International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
September-October 2018
Volume 10 | Issue 5
Page Nos. 193-243

Online since Monday, December 3, 2018

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COMMENTARY  

A comment on JAK inhibitors for treatment of alopecia areata Highly accessed article p. 193
Ralph Michel Trueb, Hudson Dutra, Maria Fernanda Reis Gavazzoni Dias
DOI:10.4103/ijt.ijt_62_18  
A meta-analysis of published trials on the treatment of alopecia areata (AA) came to the conclusion that most have been reported poorly and so small that any important clinical benefits are inconclusive, and considering the possibility of spontaneous remission, especially for those in the early stages of the disease, the options of not being treated or depending on individual preference, and of wearing a wig may be alternative ways of dealing with the condition. And yet, from clinical practice, we know that depending on patient age, surface area, disease duration, and comorbidities an empiric treatment algorithm can be designed that is successful in a significant proportion of patients. More recently, it has been suggested that Janus kinase (JAK) inhibitors may represent the drug of choice for AA, based on robust scientific background and preliminary clinical study results. The fact is that a sophisticated treatment of AA cannot be reduced to one drug, while in many patients, depending on disease duration and surface area, either intravenous methylprednisolone pulse therapy, intralesional triamcinolone acetonide or subcutaneous methotrexate will achieve remission rates in the range of the efficacy of the JAK inhibitors. Moreover, at this time point, affordability of the JAK inhibitors for long-term treatment, sustainability of treatment result, and long-term safety are major issues with regard to the treatment of AA with JAK inhibitors.
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REVIEW ARTICLE Top

Premature graying of hair: Review with updates Highly accessed article p. 198
Anagha Bangalore Kumar, Huma Shamim, Umashankar Nagaraju
DOI:10.4103/ijt.ijt_47_18  
Premature graying of hair (PGH) is defined as graying of hair before the age of 20 years in Caucasians and before 30 years in African American population. It can severely affect the self-esteem of an individual. The exact etiopathogenesis remains unknown, although it has been associated with premature aging disorders, atopy, and autoimmune diseases. Patients, who present with PGH, should be assessed for syndromes and metabolism diseases. Hair dyes remain the main modality of the treatment for cosmetic concerns after nutritional supplementation.
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ORIGINAL ARTICLES Top

Correlation between mechanical and thermal properties of human hair p. 204
Chandrakala Kunchi, Karthik Chethan Venkateshan, NVN Deeksha Reddy, Ramesh Babu Adusumalli
DOI:10.4103/ijt.ijt_24_18  
Context: Hair strength depends on integrity of protein structure, aging, and chemical effects and its exposure to mechanical (combing and curling) and thermal (hair drying and straightening) stimuli. Aims: The aim of this study is to correlate the mechanical properties such as tensile yield stress and tensile modulus of single hair fibers with thermal properties such as melting enthalpy and melting point obtained by differential scanning calorimetry. Materials and Methods: Single hair fibers covering seven decades of age were cut 2 cm above the scalp. Tensile specimens were prepared using single fibers with gauge length of 20 mm, and test was carried out with speed of 20 mm/min. For thermal analysis, 2–3 mg of hair samples were cut to 0.5 mm length and loaded in aluminum pan and heated at a rate of 10°C/min from 30°C to 280°C. Data Analysis: Tensile yield stress (determined at the onset of stress constancy at ~3% strain) and tensile modulus were determined using Origin software. The same software was used to plot the thermal data as heat flow (W/g)-temperature diagrams and to determine the peak temperature and peak area (melting enthalpy) by creating a sigmoidal baseline. Results: The typical values of tensile modulus, yield stress, and maximum stress obtained were 5.1 ± 0.5 GPa, 109 ± 9 MPa, and 161 ± 24 MPa, respectively. Further, typical values of melting enthalpy and peak temperature determined were 6.29 ± 0.20 J/g and 235°C ± 0.6°C, respectively. Conclusions: Mechanical yield stress and melting enthalpy were compared, and it was found that a good nonlinear (sigmoidal) correlation was obtained. The nonlinear correlation seems to provide an accurate representation of a composite keratin structure wherein the % crystallinity exhibits a range, and also, crystalline and amorphous regions are intertwined and intricate in nature.
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Association of epidemiological and biochemical factors with premature graying of hair: A case–control study p. 211
Nidhi Sharma, Devraj Dogra
DOI:10.4103/ijt.ijt_39_18  
Background: Premature hair graying (PHG) is often a matter of great concern for patients as it is viewed as a sign of increasing age, debility, decreasing vigor, and may lead to low self-esteem and psychological morbidity. Its etiopathogenesis is not completely understood but genetic, and various acquired factors have been implicated. The present study was undertaken to evaluate various epidemiological and biochemical variables associated with PHG. Materials and Methods: A cross-sectional case–control study was conducted at a tertiary care hospital in North India for 1 year which comprised 120 patients and equal number of controls. Various epidemiological variables were recorded and compared to controls. Serum ferritin, serum calcium, serum Vitamin D, serum Vitamin B12, lipid profile, thyroid profile, and fasting blood sugar were measured and compared among cases and controls. Results: Significantly higher proportion of cases had atopic diathesis, sedentary lifestyle, family history, history of smoking, and higher perceived stress values as compared to controls. Hair oiling seemed to protect against premature graying. Significantly, lower levels of serum calcium, ferritin, Vitamin B12, high-density lipoprotein-cholesterol, and high low-density lipoprotein-cholesterol were observed among cases. Conclusion: In the light of the present study, further studies with larger sample size are required to establish the definite etiological significance of these variables and formulate various preventive and therapeutic targets to prevent and treat PHG.
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Effect of scalp position on tensile properties of single hair fibers p. 218
Chandrakala Kunchi, Karthik Chethan Venkateshan, Ramesh Babu Adusumalli
DOI:10.4103/ijt.ijt_19_18  
Background: Hair tensile properties play a crucial role in cosmetology regarding functionality and quality. Commonly, scalp positions are subjected to varying magnitudes of environmental and physical stimuli and correspondingly different hair balding patterns are observed. Aim: This study is aimed at comparing the tensile properties of hair from four different scalp positions and quantifying the differences using statistical methods. Further, the second aim is to investigate the structure–property relationship with respect to the tensile properties obtained from hair in order to obtain a better understanding of the heterogeneous and composite structure of hair. Materials and Methods: Hair samples were subjected to tensile testing and position wise data was compared using relative rating and grey relational analysis. Scanning electron microscopy was used to study the fractography of tensile specimens. Results: The modulus, yield stress, maximum stress, and work of elongation were in the range of 2–6 GPa, 60–190 MPa, 130–340 MPa, and 30–100 MJ/m3, respectively. The postyield incremental modulus change at around 33% strain correlated well with fracture features wherein significant macrofibril pullout was observed indicating the fourth region in the stress–strain plot. Conclusion: From the statistical analysis, it was found that there was no significant difference in terms of rating of hair samples from different scalp positions. This may be attributed to the presence of microscopic and nanoscopic structural heterogeneities.
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CASE REPORTS Top

