Micropigmentation.

Micropigmentation and microblading is a popular technique now a days which is used as a semi permanent method for camoflaging various dermatological indications. This article will elaborate upon various indications of micropigmenation. Micropigmentation is used in variety of dermatological conditions like semi permanent make up and vitiligo (stable forms). In this technique, a thorough knowledge of the indication and colour theory is crucial to achieve near to natural output. Micropigmentation or medical tattooing is a novel and easy to learn technique to camouflage various dermatological conditions like stable vitiligo, alopecia (androgenetic alopecia or stable alopecia areata) as well as for semi permanent make up.

Real-World Effectiveness, Safety, and Tolerability of Cetosomal Minoxidil 5% Alone and a Fixed Drug Combination of Cetosomal Minoxidil 5% With Finasteride 0.1% in the Management of Androgenetic Alopecia (Inbilt Study).

Introduction Topical minoxidil 5% is a widely used medication in the treatment of androgenetic alopecia (AGA) but is usually associated with adverse events (AE) such as scalp irritation, dryness, and itching. This prompted the development of nonalcoholic solutions, and cetosomal minoxidil was the most recent one. Methods Retrospective multicenter data analysis was conducted at 66 centers across India for adult AGA patients. Patients treated with either cetosomal minoxidil 5% alone (Group I) or a fixed drug combination of cetosomal minoxidil 5% and finasteride 0.1% (Group II) were analyzed for the effectiveness and safety of either formulation. The Physician Global Assessment (PGA) and Patient Global Assessment (PtGA) were used to assess each treatment's effectiveness. Safety was reported by records of AE and a product tolerability assessment with subjective cosmetic acceptability as recorded by physicians. Results Of the 261 patients, 132 were in Group I, and 129 were in Group II. At 16 weeks, in PGA, mild to moderate improvement was noted in 48% and 32% of patients in Groups I and II, respectively, whereas significant to excellent improvement was seen in 52% and 68% of patients in Groups I and II, respectively. Similar results were noted for PtGA. In Group I, 64% of patients rated the product's tolerability as excellent, and 69% reported the same in Group II. Meanwhile, 64% of patients in Group I and 74% in Group II rated the product as excellent in subjective cosmetic acceptability. Conclusions From real-world analysis, cetosomal-based minoxidil solutions were found to be effective and tolerable in AGA and could serve as therapeutic alternatives to alcoholic formulations for AGA management.

Role of Lactium™ in Psychodermatology: The CERTAIN Trial# on Patients with Acne Vulgaris.

Stress plays an important role in the causation and aggravation of psychodermatological conditions such as acne vulgaris. Alpha casein hydrolysate (αs1-casein hydrolysate; Lactium) has been shown to decrease serum cortisol levels, reduce stress-related symptoms, and promote relaxation. "This study aimed to compare the efficacy and safety of Lactium™ plus standard care to those of standard of care alone in reducing stress levels and acne severity in patients with acne vulgaris." The C.E.R.T.A.I.N trial (Name registered with Clinical Trials Registry-India-No. CTRI/2019/01/017172) is a randomized, controlled, multicenter, open-label, two-arm, investigator-initiated clinical trial. A total of 100 patients with moderate-to-severe acne vulgaris were enrolled and randomly assigned to one of the two groups: Lactium™ plus standard care or standard care alone. Stress levels were assessed using serum cortisol levels, Investigator's Global Assessment (IGA) acne severity scale scores, Perceived Stress Scale (PSS) scores, and the Hamilton Anxiety Rating Scale (HAM-A) scores. The Dermatology Life Quality Index (DLQI) was also used to assess the impact of the skin disease on patients' quality of life. At 12 weeks, stress levels were significantly lower in group A (Nixiyax plus standard of care) than that in group B(only standard care), as measured by the change in serum cortisol levels (4.75 ± 4.46 vs. -0.24 ± 5.22). Furthermore, the mean change in PSS scores (3.09 ± 2.04 vs. 0.90 ± 2.76) and HAM-A scores (5.11 ± 1.94 vs. 1.25 ± 3.13) was significant. Patients in both arms had a significant decrease in total, inflammatory, and noninflammatory acne lesions, as well as a significant improvement in DLQI and IGA scores. In patients with moderate-to-severe acne vulgaris, Lactium™ was found to be both safe and well-tolerated. Lactium™ plus standard care is more effective than standard care alone in reducing acne severity through stress reduction.

Successful follicular unit extraction in a case of inactive, recalcitrant alopecia barbae.

Alopecia areata (AA) is a non-scarring autoimmune type of alopecia. Hair transplantation in AA is not practiced as the implanted follicular grafts might be destroyed due to underlying autoimmune pathology. A biopsy proven 28 year old male patient of AA presented to us with an 8-year history of a hairless patch over the beard area. He underwent many treatments by other dermatologist with oral, topical, and intralesional immunosuppressants, which curtailed his disease progression but failed to re-grow hair. Biopsy during his visit revealed absence of inflammatory infiltrates and empty hair tracts replaced by fibrotic tracts. Follicular unit extraction (FUE) was done successfully after counseling the patient about the controversial role of hair transplant surgery in AA. Hair growth was achieved within 6 months with no recurrence during 1-year follow up. FUE can be opted for long-standing and clinically stable cases of AA; histopathology and dermoscopy being the guiding lights in determining the disease inactivity.

