International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
Coverpage
July-August 2020
Volume 12 | Issue 4
Page Nos. 147-196

Online since Saturday, September 19, 2020

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REVIEW ARTICLE  

Effect of oral minoxidil for alopecia: Systematic review Highly accessed article p. 147
Israel Junior Borges do Nascimento, Matthew Harries, Vanessa Barreto Rocha, Jacqueline Y Thompson, Chun Hoong Wong, Hamed Kord Varkaneh, Nathália Sernizon Guimarães, Alair Junior Rocha Arantes, Milena Soriano Marcolino
DOI:10.4103/ijt.ijt_19_20  
Patients with major presentations of alopecia experience physically harmful effects and psychological comorbidities, such as depression and anxiety. Oral minoxidil (OM) has been suggested by dermatologists as a potential remedy; however, its effectiveness remains unclear. This systematic review aims to collate published studies and to analyze the effect of OM among patients diagnosed with any type of alopecia. For this systematic review, Medline/PubMed, Cochrane Central, EMBASE, Web of Sciences, and Latin American and Caribbean Health Sciences Information System were searched for relevant studies from inception to September 21, 2019. Of 1960 studies retrieved in several electronic databases and three additional records identified though reference list from potentially eligible studies, nine studies (one randomized controlled trial and eight nonrandomized controlled trials) met the requirements and were used in our analysis. Although we found positive effects in favor of OM, this should be interpreted cautiously due to very low quality of the evidence of outcomes in the selected studies. Definitive conclusions are not possible without high-quality trials. This review has highlighted the absence of high-quality randomized controlled trials evaluating OM in the treatment of various types of alopecia. Given the mild adverse events of OM, future studies should also analyze doses and duration to maximize efficacy and decrease side effects.
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ORIGINAL ARTICLES Top

