A New Method for the Follow-Up of Patients with Alopecia Areata.

Background: Teledermatology is the application of information and telecommunication technologies in the field of dermatology to provide remote care services based on the exchange of clinical information within a network of professionals or between professionals and patients. Tele-trichoscopy is a non-invasive, inexpensive, and easy-to-use method that applies the principle of surface microscopy at different magnifications. Alopecia areata is a non-scarring alopecia with a chronic evolution, which often needs a close follow-up. Objectives: The aim of our work was to analyze the possible benefits of telemedicine for the follow-up of patients with alopecia areata. Materials and Methods: We enrolled patients with alopecia areata, identified during the first trichological evaluation, and we divided the patients into two groups. One group was provided with the devices necessary for a telemedicine follow-up. The other group had a conventional follow-up. The total follow-up time was one year. All of the patients' photos were blindly evaluated by a team of expert dermatologists who were asked to indicate the quality of the images. The photos were also evaluated to identify disease markers. During the follow-up period, questionnaires were administered to both groups of patients to assess the quality of the visit, the level of patient satisfaction, and to identify any issues encountered by the patients. Results: There was a high degree of concordance between the images obtained by outpatient trichoscopy and those obtained by telemedicine. The satisfaction levels were the same between the patients followed via telemedicine and those seen in the outpatient clinic. Conclusions: Telemedicine applied to trichology using trichoscopy was proven to be a valid system for managing the follow-up of patients suffering from chronic recurrent scalp diseases and, above all, for maintaining continuity of care.

Recent Progress in Hair Science and Trichology.

Hair is important to our appearance as well as to protect our heads. Human hair mainly consists of proteins (80-85%), melanin pigments (0-5%), water (10-13%), and lipids (1-6%). The physicochemical properties of hair have been studied for over 100 years. However, they are not yet thoroughly understood. In this review, recent progress and the latest findings are summarized from the following three perspectives: structural characteristics, delivery and distribution of active ingredients, and hair as a template. The structural characteristics of hair have been mainly investigated by microscopic and/or spectroscopic techniques such as atomic force microscopy integrated with infrared spectroscopy (AFM-IR) and rheological measurements. The distribution of active ingredients has been generally evaluated through techniques such as nanoscale secondary ion mass spectrometry (NanoSIMS). And finally, attempts to explore the potential of hair to be used as a substrate for flexible device fabrication will be introduced.

An Academic Dermatology Center's Structured Platelet-rich Plasma Approach to Patients with Androgenetic Alopecia.

Androgenetic alopecia (AGA) is a prevalent cause of hair loss with complex pathophysiologic mechanisms that pose challenges for effective treatment. Despite various therapeutic approaches yielding only partial results, regenerative treatments, such as platelet-rich plasma (PRP), have gained popularity. However, the lack of standardized PRP practices, encompassing product preparation and application, has been a significant concern. This article aims to contribute to fill this gap by presenting a comprehensive overview of PRP practices at a large academic center. Through detailing our protocols, this work not only contributes to the understanding of AGA treatment but also emphasizes the crucial aspect of treatment standardization in the context of PRP therapy. By providing a practical representation of our institutional PRP practices, we aim to contribute to the ongoing discourse on refining and implementing standardized protocols, fostering reproducibility, and improving clinical outcomes in the management of AGA.

Androgenetic Alopecia in Children and Adolescents: From Trichoscopy to Therapy.

