10.5826/dpc.1303a140
text/xml
2160-9381
2896
en
Daniel Fernandes Melo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Positive Anagen Pull Test Predicting Lichen Planopilaris Activity
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-10-06
2023-07-31
2023-08-24
e2023140
Dermatol Pract Concept
Daniel Fernandes Melo
2023/07/31
10.5826/dpc.1303a140
e2023140
Department of Dermatology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil 
2160-9381
en
e2023140
Azulay L, Hanauer L, Leal F, Azulay DR. Alopecias cicatriciais. In: Atlas de Dermatologia da semiologia ao diagnóstico. 3rd edition. Rio de Janeiro: Guanabara Koogan; 2020: p156.
Positive Anagen Pull Test Predicting Lichen Planopilaris Activity
https://dpcj.org/index.php/dpc/article/download/2896/2224
                      Positive Anagen Pull Test Predicting
                          Lichen Planopilaris Activity
                        Raíssa Rodriguez Melo1, Rita Fernanda Cortez de Almeida1,
                         Michela Valeria Rita Starace2,3, Daniel Fernandes Melo1


1 Department of Dermatology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
2 Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
3 Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy



Citation: Rodriguez Melo R, Cortez de Almeida RF, Starace MVR, Melo DF. Positive Anagen Pull Test Predicting Lichen Planopilaris
Activity. Dermatol Pract Concept. 2023;13(3):e2023140. DOI: https://doi.org/10.5826/dpc.1303a140
Accepted: December 2, 2022; Published: July 2023
Copyright: ©2023 Rodriguez Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Raíssa Rodriguez Melo, Department of Dermatology, State University of Rio de Janeiro (UERJ), Boulevard 28 de
Setembro, 77, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil. Tel: +55 21 28688478; E-mail:rodriguezraissaa@gmail.com




Case Presentation                                                        Teaching Point
A healthy 32-year-old Caucasian male complained of                       LPP is a primary scarring alopecia that usually presents with
patches of alopecia on the right temple and mid-scalp that               hair loss at the vertex or parietal scalp, and may be asso-
started three months before. Physical examination showed                 ciated with pain, itchiness, burning, or tenderness. The his-
two irregular patches of scarring alopecia of approximately              topathology is characterized by perifollicular lymphocytic
5 cm associated with trichodynia. The patches trichoscopic               infiltrate at the follicular isthmus and infundibulum. On
features were consistent with lichen planopilaris (LPP) in the           trichoscopy, perifollicular hyperkeratosis and erythema are
acute phase (Figure 1A).                                                 typical signs of active LPP [1,2]. A positive anagen pull test
    The pull test was positive and revealed golf club-shaped,            consists of anagen bulbs with attached inner and outer root
pigmented hair roots on trichoscopy, typical of anagen                   sheaths [1-3]. Extraction of anagen hair with thickened roots
bulbs, surrounded by a translucid root sheath and bleed-                 is uncommon and strongly suggests cicatricial alopecia in the
ing area (Figure 1B). A trichoscopy-guided biopsy followed               acute phase [1,2], as the inflammatory infiltrate may prema-
by histopathological examination confirmed the suspi-                    turely release anagen hairs. It has been previously described
cion of LPP.                                                             predicting disease activity in discoid lupus erythematosus
    Treatment with topical clobetasol propionate, oral                   and Brocq’s pseudopelade, since it is compatible with active
­prednisolone 0,5mg/kg/day, and hydroxychloroquine 5mg/                  interface dermatitis on histopathology [2,3]. In the reported
kg/day was started. After 3 months, the patient had im-                  case, it was associated with LPP activity, supported by clini-
proved and presented a negative pull test.                               cal, trichoscopic, and histopathological findings.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023140                                                                               1
    Figure 1. (A) Trichoscopy shows erythema and perifollicular hyperkeratosis in lichen planopilaris. (B) Golf club-shaped pigmented
    anagen bulbs surrounded by the root sheath and a bleeding area.



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2                                                                            Image Letter | Dermatol Pract Concept. 2023;13(3):e2023140
