|Year : 2014 | Volume
| Issue : 3 | Page : 140-151
|Date of Web Publication||18-Aug-2014|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Poster Presentations. Int J Trichol 2014;6:140-51
Kerion in an immunocompetent adult caused by trichophyton rubrum
Adikrishnan S, Cordelia Babitha S, Krishnakanth M, Murugan S, Mahalakshmi V, Anandan S, Sudha R
Department of Dermatology, Sri Ramachandra University, Chennai, India
Introduction: Kerion is an inflammatory type of tinea capitis which occurs frequently in children and rarely in adults. Case Report: We report a 40 year old woman who presented with a boggy mass over the scalp with pustules and crusts and loss of hair which was clinically diagnosed as Kerion.KOH examination showed hyphae and fungal culture from the hair root growed Trichophyton rubrum.Her symptoms resolved completely after six weeks of treatment with systemic Griseofulvin (750mg/day) and topical Clotrimazole cream. Conculusion: Trichophyton rubrum as a causative for Tinea capitis is rare. Our patient who is not immunocompromised had Tinea capitis due to T.rubrum. This case is presented for rarity of Trichophyton rubrum in Tinea capitis in a healthy adult.
Basic and specific classification- aN indian prospective
Department of Dermatology Dr D Y Patil Hospital and Research Centre, Navi Mumbai, India
Introduction: Basic and Specific Classification(BASP) is a type of classification developed to classify hair loss. We conducted a study in Indian population. The Norwood-Hamilton classification is the most commonly used classification worldwide, but it has many limitations.The basic and specific (BASP) classification was introduced as an improvement over the Norwood-Hamilton classification. Materials and Methods: A total of 761 patients, both male(449) and female(313) were included in the study who had complaint of hair loss and they were categorized with a predetermined proforma along with other significant findings. Median age for males is 46 yrs (ages 23-87) and females is 36 yrs (ages 21-80). Results: In Males Shedding was the most common complaint(53%). Smoking and stress was a significant finding(17%). Paternal history was significant(48%). The most common pattern wasM2V2(21%). Individually M2 was the most common(34%)In Females Thinning was the most common complaint(46.7%). Followed by contraceptive pills (4.5%). Associated findings were-Severe acne-2.6%, Irregular menses-5.4%, Hirsutism-1.9%, 8.3% patients had stress. Maternal history was significant. Individually the most common type was F2(53.4%). Conclusion: BASP can be successfully used in India as a guiding tool by dermatological and non dermatological personnel. Most of the patterns of baldness could be classified by BASP method. Basic types of hair loss had a higher degree of inheritance from the paternal side of the family, regardless of specific type. The BASP classification is a stepwise, systematic, and universal classification system for PHL, regardless of sex.
Comparison of the efficacy and safety of long-pulsed nd:yag laser and ipl in hirsutism
Alka K Makwana
Department of Dermatology, B J Medical College, Ahmedabad, India
Background: Lasers including Nd:YAG and Intense Pulsed Light are increasingly being used for the treatment of hirsuitism. Aims and Objective: To compare the efficacy and safety of long-pulsed Nd:YAG (1064nm) laser and Intense Pulse light(590-1200) in the treatment of idiopathic facial hirsutism. Material and Methods: 40 treatment naive female patients (aged 18-45 years) having facial hirsutism with coarse terminal hair on the androgen dependent sites were randomly divided into 2 equal groups. USG abdomen plus pelvis along with hormonal profile on 2nd day of menstruation were done in every patient. Patients were treated with long-pulsed Nd:YAG laser (group A) and 20 with IPL (group B) at 4-6 weeks interval for six treatments. Efficacy was graded according to a 4-point scale from excellent to poor. Treatment outcome and any complications were observed. Results: After the end of 6 sessions, 40% of the patients in group A showed excellent response as compared to 15% in group B and moderate response was observed 35% and 45% in group A and B respectively. Side effects like transient pain and perifollicular erythema and edema were observed more in group A patients, while post inflammatory hyperpigmentation in group B. Conclusion: On statistical evaluation it was found that Long-pulsed Nd:YAG laser was more effective than IPL for hair removal. Coarser the hair better was the response. Hair regrowth was delayed in between and after the treatment sessions. Statistically insignificant side effects were noted with IPL than with Nd:YAG laser.
Ichthyosis follicularis, atrichia and photophobia: Case series with treatment response
Ameet Dandale, Rachita Dhurat, Jill Chitalia, Kuldeep Bharadwaj, Smita Ghate
Department of Dermatology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, India
Introduction: IFAP syndrome is a rare genetic keratinisation disorder with a probable X linked inheritance characterized by ichthyosis, photophobia and non scarring alopecia since birth. We report 3 cases of IFAP in different sexes with an interesting treatment response. Case Reports: Case 1 and 2 were nine year old and ten year old girls who presented with rough skin over body with partial loss of scalp and eyebrow hair since infancy. Photophobia was present in case 2. Case 3 was a three year old male child who presented with dry rough skin over body and scalp with partial loss and easy breakability of hair and photophobia since birth. Cutaneous examination of all 3 cases revealed non cicatricial alopecia and multiple non inflammatory thorn like keratotic papules over scalp and entire body. Skin biopsy from keratotic follicular lesion on scalp revealed plugging of hair follicles with keratin with no evidence of scarring alopecia. Case 1 and 2 were treated with only 0.025% tretinoin two times/day and case 3 with combination therapy (2% minoxidil and tretinoin two times/day) for 3 months. Case 3 treated with combination therapy showed good hair growth apart from disappearance of keratotic papules. This response was not seen in fist two cases. Conclusion: Thus we propose the use of combination therapy of topical retinoids and minoxidil in comparision to only topical retinoids as a better treatment modality for IFAP syndrome.
Waardenburg syndrome type 1
Bhagirath Singh, Arun Prasath P, Indira Subhadarshini Paul
Department of Dermatology, Vinayaka Mission's Medical College and Hospital, Pudhucherry, India
Introduction: Waardenburg syndrome is a rare autosomal dominant disorder of neural crest cell development with distinct cutaneousmanifestation. It is named after dutch ophthalmologist petruswaardenburg. Incidence is 1in42, 000. Case Report: A 7 days old male baby had presented with white forelock, hypopigmented patch over forehead, back, arms since birth andhyperpigmentation over genitalia.On examination he had dystopia canthorum and broad based nasal root. Detailed family history revealed that many of the family members had heterochromiairidis, whiteforelock with no deafness.There was no hearing loss, which was confirmed by brainstem evoked response audiometry test.No spinal, skeletal deformities and bowel incontinence was noted. Discussion: Waardenburg syndrome type1 is caused by mutation in the PAX8 gene located on chromosome band 2q35.According to the diagnostic criteria proposed by the waardenburg consortium a person must have 2 major or 1 major plus 2 minor criteria to be diagnosed as WS type1.As this patient has 3major and 2 minor criteria we have diagnosed this patient to be waardenburg syndrome type1.Early diagnosis of such patients may help in early treatment, social and vocational training and rehabilitation.The case is being reported for its rarity.
