International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
May-June 2019
Volume 11 | Issue 3
Page Nos. 97-142

Online since Wednesday, June 12, 2019

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COMMENTARY  

Saint rita of cascia: Patron saint for women with frontal fibrosing alopecia? p. 97
Ralph Michel Trueb, Maria Fernanda Reis Gavazzoni Dias
DOI:10.4103/ijt.ijt_30_19  
Roman Catholic tradition has made Saints the protectors of various aspects of life. Christian hagiography deals with the account of the Saints' lives and passion, and Christian iconography with the Saints' depiction in religious art. Catholic churches are full of images of Saints. Appreciation of religious art is deepened by knowledge of what is depicted. Saints are only sometimes labeled with their names. The clues to their identity are rather given in their appearance or in what they are holding. St. Rita of Cascia (1381–1457) is a Saint venerated in the Roman Catholic Church and bestowed the title of Patroness for impossible causes. Various miracles have been attributed to her. In Christian iconography, she is depicted with a bleeding forehead wound and sometimes holding a thorn. The forehead wound is understood to represent partial religious stigmatization and external sign of mystical union with Christ. In our opinion, it is at the same time reminiscent of the thorn frontal fibrosing alopecia represents to women affected with the condition, and its treatment with intralesional triamcinolone injections along the frontal hairline, much alike the forehead wounds caused by the crown of thorns. Few practices of the Catholic Church are so misunderstood as the devotion to patron Saints. Nevertheless, Saints help to find community and to break out of the isolation, anonymity, and dumbness of modern society. The communion of Saints is a spiritual union, in which each member shares in the welfare of all. The patron Saints help to believe in the possibility of miracles and miraculous healings. Ultimately, the exemplary lives of the Saints show us how salvation can be the positive effect of suffering.
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REVIEW ARTICLES Top

Expert consensus on the management of androgenetic alopecia in India Highly accessed article p. 101
Venkataram Mysore, Anchala Parthasaradhi, RD Kharkar, AK Ghoshal, Anil Ganjoo, G Ravichandran, Abir Saraswat, Yogesh Shah, Mohan Singh, TJ Remadevi, Prachi Matte
DOI:10.4103/ijt.ijt_24_19  
Androgenetic alopecia (AGA), also known as androgenic or pattern alopecia, is a frequently reported disorder that affects both the sexes, with a higher incidence generally reported in men. AGA has immense psychological effects on the patient, irrespective of the age or stage of baldness. This consensus document has been developed taking into account the opinions of leading experts in the field of dermatology. The objective of this article is to provide the dermatologists with an evidence-based platform for choosing efficacious and safe therapy for patients with AGA. This review articulately summarizes the key opinions of the experts on all aspects of treatment for the effective management of AGA.
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Expert consensus on the management of telogen effluvium in India p. 107
Venkataram Mysore, Anchala Parthasaradhi, RD Kharkar, AK Ghoshal, Anil Ganjoo, G Ravichandran, Abir Saraswat, Yogesh Shah, Mohan Singh, TJ Remadevi, Prachi Matte
DOI:10.4103/ijt.ijt_23_19  
Alopecia, a frequently reported problem, severely impacts the quality of life of patients and is often associated with loss of confidence and low self-esteem. Several conditions such as telogen effluvium (TE), anagen effluvium, diffuse type of alopecia areata, female pattern hair loss, hair shaft abnormalities, loose anagen hair syndrome, and congenital atrichia or hypotrichosis are associated with hair loss. The actual prevalence rate of TE is not reported since most cases are subclinical in nature. Further, since women get more distressed by hair fall and promptly seek treatment, they tend to be over-represented. However, both genders can suffer from this condition if triggering factors are present. This consensus paper was developed by taking into account opinions of renowned experts in the field and is hoped to serve as an evidence-based platform for selecting efficacious and safe therapy for patients with TE. This review presents a synopsis of the key opinions of experts on all aspects of treatment and effective management of this condition.
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ORIGINAL ARTICLES Top

