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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and histological characteristics of scalp sarcoidosis &#40;hematoxylin-eosin staining&#44; original magnification &#215;200&#41;&#46; A and B&#44; Case 1&#46; C and D&#44; Case 2&#46; E and F&#44; Case 3&#46;</p>"
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and mediastinal lymphadenopathy&#46; Serum levels of angiotensin converting enzyme &#40;ACE&#41; were elevated &#40;72&#46;8&#160;U&#47;L&#59; normal range&#44; 7&#8211;25&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; The ophthalmological examination revealed uveitis&#46; Biopsy of the scalp showed non-necrotizing epithelioid granulomas located in the upper to mid dermis with minimal lymphocytic infiltration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Naked granulomas were also detected in another sample taken from the leg&#46; The patient was treated with local topical steroids&#44; to which she responded poorly&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Case 2&#46; The patient was a 51-year-old man who was referred to our department with pulmonary sarcoidosis and uveitis&#46; He complained of blurred vision&#46; The ophthalmological examination revealed nodules in the iris&#44; inflammation of the anterior segment&#44; and vitreous opacity&#46; Radiography and a chest CT scan revealed BHL&#46; Serum ACE levels were elevated &#40;64&#46;5&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; The physical examination revealed indurated reddish-brown plaques and regularly distributed areas of alopecia with black spots on the scalp &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#44; as well as dark red subcutaneous nodules on the legs&#46; Biopsies of the scalp and legs revealed sarcoid granulomas located in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The patient was treated with local topical steroids&#44; to which he responded poorly&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 3&#46; The patient was a 71-year-old man who was referred to our department with uveitis&#46; He reported skin rash on the scalp and the right leg&#46; Physical examination of the scalp revealed multiple erythematous&#44; scaly&#44; indurated areas and an egg-sized&#44; indurated alopecic plaque with black spots &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; There were dark red subcutaneous nodules on the right leg&#46; Radiography and a chest CT scan revealed BHL&#46; Serum ACE levels were elevated &#40;42&#46;5&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; He complained of myodesopsia and the ophthalmological examination revealed iritis and lens opacity&#46; Biopsy of the plaque on the scalp showed sarcoid granulomas extending from the mid to deep dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; The patient was treated with local topical steroids&#44; to which he responded poorly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All 3 patients were treated with local topical steroids&#44; with a poor outcome in all cases&#46; No systemic treatments were administered&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The clinical presentation of scalp sarcoidosis consists of indurated verrucous plaques and nodular lesions&#44; often accompanied by alopecia&#44; and can resemble that of discoid lupus erythematosus&#44; necrobiosis lipoidica&#44; organoid nevus&#44; and cicatricial alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;5</span></a> In general&#44; scalp sarcoidosis is accompanied by sarcoid skin lesions in other locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Our 3 patients had infiltrated plaques with alopecia&#46; Unfortunately&#44; a trichoscopic examination&#44; which is necessary to identify the trichoscopic features of scalp sarcoidosis&#44; was not performed prior to biopsy&#46; The alopecia may have been a consequence of the effects of the sarcoid granuloma on the follicles or of follicular replacement by the granuloma&#46; All 3 patients had cutaneous sarcoidosis on the legs as well as the scalp&#46; Sarcoidosis of other organs is common in patients with scalp sarcoidosis&#44; and pulmonary and ophthalmologic sarcoidosis was observed in all 3 patients&#46; In most cases&#44; scalp sarcoidosis affects patients with active systemic sarcoidosis&#46; We have previous experience with 2 other cases of scalp sarcoidosis in which biopsies were taken from locations other than the scalp&#46; In both cases the patients&#8217; alopecia was strongly suggestive of sarcoidosis&#46; Scalp involvement is common in cases of cutaneous sarcoidosis&#44; and therefore a careful examination of the scalp should be performed if sarcoidosis is suspected&#46; Indeed&#44; scalp sarcoidosis may be less rare than previously thought&#46; It is therefore important to include a scalp examination in the clinical examination of sarcoidosis patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Three Cases of Scalp Sarcoidosis with Alopecia
Tres casos de sarcoidosis del cuero cabelludo con alopecia
M. Ishikawa
Autor para correspondencia
ishimasa@fmu.ac.jp

Corresponding author.
