Medical Treatment of Alopecia

Alopecia means partial or complete loss of hair from a part of the body where it exists naturally. It affects both men and women, and its treatment depends upon its cause, age of onset, and clinical presentation. It is divided into scarring and non-scarring alopecia. Scarring alopecia includes pseudopelade of Brocq, central centrifugal cicatricial alopecia, folliculitis decalvans, acne keloidalis nuchae, lichen planopilaris, frontal fibrosing alopecia and discoid lupus erythematosus, traumatic i.e., injury, radiation and post-operative scarring alopecia and certain neoplasms. Common causes of non-scarring alopecia are androgenic alopecia, alopecia areata, telogen effluvium, anagen effluvium, trichotillomania, traction alopecia, pressure-induced alopecia, alopecia due to iron deficiency, thyroid disease, and polycystic ovary syndrome. Topical remedies available are minoxidil 2 and 5%, topical & intralesional steroids, topical sensitization, anthralin, retinoids, tacrolimus, garlic, ketoconazole and prostaglandin analogs. Among systemic treatments, finasteride, steroids, immunosuppressant like azathioprine, methotrexate, sulfasalazine, zinc sulfate and iron are widely accepted. The phototherapies, photo-chemotherapies, platelet rich plasma (PRP) therapy, pharmacogenetics and hair transplant are new remedies for alopecia. It is concluded that minoxidil, finasteride, PRP, and hair transplant are the most widely being used modalities for alopecia

Clinical, Histological and Trichoscopic Correlations in Scalp Disorders

Trichoscopy is the term coined for the dermoscopic imaging of scalp and hair. This diagnostic technique, simple and noninvasive, can be used as a handy bedside tool for the diagnosis and follow-up of hair and scalp disorders. It allows the recognition of morphologic structures not visible by the naked eye and provides the clinician with a range of dermoscopic findings necessary for differential diagnosis. Trichoscopy observation can be broadly grouped as interfollicular patterns and follicular patterns. Recently, a third mixed class, called the follicular plus interfollicular pattern, has been introduced. Some of these features are specific to a certain scalp disease, while others can be found in many hair disorders. Although studies suggest that the use of trichoscopy can improve clinical accuracy, further investigation is needed. This review provides update information on the trichoscopic features of the most common scalp disorders, striving to show a histopathological and clinical correlation

Центральная центробежная рубцующая алопециякак редкая форма рубцового выпадения волос

The authors describe a rare form of scarring alopecia - central centrifugal scarring alopecia (synonym: follicular degeneration syndrome). A particular feature of this disorder is a combination of scarring alopecia with pathology of the thyroid gland. The authors also provide a classification of primary scarring alopecias.Приведено описание редкой формы рубцовой алопеции - центральной центробежной рубцующей алопеции (син.: синдром фолликулярной дегенерации). Особенностью данного наблюдения является сочетание рубцового выпадения волос с патологией щитовидной железы. Дополнительно приведена классификация первичных рубцовых алопеций

Canine recurrent flank alopecia: a synthesis of theory and practice

Canine recurrent flank alopecia is a non-inflammatory, non-scarring alopecia of unknown etiology and has a visually striking clinical presentation. Although this disease entity is relatively common in the northern hemisphere, there is only scant information in the literature regarding case descriptions. The aim of this article was to review the literature and to describe clinical presentations recognized in practice, which are not always extensively documented in the literature

Scalp psoriasis associated with central centrifugal cicatricial alopecia

AbstractScalp psoriasis is a very common dermatological condition with a variety of presentations, but only rarely presents as severe alopecia. We present a case of a 50-year-old female with many years of recalcitrant hair loss that was thought to be secondary to central centrifugal cicatricial alopecia which was later diagnosed as psoriasis. This case highlights an interesting presentation and rare complication of a common disease

The histopathology, direct immunofluorescence and immunoperoxidase staining in the distinction between lichen plano-pilaris and central centrifugal cicatricial alopecia