High dose pulse therapy in alopecia totalis
Bhokare Anil Balkrishna
Consultant Dermatologist, Malegaon, India
Introduction: This is a non controlled random study in which we have selected 4 cases of alopecia totalis (AT) who were initially treated with various regimens including small dose pulse therapy, immunomodulators, topical steroids, minoxidil etc. Materials and Methods: 4 patients suffering from alopecia totalis were included in this study. All patients were having disease for more than a year. All patients suffered with alopecia areata initially which rapidly progressed to alopecia totalis and were towards alopecia universalis. All were treated with multiple drugs without results. They were off t/t since last 6 months. Every case was investigated for systemic diseases associated with alopecia. All investigations like haemogram, BSL, TSH, T3, T4, ANA, USG, X-RAY CHEST, etc were within normal limits. Every patient was given 2-2.5 mg/kg body weight of prednisolone on two consecutive days in a week. Results: After investigations pts directly started with high dose pulse therapy. My 1st pt showed very enthusiastic results within 3 months. Finally 3 out of 4 showed very dramatic results within 8-12 wks. One patient lost follow up after 6wks. Conclusion: A high dose pulse therapy is highly effective, safe and can be given on outpatient basis. It can be recommended as one of successful modality in AT and widespread alopecia areata
Successful treatment of secondary cicatricial alopecia by Follicular unit hair transplantation
Binod Kumar Thakur
Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and medical Sciences, Shillong, India
Cicatricial or scarring alopecia implies that follicular epithelium has been replaced by connective tissue. In primary scarring alopecia, the target of inflammation is the follicle where as in secondary cicatricial alopecia, the follicle is merely \'innocent bystander\' in the disease process. Scalp hairs cluster together in natural grouping called as follicular unit. Follicular unit consists of two to four terminal follicles and one or more vellus hair, as well as the associated sebaceous glands, insertion of arrector pilli muscle and the surrounding perifollicular dermal sheath. Presently, the gold standard in hair transplantation is follicular unit transplantation. When in secondary cicatricial alopecia, the hair follicle is completely destroyed the only treatment option remains is hair transplantation. Here we present a case of secondary cicatricial alopecia successfully treated with follicular unit transplantation. In secondary cicatricial alopecia, when the hair follicles are irreversibly destroyed the only treatment option is hair transplantation.
Familial Graham-Little-Piccardi-Lasseur Syndrome
Hita H. Mehta, Chandra Shekhar Jaiswal
Department of dermatology, Government Medical College, Bhavnagar, India
Aim or Objective: To present 2 case reports of Graham-Little-Piccardi-Lasseur syndrome (GLPLS), Which is a rare lichenoid dermatosis defined by the triad of multifocal cicatricial alopecia of the scalp; noncicatricial alopecia of the axilla and groin; and a follicular lichen planus eruption on the body, scalp, or both. Materials and Methods - Two cases of this syndrome in same family (mother and daughter) presented in skin OPD at GMC Bhavnagar. Case 1: A 43 yr old female patient presented with patchy scarring hairloss with follicular plugging on scalp and history of pruritic horny violaceous papules on face, neck and extremities on and off. Face was first site to be involved. white patch and atrophy of the tongue with white steaks on buccal mucosa. Dystrophy of nails noted. Axillary and pubic hair are decreased. Case 2: A 23 yr old female presented with scarring alopecia on scalp and history of follicular papules on retro auricular lesion back and extremities present. History of oral erosion on and off. At present mucous membrane are normal. Axillary and pubic hair are decreased.In both cases biopsy were taken from scalp. CBC and urine tests were done. Results: Histopathology report showed extensive follicular plugging in epidermis, dense perifollicular lymphocytic infiltration in dermis. Both cases had progressive skin involvement. CBC and urine reports were normal. Conclusion: Graham-Little-Piccardi-Lasseur syndrome is a rare disorder. We present these two case report as they both presented with typical signs and symptom in OPD. Both patients are from same family.
Lichen Plano pilaris with acquired hair shaft defects
Charanya,Shwetha Rahul, Murali Narasimhan, Parveen B
Department of Dermatology, SRM Medical College and Research Institute, Kattankolathur, India
Introduction: Lichen Plano pilaris also known as Lichen Follicularis was initially described by Pringle in 1895. It is the commonest cause of adult primary scarring alopecia. We report here a case of Lichen Plano pilaris with acquired hair shaft defects. Case Report: A 22 year old male presented with complaints of hair loss with severe itching over the scalp of 9 months duration. He also reported progressive change in the hair texture resulting in frizzy, dry, coarse, unmanageable hair with easy pluckability. History of peeling of skin and erosions over both hands since 10 years of age was also present. On examination there were patchy areas of hair loss and multiple follicular papules with scaling seen all over the scalp. The hair texture was dry, coarse and frizzy. Painless easy pluckability of hair (hair pull test) +. Multiple erosions with scaling seen over the dorsa of distal phalanges of left hand. Direct microscopy of scalp hair revealed abnormal kinking and torsion of the hair shaft in few hairs. Trichoscopy of scalp revealed perifollicular tubular scales, blue-grey dots and white dots. Scalp biopsy was consistent with Lichen Plano pilaris. Discussion: Hair shaft abnormalities in Lichen Plano pilaris are a result of fibrosis, leading to Secondary kinking and twisting of hair. Conclusion: We report this case of Lichen Plano pilaris with acquired Pili Torti and Kinking of hair for its unusual presentation and paucity of similar case reports in literature.
Clinicopathological analysis of lupus hair
Dhetchenamoorthy.s, vanathi T, sowmya R, Ramesh A, Anandan V
Department of Dermatology, Government Stanley Medical College, Chennai, India
Objective: Aims to analyse the clinical, dermoscopic and pathological features of lupus hair in SLE. Materials and Methods: Four females with SLE with hair changes with mean age of 34 were included in this study. Clinical, pathological, dermoscopic of the above patients with features of dry, coarse and broken hair were analysed. Common clinical findings observed in the patients were sparse, short, dry scalp hair with clusters of regrown hair. Scalp dermoscopy showed scaling, perifollicular telangiectasia with increased numbers of short villous hairs, focal atrichia and decreased hair shaft pigmentation. Histopathological features were consistent with SLE. Conclusion: The lupus hair in patient with SLE presents a unique set of clinical, dermoscopic, and histopathological features.. Treatment of SLE had a favourable impact on lupus hairs
Follicular unit hair transplantation and excimer laser in stable vitiligo
Karthik Y, Shri Nivash, Dhepe Niteen, Munshi Abdul Ahad
Dr. Dhepe's Skin City, PG Institute of dermatology, Solapur, India
Introduction: Vitiligo is a disease of unknown cause, and many medical and surgical therapeutic methods are used to treat it. Objective: Our purpose was to evaluate the effectiveness of follicular unit hair grafting and Excimer laser in a patient with vitiligo which was not responding to any other treatment. Case Report: A patient, 11 years old male presented in Skin City OPD with complaints of three white patches with leukotrichia on his scalp for 5 years which were non-progressive. One of patch was on right sidelock of about 6.5x4.5 cm and other two patches were over frontal forelock extending to midscalp of size about 6.5x4.5 cm and 2.5x4.5 cm respectively. He was treated with homeopathic, ayurvedic and allopathic medicine without success during his course of illness. We advised him follicular unit hair grafting and subsequent Excimer laser treatment. Materials and Methods: Around 600 follicular units were grafted into vitiliginous areas of a patient. After 3 weeks of grafting weekly Excimer laser treatment was started. The response in the form of spreading pigmentation was evaluated periodically. Results: Perifollicular repigmentation around the grafted hair was observed after 3rd sitting and more than 90% repigmentation after 11th sitting of Excimer treatment. Conclusion: Follicular unit hair grafting and subsequent Excimer treatments appears to be an effective method for treating stable vitiligo with leukotrichia especially on hairy parts of the skin.
