DOCSLIB.ORG

H a W a I I D E R M P a T H Conference

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
H a W a I I D E R M P a T H Conference THE TM HAWAII DERMPATH CONFERENCE MAUI, HI 25.0 CME AMA PRA Category 1 Credits™ 25.0 SAM Credits (Approved provider) MEETING PROGRAM THURSDAY DERMATOPATHOLOGY Alopecia DR BETH RUBEN 1/25/2019 Mighty Women of Dermatopathology Hawaii 2019 Alopecia: Diagnosis via pattern analysis Beth S. Ruben, MD Professor of Dermatology/Dermatopathology University of California, San Francisco Director of Dermatopathology, Palo Alto Medical Foundation 1 Objectives Review basic hair anatomy Hair follicle anatomy Sizes of hair and organization Phases of the hair cycle Explore methods used to prepare sections for diagnosis of alopecia Employ pattern analysis in alopecia Discuss common and emerging examples of non-scarring and scarring alopecia 2 Basic hair anatomy 3 1 1/25/2019 Insert Whiting scan Whiting, 2004 4 Infundibulum SD Isthmus AP Lower follicle 5 6 2 1/25/2019 7 Lower follicle Hair root 8 Matrix Hair papilla 9 3 1/25/2019 10 11 Outer root Cortex sheath Inner Cuticle of Henley inner root root sheath Huxley sheath Cuticle of hair shaft Fibrous sheath 12 4 1/25/2019 Keratinization of hair shaft (Adamson’s fringe) Keratinization of inner root sheath (Huxley) 13 14 15 5 1/25/2019 Sizes of hair and organization 16 Vellus hair Thin, short and hypopigmented hairs Extend within the upper dermis The inner root sheath is as thick or thicker than its hair shaft less than 0.03 mm in diameter 17 Terminal hair Long, thick hair Extends into the subcutis in the scalp Hair shaft greater than 0.06 mm in diameter Normal T:V ratio: at least 2:1 (some say 4-7:1) Miniaturized hair: smaller hair but associated with a long fibrous tract Indeterminate hair: between vellus and terminal 18 6 1/25/2019 Follicular unit Contain individual follicles, including 2-5 terminal hairs and 0-2 vellus hairs This organization is apparent in the mid to upper dermis The terminal hairs are more evenly spaced in the subcutis 19 Follicular unit 20 Hair cycle phases 21 7 1/25/2019 Whiting, 2004 22 Anagen phase The growth phase 85% of hairs in this phase normally, from 2-7 years Multiple concentric layers, depending on the level examined Keratinization occurs differentially to form the hair shaft/inner sheath Zones include inferior, isthmic and infundibular 23 Catagen phase Brief transitional phase, 1% of hairs normally in this phase, lasts 2-3 weeks Eosinophilia of epithelium and evidence of apoptosis 24 8 1/25/2019 Telogen phase Resting phase, 0-15% of hairs in this phase normally, lasts 100 days Involutional, with a convoluted basaloid epithelium 25 Hair phases Indeterminate phase: in some cases, especially alopecia areata, it may be difficult to determine a precise phase Must examine the hair follicle below the level of the follicular bulge (isthmus or lower) to be able to differentiate between terminal anagen, catagen and telogen hairs above that the hair shaft is keratinized 26 Preparations of sections for alopecia diagnosis 27 9 1/25/2019 Biopsy requirements 4 mm punch biopsy, at minimum “Bury the punch”, with specimen including subcutis Early active sites, not “empty” areas Match angle of biopsy to angle of exit of hairs, if possible Improved yield with 2 punches? Transverse and routine processing 28 Why do transverse sections? 