Evolución de la técnica follicular unit extraction (FUE) / Evolution of the follicular unit extraction (FUE) technique

El microtrasplante capilar, método FUE, es la cirugía para la recuperación capilar que consta en la extracción de unidades foliculares con punches de distintos diámetros y longitudes, desde una zona llamada dadora, generalmente occipital y/o temporal aunque pueden utilizarse otras partes del cuerpo como barba, tórax, abdomen y pubis, para luego de seleccionarse y conservarse en forma adecuada ser implantadas en la llamada zona receptora. Tanto los avances en la técnica como en el uso de instrumental de última generación generan resultados mejores y más naturales, con una recuperación más rápida y menor daño de sus zonas dadoras.

Hair transplant, FUE method, is surgery for hair recovery that consists of the extraction of follicular units with punches of different diameters and lengths, from an area called the donor; usually occipital and/or temporal; although they can be used on other parts of the body such as beard, thorax, abdomen and pubes. After being appropriately selected and preserved, they are implanted in the so-called receiving area. Both advances in technique and in the use of cutting-edge instruments generate better and more natural results, with faster recovery and less damage to the donor areas

Alopecia em pacientes anticoagulados / Alopecia in anticoagulated patients

Resumo A alopecia é uma complicação comum da terapia anticoagulante que pode ter repercussões psicológicas importantes nos pacientes, especialmente nos do sexo feminino, e interferir na decisão de extensão da anticoagulação. Esta revisão tem como objetivo descrever os mecanismos potencialmente envolvidos na gênese da alopecia durante a terapia anticoagulante, pois eles ainda não estão totalmente esclarecidos, e as terapias existentes, para a adoção das condutas mais adequadas.

Abstract Alopecia is a common complication of anticoagulant therapy that may have important psychological repercussions for patients, especially female patients, and can interfere with the decision to extend anticoagulation. This review aims to describe the mechanisms potentially involved in the genesis of alopecia during anticoagulant therapy, since these are not yet fully understood, and discusses the existing therapies for the most appropriate management.

DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms

Abstract The transforming growth factor-beta 1 (TGFβ1) promotes fibrosis, differentiating epithelial cells and quiescent fibroblasts into myofibroblasts and increasing expression of extracellular matrix. Recent investigations have shown that PPAR (peroxisome proliferator-activated receptor*) is a negative regulator of fibrotic events induced by TGFβ1. Dehydroepiandrosterone (DHEA) is an immunomodulatory hormone essential for PPAR functions, and is reduced in some processes characterized by fibrosis. Although scarring alopecia characteristically develops in the female biological period in which occurs decreased production of DHEA, there are no data in the literature relating its reduction to fibrogenic process of this condition. This article aims to review the fibrogenic activity of TGFβ1, its control by PPAR and its relation with DHEA in the frontal fibrosing alopecia.

Bioestimulación capilar con plasma rico en plaquetas contra la caída del cabello / Capillary biostimulation with platelets rich plasm against alopecia

Se describe el caso clínico de una paciente de 69 años de edad, quien acudió a la consulta de medicina regenerativa por presentar estrés mantenido y pérdida del cabello, para lo cual se decidió aplicar la bioestimulación con plasma rico en plaquetas lisado como terapia regenerativa, con plaquetas alogénicas en forma tópica, puesto que es un tratamiento inocuo y carente de complicaciones. Se obtuvo un incremento de los cabellos, espesamiento de la zona alopécica y la paciente recuperó su apariencia.

The case report of a 69 years patient is described who went to the regenerative medicine service for presenting maintained stress and loss of her hair, for which it was decided to evaluate biostimulation with platelets rich plasm as regenerative therapy for her, with topical allogeneic platelets, since it is an innocuous treatment with no complications. An increment and growing of the hair in the alopecic area was obtained and the patient recovered her look.

Evaluation of Body Dysmorphic Disorder in Hair Loss Patients and Benefit After Hair Transplant.

