International Journal of Trichology International Journal of Trichology
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   2018| May-June  | Volume 10 | Issue 3  
    Online since June 20, 2018

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Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A promising therapy for the treatment of alopecia areata: A case report of six patients
Chandrashekar Byalekere Shivanna, Chaithra Shenoy, R Arti Priya
May-June 2018, 10(3):103-107
DOI:10.4103/ijt.ijt_21_18  PMID:30034188
Background: Alopecia areata (AA) is a chronic autoimmune disorder characterized by patchy loss of hair from scalp, beard, eyebrows, or rarely even body hair. Rarely, the disease can be widespread and severe leading to loss of entire scalp and body hair causing apprehension and psychological stress in patients. Management of such cases is equally difficult with the available options of topical and systemic immunosuppressant. Tofacitinib, JAK3 inhibitor, is emerging as a promising drug for the management of severe and resistant cases of AA/totalis/universalis. Objective: Our study aims to show the effectiveness of oral tofacitinib in the treatment of alopecia universalis (AU). Methods: Six patients diagnosed with AU/alopecia totalis duration of disease 6 months–15 years refractory to other treatments were selected and were started on oral tofacitinib 5 mg twice daily up to 10 mg BID and were followed up every 4 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score, and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse. Results: All our six patients showed dramatic response to oral tofacitinib. Patients were followed up every 4 weeks, and results were assessed. Significant hair regrowth was evident in all the patients by the end of 12 weeks. Currently, four of our patients are on oral tofacitinib 10 mg BID and are under follow-up. There was no relapse in one patient after stopping drug for 4 months. Another patient started developed AA patches in the eyebrows within 2 months of stopping tofacitinib. Acneiform eruptions were seen in two patients which were managed with topicals. Conclusion: In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety and confirm efficacy.
  13,828 202 12
Frictional (Sock) alopecia of the legs: Trichoscopy as an aid
Deepak Jakhar, Ishmeet Kaur
May-June 2018, 10(3):129-130
DOI:10.4103/ijt.ijt_96_17  PMID:30034193
Alopecia of the lower limbs is a rarely reported entity. Friction due to footwear, socks, and tight clothing is one of the causes of lower limb alopecia. The typical site of involvement and improvement after removal of triggering factor are an important clue to the diagnosis. Alopecia areata remains a close differential, and dermoscopy/trichoscopy can serve as an adjunctive aid in the diagnosis.
  10,550 52 2
Mesalazine in the treatment of extensive alopecia areata: A new therapeutic option?
Ana Elisa Kiszewski, Mariele Bevilaqua, Luciana Boff De Abreu
May-June 2018, 10(3):99-102
DOI:10.4103/ijt.ijt_14_18  PMID:30034187
Background: Alopecia areata (AA) is a T-lymphocyte-mediated disease that results in alopecia plaques or diffuses alopecia on the scalp and body. Etiologic factors include genetic and autoimmune susceptibility. Treatment modalities are usually considered according to the extent of hair loss and the patient's age. Since there is no approved treatment by the US Food and Drug Administration, treatment options and combinations available are off-label. Patients with extensive AA (including totalis and universalis) have a low rate of spontaneous remission and poor treatment response. Extensive AA is usually associated with severe emotional distress, social discomfort, bullying, and other psychological problems for the child and family. In this context, the need for new therapeutic schemes is clear. Materials and Methods: We retrospectively analyzed five patients (aged 2–17 years) with extensive and refractory AA who were treated with mesalazine associated or not with oral prednisolone and topical betamethasone/minoxidil. Results: We observed complete growth of terminal hair in all patients. No patient had abnormal laboratory results or manifested drug side effects. Conclusions: In extensive and refractory AA cases, the topical treatment combined with mesalazine may provide excellent results, reducing the need for extended oral corticosteroids courses. Besides that, mesalazine seems to minimize relapses on discontinuation of oral steroids. Controlled studies are needed to confirm the effectiveness of this combination.