1-2 follicles/mm of scalp Routine sections through 4 mm punch yields 4-8 follicles 2-4 follicles/mm2 of scalp Transverse sections through 4 mm punch yields 25-50 follicles! The isthmic level of the hair follicle is particularly informative with respect to seeing follicular units, determining the type of hair, and the follicular phase should be present in some sections examined 29 Transverse sections for alopecia diagnosis: biopsy size 4 mm punch 3 mm punch A=r2 1.5mm 2mm A=3.14 x 4= 12.56 mm2 A=3.14 x 2.25= 7.06 mm2 30 10 1/25/2019 Methods for processing specimens transversely for alopecia Headington method Frishberg/Sperling method “Hovert” method Elston/Tyler method 31 Modified from David A. Whiting, MD. The Structure of the Human Hair Follicle, Canfield Publishing, 2004. 32 Embed cut surfaces down in paraffin block 33 11 1/25/2019 34 Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Arch Dermatol. 1984;120(4):449–456. 35 36 12 1/25/2019 Embed cut surfaces down in paraffin block 37 38 Transverse sections Dermis Level 6 Level 5 Level 4 Level 3 Level 2 Fat Level 1 Cut Surface Inked Courtesy of John Maize, Jr., MD 39 13 1/25/2019 Frishberg DP, Sperling LC, Guthrie VM. J. Am. Acad. Dermatol. 1996;35(2 Pt 1):220–222. 40 Frishberg-Sperling method 41 42 14 1/25/2019 43 44 45 15 1/25/2019 46 Pattern analysis in alopecia Fundamental assessment of whether hair loss is present Is it scarring (permanent) or non-scarring? Caveat: many forms of hair loss are biphasic Phases in which the alopecia is not yet permanent, but may become so over time (e.g., androgenetic alopecia) Composition of the infiltrate can be considered important in scarring alopecia mainly Other specific features for final classification 47 Biphasic patterns of alopecia Modified from A. Solomon, in Sellheyer K, Bergfeld WF. Histopathologic evaluation of alopecias. Am J Dermatopathol. 2006;28(3):236–259. 48 16 1/25/2019 Pattern analysis in alopecia Analysis depends on the area chosen for biopsy If an area of burnt out alopecia is selected, diagnostic features may not be present If an area with secondary inflammation is chosen, these features may obscure the primary pathology Sampling of an area at the periphery of an alopecic zone without obvious secondary impetiginization or trauma is ideal 49 “CHECKLIST” Adapted from Sperling’s atlas Is the specimen adequate? Is the hair count normal or decreased? Are follicular units evenly spaced, or is there evidence of follicular dropout? could imply a scarring alopecia or extreme miniaturization Do most follicular units contain 2-6 follicles? Are more than 85% of hairs in anagen phase (normal) How many follicles are terminal, how many vellus? Are there sebaceous glands? Is there perifollicular fibrosis? Are there scarred fibrous tracts? Is there solar elastosis (longstanding process)? Is there inflammation, and if so, at what level of the follicle? What is the composition of the infiltrate? Are there follicles or hair shafts with unusual features? 50 Non-scarring versus scarring: common features by pattern Non-scarring Scarring Preservation of Perifollicular fibrosis, sebaceous glands at infundibular or Empty, non-scarred isthmic level follicular tracts Fibrotic follicular tracts Shifts in follicular Compound follicles phase 51 17 1/25/2019 Non-scarring alopecia 52 Non-scarring alopecia Androgenetic alopecia Alopecia areata Trichotillomania Traction alopecia Telogen effluvium Temporal triangular alopecia Alopecia mucinosa 53 Androgenetic alopecia Clinical features: Progressive thinning at bitemporal hairline, scalp vertex, widening part Thinning > shedding Even though considered a non-scarring alopecia, may become permanent over time (biphasic) Permanent alopecia due to chemotherapy for breast cancer may also display this pattern taxanes, busulfan, cisplatin, etoposide implicated 54 18 1/25/2019 Androgenetic alopecia Clinical features 55 Androgenetic alopecia Histologic features Progressive miniaturization Hairs of various diameters and lengths Decreased terminal hairs in the subcutis Reduction in ratio of terminal to vellus hairs (<2:1) Slight