Thesis (Sc.D.)--Boston UniversityLichen planopilaris (LPP) and central centrifugal cicatricial alopecia (CCCA) are lymphocytic scarring alopecias. They share overlapping clinical and histopathologic findings. The goal of this dissertation has been to fmd reliably distinguishing features between these two conditions. Toward this goal, three different studies were conducted. Study 1 was a retrospective cross-sectional data analytic review of histologic features from patients identified by diagnosis of LPP or CCCA. Horizontal sections at level of the infundibulum, isthmus and inferior from scalp biopsies of 24 patients (19 CCCA and 5 LPP) were analyzed. The findings of unaffected follicular units, retained sebaceous glands and mild perifollicular inflammation were found to favor the diagnosis of CCCA. Dilated eccrine glands and heavy perifollicular inflammation were found to favor the diagnosis of LPP. Study 2 was a prospective cross-sectional data analysis study designed to identify and compare direct immunohistochemical findings in patients with LPP or CCCA. Vertical frozen sections of scalp biopsies from eleven patients (4 CCCA and 7 LPP) were stained with IgG, IgA, IgM, C3 and fibrinogen. No DIF finding that reliably distinguishes LPP from CCCA was found. The presence of a positive DIF was significantly correlated with the amount of inflammation. Study 3 investigated and compared T lymphocyte subsets, including T helper cells, cytotoxic T cells, Th 17 lymphocytes and regulatory T cells between LPP and CCCA cases. Subjects in this study were identical to study 2. There were no significantly distinctive T lymphocyte populations that differentiate between CCCA and LPP. There were higher numbers and percentages of CD8 positive cells in LPP compared to CCCA. The CD4:CD8 ratios were decreased in LPP and increased with duration of disease approaching proportions found in the normal hair follicle and CCCA. There were higher CD1a:CD3 ratios in LPP compared to CCCA. The CD1a:CD3 ratios in LPP decrease over time, approaching those found in CCCA. Results of this study confirm role of Langerhans cells as antigen presenting cells and role of cytotoxic lymphocytes in pathogenesis of LPP in early disease. Th17 lymphocytes and Tregs may have a role in both CCCA and LPP

Role of Jaloukavacharana in the management of Cicatricle Alopecia – A Case Report

Introduction: Cicatricial alopecia is a disease of scalp in which the major clinical feature is patchy loss of hair accompanied with scarring. Cicatricial alopecia is caused by diverse group of hair disorders in which healthy tissue is replaced by scar tissue and causes permanent hair loss. It affects both men and women, most commonly adults. It can be correlated to Indralupta a type of Kapalagta Roga by Vagbhata. The basic pathophysiology of Indralupta is the vitiated Tridosha and Rakta affecting the scalp. The pathology also reveals the blockage of hair follicles with aggravated Rakta and Kapha which further prevents regrowth of hairs. This is the case report of 22 year old male who complained of patchy loss of hair at the left parital region of scalp, associated with pus discharge and swelling since 4 years. Materials and Methods: The subject who approached Shalakya Tantra OPD of Government Ayurveda Medical College, Bengaluru with symptoms of patchy hair loss at left parietal region since 4 years was systemically reviewed and Rakthamokshana, Lepa and Rasayana line of treatment is adopted. Results: The subject showed marked improvement as depicted in the photographs taken at different levels of treatment. Discussion: Idralupta is a Kshudraroga affecting scalp and involving Pitta, Vata Dusti, later Kapha and Rakta blocking the Romakupa. By adopting the holistic approach with both internal and external treatment modalities an attempt is made to bring about satisfactory results

Common Dermatoses in Patients with Obsessive Compulsive Disorders

Obsessive-compulsive disorder is a chronic, debilitating syndrome, consisting of intrusive thoughts- which are experienced as inappropriate by the patient and are producing anxiety- and compulsions, defined as repetitive behaviours produced to reduce anxiety. While patients with obsessive-compulsive disorder typically have xerosis, eczema or lichen simplex chronicus, as a result of frequent washing or rubbing their skin, several other disorders which are included in the group of factitious disorders have also been associated with obsessive-compulsive disorder. A close collaboration between the dermatologist and the psychiatrist is therefore mandatory in order to achieve favourable outcomes for these patients. The aim of the article is to present the most frequent dermatological disorders associated with obsessive-compulsive disorder and to look over some of the rare ones