Case and Research Letter
Geometric Alopecia after Embolization of a Ruptured Aneurysm
Alopecia geométrica tras embolización de un aneurisma roto
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(A) Normal epidermis with no inflammatory infiltrate. Miniaturized hair follicles (red arrow), atrophy of the sebaceous glands (yellow arrow) (hematoxylin eosin, original magnification 100×). (B) Normal dermal elastic fibers (orcein, original magnification 40×). (C) Perifollicular fibrosis (trichome, original magnification 100×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. César, T. Baudrier, A. Mota, F. Azevedo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "César" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Baudrier" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Mota" ] 3 => array:2 [ "nombre" => "F." 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Placas eritematoedematosas, con formación de micropápulas en superficie y ligera descamación, localizadas en la cara. B. Mismo tipo de lesiones con liquenificación en el dorso de la mano.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Rubio-González, F.J. Ortiz-de Frutos" "autores" => array:2 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Rubio-González" ] 1 => array:2 [ "nombre" => "F.J." 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César, T. Baudrier, A. Mota, F. Azevedo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "César" "email" => array:1 [ 0 => "arturjfc@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "T." "apellidos" => "Baudrier" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Mota" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Azevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, University of Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia geométrica tras embolización de un aneurisma roto" ] ] "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" => 970 "Ancho" => 1401 "Tamanyo" => 546518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin specimen biopsy of alopecic area. (A) Normal epidermis with no inflammatory infiltrate. Miniaturized hair follicles (red arrow), atrophy of the sebaceous glands (yellow arrow) (hematoxylin eosin, original magnification 100×). (B) Normal dermal elastic fibers (orcein, original magnification 40×). (C) Perifollicular fibrosis (trichome, original magnification 100×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Neuroradiology intervention techniques are increasingly used for treatment and diagnostic purposes, but reports of adverse cutaneous effects are rare. Herein we report a case of transient alopecia related to endovascular procedures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A previously healthy 26-year-old woman experienced sudden onset of severe occipital headache associated with vomiting approximately 3<span class="elsevierStyleHsp" style=""></span>h prior to admission to the emergency room. The neurological examination revealed anisocoria and mild neck rigidity. The patient had no history of trauma or other symptoms.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A computed tomography scan showed a subarachnoid hemorrhage in the posterior fossae and a digital subtraction angiography revealed an aneurysm of the basilar artery.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent 3 fluoroscopically guided angiographies, which resulted in successful endovascular coiling of the aneurysm. She recovered, without neurologic sequelae, within 2 days of these procedures, which in total lasted approximately 4<span class="elsevierStyleHsp" style=""></span>h. The cumulative radiation dose was 5<span class="elsevierStyleHsp" style=""></span>Gy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One week after the last angiography, the patient developed a sharply delineated rectangular alopecic area measuring 15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>cm on the right occipital-parietal region of the scalp. The bald patch was devoid of inflammatory signs and scaling (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and the pulses of the occipital and superficial temporal arteries were bilaterally palpable. The results of the pull test were unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Trichoscopy of the alopecic area revealed marked sparseness of terminal hairs and the presence of several vellus-type hairs and yellow dots. No dystrophic hairs or black dots