increase in catagen/telogen phase follicles as hairs miniaturize, spend more time in telogen Preservation of sebaceous lobules, fibrous tracts Sparse superficial lymphocytic infiltrate Late phase: follicular tracts grayish, less vascular the process become irreversible (dec. follicular density/size) 56 57 19 1/25/2019 58 59 60 20 1/25/2019 61 62 63 21 1/25/2019 64 65 66 22 1/25/2019 67 68 69 23 1/25/2019 Permanent alopecia after chemotherapy All had hair loss during chemotherapy, but then insufficient hair regrowth First attack by chemotherapy with miniaturization/inflammation, then cannot regenerate due to hormonal therapy Pattern similar to androgenetic alopecia or alopecia areata, but diffuse short hairs common Increased telogen hairs (anagen 3:1), often in groups may reflect synchronization after anagen effluvium Terminal:vellus ratio 1:1 (lower than normal scalp and AGA) Miteva M, Misciali C, Fanti PA, et al. Permanent alopecia after systemic chemotherapy: a clinicopathological study of 10 cases. Am J Dermatopathol. 2011;33(4):345–350. Fonia A, Cota C, Setterfield JF, Goldberg LJ, Fenton DA, Stefanato CM. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients. J Am Acad Dermatol. 2017;76(5):948-957. 70 Courtesy Of Anna Haemel, MD 71 Fonia A, Cota C, Setterfield JF, Goldberg LJ, Fenton DA, Stefanato CM. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients. J Am Acad Dermatol. 2017;76(5):948-957. 72 24 1/25/2019 Androgenetic alopecia Differential diagnosis: Post-inflammatory phase of alopecia areata (also miniaturized hairs, but marked catagen/telogen shift) Telogen effluvium (no significant miniaturization in “pure” acute cases) 73 Temporal triangular alopecia Clinical: localized temporal zone of alopecia may be evident at birth, or occur in the first decade rarely occurs later in life or in other
Load more

Recommended publications
  • Hair Loss in Infancy
    SCIENCE CITATIONINDEXINDEXED MEDICUS INDEX BY (MEDLINE) EXPANDED (ISI) OFFICIAL JOURNAL OF THE SOCIETÀ ITALIANA DI DERMATOLOGIA MEDICA, CHIRURGICA, ESTETICA E DELLE MALATTIE SESSUALMENTE TRASMESSE (SIDeMaST) VOLUME 149 - No. 1 - FEBRUARY 2014 Anno: 2014 Lavoro: 4731-MD Mese: Febraury titolo breve: Hair loss in infancy Volume: 149 primo autore: MORENO-ROMERO No: 1 pagine: 55-78 Rivista: GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA Cod Rivista: G ITAL DERMATOL VENEREOL G ITAL DERMATOL VENEREOL 2014;149:55-78 Hair loss in infancy J. A. MORENO-ROMERO 1, R. GRIMALT 2 Hair diseases represent a signifcant portion of cases seen 1Department of Dermatology by pediatric dermatologists although hair has always been Hospital General de Catalunya, Barcelona, Spain a secondary aspect in pediatricians and dermatologists 2Universitat de Barcelona training, on the erroneous basis that there is not much in- Universitat Internacional de Catalunya, Barcelona, Spain formation extractable from it. Dermatologists are in the enviable situation of being able to study many disorders with simple diagnostic techniques. The hair is easily ac- cessible to examination but, paradoxically, this approach is often disregarded by non-dermatologist. This paper has Embryology and normal hair development been written on the purpose of trying to serve in the diag- nostic process of daily practice, and trying to help, for ex- ample, to distinguish between certain acquired and some The full complement of hair follicles is present genetically determined hair diseases. We will focus on all at birth and no new hair follicles develop thereafter. the data that can be obtained from our patients’ hair and Each follicle is capable of producing three different try to help on using the messages given by hair for each types of hair: lanugo, vellus and terminal.