  8,409 124 4
Dermoscopic findings in 126 patients with alopecia areata: A cross-sectional study
Hamidreza Mahmoudi, Mahdieh Salehi, Saba Moghadas, Narges Ghandi, Amir Teimourpour, Maryam Daneshpazhooh
May-June 2018, 10(3):118-123
DOI:10.4103/ijt.ijt_102_17  PMID:30034191
Background: Dermoscopy is used increasingly in dermatological practice. Although dermoscopic findings of alopecia areata (AA) are described in the literature, studies are limited. Aim: Our aim was to evaluate dermoscopic findings of Iranian patients with AA and correlate them with disease activity and severity. Subjects and Methods: Totally 126 patients were examined using a Dermlite II multispectral dermoscope. Severity, activity, pull test, nail changes, treatments, and dermoscopic findings were recorded. Statistical Analysis Used: Statistical analysis was done by SPSS version 22, using appropriate statistical tools. Results: The most common dermoscopic findings were yellow dots (84.1%), vellus hairs (62.6%), black dots (48.4%), exclamation mark (30.9%), and broken hair (9.5%), in decreasing order. Furthermore, the most common dermoscopic findings in patients on diphencyprone were vellus hairs and yellow dots. Yellow dots and vellus hairs were most common in patients with alopecia universalis. However, broken hairs and exclamation mark hairs were mostly observed in patchy multiple AA patients. Yellow dots and exclamation mark hairs were also significantly more common in patients with positive pull test. Furthermore, vellus hairs were more common in patients with remitting disease pattern. With regard to scalp severity, yellow dots related positively, while vellus hairs, broken hairs, and exclamation mark hairs related negatively with severity of disease. Conclusions: Dermoscopic findings differ in various stages of activity and severity of AA. Dermoscopy is a valuable tool for the dermatologist for the diagnosis, follow-up, and evaluation of response to treatment.
  6,546 175 10
Minoxidil downregulates Interleukin-1 alpha gene expression in HaCaT cells
Erkin Pekmezci, Murat Turkoğlu, Hilal Gökalp, Zekayi Kutlubay
May-June 2018, 10(3):108-112
DOI:10.4103/ijt.ijt_18_17  PMID:30034189
Introduction: Minoxidil has been used topically to stimulate hair growth for male androgenetic alopecia (AGA) for more than 3 decades. It is currently being used for female AGA and alopecia areata (AA) as well. Although much time has passed since its first use, our understanding of its mechanism of action is highly limited. Therefore, we examined the inflammatory properties of AGA and AA, two entities in which minoxidil is being used as a therapeutic agent. We investigated the in vitro expression levels of cytokine interleukin-1 alpha (IL-1α), a potent inhibitor of hair growth, in minoxidil-treated human keratinocyte (HaCaT) cells to determine whether this molecule exerts anti-inflammatory effects. Materials and Methods: Cellular proliferation was examined using the Cell Proliferation Kit II (XTT) reagent. After determining a noncytotoxic concentration, HaCaT cells were treated with minoxidil. RNA was isolated from both untreated and treated cells with TRI Reagent®. Expression of the IL-1α gene was determined by reverse transcription quantitative polymerase chain reaction analysis and is reported relative to glyceraldehyde-3-phosphate dehydrogenase (GAPDH), which served as a control. Results: Results are presented as IL-1α/ GAPDH fold change. Minoxidil treatment downregulated IL-1α expression by 0.3433-fold compared with untreated cells (P = 0.001). Conclusion: This anti-inflammatory effect of minoxidil, as evidenced by significant downregulation of IL-1α gene expression in HaCaT cells, may represent one of its mechanisms of action in alopecia.
  5,840 60 7
“Turban PUVAsol:” A simple, novel, effective, and safe treatment option for advanced and refractory cases of alopecia areata
Banashree Majumdar, Abhishek De, Soumyodhriti Ghosh, Amrita Sil, Aarti Sarda, Koushik Lahiri, Gobinda Chatterjee, Sudip Das
May-June 2018, 10(3):124-128
DOI:10.4103/ijt.ijt_95_17  PMID:30034192
Background: Alopecia areata (AA) is an autoimmune characterized by nonscarring loss of scalp and/or body hairs. Topical PUVA has been reported to have good effect in AA. The modification of topical PUVA which we call, “Turban PUVA-sol,” is a method of localized immunotherapy using psoralen solution followed by sun exposure. Aims: We aim to study the therapeutic role and side effect profile of turban PUVA in the treatment of advanced and refractory AA. Methodology: Fifteen consecutive patients of alopecia subtotalis (at least 70% of scalp hair loss), totalis, and universalis, attending the dermatology outpatient department of a tertiary care hospital in eastern India were subjected to “Turban PUVA-sol” after duly signed consent. Alternate day therapy was given. Results: At the end of 10 months of study, 2 (13%) out of fifteen patients were lost to follow-up for some unknown reasons. The severity of alopecia tool scores showed a significant (P = 0.0002) decrease posttreatment. Correlation between the severity of alopecia and grade of improvement showed a rho value of −0.453. In the remaining thirteen patients, using physician global assessment (PGA), 4 (26%) showed good response, 4 (26%) showed moderate response, 3 showed mild (20%) response, and 2 patients (13%) showed negligible response. Three out of four patients who showed good improvement in PGA showed more than 80% of new hair growth. Side effects are minimal with some patients complaining of mild irritation and scaling. Conclusion: We found topical Turban PUVAsol to be a very cost-effective and safe treatment option for AA.
