Letter - Clinical
Case for diagnosis. Cicatricial alopecia on the vertex - Folliculitis decalvans and lichen planopilaris phenotypic spectrum
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Alopecia cicatricial no vértice" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "536" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1054 "Ancho" => 1675 "Tamanyo" => 348543 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presença de inúmeros plasmócitos e histiócitos, em meio ao infiltrado perifolicular misto (Hematoxilina & eosina, 400<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Anna Carolina Miola, Paulo Muller Ramos, Hélio Amante Miot" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Anna Carolina" "apellidos" => "Miola" ] 1 => array:2 [ "nombre" => "Paulo Muller" "apellidos" => "Ramos" ] 2 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059623000478" "doi" => "10.1016/j.abd.2021.11.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000478?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000541?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000004/v2_202307101646/S2666275223000541/v2_202307101646/pt/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S0365059623000685" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.12.012" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "749" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Congenital ulcerated nodule: self-healing Langerhans cell histiocytosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "536" "paginaFinal" => "539" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1414 "Ancho" => 2508 "Tamanyo" => 1312398 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ulcerated lesion with an infiltrate composed of epithelioid cells with kidney-shaped nucleus, with epidermotropism (Hematoxylin & eosin, ×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tiago Fernandes Gomes, José Carlos Cardoso, Victoria Guiote, Felicidade Santiago" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Tiago Fernandes" "apellidos" => "Gomes" ] 1 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Cardoso" ] 2 => array:2 [ "nombre" => "Victoria" "apellidos" => "Guiote" ] 3 => array:2 [ "nombre" => "Felicidade" "apellidos" => "Santiago" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000954" "doi" => "10.1016/j.abdp.2023.03.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000954?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000685?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000685/v1_202307031010/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059623000545" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.03.008" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "735" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - 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Bilateral ulcerations on the distal phalanges of the second and third fingers - Ulcerative carpal tunnel syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "533" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1709 "Ancho" => 2508 "Tamanyo" => 265447 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect. (A) Right hand - subungual ulceration on the index finger, ulcer with a callus border on the distal phalanx of the middle finger, and atrophy of the thenar region. (B) Left hand - ulceration on the distal phalanx of the index finger and decrease in the size of the phalanx; there is also a healed area on the distal phalanx of the middle finger.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hiram Larangeira de Almeida Jr., Fernanda Pinto Garcia, Laura de Moraes Gomes, Antônia Larangeira de Almeida" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Hiram Larangeira de" "apellidos" => "Almeida Jr." ] 1 => array:2 [ "nombre" => "Fernanda Pinto" "apellidos" => "Garcia" ] 2 => array:2 [ "nombre" => "Laura de Moraes" "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "Antônia Larangeira de" "apellidos" => "Almeida" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000632" "doi" => "10.1016/j.abdp.2023.03.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000632?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000545?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000545/v1_202307031010/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Case for diagnosis. Cicatricial alopecia on the vertex - Folliculitis decalvans and lichen planopilaris phenotypic spectrum" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "536" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Anna Carolina Miola, Paulo Muller Ramos, Hélio Amante Miot" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Anna Carolina" "apellidos" => "Miola" "email" => array:1 [ 0 => "anna.c.miola@unesp.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paulo Muller" "apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1247 "Ancho" => 1675 "Tamanyo" => 487886 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cicatricial alopecia, with follicular pustules at the periphery, erythema and perifollicular desquamation, in addition to areas with polytrichia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old white female complained of vertex alopecia for six years, associated with pruritus and local burning sensation. She reported that, since the onset of the condition, she observed the development of pustules at the periphery of the lesion. She denied comorbidities or ongoing medication use. She reported having had cycles of trimethoprim-sulfamethoxazole for 60 to 90 days, with partial improvement. The examination disclosed cicatricial alopecia area on the vertex region of the scalp, with follicular pustules at the periphery, erythema and areas with polytrichia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy revealed follicular pustules, polytrichia, perifollicular desquamation and erythema (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A biopsy of the peripheral region (area with disease activity) was performed, and histopathology showed a mixed perifollicular inflammatory infiltrate, rich in plasmocytes and histiocytes, affecting the region between the isthmus and the infundibulum, with follicular destruction (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec1005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect105">What's your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Folliculitis decalvans</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Folliculitis decalvans and lichen planopilaris phenotypic spectrum</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Centrifugal cicatricial alopecia</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Lichen planopilaris</p></li></ul></p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Folliculitis decalvans and lichen planopilaris phenotypic spectrum (FDLPPPS) is a recently described cicatricial alopecia, more prevalent on the vertex of the scalp in adults, which combines clinical and histopathological features of two other alopecias: lichen planopilaris (LPP) and folliculitis decalvans (FD), presenting with lymphocytic and neutrophilic inflammatory infiltrates, respectively.