    [Show full text]
  • Ntvdv Maart 2018, Nummer 3
    COLOFON INHOUD Het Nederlands Tijdschrift voor Dermatologie en Venereologie is het officiële orgaan van de Nederlandse Vereniging voor Dermatologie en Venereologie en verschijnt 10x per jaar in een oplage van 1.200 exemplaren. Het NTvDV is vanaf 1 januari 2008 geïndexeerd in EMBase, de internationale wetenschappelijke database van Elsevier Science. NVDV NASCHOLING DERMATOLOGENDAGEN HOOFDREDACTIE Dr. W.P. Arnold, hoofdredacteur 3 Programma Ziekenhuis Gelderse Vallei, afdeling Dermatologie W. Brandtlaan 10 | 6716 RP Ede ARTIKELEN Telefoon 0318-435007 E-mail: [email protected] 5 Behandeling female pattern hair loss ARTIKELEN 8 Non-scarring alopecia Dr. R.C. Beljaards, dr. C.J.W. van Ginkel LEERZAME ZIEKTEGESCHIEDENISSEN 10 Cicatriciële alopecie Dr. R. van Doorn, dr. S. van Ruth, dr. J. Toonstra, dr. T.M. Le ALLERGEEN VAN DE MAAND 15 Trichoscopie Prof. dr. T. Rustemeyer DERMATOCHIRURGIE 19 Geriatrische dermato-oncologie Dr. R.I.F. van der Waal DERMATOLOGIE DIGITAAL 24 Ingenolmebutaat bij actinische keratosen DERMATOLOGIE IN BEELD 25 Beeldtechnologie ondersteunt de arts Dr. R.I.F. van der Waal, dr. A.J. Onderdijk DERMATOPATHOLOGIE 29 Dermatofyten in revisie P.K. Dikrama DERMATOSCOPIE 33 Diagnostiek in de dermatologie Dr. N.A. Kukutsch GESCHIEDENIS VAN DE DERMATOLOGIE 38 Infecties van de neonaat Dr. J. Toonstra, A. Glastra ONDERZOEK VAN EIGEN BODEM 40 Herpes zoster Dr. H.J. Bovenschen, J.C.J. Hellenbrand-Hendriks 42 Chemopreventie van huidkanker PRAKTIJKVOERING Dr. C. Vrijman 46 Mohschirurgie in Nederland: afspraken REFERATEN D.J.C. Komen, dr. M.B.A. van Doorn 48 Plaveiselcelcarcinoom in het hoofd-halsgebied RICHTLIJNEN Dr. J.J.E. van Everdingen 50 Systeemtherapie voor melanoom DERMATOLOGIE IN DE KUNST Dr.
    [Show full text]
  • Copyrighted Material
    1 Index Note: Page numbers in italics refer to figures, those in bold refer to tables and boxes. References are to pages within chapters, thus 58.10 is page 10 of Chapter 58. A definition 87.2 congenital ichthyoses 65.38–9 differential diagnosis 90.62 A fibres 85.1, 85.2 dermatomyositis association 88.21 discoid lupus erythematosus occupational 90.56–9 α-adrenoceptor agonists 106.8 differential diagnosis 87.5 treatment 89.41 chemical origin 130.10–12 abacavir disease course 87.5 hand eczema treatment 39.18 clinical features 90.58 drug eruptions 31.18 drug-induced 87.4 hidradenitis suppurativa management definition 90.56 HLA allele association 12.5 endocrine disorder skin signs 149.10, 92.10 differential diagnosis 90.57 hypersensitivity 119.6 149.11 keratitis–ichthyosis–deafness syndrome epidemiology 90.58 pharmacological hypersensitivity 31.10– epidemiology 87.3 treatment 65.32 investigations 90.58–9 11 familial 87.4 keratoacanthoma treatment 142.36 management 90.59 ABCA12 gene mutations 65.7 familial partial lipodystrophy neutral lipid storage disease with papular elastorrhexis differential ABCC6 gene mutations 72.27, 72.30 association 74.2 ichthyosis treatment 65.33 diagnosis 96.30 ABCC11 gene mutations 94.16 generalized 87.4 pityriasis rubra pilaris treatment 36.5, penile 111.19 abdominal wall, lymphoedema 105.20–1 genital 111.27 36.6 photodynamic therapy 22.7 ABHD5 gene mutations 65.32 HIV infection 31.12 psoriasis pomade 90.17 abrasions, sports injuries 123.16 investigations 87.5 generalized pustular 35.37 prepubertal 90.59–64 Abrikossoff
    [Show full text]
  • T He Alo Pecias
