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Galal SA, El-Sayed SK, Henidy MMH. Postpartum Telogen Effluvium Unmasking Additional Latent Hair Loss Disorders. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:15-22. [PMID: 38779373 PMCID: PMC11107900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Obejctive We sought to detect additional underlying hair loss disorders in patients with postpartum telogen effluvium. Methods We completed clinical and dermoscopic evaluations on 200 female participants experiencing postpartum hair loss. Results 9.5 percent of patients were diagnosed with telogen effluvium (TE), 56.0 percent patients were diagnosed with TE with androgenetic alopecia (AGA), 6.5 percent patients were diagnosed with TE and TA, and 28.0 percent patients were diagnosed with TE, AGA, and TA. In the central area, patients with TE displayed upright regrowing hair and single pilosebaceous unit in 100 percent and 94.7 percent of patients, respectively. While patients with TE and AGA, displayed upright regrowing hair, single pilosebaceous unit, and hair diameter diversity greater than 20 percent. In patients diagnosed with TE and TA, the trichoscopic findings were similar in the TE group to the patients diagnosed with TE, AGA, and TA were also similar to the patients with TE and AGA. Regarding the area of traction, there was no difference observed between the patients with TE and TA and patients with TE, AGA, and TA. The frequent findings were hair diameter diversity, empty follicles, and vellus hair. Conclusion Postpartum TE may be associated with other hair loss disorders. Awareness of this is critical to appropriate diagnosis and treatment.
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Affiliation(s)
- Sara Ahmed Galal
- Drs. Galal and El-Sayed are with the Dermatology and Venereology Department and Faculty of Medicine at Al-Azhar University in Cairo, Egypt
| | - Sawsan Khalifa El-Sayed
- Drs. Galal and El-Sayed are with the Dermatology and Venereology Department and Faculty of Medicine at Al-Azhar University in Cairo, Egypt
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Kuczara A, Waśkiel-Burnat A, Rakowska A, Olszewska M, Rudnicka L. Trichoscopy of Androgenetic Alopecia: A Systematic Review. J Clin Med 2024; 13:1962. [PMID: 38610726 PMCID: PMC11012765 DOI: 10.3390/jcm13071962] [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: 02/02/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Androgenetic alopecia, the most common cause of non-scarring hair loss, is a consequence of the gradual miniaturization of the hair follicles. In the majority of male androgenetic alopecia cases, a patient's history and clinical evaluation may be sufficient to establish the diagnosis, while for women, they should be supplemented with trichoscopy. Methods: The PubMed and Scopus databases were used to collate published studies and to analyze the most typical trichoscopic findings in patients diagnosed with androgenetic alopecia. A total of 34 articles were retrieved after exclusion. Results: The most common features identified using trichoscopy included hair diameter variability (94.07% of patients), vellus hairs (66.45%) and the peripilar sign (43.27%). Others, such as the honeycomb pattern, yellow and white dots, were less relevant. Conclusions: We concluded that hair diameter variability, vellus hairs and the peripilar sign represented valuable indicators for the diagnosis of androgenetic alopecia.
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Affiliation(s)
| | - Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008 Warsaw, Poland
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Verma D, Mendiratta V, Garg T, Tripathi S, Tomer S. Assessment of Cardiovascular Risk Factors in Women Having Female Pattern Hair Loss. Indian J Dermatol 2024; 69:7-15. [PMID: 38572043 PMCID: PMC10986877 DOI: 10.4103/ijd.ijd_104_23] [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] [Indexed: 04/05/2024] Open
Abstract
Background Many studies have associated male androgenetic alopecia with the risk of cardiovascular disorders but very few studies have addressed this association in women with FPHL. Materials and Methods This was a cross-sectional hospital-based study in which a total of 50 women (18-45 years) were recruited. The objective was to measure carotid intima-media thickness (CIMT) by doppler ultrasound, Body mass index (BMI), waist circumference, lipid profile, fasting blood sugar (FBS), insulin, testosterone, Sex hormone binding globulin (SHBG), hs-CRP, ESR and fibrinogen, in pre-menopausal women having FPHL and to correlate these parameters with severity of FPHL. The prevalence of Metabolic syndrome (MetS) and Insulin resistance were evaluated. Results Metabolic syndrome and insulin resistance were found in 12 (24%) and 17 (34%) cases respectively. Hypercholesterolemia, elevated LDL levels and hypertriglyceridemia, low HDL levels and hyperinsulinemia were found in 11 (22%), 31 (62%), 9 (18%), 17 (34%) and 7 (14%) cases respectively. 8 (16%) cases were diabetics. Elevated ESR, increased fibrinogen levels and elevated hs-CRP were found in 43 (86%), 10 (20%) and 21 (42%) cases respectively. CIMT was found to be within its normal range. Correlation of CIMT, anthropometric indices (BMI and WC), biochemical markers (serum cholesterol, triglycerides, FBS, and fibrinogen), and presence of metabolic syndrome with severity of FPHL in terms of Ludwig grade was found to be statistically significant. Conclusions The determination of metabolic syndrome, insulin resistance and acute phase reactants such as hs-CRP and fibrinogen may be useful screening methods to detect increased cardiovascular risk in women with FPHL.
