Brow ulerythema is a chronic dermatosis, which is a representative of the group of keratoses (their essential variety). The pathological process is localized on the face, characterized by the accumulation of nodular elements and horny scales in the mouths of the hair follicles, which create a grater phenomenon when stroking. The overlap of the horny masses of the mouth of the hair follicle causes hair twisting, atrophy and loss. Nodules are resolved by atrophic scarring. Brow ulerythema is diagnosed by a dermatologist based on anamnesis and clinical examination. Vitamin therapy dominates the treatment, skin softening ointments are prescribed externally.
Brow ulerythema is a rare perifollicular lesion of the skin. There are no gender and racial differences in the frequency of brow ulceritis. Dermatosis often begins in childhood, the manifestations of erythema increase in winter and soften in summer, which is most likely due to insolation and increased work of the sweat glands. The pathology is not endemic.
The first description of brow ulceritis appeared in 1889 and belongs to the German dermatologist P. Tenzer, who, investigating the morphology of the disease, proposed a new method of coloring native preparations. P. Tenzer’s colleague P. Unna studied the pathological process in detail in 1891. He also modified and put into practice the proposed method of coloring collagen fibers with orsein. The Tenzer-Unna technique for the pathomorphological study of the supraorbital ulcer is still used in dermatology today. The urgency of the problem is associated with a decrease in the quality of life of patients after the appearance of cosmetic defects.
The causes of the disease are not exactly clarified. The possibility of an autosomal dominant type of inheritance of brow ulerythema is assumed. Some experts point to a possible connection with endocrine disorders, tuberculosis infection and a number of factors that negatively affect the condition of the skin. Normally, the cells of the epidermis, starting with basal keratinocytes and up to the formation of horny scales filled with keratin, provide the physiological process of keratinization. Growing young cells replace the old ones, which are located on top, gently keratinized and after two days exfoliate from the surface of the skin in the form of horny scales.
Under the influence of exo- and endogenous causes, including genetically determined ones, keratinization of the epithelium is disrupted. Keratin changes its structure, becomes more viscous and dense. Keratinocytes increase the speed of movement from the basal layer to the stratum corneum, the cells of the stratum corneum acquire a close connection with each other and slow down their rejection from the surface of the epidermis. In parallel, dystrophic changes occur in the epithelium. Intracellular vacuoles form in the upper layers of the epidermis, the stratum corneum thickens. The formation of granules of filaggrin– a protein responsible for the “packaging” of keratin in cells, and NMF, a key factor determining the moisture content of the stratum corneum, is disrupted.
The consequence of these violations is excessive loss of moisture, dryness of the skin and its peeling. The capillaries of the skin reflexively expand, the blood flow in them slows down, part of the plasma goes into the dermis, contributing to the appearance of erythema. Behind the plasma, T-lymphocytes migrate into the skin, stimulating the processes of proliferation of the dermis. The result of the proliferation of dermal cells are papular-nodular elements on the surface of the erythema.
The localization of the brow ulcer is probably due to a genetic factor. The disease primarily affects the eyebrow area. The horny masses block the lumen of the hair follicles and prevent the hair shaft from coming out, causing it to spiral. Over time, the hair atrophies and falls out, and the nodules are resolved by atrophic scarring.
The clinical picture of the disease is characterized by symmetrical erythema rashes, on the surface of which follicular nodules the size of a millet grain are located. The process is localized in the area of the outer part of the eyebrows. The skin, when touched, resembles the surface of a grater. Often there is a small bran-like peeling in the erythema area. Due to the fact that the mouths of the hair holes are blocked by keratotic scales, the hair rods do not have open access to the outside, the hair is curled with shavings. Over time, the hair sac atrophies, hair falls out, eyebrows thin out. Regression of nodular elements leads to scar-like follicular atrophy, the distinguishing feature of which is a mesh pattern on the skin.
There are no subjective sensations with supraorbital ulcer. Sometimes rashes are accompanied by a burning sensation of the skin, itching. The pathological process can spread to the forehead, temples, cheeks. At the same time, the nodules never merge with each other. Brow ulerythema can coexist with other forms of keratosis. After the stabilization of the pathological process, the business card of the disease remains on the skin – slightly noticeable areas of mesh atrophy.
Diagnosis and treatment
The diagnosis is made by a dermatologist, based on the characteristic clinical manifestations of brow ulerythema. Differentiate the disease with other varieties of ulerythema, other follicular keratoses, Darya’s dyskeratosis, lupus erythematosus, sycosis and acne. Brow ulcer therapy is ineffective, priority is given to large doses of vitamin therapy. Externally, softening and nourishing ointments are applied. The prognosis is relatively favorable, taking into account the aesthetic component of pathology.