Case and Research Letters
Concentric or Targetoid Regrowth in Alopecia Areata
Crecimiento concéntrico en la alopecia areata (patrón en diana)
B. Monteagudo
, O. Suárez-Magdalena, D. González-Vilas, Ó. Suárez-Amor
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain
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Monteagudo, O. Suárez-Magdalena, D. González-Vilas, Ó. Suárez-Amor" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Monteagudo" "email" => array:1 [ 0 => "benigno.monteagudo.sanchez@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Suárez-Magdalena" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "González-Vilas" ] 3 => array:2 [ "nombre" => "Ó." "apellidos" => "Suárez-Amor" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crecimiento concéntrico en la alopecia areata (patrón en diana)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2140 "Ancho" => 2000 "Tamanyo" => 738735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Concentric areas of alopecia and hair regrowth producing a targetoid pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Consultations for hair problems are very common in daily practice, with alopecia accounting for around 17.5% of all dermatologic consulations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Methods of examination in trichology can be classified into 3 categories: non-invasive (medical history, general examination, inspection and palpation of the hair and scalp, photographs, dermoscopy, etc.), semi-invasive (trichogram), and invasive (biopsy).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this article we discuss a case of occipital alopecia areata (AA) in which hair repopulation adopted a distinctive distribution.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 33-year-old man with no past history of interest. For the previous 6 months he had been followed up in dermatology for what we considered to be a single plaque of AA in the occipital region. Treatment with topical corticosteroids and minoxidil was prescribed in association with intralesional corticosteroids on 2 occasions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">At 1 of the follow-up appointments, examination revealed annular areas of growth of black hair at the vertex and in the occipital region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and the initial plaque of alopecia had extended to the parietal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The concentric areas of alopecia and hair repopulation produced a targetoid pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Dermoscopy revealed numerous yellow and black dots and isolated fragmented hairs. A diagnosis of concentric or targetoid regrowth in AA was made and complete hair regrowth was achieved after a cycle of oral corticosteroids.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Cases of Köbner phenomenon have been described in AA, and other unusual forms of presentation, such as canities subita (Thomas More and Marie Antoinette syndromes), sisaipho, androgenetic alopecia, diffuse atypical forms, and transient rectangular alopecia.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">When hair regrowth occurs in AA, it is initially not uncommon to observe fine white hair or changes in hair texture (the hair may become straight or curly). Four paradoxical forms of hair regrowth exist: the castling phenomenon in which, after immunotherapy treatment with diphencyprone or squaric acid dibutylester, hair regrowth occurs in areas distinct from the site of application; the Renbök phenomenon, from the name Köbner written backwards, in which hair starts to grow on plaques of psoriasis or persists on congenital hairy nevi; perinevoid alopecia, characterized by hair loss around melanocytic nevi<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a>; and targetoid or concentric regrowth, in which hair regrowth occurs in concentric rings at the vertex and in the occipital or parietal regions after treatment with topical immunotherapy, topical or intralesional corticosteroids, or even without previous therapy.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Dr Emilio del Río, one of the first to describe this phenomenon, considered that this finding is not as rare as the few published cases might suggest.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> A number of hypotheses have been proposed to explain the phenomenon, including centrifugal accumulation of the corticosteroids because of application using the fingers,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> a minimal aggression that produces AA with dystrophic hair that rapidly enters normal anagen,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> or the normal clinical course of AA,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> which, like an earthquake, starts at the center and spreads peripherally in waves<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> (spreading waves of anagen hair growth that reach refractory hair follicles in telogen giving rise to the typical concentric appearance).