International Journal of Trichology International Journal of Trichology
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   2020| March-April  | Volume 12 | Issue 2  
    Online since May 5, 2020

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Scalp hair whorl patterns in patients affected by Neurofibromatosis Type 1: A case-control study
Andrea Sechi, Iria Neri, Annalisa Patrizi, Michela Starace, Francesco Savoia, Miriam Leuzzi, Raffaele Dante Caposiena Caro, Bianca Maria Piraccini
March-April 2020, 12(2):56-61
Background: The hair whorl denotes the spiral disposition of hairs around an axis, which is determined by the follicle growing direction. Atypical variants of scalp hair patterns, identified by abnormally placed or multiple whorls, have been associated with early brain developmental disorders and several dysmorphic syndromes. Materials and Methods: A 6-month case–control, prospective monocentric study included an overall number of 557 children. A logistic regression analysis was performed to evaluate the relationship between localization, the number of scalp hair whorls, and their association with neurofibromatosis type 1 (NF1). Results: NF1 positively correlates with a frontal localization, whereas a negative association was found with a parietal whorl pattern (P < 0.001). Conclusion: Evaluation of scalp whorls gains importance in the neonatal settings and may contribute to suspect the early diagnosis of NF1, as the related National Institutes of Health diagnostic criteria cannot be usually observed at an early age.
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YKL-40 a sensitive biomarker for early androgenetic alopecia and early hidden metabolic syndrome
Doaa M Elhabak, Walid A Abdel Halim
March-April 2020, 12(2):49-55
Background: Androgenetic alopecia (AGA) is a common dermatological problem, Does the onset of the AGA matters in the general health? YKL 40 may have role in the pathogenesis of early AGA and associated metabolic syndrome (MS). YKL 40, released by many inflammatory cells and its biological role is not well known. Aim of the Work: The estimation of serum level of YKL-40 in patients with AGA to detect its role in AGA and MS pathogenesis, onset and severity. Materials and Methods: This case–control study, 100 individuals were enrolled in our study; 70 AGA patients and 30 healthy controls. We obtained an informed written consent from each individual prior the participation. AGA was diagnosed clinically, and onset was evaluated as early onset alopecia (by the age of 30 years or earlier), YKL-40 level was measured by ELISA technique. Results: Patients showed highly significant higher serum YKL-40 level more than that of the healthy subjects (P < 0.001). There was highly significant increase in YKL-40 level among early onset male and female cases compared to late onset cases (P < 0.001 each). There was significant increase in MS elements in AGA cases than controls (P < 0.05), and highly significant increase in MS associations and severity among early onset male and female cases compared to late onset cases (P < 0.001 each). AGA patients with MS showed highly significant higher serum YKL-40 level more than that without (P < 0.001). There was highly significant increase in YKL-40 level among early onset AGA with MS compared to late onset cases with MS (P < 0.001 each).Conclusions: High serum YKL-40 considered not only a biomarker of early onset AGA but also considered a potential sensitive predictor for early onset MS development and severity in patients with early onset AGA.
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Value of CD123 immunohistochemistry and elastic staining in differentiating discoid lupus erythematosus from lichen planopilaris
Fatemeh Sari Aslani, Mozhdeh Sepaskhah, Zahra Bagheri, Mojgan Akbarzadeh-Jahromi
March-April 2020, 12(2):62-67
Background: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. Patients and Methods: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. Results: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). Conclusion: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.
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Trichoscopy as a diagnostic tool for tinea capitis: A prospective, observational study
Pradeep Kumar, Deepika Pandhi, Sambit Nath Bhattacharya, Shukla Das
March-April 2020, 12(2):68-74
Background: Tinea capitis is the most common pediatric dermatophyte infection. Trichoscopy aids in the rapid diagnosis and allows prompt treatment, preventing horizontal transmission. Objectives: The objective of this study is to document the trichoscopic features of tinea capitis and evaluate its correlation with clinical type, microscopic form, and mycological culture and propose diagnostic trichoscopic criteria.Materials and Methods: Trichoscopy was performed, after taking consent in 98 participants (<18 years) of tinea capitis diagnose by hair root and scalp scraping examination for hyphae positive on potassium hydroxide mount microscopy or culture positive on SDA media. The comparison of observed trichoscopic features, with the clinical type, pattern of invasion, and etiological agent was carried out. Results: The most common clinical variant was black dot, and etiological agent was Trichophyton violaceum. The following trichoscopic features were noted: black dot, comma, short broken, corkscrew, horse-shoe, zigzag hair, and perifollicular scaling. Perifollicular scaling was significantly common in gray-patch variant, whereas comma, black dot, horse-shoe hair, and perifollicular scaling were noted in black-dot variant. Comma, corkscrew, and zig-zag hair were significantly present in endothrix form, whereas perifollicular scaling was evident in ectothrix form. Combining perifollicular scaling with comma hair, short broken, and black dot hair achieved a diagnostic sensitivity of 98.97%. Conclusions: Trichoscopy by evaluating for the combination of perifollicular scaling and 3 dystrophic hair (comma hair, black dot, and short-broken hair) is a good diagnostic tool for tinea capitis. Horse-shoe hair a novel finding, not hitherto reported in the literature requires validation in future studies.
