Trichoscopy - a valuable tool for identifying conditions mimicking androgenetic alopecia

Androgenetic alopecia (AGA) is the most prevalent type of hair loss in women and men. Recently, a European consensus group published guidelines for the diagnostic evaluation of AGA in men, women, and adolescents. This S1 guideline presents expert opinion-based recommendations for gender-dependent steps in the diagnostic procedure, which can easily be implemented in the daily clinical routine. For diagnosing AGA, detailed anamnesis and objective learning are not enough because there are several conditions mimicking this disease. Trichoscopy can be considered an important, non-invasive tool for diagnosing hair and scalp disorders that may have similar clinical signs to AGA.

Traction Alopecia: Clinical and Cultural Patterns

Background:

Traction alopecia is common and preventable but frequently overlooked disorder.

Objective:

To evaluate patients with traction alopecia.

Patients and Methods:

This study was conducted at the Dermatology Center, Medical City, Baghdad, Iraq, during the period from November 2005 to October 2019. Demographic features like age, gender, disease duration and special hair styling practices and accessories were recorded. Clinical patterns were studied.

Results:

Thirty female patients were included in this study. Their ages ranged from 6 to 47 years with mean age ± SD was 15.63 ± 9.806. Twenty-one (70%) were below the age of 16 years. No patient had tightly curled hair. All cases were asymptomatic apart from hair loss. The fringe sign was observed in 27 (90%) of cases. The response to therapy was poor.

Conclusion:

Traction alopecia is an important type of pressure-induced hair loss evident in children and adults with or without curly hair due mainly due to cultural hair styling practices with its frequency apparently increasing in recent years. The fringe sign is common and of diagnostic importance. It is a preventable form of hair loss which can be reversed if diagnosed early; otherwise, permanent scarring alopecia results. It represents a pressure phenomenon evident worldwide in both non-Sub-Saharan lineage and Sub-Saharan lineage individuals.

Review of traction alopecia in the pediatric patient: Diagnosis, prevention, and management

Hairstyles and practices that frequently apply tension to the hair follicle can result in traction alopecia (TA). Many of the hairstyles and hair practices associated with a higher risk of TA begin at a young age, making early intervention and education advantageous in the pediatric population. Recognizing TA at its reversible stage in the pediatric population is critical as early interventions, and counseling will prevent permanent scarring alopecia. While TA can affect any pediatric patient, this review highlights the reported literature on specific populations with a higher reported prevalence of TA.

Quantifying the impact of braiding and combing on the integrity of natural African hair

BACKGROUND

Afro hair breakage is most commonly attributed to grooming practices such as braiding, hair extensions and weaves, both for chemically treated hair and natural Afro hair. These grooming practices are also frequently associated with traction alopecia in clinical studies. However, there is little to no quantitative scientific data on the surface and internal hair fibre damage caused by grooming, including combing, on Afro hair.

METHODS

Qualitative and quantitative techniques such as scanning electron microscopy, cuticle cohesion and tensile testing were used to determine the effects of frequent braiding on the integrity of female Afro hair in 15 frequent braiders and 15 occasional braiders (control group) in Johannesburg, South Africa. Frequent braiders were women who braided more than 8 times per year, while occasional braiders typically limit braiding to only twice 2 per year. The severity of traction alopecia was quantified in both groups using the standard Marginal Traction Alopecia Scoring system. Surface damage on naturally curly Afro hair, that was combed but not braided, was assessed as another hairstyle option.

RESULTS

All measurements showed a relationship between surface and internal hair fibre damage and braiding frequency. Frequent braiders had thinner hair, with more cuticle damage as shown by SEM and cuticle cohesion assessments. Their hair fibres were also significantly weaker (p < 0.05), as shown by the tensile testing. In addition, they also had higher traction alopecia severity scores. In the combing impact assessment, a linear trend was observed between surface hair fibre damage and the number of combing strokes. Cuticle damage from 480 combing strokes was more severe than that from frequent braiding.

CONCLUSION

Frequent braiding and combing damage natural Afro hair. Quantification of damage caused by different grooming practices identifies a need to develop products that could help mitigate specific hair damage associated with grooming practices. The degree of damage and subsequent hair loss could also be minimized by education on best braiding practices to protect the hair fibre and avoid hair follicle miniaturization caused by high traction hairstyles.

Effect of Behavioral Factors on Severity of Female Pattern Hair Loss: An Ordinal Logistic Regression Analysis

Background: Female pattern hair loss (FPHL) is one of the most common types of hair loss with complex genetic predisposition. A frontal pattern hair loss with ponytail hairstyle is pervasively seen among young Chinese women. The purpose of this study is to investigate the association between the severity of FPHL and behavioral factors which include dietary, and sleep habits, and to test the hypothesis on whether ponytail hairstyle is an independent factor that increases the risks of being more severe on the FPHL scale. Methods: A cross-sectional survey was performed with a structured questionnaire in this study. The severity of FPHL was graded according to basic and specific (BASP) classifications. Ordinal logistic regression analysis was performed to investigate the factors related to the severity of FPHL. Results: 1,825 participants with different severities of FPHL completed the questionnaire. Ordinal logistic regression analysis revealed that the age group between thirty and forty years (OR:2.03, 95% CI: 1.56,2. 65), insufficient time with poor quality (OR:1.30, 95% CI: 1.05,1.62), presence of alcohol consumption (OR:2.15, 95% CI: 1.14,4.42), ponytail hairstyles (OR:2.03, 95% CI: 1.40,2.96), and oily scalps (OR:2.00, 95% CI: 1.65,2.43) were risk factors which increased the odds of being in the more severe type of FPHL, compared to the age group that ranged from eighteen to thirty years, sufficient sleep with good quality, without alcohol consumption, ponytail hairstyles, and oily scalps. Conclusion: Avoiding alcohol consumption and ponytail hairstyles, in combination with proper control of scalp oil, improve sleep quality with sufficient time may help prevent FPHL from deteriorating to the more severe type.