Anhidrotic ectodermal dysplasia
Karrunya KJ , Daniel SJ, Dhanalakshmi UR, Manoharan K
Department of Dermatology, Madras Medical College, Chennai, India
Introduction: Anhidrotic ectodermal dysplasia is a rare disorder also known as Christ-Siemens-Touraine syndrome More Details. It is commonly transmitted as X-linked recessive disorder. Most cases are caused by mutations in the EDA gene located in chromosome Xq12. It is characterized by triad of signs comprising sparse hair, abnormal or missing teeth and inability to sweat. It occurs in 1 in 100, 000 child births. Case Report: A 6 months old male child, second in birth order, born of non-consanguineous marriage presented with fever on and off since birth. He had history of recurrent chest infection. There were similar complaints in the elder male sibling of 2 years age. On examination the child had sparse, lightly pigmented hair over scalp associated with frontal bossing, depressed nasal bridge and everted lips. Wrinkled, hyper pigmented skin around periorbital region was noted. Teeth had not yet erupted. Skin was rough and dry with absence of sweating. Nails were normal.Skin biopsy showed normal epidermis with absence of cutaneous appendages. The clinical profile and skin biopsy favoured the diagnosis of Anhidrotic Ectodermal Dysplasia. Conclusion: Patients with Anhidrotic Ectodermal Dysplasia have a normal life expectancy and normal intelligence. However, recurrent infections and the lack of sweating may lead to hyperthermia which can cause brain damage or even death in early infancy if left unrecognized, particularly in tropical countries like India. Thus an early diagnosis is important with emphasis on genetic counseling for the families.
Tinea capitis: an adult invasion of a childhood scourge
Keerthi Subramaniam, Saritha Mohanan, Kaliaperumal Karthikeyan
Sri Manakula Vinayagar Medical College, Puducherry, India
Introduction: Tinea capitis or Tinea tonsurans, otherwise known as 'ringworm of the scalp' has been plaguing the paediatric population for over 2000 years. The rare occurrence of adult infections is most commonly reported in patients with AIDS. We report a case of inflammatory tinea capitis in an immunocompetent adult female patient presenting as extensive erosive pustular dermatosis. Case Report: A 52 year-old female patient presented with multiple painful pustules of 6 months duration all over the scalp, associated with loss of hair over the affected areas. Upon hair root examination, ectothrix was detected and histopathology showed multiple arthrospores within hair follicles and hyphae within stratum corneum. The patient was unresponsive to oral antifungals administered for a period of one month, following which a combination of oral corticosteroid with oral antifungal was administered, which produced drastic improvement within a single week. Discussion: Tinea capitis is a common dermatophytic infection of the scalp in children with infrequent occurrence in adults. However, the occurrence among post-menopausal women has been explained by the decrease in sebaceous gland secretions. Conclusion: We present this case owing to the rare occurrence of a childhood infection in adults as well as the presentation mimicking erosive pustular dermatosis. We would like to emphasize that oral corticosteroids can therefore be considered as an essential drug in the treatment of inflammatory tinea capitis.
Trichoscopic findings in androgentic alopecia: Cases vs controls
Leelavathy B, Eswari.L, Aishwarya, Shwetha, Shruthi
Department of Dermatology, Bangalore Medical College & Research Institute, Bangalore, India
Background: Trichoscopy has evolved as a useful tool in various hair loss disorders. In AGA, hair diameter diversity (HDD), perifollicular pigmentation/peripilar sign and yellow dots are trichoscopically observed. In all cases of AGA, HDD more than 20%, which corresponds to vellus transformation is useful hallmark to diagnose early AGA. Objective: To analyse the density and diameter variation according to the different grades of androgenetic alopecia in young males between 18 and 35 years of age. Material and Methods: 30 male patients attending outpatient department of Bowring and Lady Curzon hospital with different grades of androgentic alopecia, were subjected to trichoscopy and trichoscan. Hair density, hair diameter and hair diameter diversity was analysed in the the patients. Trichoscan was also performed on 30 male controls who did not have androgentic alopecia. Results: Hair diameter diversity of > 20% was found in all the 30 patients. This was not so in the controls. Hair density decreased significantly as the grades of alopecia increased. There was no significant difference in the hair diameter between the different grades of alopecia. Conclusion: Trichoscopy and trichoscan can be useful tools in differentiating hair loss due to androgenetic alopecia and other causes of hair loss. They can also be useful tools when therapeutic interventions are involved.
Comparative study of the safety and efficacy of intralesional steroid, tacrolimus (0.1%) ointment and minoxidil (5%) in the treatment of alopecia areata
Department of Dermatology, Father Muller Medical College, Mangalore, India
Aims and Objectives: To evaluate the efficacy between tacrolimus (0.1%), minoxidil (5%) and intra-lesional steroids in the treatment of alopecia areata (AA) and to evaluate the adverse effects associated with above mentioned drugs. Materials and Methods: Data was collected from 1st September 2012 to 31 August 2013 with minimal sample size of 60 with 20 patients in each group. These patients were randomly allocated to group A, group B, and group C. Group A received intra-lesional injection of Triamcinolone acetonide 10mg/ml diluted 1:1 with distilled water using insulin syringe, 0.1ml being injected at each prick 1cm apart, once in three weeks. Group B will received Minoxidil (5%). Group C were received Tacrolimus (0.1%) ointment applied twice a day. All the three modalities of treatment was continued for 12weeks and followed up every three weeks of interval. The response was analyzed by hair regrowth grade (HRG) scale as:scale-i(0-25%), scale-ii(26-50%), scale-iii(51-75%), scale-iv(76-100%). Results: 60 patients completed the study. All three groups showed significant improvement. Group A showed statistically significant clinical improvement (0.05
Conclusion: The study concluded that Intra-lesional corticosteroids are more effective than Minoxidil (5%) lotion and Tacrolimus (0.1%) ointment.
Comparative Evaluation of Intralesional Triamcinolone Acetonide Injection, Narrow Band Ultraviolet B and their Combination in Alopecia Areata
B.B. Mahajan, Sandeep Kaur, B.K. Brar
Department of Skin and V.D, GGS Medical College and Hospital, Faridkot, India
Aims: Alopecia areata, an autoimmune disorder, affects any hair-bearing area. Various treatments have been used for alopecia areata, but none has produced a consistent response. Narrow band ultraviolet B (NBUVB) has not been studied so far. So this study was undertaken for comparative evaluation of intralesional Triamcinolone Acetonide, NBUVB and their combination in alopecia areata. Materials and Methods: Forty patients of alopecia areata (28 males, 12 females) with at least 3 patches were enrolled after written informed consent. Patches were subdivided as follows: Patch 1 - Injection Triamcinolone acetonide 2.5 mg/ml (upto 3 injections) at 3 weekly interval. Patch 2 - NBUVB twice a week for upto 12 weeks. Patch 3 - Combination of injection and NBUVB. Therapeutic response was recorded as regrowth of terminal hair (G0 to G4). The results were analyzed using statistical tools like Friedman test, Kruskal-Wallis Test. Results: Therapeutic response was statistically significant in all the three groups (Friedman test - Patch 1: chi-square=56.857, p = 0.000; patch 2: chi-square=53.226, p = 0.000 and patch 3: chi-square=52.471, p = 0.000). Kruskal-Wallis Test showed statistically significant differences (chi-square=16.313, p = 0.000 at week 12) between the three treatment modalities. At week 12, higher efficacy was seen with Intralesional injection (mean rank= 71.74) followed by combination (mean rank=66.71) followed by NBUVB (mean rank=43.05). There were no untoward side-effects noted in NBUVB group; while pain, minor bleeding and less commonly folliculitis were noted with steroid injection. Conclusions: Intralesional steroid injection is superior to NBUVB in alopecia areata.