Acquired hypertrichosis localized on a subsiding psoriatic plaque after plaster application p. 229
Ambra Di Altobr, Annalisa Patrizi, Massimiliano Pazzaglia
DOI:10.4103/ijt.ijt_50_18  
Postcast hypertrichosis is a common transient occurrence in orthopedic patients and generally resolves within a few months. Until now, two cases of localized hypertrichosis occurring on more than one pre-existing psoriatic lesions are reported in the literature. We describe the case of a patient who simultaneously developed a single psoriatic plaque and overlying localized hypertrichosis after plaster application. This concurrence is exceptional and may be explained by the expression of several growth factors and cytokines influencing both the hair cycle and the psoriatic inflammatory working.
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Aseptic and alopecic nodules of scalp: A rare and underdiagnosed entity p. 231
Isha Gupta, Surabhi Dayal, Sant Prakash Kataria
DOI:10.4103/ijt.ijt_30_18  
Aseptic and alopecic nodules of the scalp (AANS) are a rare and emerging entity in literature, etiology of which is presently unknown. It is characterized by multiple skin-colored dome-shaped nodules associated with nonscarring alopecia. It is usually located in the upper part of occiput and is surrounded by normal scalp. AANS have a good prognosis and can even resolve spontaneously. Only few cases have been reported in the literature so far. We are reporting a rare case of AANS in a 26-year-old female.
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Hypotrichosis with juvenile macular dystrophy p. 234
Filipa Tavares Almeida, Rui Carneiro-Freitas, Regina Caldas, Ana Paula Vieira
DOI:10.4103/ijt.ijt_60_18  
Hypotrichosis with juvenile macular dystrophy is a rare autosomal recessive disease, characterized by hypotrichosis and progressive macular degeneration, leading to blindness in the first three decades of life. It is associated with mutations in the cadherin 3 gene, resulting in the abnormal expression of P-cadherin. We report a case of a 4-year-old female patient diagnosed with this genodermatosis.
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Development of pityriasis amiantacea after valproic acid therapy p. 237
Julio A Diaz-Perez, Joel C Joyce, Thomas L Cibull, Thomas A Victor
DOI:10.4103/ijt.ijt_53_18  
Here, we present the case of a 16-year-old male who developed pityriasis amiantacea (PA) after the use of valproic acid. We propose that the keratinocyte proliferative activity of valproic acid mediated through the inhibition of glycogen synthase kinase-3β, and subsequent activation of the Wnt/β-catenin pathway could play a role in the development of PA. We additionally review the most relevant characteristics of this disease.
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LETTERS TO EDITOR Top

A case of isotretinoin therapy-refractory folliculitis decalvans treated successfully with biosimilar adalimumab (Exemptia) p. 240
Furtado Shireen, A Sudhakar
DOI:10.4103/ijt.ijt_34_18  
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The “Starry night sky sign” Using ultraviolet-light-enhanced trichoscopy: A new sign that may predict efficacy of treatment in frontal fibrosing alopecia p. 241
Ana Rita Rodrigues-Barata, Oscar Muñoz Moreno-Arrones, David Saceda Corralo, Sergio Vañó Galvan
DOI:10.4103/ijt.ijt_17_18  
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