International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
October-December 2016
Volume 8 | Issue 4
Page Nos. 155-205

Online since Tuesday, March 28, 2017

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ORIGINAL ARTICLES  

Effect of oil application, age, diet, and pigmentation on the tensile strength and breaking point of hair p. 155
S Kavitha, Karthika Natarajan, G Thilagavathi, CR Srinivas
DOI:10.4103/0974-7753.203170  
Background: Hair strength depends on various factors such as nutrition, environmental factors, sunlight, oiling, aging, conditioner, etc. Aim: To compare the tensile strength and breaking point of the hair shaft between (1) vegetarian and nonvegetarian. (2) Those who regularly apply and those who do not apply oil. (3) Pigmented and nonpigmented hair, (4) childhood and elderly. Materials and Methods: Hair fibers were mounted in tensile strength testing machine Zwick/Roell Z010 and gradual force was administered. The elongation of hair fiber in mm and the maximum force required to break the hair strand were recorded for each fiber. Results: Elasticity of the children's hair was more than the elasticity of adult (P = 0.05) although tensile strength in children hair was not statistically significant (>0.05). Similarly, the tensile strength was more among those who regularly consumed nonvegetarian food but the difference was not statistically significant (P > 0.05). There was no statistically significant difference in other groups (P > 0.05). Conclusion: Elasticity in children hair is statistically more than elderly hair although there is no significant change in tensile strength.
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Serum vitamin D3levels and diffuse hair fall among the student population in South India: A case–control study p. 160
Kashinath Nayak, Aaina Garg, Prasanna Mithra, Poornima Manjrekar
DOI:10.4103/ijt.ijt_57_16  
Introduction and Aims: Hair fall is a common problem faced by many younger people, which has variety of risk factors. Vitamin D3has emerged as a molecule with key role to play in various disorders. This study was done to assess its role in diffuse hair fall among student population. Materials and Methods: This was a case–control study including young adults presenting with complaints of hair fall (>100 a day) as cases, with age-matched healthy controls. Vitamin D3levels were measured in all the patients. Data analysis was done using Statistical Package for Social Sciences version 11.5 software and significance was tested using Chi-square test and binary logistic regression analysis. Results: Atotal of 44 participants were enrolled; 22 in each arm. The mean age of the study population was 20.89 years (standard deviation: 1.49). The median value of Vitamin D was 6.80 (interquartile range - 5.350–16.63) for the study population. Overall, 81.8% cases had Vitamin D deficiency compared to 45.5% of controls and this difference was statistically significant (P = 0.007). Furthermore, females had a statistically significant difference in Vitamin D levels between cases and controls. Higher level of full sleeve cloth usage, sunscreen lotion application, and lesser sun exposures were seen among cases although these differences were not statistically significant. The levels of Vitamin D3were not significantly different among Indians, nonresident Indians, and foreigners. None of the cases had normal Vitamin D values whereas 4.5% controls fell in the normal category. Conclusions: Female patients with diffuse hair fall were found to have significantly low Vitamin D3levels among student population.
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CASE REPORTS Top

