Hair transplantation Follicular Unit Excision (FUE): Introducing the multipurpose octagonal ring punch.

The technique of follicular unit excision for harvesting grafts for hair transplantation procedures has become very popular. This technique relies on the use of small punches to remove viable grafts. Many different punch shapes have been developed to accommodate the varying nature of skin and hair characteristics, resulting in hair transplant surgeons requiring a variety of punches to suit a wide range of patients, which can be overwhelming to the beginner when trying to decide on the optimal choice of a punch to suit a particular skin characteristic. We describe a novel multipurpose ring punch that can be used on patients with a variety of skin and hair characteristics, as well as for shaved and long hair FUE. Features of this punch include an octagonal ring that protrudes from the outer wall of the punch and functions to control the punch's trajectory into the deeper dermis during incision. Additionally, this punch has a dull, notched edge which allows for use in long hair and shaved FUE without sacrificing ease of incision through the epidermis. This punch is the first of its kind to have this breadth of versatility with a one-size-fits-all design.

Preview long hair follicular unit excision: An up-and-coming technique.

BACKGROUND: Follicular unit excision (FUE) is a popular hair transplant technique, but requires shaving the donor area. This is a deterrent for some patients wishing to keep their hair transplant discreet. The new long hair FUE technique avoids shaving the donor area, which appeals to a wider patient population; however, it has a reputation of being technically challenging and slow. AIMS: We review the tools and techniques developed for long hair FUE and present our experience using the Trivellini Long Hair System and Long Hair punch. DISCUSSION: With the new advances in tools and techniques for long hair FUE, this method is gaining momentum and has the potential to be the next trend in the hair transplant industry. There are a few different punch designs marketed specifically for long hair FUE (window/slotted, Trivellini Long Hair, and bi-pronged). Although this technique is slower to perform than shaven FUE, graft survival and final outcome are comparable. CONCLUSIONS: Innovations in technology have made the long hair FUE technique more accessible to hair transplant surgeons. It is important for hair restoration surgeons to keep knowledgeable about this technique in order to maintain a competitive business.

High prevalence of mixed infections in global onychomycosis.

Onychomycosis is estimated at a prevalence of 10% worldwide with the infecting organism most commonly Trichophyton rubrum (T. rubrum). Traditional culture identification of causative organisms has inherent risks of overestimating dermatophytes, like T. rubrum, by inhibiting the growth of possible nondermatophyte mould (NDM) environmental contaminants which could be causative agents. Recently, molecular methods have revealed that a proportion of onychomycosis cases in North America may be caused by mixed infections of T. rubrum as an agent co-infecting with one or more NDM. Determining the global burden of mixed infections is a necessary step to evaluating the best therapies for this difficult-to-treat disease. To determine the prevalence of mixed infections in a global population, nail samples from onychomycosis patients in Brazil, Canada, and Israel (n = 216) were analyzed by molecular methods for the presence of dermatophytes and five NDMs. If an NDM was detected, repeat sampling was performed to confirm the NDM. T. rubrum was detected in 98% (211/216) of infections with 39% mixed (84/216). The infection type was more likely to be mixed in samples from Brazil, but more likely to be a dermatophyte in samples from Canada and Israel (Χ2 = 16.92, df = 2, P<0.001). The most common cause of onychomycosis was T. rubrum. In all countries (Brazil, Canada and Israel combined) the prevalence of dermatophyte (Χ2 = 211.15, df = 3, P<0.001) and mixed (dermatophyte and NDM; Χ2 = 166.38, df = 3, P<0.001) infection increased with patient age. Our data suggest that mixed infection onychomycosis is more prevalent than previously reported with the aging population being at increased risk for mixed infections.

The edge out punch: An advancement that reduces transections in follicular unit excision hair transplantation.

BACKGROUND: The follicular unit excision (FUE) technique has become the preferred method for hair transplants over the traditional strip harvest technique due to low scar visibility and shorter recovery time for the patient. However, a limitation of the FUE technique is the potential for graft trauma due to the small diameter, sharp punches used to harvest individual follicular units. AIMS: Here, we introduce the novel edge out FUE punch that is designed with a thicker wall and has an internal bevel. We describe how the dynamics of this punch reduces the risk of follicle transection. METHODS: A review of the available literature and information on the edge out punch in comparison with other punch shapes, as well as the authors' experience in this area, is provided. RESULTS: The edge out punch is designed with thick walls and an internal bevel, placing the sharp cutting edge on the outer diameter. The dynamics of this punch aid in directing the graft into the center of the punch lumen and keeps the sharp cutting edge away from the hair follicles deeper in the dermis, reducing the risk of follicle transection. CONCLUSION: The dynamics of the forces generated by the edge out punch aid in minimizing follicular transections during graft harvesting. By understanding the dynamics behind this novel punch, hair restoration surgeons (HRSs) can optimize their surgical technique to obtain consistently high-quality grafts during FUE.

The Use of Direct Immunofluorescence in Frontal Fibrosing Alopecia.

BACKGROUND: Frontal fibrosing alopecia (FFA) differs from lichen planopilaris (LPP) in many clinical aspects, but histology fails to distinguish between these entities. Direct immunofluorescence (DIF) is a diagnostic technique used for autoimmune diseases, including those affecting skin and hair. OBJECTIVE: To characterize DIF patterns in patients with FFA. METHOD: Data was collected retrospectively from FFA cases presenting to the Centre de Santé Sabouraud Hair Clinic in Paris from November 2013 to November 2014. RESULTS: Of 149 patients with FFA, 44 cases underwent DIF. Thirteen cases showed positive results with DIF. Patterns characteristic of LPP and lupus erythematosus were observed, with nearly half showing nonspecific staining. CONCLUSION: DIF patterns in patients with FFA were variable. This diagnostic technique should be used with caution in cases of cicatricial alopecia, particularly FFA.

Antifungal agents: an overview. Part I and Part II

The last decade has witnessed remarkable advances in the therapy for cutaneous fungal diseases. These will have a major impact on the choice of antifungal therapy. To understand these advances traditional therapies for fungal diseases, the polyenes, griseofulvin, older topical agents and the older azoles, will be reviewed first. Part II will focus on recent advances.

Whats new in pediatric dermatology

This report discusses some of the newly described diseases in pediatric dermatology and recent developments in other diseases that are pertinent to this field.

Psoralen photochemotherapy

Psoralens and sunlight have been used by the Egyptians and Indians for hundreds of years for the treatment of vitiligo. The combination of oral psoralens and artificial ultraviolet A (PUVA) therapy was approved for the management of severe psoriasis by the Food and Drug Administration in 1982. Since then PUVA therapy has been found to be an effective modality in the treatment of many cutaneous conditions. When properly administered, the major short-term side effects are minimal. The long-term side effects may include an increased risk of squamous cell carcinoma, atypical cutaneous pigmentation, accelerated skin aging, and ophthalmologic abnormalities. By careful patient selection and limiting the cumulative UVA dosage and frequency by using combinations or alternative therapies, these side effects may be reduced. Continued reporting of carefully carried out long-term prospective studies will provide us with more knowledge of the long-term side effects of PUVA. In the meantime, for each patient on PUVA therapy the risk/benefit ratio should be carefully considered.