  5,521 128 5
To evaluate and compare changes in baseline strength of hairs after treating them with deionized water and hard water and its role in hair breakage
Muhammad Waqas Luqman, Muhammad Haris Ramzan, Usama Javaid, Roshan Ali, Muhammad Shoaib, Muhammad Ayyas Luqman
May-June 2018, 10(3):113-117
DOI:10.4103/ijt.ijt_115_16  PMID:30034190
Background and Aim: Interaction of hair with water is common. This study was conducted to compare changes in baseline strength of hair after treating it with hard water and deionized water. Material and Methods: Hardness level of water samples collected from 10 districts of KP, Pakistan was determined, and that with maximum hardness was considered our sample hard water. Hair samples of 70 male individuals, from district with minimum hardness levels, were collected. Each hair sample was divided into three equal parts, and three groups of hair were established, each group containing 70 hairs. Group A was considered control. Group B was treated with deionized water and Group C was treated with hard water. Tensile strength of all three groups was measured using the universal testing machine and compared using paired t-test. Results: The mean age of all 70 participants were 23.87 ± 3. The mean values of tensile strength for hairs of Groups A, B, and C were 255.49, 254.84, and 234.16 with a standard deviation of 57.55, 58.74, and 56.25, respectively. Results were significant in case of hard water (P = 0.001) as compared to deionized water (P = 0.609). Conclusion: Hard water decreases strength of hair and thus increases breakage.
  4,262 61 -
Interactions between posttraumatic stress disorder and alopecia areata in child with trauma exposure: Two case reports
Tayfun Kara, Zeynep Topkarcı
May-June 2018, 10(3):131-134
DOI:10.4103/ijt.ijt_2_18  PMID:30034194
Alopecia areata (AA) is a dermatologic disease that can be seen in all age groups with nonscarring hair loss. While the causes of AA are suggested to be the role of genetic, psychological stresses, cellular and humoral immunity, and endocrine and neural factors, the underlying cause is not fully known. Psychiatric diseases are frequently reported in many studies in patients with AA. In this report, children with AA and psychiatric evaluation of them and the prominence of psychiatric evaluation in AA were discussed; AA and posttraumatic stress disorder were reviewed in the light of the relevant literature.
  4,108 39 6
Trichothiodystrophy without associated neuroectodermal features in two siblings
Jasleen Kaur, Mala Bhalla, Gurvinder Pal Thami
May-June 2018, 10(3):135-137
DOI:10.4103/ijt.ijt_63_17  PMID:30034195
Trichothiodystrophy (TTD) is characterized by the common feature of sulfur-deficient brittle hair associated with a constellation of neuroectodermal symptoms. There is a wide phenotypic variation in the severity; ranging from isolated hair defect to multiple neuroectodermal symptoms such as photosensitivity, ichthyosis, intellectual impairment, decreased fertility, and short stature. This case report describes TTD in two sisters with only hair fragility and no other associated feature. This case highlights the variable clinical presentation of TTD and the need for regular follow-up in such patients for an early detection of any neurological, physical, and sexual impairment.
  3,587 37 1
Localized hypertrichosis at vaccination site
Kavita Poonia, Pragati Gogia, Mala Bhalla
May-June 2018, 10(3):138-139
DOI:10.4103/ijt.ijt_94_17  PMID:30034196
Hypertrichosis is described as an increased hair growth on any part or over whole body in comparison to persons of the same age, sex, and race which is independent of androgen excess. It may be localized and generalized or alternatively acquired and congenital forms. The acquired localized hypertrichosis has been associated with various causes including local trauma, chronic irritation, inflammation, occlusion by cast, and drugs. Here, we report a case of 2½-month-old healthy infant presenting with localized area of hypertrichosis over anterolateral aspect of the left thigh which was confined to the site of vaccination.
  3,223 34 2
Cutis verticis gyrata – A rare presentation of primary systemic amyloidosis
Priyadarshini Sahu, Surabhi Dayal, Geetika Gera, Ashish Amrani
May-June 2018, 10(3):141-143
DOI:10.4103/ijt.ijt_6_18  PMID:30034198
  3,172 47 1
Nosological nightmare and etiological enigma: A history of alopecia areata
Jenny Callander, Paul Devakar Yesudian
May-June 2018, 10(3):140-141
DOI:10.4103/ijt.ijt_23_18  PMID:30034197
  3,083 42 5
Plica polonica secondary to pediculosis capitis and use of shampoo
Geetika Gera, Isha Gupta, Surabhi Dayal
May-June 2018, 10(3):143-144
DOI:10.4103/ijt.ijt_15_18  PMID:30034199
  2,770 50 1
Single sitting of cerebral endovascular procedure causing alopecia
Ashutosh Kaushal, Ashish Bindra, Shalendra Singh, Vattipalli Sameera
May-June 2018, 10(3):145-146
DOI:10.4103/ijt.ijt_11_18  PMID:30034200
  2,242 36 1