Hair Diameter Diversity Research Articles

Pruritus in Lichen Planopilaris and Frontal Fibrosing Alopecia—Clinical Characteristics and Dermoscopic Correlations

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy.

Trichoscopic Features in Female Pattern Hair Loss: 1-Year Hospital-Based Cross-sectional Study

Introduction: Female pattern hair loss (FPHL) a nonscarring alopecia, is a common cause of hair loss in women. FPHL shows miniaturization of the hair follicles with thinning of hair. Scalp biopsy is diagnostic of FPHL but usually not needed. Trichoscopy a noninvasive higher magnification method (vs. scalp biopsy) for diagnosis of hair loss allows measurement of anisotrichosis characteristic of FPHL. Materials and methods: A total of 110 patients with clinically diagnosed FPHL of all grades were subjected to clinical and trichoscopic examination, and findings were looked for and compared with the occipital region serving as control. Results: Trichoscopic features apart from yellow dots and 2–3 hairs per unit follicle (HU) were statistically significant like hair diameter diversity, brown and white peripilar sign, one hair per follicular unit, white dots (WD), fine scaling, and honey-comb pigmentation (HCP). Focal atrichia, 2–3 hairs/HU, WD, HCP correlated with the grade of hair loss. Conclusion: Trichoscopy could be excellent tool for diagnosing FPHL in early stages and may aid in differentiating it from other conditions like chronic telogen effluvium and obviating the need of painful procedures like scalp biopsy. The study lacks histo-pathological and hormonal investigations however past studies done have already established correlation of trichoscopic and histo-pathological changes.

Quantitative measurement of hair diameter diversity as a diagnostic indicator of androgenetic alopecia in Korean males: A cross-sectional study

BackgroundThe conventional 20% threshold for hair diameter diversity (HDD), widely accepted for diagnosing androgenetic alopecia (AGA) in the vertex area, has not quantitatively analyzed. ObjectiveTo validate the HDD 20% threshold for AGA and develop a refined, Korean-specific criterion. MethodsThis study involved 240 male patients with AGA, categorized by the V stages of the basic and specific (BASP) classification. Phototrichogram images of the vertex region were analyzed using Image J software for hair thickness measurement. ResultsROC curve analysis determined the 45 μm hair diameter threshold as the most diagnostic for AGA, with an AUC value of 0.884 and a Youden index of 0.659. Optimal AGA diagnosis was achieved when over 21% of hair had a diameter of ≤ 45 μm. LimitationsRestriction to Korean male limits its applicability to a broader population, and using a specific hair diameter threshold does not account for individual variations in hair characteristics. ConclusionThe study validates the conventional HDD 20% threshold and proposes a more appropriate 45 μm threshold for Korean males, beyond the 40 μm. It concludes that while the HDD 20% remains a key method for early detection of vertex AGA, the definition of thin hair should be ethnicity-specific.

Clinical and dermoscopic profile of female pattern hair loss

Background: Female pattern hair loss (FPHL) is one of the hair loss disorders in women characterized by a gradual reduction in hair from the frontal, central, and parietal areas of the scalp. FPHL is more common than previously thought, and data regarding the same are lacking in the Indian literature. Unlike male pattern hair loss, there are not much studies regarding FPHL in South India. Hence, we intend to study the clinical features, associations, and dermoscopic findings of FPHL in our population. Aims and Objectives: The study was conducted to estimate the clinical and dermoscopic features of FPHL. The secondary objective of the study was to estimate the severity of FPHL based on clinical and dermoscopic features. Materials and Methods: The cross-sectional descriptive study was conducted in 300 patients who were clinically diagnosed with FPHL attending the Department of Dermatology, Government Medical College, Kottayam, during a period of 18 months from February 2021 to August 2022. Results: The mean age of patients with FPHL was 46.99±13.8 years. The majority of the patients were asymptomatic. Hair diameter diversity of >20% and miniaturized hair were the most common dermoscopic findings seen in all patients. Honeycombing and yew dots in dermoscopy were seen in 17 and 8.4% of patients, respectively. Conclusion: Dermoscopes are a useful tool to differentiate FPHL from other causes of diffuse hair loss that could mimic FPHL. The presence of yellow dots and honeycombs indicated advanced FPHL. Thus, dermoscopy helps in detecting early FPHL and initiating early treatment of this condition.