    t he a lo pecias hair follicles can be noted as early as 4 days following 2. Camacho F, Montagna W. Trichologie-maladies radiation. Similar effects are noted with x-rays and elec- du follicule pilosébacé. Madrid, Spain: Grupo Aula tron beam radiation. The earliest change is thinning of Médica SA; 1997. the hair bulb, especially in the area of the matrix. Two or 3. Olsen EA. Disorders of Hair Growth—Diagnosis and 3 weeks following irradiation, hairs with tapered shafts Treatment. New York, NY: McGraw-Hill; 1997. are apparent. The number of follicles showing radiation 4. Bouhanna P. Alopécies traumatiques. In: Bouhanna P, effects is roughly proportional to the dose of radiation. Reygagne P, ed. Pathologie du cheveu et du cuir chev- The definitive treatment is the scar excision or, better, a elu. Paris, France: Masson; 1999:145–152. hair transplant restoration (Figure 10.18a and b). 5. Tosti A, Miteva M, Torres F, Vincenzi C, Romanelli P. Hair casts are a dermoscopic clue for the diagnosis of traction alopecia. Br J Dermatol. 2010;163:1353–1355. CONCLUSION 6. Tosti A. Dermascopy of Hair and Scalp Disorders. Traction alopecia and trichotillomania are types of physi- London: Informa Healthcare; 2007. cal trauma that can lead to alopecia. 7. Bouhanna P. Les alopécies traumatiques, une triple Traction alopecia is seen most commonly in black orientation diagnostique. In: Bouhanna P, ed. Les alo- females. Trichotillomania is a traction alopecia related to pécies—de la clinique au traitement. Collection Guide a compulsive disorder. In the long term, permanent alo- Pratique de Dermatologie. Paris, France: Med’Com;2004.
    [Show full text]
  • Infections, Infestations and Neoplasms of the Scalp Infections, Infestations and Neoplasms of the Scalp
    Provisional chapter Chapter 11 Infections, Infestations and Neoplasms of the Scalp Infections, Infestations and Neoplasms of the Scalp Filiz Canpolat Filiz Canpolat Additional information is available at the end of the chapter Additional information is available at the end of the chapter http://dx.doi.org/10.5772/67278 Abstract This chapter reviews common cutaneous infections, infestations, and neoplasms of the scalp. Infections of the scalp are subdivided into three major groups. The most seen are: (1) Bacterial: Folliculitis, folliculitis decalvans, tufted hair folliculitis and acne keloidalis nuchae. (2) Fungal: Tinea capitis, favus and kerion celsi. (3) Protozoal: Syphilitic alope- cia. Pediculosis capitis is the most common worldwide infestation of the scalp. The neo- plasms of the scalp are large group of different diseases due to arising different origin. In the following section, trichilemmal cyst, proliferating trichilemmal cyst, nevus sebaceous and cylindroma are discussed in detail. Keywords: infection, infestation, neoplasm, scalp 1. Introduction Scalp diseases are one of the most seen reasons for admission to dermatology clinics. There is a wide spectrum of different aetiologies for scalp lesions. This chapter will review cutaneous infections, infestations and neoplasms of the scalp. Examples of bacterial infections include folliculitis, folliculitis decalvans, tufted hair folliculitis and acne keloidalis nuchae. There will be some detailed information about fungal infections, such as tinea capitis, favus and kerion celsi. The neoplasms of the scalp represent a varied group of dermatoses. This review focuses on trichilemmal cyst, proliferating trichilemmal cyst, nevus sebaceous and cylindroma. 2. Bacterial infections of scalp There are several types of infections of the scalp including chronic scalp folliculitis [SF], fol- liculitis decalvans [FD], tufted folliculitis [TF], acne nuchae keloidalis [ANK] and dissecting ©© 2016 2017 The The Author(s).
