Utility of trichoscopy to diagnose early female pattern hair loss in resource-poor setting: A cross-sectional study

Background: Trichoscopy is a reliable instrument for diagnosis and for tracking therapy-related changes in female pattern hair loss (FPHL). Videodermoscopic diagnosis of FPHL has been established, which requires fine measurements of hair-related parameters; the method requires an expensive equipment/digital program. Aim: To determine whether a low-cost, simple USB dermoscope can ascertain the hair-related changes in early FPHL. Methods: An age-matched, cross-sectional study was performed over 3 years on subjects with less than 6-month history of hair loss and without an obvious broadening of midline hair parting. Trichoscopic analysis of the frontal and occipital scalp of the study subjects were performed, using a USB-connected dermoscope. The subjects were analyzed for the presence of microscopic hair changes in the form of anisotrichosis, vellus-like hair, single hair follicle unit, peri-pilar sign and yellow dots. Results: A total of 230 cases and 230 controls were analyzed. The dermoscopic hair changes were found to be significantly associated with the frontal scalp zone of cases. Limitations: Histopathological evaluation of the cases was not done. Conclusion: Microscopic changes recorded with the help of a simple USB dermoscope are helpful in establishing a diagnosis of FPHL even in early disease.

Subungual hyperkeratosis nail biopsy: A better diagnostic tool for onychomycosis.

Background: Onychomycosis is one of the most common nail disorders. Mycological examination by potassium hydroxide (KOH) mount and fungal culture is the most commonly used diagnostic method. However, it is associated with a low sensitivity. Aims: To evaluate the technique of subungual hyperkeratosis nail biopsy in diagnosing onychomycosis in HIV-infected and immunocompetent adults and compare it with mycological examination. Methods: 34 HIV-positive patients who presented clinically with onychomycosis were recruited in the study from the beginning. There was no screening done for patients with onychomycosis. This has been clarified in manuscript under the heading of methods. Results: All the fungal cultures yielded dermatophytes correlating with the biopsy findings. Only hyphal form of fungus was detected in KOH examination, indicating it was not a contaminant. Clinical types of onychomycosis are stated in discussion. Conclusions: PAS stain of subungual hyperkeratosis nail biopsy was the most sensitive in the diagnosis of onychomycosis in both HIV-infected and non-infected groups.