Introduction: Body dysmorphic disorder (BDD) is excessive concern about physical appearance leading to mental, social & functional distress. Patients seek cosmetic surgery not psychiatry & may remain dissatisfi ed after surgery. Study includes 100 hair transplant patients. Materials and Methods: From 1st Jan to 31st July 2013. Patient’s Personal Evaluation, Yale Brown Obsessive Scale, Sheehan Lifestyle Disability Scale & Derriford Appearance Scale were used for evaluation. Patients deformities were corrected with hair transplant and these patients were reassessed. Results: 10 months later to judge the benefi t. BDD prevalence in hair loss is 28%, which is higher than rhinoplasty 20.7%. Preoccupation of hair loss on the minds of the patients is much higher than perceived by their doctors. After hair transplant 52% patients considered their baldness has been corrected, 32% patients, had milder perception of their defect but 16% continue to feel that they have less hair than others. Conclusion: Th e study shows that hair loss patients who display BDD like concerns, can have signifi cant benefi t in personal life, social life and work performance after hair transplant. Study also shows that four diff erent psychiatry scales can be used for evaluation and follow up of BDD in hair loss patients.

Actualización del síndrome de ovario poliquístico y su importancia en dermatología / Update of polycystic ovary syndrome and its importance in dermatology

El Síndrome de Ovario Poliquístico es un trastorno endocrino común que afecta a mujeres en edad reproductiva que puede causar problemas metabólicos y deterioro psicosocial importante. Las manifestaciones dermatológicas más frecuentes del hiperandrogenismo incluyen acné, hirsutismo y alopecia, cuyo reconocimiento es esencial para hacer un diagnóstico precoz. Las modalidades de tratamiento incluyen terapia hormonal con el objetivo de modular la producción de andrógenos y su acción, así como tratamientos no hormonales dirigidos a condiciones dermatológicas específicas.

Polycystic ovarian syndrome is a common endocrine disorder that affects women of reproductive age, which can cause metabolic, reproductive and psychosocial impairment. The most common skin manifestations of hyperandrogenism are acne, hirsutism and alopecia, whose recognition is essential for early diagnosis. There are several treatment modalities, including hormonal therapy in order to modulate androgen production and their effects, as well as other non hormonal treatments targeted to specific dermatologic conditions.

Platelet-rich plasma in dermatology: Boon or a bane.

There has been a recent spurt in application of platelet-rich plasma (PRP) in dermatology and aesthetic medicine. However, the details regarding use of PRP in various dermatological indications ranging from hair restoration to chronic ulcers are dispersed in literature, herein we have tried to focus all under one heading. Overall, PRP seems to be a promising therapeutic modality but the level of evidence as of now, from the available published data is low. This review will also stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.

Alopecia rectangular transitoria post embolización de fístula carótido-cavernosa: reporte de caso y revisión de la literatura / Transient alopecia after embolization: case report and literature review

En la actualidad, los procedimientos de radiología intervencional intracraneanos son cada vez más frecuentes. Sin embargo, la exposición a altas dosis de radiación durante la fluoroscopía puede inducir a complicaciones cutáneas como la alopecia transitoria post embolización, forma peculiar de radiodermatitis que afecta a las regiones del cuero cabelludo que reciben dosis más altas de radiación durante el proceso de embolización. El cuadro clínico se caracteriza por alopecia completa, no cicatricial, en parches con bordes bien delimitados y formas peculiares(rectángulos, círculos superpuestos), generalmente de localización occipital o en región temporo-parietal. Ocurre en promedio 2 a 4 semanas después del procedimiento endovascular, con repoblación del área alopécica a partir de las 4 a 5 semanas. Es de buen pronóstico y no requiere tratamiento específico. Es importante conocer este cuadro para poder orientar adecuadamente a los pacientes y alertar respecto a la incidencia de efectos adversos de la radiación terapéutica.

In the present, the neuroradiological procedures are more frequent. However, exposure to radiation can conduce to dermatological complication as transient alopecia after embolization, rare form of radiodermatitis that affect the areas of the scalp that receive highest doses of radiation. The clinical presentation is characterized by a complete alopecia, without any signs of inflammation of the scalp, with sharply defined patches in rare forms (rectangular, overlapped circles), generally located on occipital or temporo-parietal region. This phenomenon starts after 2 or 4 weeks since endovascular procedure, with hair re-growth after 4 or 5 weeks. It has good prognosis and no specific treatment is required. It is important to recognize this condition, in order to give adequate information to patients and warn about the incidence of adverse effects of therapeutic radiation.

