of choice for patients suffering from postburn eyebrow alopecia. Objectives The aim of this study was to ascertain the efficacy and benefits of hair transplantation for postburn cicatricial alopecia of the eyebrow, using a standardized data and documented by photography. Patients and methods: The study included 20 patients suffering from postburn cicatricial alopecia of the eyebrow. Preoperatively, eyebrows were assessed for the part affected with postburn cicatricial alopecia, the side, the size of the defect, the direction of hair, and symmetry. Marking the affected eyebrow was done. Single-hair follicle grafts were extracted from the scalp and then implanted into the eyebrow defect, under the effect of local anesthesia and sedation if needed, and complete aseptic conditions. Patients were followed up for 1 year. The results were tested statistically and documented by photos. Results: On statistical analysis, there was a statistically significant improvement in 75% of cases with satisfactory outcomes. The majority of patients showed very good results with minimal accepted complications. Comparison between preoperative presentation and postoperative outcome manifested an apparent esthetic amelioration. Conclusion: Hair transplantation is effective in improving postburn alopecia of the eyebrow and camouflaging the underlying scar tissue. [ABSTRACT FROM AUTHOR]

The pemphigoid family of dermatoses is characterized by autoimmune subepidermal blistering. The classic paradigm for pemphigoid, and the most common member, is bullous pemphigoid. Its variable clinical presentation, with or without frank bullae, is linked by significant pruritus afflicting the elderly. Mucous membrane pemphigoid is an umbrella term for a group of subepidermal blistering dermatoses that favor the mucosal membranes and can scar. Epidermolysis bullosa acquisita is a chronic blistering disorder characterized by skin fragility, sensitivity to trauma, and its treatment-refractory nature. Clinicians that encounter these pemphigoid disorders may benefit from an overview of their clinical presentation, diagnostic work-up, and therapeutic management, with an emphasis on the most frequently encountered pemphigoid disease, bullous pemphigoid. [ABSTRACT FROM AUTHOR]

Cicatricial alopecias (CA) describes multiple subtypes of hair loss in which the hair follicle is destroyed by an unknown inflammatory mechanism. The main goal of treatment is to stop this inflammatory process and prevent further hair loss; however, there have been occasional reports of hair regrowth following treatment in some subtypes of CA. This review aims to highlight these reports. A total of 71 cases of hair regrowth were found documented in the literature. The treatments used varied widely both between and within each subtype of alopecia. This review highlights that regrowth is possible in at least a subset of patients with cicatricial alopecia; however, the mechanism by which this occurs has yet to be elucidated. [ABSTRACT FROM AUTHOR]

Background: Hair and scalp disorders cause significant morbidity, warranting an early diagnosis and treatment. Trichoscopy has shown great promise in the diagnosis and assessment of these disorders. Aims: The aim of this study was to determine the trichoscopic findings in cases of alopecia and scalp disorders and to determine their statistical significance. Materials and Methods: This was a case- control study in which trichoscopy using a hand-held dermoscope was done in 605 patients and 200 controls. Results: The trichoscopic findings that showed statistical significance in 405 alopecia cases when compared with controls were broken hair, exclamation hair, black dots, yellow dots, vellus hair and pigtail hair in alopecia areata, hair diameter variability, single hair predominance, brown and white peripilar sign in androgenetic alopecia, corkscrew hair, comma hair, morse-code hair and interfollicular scale in tinea capitis, and white dots and peripilar erythema in primary cicatricial alopecia. The findings which had a statistical relevance among scalp disorders included light red background, dots and globules and dermoscopic Auspitz's sign for psoriasis, dark red background and arborizing vessels for eczemas and yellowish background for Verrucae, comedo-like openings, milia-like cysts and moth-eaten borders for seborrheic keratosis, and viable nits for pediculosis capitis. Conclusion: Our study documented many trichoscopic features which were statistically significant among cases of alopecia and scalp disorders when compared with controls. Limitations: Histopathological confirmation of diagnosis was not done in most of the cases. The patients were not subjected to follow-up trichoscopy after treatment. [ABSTRACT FROM AUTHOR]

Lichen planopilaris (LPP) is an uncommon scalp disorder of unknown etiology and prevalence. It may be an autoimmune process triggered by unknown genetic and/or environmental factors that attack hair follicles of the scalp. LPP can present in association with various autoimmune diseases and immunomodulatory therapies. We present an atypical case of LPP occurring during the treatment of breast cancer with paclitaxel, after complete resolution of alopecia areata and anagen effluvium. Shortly after initiation of the paclitaxel therapy, the patient experienced a pruritic acneiform facial eruption and hair loss that was localized to her frontal scalp with complete loss of eyebrows and significant loss of her eyelashes. The lesions were biopsied revealing LPP. LPP should be considered among other causes of alopecia in patients treated with paclitaxel.

