International Journal of Trichology International Journal of Trichology
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   2016| January-March  | Volume 8 | Issue 1  
    Online since March 30, 2016

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Factors associated with premature hair graying in a young Indian population
Swagata Chakrabarty, Prafulla G Krishnappa, Dinesh G Gowda, Jyothi Hiremath
January-March 2016, 8(1):11-14
DOI:10.4103/0974-7753.179384  PMID:27127369
Context: Although the primary cause of premature hair graying (PHG) is considered to be genetic, certain environmental factors also play a role. Trace element deficiencies such as Vitamin B12, Vitamin D3, and calcium may also be associated with PHG. However, India-specific data are relatively sparse. Aims: The present study aimed at identifying factors associated with PHG in Indian patients. Settings and Design: A case–control study was conducted at a trichology clinic in Bengaluru between October 2013 and April 2014 with a total of 37 cases of PHG and 37 age- and gender-matched controls. Materials and Methods: A total of 100 subjects were investigated for various parameters such as hemoglobin, serum ferritin, zinc, copper, calcium, Vitamin B12, and Vitamin D after obtaining informed consent. Statistical Analysis Used: Chi-square test was used to compare proportions between groups. Means were compared between groups using Student's t-test.Results: Serum ferritin levels were lower in patients with PHG as compared to the control group and the differences were statistically significant (P < 0.001). Furthermore, as compared to the controls, patients with PHG had lower serum Vitamin B12 levels (P < 0.001). Individuals with PHG had significantly lower levels of high-density lipoprotein cholesterol (HDL-C) as compared to the control group (P < 0.001). Significant proportions of patients with PHG had a sedentary lifestyle and admitted to having irregular eating habits. Conclusion: PHG is associated with low serum ferritin, Vitamin B12, and HDL-C levels in Indian patients aged <25 years. However, studies with large sample sizes may be required to conclusively define these putative associations.
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Liquid nitrogen cryotherapy in recalcitrant alopecia areata: A study of 11 patients
Vijay P Zawar, Gayatri Mukund Karad
January-March 2016, 8(1):15-20
DOI:10.4103/0974-7753.179403  PMID:27127370
Context: Recalcitrant alopecia areata (AA) is not uncommon in clinical practice. In certain patients, treatment failures are known with almost every conventional therapy either singly or in combination. Aims: To study the efficacy of liquid nitrogen (LN) cryotherapy in patients with recalcitrant AA. Subjects and Methods: We present series of eleven patients of recalcitrant AA, who consulted us after getting no response to various modalities of treatment for 6 months. We treated them with LN cryotherapy every 2 weeks till significant hair regrowth or maximum five sittings (at 0, 2, 4, 6, and 8 weeks) whichever was earlier. Inclusion and exclusion criteria were applied. Each patient was counseled and a written consent was taken. Every session consisted of dual freeze and thaw cycles of 15 s each with a cryo unit spray. Two months of follow-up after last treatment was done to observe sustained re-growth of hair. Statistical Analysis Used: The clinical response was evaluated by using regrowth scale at 4th, 8th, and 16th week. Results: 11 patients were recruited, one patient dropped due to inability to attend follow-ups. Remaining ten patients completed the treatment and follow-up. Out of 10 patients, five patients (50%) showed an excellent response, three (30%) had a satisfactory response, one (10%) had a fair response, and one patient (10%) had a poor response. No serious adverse effects were seen. Sustained hair regrowth was seen in 80% of patients at the 16th week. Conclusions: LN cryotherapy may be worth trying treatment in the management of recalcitrant AA.