En Coup de Sabre - Unusual Cause of Cicatricial Alopecia
Department of Dermatology, Sri Ramachandra University, Chennai, India
Introduction: Linear morphea of the forehead or en coup de sabre (ECDS) is an unusual variant of morphea. It typically occurs in children and has a specific distribution on the frontal scalp and forehead and is usually unilateral.Sclerosis in ECDS lesions may invade deeply to involve underlying muscle and bone and hence becomes an unusual cause of cicatricial alopecia. Case Report: A 15 year old girl presented with 4 years H/O hyperpigmented linear plaque over the left frontoparietal region. There were no lesions elsewhere on his body and no treatment taken earlier.On Examination: A hypopigmented, indurated, and atrophic linear plaque was located on the left paramedian area of the forehead. It extended 4 x5 cm extending from left glabella upto the left frontoparietal area leading to cicatricial alopecia over the underlying area. Investigations: CBC-normal. Anti-nuclear antibody, anti-Ro/SSA, and anti-La/SSB titers were negative. CT Brain- normal. Discussion: ECDS is an unusual cause of cicatricial alopecia due to sclerosis involving the underlying muscle and bone and then progresses to involve the meninges and brain parenchyma, which leads to neurologic sequelae. Treatment- initial use of methotrexate and systemic glucocorticoids, followed by UVA1, PUVA photochemotherapy, narrow-band UVB phototherapy, mycophenolate mofetil, topical tacrolimus, topical vitamin D analogs in combination with topical glucocorticoids and imiquimod. Cosmesis was the primary concern for the young girl and autologus fat fillers was advised.
Naxos syndrome (incomplete form)- an interesting case report
Department of Dermatology, Sri Ramachandra University, Chennai, India
Naxos syndrome is a rare autosomal recessive inherited association of right ventricular dysplasia/dilated cardiomyopathy with woolly hair and palmoplantar keratoderma. Woolly hair appears from birth, palmoplantar keratoderma develops during the first year of life and cardiomyopathy is clinically manifested by adolescence with 100% penetrance. Case Report: A 20-year old female presented with curly hair from birth, multiple fissures and rough palms and soles since the first year of life. H/O palpitation and dyspnoea for 2 months. She is the 4th child born to 2nd degree consanguinous parents. On examination- scalp hair is sparse, fine, pale, curly and brittle having the appearance of woolly hair. Palms and soles showed diffuse palmoplantar keratoderma. Oral cavity- angular cheilitis, buccal mucosa- reticular violaceous pattern. Knees and elbows- hyperpigmented fissured plaques. Investigations: A 2D-echocardiography- trivial TR, trivial MR, normal chamber dilatation and normal LV function. Microscopic examination of the hair with KOH mount - No fungus. Scalp biopsy revealed epidermis with basket weave keratin. The papillary dermis showed a sparse lymphocytic infiltrate around the blood vessels. Hair shaft -angulated outline suggestive of woolly symptoms a diagnosis of Incomplete form of Naxos syndrome was considered.
Restrictive cardiomyopathy with patterned hair loss
Murugan Sundaram, Adikrishnan S, Mahalakshmi V, Sudha R, Krishnakanth M Trishna Vaishali
Department of Dermatology & STD, Sri Ramachandra University, Chennai, India.
Restrictive Cardiomyopathy is a rare disease of the myocardium and the least common of the the cardiomyopathies.Patients invariably develop cardiac failure with significant mortality. We herewith present a patient with restrictive cardiomyopathy wth patterned hair loss. Materials and Methods: A 50 years old female patient presented with progressive loss of hair over the scalp of 2 month duration. Patient is a known case of Restrictive Cardiomyopathy(RCM) for the past 5 years.patient's cardiac condition was diagnosed after she sought treatment for dyspnoea & fainting episode.Examination revealed diffuse hair loss over the vertex, parietal and minimal occupital involvement.Temporal and frontal areas were spared.No scarring was made out over the affected areas of scalp. Results: Echo cardiogram findings concurrent with restrictive cardiomyopathy.Patient has been advised fluid restriction and diuretic medications by the cardiologist. Hematological and biochemical investigations were normal.Patient has been started on biotin supplement and is being followed up. Conclusion Restrictive Cardiomyopathy presenting with patterned hair loss is being presented for its clinical rarity.
Clinico-investigative study of patchy hair loss on the scalp
Preksha Singh,Taru Garg, Shilpi Agarwal, Ram Chander
Department of Dermatology & STD, Lady Hardinge medical college, New Delhi, India
Aims: To study and correlate the clinical and histopathologic pattern of common clinical conditions presenting with patchy alopecia on scalp and also to know the direct immunofluoresence (DIF) findings in cases of cicatricial alopecias. Methods: Fifty-six patients were analyzed. Initially the diagnosis was made on clinical grounds. In all cases one 4mm punch biopsy was performed from the active advancing margin of the patch of alopecia for transverse sectioning. Another biopsy was performed in cases of cicatricial alopecias for vertical sectioning and DIF. Key histopathologic features were assessed in all the cases. Other supporting investigations were also done. Results: Maximum cases (55.4%) belonged to the age group of 20-30 years. Males (55.4%) outnumbered females (44.6%). Single clinical diagnosis was made in 80.4% cases (58.9% nonscarring alopecias and 21.4% scarring alopecias) whereas differential diagnosis were kept in remaining 19.4% cases. Final diagnosis was made in 91.1% (64.3% nonscarring alopecias and 26.8% scarring alopecias) on the basis of concordant clinico-histopathological and/or clinico-histopatho-immunological findings whereas in the rest 8.9% cases neither histopathologic features nor DIF features were suggestive of the clinical diagnosis. Conclusion: Histopathology is a useful tool in the diagnosis of patchy alopecia and must be carried out in cases where diagnosis is in doubt clinically. DIF studies and other investigations may have a supportive role therefore should be carried out.
Tinea capitis presenting as tinea incognito in a 2 months old baby
T.Ramya,Vivek shah,A. Gomathi Chitra, R. Madhu, C. Janaki, K. Manoharan
Madras Medical College, Chennai, India
Introduction: Tinea capitis, a dermatophyte infection of the scalp and hair caused by Trichophyton, Microsporum species is commonly seen in prepubertal children. Case Report: A 2 months old female baby, born of non- consanguinity presented with itchy, scaly lesion over the right side of forehead of 50 days duration. Baby delivered by labor natural was discharged on the 10th day. Next day, mother noticed papules on the forehead which developed to form a scaly plaque within 1 week. Baby was started on clobetasol ointment for a period of 4 weeks by a private practioner. During the first visit, Baby was a well baby with general and systemic examination being normal. Dermatological examination revealed a scaly plaque with crust of size 6*8 cm over the right side of forehead extending to the adjacent frontal region. Differential diagnosis of granuloma and eczematous dermatitis were considered and patient evaluated. Scraping of scales in 10% KOH showed hyaline uniform sized grouped spores and arthrospores. Dermoscopy revealed black dots, comma hair and crusting Culture in SDA agar revealed flat spreading colony, light brown in color with powdery surface. Reverse showed yellow brown pigmentation. Microscopic appearance in LCB showed multiple ellipsoidal 4- 6 celled macroconidia characteristic of Microsporum gypseum. None of the family members had dermatophytosis. Baby was put on Tablet Fluconazole resulting in complete resolution of the lesion. Conclusion: This case is presented to highlight the early onset of tinea capitis presenting as tinea incognito in a neonate, without any index case.