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Affiliation(s)
- Damini Verma
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Vibhu Mendiratta
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Taru Garg
- From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Smita Tripathi
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Shaili Tomer
- Department of Radiology, Lady Hardinge Medical College, New Delhi, Delhi, India
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Mohamed NE, Soltan MR, Galal SA, El Sayed HS, Hassan HM, Khatery BH. Female Pattern Hair Loss and Negative Psychological Impact: Possible Role of Brain-derived Neurotrophic Factor (BDNF). Dermatol Pract Concept 2023; 13:e2023139. [PMID: 37557155 PMCID: PMC10412050 DOI: 10.5826/dpc.1303a139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Female Pattern Hair Loss (FPHL) is considered the most common type of hair loss in females. Women with FPHL may suffer from psychological distress and defective social functioning. Patients with psychiatric and neurodegenerative disorders almost have a deficient brain and blood brain-derived neurotrophic factor levels (BDNF). This serum BDNF level may act as a diagnostic marker for negative psychological impact in FPHL patients. OBJECTIVES Evaluate the levels of serum BDNF in patients with FPHL and correlate its level to the severity of alopecia and the degree of psychological impact. METHODS Forty-six female patients with FPHL and 41 healthy age-matched female volunteers as a control were included in the study. Patients filled out a Dermatology Life Quality Index questionnaire. Both patients and controls filled Beck Depression Inventory, Beck Anxiety Inventory, and Perceived Stress Scale (PSS) questionnaires. Serum levels of BDNF were measured for all the participants using the ELISA technique. RESULTS Patients with FPHL had significantly lower levels of BDNF and significantly higher Beck depression inventory score and PSS questionnaire scores. There is a significant negative correlation between serum levels of BDNF and Beck Depression Inventory, Beck Anxiety Inventory, and PSS questionnaire scores. CONCLUSIONS Patients with FPHL are at a high risk to develop chronic stress and depression. The serum level of BDNF is a good predictor for the assessment of chronic stress and depression in FPHL patients.
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Affiliation(s)
- Noha E Mohamed
- Department of Dermatology, STDs, and Andrology, Faculty of Medicine Fayoum University, Faiyum, Egypt
| | | | - Sara A Galal
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hassan Salem El Sayed
- Medical Biochemistry and Molecular Biology, Faculty of Medicine Fayoum University, Egypt The research was conducted in the outpatient clinic of the Department of Dermatology, STDs, and Andrology, Faculty of Medicine, Fayoum University
| | - Hadir M Hassan
- Department of Dermatology, STDs, and Andrology, Faculty of Medicine Fayoum University, Faiyum, Egypt
| | - Basma Hm Khatery
- Department of Dermatology, STDs, and Andrology, Faculty of Medicine Fayoum University, Faiyum, Egypt
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Bains P, Kaur S, Kaur K. Comparison of Dermoscopic Findings in Female Androgenetic Alopecia and Telogen Effluvium and Female Controls in a Tertiary Care Center. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:29-34. [PMID: 35642228 PMCID: PMC9122275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Female androgenetic alopecia (FAGA) is a patterned hair loss caused by progressive miniaturization of hair follicles. This leads to reduction in the number and thickness of hairs, especially in the central, frontal, and parietal scalp regions. Telogen effluvium (TE) is characterized by diffuse hair loss within months of a significant systemic stressor because of premature follicular transition from the anagen to the telogen. OBJECTIVE This article aims to highlight the dermoscopic differences between TE and FAGA compared to healthy female controls. METHODS A total of 124 female patients, which included 31 women with clinical diagnosis of FAGA, 33 with TE, and 60 controls, were enrolled. Two dermatologists independently assessed each patient clinically as well as with dermoscope, recorded the history and examination findings on a proforma, and made a diagnosis. These dermoscopic images were later revised in photographs on the computer. RESULTS There was a statistically significant difference in hair diameter diversity (HDD) between patients with FAGA versus TE and FAGA versus controls (p<0.0001). The difference in the mean percentage of single PSU in both frontal and occipital areas in FAGA versus controls and FAGA versus TE patients was statistically significant. The vellus hair were significantly higher in the FAGA patients than TE and control. CONCLUSION Dermoscopic features of FAGA and TE will help in early detection on the basis of increased proportion of thin and vellus hairs, HDD, perifollicular discoloration, and the presence of a variable number of yellow dots.
