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Zhang LW, Wu J, Xu RH, Chen T. Solitary circumscribed alopecia. BMJ 2024; 384:e076986. [PMID: 38387993 DOI: 10.1136/bmj-2023-076986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Li-Wen Zhang
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong-Hua Xu
- Institute of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Tao Chen
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
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2
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Guan Z, Shi W, Ren M, Bi T, Su H. Clinical and dermatoscopic features of temporal triangular alopecia in infants. Skin Res Technol 2023; 29:e13294. [PMID: 36973981 PMCID: PMC10155784 DOI: 10.1111/srt.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To summarize the clinical and dermatoscopic features of temporal triangular alopecia in infants and explore the clinical significance of dermatoscopy in the diagnosis of triangular alopecia temporalis in infants. METHODS A retrospective analysis was performed on 20 children with temporal triangular alopecia diagnosed in the dermatology clinic of Tianjin Children's Hospital from January 2015 to December 2021. Dermatoscopy was performed on all children, and images were collected. RESULTS The clinical features of 20 children were 15 males and five females, all of which were born immediately after birth; There were eight cases (40%) in the left temporal region, 10 cases (50%) in the right temporal region, one case (5%) in the head region, and one case (5%) in the occipital region; 19 cases were single (95%), one case was multiple (5%); There were 21 skin lesions, 15 triangular lesions (71.4%), four quasi-circular lesions (19%), and two lance-shaped lesions (9.5%). Trichoscopic features: The hair follicle opening in all skin lesions is normal, and the hair follicle opening can be seen with fluffy hair (vellus hair). The vellus hair is evenly distributed, and the length is diverse (both short and long vellus hair exist in the same hair loss area). There are 14 cases of white vellus hair (70%), five cases of white spots (25%), one case of honeycomb pigment pattern (5%), and one case of vascular dilation pattern (5%). CONCLUSION Temporal triangular alopecia in infants has typical clinical and dermatoscopic characteristics, and the dermatoscopy can provide clinical basis for its diagnosis and differential diagnosis.
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Affiliation(s)
- Zhiwei Guan
- Department of DermatologyTianjin Children's HospitalTianjinChina
| | - Weijie Shi
- Department of DermatologyTianjin Xiqing HospitalTianjinChina
| | - Min Ren
- Department of DermatologyTianjin Children's HospitalTianjinChina
| | - Tiantian Bi
- Department of DermatologyTianjin Children's HospitalTianjinChina
| | - Haihui Su
- Department of DermatologyTianjin Children's HospitalTianjinChina
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3
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Hayashi R, Shimada K, Yokoyama R, Ansai O, Shinkuma S, Shimomura Y, Abe R. Atypical localization of congenital triangular alopecia associated with down's syndrome. Indian J Dermatol 2022; 67:94. [PMID: 35656278 PMCID: PMC9154146 DOI: 10.4103/ijd.ijd_1026_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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4
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Kinoshita-Ise M, Sachdeva M. Update on trichoscopy: Integration of the terminology by systematic approach and a proposal of a diagnostic flowchart. J Dermatol 2021; 49:4-18. [PMID: 34806223 DOI: 10.1111/1346-8138.16233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Rodríguez-Villa Lario A, Ferrando J, Moreno-Arrones ÓM, Gómez-Zubiaur A. Atypical Congenital Triangular Alopecia (Brauer Nevus): Case Report and Review of Literature in Occipital and Mid-Frontal Localizations. Skin Appendage Disord 2021; 7:387-392. [PMID: 34604329 DOI: 10.1159/000514698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Brauer nevus, also known as congenital triangular alopecia (CTA) is a localized alopecia that rarely affects the occipital or mid-frontal region. CTA is a localized follicular hypoplasia, commonly misdiagnosed as alopecia areata. Although named congenital, onset in adulthood is possible. Case Presentation We present a review of literature of eighteen atypical locations, providing 4 new cases to the 9 previously published, with particular attention to trichoscopy and histopathological descriptions in this exceptional presentation forms. Discussion Occipital and mid-frontal Brauer nevus are unusual findings with very few cases reported so far. Because of its rarity and atypical presentation, it can often lead to a misdiagnosis. A higher incidence in the male sex stands clear in these locations. Detection at birth is slightly more frequent than in the classical CTA. Histopathological and trichoscopy findings do not differ from the classical entity, although white or hypopigmented hairs do not seem to be an item present in the mid-frontal forms.
