Peripilar Sign Research Articles

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.

Trichoscopy of Androgenetic Alopecia: A Systematic Review.

Background: Androgenetic alopecia, the most common cause of non-scarring hair loss, is a consequence of the gradual miniaturization of the hair follicles. In the majority of male androgenetic alopecia cases, a patient's history and clinical evaluation may be sufficient to establish the diagnosis, while for women, they should be supplemented with trichoscopy. Methods: The PubMed and Scopus databases were used to collate published studies and to analyze the most typical trichoscopic findings in patients diagnosed with androgenetic alopecia. A total of 34 articles were retrieved after exclusion. Results: The most common features identified using trichoscopy included hair diameter variability (94.07% of patients), vellus hairs (66.45%) and the peripilar sign (43.27%). Others, such as the honeycomb pattern, yellow and white dots, were less relevant. Conclusions: We concluded that hair diameter variability, vellus hairs and the peripilar sign represented valuable indicators for the diagnosis of androgenetic alopecia.

Peripilar Sign in Androgenetic Alopecia: Does It Really Indicate Peripilar Infiltrate?

Peripilar sign (PPS) is a trichoscopic sign that was first described in androgenetic alopecia (AGA) and is thought to reflect the presence of perifollicular infiltrate (PFI) in histopathology. To study PPS in a cohort of patients with AGA and to assess its validity as a sign indicative of PFI. One hundred patients with AGA (confirmed by trichoscopic examination) were recruited in this cross-sectional study. From those patients, frontal scalp biopsy was done for two subgroups, 22 patients with PPS and 23 patients without PPS. Both groups were compared as regards the presence of PFI. Peripilar sign was present in 50% of the 100 studied cases. No significant difference existed between those with and those without PPS as regards PFI. Peripilar sign was significantly more encountered in patients with skin type III (p=0.001). Its absence was significantly associated with lower interpretability of yellow dots (p<0.001) and their scores were significantly positively correlated (r=0.498, p<0.001). Peripilar sign was significantly associated with absent melanophages histopathologically (p=0.011). Peripilar sign as a trichoscopic sign in AGA does not reflect PFI. It represents a dark color more encountered in patients with lighter skin types. This can be explained by the increased contrast between the dark PPS and the lighter surrounding skin in lighter skin types. Further studies using melanocyte markers and Masson Fontana's stain are needed to further verify the cause of this peri-follicular dark color.

A Cross-sectional Observational Study to Correlate the Trichoscopic Findings of Female Pattern Hair Loss with the Disease Severity and Underlying Histopathological Changes

ABSTRACT Background: The increasing prevalence of female pattern hair loss (FPHL) is an alarming concern. Trichoscopy is an important bedside diagnostic tool for the diagnosis of FPHL, but there are very few studies correlating it with disease severity or histopathological findings which would provide a better insight to the treating clinician. Hence, we decided to take up this study. Aim: This study aimed to study the trichoscopic findings of FPHL and correlate their relationship with disease severity and histopathological finding in our tertiary care hospital. Materials and Methods: Ninety females attending the dermatology outpatient department who were clinically diagnosed with FPHL were included in the study after informed consent and clearance from the institutional ethics committee. This was followed by a detailed history, clinical examination, and trichoscopic assessment. A trichoscopy-guided biopsy was performed from two sites. After the data collection, the statistical software used was IBM SPSS version 21.0 and Microsoft Office Excel 2007. P &lt; 0.05 was accepted as indicative of statistical significance. Results: Anisotrichosis, increased interfollicular distance, and decreased hairs per follicular unit were universal. Brown peripilar sign had a positive association with inflammation (P &lt; 0.0005) and white peripilar sign with duration of disease and fibrosis whereas dartboard sign had a significant association with inflammation as well as fibrosis. Conclusion: Trichoscopy helps in diagnosing the condition, assessing the severity, and monitoring the response to treatment. A knowledge about the features underlying specific trichoscopic signs such as inflammation and fibrosis would help the clinician decide the line of management.

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.

