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Background: Alopecia areata (AA) is one of the most common forms of alopecia presenting to the dermatology out patient department (OPD) worldwide as well as in Nepal. It is mostly diagnosed clinically. Treatment depends on the extent, location, and severity of the condition. Various treatment options available are topical, intralesional, and oral medications. Bimatoprost is a relatively newer treatment modality in AA. Aim and Objective: To compare the efficacy and safety of topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream in scalp AA. Materials and Methods: A total of 50 patients attending the dermatology OPD of a tertiary hospital between March 2018 and February 2019 were included in this prospective non-randomized open-label clinical trial. Patients were divided into two groups i.e., Group A- topical bimatoprost solution 0.01% and Group B- topical clobetasol propionate cream 0.05%, and followed up at weeks 4, 8, and 12. The improvement was analyzed subjectively by hair regrowth and objectively by Severity of Alopecia Tool (SALT) score. Side effects, nature of terminal hair and onset of initial response were also recorded. Results: Out of 50 patients, 27 were males and 23 were females with a mean age of 28.5 ± 9.34 years and mean duration of disease of 18.67 ± 46.1 weeks. Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost (p = 0.282 and P = 0.246, respectively). Side effects were seen more in the clobetasol group compared to bimatoprost group (p = 0.002). Onset of cosmetically acceptable hair regrowth was seen earlier in the bimatoprost group (p = 0.017) and also the nature of regrown hairs was more pigmented in bimatoprost group (p = 0.024). Conclusions: There is no significant difference in hair regrowth between clobetasol and bimatoprost in the treatment of AA on scalp at the end of 12 weeks, although bimatoprost has an advantage of lesser side effects, more rapid response and growth of more pigmented hairs. [ABSTRACT FROM AUTHOR]

Segmental vitiligo (SV) has been identified as a type of vitiligo starting early on in life with a rapidly progressive depigmentation in the affected area. Surgical modalities have shown better outcomes in SV compared with medical therapies. Perifollicular repigmentation being the mode of pigment spread after surgical treatments, follicular unit extraction graft surgery has shown complete repigmentation with minimal postoperative scarring. We present a case of SV where hair transplant surgery was done using scalp hair and pubic hair grafts at different times achieving complete repigmentation with photochemotherapy. [ABSTRACT FROM AUTHOR]

Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in males which remains a therapeutic challenge. Objectives: To compare the efficacy of topical 5% minoxidil and 0.25% finasteride combination (MNF) over 5% minoxidil (MNX) or 0.25% finasteride (FNS) alone by assessing hair count, physician assessment score (PAS), and patient satisfaction score (PSS). Materials and Methods: Pilot randomized open-label study where 60 male patients with AGA = III grade were randomized into three treatment groups and evaluated over 24 weeks. Improvement in hair count was assessed manually using dermoscopy. Global photographs were used to assess PAS. Side effects were evaluated using relevant laboratory investigations. Results: At the 12th and 24th week, all three groups showed significant improvement in total hair density as compared to baseline (P < 0.001). None of the groups was superior to the other (P > 0.05) at the 12th week but at 24th week, MNF was comparatively superior (P < 0.02). At the 12th week and 24th week, all three groups showed significant improvement in terminal hair density as compared to baseline (P < 0.001). In the 12th week, MNF was comparatively superior (P = 0.028) and at the 24th week, MNF was comparatively superior (P < 0.02). PAS and PSS were significantly better with MNF and MNX compared to FNS (P < 0.004). Side effects such as scaling and itching were reported with MNF and MNX. Conclusion: Topical minoxidil 5% and finasteride 0.25% had an overall better efficacy compared to monotherapy without significant side effects. [ABSTRACT FROM AUTHOR]

Background: Hair graft preservation is an important factor that influences graft survival in hair transplantation. Objective: To investigate the benefits of adding platelet-rich plasma (PRP), and the effect of different storage solutions and temperatures on hair follicle preservation. Materials and Methods: This randomized-controlled study included 10 androgenetic alopecia patients who underwent hair transplantation. Forty-five hair grafts were collected from each patient and then randomized to 8 different culture conditions for 7 days. Hair grafts were cultured in Williams' Medium E or Ringer's lactate solution (RLS) at either 4°C or 37°C, and with or without 10% PRP supplementation. Results: In vitro hair growth in Williams' Medium E was significantly greater than in RLS. The 37°C temperature condition was found to be significantly better than the 4°C condition. The growth of hair grafts cultured with PRP was not significance difference from those without PRP. However, immunofluorescence staining for cytokeratin 15 showed greater expression in hair graft cultured with PRP. Conclusion: PRP may have a beneficial effect for preserving the viability of hair grafts. Williams' Medium E and 37°C temperature were found to be superior to RLS and 4°C relative to hair follicle growth in organ culture. [ABSTRACT FROM AUTHOR]

