Decreased Hair Density Research Articles

The synergistic effect of phototherapy and active substances on hair growth

Androgenic alopecia (AGA) typically manifests post-puberty, resulting in decreases in hair density, disruptions in the hair growth cycle, and alterations in hair follicle micro structure. Dihydrotestosterone (DHT) is a key hormone implicated in hair loss, especially on male. In this study, we found that each of arginine (Arg), arterial extract (AE) or biotin tripeptide-1 (BT-1), when combined with low level light therapy (LLLT, at 630 nm, 2 J/cm2), showed the efficacy in enhancing mitochondrial functions, cell proliferation and collagen synthesis in fibroblasts. Additionally, CARRIPOWER (the complexes of AE, BT-1, Arg, and Diaminopyrimidine derivatives), in conjunction with LLLT (630 nm, 2 J/cm2), showed promising results in dermal papilla cells (DPCs). The promising results contained not also inflammatory cytokines (IL-1β and IL-6) and cell pro apoptotic factor (TGF-β2) reduction, but also Wnt pathway inhibition by decreasing DKK1 level, and pro-hair growth factors (vascular endothelial growth factor (VEGF) and β-catenin) increase. This innovative combination therapy offers a potential solution for the treatment of AGA, addressing both hormonal and cellular factors involved in hair loss.

A Mouse Model for Conditional Expression of Activated β-Catenin in Epidermal Keratinocytes.

We report the generation and characterization of the K5: CAT bigenic mouse in which the constitutively activated form of β-catenin (ΔN89 β-catenin) is conditionally expressed in cytokeratin-5 (K5) positive epidermal keratinocytes. Following short-term doxycycline intake during the telogen resting phase, the adult K5: CAT bigenic develops enlarged pilosebaceous units that expand deep into the dermis, an expansion usually observed during the anagen growth phase. Prolonged doxycycline treatment results in significant thickening and folding of the K5: CAT epidermis. During this persistent induction period, there is clear evidence of increased keratinocyte proliferation, particularly in the epidermal basal cell layer and the outer root sheath of the hair follicle. This unscheduled increase in cellular proliferation likely explains the decrease in hair density observed in the K5: CAT mouse following persistent doxycycline intake. Numerous hyperplastic endometrioid cysts, which display cornification toward their lumens, are also observed during this treatment period. Remarkably, de-induction of ΔN89 β-catenin expression through doxycycline withdrawal results in a marked reversal of the skin phenotype, suggesting that these morphological changes are dependent on continued signaling by β-catenin and/or its downstream molecular mediators. Joining a small group of mouse models for conditional β-catenin signaling, our K5: CAT mouse model will be particularly useful in identifying those molecular mediators of β-catenin that are responsible for initiating and maintaining these phenotypic responses in the K5: CAT skin. Such studies are predicted to shed more light on β-catenin signaling in epidermal epithelial morphogenesis, hair follicle cycling, and hair growth pathologies.

Therapeutic maintenance effect of finasteride 1 mg every other month regimen in androgenetic alopecia and study on the difference in response to finasteride treatment: A prospective cohort study.

Finasteride is commonly used for androgenetic alopecia (AGA) treatment. The aim of this study was to assess the therapeutic maintenance effect of a finasteride every other month (EOM) regimen and analyze clinical and laboratory differences in patients with AGA according to their treatment response. One hundred males with AGA who received finasteride 1 mg daily treatment for a year were enrolled in the study. At 1 year follow-up, treatment responses of patients who completed the visit schedule were assessed using five scales. The patients were assigned to good or bad response groups according to their assessment. Further, they were randomly divided into two groups (daily vs. EOM) and treated with finasteride (1 mg) for 1 more year. At 2 years follow-up, treatment efficacy was assessed. At 1-year follow-up, 36 patients completed the schedule, including eight and three patients in the good and bad response groups, respectively. At the 2-year follow-up, 23 patients completed the schedule, with nine in the daily group and 14 in the EOM group. Changes in global photographic assessment in the second year were 1.33 and 1.29 for the daily and EOM groups, respectively. The daily group showed an elevated hair density and lower concentration of dihydrotestosterone (DHT) and the DHT to testosterone ratio (DHT/T). However, the EOM group showed decreased hair density and elevated DHT and DHT/T. Following treatment response assessment after 1 year of treatment, the good response group showed early onset which was associated with maternal AGA. Analysis of serum androgen hormone magnitude of DHT reduction was much greater (54.4% vs. 44.4%). DHT/T was higher in the bad response group (1.98 vs. 2.33). We concluded that the finasteride EOM regimen showed similar maintenance effects to the daily regimen.

Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues.

Alopecia areata (AA), trichotillomania (TM), nevus sebaceous (NS), and linear scleroderma en coup de sabre (LSCS) can all present with a patch of linear alopecia, making diagnosis challenging. The purpose of this study was to combine reflectance confocal microscopy (RCM) and dermoscopy in the diagnosis of these lesions in children. A total of 36 patients with linear alopecia were enrolled, of whom 14 had AA, seven had TM, nine had NS, and six had LSCS. We evaluated the characteristics and distinguishing features of the four conditions using RCM and dermoscopy. The key to differential diagnosis was the dermal Hair follicle density in the dermis was decreased in AA, and the size and density of the follicular openings were normal in TM. In NS, the major features were petal-like and frogspawn-like structures. In LSCS, dermal papillary rings, sebaceous glands, and follicles were partially or completely missing, and abundant fibrous material was distributed in the dermis. Dermoscopy revealed alopecia, and all four conditions resulted in decreased hair density. AA patients exhibited yellow dots, black dots, and exclamation mark hairs. TM patients presented with irregularly broken hairs and blood spots. Both NS and LSCS patients exhibited an absence of follicular openings; NS patients demonstrated whitish and yellowish round structures, while an atrophic area with white patches, linear vessels, and no yellow or black dots was observed in LSCS patients CONCLUSION: RCM combined with dermoscopy can provide additional information on disease states and differentiate between AA, TM, NS, and LSCS.

Oxidative stress: Insights into the Pathogenesis and Treatment of Alopecia

Hairs are exposed to a host of endogenous and environmental stress by pollutants, microbial assaults, UV radiation, oxidized scalp lipids, grooming practices and cosmetic treatments which have diverse range of adverse consequences. The exposure to these environmental and cosmetic substances, leads to generation of free radicals, reactive oxygen species in particular, leading to oxidative stress. Oxidative stress generates inflammation, and/or psycho-emotional stress, and also influences the ageing process, including the hair follicle. The term alopecia signifies loss of hair owing to several factors, ultimately resulting in decreased hair density. Cell death on hair follicle (keratinocytes and its distinctive mesenchyme of dermal papilla) have been attributed to mechanisms of oxidative stress, including H2O2, nitric oxide and derivatives, ultraviolet rays, ionizing radiations, endotoxin-induced inflammation, photodynamic therapy and cigarette smoke. Persistent oxidative activities in the body, may generate antioxidant defense systems, which can prevent the attack of biological molecules. In case of androgenic alopecia, copper and zinc was discovered in the disrupted metabolism form in serum, urine and hair of the patients, and data suggests rise in oxidative stress. This review is focused on the effects of the reactive oxygenated species in disturbing the redox balance and inducing oxidative injury that leads to androgenic alopecia.

A Clinico-Trichoscopic Analysis of Hair Density and Diameter Variability in Relation to Severity Grading of Female Pattern Hair Loss

Hair loss is a common complaint among Indian women. For female pattern hair loss (FPHL), diagnosis is primarily clinical. In the early stages, it can be confused with other conditions. Histopathology is the diagnostic method of choice but requires multiple biopsies and can be disfiguring. Trichoscopy is an alternative noninvasive, rapid tool. The aim of this study is to study the hair density and hair diameter variance in relation with severity grading of FPHL. Cross-sectional study. Ninety women aged 18 years and above were included in this cross-sectional study conducted at the dermatology department of Bangalore Medical College and Research Institute. Trichoscopic examination was done with a videodermoscope (Firefly DE300) at 20 and 70-fold magnification. Only those patients who met the trichoscopic diagnostic criteria for FPHL were included. Descriptive statistics, ANOVA, and Spearman's correlation test for fitness of good, using Microsoft Excel data analysis tools. Increase in disease severity from grade one to grade three positively correlated with a decrease in hair density over the frontal scalp (P < 0.001) and the occipital scalp (P < 0.001), decrease in average hair shaft diameter over both frontal and occipital scalp (P < 0.001). Trichoscopic tools, particularly hair density and hair diameter variance over both frontal and occipital scalp can be useful to help determine FPHL disease severity and its progression.

