International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
July-August 2019
Volume 11 | Issue 4
Page Nos. 143-184

Online since Monday, August 19, 2019

Accessed 393 times.

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COMMENTARY  

Hair and humor - 1 - “The only problem” p. 143
Ganesh S Pai
DOI:10.4103/ijt.ijt_16_19  
Perhaps the best solution for hair loss is a little bit of philosophy and a lot of humor. Endless trips to trichologists, hair potions and lotions hardly prevent the reluctant march to baldness. Unless of course, the patient agrees to a hair transplant.
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CONTINUING MEDICAL EDUCATION Top

Lessons from the past: Avoiding placebo generated increased hair counts p. 144
D Hugh Rushton, Dominique JJ Van Neste
DOI:10.4103/ijt.ijt_37_19  
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ORIGINAL ARTICLES Top

Quality of life assessment in patients with androgenetic alopecia Highly accessed article p. 147
Sanjeev Gupta, Ishan Goyal, Aneet Mahendra
DOI:10.4103/ijt.ijt_6_19  
Background: Male-pattern alopecia (MPA) or androgenetic alopecia (AGA) is a commonly encountered dermatological condition present in males and is less common among females. Although AGA is a physiological condition, its impact on person's self-esteem is so great that it cannot be ignored. It has a significant affect over a variety of physiological and social aspects of one's life and even on the individual's overall quality of life (QOL). Aims and Objectives: The aim of this study is to study the clinical profile of 200 male patients having MPA and to access its impact on QOL using the Dermatology Life Quality Index (DLQI) and hair-specific Skindex-29. Materials and Methods: Clinical profiles of 200 patients were studied, and QOL assessment was done using the DLQI and hair-specific Skindex-29 scales. Results: Of 200 cases of MPA, majority (41.5%) of the patients belonged to the age group of 21–30 years. Smoking, alcoholism, dietary habits, nature of work, and seasonal variation did not seem to affect the incidence of MPA. Positive family history of MPA was observed in 50% of patients. A mean DLQI score of 13.52 was recorded in the study. The main affected parameter was personal relations with mean score of 2.3. Maximum number of patients had DLQI score between 11 and 20. MPA was observed in 50% of patients. In the study, the mean hair-specific Skindex-29 score was found to be 75.62. The different subscale parameters in Skindex-29 were symptoms, functions, emotions; with respective score of 22.1 ± 5.025, 25.89 ± 4.814, and 27.73 ± 5.942. The major subscales affected were symptoms with a mean score of 3.14. Both hair-specific Skindex-29 and DLQI had a significant correlation, thereby suggesting that AGA significantly affects patient's QOL. Conclusion: AGA harmfully affected the patient's QOL which warns the physicians to pay more attention to QOL impairment in patients of AGA for the better understanding of the disease burden on individual patients.
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Evaluation of physiological, psychological, and lifestyle factors associated with premature hair graying p. 153
Katherine G Thompson, Mark C Marchitto, Bao Chau K. Ly, Anna L Chien
DOI:10.4103/ijt.ijt_43_19  
Background: Canities, or hair graying, is believed to be driven by the cytotoxic effect of reactive oxygen species on follicular melanocytes, thus raising the concern that premature hair graying (PHG) may represent an outward sign of systemic oxidative stress.Objective: This study aimed to identify the physiological, psychological, and lifestyle factors associated with PHG (defined as graying at age ≤30 years) in men and women. Materials and Methods: Data from 467 participants (female = 354 and male = 113; age: 18–77 years) were collected and analyzed, including demographic information, medical history, family history, supplement intake, and lifestyle factors. Results: PHG was found to be significantly associated with a history of PHG in the mother, P<0.001, odds ratio (OR) = 3.165; father, P<0.001, OR = 5.166; maternal grandparent, P= 0.002, OR = 2.442; paternal grandparent, P= 0.007, OR = 2.369; and siblings, P<0.001, OR = 3.125. PHG was significantly associated with iron deficiency (P = 0.026, OR = 1.751) and family history of depression (P = 0.012, OR = 1.603), while herpes simplex virus infection (P = 0.004, OR = 0.367) and smoking history (P = 0.003) demonstrated significant negative associations. In Caucasians only (n = 306), in addition to these trends, irritable bowel syndrome was also significantly associated with PHG (P = 0.010, OR = 2.753). In Asians only (n = 75), history of heart disease in a first-degree relative (P = 0.038) was significantly associated with PHG. Limitations: As a survey study, the findings may be subject to recall bias. Conclusions: Important associations exist between PHG and family history of PHG, psychiatric history, supplement use, and vitamin deficiencies, providing insight into the pathophysiology and potential comorbidities of PHG.
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Histopathology of hair follicle epithelium in patients of recurrent and recalcitrant dermatophytosis: A diagnostic cross-sectional study p. 159
Payal Dilip Patil, Sushil Pande, Sadhana Mahore, Milind Borkar
DOI:10.4103/ijt.ijt_7_19  
Context: Recurrent and recalcitrant dermatophytosis is a major evolving health problem in India. Histopathology is important in the diagnosis of recurrent and resistant cases, as it is postulated that hair follicle epithelium is affected, acting as the reservoir leading to recurrence and recalcitrance. Aims: This study aims to study histopathology of hair follicle epithelium in patients of recurrent and recalcitrant dermatophytosis. Settings and Design: A diagnostic cross-sectional study was performed at tertiary care hospital and referral center in central India. Materials and Methods: A 3 mm-sized punch skin biopsy was taken from 108 patients of recurrent or recalcitrant dermatophytosis involving hair follicles. Sections were stained by hematoxylin and eosin (H and E) stain in these patients followed by special stains such as periodic acid–Schiff (PAS) stain and Gomori methenamine silver (GMS) stain in 78 individuals where hair follicle was seen on H and E stain. Results: In H and E stain, surface epidermis fungus was observed in 57/108 patients (52.7%). In hair follicle-positive sections (78), surface fungus was seen in 52.6% with H and E stain, 84.6% with PAS stain, and 91% with GMS stain. H and E was 62.12% sensitive and 100% specific to diagnose fungus when compared with PAS stain and 57.7% sensitive and 100% specific when compared with GMS stain. PAS was 91.5% sensitive and 85.7% specific when compared with GMS stain. Ectothrix infection was the most common form of hair infection observed in 87.2% cases with GMS stain. Simultaneous presence of fungus in hair follicle and stratum corneum was observed in 87.3% of patients. Conclusion: Majority of patients showed affection of hair follicles by dermatophytes in clinically chronic, recurrent, and recalcitrant dermatophytic infections. GMS stain is the acceptable gold standard for detection of fungal elements.
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CASE REPORTS Top

