AI Article Synopsis

  • Small observational studies indicate that even areas of the scalp that appear normal can show signs of subclinical disease in patients with primary cicatricial alopecias, prompting researchers to evaluate the entire scalp in those with acne keloidalis nuchae (AKN).
  • In this retrospective study involving 41 patients, doctors performed clinical evaluations and trichoscopy-guided biopsies on both affected and seemingly normal scalp regions to identify hidden conditions.
  • Results showed that all patients exhibited signs of inflammatory changes in the normal scalp, with histological evidence suggesting that these changes may signal the onset of various types of cicatricial alopecias, highlighting the importance of early detection and management strategies.

Article Abstract

Purpose: Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies.

Patients And Methods: This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed.

Results: Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44-51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis.

Conclusion: PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10464825PMC
http://dx.doi.org/10.2147/CCID.S422310DOI Listing

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