Cicatricial alopecias in children do not contribute to substantial pediatric consultations as they are relatively uncommon. Cicatricial alopecias are often missed in pediatric population as it is diagnostically and therapeutically challenging. No single treatment is usually effective and hence several off label treatments are used in children and adolescents with unknown safety and efficacy. Hair loss due to scarring may thus have a significant impact on the emotional well-being of young patients and diminishes the quality of life which often requires additional treatment. Traditional surgical treatments for cicatricial alopecia include excision, scar reduction, tissue expansion, scalp flap, and follicular unit transplantation. However, these procedures often result in unsightly scarring or unfavorable hair growth direction. Recently, hair grafting by follicular unit extraction (FUE) has now replaced the strip technique as it is minimally invasive, well-tolerated, and effective treatment for use in children and adolescents. However, use of this technique is limited in young patients. The article presents a comprehensive review of an effective surgical technique, i.e., FUE for the management of burnt-out inactive cicatricial alopecia in pediatric population. For the purpose of review, a PubMed search was done using keywords, "cicatricial alopecia," "hair transplantation," and "children." All the articles were retrieved, and the final data were then analyzed and presented in a narrative fashion. [ABSTRACT FROM AUTHOR]

Hair loss can impact a person's quality of life in ways incomprehensible. People value hair for different reasons, but value it nonetheless. There is a myriad of conditions that impede hair growth or cause hair to grow in an unattractive manner such as androgenetic alopecia, alopecia areata, and chemotherapy-induced hair loss. For conditions like cicatricial alopecia, there are hardly any options available once permanent loss of hair sets in. The role of hair transplantation too is limited in such cases where the donor area has been compromised. Thus, addressing the concern of hair loss and presenting all possible options available even after medical and surgical options flounder due to their limitations is a responsibility every dermatotrichologist carries and a plethora of camouflage options are available to improve the appearance of hair right from hairpieces to more permanent methods like scalp micropigmentation. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSIs) may be reduced by following SSI prevention measures. We assessed the SSI rate following caesarean section (CS) and gynaecologic surgery after implementing a simple SSI prevention bundle including preoperative bath and hair wash. Methods: The study was carried out in two hospitals in North India (Post Graduate Institute of Medical Education and Research [PGIMER] and Civil Hospital CH) from August 2018 to July 2019. The SSI rate during intervention period (9 months) was compared with baseline rate (3 months). Womens' knowledge about SSI was assessed preoperatively and after counselling, postoperatively. Results: The baseline SSI rate after CS (n = 165) was 11.1% at PGIMER and 8.5% at CH. After gynae surgery (n = 172), it was 13% at PGIMER and 11.5% at CH. During intervention, (CS = 585, gynae surgery = 503), SSI rate was reduced significantly at PGIMER (CS: 11.1% to 3.7%, P = 0.048; gynae surgery: 13% to 7.1%, P = 0.027), but not at CH (CS: 8.5% to 8.2%, P = 0.903; gynae surgery: 11.5% to 11.4%, P = 0.984). Three measures were followed more often at PGIMER than at CH: before CS, bath with hair-wash: 99.3% vs 78.5%, P = 0.00, hair-clipper vs razor: 100% vs 5.1%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 92.4%, P = 0.00; and before gynae surgery, bath with hair-wash: 93.2% vs 71%, P = 0.00, hair-clipper vs razor: 93.6% vs 1.9%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 80.8%, P = 0.00. Postoperatively, womens' knowledge about SSI prevention improved significantly at the two sites. Conclusion: The reduction in SSI at PGIMER was attributed to better compliance to SSI prevention measures listed above. Counselling women about simple SSI prevention method like preoperative bath with scalp hair wash increased their knowledge about these significantly. [ABSTRACT FROM AUTHOR]

Background: Pressure-induced alopecia is an uncommon type of alopecia. It can occur in both scarring as well as non-scarring form and occurs due to ischemia resulting from prolonged head immobilisation during surgery or hospitalisation. The patchy hair loss generally involves convexities of scalp specially vertex and occiput. The hair loss is usually noticed 3 -28 days after the inciting event and regrowth of hair occurs between 1 - 4 months. Objective: To describe trichoscopic features of pressure alopecia and compare it with the closest differential, alopecia areata. Methodology: It is a retrospective observational study. Trichoscopic features of six cases of pressure alopecia seen during the study period were compared with alopecia areata and analyzed using appropriate statistical methods. Results: The study had 30 cases, six cases of pressure alopecia and 24 cases of alopecia areata. The mean age of patients with pressure alopecia and alopecia areata was 45.16 and 29.08 years respectively. Comedone- like black dots, black dots and area of scarring were statistically significant for pressure alopecia while exclamation mark hairs were significant for alopecia areata. Conclusion: Trichoscopy is a non-invasive test for diagnosis of alopecia and "Comedone-like black dots" are unique trichoscopic feature of pressure alopecia. [ABSTRACT FROM AUTHOR]

