Avaliação clínica, dermatoscópica e histopatológica do padrão de acometimento folicular da madarose hansênica: alopecia cicatricial versus alopecia não cicatricial
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Data
2024-03-28
Autores
Brito, Fernanda Freitas de [UNIFESP]
Orientadores
Hirata, Sergio Henrique [UNIFESP]
Tipo
Tese de doutorado
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Introdução: a hanseníase é uma doença infectocontagiosa de evolução crônica, causada pelo Mycobacterium leprae, bacilo álcool-ácido resistente, com tropismo pelas células de Schwann e do sistema fagocítico mononuclear. Acomete principalmente a pele e tecido nervoso periférico. A madarose (rarefação parcial ou total dos pelos da sobrancelha) é um achado clínico característico dos pacientes hansênicos do polo virchowiano, sendo observada em 36,6% até 76% dos casos. A rarefação dos supercílios acrescenta um dano cosmético desfigurante aos pacientes com hanseníase, constituindo um dos estigmas mais frequentes da doença, ao lado de outras deformidades características que acometem o nariz, as orelhas e os membros. Objetivo: determinar o padrão de acometimento folicular (alopecia cicatricial versus alopecia não cicatricial) da madarose hansênica por meio da análise histopatológica de cortes horizontais de amostra de pele da região alopécica dos supercílios de um grupo de pacientes hansênicos virchowianos. Os objetivos secundários incluíram: avaliar outros achados histológicos (inflamação, fibrose e presença de bacilos) da região dos supercílios dos pacientes hansênicos virchowianos com madarose e avaliar os achados dermatoscópicos da região dos supercílios de um grupo de pacientes hansênicos virchowianos com madarose. Métodos: trata-se de um estudo transversal de pacientes hansênicos tipo virchowiano com madarose total ou parcial atendidos em um centro de referência em hanseníase no estado de São Paulo - Instituto Lauro de Souza Lima. Dados demográficos como gênero, idade, raça, fototipo, tipo de madarose (parcial ou total) e tratamento atual foram avaliados. Documentação fotográfica e avaliação dermatoscópica da região de maior rarefação dos supercílios foi realizada pelo pesquisador principal. Foi coletada uma amostra de pele com punch de 4 mm de diâmetro da região da madarose selecionada previamente pelo exame dermatoscópico. Foram realizadas colorações de Hematoxilina-Eosina, Fite-Faraco e Verhoeff-Van Gieson em todos os casos. O processamento do material foi realizado em laboratório especializado em dermatopatologia na cidade de São Paulo. As lâminas foram analisadas individualmente por dois dermatopatologistas especializados em pele e doenças foliculares. Resultados: um total de 15 pacientes (8 mulheres e 7 homens) foram incluídos, com idade média de 59,9 ± 12,0 anos (38-80 anos). Quanto à cor, a maioria era branca (12/15). O fototipo variou de II-V. Onze pacientes (11/15) apresentavam madarose parcial. Dos 15 pacientes selecionados, 93,3% (14/15) haviam concluído o tratamento com a associação de três antimicrobianos (rifampicina, dapsona e clofazimina - poliquimioterapia) e estavam curados da doença no momento da coleta da amostra de pele dos supercílios. Na dermatoscopia, observou-se pelos velos presentes em grande quantidade em todos os pacientes. Fios terminais estavam presentes em 33,3 % (5/15) pacientes, três pacientes, 20% (3/15) apresentaram telangiectasias e 26,7% (4/15) tinham feito micropigmentação dos supercílios. Pontos amarelos estavam presentes em 33,3% (5/15) e rede pigmentar da epiderme estavam presentes em 13,3% (2/15). Nenhum caso apresentou descamação peripilar, pontos pretos, pelos quebrados. O exame histopatológico demostrou folículos pilosos uniformemente distribuídos na amostra de todos os pacientes, sem áreas sugestivas de folículos pilosos destruídos. A média e a mediana da contagem folicular de fios terminais foi de 1,07 e 0, respectivamente. Em relação à contagem de fios velos, a média e a mediana, foram de 46,2 e 41, respectivamente, variando no mínimo de 18 e o máximo de 82 folículos. A média da relação da quantidade de fios terminais em relação a quantidade de fios velos, foi de 0,03 ± 0,06/1. Conclusão: o padrão de acometimento folicular analisado em cortes horizontais de 15 amostras de pele de um grupo de pacientes hansênicos virchowianos demonstrou que a madarose hansênica é uma alopecia não cicatricial com intenso grau de miniaturização folicular, sem achados inflamatórios ou fibrose. A dermatoscopia da região da madarose hansênica apresenta grande quantidade de pelos velos e poucos ou nenhum pelo terminal, sem sinais inflamatórios dermatoscópicos.
