Letter to the Editor
Reply to «Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin»
a Hospital deDermatología,VenereologíayLeprologíade Mansoura, Mansoura, Egypt
b Unidad de Cirugía Plásticay Reconstructiva, Departamento de Emergenciasy Trasplantede Órganos, Universidad de Bari, Bari, Italy
c Departamento deDermatología, Brighamy Women’s Hospital, Escuelade Medicinade Harvard, Boston, MA
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Compact orthokeratotic hyperkeratosis, thinning of the granulomatous layer, and mild spongiosis can be observed. Mild lymphocytic infiltrate in the papillary dermis, with no other dermal abnormalities (hematoxylin–eosin, x20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Fernández-González, D. Buendía-Castaño, D. Saceda-Corralo, P. Jaen-Olasolo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-González" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Buendía-Castaño" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Saceda-Corralo" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Jaen-Olasolo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019301644" "doi" => "10.1016/j.ad.2018.04.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019301644?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303221?idApp=UINPBA000044" "url" => "/15782190/0000011000000010/v1_201912080808/S1578219019303221/v1_201912080808/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to «Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin»" "subtitulo" => "[[es]]Réplica a «Pápulas faciales en alopecia frontal fibrosante con buena respuesta a isotretinoína»" "tieneTextoCompleto" => true "saludo" => "To the Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "876" "paginaFinal" => "877" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ayman Abdelmaksoud, Michelangelo Vestita" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Ayman" "apellidos" => "Abdelmaksoud" "email" => array:1 [ 0 => "behcet.behcet@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Michelangelo" "apellidos" => "Vestita" "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" => "Hospital deDermatología,VenereologíayLeprologíade Mansoura, Mansoura, Egypt" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cirugía Plásticay Reconstructiva, Departamento de Emergenciasy Trasplantede Órganos, Universidad de Bari, Bari, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento deDermatología, Brighamy Women’s Hospital, Escuelade Medicinade Harvard, Boston, MA" "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest a report by Flores-Terry et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> published recently in the Actas Dermo-Sifiliográficas journal. The authors reported 2 Spanish female patients with "yellow" facial papules(FP) of frontal fibrosing alopecia(FFA) treated with fixed low dose isotretinoine (i.e. 10<span class="elsevierStyleHsp" style=""></span>mg/day). One patient showed an excellent response beginning 1 month after starting treatment and persisting up to 6 months. The other patient showed improvement in the patient’s facial signs after 1.5 months, with a decrease in both the number and extension of FP. The authors stated " There are no data on FP treatment using topical or oral retinoids". However, this claim is uncertain. We found 3 published papers reported the successful use of low dose isotretinoine in FP in FFA/Lichen plano-pilaris (LPP). One of these reports studied 62 patients with "yellow" FP.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Frontal fibrosing alopecia (FFA) is considered a variant of lichen planopilaris affecting mainly the frontotemporal hairline. Since the first report in 1994, several other clinical features have been associated with the disease, such as facial papules (FP).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Pirmez et al. reported 3 female patients with a biopsy-confirmed FFA. All patients were started on the dosage of 20<span class="elsevierStyleHsp" style=""></span>mg/day of oral isotretinoin for the first month, which was then titrated to 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day for the following 2 months (40<span class="elsevierStyleHsp" style=""></span>mg/day in all 3 patients). At the end of the first month, a remarkable improvement was noted, with a reduction in the number and size of FP. At the end of the third month, FP had completely disappeared or were considered minimal. Isotretinoin was then discontinued and hydroxychloroquine 400<span class="elsevierStyleHsp" style=""></span>mg/day was introduced. Another interesting point is that the choice of therapeutic regimen seems to affect the time-to response with oral isotretinoin. Although it is not possible to exclude any role of concurrent systemic and topical treatments, the temporal relation between the introduction of oral isotretinoin and the disappearance of the lesions is remarkable.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Of 108 patients with FFA followed by Pedrosa et al., 62 patients exhibited yellow facial papules. Yellow papules were found on the temporal area, cheeks, chin, or diffusely distributed throughout the face. Histopathologic findings were invariably similar, with hypertrophic sebaceous glands in the papillary dermis with no associated vellus hair follicle or lichenoid inflammation. This observation led to a hypothesize that inflammation eventually resulted in the loss of vellus hair follicles replaced by fibrous scar tissue, whereas the hypertrophic sebaceous glands still remained, giving the clinical appearance of yellow noninflammatory papules on the face devoid of terminal hairs. In all of these patients, the skin was clinically very soft and thin, which made the hypertrophic sebaceous glands shine through or popping up. This finding may have an impact on therapy, because low-dose isotretinoin resulting in sebaceous gland shrinkage could be a valuable option to improve cosmetic appearance in these cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Those patients were treated with oral low-dose isotretinoin (10<span class="elsevierStyleHsp" style=""></span>mg every other day) for ≥12 months, which yielded a visible reduction of the yellow facial papules and was associated with a reduction of skin roughness after a median of 2 months.