International Journal of Trichology International Journal of Trichology
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   2012| October-December  | Volume 4 | Issue 4  
    Online since April 26, 2013

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Keratosis Pilaris Revisited: Is It More Than Just a Follicular Keratosis?
Mary Thomas, Uday Sharadchandra Khopkar
October-December 2012, 4(4):255-258
DOI:10.4103/0974-7753.111215  PMID:23766609
Background: Keratosis pilaris (KP) is characterized by keratinous plugs in the follicular orifices and varying degrees of perifollicular erythema. The most accepted theory of its pathogenesis proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris. Materials and Methods: Patients with a clinical diagnosis of KP seen between September 2011 and December 2011 were included in the study. A clinical history was obtained and examination and dermoscopic evaluation were performed on the lesions of KP. Results: The age of the patients ranged from 6-38 years. Sixteen patients had history of atopy. Nine had concomitant ichthyosis vulgaris. All the 25 patients were found to have coiled hair shafts within the affected follicular infundibula. The hair shafts were extracted with the help of a sterile needle and were found to retain their coiled nature. Perifollicular erythema was seen in 11 patients; perifollicular scaling in 9. Conclusion: Based on our observations and previously documented histological data of KP, we infer that KP may not be a disorder of keratinization, but caused by the circular hair shaft which ruptures the follicular epithelium leading to inflammation and abnormal follicular keratinization.
  3 12,338 108
A Study to Evaluate the Efficacy of Various Topical Treatment Modalities for Alopecia Areata
Vidyadhar R Sardesai, Smita Prasad, Trupti D Agarwal
October-December 2012, 4(4):265-270
DOI:10.4103/0974-7753.111223  PMID:23766611
Context: Alopecia Areata (AA) is a common form of non-scarring hair disorder of unclear etiology. The disease may have serious psychological effect. Aims: The objective is to assess the therapeutic effect and side effects of various topical modalities for the treatment of AA. Settings and Design: Open, randomized, comparative study. Materials and Methods: For this study, 30 patients were included of all age groups and both sexes having localized (<5 patches and <25% scalp involvement) alopecia, with no underlying disease or family history, and who had not received any treatment before. They were treated sequentially with 5 different combination regimes for 3 months. The response was assessed subjectively as well as objectively by the "Severity of Alopecia Tool Score". Statistical Analysis: Chi-square test. Results: Out of the 5 modalities studied, the Intralesional and Topical Steroids were the most effective with no significant side effects. Conclusions: Among the various topical modalities used for the treatment of AA, the most effective are the Intralesional and Topical steroids with no significant side-effects.
  2 4,498 163
Rapunzel Syndrome Causing Appendicitis in an 8-year-old Girl
Shruti Dogra, Yogesh Kumar Yadav, Uma Sharma, Kusum Gupta
October-December 2012, 4(4):278-279
DOI:10.4103/0974-7753.111203  PMID:23766615
Rapunzel syndrome is a rare type of presentation of trichobezoar, an extension of hair fibers into the small bowel and rarely beyond the ileocecal valve. Its clinical presentation is deceptive ranging from abdominal mass to symptoms of obstruction. We report a 8-year-old girl admitted with a history of abdominal pain and vomiting off and on for a period of 1 year. Ultrasound findings were suggestive of subacute intestinal obstruction. On laparotomy, trichobezoar was found in the stomach extending into small bowel and was removed. Appendix was inflammed hence it was also resected. Microscopic evidence of a hair shaft was seen in the appendix indicating appendicitis was due to luminal obstruction by hair concretions.
  1 1,986 26
Cytodiagnosis of Pilomatrixoma from an Uncommon Site with Unusual Presentation
Jyoti Prakash Phukan, Anuradha Sinha, Sudhanya Biswas
October-December 2012, 4(4):280-282
DOI:10.4103/0974-7753.111205  PMID:23766616
Pilomatrixoma or pilomatricoma is an uncommon benign tumor of hair matrix origin, which most commonly occurs in the head and neck region and upper extremities. In this study, we report a case of pilomatrixoma of a 35-year-old female presenting with left-leg swelling with surface ulceration, clinically thought to be malignant. Fine-needle aspiration cytology (FNAC) of the lesion showed clusters of basaloid cells with round to ovoid nuclei, nucleated squamous cells, and anucleated squames and clusters of shadow cells. Acytological diagnosis of pilomatrixoma was made. Subsequent surgical excision and histopathological examination confirmed the diagnosis. This case highlights a rare site of presentation and the role of FNAC in preoperative diagnosis of this benign tumor for proper management.
