Trichology

Applicability of trichoscopy in scalp seborrheic dermatitis Sandra Widaty, Erdina HD Pusponegoro, Githa Rahmayunita, Rinadewi Astriningrum, Meidisa Akhmad Adinda, Caroline Oktarina, Eliza Miranda, Triana Agustin International Journal of Trichology 2019 11(2):43-48 Introduction: Seborrheic dermatitis (SD) is a chronic-recidive inflammatory skin disorder with predilection in areas rich of sebaceous gland. The most common clinical manifestations are pruritus and scales. Although SD can be diagnosed without special tools, other examinations may be needed to determine additional specific therapy. Trichoscopy is one of the noninvasive tools which can help to diagnose SD as it can provide the microstructure view of the scalp. Materials and Methods: This descriptive study was conducted to explore the trichoscopic features of SD and its characteristics. There were 96 SD patients enrolled in this study. The scalp was divided into four areas, and each area was scored based on Seborrheic Area Severity Index, comprising erythema, desquamation, number of papules, and percentage of lesion area. The most severe area was examined with a trichoscopy to observe the characteristics of hair and scalp. The association between trichoscopic findings and SD severity was analyzed with Fisher's exact test. Results: Overall, the participants were 36% males and 64% females with the mean age of 30 (13–70) years old. Based on the trichoscopic examination, the most common findings were thick hair shafts (72%), white scales (69%), arborizing thin vessels (38%), yellowish area (36%), and structureless red area (19%). These findings were not significantly different between mild and moderate SD (P > 0.05). Conclusion: Considering the merits and demerits of trichoscopic examination, it can be helpful to aid the diagnosis of SD. Further studies in Asian population with greater sample size are needed to demonstrate more significant result.

Serum Vitamin D levels and Alopecia areata- A hospital based case-control study from North-India Fozia Rehman, Naina Dogra, Mashkoor A Wani International Journal of Trichology 2019 11(2):49-57 Background: Alopecia areata (AA) is an autoimmune disease which is characterized by hair loss and affects any hair-bearing area. Low levels of Vitamin D have been implicated in a variety of autoimmune diseases. This study was conducted to assess the levels of Vitamin D in patients with AA and its correlation with severity, pattern, and extent of the disease. Materials and Methods: This hospital-based study included 135 cases with AA and 135 age- and sex-matched controls. AA cases were grouped according to the severity, pattern, and extent of the disease. The levels of Vitamin D were assessed and compared between cases and controls and among different groups of cases. The data were analyzed, and the correlation was derived. Results: The more number of patients from the case group had deficient and insufficient levels of Vitamin D as compared to controls, the difference being statistically significant (P = 0.01). A highly significant difference was found in mean Vitamin D levels between cases and controls (P = 0.0004). A negative correlation was found between Vitamin D levels and severity of AA as accessed by SALT score. A negative correlation was also found between Vitamin D levels with pattern and extent of the disease. Conclusion: Vitamin D deficiency may be one of the factors having a role either in etiopathogenesis or exacerbation of AA. Supplementation of Vitamin D as a treatment modality may improve the clinical outcome of AA.

Comparative study between mesotherapy and topical 5% minoxidil by dermoscopic evaluation for androgenic alopecia in male: A randomized controlled trial Prachi Chetankumar Gajjar, Hita Hemant Mehta, Manish Barvaliya, Bhavesh Sonagra International Journal of Trichology 2019 11(2):58-67 Aim: This study aims to compare efficacy and safety between mesotherapy (intralesional injection) and 5% topical minoxidil solution in male androgenic alopecia (AGA) by dermoscopic evaluation. Methodology: In a randomized active controlled trial, we enrolled 49 clinically diagnosed males of AGA and randomly allotted them into two groups – mesotherapy (A) (25) and minoxidil (B) (24). Males in Group A were given total 8 sessions of intralesional mesosolution with microneedling procedure while Group B males were prescribed topical solution of minoxidil 5% twice daily for 4 months. Results were evaluated at baseline and then monthly for 4 months with clinical photographs, dermoscopy, trichoscan, 7-point standard assessment tool, and patient-self assessment scores. Results: Grade II was the most common presentation in our study. All dermoscopic parameters such as variation of hair shaft diameter, follicular units with single and multiple hairs, yellow dots, and perifollicular halo did not show any significant difference between the groups at all time points except at 1st month where the difference in variation of hair shaft diameter between the two group was 0.04. We observed a significant increase (P = 0.01) in the variation of hair shaft diameter between pre- and post-treatment in mesotherapy group compared to minoxidil group. The rest of parameters failed to show any significant difference within the group in mesotherapy and minoxidil. Conclusion: In our study, we observed a significant increase in the variation of hair shaft diameter between pre- and post-treatment in Group A compared to B. Other dermoscopic, trichoscan, and subjective measurement tool failed to show significant difference between two groups. Our observation suggests that there is no significant improvement of mesotherapy in male AGA over minoxidil.

