Temporal triangular alopecia and a review of 52 past cases

Small molecule agents against alopecia: Potential targets and related pathways

Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.

Congenital Triangular Alopecia: A Case of Effective Response with 5% Topical Minoxidil in a Male Adolescent

Congenital triangular alopecia (CTA) is a rare entity of non-cicatricial alopecia characterized by triangular or oval-shaped alopecia patches on the frontotemporal region of the scalp. Few therapeutic options exist, and there is currently no effective treatment except for hair transplantation. We report the case of an adolescent boy with CTA who was treated with 5% topical minoxidil solution. During therapy, the patient showed improvement in the form of the appearance of terminal hairs, which started to show after two months of treatment. After eight months of treatment, the affected area was fully covered with dense terminal hairs. The patient did not report any adverse reactions/side effects.

Atypical Congenital Triangular Alopecia (Brauer Nevus): Case Report and Review of Literature in Occipital and Mid-Frontal Localizations

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.

Brauer Nevus of Eyebrow: A Rare Entity

Brauer nevus presents as a local circumscribed area of noncicatricial alopecia. It usually involves the frontotemporal scalp. We report an unusual case of Brauer nevus involving the right eyebrow. Trichoscopy helps to confirm the diagnosis and differentiate this condition from other types of nonscarring alopecias. It also helps to avoid unnecessary diagnostic and therapeutic interventions.

An Unusual Case of Congenital Triangular Alopecia on Frontal Area Successfully Treated by Surgery

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.

Congenital Triangular Alopecia - A Case Report

Congenital triangular alopecia also known as temporal triangular alopecia or Brauer nevus may be present at birth or acquired during the first decade of life. It can present as triangular, oval, or lancet-shaped patch of alopecia. It may be misdiagnosed as alopecia areata, traction alopecia, trichotillomania, tinea capitis, and aplasia cutis congenita. Histopathological features and dermoscopic features help in its diagnosis. There is no effective treatment for it and, in most cases, there is no need for therapeutic intervention. Therapeutic modalities include topical minoxidil, surgical excision, and hair transplantation.

Hair and Scalp Disorders in Children below 2 Years: An Unremarked Sphere

Context:

Hairs contribute significantly to our appearance and are mirror to many systemic diseases. Hair and scalp disorders in children are associated with profound psychological effects arising from concerns of chronicity, severity, and contagiousness, in addition to cosmetic outline. Studies have documented children below 2 years as the most common age group affected by hair and scalp disorders in the pediatric population; however, to the best of our knowledge, none has been carried out exclusively on this age group, so far.

Aims:

To determine the pattern of hair and scalp disorders and their underlying etiologies in children below 2 years.

Settings and Design:

Observational and analytical.

Subjects and Methods:

Fifty consecutive patients, aged 0–24 months presenting with complaints of hair and scalp disorder, to the outpatient department of dermatology of a tertiary care hospital in North India, constituted the study population.

Results:

The most common disorder was seborrheic dermatitis (SD) 56%, followed by transient neonatal hair loss 22%. We also came across interesting cases of plica neuropathica (PN) 4%, trichotillomania 2%, and traction alopecia 6%, apart from a list of other disorders noted. The most common age group was 0–6 months.

Conclusions:

Hair and scalp disorders vary greatly with different demographic areas. In this region of the world, we came across cases of PN due to religious practices. SD was the most prevalent disorder as seen elsewhere. Trichotillomania noted in such a young child was not as a mere habit (as popularly believed), rather an act of anger. Hence, with this study, we want to emphasize the role of detailed history and examination, besides outlining the spectrum of disorders in this age group.

Congenital symmetrical circumscribed patterned non-scarring alopecia of eyebrows: a variant of congenital triangular alopecia or an anatomical variation?

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.

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents

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.

Trichoscopy of Focal Alopecia in Children - New Trichoscopic Findings: Hair Bulbs Arranged Radially along Hair-Bearing Margins in Aplasia Cutis Congenita

PURPOSE

To establish whether trichoscopy can be useful in the differential diagnosis of patchy alopecia in children.

PROCEDURES

The study was a retrospective analysis (2012-2015) and included 68 patients under 6 years of age. The inclusion criteria were age and the presence of 1-3 alopecia patches. A total of 124 alopecia patches were examined with the use of a videodermoscope: 102 alopecia areata, 8 tinea capitis, 6 trichotillomania, 3 temporal triangular alopecia and 5 aplasia cutis congenita.

RESULTS

In all aplasia cutis congenita lesions, trichoscopy revealed elongated hair bulbs visible through the semitranslucent epidermis, seen at the hair-bearing margin and radially arranged. Hair regrowth [upright regrowing hairs (44%), circular hairs (23%) and vellus hairs (20%)] was observed in the majority of alopecia areata patches. For triangular alopecia, upright regrowing hairs (100%; 3/3), vellus hairs (100%; 3/3) and circle hairs (33%; 1/3) were seen inside the alopecia patch.

CONCLUSION

Trichoscopy is a useful technique for the differential diagnosis of patchy alopecia in children. A novel finding in this study indicates that radially arranged hair bulbs visible through the translucent epidermis are characteristic of nonbullous type aplasia cutis congenita.