Diffuse Alopecia: Clinical, Trichoscopic, Histopathological and Immunohistochemical Challenges in the Diagnosis

Abstract Background Diffuse alopecia is characterized by a general loss of hair with no patches of full baldness. In dermatology, diffuse hair loss, particularly in women, is a common complaint. Common illnesses such as telogen effluvium, androgenetic alopecia, and widespread alopecia areata can be difficult to distinguish. The clinical signs of these three types of alopecia may be identical. Aim of Work The current study aimed to study the clinical, trichoscopic findings, histopathological in patients with acute diffuse hair shedding: female pattern hair loss (FPHL), acute telogen effluvium (TE) and alopecia areata incognita (AAI). Immunohistochemistry analysis for CD3 was done for differentiation and detection of the prognostic values of these markers. Subjects and methods: The study included 40 patients with acute diffuse hair shedding within the last 6 months with the diagnoses of AAI, TE, FPHL. All patients were subjected to full history recording, general and local examination. Hair evaluation was performed through trichoscopic assessment and punch scalp biopsy that was analyzed by hematoxylin and eosin and immunohistochemical analysis for CD3. Results Trichoscopic assessment of studied patients revealed that hair diameter diversity was significantly presented in FPHL patients. Number of thin hairs in frontal area, number of hair units with one hair, and vellus hairs were significantly presented in FPHL and TE+ FPHL patients compared to TE patients. Short regrowing hair was significantly presented in TE patients and TE +FPHL patients compared to FPHL patients. Peripilar sign and empty hair follicles in frontal area were significantly presented in FPHL patients. Multiple upright regrowing hair in all areas was significantly presented in TE+ FPHL patients. Conclusion FPH and TE represents common types of hair loss disease, each with specific trichoscopic and histochemical findings.

Trichoscopy Features of Indonesian Males with Androgenetic Alopecia in Association with Disease Severity.

Androgenetic alopecia (AGA) is a progressive loss of terminal hairs in a specific pattern distribution related to androgen. The dermoscopy of hair and scalp, known as trichoscopy, is a noninvasive method for diagnosing alopecia and other hair and scalp disorders. This study aims to report the correlation between the severity of males with AGA based on Hamilton-Norwood's scale with the clinical characteristics found in trichoscopy. This study included 40 patients aged 25-58 years who visited the dermatology outpatient clinic in a tertiary health facility in Indonesia. Clinical diagnosis was determined through history taking, physical examination, and trichoscopy. Based on Hamilton-Norwood's criteria, patients were divided into two groups: early and late stage. Parameters examined in trichoscopy include yellow dots, white dots, peripilar sign, vellus hair, hair diameter diversity, single-hair follicles, and empty follicles. The Chi-square test and Fisher's exact test were used to analyze the statistical significance between the groups. All participants presented with hair diameter diversity, vellus hair, and empty follicles (100%). None of the study participants had yellow dots. White dots and single-hair follicles were seen in 32 (80%) and 30 cases (75%), respectively. In the late-stage group, these features were more prevalent. Peripilar sign was found in 25 participants (62.50%), and it was more common in the early-stage group. No significant association was found between disease severity and trichoscopy features. The most common trichoscopy findings in particular order were hair diameter diversity, vellus hair, and empty follicles, followed by white dots, single-hair follicles, and peripilar signs. No significant association between alopecia severity and trichoscopy parameters was observed. Studies with a larger number of participants, including a control group, should be conducted to yield more significant results.

Study of endocrinal profile and trichoscopic features in female pattern hair loss at tertiary care hospital

