Male-pattern hair loss (MPHL) is a condition that affects the majority of men during adulthood. This condition is not life threatening but needs constant treatment and monitoring, especially in recent years where male appearance is gaining significant importance in society. An ideal classification with high amount of detail, practicality, and reproducibility is required to accurately diagnose and monitor this condition regularly and to assess the outcome of treatment. Numerous classifications have been invented, but many variants with different levels of detail, practicality, and reproducibility may cause confusion among clinicians. One clinician may not accurately able to convey accurate clinical description if different classifications are used. To avoid confusion, a new classification that can balance detail, practicality, and reproducibility is required. We hope that this will translate to better treatment and monitoring for patients. This review article aims to review different existing MPHL classifications and how it compares to each other in terms of detail, practicality, and reproducibility.

Background: Nutritional deficiencies are known to be associated with hair loss; however, the exact prevalence is not known. Aims: The aim of this study is to evaluate the prevalence of nutritional deficiencies in participants with hair loss. Materials and Methods: In this cross-sectional study, 100 enrolled participants were divided into telogen effluvium (TE), male-pattern hair loss (MPHL), and female-pattern hair loss (FPHL) based on the type of hair loss. All participants underwent laboratory estimation for micronutrients and amino acid levels. Results: Participants with hair loss showed varied amino acid and micronutrient deficiencies across all types of hair loss. Nutritional status did not vary much between the types of hair loss. Among the essential amino acids, histidine deficiency was seen in >90% of participants with androgenic alopecia and 77.78% of participants with TE while leucine deficiency was seen 98.15% of participants with TE and 100% with FPHL. Valine deficiency was also very common across alopecia subtypes. Among the nonessential amino acids, alanine deficiency was observed in 91.67% FPHL, 91.18% MPHL, and 90.74% TE. Cysteine deficiency was present in 55.58% and 50% of participants with MPHL and TE, respectively. A relatively higher proportion of participants with TE had iron deficiency compared to androgenic alopecia (P = 0.069). Zinc deficiency was seen in 11.76% of participants with MPHL while copper deficiency was seen in 29.41% and 31.48% of participants with MPHL and TE, respectively. Conclusion: Nutritional deficiency is a common problem in participants with hair loss irrespective of the type of alopecia. The findings of our study suggest need for identification and correction of nutritional deficiencies in patients with hair loss.

Introduction: Fusion of eyebrows above the bridge of nose is known as synophrys and is a normal variation. This variation is also recognized as a clinical feature of several genetic disorders, Cornelia De Lange syndrome being the commonest. Several studies, on aesthetics of face and eyebrows have been conducted, also on the role of eyebrows in emotional expression and nonverbal communication. A recent study has pointed a gene associated with synophrys. Surprisingly, however synophrys and its prevalence in the normal population is not known thus we conducted a study of its prevalence in Oman. Methods: All cases attending dermatology clinic at Saham hospital and their accompanying persons were examined for synophrys. The anonymous data was tabulated in a register and then it was transferred to computer system. Data was tabulated according to age, gender, presence of synophrys and any associated condition or genetic disorders or any chronic lifestyle disorders. It was analysed using SPSS 22 software. Results: We observed 927 subjects during the period of study. They ranged from ages of 4 months to 69 years. The males (68) outnumbered females (42). We found 110 cases (11.87%) who presented with synophrys. Discussion: The tendency of eyebrows to meet in the center of the face is known as synophrys. There is wide variation in the color, distribution and density of the eyebrow hair. Inheritance of synophrys however appears to be polygenic. Several genetic syndromes are associated with synophrys like Cornelia De Lange syndrome, which is the commonest. In our study we could not identify any genetic association in any of our cases. We studied the prevalence of synophrys in Omani population (11.87%).

Background: Epidermoid cysts, one of the common benign intradermal or subcutaneous tumors commonly result from the trauma to the pilosebaceous unit in the hair bearing area. In areas without hair, these cysts are considered implantation and proliferation of squamous epithelium into the dermis due to injury. Aims: The aim is to evaluate the clinicopathological details with emphasis on unusual findings related to epidermoid cysts. Study Design: This is a retrospective cross-sectional study carried out over 2 years. Materials and Methods: A total of 103 cases of epidermoid cysts were included in the study. The clinical details such as age, gender, sites, and dimensions were noted. The histopathological findings were evaluated and correlated with the clinical findings. Results: The highest incidence was observed in the age group of 21–30 years (23.3%, 24/103) and the most common affected region was the head and neck region (32%, 33/103). The size of cysts ranged from 0.3 to 9 cm in diameter with a mean of 2.1 cm. The unusual sites observed in this study were four at the left sole, two at right sole, two at prepuce, and one each at the right finger, left palm, and oral cavity. Histopathological findings included rupture of epidermoid cysts with giant cell reaction, melanin pigmentation, and association with other pathologies such as keloid and lipoma. Conclusion: Epidermoid cysts are common benign intradermal or subcutaneous tumors, but they can have unusual presentations and histopathological findings. Epidermoid cysts need early diagnosis and treatment as they can cause cosmetic and functional impairment.