were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The histopathological examination of a biopsy specimen from the affected area revealed miniaturized hair follicles surrounded by fibrosis and atrophy of the sebaceous glands (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Radiation and pressure-induced types of alopecia, as well as alopecia areata and trichotillomania, were considered in the differential diagnosis. However, radiation-induced hair loss was the most plausible cause in the clinical setting of the patient. After 3 months of follow-up without treatment, the hair had regrown completely (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Radiation-induced alopecia after fluoroscopically guided interventional procedures is a form of radiodermatitis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> As occurred in our patient, exposure to a relatively low dose of radiation (3–7<span class="elsevierStyleHsp" style=""></span>Gy) can lead to transient epilation caused by damage to the actively dividing matrix cells of the anagen hair follicles.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Anagen effluvium develops within several days or weeks, and is usually followed by transient miniaturization of anagen hairs and the emergence of broken hairs as a result of the loss of follicle stem cells.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Furthermore, the premature catagen entry of follicles in late anagen can also trigger observable telogen shedding 2.5–4 months after exposure.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> As occurred in our case, hair regrowth generally occurs 2–4 months after low radiation dose exposure and therefore no treatment is currently indicated. Nevertheless, permanent alopecia can be expected after radiation doses above 7<span class="elsevierStyleHsp" style=""></span>Gy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Temporary alopecia following therapeutic embolization of aneurysms, arteriovenous malformations, and tumors has been previously reported.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a> The complexity of posterior circulation aneurysm coiling procedures, such as those performed in our patient, has been linked to longer fluoroscopy time, increasing the risk of radiation-induced skin damage.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Cumulative radiation dose, intervals between sessions, total irradiated area, and variations in the incidence angle are important determinants of injury severity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In our patient, the location and geometric configuration of the bald patch are consistent with prolonged radiation exposure in the same area with limited variation of the direction of application during the fluoroscopically guided interventions.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our report emphasizes the need for awareness of the risk of alopecia originating from fluoroscopically guided techniques. While rare and probably underdiagnosed, this adverse effect may increase in incidence due to the growing use of minimally invasive endovascular procedures for the diagnosis and treatment of neurovascular disorders.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 901 "Ancho" => 1399 "Tamanyo" => 220775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Rectangular bald patch in the right occipital–parietal region. (B) Normal density of follicular openings, absence of terminal hairs, and presence of vellus-type hairs and yellow dots (original magnification 20×).</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" => 970 "Ancho" => 1401 "Tamanyo" => 546518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin specimen biopsy of alopecic area. (A) Normal epidermis with no inflammatory infiltrate. Miniaturized hair follicles (red arrow), atrophy of the sebaceous glands (yellow arrow) (hematoxylin eosin, original magnification 100×). (B) Normal dermal elastic fibers (orcein, original magnification 40×). (C) Perifollicular fibrosis (trichome, original magnification 100×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 929 "Ancho" => 1400 "Tamanyo" => 298645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Complete repopulation of the alopecic area after 3 months of follow-up. (B) Normal density of follicular openings with terminal hairs (original magnification 20×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Balter" 1 => "J.W. Hopewell" 2 => "D.L. Miller" 3 => "L.K. Wagner" 4 => "M.J. 