Hair loss is a common complaint in psoriatic patients with scalp involvement, but telogen effluvium due to the inflammatory process and trauma, caused by scratching of itchy lesions, are believed to be the cause in most of these cases. Few reports of scarring alopecia due to psoriasis have been published. Findings were consistent with scarring alopecia associated with psoriasiform epidermal changes. Years later, Wright and Messenger described 3 cases of psoriatic scarring alopecia and for the first time the histopathology was studied and showed adnexotropic lymphohistiocytic infiltrate which destroyed the follicular epithelium. Before this visit, our patient had been treating her psoriasis with topical clobetasol and calcipotriene. 1 Biopsy results confirmed that while the patient did have plaque psoriasis on her scalp, there was also evidence of peri-infundibular fibrosis and inflammation at the junction of the epidermis and dermis along the follicular epithelium. 2 The condition typically presents in adults ages 25 to 70, and is more common in women than in men.2 There is no known association between LPP and psoriasis. 2005;53:1-37. The diagnosis is pityriasis amiantacea (PA), sometimes also known as tinea or pseudotinea amiantacea. In a number of patients, psoriasis,3 seborrheic dermatitis, atopic dermatitis and eczemas are commonly associated with PA. More recently, case reports have been published on the association of PA with Darier’s disease,4,5 and with tumour necrosis factor (TNF)- inhibitor therapy for Crohn’s disease,6 tinea capitis7 and pityriasis rosea. Pityriasis amiantacea, an unrecognized cause of scarring alopecia, described in four patients.
An association with hepatitis C has been noted. Lesions may also be found on the genitalia, anus, larynx and, very rarely, on the tympanic membrane or oesophagus (where it can present as dysphagia and cause benign strictures). The scalp is usually spared but lichen planus affecting the scalp may cause permanent scarring alopecia. 2014 Feb;53(2):171-7. doi: 10.1111/j.1365-4632.2012.05685.x. Background: The incidence of psoriatic alopecia in psoriatic patients is underwhelming, given the prevalence of psoriasis in the North American population. The most common follicular-related changes were infundibular dilatation (87 ) followed by perifollicular fibrosis (77 ), perifollicular lymphocytic inflammation (68 ), thinning of the follicular infundibulum (55 ), and fibrous tracts (28 ). Conclusion: While a major limitation of this study is that it is a retrospective one, given that these changes are common to varying degrees in all lymphocytic scarring alopecias, we posit that psoriatic alopecia likely represents a secondary clinical change to a primary process and is not a unique histopathologic entity. This article has been cited by. We describe recent developments in psoriasis epidemiology, pathogenesis, and genetics to better understand present trends in psoriasis management. Scalp involvement might be accompanied by non-scarring alopecia (E).
In general, with both scarring and nonscarring alopecia, early intervention is best. Intralesional steroids, laser ablation, and retinoids have also been used. Topical psoriatic medications have been reported to be effective. The response to oral isotretinoin is often disappointing, but some reports describe a response to the more potent antitumor necrosis factor biologic agents. Related Reference Topics. Cicatricial alopecia, also known as scarring alopecia, is a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss. In other cases, hair loss is associated with severe itching, burning and pain and is rapidly progressive. Epidemiologic studies have not been performed to determine the incidence of cicatricial alopecias. In general, they are not common. A scar is present associated with permanent hair loss. 2005 Jul;53(1):1-37; quiz 38-40. The number and type of hairs were also recorded. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described. The purpose of this study was to evaluate patients with chronic scalp psoriasis and alopecia and to determine if the alopecia was of the scarring type.
The causes of hair loss included alopecia areata, psoriatic alopecia, lichen planopilaris, drug-induced lupus erythematosus, androgenetic alopecia, and telogen effluvium. Conclusions: TNF- inhibitors can cause different types of hair loss including severe alopecia areata and scarring alopecia. Another study described an association between beta-blockers and nonsteroidal anti-inflammatory drugs, with a possible protective effect of angiotensin-converting enzyme inhibitors 5. Other autoimmune diseases reported to be associated with FFA include vitiligo, alopecia areata, atopy, psoriasis, rheumatoid arthritis, lupus erythematosus, and polymyositis 3-5,20. FFA has also been described in patients following hair transplantation and face-lift surgery 24. It is argued that the FFA is a scarring variant of pattern hair loss13. 2005;53:1-37; quiz 38-40. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is used as a clinical tool that standardizes the way disease activity is described and provides guidelines for identifying a clinical change. It has also been reported that iNOS is expressed in human skin in the first 2 days after exposure to UVA and UVB 17. In this situation, the patient is left with a permanent area of cicatricial alopecia. Lichen planus lesions are described using the six P’s (planar flat-topped, purple, polygonal, pruritic, papules, plaques). Malignant transformation has been reported in men with oral erosive lichen planus lesions. Over the last few years, LLLT has been demonstrated to be a promising therapeutic modality for a wide range of dermatological and cosmetic applications. Additionally, fractional laser treatment provides a suitable means for the treatment of scars in individuals with darker skin tones, and has also shown remarkable pore improvement (Goel et al. The results suggested that UVB-induced apoptosis was inhibited by NIR, which was most likely induced by modulating the Bcl-2/Bax balance, suggesting that p53, a sensor of gene integrity involved in cell apoptosis and repair mechanisms, had an influential role in the process of NIR induced photoprotection against UVB radiation.