Evaluation and Management of the Hair Loss Patient in the Primary Care Setting

Alopecias represent a heterogeneous group of disorders with different etiologies, presentations, and treatment options. The evaluation of the hair loss patient includes a comprehensive clinical history and physical examination; appropriate laboratory testing; and if indicated, a scalp biopsy. Treatment methods vary depending on the type of alopecia, and include watchful waiting, topical and systemic formulations, surgery, and treatment of any underlying or associated conditions. Referral to a dermatologist is helpful in diagnostically challenging and difficult to treat cases. Alopecia can cause emotional, mental, and social distress to patients. Early diagnosis and timely institution of appropriate treatment are helpful and comforting to those affected by this disease.

Use of dermoscopy in the diagnosis of temporal triangular alopecia

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.

Congenital Triangular Alopecia

Congenital triangular alopecia (CTA) also known as temporal triangular alopecia is a benign noncicatricial pattern of hair loss. It typically affects the frontotemporal region and rarely involves the temporoparietal or occipital scalp. It is a nonprogressive disorder that presents as a triangular, oval or lancet-shaped patch of alopecia. CTA can manifest at birth or develop later in life. The exact etiology of this condition remains unknown. Rarely, it may be associated with other disorders such as Down's syndrome and phakomatosis pigmentovascularis. The diagnosis is based on its distinct clinical appearance. Histologically, hair follicles are miniaturized and replaced by sparse vellus hair follicles. Tricoscopy using a polarized light handheld dermatoscope can be a useful diagnostic tool. CTA is often asymptomatic and remains unchanged throughout the life. No treatment is required. Surgical intervention with follicular unit hair transplantation can provide a satisfactory cosmetic result. In this paper, we have identified 126 cases of CTA in the published literature cited on PubMed between 1905 and 2015. From the available evidence, 79% of patients with CTA presented with unilateral hair loss, 18.5% with bilateral involvement and rarely, with occipital alopecia (2.5%). There was no gender predilection. These figures are entirely consistent with previously published data. Physicians should remember to consider CTA as a potential diagnosis in any patient presenting with a nonscarring alopecia in order to avoid unnecessary investigations and treatments.

Congenital lipedematous alopecia: adding to the differential diagnosis of congenital alopecia

Lipedematous alopecia is a rare condition of unknown etiology characterized by a thick boggy scalp with varying degrees of hair loss. It is usually seen in adult African-American females, and a case in a 9-year-old was the youngest patient reported thus far. We report on the appearance of this condition in two children, a 6-year-old child and a 10-year-old child. Each presented with congenital patchy hair loss on the occipital area and the left temple. A boggy hairless scalp with soft swelling was detected in both patients. Histological examination showed increased thickness of the subcutaneous fat tissue with a decrease in hair follicles. These features were consistent with a diagnosis of lipedematous alopecia. We report two cases of congenital lipedematous alopecia, which has not been reported previously. Although congenital, these distinct clinical features should be kept in mind in the diagnosis of alopecic hair loss.

Case for diagnosis. Alopecia areata and congenital triangular alopecia

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.

[Acquired alopecia in childhood]

Hair loss and alopecia occur frequently in children. The prevalence of the underlying causes and conditions, treatment options and prognosis differ in part significantly from adulthood. This article focuses on frequent forms of acquired alopecia which are not associated with inflammation or scarring of the scalp. Special attention is given to alopecia areata as the most important entity and to trichotillomania as its most difficult differential diagnosis. Significant forms of diffuse hair loss include anagen-dystrophic and telogen effluvium, androgenetic alopecia and loose anagen hair.

Beyond Gómez-López-Hernández syndrome: recurring phenotypic themes in rhombencephalosynapsis

Rhombencephalosynapsis (RES) is an uncommon cerebellar malformation characterized by fusion of the hemispheres without an intervening vermis. Frequently described in association with Gómez-López-Hernández syndrome, RES also occurs in conjunction with VACTERL features and with holoprosencephaly (HPE). We sought to determine the full phenotypic spectrum of RES in a large cohort of patients. Information was obtained through database review, patient questionnaire, radiographic, and morphologic assessment, and statistical analysis. We assessed 53 patients. Thirty-three had alopecia, 3 had trigeminal anesthesia, 14 had VACTERL features, and 2 had HPE with aventriculy. Specific craniofacial features were seen throughout the cohort, but were more common in patients with alopecia. We noted substantial overlap between groups. We conclude that although some distinct subgroups can be delineated, the overlapping features seen in our cohort suggest an underlying spectrum of RES-associated malformations rather than a collection of discrete syndromes.

Bilateral Temporal Triangular Alopecia Associated with Phakomatosis Pigmentovascularis Type IV Successfully Treated with Follicular Unit Transplantation

Temporal triangular alopecia (TTA), also known as congenital triangular alopecia, is a nonscarring, noninflammatroy, circumscribed form of alopecia. TTA has been associated with several disorders, such as Phakomatosis Pigmentovascularis. Hair restoration surgery using follicular unit transplantation has been a successful treatment modality for TTA. Herein we report such a success that was sustained for over six years.