Cicatricial pemphigoid Brunsting–Perry variant masquerading as neutrophil‐mediated cicatricial alopecia
A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial tr...
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Veröffentlicht in: | Journal of cutaneous pathology 2022-04, Vol.49 (4), p.408-411 |
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description | A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy result was interpreted to represent a neutrophil‐mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis showed linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes, and plasma cells, as well as prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting–Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil‐rich form of cicatricial pemphigoid can masquerade as a neutrophil‐mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil‐mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid. |
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Kari ; Berger, Timothy ; Pincus, Laura B.</creator><creatorcontrib>Rahbar, Ziba ; Cohen, Jarish N. ; McCalmont, Timothy H. ; LeBoit, Philip E. ; Connolly, M. Kari ; Berger, Timothy ; Pincus, Laura B.</creatorcontrib><description>A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy result was interpreted to represent a neutrophil‐mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis showed linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes, and plasma cells, as well as prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting–Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil‐rich form of cicatricial pemphigoid can masquerade as a neutrophil‐mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil‐mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid.</description><identifier>ISSN: 0303-6987</identifier><identifier>EISSN: 1600-0560</identifier><identifier>DOI: 10.1111/cup.14177</identifier><identifier>PMID: 34841567</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Alopecia ; Alopecia - pathology ; Baldness ; Biopsy ; Bullous pemphigoid ; cicatricial ; Fibrosis ; Follicles ; Humans ; Immunofluorescence ; Immunoglobulin G ; Leukocytes (neutrophilic) ; Lymphocytes ; Male ; neutrophil ; Neutrophils ; Neutrophils - pathology ; pemphigoid ; Pemphigoid, Benign Mucous Membrane - pathology ; Plaques ; Plasma cells ; Scalp ; scarring ; Skin ; Skin eruptions</subject><ispartof>Journal of cutaneous pathology, 2022-04, Vol.49 (4), p.408-411</ispartof><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3207-e08ad91fef78bfbbf9d8973e9d0be6565ab9c3b654b537fc665a145a7e22636c3</citedby><cites>FETCH-LOGICAL-c3207-e08ad91fef78bfbbf9d8973e9d0be6565ab9c3b654b537fc665a145a7e22636c3</cites><orcidid>0000-0002-5146-0395</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcup.14177$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcup.14177$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34841567$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rahbar, Ziba</creatorcontrib><creatorcontrib>Cohen, Jarish N.</creatorcontrib><creatorcontrib>McCalmont, Timothy H.</creatorcontrib><creatorcontrib>LeBoit, Philip E.</creatorcontrib><creatorcontrib>Connolly, M. Kari</creatorcontrib><creatorcontrib>Berger, Timothy</creatorcontrib><creatorcontrib>Pincus, Laura B.</creatorcontrib><title>Cicatricial pemphigoid Brunsting–Perry variant masquerading as neutrophil‐mediated cicatricial alopecia</title><title>Journal of cutaneous pathology</title><addtitle>J Cutan Pathol</addtitle><description>A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy result was interpreted to represent a neutrophil‐mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis showed linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes, and plasma cells, as well as prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting–Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil‐rich form of cicatricial pemphigoid can masquerade as a neutrophil‐mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil‐mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid.</description><subject>Aged</subject><subject>Alopecia</subject><subject>Alopecia - pathology</subject><subject>Baldness</subject><subject>Biopsy</subject><subject>Bullous pemphigoid</subject><subject>cicatricial</subject><subject>Fibrosis</subject><subject>Follicles</subject><subject>Humans</subject><subject>Immunofluorescence</subject><subject>Immunoglobulin G</subject><subject>Leukocytes (neutrophilic)</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>neutrophil</subject><subject>Neutrophils</subject><subject>Neutrophils - pathology</subject><subject>pemphigoid</subject><subject>Pemphigoid, Benign Mucous Membrane - pathology</subject><subject>Plaques</subject><subject>Plasma cells</subject><subject>Scalp</subject><subject>scarring</subject><subject>Skin</subject><subject>Skin eruptions</subject><issn>0303-6987</issn><issn>1600-0560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9PwyAYh4nRuDk9-AVME08eukEp0B618V-yxB3cmQClk9m1FVrNbvsIJn7DfRLRTuNFLi_hfXhe-AFwiuAY-TVRXTNGMWJsDwwRhTCEhMJ9MIQY4pCmCRuAI-eWECKaUHIIBjhOYkQoG4LnzCjRWqOMKINGr5ons6hNHlzZrnKtqRbbzcdMW7sOXoU1omqDlXAvnbYi981AuKDSXWtrf6_cbt5XOjei1Xmg_mhFWTfa747BQSFKp092dQTmN9eP2V04fbi9zy6nocIRZKGGichTVOiCJbKQskjzJGVYpzmUmhJKhEwVlpTEkmBWKOpPUEwE01FEMVV4BM57b2Nr_1TX8mXd2cqP5BGNEWWYxMxTFz2lbO2c1QVvrFkJu-YI8q9YuY-Vf8fq2bOdsZP-i7_kT44emPTAmyn1-n8Tz-azXvkJKcaGBw</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Rahbar, Ziba</creator><creator>Cohen, Jarish N.