Diffuse Hair Thinning Research Articles

Therapy experience in alopecia after COVID-19

The coronavirus infection (COVID-2019) caused by SARS-CoV-2 continues to be studied, the virus mutates, new strains differing from the previous ones by rapid spread appear. Due to the difficult epidemiological situation around the world, the long-term course of the pandemic, doctors of various disciplines are increasingly facing its consequences. 25% of patients have various types of alopecia following infection. Suppression of some growth factors due to the collapse of the immune privilege, local and systemic inflammation, oxidative stress, tissue hypoxia, microvascular insufficiency manifested by persistent capillary spasm influence hair loss. The article presents data from the analysis, out-patient medical records of patients aged 19 to 60 years who sought advice from the Ekaterininskaya clinic network with complaints of hair loss and past history of confirmed coronavirus infection. Due to the variety of trigger factors and multifaceted pathogenetic mechanisms of influence on the hair follicle in coronavirus infection, it is more appropriate to use drugs with a complex mechanism of action for the treatment. The patients received a complex drug for the treatment of alopecia, 1 tablet three times a day for 2 months, and a peptide lotion for cutaneous use with active ingredients, which activate cellular metabolism in hair follicles, encourage the hair follicles to switch to the active growth phase. A positive result during treatment was achieved in 92% of patients. Good tolerability, absence of side effects allow us to administer the drugs we use in a range of therapeutic measures in patients with diffuse hair thinning following coronavirus infection, both in monotherapy and in combination with other drugs.

Minimally invasive procedures for the management of female pattern hair loss.

Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet-rich plasma (PRP) have been reported as adjuvant treatments. This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL. Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered. Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.

Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics.

BackgroundAndrogenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline in men and diffuse hair thinning in women, with frontal hairline retention, and can impact an individual's quality of life. The condition is primarily mediated by 5‐alpha‐reductase and dihydrotestosterone (DHT) which causes hair follicles to undergo miniaturization and shortening of successive anagen cycles. Although a variety of medical, surgical, light‐based and nutraceutical treatment options are available to slow or reverse the progression of AGA, it can be challenging to select appropriate therapies for this chronic condition.AimsTo highlight treatment options for androgenetic alopecia taking into consideration the efficacy, side effect profiles, practicality of treatment (compliance), and costs to help clinicians offer ethically appropriate treatment regimens to their patients.Materials and MethodsA literature search was conducted using electronic databases (Medline, PubMed, Embase, CINAHL, EBSCO) and textbooks, in addition to the authors' and other practitioners' clinical experiences in treating androgenetic alopecia, and the findings are presented here.ResultsAlthough topical minoxidil, oral finasteride, and low‐level light therapy are the only FDA‐approved therapies to treat AGA, they are just a fraction of the treatment options available, including other oral and topical modalities, hormonal therapies, nutraceuticals, PRP and exosome treatments, and hair transplantation.DiscussionAndrogenetic alopecia therapy remains challenging as treatment selection involves ethical, evidence‐based decision‐making and consideration of each individual patient's needs, compliance, budget, extent of hair loss, and aesthetic goals, independent of potential financial benefits to the practitioners.

Hair loss due to a new coronavirus infection: treatment approaches

Stress has always been one of the triggers of hair loss. The global pandemic of COVID-19 infection has become such a factor for many people. Considering that the pathogenesis of hair loss in this infection has not been sufficiently studied yet, many authors suggest that, as the infection itself and the associated psychoemotional condition and the therapy can cause diffuse thinning of hair and androgenic alopecia. Several studies demonstrate a link between androgens involved in the pathogenesis of COVID-19 and the possible development of androgenic alopecia. Other researchers have observed many cases of telogen hair loss associated with this infection. In our practice, we also encounter diffuse hair thinning, presumably caused by COVID-19. Often, many patients do not consider necessity of consulting with doctor for hair loss. They look for medical help only when self-medication does not give the expected result. After these attempts to independently conduct therapy in some cases patients develop negative attitude towards certain drugs. In such cases, the doctor’s task is to adequately assess the patient’s condition and offer the optimal therapy in each specific case. Often, diffuse hair thinning of a telogen nature, which has arisen against the background of various infections, can be stopped without the help of drugs. The article describes the experience of applying care products with natural and innovative components in the fight against COVID-19-induced alopecia, which can be applied in the practice of a dermatologist.

