International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
November-December 2021
Volume 13 | Issue 6
Page Nos. 1-38

Online since Monday, November 22, 2021

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EDITORIAL  

“Let food be thy medicine”: Value of nutritional treatment for hair loss Highly accessed article p. 1
Ralph M Trueb
DOI:10.4103/ijt.ijt_124_20  
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ORIGINAL ARTICLES Top

Beard reconstruction p. 4
Ummer Yaseen, Shabir Ahmed, Muzaffar Ahmed
DOI:10.4103/ijt.ijt_40_19  
Introduction: Loss of beard can occur due to many reasons. As beard has huge cosmetic importance, loss of beard can be psychologically traumatic. Beard can be absent from puberty, called as congenital absence of beard. Beard loss can be secondary to dermatological conditions such as nodulocystic acne. In our setting, the most common cause of loss of beard is burn injury. There are many treatment options such as surgical excision of scar, flaps Z/W plasty, and hair transplantation to reconstruct the beard. We present the follicular unit extraction (FUE) method of beard reconstruction. Aim: The aim of our study was to describe the evaluation of the results using FUE method for beard reconstruction. Materials and Methods: We did a study in twenty male patients. Any patient having alopecia areata were ruled out of the study. Fifteen patients had postburn loss, three had postacne scarring, and two patients had congenital absence of beard. We evaluated all patients thoroughly by calculating the density of beard over the normal areas of beard, evaluating the elasticity of skin, preoperative photography, and doing dermatoscopy. Areas were marked. FUE was used for harvesting the grafts as a limited number of grafts were needed to complete the surgery. In the recipient area, adrenaline was avoided in patients of scarring alopecia. In cases of congenital absence of hair, 1:200,000 adrenaline was used to minimize bleeding. Grafts were placed. Results were noted after 1 year. Results: All patients followed up properly for 1 year. Growth started 3 months postoperatively and continued till 1 year postoperatively. Density was good in cases with congenital absence of hair. In cases of scarring alopecia, multiple sessions were needed to provide adequate density. Results were graded as “very good,” “good,” and “poor.” Eleven patients had “very good” result, eight had “good,” and one had “poor” result. Nineteen patients were satisfied with the final result, and one patient was dissatisfied with the result. Conclusion: FUE is the ideal method of reconstructing beard loss. Proper preoperative evaluation, preparation, planning, and proper surgical technique produce the best possible result.
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A clinico-trichological study of female androgenetic alopecia p. 9
Isha Verma, Bhushan Madke, Adarsh Lata Singh, Sanjiv Choudhary
DOI:10.4103/ijt.ijt_12_19  
Background: Female Androgenetic Alopecia (FAGA) is one of the most common cause of diffuse scalp hair loss in women. FAGA is insidious in onset, gradually progressive, non scarring alopecia. Trichoscopy is a newly developed non invasive, objective, bed side analytical method of hair imaging based on video dermoscopy of scalp. The objective of this study is to study the clinical features of female androgenetic alopecia, to study the trichoscopic features in patients of female androgenetic alopecia and to correlate the trichoscopic features according to clinical grade of female androgenetic alopecia. Methods: Study enrolled 50 females with FAGA and 50 normal females. FAGA cases were divided into subgroups according to sinclair scale. Laboratory investigations including hemoglobin level, triiodothyronine (T3), thyroxine (T4) thyroid stimulating hormone (TSH) and serum ferritin level were carried out in both cases and controls. After clinical diagnosis, trichoscopic examination was done and categorised using Diagnostic Criteria set by Rakowska A. et al and trichoscopic findings were coorelated with clinical grades. Results: >4 yellow dots in frontal area , >2:1 ratio of single hair units (frontal: occiput) & >3:1 ratio of hair with perifollicular discoloration (frontal: occiput) are mainly seen in late stages of FAGA i.e. grade 4 & 5 and >1.5:1 ratio of vellus hairs (frontal :occiput) in early stages i.e. grade 2 & 3 while lower mean hair thickness in frontal area & > 10% thin hairs in frontal area are seen in all stages of FAGA Conclusion: Trichoscopy not only confirms the diagnosis by assessing the trichoscopic features of FAGA but also coorelates them with clinical severity. And as the age increases, grade of clinical severity increases. Not necessarily hemoglobin, thyroid and serum ferritin levels will be dearranged in FAGA cases. Limitation: The study is done on few number of patients. Further studies needs to be done to validate results.
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Hair loss in children: A clinicoetiological study from South India p. 17
Varsha M Shetty, Asha Gowrappala Shanmukhappa, HV Nataraj, Sacchidanand Sarvajnamurthy Aradhya
DOI:10.4103/ijt.ijt_56_19  
Background: Scalp hair loss in children is one of the common complaints encountered in dermatological practice. Accurate diagnosis of hair loss in children is of major significance as it can have severe psychological implications given the cosmetic importance of hair. Aims: This study aims to study the different causes and clinical presentations of scalp hair loss in children. Materials and Methods: This was a hospital-based descriptive study that enrolled a total of 170 children with scalp hair loss. A detailed history, scalp, and hair examination were done. Bedside investigations such as KOH mount, hair shaft microscopy, and hair pull tests were conducted. Scalp biopsy and dermoscopy were done wherever necessary to confirm the diagnosis. Results: Majority of the children with scalp hair loss were school going and adolescents accounting for 62.4% of cases; 52.4% of patients were male and 47.6% were female. Asymptomatic hair loss was the most common presenting complaint contributing to 71.2% of cases. Patchy pattern of scalp hair loss formed a majority (86.5%) compared to diffuse pattern (13.5%). Around 89.4% of scalp hair loss were of acquired type and remaining 10.6% were of congenital type. Neonatal occipital alopecia (38.9%) was the most common cause of congenital hair loss. However, in the acquired group, 90.1% had nonscarring and 9.9% had scarring alopecia. In the nonscarring group, tinea capitis, alopecia areata, and telogen effluvium accounted for 47.4%, 37.9%, and 8.8% of cases, respectively. Conclusion: Childhood alopecia is different from adult alopecia in terms of causes and the pattern of presentation. There is a scarcity of literature on childhood alopecia from India, hence, this study can serve as a useful guide in understanding the different causes and its presentation in our population. In addition, this study signifies the importance of simple diagnostic tests such as KOH and hair shaft microscopy in the diagnosis of common hair loss conditions in children.
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Serum paroxonase 1 level may be an indicator and predictor of the severity of androgenetic alopecia p. 26
Maha Tantawy, Ahmed Abdel Khabir, Nancy Mahsoub, Marwa Zohdy
DOI:10.4103/ijt.ijt_128_20  
Background: Androgenetic alopecia (AGA) is a common stressful form of hair loss caused by androgen excess, genetic factors, and exposure to oxidative stress (OS) with the formation of reactive oxygen species (ROS). Paraoxonase 1 (PON1) is an enzyme synthesized in the liver bound to high-density lipoproteins to prevent lipid peroxidation. Aim: The aim of our work is to estimate serum PON1 level in patients with AGA and correlate its levels with disease severity which may help in determining if there is a role of ROS in pathogenesis of AGA. Subjects and Methods: This study was carried out as a case and control on 40 patients with AGA (diagnosed by typical clinical and dermoscopic finding) versus 40 control subjects. Blood samples were taken from all subjects to assess serum PON1enzyme using enzyme-linked immunosorbent assay kits. Results: There was a significant decrease in serum PON1 concentration level in AGA patients in comparison to controls, in addition, there was a significant decrease correlated with AGA severity (P < 0,001). The study proved that PON1 is considered highly sensitive and specific for AGA cases and a good predictive factor of AGA in healthy subjects. Conclusion: This is the first study done to reveal that the level of PON1 significantly decreased in AGA patients, which may give additional proof that OS has role in the pathogenesis of AGA and hence may help in the management of AGA by adding antioxidants in treatment.
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CASE REPORTS Top

