Telogen Effluvium Research Articles

The Effects of the Oral Supplementation with a Natural Keratin Hydrolysate (Kera-Diet®) on Hair and Nails: Randomized, Placebo and Benchmark-Controlled Clinical Trial on Healthy Females

Background Telogen effluvium (TE) and its acute form (aTE) are two of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. ATE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex even if women are more likely to have a lowered quality of life and restricted social contacts as compared to men as a result of hair loss. Brittle nail syndrome (BNS) is a common condition affecting up to 20% of the population, especially women over 50 years of age. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis). In BNS oral supplementation, trace elements and amino acids (especially L-Cystine) have been reported to be useful to ameliorate the nail plate condition. Objective We hypothesized that a nutritional approach, with nutrients of which the composition is close to the human keratin, could be effective to decrease hair loss during telogen effluvium and to improve brittle nails condition. At this purpose, a clinical study was designed to investigate the efficacy of a natural keratin hydrolysate obtained from a non-human source (feathers) on both aTE and BNS. Methods The in vivo effects of a natural keratin hydrolysate, Kera-Diet® (KD) upon human hair and nails condition was tested in a randomized, double-blind, parallel-group, benchmark (BE) and placebo (PL) controlled study involving 60 women during 90 days. In all subjects, Anagen/Telogen hair, hair volume and density, pull test, global photography, hair and nails brightness, and nail plate growth were measured at baseline and after 45 and 90 days of products use. A self-assessment test was carried out at the end of the study. Results With the KD treatment group, hair density, percentage of hair in anagen phase, hair and nails brightness, and nails growth were significantly increased compared to PL treatment group. Interestingly, with this same group, the diagnosis of aTE by pull testing was negative from 45 days. The efficacy of KD was equal to or greater than PL treatment group. Conclusion In this study, we demonstrated that daily oral administration of 1000 mg during 3 months of a natural extensively keratin hydrolysate, Kera-Diet®, associated to trace elements and specific vitamins was effective to improve both hair and nails condition. Furthermore, it demonstrates the role of nutrients in both aTE and BNS.

Platelet-Rich Plasma Treatment for Accelerated Androgenetic Alopecia Pattern Hair Loss After COVID-19 Infection: A Case Series.

Hair-related manifestations such as alopecia areata or telogen effluvium were reported during COVID-19 disease. Accelerated hair loss with androgenetic alopecia (AGA) pattern or management has not been discussed before. This study aimed to examine the accelerated AGA pattern hair loss and management with PRP treatment. This study was designed prospectively and nine patients included to study confirmed PCR test for COVID-19 infection. Patients underwent platelet-rich plasma (PRP) injections for 4sessions. Results were accessed with the hair pull test (HPT) and self-administered hair growth questionnaire (HGQ). Nine patients were admitted with complaints of hair loss after an average of 220±24.2 (min: 182max: 264) day after recovery of COVID-19. Mean age of the patients was 33.8±8.4years old (min: 26, max: 52). Six (66.7%) patients were male, and three (33.3%) of them were female. HPT score decreased to 6.0±1.6 after the first PRP application (p=0.007, CI 95%:2.7-5.2) and decreased to 1.2±0.8 after the last PRP session (p=0.008, CI 95%: 6.4-11.1). Five (55.5%) of the patients described the treatment as "very effective" after treatment with HGQ. Accelerated hair loss associated with COVID-19 continues in long term and PRP treatment provides a satisfactory solution.

A systematic review of acute telogen effluvium, a harrowing post-COVID-19 manifestation.

This systematic review focuses on the clinical features, physical examination findings, outcomes, and underlying pathology of acute telogen effluvium (TE), a type of diffuse hair loss, occurring in coronavirus disease 2019 (COVID-19) recovered patients. MEDLINE/PubMed and Embase databases were queried till October 2021 to identify studies reporting acute TE occurring after COVID-19 recovery. Data were obtained from 19 studies, which included 465 patients who were diagnosed with acute TE. The median age of these patients was 44 years and 67.5% were females. The most common trichoscopic findings were decreased hair density, the presence of empty follicles, or short regrowing hair. The mean duration from COVID-19 symptom onset to the appearance of acute TE was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress.