  1 2,983 46
Paradise Nut Paradox: Alopecia Due to Selenosis from a Nutritional Therapy
Subramanian Senthilkumaran, Namasivayam Balamurugan, Rais Vohra, Ponniah Thirumalaikolundusubramanian
October-December 2012, 4(4):283-284
DOI:10.4103/0974-7753.111206  PMID:23766617
Selenium is a micronutrient. It presents a nutritional conundrum because of its twin status as an essential as well as a highly toxic trace element. Here, we report a case of acute non-intentional selenium toxicity due to increased ingestion of "paradise nuts" (Lecythis ollaria) which resulted in massive alopecia.
  1 2,539 47
Trichostasis Spinulosa Confirmed by Standard Skin Surface Biopsy
Özge Gündüz, Asli Aytekin
October-December 2012, 4(4):273-274
DOI:10.4103/0974-7753.111201  PMID:23766613
Trichostasis spinulosa (TS) is a common but rarely diagnosed disease. For diagnosis, it's sufficient to see a bundle of vellus hair located in a keratinous sheath microscopically. In order to obtain these vellus hair settled in comedone-like openings, Standard skin surface biopsy (SSSB), a non-invasive method was chosen. It's aimed to remind the differential diagnosis of TS in treatment-resistant open comedone-like lesions and discuss the SSSB method in diagnosis. A 25-year-old female patient was admitted with a complaint of the black spots located on bilateral cheeks and nose for 12 years. In SSSB, multiple vellus hair bundles in funnel-shaped structures were observed under the microscope, and a diagnosis of 'TS' was made. After six weeks of treatment with tretinoin 0.025% and 4% erythromycin jel topically, the appearance of black macules was significantly reduced. Treatment had to be terminated due to her pregnancy, and the lesions recurred within 1 month. It's believed that TS should be considered in the differential diagnosis of treatment-resistant open comedone-like lesions, and SSSB might be an inexpensive and effective alternative method for the diagnosis of TS.
  1 2,676 23
Topical Melatonin for Treatment of Androgenetic Alopecia
Tobias W Fischer, Ralph M Trüeb, Gabriella Hänggi, Marcello Innocenti, Peter Elsner
October-December 2012, 4(4):236-245
DOI:10.4103/0974-7753.111199  PMID:23766606
Background: In the search for alternative agents to oral finasteride and topical minoxidil for the treatment of androgenetic alopecia (AGA), melatonin, a potent antioxidant and growth modulator, was identified as a promising candidate based on in vitro and in vivo studies. Materials and Methods: One pharmacodynamic study on topical application of melatonin and four clinical pre-post studies were performed in patients with androgenetic alopecia or general hair loss and evaluated by standardised questionnaires, TrichoScan, 60-second hair count test and hair pull test. Results: Five clinical studies showed positive effects of a topical melatonin solution in the treatment of AGA in men and women while showing good tolerability: (1) Pharmacodynamics under once-daily topical application in the evening showed no significant influence on endogenous serum melatonin levels. (2) An observational study involving 30 men and women showed a significant reduction in the degree of severity of alopecia after 30 and 90 days ( P < 0.001) based on questionnaires completed by investigators and patients. (3) Using a digital software-supported epiluminescence technique (TrichoScan) in 35 men with AGA, after 3 and 6 months in 54.8% to 58.1% of the patients a significant increase of hair density of 29% and 41%, respectively was measured (M0: 123/cm² M3: 159/cm² M6: 173/cm²) ( P < 0,001). (4) In 60 men and women with hair loss, a significant reduction in hair loss was observed in women, while hair loss in men remained constant ( P < 0.001). (5) In a large, 3-month, multi-center study with more than 1800 volunteers at 200 centers, the percentage of patients with a 2- to 3-fold positive hair-pull test decreased from 61.6% to 7.8%, while the percentage of patients with a negative hair-pull test increased from 12.2.% to 61.5% ( P < 0.001). In addition, a decrease in seborrhea and seborrheic dermatitis of the scalp was observed. Conclusions: Since safety and tolerability in all of the studies was good, the topical application of a cosmetic melatonin solution can be considered as a treatment option in androgenetic alopecia.