Epithelioma adenoides cysticum: A report of two cases in a family p. 165
Najeeba Riyaz, Bindurani Sudhamani, Arakkal Riyaz
DOI:10.4103/0974-7753.203177  
Epithelioma adenoides cysticum or multiple trichoepitheliomas are rare benign hamartomas arising from the hair germ. A 35-year-old female presented with multiple skin-colored firm papules and nodules mainly affecting the central face, scalp, and external ear canal since the age of 9 years. The lesions gradually increased with age. Her 13-year-old son also had similar but smaller lesions on the central face. Histopathology was consistent with trichoepithelioma.
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Olmsted syndrome in a family p. 168
Rajyalaxmi Konathan, Sainath Kumar Alur
DOI:10.4103/0974-7753.203175  
Olmsted syndrome (OS) is a rare disorder characterized by the combination of periorificial, keratotic plaques, and bilateral palmoplantar keratoderma. Synonyms are mutilating palmoplantar keratoderma with periorificial keratotic plaques (ORPHA659, MIM #614594 and #300918). A number sign (#) is used with this entry because of evidence that mutilating palmoplantar keratoderma with periorificial keratotic plaques (OS) is caused by heterozygous mutation in the TRPV3 gene on chromosome 17p13.2. We report three cases of OS, two females and one male in the same family, who presented with palmoplantar keratoderma, sparse scalp hair, cheilitis, and periorificial fissures. We are reporting the cases due to the rarity of occurrence and to highlight the trichoscopy findings.
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Anagen effluvium following acute colchicine poisoning p. 171
Andrea Combalia, Carola Baliu-Piqué, Adriana Fortea, Juan Ferrando
DOI:10.4103/0974-7753.203171  
We present a case of a 17-year-old girl admitted to the Psychiatric Department recovering from a suicide attempt with colchicine. One week after poisoning, a sudden onset of hair loss was observed. Positive hair pull test and trichoscopy demonstrated the presence of anagen hairs with pigmented long roots covered by the root sheaths. Colchicine poisoning is an uncommon, but potentially life-threatening toxicologic emergency. An overdose of colchicine inhibits cell division, and thus the most affected organs are those which have a high rate of cell turnover. Hair loss resulting from colchicine poisoning presents as anagen effluvium, as it occurs with an exposure to toxic chemicals. Pharmacotherapy or specific treatment is not usually required, since the follicle resumes its normal activity after withdrawal of the antimitotic factors.
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Graham–Little–Piccardi syndrome: A lens through beyond what is known Highly accessed article p. 173
Abhijit Saha, Joly Seth, Anupam Das, Sandipan Dhar
DOI:10.4103/0974-7753.203180  
Graham–Little–Piccardi syndrome (GLPS) is a rare form of follicular lichen planus and comprises cicatricial alopecia of the scalp, noncicatricial alopecia of the axillae, and/or pubis and spinous follicular papules involving the trunk and extremities. We herein report a classic case of GLPS in a 49-year-old female. Uniqueness of our case is due to its additional features of frontal fibrosing alopecia (FFA). Although overlap between GLPS and FFA has been mentioned in literature, such numbers are scanty. Therapeutic response with oral steroid and retinoid is also far better in contrast to what is described in the existing literature.
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Extreme phenotype of epidermal growth factor receptor inhibitor-induced destructive folliculitis p. 176
Florian Anzengruber, Barbara Meier, Julia-Tatjana Maul, Katrin Kerl, Lars E French, Alexander A Navarini
DOI:10.4103/0974-7753.203174  
Due to the increasingly widespread use and side effect profile of epidermal growth factor receptor inhibitors (EGFRIs), cutaneous side effects of these drugs are frequently encountered. The EGFR is expressed on keratinocytes and fibroblasts. Inhibition of EGFR can produce a range of cutaneous adverse effects, the most frequent being a characteristic acneiform skin eruption. As the latter is associated with good anti-neoplastic responses, the onset of EGFRI-induced acneiform skin eruption is typically viewed as a positive sign by patients and physicians. It can usually be treated well with standard acne drugs, but in rare cases, the skin eruption can be so severe that systemic therapy and/or interruption of EGFRI treatment are required. One of the severest forms of EGFRI-induced skin eruption occurring on the head and neck area resembles folliculitis decalvans. Here, we discuss the management of such a case seen in our department. In addition, we present an analysis of tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-17A expression based on immunohistochemical stains and qPCR.
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Idiosyncratic findings in trichoscopy of tinea capitis: Comma, zigzag hairs, corkscrew, and morse code-like hair p. 180
Ebtisam Elghblawi
DOI:10.4103/ijt.ijt_92_15  
Dermoscopy is a method of growing significance in the diagnoses of dermatological pigmented skin diseases. However, in my case, mycology culture was negative and successful treatment was given on the basis of trichoscopy and wood lamp examination. I hereby describe a young boy with tinea capitis, multiple “comma hairs” and “zigzag hair” and a subtle additional feature “Morse code-like hair” when intensification was applied. Dermatoscopic aspects found skin Type 2 in a child of as a distinctive dermoscopic finding.
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Aplasia cutis congenita: Trichoscopy findings p. 184
Ana Maria Costa Pinheiro, Eduardo Botelho Silva Mauad, Luís Fernando Amarante Fernandes, Raffaela Bruno Drumond
DOI:10.4103/ijt.ijt_90_15  
Aplasia cutis congenita (ACC) is a rare disorder characterized by localized absence of skin that most commonly affects the scalp. We present a case of ACC in a 45-day-old girl and the dermoscopic findings. Dermoscopy has shown to be an easy, fast and useful method for the diagnosis of this condition.
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Loose anchoring of anagen hairs and pili torti due to erlotinib p. 186
Rodrigo Pirmez, Juan Piñeiro-Maceira, Carmen Gloria Gonzalez, Mariya Miteva
DOI:10.4103/ijt.ijt_16_16  
Erlotinib is a selective epidermal growth factor receptor inhibitor utilized in the treatment of solid tumors. Cutaneous side effects, including changes in hair texture and alopecia, have been described. In this case report, we describe two patients with a new finding of loose anagen hairs and pili torti leading to nonscarring marginal and diffuse alopecia and discuss potential mechanisms underlying erlotinib-induced hair changes.
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Methotrexate in alopecia areata: A report of three cases p. 188
Ana Batalla, Ángeles Flórez, Teresa Abalde, Hugo Vazquez-Veiga
DOI:10.4103/ijt.ijt_67_16  
There are few studies about systemic treatment in severe cases of alopecia areata (AA), especially in the pediatric population. Although there is more experience with systemic corticosteroids, recent reports have suggested methotrexate (MTX) as an alternative treatment, with a relatively good outcome. We describe three cases of AA in children treated with MTX, two of them with successful results.
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Trichoscopic patterns in squamous cell carcinoma: : A case report p. 191
Balachandra S Ankad, Mahajabeen Madarkar, Gourishetty Saipriya, Punit S Sakhare, Vijay D Dombale
DOI:10.4103/ijt.ijt_24_16  
Squamous cell carcinoma (SCC) is the second most cutaneous malignancy after basal cell carcinoma (BCC) with increasing incidence. In the view its nodular manifestation; it can appear similar to nodular BCC, atypical fibroxanthoma, sclerosing liposarcoma and desmoplastic melanoma. Prognostic and therapeutic implications are different in all these conditions and thus their distinction becomes important. Trichoscopy is a simple and non-invasive technique to visualize certain morphological features of skin lesions and it improves the diagnostic accuracy for melanocytic and nonmelanocytic pigmented lesions. Here, a case is reported wherein trichoscopic patterns were useful in the diagnosis of SCC on the scalp. To the best of our knowledge, this is the first report on trichoscopic patterns in SCC from India.
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BRIEF COMMUNICATION Top

