Sonographic comparison of subcutaneous fat layer thickness in the scalp area in patients with androgenetic alopecia compared to healthy individuals: Cross-sectional.

INTRODUCTION: Androgenetic alopecia (AGA) is one of the most common alopecia among men and women worldwide. It is a nonscarring alopecia that has a characterized pattern. In female pattern AGA, the hairline is stable but general thinning occurs most notably in the frontal region. In male-pattern AGA, the hairline is receding and the thinning is most notable in the frontotemporal region. AGA has a complex pathogenesis and relation of subcutaneous fat in the scalp region and the miniaturization of terminal hair follicles is vague. In this study, subcutaneous fat in the frontal scalp an important region for AGA is compared to the occipital scalp that is spared in AGA. METHOD: Our study is a cross-sectional study that has four groups. Male patient, female patient, male control, female control. Every group has 15 individuals. All of the people in the study are those referred to Rasoul Akram's dermatology clinic. The severity of alopecia is classified by Norwood scaling for male pattern AGA and Ludwig scaling for female pattern AGA. Subcutaneous tissue in the frontal and occipital regions is measured by ultrasonography. For evaluating the effect of aging on subcutaneous fat thickness, we subdivided any group into more than 40 years old and between 20 and 40 years old and compared these two subgroups. RESULTS: The mean age of the three groups of male patient, female patient, and female control is 40 y/o and the mean age of male control is 41 y/o. The mean subcutaneous fat layer thickness in frontal region in male patients group is 6.0 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.5 mm), in female patients group 5.1 mm (more than 40 y/o = 5.7 mm, between 20 and 40 y/o = 4.6 mm), in the male control group is 4.4 mm (more than 40 y/o = 4.7 mm, between 20 and 40 y/o = 4 mm) and in the female control group is 4.1 mm (more than 40 y/o = 4.5 mm, between 20 and 40 y/o = 3.6 mm). The mean subcutaneous fat layer thickness in the occipital region in the male patient's group is 6.4 mm (more than 40 y/o = 6.7 mm, between 20 and 40 y/o = 6 mm), in the female patient's group 6.1 mm (more than 40 y/o = 6.5 mm, between 20 and 40 y/o = 5.7 mm), in the male control group is 6.3 mm (more than 40 y/o = 6.8 mm, between 20 and 40 y/o = 5.7 mm) and in the female control group is 6.2 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.8 mm). CONCLUSION: This study demonstrates that the subcutaneous fat layer in the frontal region in both males and females is thicker in AGA patients than healthy group and the more severe the AGA, the thicker is subcutaneous layer in the frontal region. In the male patients group, the subcutaneous fat layer in the frontal region is thicker than in the female patients group but in the male and female control groups is not so different. The subcutaneous fat layer in the occipital region is thicker in older individuals in both patients and control groups but is not different when compared to AGA patients and control individuals.

Scalp Closure in Midline Cutis Aplasia-An Absolute Indication for Preoperative Imaging.

The ideal evaluation and treatment of aplasia cutis congenita remains disputed. We present a case of midline scalp cutis aplasia that healed by secondary intention, leaving an area of residual alopecia. There were no clinical indicators of an underlying calvarial defect. Tissue expansion of the scalp was done in preparation for scalp closure. However, on the removal of the expanders and scalp advancement, an unrecognized midline calvarial defect in which a scar tract of herniated dura was found. This resulted in a dural tear, repaired with minimal hemorrhage. However, manipulation of the sagittal sinus resulted in a right subdural hemorrhage followed by cerebral ischemia and a stroke. On the basis of this clinical scenario, we recommend that all cases of midline scalp cutis aplasia undergo preoperative imaging with thin slices of the calvaria before performing scalp advancement-even if the only clinical indication for surgery is scalp alopecia without a palpable skull defect.

Assessment of efficacy of different botulinum toxin A concentrations in the treatment of androgenetic alopecia assessed by dermoscopy.

