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Jerry Shapiro - One of the best experts on this subject based on the ideXlab platform.
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primary Cicatricial Alopecia
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Jerry Shapiro, Leonard C. SperlingAbstract:Both primary and secondary forms of Cicatricial Alopecia have been described. The hair follicles are the specific target of inflammation in primary Cicatricial Alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary Cicatricial Alopecia. This 2-part continuing medical education article will review primary Cicatricial Alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary Cicatricial Alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing Alopecia, and Graham–Little syndrome.
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Primary Cicatricial Alopecia: Other lymphocytic primary Cicatricial Alopecias and neutrophilic and mixed primary Cicatricial Alopecias
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Leonard C. Sperling, Jerry ShapiroAbstract:Primary Cicatricial Alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary Cicatricial Alopecias, which include pseudopelade of Brocq, central centrifugal Cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary Cicatricial Alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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Diagnosis and management of primary Cicatricial Alopecia: part II.
Skinmed, 2008Co-Authors: Nina Otberg, Kevin J. Mcelwee, Jerry ShapiroAbstract:In this 2-part article, the authors review the primary Cicatricial Alopecias. Primary Cicatricial Alopecia can be defined as predominantly lymphocytic, neutrophilic, or mixed based on the nature of the follicular infiltrate that is present around affected hair follicles. Lymphocytic primary Cicatricial Alopecias include chronic cutaneous lupus erythematosus (discoid lupus erythematosus), lichen planopilaris, classic pseudopelade of Brocq, central centrifugal Cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. In this first part, the authors summarize the classification, epidemiology, diagnostic approach, and patient management of lymphocytic Cicatricial Alopecias. In part II, the authors will focus on neutrophilic Cicatricial Alopecias and mixed Cicatricial Alopecias.
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Update on Cicatricial Alopecia
The journal of investigative dermatology. Symposium proceedings, 2003Co-Authors: Elise A. Olsen, Jerry Shapiro, Leonard C. Sperling, Wilma F Bergfeld, Kurt S. Stenn, Vera H. Price, George Cotsarelis, Rodney Sinclair, A. Solomon, David A. WhitingAbstract:Cicatricial Alopecia is an enigmatic group of hair disorders linked by the potential permanent loss of scalp hair follicles in involved areas. Progress in our understanding and treatment of these disorders has been stymied by the lack of clear diagnostic criteria for the current terms used to describe the various hair loss entities. Since all of these conditions evolve as the hair is destroyed or replaced, diagnosis is further made difficult by a lack of clinical and pathologic "snapshots" over the evolution of each disorder. Without some acceptance of general clinical and histological presentations in the early, mid and late stage of these disorders, one cannot begin to explore ways to make the diagnosis at a very early stage before significant follicular destraction has occurred (making the clinical diagnosis obvious) and when the damage is potentially repairable or progression preventable.
Leonard C. Sperling - One of the best experts on this subject based on the ideXlab platform.
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primary Cicatricial Alopecia
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Jerry Shapiro, Leonard C. SperlingAbstract:Both primary and secondary forms of Cicatricial Alopecia have been described. The hair follicles are the specific target of inflammation in primary Cicatricial Alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary Cicatricial Alopecia. This 2-part continuing medical education article will review primary Cicatricial Alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary Cicatricial Alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing Alopecia, and Graham–Little syndrome.
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Primary Cicatricial Alopecia: Other lymphocytic primary Cicatricial Alopecias and neutrophilic and mixed primary Cicatricial Alopecias
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Leonard C. Sperling, Jerry ShapiroAbstract:Primary Cicatricial Alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary Cicatricial Alopecias, which include pseudopelade of Brocq, central centrifugal Cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary Cicatricial Alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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Hair breakage as a presenting sign of early or occult central centrifugal Cicatricial Alopecia: clinicopathologic findings in 9 patients.
