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Skin Type: 1

  • Granuloma Annulare

    Granuloma Annulare

    Granuloma annulare 

    Condition Name: Granuloma annulare

    Definition: Granuloma annulare is a benign, chronic skin condition characterized by the formation of annular plaques or papules.

    Etiology: The exact cause of granuloma annulare is unknown, though it is believed to involve an immune-mediated response.

    Epidemiology: Granuloma annulare affects individuals of all ages but is more commonly seen in children and young adults. It is slightly more prevalent in females than in males. The prevalence in the general population is relatively low, and the condition is not typically associated with significant morbidity.

    Signs: The appearance of small, firm, flesh-colored or erythematous papules that coalesce to form rings with a central depression. These lesions most commonly appear on the hands, feet, elbows, and knees but can occur on any part of the body.

    Symptoms: The lesions are usually asymptomatic but can occasionally cause mild itching.

    Differentials: Conditions such as tinea corporis, sarcoidosis, and necrobiosis lipoidica should be considered.

    Diagnosis: Diagnosis is primarily clinical, based on the characteristic appearance of the lesions. A skin biopsy can confirm the diagnosis by revealing necrobiotic collagen surrounded by histiocytes and multinucleated giant cells.

    Treatment: Treatment is often unnecessary as granuloma annulare can resolve spontaneously, particularly in localized cases. Treatment options for persistent or widespread cases include topical or intralesional corticosteroids, cryotherapy, or laser therapy. Systemic treatments, such as dapsone, isotretinoin, or hydroxychloroquine, may be considered for more severe cases.

    References:

    ●       Piette, E. W., & Rosenbach, M. (2016). Granuloma annulare: Pathogenesis, disease associations, and triggers, and therapeutic options. Journal of the American Academy of Dermatology, 75(3), 467-479. doi:10.1016/j.jaad.2016.02.1222

    ●       Marneros, A. G., & Bruckner, A. L. (2010). “Granuloma annulare.” Journal of the American Academy of Dermatology, 62(2), 207-222. doi:10.1016/j.jaad.2009.03.044

  • Granuloma Annulare

    Granuloma Annulare

    Granuloma annulare 

    Condition Name: Granuloma annulare

    Definition: Granuloma annulare is a benign, chronic skin condition characterized by the formation of annular plaques or papules.

    Etiology: The exact cause of granuloma annulare is unknown, though it is believed to involve an immune-mediated response.

    Epidemiology: Granuloma annulare affects individuals of all ages but is more commonly seen in children and young adults. It is slightly more prevalent in females than in males. The prevalence in the general population is relatively low, and the condition is not typically associated with significant morbidity.

    Signs: The appearance of small, firm, flesh-colored or erythematous papules that coalesce to form rings with a central depression. These lesions most commonly appear on the hands, feet, elbows, and knees but can occur on any part of the body.

    Symptoms: The lesions are usually asymptomatic but can occasionally cause mild itching.

    Differentials: Conditions such as tinea corporis, sarcoidosis, and necrobiosis lipoidica should be considered.

    Diagnosis: Diagnosis is primarily clinical, based on the characteristic appearance of the lesions. A skin biopsy can confirm the diagnosis by revealing necrobiotic collagen surrounded by histiocytes and multinucleated giant cells.

    Treatment: Treatment is often unnecessary as granuloma annulare can resolve spontaneously, particularly in localized cases. Treatment options for persistent or widespread cases include topical or intralesional corticosteroids, cryotherapy, or laser therapy. Systemic treatments, such as dapsone, isotretinoin, or hydroxychloroquine, may be considered for more severe cases.

    References:

    ●       Piette, E. W., & Rosenbach, M. (2016). Granuloma annulare: Pathogenesis, disease associations, and triggers, and therapeutic options. Journal of the American Academy of Dermatology, 75(3), 467-479. doi:10.1016/j.jaad.2016.02.1222

    ●       Marneros, A. G., & Bruckner, A. L. (2010). “Granuloma annulare.” Journal of the American Academy of Dermatology, 62(2), 207-222. doi:10.1016/j.jaad.2009.03.044

  • Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Condition Name: Frontal fibrosing alopecia (FFA)

    Definition: Frontal fibrosing alopecia (FFA) is a type of cicatricial (scarring) alopecia characterized by the progressive recession of the frontal hairline and often the eyebrows.

