Hair loss in elderly patients is a common complaint. It can be related to different conditions that affect patients' quality of life and represents a challenge for dermatologists. It affects both men and women during the aging process with an estimated percentage of balding after 65 years of age of 53% and 37%, respectively. Androgenetic alopecia, frontal fibrosing alopecia, senile alopecia, and erosive pustular dermatosis of the scalp are the hair diseases most frequently described in this age group. The objective of this review is to summarize the current knowledge about alopecia affecting elderly patients, differentiating between chronological hair aging signs and pathological changes, to help clinicians, offer an adequate management of these disorders to their patients.

Background: Glyoxylic acid has emerged as a safe alternative to formol (formaldehyde) use as a hair straightener/relaxer. However, the possible damage to the hair fiber after its application is low known and/or published in the literature. Aims: This work aims to characterize hair locks treated with glyoxylic acid compared to traditional alkaline straighteners such as sodium and guanidine hydroxide and ammonium thioglycolate. Materials and Methods: The morphology of the hair cuticles was observed by scanning electron microscopy. Protein loss was assessed by the Lowry method modified by Peterson and as mechanical properties that were expressed in terms of tensile strength. Results: All products (sodium and guanidine hydroxides and ammonium thioglycolate) caused protein loss of about 2.5 μg/g, except glyoxylic acid that caused the worst damage (3.5 μg/g), in relation to the untreated (virgin) hair (1.12 μg/g), indicating that the chemical treatments can cause hair damage in both cuticles and cortex. The force to break the fibers treated with traditional straighteners based on sodium hydroxide, guanidine hydroxide, and ammonium thioglycolate was statistically the same. Conclusion: The treatment with glyoxylic acid showed rupture tensile statistically equivalent to the alkaline straighteners. The mechanism of action of glyoxylic acid does not appear to be based on breaking and rearrangement of disulfide bridges, but altered them, that influenced the hair strength. However, it is also essential to consider other factors relevant: technical application technique, reaction time, and interval of reapplication of the product, as this can change the pattern of the results obtained.

Background: Alopecia areata (AA) is an autoimmune disease characterized by peribulbar lymphocytic infiltration, follicular miniaturization, catagen/telogen follicles, and increased follicular stelae (streamers) in skin biopsies. Objectives: Our aim was to assess the number of follicular stelae of patients with AA and to evaluate their association with clinical type and severity and treatment response of AA. Materials and Methods: Histopathologic features including number of follicular stelae were recorded in skin biopsies taken from lesions of AA in 142 patients who attended our dermatology clinic from 2011 to 2017. Results: There was a statistically significant correlation between the patient age and the number of follicular stelae (P = 0.001). There was a statistically significant correlation between the severity of disease and the number of follicular stelae (P = 0.005). AA subtypes (0%–25% scalp hair loss) had a significantly lower number of follicular stelae than 75%–100% scalp hair loss and alopecia universalis (7.92 ± 4.21 vs. 13.23 ± 7.28). There was no statistically significant correlation between the treatment response and the number of follicular stelae (P = 0.75). Conclusion: Our results showed that number of follicular stelae varied among AA clinical types and correlated with severity. This study was the first to evaluate the correlation between the number of follicular stelae and severity of AA.

With aging, hair graying is a common sign resulting from complex regulation of melanogenesis. Multiple factors control the stimulation of melanogenesis at the level of the hair follicle, including melanin-stimulating hormone (MSH), adrenocorticotropic hormone, endothelin-1, prostaglandins, leukotrienes, neutrophils, fibroblast growth factor, nitric oxide, catecholamines, Vitamins, and minerals. Premature hair graying (PHG) has a major impact on the cosmesis, self-credibility, and social life of the affected individual. Currently, there is no medical treatment available for PHG. We present a case of a 25-year-old female with a history of graying of hair on the scalp. Clinical diagnosis revealed it as a case of premature graying/canities. She was prescribed a topical formulation (Greyverse solution) containing palmitoyl tetrapeptide 20, a biomimetic biopeptide of α-MSH for treating her PHG. The formulation was applied 1 mL twice daily directly on the affected part of the scalp. Hair supplements containing a combination of biotin and calcium pantothenate once daily orally were also prescribed. After 3 months, the patient showed some improvement, and the dose of the topical solution was reduced to 1 mL once daily. After 5 months, the patient achieved >90% conversion of gray hair to black hair.

Acute scalp hair “felting” is a rare acquired condition that presents with sudden severe twisting, entangling, and matting of scalp hair into a stiff tightly packed mass, in otherwise healthy individuals. In such conditions, the mechanism of hair matting is almost like the process of “felting” in wool and textile industry, where adjacent fibers are compacted together in a warm liquid medium. Herein, a case of acute hair “felting” during styling practice is discussed with the possible predisposing factors, prophylaxis, and treatment.

Ichthyosis follicularis with alopecia and photophobia (IFAP) syndrome is a rare congenital genetic disorder characterized clinically by a triad of follicular ichthyosis, alopecia and photophobia. The genetic inheritance pattern in IFAP syndrome is said to be X-linked with mutations of the membrane-bound transcription factor peptidase, site 2 gene. Histopathology of the skin shows dilated hair follicles with keratin plugs extending above the surface of the skin. In this case report, we describe a 6-year-old girl with clinical features of IFAP along with palmoplantar keratoderma. Skin biopsy was done to confirm the diagnosis after which she was started on acitretin (10 mg per day). Good improvement in cutaneous features was observed after 1 month.

Finasteride, a 5-α reductase inhibitor, is generally well tolerated on long-term use and cutaneous adverse events have rarely been observed with the drug. We present the case of a 25-year-old male who developed an extensive psoriasiform eruption within a week of starting finasteride 1 mg for androgenetic alopecia.

Scalp dysesthesia (SD), a variant of cutaneous dysesthesia syndrome is an underrecognized cause of scalp pruritus. It usually presents with itch, pain, burning, or stinging sensation over localized or diffuse area of the scalp without any objective findings. Trichoscopy, a rapid and in-office procedure, could aid in the early clinical diagnosis of this condition and initiate management. We report a case of SD in an elderly male diagnosed with the aid of trichoscope, evaluated and treated successfully.