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Parte 1: fisiopatología, clínica y diagnóstico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1559 "Ancho" => 1658 "Tamanyo" => 117873 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">KIT receptor structure.<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">23,24</span></a> The location of some activating mutations are shown in red in the juxtamembrane domain and the tyrosine kinase II domain (D816<span class="elsevierStyleHsp" style=""></span>V, which is the most common mutation in mastocytosis).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "4" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Mendes-Bastos, A. Camps-Fresneda" "autores" => array:2 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Mendes-Bastos" "email" => array:1 [ 0 => "pmendesbastos@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Camps-Fresneda" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology and Venereology, Curry Cabral Hospital, Central Lisbon Hospital Centre, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Catalonia General Hospital, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Teknon Medical Centre, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante de pelo en la alopecia fibrosante frontal: ¿parte de la solución?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cicatricial alopecias (PCA) are a diverse group of inflammatory hair disorders of unknown aetiology, clinically characterised by the loss of hair shafts, visible follicular ostia, and variable degrees of scalp inflammation. The hair follicle is the primary target of the disease process and persistent inflammation leads to irreversible damage to the hair follicle's stem cells. Ultimately, replacement of follicular structures by scar-like fibrous tissue occurs.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Frontal fibrosing alopecia (FFA) is one of the most common types of PCA. The clinical diagnosis is typically straightforward; FFA is considered to be a subtype of lichen planopilaris (LPP) and is based on similar histopathological findings.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> An effective medical treatment remains elusive and evidence-based recommendations are weak: intralesional triamcinolone acetonide, finasteride, dutasteride, oral and topical corticosteroids (level of evidence D), and antimalarials (level of evidence E).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5,6</span></a> Despite medical treatment, the course of FFA is uncertain and, in the best scenario, these drugs can only stop disease progression.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In daily practice, we have observed that the cosmetic impact of FFA on women is a frequent cause of anxiety, and just halting the alopecia process is generally not sufficient in most cases. Some patients with FFA insistently demand a hair transplant despite being properly informed of the high risk of hair loss a few months after the procedure.</p><p id="par0010" class="elsevierStylePara elsevierViewall">How could hair transplantation be part of the solution for FFA? Literature regarding hair transplantation for FFA is scarce. Publications by Nusbaum et al. and Jiménez et al. report similar results: despite the growth of the hair shafts for 1.5–2 years after transplantation, more than 50% of the transplanted hairs had been lost after 3 years. Histological confirmation of FFA in the remaining transplanted follicles suggests that FFA displays recipient dominance. Post-transplant medical therapy is not mentioned in either of the publications.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Gurfinkiel et al. reported a successful case of hair transplantation in a female patient with FFA and vulvar lichen sclerosus with a follow-up of 6 years, maintaining systemic finasteride 1<span class="elsevierStyleHsp" style=""></span>mg/day and topical minoxidil 2% bid as post-transplant maintenance therapy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Unger et al. have recently proposed two new categories of cicatricial alopecia: unstable and stable. Unstable cicatricial alopecias (UCA) have a tendency to progress and recur intermittently over the course of time, in either new or previously affected areas (e.g., discoid cutaneous lupus erythematous, LPP). Stable cicatricial alopecias are secondary to isolated events that cause permanent scarring in a hair-bearing region (e.g., burn, surgical scar); once successfully corrected surgically, there is no need for further therapy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The chronic and relapsing nature of FFA, even after hair transplantation, is the paradigm of UCA. It has become clear that this procedure can