International Journal of Trichology International Journal of Trichology
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   Table of Contents - Current issue
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September-October 2020
Volume 12 | Issue 5
Page Nos. 197-248

Online since Tuesday, November 3, 2020

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REVIEW ARTICLE  

Cumulative life course impairment of alopecia areata Highly accessed article p. 197
Laura J Burns, Natasha Mesinkovska, Dory Kranz, Abby Ellison, Maryanne M Senna
DOI:10.4103/ijt.ijt_99_20  
Alopecia areata (AA), an unpredictable, nonscarring hair loss, is commonly perceived as a cosmetic, rather than medical, concern. However, substantial evidence exists describing the negative impact on quality of life, as the disease affects patients personally, socially, financially, and physically. Over time, the cumulative disability may perpetuate poor confidence, social disconnection, negative coping strategies, and failure to achieve a full life potential. Here, we describe the cumulative life course impairment (CLCI) of AA by examining the complex interaction of (1) stigmatization, (2) physical and psychiatric comorbidities, and (3) coping strategies. The model aggregates existing cross-sectional data, which have previously captured disease burden only as snapshots in time. Thus, by examining cumulative effects, the CLCI model serves as a proxy for longitudinal data to better describe life course epidemiology of the disease.
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ORIGINAL ARTICLES Top

A community based study to estimate prevalence and determine correlates of premature graying of hair among young adults in Srinagar, Uttarakhand, India Highly accessed article p. 206

DOI:10.4103/ijt.ijt_28_19  
Background: There are several ways by which aging is identified, of which graying of hair is perhaps the most common way. Nowadays, graying of hairs, which was expected to occur after 40s, can be easily observed among younger age group, even before 20s. The present study aims to estimate the prevalence of graying of hairs and its correlates among young adults in Srinagar, Uttarakhand, India. Methodology: A community-based cross-sectional study was conducted among 384 young adults between 15 and 30-year age group in the urban area of Srinagar tehsil of Pauri district. Graying of hair was assessed on the basis of the number of white hairs on examination of scalp. Results: The prevalence of premature graying of hairs (PMGHs) was found to be 27.3%. Binary logistic regression analysis showed that a paternal history of PMGH, history of smoking, maternal history of PMGH, sunlight exposure, and body mass index were significant predictors of PMGH. Limitations: The factors found associated could be better determined through a follow-up study which could not be done in the current study. The present study was carried in a tehsil of one district of Uttarakhand therefore has limited external validity. Conclusion: The present study highlights the importance of maintaining a healthy lifestyle as well as adequate exposure to sunlight in preventing PMGH.
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Evaluation of impact of tinea capitis on quality of life in pediatric patients using children's dermatology life quality index and its correlation with disease duration p. 213

DOI:10.4103/ijt.ijt_58_20  
Introduction: The superficial fungal infection of the scalp caused by dermatophytes is called tinea capitis. It has a predilection for the pediatric age group. In developing countries like India factors such as overcrowding, inadequate hygiene, and low literacy rate contribute to its high incidence. Aims and Objective: This study aimed at identifying and grading the psychosocial impact of tinea capitis in children and correlating it with disease duration and socioeconomic status of patient's family. Materials and Methods: This was a cross-sectional study conducted in our skin outpatient department involving children aged 6–16 years with clinical diagnosis of tinea capitis. We used the children's dermatology life quality index (CDLQI) instrument to observe the psychological implications in these children. Results: The study included 134 patients, with a mean CDLQI score of 6.01 ± 4.17. There was a male preponderance in our study with 112 (68.3%) male patients and 52 (31.7%) female patients. The age group affected most commonly was 6–8 years (37.8%). The domains affected most severely were symptoms and feelings (Q1 and Q2) followed by sleep (Q 9). The psychological implications were higher in patients suffering from kerion, older children, and female patients. There was a statistically significant correlation between the impact on quality of life (QOL) and disease duration as well as disease severity; however, no correlation could be made between QOL and socioeconomic strata of family. Conclusion: The study brings into question the overlooked psychological implications of tinea capitis which are often overlooked by the dermatologist and parents as a mere dermatological disease. Instead a holistic approach including a complete psychological evaluation of children and appropriate counseling of both patients and their parents must be done.
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Valchlor® in the treatment of lichen planopilaris and frontal fibrosing alopecia: A single arm, open-label, exploratory study p. 220

