Acute telogen effluvium triad after resolution

Abstract Five cases of telogen effluvium undergoing resolution are shown, with the presence of frontal, bitemporal, and occipital hair regrowth. Diagnosing acute telogen effluvium after the end of the active phase can be challenging, especially when the pull test is negative. The differential diagnosis includes alopecia areata and traction alopecia. Clinical signs of hair regrowth after telogen effluvium can help in the diagnosis. The frontal and temporal areas have more telogen hairs and are more affected. On the occipital area, hairs seem to have the same behavior. The acute telogen effluvium triad during resolution is proposed: frontal fringe, temporal recess and occipital fringe.

Alopecia areata y vitamina D sérica en pacientes iraquíes: un estudio de casos y controles / Alopecia Areata And Serum Vitamin D in Iraqi Patients: a case-control study

Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.

Terapias tradicional y natural combinadas en pacientes con alopecia areata / Combined traditional and natural therapies in patients with alopecia areata

Se realizó un estudio de intervención terapéutica en 30 pacientes con diagnóstico clínico de alopecia areata en forma de placas, atendidos en la consulta de Dermatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde junio del 2014 hasta igual mes del 2015, con vistas a determinar la efectividad de la terapia tradicional china y la natural combinadas (esencias florales de Bach por modelo transpersonal, acupuntura con martillo de 7 puntas y masaje local con el rizoma del jengibre), para lo cual se conformó un grupo de estudio que la recibió y otro de control que fue tratado con crema esteroidea (triamcinolona a 0,1 por ciento). Los pacientes, cuya mayoría comprendía las edades de 25 a 34 años y era del sexo masculino, fueron evaluados al inicio, y luego a la cuarta, la octava y duodécima semanas. La terapia tradicional y la natural combinadas en pacientes con alopecia areata presentó una mejor respuesta y no existieron efectos secundarios, lo que demostró su efectividad al respecto

A study of therapeutic intervention in 30 patients with diagnosis of patchy alopecia areata, assisted in the Dermatology service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from June, 2014 to the same month in 2015, aimed at determining the effectiveness of the combined Chinese traditional therapy and the natural one (Bach flowers remedies for transpersonal pattern, acupuncture with hammer of 7 tips and local massage with ginger rhizome), for which a study group was formed which received it and another control group which was treated with steroid cream (triamcinolone 0,1 percent). Patients from the age group 25 - 34 years and male sex, were evaluated at the beginning, and then at fourth, eighth and twelfth weeks. The combined traditional and natural therapies in patients with alopecia areata provided a better response and there were no secondary effects, what demonstrated its effectiveness on this respect

Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata

ABSTRACT Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm.

Use of dermoscopy in the diagnosis of temporal triangular alopecia

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.

Alopecia areata y enfermedades asociadas: nuestra experiencia sobre 265 casos / Alopecia areata and associated diseases: our experience of 265 cases

La alopecia areata (AA) es una enfermedad inflamatoria crónica, de etiología multifactorial, que afecta el folículo piloso y, algunas veces, las uñas. Se caracteriza por áreas alopécicas no cicatrízales, asintomáticas, que pueden comprometer cuero cabelludo, cejas, pestañas, barba y pelos del resto del cuerpo. El objetivo de este trabajo es evaluar las enfermedades asociadas en pacientes con diagnóstico clínico de AA del Servicio de Dermatología del Hospital Centenario de Rosario, Argentina, durante el período comprendido entre el 01/01/1995 al 01/01/2013. La evolución de la AA es impredecible y en este estudio se observó que los procesos autoinmunes y los estados atópicos, fueron las patologías más frecuentemente asociadas.

Alopecia areata (AA) is a chronic inflammatory disease because multiple etiological factors affecting hair follicle and sometimes the nails. It is characterized by non-scarring alopecic areas, which can compromise scalp, eyebrows, eyelashes, beard and hair from any part of the body. The aim of this study is to evaluate associated diseases in patients with AA clinical diagnosis from the Dermatology Department at the Hospital Centenario, Rosario Argentina, during the period between January 1st, 1995 and January 1st, 2013. Evolution of AA is unpredictable, and this study suggests that autoimmune processes and atopic states are the most frequently associated pathologies.