Expert opinion on current and emerging treatment options in androgenetic alopecia and telogen effluvium: an Indian perspective

<p class="abstract">The diagnosis and management of hair loss needs an organized and systematic approach for recognizing pattern of hair loss and identification of hair loss etiology. Early and specific diagnosis is essential to initiate appropriate treatment in the early phases of hair loss. Topical minoxidil and oral finasteride are the only approved drugs for androgenetic alopecia (AGA). Various other treatment options are widely used but have limited clinical evidence. Similarly, there are no specific treatments recommended for telogen effluvium (TE). However, the treatment may become challenging with increasing availability of new formulations and drugs with no substantial evidence to support them. Multiple focused group discussions were conducted among Indian dermatologists to gain expert opinion on appropriate management of AGA and TE in the current scenario. This article summarizes the consensus clinical viewpoints for topical and oral medications, role of nutritional supplements, and other adjunctive therapies in managing AGA and TE. The panel highlighted that the choice of treatment for AGA and TE depends on the individual hair loss pattern and response to medications. A brief discussion on the use of shampoos and procedures has also been highlighted. </p>

The Comparison of Trichoscopic Findings in Female Pattern Hair Loss (FPHL) and Chronic Telogen Effluvium (CTE) in Female Patients

Background: Chronic hair loss is a major complaint in middle-aged females. It is sometime difficult to differentiate between female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients. Trichoscopy is a non-invasive technique that can help to distinguish between FPHL and CTE.
 Aims: To compare the trichoscopic findings in female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients.
 Materials and Methods: It is a cross sectional prospective comparative study carried out in the department of dermatology, Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Wardha, Maharashtra. Adult female patients with ages ranging from 30 to 60 years old complaining of diffuse hair loss were included in the study. Patients with scarring alopecia were excluded from the study. Patients were divided into two groups consisting of 20 patients in each group. Group A and B included patients with FPHL and CTE respectively. Trichoscan (SIF hair analysis system) was performed on frontal region of the scalp.
 Results: Hair diameter variability was significantly seen in FPHL. Hair diameter was reduced in FPHL (0.045) as compared to chronic telogen effluvium (0.063) with statistical difference between them. Hair density was significantly reduced in FPHL (32 ± 12.24) as compared to CTE (60.66 ± 18.12). Vellus hair density was significantly more in FPHL (22.4 ± 14.3) as compared to chronic telogen effluvium (7.73 ± 6.71). Single hair unit was more in FPHL (65 ± 17.08) as compared to chronic telogen effluvium. Density of yellow dots is more significantly observed in female pattern hair loss as compared to chronic telogen effluvium.
 Conclusion: Trichoscopic features based on hair shaft diameter, hair follicular density, vellus hairs, yellow dots and variability in hair shaft diameter can easily help to distinguish female pattern hair loss from chronic telogen effluvium. This differentiation can help dermatologists to plan better and specific management of hair loss in female patients.

Prevalence of Low Serum Vitamin D Levels in Patients Presenting With Androgenetic Alopecia: A Review.

The role of vitamin D receptor (VDR) has been well established and extensively studied in the hair cycle. Its deficiency is also closely linked to several types of alopecia, including alopecia areata, telogen effluvium, and androgenetic alopecia (AGA). Since there is limited research on the correlation between androgenetic alopecia and low serum vitamin D levels, our review aims to find relevant articles and comprehensively present them. A review of the literature was performed to gain insight into AGA. Specifically, PubMed and Google Scholar databases were searched to identify any relevant articles with a focus on androgenetic alopecia, male pattern baldness, and serum vitamin D levels. References within the included articles were also reviewed and taken into the study if found appropriate. All articles that met the inclusion criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcomes data. We found 13 relevant studies that elucidated the relationship between low serum vitamin D levels and androgenetic alopecia and included them in the review. We concluded that serum vitamin D might be a possible parameter for diagnosing the onset and severity of AGA. Vitamin D supplementation has proven to be useful in the regrowth of hair in non-human subjects. Vitamin D could be a valid therapeutic approach, such as topical vitamin D (calcipotriol) seems to be a good treatment option to regrow hair follicles and prevent miniaturization of follicles due to androgenetic alopecia.

Telogen effluvium caused by COVID-19 in Elmhurst, New York: report of a cohort and review.

