Case for Diagnosis
Alopecic Plaques in a Cook
Placas alopécicas en una cocinera
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Ézsöl-Lendvai, L. Iñiguez-de Onzoño, L. Pérez-García" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Z." "apellidos" => "Ézsöl-Lendvai" "email" => array:1 [ 0 => "ezsolsofia@yahoo.it" ] "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" => "L." "apellidos" => "Iñiguez-de Onzoño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Pérez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas alopécicas en una cocinera" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 401 "Ancho" => 600 "Tamanyo" => 79847 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 26-year-old woman with no relevant medical history consulted because the hair in some areas of her scalp had been gradually falling out for the previous 2 years and the rate of hair loss had increased in recent months. She was diagnosed with alopecia areata (AA). Treatment with mometasone and vitamins produced no improvement.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had long, wavy hair, which she wore loose on the day she came to our clinic. For the previous 4 years, she had been using a tight elastic headband and styling gel because, as a cook, she was required to wear her hair up at work (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed 2 symmetrical ovoid plaques of alopecia with diminished capillary density in the temporal regions, measuring 12<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm and 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cm, with a positive hair-pull test at the borders and hair casts (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). There was also a small, poorly defined frontal plaque with diminished capillary density, measuring 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm. Trichoscopy revealed empty follicular orifices and areas without follicular orifices. Black dots, hyperkeratosis, and perifollicular erythema were not observed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">It was observed that the elastic headband causes traction in the areas in which alopecia was present.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0025" class="elsevierStylePara elsevierViewall">Biochemistry profile, complete blood count, ferrokinetics, and thyroid-stimulating hormone were normal.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Histopathology</span><p id="par0030" class="elsevierStylePara elsevierViewall">Analysis of transversal and longitudinal sections revealed fibrous tracts of follicular regression with clumped melanin. Direct immunofluorescence was negative (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Partially scarring traction alopecia (TA) secondary to long-term use of an elastic headband during work.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course</span><p id="par0045" class="elsevierStylePara elsevierViewall">We recommended that the patient stop using the headband and prescribed clobetasol and minoxidil. Repopulation was not initially achieved. However, 20 weeks after advising the patient to stop using the headband, partial repopulation of the 3 plaques—especially the frontal one—was observed, although patchy areas without follicular orifices persisted.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0050" class="elsevierStylePara elsevierViewall">TA is a mechanically induced type of alopecia. The most widely recognized cause of TA is prolonged and/or repeated tension on the hair over a long period of time, caused by various types of hairstyles—tight braids, ponytails, buns, extensions, and hair straightening—or by traumatic manipulation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">TA is characterized by elongated or linear plaques of alopecia, usually in the temporoparietal and/or frontal region of the scalp, the areas where tension is greatest.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Hair casts observed by trichoscopy indicate active traction, but are not always present.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> No other specific trichoscopic signs are known. Trichomalacia and accumulations of pigment (incontinentia pigmenti) are suggestive, but not specific, histopathologic findings. Characteristically, the number of terminal hair follicles is reduced and no inflammatory infiltrate is present. In advanced stages, terminal hair follicles can be replaced by fibrosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">TA is relatively common in African American women, and very tight African-style braids (cornrows) are the most common cause of the condition.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> TA is rare in white women because of the different racial characteristics of their hair and, especially, because of their different hairstyling habits. In white women, TA is associated, very rarely, with wearing ponytails or tight buns regularly for years.