The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) and its use in androgenetic alopecia (AGA). The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on PRP. A comprehensive literature search was done in the English language on the PRP across multiple databases. The grade of evidence and strength of recommendation were evaluated on the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) framework. A draft of clinical recommendations was developed on the best available evidence, which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, the final consensus statement was prepared. A total of 30 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated, and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of manual double-spin method for the preparation of PRP for AGA. Minimum three to five sessions of PRP are recommended for AGA with a gap of 1 month between the two sessions. Patients with Grade II to V Norwood Hamilton classification of AGA are the ideal subset for PRP. A total of 5 to 7 mL of PRP and 0.05 to 0.1 mL/cm2 is the recommended dose of PRP for AGA. Activation of PRP is not required when it is used for AGA. About 1 to 1.5 million platelets/μL of platelets in PRP is the recommended platelet concentration in PRP for the treatment of AGA. I-PRF (injectable platelet-rich fibrin) has also been found to be useful in AGA, although further studies are required to establish its role. PRP can also have an adjunctive role in hair transplantation procedures. [ABSTRACT FROM AUTHOR]

Introduction: Loss of beard can occur due to many reasons. As beard has huge cosmetic importance, loss of beard can be psychologically traumatic. Beard can be absent from puberty, called as congenital absence of beard. Beard loss can be secondary to dermatological conditions such as nodulocystic acne. In our setting, the most common cause of loss of beard is burn injury. There are many treatment options such as surgical excision of scar, flaps Z/W plasty, and hair transplantation to reconstruct the beard. We present the follicular unit extraction (FUE) method of beard reconstruction. Aim: The aim of our study was to describe the evaluation of the results using FUE method for beard reconstruction. Materials and Methods: We did a study in twenty male patients. Any patient having alopecia areata were ruled out of the study. Fifteen patients had postburn loss, three had postacne scarring, and two patients had congenital absence of beard. We evaluated all patients thoroughly by calculating the density of beard over the normal areas of beard, evaluating the elasticity of skin, preoperative photography, and doing dermatoscopy. Areas were marked. FUE was used for harvesting the grafts as a limited number of grafts were needed to complete the surgery. In the recipient area, adrenaline was avoided in patients of scarring alopecia. In cases of congenital absence of hair, 1:200,000 adrenaline was used to minimize bleeding. Grafts were placed. Results were noted after 1 year. Results: All patients followed up properly for 1 year. Growth started 3 months postoperatively and continued till 1 year postoperatively. Density was good in cases with congenital absence of hair. In cases of scarring alopecia, multiple sessions were needed to provide adequate density. Results were graded as "very good," "good," and "poor." Eleven patients had "very good" result, eight had "good," and one had "poor" result. Nineteen patients were satisfied with the final result, and one patient was dissatisfied with the result. Conclusion: FUE is the ideal method of reconstructing beard loss. Proper preoperative evaluation, preparation, planning, and proper surgical technique produce the best possible result. [ABSTRACT FROM AUTHOR]

Background: Eyebrow is the main contouring line of the face. That is why any eyebrow defect, especially if resulting from burn, disturbs the whole esthetic portrait and causes psychological trauma and lack of confidence. Eyebrow-hair transplantation is considered as the management of choice for patients suffering from postburn eyebrow alopecia. Objectives The aim of this study was to ascertain the efficacy and benefits of hair transplantation for postburn cicatricial alopecia of the eyebrow, using a standardized data and documented by photography. Patients and methods: The study included 20 patients suffering from postburn cicatricial alopecia of the eyebrow. Preoperatively, eyebrows were assessed for the part affected with postburn cicatricial alopecia, the side, the size of the defect, the direction of hair, and symmetry. Marking the affected eyebrow was done. Single-hair follicle grafts were extracted from the scalp and then implanted into the eyebrow defect, under the effect of local anesthesia and sedation if needed, and complete aseptic conditions. Patients were followed up for 1 year. The results were tested statistically and documented by photos. Results: On statistical analysis, there was a statistically significant improvement in 75% of cases with satisfactory outcomes. The majority of patients showed very good results with minimal accepted complications. Comparison between preoperative presentation and postoperative outcome manifested an apparent esthetic amelioration. Conclusion: Hair transplantation is effective in improving postburn alopecia of the eyebrow and camouflaging the underlying scar tissue. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Treatment of cicatricial alopecia resulting from lymphocytic inflammatory diseases, namely lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia is challenging. Here, follicular-unit extraction hair transplantation was successfully performed for four cases of chronic lymphocytic inflammatory diseases after quiescence of the diseases. [ABSTRACT FROM AUTHOR]