The prevalence of telogen effluvium (TE) has increased during COVID-19. In this study we describe the clinical characteristics of patients with COVID-19-related TE and review the current literature on COVID-19-associated TE. We conducted a retrospective chart review of 66 patients, all of which had COVID-19 infection (confirmed by PCR or antibodies) and had either non-scarring hair loss or TE in Elmhurst, Queens. Our data suggest that this form of TE is similar to other forms of TE, after which many patients experience regrowth within several months.

Efficacy of QR678 Neo® hair growth factor formulation for the treatment of hair loss in Covid-19-induced persistent Telogen Effluvium-A prospective, clinical, single-blind study.

Telogen Effluvium (TE) in a post-Covid-19 patient causes excessive shedding of hair. No definite treatment is available till now. Past studies demonstrates that QR678Neo® has shown promising results in various types of Alopecia. In this study, we aim to establish efficacy of QR678Neo® hair growth factor formulation administration in Covid-19-induced persistent TE for treatment of hair loss and for hair regrowth. Twenty adult patients (all females) presenting with persistent TE starting few weeks after recovery from Covid-19 infection, and continuing beyond 6months were included for the study. A 1.5mL solution of QR678Neo® hair growth factor formulation was administered in the scalp per session. A total of 8sessions (one session every 4weeks) were done. The results were assessed at the baseline, after 4thsession, and 1month after 8th session. Most of the patients showed significant reduction in hair fall; 89% patients showed excellent hair growth. Global photographic assessment score showed marked improvement, which maintained even post therapy. Videomicroscopic assessment showed increase in the hair count (mean =29.32) after 8th session, that further improved even post therapy. The subjective assessment scores for overall hair growth, appearance of hair, reduction in visibility of the scalp, and hair loss were 4, 4.5, 4.25, and 5, respectively. Management of Covid-19-induced persistent Telogen Effluvium has been unclear and futile so far. Intra-dermal administration of QR678Neo® hair growth factor formulation in the scalp, reduces hair fall, improves hair regrowth, and increases the hair density.

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.

Pattern changes of cutaneous dermatoses among Iraqi women preceding and during the COVID-19 pandemic.

Background: We compared the pattern of cutaneous dermatoses among Iraqi females of all ages between 4 months preceding the coronavirus disease 2019 (COVID-19) pandemic, and the same months 1 year later within the COVID-19 pandemic. Methods: This was a cross-sectional study, that targeted all female patients attending an outpatient clinic for dermatology and venereology in Al-Kindy teaching hospital, Baghdad between October 2019 to the end of January 2020, and the same 4-month duration 1 year later (October 2020 to the end of January 2021) after the COVID-19 peak period had passed and there was no or partial curfew to exclude seasonal impact. Results: A total of 2657 female-patients of all ages were enrolled in this study with 1314 females during the 4 months pre COVID-19, and 1343 females during the pandemic. The mean age of patients presented before the pandemic was 27.2±16.6 years, while the mean age of patients during the pandemic was 28.1±15.6 years with no statistically significant difference in mean ages (P >0.05). Hair loss in general with telogen effluvium specifically increased significantly. Cutaneous contagious viral infections were reduced significantly and specifically of these molluscum contagiosum and condylomata accuminata. Other forms of infections including bacterial and parasitic were also reduced while dermatophytosis was increased but not to a significant level. Acne vulgaris, rosacea, lichen planus, urticaria, pityriasis rosea, seborrheic dermatitis, and vitiligo were increased, but psoriasis, alopecia areata, other types of dermatitis, and melasma were reduced but none to a significant level. Conclusions: The COVID-19 pandemic resulted in changes in the pattern of diseases presented to an out-patient clinic for dermatology and venereology. This could be either related to COVID-19 infection or stress associated with the pandemic, because of curfew, or wearing facemasks which maycause a decrease or increase in certain diseases.

COVID-19 induced telogen effluvium.