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 &gt; 20%. A thorough dermascopic evaluation and follow up is must for different patterns of hair loss among females.

Prevalence of Non-Scarring Alopecia among Female Patients Complaining from Hirsutism

Background: Hirsutism is a common clinical problem that cause great distress to the patient, and which true incidence is unknown. However, it is more common among Mediterranean women. Hirsutism is excessive terminal hair growth in women in androgen-dependent. Often the cause of it is hyperandrogenism but it can be also idiopathic. In hyperandrogenic states like in cases of PCOS, it can associate with other cutaneous clinical signs of this endocrine disorder like acne and AGA.Aim of the study: To evaluate the prevalence of non-scaring hair loss (alopecia) among female patients complaining of hirsutism.Patients and Methods: Cross-sectional study was conducted on more than 90 patients who have hirsutism within reproductive age (married and UN married) and complained of hair loss A special questionnaire design was developed to record all their data. Hair loss was diagnosed and assessed by visual overview examination by the naked eye and trichoscopic examination, by using Dermatoscope Foto finder stationary mode. The photo of the trichoscopic examination was saved and the features of each type of non-scaring alopecia were assessed.Results: In our study, there are three types of non-scaring hair loss associated with hirsutism (Androgenetic alopecia, telogen effluvium, androgenic alopecia with telogen effluvium). The most common type of hair loss associated with hirsutism is (Androgenetic alopecia with telogen effluvium) 55.6%. The most common trichoscopic features found in (Androgenetic alopecia with telogen effluvium) hair shaft heterogeneity 100%, HF with only one hair 74%, peripilar sign 82%, empty hair follicle 96%, up right re-growing hair 92% and black dots 36%, while these findings present in a lesser ratio in other groups.Conclusions: Androgenetic alopecia with telogen effluvium most common non-scarring alopecia associated with hirsutism.

Clinicopathological, trichoscopic and biochemical parameters in females with patterned hair loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hair has no vital functions in humans but its loss from the scalp can create a sense of negative body image and anxiety. The term ‘female pattern hair loss’ is explained by decrease in hair fiber production and their eventual miniaturization. To evaluate the clinicopathological, trichoscopic and biochemical parameters in females with patterned hair loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;37 females in age group of 18-45 years complaining of reduction in hair volume with diffuse thinning over the crown were included in our study after applying inclusion and exclusion criteria. Detailed history was taken and clinical examination was done. Written consent and ethical clearance from Institutional Ethical Committee was taken. Ludwig grading, evaluation of other clinical signs of hyperandrogenism and trichoscopy was done. These females then underwent histopathological examination. 10 ml blood was withdrawn to assess anemic, thyroid and hormonal profile in these females.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 37 females examined majority of the females had Ludwig grade 1 hair loss. Serum levels of testosterone were found significantly related to clinical signs of hyperandrogenism. Hair diameter variability and peri pilar sign formed the majority in trichoscopy (62.2% each). The most common histopathological finding was perifollicular infiltrate (70.3%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; FPHL can contribute to severe psychological distress. Despite its high prevalence, its diagnosis and treatment still impose several difficulties in clinical practice. Although hormonal factors are believed to contribute, its pathogenesis still remains elusive.&lt;/p&gt;

Evaluation of trichoscopic features in female pattern hair loss

Female pattern hair loss (FPHL) is explained by decrease in hair fiber production and their eventual miniaturization. It is considered a counterpart of male androgenetic alopecia but the role of androgens in its pathogenesis is yet to be proven. To evaluate the trichoscopic features in females with patterned hair loss. Inclusion and exclusion criteria were applied and 37 cases were enrolled in our study. Detailed history and clinical examination were done to establish the diagnosis. Trichoscopic examination was done after taking consent in diagnosed cases. On trichoscopy, hair diameter variability, peri pilar sign, white dots, scalp pigmentation and focal atrichia was observed in 62.2%, 62.2%, 40.5%, 45.9% and 40.5% respectively. Most common trichoscopy finding observed was peri pilar sign and hair diameter variability in 23/37 females. Definitive diagnosis of FPHL is difficult to be established solely on the basis of clinical examination. Thus, trichoscopy serves as a non-invasive tool to ascertain the diagnosis in these patients.

