Evaluation of Patients with Alopecia

This chapter outlines the clinical approaches for alopecic patients that are reliable in practice. We discuss three different categories of hair evaluation options: invasive methods (biopsy), semi-invasive methods (trichogram) and noninvasive methods. Besides describing the current status of diagnosis and quantification of alopecia, the chapter provides an objective assessment of these investigation tools: detailed medical history collection by structured interview and questionnaires, clinical examination of the scalp and other hair-bearing areas, laboratory investigations, assessment of hair loss distribution (patterned/diffuse/focal), dermoscopic evaluation, assessment of alopecia severity (by pull test, hair part width, counting hair test), common scales for hair loss staging, photography of alopecic areas, biopsy, trichogram, unit area trichogram, tug test, hair mount and microscopic evaluation, electron microscopy, hair card test, hair weight determination, hair densitometry, mechanical test of hair quality and computed hair analysis. Unfortunately, the disadvantages of most of these methods generate a lack of use in clinical practice, leading to few reliable evaluation methods for patients suffering from alopecia. We underline the necessity of easy, refined and precise evaluation tools for the assessment of alopecia patients

Evaluation of Psoriasis Patients

Psoriasis represents a chronic inflammatory skin disease with multisystemic involvement. The development of this autoimmune disorder depends on a complex interplay of genetic and environmental factors. Besides presenting the conditions associated with psoriasis, the chapter outlines the role of hormones (sex hormones, prolactin, and thyroid hormones) in psoriasis pathogenesis and evolution. The chapter indicates the clinical approaches recommended in practice: a detailed medical history collection (including prior exposure to treatments and evaluation of co-medication), a thorough physical examination (with the completion of specific severity and QoL scales), laboratory investigations and screening for malignancies (including lymphoma and skin cancer) or infection (Tuberculosis, Crohn’s disease). European Guidelines encourage the dermatologist to check for hypersensitivity, metabolic, gastro-intestinal and renal disorders, check for the need of vaccines and contraception. We discuss pre-treatment, during-treatment and post-treatment evaluation options and underline the necessity of clear evaluation steps in the assessment of psoriasis patients

Effect of Curcumin on Oxidative Stress in a Model of Turpentine Induced Acute Experimental Inflammation

Curcumin, a natural phenolic compound is an anti-tumor agent with anti-inflammatory and anti-oxidant properties. The aim of this research was to evaluate oxidative stress levels, the antioxidant activity and Curcumin concentrations by high performance liquid chromatography (HPLC) in an acute experimental inflammation induced by Turpentine oil (intramuscular 0.6 mg kg-1 body weight) and to compare a prophylactic versus a therapeutic regimen of Curcumin (oral suspension of 150 mg Curcumin kg-1 rat weight). Sixteen adult male Wistar rats were assigned to four groups: Control, Group I (Curcumin only), Group II (Curcumin administration, then induced inflammation after 1 hour) and Group III (induced inflammation then Curcumin administration after 2 hours). Oxidative stress was assessed by measuring serum malondialdehide and carbonylated proteins, while systemic and local total antioxidant capacity was determined by ABTS. Local tissue changes (muscle, kidney, liver) were analysed using histopathology. Results showed that acute inflammation significantly increased lipid peroxidation in Groups II and III compared to Control and Group I. A significantly reduced total antioxidant capacity (ATBS) was present in serum and kidney in Group II, also in muscle and kidney in Group III. ABTS levels were significantly increased only in the liver tissue of the animals in Groups II and III with induced inflammation as compared to Group I. This study proved the potential of Curcumin in reducing oxidative stress in both prophylactic and therapeutic regimens

Genetic and Hormonal Determinations in a Pair of Identical Twins with Early Onset Psoriasis Vulgaris: Case Report and a Brief Review of the Literature

Psoriasis vulgaris is a chronic inflammatory dermatosis with major impact on patients’ life quality. The etiopathogenesis is multifactorial, depending on complex interactions between genetic and environmental factors. We present the case of two female patients, identical twins of 33 years old, suffering from psoriasis vulgaris since childhood. Patient A developed specific lesions of psoriasis at the age of 7 and patient B started to develop psoriasis lesions on the scalp two years later. At the age of 31, patient A was diagnosed with psoriatic arthritis. Laboratory test results were within the normal ranges for both patients. Hormonal and immunological determinations revealed the presence of a high level of antithyroidperoxidase antibody in patient A and increased level of prolactin in patient B. Ultrasonographic assessment of the thyroid detected the presence of bilateral micronodules in the first subject. Knowing that early onset psoriasis is associated with the presence of Human Leukocyte Antigen Cw6(HLA-Cw6), we aimed to confirm this hypothesis for our subjects. Although HLA-Cw6 is the most frequent mutation in psoriasis patients and it is present in about two-thirds of the tested subjects,the genetic results for both patients were negative, strengthening the fact that other factors, the environmental one and the hormonal disorders had an important role in their psoriasis pathogenesis. Under these conditions, we emphasize the importance of including a hormonal evaluation approach of psoriasis patients in order to diagnose and treat pathologies that may be related with disease exacerbation