Dissecting cellulitis is a chronic, progressive, and relapsing inflammatory disease that predominantly affects the vertex and occiput of young Afro-descendent men. It starts with papules and pustules that evolve to nodules, abscesses, and cicatricial alopecia. This article illustrates the evolutive trichoscopy of dissecting cellulitis, from its early phase, through the abscess phase, to the fibrotic cicatricial phase. Trichoscopy complements clinical-pathological classification, representing a complementary tool useful in early diagnosis and monitoring of the patient during treatment. Alopecia areata (AA) is a nonscarring form of hair loss characterized by well-defined patches of alopecia, typically involving the scalp, and less commonly by near-complete or complete scalp and body hair loss.1 In a murine model of AA, up-regulation of interleukin-15 in hair follicles leads to recruitment and activation of natural killer gene 2D–expressing CD8 T cells, which, in turn, produce interferon-γ, further activating the hair follicle epithelial cells.2 Cell signaling via interferon-γ and interleukin-15 occurs via the Janus kinase (JAK) family of enzymes, and JAK inhibitors have been found to reverse disease. In particular, the JAK1/3 inhibitor, tofacitinib, and the JAK1/2 inhibitor, ruxolitinib, have been found in larger series of patients to be effective for severe disease.3, 4, 5 There is a report of a patient with AA and chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome, whose AA was successfully treated during treatment of CANDLE syndrome with high-dose baricitinib, 7 to 11 mg daily, in addition to prednisone.6 Baricitinib is a relatively new JAK1/2 inhibitor that was recently approved for the treatment of rheumatoid arthritis in Europe and Japan at doses of 2 and 4 mg daily and in the United States at 2 mg daily. Here we describe a case of a woman with severe AA, with complete scalp and near-complete body hair loss, who experienced complete hair regrowth with baricitinib 4 mg daily.

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Hair Therapy and Transplantation

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