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Tseng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Neurol Neurosurg" "fecha" => "2003" "volumen" => "105" "paginaInicial" => "215" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12860517" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack131325" "titulo" => "Acknowledgments" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We thank E. Rios MD and J.M. Lopes PhD, from the Department of Pathological Anatomy, Centro Hospitalar São João EPE in Porto, Portugal and IPATIMUP (Instituto de Patologia e Imunologia Molecular da Universidade do Porto) in Porto, Portugal for providing the histologic images.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000010600000002/v2_201502240236/S0001731014004116/v2_201502240236/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000010600000002/v2_201502240236/S0001731014004116/v2_201502240236/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004116?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 3 | 9 |
| 2024 Octubre | 40 | 30 | 70 |
| 2024 Septiembre | 34 | 18 | 52 |
| 2024 Agosto | 63 | 57 | 120 |
| 2024 Julio | 44 | 53 | 97 |
| 2024 Junio | 71 | 35 | 106 |
| 2024 Mayo | 46 | 28 | 74 |
| 2024 Abril | 53 | 22 | 75 |
| 2024 Marzo | 43 | 21 | 64 |
| 2024 Febrero | 43 | 32 | 75 |
| 2024 Enero | 57 | 26 | 83 |
| 2023 Diciembre | 50 | 21 | 71 |
| 2023 Noviembre | 50 | 29 | 79 |
| 2023 Octubre | 51 | 29 | 80 |
| 2023 Septiembre | 69 | 26 | 95 |
| 2023 Agosto | 59 | 18 | 77 |
| 2023 Julio | 73 | 39 | 112 |
| 2023 Junio | 59 | 24 | 83 |
| 2023 Mayo | 58 | 24 | 82 |
| 2023 Abril | 139 | 19 | 158 |
| 2023 Marzo | 39 | 17 | 56 |
| 2023 Febrero | 74 | 21 | 95 |
| 2023 Enero | 38 | 17 | 55 |
| 2022 Diciembre | 39 | 35 | 74 |
| 2022 Noviembre | 49 | 39 | 88 |
| 2022 Octubre | 38 | 33 | 71 |
| 2022 Septiembre | 47 | 40 | 87 |
| 2022 Agosto | 52 | 43 | 95 |
| 2022 Julio | 47 | 39 | 86 |
| 2022 Junio | 36 | 29 | 65 |
| 2022 Mayo | 38 | 38 | 76 |
| 2022 Abril | 49 | 33 | 82 |
| 2022 Marzo | 34 | 50 | 84 |
| 2022 Febrero | 32 | 16 | 48 |
| 2022 Enero | 32 | 43 | 75 |
| 2021 Diciembre | 26 | 42 | 68 |
| 2021 Noviembre | 34 | 52 | 86 |
| 2021 Octubre | 39 | 59 | 98 |
| 2021 Septiembre | 37 | 40 | 77 |
| 2021 Agosto | 54 | 22 | 76 |
| 2021 Julio | 17 | 22 | 39 |
| 2021 Junio | 53 | 20 | 73 |
| 2021 Mayo | 27 | 23 | 50 |
| 2021 Abril | 55 | 83 | 138 |
| 2021 Marzo | 43 | 14 | 57 |
| 2021 Febrero | 56 | 26 | 82 |
| 2021 Enero | 44 | 15 | 59 |
| 2020 Diciembre | 35 | 12 | 47 |
| 2020 Noviembre | 12 | 19 | 31 |
| 2020 Octubre | 31 | 12 | 43 |
| 2020 Septiembre | 33 | 7 | 40 |
| 2020 Agosto | 21 | 19 | 40 |
| 2020 Julio | 34 | 9 | 43 |
| 2020 Junio | 29 | 20 | 49 |
| 2020 Mayo | 25 | 20 | 45 |
| 2020 Abril | 24 | 25 | 49 |
| 2020 Marzo | 24 | 15 | 39 |
| 2020 Febrero | 4 | 2 | 6 |
| 2020 Enero | 3 | 0 | 3 |
| 2019 Diciembre | 6 | 3 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 6 | 0 | 6 |
| 2019 Julio | 4 | 10 | 14 |
| 2019 Junio | 4 | 11 | 15 |
| 2019 Mayo | 5 | 26 | 31 |
| 2019 Abril | 2 | 5 | 7 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 0 | 2 | 2 |
| 2019 Enero | 7 | 0 | 7 |
| 2018 Diciembre | 0 | 2 | 2 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 3 | 1 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 22 | 0 | 22 |
| 2018 Enero | 34 | 3 | 37 |
| 2017 Diciembre | 26 | 5 | 31 |
| 2017 Noviembre | 22 | 2 | 24 |
| 2017 Octubre | 23 | 5 | 28 |
| 2017 Septiembre | 22 | 6 | 28 |
| 2017 Agosto | 26 | 5 | 31 |
| 2017 Julio | 24 | 3 | 27 |
| 2017 Junio | 30 | 8 | 38 |
| 2017 Mayo | 19 | 5 | 24 |
| 2017 Abril | 15 | 8 | 23 |
| 2017 Marzo | 13 | 6 | 19 |
| 2017 Febrero | 6 | 4 | 10 |
| 2017 Enero | 8 | 4 | 12 |
| 2016 Diciembre | 25 | 11 | 36 |
| 2016 Noviembre | 14 | 11 | 25 |
| 2016 Octubre | 12 | 9 | 21 |
| 2016 Septiembre | 0 | 7 | 7 |
| 2016 Julio | 5 | 1 | 6 |
| 2016 Junio | 9 | 0 | 9 |
| 2016 Mayo | 13 | 4 | 17 |
| 2016 Abril | 9 | 2 | 11 |
| 2016 Marzo | 10 | 0 | 10 |
| 2016 Febrero | 10 | 2 | 12 |
| 2016 Enero | 20 | 1 | 21 |
| 2015 Diciembre | 10 | 0 | 10 |
| 2015 Noviembre | 10 | 2 | 12 |
| 2015 Octubre | 18 | 1 | 19 |
| 2015 Septiembre | 6 | 2 | 8 |
| 2015 Agosto | 0 | 3 | 3 |
| 2015 Julio | 7 | 0 | 7 |
| 2015 Junio | 4 | 1 | 5 |
| 2015 Mayo | 4 | 3 | 7 |
| 2015 Abril | 3 | 2 | 5 |
| 2015 Marzo | 16 | 3 | 19 |
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