Background: Transverse sections of scalp biopsies are performed for the assessment of alopecias and are considered advantageous over vertical sections. Aim: The aim was to study the histopathological features of alopecias on transverse sections of scalp biopsies. Methods: It was a descriptive study. Clinically confirmed cases of noncicatricial and cicatricial alopecias were subjected to 4 mm scalp biopsies, which were sectioned transversely and analyzed. Biopsies obtained from occipital region of androgenetic alopecia (AGA) cases were taken as controls. Results: Biopsies from 41 cases were assessed, including male and female AGA, alopecia areata (AA), trichotillomania, lichen planopilaris (LPP), discoid lupus erythematosus (DLE), and folliculitis decalvans (FD). Normal scalp (control) biopsies showed the median total number of hair follicles of 35 (32–37), anagen:telogen/catagen ratio of 17.5 (16.5–31), and terminal:vellus ratio of 15 (10.7–17.5). In AGA and AA, miniaturization and shift toward telogen and catagen hair were consistently observed. Peribulbar inflammation was seen in two-third of AA. Trichotillomania showed increased catagen hair and numerous pigment casts. In DLE, besides perifollicular inflammation, prominent peri-arrector pili and peri-eccrine inflammation were observed. Type of inflammatory infiltrate was similar in DLE and LPP (lymphocytic), whereas FD showed neutrophilic and plasma cell infiltrate, both around follicles and interstitially. Basal cell damage in the follicles and pigment incontinence were seen in majority of DLE and LPP patients. DLE also showed basement membrane thickening, mucin deposition, and telangiectasia. Reduction/absence of sebaceous glands and perifollicular fibrosis were observed in almost all cicatricial alopecias. Conclusion: Transverse sectioning may be a useful tool in the diagnosis of alopecias.

Background: Currently, the studies related to hair loss in children showed the variable prevalence of different clinical patterns and causes of scalp hair loss, that had regional variation. Aims: The aim of this study is to evaluate the epidemiology and clinical pattern of scalp hair loss in children (0–18 years age group). Materials and Methods: A total of 300 children presenting with scalp hair loss were studied during a period of 1 year from April 2015 to March 2016. The results were recorded and analyzed. Results: The most common disorder found in this study was tinea capitis seen in 166 (55.33%) cases followed by alopecia areata, seborrheic dermatitis, pediculosis with secondary infection. Other uncommon causes were lichen planopilaris, tractional alopecia, telogen effluvium, nevus sebaceous, occipital neonatal alopecia, ectodermal dysplasia, scalp psoriasis, trichotillomania, and alopecia due to nutritional deficiency. Several other rare causes were identified in this study. Conclusion: This study showed that hair loss in children in our region is not an uncommon problem and results from a variety of causes. Early diagnosis and treatment are needed to prevent further hair loss and to avoid irreversible hair loss and scarring alopecia. As has been observed in this study, hair problem may be due to important nutritional deficiency. We should be aware of such presentation. These may be a clue to the diagnosis of systemic illness.

Cicatricial lower lid ectropion is characterized by vertical shortening and/or scarring of the anterior lamella of eyelid and can be the result of thermal or chemical burns, mechanical or surgical trauma/scars, medications, sun damage, chronic inflammation, and involutional changes. Ectropion repair presents a challenge to the surgeon. The surgical management of cicatricial ectropion depends on the situation after the release of the scar traction in the lower lid area. Various techniques have been described for correcting cicatricial ectropion by lengthening the anterior lamella with transposition flaps or with full-thickness free skin grafts. We would like to describe two cases of lower lid cicatrical ectropion with two different causes, which were managed in two different ways. [ABSTRACT FROM AUTHOR]

Utilization of the Hotz‐Celsus technique with standing sedation and local nerve blocks in cattle provides adequate correction of cicatricial entropion. [ABSTRACT FROM AUTHOR]

