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  • Presentation

Finding Solutions to Challenging Cases

Description

The presentation focuses on dermatological conditions, particularly those affecting patients with skin of color, and illustrates the complexities involved in diagnosing and treating challenging cases. The first case discusses a 41-year-old African American male with hair loss diagnosed with Central Centrifugal Cicatricial Alopecia (CCCA), a condition often misinterpreted as androgenetic alopecia (AGA). The speaker highlights the importance of dermoscopy in identifying specific signs of CCCA, emphasizing treatment options like minoxidil, clobetasol, and monthly triamcinolone injections that provide solutions and improvement for the patient. The second case involves a Hispanic woman diagnosed with a rare linear variant of lichen planus pigmentosis, which improved markedly with sun protection and tacrolimus. This case emphasizes the link between lichen planus pigmentosis and frontal fibrosing alopecia, urging dermatologists to conduct thorough skin examinations. The third case involves three patients with Pemphigus foliaceus, showing the diverse clinical presentations in patients of color, with the treatment strategy focusing on methotrexate and corticosteroids. The conclusion reiterates the significance of considering various presentations and treatment options for patients of color, enhancing access and convenience in managing these dermatological conditions.

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Conclusions

  • Central Centrifugal Cicatricial Alopecia (CCCA) is often misdiagnosed in men as Androgenetic Alopecia (AGA).
  • A significant prevalence of CCCA in men remains under-researched and under-diagnosed.
  • Dermoscopy is vital for diagnosing CCCA, revealing specific findings such as peripilar white/gray halos and honeycomb patterns.
  • A case series showed that 47% of men with CCCA had a positive family history, suggesting a genetic component.
  • CCCA can present with diverse clinical appearances and can be more common in specific demographics such as Black men.
  • Treatments for CCCA may include minoxidil, clobetasol, and oral finasteride with significant benefits seen in some patients.
  • Linear Lichen Planus Pigmentosus is predominantly found in middle-aged women of specific ethnicities and can be effectively treated with sun protection and tacrolimus.
  • Lichen Planus Pigmentosus is associated with Frontal Fibrosing Alopecia, highlighting the need for comprehensive skin examinations in patients experiencing hair loss.
  • Pemphigus Foliaceous has variable presentations in different skin types, necessitating a high index of suspicion for accurate diagnosis.
  • Methotrexate has shown promising results as an alternative treatment for pemphigus, providing effective disease control in patients.
  • Lubov, J. E ., Okereke, U. R ., Clapp, B ., Toyohara, J ., Taiwò, D ., Kakpovbia, E ., ... & Adotama, P. (2023). CCCA in Black Men: A Case Series highlighting key clinical features in this cohort. JAAD Case Reports.
  • Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2014 Sep;71(3):443-9. doi: 10.1016/j.jaad.2014.04.069. Epub 2014 Jun 11. PMID: 24929886.
  • Jackson, Tiaranesha K. et al. Central Centrifugal Cicatricial Alopecia in Males: A Case Series. Journal of the American Academy of Dermatology, Volume 0.
  • Tiaranesha Jackson, MPH · Yacine Sow, BA · Jewell Dinkins, MS · Crystal Aguh, MD · Katherine Omueti Ayoade, MD, PhD · Victoria Barbosa, MD, MPH, MBA · Cheryl Burgess, MD · Valerie Callender, MD · George Cotsarelis, MD · Pearl Grimes, MD · Valerie Harvey, MD, MPH · Chesahna Kindred, MD, MBA · Jenna Lester, MD · Kristen Lo Sicco, MD · Tiffany Mayo, MD · Achiamah Osei-Tutu, MD · Melissa Piliang, MD · Maryanne Senna, MD · Jerry Shapiro, MD. Treatment for Central Centrifugal Cicatricial Alopecia - De
  • Uwakwe LN, Cardwell LA, Dothard EH, Baroudi BI, McMichael AJ. Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women. J Drugs Dermatol. 2018 Apr 1;17(4):397-400. PMID: 29601616.
  • Abdel Azim MS, Whiting CA, Friedman AD. Highlighting the Link Between Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia. Journal of Drugs in Dermatology.
  • Lepe K, Yarrarapu SNS, Zito PM. Pemphigus Foliaceus. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan -, PMID: 29763004.
  • Kolla A, Shah P, Cymerman R, Fruchter R, Adotama P, Soter NA. Assessing the use of methotrexate as an alternate therapy for pemphigus vulgaris and pemphigus foliaceus. Dermatol Ther. 2022 Aug;35(8):e15661. doi: 10.1111/dth.15661. Epub 2022 Jul 1. PMID: 35734997.