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">If the hairstyle responsible for the condition is not evident at the time of consultation, the physician may erroneously diagnose AA because both conditions are characterized by similar plaques and because there are generally no clinical manifestations of inflammation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The differential diagnosis also includes lichen planopilaris and other mechanical alopecias (trichotillomania and friction alopecia).</p><p id="par0075" class="elsevierStylePara elsevierViewall">TA can occur in 2 phases. In the initial phase, it can be reversed if the patient strictly avoids all traction and manipulation (the only effective treatment). If the cause persists, permanent follicular destruction occurs and the condition progresses to irreversible scarring alopecia, also known as end-stage TA or follicular degeneration syndrome.<span class="elsevierStyleSup">1–7</span></p><p id="par0080" class="elsevierStylePara elsevierViewall">The time needed for scarring TA to develop is unknown. It is therefore essential to assess the possibility of TA in patients with temporoparietal or temporofrontal plaques of alopecia by asking the patient specifically about his or her hairstyling and manipulation habits.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Occupational cases of TA caused by uniforms—such as nurses’ caps or nuns’ coifs—were more common years ago.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Nowadays, the cause of TA is usually cosmetic, namely, traction-inducing hairstyles. The cause in our patient—the use of an elastic headband at work—suggests occupational TA.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Histopathology" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ézsöl-Lendvai Z, Iñiguez-de Onzoño L, Pérez-García L. Placas alopécicas en una cocinera. Actas Dermosifiliogr. 2016;107:340–341.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 500 "Tamanyo" => 64129 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 401 "Ancho" => 600 "Tamanyo" => 79847 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 401 "Ancho" => 600 "Tamanyo" => 83819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alopecias por tracción y fricción" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. 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Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.07.006" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "158" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25444580" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cicatricial marginal alopecia: Is it all traction?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 91 | 34 | 125 |
| 2024 September | 82 | 16 | 98 |
| 2024 August | 88 | 56 | 144 |
| 2024 July | 74 | 37 | 111 |
| 2024 June | 64 | 24 | 88 |
| 2024 May | 69 | 27 | 96 |
| 2024 April | 73 | 31 | 104 |
| 2024 March | 72 | 31 | 103 |
| 2024 February | 80 | 23 | 103 |
| 2024 January | 55 | 37 | 92 |
| 2023 December | 54 | 29 | 83 |
| 2023 November | 71 | 32 | 103 |
| 2023 October | 70 | 41 | 111 |
| 2023 September | 79 | 37 | 116 |
| 2023 August | 58 | 20 | 78 |
| 2023 July | 79 | 38 | 117 |
| 2023 June | 63 | 29 | 92 |
| 2023 May | 107 | 19 | 126 |
| 2023 April | 48 | 19 | 67 |
| 2023 March | 61 | 25 | 86 |
| 2023 February | 55 | 24 | 79 |
| 2023 January | 42 | 29 | 71 |
| 2022 December | 62 | 38 | 100 |
| 2022 November | 60 | 30 | 90 |
| 2022 October | 56 | 28 | 84 |
| 2022 September | 30 | 38 | 68 |
| 2022 August | 34 | 41 | 75 |
| 2022 July | 29 | 40 | 69 |
| 2022 June | 25 | 33 | 58 |
| 2022 May | 55 | 44 | 99 |
| 2022 April | 52 | 26 | 78 |
| 2022 March | 51 | 54 | 105 |
| 2022 February | 46 | 27 | 73 |
| 2022 January | 78 | 33 | 111 |
| 2021 December | 55 | 37 | 92 |
| 2021 November | 44 | 38 | 82 |
| 2021 October | 54 | 46 | 100 |
| 2021 September | 49 | 36 | 85 |
| 2021 August | 51 | 22 | 73 |
| 2021 July | 40 | 26 | 66 |
| 2021 June | 47 | 12 | 59 |
| 2021 May | 35 | 30 | 65 |
| 2021 April | 108 | 53 | 161 |
| 2021 March | 80 | 20 | 100 |
| 2021 February | 47 | 17 | 64 |
| 2021 January | 42 | 15 | 57 |
| 2020 December | 26 | 14 | 40 |
| 2020 November | 25 | 12 | 37 |
| 2020 October | 27 | 11 | 38 |
| 2020 September | 28 | 10 | 38 |
| 2020 August | 18 | 13 | 31 |
| 2020 July | 23 | 16 | 39 |
| 2020 June | 32 | 30 | 62 |
| 2020 May | 31 | 11 | 42 |
| 2020 April | 32 | 14 | 46 |
| 2020 March | 24 | 15 | 39 |
| 2020 February | 7 | 1 | 8 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 May | 4 | 1 | 5 |
| 2019 April | 12 | 1 | 13 |
| 2019 March | 2 | 3 | 5 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 8 | 0 | 8 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 9 | 0 | 9 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 16 | 3 | 19 |
| 2018 January | 19 | 8 | 27 |
| 2017 December | 25 | 7 | 32 |
| 2017 November | 20 | 6 | 26 |
| 2017 October | 11 | 11 | 22 |
| 2017 September | 16 | 3 | 19 |
| 2017 August | 18 | 10 | 28 |
| 2017 July | 16 | 6 | 22 |
| 2017 June | 27 | 7 | 34 |
| 2017 May | 17 | 5 | 22 |
| 2017 April | 14 | 2 | 16 |
| 2017 March | 16 | 3 | 19 |
| 2017 February | 18 | 4 | 22 |
| 2017 January | 11 | 6 | 17 |
| 2016 December | 24 | 16 | 40 |
| 2016 November | 26 | 17 | 43 |
| 2016 October | 24 | 20 | 44 |
| 2016 May | 0 | 1 | 1 |
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