Dermoscopic assessment of microneedling alone versus microneedling with platelet-rich plasma in cases of male pattern alopecia: A split-head comparative study Highly accessed article p. 156
Kartikay Aggarwal, Sanjeev Gupta, Ravi Shankar Jangra, Aneet Mahendra, Anuradha Yadav, Aastha Sharma
DOI:10.4103/ijt.ijt_64_20  
Introduction: Male pattern alopecia (MPA) is a common disorder hugely impacting the quality of life of affected individuals. The meager number of options available for treatment has their own limitations. Novel therapies are continuously being researched for. Materials and Methods: The present study included thirty male patients with Hamilton Grade II to Grade V. All patients received four sequential treatments with microneedling (MN) on one half of the scalp and platelet-rich plasma (PRP) with MN (MN + PRP) on the other half for 4 months. Three months following the last session, evaluation was done from the vertex and temporal sites in both the groups by dermoscopic microphotographs by a blinded evaluator. In addition, the patients were asked about their satisfaction score on the basis of treatment outcome. Results: Overall hair thickness showed significant increase in both MN and MN + PRP group. Furthermore, the increase in thickness was almost double in the MN group as compared to MN + PRP group (0.006 and 0.003 mm, respectively). Overall hair density also increased significantly in both the study groups but more in MN + PRP group (14.6 hair/cm2) than the MN group (10.8 hair/cm2). However, the difference between the results of both the groups was not statistically significant. Conclusion: To the best of our knowledge, this is the first split scalp study for MPA. We conclude that MN and PRP are both effective in treatment of androgenetic alopecia and improve the hair parameters and patient satisfaction. However, no additional effect of PRP over MN was observed. Both these therapies are safe and well tolerated without any major side effects. Limitations of our study were small sample size and lack of long-term follow-up.
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The assessment of hair transplantation outcomes in cicatricial alopecia p. 164
C Madura, N Vinay, MR Kusuma, S Harsha, BS Chandrashekar
DOI:10.4103/ijt.ijt_52_19  
Background: Cicatricial alopecia (CA) is scarring alopecia due to a diverse group of disorders which destroy the hair follicle, replace it with scar tissue causing permanent hair loss. Spontaneous regrowth of hair in CA is rarely seen and thus it has a negative impact on the self-esteem of the patient. However, hair transplantation (HT) has emerged as an effective modality of treatment to replace lost hair for cosmetic benefit. Materials and Methods: This was a prospective analysis of patients affected with CA, who underwent HT from January 2015 to December 2017. Demography of patients along with the duration of disease, stability, biopsy, technique of HT, number of grafts, and other procedures done were noted on a pro forma and analyzed. A test patch of HT was done in all primary CA to assess stability and few secondary CA to look for graft uptake. The patients were followed up for a year and the outcomes were graded by patient and a single observer on a 10 point scale as poor, satisfactory, good, and very good at 3, 6, and 12 months. Results: A total of 50 patients with CA underwent follicular unit extraction. Majority of them were males(84%) with a male to female ratio of 5.25:1. Secondary CA was seen in majority(90%) of the study group. Moustache (56%) was the most common site affected, followed by scalp (22%), beard(14%) and eyebrow(8%). Around 38%(12 atrophic scars; 7 hypertrophic scars) underwent fractional CO2 laser/Erbium YAG laser with or without intralesional steroid injections in a stepwise manner prior to HT. Excellent-to-very good outcome was seen in 82% while 18% were lost for follow up. Conclusion: Scarring in CA has a significant effect on quality of life of affected patients. HT when done taking into consideration the stability of disease has good-to-excellent outcomes thus leading to a positive impact on the patient's life.
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Improvement of cell proliferation and antioxidant activity of silymarin in hair follicles dermal papillae isolated from the human scalp: Comparison with vitamin C effects p. 168
Hamid Reza Ahmadi Ashtiani, Asma Dadgar, Melika Akaberi
DOI:10.4103/ijt.ijt_124_19  
Introduction: Nowadays, hair loss is becoming a major problem for a large number of people. The main factors affecting hair growth include racial, gender, genetics, and hormonal. Furthermore, environment, physiology, and nutrition are the tools that are affecting hair growth. Materials and Methods: This article analyses the effects of silymarin and Vitamin C on the proliferation of dermal papilla cells (DPCs), COX2, inducible nitric oxide synthase (iNOS), total anti-oxidant capacity (TAC), and reactive oxygen species (ROS). The DPCs of the hair follicle treated by 50 and 100 μM of silymarin and 100 μM of Vitamin C on days 2, 7, and 14. Results: A comparatively effect of silymarin and Vitamin C demonstrated that Vitamin C is more effective in the stimulation of dermal papillae in cell culture. Furthermore, the stimulation effects of silymarin are attributed to its antioxidant activity of the cells. Conclusion: The overall result shows that cell proliferation and TAC significantly increased. However, iNOS, ROS, and COX2 levels were decreased.
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Increased association between previous pregnancies and use of chemical relaxers in 74 women with central centrifugal cicatricial alopecia p. 176
Manasa Narasimman, Valeria De Bedout, David E Castillo, Mariya I Miteva
DOI:10.4103/ijt.ijt_37_20  
Background: Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia exclusively seen in women of African descent. The etiology is unknown and epidemiologic studies including data on comorbidities in patients with CCCA are limited. Our primary objective was to identify possible etiologic and lifestyle associations in patients with CCCA. Materials and Methods: A retrospective chart review was conducted for patients diagnosed with CCCA between January 1, 2013, and January 1, 2018, at a university dermatology outpatient clinic. Controls consisted of age-, sex-, and race-matched African–American women diagnosed with other hair loss conditions. Data from 74 cases and 96 controls were collected and analyzed via logistic regression. In addition, a phone survey was conducted in the CCCA cohort asking specific questions related to their condition and quality of life. Results: A significant relationship was found between CCCA and previous pregnancies as well as the use of chemical relaxers: patients with CCCA were 11.71 times more likely to have had a previous pregnancy (P < 0.001) and 12.37 times more likely to have used chemical relaxers in the past (P < 0.001). Association with uterine fibroids was found not statistically significant (P > 0.05). Conclusion: We identified an association between previous pregnancies and use of chemical relaxers in patients diagnosed with CCCA when compared to controls. These findings may help to plan prospective studies aiming at establishing a more concrete link between hormones and CCCA.
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More is not always better in hair growth factors. epidermal growth factor: hair growth factor involved in alopecia areata pathogenesis p. 182
Asmaa M El-Refai, Doaa Mohamed Elhabak, Rana Atef Khashaba
DOI:10.4103/ijt.ijt_51_20  
Background: Alopecia areata (AA) is the second most frequent nonscarring alopecia after androgenetic alopecia; the trigger factor induces changes in the growth plate of hair bulb and leads to premature termination of anagen phase. Epidermal growth factor (EGF) can be the key molecule that participates in initiation and suppression of normal hair growth cycle. The role of EGF in the pathogenesis of AA is still uncertain. Aim of the Work: This aim is to estimate the serum level of EGF in patients with AA trying to detect its role in AA pathogenesis and correlate it with the disease severity. Subjects and Methods: This case–control study included 60 clinically diagnosed patients with AA with different variants and severities and 25 age- and sex-matched healthy controls. EGF level was measured using ELISA. Results: The mean serum EGF was statistically significantly higher in patients than of controls (P < 0.0003). The EGF level was higher in patients with disease duration >1 month than patients with disease duration ≤ 1 month, and it was higher in patients with high recurrence than patients without recurrence (P > 0.05). The EGF in patients of severe AA was statistically significantly higher than moderate AA patients, and moderate cases were higher than mild AA patients (P = 0.0001). Furthermore, the level of EGF with scalp involvement was higher; the highest serum level of EGF marker in S4 (75%-99%) hair loss then S3 (50%-74% hair loss), illustrated in table (4) followed by different percentage of hair loss, difference statistically significant. Conclusions: Elevated hair-specific growth factor as EGF is not always a good sign for hair growth and functioning promotor inducing hair recovery, but it may be linked to the pathogenesis of hair disorders as AA.
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CASE REPORT Top