A preliminary result of adipose derived stem cell treatment for female pattern hair loss

Female pattern hair loss (FPHL) shows diffuse hair thinning over the central scalp usually retaining frontal hairline. Differential diagnosis includes telogen effluvium (TE), postpartum hair loss, and alopacia areata (diffuse, DAA or incognitia AAI). FPHL diagnostic definition generate confilcts between authors of different publications and the actual participation of hormones is still unclear (1).So its diagnosis can only be established based on clinical elements.

AB023. An atypical clinical presentation of alopecia in two patients with systemic lupus erythematosus

Alopecia in varying patterns is a common feature of lupus erythematosus (LE). Several forms of alopecia that are not specific to LE can occur in the setting of lupus, such as alopecia areata, telogen effluvium, and anagen effluvium. LE-specific alopecias are defined as those with histology consistent with LE, and include forms of acute, subacute, and chronic cutaneous lupus erythematosus (CCLE). Common patterns of LE-specific alopecia include the non-scarring diffuse hair thinning and fragility of acute LE and the scarring, erythematous scaly plaques with follicular keratotic plugs, peripheral hyperpigmentation, and central hypopigmentation of discoid lupus erythematosus (DLE). Lupus erythematosus tumidus (LET) may also present on the scalp as well-defined, non-scarring alopecia without overlying scale, atrophy, and dyspigmentation. We report two male patients with large circular non-scarring alopecic plaques on the scalp without overlying scale or erythema, but with central hyperpigmentation and scarring – findings reminiscent of but also distinct from both DLE and LET. Punch biopsy from the hyperpigmented area of alopecia revealed peri-follicular lymphocytic infiltrate, follicular dropout, and increased dermal mucin consistent with LE; further workup and serologic testing revealed systemic lupus in both patients. These two cases demonstrate a unique clinical presentation of central scarring alopecia within a larger non-scarring alopecic plaque in the setting of SLE that deviates from typical lupus-related alopecia. Teaching point: these two cases underscore the morphologic heterogeneity of CCLE and need for thorough evaluation of systemic disease in patients presenting with both scarring and non-scarring alopecia.

An updated review of the sebaceous gland and its role in health and diseases Part 2: Pathophysiological clinical disorders of sebaceous glands.

Sebaceous glands are sebum-secreting components of pilosebaceous units. In the second of this two-part series, we review the pathologies in which sebaceous glands are primarily and secondarily implicated. They are primarily involved in steatocystoma simplex and multiplex, sebaceous gland hyperplasia, sebaceoma, sebaceous adenoma, sebaceous carcinoma, nevus sebaceus, and folliculosebaceous cystic hamartoma. Sebaceous glands are secondarily involved in acne vulgaris, seborrheic dermatitis, and androgenic alopecia. Steatocystoma multiplex is a benign congenital anomaly presenting as yellow cysts primarily on the upper body. Sebaceous gland hyperplasia is characterized by yellow, telangiectatic papules with a central dell, and it can be treated with topical retinoids or surgical excision. Sebaceoma clinically presents on the head and neck region as a skin-colored nodule and can be distinguished by immunohistochemistry. Stains used in the diagnosis of sebaceous adenoma and carcinoma include epithelial membrane antigen and adipophilin immunoperoxidase. Surgical excision is the preferred treatment for sebaceoma, sebaceous adenoma, and sebaceous carcinoma. Excision is not always indicated for nevus sebaceus. Folliculosebaceous cystic hamartoma is a relatively rare condition exhibiting both epithelial and mesenchymal components. Patients with acne vulgaris commonly present with papules of closed and open comedones displaying hypercornification. Seborrheic dermatitis presents as sharply demarcated yellow or red patches or plaques; antifungal agents, corticosteroids, and combination antifungal/anti-inflammatory therapies are common treatment modalities. As a result of hair follicle miniaturization, females with androgenic alopecia present with diffuse hair thinning, while men tend to present with balding and hairline recession.

Getting under the skin of hair aging: the impact of the hair follicle environment.