    [Show full text]
  • Pattern of Alopecia and the Effect of Alopecia on the Quality of Life of Patients
    PATTERN OF ALOPECIA AND THE EFFECT OF ALOPECIA ON THE QUALITY OF LIFE OF PATIENTS BY DR. EKPUDU, VIOLET IDONNI A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FUFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF FELLOWSHIP OF THE COLLEGE IN INTERNAL MEDICINE (IN THE SUBSPECIALTY OF DERMATOLOGY). MAY 2008 ii TABLE OF CONTENTS Page Title Page --------------------------------------------------- i Declaration ----------------------------------------------- ii Supervisor’s Certification ------------------------------- iii Head of Department’s Signature ----------------------- v Table of contents ------------------------------------ ------ vi List of Figures -------------------------------------------- vii List of Tables ---------------------------------------------- viii List of Abbreviations ------------------------------------ ix Dedication ------------------------------------------------ x Acknowledgement --------------------------------------- xi Summary ------------------------------------------------- xii Chapter 1. Introduction -------------------------------- 1 Chapter 2. Literature Review -------------------------- 4 Chapter 3. Aim and Objectives ------------------------ 49 Chapter 4. Materials and Methods -------------------- 50 Chapter 5. Results ------------------------------------- 62 Chapter 6. Discussion --------------------------------- 113 Chapter 7. Conclusion and Recommendations ----- 131 References ---------------------------------------------- 135 Appendix I. Questionnaire -----------------------------
    [Show full text]
  • Copyrighted Material
    1 Index Note: Page numbers in italics refer to figures, those in bold refer to tables and boxes. References are to pages within chapters, thus 58.10 is page 10 of Chapter 58. A definition 87.2 congenital ichthyoses 65.38–9 differential diagnosis 90.62 A fibres 85.1, 85.2 dermatomyositis association 88.21 discoid lupus erythematosus occupational 90.56–9 α-adrenoceptor agonists 106.8 differential diagnosis 87.5 treatment 89.41 chemical origin 130.10–12 abacavir disease course 87.5 hand eczema treatment 39.18 clinical features 90.58 drug eruptions 31.18 drug-induced 87.4 hidradenitis suppurativa management definition 90.56 HLA allele association 12.5 endocrine disorder skin signs 149.10, 92.10 differential diagnosis 90.57 hypersensitivity 119.6 149.11 keratitis–ichthyosis–deafness syndrome epidemiology 90.58 pharmacological hypersensitivity 31.10– epidemiology 87.3 treatment 65.32 investigations 90.58–9 11 familial 87.4 keratoacanthoma treatment 142.36 management 90.59 ABCA12 gene mutations 65.7 familial partial lipodystrophy neutral lipid storage disease with papular elastorrhexis differential ABCC6 gene mutations 72.27, 72.30 association 74.2 ichthyosis treatment 65.33 diagnosis 96.30 ABCC11 gene mutations 94.16 generalized 87.4 pityriasis rubra pilaris treatment 36.5, penile 111.19 abdominal wall, lymphoedema 105.20–1 genital 111.27 36.6 photodynamic therapy 22.7 ABHD5 gene mutations 65.32 HIV infection 31.12 psoriasis pomade 90.17 abrasions, sports injuries 123.16 investigations 87.5 generalized pustular 35.37 prepubertal 90.59–64 Abrikossoff
    [Show full text]
  • Approach to Hair Loss in Women of Color Jennifer M
    Approach to Hair Loss in Women of Color Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C) Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appro- priate education of the public and medical establishment. Semin Cutan Med Surg 28:109-114 © 2009 Elsevier Inc. All rights reserved. Clinical Examination the hair and scalp from above. Good lighting is essential, and ideally includes a magnifying examination light. he patient with hair loss arrives at your office and re- Once the patient is seated, the examination ensues, taking Tports: “I am losing my hair, or, my hair has stopped into account the following key features: growing, or my hair is breaking.” These words can mean drastically different things to different patients. The role of 1. Hair loss. To what extent is there hair loss? Is it in the astute clinician is to unearth their true significance with a patches or all over? Is the scalp visible? Are there bare thoughtful and stepwise diagnostic approach.