Clinical experience with oral tofacitinib in a patient with alopecia areata universalis and rheumatoid arthritis p. 188
Daniele Tiemi Abe, Letícia Mari Tashima, Flavia Machado Alves Basilio, Fabiane Mulinari-Brenner
DOI:10.4103/ijt.ijt_107_20  
Alopecia areata (AA) is a chronic and autoimmune disease frequently characterized by a challenge management between dermatologists. At present, JAK-inhibitors have demonstrated encouraging results in AA treatment. Therefore, this study reports a case of alopecia universalis in a patient with rheumatoid arthritis (RA), whose methotrexate therapy shown unsatisfactory response in RA control. After the introduction of 10 mg (oral route) per day of tofacitinib, a JAK-inhibitor, an improvement of almost 50% in severity alopecia tool score occurred with maintained response even after 3 months of medication suspension. From this time, we corroborate the effectiveness of JAK-inhibitors presented in the scientific literature. In addition, we inquiry the real impact of methotrexate on JAK-start signaling inhibition in AA pathophysiology.
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CLINICAL CHALLENGE Top

Sudden hair change after first birthday p. 191
Ines Bertlich, Wolfgang Hartschuh, Alexander Enk, Ferdinand Toberer
DOI:10.4103/ijt.ijt_36_20  
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LETTERS TO EDITOR Top

Folliculitis decalvans in the era of antibiotic resistance: Microbiology and antibiotic sensitivities in a tertiary hair clinic p. 193
Leila Asfour, Elizabeth Trautt, Matthew John Harries
DOI:10.4103/ijt.ijt_98_20  
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Dodging Pitfalls in Trichoscopy: How to Nail the Right Diagnosis p. 195
Taynara de Matos Barreto, Daniel Fernandes Melo, Thaís de Barros Castro Alves, Mariana Modesto Dantas de Andrade Lima, Caren dos Santos Lima
DOI:10.4103/ijt.ijt_9_20  
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