  1 11,110 214
Short Anagen Syndrome in an Indian Woman with its Impact on Quality-of-Life
Niteen V Dhepe, Ashok S Naik
October-December 2012, 4(4):271-272
DOI:10.4103/0974-7753.111200  PMID:23766612
Short anagen syndrome (SAS) is a recently described entity characterized by idiopathic shortening of anagen phase. The condition is poorly described in Indian population. We describe the 1 st Indian case with clinico-pathological features of a 30-year-old woman diagnosed with SAS. Case was diagnosed on the basis of clinical examination, trichogram, microscopic examination of the hair shaft, histopathologic examination of scalp, and measurement of hair growth rate.
  - 2,306 43
Rapunzel Syndrome Case Report: A 13-year-old Girl
Hakan Ozdemir, Zehra U Ozdemir, Ibrahim T Sahiner, Metin Senol
October-December 2012, 4(4):275-277
DOI:10.4103/0974-7753.111202  PMID:23766614
Bezoars are masses, which are commonly encountered in patients after stomach surgery or in those with psychiatric problems, formed by the accumulation of intraluminal nondigestible substances that can lead to obstruction of the stomach and the small intestine. The anatomical changes in the gastrointestinal tract are known to cause bezoar formation. In the absence of an anatomical change, psychiatric disorders such as trichotillomania may lead to the formation of trichobezoars in the stomach. The so-called Rapunzel syndrome is the extension of the bezoars down to the duodenum and the jejunum, which is a rare condition. In this paper, a 13-year-old patient with trichotillomania is reported, who was admitted to our clinic with nausea, vomiting, and fatigue complaints, in whom a giant trichobezoar was identified, which completely filled the stomach and duodenum, without causing obstruction.
  - 2,280 42
Itchy Black Hair Bristles on Back
Rameshwar M Gutte
October-December 2012, 4(4):285-286
DOI:10.4103/0974-7753.111210  PMID:23766618
  - 3,509 55
Highlights of Hair India 2012
Patrick Yesudian
October-December 2012, 4(4):233-234
DOI:10.4103/0974-7753.111197  PMID:23766604
  - 1,838 53
Hair India 2012: A letter of Appreciation
Ralph M Trüeb
October-December 2012, 4(4):235-235
DOI:10.4103/0974-7753.111198  PMID:23766605
  - 653 7
Hair Loss: A Harbinger of the Morbidities to Come!
Dilip Gude
October-December 2012, 4(4):287-288
DOI:10.4103/0974-7753.111212  PMID:23766619
  - 2,680 38
Familial Woolly Hair: A Rare Entity
Satyendra Kumar Singh, Kajal Manchanda, Anand Kumar, Anurag Verma
October-December 2012, 4(4):288-289
DOI:10.4103/0974-7753.111214  PMID:23766620
  - 2,108 46
Hairy Mouth
Shanmuga C Sekar, Swetha Sunny Kurian, P Surendran
October-December 2012, 4(4):289-290
DOI:10.4103/0974-7753.111218  PMID:23766621
  - 2,092 42
Woolly Hair in Two Siblings
SS Pandey, Tulika Rai
October-December 2012, 4(4):290-291
DOI:10.4103/0974-7753.111220  PMID:23766622
  - 1,622 41
Role of Platelet-rich Plasma in the Management of Androgenetic Alopecia
Nitin D Chaudhari, Yugal K Sharma, Kedar Dash, Palak Deshmukh
October-December 2012, 4(4):291-292
DOI:10.4103/0974-7753.111222  PMID:23766623
  - 3,936 281
Hirsutism: A Clinico-investigative Study
Sunny Chhabra, Ram Krishan Gautam, Bindu Kulshreshtha, Akhilandeswari Prasad, Neera Sharma
October-December 2012, 4(4):246-250
DOI:10.4103/0974-7753.111204  PMID:23766607
Background: Hirsutism is a common clinical condition characterized by presence of terminal hair at body sites under androgenic influence. Inspite of the significant worldwide prevalence of hirsutism, studies on hirsutism from India are not many. Objective: To assess the etiology of hirsutism and correlate its severity with underlying causes and various hormone levels. Materials and Methods: In this prospective study, 40 patients of hirsutism enrolled on first come basis were included. All patients underwent detailed clinical assessment and transabdominal ultrasonography. Free and total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone, follicle stimulating hormone, prolactin, free tri-iodothyronine, free tetra-iodothyronine, and thyroid stimulating hormone, and sex hormone binding globulin were estimated. Forty age-matched controls without features of hyperandrogenemia were included for the comparison. Results: Thirteen (32.5%) patients had mild, 52.5% had moderate whereas 15% had severe hirsutism. Positive family history was documented in 42.5% patients. The clinical features found to be associated with hirsutism included acne (55%), menstrual irregularities (40%), acanthosis nigricans (37.5%), obesity (37.5%), and androgenetic alopecia in 27.5% of patients. Polycystic ovarian syndrome (PCOS) was the underlying cause in 70%, non-classical congenital adrenal hyperplasia and hypothyroidism in 7.5% each whereas idiopathic hirsutism was found in 15% patients. Conclusion: PCOS was the most common cause of hirsutism found in the instant study. Further, there was positive correlation between severity of hirsutism and free testosterone levels.