Follicular Unit Extraction [FUE] - One Procedure, Many Uses.

Follicular unit extraction [FUE] is a minimally invasive hair restoration surgery popularly known for its utility in androgenetic alopecia (AGA). In FUE, individual follicular grafts are extracted from donor area and implanted in the recipient area. Advantages of FUE are that it is comparatively 'scarless', has faster healing time, has less downtime and requires less technical staff. This article is aimed to highlight upon the multi-faceted utility of FUE technique in various dermatological indications like androgenetic alopecia, alopecia areata, facial hair restoration, tractional alopecia, scarring alopecia, body hair transplant, vitiligo as well as hirsutism.

Microblading and the Science Behind it.

Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new technique in the field of permanent cosmetics for eyebrow restoration. Currently, it is one of the most sort after treatment in aesthetic procedures due to the curiosity and awareness raised by social media. Microblading is a form of superficial micropigmentation, wherein pigment is deposited till the papillary dermis, with the help of a manual device and a blade consisting of stacked needles. The resultant crisp, discrete hair like incisions simulate the eyebrow hair to give a natural look. The results are semi-permanent and last only 12-18 months. In the recent years, with the advancement in the instrumentation of microblading there have been several modifications in this procedure. Microblading has now found its applications not only in cosmetic treatments but also in dermatological conditions such as alopecia totalis, hypothyroidism, chemotherapy induced madarosis etc. It is a vital tool in any dermatology or cosmetic practise for its extensive applications. But with the rise in popularity of microblading, there is also a rise of untrained professionals performing it leading to a rise in its side-effects. This article aims at not only guiding on the instrumentation and procedure of microblading but also its pre and post procedure care, interaction with other aesthetic procedures and treating its complications.

Donor Area Acute Effluvium following Follicular Unit Extraction-Trichoscopic Simulator of Alopecia Areata: Series of Four Cases.

Follicular unit extraction (FUE) is a popular hair transplant technique, which involves extraction of follicular grafts from the donor area, usually occipital area of scalp. We have described few cases where non-scarring alopecia patches appeared at donor area similar to that of alopecia areata clinically, after 2-3 weeks of surgery. Even trichoscopically, findings were similar to alopecia areata showing exclamation marks, black dots. However, on histopathology, there were dilated blood vessels, mucin deposition, and only few lymphocytes, which mimic histopathology of healing wound. We hypothesize that compromised blood supply and trauma to the existing hairs after harvesting can lead to post-hair transplant effluvium, which is probably due to anagen effluvium.

Effect of COVID-19 Outbreak on Hair Transplant Field of India.

World Health Organization declared the novel coronavirus (COVID-19) infection a global pandemic. All cosmetic, aesthetic, and hair transplant (HT) surgeries are stopped as elective surgeries may become the reason for infection spread. Most of the HT clinics have stopped surgeries or postponed till lockdown date limit. This pandemic situation has caused financial implications for these setups. India is still working to flatten the curve of the pandemic. Once the peak of the pandemic is over, virus may become endemic, and the risk of transmission of the disease to the HT team is also a possibility. HT field of India is thus in an extremely challenging position. We did a survey among the members of Association of Hair Restoration Surgeons of India (AHRS) to know the current status of the HT field of India and surgeon's perspective toward the situation.

Kerure Clamp: A New Age Tool to Improve Extraction Technique in Follicular Unit Extraction.

BACKGROUND: Follicular unit extraction (FUE) has caused evolution in the management of pattern baldness. FUE methods is less traumatic with faster healing and minimal scarring. FUE is still evolving and many innovations are possible in the future. AIMS AND OBJECTIVES: To address the usefulness of Kerure clamp, an innovative tool for FUE method of hair transplantation. MATERIALS AND METHODS: The clamp was used on 20 consecutive patients undergoing FUE for male-pattern baldness. Part of the donor area was divided into test side where extraction was done with clamp in situ and the control where clamp was not used. Follicular transection rate (FTR) was calculated as a percentage for each side and subjected to statistical analysis. RESULT: We found an improvement in the FTR scores on the test side, and this difference was statistically significant (t = 9.63, P < 0.0001). CONCLUSION: A low-cost instrument has been devised by the authors which was shown to improve the the scoring of grafts and also aid in surgeon's efficacy and efficiency.

Complications in Hair Transplantation.

Hair transplantation is a relatively safe surgery and is associated with very few complications. It is a cosmetic surgery so the complications may impact social and psychological aspect of the patient. Every hair transplantation surgeon should be aware of possible complications and techniques for the prevention and techniques of their management. Most of the complications are avoidable and can be minimized by proper surgical technique and wound care. Counseling and discussion with the patient before surgery help in proper planning and avoid patient dissatisfaction. Every patient should be individualized, planned, and operated with an aim to zero-down the complications and complaints.