The Hair Damage Dilemma
Rashmi Dharmadhikari, Punit Saraogi
RDC Hair Category, Hindustan Unilever Limited, Mumba, India
Hair fashion trends dictate that people repeatedly subject their hair to mechanical (combing, brushing, ironing) & chemical treatments (coloring, perming, straightening), resulting in tactile/structural changes, cumulatively called as weathering (Hair Damage). Damaged-hair breaks easily and is aesthetically less appealing. Hair damage once occurred isn't reversible through intrinsic body-repair mechanisms. Damaged-hair can be repaired by use of Keratin-active-materials. The study demonstrates the effect of Keratin-Active-materials in shampoo & conditioner on structural-integrity, hair-breakage and texture in comparison to a non-conditioning shampoo. Shampoo and Conditioner containing Keratin-active-materials were evaluated on virgin-hair, double bleached-hair and heat ironed-hair. Differential Scanning Calorimetry (DSC) was used to measure structural integrity, Hair lifecycle rig (HLCR) was used to measure the effect of repeated combing. Texture analyzer (TA) was used to measure smoothness of hair fiber. DSC measures the denaturation temperature, a measure of protein breakdown within the hair fiber: higher the denaturation temperature, higher the protein bonding. DSC measurements on double bleached-hair after 5 washes with shampoo and conditioner containing Keratin-active-materials showed significantly higher denaturation temperature. Double bleached-hair and heat-ironed hair treated with shampoo and conditioner containing Keratin-active-material evaluated on HLCR showed that the hair breakage was significantly reduced after 3 washes when subjected to 1000 combing strokes. Texture analysis (TA) also showed significant improvement in smoothness. To conclude, damaged hair can be repaired by the use of Keratin-active-materials in a shampoo and conditioner format to help the hair restore its structural integrity and external appearance.
Investigation of the efficacy of a novel injectable composition of hair growth factors and peptides in enhancing human hair growth
Rinky Kapoor, Debraj Shome
Cosmetic Dermatology, The Esthetic Clinic, Mumbai, India
Aim: The present study was done to investigate the efficacy of a novel injectable composition of hair growth factors and peptides in enhancing human hair growth. Materials and Methods: A total of 100 patients were treated for hair loss with multiple intradermal injections of a solution, composed of combination of specific growth factors and peptides in optimal strength, given in the scalp, three weekly for 8 such sessions. Videomicroscopic images were taken at baseline, after 4 sessions, after 8 sessions, and 2 months after 8 sessions, and analysed for changes in vellus and terminal hair counts and shaft diameter. Both videomicroscopic and global changes underwent blinded review for evidence of subjective improvement. Patients also answered questionnaires assessing hair growth throughout the study. Results: Results indicate that on an average, patients had a decrease in the number of vellus hairs, increase in number of terminal hairs and increase in shaft diameter. Paired t-testing indicated these results were statistically significant. Blinded evaluation of global images supported an improvement in hair density as well as calibre. All efficacy end points showed significant improvement with therapy (p< 0.05) and the treatment was well tolerated. Conclusion: The tested composition may be a promising option for male and female patterns of hair loss, for those who do not respond to conventional line of therapy for hairloss, those who do not want a hair transplant, or who have hair loss continuing post hair transplant. It reduces hair loss and improves hair growth.
A clinical study of diffuse hair loss in women
Ritu Marfatia, Aarti N Shah
Department of Dermatology, Sheth VS Hospital, Ahmedabad, India
Materials and Methods: A total of 250 females attending skin OPD of VS Hospital Ahmedabad in the period of 2 years with complaints of hair loss were included in the study. Detailed history and physical examination was carried out. Routine investigations, trichogram, trichoscopy and scalp biopsy where necessary were carried out. Results: Patients were in the age group of 10 to 70 years of which 56% were in the age group 21-40 years and 50% presented within 6 months of onset of hair fall. Female pattern hair loss was the most common finding followed by chronic telogen effluvium and acute telogen effluvium respectively. 7 patients had hair shaft abnormality and 2 patients had cicatricial alopecia. 56% of the patients had abnormal hemograms and 31 out of 67 tested had low serum ferritin values. Trichogram revealed abnormality in 72% of patients. The most common finding being decreased anagen to telogen ratio. Trichoscopy findings correlated with the clinical diagnosis. Scalp biopsy was carried out in 2 patients with cicatricial alopecia showed lichen plano pilaris and SCLE. Conclusion: Women presenting with diffuse hair loss is a very common and challenging problem for dermatologists. Timely and appropriate investigations serve as an aid in correct diagnosis and ensure satisfactory treatment outcome.
Prevalence of Hypothyroidism in Men with Androgenetic alopecia
Department of Dermatology, Vydehi Institute of medical sciences and research center, Bangalore, India
Aim: Estimation of prevalence of Hypothyroidism in men with Androgenetic alopecia. Materials and Methods: Men in age group of 20-50yrs with all other underlying causes of hair loss being ruled out were included and evaluated for hypothyroidism by history, examination and necessary laboratory investigations and the results tabulated. Results: 45 men were included in the study. Commonest age group was in the 3rd decade. Majority had disease for 2-3years.10 had low thyroid levels. Out of 10 patients 6 were already on conventional treatment for androgenetic alopecia with no satisfactory improvement.7 patients had TSH levels <20 (subclinical hypothyroidism) and 3 patient had TSH level >20 (hypothyroidism).Other parameters like hb% were within normal limits. Conclusion: Significant number of cases (18%) had low thyroid levels in our study. Androgenetic alopecia is the most common form of hair loss in both sexes in varying severity based on factors like genetics, race, family history and underlying systemic illnesses. In addition, men are more susceptible to disorders like cardiovascular diseases, metabolic syndrome, hypertension, hypothyroidism etc. Though most of the causes have been studied quite extensively, there are very few studies determining the association of androgenetic alopecia in men and hypothyroidism.
Woolly hair in siblings
Shubhra Shukla, Saradha KP, Mohanasundari PS, Ramesh A, Anandan V
Department of Dermatology, Government Stanley medical college, Chennai, India
Background: Woolly hair is the presence of kinky, wavy hair on the scalp of a person of non- African/negroid background. The condition may be Autosomal dominant/autosomal recessive/sporadic, characterised by tightly coiled, markedly curly hair which is short because of shortened growth cycle. Case Report: Two siblings were brought by their mother with complain of tightly curled hair all over scalp, short in length and difficult to comb. Younger sibling had sparse hair and also history of delayed development of speech. Light Microscopy of hair showed elliptical cross section and smaller diameter. No other associated skin or mucosal lesion. Patients were subjected to Chest x-ray, ECG, ECHO, Ophthalmic Examination, all of which were found to be normal. Discussion: Woolly hair is a rare congenital abnormality of structure of scalp hair.It is marked by extreme kinkiness of hair. Woolly hair is either already present at birth or appears in first few months of life. Hair growth is normal but anagen phase is truncated, resulting in short hair. No treatment is currently available. Traumatic, physical, chemical cosmetic treatments should be avoided. Conclusion: This case is highlighted because of its rarity and associated delayed language development in younger sibling. Proper work up should be done to rule out associated abnormalities.