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of progressive hair loss in men and women. AGA is characterized by the miniaturization of the hair follicle, leading to the transformation of terminal hair to vellus hair. OBJECTIVE: To evaluate the efficacy and safety of injecting two different concentrations of botulinum toxin A (BTA) for the treatment of AGA in Egyptian patients. METHODS: Adult male (Hamilton-Norwood I-VII) and female (Ludwig I-III) patients (N = 32) were assigned to receive two different concentrations BTA (33.3 and 25 U/mL) on each side of the scalp; in total, there were 15 injections administered on each side, with injection volume of 0.1 mL containing 3.3 U for the right half and 2.5 U for the left half. Treatment efficiency was assessed at baseline, Month 3 and Month 6, by degree of clinical improvement and dermoscopy assessment. RESULTS: By Month 6, proportion of male patients (N = 5) classified as Hamilton-Norwood Grade II increased from 0% to 60% (3/5), proportion of female patients (N = 27) classified as Ludwig Grade I also increased from 14.8% (4/27) to 70% (19/27). Dermoscopy result showed a significant increase in vellus hair density from baseline to Month 6 on the right side (33.3 U/mL), while no change was observed on the left (25 U/mL); however, vellus hair density was higher at Month 3 compared to Month 6. There were changes in yellow spots and peripilar sign more on the right side. Adverse reactions reported include irritation, headache, injections site pain, and nausea. CONCLUSION: The results of the present study showed that BTA is a safe and effective treatment for AGA in both genders. These findings offer a cutting-edge conceptual structure and therapeutic strategy for the management of AGA in Egyptian population.

Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues.

BACKGROUND: Alopecia areata (AA), trichotillomania (TM), nevus sebaceous (NS), and linear scleroderma en coup de sabre (LSCS) can all present with a patch of linear alopecia, making diagnosis challenging. The purpose of this study was to combine reflectance confocal microscopy (RCM) and dermoscopy in the diagnosis of these lesions in children. METHODS: A total of 36 patients with linear alopecia were enrolled, of whom 14 had AA, seven had TM, nine had NS, and six had LSCS. We evaluated the characteristics and distinguishing features of the four conditions using RCM and dermoscopy. RESULTS: The key to differential diagnosis was the dermal Hair follicle density in the dermis was decreased in AA, and the size and density of the follicular openings were normal in TM. In NS, the major features were petal-like and frogspawn-like structures. In LSCS, dermal papillary rings, sebaceous glands, and follicles were partially or completely missing, and abundant fibrous material was distributed in the dermis. Dermoscopy revealed alopecia, and all four conditions resulted in decreased hair density. AA patients exhibited yellow dots, black dots, and exclamation mark hairs. TM patients presented with irregularly broken hairs and blood spots. Both NS and LSCS patients exhibited an absence of follicular openings; NS patients demonstrated whitish and yellowish round structures, while an atrophic area with white patches, linear vessels, and no yellow or black dots was observed in LSCS patients CONCLUSION: RCM combined with dermoscopy can provide additional information on disease states and differentiate between AA, TM, NS, and LSCS.

The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia.

Trichoscopy is currently regarded as an essential part of the hair loss consultation. It allows visualization of morphologic structures that are not obvious to the naked eye, including peri- and interfollicular skin surface abnormalities and changes to hair shaft thickness and shape. In this paper, we aim to discuss current knowledge on trichoscopy of the most common forms of scarring and nonscarring alopecias.

Deciphering gynaecological pathologies in women with acne and alopecia: an imaging experience.

Polycystic ovarian syndrome manifests acne and alopecia in teenagers and young adult females. To evaluate ovarian morphology and the prevalence of polycystic ovarian morphology (PCOM) in females between the ages of 21 and 45 who are in the reproductive stage and have isolated acne and/or androgenic alopecia. And their association. The present study was done with patients in the age group of 21 to 45 years with acne and/or androgenic alopecia. Modified Ferriman-Gallwey score was used to assess the degree of hirsutism (with score of more or equal to 8 as significant). Grading of acne vulgaris and androgenic alopecia was done by a single observer. Subjects were then evaluated for biochemical investigations of Hormonal assays on day 2 to 7. Transabdominal ultrasonography was performed in the follicular phase to demonstrate the ovarian morphology. In our study isolated androgenic alopecia was present in 28 patients (24.34%). In our study 54 (46.95%) patients out of 115 had combined acne and androgenic alopecia. In our study out of 33 patients with isolated acne 17 (51.5%) had PCO Morphology with grade I, grade II, grade III having prevalence of 46.2%, 53.8% and 57.1% respectively. In our study of the 28 patients with isolated androgenic alopecia 16 (57.1%) had PCOM with grade I, II and III respectively having prevalence of 56.3%, 55.6%, 66.7% with P value of 0.939. Patients with normal ovarian morphology were 12 in number (42.9%). Of the 54 patients with combined acne and androgenic alopecia 32 (59.3%) had PCOM and 22 patients had normal ovarian morphology. Higher overall prevalence was found in patients with combined acne and alopecia (59.3%) than in isolated groups; acne (51.5%), alopecia (57.1%). In our study it was to found that women with dermatological manifestations like acne and androgenic alopecia with regular menstruation. In our study it was found that these women with have high prevalence of PCOS.