  7 5,336 103
Carvajal syndrome
Sahana M Srinivas, Pragalatha Kumar, GV Basavaraja
January-March 2016, 8(1):53-55
DOI:10.4103/0974-7753.179400  PMID:27127386
  5 3,581 64
Trichoscopy: The best auxiliary tool in the evaluation of nevus sebaceous
Balachandra S Ankad, Savitha L Beergouder, Vijay Domble
January-March 2016, 8(1):5-10
DOI:10.4103/0974-7753.179394  PMID:27127368
Introduction: Nevus sebaceous (NS) presents as alopecia and yellowish discoloration during infantile stage. In adult stage, lesions become verrucous. Importantly, various appendageal tumors such as trichoblastoma, syringocystadenoma papilliferum and basal cell carcinoma develop during this stage. Hence it is very important to follow the course of NS for early detection of neoplasms. Trichoscopy, being in vivo diagnostic technique, can be utilized in this condition. as it demonstrates specific trichoscopic patterns. Patterns of NS on trichoscopy are evaluated. Materials and Methods: Study was conducted in SN Medical College, Bagalkot. It is a case series study. Ten patients with NS were studied using polarised dermoscopy. All NS lesions were subjected to histopathology for confirmation of diagnosis. Correlation of histopathological changes and trichoscopic patterns was done. Data were tabulated in Microsoft excel sheet. The results are presented in proportions and percentages. Results: Total of 10 patients including 6males and 4 females were present in the study. The mean age was 20years. Two patients were with childhood stage and 8 patients were with adulthood stage of NS. Trichoscopy showed 'cobble stone pattern' in 20% and 'cerebriform pattern' in 80% of patients. Histopathological features showed numerous and hyperplastic sebaceous glands with primordial hair follicles which were consistent with NS in all the patients. Conclusion: Trichoscopy helps in the diagnosis of NS with specific patterns. Yellowish globules in the cobblestone pattern and cerebriform patterns are specific to childhood and adult stages of NS respectively. Hence, trichoscopy is good, non-invasive diagnostic technique in NS. Authors strongly recommend regular trichoscopic examination of NS.
  4 7,135 95
Trichostasis spinulosa: An unusual diagnosis presenting as a double lower eyelid
Arunava Kundu, Tamalika Kundu, Sonia Gon
January-March 2016, 8(1):21-23
DOI:10.4103/0974-7753.179396  PMID:27127371
Trichostasis spinulosa (TS) is a relatively common but underdiagnosed disorder of the pilosebaceous follicles in which there is follicular hyperkeratosis of a dilated hair follicle with retention of telogen hairs. Clinical presentation of this disorder can be confused with comedogenic acne, keratosis pilaris, eruptive vellus hair cysts, and Favre–Racouchot syndrome. A case of a nonpruritic variant of TS in a 16-year-old boy is reported because of its unusual location as well as presentation in the lower eyelid, giving an appearance of a double eyelid. Although TS is common, it is mostly under diagnosed and henceforth underreported hair follicular disorder. The differential diagnosis of this disorder should be always kept in mind even if it presents in unusual location to avoid unnecessary application of various therapeutic modalities.
  3 7,209 58
Whisker hair (acquired progressive kinking of the hair): An indication for finasteride 1 mg?
Lorea Bagazgoitia, Sonsoles Aboín
January-March 2016, 8(1):24-25
DOI:10.4103/0974-7753.179391  PMID:27127372
Acquired progressive kinking of the hair (APKH) and whisker hair are relatively rare conditions. To our knowledge, fewer than 25 cases have been reported in the English literature. We present the case of a 23-year-old man whose hair on the parietal and occipital areas changed and turned curlier and shorter. Patients suffering from APKH have higher risk of developing androgenetic alopecia and therefore finasteride 1 mg daily is proposed as an adequate treatment for these patients.