A rare pigmented lesion of the eyelid p. 167
Dilip Kumar Mishra, Saumya Jakati, Tarjani Vivek Dave, M Agrawal
DOI:10.4103/ijt.ijt_51_19  
This study aims to report a rare case of melanoacanthoma of the eyelid. Melanoacanthoma is very rare variant of seborrheic keratosis presenting as a rare benign pigmented lesion composed of both melanocytes and keratinocytes usually presenting over the head, neck, and trunk of elderly people. A 61-year-old female presented with 8 mm × 4 mm × 3 mm brownish black mass in her right lower lid for the past 4 years associated with itching. Clinical differential diagnosis of seborrheic keratosis and nevus was offered. The patient underwent shave biopsy, and biopsy tissue was sent for histopathological examination. A diagnosis of melanoacanthoma was made on histopathology. Melanoacanthoma of the eyelid is a rare entity, and one should consider in differential diagnosis of pigmented lesion of the eyelid mass.
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Overnight alopecia: A subtype of acute diffuse and total alopecia? p. 170
BS Chandrashekar, Chaithra Shenoy, Rashmi Agarwal
DOI:10.4103/ijt.ijt_36_19  
Acute diffuse and total alopecia (ADTA) is a variant of alopecia areata which lacks the typical patchy hair loss seen in classical alopecia areata and presents with an acute onset of diffuse hair loss commonly reported in young females with the duration from disease onset to diffuse hair loss ranging from 2 to 20 weeks. Although the clinical features of ADTA resemble telogen effluvium, dermoscopy can prove to be a useful tool for differentiating these two conditions and avoiding unnecessary investigations as specific dermoscopic findings of alopecia areata are invariably present along the disease course. Herein, we report a case of ADTA in a 42-year-old Indian female who presented with sudden onset of diffuse hair loss of only 1-day duration.
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Alopecia universalis in a case of rheumatoid arthritis after treatment with etanercept p. 173
Renu Kandpal
DOI:10.4103/ijt.ijt_22_19  
Alopecia universalis (AU) is a condition which causes generalized hair loss of the body. It is postulated that autoimmunity plays an important role in its pathogenesis. It is characterized by the involvement of multiple inflammatory cytokines such as tumor necrosis factor-alpha and multiple interferons. Hence, biologics like tumor necrosis factor alpha (TNF-α) antagonist may be used to block this inflammatory process. It is not very commonly appreciated that the use of biologics can lead to alopecia areata. Here, we report a case of severe alopecia areata which progressed to AU after etanercept administration. We here describe a 23-year-old unmarried female who was a known case of rheumatoid arthritis who developed AU after 6 months of continuous treatment with etanercept. TNF-α antagonist may not play a sufficient role in the treatment of alopecia areata. There exists a strong and significant connection between TNF-α blockers and development of alopecia and specifically AU and their role in the pathophysiology of the disease should be called into question if our findings are observed again.
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LETTERS TO EDITOR Top

Unraveling the locks of wigs: A historical analysis p. 177
Yakeen Hafouda, Paul Devakar Yesudian
DOI:10.4103/ijt.ijt_68_19  
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Low-cost standardization of photography in pattern hair loss with “chin–nose–brow rest” p. 178
Mahima Agrawal, Sidharth Sonthalia, Manjul Agrawal
DOI:10.4103/ijt.ijt_44_19  
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Trichodynia – A condition worth treatment-directed evaluation rather than “silencing” p. 180
Sidharth Sonthalia, Poonam Sharma, Mahima Agrawal, Jyoti Kapoor
DOI:10.4103/ijt.ijt_71_19  
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Telephone handle hair: A novel trichoscopic finding in black dot tinea capitis p. 181
Vishu Michelle, Kanathur Shilpa, Budamakuntala Leelavathy, Gowrappala Shanmukhappa Asha
DOI:10.4103/ijt.ijt_25_19  
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Ultrasonographic characteristics of frontal fibrosing alopecia p. 183
Oscar Muñoz Moreno-Arrones, Fernando Alfageme, Adrian Alegre, Gaston Roustan
DOI:10.4103/ijt.ijt_58_19  
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