The effect of placebo in split-scalp and whole-head platelet-rich plasma trials for androgenetic alopecia differs: Findings from a systematic review with quantitative evidence syntheses.

Some studies have shown that platelet-rich plasma (PRP) improves androgenetic alopecia (AGA), while others do not. We determined whether the placebo effect significantly varies between split-scalp and whole-head trials on PRP monotherapy for AGA. Our rationale was based on the plausibility of PRP diffusing to the control (i.e., "placebo") side of split-scalp trials. This is not possible in whole-head studies. We systematically searched the literature for available data. Our choice of analyses and outcomes were determined by the available data. Our endpoint was change in total hair density 6months after baseline. Our regression showed that total hair density after 6months was significantly (p<0.05) higher in the placebo arm of split-scalp trials, compared to whole-head studies, by 37hairs/cm2 . Our one-arm meta-analyses showed that the pooled change in total hair density between the PRP side and placebo side in split-scalp studies was -3hairs/cm2 (p=0.37), that is, a slight decrease in hair density in the placebo side of the scalp. For whole-head studies, the corresponding difference in total hair density between patients receiving PRP and those on placebo was -30hairs/cm2 (p=0.000017), that is, a much larger decrease in hair density. Patients in the placebo group in whole-head trials lost significantly more hair than in the placebo side of the split-head trials where hair loss was comparatively reduced - presumably because of PRP diffusing from the treatment side of the scalp. The association between design (i.e., split-scalp vs. whole-head) and outcome, in placebo arms of AGA trials on PRP monotherapy, had never been reported. This "design effect" could partly reconcile the incongruent conclusions across the PRP literature for AGA; furthermore, clinical guidelines can consider "design effect" when selecting evidence to base care practices on.

A systematic review of acute telogen effluvium, a harrowing post-COVID-19 manifestation.

This systematic review focuses on the clinical features, physical examination findings, outcomes, and underlying pathology of acute telogen effluvium (TE), a type of diffuse hair loss, occurring in coronavirus disease 2019 (COVID-19) recovered patients. MEDLINE/PubMed and Embase databases were queried till October 2021 to identify studies reporting acute TE occurring after COVID-19 recovery. Data were obtained from 19 studies, which included 465 patients who were diagnosed with acute TE. The median age of these patients was 44 years and 67.5% were females. The most common trichoscopic findings were decreased hair density, the presence of empty follicles, or short regrowing hair. The mean duration from COVID-19 symptom onset to the appearance of acute TE was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress.

Evaluation of the Effectiveness of Personalized Treatment of Trace Element and Vitamin Status in Men with Initial Stages of Androgenic Alopecia Treated with Conservative Therapy

Background. Androgenic alopecia (AGA) is the most common form of pathological hair loss with multiple micronutrient disorders involvedin its occurrence and development.&#x0D; Aimto evaluatethe effectiveness of personalized treatment of micronutrient deficiencies in patients with early stages of AGA and conservative therapy using a vasodilator drug minoxidil based on evidence-based medicine.&#x0D; Methods. A total 48 patients with stages IIV of AGA (according to the NorwoodHamilton scale) were recruited to experimental prospective clinical study evaluating the effectiveness of pharmaceutical forms of trace elements and vitamins. The primary diagnosis of micronutrient deficiency was carried out by comparing laboratory parameters of patients with AGA and 25 healthy volunteers. After that, conservative treatment with 5% topical minoxidilin AGA patients was enriched with 2-month personalized systemic supplementation of pharmaceutical forms of trace elements and vitamins. At the end of the study, the correspondence between changes in trace elements and vitamins content in the plasma and the trichogram parameters before and after conservative therapy was assessed.&#x0D; Results. The majority (96%) of the examined patients with AGA were characterized by mono- or polynutrient deficiencies. Personalized correction made it possible to restore the content of Se, Mg, Fe and vitamin E to the baseline levels and to achieve a significant increase in Zn, vitamin D and folic acid plasma content. The relationship between changes in the level of micronutrients and trichogram parameters was recorded only for Se (decrease in anagen hairs: r = 0.43; p = 0.037; decrease in hair density: r = 0.45; p = 0.028) and folic acid (an increase in anagen hairs: r = 0.41; p = 0.024); the positive effect of vitamin E on hair density was also detected.&#x0D; Conclusion. The results of the study allow to recommend a personalized treatment of folic acid and vitamin E deficiencies, with possible refusal to use the Se-containing drugs in conservative therapy of patients with the early stages of AGA.