Follicular unit extraction [FUE] is a minimally invasive hair restoration surgery popularly known for its utility in androgenetic alopecia (AGA). In FUE, individual follicular grafts are extracted from donor area and implanted in the recipient area. Advantages of FUE are that it is comparatively ‘scarless’, has faster healing time, has less downtime and requires less technical staff. This article is aimed to highlight upon the multi-faceted utility of FUE technique in various dermatological indications like androgenetic alopecia, alopecia areata, facial hair restoration, tractional alopecia, scarring alopecia, body hair transplant, vitiligo as well as hirsutism. [ABSTRACT FROM AUTHOR]

Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new technique in the field of permanent cosmetics for eyebrow restoration. Currently, it is one of the most sort after treatment in aesthetic procedures due to the curiosity and awareness raised by social media. Microblading is a form of superficial micropigmentation, wherein pigment is deposited till the papillary dermis, with the help of a manual device and a blade consisting of stacked needles. The resultant crisp, discrete hair like incisions simulate the eyebrow hair to give a natural look. The results are semi-permanent and last only 12-18 months. In the recent years, with the advancement in the instrumentation of microblading there have been several modifications in this procedure. Microblading has now found its applications not only in cosmetic treatments but also in dermatological conditions such as alopecia totalis, hypothyroidism, chemotherapy induced madarosis etc. It is a vital tool in any dermatology or cosmetic practise for its extensive applications. But with the rise in popularity of microblading, there is also a rise of untrained professionals performing it leading to a rise in its side-effects. This article aims at not only guiding on the instrumentation and procedure of microblading but also its pre and post procedure care, interaction with other aesthetic procedures and treating its complications. [ABSTRACT FROM AUTHOR]

Background: The present study is a cross-sectional comparison to evaluate the association between hair loss and hair structural changes (gross and microscopic), and hairstyling procedures in women. Methods: We included 94 women; and collected data on sociodemographics, clinical history, sun-exposure, and hair-product use history. Women who reported blow drying of hair, hair straightening, use of hair iron or perming in the past 6 months were classified as cases. Age matched (±2 years) women who did not report any of the above procedures in the past 6 months were controls. The following tests were done: hair pull test; hair density assessment; hair breakage index (HBI); and microscopic examination. A logistic regression model was used for estimation of the odds ratio (OR) and 95% confidence intervals (CI). Results: The mean (standard deviation [SD]) age in the case and control group was 26.4 (6.3) and 27.4 (6.3) years, respectively (P = 0.43). There was no significant difference in the mean (SD) HBI (1.05 [0.08] vs 1.07 [0.05], P = 0.22) or hair density (3.28 [0.41] vs 3.16 [0.39], P = 0.19). Cases were significantly more likely to have microscopic changes compared with controls (OR: 22.0, 95% CI: 4.3, 112.6; P < 0.001). Sun exposure for more than 3 h was significantly associated with microscopic changes (OR: 6.7, 95% CI: 1.2, 39.1; P = 0.03). Conclusion: Women with hairstyling procedures in the past 6 months were more likely to have microscopic changes, even though there was no difference in the hair assessment parameters. Specific guidelines on use of hairstyling procedures for Indian hair should be developed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Temporal triangular alopecia (TTA) is congenital anomalies that usually develops in childhood, with rarely acquired cases in adults. TTA shares common clinical, dermoscopic, and histologic features of characterized vellus hair formation change, similar to androgenetic alopecia (AGA). Whereas, platelet-rich plasma (PRP) with multiple growth factors can provide treatment efficacy in AGA. Due to limited treatment for TTA, such as topical minoxidil, complete surgical excision, and hair transplantation, the multiple growth factors in PRP is thus postulated to be also effective for TTA treatment, just as in AGA. We present a case of TTA with unsatisfactory treatment outcome of only increased number and thickness of vellus hair by dermoscopic examination follow-up after the 5-session PRP injection and only transient response for 6 months. Unlike, AGA, the PRP injection might not consequently be a suitable treatment option for TTA. Nonetheless, further studies should be performed to investigate the potential treatment modality for TTA. [ABSTRACT FROM AUTHOR]

Introduction: Cosmetic dermatology is a branch of dermatology which deals with the enhancement of beauty. There is a rise in cosmetic dermatological procedures throughout the world, but its awareness is limited not only in the general population but also among the health workers. Materials and Methods: We conducted a cross-sectional questionnaire-based study to know the knowledge and awareness of cosmetic dermatological procedures among health workers in a hospital setting. Results: There were a total of 155 respondents. The maximum number of respondents belonged to age group of 20–30 years (65.2%). Female respondents were 66% and males were 34%. Of the total respondents, 39% were medical students, 31% doctors, 23% nurses, 6% OPD assistants, and 1% ward maids. Hinduism was practiced by 91% of the respondents. About 84.5% of subjects were aware of cosmetic dermatological procedures. Regarding the source of information, 34.2% implicated textbooks. According to 53.5% participants, cosmetic dermatological procedures are done by a dermatologist. Around 59.4% responded that they were aware of many procedures such as botox injections, laser hair removal, hair transplant, and chemical peeling; 51% were aware of risks associated with procedures, such as allergy, burns, and pigmentation; 44.5% rated the facility as good; 31% believed that outcome of the procedures is different in Nepal as compared to a foreign countries. About 23.9% thought public disposition will change if they underwent the procedures. Around 11.6% thought this shall negatively affect them; however, 53.5% believed it would be socially acceptable. About 78.1% thought that these procedures are done only in cities with 62.6% believing it is commonly done by high-class economic status people. About 73.5% respondents believed that this was adopted by literate people; 7.1% were concerned about taboos against cosmetic dermatosurgical procedures; 84.5% agreed that there should be awareness program on these procedures. Conclusion: We found lack of awareness, knowledge, attitudes, and disposition about cosmetic dermatosurgical procedures among health workers. Further community-based population studies and awareness programmes should be carried out regarding this aspect. [ABSTRACT FROM AUTHOR]