What’s new in cicatricial alopecia.

Scalp hairs complete the body self-image and patients with alopecia suffer from overt disfi guration, leading to psychosocial embarrassment and signifi cant lack of self-esteem. Hence an early diagnosis and an aggressive treatment in the case of active hair loss are crucial in the management of scarring alopecia. This review presents a comprehensive study of newer theories in aetiopathogenesis, evolving diagnostic modalities and a step ladder approach in management of primary cicatricial alopecia.

Polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

Alopecias / Alopecia

Desde los inicios de la humanidad el cabello ha tenido una importancia trascendental desde el punto de vista religioso, racial, sexual y ornamental. En los seres humanos el pelo es un vestigio evolutivo, a diferencia de otros seres vivos, que cumple funciones de protección y regulación de la temperatura. El número de pelos que se desprenden normalmente es de aproximadamente 100 por día y esta tasa aumenta al final del verano y principios de otoño, quizás debido a efectos de la mayor radiación solar y temperatura. La alopecia es la pérdida anormal del cabello, resultado de un proceso patológico. Las causas de alopecia son diversas y representan un desafío tanto para el médico como para el paciente. El objetivo de esta revisión es profundizar en la fisiopatología del cabello, las causas de alopecia y su tratamiento.

Hair has been always an important issue for humanity, from a religious, racial, sexual and ornamental point of view. In human beings hair is an evolution vestige. In other animals, hair serves to regulate body temperature and also has protective functions. Normally one hundred hairs fall in a day, and this rate increases by the end of summer and the first days of autumn, may be because of the more temperature end radiation. Alopecia is the abnormal loss of hair because of a pathologic process. The causes of alopecia are diverse, and they represent a challenge for the doctor and patient. The aim of this study is to deepen in the physiopathology of hair, causes of hair loss and their management.

Dermatosis del adolescente / Skin disease in teenagers

Durante la adolescencia se producen cambios importantes en la piel que son motivo de consulta frecuente al especialista. Estos son producidos por múltiples factores, dentro de los cuales están los hormonales, inmunológicos, psicológicos y los psicosociales. Las dermatosis más frecuentes son: el acné, en sus distintas formas clínicas, que afecta a más del 90 por ciento de los adolescentes en distintos grados de severidad; la dermatitis seborreica; las alopecias no cicatriciales; hiperhidrosis y dishidrosis. Además, este grupo etáreo está presentando con mayor frecuencia complicaciones cutáneas por realizar arte corporal (perforaciones, tatuajes, entre otros). Estas dermatosis deben ser conocidas por los médicos generales y especialistas, porque los adolescentes son una población muy vulnerable psicológicamente y muchas de estas enfermedades van en detrimento de su calidad de vida. Las enfermedades cutáneas infecciosas (virales, bacterianas y parasitarias) que también comprometen a los adolescentes se analizarán en el capítulo sobre Infecciones Cutáneas.

Adolescent skin undergoes significant changes that may lead to frequent specialized consultation. These changes can be due to a number of factors such as physiological, hormonal and psychosocial changes. The most common skin diseases are acne in its various clinical forms which is suffered by over 90 per cent of teenagers at different levels of severity, seborreic dermatitis, non scarring alopecia, hyperhydrosis and dishydrosis and the skin complications originated by Body Art (tattooing, piercing, scarring andbranding), that are on the increase in this age group. General practitioners and specialist should be aware ofthese skin conditions since teenagers are psychologically vulnerable and many of these diseases have a negative effect on their lives. The infectious skin diseases (viral, bacterial an parasitic) which also affect adolescent will be reviewed in the Chapter related to skin infections.