Introduction: Pediatric androgenetic alopecia is a product of hormonal and genetic factors. The diagnosis depends on recognizing the hair loss pattern in the context of a positive family history and a typical trichoscopy. Methods: A multicenter retrospective study assessing medical data from January 2008 to January 2023 of two reference centers - one public and one private in west Mexico. Patients under 18 years old were included. The clinical features, trichoscopic findings, associated conditions, and treatment received were documented and analyzed. Results: We found 145 patients, with a mean age of 16.08 ± 1.30 years, predominantly comprising males (72%). Trichoscopy was performed on 33 patients. The main trichoscopic findings were hair shaft thickness variability in 100% of the cases, vellus hair in 85%, and single-hair units in 79%. Vitamin D deficiency was found in 84% of the cases with laboratory determination, insulin resistance in 33%, and hyperandrogenemia in 12.5%. Topical minoxidil emerged as the main treatment modality in 24% of cases, demonstrating both efficacy and tolerability. Conclusion: Pediatric androgenetic alopecia could be more prevalent than commonly perceived, potentially explained by the lower level of suspicion among medical practitioners. Distinctive trichoscopic findings offer valuable guidance for therapeutic strategies and ongoing management.

Folliculitis decalvans managed with adalimumab: A case report.

Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia of the scalp that manifest with inflammation, pruritus, pustules, and tufted hair. Most dermatologist treat FD with topical or oral antibiotics. We recommend considering treatment with biologics to preserve and stabilize the ongoing inflammatory process in moderate to severe FD.

Plica Neuropathica as a Presenting Rare Dermatologic Symptom of Schizophrenia.

Plica neuropathica (PN), also known as plica polonica, trichoma, matting, felting, or bird's nest hair, is a common but rarely reported hair disorder. It is characterized by the abrupt onset of irreversible hair entanglement, forming a densely matted hair mass. PN has been associated with the use of ionic or herbal shampoos, vigorous hair care practice, self-neglect, systemic infection, parasitic infestation, immunosuppressive drugs, and psychiatric conditions. However, literature supporting the coexistence of PN in psychiatric disorders is scarce. PN may be one of the presenting symptoms observed by physicians. In some cases of psychiatric illness, patients consult more readily with non-mental health professionals than psychologists or psychiatrists. To highlight this issue, we herein report a case of PN in a 32-year-old woman with a 1-month history of being unable to detangle her hair. The patient initially visited the dermatology department and was subsequently diagnosed with schizophrenia following psychiatric consultation. After establishing the fundamental diagnosis apparently underlying the PN, psychiatric treatment with antipsychotic medication and dermatological treatment of the hair condition were instituted. There was an improvement in both at the four-week follow-up. This case history highlights a rare presentation of schizophrenia.

Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases.

(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

Actualización en tricoscopia / Trichoscopy: An Update

La tricoscopia es una técnica sencilla y no invasiva que se puede realizar durante la consulta con un dermatoscopio manual o digital. Esta herramienta ha ganado popularidad en los últimos años, ya que la visualización e identificación de estructuras y signos característicos puede ser la clave en el diagnóstico de alopecias y enfermedades del cuero cabelludo. El enfoque de esta revisión es el estudio y actualización de los hallazgos tricoscópicos en las alopecias más frecuentes en la práctica clínica habitual. Así pues, existen algunas alopecias como la alopecia areata, la tricotilomanía o la alopecia frontal fibrosante en las que los hallazgos con la tricoscopia resultan clave para su diagnóstico y seguimiento. El reconocimiento de estas estructuras distintivas puede ser de gran ayuda y, por ello, como dermatólogos debemos estar familiarizados con las mismas (AU)

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia (AU)

[Translated article] Trichoscopy: An Update / Actualización en tricoscopia

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia (AU)

La tricoscopia es una técnica sencilla y no invasiva que se puede realizar durante la consulta con un dermatoscopio manual o digital. Esta herramienta ha ganado popularidad en los últimos años, ya que la visualización y la identificación de estructuras y de signos característicos puede ser la clave en el diagnóstico de alopecias y enfermedades del cuero cabelludo. El enfoque de esta revisión es el estudio y la actualización de los hallazgos tricoscópicos en las alopecias más frecuentes en la práctica clínica habitual. Así pues, existen algunas alopecias, como la alopecia areata, la tricotilomanía o la alopecia frontal fibrosante, en las que los hallazgos con la tricoscopia resultan clave para su diagnóstico y su seguimiento. El reconocimiento de estas estructuras distintivas puede ser de gran ayuda y, por ello, como dermatólogos debemos estar familiarizados con ellas (AU)

Trichoscopy: An Update. / Actualización en tricoscopia.