Case for diagnosis

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.

Anagen effluvium.

Disturbances of hair follicle cycling lie at the heart of most hair growth disorders, and have dramatic effects on visible hair growth and shedding. The two common disorders due to aberration in hair follicle cycling are telogen and anagen effluvium. Though a lot of literature addresses the problem of telogen effluvium, there are not many reviews on anagen effluvium or anagen hair loss. Anagen effluvium is considered synonymous with chemotherapy-induced alopecia and other causes are rarely considered. In this review, we try to discuss the etiopathogenesis, clinical presentation, differentials, and management issues in anagen effluvium. Anagen effluvium is the abrupt loss of hairs that are in their growing phase (anagen) due to an event that impairs the mitotic or metabolic activity of hair follicle. Chemotherapy, radiation and toxic chemicals, and sometimes inflammatory diseases like alopecia areata and pemphigus are also capable of diminishing the metabolic activity of hair follicles resulting in anagen hair loss. Although it is reversible, and hair regrowth occurs after a delay of 1-3 months; sometimes it can lead to permanent alopecia and can be psychologically devastating with negative impact on individual perceptions of appearance, body image, sexuality, and self-esteem. For some patients, the emotional trauma may be so severe that it may lead to discontinuing or refusing therapy that might otherwise be beneficial. In such cases, a psychosomatic approach as well as empathic consideration of the patients concerns and fears as well as the provision of practical medical-aesthetic and styling tips are equally important and can be integrated in management.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.

Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part II / Desafio clínico e histológico no diagnóstico diferencial de alopecia difusa: alopecia androgenética, eflúvio telógeno e alopecia areata - parte II

Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (femalepattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alopecia.

A alopecia difusa tem como principais causas eflúvio telógeno, alopecia androgenética difusa (alopecia androgenética de padrão feminino) e alopecia areata difusa. Em muitas ocasiões o diagnóstico diferencial entre as três entidades é difícil. Na segunda parte deste artigo se discute em mais detalhes as características clínicas, dermatoscópicas e histológicas do eflúvio telógeno crônico e da alopecia areata difusa. Uma maneira prática e objetiva de abordagem diagnóstica da alopecia difusa é apresentada através de um fluxograma.

Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence ( or = 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.

Value of transverse section scalp biopsy in alopecia areata - a clinicopathological correlation

To correlate the histopathological features of alopecia areata with clinical stage by means of transverse sectioned scalp biopsy specimens, in terms of extent and duration of disease. Cross-sectional. Department of Dermatology, Combined Military Hospital, Kharian Cantonment, Pakistan, from January 2002 to December 2004. Fifty consecutive patients with alopecia areata were included in the study Four millimeter punch biopsy was taken and representative horizontal sections from lower and upper dermis were examined. Patients were divided according to disease extent i.e. Group I [<25% of scalp surface area], Group II [25 - 75% of scalp surface area] and Group III [>75% of scalp surface area including alopecia totalis and universalis]. Patients were also analyzed according to the disease duration, i.e. 0-6 months, > 6-12 months, > 1-5 years and > 5 years. Follicular unit counts and density/ mm[2], terminal to vellus hair ratio, anagen to telogen ratio, cellular infiltrate and fibrosis were measured to assess the diagnosis and prognosis of disease. Chi-square test was used to assess statistical significance. Diagnosis of alopecia areata could be made in 82% of biopsies. Follicular unit counts and density per mm[2] decreased with the disease duration [p=0.01]. Catagen and telogen hair follicle counts increased with disease duration [p=0.0001]. Cellular infiltrate decreased and fibrosis increased with the duration of disease [p=0.0001]. Anagen telogen ratio and terminal to vellus hair ratio inverted in long-standing disease. Transverse section scalp biopsy can help in the diagnosis of alopecia areata and the disease stage can be predicted by analyzing the histopathological findings quantitatively

Dermatofibrosarcoma protuberans in a patient with alopecia areata univerisalis

Dermatofibrosarcoma protuberans [DFSP] is an uncommon locally infiltrative, low grade soft tissue sarcoma. Alopecia areata universalis is a severe form of non-scarring alopecia involving the whole body. We are reporting a rare case where both of these occured in the same patient