Trichotillomania Masked by Diffuse Alopecia Areata: A Case Report

An 11-year-old girl previously treated for tinea capitis presented a 3-month history of continuous decrease in hair density on the vertex, frontal, and parieto-temporal areas of the scalp. Hair pull test was negative. Trichoscopic findings showed black dots, micro-exclamation point hairs, regrowing vellus hair, and zigzag hairs. Histopathology showed CD3+ peribulbar lymphocytic infiltrates and occasional eosinophils around the anagen hair follicle consistent with a non-scarring alopecia. A diagnosis of diffuse alopecia areata was made. Patient was given methylprednisolone (0.5 mg/kg/day) for 2 weeks and noted marked increase in hair density except on focal areas of the scalp. Patient eventually admitted to occasional hair pulling. Trichoscopy revealed trichoptilosis, V-sign, tulip hairs, and multiple broken hairs of varying length while a second biopsy showed trichomalacia and pigment casts consistent with trichotillomania. In this case, where co-existence of alopecia areata and trichotillomania is considered to be uncommon, trichoscopy proved to be an important tool in differentiating hair disorders with similar presentation. Knowing key features of hair diseases can help elucidate the diagnosis when presented with an atypical case.

575 An extract of Leontopodium alpinum prolongs anagen phase in human hair follicles ex vivo

Aging and hair follicle disorders, such as telogen effluvium or androgenetic alopecia, lead to premature catagen induction and decreased hair density. Hair loss is an aesthetic problem that may cause major psychological distress in affected individuals. While severe types of hair loss are targeted by the pharmaceutical industry, with drugs exhibiting unwanted side effects, the cosmetic industry is looking for milder, and natural treatment options. Bearing this in mind, we focused on an extract of Leontopodium alpinum (Edelweiss) and investigated its effects on hair growth ex vivo. We treated microdissected anagen VI scalp hair follicles (HFs) from three individuals (two female, one male) with 0.001% edelweiss extract and evaluated hair growth-associated parameters. After 5 days of treatment, we observed significantly more HFs remaining in anagen, and increased hair matrix keratinocyte proliferation. On a molecular level, higher activity of alkaline phosphatase, and up-regulated expression of versican was observed in the dermal papilla of female treated HFs, suggesting improvement of dermal papilla inductivity. In addition, the expression of hair growth-associated growth factors, i.e. IGF-1 or FGF7, was found to be up-regulated in the outer root sheath, and/or dermal papilla of female hair follicles. Our ex vivo results provide preliminary evidence for a beneficial effect of the Leontopodium alpinum extract in limiting hair shedding in vivo.

Female Pattern Hair Loss in Female and Male: A Quantitative Trichoscopic Analysis in Chinese Han Patients.

