Dermoscopic findings and comparison of usefulness of longitudinal versus transversal sections in the histological diagnosis of alopecia X.

BACKGROUND: A combination of dermoscopic and histological findings may provide useful information for the diagnosis of hair follicle diseases. However, there are no studies on dermoscopic-histopathological correlations in dogs affected by alopecia X, and comparison of longitudinal versus transversal sectioning of skin biopsy specimens in the assessment of this hair loss disorder has not been thoroughly investigated. HYPOTHESIS/OBJECTIVES: The aim of this study was to correlate dermoscopic and histological features using both longitudinal and transversal sectioning of skin biopsy samples to gain additional information for the diagnosis of alopecia X. ANIMALS: Nineteen Pomeranian dogs affected by alopecia X and five healthy Pomeranians as controls. MATERIALS AND METHODS: Dermoscopic-histological correlation was performed within the diseased group, whereas histological comparisons against controls. The demographic and clinical characteristics also were related to the histological findings. RESULTS: The dermoscopic findings revealed scattered, thinned, short hairs mixed with amorphous keratoseborrhoeic-like material (follicular plugging), perifollicular and intrafollicular scaling, and hyperpigmentation varying from pinpoint black spots to a diffuse texture. Dermoscopic findings correlated with histological findings for selected qualitative and quantitative findings. The usefulness of transversal sections was demonstrated in accurately determining the hair follicular density and counts, growth arrest phases and in identifying mineralisation of hair follicle basement membrane when compared to the longitudinal. Conversely, no correlations between histological findings and demographic and clinical characteristics were detected. CONCLUSIONS AND CLINICAL RELEVANCE: These data provide evidence of the usefulness of dermoscopic evaluation as an accessory diagnostic tool and of transversal sections of skin biopsies as complementary to the diagnosis of alopecia X.

The effect of platelet-rich plasma injection in the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the most common type of hair loss in men, which is manifested by a progressive terminal hair loss in specific areas of scalp. Platelet-rich plasma (PRP) is among treatment options for androgenetic alopecia. PRP is a human platelet concentrate in a small volume of plasma containing certain cytokines. AIM: The aim of this study was to evaluate the efficacy and safety of autologous PRP in treatment of male androgenetic alopecia. METHODS: This was a clinical trial in 19 patients with grade III vertex to grade V androgenetic alopecia referring to the Clinic of Ghaem Hospital between March 2015 and March 2016. All obtained liquid PRP (5 cc) was injected at around 125 points (equals to 125 cm2 ) into the scalp, and operation was repeated in three sessions at 0, 4, and 8 weeks. We took macroscopic and dermoscopic pictures of each patient in 0, 4, and 8 weeks and 3 months after the last injection session. A dermatologist evaluated the treatment response using dermoscopy photos. RESULT: Our results showed that the trend of hair thickness and number variations during study period was significant (P < 0.001). However, there was no significant change in the hair thickness from the second injection forward. Our findings indicate the number of hair follicles during follow-up in pairwise comparison was significantly more than baseline. CONCLUSION: Findings of our study were in line with other studies in this field and showed that the use of PRP as a new and safe treatment can be effective in androgenetic alopecia.

Hair removal with the 3-msec alexandrite laser in patients with skin types IV-VI: efficacy, safety, and the role of topical corticosteroids in preventing side effects.

BACKGROUND: Laser hair removal targets melanin in the hair shaft. The abundance of melanin in the epidermis of patients with dark skin color has always been regarded as hazardous due to the increased incidence of side effects in this patient population. OBJECTIVE: To establish the efficacy and safety of using the 3-msec alexandrite laser in patients with skin types IV to VI, and evaluate the role of topical corticosteroids in preventing side effects. METHODS: Thirty-seven patients with skin types IV to VI and brown or black hair were recruited and divided into 2 groups. Twenty-six patients were treated with the 18-mm spot size and 11 patients were treated with the 15-mm spot size. Hair shafts in the treatment and control areas were counted and clipped for measurement of the thickness at the base. The laser was used with fluences between 8 and 32 J/cm2. Two 16-cm2 areas were treated; one area was pretreated with a class I topical corticosteroid (TCS) cream (betamethasone dipropionate) 10 minutes prelaser and twice a day for 5 days postlaser. The dynamic cooling device (DCD) spray duration was set at 90 msec, and the delay was set at 20 msec. Pain was graded on a scale from I to 10. Patients were followed up on day 1 and day 7 and at 1, 3, and 6 months. Histological samples from the 2 treatment areas and control were obtained from 5 patients. At follow-up visits, side effects were graded on a scale from 1 to 3. Hair reduction was evaluated by performing hair counts. The thickness of hair was measured microscopically at the base. Average hair count reduction and hair thickness were recorded at the 3- and 6-month visits. RESULTS: Thirty-one patients completed the study. The average hair count reduction at 6 months was 35.4%. The average hair thickness reduction was 31.2%. At one week hyperpigmentation was seen in 48.4% of the laser only treated area and in 45.2% of laser/TCS treated area. The effect of TCS was minimal and more prominent at 1 and 3 months. The incidence of hyperpigmentation was higher in the 15-mm group than the 18-mm group as a result of using higher fluence. Hypopigmentation was generally preceded by crust formation and lasted up to 3 months. Reducing spot size resulted in decreased peripheral crust formation. TCS appears to have a role in reducing the erythema and crusting. Histopathology of both groups at day one showed necrosis of the follicular infundibulum and the inner layer of the perifollicular epithelium. No vascular damage was seen. CONCLUSION: The 3-msec alexandrite laser utilized in this study provides a safe and effective treatment achieving long-term reduction of unwanted, pigmented hair in skin types IV and V, but is less safe in skin type VI. Using a TCS helps in minimizing post-treatment erythema and edema; it also decreases the duration of hyperpigmentation.