Tricotilomanía: abordaje diferenciado según la franja etaria en la infancia / Trichotillomania: differentiated approach depending on the age group in children

Introducción: La tricotilomanía se caracteriza por áreas de alopecia causadas por la tracción de cabellos realizada por el mismo paciente y es más frecuente en edades pediátricas. No obstante, existen pocos trabajos sobre esta enfermedad. Este estudio tiene como objetivo delinear las características clínicas y evolutivas de la tricotilomanía en un grupo de niños Resultados: Hubo 47 casos de tricotilomanía, de los cuales 32 (68%) fueron niñas. Se observó una mayor predisposición en el género femenino luego de los 5 años (mientras en las menores de 5 años el 56% estuvo afectada, en las mayores de 5 años el porcentaje se elevó al 76%). La edad media de inicio fue de 6 años, variando entre los 7 meses y los 11 años. La presencia de factores precedentes como cambios en la dinámica familiar, problemas psicológicos y enfermedades se determinó en 29 pacientes y fue más común en los niños mayores de 5 años. La región parieto-temporal fue la más afectada y las pestañas y cejas las menos comprometidas. En el 74% de los casos se inició tratamiento con placebo y se obtuvo una buena respuesta...

Introduction: Trichotillomania is characterised by alopecic areas caused by patients pulling out their hair. There are few works on this disease in the pediatric age group. The aim of this study is to delineate the clinical characteristics and evolution of trichotillomania in childhood.Results: There were 47 cases, 32 (68%) girls, with a higher difference between genders was observed over the age of 5 (of the group of under 5, 56% were while over this age they represented the 76%). Median age at onset was 6 years, ranging from 7 months to 11 years. Prior factors such as changes in family dynamics, psychological problems and diseases occurred in 29 patients, more current in the over 5 years old. The parieto-temporal region was the most affected and eyelashes and eyebrows the least removed. Placebo treatment was instituted in 74% with good response...

Alopecia de patrón femenino / Female pattern hair loss

La alopecia androgénetica femenina, o alopecia de patrón femenino, es una de las causas más frecuentes de caída de pelo. Su aparición origina importante estrés y problemas psicológicos; de ahí la importancia de un manejo adecuado. Hay casos que se asocian a hiperandrogenismo. En este trabajo revisamos las distintas formas clínicas, discutimos las pruebas de laboratorio más indicadas y los distintos tratamientos, entre ellos, la finasterida.

Female androgenetic alopecia or female pattern hair loss is one of the most frequent causes of hair loss. It can originate high stress and psychological problems, and a correct approach is therefore important. Certain cases are associated with hyperandrogenism. In this report we review the different clinical patterns, the most indicated laboratory tests and the different treatments, including finasteride.

Tratamiento de la alopecia androgenética / Treatment of androgenetic alopecia

La alopecia es un motivo de preocupación muy frecuente en hombres y mujeres. Desde hace muchos años se ha intentado encontrar, con escaso éxito, un tratamiento eficaz. Este artículo describe las causas y las formas de detectarlas a través del interrogatorio y el examen físico, para poder emplear con seguridad los mejores tratamientos disponibles para el tratamiento de la alopecia androgenética: minoxidil tópico y finasteride oral.

Alopecia is a frequent health concern that affects both men and women. A succestul treatment has been searched for manyyears.This article deals with causes that can be detected through questioning and physical examination in order to treat patientswith androgenetic alopecia in the best possible way: topic minoxidil and oral finasteride

Alopecia / Alopecia

Alopecia é a diminuição excessiva de pêlos no corpo com causas e padrões que variam. A alopecia é tanto um sinal quanto um sintoma de doença, interna, na maioria das vezes, ou externa, que se manifesta de diferentes maneiras e acomete diferentes tipos de pacientes, abrangendo todas as faixas etárias. Este artigo é uma revisão da literatura e dos últimos guidelines e tem como finalidade instruir o leitor sobre os aspectos clínicos e anatomopatólogicos das alopecias cicatriciais e não-cicatriciais. Além disso, os tipos de tratamentos vigentes para tais afecções são brevemente comentados. É um resumo de aspectos relevantes das alopecias mais prevalentes e sem pretensão de esgotar o assunto.