    [Show full text]
  • The Potential Relevance of the Microbiome to Hair Physiology and Regeneration: the Emerging Role of Metagenomics
    biomedicines Review The Potential Relevance of the Microbiome to Hair Physiology and Regeneration: The Emerging Role of Metagenomics Andria Constantinou 1 , Varvara Kanti 1, Katarzyna Polak-Witka 1, Ulrike Blume-Peytavi 1 , George M. Spyrou 2 and Annika Vogt 1,* 1 Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; [email protected] (A.C.); [email protected] (V.K.); [email protected] (K.P.-W.); [email protected] (U.B.-P.) 2 Bioinformatics ERA Chair, The Cyprus Institute of Neurology and Genetics, 6 Iroon Avenue, 2371 Ayios Dometios, Nicosia, Cyprus; [email protected] * Correspondence: [email protected] Abstract: Human skin and hair follicles are recognized sites of microbial colonization. These micro- biota help regulate host immune mechanisms via an interplay between microbes and immune cells, influencing homeostasis and inflammation. Bacteria affect immune responses by controlling the local inflammatory milieu, the breakdown of which can result in chronic inflammatory disorders. Follicu- lar microbiome shifts described in some inflammatory cutaneous diseases suggest a link between their development or perpetuation and dysbiosis. Though the hair follicle infundibulum is an area Citation: Constantinou, A.; Kanti, V.; of intense immunological interactions, bulb and bulge regions represent immune-privileged niches. Polak-Witka, K.; Blume-Peytavi, U.; Immune privilege maintenance seems essential for hair growth and regeneration, as collapse and Spyrou, G.M.; Vogt, A. The Potential inflammation characterize inflammatory hair disorders like alopecia areata and primary cicatricial Relevance of the Microbiome to Hair alopecia.
    [Show full text]
  • American Osteopathic College of Dermatology Journal of the American Osteopathic College of Dermatology
    Journal of the American Osteopathic College of Dermatology Journal of the American Osteopathic College of Dermatology 2009-2010 AOCD Officers President: Leslie Kramer, DO, FAOCD President-Elect: Bradley Glick, DO, FAOCD First Vice-President: James Towry, DO, FAOCD Second Vice-President: Karen Neubauer, DO, FAOCD Third Vice-President: David Grice, DO, FAOCD Secretary-Treasurer: Jere Mammino, DO, FAOCD Immediate Past President: Marc Epstein, DO, FAOCD Trustees: Celeste Angel, DO, FAOCD Alpesh Desai, DO, FAOCD Mark Kuriata, DO, FAOCD Editors Rick Lin, DO, FAOCD Jay S. Gottlieb, DO Andrew Racette, DO, FAOCD Jon Keeling, DO Suzanne Rozenberg, DO, FAOCD Editorial Review Board Kevin Belasco, DO Rich Bernert, M.D. Sponsors: Iqbal Bukhari, MD Global Pathology Laboratory JAOCD Ryan Carlson, DO Medicis Founding Sponsor Igor Chaplik, DO JAOCD Founding Sponsor Michael Conroy, M.D. Galderma Brad Glick, DO, FAOCD Ranbaxy Melinda Greenfield, DO Andrew J Hanly, MD David Horowitz, DO, FAOCD JAOCD Matt Leavitt, DO, FAOCD Founding Sponsor Mark Lebwohl, MD AOCD • 1501 E. Illinois • Kirksville, MO 63501 Rick Lin, DO 800-449-2623 • FAX: 660-627-2623 www.aocd.org Megan Machuzak, D.O. Jere Mammino, DO, FAOCD COPYRIGHT AND PERMISSION: written permission must be obtained from the Journal of the American Osteopathic College of Dermatology John Minni, DO for copying or reprinting text of more than half page, tables or figures. Navid Nami, DO Permissions are normally granted contingent upon similar permission from the author(s), inclusion of acknowledgement of the original source, Shaheen Oshtory, DO and a payment of $15 per page, table or figure of reproduced material. Permission fees are waived for authors wishing to reproduce their own John Perrotto, DO articles.