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Affiliation(s)
- Pooja Bains
- Dr. Bains is an associate professor with Department of Dermatology Venereology & Leprosy at Sri Guru Ram Das Institute of Medical Sciences & Research in Amritsar, India
| | - Simplepreet Kaur
- Dr. S. Kaur is a consultant deramtologist with the Department of Dermatology Venereology & Leprosy the Government Multispeciality Hospital Sector in Chandigarh, India
| | - Komalpreet Kaur
- Dr K. Kaur is a junior resident at the Department of Dermatology Venereology & Leprosy at Sri Guru Ram Das Institute of Medical Sciences & Research in Amritsar, India
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Penha MÁ, Müller Ramos P, de Souza V, Miot HA. Development and Validation of a Dermoscopic Severity Score for Female Pattern Hair Loss. Skin Appendage Disord 2021; 8:228-235. [PMID: 35707288 PMCID: PMC9149399 DOI: 10.1159/000520108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Despite the high prevalence and impact on quality of life, there are no objective methods to estimate the severity of female pattern hair loss (FPHL). Here, we aimed to develop a dermoscopic severity score for FPHL. Methods: Cross-sectional study involving 76 women with FPHL and 12 controls. Standardized dermoscopic photos of the scalp were taken to evaluate the main findings of FPHL. The variable selection and their scores in the final model were defined by multivariate methods. Twenty participants were retested to assess the reliability, and 10 participants were tested before and after treatment for estimating its sensibility to change after 6 months. Results: Eight patients (11%) presented the Sinclair clinical scale grade I, 40 (53%) presented at grade II, 19 (25%) presented at grade III, and 9 (12%) presented at grades IV and V. In the multivariate exploration, the following variables were considered significant: total terminal hairs, total miniaturized hairs, brown peripilar sign, scalp honeycomb pigmentation, white peripilar sign, and yellow dots. The final model resulted in a high correlation (rho = 0.89) with the ranked clinical assessment. Conclusion: An objective and reliable severity score of FPHL was developed and validated, allowing its use as an additional outcome in therapeutic trials.
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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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8
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Treister-Goltzman Y, Yarza S, Peleg R. Iron Deficiency and Nonscarring Alopecia in Women: Systematic Review and Meta-Analysis. Skin Appendage Disord 2021; 8:83-92. [DOI: 10.1159/000519952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There is no clear-cut evidence in the existing medical literature of an association between iron deficiency and nonscarring alopecia. Objective: The objective of the study was to conduct a systematic review of the medical literature on the prevalence of iron deficiency in women with nonscarring alopecia and compare their ferritin levels with those of women without this condition. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched between June 15, 2019, and July 24, 2019. Studies that evaluated the prevalence of iron deficiency in women with nonscarring alopecia and/or compared ferritin levels in women with and without this condition were entered into the meta-analysis. Thirty-six of 928 identified studies entered the systematic meta-analysis. The meta-analysis was performed using the random-effects method. Results: The overall number of participants was 10,029. The prevalence of ferritin levels from 10 to 15 ng/dL and below was 21% (12; 29). Women with nonscarring alopecia had lower ferritin values at MD = −18.51 ng/dL (−25.85; −11.16, p < 0.01). Conclusion: Women with hair loss can benefit from higher ferritin levels.
