Common link determined in scarring alopecia conditions
Skin inflammation and scarring linked to certain types of acne and hair loss conditions (1,400 words, 7 minutes)
Researchers at a skin and hair clinic in Los Angeles have identified a precursor condition shared by both acne keloidalis nuchae (AKN) and primary cicatricial alopecias.
In a paper published in Clinical, Cosmetic and Investigative Dermatology, the investigators write that their findings have significant implications for diagnostics and treatments.
The researchers note in a press release that AKN and scarring alopecias have usually been studied in isolation. However, findings from prior small, observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, physicians at the clinic conducting this research began routinely evaluating the entire scalp of patients with AKN, including trichoscopy-guided biopsies.
This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and Dec. 2022. The investigators evaluated primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones. They also biopsied and histologically analyzed areas showing perifollicular erythema or scales or casts.
All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. The 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 to 51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis.
In the release, lead researcher Dr. Sanusi Umar underscored that this discovery suggests the potential for more precise therapies targeting root causes and refining diagnostic strategies.
“Our findings, along with other studies, suggest that PIILIF potentially links all common scarring alopecias, such as AKN, folliculitis decalvans (FD), lichen planopilaris (LPP), frontal fibrosing alopecia, and central centrifugal cicatricial alopecia,” Dr. Umar said. “This highlights their interconnections, offering new insights into their origins and enabling a more holistic diagnostic and therapeutic strategy. Moreover, this might streamline the intricate classification of scarring alopecias by reducing redundancies in closely related conditions. For instance, our research questions the necessity of the entity currently designated LPP-FD phenotype."
Bottom line: There appears to be a common precursor condition behind many scarring alopecias, suggesting a new target for prevention and treatment. AKN may also be more prevalent than previously realized in European-descended White males but is unnoticed or misdiagnosed as nape irritation or dandruff.
From the literature on scarring alopecias
Online health information for acne keloidalis nuchae has a difficult level of readability
In this paper, researchers note that more than 50% of patients with keloids search the internet for information on their condition. To determine the level of readability of patient education materials (PEM) available to patients, investigators searched and screened for the term 'acne keloidalis nuchae' on the Google search engine and evaluated the top 100 results.
Researchers collected six readability metrics (Flesch-Kincaid grade level, Gunning Fog index, Coleman-Liau index, SMOG index, automated readability, and Linsear Write Formula) by entering text from each reference site into an automatic readability calculator for computation.
Median readability scores of acne keloidalis nuchae PEMs ranged from 10.3th to 13.5th grade levels. Overall, a readability median above the 8th-grade level was consistently seen across all six readability measures, with some median scores reaching university undergraduate levels. The authors conclude that more readable educational tools are needed for acne keloidalis nuchae online
Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia
The authors of this paper write that central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent and negatively impacts their quality of life.
To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes, researchers analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year.
The researchers found after one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease, using metformin for diabetes control, using hooded dryers, wearing natural hairstyles, and having no other physical signs besides cicatricial, had higher odds of improvement after treatment.
Patients with scaling or pustules had higher odds of worsening. Patients with a history of thyroid disease, not using hooded dryers, or not wearing natural hairstyles had higher odds of remaining stable.
Papular acne keloidalis nuchae treatment success using follicular unit excision
Various studies have shown that laser hair removal can achieve long-term remission in papular acne keloidalis nuchae (AKN), the authors of this paper write. However, they note that laser hair removal is not always an option for some patients.
They write that follicular unit excision, a method of extracting single hair follicular unit groups using small punches that avoid the creation of large wounds and scars, may be a method of removing hair follicles from the centre of visible AKN papules while preventing scarring or loss of surrounding hair.
This paper describes three patients who had AKN lesions that included visible hair follicles and underwent this follicular unit excision.
In all three patients, hair removal was an effective therapy that resulted in long-term disease remission with esthetically satisfactory results.
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At the intersection of skin and society
The Schulich School of Law at Dalhousie University in Halifax has launched a new website dedicated to highlighting the work of its students, faculty, and staff in the areas of Aboriginal and Indigenous law.
