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. Puig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Montagna Tricología. Enfermedades del folículo pilosebáceo" "paginaInicial" => "869" "paginaFinal" => "878" "edicion" => "Tercera edición" "serieFecha" => "2013" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopatología de las alopecias. Parte I: alopecias no cicatriciales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Bernárdez" 1 => "A.M. Molina-Ruiz" 2 => "L. 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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 1 | 5 |
| 2024 Octubre | 91 | 34 | 125 |
| 2024 Septiembre | 82 | 16 | 98 |
| 2024 Agosto | 88 | 56 | 144 |
| 2024 Julio | 74 | 37 | 111 |
| 2024 Junio | 64 | 24 | 88 |
| 2024 Mayo | 69 | 27 | 96 |
| 2024 Abril | 73 | 31 | 104 |
| 2024 Marzo | 72 | 31 | 103 |
| 2024 Febrero | 80 | 23 | 103 |
| 2024 Enero | 55 | 37 | 92 |
| 2023 Diciembre | 54 | 29 | 83 |
| 2023 Noviembre | 71 | 32 | 103 |
| 2023 Octubre | 70 | 41 | 111 |
| 2023 Septiembre | 79 | 37 | 116 |
| 2023 Agosto | 58 | 20 | 78 |
| 2023 Julio | 79 | 38 | 117 |
| 2023 Junio | 63 | 29 | 92 |
| 2023 Mayo | 107 | 19 | 126 |
| 2023 Abril | 48 | 19 | 67 |
| 2023 Marzo | 61 | 25 | 86 |
| 2023 Febrero | 55 | 24 | 79 |
| 2023 Enero | 42 | 29 | 71 |
| 2022 Diciembre | 62 | 38 | 100 |
| 2022 Noviembre | 60 | 30 | 90 |
| 2022 Octubre | 56 | 28 | 84 |
| 2022 Septiembre | 30 | 38 | 68 |
| 2022 Agosto | 34 | 41 | 75 |
| 2022 Julio | 29 | 40 | 69 |
| 2022 Junio | 25 | 33 | 58 |
| 2022 Mayo | 55 | 44 | 99 |
| 2022 Abril | 52 | 26 | 78 |
| 2022 Marzo | 51 | 54 | 105 |
| 2022 Febrero | 46 | 27 | 73 |
| 2022 Enero | 78 | 33 | 111 |
| 2021 Diciembre | 55 | 37 | 92 |
| 2021 Noviembre | 44 | 38 | 82 |
| 2021 Octubre | 54 | 46 | 100 |
| 2021 Septiembre | 49 | 36 | 85 |
| 2021 Agosto | 51 | 22 | 73 |
| 2021 Julio | 40 | 26 | 66 |
| 2021 Junio | 47 | 12 | 59 |
| 2021 Mayo | 35 | 30 | 65 |
| 2021 Abril | 108 | 53 | 161 |
| 2021 Marzo | 80 | 20 | 100 |
| 2021 Febrero | 47 | 17 | 64 |
| 2021 Enero | 42 | 15 | 57 |
| 2020 Diciembre | 26 | 14 | 40 |
| 2020 Noviembre | 25 | 12 | 37 |
| 2020 Octubre | 27 | 11 | 38 |
| 2020 Septiembre | 28 | 10 | 38 |
| 2020 Agosto | 18 | 13 | 31 |
| 2020 Julio | 23 | 16 | 39 |
| 2020 Junio | 32 | 30 | 62 |
| 2020 Mayo | 31 | 11 | 42 |
| 2020 Abril | 32 | 14 | 46 |
| 2020 Marzo | 24 | 15 | 39 |
| 2020 Febrero | 7 | 1 | 8 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Mayo | 4 | 1 | 5 |
| 2019 Abril | 12 | 1 | 13 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 8 | 0 | 8 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 9 | 0 | 9 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 16 | 3 | 19 |
| 2018 Enero | 19 | 8 | 27 |
| 2017 Diciembre | 25 | 7 | 32 |
| 2017 Noviembre | 20 | 6 | 26 |
| 2017 Octubre | 11 | 11 | 22 |
| 2017 Septiembre | 16 | 3 | 19 |
| 2017 Agosto | 18 | 10 | 28 |
| 2017 Julio | 16 | 6 | 22 |
| 2017 Junio | 27 | 7 | 34 |
| 2017 Mayo | 17 | 5 | 22 |
| 2017 Abril | 14 | 2 | 16 |
| 2017 Marzo | 16 | 3 | 19 |
| 2017 Febrero | 18 | 4 | 22 |
| 2017 Enero | 11 | 6 | 17 |
| 2016 Diciembre | 24 | 16 | 40 |
| 2016 Noviembre | 26 | 17 | 43 |
| 2016 Octubre | 24 | 20 | 44 |
| 2016 Mayo | 0 | 1 | 1 |
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