International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
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October-December 2017
Volume 9 | Issue 4
Page Nos. 147-192

Online since Thursday, October 5, 2017

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Dissecting cellulitis of the scalp early diagnosed by color doppler ultrasound p. 147
Karina Cataldo-Cerda, Ximena Wortsman
DOI:10.4103/ijt.ijt_2_17  
Dissecting cellulitis of the scalp (DC) is a chronic inflammatory condition of the scalp that ultimately leads to scarring alopecia. A healthy 19-year-old male presented with a solitary, soft, alopecic nodule that had appeared 1 year before. A color Doppler ultrasound examination showed a hypodermal anechoic fluid collection in the left parietotemporal region of the scalp, connected to the base of widened hair follicles, and presented inner echoes suggestive of debris, as well as several fragments of hair tracts. A diagnosis of DC was made and an epidermal or trichilemmal cyst was ruled out. This case shows the importance of color Doppler ultrasound for supporting the diagnosis at an early stage or with an unusual presentation of DC.
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ORIGINAL ARTICLES Top

Insignificant correlation between thyroid hormone and antithyroid peroxidase antibodies in alopecia areata patients in Northern Rajasthan p. 149
Gagandeep Kaur, CM Kuldeep, Puneet Bhargava, Deepak Kumar Mathur, Sonam Sharda, Pulkit Chaturvedi
DOI:10.4103/ijt.ijt_32_17  
Background: Alopecia areata (AA) is a common, recurrent form of nonscarring alopecia which often presents as circumscribed patches of spontaneous hair loss. The global prevalence of this disease varies from 0.1% to 0.2% in general population and 7–30 cases per 1000 dermatological patients. The etiology of AA still remains uncertain; however, genetic or environmental factor and autoimmunity are claimed responsible for it. Various autoimmune diseases, such as Hashimoto's thyroiditis, diabetes mellitus, vitiligo, and lupus erythematosus, have been reported in association with AA. Aim: The index study was aimed at estimation of serum T3, T4, thyroid-stimulating hormone, and antithyroid peroxidase (TPO) antibodies. Material and Methods: Similar age/sex-matched AA patients and controls (110 in each group). Enhanced chemiluminescence immunoassay for thyroid profile and anti-TPO antibody level estimation in veinous blood sample. Observations: The mean/standard deviation (SD) of T3 was 3.30 ± 0.84 pg/ml in AA while 3.27 ± 0.67 pg/ml in controls (P = 0.302). Serum mean/SD of T4 level was1.23 ± 0.76 ng/dl in AA patients while 1.17 ± 0.34 ng/dl in controls (P = 0.522). The mean/SD of anti-TPO levels in AA patients was 21.52 ± 35.09 while 56.43 ± 140.72 in controls (P = 0.136). Limitation: The limitation of this study was moderate number of AA patients and different genotype of study population. Conclusion: Occurrence of thyroid dysfunction and evidence of anti-TPO antibodies in AA is rare event in this study population.
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Detection of tumor necrosis factor-alpha in nonlesional tissues of alopecia areata patients: A prove for a systemic disease p. 154
Yasser Mostsfa Gohary, Dina Sabry Abdel Fattah
DOI:10.4103/ijt.ijt_47_17  
Introduction: The pathogenesis of alopecia areata (AA) remains incompletely understood. Different cytokines may play a role in AA. Tumor necrosis factor-alpha (TNF-α) has been shown to be inhibitory to hair follicle growth in in vitro studies suggesting that it may play an important role in AA. This study was conducted to assess the presence of TNF-α in lesional and nonlesional skin of AA, to review its possible role in AA, and to show whether AA is a systemic or localized disease by comparing the level of TNF-α between lesional and nonlesional skin biopsies of the patients. Materials and Methods: Thirty patients with AA and thirty age- and sex-matched healthy controls were included in the study. A 4 mm punch skin biopsy was taken from lesional and nonlesional skin of every patient, as well as from the normal skin of each individual in the control group for immunohistochemical analysis of TNF-α. Results: The level of TNF-α in lesional skin biopsies was significantly higher than in nonlesional skin biopsies of patients as well as controls' biopsies. Furthermore, TNF-α level in nonlesional biopsies of patients was significantly higher than the level in controls' biopsies. Conclusions: We concluded that skin of AA has a high level of TNF-α (a normal inhibitor of hair follicle growth in vitro). This high level may point to the important role of TNF-α in AA. Further studies should be conducted to detect the level of TNF-α in long-standing AA and the more severe cases of AA.