    Etiology: The etiology of FFA remains unclear, though hormonal, genetic, and environmental factors are believed to contribute. It is considered a variant of lichen planopilaris, an inflammatory condition that results in scarring hair loss.

    Epidemiology: FFA predominantly affects postmenopausal women, though it can also occur in men and younger women. It has been increasingly recognized since its initial description in the 1990s, with rising incidence rates suggesting either a true increase in prevalence or better recognition by clinicians. It primarily affects women over the age of 50, but cases in younger women and men have been reported.

    Signs: The symmetrical recession of the frontal hairline, is often accompanied by perifollicular erythema and follicular hyperkeratosis. Loss of eyebrows and, less commonly, body hair can also occur.

    Symptoms: Patients may experience pruritus and a sensation of tightness in the scalp, in addition to hair loss.

    Differentials: Conditions such as lichen planopilaris, traction alopecia, and alopecia areata should be considered.

    Diagnosis: Diagnosis is based on clinical examination, and patient history, and may include a scalp biopsy to confirm the presence of scarring and inflammation around hair follicles.

    Treatment: Treatment aims to halt the progression of hair loss and reduce symptoms. Common therapeutic approaches include topical and intralesional corticosteroids, oral antimalarials like hydroxychloroquine, and systemic anti-inflammatory medications such as doxycycline and finasteride. Early diagnosis and intervention are crucial for effective management.

    References:

    ●       Tziotzios, C., Stefanato, C. M., Fenton, D. A., & McGrath, J. A. (2015). Frontal fibrosing alopecia: Reflections and hypotheses on aetiology and pathogenesis. Experimental Dermatology, 25(3), 847-852. doi:10.1111/exd.13061

    ●       Kossard, S., Lee, M. S., Wilkinson, B., & Kossard, D. (2020). “Frontal fibrosing alopecia: A review of 60 cases.” Journal of the American Academy of Dermatology, 83(4), 1105-1112. doi:10.1016/j.jaad.2020.04.007

  • Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Condition Name: Frontal fibrosing alopecia (FFA)

    Definition: Frontal fibrosing alopecia (FFA) is a type of cicatricial (scarring) alopecia characterized by the progressive recession of the frontal hairline and often the eyebrows.

    Etiology: The etiology of FFA remains unclear, though hormonal, genetic, and environmental factors are believed to contribute. It is considered a variant of lichen planopilaris, an inflammatory condition that results in scarring hair loss.

    Epidemiology: FFA predominantly affects postmenopausal women, though it can also occur in men and younger women. It has been increasingly recognized since its initial description in the 1990s, with rising incidence rates suggesting either a true increase in prevalence or better recognition by clinicians. It primarily affects women over the age of 50, but cases in younger women and men have been reported.

    Signs: The symmetrical recession of the frontal hairline, is often accompanied by perifollicular erythema and follicular hyperkeratosis. Loss of eyebrows and, less commonly, body hair can also occur.

    Symptoms: Patients may experience pruritus and a sensation of tightness in the scalp, in addition to hair loss.

    Differentials: Conditions such as lichen planopilaris, traction alopecia, and alopecia areata should be considered.

    Diagnosis: Diagnosis is based on clinical examination, and patient history, and may include a scalp biopsy to confirm the presence of scarring and inflammation around hair follicles.

    Treatment: Treatment aims to halt the progression of hair loss and reduce symptoms. Common therapeutic approaches include topical and intralesional corticosteroids, oral antimalarials like hydroxychloroquine, and systemic anti-inflammatory medications such as doxycycline and finasteride. Early diagnosis and intervention are crucial for effective management.

    References:

    ●       Tziotzios, C., Stefanato, C. M., Fenton, D. A., & McGrath, J. A. (2015). Frontal fibrosing alopecia: Reflections and hypotheses on aetiology and pathogenesis. Experimental Dermatology, 25(3), 847-852. doi:10.1111/exd.13061

    ●       Kossard, S., Lee, M. S., Wilkinson, B., & Kossard, D. (2020). “Frontal fibrosing alopecia: A review of 60 cases.” Journal of the American Academy of Dermatology, 83(4), 1105-1112. doi:10.1016/j.jaad.2020.04.007

  • Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Condition Name: Frontal fibrosing alopecia (FFA)

    Definition: Frontal fibrosing alopecia (FFA) is a type of cicatricial (scarring) alopecia characterized by the progressive recession of the frontal hairline and often the eyebrows.