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9
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Saqib NU, Bhat YJ, Shah IH, Haq I, Devi R, Shah AA, Shah FY. Assessment, reliability, and validity of trichoscopy in the evaluation of alopecia in women. Int J Womens Dermatol 2021; 7:458-465. [PMID: 34621959 PMCID: PMC8484948 DOI: 10.1016/j.ijwd.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/27/2022] Open
Abstract
Background Alopecia in women is generally difficult to diagnose clinically. Trichoscopy may help make the correct diagnosis in doubtful cases. Objective The aims of the study were to assess the trichoscopic features of different types of alopecia in women, the reliability of trichoscopy vis-à-vis clinical findings, and the validity of trichoscopy in cases with a doubtful clinical diagnosis. Methods A hospital-based observational, cross-sectional study was carried out on female patients with alopecia. A trichoscopic diagnosis was made and correlated with a clinical diagnosis. The validity of trichoscopy in doubtful cases was evaluated by reporting the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value. Results On trichoscopy, increased hair diameter diversity > 20%, single-hair follicular unit, vellus hair, peripilar sign, and focal atrichia were commonly seen in female pattern hair loss. In telogen effluvium, there was a scarceness of specific findings. In cicatricial alopecias, loss of follicular ostia, erythema, white macules, blue-gray dots, white dots, tufted hair, and keratotic follicular plugging were observed. A good agreement between trichoscopy and clinical diagnosis was found (Cohen’s Kappa = 0.824; 95% confidence interval, 0.756–0.892). The validity of trichoscopy in doubtful cases was evaluated using the validity parameters, which were high in all alopecias. Limitations Histopathology testing was not done in all patients. Conclusion Trichoscopy helped reach a definitive diagnosis in patients in whom the clinical diagnosis was doubtful. Thus, trichoscopy is a sensitive and specific investigation that can be valuable in women with alopecia.
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Affiliation(s)
- Najam U Saqib
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Yasmeen Jabeen Bhat
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Iffat Hassan Shah
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Inaam Haq
- Department of Social & Preventive Medicine, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Reeta Devi
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Aaqib Aslam Shah
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Faizan Younis Shah
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
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Chen X, Li X, Chen B, Yin Y, Zhang J, Zhou C. Female Pattern Hair Loss in Female and Male: A Quantitative Trichoscopic Analysis in Chinese Han Patients. Front Med (Lausanne) 2021; 8:649392. [PMID: 33842510 PMCID: PMC8032947 DOI: 10.3389/fmed.2021.649392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/01/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Xi Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China.,Department of Dermatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiangqian Li
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Baifu Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Yue Yin
- Department of Dermatology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Cheng Zhou
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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Ray R, Sharma A. Comparison of 5% minoxidil lotion monotherapy versus its combination with autologous platelet rich plasma in androgenetic alopecia in hundred males. Med J Armed Forces India 2021; 77:355-362. [PMID: 34305291 DOI: 10.1016/j.mjafi.2020.11.010] [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: 05/03/2017] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Androgenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA. Methods This observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter. Results The combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth - photographic assessment and trichoscopic mean diameter. Conclusion We hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.
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Affiliation(s)
- Rahul Ray
- Consultant (Dermatologist), INHS Asvini, Mumbai, India
| | - Aseem Sharma
- Chief Dermatologist, Skin Saga Centre for Dermatology, Mumbai, India
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12
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Salah M, Samy N, Fawzy MM, Farrag AR, Shehata H, Hany A. The Effect of the Fractional Carbon Dioxide Laser on Improving Minoxidil Delivery for the Treatment of Androgenetic Alopecia. J Lasers Med Sci 2019; 11:29-36. [PMID: 32099624 DOI: 10.15171/jlms.2020.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2 ) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.