Follicular unit extraction (FUE) is becoming an increasingly popular method for hair restoration. As FUE leaves behind no linear scars, it is more suitable to harvest from various body areas including beard, chest, and extremities in hirsute individuals. Body hair characteristics such as thickness, length, and hair cycle may not completely match to that of the scalp hair. The techniques of harvesting body hairs are more time consuming, requiring higher degree of skill than regular scalp FUE. Body hair transplantation can be successfully used either alone or in combination with scalp hair in advanced grades of baldness, for improving the cosmetic appearance of hairlines and in scarring alopecia when there is paucity of donor scalp hair. Harvesting of body hairs opens up a new viable donor source for hair restoration surgeons, especially in cases of advanced Norwood grades five and above of androgenetic alopecia. [ABSTRACT FROM AUTHOR]

Synthetic hair implants are considered in alopecia when the patient requests an immediate result with minor surgery and with a poor donor area. However, the procedure has historically been marred by poor quality fiber and performance resulting in serious complications. Nevertheless, companies continue to market the procedure with the claim that previous problems have been sorted out. We report a case of inflammation in synthetic hair implants, in which microbiological studies revealed infection with Staphylococcus lugdunensis and Trichophyton tonsurans. The procedure was performed by a hair stylist. The patient experienced symptoms at the site of the implants. Nevertheless, he had the artificial implants repeated. Despite persistent symptoms of peri-implantitis, medical assistance was not sought. It is the view of the International Society of Hair Restoration Surgery that artificial hair fiber implants represent a surgical procedure and as such should be confined to experienced and licensed medical doctors in a reputable medical clinic. As with any surgical procedure, complications may occur which should be handled under a physician's care. Usually, problems result from lack of asepsis during the procedure, lack of patient hygiene, excessive quantity and density of implanted fibers in one session, incorrect choice of implant area, and poor aftercare. In cases, where implant-related problems cannot be resolved within 15 days of antibiotic and anti-inflammatory treatment, an extended microbiological work-up is warranted, and it may be necessary to remove the fibers that may harbor microbial biofilms. [ABSTRACT FROM AUTHOR]

Context: In androgenetic alopecia, follicular miniaturization and dynamic changes to the hair cycle produce patterned baldness. The most effective treatment for baldness is hair transplantation surgery. The major limitation to hair transplantation is the availability of donor hair from the relatively unaffected occipital scalp. Hair induction with in vitro expansion of donor follicle populations has the potential to overcome this. The major obstacle to this is that in vitro expansion of human dermal papilla cell (DPC) colonies is associated with irreversible loss of aggregative behavior and hair follicle-inductive potential. In contrast, cultured ovine DPCs maintain these properties after extensive proliferation. Aims: To determine whether aggregating ovine DPC secrete factors that enhance the aggregative behavior or inductive potential of human DPC. Subjects and Methods: Fluorescently-labelled ovine DPC were mixed in culture with human DPC at passage number seven-nine, which had lost their aggregative behavior. The effects of different culture substrates and medium compositions on aggregative behavior were determined. Ovine and human papilla cells were co-cultured, separated by a permeable membrane to determine whether the ovine cells secrete soluble factors that affect human papilla cells. Results: In direct co-culture experiments, well-formed aggregates were produced by 90:10 human:ovine and 50:50 human:ovine DPC mixtures. In contrast, unmixed human DPC remained in a monolayer state after 18 days. Both human and ovine DPC had a higher tendency to aggregate in medium containing 20% (v/v) lamb serum (LS) compared to 10% (v/v) fetal calf serum (FCS). In co-culture experiments separated with permeable membrane, the human DPC aggregates were bigger and more rapidly formed with the addition of ovine secreted soluble factors. Conclusions: Soluble factors secreted by ovine DPC and present in LS increase the aggregative behavior of human DPC. These molecules might improve follicle inductiveness of human DPCs for the purpose of hair replacement therapy. [ABSTRACT FROM AUTHOR]

Context: The dermal papilla (DP) is a condensation of mesenchymal cells at the proximal end of the hair follicle, which determines hair shaft size and regulates matrix cell proliferation and differentiation. DP cells have the ability to regenerate new hair follicles. These cells tend to aggregate both in vitro and in vivo. This tendency is associated with the ability of papilla cells to induce hair growth. However, human papilla cells lose their hair-inducing activity in later passage number. Ovine DP cells are different from human DP cells since they do not lose their aggregative behavior or hair-inducing activity in culture. Nonetheless, our understanding of ovine DP cells is still limited. Aim: The aim of this study was to observe the expression of established DP markers in ovine cells and their association with aggregation. Subjects and Methods: Ovine DP cells from three different sheep were compared. Histochemistry, immunoflourescence, and polymerase chain reaction experiments were done to analyze the DP markers. Results: We found that ovine DP aggregates expressed all the 16 markers evaluated, including alkaline phosphatase and versican. Expression of the versican V0 and V3 isoforms, neural cell adhesion molecule, and corin was increased significantly with aggregation, while hey-1 expression was significantly decreased. Conclusions: Overall, the stable expression of numerous markers suggests that aggregating ovine DP cells have a similar phenotype to papillae in vivo. The stability of their molecular phenotype is consistent with their robust aggregative behavior and retained follicle-inducing activity after prolonged culture. Their phenotypic stability in culture contrasts with DP cells from other species, and suggests that a better understanding of ovine DP cells might provide opportunities to improve the hair-inducing activity and therapeutic potential of human cells. [ABSTRACT FROM AUTHOR]

We report a patient with frontal fibrosing alopecia (FFA), in whom autologous hair transplantation was successfully performed despite evidence of active disease. Since the underlying pathology of FFA is usually lichen planopilaris, reservations, and caveats have been expressed with respect to the risk of köbnerization phenomena following hair transplantation surgery. An important question that arises is how the lichenoid tissue reaction pattern is generated around the hair follicles in FFA. Follicles with some form of damage or malfunction might express cytokine profiles that attract inflammatory cells to assist in damage repair or in the initiation of apoptosis-mediated organ deletion. Alternatively, an as yet unknown antigenic stimulus from the damaged or malfunctioning hair follicle might initiate a lichenoid tissue reaction in the immunogenetically susceptible individual. Therefore, it might be expected that the transplantation of whole healthy hair follicles might less give rise to an inflammatory reaction than the disease itself, as revealed in our case report of successful hair transplantation in FFA. [ABSTRACT FROM AUTHOR]

Background: The study was conducted to compare the angles of the hair shafts created by straight/flat blade and curved blade. Materials and Methods: The study was conducted in a private hair transplant surgery center. Five patients undergoing the first session of hair transplant were included. In each patient, 1 cm2 area was selected in the anterior hairline in midline. Five slits were created with 1.0 mm straight/flat blade and five slits were created with 1.0 mm curved blade in each patient. After the slits creation, the grafts were inserted into the slits. The custom-made macrophotography technique was used to take high-magnification photographs of the grafts. The software was used to measure the angle of the hair at the level of the skin. The angles of all the hair shafts were measured in both the groups. The data were then analyzed statistically using paired t-test. Results: A total of five patients were included in the study. The mean age of the patients was 35.0 years. The mean hair angle of the hair shafts created with straight/flat blade was 17.42°, whereas the average hair shaft angle created with curved blade was 9.56°. The hair shafts angles varied from 14.3° to 23.1° while using straight blade. The hair shafts angle resulting due to curved blade ranged from 8.6° to 11.3°. Conclusion: The curved blade created the slits which were more acute than the slits created by the straight/flat blade. [ABSTRACT FROM AUTHOR]

Hair transplantation, a generally regarded as a safe surgical modality for the treatment of androgenetic alopecia, is not without its potential risks and complications. A case of an extensive keloid formation at donor site following follicular unit extraction is discussed. Hair transplant surgeons should be aware of this significant potential complication, especially in patients having previous keloidal tendencies to avoid such disastrous outcomes. [ABSTRACT FROM AUTHOR]

Background: During hair transplantation as an effective therapy for androgenetic alopecia, hair follicles were typically trans-located from the nonaffected occipital to the balding frontal or vertex region of the scalp. Although this is an autologous intervention, the donor and recipient hair follicle tissue differ in composition and local environment. Settings and Design: In two case studies, we investigated the changes in hair follicle morphology and the immune status of scalp and body hair follicles from different origins transplanted to the eyebrows and the frontal scalp using follicular unit extraction. Results: Quantitative histomorphometry and immunohistochemistry revealed a transformation in hair follicle length and dermal papilla size of the scalp, chest and beard hair follicles, which had been re-extracted after a 6-month period posttransplantation. Furthermore, a significant infiltration of B and T lymphocytes as well as macrophages could be observed most prominently in the infundibulum of transplanted hair follicles. Conclusion: The presented results demonstrate that hair follicle units from different body sites are capable to replace miniaturized or degraded hair follicles in different recipient areas like scalp or eyebrows as they keep their intrinsic capability or acquire the potential to readjust plastically within the beneficiary skin region. The essential secretory crosstalk underlying the observed tissue remodeling is possibly mediated by the infiltrating immune cells. [ABSTRACT FROM AUTHOR]

