Context: Although etiopathogenesis of frontal fibrosing alopecia (FFA) is not fully discovered, it seems that hormonal factors play a role. Aims: The aim of this study was to investigate the serum level of sex hormones in patients with FFA compared to a control group. Settings and Design: This was a case–control study. Subjects and Methods: All patients who referred to the Dermatology Clinic of Faghihi Hospital, Shiraz University of Medical Sciences, between 2013 and 2018 and were pathologically and clinically diagnosed with FFA were considered as the case group. The control group was selected from community people who did not have alopecia, and each was matched with its counterpart in the case group in terms of gender, age, and menstrual status. Both the groups were evaluated for serum level of sex hormones. Statistical Analysis Used: SPSS software version 23 was used in this study. Results: Of 20 patients, who were all female, 8 were postmenopausal and 12 were cyclic. There was no significant difference between sex hormone levels of the case and control groups regardless of their menstrual statuses. Similarly, there was no significant difference between hormonal levels in postmenopausal women of both the groups. However, follicle-stimulating hormone (FSH) was significantly lower in the case group cyclic women. Moreover, postmenopausal patients with premenopausal onset of FFA had lower levels of FSH and luteinizing hormone than those with postmenopausal onset. Free testosterone correlated inversely with duration of FFA. Conclusions: It seems that the pathogenesis of FFA is not associated directly with serum concentrations of sex hormones. Therefore, future studies are recommended to investigate possible tissue mechanisms of hormonal factors involved in its pathogenesis.

Aim: The aim of this study is to propose a new quantification protocol for determining the change in hair properties on weathering and formulate hair damage protection metric to compare different hair care products. Subjects and Methods: The study was conducted with 30 participants (nonhair oil users), wherein hair samples were collected and evaluated for (a) average cross-section and mean diameter at different sections of strand and (b) breakage point location on hair extension. Correlation between breakage point and hair mean diameter as function of length was studied. Inferences were extrapolated to characterize the quality of hair samples in (a) another matched group of 30 participants (coconut oil users) and (b) studies on hair swatches with different hair treatments. Results: In accordance with the weakest link theory, on extension hair fractured at the section where average mean diameter (or cross section) is the smallest (correlation R² = 0.86). The weakest link in hair fiber is connected with irregularity in hair strands-characterized by root mean square variability (Rq). We found that tips of hair have ~100% more Rq than the roots. Furthermore, regular coconut oil users have hairs with Rq lower by ~65% in comparison to nonoilers. Hair swatch studies confirmed that coconut oil-wash cycles (n = 20) help reduce Rq by 30%, whereas other hair treatments such as shampoos and conditioners did not lead to much change. A new metric was proposed – hair protection factor – to quantify damage control power of various products. Conclusions: Hair breakage is a complex phenomenon with multi-factorial effects. The present work identifies irregularities in mean diameter along hair length as the precursor for hair strength. The weakest link in hair is characterized by the presence of internal defects-preceded by surface irregularities. From root to the tip, cuticle chip-off increases and so does the Rq and tendency to break. Thus, the metric based on Rq can help compare hair care treatments in their promise to control hair damage.

Context: Premature canities etiopathogenesis is unclear, and approach to its therapy remains arbitrary. Reactive oxygen species generated during melanin biosynthesis in anagen hair bulb have been implicated in melanocyte apoptosis and hair graying. Extraneous factors, namely environmental pollution, stressful lifestyle, may compound the melanogenesis-induced endogenous oxidative stress. Aims: We aimed to investigate the role of systemic oxidative stress in causation of premature canities and its correlation with the severity of hair graying. Settings and Design: This was a tertiary care hospital-based cross-sectional study. Materials and Methods: Consecutive 50 patients with premature hair graying, aged <25 years, and 30 age and sex-matched healthy controls were recruited. Severity of premature canities was graded based on the total number of gray hair on the scalp. Redox status was evaluated in cases and controls, by malondialdehyde (MDA), reduced glutathione (rGSH), and superoxide dismutase (SOD) measurement in serum, by enzyme-linked immunosorbent assay. Results: Serum MDA concentration, an oxidative stress marker, was significantly higher (P < 0.01), while serum rGSH and SOD levels, both indicators of antioxidant potential, were significantly lower (P < 0.0001 and P < 0.01 respectively) in premature canities patients compared to controls. A novel observation was the significant correlation of serum MDA rise and serum rGSH decline with increasing severity of hair graying (P < 0.01 and P = 0.01, respectively). Conclusion: Systemic redox imbalance is present in premature canities patients, with the severity of hair graying varying in parallel to the degree of oxidative stress. Antioxidants supplementation is likely to yield therapeutic benefit in premature canities.

Background: Dermoscopy is a noninvasive tool for the diagnosis of various dermatological disorders. Dermoscopy of alopecia areata (AA) aids in confirming the diagnosis and severity of the disease. Materials and Methods: A total of 100 patients of AA were evaluated with a dermoscope (×20 and × 200) to determine the dermoscopic features at the center and periphery of patches of AA. Results: Black dots were the most common dermoscopic finding at the periphery of AA patch among the study population, followed by yellow dots, vellus hair, broken hair, tapering/exclamation mark hair, kinking at the point of emergence of a hair shaft, piggy tail hair, and depressed follicular opening. At the center of the patch, yellow dots were the most common dermoscopic findings among the study population, followed by black dots, vellus hair, broken hair, and piggy tail hair. Conclusion: Black dots were the most common dermoscopic findings at the periphery of the patch. Yellow dots were the most common dermoscopic findings at the center of patch among the study population. Kinking at the point of emergence of the hair shaft was a new sign in this study seen at the periphery of the patches in 19 patients. It is the latest finding which requires further elaboration with larger sample size studies.

We present a unique patient with erosive pustular dermatosis of the scalp (EPDS) with several unique features: (1) a rare case of EPDS occurring after herpes zoster (HZ) infection and (2) the first reported case of recurrence of HZ induced by topical immunosuppressive therapy (clobetasol 0.05% cream and tacrolimus 0.01% cream) in a patient with underlying EPDS. Based on our patient, we recommend to exercise caution with the prolonged use of potent topical steroids in areas previously affected by herpes zoster.

Congenital triangular alopecia (CTA) is a form of circumscribed, noncicatricial, and noninflammatory hair loss. It manifests as a triangular or oval-shaped alopecic patch on the frontotemporal region of the scalp and rarely involves the temporoparietal or occipital area. That is why it is also called temporal triangular alopecia. However, there has been just one case reported in the middle frontal area. Here, we report a successfully treated case of CTA in a 17-year-old boy who was born with a 2.5 cm × 3.5 cm alopecic patch in the middle frontal area.

Acne conglobata (AC) is a rare form of severe and chronic nodulocystic acne. It is characterized by nodulocystic lesions, borrowing, interconnecting abscesses, scars, in addition to grouped comedones. AC usually appears on the trunk and may extend to the buttocks. It can also appear, to a lesser extent, on the face, neck, shoulders, proximal arms, abdomen, and thighs. To the best of our knowledge, AC of the scalp has not been reported in the literature. Herein, we are reporting a case of AC of the scalp, emphasizing its clinical and trichoscopic features and how to differentiate it clinically from similar scalp conditions, especially alopecic and aseptic nodules of the scalp and dissecting cellulitis of the scalp.