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

Cicatricial ectropion can involve the skin, subcutaneous tissue, muscle, and septum to result in chronic tearing and keratopathy. Surgery involving the orbital rim or eyelid is a common cause. Minimally invasive techniques may provide alternative options for correction, but the comparative benefit to surgery is unknown. To compare the efficacy of surgical and minimally invasive minimally invasive treatment options for cicatricial ectropion. A comprehensive literature search of Medline, EMBASE, and the Cochrane Library published from 1960 to August 2019 was performed for studies that described any treatment of cicatricial ectropion. 1391 studies were found, of which 31 had extractable data for 299 patients. Pooling of outcome data occurred for the primary and secondary outcomes. The complete and partial response rates to treatment (primary outcomes) as well as the recurrence rate and physician global assessment of cosmesis (secondary outcomes) were analyzed. Surgical correction resulted in complete correction in 79% of patients compared to 63% of hyaluronic acid treated patients. Hyaluronic acid injection had a better aesthetic outcome, but a higher recurrence rate overall. Hyaluronic acid filler with a high G' along with delayed dissolution trended toward a lower recurrence rate. Other minimally invasive treatments had little data. The literature found was limited to mostly single-center, observational studies. Hyaluronic acid may be a viable alternative for cicatricial ectropion in those patients who cannot undergo surgery. Further prospective studies are required to routinely recommend minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to compare the histopathologic and immunophenotypic features of central centrifugal cicatricial alopecia (CCCA) and lichen planopilaris (LPP) to better characterize and differentiate these two clinical entities. CCCA remains an ill‐defined and still‐unsettled histologic entity and many hair loss experts regard CCCA to be histologically indistinguishable from LPP. Given the overlapping histologic features of these two lymphocyte‐predominant cicatricial alopecias, and the lack of consensus regarding the significance of proposed distinctions, dermatopathologists face difficulty in providing clinicians and patients certainty with a definitive diagnosis of CCCA vs LPP. Methods: We performed a retrospective review of 51 scalp biopsies of patients with either the clinical diagnosis of CCCA (27 cases) or LPP (24 cases). Clinical information, histologic features of hematoxylin‐eosin‐stained sections, and a panel of immunohistochemical markers were evaluated on scalp biopsies. Tested parameters were quantified, and statistical analysis was performed. Results: Our study found no differences on either histologic assessment or immunophenotypic characterization between cases of classic LPP and CCCA. Conclusion: The conclusion of this study is that the inflammatory infiltrates in CCCA and LPP are not only histologically similar but also immunophenotypically indistinguishable. [ABSTRACT FROM AUTHOR]

The pemphigoid family of dermatoses is characterized by autoimmune subepidermal blistering. The classic paradigm for pemphigoid, and the most common member, is bullous pemphigoid. Its variable clinical presentation, with or without frank bullae, is linked by significant pruritus afflicting the elderly. Mucous membrane pemphigoid is an umbrella term for a group of subepidermal blistering dermatoses that favor the mucosal membranes and can scar. Epidermolysis bullosa acquisita is a chronic blistering disorder characterized by skin fragility, sensitivity to trauma, and its treatment-refractory nature. Clinicians that encounter these pemphigoid disorders may benefit from an overview of their clinical presentation, diagnostic work-up, and therapeutic management, with an emphasis on the most frequently encountered pemphigoid disease, bullous pemphigoid.

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.

Background: Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach., Methods: A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis., Results: The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods., Conclusions: Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.

Background: Currently, the studies related to hair loss in children showed the variable prevalence of different clinical patterns and causes of scalp hair loss, that had regional variation. Aims: The aim of this study is to evaluate the epidemiology and clinical pattern of scalp hair loss in children (0–18 years age group). Materials and Methods: A total of 300 children presenting with scalp hair loss were studied during a period of 1 year from April 2015 to March 2016. The results were recorded and analyzed. Results: The most common disorder found in this study was tinea capitis seen in 166 (55.33%) cases followed by alopecia areata, seborrheic dermatitis, pediculosis with secondary infection. Other uncommon causes were lichen planopilaris, tractional alopecia, telogen effluvium, nevus sebaceous, occipital neonatal alopecia, ectodermal dysplasia, scalp psoriasis, trichotillomania, and alopecia due to nutritional deficiency. Several other rare causes were identified in this study. Conclusion: This study showed that hair loss in children in our region is not an uncommon problem and results from a variety of causes. Early diagnosis and treatment are needed to prevent further hair loss and to avoid irreversible hair loss and scarring alopecia. As has been observed in this study, hair problem may be due to important nutritional deficiency. We should be aware of such presentation. These may be a clue to the diagnosis of systemic illness. [ABSTRACT FROM AUTHOR]

