Trichoscopic Diagnosis of Structural Hair Defects in a Clinical Setting: A Cross-Sectional Analytical Study.

BACKGROUND: Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists. OBJECTIVES: The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders. METHODS: Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair, were the subjects of the study. All patients were examined by the handheld dermoscope, and 400 were additionally examined by the folliscope, digital dermoscope, or their hairs mounted for light microscopy. RESULTS: Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and a predominance of single-haired scalp pilosebaceous units (57% and 55.5%, respectively). Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs, and increased vellus hairs (37%, 31%, and 25%, respectively). Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%), and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency: female pattern hair loss, telogen effluvium, traction alopecia, and trichotillomania. Trichodynia appeared to be significantly associated with numerous hair shaft abnormalities. CONCLUSION: Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of dermoscopy is an important aid in the diagnosis of hair and scalp disorders.

Sensitive Scalp: Diagnosis and Practical Management. / Cuero cabelludo sensible: diagnóstico y manejo práctico.

Sensitive scalp is sensitive skin located on the scalp. Sensitivity is considered primary in the absence of an associated scalp disorder and secondary when caused by conditions such as psoriasis, seborrheic dermatitis, and atopic dermatitis. The clinical manifestations of primary sensitive scalp are subjective. Common presenting symptoms are burning, itching, trichodynia, and dysesthesia, often coinciding with hair loss. Clinically, the skin appears normal or red. An objective diagnosis based on laboratory or histologic findings is not possible. Triggers may be endogenous (e.g., stress and emotional or psychopathological disturbances) or exogeneous (e.g., topical products and cosmetics). Treatment must be individualized. Options include pimecrolimus, hydration with hyaluronic acid, and mesotherapy with plasma rich in growth factors.

Successful Treatment of Refractory Trichodynia With Onabotulinumtoxin-A.

Trichodynia is a common symptom, which is characterized by a painful, burning or stinging sensation of the scalp, often in patients presenting with hair loss. It is typically associated with co-morbid psychiatric conditions and remains challenging to treat, with no Food and Drug Administration (FDA) treatments currently available. We herein report the successful use of off-label onabotulinumtoxin-A in treating a patient with trichodynia who has failed conventional therapies.

Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management.

Sensitive scalp (SSc) is considered a sensitive skin on the scalp, with its particularities. Although it is not rare in the dermatological practice and the term is commonly present in personal care products, this entity is poorly investigated in the medical literature. The etiopathogenesis is still uncertain, and the sensitivity may be associated with hair loss. Clinical manifestations are subjective symptoms of pruritus, burning, pain, pricking, and/or trichodynia, often with scalp erythema. SSc can be triggered by several factors (endogenous or exogenous). The diagnosis is guided by the anamnesis, and there are still no specific trichoscopic features. Trigeminal trophic syndrome and postherpetic neuralgia are the main differential diagnosis to be considered. We organized the therapeutical approach in three steps: scalp care, topical and systemic treatment.

Presence of Trichodynia Symptoms in Hair Diseases and Related Factors.

BACKGROUND: Trichodynia can be described as a feeling of discomfort in the scalp. Studies on trichodynia also have different data. AIM: The aim of this study was to investigate the frequency and associated factors of trichodynia. METHODS: A questionnaire was applied to 249 patients who were admitted to the Hair Diseases Unit of Istanbul University, Cerrahpasa Hospital. We recorded the age, sex, hair loss duration, diagnosis, and whether or not patients had trichodynia symptoms. RESULTS: Out of a total of 249 patients, 89 patients (35.7%) had trichodynia. We found that the mean age of patients with trichodynia was higher than the mean age of those without trichodynia. Trichodynia was more common in women than in men. In addition, it was more common in the cicatricial alopecia group than the other disease groups. DISCUSSION: The frequency of trichodynia was significantly higher in women in comparison to that in men. Symptoms of trichodynia were significantly more common in patients with cicatricial alopecia in comparison to that in the other 4 diagnostic categories. There was no significant difference between the 4 diagnostic categories in terms of trichodynia severity.

The role of sleep in telogen effluvium and trichodynia: A commentary in the context of the current pandemic.

Telogen effluvium (TE), a common hair disease, is supposed to be related to stress, which could be secondary to poor sleep. We call attention to the current COVID-19 pandemic, that is leading to an increase in the prevalence of sleep disturbances, and as a consequence, higher states of stress and anxiety, which are possible triggers for TE. In parallel, trichodynia is a sensorial symptom that is commonly related with hair diseases, including TE. We argue that substance P, a neuropeptide that has participation in the neuroinflammation and in the sleep regulation, may play a possible role in this scalp paresthesia. We suggest that there may be an association between this substrate and sleep, which can aggravate trichodynia and TE. Further studies on this subject could provide more evidence on these relationships, and help to improve the patients' quality of life and management of the condition.

Trichodynia Revisited.

Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findings. The respective studies failed to demonstrate correlations between trichodynia and quantifiable hair loss activity, nor histopathologic evidence for follicular inflammation. A symptomatic scalp is a frequent condition in specific dermatological conditions of the scalp. By definition of exclusion, we are not dealing with trichodynia in these cases. It is conceivable that neuropeptides are key players between the central nervous system and the skin immune and microvascular system. Such mechanisms would explain the noxious effects of both external stimuli and emotional distress in eliciting cutaneous nociception. Since we have begun to understand the diverse etiologies of trichodynia, and a single term does not measure up to this circumstance, it may be wiser to describe the condition depending on the type of scalp sensation and its specific disease association. Further studies are warranted into the neural/endothelial/follicular interactions both in hair growth and shedding and the psychosomatic diseases of the hair and scalp.

Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management.

BACKGROUND: The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported. OBJECTIVE: To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease. METHODS: Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. RESULTS: Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more. LIMITATIONS: The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. CONCLUSION: The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.

Evaluation of Anxiety and Levels of Serum B12, Folate, TSH, Ferritin, and Zinc in Telogen Alopecia Patients with Trichodynia.

BACKGROUND: Trichodynia refers to pain, discomfort, and/or paresthesia of the scalp. Trichodynia may be associated with anxiety. AIM: To assess serum vitamin B12, folate, thyroid stimulating hormone (TSH), ferritin, and zinc levels, and to investigate anxiety in telogen alopecia patients with trichodynia. MATERIALS AND METHODS: The study included 31 telogen alopecia patients who complained of trichodynia and 30 telogen alopecia patients without trichodynia. Their serum vitamin B12, folate, TSH, ferritin, and zinc levels were assessed and their anxiety levels were scored using the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI). RESULTS: No significant difference was found in the serum levels of vitamin B12, folate, TSH, ferritin, and zinc in the patient and control groups. The anxiety scores in both groups were similar. CONCLUSION: Our data provide no evidence for the association of serum vitamin B12, folate, TSH, ferritin, and zinc levels or anxiety scores with trichodynia.