Objectives: To investigate the trichoscopic features of female pattern hair loss (FPHL) in Chinese Han patients and analyze the difference between male and female patients with FPHL.Materials and Methods: Trichoscopic images were taken in four different scalp areas, including right frontal hairline, vertex, right parietal and occipital areas. Hair density, hair shaft diameter, vellus hair ratio and single hair follicle unit ratio were counted manually and analyzed.Results: Seventy-three subjects were enrolled in this study, including 38 patients with FPHL (28 females and 10 males) and 35 normal controls without hair loss. The hair density and hair shaft diameter of FPHL patients reduced in the whole scalp. Vellus hair ratio and single hair follicle unit ratio were both increased in FPHL compared to normal controls. The vertex was the most affected area and the hair shaft diameter showed the most significant difference. Parietal and occipital area were also affected in FPHL. The reduction or increase was correlated with the severity of Ludwig staging. Very few gender differences were detected in male and female FPHL patients.Conclusion: FPHL patients showed decreased hair density and hair shaft diameter, accompanied by increased vellus hair ratio and single hair follicle unit ratio. Parietal and occipital area can be also affected in FPHL, though not as severe as in vertex area. FPHL in male basically has the same characteristic as those in female patients.Limitation: The main limitation of the study is the small sample size which only enrolled 10 male FPHL patients, in comparison to the female cases. The findings could not be representative of the normal population with the limited sample size.

Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option.

Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options. A retrospective chart review was performed of the senior author's (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss. A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients. Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low. Therapeutic, IV.

Clinical, trichoscopy, and light microscopic findings in hypohidrotic ectodermal dysplasia: Report of 21 patients and a review of the literature.

Hypohidrotic ectodermal dysplasia (HED) is a genetic condition typified by alterations in skin structures including sweat glands, hair, nails, and teeth. Hair findings in HED have been poorly characterized in larger series. To characterize scalp and hair findings of patients with HED clinically and with trichoscopy and light microscopy. A cross-sectional study in 21 pediatric HED patients was performed using available clinical and scalp dermatoscopic images, as well as pulled-hair samples for clinical evaluation, trichoscopic, and light microscopic analyses. Seventeen out of 21 patients (81%) were men. Twenty patients had straight hair. Sixteen patients had decreased hair density, 6 of whom had hair loss mainly in the temporal and occipital regions. Fourteen patients had hair whorls. On trichoscopy, we observed: single-hair follicular units (n=19, 90%), scalp hyperpigmentation (n=13, 62%), variable diameter of the hair shafts (n=12, 57%), perifollicular scales (n=8, 38%), scalp erythema (n=8, 38%), and short curly pigtail hairs (n=6, 29%). On light microscopy, findings included: hair shafts with irregular diameter (n=7, 33%), heterogeneous hair color (n=6, 29%), trichoptilosis (n=2, 10%), and pili torti (n=1, 5%). In this series, hair findings in HED were similar to those described in previous studies. However, we describe two new clinical and two trichoscopic findings: decreased hair density mainly in the temporal and occipital regions, oblique upwards occipital hair follicles orientation, angled hairs, and short curly pigtail hairs. These heterogeneous findings may reflect the multiple factors and signaling pathways that can be affected in these syndromes.

Evaluation of The Role of Topical Cetirizine 1% in Treatment of Male Androgenetic Alopecia

Background: Androgenetic alopecia [AGA] one of the common scalp hair loss disorders affecting males. Androgenetic alopecia is characterized by progressive miniaturization of hair follicles in the scalp and gradual transformation of terminal hairs into vellus hairs leading to progressive decrease in hair density. The pattern of loss follows the scale developed by Hamilton and later extended by Norwood. Aim of Work: Evaluation of the efficacy of topical cetirizine 1% for the treatment of androgenetic alopecia in male patients. Patients and methods: This case-controlled study included 30 male patients treated by topical cetirizine1%and 30 male patients as a control group treated by placebo for 6 months recruited from dermatology outpatient clinic of Damietta Hospital and Al-Sarou hospital during the period from September 2018 to August 2019. For each patient, the trichoscopic evaluation was performed before the beginning of treatment and after 6 months of treatment. Results: Treatment with topical cetirizine 1% in male patients with AGA showed that according to number of new up growing hairs, the majority [56.7%] of cases had no new growing hair, 20.0%, 16.7% &6.7% had one, two and three new hair respectively. On the other hands, all control had no new hair after 6 months of treatment. Conclusion: Topical cetirizine is effective in the treatment of Androgenetic alopecia in men.