Cutaneous hybrid tumor composed of epidermal cyst and cystic pilomatricoma: Unusual presentation in a child p. 195
Konstantinos Lamprou, Christos Plataras, Maria Chorti, Efstratios Christianakis
DOI:10.4103/ijt.ijt_62_15  
We report a rare case of cutaneous hybrid tumor composed of epidermal cyst and cystic pilomatricoma that presented in an unusual way in a child. A 14-year-old teen girl presented with a skin lesion on the inner side of the left arm, approximately at the level of the elbow. The lesion was initially observed 5 months before and was continuously increasing in size during that time resembling other benign or malignant cutaneous tumors.
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UPDATE Top

Comparative analysis of immunopathological features of lichen planopilaris and female patients with frontal fibrosing alopecia p. 197
Emanuella RD Cerqueira, Neusa Valente, Mírian Nacagami Sotto, Ricardo Romiti
DOI:10.4103/0974-7753.203179  
Background: Frontal fibrosing alopecia (FFA) is a disorder characterized by progressive cicatricial alopecia (CA). Its classification as a clinical variant of lichen planopilaris (LPP) or as a unique disorder is controversial. The presence of Langerhans cells within the bulge area and the sebaceous epithelium and the presence of lymphocytic infiltrate in this area in CA have led to a series of hypotheses, although limited, about their development. To our knowledge, scarce is the literature demonstrating immunoanalytical studies comparing both disorders. Objective: The authors sought to describe diagnostic findings, comorbidities, and immunopathological features of female patients with FFA as compared to LPP. Materials and Methods: This retrospective single-center study included patients given the diagnosis of FFA or LPP. The LPP activity index was used to evaluate objective signs and subjective symptoms. Biopsy specimens were obtained from active, inflammatory areas of the scalp, and the inflammatory infiltrate intensity and quality were compared. Direct immunofluorescence for IgA, IgM, and IgG and immunohistochemistry to demonstrate the expression of CD1a, CD3, CD4, CD8, CD68, and 2,3-dioxygenase indoleamine were performed. Results: Twenty female patients (10 patients with FFA and 10 patients with LPP) were included in the study. Histopathological findings evidenced reduced number of hair follicles and perifollicular fibrosis in both disorders. Immunofluorescence findings resulted positive in 50% of FFA cases and 40% of LPP cases. Conclusion: Although clinically different, our findings suggest that there are, to date, no histological or immunological findings that allow us to accurately separate these two forms of scarring alopecia, namely FFA and LPP.
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REMINISCENCE Top

A comment on frontal fibrosing alopecia (Axel munthe's syndrome) p. 203
Ralph M Trüeb
DOI:10.4103/0974-7753.203176  
Frontal fibrosing alopecia (FFA) represents a peculiar condition with a quasi-symmetrical, marginal alopecia along the frontal and temporal hairline with scarring. Steven Kossard is credited with the original description of the condition in 1994. Since its first description, FFA has become increasingly common while its etiology has remained obscure. While FFA has been related to lichen planopilaris, in fact, the pattern of clinical disease presentation might be more specific for the condition than the underlying inflammatory autoimmune reaction. It has been speculated as to whether FFA existed before Kossard's original report since artistic depictions dating from the 15th to 16th century often show a high frontotemporal hairline. Rather, these represent fashionable forms of frontal pseudo-alopecia than FFA. Nevertheless, there is compelling evidence that FFA existed well before 1994 from the Swedish Physician Axel Munthe's (1857–1948) account of the distinctive features of the condition in his book of memoirs “The Story of San Michele.” Therefore, Axel Munthe is to be acknowledged the first description of FFA in 1929.
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