Diagnosis and differential diagnosis of tertiary androgenetic alopecia with severe alopecia areata based on high-resolution MRI.

BACKGROUND AND AIM: No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia. MATERIALS AND METHODS: Forty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata. RESULTS: At the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively. CONCLUSIONS: HR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.

Correlación entre histopatología y tricoscopia en alopecias no cicatriciales / Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias

La tricoscopia es una herramienta esencial en el examen de las alopecias. La semiología elaborada durante las últimas décadas ha contribuido a la comprensión patogénica y al diagnóstico diferencial entre las distintas formas de alopecia. Todos los signos tricoscópicos tienen su base en la patogenia de la alopecia examinada. En el presente artículo, examinamos la correlación entre los principales hallazgos tricoscópicos de las alopecias no cicatriciales y la base histopatológica que sustenta esos signos tricoscópicos (AU)

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias (AU)

[Translated article] Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias / Correlación entre histopatología y tricoscopia en alopecias no cicatriciales

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias (AU)

La tricoscopia es una herramienta esencial en el examen de las alopecias. La semiología elaborada durante las últimas décadas ha contribuido a la comprensión patogénica y al diagnóstico diferencial entre las distintas formas de alopecia. Todos los signos tricoscópicos tienen su base en la patogenia de la alopecia examinada. En el presente artículo, examinamos la correlación entre los principales hallazgos tricoscópicos de las alopecias no cicatriciales y la base histopatológica que sustenta esos signos tricoscópicos (AU)

[Translated article] Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias.

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias.

A challenge of deep-learning-based object detection for hair follicle dataset.

BACKGROUND: Deep-learning object detection has been applied in various industries, including healthcare, to address hair loss. METHODS: In this paper, YOLOv5 object detection algorithm was used to detect hair follicles in a small and specific image dataset collected using a specialized camera on the scalp of individuals with different ages, regions, and genders. The performance of YOLOv5 was compared with other popular object detection models. RESULTS: YOLOv5 performed well in the detection of hair follicles, and the follicles were classified into five classes based on the number of hairs and the type of hair contained. In single-class object detection experiments, a smaller batch size and the smallest YOLOv5s model achieved the best results, with an map of 0.8151. In multiclass object detection experiments, the larger YOLOv5l model was able to achieve the best results, and batch size affected the result of model training. CONCLUSION: YOLOv5 is a promising algorithm for detecting hair follicles in a small and specific image dataset, and its performance is comparable to other popular object detection models. However, the challenges of small-scale data and sample imbalance need to be addressed to improve the performance of target detection algorithms.

Clinical and dermatoscopic features of temporal triangular alopecia in infants.

OBJECTIVE: To summarize the clinical and dermatoscopic features of temporal triangular alopecia in infants and explore the clinical significance of dermatoscopy in the diagnosis of triangular alopecia temporalis in infants. METHODS: A retrospective analysis was performed on 20 children with temporal triangular alopecia diagnosed in the dermatology clinic of Tianjin Children's Hospital from January 2015 to December 2021. Dermatoscopy was performed on all children, and images were collected. RESULTS: The clinical features of 20 children were 15 males and five females, all of which were born immediately after birth; There were eight cases (40%) in the left temporal region, 10 cases (50%) in the right temporal region, one case (5%) in the head region, and one case (5%) in the occipital region; 19 cases were single (95%), one case was multiple (5%); There were 21 skin lesions, 15 triangular lesions (71.4%), four quasi-circular lesions (19%), and two lance-shaped lesions (9.5%). Trichoscopic features: The hair follicle opening in all skin lesions is normal, and the hair follicle opening can be seen with fluffy hair (vellus hair). The vellus hair is evenly distributed, and the length is diverse (both short and long vellus hair exist in the same hair loss area). There are 14 cases of white vellus hair (70%), five cases of white spots (25%), one case of honeycomb pigment pattern (5%), and one case of vascular dilation pattern (5%). CONCLUSION: Temporal triangular alopecia in infants has typical clinical and dermatoscopic characteristics, and the dermatoscopy can provide clinical basis for its diagnosis and differential diagnosis.