</creator><creator>McCalmont, Timothy H.</creator><creator>LeBoit, Philip E.</creator><creator>Connolly, M. Kari</creator><creator>Berger, Timothy</creator><creator>Pincus, Laura B.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><orcidid>https://orcid.org/0000-0002-5146-0395</orcidid></search><sort><creationdate>202204</creationdate><title>Cicatricial pemphigoid Brunsting–Perry variant masquerading as neutrophil‐mediated cicatricial alopecia</title><author>Rahbar, Ziba ; Cohen, Jarish N. ; McCalmont, Timothy H. ; LeBoit, Philip E. ; Connolly, M. Kari ; Berger, Timothy ; Pincus, Laura B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3207-e08ad91fef78bfbbf9d8973e9d0be6565ab9c3b654b537fc665a145a7e22636c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Alopecia</topic><topic>Alopecia - pathology</topic><topic>Baldness</topic><topic>Biopsy</topic><topic>Bullous pemphigoid</topic><topic>cicatricial</topic><topic>Fibrosis</topic><topic>Follicles</topic><topic>Humans</topic><topic>Immunofluorescence</topic><topic>Immunoglobulin G</topic><topic>Leukocytes (neutrophilic)</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>neutrophil</topic><topic>Neutrophils</topic><topic>Neutrophils - pathology</topic><topic>pemphigoid</topic><topic>Pemphigoid, Benign Mucous Membrane - pathology</topic><topic>Plaques</topic><topic>Plasma cells</topic><topic>Scalp</topic><topic>scarring</topic><topic>Skin</topic><topic>Skin eruptions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rahbar, Ziba</creatorcontrib><creatorcontrib>Cohen, Jarish N.</creatorcontrib><creatorcontrib>McCalmont, Timothy H.</creatorcontrib><creatorcontrib>LeBoit, Philip E.</creatorcontrib><creatorcontrib>Connolly, M. Kari</creatorcontrib><creatorcontrib>Berger, Timothy</creatorcontrib><creatorcontrib>Pincus, Laura B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Journal of cutaneous pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rahbar, Ziba</au><au>Cohen, Jarish N.</au><au>McCalmont, Timothy H.</au><au>LeBoit, Philip E.</au><au>Connolly, M. Kari</au><au>Berger, Timothy</au><au>Pincus, Laura B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cicatricial pemphigoid Brunsting–Perry variant masquerading as neutrophil‐mediated cicatricial alopecia</atitle><jtitle>Journal of cutaneous pathology</jtitle><addtitle>J Cutan Pathol</addtitle><date>2022-04</date><risdate>2022</risdate><volume>49</volume><issue>4</issue><spage>408</spage><epage>411</epage><pages>408-411</pages><issn>0303-6987</issn><eissn>1600-0560</eissn><abstract>A 72‐year‐old male presented with scarring alopecia on the scalp vertex, multiple crusted plaques on the hairline, and a history of vesicular eruption on the face. The scalp showed crusted plaques with loss of follicular ostia. No follicular pustules or compound follicles were present. An initial transverse scalp biopsy showed perifollicular neutrophils, lymphocytes, and plasma cells along with dermal fibrosis. Focal epidermal/dermal and follicular/adventitial dermal clefts were apparent but were thought to be secondary to fibrosis, and the biopsy result was interpreted to represent a neutrophil‐mediated cicatricial alopecia. Concurrently, direct immunofluorescence (DIF) analysis showed linear junctional deposition of IgG and C3. A repeat scalp biopsy revealed more prominent epidermal/dermal clefts, fibrosis, mixed infiltrate with neutrophils, lymphocytes, histiocytes, and plasma cells, as well as prominent follicular/adventitial dermal clefts with perifollicular neutrophils. Given the combination of clefts, perijunctional neutrophils, and positive DIF findings, it became clear that this eruption represented the Brunsting–Perry variant of cicatricial pemphigoid. Here, we illustrated that a neutrophil‐rich form of cicatricial pemphigoid can masquerade as a neutrophil‐mediated scarring alopecia. In evaluating a specimen suspected to be a neutrophil‐mediated scarring alopecia, one should be alert to the presence of subepidermal and perifollicular clefting, and consider cicatricial pemphigoid.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>34841567</pmid><doi>10.1111/cup.14177</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-5146-0395</orcidid></addata></record> |
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subjects | Aged Alopecia Alopecia - pathology Baldness Biopsy Bullous pemphigoid cicatricial Fibrosis Follicles Humans Immunofluorescence Immunoglobulin G Leukocytes (neutrophilic) Lymphocytes Male neutrophil Neutrophils Neutrophils - pathology pemphigoid Pemphigoid, Benign Mucous Membrane - pathology Plaques Plasma cells Scalp scarring Skin Skin eruptions |
title | Cicatricial pemphigoid Brunsting–Perry variant masquerading as neutrophil‐mediated cicatricial alopecia |
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