COVID‐19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID‐19. To assess the frequency of TE in post‐COVID‐19 patients and the correlation between the development of TE and the severity of COVID‐19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS‐CoV‐2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID‐19 and whose hair loss started after COVID‐19 were considered as “COVID‐19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23.772) days after COVID‐19 real‐time reverse transcription polymerase chain reaction (RT‐PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p < 0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID‐19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p < 0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID‐19, compared to those without. TE developed in approximately one‐quarter of people who have had COVID‐19, and our study is the first to detect it. The time to onset of CATE, which was 7–8 weeks after the SARS‐CoV‐2 RT‐PCR positivity, was not much different from post‐infectious TE. Patients with severe COVID‐19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID‐19. During the pandemic, clinicians should consider a previous SARS‐CoV‐2 infection in patients presenting with hair loss.

Hair Loss in Children: A Clinicoetiological Study from South India.

Background:Scalp hair loss in children is one of the common complaints encountered in dermatological practice. Accurate diagnosis of hair loss in children is of major significance as it can have severe psychological implications given the cosmetic importance of hair.Aims:This study aims to study the different causes and clinical presentations of scalp hair loss in children.Materials and Methods:This was a hospital-based descriptive study that enrolled a total of 170 children with scalp hair loss. A detailed history, scalp, and hair examination were done. Bedside investigations such as KOH mount, hair shaft microscopy, and hair pull tests were conducted. Scalp biopsy and dermoscopy were done wherever necessary to confirm the diagnosis.Results:Majority of the children with scalp hair loss were school going and adolescents accounting for 62.4% of cases; 52.4% of patients were male and 47.6% were female. Asymptomatic hair loss was the most common presenting complaint contributing to 71.2% of cases. Patchy pattern of scalp hair loss formed a majority (86.5%) compared to diffuse pattern (13.5%). Around 89.4% of scalp hair loss were of acquired type and remaining 10.6% were of congenital type. Neonatal occipital alopecia (38.9%) was the most common cause of congenital hair loss. However, in the acquired group, 90.1% had nonscarring and 9.9% had scarring alopecia. In the nonscarring group, tinea capitis, alopecia areata, and telogen effluvium accounted for 47.4%, 37.9%, and 8.8% of cases, respectively.Conclusion:Childhood alopecia is different from adult alopecia in terms of causes and the pattern of presentation. There is a scarcity of literature on childhood alopecia from India, hence, this study can serve as a useful guide in understanding the different causes and its presentation in our population. In addition, this study signifies the importance of simple diagnostic tests such as KOH and hair shaft microscopy in the diagnosis of common hair loss conditions in children.

Assessment of the effects of a hair lotion in women with acute telogen effluvium: a randomized controlled study.

Telogen effluvium is a hair loss disorder occurring about 3months after a triggering event. The acute form impairs quality of life, but spontaneous recovery usually begins 3-6months after identification and elimination of the cause, with complete recovery taking around 12months. To investigate the effectiveness and safety of a hair lotion containing creatine, acetyl tetrapeptide-2 and B vitamins for reducing hair loss in acute telogen effluvium. In this open, randomized, controlled study (NCT04652232), women with acute telogen effluvium from two clinical centres were randomly allocated to receive either the lotion and a mild shampoo (intervention group), or the mild shampoo alone (controls). Hair growth parameters and hair loss were measured from phototrichograms at weeks (W) 1, 4, 8 and 16, and through investigator assessments of standardized photographs at W1 and W16. The primary criterion was the change in anagen to telogen (A/T) ratio between W1 and W16. One hundred women (aged 19-50years) were included (intervention group, N=51; controls, N=49). Compared to baseline, the A/T ratio was higher at W16 in both groups and was significantly higher at both W4 and W8 in the intervention group, compared to only at W8 in controls. Significant decreases in telogen hair density were seen at all time points in the intervention group, compared to only at W16 in controls, and the between-group difference was significant at W8 (P=0.0465). A larger reduction in the total number of hairs shed was observed at W8 in the intervention group (P=0.0392). Investigator-assessed scores showed improvements in hair density for the intervention group. Global tolerance of the lotion was excellent. The lotion tested had a significant impact on hair loss in women with acute telogen effluvium and appeared to accelerate recovery from this condition.

