Dystrophic Hair Research Articles

Assessment and Validity of Trichoscopy for Eyebrow Involvement in Lichen Planopilaris: A Case-Control Study

Introduction: Few publications are available on eyebrow trichoscopy in patients with alopecia areata and frontal fibrosing alopecia (FFA). Objective: We aimed to investigate the validity of using trichoscopy to examine the eyebrow involvement in patients with lichen planopilaris (LPP) and its variants. Methods: In this case control study, 109 patients with eyebrow involvement in LPP and FFA (cases) and with acquired hair disorders of the eyebrows (controls) were included. Results: Trichoscopy was highly specific and sensitive for the diagnosis of LPP and its variants, including FFA. Trichoscopic features significantly associated with LPP were peripilar scaling, peripilar pigmentation, broken hairs, peripilar white halos, diffuse empty follicles, and vellus hair. Localized peripilar erythema and empty follicles were significantly associated with the diffuse form of LPP and zigzag-type FFA. Yellow dots, dystrophic hairs, regrowth in different directions, and diffuse empty follicles were associated with LPP activity and FFA severity. Conclusions: Trichoscopy is a valid tool for evaluating eyebrow involvement in LPP. Thus, it could help increase the diagnostic accuracy and predict the prognosis of eyebrow hair loss at an early stage.

Alopecia patterns and trichoscopic findings in patients with autosomal recessive congenital ichthyosis.

Autosomal recessive congenital ichthyosis (ARCI) is a rare genodermatosis categorized among nonsyndromic ichthyoses. While ARCI patients often manifest hair abnormalities, their impact on the quality of life remains underreported in the literature. This study aims to comprehensively characterize the clinical and trichoscopic findings of alopecia in ARCI patients. A prospective study spanning from January 2019 to December 2021 (3 years) was conducted at the Dermatology Department of Habib Thameur Hospital, Tunis, Tunisia. Clinical and trichoscopic examinations were performed on the hair of the participants, with molecular studies conducted on 15 patients. The study included 30 patients, predominantly female (male/female = 0.58), with a mean age of 20 years. Twenty-eight patients were born from consanguineous marriages. Lamellar ichthyosis was observed in 22 cases, while congenital ichthyosiform erythroderma and bathing suit ichthyosis were each present in 4 cases. The ARCI severity score, assessed using the Visual Index For Ichthyosis Severity scale, had a mean value of 15 (4-28). Alopecia emerged as a prominent finding in 11 patients, presenting as hairline recession (13%), multiple patchy alopecia (27%), and alopecia of the eyebrows (13%). Trichoscopic findings included interfollicular and perifollicular scaling, perifollicular lamellar hyperkeratosis, peripilar casts, interfollicular erythema, loss of hair openings, predominance of single hair follicles, broken hair, vellus hair, anisotrichosis, pili torti, dystrophic hair, and comma hair. Several trichoscopic findings showed statistically significant associations with the severity of ARCI. In our study, we only included 30 patients due to the rarity of this genodermatosis. Contrary to previous perceptions, alopecia is a notable finding in ARCI, particularly in patients with a severe form. This study provides a detailed characterization of alopecia in ARCI, shedding light on its prevalence and associated trichoscopic features, thereby enhancing our understanding of this dermatological condition.

Evaluation of fractional carbon dioxide laser alone versus its combination with betamethasone valerate in treatment of alopecia areata, a clinical and dermoscopic study

Alopecia areata (AA) is a non-scarring tissue-specific autoimmune disorder. Many therapeutic modalities are available for the treatment of AA, but none has yet proven to be uniformly effective. Fractional carbon dioxide (FRCO2) laser has been introduced as a treatment modality for AA. The objective is to evaluate and compare the efficacy and safety of FRCO2 laser in treatment of AA alone or in combination with betamethasone valerate cream. 30 patients were assigned to one of the following groups, Group A FRCO2, Group B FRCO2 plus betamethasone valerate cream or Group C (betamethasone valerate cream). Patients received eight laser sessions 2 weeks apart, treatment period was 4 months. A statistically significant decrease in SALT score, dystrophic hair and a statistically significant increase in terminal hair was observed in all groups. Patient satisfaction level and reduction in SALT score were significantly higher among FRCO2 and FRCO2 plus betamethasone valerate group. However, no statistical significant difference was found between FRCO2 group and FRCO2 combined with betamethasone valerate cream group. FRCO2 laser is a safe and effective treatment modality for AA when used alone or in combination with betamethasone valerate cream. However, it was found superior to betamethasone valerate cream monotherapy.