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Affiliation(s)
- Manal Salah
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (N.I.L.E.S), Cairo University, Cairo, Egypt
| | - Nevien Samy
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (N.I.L.E.S), Cairo University, Cairo, Egypt
| | - Marwa Mohamed Fawzy
- Department of Dermatology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Abdel Razik Farrag
- Pathology Department, Medical Division Research National Research Centre, Cairo, Egypt
| | - Hany Shehata
- Department of Dermatology and Venereology, National Research Centre (NRC), Cairo, Egypt
| | - Aya Hany
- Department of Dermatology and Venereology, National Research Centre (NRC), Cairo, Egypt
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Ummiti A, Priya PS, Chandravathi PL, Kumar CS. Correlation of Trichoscopic Findings in Androgenetic Alopecia and the Disease Severity. Int J Trichology 2019; 11:118-122. [PMID: 31360040 PMCID: PMC6580806 DOI: 10.4103/ijt.ijt_103_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Androgenetic alopecia (AGA) refers to the appearance of the common nonscarring progressive patterned loss of terminal hair on the frontal scalp and/or vertex of the scalp in both men and women, seen with increasing age in genetically predisposed individuals. Until recently, a scalp biopsy was the only objective tool to diagnose and monitor the disease severity. Trichoscopy of scalp is a new noninvasive technique applied to facilitate the diagnosis of hair and scalp disorders using a manual or video dermatoscope. We found a significant difference in some of the variables such as brown peripilar sign (BPPS), white peripilar sign (WPPS), focal atrichia which may aid in the diagnosis of early and late stages of both male and female AGA along with its clinical correlation. No significant difference in the occipital area was found in all AGA patients. Aims: This study aims to study the trichoscopic findings of AGA and to correlate their relationship with disease severity in our tertiary care hospital. Settings and Design: This was a prospective, observational study. Subjects and Methods: A total of 91 patients (66 males and 25 females) of the age group between 18 and 70 years, were included in the study at the outpatient department of dermatology in 1 year. Each patient underwent a detailed general physical, systemic, and dermatological examination. The diagnosis of AGA was based on clinical grounds. The type of hair loss in each patient was recorded. Trichoscopic evaluation and capture of trichoscopic images was performed using an eScope Oitez Digital Microscope. Ethics: In accordance with the Helsinki Declaration of 1975 (revised in 2000), the study was approved by Ethical and Scientific Research committees of Care Institute of Medical Sciences, Hyderabad. Statistical Analysis Used: Statistical analysis was carried out with R-studio. Statistical significance in the difference in the outcome variables between the stages was assessed by Fisher's exact test. The statistical test was considered statistically significant at P < 0.05. Results: A positive correlation between clinical and trichoscopic findings with respect to disease severity was seen in some of the variables in our study. Both male and female AGA patients have hair shaft thickness heterogeneity as the most common feature. BPPS is seen in early grades of AGA (P < 0.01); WPPS and focal atrichia are seen in later grades of AGA (P < 0.01). Scalp honeycomb pigmentation was most commonly seen in all stages and is not correlated to the disease severity of AGA. Conclusion: As trichoscopy can reveal early variations in hair follicle diameter long before hair loss becomes clinically visible and has the advantage of examining larger areas in a relatively short duration makes it a practical choice for clinic set up. It adds new easily recognizable images for visual teledermatology. Besides, the easy documentation allows the doctor and patient to view the video graphics images simultaneously and helps in evaluating a therapeutic response by comparing it with pre-treatment images.
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Affiliation(s)
- Amudha Ummiti
- Department of Dermatology Venerology and Leprology, CARE Hospitals, Hyderabad, Telangana, India
| | - Puvvada Swapna Priya
- Department of Dermatology Venerology and Leprology, CARE Hospitals, Hyderabad, Telangana, India
| | - P L Chandravathi
- Department of Dermatology Venerology and Leprology, CARE Hospitals, Hyderabad, Telangana, India
| | - Ch Sudhir Kumar
- Department of Dermatology Venerology and Leprology, CARE Hospitals, Hyderabad, Telangana, India
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Tawfik SS, Sorour OA, Alariny AF, Elmorsy EH, Moneib H. White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes. Int J Dermatol 2018; 57:1221-1228. [DOI: 10.1111/ijd.14140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/13/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Soha S. Tawfik
- Dermatology, Venereology and Andrology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - Osama A. Sorour
- Dermatology, Venereology and Andrology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - Aly F. Alariny
- Dermatology, Venereology and Andrology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - Eman H. Elmorsy
- Dermatology, Venereology and Andrology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - Hoda Moneib
- Department of Dermatology; Venereology and Andrology; Ain Shams University; Cairo Egypt
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15
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Poonia K, Thami GP, Bhalla M, Jaiswal S, Sandhu J. NonScarring Diffuse Hair Loss in Women: a Clinico‐Etiological Study from tertiary care center in North‐West India. J Cosmet Dermatol 2018; 18:401-407. [DOI: 10.1111/jocd.12559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kavita Poonia