<p class="abstract"><strong>Background:</strong> Patterned hair loss is one of the commonest conditions for which both men and women seek dermatologist. Though term androgenetic alopecia is used synonymously for female pattern hair loss, role of androgens and other hormones in its causation remains controversial. Also, in literature few studies are present suggesting role of trichoscopy in female pattern hair loss. We sought to investigate role of endocrine disturbances and trichoscopic findings in female pattern hair loss as per Ludwig classification.</p><p class="abstract"><strong>Methods:</strong> This was a prospective case control study. 100 cases and 100 age matched controls were enrolled in study. Laboratory investigations were done in both groups and trichoscopic examination was done in cases, at frontal and occipital scalp. The data was analyzed using t test, McNemar test and as mean, standard deviation and as percentages.<strong></strong></p><p class="abstract"><strong>Results:</strong> The difference between the mean value of body mass index, hemoglobin, T4, prolactin, follicle stimulating hormone, testosterone and dehydroepiandrosterone were found to be statistically significant as compared to controls. On trichoscopy, hair diameter diversity was commonest findings, however focal atrichia, 2-3 hairs/hair unit, white dots, honey comb pigmentation (HCP) correlated with grade of hair loss.</p><p class="abstract"><strong>Conclusions:</strong> Our study supports role of hormonal disturbances in causation of female pattern hair loss and thus we recommend doing tests in early onset and severe degrees of hair loss. Though diagnosis is mainly clinical trichoscopy could be excellent tool which is simple, non-invasive and cost-effective tool and may help to differentiate Female patterned hair loss from other condition like chronic telogen effluvium.</p>

A clincodermoscopic evaluation of chronic diffuse hair loss among females in a Tertiary Care Center

Background: Diffuse alopecia in females is a common complaint and still a major challenge in the practice of dermatology. Female androgenetic alopecia (FAGA), chronictelogen effluvium (CTE), and diffuse alopecia areata(AA) are its three main causes for diffuse hair loss. It is often difficult one from the other and clinical data, physical examination, biochemical tests, dermoscopy, and some cases biopsy may be needed for a definitive diagnosis.In this study, scalp dermoscopy as a main tool used to differentiate between different causes of hair loss and definitive role of dermoscopy in the treatment follow up. Objectives: Our aim is to evaluate and determine dermoscopic findings of different causes of diffuse alopecia that can be used as the clinical indicator of the disease. Another aim is to study the correlation of haemoglobin, S. ferritin and TSH levels in different causes of diffuse alopecia in females. Methods: Total50 patients were enrolled for this prospective study and was conducted for a period of 6 months. Detailed history, Clinical examination, Dermoscopic evaluation, complete hemogam, S. ferritin and Thyroid profile was done. Results: Most of them (66%) were between age group 18 to 30. Out of total cases 31 cases were TE, 9 cases were FAGA, 7 cases of diffuse Alopecia. Dermoscopic findings seen were yellow dots in 41 patients, thinning of hair in 33 patients, vellus hairs in 14 patients, peripilar sign in 12 patients, hair diameter diversity more than 20 % (HDD) in 8 patients, exclamation mark hair in 7 patients, honey comb pigment pattern and loss of follicles in 3 patients each. Conclusion: In TE cases most common dermoscopic findings were Yellow Dots, In FPHL most common and specific finding was HDD > 20%. A thorough dermascopic evaluation and follow up is must for different patterns of hair loss among females.

Update on trichoscopy: Integration of the terminology by systematic approach and a proposal of a diagnostic flowchart.

Trichoscopy represents a non-invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established, some key issues remain to be addressed. Complexity and inconsistency in terminology in past literature are likely to confuse investigators when they are recording, reporting, and retrieving the findings. In addition, a diagnostic algorithm adopting sufficiently integrated and updated findings is not readily available. By adopting a systematic review approach, this review attempted to redefine major trichoscopic findings and integrate their synonyms individually into the most frequently used terms besides identifying and discussing terms which potentially cause confusion. The findings are categorized into five subgroups: hair shaft, follicular, perifollicular, scalp findings, and hair distribution pattern abnormalities. The calculation of sensitivities and positive predictive values of such redefined findings was conducted by reviewing the descriptions in the past literature on major hair diseases, including alopecia areata, androgenetic alopecia/female pattern hair loss, telogen effluvium, trichotillomania, lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus erythematosus, folliculitis decalvans, tinea capitis, and dissecting cellulitis, to confirm the diagnostically meaningful findings for representative diseases. This attempt redefined, for instance, yellow dots, short vellus hairs, exclamation mark hairs, black dots, and broken hairs as the findings of diagnostic significance for alopecia areata and hair diameter diversity, peripilar sign, and focal atrichia for androgenetic alopecia/female pattern hair loss. An updated diagnostic flowchart is proposed with the instructions to maximize its usefulness. Current limitations and future perspectives of trichoscopy as well as other emerging non-invasive diagnostic modalities for hair diseases are also discussed.