Evaluation of dermatoscopic findings of alopecia areata and tinea capitis in pediatric patients.

Pediatric patients often reveal localized alopecic foci on the scalp. The essential point upon approaching a child with localized alopecia is distinguishing the two most common causes, alopecia areata and tinea capitis, as their treatments are entirely different. Although potassium hydroxide examination is the preferred method for their clear distinction, dermatoscopy is also emerging as a rapid diagnostic tool. This study aimed to assess and compare the dermatoscopic findings of alopecia areata and tinea capitis. Enrolled in this study were 34 children with tinea capitis and 21 children with alopecia areata admitted to a single-center outpatient clinic between 2017 and 2021. The authors confirmed all children's diagnoses by an integrative evaluation of clinical features, potassium hydroxide examination results, and treatment response patterns. Clinical features and the variables of interest (dermatoscopic findings) were investigated through the medical records and the baseline dermatoscopic images. The most common dermatoscopic finding within the tinea capitis cohort was comma hairs, detected in 33 (97.1%) of the patients. Other findings of the tinea capitis group included squamation (n=31, 91.2%), broken and dystrophic hairs (n=30, 88.2%), corkscrew hairs (n=24, 70.6%), zigzag hairs (n=18, 52.9%), and pigtail hairs (n=9, 26.5%). The most common dermatoscopic finding within the alopecia areata cohort was exclamation mark hairs (n=13, 61.9%), that was followed by black dots (n=9, 42.9%), yellow dots (n=8, 38.1%), vellus hairs (n=6, 28.6%), and broken and dystrophic hairs (n=5, 23.8%). Among the detailed evaluation of dermatoscopic findings of tinea capitis and alopecia areata patients, the only overlapping feature was dystrophic and broken hairs that could be present in both diseases; but were more common within the TC group than within the AA group (88.2% vs. 23.8%).

Evaluation of hair structural abnormalities in children with different neurological diseases

Hair microscopy is a fast and effortless diagnostic method for many diseases affecting hair in daily practice. Many diseases can present with hair shaft disorders in pediatric neurology practice. Children with pathological hair findings were included in our study. Microscopic evaluation of the hair was performed under light microscopy. The clinical findings, pathological hair shaft findings, laboratory tests, and final diagnosis of the patients were evaluated. In our study, 16 patients with rare pathological hair findings were identified. Of these 16 patients, nine were diagnosed with giant axonal neuropathy, three with Griscelli syndrome, two with Menkes disease, and two with autosomal recessive woolly hair disease. In hair inspection, curly and tangled hair in patients with giant axonal neuropathy; silvery blond hair in patients with Griscelli syndrome; sparse, coarse, and light-colored hair in patients with Menkes disease; and hypotrichosis in patients with autosomal recessive woolly hair were remarkable findings. Dystrophic hair was detected in most of the patients on light microscopy. In addition, signs of trichorrhexis nodosa, tricoptylosis, and pili torti were found. In particular, pigment deposition in the hair shaft of two patients diagnosed with Griscelli syndrome and pili torti findings in two patients with Menkes disease were the most important findings suggestingthe diagnosis. Detection of hair findings in the physical examination and performing light microscopic evaluation facilitates the diagnosis of rare diseases accompanied by hair findings. A hair examination should be performed as a part of physical and neurological examinationson eachpatient regardless of thecomplaint.