Tumor necrosis factor-like weak inducer of apoptosis: A novel serum marker in patients with severe alopecia p. 113
Abdul-Aziz Ibrahim Al Taweel, Ahmed Mohamed Hamed, Amira Mohamed Noureldin Abdelrahman, Mona Nady Ibrahim Hassan
DOI:10.4103/ijt.ijt_9_19  
Background: Alopecia areata (AA) is a common form of nonscarring hair loss of scalp and/or body. Genetic predisposition, autoimmunity, and environmental factors play a major role in the etiopathogenesis of AA. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a multifunctional cytokine expressed on various cell types and tissues and acts through binding to its sole receptor factor-inducible 14 (Fn14). TWEAK/Fn14 activation contributes to various pathological processes, including cell proliferation and death, angiogenesis, carcinogenesis, and inflammation. Aim: The aim of this current study was to measure serum levels of TWEAK in patients with AA and to assess the correlation between it and severity of the disease. Subjects and Methods: This study included 50 patients who had patchy AA, in addition to 50 apparently healthy controls. Severity of AA was assessed using Severity of Alopecia Tool Score. Serum TWEAK levels in all participants were determined using ELISA technique and were correlated with the severity of the disease. Results: Mean serum levels of TWEAK were significantly higher in AA patients, with a positive significant correlation between serum levels of TWEAK and severity of the disease. Conclusion: TWEAK as a novel marker of many autoimmune inflammatory dermatological diseases, could be a promising marker in the diagnosis of AA, and also can be used as a prognostic marker for its severity.
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Correlation of trichoscopic findings in androgenetic alopecia and the disease severity p. 118
Amudha Ummiti, Puvvada Swapna Priya, PL Chandravathi, Ch Sudhir Kumar
DOI:10.4103/ijt.ijt_103_17  
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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Comparative study of efficacy of topical mometasone with calcipotriol versus mometasone alone in the treatment of alopecia areata p. 123
Mahtab Alam, Syed Suhail Amin, Mohammad Adil, Tasleem Arif, Fatima Tuz Zahra, Iti Varshney
DOI:10.4103/ijt.ijt_18_19  
Background: Alopecia areata is one of the common causes of nonscarring hair loss with autoimmune etiology. This study was designed to evaluate any added benefit of topical calcipotriol when combined with topical mometasone in the treatment of alopecia areata. To the best of our knowledge, no such study has been conducted in the past. Materials and Methods: It was a comparative analytical study done over 100 patients of clinically diagnosed alopecia areata. Group A patients (n = 50) were advised to apply topical mometasone 0.1% cream along with topical calcipotriol 0.005% ointment each once daily, whereas patients of Group B (n = 50) were advised to apply only topical mometasone 0.1% cream in the same amount, once a day. Follow-up of all patients was done at 6, 12, and 24 weeks, and the outcome was assessed according to the Severity of Alopecia Tool (SALT) score at every visit. Results: Both the groups were statistically comparable in terms of age (P = 0.694) and sex (P = 0.683) distribution. Baseline mean SALT score of Group A and Group B patients was 7.22 and 6.05, respectively (P = 0.145). At the end of 24 weeks, mean SALT score of Group A and Group B patients decreased by 4.24 and 3.39, respectively (P < 0.001). We also found that there was a significant decrease (P < 0.001) in mean SALT score at 24 weeks in patients of both groups when compared with baseline values. Conclusion: We found that adding topical calcipotriol 0.005% ointment with topical mometasone 0.1% cream has higher efficacy than topical mometasone alone, in the treatment of alopecia areata.
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CASE REPORTS Top

Injectable-platelet-rich fibrin-smart blood with stem cells for the treatment of alopecia: A report of three patients p. 128
Ritika Arora, Sagrika Shukla
DOI:10.4103/ijt.ijt_73_18  
Hair loss or alopecia in males is very common, and so is its treatment. Until now, platelet-rich plasma has been in use for hair regeneration, which has shown results but lacks regenerative potential as compared to platelet-rich fibrin (PRF). Injectable-PRF (i-PRF) is advanced version of PRF in liquid form which can be injected and contains stem cells with high regenerative potential. Hair regeneration in Type VI and Type VII was observed which are difficult to treat. Hair growth with i-PRF has better regenerative potential. All cases reported showed improvement in hair growth.
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Acute onset of painful hairy eruption on dorsum of foot: An interesting story! p. 132
Vijay Zawar, Madhur Kelkar, Manoj Pawar
DOI:10.4103/ijt.ijt_34_19  
Caterpillar dermatitis is a commonly observed dermatological condition in tropical countries. Contact with caterpillar can cause localized stings, eczematous or papular dermatitis, urticaria, and in some cases life-threatening reactions. We report a case of a patient presenting with acute-onset painful hairy eruption on dorsum of the left foot near great toe. Detailed history and investigations led to appropriate diagnosis.
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A case of scalp white piedra caused by trichosporon ovoides p. 134
Arti Singh, Asha Nyati, Alpana Mohta, Ramesh Kumar Kushwaha, Suresh Kumar Jain
DOI:10.4103/ijt.ijt_19_19  
White piedra also known as trichomycosis nodularis or trichomycosis nodosa is a superficial fungal infection of the hair shaft caused by Trichosporon asahii. We are reporting a case of white piedra in a female for the rarity of such occurrence.
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LETTERS TO EDITOR Top

Tulipoid hair: An avoidable addition to metaphoric trichoscopic terminology p. 138
Sidharth Sonthalia, Ashu Abhishek
DOI:10.4103/ijt.ijt_96_18  
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Autistic-undisciplined - Practice what you preach! p. 140
D Hugh Rushton, Dominique J J Van Neste
DOI:10.4103/ijt.ijt_27_19  
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Enthalpy–entropy compensation in the melting of human hair p. 141
Matthew L Cowan, Jonghoon Kang
DOI:10.4103/ijt.ijt_21_19  
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