Like the skin, our hair shows striking changes with age, producing hairs with altered diameter, lustre and texture. The biology of hair aging has focused predominately on various aspects of the hair cycle, follicle size and the fibre produced, but surprisingly the impact of the aging scalp dermal environment on the hair follicle and fibre has been generally overlooked. Hair loss affects both sexes with incidence increasing with age. In men, male pattern-balding (androgenetic alopecia) is driven by androgens and follows a specific pattern of frontotemporal and vertex regression. Women also experience female pattern hair loss (FPHL), presenting as more general, diffuse hair thinning. Hair thinning in women is commonly associated with the menopause, corresponding with other age-related changes in skin. The rapidly growing hair follicle undergoes continued renewal throughout the life span of an individual, where it is exposed to a substantial number of extrinsic and intrinsic stressors. As the hair follicle sits deep within the dermis with its bulb residing in the hypodermis, detrimental age-related changes in the surrounding scalp skin may likely disrupt the hair follicle machinery. The impacts of these changes are unknown, but evidence suggests that scalp skin aging and hair follicle aging go hand-in-hand. Herein, we summarize the evidence that the age-related changes observed in sun-exposed human skin also occur in scalp skin and that these changes are likely to play a contributing role in the aging hair phenotype.

Diffuse variants of scalp lichen planopilaris: Clinical, trichoscopic, and histopathologic features of 40 patients

Fibrosing alopecia in a pattern distribution and cicatricial pattern hair loss are poorly recognized diffuse variants of lichen planopilaris (LPP). The medical features of 40 patients affected by a diffuse hair thinning associated with a long-lasting history of pruritus and erythema of the scalp and a histopathologic diagnosis of LPP were reviewed. Clinical data, results of trichoscopy and histopathology, response to treatment, and follow-up were analyzed. There were 18 patients diagnosed with fibrosing alopecia in pattern distribution and 2 patients with cicatricial pattern hair loss. A new variant of diffuse LPP, named "lichen planopilaris diffuse pattern," was described in 20 individuals. Low number of cases due to rarity of the diseases. In patients complaining of a long-lasting history of scalp erythema, itching/dysesthesia, anddiffuse hair thinning, it is advisable to consider diffuse variants of LPP.

Female Androgenetic Alopecia: An Update on Diagnosis and Management.

Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.

Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

Alopecia areata is a nonscarring hair loss that usually causes round patches of baldness, but alopecia areata incognita (AAI) and diffuse alopecia areata (DAA) can cause a diffuse and acute pattern of hair loss. To analyze the clinical, trichoscopic, histological, and therapeutic features of AAI and DAA. The study was designed to include data of patients with histological diagnosis of AAI and DAA enrolled in our Hair Disease Outpatient Consultations. DAA had a greater involvement of the parietal and anterior-temporal regions, while AAI manifested itself mainly in the occipital-parietal regions. The most frequent pattern was empty yellow dots, yellow dots with vellus hairs, and small hair in regrowth, but the presence of pigtail hair was found almost exclusively in those with AAI. In cases of DDA, the finding of dystrophic hair and black dots was more frequent. The most frequent trichoscopic sign in both diseases was the presence of empty yellow dots, which, however, were described in a higher percentage in cases of DAA. The diseases have a benign course and are responsive to topical steroid therapy. Trichoscopy is very important for the differential diagnosis between the 2 diseases and to select the best site for biopsy. In the presence of diffuse hair thinning, these entities must be considered.

Citalopram-Associated Alopecia: A Case Report and Brief Literature Review

Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line treatments for various psychiatric disorders. SSRIs offer an improved side effect profile compared to older treatments, which improves patients' adherence and quality of life. Here we discuss a case of an uncommon, but a distressing side effect of citalopram. A 76-year old woman was referred to the psychiatry clinic for bizarre behavior. The patient was diagnosed with behavioral variant frontotemporal dementia and was started on citalopram 20 mg and aripiprazole 5 mg daily. At 3.5 months the patient complained of diffuse hair thinning on her scalp. Citalopram was considered the offending agent and was discontinued. Within a few months, the patient regained most of her hair. Although drug-induced alopecia is common among other SSRIs, it is relatively rare with citalopram. Early recognition, withdrawal of offending agent, and reassurance to the patient that hair loss is reversible can help alleviate patient distress and avoid relapse.

