Evaluation of Cicatricial Alopecia in Iran
Shahla Babaei Nejad,
Cicatricle alopecia represents a diverse group of diseases characterized by a lack of follicular ostia and irreversible alopecia. This study aimed at evaluating cicatricial alopecia in Iranian patients. One hundred patients with cicatricial alopecia were studied. Patients disease was pathologically proven. All epidemiologic and clinicopathologic data were obtained through questionnaires. The results were analyzed by means of descriptive statistical methods. One hundred patients were consisted of 52 (52%) males and 48 (48%) females. 30 patients (24 males and 6 females) suffered from folliculate decalvans, 25 cases (10 males and 15 females) from DLE, 18 patients (6 males and 11 females) from brocq pseudopelade, 14 patients (4 males and 10 females) from lichen planopilaris, 8 patients (4 males and 4 females) from morphea and 5 cases (4 males and 1 female) from folliculate colloidalis. Early stage diagnosis by biopsy and proper treatment will reduce further progression and especially alleviate psychosocial disturbances.
Received: January 08, 2013;
Accepted: March 02, 2013;
Published: May 08, 2013
Cicatricial alopecia- a diverse group of rare disorders that destroy the hair
follicle, replace it with scar tissue and cause permanent hair loss (Goldust
et al., 2013a; Lotti et al., 2013).
The hair loss may be accompanied with severe itching, pain and burning and progress
rapidly. In other cases the hair loss is gradual,without symptoms and is unnoticed
for long periods (Goldust et al., 2013a; Mohebbipour
et al., 2012). Cicatricial alopecia, also known as scarring alopecia,
occurs in otherwise healthy men and women of all ages and is seen worldwide
(Goldust et al., 2013b, c).
Cicatricial alopecias are classified as primary or secondary. This discussion
is confined to the primary cicatricial alopecias in which the hair follicle
is the target of the destructive inflammatory process (Goldust
et al., 2013d; Vafaee et al., 2012).
In secondary cicatricial alopecias, destruction of the hair follicle is incidental
to a non-follicle-directed process or external injury, such as severe infections,
burns, radiation, or tumors ( Goldust and Rezaee, 2013;
Goldust et al., 2012; Sadighi
et al., 2011). Hairs less likely grow after recovery of the disease
or primary inflammation (Ohyama, 2012). Discoid lupus
erythmatosus (chronic), lichen planopilaris, folliculate decalvans are known
as primary factors of cicatricle alopecia (Khumalo, 2010).
Burn, radiodermatitis and infections such as favus or skin tuberculosis are
regarded as the secondary reasons (Chiu and Lin, 2010).
In most cases, a diagnostic biopsy is necessary. Biopsy place should be carefully
selected and priority is given to the new lesions (Wu et
al., 2008). Primary cicatricle alopecia is pathologically divided into
lymphocytic and neutrophilic. Lymphocytic types include discoid lupus erythmatosis,
lichen planopilaris, pseudopelade of Brocq, morphea and neutrophilic includes
folliculate decalvans and folliculate colloidalis ( De
Berker, 2002; Gardani et al., 2007). The
study aims at evaluating epidemiological and clinicopathological characteristics
of patients suffering from cicatricle alopecia in Tabriz.
MATERIALS AND METHODS
The research was conducted on file of 100 patients suffering from cicatricle alopecia and referring to skin clinic of Tabriz Sina Hospital within a 7 year period. Written consent was obtained from all the patients. This study was approved by ethic committee of Tabriz university of medical sciences. Patients skin lesions were underwent biopsy and pathological diagnosis was confirmed. The obtained data including age, gender, occupation, residence, type of lesion resulting in cicatricle alopecia and type of dermal exudation specified in pathology were analyzed using descriptive statistics methods. SPSSTM, version 16 is the used statistical software program. The results were expressed as Means±standard deviations. The Chi-square test was used for statistical analysis. The level of statistical significance was set at a value of p<0.05.
One hundred patients were consisted of 52 (52%) males and 48 (48%) females.
Most male patients (50%) were self-employed and most of females (80%) were housewives.
In this study, 79 patients were of Tabriz and 21 subjects were of other cities
of Azerbaijan. In this study, 30 patients (24 males and 6 females) suffered
from folliculate decalvans, 25 cases (10 males and 15 females) from DLE, 18
patients (6 males and 11 females) from brocq pseudopelade, 14 patients (4 males
and 10 females) from lichen planopilaris, 8 patients (4 males and 4 females)
from morphea and 5 cases (4 males and 1 female) from folliculate colloidalis.