    [Show full text]
  • Dissecting Scalp Folliculitis a 25-Year Old African
    Running head: Dissecting Scalp Folliculitis A 25-year old African-American Male with Chronic Scalp Abscesses Resulting in Dissecting Folliculitis Requiring Systemic Therapy TEXAS WOMAN’S UNIVERSITY NURS 6035 – DNP Practicum I Dr. Susan Chaney, Dr. Elaine Ballard and Dr. Terri White Consuela “Swae” Witherspoon MSN APRN-FNP November 2, 2009 Dissecting Scalp Folliculitis 2 A 25-year old African-American male with chronic scalp abscesses resulting in dissecting scalp folliculitis with alopecia scarring requiring systemic therapy OVERVIEW An abscess is an infection characterized by a collection of pus underneath certain portions of the skin. Streptococcus and Staphylococcus aureus are the most common bacteria causing abscesses of the skin. Cracks and injury to the skin is the usual pathway of entry for the specified bacteria. Fever may be a direct result of the bacteria and the areas of the affected skin usually become swollen, red, tender and warm. Most abscesses resolve quickly once appropriately treated (skinsight.com). Dissecting folliculitis is a rare chronic suppurative disease, usually affecting African American adult males causing alopecia scarring of the scalp (S. Sivakumaran et al, 2001). Many dermatologist and or pathologist receive little to no training is the evaluation of hair disease (Sperling, 2001). This classification of scarring alopecia recognizes five fairly distinct diseases. However, many cases of scarring alopecia will demonstrate clinical and /or histologic features that are shared by more than one diagnostic entity. A sixth category (‘‘scarring alopecia, unclassified‘‘) is needed for cases of scarring alopecia that cannot be confidently identified. LPP½lichen planopilaris; DLE½ discoid lupus erythematosus; CCSA½central, centrifugal scarring alopecia (Sperling, 2001).
    [Show full text]
  • Appearances in Clinical Dermatology Page
    Resident’s Appearances in clinical dermatology Page Bhushan Madke, Bhavana Doshi Chougule1, Sumit Kar, Uday Khopkar2 INTRODUCTION appearance. Beefy red tongue has two components: inflammation and papillary atrophy. Inflammation In this paper, we have attempted to compile of the tongue with redness and soreness may occur “appearances” observed on clinical[1] inspection in at any time in vitamin B12 or folic acid deficiency; dermatology which can help a post‑graduate student however, atrophy of the papillae with a resulting in making a clinical diagnosis more easily. However, smooth tongue develops in later stages of the this paper will only concentrate on appearances in deficiency.[3] clinical aspects and not in dermatopathology and other investigative dermatology. Beefy red appearance in granuloma inguinale (donovanosis) Asbestos‑like appearance Granuloma inguinale is a sexually transmitted Pityriasis amiantacea tinea amiantacea is a infection caused by Klebsiella granulomatis. an papulosquamous condition of the scalp that presents intracellular Gram‑negative bacterium. The infection with asbestos‑like thick scales attached to the hair produces ulceration at the primary site of inoculation shaft. Scales are arranged in an overlapping manner which is usually genital but may be oral, anal, or at like flakes of asbestos, hence the name “amiantaceus.” other extra‑ genital locations. Ulcero‑granulomatous Pityriasis amiantacea is commonly seen in psoriasis type of donovanosis is characterized by non‑tender but can be encountered in seborrheic dermatitis, ulcers that bleed easily owing to its high vascularity atopic eczema, and pityriasis rosea.[2] giving rise to the beefy red appearance characteristic of this condition[4] [Figure 1]. Beefy red appearance of tongue Vitamin B12 deficiency due to pernicious anemia In addition to donovanosis, wounds healing by and folic acid deficiency cause soreness of tongue secondary intention may also show beefy red with papillary atrophy giving it a smooth beefy red granulation.
    [Show full text]