330 A novel cosmetic anti-hair loss approach: An extract of Leontopodium alpinum inhibits catagen development

Hair loss disorders, such as telogen effluvium or androgenetic alopecia, as well as reduction of hair volume during aging result mainly from the shortening of the phase during which the hair follicles (HFs) are producing the hair shaft (anagen). Therefore, novel anti hair loss strategies should aim at efficiently inhibiting the development of the regression phase (catagen). Here, we investigated the potential of a novel cosmetically applicable extract deriving from Leontopodium alpinum (Edelweiss), first ex vivo, in human microdissected anagen VI scalp hair follicles (HFs) from three individuals (two females, one male). After 5 days of treatment with the 0.001% edelweiss extract, significantly more HFs remained in anagen and showed increased hair matrix keratinocyte proliferation. Given that higher activity of alkaline phosphatase, and up-regulated expression of versican, and FGF7 was observed in the dermal papilla of female treated HFs, the anagen prolonging effect of the extract may be possibly mediated by stimulation of dermal papilla fibroblasts inductivity. To independently confirm these results, a 5 months double-blind, placebo controlled clinical study on Caucasian volunteers (both male and female, age 18-65, 30 volunteers per group) was conducted. Treatment with the edelweiss extract lead to a significant increase in hair density (Trichoscan) over time, as well as anagen to catagen/telogen ratio (Trichogram) compared to placebo. Therefore, our results provide evidence for a beneficial effect of the Leontopodium alpinum extract as an adjuvant anti-hair loss agent.

COVID-19 pandemic and teledermatology in low-income regions

COVID-19 pandemic and teledermatology in low-income regions

Vitamin D level and telogen hair loss: A Case control study

Abstract&#x0D; &#x0D; Background: Hair loss is a common skin condition. Hair is not a vital organ but losing it has a worse effect on the psychological state of the patient and may interrupt his daily social activities. Telogen effluvium founded to be the commonest noninflammatory cause to diffuse hair loss. Since nutritional disturbances are one of the triggering factors for it. It might be useful in the management of TE Due to the limited number of studies&amp; little information is available on this subject possible role of vitamin D or its deficiency should be studied further.&#x0D; Aim of the study: to determine the association between Telogen effluvium and vitamin D level.&#x0D; Materials and methods: This is a case-control study performed in a period between December 2018 until June 2020; in Baghdad dermatology center at medical city. One hundred women who were seeking treatment for diffuse hair shedding and who hadn’t received treatment or supplements yet and One hundred fifty control subjects are chosen from patients who were referred to the dermatology clinic for the treatment of nevi and who are not pregnant or lactating, had no systemic or local scalp diseases are included in the study. Full History, physical examination performed for all cases including looking for cutaneous diseases, supplements &amp; drug intake. Serum Vitamin D3 is measured using (Ichroma (TM), Boditech Med Inc., Korea).&#x0D; Result: A total of 250 females were included in this study, 100 of them got telogen effluvium &amp; 150 were patients who attend dermatology clinic seeking treatments for nevi or skin tag (control group) .The mean age of cases was (22.59 ±4.837 year) that wasn’t significantly different from mean age of control group (23.647±6.022 years) (p-value =0.127). The mean level of Vitamin D was significantly lower than that of control group (11.16±4.49) Vs (18.98±10.65), P value &lt;0.001. Vitamin D mean level in acute phase was significantly higher than that of chronic phase pts. (11.68±4.77 &amp; 9.93 ±3.55 respectively), p value=0.04. Mean vit. D among symptomatic patients. (9.7 ± 3.5) was significantly lower than that among asymptomatic pts. (13±4.19) (p=0.001).No significant association were noticed between job &amp; residence of the patients of both groups, (P-value =0.283 &amp; 0.069 respectively (.&#x0D; Conclusion: Age mean difference was not significant among cases and controls. Deficiency in vitamin D may assume a possible leading cause of telogen effluvium among women with hair loss. Cases were significantly associated with low level of Vitamin D3 than controls.Low level of vitamin D was dominant among housewives, urban women, and among symptomatic patients with acute duration.

Role of nutritional supplements in selected dermatological disorders: A review.

While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder. Literature review of last 15 years was made using the terms "diet in dermatology," "nutrition and skin," "nutritional supplements in dermatology," "nutritional agents and acne," "nutritional agents and alopecia," and "nutritional agents and psoriasis." While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet. Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management.