- Department of Dermatology, Venereology and Leprology Government Medical College and Hospital Chandigarh India
| | - Gurvinder Pal Thami
- Department of Dermatology, Venereology and Leprology Government Medical College and Hospital Chandigarh India
| | - Mala Bhalla
- Department of Dermatology, Venereology and Leprology Government Medical College and Hospital Chandigarh India
| | - Shivani Jaiswal
- Department of Biochemistry Government Medical College and Hospital Chandigarh India
| | - Jasleen Sandhu
- Department of Dermatology, Venereology and Leprology Government Medical College and Hospital Chandigarh India
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16
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Lee S, Choe SJ, Lee H, Choi J, Lee WS. Variation in male sex hormone levels among the pattern subtypes of hair loss in patients with androgenetic alopecia. J Dermatol 2018; 45:240-241. [DOI: 10.1111/1346-8138.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Solam Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Sung Jay Choe
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Hanil Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Jaewoong Choi
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Won-Soo Lee
- Department of Dermatology; Institute of Hair and Cosmetic Medicine; Yonsei University Wonju College of Medicine; Wonju Korea
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17
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Banihashemi M, Nahidi Y, Meibodi NT, Jarahi L, Dolatkhah M. Serum Vitamin D3 Level in Patients with Female Pattern Hair Loss. Int J Trichology 2016; 8:116-20. [PMID: 27625563 PMCID: PMC5007917 DOI: 10.4103/0974-7753.188965] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Female pattern hair loss (FPHL) is the most common cause of alopecia in women, characterized by diffuse nonscarring hair loss in frontal, central, and parietal areas of the scalp. Pathophysiology of FPHL is still not well known, and it is probably a multifactorial genetic trait. FPHL is also observed in women without increased androgen levels, which raises the likelihood of androgen-independent mechanisms and explains the lack of response to antiandrogen treatments in some patients. Vitamin D is a factor that has recently been considered in dealing with these patients. The purpose of this study was to evaluate the serum levels of Vitamin D in patients with FPHL and compare it with healthy controls. Methods: In this case-control study, 45 women with FPHL were evaluated as well as the same number of healthy women matched for age, hours spent under sunlight per day, and body mass index. Serum 25(OH) D3 level was measured using ELISA. Results: 60% of FPHL patients were in 15–30 years old age group with the mean standard deviation (SD) age of 29.11 (7.30) years. In the majority of patients (66.7%), severity of hair loss was Ludwig I. Mean (SD) serum Vitamin D3 level in patient and control group was 13.45 (8.40) and 17.16 (8.96), respectively. T-test showed a significant difference between the two groups in terms of Vitamin D3 serum levels (P = 0.04). Conclusions: This study indicated the correlation between the incidence of FPHL and decreased serum levels of Vitamin D3. It is recommended to evaluate serum Vitamin D3 levels as well as other hormone assays in these patients.
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Affiliation(s)
- Mahnaz Banihashemi
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Nahidi
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Tayyebi Meibodi
- Department of Pathology, Cutaneous Leishmaniasis Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Addiction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Dolatkhah
- Department of Ophthalmology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Malkud S. A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women. J Clin Diagn Res 2015; 9:WC01-4. [PMID: 26436027 DOI: 10.7860/jcdr/2015/14089.6170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diffuse hair loss is a common complaint encountered by dermatologists in their daily clinical practice. Hair loss in women is a distressing condition. Various underlying factors individually or in combination contribute to the pathogenesis. OBJECTIVES To determine causes of diffuse hair loss in women and to find the association between probable causes and relevant laboratory parameters, wherever applicable. MATERIALS AND METHODS One hundred and eighty women with diffuse hair loss were included in the study. Detailed history and clinical examination including hair pull test and hair microscopy were done in all study subjects. Specific laboratory investigations for determining iron deficiency anaemia, thyroid dysfunction and parasitic infestation were done. RESULTS Among 180 patients, 116 (64.44%) had telogen effluvium, 28 (15.55%) had CTE, 21 (11.66%) had FPHL and 1 (0.55%) had AE. Fourteen patients (7.77%) had more than one aetiological diagnosis of diffuse hair loss. TE was the commonest type of diffuse hair loss. Incidence of TE and FPHL were highest in the age group of 21-30 years, whereas CTE in 30-40 years. Psychological stress and iron deficiency anaemia were the most common underlying aetiological factors for TE, which is statistically significant (p<0.05). Out of 130 patients with TE, more than one aetiological factor was recorded in 10 cases whereas in 32 cases probable aetiological factors could not be elicited from history. Most cases of CTE were idiopathic. No significant relationship was observed between CTE, haemoglobin level and serum ferritin level. Out of 35 patients with FPHL, low haemoglobin level was observed in 6/20 (30%) and low serum ferritin level in 14/17 (82.35%). CONCLUSION Diffuse hair loss is a multifactorial condition. A detailed history, thorough clinical examination and appropriate investigations help to identify the causative factors and treat them accordingly.