Archives of dermatology, 2012Co-Authors: Valerie D. Callender, Dakara Rucker Wright, Erica C. Davis, Leonard C. SperlingAbstract:Background Central centrifugal Cicatricial Alopecia is the most common form of Cicatricial Alopecia in African American women. Treatment options are limited and mostly aimed at halting further hair loss but rarely result in hair regrowth. Therefore, it is important to recognize early clinical signs, perform a confirmatory biopsy, and begin treatment promptly. We have observed that hair breakage may be a key sign of early central centrifugal Cicatricial Alopecia, and this association is not clearly described in the literature. Observations Nine patients with hair breakage on the vertex with or without scalp symptoms underwent scalp biopsies as part of their evaluation. Of these, 8 had histologic samples adequate for complete interpretation: 5 specimens (63%) showed histologic changes typical of central centrifugal Cicatricial Alopecia, with 1 of these showing advanced end-stage changes of Cicatricial Alopecia. Two (25%) revealed premature desquamation of the inner root sheath as the sole finding suggestive of early central centrifugal Cicatricial Alopecia and 1 (13%) was normal. Conclusions Although hair breakage can have multiple causes, early central centrifugal Cicatricial Alopecia must be considered in the differential diagnosis, particularly in women of African ancestry. Histologic evaluation may reveal early or late findings that can help establish the diagnosis.
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Differentiating Central Centrifugal Cicatricial Alopecia and Androgenetic Alopecia in African American Men: Report of Three Cases
The Journal of clinical and aesthetic dermatology, 2012Co-Authors: Erica C. Davis, Valerie D. Callender, Sophia D. Reid, Leonard C. SperlingAbstract:Central centrifugal Cicatricial Alopecia is a scarring Alopecia that is predominantly seen in African American women, but occurs less frequently in men. The authors present three cases of African American men with biopsy-proven central centrifugal Cicatricial Alopecia and detail the clinical presentation, histological findings, and treatment regimens. Central centrifugal Cicatricial Alopecia should be considered in the differential diagnosis when evaluating male patients with vertex hair loss accompanied by scalp symptoms. Physicians should maintain a high index of suspicion in African American men with the appropriate clinical picture and confirm the diagnosis by scalp biopsy. Prompt and appropriate treatment can help halt or slow disease progression.
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Cytokeratin 15 expression in central, centrifugal, Cicatricial Alopecia: new observations in normal and diseased hair follicles.
Journal of cutaneous pathology, 2011Co-Authors: Leonard C. Sperling, Sean Hussey, Ji-an Wang, Thomas DarlingAbstract:Cytokeratin 15 (CK15) is a useful marker for the bulge zone (BZ) and has been used to examine follicles in Cicatricial Alopecia. We studied the expression of CK15 in hair follicles of patients with central, centrifugal, Cicatricial Alopecia (CCCA) in an attempt to define BZ integrity. A commercially available antibody to CK15 was used on formalin-fixed, paraffin-embedded tissue from clinically and histologically 'normal' scalps, clinically diseased scalps from patients with CCCA and clinically 'normal' scalps from patients with CCCA. In both normal and diseased follicles, CK15 expression was closely linked to anatomical zone cellular morphology. Normal and abnormal inner root sheath (IRS) desquamation occurred in concert with predictable cellular morphological changes and CK15 expression. In most abnormal follicles, once the IRS desquamated, the morphology of BZ epithelium changed and CK15 expression disappeared. CK15 highlights BZ cells in normal human follicles, but may be unreliable for this purpose in diseased follicles. CK15 should not be the sole marker for studying stem cells in Cicatricial Alopecia because any disease-induced structural changes could alter CK15 expression. More sophisticated studies of stem cells will be required to reliably define their role in the pathogenesis of Cicatricial Alopecia. Published 2011. This is a US Government work and is in the public domain in the USA.
Paradi Mirmirani - One of the best experts on this subject based on the ideXlab platform.
