Scarring alopecias

Ožiljne alopecije su heterogena skupina rijetkih poremećaja karakterizirana trajnom destrukcijom folikula dlake koja rezultira ožiljkom i trajnim, ireverzibilnim gubitkom dlaka. Smatra se da primarne ožiljne alopecije čine 3% ukupnog broja alopecija, a dijele se na primarne i sekundarne ožiljne alopecije. U ovom radu je naglasak na primarnim ožiljnim alopecijama, koje se klasificiraju tipu dominantnog upalnog infiltrata utvrđenog patohistološkom analizom bioptata zahvaćenog dijela vlasišta. Prema navedenoj klasifikaciji, primarne ožiljne alopecije dijele se na limfocitne, neutrofilne, mješovite i nespecifične. Limfocitne alopecije čine najveću skupinu primarnih ožiljnih alopecija obilježenih dominantno limfocitnim infiltratom i među njima razlikujemo nekoliko glavnih kliničkih entiteta: kronični kožni eritemski lupus, lichen planopilaris, frontalna fibrozirajuća alopecija, Graham-Little sindrom, pseudopelade Brocq, centralna centrifugalna ožiljna alopecija, alopecia mucinosa, keratosis follicularis spinulosa decalvans te, kao novi entitet, fibrozirajuća alopecija s posebnim uzorkom distribucije. Neutrofilne primarne ožiljne alopecije karakterizirane su većinski neutrofilnim infiltratom, a u ovu skupinu pripadaju folliculitis decalvans i disecirajući folikulitis vlasišta. Manje zastupljene primarne ožiljne alopecije su mješovite (acne keloidalis, acne necrotica i erozivna pustularna dermatoza vlasišta) i nespecifične (tinea capitis). Terapija ovih bolesti temelji se na smanjenju upale ako ista postoji (intralezionalni i lokalni kortikosteroidi, antibiotici) i modulaciji imunološkog odgovora (retinoidi, antimalarici, inhibitori kalcineurina). Naravno, svaki klinički entitet naveden u radu zahtijeva specifičnu terapiju koja je detaljno opisana.Scarring alopecia is a heterogeneous group of rare disorders characterized by permanent destruction of hair follicles resulting in scarring and permanent, irreversible hair loss. It has been estimated that primary scarring alopecias account for 3% of the total number of alopecia, and they are divided into primary and secondary scarring alopecia. This paper emphasizes primary scarring alopecias, which are classified according to the type of dominant inflammatory infiltrate determined by pathohistological analysis of biopsies of the affected part of the scalp. This classification divides primary scarring alopecias into lymphocytic, neutrophilic, mixed, and nonspecific. Lymphocytic alopecia is the largest group of primary scarring alopecia characterized by predominantly lymphocytic infiltrate, and among them, we distinguish several main clinical entities: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, Graham-Little syndrome, alopecia mucinosa, keratosis follicularis spinulosa decalvans and, as a new entity, fibrosing alopecia in a pattern of distribution. Neutrophilic primary scarring alopecia is characterized by a predominantly neutrophilic infiltrate, and folliculitis decalvans and dissecting scalp folliculitis belong to this group. Less common primary scarring alopecias include mixed (acne keloidalis, acne necrotica, and erosive pustular dermatosis of the scalp) and nonspecific (tinea capitis). Treatment of these diseases is based on reducing inflammation if present (intralesional and local corticosteroids, antibiotics) and modulating the immune response (retinoids, antimalarials, calcineurin inhibitors). Of course, each clinical entity listed in the paper requires a specific therapy that is described in detail