Hair diameter measurements for planning follicular unit extraction surgery (FUE): Is there a correlation between the micrometer caliper and scanning electron microscopy (SEM) findings?

Hair shaft diameter is one of the most important factors for the outcome of follicular unit extraction (FUE) surgery. In fact, the hair shaft is elliptical. Therefore, it has a long and short axis. Many hair transplantation surgeons use manual micrometer caliper for gauging hair diameter and use the results in the management of recipient and donor area. In this study, we aimed to identify the dependability of micrometer caliper and also the hair diameter diversity pattern in the donor area. Two hundred and seventy hairs were collected from three males with androgenetic alopecia. Hair samples were obtained from the 1cm2 boxes from superior to inferior at the mid-point of temporal, parietal, and occipital donor areas. The diameter of each hair was measured both with a micrometer caliper and scanning electron microscopy (SEM). Average diameter measured by scanning electron microscopy was 83.01µm for the long axis and 51.51µm for the short axis. The average value for the micrometer caliper measurement was 53.32µm. Comparison of micrometer caliper results with the short-axis measurements of SEM revealed a strong significant correlation. The hair diameters from superior, middle, and inferior boxes revealed a tendency to decrease toward the inferior regions. A manual micrometer caliper is a dependable tool for planning FUE surgery, and it measures the short axis of the elliptical hair shaft. Hair diameter tends to decrease toward the inferior regions of the donor area.

Conflicting Reports Regarding the Histopathological Features of Androgenic Alopecia: Are Biopsy Location, Hair Diameter Diversity, and Relative Hair Follicle Miniaturization Partly to Blame?

Despite decades of study, debate persists over the role of inflammation, fibrosis, and prostaglandins in the histopathology of androgenic alopecia (AGA). This brief review proposes that inconsistent findings across histological studies are a consequence of three inadequately controlled variables: 1) biopsy location, 2) hair diameter diversity (HDD), and 3) relative hair follicle miniaturization (HFM) within and across subjects. We suggest new methodological considerations to improve AGA histopathological research, as well as a novel classification system to quantify HFM by its stages. Finally, we hypothesize a dynamic relationship between inflammation, fibrosis, and prostaglandin activity dependent on relative HFM.

Clinico -laboratory and trichoscopic evaluation of various patterns of female baldness – A prospective case control study

Introduction: Female pattern hair loss (FPHL) is a form of non scarring diffuse hair loss and hair thinning in a pattern fashion. The role of hyperandrogenemia is not clear in FPHL. An association between iron deficiency and FPHL is also debated. Literature investigating trichoscopic features in this condition are few. Aim: To analyse the clinico laboratory findings in women with pattern baldness and to correlate the trichoscopic parameters in the three forms of FPHL namely Ludwig, Olsen, Hamilton & Norwood. Materials and Methods : This was a prospective case control study. Seventy (70) female patients of age between 18-48 years with pattern baldness and thirty(30) age matched females were included in the study. Trichoscopy was done for all the cases. Laboratory evaluation was done for both cases and controls. The data was analysed using SPSS 16.0 version. Chi Square and ‘ t ’ tests were used and the results expressed in mean, standard deviation. Results: A statistically significantly difference was observed between the mean values of total testosterone, DHEAS, TSH of cases when compared to controls. The serum ferritin level less than the cut off level of 40 mic.gram/L was seen in 52% of cases and the mea n serum ferritin values of cases is less than that of controls. Hair diameter diversity( 90%), peripilar sign(91.4%) were the most frequent trichoscopic findings. Conclusion: The biochemical findings in our study support the role of hormones, Iron deficiency in the etiology of FPHL. The trichoscopic findings did not differ significantly between the three forms of FPHL. Keywords: Trichoscopic features, Patterns of female Baldness, Case control study.

Assessment, reliability, and validity of trichoscopy in the evaluation of alopecia in women.