Development and Validation of a Dermoscopic Severity Score for Female Pattern Hair Loss

Introduction: Despite the high prevalence and impact on quality of life, there are no objective methods to estimate the severity of female pattern hair loss (FPHL). Here, we aimed to develop a dermoscopic severity score for FPHL. Methods: Cross-sectional study involving 76 women with FPHL and 12 controls. Standardized dermoscopic photos of the scalp were taken to evaluate the main findings of FPHL. The variable selection and their scores in the final model were defined by multivariate methods. Twenty participants were retested to assess the reliability, and 10 participants were tested before and after treatment for estimating its sensibility to change after 6 months. Results: Eight patients (11%) presented the Sinclair clinical scale grade I, 40 (53%) presented at grade II, 19 (25%) presented at grade III, and 9 (12%) presented at grades IV and V. In the multivariate exploration, the following variables were considered significant: total terminal hairs, total miniaturized hairs, brown peripilar sign, scalp honeycomb pigmentation, white peripilar sign, and yellow dots. The final model resulted in a high correlation (rho = 0.89) with the ranked clinical assessment. Conclusion: An objective and reliable severity score of FPHL was developed and validated, allowing its use as an additional outcome in therapeutic trials.

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.

716A study of clinical and trichoscopic evaluation of diffuse hair loss in adult females

Abstract Background Hair fall is a major concern to the patient leading to angst, psychological distress and decrease in quality of life style, more so in female. The aim of the study is to evaluate diffuse hair loss (DHL) in adult females &amp; find the underlying causes. Methods This was an observational, prospective time bound hospital-based study including clinical and trichoscopic evaluation of DHL in women. 222 adult women who had DHL of 4 or more weeks were studied. Detailed history was taken and clinical examination was performed. Laboratory investigations like Hb, Iron Profile, Thyroid Panel was also noted. Trichogram, trichoscopy was performed for perfect visualization of hairs. Results Among the subjects, 95 women were diagnosed as having female pattern hair loss (FPHL), 89 as telogen effluvium, 24 as chronic telogen effluvium (CTE) while 14 had FPHL and TE both. Mean age of females was 33.92 ± 5.46 years. Majority, 145 (65.3%) of the patients were in the age group of 31-40 years. Stress (18%) and PCOD (15%) were the most common precipitating factors. Majority (75.3 %) females with TE have positive hair pull test. Brown peripilar sign (PPS) and white PPS was present in 15.8% and 8.1% women respectively. Conclusions The common causes for DHL are FPHL, TE, CTE and FPHL with TE. Key messages Along with definitive treatment, understanding of the cause of hair loss by the patient goes a long way in appropriate beneficial lifestyle modification and holistic management.

Trichoscopy as an Essential Diagnostic Technique for Hair and Scalp Disorders in Skin of Color

Background: Hair and scalp disorders cause significant morbidity, warranting an early diagnosis and treatment. Trichoscopy has shown great promise in the diagnosis and assessment of these disorders. Aims: The aim of this study was to determine the trichoscopic findings in cases of alopecia and scalp disorders and to determine their statistical significance. Materials and Methods: This was a case–control study in which trichoscopy using a hand-held dermoscope was done in 605 patients and 200 controls. Results: The trichoscopic findings that showed statistical significance in 405 alopecia cases when compared with controls were broken hair, exclamation hair, black dots, yellow dots, vellus hair and pigtail hair in alopecia areata, hair diameter variability, single hair predominance, brown and white peripilar sign in androgenetic alopecia, corkscrew hair, comma hair, morse-code hair and interfollicular scale in tinea capitis, and white dots and peripilar erythema in primary cicatricial alopecia. The findings which had a statistical relevance among scalp disorders included light red background, dots and globules and dermoscopic Auspitz’s sign for psoriasis, dark red background and arborizing vessels for eczemas and yellowish background for verrucae, comedo-like openings, milia-like cysts and moth-eaten borders for seborrheic keratosis, and viable nits for pediculosis capitis. Conclusion: Our study documented many trichoscopic features which were statistically significant among cases of alopecia and scalp disorders when compared with controls. Limitations: Histopathological confirmation of diagnosis was not done in most of the cases. The patients were not subjected to follow-up trichoscopy after treatment.