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Utilization of mental health resources and complementary and alternative therapies for alopecia areata: A U.S. survey p. 160
Salman T Hussain, Arash Mostaghimi, Paul J Barr, Jeremiah R Brown, Cara Joyce, Kathie P Huang
DOI:10.4103/ijt.ijt_53_17  
Background: The efficacy of traditional medical treatments for alopecia areata (AA) is limited, leading some to pursue alternative treatments. The utilization and nature of these treatments are unclear. Objective: To assess the extent to which patients with AA pursue alternative treatments and to characterize these treatments. Methods: A 13-item electronic survey was E-mailed by the National Alopecia Areata Foundation (NAAF) to their patient database and shared on the NAAF social media to individuals with AA. Results: Of 1083 respondents, 78.1% of patients were very or somewhat unsatisfied, compared to 7.7% who were very or somewhat satisfied with the current medical treatments for AA. Approximately a third of patients pursued therapy-related mental health services (31.2%) and attended support groups (29.0%). Patients were more likely to pursue a mental health-related therapy if they had long-standing alopecia, or if they were young, female, or white. Limitations: This was a convenience sample of patients recruited online and via the NAAF AA registry. Conclusion: Many patients with AA are dissatisfied with current treatments and are seeking mental health treatment for AA. While the efficacy of alternative therapies is unknown, further research is needed to determine their role in the treatment of AA.
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A proposal of an effective platelet-rich plasma protocol for the treatment of androgenetic alopecia Highly accessed article p. 165
Juan Ferrando, Sandra Cecilia García-García, Ana Cecilia González-de-Cossío, Lola Bou, Esperanza Navarra
DOI:10.4103/ijt.ijt_27_17  
Background: Platelet-rich plasma (PRP) has emerged as a promising treatment for androgenetic alopecia (AGA). In spite of the several studies previously reported, to date, a standardized protocol for PRP preparation and application, as well as a standard method for evaluating results has not been established. Aims: The aim of this study is to propose a standardized method for preparation and application of PRP for male AGA (MAGA) and female AGA (FAGA) and assess its safety and efficacy as a co-adjuvant therapy. Materials and Methods: Seventy-eight patients, 19 men and 59 women with AGA Grades II–IV in Ebling's scale, currently on treatment with topical minoxidil and/or oral finasteride for more than a year without improvement, were included in this study. PRP was prepared using a single spin method, and injected in affected areas for 3 monthly sessions, followed by 3 bimonthly sessions. A decrease of at least one grade in Ebling's scale was considered a successful result. Results: After the 6° session, 71.4% of MAGA and 73.4% of FAGA patients reached a successful outcome while 21.4% and 16.3%, respectively, remained without changes. Only 7.1% of MAGA and 10.2% of FAGA presented worsening of their condition. Conclusions: PRP together with a periodical application protocol can be considered effective as a coadjuvant therapy in patients who no longer respond to pharmacological treatments. Ebling's scale was a practical and reliable parameter to allow a better evaluation in both MAGA and FAGA.
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Association of leukotrichia in vitiligo and Asp148Glu polymorphism of apurinic/apyrimidinic endonuclease 1 p. 171
A Fatih Aydin, İkbal Esen Aydıngöz, Semra Doğru-Abbasoğlu, Pervin Vural, Müjdat Uysal
DOI:10.4103/ijt.ijt_4_17  
Background: Oxidative stress and increased DNA damage have been implicated in the etiopathogenesis of vitiligo. Oxidative DNA damage is mainly repaired by the base excision repair (BER) pathway. Aim: We sought to determine whether polymorphisms in DNA repair genes may have a role in the pathogenesis of vitiligo. Materials and Methods: We conducted a study including 100 patients with vitiligo and age- and sex-matched 193 control subjects to examine the role of single-nucleotide polymorphisms of BER genes, human 8-oxoG DNA N-glycosylase 1 (codon 326), apurinic/apyrimidinic endonuclease 1 (APE1) (codon 148), and X-ray repair cross-complementing group 1 (codon 399) as risk factors for vitiligo. These polymorphisms were determined by quantitative real-time polymerase chain reaction and melting curve analysis. Results: No significant association was observed between the variant alleles of studied genes and vitiligo. Conclusion: However, we showed that the presence of APE1 148Glu variant allele is associated with leukotrichia. This preliminary study suggests that APE1 (codon 148) polymorphism may play a role in vitiligo pathogenesis.
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CASE REPORTS Top

Three cases of hair loss analyzed by the point of view of the analytical psychology p. 177
Ademir Carvalho Leite Júnior, Tatiele Katzer, Denise Gimenez Ramos
DOI:10.4103/ijt.ijt_106_16  
Psychotrichology is the science, which covers the psychosomatics applied to hair problems, i.e., body-psyche phenomena involving scalp and hair disorders. The approaches involving psychotricology are varied and may include psychiatric,[1] psychoanalytical,[2],[3] and those involving knowledge related to analytical psychology.[4] An analysis from the analytical psychology point of view, a theory developed by the physician Carl Gustav Jung, favors a symbolic view to the disease, providing it attributions and meanings that go beyond those related to physical body signs and symptoms only. This paper aims to describe and analyze, under the analytical psychology view, three cases the psychic and clinical demonstrations of which relate to symbolic and historic aspects concerning life of patients as possibilities of cause and maintenance of hair problems. The first of them is related to an 8-year-old girl who witnessed a scene of physical aggression by her father against her mother and developed a case of total alopecia. The second case is related to a 43-year-old woman who developed self-inflicted scalp dermatitis due to severe anxiety; and at last, the case of a telogen effluvium in a 23-year-old woman who developed hyperprolactinemia after the death of her mother, having to substitute her in the care about her husband and brothers. Looking at the clinical history and symbolic matters of scalp and hair diseases enabled, in the aforementioned cases, a better understanding of patients' psychoemotional disorders that may be related to the beginning and maintenance of clinical cases presented by them.