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Affiliation(s)
- Ana Rodríguez-Villa Lario
- Department of Dermatology, Príncipe de Asturias University Hospital, University of Alcalá, Madrid, Spain.,Trichology Unit, Instituto Médico Ricart., Madrid, Spain
| | - Juan Ferrando
- Department of Dermatology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Óscar M Moreno-Arrones
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá., Madrid, Spain.,Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic., Madrid, Spain
| | - Alba Gómez-Zubiaur
- Department of Dermatology, Príncipe de Asturias University Hospital, University of Alcalá, Madrid, Spain.,Trichology Unit, Instituto Médico Ricart., Madrid, Spain
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6
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McKenzie PL, Castelo-Soccio L. Localized hair loss in infancy: a review. Curr Opin Pediatr 2021; 33:416-422. [PMID: 34016809 DOI: 10.1097/mop.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review will address the different causes of localized hair loss in infancy. The data presented here will provide clinicians with the latest understanding of different disorders leading to localized hair loss and will provide recommendations for further management of infants who present with alopecia. RECENT FINDINGS Localized hair loss in infancy is common, but its underlying causes vary greatly. Alopecia in infants can be categorized into congenital, genetic, inflammatory, mechanical, and physiologic causes. Decisions regarding further management are complex, as they often involve not only cosmetic concerns, but also work-up of possible systemic medical issues related to hair loss. SUMMARY Clinicians must be able to distinguish between the different causes of infantile hair loss so that appropriate work-up and further management can be pursued. Factors such as physical appearance, timing of presentation, dermoscopic exam, histopathology, and associated systemic features can help lead clinicians to the correct diagnosis in the case of an infant with localized alopecia.
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Affiliation(s)
- Paige L McKenzie
- Section of Dermatology, Division of Pediatrics, The Children's Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Division of Pediatrics, The Children's Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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The art of prevention: It's too tight-Loosen up and let your hair down. Int J Womens Dermatol 2021; 7:174-179. [PMID: 33937486 PMCID: PMC8072502 DOI: 10.1016/j.ijwd.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Traction alopecia is prevalent in patients of color. Its significance in clinical practice may be underemphasized due to the transient nature of the condition; however, it has the potential to become permanent and cause significant psychosocial distress. Understanding of afro-textured hair and cultural practices, as well as early recognition and treatment, provides an opportunity to prevent permanent traction alopecia and long-term sequelae.
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8
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Affiliation(s)
| | - Dawn Marie R Davis
- Department of Dermatology and.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Megha M Tollefson
- Department of Dermatology and.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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9
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Govindarajulu SM, Srinivas RT, Kuppuswamy SK, Prem P. Trichoscopic Patterns of Nonscarring Alopecia's. Int J Trichology 2020; 12:99-106. [PMID: 33223733 PMCID: PMC7659741 DOI: 10.4103/ijt.ijt_1_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/20/2020] [Accepted: 07/19/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Hair loss (alopecia) is a common problem and is a major cause of psychological stress and anxiety among affected individuals. It is of utmost importance to diagnose these cases at the earliest and treat them accordingly. Trichoscopy provides a noninvasive option that can be used for early diagnosis and monitoring the progression of the hair disorders. Aims and Objectives: To perform trichoscopy and document the findings in patients with nonscarring alopecia's. Materials and Methods: A total of 100 cases satisfying the inclusion criteria were screened for general physical examination and scalp examination including hair shaft and root, and tests for hair anchorage and fragility were also done. The lesions were examined through dermoscope, photographs were taken, and findings were documented. Results: Among the total of 100 cases screened, 57 were female and 43 were male. The mean age of the study group was 26 ± 14.8 years. Females were affected by alopecia areata (AA) and female pattern hair loss (29.8%) equally, whereas males were most commonly affected by AA (41.8%). The common trichoscopic follicular features noted were broken hair (48%), black dots (48%), single hair follicle unit (45%), short vellus hair (44%), upright hair (41%), and yellow dots (40%). The common interfollicular features seen were honeycomb pigmentation (26%) and arborizing red lines (12%). Conclusion: The emergence of newer hair signs on trichoscopic studies aids in identification and has a definitive role in the diagnosis of clinically difficult cases, so it is recommended to use trichoscopy in the routine examination of nonscarring alopecia's.
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Affiliation(s)
| | - Rajashekar Talari Srinivas
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| | - Suresh Kumar Kuppuswamy
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| | - Priya Prem
- Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
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10
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Lueangarun S, Pacharapakornpong S, Tempark T. Transient Treatment Response of Platelet-rich Plasma Injection for Temporal Triangular Alopecia: A Case Report with Dermoscopic Examination Follow-up. Int J Trichology 2020; 12:126-128. [PMID: 33223739 PMCID: PMC7659735 DOI: 10.4103/ijt.ijt_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/17/2020] [Indexed: 11/05/2022] Open
Abstract
Temporal triangular alopecia (TTA) is congenital anomalies that usually develops in childhood, with rarely acquired cases in adults. TTA shares common clinical, dermoscopic, and histologic features of characterized vellus hair formation change, similar to androgenetic alopecia (AGA). Whereas, platelet-rich plasma (PRP) with multiple growth factors can provide treatment efficacy in AGA. Due to limited treatment for TTA, such as topical minoxidil, complete surgical excision, and hair transplantation, the multiple growth factors in PRP is thus postulated to be also effective for TTA treatment, just as in AGA. We present a case of TTA with unsatisfactory treatment outcome of only increased number and thickness of vellus hair by dermoscopic examination follow-up after the 5-session PRP injection and only transient response for 6 months. Unlike, AGA, the PRP injection might not consequently be a suitable treatment option for TTA. Nonetheless, further studies should be performed to investigate the potential treatment modality for TTA.
