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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">To date&#44; reports on alopecia in patients with palmoplantar pustulosis &#40;PPP&#41; are rarely seen&#46; We herein describe four cases of alopecia in patients with PPP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During these 10 years&#44; we diagnosed 128 patients with PPP &#40;M&#58;F&#61;1&#58;2&#41; in our department&#46; Among these patients&#44; four patients had PPP and alopecia &#40;3&#46;1&#37;&#41;&#46; All of the patients were female&#44; and the age range was from 39 to 56 years old &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Three patients developed alopecia prior to the onset of PPP&#44; and the remaining patient developed alopecia 10 years after the onset of PPP&#46; Two patients had pustulotic arthro-osteitis&#46; Two patients were smokers&#44; and one was a passive smoker&#46; A metal patch test was carried out in all cases&#46; Three patients showed no reaction&#44; while one patient showed a positive reaction &#40;&#43;&#41; to zinc according to the criteria of the International Contact Dermatitis Research Group&#46; Regarding the type of alopecia&#44; all patients presented with alopecia areata multiplex&#46; Severe types of alopecia involving sites other than the scalp&#44; such as the eyelashes and eyebrows&#44; were not observed&#46; Representative figures are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Laboratory examination did not reveal positive antinuclear antibodies and thyroid abnormalities&#46; Examination of focal infection was performed in all cases&#44; in which dental caries and tonsil hypertrophy were observed each in one case&#46; All cases were conservatively treated for alopecia&#46; Topical immunotherapy with squaric acid dibutylester &#40;SADBE&#41; was applied in one case &#40;Case 1&#41;&#44; while the other cases were treated with topical corticosteroid or carpronium chloride lotion&#46; Among four patients&#44; Case 1 was resistant while others were relatively responsive to topical therapies for alopecia&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Thyroiditis&#44; diabetes mellitus&#44; hyperlipidaemia&#44; and psychiatric disorders are sometimes accompanied by PPP&#46; By contrast&#44; There is a limited number of reports on autoimmune skin disorders such as vitiligo and alopecia&#46; Previously&#44; Nakamura et al&#46; reported a patient with PPP&#44; alopecia totalis and Hashimoto&#39;s thyroiditis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In their case&#44; the alopecia was severe with involvement of the total scalp&#44; eyebrow&#44; and eyelashes&#44; suggesting immunological interplay among PPP&#44; alopecia&#44; and thyroid disorders&#46; By contrast&#44; our four patients showed a common type of alopecia areata multiplex&#46; Both alopecia and PPP are occasionally associated with autoimmune thyroiditis&#59; however&#44; autoimmune thyroiditis was not detected in any of our patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Similar to psoriasis&#44; IL-23&#47;IL-17 inflammatory pathway has recently been suggested to be important in PPP&#46; IL-17 and IL-22 are detected close to or in the acrosyringium of PPP skin lesions&#44; and increased serum levels of both cytokines&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The etiology of alopecia areata is complicated&#44; and recent studies have suggested Th1 dominance&#44; Th2 dominance&#44; and Th17 involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> It is known that psoriasis and alopecia mutually exert exclusive local effects&#44; <span class="elsevierStyleItalic">e&#46;g&#46;</span> the protective effect of psoriatic lesions against hair loss&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This Renb&#246;k phenomenon is speculated to occur due to a local balance of different Th1&#47;Th2&#47;Th17 subsets which amplify self-sustaining cytokines while suppressing alternative pathways&#46; Most likely&#44; the immune balance may depend on the disease stages&#44; such as initial and progressive phases&#44; or associated diseases such as atopic dermatitis&#44; autoimmune diseases&#44; and connective tissue disorders&#46; In conclusion&#44; alopecia associated with PPP may be overlooked&#44; and thus more attention should be paid to alopecia in the clinical examination of PPP&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&#47;Age&#47;Sex&nbsp;\t\t\t\t\t\t\n
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Case and Research Letters
Alopecia Areata and Palmoplantar Pustulosis: Report of 4 Cases
Alopecia areata y pustulosis palmoplantar: informe de 4 casos
T. Hiraiwa, T. Yamamoto
Corresponding author
toyamade@fmu.ac.jp

Corresponding author.
