A 75-year-old woman presented with a 3-year history of progressive loss of her eyebrow hair and with frontal-parietal hairline recession. Multiple biopsy specimens supported a histopathologic diagnosis of lichen planopilaris. With these histolopathologic findings, and the patient's clinical presentation, a diagnosis of frontal fibrosing alopecia was made. Treatment to date with topical glucocorticoid preparations, intralesional triamcinolone injections, and tacrolimus ointment have been unsuccessful.
[Show abstract][Hide abstract] ABSTRACT: Frontal fibrosing alopecia (FFA) was first described in 1994 and is considered a variant of lichen planopilaris in a patterned distribution that primarily affects postmenopausal women. Cicatricial alopecia of the frontoparietal hairline is characteristic; the affected area appears as a shiny, band-like zone of incomplete hair loss with skin-coloured small hyperkeratotic papules. We describe a case of a premenopausal woman with this rare disease. To date there are very few reports of FFA in premenopausal women. The immunohistochemical investigation with lymphocytic markers (CD4, CD8, CD20, CD45RA, CD57) revealed CD8 positive lymphocytes penetrating the follicular epithelium. Direct immunofluorescence showed clumped deposition of IgM along the follicular basement membrane zone.
[Show abstract][Hide abstract] ABSTRACT: Tacrolimus is an ascomycin macrolactam derivative with immunomodulatory and anti-inflammatory activity that belongs to the class of calcineurin inhibitors. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis in two concentrations, 0.03 and 0.1%. In a thorough research of literature the authors review all of the available data regarding the off-label uses of the medication in other dermatoses. It seems that compared to pimecrolimus, tacrolimus has proved to be a more effective treatment. There is no causal relationship that has been established between tacrolimus and carcinogenesis. Furthermore, the authors believe that, without any evidence, the theoretical concerns are not enough to produce warnings. Tacrolimus ointment 0.1% may be recommended as a first-line choice for seborrheic dermatitis of the face and trunk, facial and intertriginous psoriasis and probably for allergic contact dermatitis and Zoon's balanitis. It has been ineffective in numerous dermatoses such as alopecia areata, necrobiosis lipoidica, internal pruritus and in thick hyperkeratotic plaques of psoriasis when administered as the commercially available formulation without occlusion. There is yet unexploited therapeutic potential regarding the use of topical tacrolimus in dermatology. Isolated cases of successful administration of the medication in various cutaneous conditions require further large-scale studies to clarify the actual effectiveness.
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