Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and may present at any age. In this article, we review the epidemiology, clinical features, pathogenesis, and new treatment options of AA, with a focus on the immunologic mechanism underlying the treatment. While traditional treatment options such as corticosteroids are moderately effective, a better understanding of the disease pathogenesis may lead to the development of new treatments that are more directed and effective against AA. Sources were gathered from PubMed, Embase, and the Cochrane database using the keywords: alopecia, alopecia areata, hair loss, trichoscopy, treatments, pathogenesis, and epidemiology.

Background: Global photographs (GPs) have been widely used to grade the severity in female pattern hair loss (FPHL). However, existing classifications for FPHL are not useful in the evaluation of early FPHL. Although there are some variations in early FPHL, even to a mild degree, all types of early FPHL are included in just one category. Therefore, the authors have devised a grading system for early FPHL with five levels focusing on the changes revealed by the surface reflected light of flash generated on GPs. Aims: This study aims to examine the possibility of evaluating the treatment course of early FPHL using the grading system based on changes in hair surface reflection patterns. Subjects and Methods: Retrospective chart review of 114 early FPHL patients was performed. GPs of these patients were classified into five grades. Photographs of the lowest and the highest grades of each patient were selected and paired. First, the relevance between the value of FPHL-severity index (FPHL-SI) and grades of all the selected photos was analyzed. Next three volunteers graded the paired photographs and chose the milder degree, and then, the concordance rate among author's and volunteers' evaluations were analyzed. Results: The value of FPHL-SI and incidence rate of hair diameter diversity tended to rise along with increasing of GP grade. Concordance rate of grading among author and more than two volunteers was 57%. The concordance rate of course evaluation between author and two volunteers was 97%. Conclusion: The new classification can finely classify the grade of early FPHL and can be used for treatment course evaluation.

Background: The study was conducted to compare the angles of the hair shafts created by straight/flat blade and curved blade. Materials and Methods: The study was conducted in a private hair transplant surgery center. Five patients undergoing the first session of hair transplant were included. In each patient, 1 cm² area was selected in the anterior hairline in midline. Five slits were created with 1.0 mm straight/flat blade and five slits were created with 1.0 mm curved blade in each patient. After the slits creation, the grafts were inserted into the slits. The custom-made macrophotography technique was used to take high-magnification photographs of the grafts. The software was used to measure the angle of the hair at the level of the skin. The angles of all the hair shafts were measured in both the groups. The data were then analyzed statistically using paired t-test. Results: A total of five patients were included in the study. The mean age of the patients was 35.0 years. The mean hair angle of the hair shafts created with straight/flat blade was 17.42°, whereas the average hair shaft angle created with curved blade was 9.56°. The hair shafts angles varied from 14.3° to 23.1° while using straight blade. The hair shafts angle resulting due to curved blade ranged from 8.6° to 11.3°. Conclusion: The curved blade created the slits which were more acute than the slits created by the straight/flat blade.

Objective: To investigate scalp hair as biomarker for chronic fluoride exposure among fluoride endemic and low fluoride areas. Methodology: Two areas were identified in Vadodara district, Ajod, as a low fluoride area (Fluoride content of drinking water = 0.11 ppm) and Karsan, a high fluoride area (fluoride content in drinking water = 3.43 ppm). The study was performed on a total of 36 participants from the two villages, 18 from Ajod and 18 from Karsan. Thylstrup Fejerskov Index (TFI) was recorded for each of the participants and sample of hair was collected from the occipital region. Analysis of hair samples was done for assessing the fluoride content. Results: The study consisted of total 36 participants, ranging from the age of 34–60 years and a mean age of 46.53 years. The mean TFI score for the participants in Karsan was 3.39 (±0.979) and in Ajod was 0.83 (±0.786). The difference in this mean score between the two groups was found to be statistically significant. Furthermore, the average fluoride content in hair of the participants in Karsan was 3.40(±1.043) and that in Ajod was 0.35 (±0.063). This difference was statistically significant between the two groups. The TFI scores were found to be positively correlated with the fluoride content in hair. Conclusion: Hair can be used as a useful biomaterial for fluoride exposure monitoring. Having certain advantages over other biomaterials such as easy to collect, store, and transport, hair also serves as a biomarker of chronic fluoride exposure. Hair analysis should thus play a greater role in routinely measuring the chronic exposure to fluorides.