DLE was the most common disease with inflammatory lymphocytic exudation. Distribution
of kinds of disease with inflammatory lymphocytic exudation based on age, gender
and clinical symptoms has been demonstrated in Table 1. There
was inflammatory neutrophilic exudation in 30 patients (24 males and 6 females)
with age range of 20-40 years old. These patients suffered from folliculate
decalvans with pustule and scar plaques in scalp. Such an exudation has been
reported in 5 patients (4 males and 1 female) with age range of 25-45 years
old suffering from follicular colloid with clinical symptoms of nodule and colloid
platelets at lower parts of back of the head posterior.
Cicatricle alopecia leading to destruction of hair follicles and hairs permanent
disappearing may be a result of some diseases including discoid lupus erythmatosis
primarily affecting hair follicles or developed following a secondary disease
such as burn, infection or radiotherapy (Messenger, 2002).
Significant studies have not been conducted in our country regarding these lesions
while most of them indicate diseases which can be controlled regarding their
progress and complications through early diagnosis and appropriate treatment.
The research was conducted on 100 patients suffering from cicatricle alopecia
and their lesions underwent biopsy and type of lesion was diagnosed and confirmed
through pathological examination.
|| Clinical types of cicatricle alopecia
Generally, the patients were consisted of 52 (52%) males and 48 (48%) females
with almost equal prevalence. This is while, according to the reports of the
researches conducted in other countries, disease in women is more prevalent
than men (Tan et al., 2004). It can be attributed
to the social-cultural differences of different societies and kind of women
coverage-as an appropriate and protective cover against sun light-or delayed
referring of women to the clinic. Considering type of lesions cellular exudation,
pathological evaluations demonstrated that lymphocytic and neutrophilic exudations
are more common in females and males, respectively. Most patients were middle-aged
which is in correspondence with other studies (Amato et
al., 2002). Lymphocytic and neutrophilic types with exudation were respectively
more common in middle-aged women and men which are again in correspondence with
other researches (Amato et al., 2002). Considering
occupation, most male patients were self-employed and most female ones were
housewives. In this case, it can be stated that environmental factors such as
sun light and job stress may be effective in developing some lesions including
DLE and lichen plan (Sharquie et al., 2002).
In this study, 79% of the understudy patients referred to the skin clinic from
Tabriz and the rest were of other cities of Azerbaijan. The difference may be
attributed to high levels of social, economical, cultural, hygienic factors
and awareness of people in big cities and their easy access to therapeutic centers.
The lesions were pathologically evaluated to specify (1) type of inflammatory
exudation, (2) type of lesion. Generally, the lesions are divided into two categories
considering type of inflammatory exudation: (a) Lesions with lymphocytic exudation
(b) Lesions with neutrophilic exudation. In this study, 65 patients (65%) suffered
from lymphocytic exudation and 35 ones (35%) experienced neutrophilic exudation.
High rate of lymphocytic type was in correspondence with researches conducted
in other countries (Amato et al., 2002). Lymphocytic
exudation lesions included DLE, brocq pseudopelade, lichen planopilaris and
morphea. The neutrophilic exudation lesions were folliculate decalvans and folliculate
colloidalis. In lymphocytic type, DLE was the most common lesion leading to
cicatricle alopecia. It was more common in middle-aged women. The results are
in correspondence with other researches (Amato et al.,
2002). Considering prevalence, brocq pseudopelade, lichen planopilaris and
morphea occupied the next ranks. Again, it corresponded with other studies (Annessi
et al., 1999). The present study revealed that folliculate decalvans
(30%) was the most prevalent lesion among cicatricle alopecia with neutrophilic
exudation and is in correspondence with other studies (Fabbri
et al., 2004). Folliculate colloidalis was the next lesion (5%).
Considering that the lesion is more common in blacks and it is confirmed by
other studies (Amato et al., 2002), it is relatively
less common in our country. Generally, primary cicatricle alopecia with neutrophilic
exudation is prevalent in middle-aged men such that 24 patients (out of 30 ones)
suffered from folliculate decalvans (80%) and 4 patients (out of 5 ones) experienced
folliculate colloidalis (80%). High prevalence in males equals with other researches
Amato et al. (2002).
Cicatricle alopecia is one of the tricologic emergencies and is usually irrevocable. The progress of the lesion and its complications can be prevented through early diagnosis and treatment. The lesions can be diagnosed using an exact clinical-pathological evaluation. Therefore, dermal biopsy should be conducted at initial stages as soon as possible and necessary therapeutic actions should be taken.
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