    Etiology: The etiology of FFA remains unclear, though hormonal, genetic, and environmental factors are believed to contribute. It is considered a variant of lichen planopilaris, an inflammatory condition that results in scarring hair loss.

    Epidemiology: FFA predominantly affects postmenopausal women, though it can also occur in men and younger women. It has been increasingly recognized since its initial description in the 1990s, with rising incidence rates suggesting either a true increase in prevalence or better recognition by clinicians. It primarily affects women over the age of 50, but cases in younger women and men have been reported.

    Signs: The symmetrical recession of the frontal hairline, is often accompanied by perifollicular erythema and follicular hyperkeratosis. Loss of eyebrows and, less commonly, body hair can also occur.

    Symptoms: Patients may experience pruritus and a sensation of tightness in the scalp, in addition to hair loss.

    Differentials: Conditions such as lichen planopilaris, traction alopecia, and alopecia areata should be considered.

    Diagnosis: Diagnosis is based on clinical examination, and patient history, and may include a scalp biopsy to confirm the presence of scarring and inflammation around hair follicles.

    Treatment: Treatment aims to halt the progression of hair loss and reduce symptoms. Common therapeutic approaches include topical and intralesional corticosteroids, oral antimalarials like hydroxychloroquine, and systemic anti-inflammatory medications such as doxycycline and finasteride. Early diagnosis and intervention are crucial for effective management.

    References:

    ●       Tziotzios, C., Stefanato, C. M., Fenton, D. A., & McGrath, J. A. (2015). Frontal fibrosing alopecia: Reflections and hypotheses on aetiology and pathogenesis. Experimental Dermatology, 25(3), 847-852. doi:10.1111/exd.13061

    ●       Kossard, S., Lee, M. S., Wilkinson, B., & Kossard, D. (2020). “Frontal fibrosing alopecia: A review of 60 cases.” Journal of the American Academy of Dermatology, 83(4), 1105-1112. doi:10.1016/j.jaad.2020.04.007

  • Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Frontal Fibrosing Alopecia

    Condition Name: Frontal fibrosing alopecia (FFA)

    Definition: Frontal fibrosing alopecia (FFA) is a type of cicatricial (scarring) alopecia characterized by the progressive recession of the frontal hairline and often the eyebrows.

    Etiology: The etiology of FFA remains unclear, though hormonal, genetic, and environmental factors are believed to contribute. It is considered a variant of lichen planopilaris, an inflammatory condition that results in scarring hair loss.

    Epidemiology: FFA predominantly affects postmenopausal women, though it can also occur in men and younger women. It has been increasingly recognized since its initial description in the 1990s, with rising incidence rates suggesting either a true increase in prevalence or better recognition by clinicians. It primarily affects women over the age of 50, but cases in younger women and men have been reported.

    Signs: The symmetrical recession of the frontal hairline, is often accompanied by perifollicular erythema and follicular hyperkeratosis. Loss of eyebrows and, less commonly, body hair can also occur.

    Symptoms: Patients may experience pruritus and a sensation of tightness in the scalp, in addition to hair loss.

    Differentials: Conditions such as lichen planopilaris, traction alopecia, and alopecia areata should be considered.

    Diagnosis: Diagnosis is based on clinical examination, and patient history, and may include a scalp biopsy to confirm the presence of scarring and inflammation around hair follicles.

    Treatment: Treatment aims to halt the progression of hair loss and reduce symptoms. Common therapeutic approaches include topical and intralesional corticosteroids, oral antimalarials like hydroxychloroquine, and systemic anti-inflammatory medications such as doxycycline and finasteride. Early diagnosis and intervention are crucial for effective management.