Pseudopelade of Brocq (PPB) is a rare, chronic, slowly progressive cicatricial alopecia that generally affects middle-aged women. Vertex and parietal scalp are commonly involved. It can be primary or secondary to end stage of other scarring alopecia such as lichen planopilaris and discoid lupus erythematosus. It is diagnosed by exclusion both clinically and trichoscopy. There is no standard treatment for PPB. We hereby report a case of rapidly progressing primary idiopathic pseudopelade of Brocq in a young female child confirmed by trichoscopy and histopathology.

Acute hair felting is a rare disorder of scalp hair. In this condition, the hair becomes twisted, entangled as a hard stony mass resembling a bird's nest. Sudden hair matting has been reported earlier in the literature after vigorous use of chemical and herbal shampoos. Plica polonica is a patchy area of hair matting occurring in due course of time in neglected hair or underlying psychiatric illness. This case is interesting as the whole scalp hair matted immediately after using coconut oil and castor oil following washing. Growing long hair and taking oil bath are cultural and religious customs in South India. The high viscosity of castor oil and long hair had contributed to sudden felting of hair. This disorder of hair is irreversible and the hair should be cut off. Acute nature of this disorder will result in a serious psychological impact on the patient and the family.

Any cutaneous cyst differentiating toward two or more pilosebaceous components is known as follicular hybrid cyst (FHC). A combination of epidermal and trichilemmal cyst is its most frequent example. Other combinations of pilosebaceous derivatives occur uncommonly as well. The histogenesis of this condition has been controversial. In this latest report, we describe an unusual FHC from the earlobe of a 19-year-old male, which expressed the cohabitation of epidermal cyst and steatocystoma. A sharp transition was noted between the two kinds of epithelial components.

Exposing wet hair to high temperatures can create gas bubbles within the hair shaft, leading to brittle, dry hairs in a disorder known as bubble hair abnormality. We present a case of a 61-year-old woman who presented for hair breakage over her crown. She regularly dried her damp hair with a blow dryer. Dermoscopy revealed multiple bubbles within the hair shaft, and diagnosis of bubble hair abnormality was confirmed by light microscopy. Our unusual case highlights the ease of acquisition of this abnormality by means of a common hair dryer, and the utility of dermoscopy to make a fast and accurate diagnosis within the office.

Plica polonica (plica neuropathica) is an uncommon entity characterized by irreversible twisting and matting of hair resulting in a hard impermeable mass of keratin. Although the exact mechanism is not fully understood, it has been attribute to longitudinal splitting or weathering of hair shaft due to vigorous friction and frequent use of harsh shampoos and harsh cleansers and/or due to keeping long hair with poor hair care or neglect, parasitic infection. We describe an unusual case of plica polonica occurring in a patient of lung adenocarcinoma on chemotherapy and review the literature. Anagen effluvium due to chemotherapy (paclitaxel and carboplatin) and use of an uncustomary shampoo by the patient are the causative factors for matting of the hair.

Hair transplantation, a generally regarded as a safe surgical modality for the treatment of androgenetic alopecia, is not without its potential risks and complications. A case of an extensive keloid formation at donor site following follicular unit extraction is discussed. Hair transplant surgeons should be aware of this significant potential complication, especially in patients having previous keloidal tendencies to avoid such disastrous outcomes.

Frontal fibrosing alopecia (FFA) and fibrosing alopecia in a pattern distribution (FAPD) as originally reported by Kossard in 1994 and by Zinkernagel and Trüeb in 2000, respectively, represent two distinct patterns of cicatricial pattern hair loss. Both share a patterned distribution and histological evidence of a lichenoid follicular inflammation with fibrosis. FFA is characterized by a marginal alopecia along the frontotemporal hairline, and FAPD by a progressive alopecia of the centroparietal scalp. Since the original reports, evidence has accumulated that there exists considerable clinical overlap among FFA, FAPD, and lichen planopilaris, with coexistence of features of the three conditions within the same individual. Moreover, familial cases of FFA have been reported, pointing to a possible genetic background to the condition. Our observation of familial occurrence of FFA and FAPD in daughter and mother, respectively, further underscore a nosologic relationship between the two conditions with respect to both an androgenetic background and the (lichenoid) inflammatory reaction pattern.