BackgroundAlopecia in women is generally difficult to diagnose clinically. Trichoscopy may help make the correct diagnosis in doubtful cases.ObjectiveThe aims of the study were to assess the trichoscopic features of different types of alopecia in women, the reliability of trichoscopy vis-à-vis clinical findings, and the validity of trichoscopy in cases with a doubtful clinical diagnosis.MethodsA hospital-based observational, cross-sectional study was carried out on female patients with alopecia. A trichoscopic diagnosis was made and correlated with a clinical diagnosis. The validity of trichoscopy in doubtful cases was evaluated by reporting the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value.ResultsOn trichoscopy, increased hair diameter diversity > 20%, single-hair follicular unit, vellus hair, peripilar sign, and focal atrichia were commonly seen in female pattern hair loss. In telogen effluvium, there was a scarceness of specific findings. In cicatricial alopecias, loss of follicular ostia, erythema, white macules, blue-gray dots, white dots, tufted hair, and keratotic follicular plugging were observed. A good agreement between trichoscopy and clinical diagnosis was found (Cohen’s Kappa = 0.824; 95% confidence interval, 0.756–0.892). The validity of trichoscopy in doubtful cases was evaluated using the validity parameters, which were high in all alopecias.LimitationsHistopathology testing was not done in all patients.ConclusionTrichoscopy helped reach a definitive diagnosis in patients in whom the clinical diagnosis was doubtful. Thus, trichoscopy is a sensitive and specific investigation that can be valuable in women with alopecia.

Trichoscopy in common scalp alopecia: an observational study

<p class="abstract"><strong>Background:</strong> Many patients of alopecia are encountered in daily practice with diagnostic dilemma. Trichoscopy is a sensitive, non-invasive tool which aids in clinical diagnosis.</p><p class="abstract"><strong>Methods:</strong> An observational study performed in adult patients with alopecia attending R.D. Gardi Medical College, Ujjain, over a period of one year. Trichoscopy was performed using a Dinolite digital microscope with both polarized and non polarized modes.<strong></strong></p><p class="abstract"><strong>Results:</strong> 269 patients of alopecia (257 non cicatricial, 12 cicatricial) aged 18-50 years were enrolled. The diagnosis was made after detailed history and clinical examination. 173 (64.3%) males and 96 (35.7%) females. 45.4% patients were diagnosed to have alopecia areata in which yellow dots were the most common trichoscopic finding observed in 88.5% patients. 37.2% patients were diagnosed with androgenetic alopecia with hair diameter diversity >20% observed in all the patients. 9.3% patients were diagnosed to have telogen effluvium with short vellus hair seen in 64% patients. 3.7% of the patients were diagnosed to have seborrheic dermatitis with arborizing vessels being the most common finding seen in 90% patients. 2.9% patients were diagnosed with lichen planopilaris in which loss of follicles and peritubular white casts were seen in all the cases. 0.9% patients were diagnosed to have discoid lupus erythematosus with hyperkeratotic follicular plugging seen in all the cases. Overall yellow dots were the most common trichoscopic findings seen in 61% cases.</p><p class="abstract"><strong>Conclusions:</strong> Trichoscopy is a reliable diagnostic tool in hair and scalp disorders. Hence trichoscopic evaluation should be done in every case of alopecia. </p><p class="abstract"> </p>

Trichoscopic evaluation of frontal hairline recession in Egyptian female patients.