Significance of iron levels in patients with non-cicatricial alopecias: a cross sectional study

<p class="abstract"><strong>Background: </strong>Among all the nutritional causes of hair loss, iron levels are found to be important key nutrient. Synthesis of hair involves many steps which require iron as a cofactor. The intention of present study is to evaluate relationship between iron and hair loss. The objectives of the study are to study the clinical patterns, demographic and epidemiological factors associated with hair loss and to find association between iron study parameter (Hb, serum iron, serum ferritin, TIBC) and hair loss.</p><p class="abstract"><strong>Methods: </strong>The study was a cross section- observational study, conducted among the patients with diagnosed non-cicatricial alopecias from June 2018 to April 2019. A total of 50 study participants were recruited. Specific investigations like hair pull test and trichogram were done. Chi square test was applied and p<0.05 was considered significant.</p><p class="abstract"><strong>Results:</strong> Among the total 50 participants 35 (70%) were males and 15 (30%) were females. Mean (±SD) age was 44 (±9.5) years. Mean (SD) of haemoglobin, serum iron, TIBC and ferritin are 9.6 (±2.6), 75.5 (±50), 365 (±54) and 106 (±87) respectively. Trichogram result proves telogen hair- 22 (44%), dystrophic hair loss- 14 (28%) and anagen hair loss-14 (28%). Hair pull test was positive in 27 (54%). Higher proportion of male pattern hair loss was associated with lower haemoglobin and low serum ferritin levels. (p value -0.046, 0.031)</p><p class="abstract"><strong>Conclusions:</strong> Significant association was found between the diagnosis of non cicatricial alopecia and mean values of haemoglobin and serum ferritin with lower haemoglobin and low serum ferritin was mostly associated with male pattern hair loss.</p>

Eyelash involvement in frontal fibrosing alopecia: A prospective study

Eyelash involvement in frontal fibrosing alopecia: A prospective study

Trichoscopy as a monitoring tool in assessing treatment response in 98 children with tinea capitis: A prospective clinical study.

Tinea capitis (TC) is the most common dermatophyte infection in children. Fungal culture the gold standard diagnostic method takes several weeks and has poor yields. Trichoscopy helps in rapid diagnosis and could work as a monitoring tool during antifungal therapy. Our main objective is to document the evolution of trichoscopic features with treatment and their correlation with clinical parameters in patients of TC. Forty-six and 52 children with clinically diagnosed TC that was confirmed by potassium hydroxide microscopy, received griseofulvin and terbinafine, respectively. Recruited children were subjected to clinical and trichoscopic assessment by calculation of CASS (clinical assessment severity score) and counting of TAHC (Total Altered hair count; negative and positive), respectively, at baseline and follow-up at 2, 4, and 6 weeks. McNemar, Wilcoxon singed ranked test and Spearman-rho correlation of various parameters was evaluated. Follow-up trichoscopy revealed significant (p < 0.009) disappearance of negative TAHC like black dot (second week onward), corkscrew, horseshoe and zigzag hair at 4 weeks and short broken hair, erythema telangiectasia hemorrhage (ETH) resolved at 6 weeks. Positive TAHC (regrowing hair) shows significant increase at 6 weeks (p < 0.001). CASS and negative TAHC showed significant difference at 4 weeks (p < 0.001) by analyzing boxplot graph. Therefore, trichoscopic resolution occurred before the clinical cure. Terbinafine subjects showed a higher clinical cure rate at 4 weeks (p=0.02) as compared to griseofulvin. To conclude, trichoscopy is a good monitoring tool that could document the disappearance of almost all dystrophic hair at 4 to 6 weeks and is a more sensitive tool than microscopic examination. Regrowing hair and perifollicular scaling are markers of recovery.

Intralesional betamethasone versus triamcinolone acetonide in the treatment of localized alopecia areata: a within-patient randomized controlled trial

Background Betamethasone can be used for intralesional infiltration, but there is little evidence in the literature to indicate its effectiveness in alopecia areata. Objective To assess the safety and effectiveness of the use of different doses of intralesional betamethasone, when compared to triamcinolone acetonide for the treatment of alopecia areata. Methods We recruited 12 patients with alopecia patch divided into four quadrants. Each quadrant, after randomization, received an intralesional injection with one of the following treatments: triamcinolone acetonide 2.5 mg/ml, betamethasone 0.375 mg/ml, betamethasone 1.75 mg/ml, or 0.9% saline (placebo). The intervention was repeated in the same quadrant every 4 weeks, totaling 3 sessions. Visual and dermoscopic evaluation of the results were performed. Trial registration: ReBec RBR-5kyg2r. Results At 4 and 8 weeks of intervention, triamcinolone acetonide 2.5 mg/ml provided the best visual results. Nevertheless, at the end of the study, the best visual results were seen with both triamcinolone acetonide and betamethasone 1.75 mg/ml, with significant difference when compared to betamethasone 0.375 mg/ml and placebo (p=.0489 and <.0001, respectively). There was a progressive reduction in the number of dystrophic hairs in all quadrants. Conclusion Triamcinolone acetonide shows earlier results in repilation, but at 12 weeks betamethasone 1.75 mg/ml had similar results.