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Affiliation(s)
- Shashikant Malkud
- Senior Resident, Department of Dermatology, Venereology and Leprosy, ESIC Medical College Kalaburagi, Karnataka, India
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Hu R, Xu F, Han Y, Sheng Y, Qi S, Miao Y, Yang Q. Trichoscopic findings of androgenetic alopecia and their association with disease severity. J Dermatol 2015; 42:602-7. [PMID: 25810236 DOI: 10.1111/1346-8138.12857] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Abstract
Trichoscopy is a novel tool for the diagnosis of hair loss disorders such as androgenetic alopecia (AGA), but there are still few reports on the association between trichoscopic findings and disease severity, especially in the Chinese population. A case-control observational study was conducted to observe the trichoscopic findings of AGA and to evaluate their relationship with disease severity. Trichoscopic examination was performed with a handheld dermoscope on 750 Chinese male AGA (MAGA) and 200 female AGA (FAGA) patients, along with 100 male and 50 female normal controls. Trichoscopically, AGA was featured by hair shaft thickness heterogeneity (HSTH), brown peripilar sign (BPPS), white peripilar sign (WPPS), yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation. No significant difference in the occipital area was found between AGA and controls (P > 0.05). HSTH of more than 20% was demonstrated in all MAGA patients, and HSTH of more than 10% was seen in all FAGA patients. WPPS, yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation were positively related to severity of disease (P < 0.05), while BPPS was the contrary (P < 0.05). HSTH is an essential criterion for diagnosing AGA. BPPS was more common in early AGA. However, WPPS, yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation are positively correlated with advanced AGA.
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Affiliation(s)
- Ruiming Hu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yumei Han
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Youyu Sheng
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sisi Qi
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Miao
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qinping Yang
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Kibar M, Aktan S, Bilgin M. Scalp dermatoscopic findings in androgenetic alopecia and their relations with disease severity. Ann Dermatol 2014; 26:478-84. [PMID: 25143677 PMCID: PMC4135103 DOI: 10.5021/ad.2014.26.4.478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/09/2013] [Accepted: 09/14/2013] [Indexed: 11/17/2022] Open
Abstract
Background Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively. Objective Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia. Methods The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ2 analyses, and logistic regression analysis were used for statistical analysis. Results No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia. Conclusion No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.
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Affiliation(s)
- Melike Kibar
- Department of Dermatology, Beypazarı Public Hospital, Ankara, Turkey
| | - Sebnem Aktan
- Department of Dermatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
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Herskovitz I, de Sousa ICV, Tosti A. Vellus hairs in the frontal scalp in early female pattern hair loss. Int J Trichology 2014; 5:118-20. [PMID: 24574688 PMCID: PMC3927167 DOI: 10.4103/0974-7753.125601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Dermoscopy of the scalp (trichoscopy) is a technique to evaluate the skin of the scalp and the hair disorders. It clinically helps to establish early female pattern hair loss (FPHL) without the need for more invasive techniques. Objectives: This work intends to demonstrate new adjunct criteria for the clinical diagnosis of FPHL by determining the number of short vellus hairs encountered in the frontal area of the scalp of female patients with FPHL. Materials and Methods: We retrospectively reviewed the trichoscopy images from 45 women affected by FPHL in initial stages, at 20 fold magnification dermoscopy at 2 cm from the hairline into the frontal area of the scalp. Results: A total of 45 patients images included had more than 20% variability at dermoscopy, criteria utilized to diagnose and included them in the study. All patients were graded as Ludwig I severity, 14 patients had frontal accentuation. The average number of vellus hairs in the frontal area at 20-fold magnification of all patients was of 12.02 vellus hair in the frontal area. When comparing the Ludwid I pattern group versus the Ludwig I with frontal accentuation pattern group there was no statistical difference between the two clinical groups. Conclusions: All 45 patients analyzed in this study were clinically diagnosed with FPHL. The number of vellus hairs in the frontal area was greater than the average found in normal subjects. Most patients (80%) with FPHL had more than or equal to seven vellus hairs per 20-fold magnification field in the frontal area, therefore we suggest that the presence of more than 6 vellus hairs in the frontal scalp at 20-fold magnification can be used as an additional criterion of FPHL.
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Affiliation(s)
- Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
| | - Isabel Cristina Vd de Sousa
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA ; Private Practice, Mexico City, Mexico
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
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