Trichoscopy is the term coined for dermoscopic imaging of the scalp and hair. This novel diagnostic technique, both simple and non-invasive, can be used as a handy bed side tool for diagnosing common hair and scalp disorders. Trichoscopic observations can be broadly grouped as hair signs, vascular patterns, pigment patterns and interfollicular patterns. In this article, we have briefly described the trichoscopic findings in the common categories of cicatricial and non-cicatricial alopecias such as androgenetic alopecia, alopecia areata, telogen effluvium, tinea capitis, trichotillomania, lichen planopilaris, discoid lupus erythematosus and hair shaft disorders. Besides diagnosing alopecia, it has the potential for obviating unnecessary biopsies and when a biopsy is still needed it is helpful in choosing an ideal biopsy site. Moreover, trichoscopy is a valuable tool for evaluating the treatment response photographically at each follow-up. The last statement here is deleted as asked.

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Piedra is a superficial fungal infection of the hair shaft characterized by nodules along the hair shaft. Black piedra affects the scalp hair more frequently than white piedra. Occurrence of both types of piedra simultaneously in a patient is extremely rare. We describe here a rare case of mixed piedra of scalp hair.

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Trichoscopy enables visualization of subsurface structures and color patterns of scalp and hair. Recently, its applications expanded to diagnose inflammatory conditions such as lichen planopilaris (LPP), scalp psoriasis, and discoid lupus erythematosus (DLE). Clinically, both LPP and DLE appear similar as cicatricial alopecia on the scalp making the diagnosis difficult. Here, we report the utility of trichoscopy in the clinical diagnosis of LPP and DLE. Clinically, suspected lesions of DLE and LPP on the scalp of each patient were observed under trichoscopy. Histopathology of lesions confirmed the clinical diagnosis. Authors observed characteristic trichoscopic features in LPP as well as in DLE proving the clinical diagnosis. Hence, trichoscopy can be used to diagnose LPP and DLE clinically avoiding skin biopsy.

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Circle hairs (CH) represent a body hair growth disorder characterized by asymptomatic presence of hairs with typical circular or spiraliform arrangement, not associated with follicular or inflammatory abnormalities. Although this condition is rarely reported, it is probably underestimated, as a medical consultation for CH only is rare in practice. Trichoscopic and histopathological findings of CH have never been reported and this article will present and discuss six cases along with literature review.

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Background: Alopecia is a common complaint in dermatology clinics, and can be caused by a number of conditions, and has patterns that are different from that seen in adults. Aim of Study: No previous studies investigating the clinical types of hair loss in Jordan and its epidemiology. The ultimate aim was to provide a guide for the evaluation of hair loss commonly occurring in childhood in our environment. Patients and Methods: A total of 2800 children were seen at the dermatology clinics (Karak teaching hospital and Mutah university medical center) during January 2009 to October 2013 complaining of various clinical dermatological symptoms. Results: Of these patients, 210 children were complaining of hair loss and scalp disorders (7.5% of pediatric dermatology cases seen in Jordan). The most common presentation was asymptomatic patchy hair loss (40%). Other symptoms were scaly scalp (22.9%), diffuse hair loss (21.4%), change in hair texture and color (8.1%), pruritus (5.7%), and pain in the scalp (1%). Tinea capitis was the commonest causes of hair loss (40.0%) followed by alopecia areata (26.2%) and telogen effl uvium (17.6%). Other common causes of hair loss were observed in this study, these include chronic diffuse form of hair loss, trichotillomania, and traction alopecia. Conclusions: As has been observed in this study, hair problem may be due to important nutritional deficiency such as iron and zinc elements, and this is very important problem to think of especially in developing countries. Therefore, hair examination by a pediatrician or dermatologist is an important part of the physical examination.

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Graham Little Piccardi Lasseur Syndrome (GLPLS) is a rare variant of lichen planopilaris comprising of a triad of multifocal and patchy cicatricial alopecia of scalp, non-cicatricial alopecia of axillae and pubic region and keratotic follicular papules over a body. Its exact etiology is not known until date, but primarily involves an immune mediated inflammatory reaction against the bulge region of hair follicles resulting in cicatricial alopecia. We report an extensive and diffuse presentation of this rare syndrome in a middle-aged female with hypertrophic lichen planus (LP) present on malar region of face, etiologically relating GLPLS to LP.

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Trichotillomania manifests as a compulsive desire to pull out own hair. The clinical presentation of trichotillomania is usually characteristic, with varying length hair distributed within areas of alopecia on otherwise normal scalp. In severe forms, tonsure pattern of baldness results, involving the entire scalp sparing the hair at the margins. Extensive tonsure pattern trichotillomania is rare and difficult to differentiate from other nonscarring alopecias on clinical grounds alone. Trichoscopy and histopathology of scalp play a corroborative role in definitive diagnosis. We hereby report two cases of extensive tonsure pattern trichotillomania, with special reference to their trichoscopic and histopathological features.