Introduction: leprosy is an infectious and contagious disease of chronic evolution, caused by Mycobacterium leprae, an alcohol-acid resistant bacillus, with tropism for Schwann cells and the mononuclear phagocytic system. It mainly affects the skin and peripheral nervous tissue. Madarosis (partial or total thinning of the eyebrow hairs is a characteristic clinical finding of leprosy patients of the virchowian pole, being observed in 36.6% to 76% of cases. The thinning of the eyebrows adds a disfiguring cosmetic damage to patients with leprosy, constituting one of the most frequent stigmas of the disease, alongside other characteristic deformities that affect the nose, ears and limbs. Objective: to determine the pattern of follicular involvement (cicatricial alopecia versus non-cicatricial alopecia) of leprosy madarosis by means of histopathological analysis of horizontal sections of skin sample from the alopecic region of the eyebrows of a group of leprosy patients virchowian. The secondary objectives included: to evaluate other histological findings (inflammation, fibrosis and presence of bacilli) of the region of the eyebrows of leprosy patients virchowian with madarosis and to evaluate the dermoscopic findings of the region of the eyebrows of a group of leprosy patients virchowian with madarosis. Methods: this is a cross-sectional study of leprosy patients of the virchowian type with total or partial madarosis attended at a reference center in leprosy in the state of São Paulo - Instituto Lauro de Souza Lima. Demographic data such as gender, age, race, phototype, type of madarosis (partial or total) and current treatment were evaluated. Photographic documentation and dermoscopic evaluation of the region of greatest thinning of the eyebrows was performed by the main researcher. A skin sample with a 4 mm diameter punch was collected from the region of the madarosis previously selected by the dermoscopic examination. Hematoxylin-Eosin, Fite-Faraco and Verhoeff-Van Gieson stains were performed in all cases. The material processing was performed in a laboratory specialized in dermatopathology in the city of São Paulo. The slides were individually analyzed by two dermatopathologists specialized in skin and follicular diseases. Results: a total of 15 patients (8 women and 7 men) were included, with a mean age of 59.9 ± 12.0 years (38-80 years). As for color, most were white (12/15). The phototype ranged from II-V. Eleven patients (11/15) had partial madarosis. Of the 15 patients selected, 93.3% (14/15) had completed treatment with a combination of three antimicrobials (rifampicin, dapsone and clofazimine – multidrug therapy) and were cured of the disease at the time of skin sample collection from the eyebrows. In dermoscopy, vellus hairs were present in large quantities in all patients. Terminal hairs were present in 33.3% (5/15) patients, three patients, 20% (3/15) presented telangiectasias and 26.7% (4/15) had done micropigmentation of the eyebrows. Yellow dots were present in 33.3% (5/15) and epidermal pigment network were present in 13.3% (2/15). No case presented peripilar scaling, black dots, broken hairs. The histopathological examination showed hair follicles evenly distributed in the sample of all patients, without areas suggestive of destroyed hair follicles. The mean and median of the terminal hair follicular count was 1.07 and 0, respectively. Regarding the count of vellus hairs, the mean and median were 46.2 and 41, respectively, varying from a minimum of 18 and a maximum of 82 follicles. The mean of the ratio of the amount of terminal hairs to the amount of vellus hairs was 0.03 ± 0.06/1. Conclusion: the pattern of follicular involvement analyzed in horizontal sections of 15 skin samples from a group of lepromatous leprosy patients showed that leprosy madarosis is a non-scarring alopecia with intense degree of follicular miniaturization, without inflammatory or fibrosis findings. The dermoscopy of the region of leprosy madarosis shows a large amount of vellus hairs and few or no terminal hair, without dermoscopic inflammatory signs.