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.

A Comment on Mercantilism in the Trichological Sciences.

A quasi-scientific interest in hair loss and hair care originated in a London barbershop, and became known as trichology, with the Institute of Trichologists being founded. Other corporations successively followed, offering paid courses by home-study for training of initiates who desire more knowledge about hair. Trichologists are not medically qualified but are taught the practice of care and treatment of the hair and scalp in health and disease within their restricted but specialized role. With the advent of opportunities in the social media, and of epiluminiscence microscopy, a procedure practiced by the guild of trichologists long before its nominal introduction as trichoscopy into dermatologic practice, representatives of the medical profession are following the example of the trichologists in offering online courses, though with a better understanding of clinical-pathological correlations based on their academic learning. Despite the enthusiasm emerging with its establishment as a dermatologic tool in the diagnosis of hair and scalp disorders, caution is warranted not to elevate trichoscopy to something like a fetish status. As a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a comprehensive dermatological examination. The Hippocratic Oath is one of the oldest binding documents in history, allegedly still held sacred by physicians: to treat the ill to the best of one's ability, to preserve a patient's privacy, and to teach the secrets of medicine to the next generation without fee. And yet, as in no other field of medicine, paid online courses on trichoscopy are flourishing and with a primary commercial aim. However, dermato-trichology, or trichiatry require the same due diligence as any other medical discipline, with respect to its practice and its ethics. Medical artistry is neither reducible to a single hand-held diagnostic technique nor is it negotiable.

The Problem with Capitalism in the Trichological Sciences.

Karl Marx and Friedrich Engels exposed a pattern of societal conduct they chose to name capitalistic bourgeoisie. The bourgeoisie created a common language of communication through collaboration, gathered in circles such as free academies, scientific academies, literary circles, and the media, that provided forums for the emerging bourgeoisie to conceive of new social orders. One aspect of bourgeoisie culture is conspicuous consumption, central to which, is a culture of prestige through material consumption. Capitalism is an economic system based on private ownership and the operation for profit. Characteristic features of capitalism include competitive market, commercialism, property rights recognition, capital accumulation, material consumption, culture of prestige, sycophancy, and coterie. Critiques of capitalism allege that it is exploitative, alienating, unstable, unsustainable, and inefficient. In turn, critical theory inspired philosophers such as Michel Foucault to conceptualize how we form identities through social interaction. When the patient's body entered the field of medicine, it also entered the field of power where the patient can be manipulated by professional authority. Without forcibly being a proponent of political theory, as an academic, one is inevitably confronted with Marxism in terms of philosophy. As a discipline at the interface of medicine, lifestyle, and cosmetics, trichology is particularly susceptible to the primary aims of profit, consumption, and prestige that characterize the capitalistic bourgeoisie. The trichological sciences, particularly trichoscopy, have discovered a profitable market for itself. The practice of trichology is not immune to malpractice. It has created an industry that dwells on the autistic thinking of patients and doctors, and because it is prosperous, makes propaganda among lay people and doctors that necessarily leads to abuses.

Patient Satisfaction and Clinical Effects of Platelet-Rich Plasma on Pattern Hair Loss in Male and Female Patients.

