Significant relationship between temporal hair loss and other scalp areas in female pattern hair loss

The Predictive Value of Midscalp Hair Density and Terminal Hair Percentage in the Severity Evaluation of FPHL Assessed by Trichoscan in a Sample of Chinese Population

BACKGROUND

Female pattern hair loss (FPHL) is the most common hair loss disorder in women, which may impair patient's self-identity. It presents as a diffuse reduction in hair density at the mid and frontal regions of the scalp with preservation of the frontal hairline. TrichoScan can be used as a diagnostic tool and for monitoring patients in male pattern hair loss, but little is known in FPHL with Chinese population.

OBJECTIVE

To explore the predictive value of various TrichoScan characteristics at different areas of the scalp in the diagnosis and evaluation of FPHL.

MATERIALS AND METHODS

A total of 261 FPHL subjects were divided into three groups according to Ludwig classification. Together with 108 healthy controls, they were evaluated by computer-assisted TrichoScan. Various hair parameters were analyzed in the frontal, midscalp, vertex, parietal, and occipital areas of the scalp.

RESULTS

Declining hair densities, terminal hair percentage, hair follicular unit density, mean hair diameter, and average hair/unit combined with increased intermediate hair percentage, and vellus hair percentage were observed across all areas of the scalp for FPHL subjects. Hair density and terminal hair percentage in the midscalp area were the factors most affecting Ludwig classification. The two parameters combined achieved 85.12% correct classification rate and an area under the ROC curve of 0.88 in the diagnosis of FPHL. Additionally, we reported a unique type of FPHL which mostly affected the parietal area, occurring with or without traditional midline changes.

CONCLUSION

FPHL in a Chinese population presented characteristics of reduced hair density and miniaturization of hair follicles in the midline scalp and to a lesser extent in the parietal area. Hair density and terminal hair percentage in the midscalp exhibited the greatest predictive value of Ludwig classification. Our results may further provide the basis for quantitative classification of FPHL.

Current status and development potential of scalp healthcare in the COVID-19 blue era: A critical review focused on Republic of Korea

AIMS

The purpose of this paper was to review the literature focusing on the scalp health of the Korean people in the COVID-19 blue era and the possibility of significant development as an academic.

METHODS

This review paper is a literature review, and the method is a narrative review.

RESULTS

It was found that the higher the awareness of hair loss, the better the scalp and hair management behavior. South Korea needs to develop systematic customized management methods, scalp programs, and products due to the development of the COVID-19 era and the development of the 4th industry.

CONCLUSION

South Korea still needs to improve the expertise of tricolologists and national social security insurance and research along with the growth of the beauty and healthcare service industry in the COVID-19 blue era.

Variation of Hair Follicle Counts among Different Scalp Areas: A Quantitative Histopathological Study

INTRODUCTION

Scalp biopsy is a standard method for the definitive diagnosis of alopecia. The hair count parameters of each scalp area remain unclear. This study aimed to determine hair count values at different scalp locations from histopathology and to establish reference values for each part of the scalp.

METHODS

We obtained biopsy specimens from the frontal, vertex, temporoparietal, and occipital areas of the scalps of normal deceased subjects. All specimens were evaluated for the number of follicular units, hair counts, hair types, and stages of the hair cycle.

RESULTS

In total, 240 specimens were collected from 60 cadavers. Across all scalp sites, the temporoparietal area showed the lowest mean hair count, number of follicular units, terminal and vellus hairs, and terminal-to-vellus hair ratio. The average anagen-to-telogen hair ratio was comparable across all scalp sites. This study did not observe a significant association of hair parameters with gender differences or increasing age in all scalp areas.

CONCLUSIONS

The present study revealed the diversity of the hair index among different scalp areas and suggested that normal hair count values should be separately standardized on each scalp region. Our findings may provide useful reference values for the histopathological evaluation of hair disorders in Asians.

Distinctive age distribution and hair loss pattern putatively highlighting uniqueness of Japanese cases of fibrosing alopecia in a pattern distribution

Fibrosing alopecia in a pattern distribution (FAPD) is a unique entity which presents clinicopathological characteristics of both male/female pattern androgenetic alopecia (AGA) and lichen planopilaris (LPP). This entity was first reported in 2000 and its criteria was recently proposed. Etiopathogenesis of FAPD has been speculated to be immunological destruction involving miniaturized hair follicles but still remains elusive. To date, few Asian FAPD cases have been reported in the literature. In this study, Japanese FAPD cases were identified based on the aforementioned criteria and analyzed to delineate clinicopathological characteristics. By retrospectively revisiting medical records and clinical photographs, 24 Japanese cases comprising 17 women and seven men were diagnosed as FAPD. All male patients had disease onset by their early 30s, whereas most female patients had developed the condition in middle age or later. Their initial diagnoses prior to the diagnostic confirmation of FAPD were mostly LPP. Based on the clinical phenotypes, the cases were categorized into AGA and LPP types. These subtypes were characterized by foremost trichoscopic and histopathological findings of AGA or LPP, respectively. Unlike previously reported cases, our patients tended to manifest hair loss in both vertex and frontal to mid-scalp with minimal regression of anterior hairline, manifesting unique "parachute" pattern, which has been reported as a representative characteristic of East Asian AGA in the literature. Anti-inflammatory therapies seemed to be effective to deter hair loss but insufficient to achieve improvement. Further accumulation of the cases is necessary; however, these findings may provide additional pathophysiological insights into FAPD and highlight uniqueness of the etiology and clinical phenotype of Japanese FAPD putatively influenced by racial predispositions.

Female Pattern Hair Loss in Female and Male: A Quantitative Trichoscopic Analysis in Chinese Han Patients

Objectives: To investigate the trichoscopic features of female pattern hair loss (FPHL) in Chinese Han patients and analyze the difference between male and female patients with FPHL.

Materials and Methods: Trichoscopic images were taken in four different scalp areas, including right frontal hairline, vertex, right parietal and occipital areas. Hair density, hair shaft diameter, vellus hair ratio and single hair follicle unit ratio were counted manually and analyzed.

Results: Seventy-three subjects were enrolled in this study, including 38 patients with FPHL (28 females and 10 males) and 35 normal controls without hair loss. The hair density and hair shaft diameter of FPHL patients reduced in the whole scalp. Vellus hair ratio and single hair follicle unit ratio were both increased in FPHL compared to normal controls. The vertex was the most affected area and the hair shaft diameter showed the most significant difference. Parietal and occipital area were also affected in FPHL. The reduction or increase was correlated with the severity of Ludwig staging. Very few gender differences were detected in male and female FPHL patients.

Conclusion: FPHL patients showed decreased hair density and hair shaft diameter, accompanied by increased vellus hair ratio and single hair follicle unit ratio. Parietal and occipital area can be also affected in FPHL, though not as severe as in vertex area. FPHL in male basically has the same characteristic as those in female patients.

Limitation: The main limitation of the study is the small sample size which only enrolled 10 male FPHL patients, in comparison to the female cases. The findings could not be representative of the normal population with the limited sample size.