Sporadic congenital hypotrichosis with keratosis pilaris
Siddhi Tiwari, Puneet Bhargava
Department of Dermatology, Venereolgy and Leprology, SMS Medical College and Attached Hospital, Jaipur, India
An 18 year old boy, born out of a non-consanguineous marriage, presented with the complaints of reduced hair density and increased fragility of hair over the scalp since 4 months of age, reduced hair density over the axillary and beard region since puberty (14 years of age). There was no skin, nail, mucosal or sweating abnormality. There was no history of systemic involvement, drug intake. Family history was negative. On examination, there was diffuse involvement of scalp in the form of decreased hair density, which was an admixture of dry, coarse, brittle, black pigmented hair of variable length interspersed with fine, thin, poorly pigmented hair. Perifollicular skin was normal in color and texture, there were no keratotic lesions or evidence of scarring. There was increased fragility on hair pull test. Hair in the axillary and beard region were sparse but normal in color and texture. Hair over the other body sites were normal. Multiple 1-3 mm sized, discrete, follicular, keratotic papules with central horny plugs were present over the back and both arms. Nails and mucosa were normal. On systemic examination, no abnormality was detected. On investigations, routine haematological and biochemical investigations were normal. Hair on light microscopy showed variable shaft diameter at places with no beading, twisting, nodes or fractures. Scalp biopsy shows normal follicles. On the basis of clinical and histological findings, the diagnosis of sporadic congenital hypotrichosis simplex with keratosis pilaris was kept, after exclusion of the other causes of hypotrichosis.
A study of hormonal profile in females with patterned baldness
Sidharth Tandon, Ram Krishna Gautam, Minakshi Bhardwaj, Umesh Garga
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Ghaziabad, India
Aims and Objectives: To study the clinical pattern, histopathological findings and association between hormone levels in females with patterned hair loss. Materials and Methods: Thirty females were recruited as cases after clinical and histopathological conformation of androgenetic alopecia and were grouped into Ludwig, Olsen and Hamilton and Norwood pattern of baldness and were subjected to ultrasonography of abdomen and pelvis. Thirty age and sex matched healthy females were taken as controls. Cases and controls were evaluated for Free and total testosterone, sex hormone binding globulin, serum albumin, Dehyroepiandrosteronesulfate, 17-hydroxy progesterone, Androstenedione, Luetinizing and follicle stimulating hormone, Prolactin and Thyroid profile. Results: Statistically significant increase in the mean levels of Dehyroepiandrosterone sulfate, Prolactin, Androstenedione and free T3 was seen in cases as compared to controls. Statistically significant association was seen between the different patterns of hair loss and raised levels of DHEAS, free and total testosterone. Histopathological findings were increase in percentage of telogen hair in 19 patients, miniaturization and perifollicular fibrosis in 9 patients each and perifollicular inflammation in 17 patients. A combination of all the 4 histopathological findings was not seen in any patient. Eight cases had findings of PCOS on ultrasonography. Conclusions: The above findings confirm an association between female pattern hair loss (FPHL) and hyperandrogenemia and all the histopathological findings may not be necessary to confirm the diagnosis of FPHL. As it was found that about 26.6% of FPHL patients had PCOS in our study, it is suggested that all patients of FPHL should be evaluated for PCOS
Congenital generalized hypertrichosis terminalis-A rare case report
Snehal Tapadiya, N Saravanan, R.Priyavathini, K. Manoharan
Department of Dermatology, Madras Medical College, Hingoli, India
Introduction: Congenital generalized hypertrichosis terminalis (CGHT) is a rare idiopathic condition characterized by universal excessive growth of pigmented terminal hair. It is commonly associated with gingival hypertrophy. Case Report: Four year girl born of nonconsangious marriage presented with excessive hair growth since birth which was progressive.There is no history of systemic complaints or prior drug intake. Mother didn't have any complications during pregnancy and she didn't take alcohol or any other drugs during pregnancy. On examining the child she had excessive coarse terminal hair more over entire back, buttocks and upper limbs.Other parts of body also had excessive hair growth expect over the chest which showed normal growth. There were no obvious facial dysmorphic features or gingival hyperplasia. On investigating the child her thyroid function, USG abdomen, x ray spine and all other routine investigations were normal. Conclusion: This case is presented since congenital generalized hypertrichosis terminalis is rare idiopathic condition which warrants thorough examination and investigations to rule out other causes of generalized hypertrichosis. It not only results in cosmetic disfigurement but also psychosocial trauma to patient and family
Unusual association of verrucous epidermal naevus and hypotrichosis simplex - A case report
Sridhar V, Vanathi T, Ramesh A, Anandan V
Department of Dermatology, Government Stanley Medical College, Chennai, India
Verrucous epidermal naevi (VEN) are congenital, non inflammatory cutaneous hamartomas.Prevalence of the disease varies from 0.1 to 0.5. They occur equally in males and females. They are divided into epidermolytic and non-epidermolytic types.
Hypotrichosis simplex is an autosomal dominant condition where hair is normal at birth but becomes sparse and thin during childhood. The disorder is due to mutations in CDSN gene encodes a protein called corneodesmin. Case Report: A 26 year old female has presented with chief complaints of raised skin lesions over back, left hand and hair loss over scalp since childhood. O/E linear hyperkeratotic warty papules seen over left upper limb and back. There was presence of thin, sparse hair with loss of hair over frontal and left tempero-parietal areas.Other skin and mucosa normal. Nutritional and endocrine causes were ruled out. Discussion: Hypotrichosis usually associated with any ectodermal defects while VEN can occur sporadically. No ectodermal abnormalities detected in this case. And this case is reported for its rare and unusual association.
Chemotherapy induced alopecia (CIA) among children treated for acute lymphoblastic leukemia: A clinico-epidemiological study
Sudarshan R, Maria Kuruvila, Kamalakshi Bhat
Department of Dermatology, Kasturba Medical College, Mangalore, India
Aim: To observe incidence of chemotherapy induced alopecia among children treated for acute Lymphoblastic Leukemia. Material and Methods: Thirty cases of proven diagnosis of Acute Lymphoblastic Leukemia below 16 yrs receiving MCP 841 PROTOCOL chemotherapy were included. Detailed evaluation of hair loss during chemotherapy was carried out and tabulated according to OSLEN CIA grading; Regrowth o-f hair was noticed after follow up for 6 months.
Oslen CIA grading scale:
GRADES % OF HAIR LOSS
0 0% No scalp hair loss
1 1-24% Minimal scalp hair loss
2 25-49% Moderate scalp hair loss
4a 75-95% Extensive scalp hair loss
5 100% Complete scalp hair loss
Results and Observations: Study group had a male predominance (63.33 %) with male: female ratio of (1.7:1). Majority (50%) were less than 5 years of age. Alopecia was observed in 70% (38.09%) cases in grade one followed by grade 4(28.57%), grade 1(14.28) grade 2 and grade 5 was observed in(9.52%). 55% showed hair loss around 3-6wks after onset of chemotherapy. Complete hair regrowth was seen in 62% within six months. Conclusion: 73.3% CIA distribution was seen among children <5yrs with complete recovery in majority of the cases. Early onset of alopecia within <3 weeks after commencing chemotherapy was associated with higher grading of alopecia and prolonged time to recover, since the study population is small further studies are required to confirm our results.