Background: Transverse sections of scalp biopsies are performed for the assessment of alopecias and are considered advantageous over vertical sections. Aim: The aim was to study the histopathological features of alopecias on transverse sections of scalp biopsies. Methods: It was a descriptive study. Clinically confirmed cases of noncicatricial and cicatricial alopecias were subjected to 4 mm scalp biopsies, which were sectioned transversely and analyzed. Biopsies obtained from occipital region of androgenetic alopecia (AGA) cases were taken as controls. Results: Biopsies from 41 cases were assessed, including male and female AGA, alopecia areata (AA), trichotillomania, lichen planopilaris (LPP), discoid lupus erythematosus (DLE), and folliculitis decalvans (FD). Normal scalp (control) biopsies showed the median total number of hair follicles of 35 (32–37), anagen:telogen/catagen ratio of 17.5 (16.5–31), and terminal:vellus ratio of 15 (10.7–17.5). In AGA and AA, miniaturization and shift toward telogen and catagen hair were consistently observed. Peribulbar inflammation was seen in two-third of AA. Trichotillomania showed increased catagen hair and numerous pigment casts. In DLE, besides perifollicular inflammation, prominent peri-arrector pili and peri-eccrine inflammation were observed. Type of inflammatory infiltrate was similar in DLE and LPP (lymphocytic), whereas FD showed neutrophilic and plasma cell infiltrate, both around follicles and interstitially. Basal cell damage in the follicles and pigment incontinence were seen in majority of DLE and LPP patients. DLE also showed basement membrane thickening, mucin deposition, and telangiectasia. Reduction/absence of sebaceous glands and perifollicular fibrosis were observed in almost all cicatricial alopecias. Conclusion: Transverse sectioning may be a useful tool in the diagnosis of alopecias. [ABSTRACT FROM AUTHOR]

Background: Entropion is the inward turning of the lid margin that brings both lashes and external keratinized skin into contact with the globe. Aim of the study: It was to compare the surgical outcome and aesthetic appearance between anterior lamellar repositioning only and anterior lamellar repositioning with blepharoplasty in management of upper eye lid entropion trichiasis. Patients and Methods: This was prospective interventional study includes 20 lids of 13 patients with upper eyelid cicatricial entropion selected from the ophthalmology outpatient clinic of "Ain Shams University" Hospitals. Patients were randomly divided in 2 groups: group A: Ten lids had an anterior lamellar reposition technique (ALR) with grey line split (GLS) technique. Group B: Ten lids had an anterior lamellar reposition with GLS technique and blepharoplasty. All surgeries were performed by one surgeon (third author) in Ain Shams University hospital. Results: Our study showed that after 3 month follow up, success rate of first group was 70 %, patient satisfaction was 60% and final aesthetic outcome was 30% excellent, 30% fair and 40% poor results. The second group success rate was 100%, patient satisfaction was 100% and final aesthetic outcome was 100% excellent results. Conclusion: Combining the procedure of ALR with GLS technique with blepharoplasty in surgical correction of upper eye lid cicatricial entropion has excellent both functional and aesthetic outcome and a higher success rate with minimal complication than anterior lamellar reposition only. [ABSTRACT FROM AUTHOR]

Background: Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris (LPP) and is characterised as a progressive cicatricial alopecia affecting the frontotemporal hairline. Objectives: To perform a comprehensive, up-to-date review of the etiopathogenesis, clinicopathological features, and therapeutic options for FFA. Methods: A literature search was conducted using PubMed (from 1946) and Cochrane (from 1991) databases on March 7, 2017. We included all retrospective and prospective studies reported in English. Only cases studies with reported treatment regimen and outcome were included. No randomised control trials were found. MeSH terms used included frontal fibrosing alopecia, postmenopausal, histopathologic, cicatricial, and treatment. Results: With an increasing incidence of FFA occurring predominantly in postmenopausal women, progress has been made clinically and histologically in understanding this scarring alopecia. Conflicting results have been reported with various treatments, including intralesional or oral corticosteroids, antiandrogens, antimalarials, antibiotics, and surgery. To date, no randomised control trials for treatment of FFA have been conducted. Conclusion: The aetiology and clinical course of FFA remain to be established. Unfortunately, despite the numerous treatment options available, no one therapeutic regimen has proven effective in stopping recession of the hairline and inducing hair growth. [ABSTRACT FROM AUTHOR]

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 < .001). The subcutaneous inflammation was better detected in V (p < .001). The T revealed higher diagnostic accuracy compared with V especially for noncicatricial alopecia (DOR, 157.5 vs. 21.2, p < .001). Conclusions The accurate diagnosis of alopecia requires both vertical and transverse section examination. Techniques providing both horizontal and vertical sections may be best suited for this indication. However, when expertise in such novel techniques are lacking, the higher diagnostic accuracy for T section justifies using T section for noncicatricial alopecia, if patient consented for single biopsy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]