    References:

    ●       Tziotzios, C., Stefanato, C. M., Fenton, D. A., & McGrath, J. A. (2015). Frontal fibrosing alopecia: Reflections and hypotheses on aetiology and pathogenesis. Experimental Dermatology, 25(3), 847-852. doi:10.1111/exd.13061

    ●       Kossard, S., Lee, M. S., Wilkinson, B., & Kossard, D. (2020). “Frontal fibrosing alopecia: A review of 60 cases.” Journal of the American Academy of Dermatology, 83(4), 1105-1112. doi:10.1016/j.jaad.2020.04.007

  • Folliculitis Decalvans

    Folliculitis Decalvans

    Folliculitis Decalvans

    Condition Name: Folliculitis decalvans

    Definition: Folliculitis decalvans is a chronic inflammatory disorder that primarily affects hair follicles, leading to scarring alopecia. It is characterized by recurrent pustules and crusts around hair follicles, eventually causing permanent hair loss in the affected areas.

    Etiology: The etiology of folliculitis decalvans is not fully understood, but it is believed to involve bacterial infection, particularly with Staphylococcus aureus, combined with an abnormal immune response.

    Epidemiology: Folliculitis decalvans is relatively rare and typically affects adults, with a slight male predominance. The exact prevalence is not well documented.

    Signs: Clinically, it presents with tufted folliculitis, where multiple hairs emerge from a single follicular opening surrounded by inflammation, along with recurrent pustules and crusts on the scalp.

    Symptoms: Symptoms include itching, pain, and the presence of pustules and crusts on the scalp.

    Differentials: Conditions such as dissecting cellulitis, lichen planopilaris, and acne keloidalis nuchae should be considered.

    Diagnosis: Diagnosis is based on clinical examination, patient history, and, if needed, biopsy to confirm the presence of inflammation and scarring around hair follicles.

    Treatment: Treatment focuses on controlling infection and inflammation to prevent further hair loss. Topical and systemic antibiotics, such as clindamycin and rifampicin, are commonly used. Additionally, anti-inflammatory medications like corticosteroids and immunosuppressive agents may be prescribed. Early intervention is crucial to manage symptoms and slow the progression of scarring.

    References:

    ●       Scheinfeld, N. (2003). “Folliculitis decalvans: A review of the literature.” American Journal of Clinical Dermatology, 4(6), 369-374. doi:10.2165/00128071-200304060-00003

    ●       Otberg, N., & Shapiro, J. (2008). “Diagnosis and management of primary cicatricial alopecia: Part II. Treatment.” Journal of the American Academy of Dermatology, 59(1), 1-22. doi:10.1016/j.jaad.2008.01.072

  • Folliculitis Decalvans

    Folliculitis Decalvans

    Folliculitis Decalvans

    Condition Name: Folliculitis decalvans

    Definition: Folliculitis decalvans is a chronic inflammatory disorder that primarily affects hair follicles, leading to scarring alopecia. It is characterized by recurrent pustules and crusts around hair follicles, eventually causing permanent hair loss in the affected areas.

    Etiology: The etiology of folliculitis decalvans is not fully understood, but it is believed to involve bacterial infection, particularly with Staphylococcus aureus, combined with an abnormal immune response.

    Epidemiology: Folliculitis decalvans is relatively rare and typically affects adults, with a slight male predominance. The exact prevalence is not well documented.

    Signs: Clinically, it presents with tufted folliculitis, where multiple hairs emerge from a single follicular opening surrounded by inflammation, along with recurrent pustules and crusts on the scalp.

    Symptoms: Symptoms include itching, pain, and the presence of pustules and crusts on the scalp.

    Differentials: Conditions such as dissecting cellulitis, lichen planopilaris, and acne keloidalis nuchae should be considered.

    Diagnosis: Diagnosis is based on clinical examination, patient history, and, if needed, biopsy to confirm the presence of inflammation and scarring around hair follicles.

    Treatment: Treatment focuses on controlling infection and inflammation to prevent further hair loss. Topical and systemic antibiotics, such as clindamycin and rifampicin, are commonly used. Additionally, anti-inflammatory medications like corticosteroids and immunosuppressive agents may be prescribed. Early intervention is crucial to manage symptoms and slow the progression of scarring.

    References:

    ●       Scheinfeld, N. (2003). “Folliculitis decalvans: A review of the literature.” American Journal of Clinical Dermatology, 4(6), 369-374. doi:10.2165/00128071-200304060-00003

    ●       Otberg, N., & Shapiro, J. (2008). “Diagnosis and management of primary cicatricial alopecia: Part II. Treatment.” Journal of the American Academy of Dermatology, 59(1), 1-22. doi:10.1016/j.jaad.2008.01.072

  • Basal Cell Carcinoma – Nodular

    Basal Cell Carcinoma – Nodular

    Nodular Basal Cell Carcinoma 

    Definition: Nodular Basal Cell carcinoma is a subtype of BCC that is marked by raised, pearly flesh coloured nodules with melanogenesis typically localized to the face (2,3).

