title: Clinical and histological study of permanent alopecia after bone marrow transplantation.
abstract: BACKGROUND
  Permanent alopecia after bone marrow transplantation is rare, but more and more cases have been described, typically involving high doses of chemotherapeutic agents used in the conditioning regimen for the transplant. Busulfan, classically described in cases of irreversible alopecia, remains associated in recent cases. The pathogenesis involved in hair loss is not clear and there are few studies available. In addition to chemotherapeutic agents, another factor that has been implicated as a cause is chronic graft-versus-host disease. However, there are no histopathological criteria for defining this diagnosis yet.
  
  
  OBJECTIVE
  the study aims to evaluate clinical and histological aspects in cases of permanent alopecia after bone marrow transplantation, identifying features of permanent alopecia induced by myeloablative chemotherapy and alopecia as a manifestation of chronic graft-versus-host disease.
  
  
  METHODS
  data were collected from medical records of 7 patients, with description of the clinical features and review of slides and paraffin blocks of biopsies.
  
  
  RESULTS
  Two distinct histological patterns were found: one similar to androgenetic alopecia, non-scarring pattern, and other similar to lichen planopilaris, scarring alopecia.
  
  
  CONCLUSIONS
  The first pattern corroborates the literature cases of permanent alopecia induced by chemotherapeutic agents, and the second is compatible with manifestation of chronic graft-versus-host disease on scalp, that has never been described yet. The results contribute to the elucidation of the factors involved in these cases, including the development of therapeutic methods.
authors.affiliation: Universidade Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Flávia Machado Alves
authors.initials: FM
authors.lastname: Basilio
authors.affiliation: Universidade Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Fabiane Mulinari
authors.initials: FM
authors.lastname: Brenner
authors.affiliation: Universidade Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Betina
authors.initials: B
authors.lastname: Werner
authors.affiliation: Universidade Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Graziela Junges Crescente
authors.initials: GJ
authors.lastname: Rastelli
mesh_terms: D000328:Adult; D000505:Alopecia / Q000139:chemically induced* / Q000473:pathology*; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002066:Busulfan / Q000009:adverse effects*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D018859:Hair Follicle / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects*; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D013997:Time Factors; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists; D002066:Busulfan