Introduction: leprosy is an infectious and contagious disease of chronic evolution, caused by Mycobacterium leprae, an alcohol-acid resistant bacillus, with tropism for Schwann cells and the mononuclear phagocytic system. It mainly affects the skin and peripheral nervous tissue. Madarosis (partial or total thinning of the eyebrow hairs is a characteristic clinical finding of leprosy patients of the virchowian pole, being observed in 36.6% to 76% of cases. The thinning of the eyebrows adds a disfiguring cosmetic damage to patients with leprosy, constituting one of the most frequent stigmas of the disease, alongside other characteristic deformities that affect the nose, ears and limbs. Objective: to determine the pattern of follicular involvement (cicatricial alopecia versus non-cicatricial alopecia) of leprosy madarosis by means of histopathological analysis of horizontal sections of skin sample from the alopecic region of the eyebrows of a group of leprosy patients virchowian. The secondary objectives included: to evaluate other histological findings (inflammation, fibrosis and presence of bacilli) of the region of the eyebrows of leprosy patients virchowian with madarosis and to evaluate the dermoscopic findings of the region of the eyebrows of a group of leprosy patients virchowian with madarosis. Methods: this is a cross-sectional study of leprosy patients of the virchowian type with total or partial madarosis attended at a reference center in leprosy in the state of São Paulo - Instituto Lauro de Souza Lima. Demographic data such as gender, age, race, phototype, type of madarosis (partial or total) and current treatment were evaluated. Photographic documentation and dermoscopic evaluation of the region of greatest thinning of the eyebrows was performed by the main researcher. A skin sample with a 4 mm diameter punch was collected from the region of the madarosis previously selected by the dermoscopic examination. Hematoxylin-Eosin, Fite-Faraco and Verhoeff-Van Gieson stains were performed in all cases. The material processing was performed in a laboratory specialized in dermatopathology in the city of São Paulo. The slides were individually analyzed by two dermatopathologists specialized in skin and follicular diseases. Results: a total of 15 patients (8 women and 7 men) were included, with a mean age of 59.9 ± 12.0 years (38-80 years). As for color, most were white (12/15). The phototype ranged from II-V. Eleven patients (11/15) had partial madarosis. Of the 15 patients selected, 93.3% (14/15) had completed treatment with a combination of three antimicrobials (rifampicin, dapsone and clofazimine – multidrug therapy) and were cured of the disease at the time of skin sample collection from the eyebrows. In dermoscopy, vellus hairs were present in large quantities in all patients. Terminal hairs were present in 33.3% (5/15) patients, three patients, 20% (3/15) presented telangiectasias and 26.7% (4/15) had done micropigmentation of the eyebrows. Yellow dots were present in 33.3% (5/15) and epidermal pigment network were present in 13.3% (2/15). No case presented peripilar scaling, black dots, broken hairs. The histopathological examination showed hair follicles evenly distributed in the sample of all patients, without areas suggestive of destroyed hair follicles. The mean and median of the terminal hair follicular count was 1.07 and 0, respectively. Regarding the count of vellus hairs, the mean and median were 46.2 and 41, respectively, varying from a minimum of 18 and a maximum of 82 follicles. The mean of the ratio of the amount of terminal hairs to the amount of vellus hairs was 0.03 ± 0.06/1. Conclusion: the pattern of follicular involvement analyzed in horizontal sections of 15 skin samples from a group of lepromatous leprosy patients showed that leprosy madarosis is a non-scarring alopecia with intense degree of follicular miniaturization, without inflammatory or fibrosis findings. The dermoscopy of the region of leprosy madarosis shows a large amount of vellus hairs and few or no terminal hair, without dermoscopic inflammatory signs.
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Citação
BRITO, Fernanda Freitas de. Avaliação clínica, dermatoscópica e histopatológica do padrão de acometimento folicular da madarose hansênica: alopecia cicatricial versus alopecia não cicatricial. 2024. 100 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulos, 2024.