, M. Ohtsuka, T. Yamamoto
Departamento de Dermatología, Universidad de Medicina de Fukushima, Fukushima, Japón
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and histological characteristics of scalp sarcoidosis &#40;hematoxylin-eosin staining&#44; original magnification &#215;200&#41;&#46; A and B&#44; Case 1&#46; C and D&#44; Case 2&#46; E and F&#44; Case 3&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Scalp sarcoidosis is a relatively infrequent disease that mainly affects African-American women&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> To date&#44; very few cases of this disease have been described&#46; We describe 3 patients with scalp sarcoidosis&#44; which manifested as infiltrated plaques with alopecia&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case 1&#46; The patient was a 50-year-old woman who was admitted to our hospital with exertional dyspnea&#44; photophobia&#44; and skin rash&#46; The physical examination revealed several indurated brown plaques on both lower limbs&#44; as well as partial&#44; irregularly distributed alopecia and scaling erythema &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Radiography and computed tomography &#40;CT&#41; of the thorax revealed bilateral hilar lymphadenopathy &#40;BHL&#41; and mediastinal lymphadenopathy&#46; Serum levels of angiotensin converting enzyme &#40;ACE&#41; were elevated &#40;72&#46;8&#160;U&#47;L&#59; normal range&#44; 7&#8211;25&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; The ophthalmological examination revealed uveitis&#46; Biopsy of the scalp showed non-necrotizing epithelioid granulomas located in the upper to mid dermis with minimal lymphocytic infiltration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Naked granulomas were also detected in another sample taken from the leg&#46; The patient was treated with local topical steroids&#44; to which she responded poorly&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Case 2&#46; The patient was a 51-year-old man who was referred to our department with pulmonary sarcoidosis and uveitis&#46; He complained of blurred vision&#46; The ophthalmological examination revealed nodules in the iris&#44; inflammation of the anterior segment&#44; and vitreous opacity&#46; Radiography and a chest CT scan revealed BHL&#46; Serum ACE levels were elevated &#40;64&#46;5&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; The physical examination revealed indurated reddish-brown plaques and regularly distributed areas of alopecia with black spots on the scalp &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#44; as well as dark red subcutaneous nodules on the legs&#46; Biopsies of the scalp and legs revealed sarcoid granulomas located in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The patient was treated with local topical steroids&#44; to which he responded poorly&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 3&#46; The patient was a 71-year-old man who was referred to our department with uveitis&#46; He reported skin rash on the scalp and the right leg&#46; Physical examination of the scalp revealed multiple erythematous&#44; scaly&#44; indurated areas and an egg-sized&#44; indurated alopecic plaque with black spots &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; There were dark red subcutaneous nodules on the right leg&#46; Radiography and a chest CT scan revealed BHL&#46; Serum ACE levels were elevated &#40;42&#46;5&#160;U&#47;L&#41;&#46; The patient had a negative reaction in the tuberculin test&#46; He complained of myodesopsia and the ophthalmological examination revealed iritis and lens opacity&#46; Biopsy of the plaque on the scalp showed sarcoid granulomas extending from the mid to deep dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; The patient was treated with local topical steroids&#44; to which he responded poorly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All 3 patients were treated with local topical steroids&#44; with a poor outcome in all cases&#46; No systemic treatments were administered&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The clinical presentation of scalp sarcoidosis consists of indurated verrucous plaques and nodular lesions&#44; often accompanied by alopecia&#44; and can resemble that of discoid lupus erythematosus&#44; necrobiosis lipoidica&#44; organoid nevus&#44; and cicatricial alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;5</span></a> In general&#44; scalp sarcoidosis is accompanied by sarcoid skin lesions in other locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Our 3 patients had infiltrated plaques with alopecia&#46; Unfortunately&#44; a trichoscopic examination&#44; which is necessary to identify the trichoscopic features of scalp sarcoidosis&#44; was not performed prior to biopsy&#46; The alopecia may have been a consequence of the effects of the sarcoid granuloma on the follicles or of follicular replacement by the granuloma&#46; All 3 patients had cutaneous sarcoidosis on the legs as well as the scalp&#46; Sarcoidosis of other organs is common in patients with scalp sarcoidosis&#44; and pulmonary and ophthalmologic sarcoidosis was observed in all 3 patients&#46; In most cases&#44; scalp sarcoidosis affects patients with active systemic sarcoidosis&#46; We have previous experience with 2 other cases of scalp sarcoidosis in which biopsies were taken from locations other than the scalp&#46; In both cases the patients&#8217; alopecia was strongly suggestive of sarcoidosis&#46; Scalp involvement is common in cases of cutaneous sarcoidosis&#44; and therefore a careful examination of the scalp should be performed if sarcoidosis is suspected&#46; Indeed&#44; scalp sarcoidosis may be less rare than previously thought&#46; It is therefore important to include a scalp examination in the clinical examination of sarcoidosis patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ishikawa M&#44; Ohtsuka M&#44; Yamamoto T&#46; Three Cases of Scalp Sarcoidosis with Alopecia&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;933&#8211;934&#46;</p>"
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