Comparative evidence for the independent evolution of hair and sweat gland traits in primates

Humans differ in many respects from other primates, but perhaps no derived human feature is more striking than our naked skin. Long purported to be adaptive, humans' unique external appearance is characterized by changes in both the patterning of hair follicles and eccrine sweat glands, producing decreased hair cover and increased sweat gland density. Despite the conspicuousness of these features and their potential evolutionary importance, there is a lack of clarity regarding how they evolved within the primate lineage. We thus collected and quantified the density of hair follicles and eccrine sweat glands from five regions of the skin in three species of primates: macaque, chimpanzee and human. Although human hair cover is greatly attenuated relative to that of our close relatives, we find that humans have a chimpanzee-like hair density that is significantly lower than that of macaques. In contrast, eccrine gland density is on average 10-fold higher in humans compared to chimpanzees and macaques, whose density is strikingly similar. Our findings suggest that a decrease in hair density in the ancestors of humans and apes was followed by an increase in eccrine gland density and a reduction in fur cover in humans. This work answers long-standing questions about the traits that make human skin unique and substantiates a model in which the evolution of expanded eccrine gland density was exclusive to the human lineage.

Permanent diffuse alopecia after haematopoietic stem cell transplantation in childhood.

Permanent alopecia after haematopoietic stem cell transplantation (HSCT) is distressing and few studies have investigated this late effect. The aim of the study was to assess the percentage of patients with alopecia and investigate risk factors for alopecia. Patients who underwent allogeneic HSCT before age 19 years, from January 1990 to January 2013, who were at least 2 years after transplant and in follow-up in our clinic were included. Alopecia was defined as clinically apparent decreased hair density. Possible risk factors considered for alopecia after HSCT included: gender, age, diagnosis, donor type, conditioning regimen: cranial irradiation (TBI/cranial radiotherapy) and/or chemotherapy, which chemotherapeutic agents were used and acute/chronic GvHD. The percentage of permanent alopecia in our cohort was 15.6% (41/263 patients). All patients had diffuse alopecia except for one with alopecia totalis. In multivariate analysis, a conditioning regimen with busulphan and busulphan plus fludarabine (odds ratio (OR) 5.7 (confidence interval (CI): 2.5-12.7) and OR 7.4 (CI: 3.3-16.2), respectively, was the main risk factor and associated with alopecia independent of acute/chronic GvHD. Neither TBI nor other alkylating chemotherapy, including treosulfan, was associated with alopecia. In conclusion, permanent alopecia after HSCT is associated with busulphan and GvHD and occurs in 16% of patients.

Autosomal Recessive Hypotrichosis with Woolly Hair Caused by a Mutation in the Keratin 25 Gene Expressed in Hair Follicles

Hypotrichosis is an abnormal condition characterized by decreased hair density and various defects in hair structure and growth patterns. In particular, in woolly hair, hypotrichosis is characterized by a tightly curled structure and abnormal growth. In this study, we present a detailed comparative examination of individuals affected by autosomal-recessive hypotrichosis (ARH), which distinguishes two types of ARH. Earlier, we demonstrated that exon 4 deletion in the lipase H gene caused an ARH (hypotrichosis 7; MIM: 604379) in populations of the Volga-Ural region of Russia. Screening for this mutation in all affected individuals revealed its presence only in the group with the hypotrichosis 7 phenotype. Other patients formed a separate group of woolly hair-associated ARH, with a homozygous missense mutation c.712G>T (p.Val238Leu) in a highly conserved position of type I keratin KRT25 (K25). Haplotype analysis indicated a founder effect. An expression study in the HaCaT cell line demonstrated a deleterious effect of the p.Val238Leu mutation on the formation of keratin intermediate filaments. Hence, we have identified a previously unreported missense mutation in the KRT25 gene causing ARH with woolly hair.

Localized telogen effluvium after face lift surgery.

