Link, Jenny L.

Study Design: A panel of 13 clinicians with experience in dermatology and primary care was assembled to review literature regarding the diagnostic workup of scarring and nonscarring alopecias. The literature for review included clinical trials, meta-analyses, systematic reviews, and previously published guidelines from the last 10 years. After review, the panel drafted a list of consensus statements and then voted on these statements using a modified eDelphi method in order to verify the validity and clarity of each statement. Objective: Our objective, as a panel, was to formulate a clear set of guidelines in the workup of various forms of hair loss by a systematic review of clinical data and literature on the matter. Background: Hair loss is a common and frustrating medical concern for patients worldwide and accounts for significant health care utilization and cost. Moreover, hair loss may present as a symptom of an underlying medical condition requiring attention and treatment. Results: After review, the panel reached a total of 22 consensus statements regarding recommendations for diagnostic testing in the setting of hair loss, 17 of those statements focused on nonscarring alopecias, and 5 statements directed toward scarring alopecias. The statements were evaluated by members of the panel and voted on through a modified eDelphi method and discussed in an open forum. Conclusion: The panel’s review revealed that the diagnostic laboratories and/or scalp biopsy should be considered to varying degrees depending on the type of hair loss at presentation. If there is concern for a scarring process, a biopsy should be strongly considered, while serum laboratory work may be of little benefit. In nonscarring alopecias including alopecia areata, telogen effluvium, and androgenetic alopecia, the literature supports ordering certain serologic tests based on the type of hair loss at presentation.

AbstractDemodex folliculorum is a commensal mite that inhabits the orifices of cutaneous pilosebaceous follicles. Overgrowth of these organisms can lead to Demodex folliculitis, which typically presents as papules and pustules predominantly involving the temples, cheeks, and occasionally the chest. We present a 51‐year‐old woman with iatrogenic Demodex folliculitis secondary to immunosuppressive treatment for an autoimmune connective tissue disease. Histopathological exam of a skin biopsy, which revealed follicular Demodex mites, confirmed the diagnosis. The eruption was treated with oral ivermectin and topical metronidazole gel, and the patient's immunosuppressive regimen was decreased, resulting in marked improvement in the eruption within 6 weeks and no worsening of her underlying autoimmune disorder. This case emphasizes the importance of considering Demodex folliculitis in the differential diagnosis of a new onset rash in the context of immunosuppressive treatment.