  - 3,225 139
Evaluation of Anxiety and Levels of Serum B12, Folate, TSH, Ferritin, and Zinc in Telogen Alopecia Patients with Trichodynia
Perihan Ozturk, Fatma Ozlem Orhan, Ali Ozer, Yasemin Akman, Ergul Kurutas
October-December 2012, 4(4):251-254
DOI:10.4103/0974-7753.111208  PMID:23766608
Background: Trichodynia refers to pain, discomfort, and/or paresthesia of the scalp. Trichodynia may be associated with anxiety. Aim: To assess serum vitamin B12, folate, thyroid stimulating hormone (TSH), ferritin, and zinc levels, and to investigate anxiety in telogen alopecia patients with trichodynia. Materials and Methods: The study included 31 telogen alopecia patients who complained of trichodynia and 30 telogen alopecia patients without trichodynia. Their serum vitamin B12, folate, TSH, ferritin, and zinc levels were assessed and their anxiety levels were scored using the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI). Results: No significant difference was found in the serum levels of vitamin B12, folate, TSH, ferritin, and zinc in the patient and control groups. The anxiety scores in both groups were similar. Conclusion: Our data provide no evidence for the association of serum vitamin B12, folate, TSH, ferritin, and zinc levels or anxiety scores with trichodynia.
  - 7,732 102
Cross-section Trichometry: A Clinical Tool for Assessing the Progression and Treatment Response of Alopecia
Tongyu Cao Wikramanayake, Lucia M Mauro, Irene A Tabas, Anne L Chen, Isabel C Llanes, Joaquin J Jimenez
October-December 2012, 4(4):259-264
DOI:10.4103/0974-7753.111221  PMID:23766610
Background: To properly assess the progression and treatment response of alopecia, one must measure the changes in hair mass, which is influenced by both the density and diameter of hair. Unfortunately, a convenient device for hair mass evaluation had not been available to dermatologists until the recent introduction of the cross-section trichometer, which directly measures the cross-sectional area of an isolated bundle of hair. Objective: We sought to evaluate the accuracy and sensitivity of the HairCheck® device, a commercial product derived from the original cross-section trichometer. Materials and Methods: Bundles of surgical silk and human hair were used to evaluate the ability of the HairCheck® device to detect and measure small changes in the number and diameter of strands, and bundle weight. Results: Strong correlations were observed between the bundle's cross-sectional area, displayed as the numeric Hair Mass Index (HMI), the number of strands, the silk/hair diameter, and the bundle dry weight. Conclusion: HMI strongly correlated with the number and diameter of silk/hair, and the weight of the bundle, suggesting that it can serve as a valid indicator of hair mass. We have given the name cross-section trichometry (CST) to the methodology of obtaining the HMI using the HairCheck® system. CST is a simple modality for the quantification of hair mass, and may be used as a convenient and useful tool to clinically assess changes in hair mass caused by thinning, shedding, breakage, or growth in males and females with progressive alopecia or those receiving alopecia treatment.
  - 2,800 93