Reconstruction of Scalp Anterior Hairline with Tissue Expansion and Skin Flap.

Introduction: Cutaneous defects involving the frontal region and anterior hairline of the scalp can result from congenital or acquired conditions. The negative esthetic impact can cause disturbances in the psychic and social sphere of the patient, causing problems in interpersonal relationships and in the body image itself. The use of skin expanders is usually effective in this region due to the bone base providing support and stability for its use. Case Report: We describe the case of a 64-year-old woman submitted to reconstruction of the anterior hairline of the scalp due to scar sequelae after coronal rhytidoplasty followed by pustular erosive dermatosis. We used tissue expansion (50 mL of saline per week until it reached 300 mL) and advancement flap. Discussion/Conclusion: Scalp reconstruction also includes vascularized soft tissue coverage, acceptable cosmetic appearance, and minimal morbidity for the donor area. The correction of scalp scars must obey 2 basic principles: tissue similarity and natural capillary pattern (direction, angle, capillary growth, and proper capillary line design). Tissue expansion and skin flap techniques can successfully correct defects in extensive scarring alopecia such as in the presented case.

Treatment of Male-Pattern Alopecia with Platelet-Rich Plasma.

BACKGROUND: Androgenetic alopecia (AGA) affects up to 80% of men and 50% of women throughout their lifetime, causing significant discomfort. Minoxidil, finasteride, and low-level laser light therapy are the only Food and Drug Administration-approved treatments for AGA, and they have shown positive results in randomized controlled trials and meta-analyses. However, their efficacy is limited, and new therapies are needed. Injection of platelet-rich plasma (PRP), a minimally invasive technique, has been described by several authors as a promising treatment for AGA. Although many studies report beneficial effects of PRP on AGA, there is no standardized practice for PRP preparation and administration or a standard method to evaluate results. OBJECTIVE: The aim of this study was to evaluate the efficacy of manually prepared PRP in the treatment of male AGA. MATERIALS AND METHODS: We treated 20 male patients with AGA with 3 monthly injections of PRP and analyzed results by TrichoScan®. RESULTS: In this study, there was no statistically significant improvement in hair count or proportion of anagen hairs. CONCLUSIONS: This lack of response could be related to any of the variables during PRP preparation described above and also to the limited number of patients in the study.

The Use of Direct Immunofluorescence in Frontal Fibrosing Alopecia.

BACKGROUND: Frontal fibrosing alopecia (FFA) differs from lichen planopilaris (LPP) in many clinical aspects, but histology fails to distinguish between these entities. Direct immunofluorescence (DIF) is a diagnostic technique used for autoimmune diseases, including those affecting skin and hair. OBJECTIVE: To characterize DIF patterns in patients with FFA. METHOD: Data was collected retrospectively from FFA cases presenting to the Centre de Santé Sabouraud Hair Clinic in Paris from November 2013 to November 2014. RESULTS: Of 149 patients with FFA, 44 cases underwent DIF. Thirteen cases showed positive results with DIF. Patterns characteristic of LPP and lupus erythematosus were observed, with nearly half showing nonspecific staining. CONCLUSION: DIF patterns in patients with FFA were variable. This diagnostic technique should be used with caution in cases of cicatricial alopecia, particularly FFA.

An Overlap of Secondary Cutis Verticis Gyrata, Folliculitis Decalvans, Folliculitis Keloidalis Nuchae and the Use of Dreadlocks: The Role of Inflammation due to Traction.

We report a 29-year-old black male with cutis verticis gyrata, folliculitis decalvans and folliculitis keloidalis nuchae confirmed by biopsy. He had been using dreadlocks for 5 years before the appearance of the lesions. An activation of the different fibroblast growth factor members may explain the development of hyperproliferation of collagen, fibrosis and keloid lesions. We suggest a hypothesis of a common pathogenesis for the three conditions in a genetically predisposed patient. Inflammation and traction caused by the dreadlocks can act as a possible trigger factor.

Concentric Polycyclic Regrowth Pattern in Alopecia Areata.

Alopecia areata (AA) is a common form of autoimmune nonscarring hair loss of scalp and/or body. Atypical hair regrowth in AA is considered a rare phenomenon. It includes atypical pattern of hair growth (sudden graying, perinevoid alopecia, Renbok phenomenon, castling phenomenon, and concentric or targetoid regrowth) and atypical dark color hair regrowth. We report a case of AA that resulted in a concentric targetoid hair regrowth and discuss the possible related theories regarding the significance of this phenomenon.

Pili Annulati and Trichorrhexis Nodosa in the Same Patient: Cause or Coincidence?

PURPOSE: To determine the relationship between pili annulati (PA) and acquired trichorrhexis nodosa (TN) seen in the same patient, considering the two main theories evoked by previous studies: greater stiffness of darker PA bands or associated cuticular damage. PROCEDURES: Light microscopy of hair shafts from different regions of the patient's scalp. RESULTS: TN was not superimposed to dark bands of PA. CONCLUSIONS: Greater stiffness of darker PA bands was excluded as the cause of hair breakage. Hair breakage in PA patients might be related to cuticular abnormalities, as previously reported. Because weathering of long thin chemically treated hairs is extremely common, coincidence cannot be completely ruled out in this case.