Trichloroacetic acid 35% as a therapeutic line for localized patchy alopecia areata in comparison with intralesional steroids: Clinical and trichoscopic evaluation.

Intralesional corticosteroids (ILCs) is the first-line therapy for patients older than 10 years having patchy alopecia areata, however some patients do not respond effectively. To evaluate the efficacy of a chemical peel trichloro acetic acid (TCA 35%) in comparison to ILCs. Twenty-two patients with two patches of alopecia areata were included. Two treatment modalities with ILCs and topical TCA 35% were performed in two randomly selected patches. Three sessions were done, 3 weeks apart and were followed-up for three months. Evaluation was done using Mac Donald Hull and Norris grading system and by counting trichoscopic parameters in each patch. Both ILCs and TCA 35% treated patches showed measurable improvement with no statistically significant difference between the results of the two modalities (p>0.05) at different times of the study. Yellow dots, black dots, exclamation marks and dystrophic hair were all reduced by 100%, 82.0%, 100% and 88.3% in ILCs treated patches and by 70.4%, 69.1%, 100% and 75.0% in TCA treated patches, respectively. Topical TCA 35% is an effective and safe treatment for the treatment of AA without serious side effects, despite the slower response when compared to ILCs.

Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata

Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth. To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA. This comparative, randomized, double-blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3weeks for 9weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow-up visits over 6months past treatment cessation. A total of 19 patients completed the study and showed significant reduction in SALT score. TCA- and phenol-treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected. Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.

Trichoscopy as a Diagnostic Tool for Tinea Capitis: A Prospective, Observational Study.

Background:Tinea capitis is the most common pediatric dermatophyte infection. Trichoscopy aids in the rapid diagnosis and allows prompt treatment, preventing horizontal transmission.Objectives:The objective of this study is to document the trichoscopic features of tinea capitis and evaluate its correlation with clinical type, microscopic form, and mycological culture and propose diagnostic trichoscopic criteria.Materials and Methods:Trichoscopy was performed, after taking consent in 98 participants (<18 years) of tinea capitis diagnose by hair root and scalp scraping examination for hyphae positive on potassium hydroxide mount microscopy or culture positive on SDA media. The comparison of observed trichoscopic features, with the clinical type, pattern of invasion, and etiological agent was carried out.Results:The most common clinical variant was black dot, and etiological agent was Trichophyton violaceum. The following trichoscopic features were noted: black dot, comma, short broken, corkscrew, horse-shoe, zigzag hair, and perifollicular scaling. Perifollicular scaling was significantly common in gray-patch variant, whereas comma, black dot, horse-shoe hair, and perifollicular scaling were noted in black-dot variant. Comma, corkscrew, and zig-zag hair were significantly present in endothrix form, whereas perifollicular scaling was evident in ectothrix form. Combining perifollicular scaling with comma hair, short broken, and black dot hair achieved a diagnostic sensitivity of 98.97%.Conclusions:Trichoscopy by evaluating for the combination of perifollicular scaling and 3 dystrophic hair (comma hair, black dot, and short-broken hair) is a good diagnostic tool for tinea capitis. Horse-shoe hair a novel finding, not hitherto reported in the literature requires validation in future studies.