Since its original report in 1994, frontal fibrosing alopecia has become increasingly common, attracting the attention of the medical community and giving rise to speculations on its etiology, specifically the possibility of environmental factors. Familial cases of frontal fibrosing alopecia point to the possible contribution of hereditary factors maybe related to androgenetic alopecia. We report the first case of connubial frontal fibrosing alopecia in a genetically unrelated couple pointing to the possibility of a common environmental exposure in the etiology of the condition. Our observation may be fortuitous, considering the high frequency of female frontal fibrosing alopecia. Nevertheless, the incidence of male frontal fibrosing alopecia has remained low with a consequently low statistical probability of random occurrence of the condition in a marital couple. We, therefore, suggest to systematically includes the hair condition of marital partners in the patient history of patients with frontal fibrosing alopecia, to elucidate the actual frequency of connubial frontal fibrosing alopecia and maybe a common causative agent or hair grooming practice.

A case of cutaneous graft versus host disease (GvHD) presenting as fibrosing alopecia in a pattern distribution (FAPD) is discussed, possibly providing a mechanistic model for a better understanding of the pathogenic events underlying cicatricial pattern hair loss. The implication of a follicular inflammation and fibrosis associated with patterned hair loss has emerged from several independent studies. Eventually, Zinkernagel and Trüeb reported a peculiar type of cicatricial pattern hair loss with histopathological features consistent with lichen planopilaris (LPP) associated with androgenetic alopecia (AGA). With regard to its pathogenesis, LPP is regarded to constitute a T-cell-mediated autoimmune reaction. An as yet unknown antigenic stimulus from the malfunctioning hair follicle may initiate a lichenoid tissue reaction that triggers apoptosis of the follicular epithelial cells in the susceptible individual. GvHD is a complication following allogeneic tissue transplantation and is induced and maintained by immunocompetent cells from the donor tissue that particularly attack epithelia of fast-proliferating tissues in the recipient. Due to its analogies with lichen planus, GvHD constitutes a valid immunologic model for lichen planus, LPP and ultimately FAPD. Specifically, the presentation of GvHD of the scalp combines features of AGA and of LPP, as originally proposed in earlier observations on permanent alopecia after bone marrow transplantation.

Frontotemporal dementia (FTD) is the most common form of dementia in the younger age group and often exists with comorbid obsessions and compulsions in up to 80% of the patients. Trichotillomania or compulsive “hair-pulling” disorder is a rare manifestation of FTD and is a poorly evaluated symptom in this condition. The release of “grooming functions” due to frontal disinhibition is often attributed to the evolutionary perspective; however, recent findings also implicate the role of neurotransmitter dysfunction. Trichotillomania is currently classified under obsessive and compulsive behavioral spectrum disorders and is often encountered in the younger population with research evidence of response to selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and newer drugs such as N-acetyl cysteine. The role of behavioral therapy also has robust evidence in trichotillomania. We herewith report the case of a middle-aged male patient who presented with features of personality change and behavioral problems in terms of anger, agitation, and disinhibitory behavior who on detailed clinical evaluation and radiological assessment had features consistent with behavioral variant of FTD along with compulsive “hair plucking” behavior which responded minimally with SSRIs. FTD can have features of trichotillomania which is an often overlooked and relatively uncommon manifestation of dementias. Treatment options such as N-acetyl cysteine and behavioral therapy could have potential utility in this degenerative condition hitherto at an earlier stage.

Cutaneous adverse effects of chemotherapy are widely known but underreported. A significant advancement is made in the field of oncology with the advent of new classes of drug being added to the existing classes at a fast pace. Most of these cutaneous adverse effects are self-limiting and subsides on suspending the drug either temporarily or permanently. Some of these effects are merely overlooked by the patients and the treating physician hence goes un-noticed. Nilotinib is a newer second-generation tyrosine-kinase inhibitor approved for the management of chronic myeloid leukemia. This drug is rapidly establishing itself as a first-line therapy for chronic myeloid leukemia. Like other chemotherapeutic agents, a wide array of cutaneous adverse effects is noted with this drug. We report two cases of perforating folliculitis induced by nilotinib.