  3 9,329 55
Clinical and dermoscopic study of pseudofolliculitis of the beard area
Feroze Kaliyadan, Joel Kuruvilla, Heba Yousef Al Ojail, Sayed A Quadri
January-March 2016, 8(1):40-42
DOI:10.4103/0974-7753.179385  PMID:27127378
Background: Pseudofolliculitis of the beard area is a very common dermatological problem in our geographical region. This could be partly because of the racial predilection as a large percentage of the population has curly hair and also may be due to local cultural customs, unlike the west do not encourage daily shaving of facial hair. Objectives: We aimed to mainly study the dermoscopic features of cases presenting with pseudofolliculitis. Secondary objectives included evaluating clinical patterns and possible etiological factors. Methods: Twenty-four consecutive male patients presenting to a University Health Center with a clinical diagnosis of pseudofolliculitis involving beard area were included in the study. Patient history with regards to shaving habits, patient hair type, morphological patterns of the skin lesions, and dermoscopic findings were recorded. Results: Majority of the patients had “curly” hair. Most of the patients had a usual shaving frequency of 2 or less per week. All the patients who were using razors mentioned that they tended to stretch the skin while shaving. The most common dermoscopic findings included - “Handle bar” sign showing curved hair attached to the skin on both ends, white areas indicate fibrosis and scaling, underlying linear bluish pigmentation (indicating the buried hair shaft), and linear vessels with occasional areas of hemorrhage. Conclusion: Dermoscopy can be a useful adjunct for diagnosis and patient counseling in pseudofolliculitis. Stretching the skin while using razors and growing the facial hair to a point where it has the length to curve might be important risk factors in the development of pseudofolliculitis. Limitations: The lack of histopathological correlation is the main limitation in our study.
  2 3,522 58
Report of a rare case of alopecia areata coexisting with trichotillomania
Piotr Brzezinski, Ewelina Cywinska, Anca Chiriac
January-March 2016, 8(1):32-34
DOI:10.4103/0974-7753.179388  PMID:27127375
Alopecia areata (AA) is a common dermatological disease characterized by patchy areas of nonscarring alopecia. Trichotillomania (TT) is an expression of obsessive-compulsive disorder defined by the urge to pull out his/her hair. We describe a case of AA coexisting with TT. A 6-year-old male child presented with a localized patch of hair loss in the occipital area of 2 years duration. Dermoscopy revealed numerous exclamation mark hairs along with signs of scratching and bleeding. A detailed medical anamnesis and thorough examination of the child during the consultation put in evidence TT.
  2 4,771 48
Interdigital pilonidal sinus, report of two cases
Dogus Yalcin, Burak Tekin, Bulent Sacak, Gulcicek Ayranci, Ipek Erbarut
January-March 2016, 8(1):38-39
DOI:10.4103/0974-7753.179386  PMID:27127377
Hairdresser's disease is an occupational acquired interdigital pilonidal sinus (IPS) of especially male barbers. Here, two cases of IPSs are reported. Both cases underwent surgical excision and primary closure. Six months follow-up period did not present any complications or recurrence. Caused by repeated implantation of foreign hair to the interdigital web space, IPS is preventable, but once acquired treated with surgical excision and primary closure or with a skin flap for postoperative comfort.
  2 3,477 38
Concentric polycyclic regrowth pattern in alopecia areata
Lilian Mathias Delorenze, Maria Fernanada Reis Gavazzoni-Dias, Marcelo S Teixeira, Marcia Kalil Aide
January-March 2016, 8(1):35-37
DOI:10.4103/0974-7753.179397  PMID:27127376
Alopecia areata (AA) is a common form of autoimmune nonscarring hair loss of scalp and/or body. Atypical hair regrowth in AA is considered a rare phenomenon. It includes atypical pattern of hair growth (sudden graying, perinevoid alopecia, Renbok phenomenon, castling phenomenon, and concentric or targetoid regrowth) and atypical dark color hair regrowth. We report a case of AA that resulted in a concentric targetoid hair regrowth and discuss the possible related theories regarding the significance of this phenomenon.