Female pattern hair loss.

Female pattern hair loss (FPHL) is a commonly encountered clinical presentation in primary care. Patterned hair loss in women is characterised by diffuse hair thinning and often becomes an ongoing cause of psychosocial distress. The aim of this article is to present a practical approach for the clinical assessment of female hair loss and to review the up-to-date treatment modalities. Alopecia can be the first symptom of systemic illness. It is therefore crucial for the primary care physician to be able to differentiate between FPHL and more concerning causes of hair loss. Treatment options often involve a combination of non-androgenic and androgenic therapy. The use of oral minoxidil in combination with oral spironolactone is a novel therapy with promising results. The role of the general practitioner is paramount in establishing the diagnosis, setting achievable therapeutic goals and navigating the psychosocial comorbidity associated with this chronic condition.

Comparative (Quantitative and Qualitative) Analysis of Three Different Reagents for Preparation of Platelet-Rich Plasma for Hair Rejuvenation.

Objective:The aim of this study was to compare the quantity and quality of platelets in platelet-rich plasma (PRP) samples prepared using three different reagents, namely, ethylenediaminetetraacetic acid (EDTA), sodium citrate, and acid citrate dextrose-A (ACD-A) solution.Materials and Methods:A prospective study was carried out in which all the 50 patients who attended the outpatient department for hair rejuvenation were enrolled for the study. All the patients had a history of hair fall with diffuse thinning of hair, Norwood Grades 2 and 3. Patients with complete hair loss were not included in the study. No specific randomization was carried out. All the patients were explained about the procedure and the use of vials containing the aforementioned three reagents. Then, 40mL blood was taken from each patient. Both quantitative and qualitative analyses of platelets were carried out on PRP samples. Quantitative analysis was done by using an automatic cell counter and cross-checking manually. Qualitative analysis was carried out by preparing smears from each of the three samples from each vial. All the patients were followed up at 4 weekly intervals for a duration of 6 months and then at the end of 1 year. All the patients received six sessions of PRP.Results:All the data were subjected to statistical analysis using Student’s t-test, and P value of <0.001 was obtained in samples from ACD-A vials, which was statistically significant. In all the 50 patients, the samples collected in vials containing ACD-A yielded the maximum quantitative count and the best morphology of platelets under smear examination.Conclusion:Within the limits of this study, we would like to conclude that ACD-A vials should be used for collecting and processing blood for PRP preparation to obtain best results in hair rejuvenation.

Thyroid Disease in Alopecia Areata, Lichen Planopilaris, and Frontal Fibrosing Alopecia—A Case Control Study of 144 Patients

Background: Hair loss can be a troublesome aspect of thyroid disease for some patients. In addition to diffuse hair thinning, thyroid disease has been associated with clinically significant forms of alopecia, including alopecia areata (AA) and telogen effluvium. The role of thyroid disease in other causes of alopecia, such as lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA), remains unclear. This study retrospectively assessed the role of thyroid dysfunction in AA, LPP and FFA. Methods: A systematic chart review of 144 patients was performed from September 2010 to July 2013. Data were analyzed using multivariate logistic regression to test for a relationship between thyroid disease and type of alopecia. Results: A total of 113 alopecia patients were analyzed. A positive history of thyroid disease was found in 16.0% of AA, 25.0% of FFA, 17.1% of LPP, and 15.1% of control patients. After controlling for age and sex, alopecia was not found to be a statistically significant predictor of thyroid disease. Conclusions: Although alopecia patients in this study had rates of thyroid dysfunction higher than the U.S. population, there were no significant differences in rates of thyroid dysfunction compared to the control group.