In a press release from the university, Naiomi Metallic, an associate professor and the Chancellor’s Chair in Aboriginal Law and Policy, says the inspiration for Abajignmuen—which means "giving back" in Mi’kmaq—came from recognizing the hard work of students on papers and assignments in Aboriginal and Indigenous law courses.
“There is valuable information in this work that can benefit Indigenous communities, practitioners, and members of the public,” said Prof. Metallic. “I believe there is a significant need for education and legal information in the area of Aboriginal and Indigenous law by the general public, the Indigenous community, and the legal profession.”
The website currently features more than 50 student projects and is planned to grow every year. This site will allow those working and studying in this area to give back to the broader community by sharing what they are learning in an accessible way, according to the release.
Abajignmuen contains a large and growing repository of access to justice (A2J) projects and papers created by students for courses they have taken at Schulich Law. These are intended to be resources to help the public achieve a better understanding of issues related to Aboriginal and Indigenous law.
Information about the Lnuwey Dêbludaqan Wiguom (Indigenous law lodge) is also available on the site. This is a research, teaching and service unit dedicated to supporting Mìgmaq and other Indigenous groups in the region to revitalize and implement their laws, governance and economies based on their Indigenous values, principles, protocols, and processes. This long-term initiative is currently in the early phases of development.
Registration is open for the 9th annual 2023 Skin Spectrum Summit conference.
This year’s edition of the landmark medical educational congress dedicated to providing better dermatologic care for Canada's diverse population will be held on October 21, 2023, at the University of Toronto’s Chestnut Conference Centre in Toronto.
Now in its 9th year, the conference provides education on treating patients across all six Fitzpatrick skin types, emphasizing care for Types IV–VI.
Among the confirmed faculty members, Dr. Renee Beach (Toronto) will be speaking on alopecia areata, and other common hair disorders across the skin spectrum, and new treatments for these conditions.
Other faculty include:
· Dr. Danielle Marcoux (Montreal)
· Dr. Renita Ahluwalia (Toronto)
· Dr. Johnathan Shapero (Toronto)
· Dr. Rachel Asiniwasis (Regina)
· Dr. Raed Alhusayen (Toronto)
· Dr. Anna Chacon (Miami)
· Dr. Monica Li (Vancouver)
· Dr. Jaggi Rao (Edmonton)
· Dr. Marissa Joseph (Toronto)
· Dr. Andrew F. Alexis (New York)
· Dr. Joel Claveau (Quebec)
· Moderator for the event is Dr. Shafiq Qaadri (Toronto)
This week
September is Alopecia Areata Awareness Month in the U.S.
Sept. 30 is Orange Shirt Day, promoting awareness about the Indian residential school system
October is International Black History Month in the U.K.
Something to think about in the week ahead. . .
—Henry Miller, U.S. author, [1891-1980]
Next week
The 2023 Skin Spectrum Summit is less than a month away. The next edition of Skin Spectrum Weekly will include an overview of the faculty and a preview of the subjects of the talks they will give during the meeting.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Lisa Kellett (Toronto), Michal Martinka (Calgary), and Jaggi Rao (Edmonton) discuss strategies for optimizing the management rosacea.
In a therapeutic update, Drs. Marcie Ulmer (Vancouver), Jen Lipson (Ottawa), and Sonya Cook (Toronto), detail current and upcoming advances in acne treatments.
An essay from Dr. Nickoo Merati (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Merati wrote about the importance of people with skin of colour to “see” their community members represented at decision-making tables to rise to their full potentials. The essay also touches on efforts by Canadian medical students to improve the representation of skin of colour in dermatology education materials.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Yadav on Acne podcast with Dr. Geeta Yadav has launched. Listen to the new season here. In episode one, Dr. Yadav comments on recent research into managing moderate-to-severe acne using isotretinoin.
Season three of the Vender on Psoriasis podcast, hosted by Dr. Ron Vender, is right around the corner. Watch this space for links for the first episode of the new season.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.