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Affiliation(s)
- Suparuj Lueangarun
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, Thailand
| | - Sarun Pacharapakornpong
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, Thailand
| | - Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand
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11
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Seol JE, Jin WJ, Yun JY, Kim H. An Unusual Case of Congenital Triangular Alopecia on Frontal Area Successfully Treated by Surgery. Int J Trichology 2020; 12:32-34. [PMID: 32549698 PMCID: PMC7276158 DOI: 10.4103/ijt.ijt_87_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/05/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022] Open
Abstract
Congenital triangular alopecia (CTA) is a form of circumscribed, noncicatricial, and noninflammatory hair loss. It manifests as a triangular or oval-shaped alopecic patch on the frontotemporal region of the scalp and rarely involves the temporoparietal or occipital area. That is why it is also called temporal triangular alopecia. However, there has been just one case reported in the middle frontal area. Here, we report a successfully treated case of CTA in a 17-year-old boy who was born with a 2.5 cm × 3.5 cm alopecic patch in the middle frontal area.
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Affiliation(s)
- Jung Eun Seol
- Department of Dermatology, Inje University Busan Paik Hospital, College of Medicine, Busan, Korea.,Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Woo Jung Jin
- Department of Dermatology, Inje University Busan Paik Hospital, College of Medicine, Busan, Korea
| | - Ji Young Yun
- Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Inje University Busan Paik Hospital, College of Medicine, Busan, Korea
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12
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Yadav D, Khandpur S, Subhadarshani S, Sahni K. Congenital symmetrical circumscribed patterned non-scarring alopecia of eyebrows: a variant of congenital triangular alopecia or an anatomical variation? BMJ Case Rep 2019; 12:e227472. [PMID: 31129634 PMCID: PMC6536221 DOI: 10.1136/bcr-2018-227472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/04/2022] Open
Abstract
Triangular alopecia presents as a unilateral triangular-shaped non-scarring alopecia usually involving the temporal scalp. There are few reports of occipital scalp involvement and bilateral disease. Usually it is seen at 2-3 years of age but occasionally can be present at birth. Here we present a unique case of triangular alopecia involving the eyebrows in a 23-year-old man. He had bilateral symmetrical involvement since birth. Points in favour of triangular alopecia in our case were non-scarring alopecia, oval-to-triangular shape, fringe of terminal hair at superior margin; trichoscopy showing significant decrease in hair diameter diversity with increased number of vellus and intermediate hair and histopathology showing normal hair follicle density and increased vellus and intermediate hair (miniaturisation) with absence of inflammation on histopathology. Other differential diagnoses kept were partial duplication of eyebrows, congenital alopecia areata and mild form of ectodermal dysplasia.
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Affiliation(s)
- Deepika Yadav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sweta Subhadarshani
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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13
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Affiliation(s)
- Yu-Lei Zhao
- Department of Dermatology, The Third Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | - Ru-Zhi Zhang
- Department of Dermatology, The Third Hospital of Soochow University, Changzhou, Jiangsu 213003, China
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14
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Alternative uses of dermoscopy in daily clinical practice: An update. J Am Acad Dermatol 2018; 79:1117-1132.e1. [PMID: 29920317 DOI: 10.1016/j.jaad.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023]
Abstract
Dermoscopy is a noninvasive diagnostic tool that is currently being used for neoplastic skin lesions, several inflammatory and infectious diseases, and skin appendage disorders. As the clinical applications of dermoscopy beyond pigmented lesions are constantly increasing, the aim of this article is to provide an update on this topic. This comprehensive review substantiates how several diseases may show peculiar dermoscopy features so as to enhance the diagnosis and avoid (in selected cases) unnecessary histologic confirmation. In other cases, dermoscopy features may be shared with other conditions, with the advantage of narrowing down the differential diagnosis by ruling out those dermatoses with similar clinical aspect but different dermoscopic presentation.
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15
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Alopecia areata. J Am Acad Dermatol 2018; 78:1-12. [DOI: 10.1016/j.jaad.2017.04.1141] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/01/2023]
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16
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Xu L, Liu KX, Senna MM. A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents. Front Med (Lausanne) 2017; 4:112. [PMID: 28791288 PMCID: PMC5522886 DOI: 10.3389/fmed.2017.00112] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child’s hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders.
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Affiliation(s)
- Liwen Xu
- Harvard Medical School, Boston, MA, United States
| | - Kevin X Liu
- Harvard Medical School, Boston, MA, United States
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
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17
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Kelati A, Baybay H, Mernissi FZ. Temporal Triangular Alopecia in Children: The Same Clinical Feature for Two Distinct Entities. Skin Appendage Disord 2017; 3:64-66. [DOI: 10.1159/000452976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022] Open
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