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Elastin staining patterns in primary Cicatricial Alopecia
Journal of the American Academy of Dermatology, 2013Co-Authors: Maxwell A Fung, Victoria R. Sharon, Mondhipa Ratnarathorn, Thomas Konia, Keira L. Barr, Paradi MirmiraniAbstract:Background Most biopsy specimens of Cicatricial (scarring) Alopecia can be readily subclassified as lymphocytic versus neutrophilic, but specific diagnosis remains difficult, particularly when a late stage of the disease is sampled. Objective We sought to document patterns of scarring highlighted by elastic tissue staining in primary Cicatricial Alopecia. Methods We documented Verhoeff elastic van Gieson staining patterns in 58 routinely embedded (vertical) biopsy specimens of Cicatricial Alopecia. Patterns of fibrosis included perifollicular (wedge-shaped vs broad tree trunk–shaped) and diffuse. The patterns were compared against the diagnosis obtained by independent expert clinical review, including central centrifugal Cicatricial Alopecia (CCCA), lichen planopilaris, traction Alopecia, frontal fibrosing Alopecia, discoid lupus erythematosus, and tufted folliculitis. Results Wedge-shaped perifollicular fibrosis was seen in lichen planopilaris but also in CCCA. Broad tree trunk–shaped perifollicular fibrosis was most commonly encountered in CCCA. Limitations The retrospective nature of the study precluded temporal staging of the disease process. Conclusions Patterns of fibrosis highlighted by elastin staining in primary Cicatricial Alopecia appear to be disease specific. Superficial wedge-shaped perifollicular fibrosis is associated with but may not be specific for lichen planopilaris. Broad tree trunk–like perifollicular fibrosis is specific for CCCA but not present in many cases. Elastin staining represents a useful ancillary study for the evaluation of late-stage scarring Alopecia in routinely oriented punch biopsy specimens.
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Tinea capitis mimicking Cicatricial Alopecia: What host and dermatophyte factors lead to this unusual clinical presentation?
Journal of the American Academy of Dermatology, 2009Co-Authors: Paradi Mirmirani, Andrea Willey, Sarah L. Chamlin, Ilona J. Frieden, Vera H. PriceAbstract:Tinea capitis is the most common dermatophyte infection in children. The clinical presentation varies from subtle asymptomatic scaling to inflammatory suppurative nodules and draining tracks. Both chronic and acute inflammatory infections may damage the hair follicle leading to secondary Cicatricial Alopecia. In rare instances, the initial presentation can mimic a primary Cicatricial Alopecia. We present three cases of tinea capitis in children masquerading as Cicatricial Alopecia and discuss the possible host immune and fungal antigenic factors that may influence the course of disease and its clinical presentation. An understanding of the clinical morphology of tinea capitis in the context of both host and fungal factors may improve treatment strategies and direct future paradigms of therapy.
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Central centrifugal Cicatricial Alopecia: Superimposed tinea capitis as the etiology of chronic scalp pruritus.
Dermatology online journal, 2008Co-Authors: Charles Chiang, Vera H. Price, Paradi MirmiraniAbstract:We discuss a patient with central centrifugal Cicatricial Alopecia (CCCA) who developed severe scalp pruritus that was initially attributed to the Cicatricial Alopecia and ultimately diagnosed as tinea capitis. The rarity of severe pruritus in CCCA should prompt a search for a fungal infection in these patients.
Vera H. Price - One of the best experts on this subject based on the ideXlab platform.
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Tinea capitis mimicking Cicatricial Alopecia: What host and dermatophyte factors lead to this unusual clinical presentation?