Trichoscopy findings of frontal fibrosing alopecia on the eyebrows: A study of 151 cases

Eyebrowloss (madarosis) is a frequent sign of frontal fibrosing alopecia (FFA), and it can be the first sign of the disease. To describe trichoscopy findings of FFA on the eyebrows. The analysis included 151 women with histologically proven diagnosis of FFA and eyebrow loss. Trichoscopy of the eyebrow area was performed with either a FotoFinder videodermatoscope or handheld dermoscope DermLite II pro. The most frequent signs on trichoscopy were yellow dots (92.7%), multiple pinpoint dots (79.5%), short thin hairs/vellus (76.2%), black dots (66.2%), and dystrophic hairs (60.9%). Tapering hairs were found in 21 (13.9%) patients and dystrophic hairs in 92 (60.9%) patients. Inner limitations of a case series (there was no comparison with healthy control individuals or patients with other hair disorders) and lack of histologic correlation to the trichoscopy findings. Although FFA is a scarring alopecia, the most common trichoscopy signs found in the eyebrows are usually related to noncicatricial alopecia. Therefore, in most cases, trichoscopy of the eyebrows does not resemble the trichoscopy of FFA on the scalp. Black dots, dystrophic hairs, and broken hairs are frequent signs. Occasionally, tapered hairs can be present on the eyebrows in FFA, leading to misdiagnosis of alopecia areata.

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.

Evaluation of platelet-rich plasma vs intralesional steroid in treatment of alopecia areata.

Alopecia areata (AA) is nonscarring patchy area of hair loss. Platelets rich plasma (PRP) promotes development of new hair follicles. Dermoscopy is a diagnostic tool that helps in evaluation of skin microstructures which are not visible to naked eye. To evaluate safety and efficacy of (PRP) vs intralesional corticosteroid (ILCs) in treatment of AA. This study was conducted on 80 patients of both sexes who had AA. Patients were classified into Group I treated by ILCs and group II treated by (PRP). Results were assessed by dermoscopic evaluation and by hair re-growth score (RGS) at (baseline), 2, 4, 6, 8, and 12weeks. Patients were followed up for 6months. There was greater hair re-growth after treatment in both groups. In group I, (26) patients (65%) showed improvement >70% compared to 29 patients (72.5%) in group II. There was significant re-growth of pigmented hair and decrease in dystrophic hair (P<0.001) by dermoscopic evaluation in both groups. The difference between both groups was insignificant (P=0.57). At follow-up, two (5%) patients in group II had relapse compared to 10 (25%) patients in group I. Platelets rich plasma is safe and promising therapeutic option in AA.

The value of dermoscopy in diagnosing eyebrow loss in patients with alopecia areata and frontal fibrosing alopecia

Alopecia areata and frontal fibrosing alopecia are common causes of eyebrow loss (madarosis). Assessment of trichoscopic markers of eyebrow loss in alopecia areata and frontal fibrosing alopecia. The analysis included 50 patients with scalp alopecia areata with madarosis, 50 patients with scalp frontal fibrosing alopecia with madarosis and 50 healthy controls. In every case, trichoscopy of the eyebrow area was performed. Empty follicular and eccrine duct openings were observed in all patients and presented predominantly as yellow dots. Exclamation mark hairs were only detected in patients with alopecia areata (30%). Tapered hairs, broken hair, black dots and Pohl-Pinkus constrictions were observed in 14%, 36%, 26% and 4% of patients with alopecia areata, respectively, 4%, 16%, 2% and 0% of patients with frontal fibrosing alopecia, respectively, and they were not present in healthy controls. Dystrophic hairs and whitish areas were observed only in patients with frontal fibrosing alopecia (28% and 32%, respectively). Eyebrow regrowth in distinct directions was present in 32% of patients with frontal fibrosing alopecia, 8% of patients with alopecia areata and 4% of healthy controls. Diffuse erythema was detected in 60% of patients with alopecia areata and frontal fibrosing alopecia and 56% of healthy controls. Vellus hairs and upright regrowing hairs were observed in patients with alopecia areata (62% and 58%, respectively), frontal fibrosing alopecia (60% and 84%, respectively) and healthy controls (100% and 100%, respectively). Trichoscopy of the eyebrow area is useful in diagnosing patients with isolated eyebrow loss. The most characteristic trichoscopic features of eyebrow loss in alopecia areata include exclamation mark hairs, tapered hairs, broken hairs and black dots. Frontal fibrosing alopecia of the eyebrows is characterized by the presence of dystrophic hairs, white areas and eyebrow regrowth in distinct directions.