Dear Editor: A 62-year-old woman presented at Kyung Hee University Hospital at Gangdong with a 2-month history of frontal and bitemporal shedding and thinning. Two months prior to visiting our clinic, she had undergone rhytidectomy at a local plastic surgery clinic. Her past medical history was not significant. There was no drug history, weight change, or chronic illness, and the patient denied any other trauma history. The physical examination revealed symmetric frontal and bitemporal thinning and decreased hair density (Fig. 1A, B). In a hair pull test, ≥10 hairs were easily pulled from around the suture line of the rhytidectomy; however, the hair pull test was negative in other parts of the scalp. On transverse sections of a 5-mm punch biopsy specimen, normal follicular density and increased numbers of telogen hair follicles were observed. Peribulbar inflammation, scarring, and hair shaft abnormality were not observed (Fig. 1C). On the basis of the clinical and histopathologic findings, she was diagnosed with telogen effluvium, which occurred after rhytidectomy. Without any treatment, the patient noted the natural recovery of hair shedding, and the regrowth of many hairs was observed around the affected areas 4 months after rhytidectomy (Fig. 2). Fig. 1 (A, B) Hair thinning and a decreased hair density is observed symmetrically along the frontal and bitemporal incision lines. (C) Increased numbers of telogen hair follicles are found, and peribulbar inflammation, scarring, and hair shaft abnormality are ... Fig. 2 Three months after the rhytidectomy, hair regrowth is detected around the frontal and bitemporal incision lines. Temporary hair loss following rhytidectomy has been reported to occur in up to 8.4% of patients after rhytidentomy1. Several causes have been suggested, which include undue tension at the time of flap closure, excessively thin flaps with a diminished blood supply to the hair follicles, and direct trauma to the hair follicles during dissection2. Telogen effluvium is also known as the cause of temporary hair loss after rhytidectomy3. The hallmarks of an acute telogen effluvium include diffuse shedding sometimes with accentuated hair thinning, a normal appearing scalp, and a markedly positive pull test4. Possible causes include a high fever, postpartum, severe illness, severe psychological distress, major surgery, thyroid disease, drugs, and crash diets4. It is a reversible disorder once the initiating factor is eliminated and no specific treatment is needed. In this case, hair loss began 2 months postoperatively, and a scalp biopsy at the beginning of the hair loss revealed an increased ratio of telogen hair follicles and few peribulbar inflammatory cell infiltrates. Without any treatment, the hair shedding ceased and regrowth of the hairs was observed around the frontal and bitemporal incision lines. Based on all this evidence, the authors concluded that localized telogen effluvium could have been the cause of temporary hair loss after rhytidectomy. Moreover, a study reported that preoperative and postoperative prophylactic use of minoxidil reduces the percentage of hair loss that occurs after rhytidectomy5, and this finding also supported our conclusion. Herein, we report on the first case of telogen effluvium that occurred after rhytidectomy with histopathologic findings and a natural course of recovery. Dermatologic surgeons should be aware that localized telogen effluvium can cause temporary hair loss after face lift surgery. To prevent temporary hair loss, surgeons must reduce the trauma to the hair follicles by making incisions that are parallel to the hair follicles, reduce tension to the scalp around the suture lines, and ensure that the skin flap is not too thin.

Advances in hair transplantation: longitudinal partial follicular unit transplantation.

There are different techniques of hair transplantation. The most common and known hair transplantation methods are the 'strip' method, where a strip of skin containing hair follicles is removed, cut into grafts and implanted in the recipient area, and the follicle unit extraction (FUE) method, in which whole follicle units are extracted one by one and implanted one by one back into the recipient area. The FUE method is more patient friendly and leaves only tiny scars compared to the strip method, which leaves visible linear scars at the donor area. Both methods, however, have the major disadvantage that the extracted hair follicles are removed and the availability of donor hair follicles are limited and results in a decrease in hair density, as no re-grow will occur in the donor area. Since partial longitudinal-follicular unit transplantation (PL-FUT) extracts partial longitudinal follicular units that can be used as complete follicular units to regenerate completely differentiated hair growth and the partial follicular units that remain in the dermis in the donor area can survive and produce hair, PL-FUT enables us to multiply hair follicles in vivo while preserving the donor area. Although this technique is suitable for androgenic alopecia, PL-FUT could also be suitable in persons who have a relative small donor area compared to the recipient area like burn victims, as well as scarring alopecia's like frontal fibrosing alopecia.