  1 4,730 52
Two episodes of simultaneous identical alopecia areata in identical twins
Nino Lortkipanidze, Abraham Zlotogorski, Yuval Ramot
January-March 2016, 8(1):47-48
DOI:10.4103/0974-7753.179398  PMID:27127382
  1 2,699 43
Anterolateral leg alopecia
Sahana M Srinivas, S Sacchidanand, Balaji Jagannathan
January-March 2016, 8(1):49-50
DOI:10.4103/0974-7753.179402  PMID:27127383
  1 11,277 40
Concurrence of immune thrombocytopenic purpura and alopecia areata: A rare association
Andac Salman, Ali Eser
January-March 2016, 8(1):52-53
DOI:10.4103/0974-7753.179392  PMID:27127385
  1 2,632 33
Dermatitis artefacta presenting with localized alopecia of right eyebrow and scalp
A Sarin, Shijin A Ummar, Betsy Ambooken, Sonali R Gawai
January-March 2016, 8(1):26-28
DOI:10.4103/0974-7753.179395  PMID:27127373
Dermatitis artefacta (DA) and trichotemnomania are self-inflicted dermatoses often preceded by psychosocial stressful events. A 38-year-old female presented with sudden loss of hair in the right frontal area along with discoloration and edema of skin. On examination, there was complete loss of hair involving the right frontal area and the lateral half of right eyebrow with skin over that area appearing scalded, edematous, bruised, and discolored. After a detailed medical and psychological evaluation, a clinical diagnosis of DA with trichotemnomania was made. A tactful multidisciplinary approach is essential in managing such patients as outright referral to a psychiatrist could be counterproductive.
  - 3,186 44
A rare association of pili multigemini and rolled hairs in a young female
Pragya Ashok Nair, Rahulkrishna S Kota, Shailee Gandhi, Rochit R Singhal
January-March 2016, 8(1):29-31
DOI:10.4103/0974-7753.179401  PMID:27127374
Pili multigemini and circle hairs (CHs) both are hair shaft deformities. Being asymptomatic and benign they are often under-reported in medical science. Till now, literature showed the involvement of only males. CHs are seen in obese individuals with sedentary lifestyle and pili multigemini is seen in adults over beard and children over scalp. Cosmetic concern in a young female with asymptomatic hyperpigmented papular lesions brought her to dermatology clinic. Apart from histopathology, dermatoscopy is a noninvasive technique that can be utilized for the evaluation of various hair disorders, especially like this.
  - 9,798 52
Congenital triangular alopecia: The 127th case
Vivek Kumar Dey, Tanvi Singh Bhadoria, Animesh Saxena, Avtar Kishan Jaisinghani, Anjali Y Patil, Neha Dubey
January-March 2016, 8(1):50-51
DOI:10.4103/0974-7753.179399  PMID:27127384
  - 3,012 57
Giant pilomatricoma of the arm: A diagnostic challenge for cytopathologist
Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Divya Ail, Vishakha Kothikar, Maithili Mandar Kulkarni
January-March 2016, 8(1):43-45
DOI:10.4103/0974-7753.179387  PMID:27127379
  - 3,026 55
Polarized versus nonpolarized dermoscopy for hair and scalp evaluation
Feroze Kaliyadan
January-March 2016, 8(1):45-46
DOI:10.4103/0974-7753.179390  PMID:27127380
  - 2,798 63
Plica polonica after use of shampoo
Tejinder Kaur, Daljit Singh, Suresh Kumar Malhotra, Jaswant Singh
January-March 2016, 8(1):46-47
DOI:10.4103/0974-7753.179389  PMID:27127381
  - 2,821 55
Bird's nest view from a dermatologist's eye
Sethi Anisha, Kaur Sukhjot, Gupta Kumar Sunil, Puri Sandeep
January-March 2016, 8(1):1-4
DOI:10.4103/0974-7753.179393  PMID:27127367
Plica neuropathica also known as “birds nest” is irreversible matting of hair seen in otherwise healthy individuals and is usually associated with use of ionic/herbal soaps, shampoos, parasitic infestations, psychiatric alterations, or neglect. Anagen effluvium is a known side effect of many immunosuppressive drugs. Rarely matting of hair has been reported following azathioprine. We report plica neuropathica in two chronically ill patients on immunosuppressive drugs, that is, azathioprine and methotrexate along with a review of literature of its etiological factors and pathogenesis.
  - 5,277 97