Role of Hair Transplantation in Scarring Alopecia—To Do or Not to Do

Alopecia in the scalp region leads to psychosocial embarrassment for an individual. Alopecia could be due to several reasons, including genetic, hormonal, traumatic and infections. Cicatricial alopecias (CAs) are considered as trichological emergency, since their progression is rapid and always results in permanent hair loss. The pathogenesis, disease progression and prognosis of CA are poorly understood, and the treatment process is still evolving. An early diagnosis must be established, and aggressive treatment protocol should be followed in the management of scarring alopecia. This article presents various aspects of CA and determines whether hair transplant (HT) should be done in this condition.

Discoid lupus erythematosus skin lesion distribution and characteristics in Black patients: a retrospective cohort study

ObjectiveEpidemiological studies have shown that discoid lupus erythematosus (DLE) has a higher incidence and prevalence in racial/ethnic minority groups, particularly Black individuals. The objective of this retrospective cohort study was to identify the differences in DLE lesion distribution and characteristics in Black individuals compared with non-Black individuals.Methods183 patients with DLE (112 Black patients and 71 non-Black patients) with a reported race/ethnicity and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores were included in this retrospective cohort study. Univariate analysis was performed to determine significant differences in demographic data, clinical characteristics, DLE lesion distribution and DLE lesion characteristics in Black and non-Black patients with DLE. Multivariable logistic regression was preformed to determine significant predictors of DLE lesion location and characteristics.ResultsBlack patients with DLE had worse baseline CLASI damage scores compared with non-Black patients with DLE (median (IQR): 10.0 (6.0–14.5) vs 6.0 (3.0–10.0), p<0.001) and had 48.9 greater odds of dyspigmentation in any anatomical location (p<0.001). Black patients had 2.54 greater odds of having scalp involvement (p=0.015) and 1.97 greater odds of having ear involvement (p=0.032) compared with non-Black patients. Black patients also had greater odds of scalp dyspigmentation (OR=5.85, p<0.001), ear dyspigmentation (OR=2.89, p=0.001) and scarring alopecia (OR=3.00, p=0.001) compared with non-Black patients.ConclusionsSigns of disease damage, particularly ear dyspigmentation, scalp dyspigmentation and scarring alopecia, can more frequently affect Black patients with DLE. Recognising differences in clinical presentation of DLE among Black patients can assist future efforts with understanding biological, cultural, psychosocial and systemic factors that influence DLE presentation and outcomes in Black patients and may guide clinicians when counselling Black patients.

Recent Advances in Topical Nanotechnological Strategies for Treatment of Alopecia

Alopecia can be characterized as a hair-related disorder leading to decreased hair growth, especially on the scalp. It has affected approximately 2% of the world population. The hair loss may emerge due to genetic or environmental factors like stress, infectious agents, tensile forces or medications. The pathogenetic pathway of induction of alopecia comprises of different factors, but exploitation of hair follicle immune privilege system (HFIP) is the most prominent one. Alopecia can be classified into two types: scarring alopecia or non-scarring alopecia. Although, many conventional dosage forms have been formulated against alopecia, but they have been associated with different adverse effects such as weight gain, palpitations, itching etc. In order to overcome the adverse effects associated with conventional dosage forms, the topical nano-formulations have been used for the treatment of dermatological disorders. Nano-formulations are known to increase the contact time of drug with the target site, thereby, achieving sustained and controlled release of the drug leading to enhanced therapeutic compliance. This review provides an in-depth study of developed nanocarriers like liposomes, nano-emulsions, ethosomes, solid lipid nanoparticles (SLNs), nanostructured lipid carriers (NLCs) along with their composition, method of preparation, results obtained after formulation, suitable use and along with their potential use in treatment of different forms of alopecia.