Hypohidrotic Ectodermal Dysplasia with sparse hair- A rare case Report
Sudhakar N, Mani Surya Kumar, Jayanthi N S, Ramesh A, Anandan V
Department of Dermatology, Government Stanley Medical College, Chennai, India
Background: Ectodermal dysplasia is a heriditary disorder characterised by developmental dystrophies of ectodermal derivatives. It is characterised by triad of signs comprising sparse hair, abnormal or missing teeth and inability to sweat. Case Report: A 10 year old boy presented with features of sparse hair over scalp since 2 yrs of age. On examination there is impaired sweating, supraciliary madarosis, abnormality of both primary and permanent dentition. Developmental milestones were normal. Discussion: Owing to the need for treatment at an early stage for anodontia and due to the ill-formed maxillary and mandibular residual ridges, the prosthetic management can be difficult. Effective supportive therapy should also be initiated at the earliest.
Trichoscopy of alopecia areata: A diagnostic aide
Sujana L, Balchandra S Ankad, Savitha L Beergouder
Department of Dermatology, S Nijalingappa Medical College, Bagalkot, India
Objective: Alopecia areata is a common, chronic disorder presents as patchy loss of hair on the scalp, beard area, eyebrows and other parts of body. Trichoscopy, dermoscopy of hair, is a non-invasive diagnostic tool which helps in visualization of subsurface features. Diagnosis of alopecia areata is easy, however, diffuse alopecia, alopecia on the eyebrows, patients presenting with total loss of hair can pose problem in identifying this condition. Trichoscopy, showing particular and specific patterns, can be utilized to diagnose this condition. Objective of our study was to identify the specific patterns of trichoscopy in alopecia areata. Materials and Methods: Fifty patients with alopecia areata were included in the study. Dermlite 3 dermoscope (10 x magnification) with polarized light was employed in the study. Informed consent taken from patients and ethical clearance obtained from the ethics committee of our institute. Histopathological examination confirmed clinical diagnosis. Data collected were analyzed and tabulated in Microsoft excel sheet. The results are presented in proportions and percentages. Results: A total of 50 patients were evaluated and trichoscopy showed yellow dots, exclamation mark hairs, broken hairs, black dots, short vellous hairs in 25(50%), 30(60%), 15(30%), 10(20%), 05(10%) patients respectively. Conclusion: Trichoscopy demonstrates definitive and specific patterns in alopecia areata. It helps not only in diagnosis but also identifies activity and severity of alopecia areata. Yellow dots were observed in every stage of alopecia areata and black dots, exclamation mark hairs, broken hairs were demonstrated in active disease.
Trichorrhexis in the absence of nodes
Department of Dermatology, Bangalore Medical College and Research Institute, Mangalore, India
Trichorrhexis nodosa is the mst common hair shaft anomaly known to occur in humans which can be congenital or acquired in nature. The presence of such a defect in a inherent weak hair shaft is known as Trichorrhexis nodosa congenita. This form of the disease may appear at birth or early infancy, it can occur alone or along with a constellation of systemic symptoms. The congenital disorders that display this defect are Menkes disease, Arginino-succinic aciduria, and trichothiodystrophy. We report a case of increased hair fragility and scarcity of body hair occurring since birth, in twins born of a second degree consanguineous parentage. A detailed hair analysis revealed dry, lustreless, fragile over the scalp and scarcity of body hair. On light microscopy irregularities of the hair shaft, broom-like splintering within the hair shaft and shaft ends were seen. Examination of skin, nail and mucosa were normal and systemic examination revealed no abnormalities. The laboratory examination was normal and revealed no amino aciduria. Thus a diagnosis of Trichorrhexis congenita was made since the defect was congenital in nature, with the presence of shaft fractures and splintering, and the lack of nodes a hallmark feature of Trichorrhexis nodosa.
Tight caps and scarfs as a trigger for pityriasis amiantacea - a clinical & epidemiological analysis of 235 cases
S. Rajagopal, Abdelazis
Department of Dermatology, Beida Teaching Hospital, Libya
Background: Pityriasis Amiantacea is not common in many places but is common in Mediterranean region.This made me to analyze this entity. Materials and Methods: This was a study of 235 cases of PA attending skin opd in Almarj & Albeida Hospital from june 2001 to jan 2014.79 were female children, 64 male children, 49 adult females & 43 adult males.The condition affected females more than males.Some cases of mild itching with thick adherent and matted hair in the scalp.Few associated with psoriasis, tinea capitis and seborroeic dermatyitis.Most of the cases were asymptomatic with thick silvery adherent scales surrounded and bound tuffs of hair and in overlapping tiles of roof pattern. Scraping and hairroot examination for fungus were negative in most of the cases. Results:The cause of PA remains obscure.It is representing a particular reaction pattern of the scalp to various inflammatory scalp diseases.Here in our analysis, probably in adult females tightly worn synthetic materials may be one of the causes. Conclusion: The outcome of PA was usually benign in majority of the cases.Recurrence were common.Less 26% of cases shown non scarring alopecia. Most of the cases responded well to betamethasone scalp lotion, clotrimazole lotion, ketoconazole shampoo, antihistamines and topical application of olive oil.
Clinical spectrum of cicatricial alopecia and it's etio-clinico-histopathological correlation
Swagat waghmare, Manish sethiya, M. K. singhi
Department of Skin and VD, Dr. S N Medical College, Jodhpur, Rajasthan
Introduction: Cicatricial alopecia is an enigmatic group of disorder characterised by replacement of follicular units by fibrous tissue resulting in permanent hair loss. The correct interpretation of cutaneous findings combined with a properly performed biopsy yields important insights into not only underlying diagnosis, but also into the pathophysiological and etiological mechanism of individual cases, and help in ultimate outcome. Methodology: 84 patients who were clinically diagnosed as cicatricial alopecia were included in study. A detailed history, examination and relevant investigations were recorded in proforma. A 4-5 mm punch biopsy specimen of the recent alopecic patch was taken from active margin and sent for histo-pathology. Result: Lichen planopilaris was the most common cause of cicatricial alopecia followed by DLE and pseudopelade. The most common presenting feature was asymptomatic to erythematous plaque and patches of hair loss. There was high degree of agreement between histological diagnosis and final diagnosis based on histopathology and clinical features. Discussion: The primary scarring alopecias are diagnostic challenge both for the clinician and pathologist. It is a heterogenous group presenting with overlapping clinical features. Cicatricial alopecia is a trichological emergency thus requiring aggressive management to prevent further follicular destruction. Conclusion: We conclude that scalp biopsy should be performed in all cases from an active lesion. Multiple sections should be studied in each case supplemented with special stains. A combined clinico-pathological and immunologic approach should be followed for an early correct diagnosis.
Tufted folliculitis and acantholytic hair cast in a case of Pemphigus vulgaris
Usha Naraindas Khemani, Rahu Bute, Devita, Manjeet, Namrata
Department of Dermatology, Grant Medical College, Sir J J Group of Hospitals, Mumbai, India
Pemphigus vulgaris (PV) is an intraepidermal blistering disease affecting the skin and mucosa, in which the histopathologic hallmark is of suprabasal clefting and acantholysis. In addition to the epidermis, acantholysis frequently develops in the wall of the hair follicle. Lesions of pemphigus vulgaris that persist on the scalp for a long period may be accompanied by tufted hair folliculitis with very few reports reported in literature. Also hair cast seen in these patients is an underreported clinical feature. We report 2 unusual features of tufted hair folliculitis and acantholytic hair cast in a 47- years- old-lady having persistent pemphigus vulgaris since three yrs.