Sebaceous gland abnormalities in fatty acyl CoA reductase 2 (Far2) null mice result in primary cicatricial alopecia.

In a large scale screen for skin, hair, and nail abnormalities in null mice generated by The Jackson Laboratory’s KOMP center, homozygous mutant Far2tm2b(KOMP)Wtsi/2J (hereafter referrred to as Far2-/-) mice were found to develop focal areas of alopecia as they aged. As sebocytes matured in wildtype C57BL/NJ mice they became pale with fine, uniformly sized clear lipid containing vacuoles that were released when sebocytes disintegrated in the duct. By contrast, the Far2-/- null mice had sebocytes that were similar within the gland but become brightly eosinophilic when the cells entered the sebaceous gland duct. As sebocytes disintegrated, their contents did not readily dissipate. Scattered throughout the dermis, and often at the dermal hypodermal fat junction, were dystrophic hair follicles or ruptured follicles with a foreign body granulomatous reaction surrounding free hair shafts (trichogranuloma). The Meibomian and clitoral glands (modified sebaceous glands) of Far2-/- mice showed ducts dilated to various degrees that were associated with mild changes in the sebocytes as seen in the truncal skin. Skin surface lipidomic analysis revealed a lower level of wax esters, cholesterol esters, ceramides, and diacylglycerols compared to wildtype control mice. Similar changes were described in a number of other mouse mutations that affected the sebaceous glands resulting in primary cicatricial alopecia.

Use of the drug Wolvit® (biotin 5 mg) in treatment of defuse telogenous alopecia

The article considers the use of biotin in the practice of treatment of diffused telogen alopecia and assesses the effectiveness and tolerability of the use of the drug Wolvit® (biotin 5 mg) in the treatment of women with this pathology. Of 88 volunteers, 66 patients with a confirmed by a phototrichogram diagnosis of diffuse telogenous alopecia were selected. The study included 54 patients who were divided into two groups (main group — 28 patients, control group — 26 patients). The criteria for inclusion are female sex, age from 18 to 40 years, diagnosis of diffuse telogenous alopecia (telogen share more than 15 % in phototrichogram). Patients were examined using the following methods: clinical examination with a formalized questioning of the patient’s sensations; phototrichogram; measurement of moisture and fat content of the skin. The main group was assigned Wolvit® (biotin 5 mg) once a day for 3 months. The processing of the results was carried out using statistical on-­line calculators. Analysis of the results of the study indicates a statistically significant decrease in the amount of hair in the telogen phase, dying and dystrophic hair, and also their fat content, while the thickness and speed of hair growth increased.Conclusions. The drug Wolvit® (biotin 5 mg) manufactured by KUSUM HELTKHER PVT LTD (India) is convenient for patients due to its form (tablets) and the regimen (once a day), which ensures high compliance. The purpose of the drug Wolvit® (biotin 5 mg) ex juvantibus is advisable in all cases of alopecia and seborrheic dermatitis, considering its effectiveness and safety. The positive result of using the drug Wolvit® (biotin 5 mg) should not stop the doctor in search of other possible causes of hair loss, except for biotin hypovitaminosis.

Study of the efficacy of carboxytherapy in alopecia.

Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.

Clouston�s hidrotic ectodermal dysplasia

A 2-year-old girl, from a consanguineous and phenotypically normal family. Her mother who brought her to our institution reporting that the child had hair loss, scanty eyelashes and eyebrows since she was two months old. Physical examination revealed severely dystrophic nails and thin scalp hair, fine eyebrows and eyelashes and thin body hair. Hyperkeratotic and desquamative plaques on her palms and soles. The patient did not present changes in sudoresis, dentition or hearing. So with the above clinical findings, a diagnosis of hidrotic ectodermal dysplasia was made, and the patient treated with skin emollients and topic keratolytics, she is under regular monitoring. Clouston syndrome is a rare genodermatosis that affects skin and annexes, it's belong to ectodermal dysplasias, which occur approximately one in every 100,000 births, which are caused by primary defects in the development of two or more tissues derived from the embryonic ectoderm.