Dermatological lesions among people living with HIV in Turkey

This study aimed to document the dermatoses and their relationships with CD4+ T lymphocyte counts and clinical stages of disease among people living with HIV followed by our Clinical Department, to investigate the effect of antiretroviral therapy (ART) on findings and to compare with real-world data. Medical records of people living with HIV were analyzed retrospectively in our outpatient clinic from January 2005 to June 2017. A total of 500 patient files were examined. 179 patients with dermatoses were included in the study. Demographic data, clinical and laboratory findings, dermatological findings, type and distribution of lesions, serological and histopathological examinations, diagnosis, treatment, and follow-up of patients were transferred to data forms. 84.4% of the patients were male and the mean age was 38.65 ± 11.6 years. The median CD4+ T lymphocyte count was 253/mm3 (range:0-1067). At least one dermatosis was present in 69.3% of the patients. Compared with their median CD4+ T lymphocyte counts, the ratio of CD4+ T lymphocytes was significantly lower in the group with three or more dermatoses (p = 0.019). Condyloma acuminatum (15.1%), drug eruption (13.4%), seborrheic dermatitis (11.7%), oral candidiasis (11.2%), dermatophytoses (11.2%), syphilis (8.4%), Kaposi's sarcoma (8.4%), and telogen effluvium (8.4%) were the most common dermatoses. Kaposi sarcoma (KS), oral candidiasis, onychomycosis, and molluscum contagiosum were significantly higher in the CD4+ T lymphocyte <200/mm³ group when CD4+ T lymphocyte threshold value was determined as 200/mm³. Compared with other TDF/FTC-containing regimens, a significantly higher proportion of alopecia was reported in patients receiving TDF/FTC/EVG/c (p = 0.007). Dermatoses may be a good clinical marker for detecting clinical stage and diagnosing HIV infection; also, there may be a significant increase in the number of dermatoses in advanced stages. Although there are only a few studies in the literature, it should be kept in mind that ART-associated alopecia rates may increase nowadays when ART is targeted at everyone.

Role of vitamin D in hair loss: A short review.

Vitamin D, a vitamin and hormone, plays an important role in dermatology and dermatotherapeutics, due to its anti-inflammatory and immunomodulatory properties, and regulation of keratinocyte differentiation and proliferation. It also affects the hair cycle, and its role in hair loss is under constant research. This review aims to give a brief overview of vitamin D biology within the hair follicle, role in the etiopathogenesis, and rationale for supplementation in various alopecias. A PubMed literature search was performed to review relevant current literature and studies investigating the role of vitamin D in the etiopathogenesis, as a supplement and a potential therapeutic modality in hair loss. Vitamin D is intricately involved in various signaling pathways of growth and differentiation of hair follicles. Most studies show an inverse relationship between serum vitamin D levels and non-scarring alopecias such as telogen effluvium, androgenetic alopecia, alopecia areata, and trichotillomania. Vitamin D deficiency is also associated with scarring alopecia. However, conclusive studies to demonstrate the benefit of vitamin D administration in correcting hair loss and managing these conditions are lacking. Hence, further studies are needed before vitamin D can be routinely recommended as a treatment modality in these conditions.

Role of proteoglycans in the treatment of alopecia of various genesis

Hair loss has always been and remains an urgent challenge in the world today. Although this condition is not life-threatening, it still has a strong impact on the patients’ quality of life. Hairlines are affected by multiple factors including age, family history, smoking, nutrition, etc. Alopecia can take many forms, and the specialist’s objective is to determine the correct cause of the disorder of hair growth cycle by taking a medical history from a patient.The key role in the pathogenesis of androgenetic alopecia is assigned to changes in hormonal status. Telogen effluvium can be triggered by stress, medication, pregnancy, or other medical conditions. For instance, the high number of patients who have had COVID-19 are now faced with hair loss a few months after recovery.Despite the variety of underlining causes of hair loss, the principle of therapy is the same – the elimination of the trigger and the selection of drugs to normalize the natural hair growth cycle. In this case, the use of drugs containing proteoglycans that are specific proteins involved in the regulation of the hair growth cycle looks promising. Numerous studies demonstrate the efficacy of such proteoglycans as versican, decorin, and syndecan. They activate hair growth and help prolong the anagen phase. This effect of proteoglycans affords to speak about their good therapeutic and even prophylactic properties applied to the problem of hair loss.