Unidad de Dermatología, Facultad de Medicina, Universidad de Fukushima, Fukushima, Japón
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    "titulo" => "Alopecia Areata and Palmoplantar Pustulosis&#58; Report of 4 Cases"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Representative figures are shown&#46; Case 2 presented with plantar lesion of PPP &#40;a&#41; and alopecia areata &#40;b&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">To date&#44; reports on alopecia in patients with palmoplantar pustulosis &#40;PPP&#41; are rarely seen&#46; We herein describe four cases of alopecia in patients with PPP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During these 10 years&#44; we diagnosed 128 patients with PPP &#40;M&#58;F&#61;1&#58;2&#41; in our department&#46; Among these patients&#44; four patients had PPP and alopecia &#40;3&#46;1&#37;&#41;&#46; All of the patients were female&#44; and the age range was from 39 to 56 years old &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Three patients developed alopecia prior to the onset of PPP&#44; and the remaining patient developed alopecia 10 years after the onset of PPP&#46; Two patients had pustulotic arthro-osteitis&#46; Two patients were smokers&#44; and one was a passive smoker&#46; A metal patch test was carried out in all cases&#46; Three patients showed no reaction&#44; while one patient showed a positive reaction &#40;&#43;&#41; to zinc according to the criteria of the International Contact Dermatitis Research Group&#46; Regarding the type of alopecia&#44; all patients presented with alopecia areata multiplex&#46; Severe types of alopecia involving sites other than the scalp&#44; such as the eyelashes and eyebrows&#44; were not observed&#46; Representative figures are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Laboratory examination did not reveal positive antinuclear antibodies and thyroid abnormalities&#46; Examination of focal infection was performed in all cases&#44; in which dental caries and tonsil hypertrophy were observed each in one case&#46; All cases were conservatively treated for alopecia&#46; Topical immunotherapy with squaric acid dibutylester &#40;SADBE&#41; was applied in one case &#40;Case 1&#41;&#44; while the other cases were treated with topical corticosteroid or carpronium chloride lotion&#46; Among four patients&#44; Case 1 was resistant while others were relatively responsive to topical therapies for alopecia&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Thyroiditis&#44; diabetes mellitus&#44; hyperlipidaemia&#44; and psychiatric disorders are sometimes accompanied by PPP&#46; By contrast&#44; There is a limited number of reports on autoimmune skin disorders such as vitiligo and alopecia&#46; Previously&#44; Nakamura et al&#46; reported a patient with PPP&#44; alopecia totalis and Hashimoto&#39;s thyroiditis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In their case&#44; the alopecia was severe with involvement of the total scalp&#44; eyebrow&#44; and eyelashes&#44; suggesting immunological interplay among PPP&#44; alopecia&#44; and thyroid disorders&#46; By contrast&#44; our four patients showed a common type of alopecia areata multiplex&#46; Both alopecia and PPP are occasionally associated with autoimmune thyroiditis&#59; however&#44; autoimmune thyroiditis was not detected in any of our patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Similar to psoriasis&#44; IL-23&#47;IL-17 inflammatory pathway has recently been suggested to be important in PPP&#46; IL-17 and IL-22 are detected close to or in the acrosyringium of PPP skin lesions&#44; and increased serum levels of both cytokines&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The etiology of alopecia areata is complicated&#44; and recent studies have suggested Th1 dominance&#44; Th2 dominance&#44; and Th17 involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> It is known that psoriasis and alopecia mutually exert exclusive local effects&#44; <span class="elsevierStyleItalic">e&#46;g&#46;</span> the protective effect of psoriatic lesions against hair loss&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This Renb&#246;k phenomenon is speculated to occur due to a local balance of different Th1&#47;Th2&#47;Th17 subsets which amplify self-sustaining cytokines while suppressing alternative pathways&#46; Most likely&#44; the immune balance may depend on the disease stages&#44; such as initial and progressive phases&#44; or associated diseases such as atopic dermatitis&#44; autoimmune diseases&#44; and connective tissue disorders&#46; In conclusion&#44; alopecia associated with PPP may be overlooked&#44; and thus more attention should be paid to alopecia in the clinical examination of PPP&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Hiraiwa T&#44; Yamamoto T&#46; Alopecia areata y pustulosis palmoplantar&#58; informe de 4 casos&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;751&#8211;752&#46;</p>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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