only be considered for FFA after a certain period of observation with no disease activity, and recommendations range from 1 to 5 years<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a>; we do not usually consider hair transplantation in FFA until 2 years of clinical stability have been observed. However, once hair transplantation has been performed, these patients should be kept on maintenance medical treatment for affected areas, even if no clinical signs of disease activity are visible. The usefulness of performing trichoscopy to monitor disease activity and response to therapy cannot be emphasised enough: look for the presence of perifollicular hyperkeratosis/desquamation and perifollicular erythema, which are correlated with disease activity in FFA.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the maintenance medical treatment to be prescribed after hair transplantation for FFA, clobetasol propionate 0.05% lotion twice a week could be considered as a possible maintenance scheme; from our clinical practice experience, the risk of adverse effects with this regimen appears to be very small. As an alternative, a topical calcineurin inhibitor such as tacrolimus 0.1% ointment or pimecrolimus 1% cream could also be considered (tolerability: pimecrolimus<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>tacrolimus). In our experience, maintaining concomitant post-transplant therapy with systemic finasteride 5<span class="elsevierStyleHsp" style=""></span>mg/day and topical minoxidil 5% is also advisable, particularly if androgenetic alopecia is concomitantly present. Dutasteride has been recently attempted as an alternative to finasteride; although dutasteride might appear at least equally effective, its superiority and more favourable safety profile are not yet proven. Follow-up visits should be frequent, and more aggressive anti-inflammatory therapy must be initiated in case of clinical relapse, not only to “protect” transplanted hairs but also to prevent alopecia progression to previously uninvolved areas.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To summarise, the need for post-transplant medical therapy for FFA is, in our opinion, absolutely decisive for the success of the transplantation. Prior to surgery, two requirements for FFA hair transplantation must be met: 2 years of clinical stability and the patient's commitment to follow-up visits and adherence to post-transplant medical therapy. Strong evidence-based recommendations for the medical and surgical treatment of FFA are warranted.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of primary cicatricial alopecias: options for treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Harries" 1 => "R.D. Sinclair" 2 => "D.A. Whiting" 3 => "C.E.M. Griffiths" 4 => "R. 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2021 December | 74 | 26 | 100 |
2021 November | 99 | 39 | 138 |
2021 October | 86 | 36 | 122 |
2021 September | 62 | 35 | 97 |
2021 August | 56 | 28 | 84 |
2021 July | 69 | 22 | 91 |
2021 June | 88 | 24 | 112 |
2021 May | 93 | 28 | 121 |
2021 April | 268 | 28 | 296 |
2021 March | 128 | 19 | 147 |
2021 February | 105 | 20 | 125 |
2021 January | 95 | 14 | 109 |
2020 December | 94 | 14 | 108 |
2020 November | 69 | 36 | 105 |
2020 October | 96 | 12 | 108 |
2020 September | 56 | 8 | 64 |
2020 August | 62 | 14 | 76 |
2020 July | 50 | 17 | 67 |
2020 June | 34 | 29 | 63 |
2020 May | 44 | 20 | 64 |
2020 April | 25 | 19 | 44 |
2020 March | 33 | 21 | 54 |
2020 February | 3 | 0 | 3 |
2020 January | 4 | 0 | 4 |
2019 December | 4 | 4 | 8 |
2019 November | 4 | 1 | 5 |
2019 October | 0 | 6 | 6 |
2019 August | 6 | 0 | 6 |
2019 July | 4 | 0 | 4 |
2019 June | 4 | 0 | 4 |
2019 May | 7 | 2 | 9 |
2019 April | 2 | 1 | 3 |
2019 March | 2 | 10 | 12 |
2019 January | 4 | 0 | 4 |
2018 November | 8 | 0 | 8 |
2018 October | 22 | 0 | 22 |
2018 September | 4 | 0 | 4 |
2018 August | 1 | 0 | 1 |
2018 July | 0 | 4 | 4 |
2018 June | 0 | 3 | 3 |
2018 May | 0 | 5 | 5 |
2018 April | 0 | 4 | 4 |
2018 March | 7 | 7 | 14 |
2018 February | 54 | 7 | 61 |
2018 January | 82 | 14 | 96 |
2017 December | 56 | 15 | 71 |
2017 November | 63 | 19 | 82 |
2017 October | 55 | 13 | 68 |
2017 September | 32 | 16 | 48 |
2017 August | 40 | 28 | 68 |
2017 July | 50 | 15 | 65 |
2017 June | 30 | 36 | 66 |
2017 May | 39 | 21 | 60 |
2017 April | 21 | 43 | 64 |
2017 March | 12 | 30 | 42 |
2017 February | 12 | 20 | 32 |
2017 January | 19 | 16 | 35 |
2016 December | 23 | 14 | 37 |
2016 November | 23 | 20 | 43 |
2016 October | 13 | 18 | 31 |
2016 September | 0 | 3 | 3 |
2016 August | 0 | 8 | 8 |
2016 July | 0 | 2 | 2 |
2016 June | 0 | 7 | 7 |
2016 May | 0 | 1 | 1 |
2016 April | 0 | 1 | 1 |
2016 March | 0 | 7 | 7 |
2016 February | 0 | 10 | 10 |
2016 January | 0 | 8 | 8 |