Scoping the scalp for scarring alopecias
Usha Naraindas Khemani, Rahu Bute
Department of Dermatology, Grant Medical College, Sir J J Group of Hospitals, Mumbai, India
Introduction: Scarring or cicatricial alopecias are classified into primary, where hair follicle is the main target of destruction; and secondary, where follicular destruction is not the primary pathologic event. The objective of this study was to describe dermatoscopic findings in patients of scarring alopecias. Material and Methods: 15 patients with scarring alopecia based on clinical and histopathological diagnosis were evaluated using the E-Scope (magnification 10x to 200x). The underlying cause was lichen planopilaris (LPP) in five, frontal fibrosing alopecia (FFA) in two and discoid lupus erythematosus (DLE) in eight patients. Results: In DLE, hyperkeratosis and keratotic plugging of follicular ostia, was seen as large yellow dots on trichoscopy; acute or chronic inflammation in perivascular and periadnexal areas was seen as scattered dark-brown discoloration with branching capillaries, thick arborizing vessels, blue-grey dots. In LPP, follicular involvement limited to the infundibulum and isthmus with lichenoid inflammation was seen as silver-white perifollicular scaling with scales entangling hair shafts; colloid bodies and interfollicular changes of lichen planus in epidermis were seen as violaceous- grey interfollicular areas on scoping. In FFA, histological features are similar to LPP except that lichenoid inflammation does not affect the interfollicular epidermis, on trichoscopy it was seen as minor perifollicular scaling and strong predominance of single hair follicular ostia with ivorywhite background, with lack of violaceous grey interfollicular areas and lack of follicular ostia in late FFA. Conclusion: Scalp Dermatoscopy may facilitate diagnosis of early and focal cicatricial alopecia, selection of biopsy site for histopathological confirmation and in patients reluctant for biopsy.
Clinico-aetiological study of scalp hair loss in children
Varsha M. Shetty, G. S. Asha, H. V. Nataraj, S. Sacchidanand, B. Leelavathy, T N. Revathi, K. Shilpa, L. Eswari
Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, India
Aim of the Study: Hair loss in children accounts for 3% of the children visiting a dermatologist. Our aim is to evaluate different causes of scalp hair loss and their varying presentations in children as most hair disorders in childhood consist mainly of a cosmetic problem with psychological implications for both parents and children. Material and Methods: 100 children below 19 years of age presenting to the dermatology OPD with complaints of scalp hair loss were included. A detailed history, examination of the scalp and other hair bearing areas were performed. Bedside tests like hair pull test, hair shaft microscopy and dermoscopy were done. KOH and biopsy were done wherever appropriate. Results: Out of 100 children enrolled, 53 were males and 47 were females. The age of presentation ranged from 2 days to 19 years. 84 had patchy and 16 had diffuse alopecia. Ten patients had scarring alopecia. Tinea capitis accounted for 42 cases, alopecia areata 30 cases and other causes contributed for the rest 28 cases. Gray patch and patchy pattern were the most common clinical types among tinea capitis and alopecia areata respectively. Conclusion: Scalp hair loss in children is one of the common problems encountered. Both common and uncommon causes of hair loss were observed in our study. Common causes included tinea capitis and alopecia areata. Uncommon causes like nevus sebaceous, aplasia cutis, trichotillomania, and hair shaft disorders were also encountered. Simple tests like KOH and trichoscopy are important and simple tests to diagnose these conditions.
Socio-psychological aspects in Indian patients desirous of hair loss treatments
Consultant Dermatologist, Mumbai, India
Introduction: Hair loss affects not only the physical but also the psychological being of the individual, causing varying degrees of low self-esteem, loss of self-confidence and perception of decreased personal attractiveness. There is a greater degree of psychological impact of hair loss among younger men, arguably due to the challenge of fitting in with their peers. This study seeks to understand psychological aspects pertaining to individuals desirous of hair restoration. Objective: To study the various psychological aspects of patients desirous of hair restoration treatments materials and method: 300 patients visiting the hair restoration clinic were enrolled in this study. Patients requiring only medical treatment were excluded from the study. Each selected patient was given a set of questions encompassing their lifestyle patterns and behavioral reactions to hair loss, with a focus on understanding personal and social well-being. Conclusion: Psychological stress was reported by 35.33%. Reason for hair consultation were as Personal reasons: 45%, Psychological and aesthetic: 25%, Health related 19%. Past treatments were Cosmetic products: 60%, Minoxidil: 17%, Laser treatment: 8%, FUT: 9%, Hair weaving: 3%. Satisfaction with past treatments was Disappointed: 40%, Very Disappointed: 44%. Concerns about hair transplant were Final outcome: 67%, Cost: 14%, Invasive: 10%. Source of information was (in decreasing order) Friends and Relatives, Search engine and website, Print advertisement, Other doctors. Constraints for hair transplants were Cost: 52%, Not interested: 26%, Waiting for establishment of hair loss pattern: 14%, Awaiting results of other patients: 8%
Pseudopelade of brocq: a rare case report
Yogeshree R. Deshmukh, S. N. Agrawal
Department of Dermatology, Dr Punjabrao Deshmukh Memorial Medical College, Amravati, India
A 46 years old female patient complained of hairless patch over vertex since 7 years. The characteristic clinical findings were suggestive of Pseudopelade of Brocq and was confirmed on histopathology. All her laboratory investigations including ANA titre were within normal limits. She was treated with topical corticosteroids, oral mini pulse steroid therapy and also hydroxychloroquine. This could be one of the very few cases of Pseudopelade of Brocq reported. Pseudopelade of Brocq is an asymptomatic, beginning insidiously with small, white, depressed, bald spots, devoid of normal hair that mark the borders of some of the earlier lesions with atrophy and minimal perifollicular erythema, if at all.
Isolated poliosis in a neonate
K. Bhumesh Kumar
Introduction: Poliosis is the name given to a localized patch of white hair. Poliosis can occur either in healthy people or associated with genetic conditions. Here we report a case of poliosis in a neonate not associated with any other findings suggestive of syndromes with poliosis. Case Report: A 6 days old male baby born to non consanguineous parents was noticed to have gray hairs on the scalp. The neonate had seizures on the 3rd day of life which was controlled by medicines without any neurological deficit. On examination the neonate was otherwise healthy with tuft of gray hair over the scalp with the normal underlying skin. Since there were no associated abnormalities clinically and all the necessary investigations were normal, we made the diagnosis of isolated poliosis without associated genetic syndromes. Discussion: Poliosis can be associated with pigmentary disturbances of the skin, eye, hypogonadism, hypotrichosis and thyroid diseases. Nevi and focal skin cancers may result in patches of white hair growth in the areas of affected skin. Poliosis can be a part of several genetic disorders such as Marfan's syndrome, Vogt-Koyanagi-Harada (VKH) syndrome, and Waardenburg's syndrome. These syndromes involve other physical and mental retardation to varying degrees. Conclusion: Poliosis can occur either in healthy people or associated with genetic conditions. Elimination of genetic disorders by detailed history, examination with appropriate investigations gives reassurance to the parents and helps to assess growth and development of the neonate.