Recovery of alopecia universalis with associated nail dystrophy treated with tofacitinib: A 6-year-old child's case report p. 32
Vineet Dube
DOI:10.4103/ijt.ijt_91_21  
An emerging treatment modality whose established efficacy in systemic inflammatory diseases is now being actively explored for cutaneous disorders: tofacitinib, an oral Janus kinase inhibitor, is one such treatment. Alopecia universalis has been reported to improve with the use of tofacitinib in various case reports and case series. Nail dystrophy is a diverse skin disorder that has been linked to autoimmune illnesses such as psoriasis and psoriatic arthritis in certain subtypes. Alopecia areata and alopecia universalis are also commonly associated with nail dystrophy. In the present case report, we see that there are also improvements in nail dystrophy in the patient with alopecia universalis who is using tofacitinib.
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Trichoscopic findings in pressure alopecia: Report of two cases and review of the literature p. 34
María Librada Porrino-Bustamante, Salvador Arias-Santiago, María Antonia Fernández-Pugnaire
DOI:10.4103/ijt.ijt_117_20  
Pressure alopecia (PA) is an uncommon type of hair loss due to ischemic changes of the scalp, as a result of prolonged immobilization. Clinically, it often appears within the 1st month of the trigger and tends to resolve spontaneously within 4 months. If the duration of the immobilization is longer, irreversible alopecia can be developed. Trichoscopy is usually nonspecific, being black dots, broken, and dystrophic hairs the most frequent findings. However, yellow dots and thin hairs have also been reported. We herein present two patients with PA, one with a recent development and another one with a long-lasting alopecia. Both of them showed keratotic follicular plugs and thin hairs as the main trichoscopic findings.
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Pemphigus vulgaris localized to the scalp with complete response to topical steroids p. 36
David Vega-Diez, Ana Rodríguez-Villa Lario, Alba Gómez Zubiaur, Susana Medina
DOI:10.4103/ijt.ijt_95_20  
Pemphigus vulgaris (PV) is an anti-cadherin autoimmune disease, characterized by the production of anti-desmoglein 3 (and to a lesser extent anti-desmoglein 1) antibodies, producing acanthosis, typically suprabasal, which clinically translates into flaccid blisters and erosions, generally starting on mucous membranes, with subsequent appearance of skin lesions. Only about 25 cases of PV of exclusively cutaneous location have been described in the literature. Treatment with potent topical steroids is usually sufficient to control the symptoms. We present the case of a 68-year-old female patient with localized PV in the scalp, presenting as alopecic and scabby plaque, with excellent response and hair regrowth with topical corticotherapy.
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