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Trichilemmal carcinoma of scalp masquerading as squamous cell carcinoma: A report of a rare case with histogenesis and literature review
Kavitha Kannan, Kiran C Mahesh, Niraimathi Manickam, Anita Ramdas
March-April 2020, 12(2):82-85
Trichilemmal carcinoma is a rare malignant adnexal neoplasm of follicular type usually seen over the sun-exposed areas of elderly people. We present a report of a 60-year-old male with ulceroproliferative lesion over the occipital region of the scalp for 2 months, clinically diagnosed as squamous cell carcinoma. A wide local excision was done, and histopathological examination showed atypical clear cells with abrupt keratinization. The histogenesis and other differential diagnoses are discussed.
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Congenital triangular alopecia - A case report
Dhruv Ramanbhai Patel, Jinal Jainendrabhai Tandel, Pragya Ashok Nair
March-April 2020, 12(2):89-92
Congenital triangular alopecia also known as temporal triangular alopecia or Brauer nevus may be present at birth or acquired during the first decade of life. It can present as triangular, oval, or lancet-shaped patch of alopecia. It may be misdiagnosed as alopecia areata, traction alopecia, trichotillomania, tinea capitis, and aplasia cutis congenita. Histopathological features and dermoscopic features help in its diagnosis. There is no effective treatment for it and, in most cases, there is no need for therapeutic intervention. Therapeutic modalities include topical minoxidil, surgical excision, and hair transplantation.
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A study of association of premature graying of hair and osteopenia in North Indian population
Soumya Agarwal, Anshul Choudhary, Arushi Kumar, Aliza Zaidi, Swosti Mohanty, Shivani Yadav
March-April 2020, 12(2):75-78
Context: Hair graying is one of the signs of human aging and is caused by a progressive loss of pigmentation from growing hair shafts. Studies have shown a correlation of early hair graying with osteopenia, indicating that premature graying could serve as an early marker of osteopenia. Aim: To compare the degree of osteopenia in individuals with premature graying of hair (PGH) compared to ordinary individuals. Settings and Design: We conducted an observational, case–control study among 132 healthy individuals between 18 and 30 years of age. Subjects and Methods: Detailed history and examination of PGH was taken. Bone mineral density (BMD) was assessed using Furuno CM-200 ultrasound bone densitometer. Statistical Analysis: SPSS 21 software was used, and the data were summarized in the form of mean ± standard deviation for quantitative values and percentages for qualitative values. Chi–square test, Student's t-test, analysis of variance, and other appropriate tests were applied for comparison, and P < 0.05 was considered statistically significant. Results: PGH was present in 82 (62.1%) cases, whereas osteopenia was present in 56 (42.4%) cases. The mean age of onset of graying of hair among the cases was 20.62 ± 3.74 years. A higher age group of 25–30 years (P = 0.016) and family history of PGH (P < 0.001) were significant risk factors for PGH. The mean BMD of the case group was 0.76 ± 1.00 and the control group was 0.68 ± 1.11, but the difference was not statistically significant (P = 0.649). Conclusion: The study concluded that there is no significant association between osteopenia and PGH.
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Anagen effluvium after methotrexate: An idiosyncratic reaction
Preema Sinha, Siddharth Bhatt, Subramaniyan Radhakrishnan, Shekhar Neema, Anwita Sinha
March-April 2020, 12(2):93-96
Low-dose methotrexate (MTX) is the backbone of treatment for extensive psoriasis vulgaris not responding to topical therapy. Since its induction for the treatment of psoriasis in the 1970, its short- and long-term side effect profile has been extensively studied. Hair loss with MTX has been reported mostly with high-dose MTX used in chemotherapy. Here, we report a case of guttate psoriasis who presented with acute-onset anagen effluvium following the administration of only two doses of MTX 7.5 mg per week.
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Anterior ectopic cilia with myopia and lichen nitidus: A rare case report with dermoscopic findings
Alpana Mohta, Aditi Agrawal, Pritee Sharma, Ramesh Kumar Kushwaha, Rajeev Saxena, Rekha Mohta, Suresh Kumar Jain
March-April 2020, 12(2):79-81
Ectopic cilia, or lash follicles situated over abnormal sites, are an extremely rare entity. Here, we report the case of a 6-year-old-boy who presented with ectopic cilia over the left upper eyelid along with a positive family history. Dermoscopy revealed discreet terminal hair emerging from the individual hair follicles surmounted over a diffuse structureless whitish-yellow zone and a few vellus hairs in the surrounding normal skin. These hairs, on histopathological examination, had multiple pilosebaceous follicular units embedded in a desmoplastic stroma with multiple eccrine sweat glands. Other incidental findings included lichen nitidus and myopia.
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Graham-little-piccardi-lassueur syndrome: Report of a chinese case with hair casts
Xiangqian Li, Xi Chen, Jianzhong Zhang, Cheng Zhou
March-April 2020, 12(2):97-98
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Woolly hair nevus with trichotillomania in a 9-year-old boy: A rare case association
Shivani Saini, Ramesh Kumar, Devendra Yadav
March-April 2020, 12(2):86-88
Woolly hair nevus is a rare entity characterized by structural anomaly, which presents as curly hair in a circumscribed area of scalp, in a nonNegroid individual. These are abnormal hairs which are short, thin, and sparse. The term “woolly hair” refers to tightly coiled hair covering the whole scalp or part of it and has a hereditary character. Trichotillomania is a chronic impulse control disorder, characterized by the repetitive pulling out of one's own hair, leading to noticeable hair loss. Here, we present the case of a 9-year-old male child with woolly hair nevus over the occipital area, which developed at the age of 3 years; later, he developed trichotillomania at the age of 5 years, adjacent to the nevus. According to the best of our knowledge, there is no case report of woolly hair nevus presenting with trichotillomania till date.
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