Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-10-09T12:17:33Z No. of bitstreams: 1 Ademir Carvalho Leite Júnior.pdf: 1086030 bytes, checksum: a4a25c152f48c5f898a986313b25dbe0 (MD5) / Made available in DSpace on 2017-10-09T12:17:33Z (GMT). No. of bitstreams: 1 Ademir Carvalho Leite Júnior.pdf: 1086030 bytes, checksum: a4a25c152f48c5f898a986313b25dbe0 (MD5) Previous issue date: 2017-09-29 / Frontal fibrosing alopecia (AFF) is a primary cicatricial alopecia that was described in 1994. It predominantly affects women, most often in menopause. Studies have shown that alopecias, in general, may have stress as a trigger and maintenance factor. Regarding cicatricial alopecia, especially AFF, the relevance of these factors was little studied, however, studies suggest that stressful events may be associated with the onset of alopecia conditions. The objective of this study is to evaluate the relevance of suffering as a stressful event as a possible triggering factor for AFF patients. To perform this evaluation a socio-demographic form, a quality of life inventory in Dermatology (DQLI) and a semi-structured interview was held in a single meeting with the research volunteers. The 12 volunteers in the study present life stories with intense reports of frustration, impotence, insecurity, loss, shame and loneliness. DQLI, used to assess the impact of AFF on the life of the volunteers, was consistent with the observations made by them, that the disease accompanies a high degree of stress and suffering / A Alopecia Fibrosante Frontal (AFF) é uma alopecia cicatricial primária que foi descrita em 1994. Acomete predominantemente mulheres, na maior parte das vezes na menopausa. Estudos mostram que as alopecias, em geral, podem ter como fator causal e de manutenção o estresse. Sobre as alopecias cicatriciais, em especial a AFF, a relevância destes fatores foi pouco estudada, ainda assim, estudos sugerem que eventos estressantes podem estar associados ao surgimento de alopecias. O objetivo deste estudo é avaliar a relevância do sofrimento tendo o evento estressante como possível fator desencadeante de quadros de AFF. Para realizar esta avaliação um formulário sociodemográfico, um inventário de qualidade de vida em dermatologia (DQLI) e uma entrevista semiestruturada serão realizados em encontro único com os participantes da pesquisa. As doze voluntárias do estudo apresentam histórias de vida com intensos relatos de frustrações, impotência, insegurança, perdas, vergonha e solidão. O DQLI, utilizado para avaliação do impacto da AFF, na vida das voluntárias, foi coerente com as observações feitas pelas mesmas, de que a doença acompanha elevado grau de estresse e sofrimento

Primary scalp alopecia is classically divided into cicatricial (scarring) and non-cicatricial (non-scarring). Challenging cases are assessed with a scalp biopsy. The use of both horizontal and vertical sections (HoVert sections) has dramatically improved the accuracy of histopathological diagnosis. In this work, we have used immunostaining to address diagnostic difficulties, which persist despite all currently available tools. We performed an immunostain panel (CD3, CD4, CD8 and CD20) in order to distinguish pattern hair loss from alopecia aerate in cases which do not have the usual peribulbar lymphocytic infiltrate and showed that CD3+ T-lymphocytes within the empty fibrous follicular tracts favor a diagnosis of alopecia areata. We performed CD123 in order to distinguish lichen planopilaris from alopecia lupus erythematosus in cases with only a superficial lymphocytic infiltrate and an uninvolved interfollicular epidermis and showed that clusters of CD123+ plasmacytoid dendritic cells favor a diagnosis of lupus erythematosus. We performed cytokeratin 15 in order to assess whether the loss of the follicular bulge stem cells has diagnostic value in cicatricial alopecia and demonstrated that the loss of cytokeratin 15+ bulge stem cells is identified in lichen planopilaris, frontal fibrosing alopecia, and lupus erythematous, so cytokeratin 15 has no diagnostic value. We have attempted to integrate the new concepts and our findings into the traditional classifications of alopecia and proposed a new diagnostic algorithm. In conclusion, immunostaining combined with HoVert grossing advances the accuracy of histopathological diagnosis of primary scalp alopecia. / L’alopécie primitive du cuir chevelu est habituellement classée en cicatricielle et non-cicatricielle. Dans les cas difficiles, la biopsie du cuir chevelu peut aider au diagnostic. L’utilisation de coupes, à la fois verticales et horizontales sur le même spécimen (technique HoVert), a radicalement amélioré le diagnostic histopathologique. Dans ce travail, nous avons utilisé l’immunohistochimie pour évaluer les difficultés diagnostiques qui persistent malgré tous les outils actuels. Nous avons utilisé les CD3, CD4, CD8 et CD20 pour différencier l’alopécie androgénique de la pelade dépourvue de l’infiltrat lymphocytaire péribulbaire habituel et nous avons démontré que la présence de lymphocytes CD3+ dans les travées folliculaires fibreuses est en faveur de la pelade. Nous avons utilisé le CD123 pour différencier le lichen plan pilaire du lupus érythémateux alopécie avec infiltrat lymphocytaire superficiel et sans atteinte de l’épiderme interfolliculaire et nous avons démontré que la présence d’amas de cellules dendritiques plasmacytoïdes CD123+ est en faveur du lupus érythémateux. Nous avons utilisé la cytokératine 15 pour évaluer si la perte des cellules souches du bulge a une valeur diagnostique dans l’alopécie cicatricielle et nous avons démontré que cette perte s’observait de manière identique dans le lichen plan pilaire, l’alopécie frontale fibrosante comme dans le lupus érythémateux et n’avait donc aucune valeur diagnostique. Nous avons tenté d’intégrer les nouveaux concepts et nos données dans les classifications traditionnelles des alopécies et nous avons élaboré un nouvel algorithme diagnostique. L’association des immunomarquages avec la technique HoVert ouvre de nouvelles perspectives dans le diagnostic histopathologique des alopécies primaires du cuir chevelu. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished