Permanent Hair Loss Research Articles

Evaluation of the Environmental Risk Factors and Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study

Introduction: Lichen planopilaris (LPP) is an uncommon cicatricial alopecia clinically characterized by follicular hyperkeratosis, perifollicular erythema, and permanent hair loss. The association of LPP with certain underlying diseases and environmental factors has been evaluated but there are limited data about this association. This study was designated to evaluate the environmental risk factors and comorbidities in LPP patients. Method: This case-control study was performed on LPP patients referred to two dermatology referral centers from 2019 to 2022. A group of non-LPP healthy individuals referring for cosmetic concerns was recruited as control group. Data collection was performed using two questionnaires: a general questionnaire, including demographic information, comorbidities, environmental risk factors, and disease-related information, and the lichen planopilaris activity index (LPPAI) questionnaire. Results: One hundred LPP patients as case group were compared with 100 healthy people without LPP as control group. Unemployment, history of major stressful events, thyroid disorder, history of hair dyeing, using face soaps, taking supplements, postmenopausal status, and family history of LPP or other types of alopecia had significant relationship with LPP (all p values <0.05). Conclusion: LPP has associations with environmental and non-environmental risk factors and, also, genetic component.

Low-Dose Metformin and Profibrotic Signature in Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia predominantly affecting Black female individuals. Current conventional treatments target inflammation but not the underlying fibrotic processes, often leading to permanent hair loss. To investigate the associations of low-dose oral metformin, an antidiabetic medication with antifibrotic properties, with clinical symptoms and scalp gene expression patterns in patients with CCCA. This retrospective clinical case series and transcriptomic analysis included patients treated at a single tertiary academic medical center between January 2023 and March 2024. All patients had biopsy-confirmed CCCA refractory to standard treatments. Transcriptomic analysis was performed on patients with previously banked, paired scalp biopsies before and after treatment with adjuvant metformin for at least 6 weeks. Extended-release metformin, 500 mg, once daily was added to participants' baseline CCCA treatment regimens. Clinical assessments included pruritus, inflammation, scalp resistance, and hair regrowth. Gene expression profiling via bulk RNA sequencing analysis evaluated differential gene expression and pathway enrichment. A total of 12 Black female participants were included in the study, and transcriptomic analysis was performed in 4 participants. After at least 6 months of metformin treatment, 9 participants experienced improvement in disease, including scalp pain, inflammation, and/or pruritus, and 6 demonstrated clinical evidence of hair regrowth. The addition of metformin led to reversal of many prominent gene pathways previously identified in CCCA. Transcriptomic analysis revealed upregulation of pathways and genes (keratin-associated proteins [KRTAPs]) involved in keratinization, epidermis development, and the hair cycle (absolute log2-fold change > 4), with concomitant downregulation of fibrosis-related pathways and genes (eg, MMP7, COL6A1) (fold change >1.5; all false discovery rate <.05). Gene set analysis showed reduced expression of helper T cell 17 and epithelial-mesenchymal transition pathways and elevated adenosine monophosphate kinase signaling and KRTAPs after metformin treatment. In this case series of patients with treatment-refractory CCCA, low-dose oral metformin was associated with symptomatic improvement and dual modulation of gene expression, stimulating hair growth pathways while suppressing fibrosis and inflammation markers. These findings provide a rationale for future clinical trials studying metformin as a targeted therapy for CCCA and other cicatricial alopecias.

Act Fast With Traction Alopecia to Avoid Permanent Hair Loss.

Act Fast With Traction Alopecia to Avoid Permanent Hair Loss.

Act Fast With Traction Alopecia to Avoid Permanent Hair Loss

Act Fast With Traction Alopecia to Avoid Permanent Hair Loss

Patient-Based Ratio Method for Permanent Zone Donor Area Calculation in Hair Transplant

Abstract Introduction Most common type of hair loss is androgenetic alopecia. Orentreich's donor dominance theory and the definition of safe donor area are the theoretical foundation of modern hair transplantation. In safe donor area no progression of permanent hair loss occurs. Its knowledge is important to prevent loss of transplanted hair. Estimation is not tailored to every patient, also in early stages, the margins are assumed to be free from future hair loss. Our study is an attempt to find and establish a relationship between safe zone dimensions and other standard scalp dimensions, and effectively predict the complete safe zone in early stages of hair loss. Materials and Methods From July to December 2022, the first 100 patients with Norwood IV onwards of hair loss were included. Then, the distance between the vertex and the point of change in occipital hair quality and density was measured, and from this point till occipital protuberance were taken. The ratio between the two was taken. In the next 100 patients of Norwood II to IVa, the applicability of the new ratio to assess the permanent zone was used. Results Ratio method takes into account the patient's measurements, that is, permanent zone and total distance from vertex occiput. The ratio range we got is:Permanent zone: total distance from vertex to occiput: 0.43–0.53Therefore, the permanent zone would be equal to = total distance from vertex to occiput × 0.43–0.53. With the lower limit being the occiput. Over 90% of the patients did not have significant reduction in density of transplanted hair. Conclusion The authors suggest the use of this ratio method to determine the dimensions of the permanent zone especially in patients with early grades of hair loss as per the Norwood scale. It is a simple, effective, and easily applicable concept that can ensure long-lasting results in patients undergoing hair transplants.

Polydopamine Synergizes with Quercetin Nanosystem to Reshape the Perifollicular Microenvironment for Accelerating Hair Regrowth in Androgenetic Alopecia.

Accumulated reactive oxygen species (ROS) and their resultant vascular dysfunction in androgenic alopecia (AGA) hinder hair follicle survival and cause permanent hair loss. However, safe and effective strategies to rescue hair follicle viability to enhance AGA therapeutic efficiency remain challenging. Herein, we fabricated a quercetin-encapsulated (Que) and polydopamine-integrated (PDA@QLipo) nanosystem that can reshape the perifollicular microenvironment to initial hair follicle regeneration for AGA treatment. Both the ROS scavenging and angiogenesis promotion abilities of PDA@QLipo were demonstrated. In vivo assays revealed that PDA@QLipo administrated with roller-microneedles successfully rejuvenated the "poor" perifollicular microenvironment, thereby promoting cell proliferation, accelerating hair follicle renewal, and facilitating hair follicle recovery. Moreover, PDA@QLipo achieved a higher hair regeneration coverage of 92.5% in the AGA mouse model than minoxidil (87.8%), even when dosed less frequently. The nanosystem creates a regenerative microenvironment by scavenging ROS and augmenting neovascularity for hair regrowth, presenting a promising approach for AGA clinical treatment.

Central centrifugal cicatricial alopecia: adeeper insight into the disease.

Central centrifugal cicatricial alopecia (CCCA) is ascarring alopecia of multifactorial etiology that presents on the vertex as patchy areas of hair loss, spreading centrifugally over the scalp. It most commonly affects women of African descent, but cases among other ethnicities have also been reported. CCCA typically starts with thinning and breaking of the hair as the first sign of presentation, which eventually progresses to hair loss over the central part of the scalp, spreading symmetrically outwards to involve alarger area. Currently, there is no definitive cure for the disease; however, multiple management options are available, which should aim to be tailored to the individual patient. Owing to its cosmetic outcomes, the quality of life (QoL) of patients with central centrifugal cicatricial alopecia is also disturbed, as patients may face psychological and social stress due to their permanent hair loss. This article focuses on various aspects of the pathogenesis, clinical trials, quality of life, barriers faced by patients, and treatment of central centrifugal cicatricial alopecia.

Prevention and control of pediatric tinea capitis

Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among preadolescent children worldwide, including in developing countries such as China. The highly contagious nature of tinea capitis can result in outbreaks within communal settings for children. Furthermore, pustular lesions associated with this condition can lead to permanent scarring and hair loss, imposing a significant psychological burden on affected children and their parents. This article aims to provide a comprehensive literature review encompassing the susceptible person, epidemiological characteristics, trends, etiology, modes of transmission, clinical manifestations, treatment, and prevention strategies of tinea capitis. The ultimate objective is to raise awareness, implement effective prevention and control measures, interrupt the transmission cycle, and ultimately reduce the incidence of tinea capitis in the pediatric population.

Efficacy and Safety of Combination 308-nm Excimer Laser and Intralesional Corticosteroid versus Intralesional Corticosteroid Monotherapy in the Treatment of Frontal Fibrosing Alopecia: A Pilot Study

Frontal fibrosing alopecia (FFA) is a slowly progressive cicatricial alopecia that can result in permanent hair loss, so early diagnosis and treatment is crucial. However and of concern, a standard treatment regimen for FFA has not yet been established. In an attempt to remedy this gap, we conducted this study to investigate the efficacy and safety of combined 308-nm excimer laser with intralesional corticosteroid (ILC) compared to ILC alone to treat FFA. The results of our study revealed that the combination of 308-nm excimer laser and ILC was not superior to ILC alone for treating FFA. Moreover, side effects, including erythema and postinflammatory hyperpigmentation, were reported in both groups.

P07 Pityriasis amiantacea: a unique presentation of psoriasis associated with tumour necrosis factor-α inhibitor therapy

Abstract Introduction Pityriasis amiantacea (PA) is a rare but distinctive scalp condition. It is characterised by thick, silvery scales that bind together causing matting of multiple hair shafts. This can ultimately result in temporary or permanent hair loss. PA is thought to be a reaction pattern rather than a specific diagnosis and common associated conditions include: scalp psoriasis, seborrhoeic dermatitis, tinea capitis and atopic dermatitis. We report a case of PA presenting in a patient with longstanding rheumatoid arthritis (RA), associated with tumour necrosis factor-α inhibitor (anti-TNF-α) therapy. Case description A 42-year-old was reviewed at her routine rheumatology follow up appointment. She has a 15-year history of seropositive, erosive RA managed with monthly golimumab injections for the last eight years. Prior to this she had been on etanercept for four years, but this lost efficacy. Unfortunately, she had poor disease control on methotrexate, leflunomide and sulphasalazine. She developed a sore area on her scalp nine months previously with accompanying itch. This then spread into an extensive confluent area of redness, associated with soreness, scale, matting onto hair and hair loss. She had been treated unsuccessfully with multiple antibiotic courses, including flucloxacillin, doxycycline and clarithromycin, oral fexofenadine, topical diprosalic and ketoconazole shampoo. The pruritic skin lesions continued to progress and even spread to behind the ears. This had been managed by her general practitioner (GP) as otitis externa. The patient was otherwise well with no joint pains, fever, weight loss or other systemic features. On examination, thickened, hyperkeratotic scaling plaques were seen with clumped hair shafts and underlying erythema of the entire scalp. There were no skin lesions over the rest of the body and nail changes were absent. Swab culture from the scalp was negative for fungal infection but Staphylococcus aureus and Psuedomonas aeruginosa were identified. Dermatology consult was sought, and she was diagnosed with extensive impetiginized pityriasis amiantacea associated with otitis externa. This was thought to be secondary to her anti-TNF-α therapy. Initial management was with scalp oils to soften the scales, Betnovate scalp ointment and a course of antibiotics. However, the mainstay of treatment was stopping the golimumab. Within one month of these interventions she made a dramatic improvement. Discussion The pathogenesis of PA is yet to be definitively established; however, it has been thought that PA may be a manifestation of an underlying inflammatory skin disease. Most commonly, PA is associated with psoriasis and seborrheic dermatitis. Drug induced cases have also been described. There are case reports of PA occurring in patients treated with valproic acid, vemurafenib and minoxidil. The skin symptoms seen in PA are likely a reaction of hair-bearing scalp to various inflammatory and microbial insults. Moreover, a study undertaken in Egypt found that over 96% of patients with PA had Staphylococcus isolates found in skin swabs taken from the affected scalp. Both S. aureus and S.epidermidis were identified; this could suggest incidental colonisation or that these bacteria play a part in development of PA. Multiple studies have looked at distinguishing microbial biofilms and their structure and physical properties. Resilient biological scaffolding of microbial biofilms, rich in polysaccharides, proteins, lipids, and nucleic acids, is triggered by the bacteria and develops on the scalp and hair shafts. As this continues it promotes accumulation of adherent scale and the hair shafts are increasingly bound together and matted to the scalp. TNF-a is an inflammatory cytokine produced by macrophages during acute inflammation. It causes a range of signalling events within cells, leading to necrosis or apoptosis, which contributes to the pathogenesis of many chronic inflammatory diseases, like psoriasis. However, in some cases TNF-a inhibition can paradoxically lead to new psoriasis or worsening of existing psoriasis. This has been observed with the three major anti-TNF-a agents (infliximab, etanercept and adalimumab). Often it is seen in patients receiving treatment for rheumatoid arthritis or inflammatory bowel disease. On average, cutaneous adverse effects are seen approximately 17 months after starting anti-TNF-a therapy. The most frequently seen presentations are of plaque psoriasis and palmoplantar pustulosis. Key learning points Inhibition of TNF-a causes increased production of interferon-a by dendritic cells, which has been associated with induction of psoriasis. Interleukin-1 (IL-1) has also been implicated in the development of psoriasis. Furthermore, TNF-a can activate apoptosis of potentially autoreactive T-cells. Blockade of this action could lead to T-cell mediated tissue and psoriatic pathology. Anti-TNF-a induced PA is a rare adverse reaction that usually requires drug discontinuation. The exact pathogenetic mechanism is unclear but an imbalance of the cytokine environment has been theorised. Our patient highlights the need to stay vigilant for cutaneous adverse reactions and the evolving diverse spectrum of psoriasiform conditions that can be seen secondary to anti-TNF-a therapy.

Caregiver-reported dental manifestations in individuals with genetic neurodevelopmental disorders.

Children with neurodevelopmental disorders (NDDs) often have poor oral health and dental abnormalities. An increasing number of genes have been associated with neurodevelopmental conditions affecting the oral cavity, but the specific dental features associated with many genes remain unknown. To report the types and frequencies of dental manifestations in children with neurodevelopmental conditions of known genetic cause. A 30-question survey assesing ectodermal and dental features was administered through Simons Searchlight, with which formed a recontactable cohort of individuals with genetic NDDs often associated with autism spectrum disorder (ASD). Data were collected from a largely paediatric population with 620 affected individuals across 39 genetic conditions and 145 unaffected siblings without NDDs for comparison. Drooling, difficulty accessing dental care, late primary teeth eruption, abnormal primary and permanent teeth formation, misshapen nails, and hair loss were more frequent in individuals with NDDs. Additionally, we evidenced an association between three new pathogenic gene variant/oral manifestation pairs: CSNK2A1/unusual primary teeth, DYRK1A/late primary teeth eruption, and PPP2R5D/sialorrhea. Our results demonstrate that genetic NDDs caused by mutations in CSNK2A1, DYRK1A, and PP2R5D are associated with unique dental manifestations, and knowledge of these features can be helpful to personalize dental care.

Porphyria: A metabolic disorder

Porphyrias are heterogenous group of metabolic disorders arising from defects in the heme biosynthetic pathway, each being characterized by a specific partial enzyme deficiency. Also, a flawed gene that control the action of enzyme in the heme synthesis creates a lack of heme and build up of porphyrin. Porphyria can be triggered by environmental factors such as; infections, cigarette smoking, antibiotics, etc. Porphyria can be classified into acute porphyria that causes neurological symptoms, and cutaneous porphyria that cause photosensitivity, affecting the skin. In cutaneous porphyria, the two distinct pattern of skin disease seen are the immediate photosensitivity and vesiculo-erosive skin disease. Symptoms include; abdominal pain, muscle weakness, hallucination, pain in the back or chest, burning pain on the skin, red or brown urine. Long term complication include paralysis, skin scarring, permanent hair loss, gall stones, breathing difficulties, dehydration. It can be diagnosed using blood, urine and stool samples, urine estimation of porphobilinogen is also done. Treatment of porphyria include; administration of heme arginate, regular blood removal, low doses of antimalarial drug, narrow band UVB therapy, avoidance of triggers. It can be prevented by avoiding factors that precipitate it such as; stress, fasting, infection, alcohol.

BH10 Granulomatous scarring alopecia associated with rheumatoid arthritis: a case report with distinct folliculocentric granulomas histologically mimicking granulomatous alopecia areata

Abstract A 54-year-old woman presented with an 8-month history of a superficial erythematous skin lesion on the lower quadrant of her left breast and scarring hair loss in the vertex confirmed by diffuse central alopecia with erythema and tufted hairs. She also reported an 8-year history of seropositive rheumatoid arthritis and a history of breast cancer that was treated by surgery, followed by radiotherapy and tamoxifen. On histological examination, punch biopsy of the scalp showed a distinct folliculocentric pattern of multi­nucleated giant cells associated with a dense lymphocytic infiltrate in the hair follicular isthmic and infundibular areas extending into the subcutis, with some hair follicular tufting. Immunohistochemistry confirmed the T-cell nature of the lymphocytes. Punch biopsy of the breast showed noncaseating granulomas in the upper and lower dermis. This folliculocentric pattern was well demarcated and not associated with a granulomatous reaction to other skin adnexa. The interfollicular areas were relatively spared. There were no significant lymphocyte epidermotropism, Pautrier microabscesses or atypical lymphocytes. The differential diagnosis of the scalp included granulomatous folliculotropic mycosis fungoides; however, in our case, there was association with longstanding rheumatoid arthritis. Other differential diagnoses included granulomatous drug reaction and chronic infections such as mycobacteria and fungi. A very similar folliculocentric pattern has been described in only a handful of extremely rare cases of granulomatous alopecia areata (Wilk M, Zelger BG, Zelger B. Granulomatous alopecia areata. J Cutan Pathol 2014; 41:329–31); however, the granulomas are mainly in the hair bulb and spare the higher section of the hair follicle. The lesion in the breast was an area of previous radiotherapy for breast cancer. Other working diagnoses of the breast lesion included interstitial granulomatous dermatitis and palisading and neutrophilic dermatitis. Treatment consisted of potent topical and systemic steroids, immunosuppression, phototherapy and tumour necrosis factor-α inhibitors. Spontaneous resolution, periods of flares and remission, and treatment-resistant forms have been described. We have reported a case of scarring alopecia with a distinct pattern of folliculocentric noncaseating granulomas associated with granulomatous dermatitis in the breast as a cutaneous manifestation of rheumatoid arthritis. This hair loss is a result of an autoimmune-mediated reaction to the skin and hair follicles. Although folliculocentric noncaseating granulomas have been described in the hair bulb in very rare case reports of granulomatous alopecia areata, this pattern of folliculocentric isthmic and infundibular granulomas has not been clearly described before and needs to be better studied. Early diagnosis by skin biopsy is needed to start treatment in order to avoid permanent scarring hair loss.

BH13 Is this dissecting cellulitis of the scalp in a White child?

Abstract Dissecting cellulitis of the scalp (DCS) is characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Follicular obstruction is a key pathogenic event and is associated with hidradenitis suppurativa and acne conglobate. Commonly, DCS is found in adult men of Afro-Caribbean descent (Arneja J, Vashi C, Gursel E, Lelli J. Management of fulminant dissecting cellulitis of the scalp in the pediatric population: case report and literature review. Can J Plast Surg 2007; 15:211–14). We describe a rare case of a White child who presented with features suggestive of DCS. An 11-year-old boy was referred with a 2-year history of patches of alopecia affecting the occipital scalp which was initially treated as tinea capitis with antifungal creams, but this was ineffective. On examination, there was diffuse, boggy subcutaneous swelling with scarring, overlying erythema and patches of alopecia on the occipital scalp. A course of erythromycin and oral terbinafine showed a partial response of the affected areas, although subsequent new patches of alopecia were noted with a similar manifestation of bogginess and overlying erythema. Systemic examination, blood tests and skin scrapings were unremarkable. While continuing erythromycin, he was counselled for isotretinoin and a referral to a tertiary centre has been made to guide further management. Paediatric scarring alopecia encompasses congenital and acquired causes (Imhof R, Cantwell H, Proffer S et al. The spectrum of pediatric scarring alopecia: a retrospective review of 27 patients seen at Mayo Clinic. Pediatr Dermatol 2021; 38:580–4). The differential diagnosis for our patient included tinea capitis causing irreversible alopecia, and being aware of this phenomenon with late presentations and delayed treatment is vital. Other differentials are discoid lupus and cutaneous morphoea. However, the clinical features in this case are more in keeping with DCS, which is scarcely reported in the paediatric literature. Histological confirmation is not always practical with children, and follow-up to assess course of the disease is prudent. Importantly, the discussion of permanent hair loss with a child and parent remains challenging, and clinicians should be aware of the associated psychosocial impact.

Improving hairdressers' knowledge and identification of scarring alopecia using an educational video.

What is known about this subject in regard to women and their families? Hairstylists have a unique role as they are the first people to notice or to be told about a woman’s hair loss complaints. What is new from this article as messages for women and their families? The current study shows that an educational video increases a hairstylist's knowledge regarding clinical signs and symptoms of scarring alopecias, conditions that largely impact women. Dear Editor, Hair loss can have a significant impact on mental health and quality of life. Early detection and treatment of alopecia can help lessen the associated emotional burden and improve patient outcomes.1 Hair stylists make frequent observations of the hair and scalp of their clients and are uniquely positioned to aid in the early detection of dermatologic conditions affecting the hair and scalp. A 2018 study using an educational video was shown to increase hairdresser knowledge and confidence in detecting melanoma in clients.2 Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA) are 3 forms of inflammatory scarring alopecia that lead to permanent hair loss.3 Early detection of these conditions and referral for diagnosis and treatment are critical. The aim of the current study is to explore whether a video-based education tool aids haircare professionals in identifying early signs of inflammatory scarring alopecia. This institutional review board-approved study included 40 participants with a mean age of 44.1 years and an average of 20.3 years’ experience in the haircare profession. All participants completed a pretest questionnaire to evaluate their knowledge of clinical signs of scarring alopecia. Participants then watched a 15-minute educational video by the supervising author on the topic of signs and symptoms of different types of scarring alopecia with an emphasis on how to identify patients who require urgent dermatologic consultation and completed a posttest questionnaire. Paired t tests were used to measure significant differences between pretest and posttest groups. Concerning participants’ prior hair loss training, 75% reported receiving little to no education about hair loss in their cosmetology curriculum, yet 67.5% reported being asked about hair loss by their clients on a daily or weekly basis (Table 1). Before viewing the educational video, 77.5% of participants had very little or no awareness of/exposure to LPP, FFA, or CCCA. In the post-video questionnaire, the subjects reported greater confidence in their ability to identify LPP, FFA, and CCCA (P < .001) (Table 2). The posttest group showed improvements in knowledge about all aspects of hair loss, with statistically significant improvements in identifying scalp perifollicular erythema and scale as signs of scarring alopecia (50% vs 90%, P < .001). Table 1 - Participant characteristics Female sex, N, % 36, 90 Race, N, % Caucasian 25, 62.5 Black or African American 10, 25 Other 5, 12.5 Age, mean (SD) [range], y 44.1 (10.9) [23–65] Length of time practicing cosmetology, mean (SD) [range], y 20.3 (10.1) [0–38] In cosmetology training, how much education about hair loss, N, % Little or none 30, 75 Some 8, 20 Very much 2, 10 How often do clients ask about hair loss?, N, % Daily 12, 30 Weekly 15, 37.5 Monthly 9, 22.5 Rarely 4, 10 Table 2 - Changes in hairdressers’ scarring alopecia confidence Pre-video confidence in recognizing disorder (0–4) 0 = never heard of it 4 = extremely confident Post-video confidence in recognizing disorder (0–4) P value (paired t test) Lichen planopilaris 0.69 2.47 <.001 Frontal fibrosing alopecia 1.05 2.73 <.001 Central centrifugal cicatricial alopecia 1.08 2.69 <.001 The data demonstrate that an educational video is effective in increasing hairdressers’ knowledge about the clinical signs of inflammatory scarring alopecia. Although the generalizability of these results is limited by a small sample size, this study indicates that training hairdressers in detecting scarring alopecia is a promising avenue for possible earlier detection and improved clinical outcomes. Conflicts of interest None. Funding None. Study approval N/A Author contributions SA: Performance of research, writing/editing, data analysis. MC, IPW, and DH: Writing/editing, performance of research. LB: Research design, performance of research, writing/editing. JP: Research design, writing/editing, supervision. MS: Research design, writing/editing, supervision, data analysis.

Central Centrifugal Cicatricial Alopecia Associated With PDL1 Loss and Increased Expression of Caspase 3: A Case Series.

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that disproportionately affects patients with skin of color. Genetic studies have revealed that approximately 30% of CCCAs are associated with peptidyl arginine deiminase 3 misfolding mutations. Patients with CCCA usually have a poor prognosis with progressive and permanent hair loss. To further characterize CCCA, we evaluated the inflammatory milieu, PDL1, and caspase 3 expression. The data support the idea of CCCA being a CD4-predominant T-cell process. The loss of PDL1 and increase in caspase 3 expression raises the possibility of involvement of the PD1/PDL1 pathway in CCCA.

Histopathology in the Diagnosis of Tinea Capitis: When to Do, How to Interpret?

The diagnosis of tinea capitis is usually made by clinical signs and direct microscopic examination. Early diagnosis of this dermatophytic infection, which may cause permanent hair loss if not treated appropriately, is very crucial. In recent years, the use of dermoscopy has helped with early diagnosis. However, when tinea capitis has an atypical course and develops in adulthood, it can be confused with several diseases, such as psoriasis, seborrheic dermatitis, folliculitis decalvans, acne keloidalis, and dissecting cellulitis. Due to the different treatment approaches and prognoses, it is important to distinguish tinea capitis from invasive dermatoses on the scalp. In this article, histopathological findings of tinea capitis and several advantages and disadvantages of histopathology in the diagnosis of fungal infections are also reviewed and updated.

Extraction of Gallic Acid and Ferulic Acid for Application in Hair Supplements

Food supplements based on antioxidants and vitamins are often prescribed to correct inefficiencies in the human diet and delay diseases such as premature aging and alopecia (temporary or permanent hair loss), given the free radical scavenging activity of these biomolecules. By reducing the concentration of reactive oxygen species (ROS), which promote abnormal hair follicle cycling and morphology, follicle inflammation and oxidative stress are reduced, minimising the effects of these health issues. Gallic acid (GA), which is significantly present in gallnuts and in pomegranate root bark, and ferulic acid (FA), commonly found in brown rice and coffee seeds, are very important antioxidants for the preservation of hair colour, strength and growth. In this work, these two secondary phenolic metabolites were successfully extracted in the Aqueous Two-Phase Systems (ATPS) {ethyl lactate (1) + trisodium citrate (2) + water (3)} and {ethyl lactate (1) + tripotassium citrate (2) + water (3)} at 298.15 K and 0.1 MPa, moving towards the application of these ternary systems in extracting antioxidants from biowaste and their a posteriori processing as food supplements for hair fortification. The studied ATPS provided biocompatible and sustainable media for the extraction of gallic acid and ferulic acid, yielding low mass losses (<3%) and contributing to an eco-friendlier production of therapeutics. The most promising results were obtained for ferulic acid, which attained maximum partition coefficients (K) of 15 ± 5 and (3 ± 2) · 101 and maximum extraction efficiencies (E) of (92.7 ± 0.4)% and (96.7 ± 0.4)% for the longest tie-lines (TLL = 69.68 and 77.66 m%) in {ethyl lactate (1) + trisodium citrate (2) + water (3)} and {ethyl lactate (1) + tripotassium citrate (2) + water (3)}, respectively. Moreover, the effect of pH on the UV-Vis absorbance spectra was studied for all the biomolecules to minimise errors in solute quantification. Both GA and FA were found to be stable at the used extractive conditions.

Treatment of Frontal Fibrosing Alopecia

Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer‐assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5‐alpha‐reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5‐alpha‐reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.

High dose craniospinal irradiation as independent risk factor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review

PurposeOur aim was to determine the main risk factors related to the occurrence of permanent alopecia in childhood medulloblastoma (MB) survivors.MethodsWe retrospectively analyzed the clinical features of all consecutive MB survivors treated at our institute. We divided the patients into 3 groups depending on the craniospinal irradiation (CSI) dose received and defined permanent alopecia first in terms of the skin region affected (whole scalp and nape region), then on the basis of the toxicity degree (G). Any relationship between permanent alopecia and other characteristics was investigated by a univariate and multivariate analysis and Odds ratio (OR) with confidence interval (CI) was reported.ResultsWe included 41 patients with a mean10-year follow-up. High dose CSI resulted as an independent factor leading to permanent hair loss in both groups: alopecia of the whole scalp (G1 p-value 0.030, G2 p-value 0.003) and of the nape region (G1 p-value 0.038, G2 p-value 0.006). The posterior cranial fossa (PCF) boost volume and dose were not significant factors at multivariate analysis neither in permanent hair loss of the whole scalp nor only in the nuchal region.ConclusionIn pediatric patients with MB, the development of permanent alopecia seems to depend only on the CSI dose ≥ 36 Gy. Acute damage to the hair follicle is dose dependent, but in terms of late side effects, constant and homogeneous daily irradiation of a large volume may have a stronger effect than a higher but focal dose of radiotherapy.