Since frontal hairline is the most characteristic feature of the face for both men and women, affecting the psychological state of patients, hair loss has been considered to be one of the most prominent esthetic problems. Hair loss either resulting from the androgenetic or nonandrogenetic origin is characterized by changes in the anterior line. The aim of this study was to evaluate the causes of the frontal hairline recession in Egyptian female patients using trichoscopy and to detect the prevalence of each of those causes in Egyptian females. This study was performed on a total of 200 Egyptian female patients aged between 15 and 65years who complained of frontal hairline recession. All patients were derived from Al-Zahraa University hospital outpatient clinic over a period from November 2017 to April 2019. We classified them into two groups according to age: Group A: 15-45 and Group B: 46-65. After full history taking, general and dermatological examination, photographs of hair recession were taken from both frontal and temporal sides. Then, the trichoscopic examination by noncontact dermoscopy was done photographed and evaluated. The most common cause of the frontal hairline recession in Egyptian female patients was androgenetic alopecia (AGA) (50%). Most of the patients were of old age (58%). The high statistically significant trichoscopic findings in androgenetic alopecia were yellow dots, peripilar sign, hair diameter diversity, and single-hair pilosebaceous unit (45.0%, 61.0%, 100.0%, and 96.0%), respectively. On the other hand, perifollicular scaling, absence of hair follicles, and lonely hair revealed a high statistically significant presentation (88.9%, 100.0%, and 22.2%), respectively, with frontal fibrosing alopecia, and vellus hair (100.0%) and perifollicular casts (91.8%) with tractional alopecia. Finally, hair broken at different levels (100%), black powder (88.9%), black dots (100.0%), hook hairs (11.1%), i hair (16.7%),V sign (44.4%), flame hairs (33.3%), coiled hair (5.6%), and burnt match stick sign (5.6%) showed a high statistically significance presentation with trichotillomania. The present study supports the trichoscopic criteria for the diagnosis of causes of frontal hairline recession, which provide a noninvasive diagnostic tool compared with histopathological diagnosis.

Trichoscopy in hair disorders in darker skin: An approach to diagnosis

Introduction: Trichoscopy is a non-invasive technique that shows promising results in the diagnosis and assessment of response to treatment in various types of alopecias. Besides diagnosing alopecia, it is helpful in choosing an ideal biopsy site. Here authors have attempted to describe trichoscopic findings of healthy scalp and compare hair shaft abnormalities, follicular and interfollicular features and vascular patterns of common non-cicatricial and cicatricial alopecias in skin of color. Summary: Trichoscopy of androgenetic alopecia shows hair diameter diversity, brown and white peripilar sign. Exclamatory hairs and coudability hairs are characteristics of alopecia areata. 'i' hair and pigtail hair indicates good prognosis in alopecia areata. Mace hair sign and burnt matchstick sign are newer findings of trichotillomania. Tinea capitis shows comma hairs, corkscrew hairs. Morse-code like hairs, zigzag hairs and bent hair are specific for tinea capitis. Traction alopecia shows anisotrichosis and hair casts with follicular drop outs in severe disease. Trichoteiromania shows trichoptilosis and broom hairs. Lichen planopilaris (LPP) and discoid lupus erythematosus show 'targetoid' and speckled patterns of blue-grey dots respectively. Perifollicular tubular scaling is characteristic in LPP. Frontal fibrosing alopecia presents as absent follicular openings and follicular plugging. Follicular tufting with starburst fibrotic bands is definitive of folliculitis decalvans. Pseudopelade of Brocq presents with loss of follicular ostia with prominent honeycomb pigmentation.

Trichoscopic findings and quality-of-life assessment in Egyptian patients with noncicatricial alopecia

Background Trichoscopy has become a routine technique in dermatology practice. It is a simple, rapid, and noninvasive technique that allows early diagnosis and management, especially, of hair disorders. Aim This study aimed to evaluate the role of trichoscopy in diagnosis of noncicatricial alopecia (alopecia areata, androgenic alopecia, and telogen effluvium), clinical severity, and assessment of quality of life (QoL) in these disorders. Patients and methods One hundred and fifty patients with noncicatricial alopecia were divided according to their clinical diagnosis into three groups: alopecia areata (55 patients), androgenic alopecia (35 patients), and telogen effluvium (60 patients). Patients were assessed by clinical diagnosis, trichoscopy, and the Arabic version of Dermatology Life Quality Index (DLQI). In alopecia areata, patients were assessed clinically by severity of alopecia tool (SALT) score. Results The study revealed that the three types of alopecia had very large effect on QoL in most of the patients measured by DLQI. In alopecia areata, SALT score was very effective tool to evaluate AA severity, which revealed mild to moderate degree of severity, and there was a positive significant correlation between DLQI and SALT score. Trichoscopic examination revealed yellow dots, black dots, broken hairs, exclamation marks, and short vellus hairs. In androgenic alopecia, hair diameter diversity greater than 20% was the most significant sign, and also there was presence of yellow dots and vellus hair but in number less than that in alopecia areata. Stress was the most common provocative factor in telogen effluvium. Conclusion The clinical and dermoscopic features were matched among diagnosis in the three types of noncicatricial alopecia (telogen effluvium, alopecia areata, and androgenic alopecia).The observed correlation between DLQI findings and the clinical severity of alopecia areata suggests that alopecia has a negative effect on a patient's QoL.