DOI:10.4103/ijt.ijt_16_20  
Background: Lichen Planopilaris (LPP) is a lymphocyte-mediated scarring alopecia that frequently is treatment resistance to both topical and systemic therapies. Aims and Objectives: The object of this pilot study was to assess the effectiveness of topical mechlorethamine 0.016% gel (Valchlor®) in decreasing disease activity in LPP and the related clinical variant frontal fibrosing alopecia (FAA). Methods: Twelve patients with biopsy-proven LPP/FAA who failed prior topical or systemic therapy with active disease were included. Participants applied mechlorethamine 0.016% gel to involved areas daily for 24 weeks. Outcome measures included LPP Activity Index (LPPAI) score, Physician Global Assessment (PGA) score, Dermatology Quality of Life Index (DQLI) score, and phototrichograms assessing follicular counts before and after six months of therapy. Results: LPP Activity Index (LPPAI) before and after treatment was significantly different (5.0 before treatment, 2.0 after treatment; p value=0.006). Mean follicular density and follicular units were unchanged during the treatment period. Conclusion: Treatment with mechlorethamine 0.016% gel for 24 weeks resulted in statistically significant improvement of LLP/FFA with no change in phototrichogram parameters. Treatment duration was limited by high rate of contact dermatitis. Further investigation to optimize dosing frequency and to assess the role of combination topical therapy is needed.
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Alopecia Areata-Quality of Life Index questionnaire (reliability and validity of the Persian version) in comparison to Dermatology Life Quality Index p. 227

DOI:10.4103/ijt.ijt_112_20  
Background: Alopecia areata (AA) is an autoimmune disease with an incidence of 2% globally and plays a key role in the quality of life (QOL) of patients with AA. It has been recently shown that there are no sufficient disease-specific questionnaires to assess the QOL in patients with AA. Aims: This study tried to evaluate the validity and reliability of the Persian version of AA-Quality of Life Index (AA-QLI) and compare it with the Dermatology Life Quality Index (DLQI) questionnaire. Materials and Methods: During 1 year, 100 individuals were enrolled in this study and asked to complete the DLQI questionnaire and AA-QLI questionnaire. First of all, we enrolled 25 individuals for evaluating the validity of the Persian version of the questionnaire, and after achieving the proper validity, 75 additional patients were enrolled in this project. Results: The results showed that the test had an appropriate validity (P < 0.001, R = 0.76), reliability (P < 0.001 , internal stability R = 0.89), and (α = 0.91). In this study, we observed that the scores of both questionnaires are quite close. In this regard, in both questionnaires, females had higher scores in comparison to males (P = 0.03), and also both of them correlated with age, age of onset of disease, and skin involvement percentage. Conclusions: The Persian version of the AA-QLI questionnaire is valid and reliable. The QOL of AA patients needs to be considered more seriously. Psychological evaluation of patients is one of the important suggestions in this study.
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Validation of case identification for alopecia areata using international classification of diseases coding p. 234

DOI:10.4103/ijt.ijt_67_20  
Background: Search algorithms used to identify patients with alopecia areata (AA) need to be validated prior to use in large databases. Objectives: The aim of the study is to assess whether patients with an International Statistical Classification of Diseases and Related Health Problems (ICD) 9 or 10 code for AA have a true diagnosis of AA. Materials and Methods: A multicenter retrospective review was performed at Columbia University Irving Medical Center, Brigham and Women's Hospital, and Massachusetts General Hospital to determine whether patients with an ICD 9 codes (704.01 - AA) or ICD 10 codes (L63.0 -Alopecia Totalis, L63.1 - Alopecia Universalis, L63.2 - Ophiasis, L63.8 - other AA, and L63.9 - AA, unspecified) for AA met diagnostic criteria for the disease. Results: Of 880 charts, 97.5% had physical examination findings consistent with AA, and 90% had an unequivocal diagnosis. AA was diagnosed by a dermatologist in 87% of the charts. The positive predictive value (PPV) of the ICD 9 code 704.01 was 97% (248/255). The PPV for the ICD 10 codes were 64% (75/118) for L63.0, 86% (130/151) for L63.1, 50% (1/2) for L63.2, 91% (81/89) for L63.8, and 93% (247/265) for L63.9. Overall, 89% (782/880) of patients with an ICD code for AA were deemed to have a true diagnosis of AA. Conclusions: Patients whose medical records contain an AA-associated ICD code have a high probability of having the condition.
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LETTER TO EDITORS Top

A case of monilethrix with trichoscopic changes p. 238

DOI:10.4103/ijt.ijt_104_19  
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Early-onset trichotillomania with habit disorder in a 5-year-old-girl – With trichoscopic findings p. 241

DOI:10.4103/ijt.ijt_31_20  
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A case of post hair transplant dermatosis neglecta: A rare entity p. 243

DOI:10.4103/ijt.ijt_78_20  
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Naxos disease: The model for scientific discovery p. 245

DOI:10.4103/ijt.ijt_114_20  
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Identical alopecia areata in identical twin sisters p. 247

DOI:10.4103/ijt.ijt_120_20  
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