    Etiology: Similar to other BCCs, Nodular BCC is caused primarily by exposure to ultraviolet light as well as genetic factors (3). In the skin of color, pigmented Nodular BCCs are more common (1).

    Epidemiology: Nodular Basal Cell carcinoma is the most common subtype of BCC and has a high incidence in individuals with fair skin with a significant history of sun exposure (1). Approximately 60% to 80% of BCC are of the Nodular subtype (4).

    Signs: Nodular BCC manifests as skin-coloured papules or nodules with pearly or translucent telangiectatic border (3,4). It may be described as having a rolled border in which the edges of the lesion are higher than the center (4). Large lesions may include ulceration (4).

    Symptoms: Typically asymptomatic but with time the lesions may crust or bleed (2,3).

    Differentials: Trichoblastoma and trichoepithelioma (1).

    Diagnosis: Diagnosis is confirmed through a shave or punch biopsy but clinical exam and dermoscopy can supplement the assessment (2).

    Treatment: Treatment is usually surgical involving either surgical excision or Mohs micrographic surgery (1,3). Non-surgical options include cryotherapy, topical therapies or radiation in some cases (1,3).

    References: (AMA)

    1.      1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

    2.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

    3.     1. Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

    4.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0 

  • Basa Cell Carcinoma – Nodular

    Basa Cell Carcinoma – Nodular

    Nodular Basal Cell Carcinoma 

    Definition: Nodular Basal Cell carcinoma is a subtype of BCC that is marked by raised, pearly flesh coloured nodules with melanogenesis typically localized to the face (2,3).

    Etiology: Similar to other BCCs, Nodular BCC is caused primarily by exposure to ultraviolet light as well as genetic factors (3). In the skin of color, pigmented Nodular BCCs are more common (1).

    Epidemiology: Nodular Basal Cell carcinoma is the most common subtype of BCC and has a high incidence in individuals with fair skin with a significant history of sun exposure (1). Approximately 60% to 80% of BCC are of the Nodular subtype (4).

    Signs: Nodular BCC manifests as skin-coloured papules or nodules with pearly or translucent telangiectatic border (3,4). It may be described as having a rolled border in which the edges of the lesion are higher than the center (4). Large lesions may include ulceration (4).

    Symptoms: Typically asymptomatic but with time the lesions may crust or bleed (2,3).

    Differentials: Trichoblastoma and trichoepithelioma (1).

    Diagnosis: Diagnosis is confirmed through a shave or punch biopsy but clinical exam and dermoscopy can supplement the assessment (2).

    Treatment: Treatment is usually surgical involving either surgical excision or Mohs micrographic surgery (1,3). Non-surgical options include cryotherapy, topical therapies or radiation in some cases (1,3).

    References: (AMA)

    1.      1. McDaniel B. Basal cell carcinoma. StatPearls [Internet]. March 13, 2024. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482439/#:~:text=BCC%20typically%20presents%20as%20a,rolled%20or%20rodent%20ulcer%20appearance.

    2.     Oakley A. Basal cell carcinoma: Symptoms, causes, and treatment – dermnet. DermNet®. July 3, 2024. Accessed August 18, 2024. https://dermnetnz.org/topics/basal-cell-carcinoma. 

    3.     1. Robert S Bader M. Basal cell carcinoma. Practice Essentials, Background, Pathophysiology. April 3, 2024. Accessed August 18, 2024. https://emedicine.medscape.com/article/276624-overview?gad_source=1&gbraid=0AAAAADoSQiUCwFng3uMBdxWlXHVuNMVrw&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Dqhf-P79uzm848PdW5k8auVX_QjoRGo38V0m2dFrNN42l3MpFCbyS0aAm4_EALw_wcB&form=fpf#a2.

    4.     Tanese K. Diagnosis and management of basal cell carcinoma. Current Treatment Options in Oncology. 2019;20(2). doi:10.1007/s11864-019-0610-0