Vrijednost trihoskopije u dijagnostici primarnih ožiljnih alopecija

doctoral thesis

• Author: Željana Bolanča
• Mentor: Mirna Šitum (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2019-09-02, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Ožiljne alopecije su rijetka, ali značajna skupina bolesti jer uzrokuju nepovratno oštećenje folikula dlake što dovodi do zamjene pilosebacealnog aparata fibroznim tkivom, a time i do trajnog gubitka kose. Upravo zbog nepovratnog oštećenja potrebno je što ranije dijagnosticirati bolest i započeti liječenje. Postavljanje dijagnoze i liječenje se temelji na klasifikaciji ožiljnih alopecija prema radnoj klasifikaciji koju je stvorila grupa stručnjaka na skupu u organizaciji North American Hair Research Societya (NAHRS) u veljači 2001.godine, a koja se primarno temelji na patohistološkoj analizi bioptata iz aktivne faze bolesti, odnosno prema tipu upalnog infiltrata koji okružuje folikul dlake u aktivnoj fazi bolesti te sekundarno prema kliničkoj slici. Biopsija vlasišta je ključni dijagnostički test za dijagnozu ožiljnih alopecija jer određuje dominantni upalni infiltrat potreban za klasifikaciju primarnih ožiljnih alopecija. Glavne pogreške uključuju premale ili preplitko uzete biopsije, artefakte prilikom manipuliranja uzorkom, rezanje „kroz“ folikule te neadekvatan izbor mjesta biopsije. Bez obzira na klinički relativno jasnu kliničku sliku ožiljne alopecije, nije jednostavno odrediti mjesto biopsije, tim više što nisu svi folikuli zahvaćeni bolešću. Upravo zbog toga je potrebno preciznije odrediti mjesto uzimanja biopsije. Hipoteza ovog istraživanje je bila sljedeća: koristeći trihoskopiju moguće je odrediti optimalno mjesto biopsije vlasišta kod primarnih ožiljnih alopecija i time povećati vjerojatnost patohistološke dijagnoze. Ovim istraživanjem su analizirani patohistološki uzorci 60 kliničkih ožiljnih alopecija, od kojih je 30 biospija uzeto s ruba lezije, a mjesto određeno golim okom, a u 30 slučajeva je mjesto određeno koristeći dermatoskop, a na osnovi poznatih dermoskopskih kriterija za ožiljne alopecije. Na temelju rezultata može se zaključiti da pregled i biopsija uz uporabu dermatoskopa povećava vjerojatnost točne patohistološke dijagnoze za oko 48 % u usporedbi s pregledom i biopsijom bez dermatoskopa. Zaključno, rezultati studije potvrdili su značajnu ulogu trihoskopije u izboru mjesta biopsije vlasišta u cilju potvrde dijagnoze primarne ožiljne alopecije. Uz to, rezultati ukazuju na jasan potencijal trihoskopije kao moguće dijagnostičke, a ne samo pomoćne metode.

Abstract (english)

Primary cicatricial alopecias (PCAs) are a rare and poorly understood group of disorders that result in replacement of pilosebaceous unit with fibrous tissue which leads to permanent hair loss and therefore significantly affects the quality of life. The aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. The diagnosis and therefore treatment are based on the Classification of scarring alopecia created by a group of experts from the North American Hair Research Society (NAHRS) at a meeting organized in February 2001. The classification is based on a clinical picture and a pathohistological analysis of the biopsies from the active phase of the disease. Scalp biopsy is the key diagnostic test for diagnosis of PCA because it determines the dominant inflammatory infiltration in active phase of the disease. However, pathohistological interpretation of scalp biopsy can be a major challenge for the pathologist, especially in the absence of detailed anamnesis, inadequate samples, inadequate tissue cuts and an inadequately chosen biopsy site. Although it is known that the biopsy should be taken from the edge of the active lesion, not all the follicles on the edges of the lesion are affected by the disease, especially at the early stage, when the changes are barely visible to the naked eye. Tools to increase the diagnostic accuracy of scalp biopsy are needed. The hypothesis of this study is that the trichoscopy is useful in determining the optimal site for scalp biopsies in primary scarring alopecia, thereby increasing the probability of exact pathohistological diagnosis. This study investigated the pathohistological interpretation of 60 primary scarring alopecia, of which 30 were taken from the edge of the lesion and the site was chosen by the naked eye, and in 30 cases the biopsy was guided with dermatoscope. Based on the results of the study it can be concluded that the examination and dermoscopy guided biopsy increases the probability of an exact histopathological diagnosis by 48% compared with examination and biopsy without dermoscopy. The results of additional analyzes showed that there is a good potential of trichoscopy to completely rule out the need for biopsy in terms of confirmatory diagnosis LPP and DLE. To conclude, the results of our study confirmed the important role of trihoscopy in determining the biopsy site in order to confirm the diagnosis of primary scarring alopecia. In addition, the results indicate a clear potential of trihoscopy as a possible diagnostic and not just auxiliary method.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:117398
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 80 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:38:06