Anagen Effluvium after Neurointerventional Radiation: Trichoscopy as a Diagnostic Ally

Minimally invasive procedures for vascular brain lesions are being performed more frequently. Radiation exposure caused by endovascular embolization of cerebral aneurysms may give rise to nonscarring scalp alopecia located in the treated area. Clinical and trichoscopic features of this type of alopecia are similar to alopecia areata (AA). Herein, we performed a comprehensive review to describe the clinical and trichoscopic characteristics of radiation-induced anagen effluvium. Predominant trichoscopic findings include black dots, yellow dots, short vellus hairs, and absence of exclamation marks hairs. It is important to consider this diagnosis in patients who have recently undergone such procedures that can easily be misdiagnosed as AA.

Variation of Hair Follicle Counts among Different Scalp Areas: A Quantitative Histopathological Study

<b><i>Introduction:</i></b> Scalp biopsy is a standard method for the definitive diagnosis of alopecia. The hair count parameters of each scalp area remain unclear. This study aimed to determine hair count values at different scalp locations from histopathology and to establish reference values for each part of the scalp. <b><i>Methods:</i></b> We obtained biopsy specimens from the frontal, vertex, temporoparietal, and occipital areas of the scalps of normal deceased subjects. All specimens were evaluated for the number of follicular units, hair counts, hair types, and stages of the hair cycle. <b><i>Results:</i></b> In total, 240 specimens were collected from 60 cadavers. Across all scalp sites, the temporoparietal area showed the lowest mean hair count, number of follicular units, terminal and vellus hairs, and terminal-to-vellus hair ratio. The average anagen-to-telogen hair ratio was comparable across all scalp sites. This study did not observe a significant association of hair parameters with gender differences or increasing age in all scalp areas. <b><i>Conclusions:</i></b> The present study revealed the diversity of the hair index among different scalp areas and suggested that normal hair count values should be separately standardized on each scalp region. Our findings may provide useful reference values for the histopathological evaluation of hair disorders in Asians.

Innovative Method of Alopecia Treatment by Using Adipose-derived Stromal Vascular Fraction (SVF) Cells

BackgroundAndrogenetic alopecia (AGA) is characterized by progressive reduction of hair density on the scalp through gradual conversion of terminal hairs into vellus hairs. Stromal vascular fraction (SVF) cells harvested from fat cells are one of the latest breakthroughs in the aesthetic field. This study aimed to present clinical cases for the treatment of alopecia areata by transplantation of SVF into the scalp.Objective To evaluate the efficacy of the use of the stromal vascular fraction (SVF) in androgenetic alopecia patients.Methods9 patients (age range 43-64 years; 4 men, grade IV to V and 5 women, grade I to III), who are suffering from AGA, have been treated with a single injection of autologous SVF in the upper scalp. Autologous SVF was generated and characterized before the injection of 7-8 × 106 cells into the scalp of the patient. Hair regeneration was assessed by three clinical tests: hair skin quality, hair thickness, and hair density at 3 and 6 months post-injection and compared to pre-injection results.ResultsHair density was significantly increased after 3 and 6 months post injection (P = 0.01 and P=0.009). The increase in thickness was notably seen at 6 months post injection (P = 0.02). Furthermore, a significant improvement in the score of keratin of scalp was seen in the treated side as compared to the nontreated side (p=0.032). No side effects were noted after treatment.ConclusionsA single treatment of SVF injected into the scalp of patients with AGA significantly increased hair density within 3 to 6 months. The obtained results prove the efficacy and the safety of the treatment, and satisfaction of the patients confirm the quality of the results.

Clinical and trichoscopic features in 18 cases of Folliculotropic Mycosis Fungoides with scalp involvement

Folliculotropic Mycosis Fungoides (FMF) is a rare variant of Mycosis Fungoides involving the scalp leading to alopecia. The clinical and trichoscopic features in 18 patients were analyzed and compared with the reports in the literature. Gender, age, disease stage, site of onset were taken into consideration. Clinical and trichoscopic analyses were performed on each patient. From a clinical point of view, Folliculotropic Mycosis Fungoides lesions involving the scalp presented as generalized alopecia (27.8%) or patchy-plaque alopecia (72.2%). Trichoscopic analysis revealed six most frequent features: single hair (83.3%), dotted dilated vessels (77.8%), broken-dystrophic hairs (66.7%), vellus hairs (61.1%), spermatozoa-like pattern vessels (55.6%), and yellow dots (55.6%). Additional identified trichoscopic patterns were dilation of follicular openings, scales-crusts, purpuric dots, short hair with split-end, pigtail hairs, perifollicular hyperkeratosis, milky-white globules, black dots, white dots/lines and absence of follicular dots. These trichoscopic features were further correlated to clinical presentations and stage of the disease. The rarity of the disease is a limitation. The relatively high number of patients allowed to identify several clinical and trichoscopic patterns that could be featured as specific or highly suspicious for FMF in order to consider trichoscopy as a complementary diagnostic approach and improve the differential diagnoses between FMF and other scalp disorders.

Trichostasis Spinulosa: A Case Report with an Unusual Presentation

Trichostasis spinulosa (TS) is a follicular disorder characterized by the retention of multiple vellus hairs in a hyperkeratotic dilated hair follicle. TS is considered as a common disorder; however, it is often underdiagnosed due to its asymptomatic nature. Although the condition frequently affects the face or extremities, the widespread distribution of TS over the entire body has been once reported in a patient with chronic renal failure. To emphasize the infrequent presentation of TS, we herein report a 57-year-old male with an unusual location of TS.