A study to compare the efficacy of platelet-rich plasma and minoxidil therapy for the treatment of androgenetic alopecia Kuldeep Verma, Gita Ram Tegta, Ghanshyam Verma, Mudita Gupta, Ajeet Negi, Reena Sharma International Journal of Trichology 2019 11(2):68-79 Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) therapy is one of the newer treatment options in the management of AGA which has shown promising results. Aims and Objectives: This study was aimed at comparing the clinical efficacy of PRP therapy with minoxidil therapy. Materials and Methods: In the study, patients were randomized into two groups – Group A (given PRP therapy) and Group B (given minoxidil therapy). Both groups were followed up over a period of 6 months, and final analysis was done with the help of global photography, hair pull test, standardized hair growth questionnaire, patient satisfaction score; in addition, a comparison of platelet counts in PRP was done, to know that if a clinical correlation exists between platelet concentration and clinical improvement. A total of 40 patients clinically diagnosed with AGA were enrolled in the study with 20 patients in each group. Four patients from Group A (PRP) and six patients from Group B (minoxidil) could not complete the treatment for 6 months and were eventually excluded. Results: At the end of 6 months, 30 patients were evaluated to compare the efficacy of intradermal PRP and topical minoxidil therapy. On global photography, Group A (PRP) was found to have a comparatively better outcome than Group B (minoxidil). In hair pull test, hair growth questionnaire, and patient satisfaction score, Group A was found to be better than Group B. Mean platelet count at baseline was 3.07 ± 0.5 lac/mm, 3 while platelet count in final PRP prepared was 12.4 ± 1.7 lac/mm, and patients with a higher platelet count in PRP had a much better clinical improvement compared to patients with a low platelet count in PRP. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient. Conclusion: PRP therapy can be a valuable alternative to topical minoxidil therapy in the treatment of AGA.

Drug-associated plica polonica: An unusual presentation Sumir Kumar, Balvinder Kaur Brar, Priya Kapoor International Journal of Trichology 2019 11(2):80-81 Plica polonica is an uncommon condition characterized by irreversible matting of hair on the scalp. It is usually associated with psychiatric disturbance, neglect of hair, scalp infestation, and use of ionic surfactants for shampooing. Rarely, plica polonica has been associated with drugs. We report this condition in a patient of metastatic carcinoma breast on docetaxel chemotherapy.

A rare case of white piedra caused by Candida parapsilosis in the Sub-Himalayan Region of North India Reena Kumari Sharma, Ghanshyam K Verma, Santwana Verma, Saru Thakur, Anumeha Gupta International Journal of Trichology 2019 11(2):82-85 White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon, a noncandidal yeast characterized by the presence of numerous, discrete, asymptomatic nodules attached to the infected hair shafts. White piedra is considered a disease of tropical regions and occasionally reported from temperate countries. Although Candida parapsilosis such as Candida albicans is well known to cause cutaneous infections, it has been reported as a co-isolate for white piedra along with Trichosporon. We report a case of white piedra from a temperate region caused by C. parapsilosis.

Trichoscopy of scalp metastases Giulia Maria Ravaioli, Michela Starace, Aurora Maria Alessandrini, Federica Guicciardi, Farah Moustafa, Nicolò Brandi, Bianca Maria Piraccini International Journal of Trichology 2019 11(2):86-87 A 69-year-old woman with invasive ductal breast cancer (BC) presented multiple asymptomatic alopecic areas of the scalp. Trichoscopy revealed peripheral black dots (BDs) and an atypical vascular pattern. Histopathology confirmed the diagnosis of BC metastases. Cutaneous and scalp metastases are a possible sign of advanced and widespread BC, and the diagnosis may be challenging. The trichoscopy of scalp metastases has never been described. BDs and an atypical vascular pattern in our case were a diagnostic clue.

Pili migrans T Pari International Journal of Trichology 2019 11(2):88-89

Loose anagen syndrome: A little response to minoxidil Ilyass Anouar, Naoufal Hjira, Mohammed Boui International Journal of Trichology 2019 11(2):89-91

Does straight-hair nevus exist? Juan Ferrando, Roxana Castañeda, Antonio Guilabert International Journal of Trichology 2019 11(2):92-93