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Patients treated with 10<span class="elsevierStyleHsp" style=""></span>mg of isotretinoin every other day reported improvement of skin roughness only after a median of 2 months that was clinically observed after a median of 4 months.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Yellow facial papules present a distinct histologic pattern, which might represent an intermediate step between an initial perifollicular lichenoid inflammation and the ultimate epidermal atrophy without hair follicles but with large sebaceous glands remaining.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Hence, there is a difference between the simple FP and the yellow FP; yellow facial papules involve large sebaceous glands lacking vellus hair follicles and lichenoid inflammation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In a similar vein, Namazi et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> reported 4 cases of famililal LPP presented with isolated "simple" FP. Vellus hair involvement by LPP presenting as facial papules is an uncommon manifestation of LPP, this feature was seen in three of four of their patients. Interestingly, three of the four patients responded well to isotretinoin. One of the 3 responders was on low dose isotretinoin (20<span class="elsevierStyleHsp" style=""></span>mg/day) combined with finasteride (5<span class="elsevierStyleHsp" style=""></span>mg/day).</p><p id="par0015" class="elsevierStylePara elsevierViewall">To sum up, FP has 2 clinical and histopathoogical variants; simple and yellow FP. Both are low-dose isotretinoine responders. The report by Flores-Terry et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> represented a cumulative 2 cases with "yellow" FP of FFA responding to a very low dose of isotretinoine.</p><p id="par0020" class="elsevierStylePara elsevierViewall">DECLARATION AUTORIA</p><p id="par0025" class="elsevierStylePara elsevierViewall">Michelangelo Vestita: (1) la concepción y el diseño del estudio, o la adquisición de datos, o el análisis y la interpretación de los datos, (2) el borrador del artículo o la revisión crítica del contenido intelectual, (3) la aprobación definitiva de la versión que se presenta.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ayman Abdelmaksoud: (1) la concepción y el diseño del estudio, o la adquisición de datos, o el análisis y la interpretación de los datos, (2) el borrador del artículo o la revisión crítica del contenido intelectual, (3) la aprobación definitiva de la versión que se presenta.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding source and conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "xpalclavsec1177569" "titulo" => "Keywords" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding source and conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-01-09" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1177569" "palabras" => array:2 [ 0 => "Facial papules" 1 => "Isotretinoine" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abdelmaksoud A, Vestita M. Réplica a «Pápulas faciales en alopecia frontal fibrosante con buena respuesta a isotretinoína». Actas Dermo-Sifiliográficas. 2019;110:876–877.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial papules in frontal fibrosing alopecia: good response to isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.Á Flores-Terry" 1 => "M. García-Arpa" 2 => "M. Franco-Muñóz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2017.08.018" "Revista" => array:3 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2018" "numero" => "Jan" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial papules in frontal fibrosing alopecia: beyond vellus hair follicle involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Pirmez" 1 => "T. Barreto" 2 => "B. Duque-Estrada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000481695" "Revista" => array:6 [ "tituloSerie" => "Skin Appendage Disord" "fecha" => "2018" "volumen" => "4" "paginaInicial" => "145" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30197890" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of facial papules in frontal fibrosing alopecia with oral isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Pirmez" 1 => "B. Duque-Estrada" 2 => "T. Barreto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000464334" "Revista" => array:6 [ "tituloSerie" => "Skin Appendage Disord" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "111" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28560221" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Yellow facial papules associated with frontal fibrosing alopecia: a distinct histologic pattern and response to isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.F. Pedrosa" 1 => "A.F. Duarte" 2 => "E. Haneke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.04.1118" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "77" "paginaInicial" => "764" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28917459" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reply to: "Histopathology of facial papules in frontal fibrosing alopecia and therapeutic response to oral isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.F. Pedrosa" 1 => "A.F. Duarte" 2 => "E. Haneke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.10.037" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "e47" "paginaFinal" => "e48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29332727" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial facial lichen planopilaris and satisfactory response to isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Namazi" 1 => "N. Niknezhad" 2 => "N. Niknejad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/dth.12633" "Revista" => array:3 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2018" "numero" => "Aug" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000010/v1_201912080808/S157821901930280X/v1_201912080808/en/main.assets" "Apartado" => array:4 [ "identificador" => "6202" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000010/v1_201912080808/S157821901930280X/v1_201912080808/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930280X?idApp=UINPBA000044" ]
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