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The pathogenesis of LPP and FD is still poorly understood; however, whereas in LPP there is activation of TCD8+ lymphocytes and loss of follicular immune privilege, in DF the presence of <span class="elsevierStyleItalic">Staphylococcus aureus</span> induces a biofilm that stimulates the innate immune response, perpetuating the neutrophil-mediated inflammatory process.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The etiology of FDLPPPS is still under discussion, given the coexistence (or alternation) of both inflammatory processes. It has been suggested that dysbiosis of the DF follicular microbiome may induce the exposure of follicular autoantigens, stimulating a Th1 response pattern.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">As for the clinical picture, patients with FDLPPPS usually show a sequential biphasic process with the characteristics of FD preceding LPP, or even concomitant clinical characteristics: areas of cicatricial alopecia with follicular pustules, erythema and perifollicular desquamation, which may evolve with polytrichia, as in the present case.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Regarding histopathology, a mixed infiltrate is observed in the infundibulum region, with destruction and atrophy of the follicular epithelium and prevalence of plasma cells and histiocytes, in contrast to the predominance of neutrophils in the FD and lymphocytes in the LPP.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7,8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There is yet no standardized treatment for FDLPPPS, given its recent description. However, treatments used in FD and LPP are usually associated, such as corticosteroids, sulfonamides, doxycycline, retinoid antimalarials, and immunosuppressants, according to the predominance of clinical and trichoscopic characteristics. In this case, oral hydroxychloroquine 400 mg/d and isotretinoin 30 mg/d, and clobetasol 0.05% gel were introduced, with stabilization of the condition after six months. The rationale for choosing anti-inflammatory drugs and oral retinoids was based on the predominance of clinical and trichoscopic signs of the LPP spectrum, in this case, mainly after previous treatment with antibiotics, aiming to reduce the neutrophil activity intensity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a> However, it is noteworthy the lack of controlled studies on the efficacy of therapeutic strategies in cicatricial alopecia.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The cases described in adults and children with FDLPPPS do not seem to reach a large area of the scalp, despite the delay in its diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4–8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Dermatologists should be aware of the diagnosis of FDLPPPS in the presence of less characteristic cases of cicatricial alopecia on the vertex of the scalp, with pustules, erythema and follicular desquamation, in which the inflammatory infiltrate is mixed, or with alternating patterns in subsequent biopsies, and containing plasma cells.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors' contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Miola AC: Design and planning of the study; collection, analysis and interpretation of data; critical review of the literature; critical review of the manuscript; writing and approval of the final version of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Ramos PM: Critical review of the literature; critical review of the manuscript, writing and approval of the final version of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Miot HA: Design and planning of the study; effective participation in research orientation; critical review of the literature; critical review of the manuscript, writing and approval of the final version of the manuscript.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec1005" "titulo" => "What's your diagnosis?" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-10-07" "fechaAceptado" => "2021-11-09" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Dermatology Outpatient Clinic, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1247 "Ancho" => 1675 "Tamanyo" => 487886 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cicatricial alopecia, with follicular pustules at the periphery, erythema and perifollicular desquamation, in addition to areas with polytrichia.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1086 "Ancho" => 2508 "Tamanyo" => 446197 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follicular pustules, desquamation and perifollicular erythema on dermoscopy. Areas with absence of follicular ostia; however, with the presence of polytrichia.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1382 "Ancho" => 2175 "Tamanyo" => 830830 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mixed perifollicular inflammatory infiltrate in the region between the isthmus and the infundibulum, with follicular destruction (Hematoxylin & eosin, ×100).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1054 "Ancho" => 1675 "Tamanyo" => 348543 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presence of numerous plasma cells and histiocytes amidst the mixed perifollicular infiltrate (Hematoxylin & eosin, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Folliculitis decalvans and lichen planopilaris phenotypic spectrum: a case series of biphasic clinical presentation and theories on pathogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. 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