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Background: Alopecia areata (AA) is a common hair disorder of unknown etiology and prognosis with no definitive cure. Aims and Objective: (i) To study the efficacy and immunomodulatory action of 88% phenol on hair growth on test area in AA. (ii) To study various epidemiological factors in relation to AA. Materials and Methods: A total of 50 subjects presenting with nonscarring patchy hair loss on scalp were enrolled in this prospective open label study to receive 88% phenol at 3 weekly intervals in a tertiary care hospital. Efficacy was assessed using scoring system for density, pigmentation, and texture of growing hair. Results: Texture and pigmentation of hair growth was significantly improved at 9 week, while density of hair growth showed steady improvement, which was significant from 9 week onwards. About 78% of patients showed good to excellent response while none of them showed poor response. Conclusion: 88% phenol was found to be efficacious with all patients showing hair regrowth. 88% phenol can be considered as a treatment of choice for stable AA due to its ease of application, easy availability, and low cost.

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Endovascular interventional procedures are the first choice of treatment for many vascular intracranial lesions, especially those with complex anatomy. These procedures may cause numerous skin lesions depending on the dose of radiation to which patients have been exposed. In this report, we presented a case of a 38-year-old man who developed a square plaque of alopecia in the occipital area after two selective embolization of a left posterior parasagittal arteriovenous malformation. The alopecia was transient and the hair grew up 2 months later after the last procedure. This case illustrates one of the effects of radiation on the scalp and expands our knowledge about the clinical manifestation of this transient disease.

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The Renbök phenomenon designates the withdrawal of a lesion when a different one appears. We describe a 23-year-old patient with psoriasis, who experienced regression of a psoriatic plaque on the scalp concurrently with the appearance of a patch of alopecia areata (AA). In 3 months, plaques of psoriasis appeared inside the patch of hair loss, accompanied by terminal hair growth in the plaques. Such rapid interchange between these two autoimmune disorders have not been described previously, and might reflect a quick substitution between two different T-cell populations, namely Th-17 and Th-1. Better understanding of the trigger for such an exchange can help in elucidating the pathogenesis for AA.

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Frontal fibrosing alopecia (FFA) is a scarring alopecia, now an accepted subset variant of lichen planopilaris (LPP). Its occurrence in males is rare, with only nine cases reported to date. We describe a case of FFA in a male in association with lupus erythematosus. Multiple biopsies from the scalp, eyebrow and arm showed features consistent with LPP, in keeping with the clinical presentation of FFA. Direct immunofluorescence studies showed a positive lupus band test. Further serological investigation confirmed the presence of antinuclear, anticardiolipin and lupus anticoagulant antibodies. Whilst the findings of lupus erythematosus may be coincidental or a forme fruste of the disease occurring in association with FFA, it is feasible that lupus and LPP may occur as an overlap syndrome. This case underscores the importance of multiple biopsies and the role of direct immunofluorescence in disclosing more than one pathology in the follow-up of patients with scarring alopecia.

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Sweat gland adenocarcinoma is a rare tumor particularly over scalp. They have potential to be benign as well as distant metastasis. Usually presents with papules or nodules. Ulcerative morphology is uncommon. Wide surigical excision with regional lymph not dissection is the treatment of choice. A 42-year-old female with sweat gland adenocarcinoma of scalp is reported with cervical lymph node involvement.

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Aim: The aim of the following study is to characterize the cytological features of pilomatricomas (PMXs) on fine-needle aspiration (FNA) and correlate with the histopathological features. Materials and Methods: FNA, histopathological and clinical diagnosis of 12 cases of PMXs were analyzed. Clinical, aspiration findings and histopathological features were correlated with histopathological diagnosis which was taken as the gold standard. A written consent was taken from patients or parents as appropriate. Morphological features of both aspiration as well as histopathological features were graded. The study was duly approved by the Hospital Scientific Review Committee. Results: Out of the 7600 cases studied retrospectively over a period of 4 years, only 12 cases were diagnosed as PMXs. These tumors were mainly located in the head and neck region and mostly affected young females (median age 9.5 years). The mean size of these lesions was 0.9 cm. Out of the 12 histopathologically proven cases of PMX, the correct clinical diagnosis was given in only one case while cytopathological diagnosis was achieved in four cases. Conclusion: PMX is a rare tumor, which is mostly found in the pediatric age group. The clinical features should be keenly observed. Keeping in mind the diagnostic pitfalls a cytopathologist may encounter, histopathology should be regarded as the gold standard for diagnosis.

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Microsporum gypseum is a rare cause of kerion in infancy. Light microscopy, fluorescent microscopy and fungal culture of the infected hair aids in early and correct diagnosis. Griseofulvin is the drug of choice for ectothrix fungi. We report a case of neonatal kerion caused by M. gypseum occurring at the age of 1 month, successfully treated with griseofulvin.

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