[Psoriatic alopecia manifestation, course and therapy in 34 patients]

We report on a long-term clinical study on 34 patients (aged 6 to 88) suffering from psoriasis vulgaris capillitii with ensuing loss of hair and alopecia. Most patients showed heavy hyperkeratosis. The loss of hair was either massive (sometimes in tufts) or moderate; its course was acute in 53%, chronically recurrent in 15%, and chronically progressive in 32% of the cases. The psoriatic alopecia was circumscribed in 80% (from the size of a coin up to that of a palm of a hand; thinned out or bare) and diffuse in 20% of the patients. Alopecia was only observed in psoriatic lesions, but not necessarily in every plaque. Thus, psoriasis of the entire scalp did either result in circumscribed or in diffuse alopecia. The trichogram taken from regions next to alopecic areas revealed a telogen rate between 25 and 86%, according to the respective progression of the disease. The light microscope showed the typical features of psoriasis associated with distinct follicular hyper-(para-)keratosis; in some of the histologic sections, we saw a well-defined perifollicular adnexophilic infiltration of lymphocytes and histiocytes, which could cause alterations of the follicular epithelium and sometimes even destroy it altogether. In due course, these alterations resulted in granulomatous foreign-body reaction with scar formation. After topical anti-psoriatic treatment, we noticed regrowth of hair in more than 70% of the patients, whereas 25% developed scarring alopecia. - What we call psoriatic alopecia is the symptomatic loss of hair in psoriatic lesions of the scalp. In most of the cases, it can easily be identified on account of the underlying psoriasis.(ABSTRACT TRUNCATED AT 250 WORDS)