Anagen Effluvium after Neurointerventional Radiation: Trichoscopy as a Diagnostic Ally

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Abstract

Minimally invasive procedures for vascular brain lesions are being performed more frequently. Radiation exposure caused by endovascular embolization of cerebral aneurysms may give rise to nonscarring scalp alopecia located in the treated area. Clinical and trichoscopic features of this type of alopecia are similar to alopecia areata (AA). Herein, we performed a comprehensive review to describe the clinical and trichoscopic characteristics of radiation-induced anagen effluvium. Predominant trichoscopic findings include black dots, yellow dots, short vellus hairs, and absence of exclamation marks hairs. It is important to consider this diagnosis in patients who have recently undergone such procedures that can easily be misdiagnosed as AA.

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Most cited references 16

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Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair.

Stephen Balter, John W Hopewell, Donald L Miller … (2010)

Most advice currently available with regard to fluoroscopic skin reactions is based on a table published in 1994. Many caveats in that report were not included in later reproductions, and subsequent research has yielded additional insights. This review is a consensus report of current scientific data. Expected skin reactions for an average patient are presented in tabular form as a function of peak skin dose and time after irradiation. The text and table indicate the variability of reactions in different patients. Images of injuries to skin and underlying tissues in patients and animals are provided and are categorized according to the National Cancer Institute skin toxicity scale, offering a basis for describing cutaneous radiation reactions in interventional fluoroscopy and quantifying their clinical severity. For a single procedure performed in most individuals, noticeable skin changes are observed approximately 1 month after a peak skin dose exceeding several grays. The degree of injury to skin and subcutaneous tissue increases with dose. Specialized wound care may be needed when irradiation exceeds 10 Gy. Residual effects from radiation therapy and from previous procedures influence the response of skin and subcutaneous tissues to subsequent procedures. Skin irradiated to a dose higher than 3-5 Gy often looks normal but reacts abnormally when irradiation is repeated. If the same area of skin is likely to be exposed to levels higher than a few grays, the effects of previous irradiation should be included when estimating the expected tissue reaction from the additional procedure. (c) RSNA, 2010.

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Trichoscopy of alopecia areata: An update.

Anna Waśkiel, Adriana Rakowska, Mariusz Sikora … (2018)

The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6-100% patients), short vellus hairs (34-100%), black dots (0-84%), broken hairs (0-71%) and exclamation mark hairs (12-71%). Tapered hairs (5-81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11-96%), pigtail (circle) hairs (4-61%) and Pohl-Pinkus constrictions (2-10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature.

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Radiation-induced temporary alopecia after embolization of cerebral arteriovenous malformations.

Chung-Shi Wen, Swei-Ming Lin, Yun Chen … (2003)

Alopecia after endovascular embolization of cerebral arteriovenous malformations (AVMs) is uncommon. In this report, we present a 33-year-old man who developed temporary alopecia after staged embolization of a cerebral AVM. Four days after the last procedure, this patient had hair loss over his right temporoparietal and occipial areas. No scalp erythema or other sign of dermatitis was noted. The hair regrew 2 months later. The alopecia was considered to be related to repeated exposure to radiation during embolization. The experience in this case and review of the literature suggest that interventional neuroradiological procedures may cause substantial radiation exposure to the patient. Therefore, radiation use should be limited to the least amount necessary to complete the endovascular procedure to prevent radiation-induced biological changes and morbidity. Patients should be well informed of adverse effects such as alopecia.

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Journal

Journal ID (publisher-id): SAD

Journal ID (pmc): SAD

Journal ID (doi): 10.1159/issn.2296-9160

Title: Skin Appendage Disorders

Publisher: S. Karger AG

ISSN (Print): 2296-9195

ISSN (Electronic): 2296-9160

Publication date Subscription-year: 2022

Publication date (Print): March 2022

Publication date (Electronic): 14 September 2021

Volume: 8

Issue: 2

Pages: 102-107

Affiliations

[_a] _aUniversidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Dermatología Hospital Universitario “Dr. José Eleuterio González,”, Monterrey, Mexico

[_b] _bTecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico

[_c] _cDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

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*Verónica Garza-Rodríguez, verogarzardz@hotmail.com

Author information

Rodrigo J. Castillo-de la Garza https://orcid.org/0000-0002-3580-8494

Antonella Tosti https://orcid.org/0000-0001-5516-4043

Article

Publisher ID: 518743 Other ID: Skin Appendage Disord 2022;8:102–107

DOI: 10.1159/000518743

PubMed ID: 35419426

SO-VID: 5fc5b9f0-3ac9-4429-bc1c-91a189a43c7a

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 17 May 2021

Date accepted : 16 July 2021

Page count

Figures: 4, Tables: 3, Pages: 6

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Anagen Effluvium after Neurointerventional Radiation: Trichoscopy as a Diagnostic Ally

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Abstract

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Karger: Dermatology

Most cited references 16

Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair.

Trichoscopy of alopecia areata: An update.

Radiation-induced temporary alopecia after embolization of cerebral arteriovenous malformations.

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