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although diagnosis is usually simple based on patient age, disease duration, and the medical history, the hair distribution can simulate other disorders that can present plaques of alopecia with an annular morphology or artifactual appearance. Trichotemnomania, a variant of trichotillomania in which sharp tools (scissors or razors) are used to cut the hair, has characteristic dermoscopic features such as the “V” sign, hair powder, and broken, spiral, flame, and tulip hairs, which help in its differentiation from AA. Lupus panniculitis can adopt an annular distribution following the Blaschko lines of the scalp. Traction alopecia, also called marginal alopecia because it typically affects the frontal, temporal, and occipital hairlines, is a condition produced by prolonged or repetitive tension on the scalp due to hairstyles in which the hair is placed under tension; a typical finding in this condition is the border sign, which consists of the preservation of hairs along the original line of hair implantation, giving it an annular appearance. Finally, transitory neonatal hair loss in the occipital region can also present an annular morphology.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a new case of concentric or targetoid hair growth, a possibly underdiagnosed form of paradoxical hair regrowth in AA that needs to be recognized to avoid confusion with other types of alopecia.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Monteagudo B, Suárez-Magdalena O, González-Vilas D, Suárez-Amor Ó. Crecimiento concéntrico en la alopecia areata (patrón en diana). Actas Dermosifiliogr. 2016;107:348–350.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1043 "Ancho" => 2000 "Tamanyo" => 467342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Annular areas of regrowth of black hair at the vertex and in the occipital region. B, Spread of the initial plaque of alopecia to the parietal region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2140 "Ancho" => 2000 "Tamanyo" => 738735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Concentric areas of alopecia and hair regrowth producing a targetoid pattern.</p>" ] ] ] "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" => "Alopecia androgenética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 72 | 27 | 99 |
| 2024 September | 97 | 25 | 122 |
| 2024 August | 99 | 51 | 150 |
| 2024 July | 108 | 34 | 142 |
| 2024 June | 126 | 26 | 152 |
| 2024 May | 132 | 28 | 160 |
| 2024 April | 109 | 20 | 129 |
| 2024 March | 88 | 38 | 126 |
| 2024 February | 95 | 41 | 136 |
| 2024 January | 75 | 33 | 108 |
| 2023 December | 75 | 10 | 85 |
| 2023 November | 128 | 25 | 153 |
| 2023 October | 106 | 27 | 133 |
| 2023 September | 128 | 30 | 158 |
| 2023 August | 76 | 20 | 96 |
| 2023 July | 114 | 35 | 149 |
| 2023 June | 74 | 18 | 92 |
| 2023 May | 116 | 29 | 145 |
| 2023 April | 88 | 23 | 111 |
| 2023 March | 95 | 21 | 116 |
| 2023 February | 69 | 20 | 89 |
| 2023 January | 69 | 25 | 94 |
| 2022 December | 55 | 40 | 95 |
| 2022 November | 35 | 20 | 55 |
| 2022 October | 29 | 15 | 44 |
| 2022 September | 29 | 42 | 71 |
| 2022 August | 36 | 31 | 67 |
| 2022 July | 28 | 31 | 59 |
| 2022 June | 33 | 20 | 53 |
| 2022 May | 126 | 34 | 160 |
| 2022 April | 148 | 26 | 174 |
| 2022 March | 157 | 46 | 203 |
| 2022 February | 123 | 22 | 145 |
| 2022 January | 171 | 36 | 207 |
| 2021 December | 94 | 39 | 133 |
| 2021 November | 62 | 31 | 93 |
| 2021 October | 103 | 55 | 158 |
| 2021 September | 71 | 37 | 108 |
| 2021 August | 130 | 25 | 155 |
| 2021 July | 109 | 28 | 137 |
| 2021 June | 91 | 25 | 116 |
| 2021 May | 82 | 31 | 113 |
| 2021 April | 248 | 67 | 315 |
| 2021 March | 83 | 22 | 105 |
| 2021 February | 87 | 20 | 107 |
| 2021 January | 55 | 17 | 72 |
| 2020 December | 69 | 11 | 80 |
| 2020 November | 43 | 17 | 60 |
| 2020 October | 41 | 14 | 55 |
| 2020 September | 53 | 6 | 59 |
| 2020 August | 31 | 12 | 43 |
| 2020 July | 49 | 16 | 65 |
| 2020 June | 37 | 27 | 64 |
| 2020 May | 22 | 13 | 35 |
| 2020 April | 30 | 21 | 51 |
| 2020 March | 30 | 13 | 43 |
| 2020 February | 4 | 0 | 4 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 8 | 0 | 8 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 2 | 8 |
| 2019 April | 2 | 2 | 4 |
| 2019 March | 3 | 5 | 8 |
| 2019 February | 4 | 0 | 4 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 2 | 0 | 2 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 31 | 5 | 36 |
| 2018 January | 45 | 6 | 51 |
| 2017 December | 44 | 10 | 54 |
| 2017 November | 30 | 10 | 40 |
| 2017 October | 31 | 6 | 37 |
| 2017 September | 31 | 10 | 41 |
| 2017 August | 28 | 11 | 39 |
| 2017 July | 27 | 9 | 36 |
| 2017 June | 31 | 29 | 60 |
| 2017 May | 21 | 16 | 37 |
| 2017 April | 16 | 12 | 28 |
| 2017 March | 23 | 24 | 47 |
| 2017 February | 23 | 7 | 30 |
| 2017 January | 12 | 9 | 21 |
| 2016 December | 13 | 24 | 37 |
| 2016 November | 28 | 9 | 37 |
| 2016 October | 15 | 11 | 26 |
| 2016 September | 0 | 2 | 2 |
| 2016 June | 0 | 3 | 3 |
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