Female pattern alopecia: current perspectives

Hair loss is a commonly encountered problem in clinical practice, with men presenting with a distinctive pattern involving hairline recession and vertex balding (Norwood-Hamilton classification) and women exhibiting diffuse hair thinning over the crown (increased part width) and sparing of the frontal hairline (Ludwig classification). Female pattern hair loss has a strikingly overwhelming psychological effect; thus, successful treatments are necessary. Difficulty lies in successful treatment interventions, as only two medications – minoxidil and finasteride – are approved for the treatment of androgenetic alopecia, and these medications offer mediocre results, lack of a permanent cure, and potential complications. Hair transplantation is the only current successful permanent option, and it requires surgical procedures. Several other medical options, such as antiandrogens (eg, spironolactone, oral contraceptives, cyproterone, flutamide, dutasteride), prostaglandin analogs (eg, bimatoprost, latanoprost), and ketoconazole are reported to be beneficial. Laser and light therapies have also become popular despite the lack of a profound benefit. Management of expectations is crucial, and the aim of therapy, given the current therapeutic options, is to slow or stop disease progression with contentment despite patient expectations of permanent hair regrowth. This article reviews current perspectives on therapeutic options for female pattern hair loss.

Frontal Fibrosing Alopecia and Lichen Planopilaris: Clinical, Dermoscopic and Histological Comparison

Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) are classified as scarring alopecia. Most authors consider FFA as a clinical variant of LPP on the basis of their similar histological findings; other authors think these pathologies are two different entities. We studied 48 cases of FFA and 86 cases of LPP. Clinical diagnosis was histologically confirmed and all patients underwent videodermoscopy. Moreover, histological study, identifying the main targets of these diseases, results helpful to confirm the diagnosis. FFA selectively affects vellus-like hair in the frontoparietal region and is characterized by a mild skin atrophy and a total loss of follicular openings. In LPP an involvement of total preterminal, terminal and vellus-like follicles, partial or total loss of follicular openings, diffuse hair thinning and twisting, perifollicular erythematous or violaceous papules and mild/severe spinous follicular hyperkeratosis with scalp sclerosis are the features observed. Videodermoscopy improves diagnostic capability, appearing to be helpful to underline FFA and LPP features, confirmed by histologic studies which identify and show different intensity of inflammatory process. Therefore, the two diseases could be considered two different entities on the basis of the different clinical features and the different targets, that can be related to a different pathogenetic mechanism.

Histopathologic features of alopecia areata incognito: a review of 46 cases

Alopecia areata (AA) incognito represents a variant of AA characterized by acute diffuse hair thinning. Dermoscopy shows yellow dots and short regrowing hairs. The differential diagnosis with telogen effluvium (TE) and androgenetic alopecia may be difficult. In order to establish histopathological criteria for the diagnosis of AA incognito, we evaluated retrospectively 92 specimens (46 horizontal and 46 vertical) of 46 patients diagnosed with AA incognito within 1 year. All specimens were assessed for 20 features, including hair counts and follicular ratios. The numbers were compared with 46 control specimens, consisting of 21 cases of TE and 25 cases of androgenetic alopecia. The following main criteria are proposed: (a) preserved number of follicular units and decreased number of terminal follicles; (b) increased number of telogen structures (mean count of 37%) with presence of at least one telogen germinal unit or/and one small telogen follicle (c) decreased terminal:vellus ratio (mean ratio of 3.3 : 1) and (d) dilated infundibular openings. Two histopathologic clues for AA incognito include the presence of dilated infundibular openings and small basaloid aggregates of cells with round, irregular or polygonal shape, lack of hair shaft and no apoptosis in the outer root sheath, corresponding to small telogen follicles.

Tinea capitis in the form of concentric rings in an HIV positive adult on antiretroviral treatment

Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine.

An overview of female pattern hair loss

Female pattern hair loss (FPHL) is the most common cause of hair loss in women at any age. Clinical presentation of FPHL differs from its male counterpart, male pattern baldness. Women tend to present earlier with a reduction in hair volume from diffuse thinning over the crown and rarely with fronto-temporal recession. The diffuse hair thinning results from androgen-mediated miniaturization of hair follicles in addition to decrease in hair fiber length. Histologically, hair follicle miniaturization and a decrease in terminal-to-vellus hair ratio are diagnostic features of FPHL, and are also identical to that seen in male pattern baldness. The role of androgens in FPHL has not been clearly established, and most women with androgenetic alopecia have normal serum androgen levels; however, antiandrogen medications can still be effective in the treatment. Several medical treatments are available for the management of FPHL, with variable efficacy. Other measures to camouflage hair loss are popular. Increasingly...