New pattern hair loss in young Turkish women; What's wrong in their daily life?

The application of heat, used to straighten the typically coiled hair, has long been hypothesized to play a role in the etiologic factor for central centrifugal cicatricial alopecia (CCCA). The aim of this study was to evaluate the effect of thermal hair straightening on hair loss pattern in Asian women exist. Thirty-five patients with hair loss who have been using hair straightening devices and 25 patients with telogen effluvium were enrolled in this prospective study. Laboratory analysis and dermatoscopic findings were used to compare these groups. The peripilar white halo around hairs, peripilar dark/gray halo around follicular orifices, the predominance of a single hair perifollicular unit (FU), hair diameter diversity, the thin miniaturized hair, interfollicular pinpoint white dots, and white patches were statistically higher in hair straightener group (P<0.001). White patches of the scalp increased by the time of the application of these devices (P<0.01). White patches of vertex region were significantly higher than the midfrontal region (P<0.01). The common side effects of thermal hot comb strengtheners' were summarized as damage to the hair shaft; decreasing in the brightness of the hair, burns, and scars on the scalp; and lastly CCCA-like hair loss.

Dermoscopic pre- and posttreatment evaluation in patients with androgenetic alopecia on platelet-rich plasma-A prospective study.

Platelet-rich plasma is rich in growth factors that promote differentiation and growth of dermal papilla cells by various signaling pathways. Dermoscopy is handy, bedside tool that helps to improve diagnostic accuracy in various hair disorders. To evaluate and study the role of dermoscopy in patients with androgenetic alopecia (AGA) pre- and posttreatment with platelet-rich plasma (PRP). It is a prospective comparative study. Twenty male patients with AGA, aged 18-45years with modified Norwood-Hamilton classification grade II-VI were included in this study. Patients were given platelet-rich plasma injections every 3week for a period of 3months. Dermoscopy was performed with 10 x magnifications in polarized mode at baseline and at 3months from the baseline and photographs were taken. Patients were evaluated based on following dermoscopic findings (a) hair count, (b) hair density, (c) hair diameter diversity, perifollicular pigmentation, yellow dots, multi-hair follicular units, honeycomb pigment pattern and white dots, (d) patient's hair growth assessment score. Posttherapy, patients showed significant improvement in hair count (27.4%), hair diversity (84.2%), increase in number of thick, terminals hairs, reduction in yellow dots (60%), perifollicular pigmentation (92.3%) was appreciated. Hair pull test negative after treatment in 10 patients (50%). Patient's hair growth assessment score showed 50%-75% improvement in 7 (35%) patients. Dermoscopy helps to easily evaluate and compare the therapeutic response pre- and posttreatment which can be easily documented and visualized at every visit.

A New Classification of Early Female Pattern Hair Loss.

Background:Global photographs (GPs) have been widely used to grade the severity in female pattern hair loss (FPHL). However, existing classifications for FPHL are not useful in the evaluation of early FPHL. Although there are some variations in early FPHL, even to a mild degree, all types of early FPHL are included in just one category. Therefore, the authors have devised a grading system for early FPHL with five levels focusing on the changes revealed by the surface reflected light of flash generated on GPs.Aims:This study aims to examine the possibility of evaluating the treatment course of early FPHL using the grading system based on changes in hair surface reflection patterns.Subjects and Methods:Retrospective chart review of 114 early FPHL patients was performed. GPs of these patients were classified into five grades. Photographs of the lowest and the highest grades of each patient were selected and paired. First, the relevance between the value of FPHL-severity index (FPHL-SI) and grades of all the selected photos was analyzed. Next three volunteers graded the paired photographs and chose the milder degree, and then, the concordance rate among author's and volunteers' evaluations were analyzed.Results:The value of FPHL-SI and incidence rate of hair diameter diversity tended to rise along with increasing of GP grade. Concordance rate of grading among author and more than two volunteers was 57%. The concordance rate of course evaluation between author and two volunteers was 97%.Conclusion:The new classification can finely classify the grade of early FPHL and can be used for treatment course evaluation.