Introduction Hair loss is a widespread condition in both genders. Over the past decade, platelet-rich plasma (PRP) has become a common treatment for hair loss. Our goal was to analyze patient satisfaction and the clinical effects of PRP on male and female pattern hair loss. Methods Over a period of 12 months, we treated a total of 56 patients for androgenetic alopecia with PRP. All of these patients were included in this study; 15 cc of whole blood was spun in an ACP double syringe (Arthrex Inc., Naples, Forida) for five minutes. The yielded 5 to 6 cc of PRP were then injected into the scalp. Forty-nine patients were treated with a series of three injections at monthly intervals, three patients with a series of four injections, two patients with a series of five injections, one patient was treated with a series of seven injections, and one patient with a series of eight injections. Follow-ups were conducted one month after the last treatment. A self-drawn questionnaire was used to assess the satisfaction and clinical results from the patient's and the clinician's perspectives. Results The average age was 41 years (20-68 years). Fifty-seven percent of all patients were male and 43% female. In total, the patients were satisfied with the treatment results. The average score was 7.29 on a scale from 0 to 10. The clinician's rating was similar (6.46). Moreover, with an average score of 8 on a scale from 0 to 10, it is very likely that the patients will recommend PRP treatments to friends. The probability of occurrence of clinical effects among the entire study population was reported as follows: improvement in hair density (patient's rating: 64%; clinician's rating: 46%), thickness (38%; 45%), quality (46%; 54%), sheen/lustre (27%; 21%), new hair growth (57%; 68%), less hair loss (48%; 20%), other positive effects (5%, 2%), no effects (4%; 4%), negative effects (0%; 0%). Conclusion Our study revealed encouraging results for the treatment of male and female pattern hair loss with PRP. The autologous treatment was rated with high satisfaction scores and can be considered a safe and effective treatment modality.

[Platelet-rich plasma (PRP) for the treatment of androgenetic alopecia (AGA): a review of the current literature]. / Plättchenreiches Plasma (PRP) zur Behandlung der androgenetischen Alopezie (AGA): ein aktueller Literaturüberblick.

BACKGROUND: Platelet rich plasma (PRP) injections have been reported to be an effective and low side effect treatment for androgenetic alopecia (AGA). However, robust data concerning this therapy are lacking. AIM: We address some potentially critical aspects of PRP treatment and give some reasons why study results may differ. MATERIALS AND METHODS: In the following review we give a brief overview of the current literature and compare the results of the various trials. RESULTS: In recent years, several clinical trials have been published that have revealed different but rather positive results, which offers hope to those affected by AGA and to physicians as well. However, the results were observed in methodologically weak trials and data from randomized controlled trials are lacking. Differences in trial designs have made it difficult to draw concrete conclusions about its clinical efficacy. Even in the studies where no hair-growth-promoting effect could be observed, the majority of subjects were at least satisfied with the result. The combination of several treatment approaches seems to lead to optimal improvement in hair growth. CONCLUSION: There are many factors that could have influenced the results of the different studies. The results were observed in methodologically weak studies, giving reason for caution when drawing conclusions. Nevertheless, the majority of the subjects were at least satisfied with the result. Given the current low level of evidence, PRP treatments need to be further investigated in larger studies.

Recommendations on trichological treatments during COVID-19 pandemic.

COVID-19 is an infectious disease caused by the novel coronavirus SARS-CoV-2, which rapidly spreads via respiratory droplets and is the cause of the current pandemic. In this alarming situation, it is a delicate matter how to visit patients safely and how to manage their chronic treatments. The aim of this paper is to examine in detail the potential impact on SARS-CoV-2 infection of treatments routinely used in trichology and to provide a useful guide for the therapeutic management of trichological patients in this new COVID-19 era.

Straight to the Point: What Do We Know So Far on Hair Straightening?

BACKGROUND: Hair represents a valued aspect of human individuality. The possibility of having an easy to handle hairstyle and changing it from time to time promoted an increasing search for chemical hair transformations, including hair straightening. Hair straightening is the process used to convert curly into straight hair. AIMS: This review aims to discuss hair straightening, addressing techniques, products, methods of application, consequences to hair shafts, recommendations on this topic, and the risks involving the safety of both the user and the performing professional. METHODS AND RESULTS: The terms "straightening" AND "hair," "straightening" AND "alopecia," and "straightening" AND "human hair" were used to perform a literature search in MEDLINE through PubMed until July 15, 2020. We limited the search to articles available in English, considering those mentioning alternatives to straighten the hair. We had a total of 33 relevant articles. CONCLUSIONS: This article will help dermatologists to advise their patients, providing a more suitable orientation on how to get the best outcome without risking one's safety.