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Collision tumor between trichofolliculoma and melanocytic nevus p. 181
Christel Bolte, Roberto Cullen, Ivo Sazunic
DOI:10.4103/ijt.ijt_108_16  
Trichofolliculoma (TF) is a hamartomatous hair follicle-related tumor, clinically described as a dome-shaped papule with a central pore crossed by one or more silky white hairs. Histologically, it described as a cystic cavity containing keratinous debris, hair shaft fragments, and numerous hair follicles arising from its linings. Collision or compound tumors are a coexistence of two or more identifiable tumors in the same lesion. We present a case of a 47-year-old man with a lesion on his left cheek clinically characterized as a TF. However, the histopathological study reveals a collision tumor involving a TF and a melanocytic nevus. Collision tumors involving melanocytic nevi and hair follicle-related tumors have been previously reported, such as desmoplastic trichoepithelioma, epidermoid cyst, folliculosebaceous cystic hamartoma, and trichoadenoma.
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Cytodiagnosis of eccrine porocarcinoma of the scalp p. 184
Subrata Pal, Jyoti Prakash Phukan, Kingshuk Bose, Abhijit Saha
DOI:10.4103/ijt.ijt_27_16  
Eccrine porocarcinoma is a rare, malignant adnexal tumor of the duct of eccrine sweat gland. Cytology of eccrine porocarcinoma has been described in very few previous literature. Here, we present a case of fine needle aspiration cytology (FNAC) of eccrine porocarcinoma of the scalp, which is subsequently confirmed by histology. Accurate diagnosis of eccrine porocarcinoma by FNAC is very difficult, but determining the malignant nature of the lesion is crucial for curative surgery. FNAC can be a convenient, safe, and effective approach to solve difficult diagnostic dilemma.
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Panfolliculoma: A clinical case report p. 187
Roberto Estrada-Castanon, María Elisa Vega-Memije, Juan Carlos Cuevas-González, Maria de Guadalupe Chavez-Lopez
DOI:10.4103/ijt.ijt_43_17  
Panfolliculoma is a benign neoplasm of follicular differentiation, and its morphological characteristics are similar to those of trichoblastoma, but it shows greater follicular differentiation. A 55-year-old female patient, visited for a dermatological consultation, presented comedo-like lesions on the eyelids, which were accompanied by moderate pruritus that spread gradually. On examination, the patient had localized dermatosis on the face, which symmetrically affected both upper eyelids and to a lesser extent the lower eyelids. The lesions consisted of papulonodular neoformations, comedones, and redundant skin, and a biopsy was performed. The histopathological report mainly described the presence of atrophic epidermis and dermis that was occupied entirely by a neoplasm of epithelial strain, comprising cystic structures that were surrounded by infundibular epithelium of an internal radicular sheath. Panfolliculoma is a rare benign neoplasm of follicular differentiation, and its morphological characteristics are similar to those of trichoblastoma, the pathologist must perform the clinicopathological correlation to establish the correct diagnosis.
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Unusual pattern of whitening of eyebrows following sunitinib therapy: A case report with brief review of literature p. 190
Chaturbhuj R Agrawal, Vineet Talwar, Venkata Pradeep Babu, Parveen Jain, Pankaj Goyal
DOI:10.4103/ijt.ijt_20_17  
Sunitinib is a vascular endothelial growth factor receptor inhibitor which has shown high activity in metastatic renal cell carcinoma (mRCC) patients and is now widely used for the same. It is generally well tolerated, but sometimes, it exhibits a distinct pattern of novel side effects that require monitoring and management. Important known side effect of sunitinib includes fatigue, diarrhea, anorexia, skin toxicity, and hypertension which need special mention. Considering its effectiveness in first-line setting in mRCC and paucity of other good options, utmost efforts are made to continue it with identification of side effects which may require only slight dose modification or no dose alteration. We report here a 38-year-old male who was diagnosed as a case of mRCC and started on sunitinib at the diagnosis and developed whitish discoloration of eyebrows and body hairs after 3 months of starting sunitinib. In view of good overall response to treatment and no other significant toxicity, sunitinib was continued with good tolerability.
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