Actualizaciones en alopecia areata / Alopecia areata updates

La alopecia areata es una enfermedad dermatológica caracterizada por áreas o parches de alopecia con bordes netos en cuero cabelludo (principalmente) y resto del cuerpo. Es no cicatricial y tiene un curso impredecible, incluso la involución espontánea. Corresponde al 2 por ciento de las consultas dermatológicas. Puede asociarse a alteraciones autoinmunes como la tiroiditis de Hashimoto, vitíligo y atopia. Hasta una 20 por ciento de los pacientes tienen antecedentes familiares de la enfermedad. Actualmente puede tratarse con corticoides intralesionales, inmunoterapia tópica o sistémica, antralina, minoxidil y fotoquimioterapia. El tratamiento y la evolución dependen principalmente de dos factores: extensión y la edad de los pacientes.

Analise de aspectos afetivo-familiares de mulheres portadoras de alopecia areata / Analysis of affective-familial aspects of women with alopecia areata

O objetivo deste trabalho é levantar e analisar os fragmentos da historia de vida de mulheres portadoras de alopecia areata, em relacao as experiencias afetivas, com enfase em aspectos da relacao parental e conjugal. Entrevistamos, individualmente, cinco mulheres adultas, encaminhadas pelo Ambulatorio de Tricoses (dermatoses do cabelo). Elas preenchem o requisito de terem experienciado relacionamentos conjugais, pelo menos em algum periodo da vida, sejam elas casadas, viuvas, divorciadas ou amasiadas. Utiliamos a analise interpretativa e qualitativa ao identificar caracteristicas unicas e singulares. Aborsdamos as entrevistas, enquanto pessoas distintas uma das outras, e, em alguns momentos, destacamos aspectos que se conjugam quanto ao conteudo dos depoimentos. Constatamos que, no decorrer das historias de vida, as experiencias afetivas sao revividas intensamente, com sentimentos de abandono, rejeicao e carencia afetiva, embora perpetuem-se na fase adulta e se atualizem no convivio conjugal. A aderencia anormal ao passado impede a exteriorizacao de afetos nos relacionamentos conflitivos atuais que sao apenas descrits e pouco vivenciados por elas. Verificamos que a queda de cabelos desenvolve-se com expressao, mediante representacoes afetivas que essasmulheres estabelecem e mantem com os pais e marido, vistos como principais figuras de apego. A doenca manifesta-se em meio as condicoes de esvaziamento da plenitude afetiva, como expressao do afeto reprimido por ocasiao de acontecimentos traumaticos, acompanhada de outras desorganizacoes somaticas. Nossas entrevistas apresentam sentimentos auto-depreciativos, inseguranca, empobrecimento nas trocas interpessoais e dificuldade de interiorizar os sentimentos afetivos de maneira nao traumatica. Alem de reviver psiquicamente as experiencias de afeto e as circunstancias de maneira insatisfatoria, estabelecem uma relacao causal entre os eventos do passado e do presente. Atribuem suas insatisfacoes afetivas e prejuizos...

Alopecía areata nevocéntrica / Nevocentric areata alopecy

Se presentan dos casos de alopecia areata de cuero cabelludo, cuya lesión se desarrolla alrededor de un nuevo melanocítico y que, luego de la extirpación de los nevus involucrados, se produjo un rápido recrecimiento de los pelos en el área afectada. Se revisan otras reacciones nevocéntricas o perinévicas.

Alopecia areata: hallasgos histopatológicos / Alopecia areata: histopatologics found

La alopecia areata es un proceso inflamatorio que puede provocar una permanente perdida de cabello como concecuencia de fibrosis cicatrizal focal. En todas las etapas del mismo existen claves disponibles para su diagnóstico. En su comienzo se aprecian densos infiltrados linfocitarios alrededor de bulbos papilas pilosas; más tarde existen folículos terminales en catagen situados al mismo nivel de la dermis y finalmenmte, se aprecian masas de tejido fibroso que representan papilas foliculares antiguas.