Cicatricial Alopecia: An Approach to Diagnosis and Management

98 Pages·2011·3.75 MB·English

by  Vera Price

Cicatricial Alopecia
wwwwwwwwwwwwwwwwwwwwwww
Vera Price
Paradi Mirmirani (EDs.)
Cicatricial Alopecia
An Approach to Diagnosis
and Management
Editors
Vera Price Paradi Mirmirani
Professor, Department of Dermatology Staff Physician
University of California, San Francisco Department of Dermatology,
San Francisco, California 94115 University of California, San Francisco
USA San Francisco, California 94115,
[email protected] USA
and
Department of Dermatology
Case Western Reserve University
Cleveland, OH
USA
and
Department of Dermatology
The Permanente Medical Group,
975 Sereno Drive, Vallejo,
California 94589,
USA
[email protected]
ISBN 978-1-4419-8398-5 e-ISBN 978-1-4419-8399-2
DOI 10.1007/978-1-4419-8399-2
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011924224
© Springer Science+Business Media, LLC 2011
All rights reserved. This work may not be translated or copied in whole or in part without the
written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring
Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or
scholarly analysis. Use in connection with any form of information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now
known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms,
even if they are not identified as such, is not to be taken as an expression of opinion as to
whether or not they are subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibility for any errors or omissions that may be made. The publisher makes no warranty,
express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Preface
There have been several recent reviews published of the primary cicatricial
alopecias, so why was this monograph produced? We felt there was a need
for a richly-illustrated and practical text that would be a teaching vehicle
primarily for dermatology residents and interested dermatology colleagues.
We realize that hair loss in general is not a topic on the curriculum of all
dermatology departments, and cicatricial alopecia (scarring alopecia) in
particular is frequently not covered.
At the University of California, San Francisco, we have held grand
rounds dedicated entirely to the scarring alopecias. Introductory lectures
are given highlighting clinical and histologic aspects, current treatments,
and a summary of new research. In the patient viewing session, patients
with characteristic features of each of the predominantly lymphocytic and
neutrophilic cicatricial alopecias are presented. By “immersing” residents
and colleagues in the topic of cicatricial alopecias, they have been able to
envision a more global and systematic view of these disorders. The feed-
back has been tremendous: “I finally got it!”
In writing this monograph, we sought to replicate such a teaching ses-
sion, and the information is presented as though the reader was “shadow-
ing” us in the clinic. Each disease chapter is introduced with a clinical
scenario of a patient, along with relevant clues for making the diagnosis.
The discussion section follows and includes multiple photographs and
take-away pearls to provide practical information needed to diagnose,
manage, and counsel the patient. The suggested reading is not meant to be
an exhaustive literature review, but rather a list of a few salient references.
The voices of the patients can be heard in the chapter written by patients
who tell of their frustrations in being undiagnosed by doctor after doctor,
and untreated or mistreated for years. Our goal is to put the cicatricial
alopecias on the center stage for dermatology residents and colleagues,
because dermatologists may be the only physicians who can diagnose and
treat these patients.
San Francisco, CA, USA Vera Price
Vallejo, CA, USA Paradi Mirmirani
v
wwwwwwwwwwwwwwwwwwwwwww
Acknowledgments
We have been privileged to care for and follow many patients with cica-
tricial alopecia, and are grateful to all of them for giving us the first-hand
opportunity to learn about these conditions. Our patients emphasize how
much research is needed to increase our understanding and improve our
current treatments, and we dedicate this monograph to them. We thank the
six patients who shared their personal experiences with cicatricial alopecia
in Chapter 10.
We are indebted to the Cicatricial Alopecia Research Foundation
(CARF) for changing the landscape for these diseases. The Foundation
was associated with the production of this monograph and is an indispens-
able resource for patients and doctors alike. We are grateful to the many
CARF volunteers who provided valuable contributions during various
phases of this monograph. We also thank Sheila Belkin, CARF’s CEO, for
coordinating the patient chapter and for her encouragement throughout.
We would like to thank Dr. Bruce Wintroub for his ongoing support of
our interest in cicatricial alopecia. He has been instrumental in fostering
collaborations that have moved our work and knowledge forward. We are
grateful to many individuals whose help has been invaluable in creating
the monograph. Dr. Tim McCalmont guided us through countless scalp
biopsies and wrote the chapter on dermatopathology. He and Dr. Phil
LeBoit both continue to enlighten us about the histopathology of cicatri-
cial alopecia. Dr. Aman Samrao worked diligently throughout the entire
production, and her assistance was indispensable in handling tables, fig-
ures, clinical images, and whatever was asked of her. Dr. Jeffrey Donovan
gave valuable editorial input and assisted with assembling the references.
Dr. Tim Berger helped to update many concepts and to remove old bag-
gage from this field; we greatly appreciate his interest in clarifying the
lexicon. We thank Canfield Scientific for generously giving us the use of
their Nikon camera. We are indebted to Dr. Sarah Cipriano and Leslie
Chau for their expert technical and administrative support. Finally, we
gratefully acknowledge the major contribution of Dr. Pratima Karnik
whose molecular studies have pioneered a breakthrough in understanding
the crucial role of the sebaceous gland in normal hair growth and in the
pathogenesis of cicatricial alopecia. We also wish to acknowledge
Dr. Kurt Stenn, who for many prior years had advocated further study of
the sebaceous gland and its role in hair growth and hair loss.
vii
wwwwwwwwwwwwwwwwwwwwwww
Contents
1 Introduction ............................................................................. 1
How Are the Cicatricial Alopecias Classified? ......................... 1
What Are the Demographics of Patients
with Cicatricial Alopecia?......................................................... 1
Why Is Hair Loss in Cicatricial Alopecia Irreversible? ............ 5
Suggested Reading .................................................................... 5
2 Clinical Assessment of the Patient ......................................... 7
If Time Is Limited On the Initial Visit, Take the Scalp
Biopsy On the First Visit, and Complete the Evaluation
at Next Visit .............................................................................. 7
Scalp Biopsy ......................................................................... 7
Evaluation of the Patient ........................................................... 8
History................................................................................... 8
Examination .......................................................................... 8
Standardized Patient Flow Chart ........................................... 12
Suggested Reading ................................................................ 13
3 Dermatopathology ................................................................... 15
Timothy H. McCalmont
Lymphocyte-Mediated Primary Cicatricial Alopecias .............. 17
Neutrophil-Mediated Primary Cicatricial Alopecias ................ 20
Mixed Cicatricial Alopecia ....................................................... 21
References ................................................................................. 23
4 Medical Management ............................................................. 25
Choice of Treatment.................................................................. 25
Counseling and Setting Expectations........................................ 25
Treatment of Predominantly Lymphocytic
Cicatricial Alopecia .................................................................. 26
Treatment of Predominantly Neutrophilic/Plasmacytic
Cicatricial Alopecia .................................................................. 26
Laboratory Workup and Side Effects
of Systemic Drugs ..................................................................... 27
ix