ISABELLA IBRAHIM DOCHE SOARES
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- Evidence for neurogenic inflammation in lichen planopilaris and frontal fibrosing alopecia pathogenic mechanism(2020) DOCHE, Isabella; WILCOX, George L.; ERICSON, Marna; VALENTE, Neusa S.; ROMITI, Ricardo; MCADAMS, Brian. D.; HORDINSKY, Maria K.Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic scarring alopecias affecting primarily the scalp. Although both diseases may share some clinical and histopathological features, in the last decade, FFA has become an ""epidemic"" particularly in Europe, North and South America with unique clinical manifestations compared to LPP, thus, raising the idea that this disease may have a different pathogenesis. Symptoms such as scalp burning, pruritus or pain are usually present in both diseases, suggesting a possible role for nerves and neuropeptides in the pathogenesis of both diseases. Based on some previous studies, neuropeptides, such as substance P (SP) and calcitonin gene-related peptide (CGRP), have been associated with lipid metabolism and many chronic inflammatory disorders. In this study, we asked if these neuropeptides are associated with LPP and FFA scalp lesions. Alteration in the expression of SP and CGRP in affected and unaffected scalp skin from patients with both diseases was found with examination of sections using immunohistochemical techniques and confocal microscopy. We then quantitatively assessed and compared SP and CGRP expression from control, LPP and FFA scalp biopsies. Although LPP and FFA share similar histopathologic findings, opposite results were found in affected and unaffected scalp in the ELISA tests, suggesting that these diseases may have different pathogenic mechanisms. We also found presence of histopathological inflammation irrespective of evident clinical lesions, which raises the possibility that both diseases may be more generalized processes affecting the scalp.
- Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG)(2021) OLSEN, E. A.; HARRIES, M.; TOSTI, A.; BERGFELD, W.; BLUME-PEYTAVI, U.; CALLENDER, V.; CHASAPI, V.; CORREIA, O.; COTSARELIS, G.; DHURAT, R.; DLOVA, N.; DOCHE, I.; ENECHUKWU, N.; GRIMALT, R.; ITAMI, S.; HORDINSKY, M.; KHOBZEI, K.; LEE, W. -S.; MALAKAR, S.; MESSENGER, A.; MCMICHAEL, A.; MIRMIRANI, P.; OVCHARENKO, Y.; PAPANIKOU, S.; PINTO, G. M.; PIRACCINI, B. M.; PIRMEZ, R.; REYGAGNE, P.; ROBERTS, J.; RUDNICKA, L.; SACEDA-CORRALO, D.; SHAPIRO, J.; SILYUK, T.; SINCLAIR, R.; SOARES, R. O.; SOUISSI, A.; VOGT, A.; WASHENIK, K.; ZLOTOGORSKI, A.; CANFIELD, D.; VANO-GALVAN, S.Background Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. Objectives To enable data to be collected worldwide on FFA using common criteria and assessment methods. Methods A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. Results Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. Conclusions These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
- Occipital Fibrosing Alopecia in a Young Male: A Case Report(2021) DOCHE, Isabella; REBEIS, Marina; VALENTE, Neusa; RIVITTI-MACHADO, Maria CeciliaIntroduction: Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia with 3 recognized clinical variants. Lately, LPP clinical spectrum has expanded with new and overlapping clinical variants. First considered as a subtype of LPP affecting postmenopausal women, the increasing worldwide incidence of FFA including atypical lesions in young female and male suggests a different pathomechanism for this disease. Although LPP-spectrum disorders may share similar histopathological findings, clinical features and prognosis are different. Case Report: A 26-year-old Caucasian male presented with occipital scarring alopecia and pruritus for the last 6 months. The patient had been treated for an associated androgenetic alopecia and superficial recurrent scalp folliculitis over the vertex scalp for the last 5 years. Trichoscopy of the occipital scalp showed mild diffuse erythema, moderate peripilar scaling, and absence of follicular openings, suggestive of a scarring process. The patient underwent an occipital scalp biopsy that confirmed the diagnosis of a LPP-spectrum disorder. Discussion/Conclusion: Both LPP and FFA mostly affect the anterior-mid scalp of females. However, recent reports on FFA also in premenopausal women and men should make physicians aware of atypical features of this disease and unusual clinical presentation.
- Normal-appearing scalp areas are also affected in lichen planopilaris and frontal fibrosing alopecia: An observational histopathologic study of 40 patients(2020) DOCHE, Isabella; ROMITI, Ricardo; HORDINSKY, Maria K.; VALENTE, Neusa S.Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocyte-mediated scarring alopecias which clinically affect primarily the anterior and mid-scalp. However, unaffected scalp areas have not yet been investigated in a systemic manner. In this study, we assessed histopathologic changes in affected and unaffected scalp in both diseases and healthy control subjects and compared these findings with clinical signs and scalp symptoms. We have demonstrated that ""normal-appearing"" scalp that is devoid of clinical lesions of LPP and FFA showed lymphocytic perifollicular inflammation around the isthmus/infundibulum areas in 65% of biopsy specimens, perifollicular fibrosis in 15% and mucin deposits in 7.5% of the cases. None of these findings were found in control samples. No direct correlation was found between the degree of histopathological inflammation, scalp symptoms and clinical lesions in the corresponding affected scalp areas. This preliminary study suggests that both diseases may be more generalized processes which affect the scalp and therefore need systemic or total scalp therapy.
- Trichoscopy of Steroid-Induced Atrophy(2017) PIRMEZ, Rodrigo; ABRAHAM, Leonardo S.; DUQUE-ESTRADA, Bruna; DAMASCO, Patricia; FARIAS, Debora Cadore; KELLY, Yanna; DOCHE, IsabellaIntralesional corticosteroid (IL-CS) injections have been used to treat a variety of dermatological and nondermatological diseases. Although an important therapeutic tool in dermatology, a number of local side effects, including skin atrophy, have been reported following IL-CS injections. We recently noticed that a subset of patients with steroid-induced atrophy presented with ivory-colored areas under trichoscopy. We performed a retrospective analysis of trichoscopic images and medical records from patients presenting ivorycolored areas associated with atrophic scalp lesions. In this paper, we associate this feature with the presence of steroid deposits in the dermis and report additional trichoscopic features of steroid-induced atrophy on the scalp, such as prominent blood vessels and visualization of hair bulbs. (C) 2017 S.Karger AG, Basel
- Trichostasis spinulosa of the scalp mimicking Alopecia Areata black dots(2014) CHAGAS, Flavianne Sobral Cardoso; DONATI, Aline; SOARES, Isabella Ibrahim Doche; VALENTE, Neusa Sakai; ROMITI, RicardoAlopecia areata is a common autoimmune disorder that leads to nonscarring hair loss. Black dots, also called comedo-like cadaver hairs, can be found in almost 50% of alopecia areata patients and indicate disease activity. Trichostasis spinulosa is a follicular disorder resulting from the retention of numerous hairs surrounded by a keratinous sheath in dilated follicles. Trichostasis spinulosa is a relatively common but underdiagnosed disorder of hair follicles. Here, we describe a man with alopecia areata of the eyebrows, androgenetic alopecia and trichostasis spinulosa at the vertex and show how dermoscopy can be useful in distinguishing black dots from Trichostasis spinulosa lesions.
- Correlation of clinical, histopathologic, and direct immunofluorescence findings in lesional and nonlesional scalp of frontal fibrosing alopecia and lichen planopilaris – An observational study(2023) DOCHE, I.; VALENTE, N.; SOTTO, M. N.; RIVITTI-MACHADO, M. C.; AOKI, V.; GERLERO, P.; HORDINSKY, M. K.