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Background Eyebrow loss (madarosis) is a frequent sign of frontal fibrosing alopecia (FFA), and it can be the first sign of the disease. Objective To describe trichoscopy findings of FFA on the eyebrows. Methods The analysis included 151 women with histologically proven diagnosis of FFA and eyebrow loss. Trichoscopy of the eyebrow area was performed with either a FotoFinder videodermatoscope or handheld dermoscope DermLite II pro. Results The most frequent signs on trichoscopy were yellow dots (92.7%), multiple pinpoint dots (79.5%), short thin hairs/vellus (76.2%), black dots (66.2%), and dystrophic hairs (60.9%). Tapering hairs were found in 21 (13.9%) patients and dystrophic hairs in 92 (60.9%) patients. Limitations Inner limitations of a case series (there was no comparison with healthy control individuals or patients with other hair disorders) and lack of histologic correlation to the trichoscopy findings. Conclusions Although FFA is a scarring alopecia, the most common trichoscopy signs found in the eyebrows are usually related to noncicatricial alopecia. Therefore, in most cases, trichoscopy of the eyebrows does not resemble the trichoscopy of FFA on the scalp. Black dots, dystrophic hairs, and broken hairs are frequent signs. Occasionally, tapered hairs can be present on the eyebrows in FFA, leading to misdiagnosis of alopecia areata.

Pattern hair loss (PHL) is a chronic regressive condition of the scalp, where follicular miniaturisation and decreased scalp hair coverage occurs in affected areas. In all PHL cases, there is a measurable progressive shortening of the terminal hair growth duration, along with reduced linear growth rates. In both genders, PHL initially shows an increase in short telogen hairs ≤30 mm in length, reflecting a cycle completion of under 6 months in affected terminal hair follicles. To understand the miniaturisation process, we re-examine the dynamics of miniaturisation and ask the question, "why do miniaturised hair follicles resist treatment?" In the light of recent developments in relation to hair regeneration, we looked back in the older literature for helpful clues "lost to time" and reprise a 1978 Hermann Pinkus observation of an array of elastin deposits beneath the dermal papilla following subsequent anagen/telogen transitions in male balding, originally described by Arao and Perkins who concluded that these changes provide a "morphologic marker of the entire biologic process in the balding scalp." Thus, we have reviewed the role of the elastin-like bodies in hair pathology and we propose that alterations in elastin architecture may contribute to the failure of vellus-like hair reverting back to their terminal status and may indicate a new area for therapeutic intervention.

Background Androgenetic alopecia (AGA) is a common disorder in both males and females and may be improved by platelet-rich plasma (PRP) treatment. Objectives The aim of this study was to compare safety, efficacy, and satisfaction following treatment with a lower or higher number of platelets over 6 months. Methods This was a prospective randomized, double-blinded, placebo, parallel-group, half-scalp IRB-approved study involving 8 subjects with moderate AGA. Participants received intradermal PRP injections (baseline and Month 3), according to 2 treatment protocols (high vs low platelet numbers) to the frontal and crown portions of the hemiscalp and normal saline to control sites. Phototrichoscans were recorded at baseline and at 6 months, and global photography and subject and investigator satisfaction questionnaires were obtained at baseline, 3, and 6 months. Results At the end of 6-month evaluation period, both groups demonstrated absolute increases in total hair density, follicle diameter, and terminal hair density, as well as absolute and percentage changes at the frontal and crown targeted sites compared with baseline. These improvements tended to occur more often in areas treated with higher platelet numbers than with lower numbers. Vellus hair densities did not exhibit any significant changes with either PRP dosages. The investigator and 6 of the subjects were “satisfied” with the results at 3 months and no adverse reactions were associated with the treatments. Conclusions Intradermal injections with 2 therapeutic quantities of platelets were equally safe and efficacious for treating men and women with AGA. Higher numbers of platelets may have a greater effect than lower numbers of platelets in regard to hair density, follicle diameter, and terminal hair density but exhibited minimal effects on vellus hair densities at the 6-month evaluation point. Further studies are required to determine whether any significant advantages occur when delivering either lower or higher numbers of platelets in AGA treatments as long as therapeutic levels are administered. Level of Evidence: 2

Background: Androgenic alopecia (AGA) is a type of progressive hairloss, where there is androgen mediated conversion of susceptible terminal hairs into vellus hairs, in genetically predisposed individuals. Aims and Objectives: To compare efficacy of Topical 5% Minoxidil alone versus Topical 5% Minoxidil with Autologous Platelet Rich Plasma (PRP) therapy in patients with Androgenetic Alopecia. Materials a nd Methods: This is a Prospective study conducted in Department of Dermatology GMERS Medical College, Gandhinagar, Gujarat. A convenience sample of 62 men in the age group of 20-40 with Grade 2-5 AGA according to Hamilton- Norwood Grading were selected and was divided into 2 groups of 31 each. Presitting digital photographs and dermoscopic photos were taken. Autologous PRP was prepared using 18 ml of patients blood after double spin centrifugation and injected by Nappage technique. Results were assessed at the baseline and at the end of each sitting on the basis of change in hair density, photographic evaluation and patient’s self satisfaction. Result: Highly significant increase in hair density was achieved after 4 months of treatment. At T4 (Fourth Session of treatment) Group B showed higher hair density (42.97± 8.96) as compared to Group A (36.94 ± 11.57) which was statistically significant at P = 0.03 Conclusion: Group B showed better improvement as compared to Group A.PRP treatment has a positive therapeutic effect on male Androgenetic alopecia without major side effects. Keywords: Androgenic alopecia, Minoxidil, Platelet Rich Plasma, Randomised open label study.

Folliculotropic Mycosis Fungoides (FMF) is a rare variant of Mycosis Fungoides involving the scalp leading to alopecia. The clinical and trichoscopic features in 18 patients were analyzed and compared with the reports in the literature. Gender, age, disease stage, site of onset were taken into consideration. Clinical and trichoscopic analyses were performed on each patient. From a clinical point of view, Folliculotropic Mycosis Fungoides lesions involving the scalp presented as generalized alopecia (27.8%) or patchy-plaque alopecia (72.2%). Trichoscopic analysis revealed six most frequent features: single hair (83.3%), dotted dilated vessels (77.8%), broken-dystrophic hairs (66.7%), vellus hairs (61.1%), spermatozoa-like pattern vessels (55.6%), and yellow dots (55.6%). Additional identified trichoscopic patterns were dilation of follicular openings, scales-crusts, purpuric dots, short hair with split-end, pigtail hairs, perifollicular hyperkeratosis, milky-white globules, black dots, white dots/lines and absence of follicular dots. These trichoscopic features were further correlated to clinical presentations and stage of the disease. The rarity of the disease is a limitation. The relatively high number of patients allowed to identify several clinical and trichoscopic patterns that could be featured as specific or highly suspicious for FMF in order to consider trichoscopy as a complementary diagnostic approach and improve the differential diagnoses between FMF and other scalp disorders.

Background Alopecia areata (AA) is a common cause of hair loss. It is mediated by T lymphocytes. Scalp biopsy findings in AA differ according to the disease phase and activity. Objectives To study the cellular infiltrate in the transverse section of scalp biopsy of AA at different disease stages and in relation to disease activity. Methods The study was performed on 40 subjects with AA. A 4-mm punch biopsy was obtained from an AA scalp lesion. Biopsies were sectioned horizontally; 2 anatomical levels were studied (mid dermal and deep dermal levels). Results Ninety-five percent of AA showed noncicatrical alopecia. A significant relation was found between the course of AA and the terminal:vellus ratio. Peribulbar lymphocytic infiltration was seen in 70% of cases. Mast cells were observed in 87.5% of cases, including fibrous tract and around the arrector pili muscles. Eosinophils were detected in the scalp biopsy of 22.5% of cases. Course and activity of AA were significantly related to the peribulbar lymphocytic cell infiltration but not to mast cells and eosinophils. Conclusion Although a peribulbar lymphocytic infiltrate is the classical finding of AA, it is absent in the chronic phase. Mast cells are commonly found in the scalp biopsy of AA and could explain the potential therapeutic effect of antihistamines.

Since first recognized in 1839, the pathogenesis of acne inversa (AI) has undergone repeated revisions. Although there is agreement that AI involves occlusion of hair follicles with subsequent inflammation and the formation of tracts, the histologic progression of this disease still requires refinement. The objective of this study was to examine the histologic progression of AI based on the examination of a large cohort of punch biopsies and excisional samples that were examined first by hematoxylin and eosin staining. The most informative of these samples were step‐sectioned and stained by immunohistochemistry for epithelial and inflammatory markers. Based on this examination, the following observations were made: 1) AI arises from the epithelium of the infundibulum of terminal and vellus hairs; 2) These form cysts and epithelial tendrils that extend into soft tissue; 3) Immunohistochemical staining demonstrates the epithelium of AI is disordered with infundibular and isthmic differentiation and de novo expression of stem cell markers; 4) The inflammatory response in AI is heterogeneous and largely due to cyst rupture. The conclusions of this investigation were that AI is an epithelial‐driven disease caused by infiltrative, cyst forming tendrils and most of the inflammation is due to cyst rupture and release of cornified debris and bacteria. Cyst rupture often occurs below the depths of punch biopsy samples indicating their use for analysis may give an incomplete picture of the disease. Finally, our data suggest that unless therapies inhibit tendril development, it is unlikely they will cause prolonged treatment‐induced remission in AI.

Introduction: Hair loss is a cause of emotional and mental distress, especially in the modern age of social media. Hair loss can be classified as Cicatricial and Non-Cicatricial, based on the permanence of the damage wrought to the hair follicles. The conditions selected for evaluation in this particular study are androgenetic alopecia and telogen effluvium, owing to their higher rate of incidence and their amenable response to timely intervention.Trichoscopy aids in diagnosis, determination of biopsy site and acts as a prognostic tool. In this study, we will enumerate trichoscopic features of the scalp in androgenic alopecia (AGA) and telogen effluvium (TE) on the basis of follicular patterns, interfollicular patterns and hair signsMaterial and Methods: It is a cross-sectional and observational study is suited for estimating the prevalence of each trichoscopic feature in AGA and TE. The study was conducted in the Department of Dermatology, Venereology and Leprosy, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka. The study was conducted between January 2020 to December 2020 with sample size of 100 patients.Results: In the 100 cases of AGA and TE, 69% had AGA and 31% TE. Hair pull test was positive in 90% patients of TE. Yellow dots (69%), empty hair follicles, (65%) peripilar sign (71%), vellus hair (95%) and variation in hair shaft diameter in frontotemporal areas (98%) are the characteristic findings in AGA patients. The follicular features present in TE are peripilar sign (10%), yellow dots (29%) and vellus hair (30%). The characteristic finding is that the variation in hair – shaft diameter is prevalent in fronto-temporal (15%) and occipital areas (65%).Conclusion: The characteristic follicular features on Trichoscopy observed in AGA were peripilar sign, yellow dots and empty hair follicles. The characteristic hair shaft pattern observed was vellus hair. Variation in hair shaft diameter was more prevalent in fronto-temporal areas. TE is said to be a disease of exclusion on Trichoscopy. It is important to differentiate this condition from AGA, where-in the variation in hair shaft thickness is present in fronto-temporal areas and absent in occipital area.

Hair loss is a matter of concern in any individual irrespective of age and gender, more so in females. This study was undertaken to analyze the clinical patterns of hair loss in women in various disorders based on trichoscopic evaluation. In each patient, hair pull test and trichoscopy was done. Majority of the patients (67%) were in the age group of 21-40 years. The most common presentation was hair fall. Hair pull test was positive in 69.2% cases. The most common diagnosis observed was female pattern hair loss (36.2%); followed by telogen effluvium, pityriasis sicca, alopecia areata, canities, pediculosis capitis, scalp psoriasis and seborrheic dermatitis. Trichoscopy showed empty hair follicles, focal atrichia, anisotrichosis, increased vellus hair, pilosebaceous units with 1-2 hair, white dots of eccrine ducts, honeycomb pattern. Trichoscopy is an important diagnostic tool especially in patients when diagnosis was unclear. It is an important technique and allowed us to avoid scalp biopsy for difficult cases.

Background Platelet-rich plasma (PRP) is effective in the treatment of androgenetic alopecia (AGA). Aims The purpose of this study is to assess the effect of PRP on the proliferation of human follicle dermal papilla cells (HFDPCs), to observe the effect of PRP on the growth of hair follicles and hair shaft in vitro, to measure growth factors, and to evaluate the efficacy and safety of PRP injection. Patients/methods The effect of PRP on the proliferation of HFDPCs was observed. The length of hair follicle and hair shaft in vitro was measured. Then, the concentration of growth factors (EGF, FGF-2, FGF-7, IGF-1, HGF, PDGF-BB, and VEGF-A) was evaluated. Half-head injection of PRP was conducted to 10 males. Three treatments were conducted at 30-day intervals. Digital photographs were taken; hair diameter, hair density, unit density of hair follicles, and terminal hair/ vellus hair were analyzed. Results Platelet-rich plasma significantly promoted the proliferation of HFDPCs. Under the PRP culture, the hair follicle and hair shaft were grown, and the hair growth length on the 3rd and 6th days was greater than that of the control. PRP contained growth factors such as EGF, FGF-2, FGF-7, IGF-1, HGF, PDGF-B, and VEGF-A. Hair diameter, hair density, and unit hair follicle density on the PRP injection side peaked in the 6th month. The terminal hair/ vellus hair of the PRP injection side reached a peak in the 4th month. The average patient satisfaction during the entire treatment was 5.4 points (0-10 points). Conclusion Platelet-rich plasma can promote hair growth. PRP injection is safe and effective for the treatment of AGA.

Trichostasis spinulosa (TS) is a follicular disorder characterized by the retention of multiple vellus hairs in a hyperkeratotic dilated hair follicle. TS is considered as a common disorder; however, it is often underdiagnosed due to its asymptomatic nature. Although the condition frequently affects the face or extremities, the widespread distribution of TS over the entire body has been once reported in a patient with chronic renal failure. To emphasize the infrequent presentation of TS, we herein report a 57-year-old male with an unusual location of TS.

Background: Androgenetic alopecia [AGA] one of the common scalp hair loss disorders affecting males. Androgenetic alopecia is characterized by progressive miniaturization of hair follicles in the scalp and gradual transformation of terminal hairs into vellus hairs leading to progressive decrease in hair density. The pattern of loss follows the scale developed by Hamilton and later extended by Norwood. Aim of Work: Evaluation of the efficacy of topical cetirizine 1% for the treatment of androgenetic alopecia in male patients. Patients and methods: This case-controlled study included 30 male patients treated by topical cetirizine1%and 30 male patients as a control group treated by placebo for 6 months recruited from dermatology outpatient clinic of Damietta Hospital and Al-Sarou hospital during the period from September 2018 to August 2019. For each patient, the trichoscopic evaluation was performed before the beginning of treatment and after 6 months of treatment. Results: Treatment with topical cetirizine 1% in male patients with AGA showed that according to number of new up growing hairs, the majority [56.7%] of cases had no new growing hair, 20.0%, 16.7% &6.7% had one, two and three new hair respectively. On the other hands, all control had no new hair after 6 months of treatment. Conclusion: Topical cetirizine is effective in the treatment of Androgenetic alopecia in men.

Abstract Androgens have an intense consequence on the human scalp and body hair. Scalp hair sprouts fundamentally in awol of androgens whereas the body hair hike is vulnerable to the activity of androgens. Androgenetic alopecia (AGA) invoked as males emulate Alopecia due to the cause of the dynamic reduction of scalp hair. Androgens are medium of terminus growth of hair although the body. Local and system androgens convert the extensive terminal follicles into lesser vellus like structure. The out start of this type of alopecia is intensely irregular and the reason behind this existence of enough circulating steroidal hormones androgens and due to genetic predisposition. Effective treatments are available in the market as well as under clinical and preclinical testing. Many herbal formulations are also available but not FDA approved. Different conventional and NDDS formulations are already available in the market. To avoid various systemic side effects of both Finasteride and Minoxidil, topical formulations and natural products (nutrients, minerals, vitamins) now a days are being widely used to treat Androgenic alopecia. CAM (complementary and alternative medicine) provides the option to elect favorable, low-risk, adjuvant and alternative therapies. Herein, we offer a widespread review of topical marketed formulations, natural products, and CAM treatment options for AGA. Graphic Abstract

Background Hair is an essential identity of women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Female pattern hair loss is found in 20%-30% of patients with polycystic ovary syndrome (PCOS). Aim The aim of the present study was to evaluate the efficacy of QR678® and QR678 Neo® therapy in the treatment of female alopecia with PCOS. Method A total of 20 females diagnosed with PCOS in the age 25-50 years, with complaints of female pattern alopecia with Ludwig, grades I, and II were selected for the study. At each visit, 1.5 ml solution of QR678® was injected in the scalp skin of patients. A total of eight sessions were performed at an interval of 3 week each. All the patients were evaluated with standard global photography at baseline, 4th and 8th session, and 2 months after 8th session. Result Marked improvement was seen in the global photographic assessment score (mean = 8) which was maintained for over 1 year. In videomicroscopic assessment, after four sessions the patients had 8.07 fewer vellus hair, 6.07 more terminal hair, and average hair shaft diameter was 0.82 μm wider. After eight sessions, they had 11.66 fewer vellus hair, 13.77 more terminal hair, and hair shaft diameter was 2.86 μm wider than at baseline. Conclusion Intra-dermal injections of QR 678® hair growth factor formulation is an effective option for female pattern alopecia with PCOS. This is the first of its kind study using QR678® and QR678 Neo® in PCOS patients.

Background Hair fall is a widespread problem among all genders, ages, and ethnicity with both physical and psychological effects. Objective This clinical study was designed to evaluate the efficacy and safety of a hair serum formulation containing amla extract, freeze-dried coconut water, and the micronutrient selenium along with sandalwood odorant and peanut shell extract in healthy male and female volunteers with hair fall. Methods A total of 42 subjects were enrolled and completed the study and they used the test product daily for 90 days. TrichoScan® was used to evaluate the efficacy of the test product for improving hair growth rate, hair density, anagen hair, telogen hair, and the density of vellus and terminal hair. Hair thinning and hair fall reduction were compared to its basline by both dermatologists and subject self-assessment questionnaires. Result and Discussion After 90 days of test product application, there was a significant improvement in hair growth rate (

Introduction: Alopecia areata is a common chronic autoimmune inflammatory disease that involves hair follicles, characterized by hair loss on the scalp and/or body without scarring. Clinically, the disease presents as smooth, patchy hair loss with various patterns - diffuse or reticulate alopecia, ophiasis, ophiasis inversus, alopecia totalis (loss of hair all the scalp), or alopecia universalis (loss of hair all over the body). Clinical diagnosis of AA is made based on typical pattern of hair loss and the presence of characteristic exclamation mark hair in microscopy. Invasive (punch biopsy) techniques are often required in some cases where the clinical diagnosis is not straight forward Biopsy shows peribulbar lymphocytic infiltrates in a “swarm of bee pattern” which is characteristic of the acute stage of the disease. Dermoscopy is an imaging instrument that immensely magnifies surface features of skin lesions. It works on the principle of illumination and transillumination of skin with different light sources and studying it with a high magnification lens. Dry dermoscopy was done with heine delta 20 dermoscope which was followed by wet dermoscopy. Liquid paraffin was used as the immersion media. It is a noninvasive, repeatable, recordable bedside investigation. Objective: To study dermoscopic findings in alopecia areata. Materials and Methods: Study Design: Cross sectional study; Study Area: Skin Outpatient Department, Sree Balaji Medical College and Hospital; Study Population: All patients with hair loss, attending skin OPD, who are clinically diagnosed as Alopecia Areata; Study Method: Observational study; Sample Size: 30. Results: Clinically, the disease presents as smooth, patchy hair loss with various patterns. Dermoscopy is useful for diagnosis of AA clinically by the presence of cadaverized hairs (black dots), circle hair, coudablity hair, exclamation mark hairs (tapering hairs), broken hairs, yellow dots and clustered short vellus hairs in the hair loss areas. The results wear tabulated.

Background: Hair loss (alopecia) is a common problem and is a major cause of psychological stress and anxiety among affected individuals. It is of utmost importance to diagnose these cases at the earliest and treat them accordingly. Trichoscopy provides a noninvasive option that can be used for early diagnosis and monitoring the progression of the hair disorders. Aims and Objectives: To perform trichoscopy and document the findings in patients with nonscarring alopecia's. Materials and Methods: A total of 100 cases satisfying the inclusion criteria were screened for general physical examination and scalp examination including hair shaft and root, and tests for hair anchorage and fragility were also done. The lesions were examined through dermoscope, photographs were taken, and findings were documented. Results: Among the total of 100 cases screened, 57 were female and 43 were male. The mean age of the study group was 26 ± 14.8 years. Females were affected by alopecia areata (AA) and female pattern hair loss (29.8%) equally, whereas males were most commonly affected by AA (41.8%). The common trichoscopic follicular features noted were broken hair (48%), black dots (48%), single hair follicle unit (45%), short vellus hair (44%), upright hair (41%), and yellow dots (40%). The common interfollicular features seen were honeycomb pigmentation (26%) and arborizing red lines (12%). Conclusion: The emergence of newer hair signs on trichoscopic studies aids in identification and has a definitive role in the diagnosis of clinically difficult cases, so it is recommended to use trichoscopy in the routine examination of nonscarring alopecia's.

Background Human hair follicles (HFs) express the olfactory receptor (OR)2AT4, which is selectively stimulated by the synthetic sandalwood-like odorant, Sandalore® . In organ-cultured, human scalp HFs, Sandalore® prolongs anagen and suppresses apoptosis by up-regulating intrafollicular IGF-1 mediated signaling. Aims The objective of this study is to demonstrate whether effects of Sandalore® observed ex vivo translate into a clinically relevant effect in patients with telogen effluvium. Patients/methods In a randomized, double-blinded, placebo-controlled, clinical trial, 60 female volunteers (18-65 years) affected by telogen effluvium received over a period of 24 weeks treatment with either 1% Sandalore® solution (n = 30) or placebo (identically smelling, but non-OR2AT4 activating sandalwood oil n = 30). The study read-out parameters were the degree of hair shedding, hair volume, terminal/vellus hair ratio, anagen/catagen-telogen ratio, and patient self-assessment. Results Sandalore® 1% ameliorated clinical signs of telogen effluvium, namely it reduced hair shedding, and increased hair volume and the percentage of anagen HFs, the latter two parameters significantly more than placebo when changes were calculated to baseline. Sandalore® also increased the ratio of terminal/vellus hairs at week 8. Most of the anti-hair shedding effects were seen after 8 weeks and maintained at week 24. Patient questionnaire showed that verum group patients were more satisfied than the placebo group in regard to the overall results. Conclusion This clinical trial supports previous findings of anagen-prolonging effects of Sandalore® ex vivo with similar results now reproduced in clinical practice. It also provides proof-of-principle that a topically applied cosmetic odorant acting through HF olfactory receptors can be a therapeutic alternative to treat hair loss disorders characterized by excessive hair shedding such as telogen effluvium.

In spite of several modalities for androgenic alopecia therapy used such as topical minoxidil solution or oral finasteride; it still has a great challenge. This study evaluated the effect of platelet-rich plasma in androgenic alopecia treatment regarding improvement percentage as well as the rate of adverse. Fifty patients complaining of androgenic alopecia were evaluated by Micro Viewer dermoscopy, analyzed by Compare view software and treated four times at one month interval with platelet-rich plasma injection. At every visit patient evaluation and satisfaction was completed, their age ranges from 18-40 years with a mean ± SD of 25.96 ± 5.99 years, the duration of hair loss ranges from 1-15 years with a mean ± SD of 4.58 ± 3.38 years. The mean Compare view software parameters showed a statistically significant increased from 261.47 ± 39.79 to 312.03 ± 48.61 for hair density, 0.64 ± 0.13 to 0.76 ± 0.16 for hair width and 2.25 ± 1.38 to 3.56 ± 2.71 for terminal/Vellus ratio (p < 0.05), additionally a high overall patient satisfaction in the absence of adverse effects. The present study indicates that APRP is a good tool for androgenic alopecia treatment in the absence of adverse effects.

Frontal Fibrosing Alopecia (FFA) is a type of scarring alopecia known as a clinical variant of lichen planopilaris (LPP). It is characterized by slowly progressive scarring alopecia on the hairline and affects explicitly postmenopausal women. The point of the current examination was to survey trichoscopic discoveries in instances of Frontal Fibrosing Alopecia. The examination was led on 50 female patients with frontal fibrosing alopecia who were selected from Dermatology outpatient center of Benha University clinic in the period from January 2019 to January 2020. A composed educated assent was acquired from all members. The examination was endorsed by the nearby morals board on look into including human subjects of Benha Faculty of Medicine. All patients were exposed to Dermatological assessment for clinical appraisal and trichoscopic assessment of frontal fibrosing alopecia. Trichoscopy featured a checked decrease in the quantity of follicular ostia, perifollicular desquamation, perifollicular blue-dim spots Follicular hyperkeratosis, Perifollicular erythema, Lonely hair , unexpected interference of the hairline, with the nonattendance of the vellus hairs that are regularly seen in typical scalp. Trichoscopy is a useful apparatus in the conclusion of frontal fibrosing alopecia.

Introduction Recently, dermoscopy of the hair and scalp, also known as trichoscopy, has become an important diagnostic tool in the diagnosis of hair diseases. There are few studies describing trichoscopic findings of trichotillomania (TTM). Aim To evaluate and identify specific trichoscopic features of TTM. Material and methods The study included 20 patients diagnosed with TTM on the basis of the clinical history, physical examination and trichoscopic findings. All of the trichoscopic images of the patients were retrospectively reviewed and the findings identified were recorded. Descriptive statistical analysis was performed. Results The findings detected were broken hairs at different levels (100%), short vellus hairs ( 90%), black dots (85%), trichoptilosis (75%), V hair (70%), hair powder (65%), yellow dots (55%), Mace hair (45%), coiled hairs (45%), exclamation mark hair (40%), blood spots (40%), branched hair (40%), angulated hair (40%), concentric hair (35%), flame hair (30%), and tulip hair (25%). Conclusions Here we have documented trichoscopic findings of TTM retrospectively. Trichoptilosis, V hair and hair powder were the most frequent relatively specific findings. We tried to define novel findings that we named branched hair and concentric hair. We also detected Mace hair in 9 cases. Mace hair was previously described just in 3 cases of TTM in a case study. Angulated hairs, to the best of our knowledge, were also firstly described for TTM in the present study. Lack of a comparison group is the main limitation of the study.

Background Milia are superficial keratinous cysts seen as pearly white, dome-shaped lesions 1–2 mm in diameter. Milia are associated with diseases that cause subepidermal blistering, such as hereditary forms of epidermolysis bullosa, epidermolysis bullosa acquisita, bullous pemphigoid, bullous lichen planus, and porphyria cutanea tarda. Multiple eruptive milia are rare and more extensive in number than primary milia. Objective The aim of this study was to search the literature for cases of blistering diseases with multiple milia formation, especially in areas of the skin where there was no evidence of blistering or trauma, and review the interpretations of their pathogenesis. Methods We performed a literature search with the terms multiple milia and bullous diseases, pemphigoid, and pemphigus. Results Very few studies have investigated the origin of milia. Primary milia are thought to originate from the sebaceous collar of vellus hairs, and secondary milia are believed to derive from eccrine ducts more commonly than from overlying epidermis, hair follicles, or sebaceous ducts. Milia secondary to blisters or trauma are speculated to be produced through the regeneration process of disrupted sweat glands or hair follicles. Immunological predisposition, aberrant interaction between the hemidesmosomes, and the extracellular matrix components beneath the hemidesmosomes have been described with regard to the formation of numerous milia during recovery. Multiple milia could be a primary manifestation of dystrophic epidermolysis bullosa in skin areas without evidence of blistering. Conclusion The exact etiology of multiple milia remains unknown. Immunological predisposition and improper interaction between hemidesmosomes and extracellular matrix components are speculated to play a role in the formation of milia during recovery of bullous lesions in blistering diseases. Still, further studies on the triggering mechanisms of keratinocyte dysfunction in cases of multiple milia formation without evidence of prior blistering are needed.

Alopecia areata (AA) is second most common disease leading to non scarring alopecia . It occurs in many patterns and can occur on any hair bearing site of the body. Many factors like family history, autoimmune conditions and environment play a major role in its etio-pathogenesis. Histopathology shows bulbar lymphocytes surrounding either terminal hair or vellus hair resembling ”swarm of bees” appearance depending on chronicity of alopecia areata. 1 Alopecia areata in children is frequently seen. Pediatric AA has been associated with atopy, thyroid abnormalities and a positive family history.We have done a study to find out if there is any association between alopecia areata and other auto immune diseases in children. This study is an observational study conducted in 100 children with AA to determine any associated autoimmune conditions in them. SALT score helps to assess severity of alopecia areata. Severity of alopecia areata was assessed by SALT score-1. S1- less than 25% of hairloss, 2. S2- 25-45% of hairloss, 3. 3.S3- 50-74% of hairloss. Keywords: Alopecia areata, Auto immunity, Pediatric population.

The ultrasound features of 87 steatocytoma multiplex (SCM) lesions detected in 9 patients are reported. Steatocytoma multiplex is a hamartomatous condition derived from the pilosebaceous duct junction that generates multiple cutaneous cystic lesions. It appeared as clusters of well-defined hypoechoic nodules with mild posterior enhancement in 100% of cases, with both dermal and subcutaneous locations in 67%. No calcification foci were detected within or at the periphery of the lesions. Fifty-six percent of the cases showed signs of hypervascularity in the edge of the nodules, and 44% of the lesions were associated with another dermatologic condition, most frequent being hidradenitis suppurativa (75%), followed by vellus hair cysts (25%). Steatocytoma multiplex shows ultrasound features that allow discrimination from other common cutaneous entities.

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.

Androgenetic alopecia (AGA), also termed as androgenic alopecia or common baldness, is a condition where there is androgen mediated conversion of susceptible terminal hair into vellus hair. Although it is reported more commonly in males, it also affects females but the incidence is relatively unknown. AGA tremendously affects the psychology of the patient due to its chronicity of treatment and cosmetic implications. There are numerous treatment options available for AGA but the choice of treatment has to often be tailored according to the patient's needs, affordability, and compliance. This review focusses on the various treatment options available, with special emphasis on the role of low-level laser therapy (LLLT) in the management of AGA. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review.

Introduction: Many dermatological conditions require extraction of material from the lesion followed by visualization under a microscope. However, visualization of the extracted material can be done using a dermoscope instead. We propose “extraction dermoscopy” as an addition to the already existing treasury that dermoscopy holds. Methods: After approval from the institutional ethics committee, a cross-sectional study was carried out in a tertiary care hospital. Polarized and non-polarized versions of in vivo dermoscopy, as well as extraction dermoscopy, were performed on a total of 77 lesions, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Heine Delta 20T and Dino-Lite Premier AM4113T were employed for dermoscopic examination. Results: A total of 77 lesions were selected, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Extraction dermoscopy of the eruptive vellus cysts revealed skin color to brownish colored cysts with a bunch of pigmented hair. Similarly, findings of all other lesions were described and recorded post-extraction. Conclusion: Extraction dermoscopy helps confirm the diagnosis without visualization under a microscope. Its application in recent times makes the explanation of the nature of many disorders to patients easier, and demonstration of extracted lesions may further improve doctor-patient communication.

Melanoma is the deadliest type of skin cancer with its prevalence on the rise. Recently, the melanocyte stem cells in hair follicles have been identified as the possible origin of melanoma upon exposure to ultraviolet radiation (UVR) through skin. It is hypothesized that colourless vellus hair (predominant in childhood) can serve as an alternative pathway in transmitting these ultraviolet (UV) photons to the stem cells. To investigate this, we have used the CRAIC microspectrophotometer to investigate the optical properties of ‘vellus-like’ hairs and terminal hairs of different colours using UV–VIS–NIR light sources. It was found that the average attenuation coefficient of ‘vellus-like’ hair is significantly lower than that of terminal hair in the UVA (p < 0.0001) and UVB (p < 0.001) wavelength ranges. Next, the optical properties of hairs are applied to simulations for examining their influence on UV transmission into the skin. The results show that the presence of vellus hair would increase the solar UV transmission to the melanocyte stem cell layer significantly. The findings explain why children are particularly vulnerable to sun exposure and the positive correlation found between the incidence of melanoma in adults’ bodies and the number of vellus hairs in these areas.

Background: Androgenetic alopecia (AGA) is the most common hair loss disorder seen in men. It can have an early onset but has also been associated with ageing and senescence. It often induces pronounced psychological impact. ALRV5XR, a new hair loss treatment herein evaluated, was designed to target multiple molecular pathways involved in hair growth and hair follicle stem cell biology. The main objectives of the study were the assessment of safety and efficacy profiles of ALRV5XR in men.Methods: This 24-week, parallel randomised, placebo-controlled, double-blinded clinical trial was performed in a USA community clinic. Healthy men (age 22-65) with AGA and belonging to the Hamilton-Norwood (HN) classification I-VII and Fitzpatrick skin type (FST) I-VI, were randomly allocated in a 1:1 ratio into ALRV5XR or placebo treatment groups. Dermatologist assessment, phototrichograms, and blood samples were obtained in a blinded fashion at baseline, 12 and 24 weeks. Subjects were given a masked treatment consisting of oral capsules, shampoo, conditioner, and follicle serum, which was intended for daily use. Efficacy was assessed via absolute and per cent changes in terminal hair (TH) density, and response rates. The trial was registered with clinicaltrials.gov (NCT04450589) and is completed.Findings: Forty-six subjects were enroled in the study, 23 allocated to the ALRV5XR treatment and 23 to the placebo group. Enrolment occurred from April 11 to October 23, 2018. Thirty-six subjects completed the trial (17 ALRV5XR, 19 placebo) and 11 subjects in each group were evaluable for TH outcomes. At 24 weeks, the absolute change in TH density improved by 21.0 THs/cm(2) (95% CI: 9.2-32.8; p = 0.0014), and the relative density increased by 16.4% (95% CI: 7.4%-25.5%; p = 0.0012). The odds ratio for being a responder ( >= 0 change) was 87.4. TH density increased linearly and was not affected by HN, FST, ethnicity, age, or body mass index. All subjects in the ALRV5XR group responded to treatment while 81.8% of the placebo group decreased TH density. ALRV5XR induced statistically significant changes in both decrease in vellus hair (VH) density as well as in concomitant increase of the TH/VH ratio when compared to placebo. ALRV5XR was well tolerated, and no adverse events were observed.Interpretation: ALRV5XR treatment resulted in clinically significant TH regrowth in men with AGA. Furthermore, it appeared to reverse the characteristic hair miniaturisation seen in this condition. When compared to results of published trials of standard therapy, ALRV5XR showed a multi-fold increase both in efficacy and in response rates. In addition, the continuance of TH regrowth from 12 to 24 weeks suggests that the normal structure and function of non-productive telogen follicles is restored and that a normal hair phenotype may be attained by extended ALRV5XR treatment. (C) 2021 The Author(s). Published by Elsevier Ltd.