Journal of the American Academy of Dermatology, 2009Co-Authors: Paradi Mirmirani, Andrea Willey, Sarah L. Chamlin, Ilona J. Frieden, Vera H. PriceAbstract:Tinea capitis is the most common dermatophyte infection in children. The clinical presentation varies from subtle asymptomatic scaling to inflammatory suppurative nodules and draining tracks. Both chronic and acute inflammatory infections may damage the hair follicle leading to secondary Cicatricial Alopecia. In rare instances, the initial presentation can mimic a primary Cicatricial Alopecia. We present three cases of tinea capitis in children masquerading as Cicatricial Alopecia and discuss the possible host immune and fungal antigenic factors that may influence the course of disease and its clinical presentation. An understanding of the clinical morphology of tinea capitis in the context of both host and fungal factors may improve treatment strategies and direct future paradigms of therapy.
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Central centrifugal Cicatricial Alopecia: Superimposed tinea capitis as the etiology of chronic scalp pruritus.
Dermatology online journal, 2008Co-Authors: Charles Chiang, Vera H. Price, Paradi MirmiraniAbstract:We discuss a patient with central centrifugal Cicatricial Alopecia (CCCA) who developed severe scalp pruritus that was initially attributed to the Cicatricial Alopecia and ultimately diagnosed as tinea capitis. The rarity of severe pruritus in CCCA should prompt a search for a fungal infection in these patients.
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The medical treatment of Cicatricial Alopecia.
Seminars in cutaneous medicine and surgery, 2006Co-Authors: Vera H. PriceAbstract:The best outcome of current treatments of Cicatricial Alopecia is induction of a clinical remission with arrest of symptoms and signs, but the progression of hair loss may continue insidiously. Current treatments do not arrest the underlying disease process. A scalp biopsy is the first step in management. Selection of treatment described herein is guided by the histopathologic findings, including the type, location and extent of the predominant cellular inflammatory infiltrate, and clinical disease activity. Cicatricial Alopecias with predominantly lymphocytic infiltrates are treated with immunomodulating agents, and those with predominantly neutrophilic infiltrates are treated with antimicrobial agents. Treatment selection may be challenging and requires flexibility, as histopathologic features frequently overlap, are not clear cut, or change over time. In the future, cellular and molecular biology studies will hopefully identify unique markers for the clinically distinct Cicatricial Alopecias and lead to better treatments and a cure.
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Update on Cicatricial Alopecia
The journal of investigative dermatology. Symposium proceedings, 2003Co-Authors: Elise A. Olsen, Jerry Shapiro, Leonard C. Sperling, Wilma F Bergfeld, Kurt S. Stenn, Vera H. Price, George Cotsarelis, Rodney Sinclair, A. Solomon, David A. WhitingAbstract:Cicatricial Alopecia is an enigmatic group of hair disorders linked by the potential permanent loss of scalp hair follicles in involved areas. Progress in our understanding and treatment of these disorders has been stymied by the lack of clear diagnostic criteria for the current terms used to describe the various hair loss entities. Since all of these conditions evolve as the hair is destroyed or replaced, diagnosis is further made difficult by a lack of clinical and pathologic "snapshots" over the evolution of each disorder. Without some acceptance of general clinical and histological presentations in the early, mid and late stage of these disorders, one cannot begin to explore ways to make the diagnosis at a very early stage before significant follicular destraction has occurred (making the clinical diagnosis obvious) and when the damage is potentially repairable or progression preventable.
Chantal Bolduc - One of the best experts on this subject based on the ideXlab platform.
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primary Cicatricial Alopecia
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Jerry Shapiro, Leonard C. SperlingAbstract:Both primary and secondary forms of Cicatricial Alopecia have been described. The hair follicles are the specific target of inflammation in primary Cicatricial Alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary Cicatricial Alopecia. This 2-part continuing medical education article will review primary Cicatricial Alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary Cicatricial Alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing Alopecia, and Graham–Little syndrome.
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Primary Cicatricial Alopecia: Other lymphocytic primary Cicatricial Alopecias and neutrophilic and mixed primary Cicatricial Alopecias
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Leonard C. Sperling, Jerry ShapiroAbstract:Primary Cicatricial Alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary Cicatricial Alopecias, which include pseudopelade of Brocq, central centrifugal Cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary Cicatricial Alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.