Background: Hair restoration surgery (HRS) is a very promising and sought after aesthetic procedure with very few complications. Complications may occur in the donor or the recipient area, and it may be due to surgical or idiopathic causes. Aim: The aim was to analyze the complications in male patients who underwent HRS for androgenetic alopecia (AGA). Materials and Methods: We conducted a retrospective analysis of male patients who underwent HRS for AGA from December 2010 to August 2014. Data were collected from the registers, telephonic enquiry and electronic mails. All complications during and after surgery, and their subjective feeling about hair growth was recorded. Results: Seventy-three patients were included in the analysis. A total of 65 patients had undergone follicular unit transplant, 7 patients underwent FUE, and one patient had body hair transplantation. Postoperative edema was found in 42.47% of patients, followed by sterile folliculitis in 23.29% of patients, wide donor scar in 15.07% of patients, bacterial folliculitis and numbness/paresthesia in 10.96% of patients. Other complications such as raised scar, hiccups, pruritus, excessive bleeding were found in isolated cases. Conclusion: Thorough preoperative evaluation, skillful surgical techniques, good communication and postoperative follow-up go a long way in giving satisfactory outcome with fewer complications in HRS. [ABSTRACT FROM AUTHOR]

Background: Clinical hair transplant studies have revealed that follicular unit extraction (FUE) is superior in terms of stable hair growth in comparison to follicular plucking (FP). Various reasons have been cited for this clinical outcome. FUE and FP are employed to obtain the hair follicle units for hair transplant and recently for cell based therapies in vitiligo. However, there is no scientific data available on the comparison of stem cell fraction in the cell suspension obtained by FUE and FP. Therefore, we undertook this study to compare the percentage of stem cells in the hair follicle obtained by FUE and FP. Objective: The purpose of the following study is to evaluate the quantitative stem cell pool in the hair follicle obtained by FUE and FP. Materials and Methods: A total of 3 human subjects were enrolled with age groups of 17-5 years. Both methods of tissue harvest: FUE and FP; were employed on each subject. There was no vitiligo lesion on the scalp in any of the patients. Hair follicles were incubated with trypsin-EDTA solution at 37°C for 90 min to separate outer root sheath cells. The cell suspension was passed through a 70 μm cell strainer; filtrate was centrifuged to obtain the cell pellet. Cells were labeled with cluster of differentiation (CD200) antibody and acquired with flowcytometry. Results: The mean percentage of CD200 positive cells in FUE and FP method come out to be 8.43 and 1.63 respectively (P = 0.0152). Conclusion: FUE is a better method of the hair follicle harvesting for cell based applications as the stem cell fraction is significantly higher in comparison to FP. [ABSTRACT FROM AUTHOR]

Background: Mild perifollicular inflammation is seen in both androgenetic alopecia (AGA) cases and normal controls, whereas moderate or dense inflammation with concentric layers of collagen, is seen in AGA cases but only in very few normal controls, and may lessen the response to topical minoxidil. Moderate or dense lymphocytic inflammation and perifollicular fibrosis have poor hair growth following transplantation. Aim: The purpose of the study is to evaluate the perifollicular lymphocytic inflammation and fibrosis in AGA patients during follicular unit hair transplantation (FUT) and its comparison in normal controls. Materials and Methods: A total of 21 male patients with AGA and 7 matched controls participated in the study. Histopathological analysis of biopsy specimens from donor strip of patients during the hair transplantation and two 4 mm punch biopsies on controls were performed. Morphometric analysis was performed and perifollicular fibrosis was scored based on the width of the condensed collagen at the lower infundibulum and isthmus from 0 to 3. Perifollicular infiltrate was also scored 0-3 and a total score of 3 or more out of 6 was considered significant. Results: Nearly 76% of AGA patients had perifollicular fibrosis more than 50 μm at ×200 magnification. Almost 33.33% patients had moderate/dense perifollicular lymphocytic infiltrate whereas none of the controls had it. Total score in AGA cases was significantly higher than controls (P = 0.012) using Chi-square test. Out of 21 patients, 13 had a score of 3 or more and were followed-up with monthly treatment with intralesional steroids using a dermaroller. Conclusion: Histopathological evaluation of the donor area is a must during hair transplantation to evaluate the extent of perifollicular inflammation and achieve better results by following it up with treatment directed to decrease the inflammation. [ABSTRACT FROM AUTHOR]

Follicular unit extraction (FUE) is an accepted method of extracting individual follicular unit grafts for hair transplant surgery. Since follicles are harvested from the back of the scalp using tiny punches resulting in minimal scarring, it has gained rapid acceptance among the patients. However, due care needs to be exercised while performing FUE. FUE should not be confused with the older plug graft extraction methods of coring out hair-bearing skin plugs. Lack of due diligence while performing such extractions can lead to subluxation of the grafts into the subdermal layer of scalp. Overtumescence of the scalp donor area, use of blunt punches and trying to "core" out the full thickness grafts can all contribute to this. The following cases illustrate some pitfalls to be avoided while performing FUE and the adverse consequences if they occur. [ABSTRACT FROM AUTHOR]

The article presents the program of events in the Hair India 2010 international conference on September 2-5, 2010 sponsored by Hair Research Society of India. The program includes a preconference workshop on hair, panel discussion and poster viewing. It also talks about various topics that include the anatomy of hair, baldness, and hair restoration surgery.

Introduction: The use of body donor hair for transplanting to the bald scalp is termed body hair transplant. In recent times, robust body hair has been used as an adjunct to scalp donor hair to augment the donor hair supply. A large percentage of body hair are in telogen and, as single hair units. Aims: To devise a non invasive protocol to identify the body donor hair in anagen phase prior to extraction. Materials and Methods: Hairs are shaved flush with the skin, four days prior to extraction. On fourth day, the actively growing hair follicles as well as non growing hairs were extracted and phase of hair growth determined. Results: Nineteen out 22 extracted hair follicles in nongrowing phase were found to be the telogen phase. Conclusion: Preshaving the body donor areas is a simple non invasive method of isolating the hair in anagen phase. [ABSTRACT FROM AUTHOR]

Context: Male androgenetic alopecia (AGA) is a common condition. There is limited information on its prevalence and patterns. Aims: (1). To find the prevalence and most common pattern (2). To correlate the age and pattern of alopecia. Settings and Design: Population-based study. Materials and Methods: This is a population-based study from the public. The selection was random. The method involved was asking the age and, if found to between 30 and 50 years, the scalp was examined for alopecia and the pattern was determined using the Hamilton Norwood classification. Results: Of 1,005 subjects, the youngest was 30 years old and the oldest 49 years old, with a mean age of 37.05 ± standard deviation 4.79. 39.2% of the subjects were in the age group of 30-35, 34.4% in the 36-40 year age group, 26.0% in the 41-45 years age group and 0.4% in the 46-50 years age group. Five hundred and eighty-three subjects (58%) had AGA, the most common type being grade II (27.27%) followed by grade I (22.12%) and grade III (21.78%). 47.5% (P = 0.003) had pattern alopecia in the 30-35 years age group, 58.7% in the 36-40 years age group (P = 0.8) and 73.2% in the 41-45 years age group (P ⩽ 0.001). In the 30-35 years age group, grade I was 51.18%, grade II was 42.77% and grade VI was 18.52%. In the 41-45 years age group, grade I was 13.38%, grade III was 33.85% and grade VI was 66.67%. Conclusions: Fifty-eight percent of the male population aged 30-50 years had AGA. Its grade increased with increase in age. 12.9% of the male population had grades IV to VI, and would benefit from hair transplantation while 44.1% had grades I to III and are potential candidates for medical treatment. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 40‑year‑old man has presented with hairline recession and abnormal pattern of hair growth following a 4 mm follicular punch grafting hair restoration surgery 5 years back by a private practitioner. Topics include the cosmetically has dissatisfied with the appearance of his scalp post‑procedure, the hair restoration surgery has evolved significantly since its inception in late 1930, and the suboptimal practice often leaves unpleasant sequelae.

Perhaps the best solution for hair loss is a little bit of philosophy and a lot of humor. Endless trips to trichologists, hair potions and lotions hardly prevent the reluctant march to baldness. Unless of course, the patient agrees to a hair transplant. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old man diagnosed with hot oil burn-induced cicatricial alopecia. The patient underwent hair and follicular unit transplantations and witnessed hair regrowth after three months. However, the patient observed poor result after one year because the existing hair became thin and there was no new hair growth.

Androgenic alopecia (pattern baldness) is a condition in which there is androgen mediated progressive miniaturization and loss of hair follicles in a genetically susceptible individual. A 47-year-old male patient with advanced degree of hair loss (Norwood 6 category) wanted to go for full hair restoration surgery. Due to the limited availability of donor hair in the scalp, a small session with 700-chest hair was performed. On follow-up at eight months it was observed that chest hair grew and formed a cosmetically acceptable forelock. [ABSTRACT FROM AUTHOR]

The article discusses the donor sealing method, a technique used to decrease visible scarring following full thickness punch excision of the skin in follicular unit extraction in hair transplant surgery. This technique involves the use of epidermis of the follicular unit grafts to close the donor area wounds. The size of the punch does not change the outcome as far as visible scarring is concerned. Details of how the sealing method is done are provided.