Atypical Presentation of Congenital Triangular Alopecia: A Case Series in Italy

Background: Congenital triangular alopecia (CTA) is a benign, asymptomatic, nonprogressive, localized and noncicatricial type of alopecia that is usually first noted during infancy or childhood. The pattern of hair loss is traditionally described as triangular, oval or lancet shaped with apex toward the vertex. Objectives: We present a case series of CTA located in unusual sites. Patients and Methods: We performed trichoscopy in 78 patients with CTA. From this group, we selected 10 individuals (4 males and 6 females) whose disease was not localized on the typical scalp area. Results: The alopecic area was located on the occipital region in 5 patients, the parietal region in 4 patients, at the vertex in 1. With trichoscopy, vellus hairs were detected in all patients, and evidence of empty follicles was noticed only in 3 patients. Conclusions: In contrast with the preconceived notion that all CTAs are frontotemporal, our case series points out that this disease could be localized in other scalp sites.

A study of clinical and dermoscopic features in alopecia areata at a tertiary referral center

<p class="abstract"><strong>Background:</strong> Alopecia areata (AA) is a common chronic inflammatory disease causing unpredictable non scarring form of hair loss. Dermoscopy is a clear cut as well as valuable method done in a noninvasive manner to study the signs of alopecia areata. Aim was to elucidate the various clinical characteristics and dermoscopic findings of alopecia areata.</p><p class="abstract"><strong>Methods:</strong> A total of 150 patients were examined using a dermlite dermoscope at dermatovenereology OPD of Vydehi Hospital. Detailed history, clinical features, associated changes, severity and dermoscopic findings were noted.</p><p class="abstract"><strong>Results: </strong>In our study males (54.7%) were more than females (45.35%) with the ratio of 1.2:1. Mean age of the patients was 25 years. Mean duration of the disease was around 6 months. The most common type noted in our study was patchy alopecia (76%) and most common affected site was scalp (frontal and parietal region) (49.35%). 28% of the people have itching, otherwise it is mostly asymptomatic. Stress was a triggering factor in 24.70% patients. Nail changes in the form of pitting seen in 20.7% patients. The various dermoscopic findings observed in our study are yellow dots (80%), short vellus hair (74.7%), exclamation hair (34%), black dots (28%), broken hair (25.3%).</p><p class="abstract"><strong>Conclusions:</strong> Short vellus hair and yellow dots are seen in most cases of our study. They vary according to the activity of the disease and treatment. Yellow dots, black dots and tapering hair indicate active disease, while short vellus hairs indicate remission.</p><p> </p>

Trichoscopy of Alopecia Areata: Hair Loss Feature Extraction and Computation Using Grid Line Selection and Eigenvalue

Recently, the hair loss population, alopecia areata patients, is increasing due to various unconfirmed reasons such as environmental pollution and irregular eating habits. In this paper, we introduce an algorithm for preventing hair loss and scalp self-diagnosis by extracting HLF (hair loss feature) based on the scalp image using a microscope that can be mounted on a smart device. We extract the HLF by combining a scalp image taken from the microscope using grid line selection and eigenvalue. First, we preprocess the photographed scalp images using image processing to adjust the contrast of microscopy input and minimize the light reflection. Second, HLF is extracted through each distinct algorithm to determine the progress degree of hair loss based on the preprocessed scalp image. We define HLF as the number of hair, hair follicles, and thickness of hair that integrate broken hairs, short vellus hairs, and tapering hairs.

ALOPECIAAREATAAND TRICHOSCOPY: AN OBSERVATIONAL STUDY

Background: Alopecia areata (AA) is a common type of non-scarring alopecia. Genetic predisposition, autoimmunity, and environmental factors play a major role in the etiopathogenesis of AA. Trichoscopy is a simple and a non invasive technique used to detect various types of scalp and hair disorders. It is a simple bed side test which avoids unnecessary biopsies, besides diagnosing the condition it also helps in determining the treatment response. Aim and Objectives: To determine the various trichoscopic findings in alopecia areata. Materials and Methods: 50 patients with clinically diagnosed alopecia areata were enrolled for the present study. Trichoscopy was done using a digital microscope system in both non polarized and polarized modes after obtaining written informed consent. Result: Most common trichoscopic finding was yellow dots seen in 86% followed by short vellus hairs seen in 76%, broken hair in 60% and black dots in 44% patients respectively.

Differential diagnostics of syphilitic alopecia and alopecia areata: The clinical picture and trichoscopic signs

This paper describes a clinical case of secondary syphilis, which was manifested exclusively by syphilitic alopecia.We describe the details of the clinical picture, as well as a differential diagnosis of syphilitic alopecia and alopecia areata on the basis of trichoscopy data.For a patient with scalp lesions typical of syphilis (focal form of alopecia), the trichoscopic picture was represented by hairs broken at different heights from 1 to 5 mm, “empty” follicles (“yellow” dots), anisotrichosis due to the loss of terminal hair. The eyebrow trichoscopy showed “yellow dots”, vellus hairs, hair thinning due to the loss of bristly hair. A comparison of the trichoscopic pictures for alopecia areata and syphilitic areata have revealed the absence in the latter of a number of signs typical of the former, such as pencil-point, ex clamation-point, zigzag, monilethrix and tulip hairs.Patients with a clinical picture of focal, diffuse or mix ed alopecia should be tested for syphilis using serological methods.