Scarring Alopecias: Pathology and an Update on Digital Developments

Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI).

ROLE OF PANCHKARMA THERAPY IN MANAGEMENT OF DARUNAKA (SEBORRHOEIC DERMATITIS) - A SINGLE CASE STUDY

Dandruff is a common scalp ailment that causes flaking of the skin. It is neither communicable nor dangerous. It can, however, be humiliating and difficult to treat. Darunaka is a Kapalagataroga, but Acharya Sushruta described it as a Kshudraroga due to the vitiation of Vata and Kapha Doshas, with symptoms such as Kandu (itching on the scalp), Keshachyuti (hair loss), Swapa (abnormalities of touch sensation on the scalp), Rookshata (roughness or dryness of the scalp), and Twaksphutana (breaking or cracking of the scalp skin). Seborrheic Dermatitis is an irri- tative scalp illness characterized by the shedding of dead tissue from the scalp, as well as an itchy sensation. Seb- orrheic Dermatitis affects roughly 4% of the population, while dandruff (mild seborrheic dermatitis of the scalp) affects about half of all adults, according to studies. It can begin at any point after puberty and is more common in men. It might lead to social and self-esteem issues. A 25-year-old male patient from Jodhpur came to OPD of Panchakarma, with a chief complaint of Shira Kandu (itching on the scalp), Rukshata (dryness on the scalp), Twak- sphutana (cracks in the skin) and Keshachyuti (hair fall). In this case, Ayurvedic formulations and Panchakarma therapy gave the patient till 30 days. The improvement provided by the therapy was assessed based on signs and symptoms before and after the treatment, The therapy's effectiveness was determined by comparing signs and symp- toms before and after treatment. For evaluating signs and symptoms, a unique scoring scheme was created. Themedicine was proven to be both safe and effective at treating signs and symptoms as well as enhancing the general health of the scalp. Keywords: Darunaka, Shirodhara, Shiro basti, Seborrheic dermatitis

Pathophysiological significance of increased α-synuclein deposition in sympathetic nerves in Parkinson disease: A post-mortem observational study

Background: Parkinson disease (PD) is characterized by intra-neuronal deposition of the protein α-synuclein (α-syn) and by deficiencies of the catecholamines dopamine and norepinephrine (NE) in the brain and heart. Accumulation of α-syn in sympathetic noradrenergic nerves may provide a useful PD biomarker; however, whether α-syn buildup is pathophysiological has been unclear. If it were, one would expect associations of intra-neuronal α-syn deposition with catecholaminergic denervation and with decreased NE contents in the same samples. Methods: We assayed immunoreactive α-syn and tyrosine hydroxylase (TH, a marker of catecholaminergic innervation) concurrently with catecholamines in coded post-mortem scalp skin, submandibular gland (SMG), and apical left ventricular myocardial tissue samples from 14 patients with autopsy-proven PD and 12 age-matched control (CTRL) subjects who did not have a neurodegenerative disease. Results: PD patients had increased α-syn in sympathetic noradrenergically innervated arrector pili muscles (5.7 times CTRL, p<0.0001), SMG (35 times CTRL, p=0.0011), and myocardium (11 times CTRL, p=0.0011). Myocardial TH in the PD group was decreased from CTRL by 65% (p=0.0008), whereas the groups did not differ in TH in either arrector pili muscles or SMG. Similarly, myocardial NE was decreased by 92% in the PD group (p<0.0001), but the groups did not differ in NE in either scalp skin or SMG. Conclusions: PD entails increased α-syn in skin, SMG, and myocardial tissues. In skin and SMG augmented α-syn deposition in sympathetic nerves does not seem to be pathogenic. The pathophysiological significance of intra-neuronal α-syn deposition appears to be organ-selective and prominent in the heart.

Utility of Neonatal Findings in Early Diagnosis of a Case of Haberland Syndrome

Haberland syndrome or encephalocraniocutaneous lipomatosis (ECCL) is a rare, congenital syndrome characterized by lipomas and noncancerous tumors of the scalp, skin, and eyes, in addition to intellectual disability, early onset seizures, and ectomesodermal dysgenesis. The diagnosis of ECCL is classically made by clinical presentation, imaging, and histopathological findings, but due to the spectrum of clinical presentation and symptom severity, diagnosis is often delayed until adolescence or adulthood. Here we present a newborn male infant, one of the earliest case diagnoses to our knowledge, with a unique constellation of physical exam and neuroimaging findings consistent with this diagnosis. We aim to address important neonatal findings to aid in early detection and diagnosis of this unique disease, which is thought to improve clinical outcomes and patient quality of life.

Primary essential cutis verticis gyrata – A case report

Cutis verticis gyrata (CVG) is a rare condition of the scalp characterized by convoluted folds and furrows produced by the excessive growth of the skin of the scalp and resembling the cerebral gyri. CVG can be identified as primary—essential or nonessential—or secondary. Herein, we report the case of a 20-year-old female with primary essential CVG, who presented herself with thickened and convoluted skin folds over the vertex and parietal region of the scalp persistent for one year prior without other symptoms. CVG is a rare congenital or acquired disease distinguished by redundancy of the scalp skin that resembles the cerebral gyri. The management of primary essential CVG can be symptomatic or surgical depending on the patient’s aesthetic expectations.

Dysbiosis and Enhanced Beta-Defensin Production in Hair Follicles of Patients with Lichen Planopilaris and Frontal Fibrosing Alopecia

Despite their distinct clinical manifestation, frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) display similar histopathologic features. Aberrant innate immune responses to endogenous or exogenous triggers have been discussed as factors that could drive inflammatory cascades and the collapse of the stem cell niche. In this exploratory study, we investigate the bacterial composition of scalp skin and plucked hair follicles (HF) of patients with FFA, LPP and alopecia areata circumscripta (AAc), as well as healthy individuals, in relation to cellular infiltrates and the expression of defense mediators. The most abundant genus in lesional and non-lesional HFs of LPP and FFA patients was Staphylococcus, while Lawsonella dominated in healthy individuals and in AAc patients. We observed statistically significant differences in the ratio of Firmicutes to Actinobacteria between healthy scalp, lesional, and non-lesional sites of FFA and LPP patients. This marked dysbiosis in FFA and LPP in compartments close to the bulge was associated with increased HβD1 and HβD2 expression along the HFs from lesional sites, while IL-17A was increased in lesional HF from AAc patients. The data encourage further studies on how exogenous factors and molecular interactions across the HF epithelium could contribute to disease onset and propagation.