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.

Trichoscopic features of androgenic alopecia and telogen effluvium

Introduction: Hair loss is a cause of emotional and mental distress, especially in the modern age of social media. Hair loss can be classified as Cicatricial and Non-Cicatricial, based on the permanence of the damage wrought to the hair follicles. The conditions selected for evaluation in this particular study are androgenetic alopecia and telogen effluvium, owing to their higher rate of incidence and their amenable response to timely intervention.Trichoscopy aids in diagnosis, determination of biopsy site and acts as a prognostic tool. In this study, we will enumerate trichoscopic features of the scalp in androgenic alopecia (AGA) and telogen effluvium (TE) on the basis of follicular patterns, interfollicular patterns and hair signsMaterial and Methods: It is a cross-sectional and observational study is suited for estimating the prevalence of each trichoscopic feature in AGA and TE. The study was conducted in the Department of Dermatology, Venereology and Leprosy, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka. The study was conducted between January 2020 to December 2020 with sample size of 100 patients.Results: In the 100 cases of AGA and TE, 69% had AGA and 31% TE. Hair pull test was positive in 90% patients of TE. Yellow dots (69%), empty hair follicles, (65%) peripilar sign (71%), vellus hair (95%) and variation in hair shaft diameter in frontotemporal areas (98%) are the characteristic findings in AGA patients. The follicular features present in TE are peripilar sign (10%), yellow dots (29%) and vellus hair (30%). The characteristic finding is that the variation in hair – shaft diameter is prevalent in fronto-temporal (15%) and occipital areas (65%).Conclusion: The characteristic follicular features on Trichoscopy observed in AGA were peripilar sign, yellow dots and empty hair follicles. The characteristic hair shaft pattern observed was vellus hair. Variation in hair shaft diameter was more prevalent in fronto-temporal areas. TE is said to be a disease of exclusion on Trichoscopy. It is important to differentiate this condition from AGA, where-in the variation in hair shaft thickness is present in fronto-temporal areas and absent in occipital area.

Topical Finasteride versus Topical Spironolactone in the Treatment of Androgenetic Alopecia

Abstract Background: Androgenetic Alopecia (AGA) is a non-scarring alopecia that affects both males and females. It is characterized by a progressive miniaturization of hair follicles with a characteristic pattern distribution in genetically predis-posed men and women. Topical finasteride is being investigated as a new treatment for AGA with fewer side effects than oral finasteride. Topical Spironolactone is the most commonly used off-label anti-androgen for the treatment of AGA. In the treatment of AGA, it acts by decreasing the production and competitively blocking the androgen receptor in the target tissue. Aim of Study: The aim of this study was to evaluate the role and compare the effect of topical finasteride and topical spironolactone in the treatment of (AGA). Patients and Methods: After meeting inclusion and ex-clusion criteria and diagnosis of AGA was clinically established by the characteristic distribution of frontal and vertex hair in males and the Christmas tree pattern of diffuse hair loss at middle hairline in females. It was dermosopically established by the characteristic hair shaft thickness heterogeneity, peripilar brown depressions (peripilar signs) and focal atrichia and also folliscope established for hair density. Cases included in this study had Norwad-Hamilton Scale types I to VII for men and Ebling Scale types I to IV for women. Result: Our study shows that a topical spironolactone is better than topical finasteride in male and female group. Conclusion: In this study, topical finasteride and topical spironolactone are good options for management of androgenic alopecia but topical spironolactone is better than topical finasteride with few side effects when compared to oral administration.

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.

Effect of fractional carbon dioxide (CO2) laser on improving minoxidil delivery for treatment of androgenetic alopecia

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.