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      Alopecia: evaluation and treatment

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      Clinical, Cosmetic and Investigational Dermatology

      Dove Medical Press

      alopecia, evaluation, treatment

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          Abstract

          Hair loss is a very common complaint. Patients may describe increased shedding and diffuse or localized alopecia. The differential diagnosis of hair loss includes a number of disorders causing cicatricial or noncicatricial alopecias. This paper describes the clinical approaches and diagnostic tests that are useful in the evaluation of patients presenting with alopecia. It also reviews treatments for noncicatricial alopecias, including androgenetic alopecia, alopecia areata, and telogen effluvium, as well as cicatricial alopecias, including lichen planopilaris, its clinical variant frontal fibrosing alopecia, and discoid lupus erythematosus.

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          Most cited references 62

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          Alopecia areata update: part II. Treatment.

          Various therapeutic agents have been described for the treatment of alopecia areata (AA), but none are curative or preventive. The aim of AA treatment is to suppress the activity of the disease. The high rate of spontaneous remission and the paucity of randomized, double-blind, placebo-controlled studies make the evidence-based assessment of these therapies difficult. The second part of this two-part series on AA discusses treatment options in detail and suggests treatment plans according to specific disease presentation. It also reviews recently reported experimental treatment options and potential directions for future disease management. After completing this learning activity, participants should be able to compare the efficacy and safety of various treatment options, formulate a treatment plan tailored to individual patients, and recognize recently described treatments and potential therapeutic approaches. Copyright (c) 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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            Videodermoscopy in the evaluation of hair and scalp disorders.

            The standard methods used to diagnose scalp and hair disorders (eg, simple clinical inspection, pull test, biopsy) vary in sensitivity, reproducibility, and invasiveness. Studies on a few entities suggest that use of dermoscopy can improve clinical accuracy, but further investigation is needed. We sought to: (1) characterize features of several nontumoral scalp and hair conditions using videodermoscopy; and (2) assess the potential usefulness of videodermoscopy in the clinical evaluation of these conditions. Images (x20-70 magnification) obtained with videodermoscopy from 220 patients with various scalp and hair disorders and 15 unaffected control subjects were reviewed for distinguishing features. Conditions evaluated included psoriasis (23), seborrheic dermatitis (26), alopecia areata (58), androgenetic alopecia (64), chronic telogen effluvium (7), trichotillomania (12), and primary cicatricial alopecia (30). Clinical features evident to the naked eye were seen in great detail when videodermoscopy was used. Novel features (eg, yellow dots in alopecia areata) were also identified. Findings require confirmation by blinded, prospective investigation. Use of videodermoscopy in the clinical evaluation of scalp and hair disorders improves diagnostic capability beyond simple clinical inspection and reveals novel features of disease, which may extend clinical and pathogenetic understanding.
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              Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.

               Scott Whiting (1993)
              Vertical sections of small scalp biopsy specimens are often inadequate for the diagnosis of male pattern androgenetic alopecia (MPAA). Quantitative analysis of follicular structures in horizontal sections can provide more information. Our purpose was to establish better diagnostic criteria by comparing horizontal and vertical sections of scalp biopsy specimens from MPAA and normal control subjects and to determine the predictive value of horizontal sections, by relating counts of follicular structures in MPAA to subsequent hair regrowth from topical minoxidil therapy. Paired 4 mm punch biopsy specimens were taken from 22 normal control subjects and 106 patients with MPAA, for horizontal and vertical sectioning. In horizontal sections, hair bulbs, terminal anagen, catagen and telogen hairs, telogen germinal units, and vellus hairs were counted, as were follicular units and stelae. The diagnosis of MPAA was confirmed by finding decreased terminal hairs and increased stelae and vellus hairs. The average horizontal section contained 22 terminal and 13 vellus hairs, a 1.7:1 ratio. Changes compatible with MPAA were found in most vertical and horizontal sections, but horizontal sections were required for follicular counts and showed terminal:vellus hair ratios diagnostic of MPAA in 67% of cases. Of 44 patients treated with topical minoxidil, five with less than 2 follicular structures/mm2 showed no hair regrowth, 32 with 2 to 4 follicular structures/mm2 showed regrowth in 72%, and seven with more than 4 follicular structures/mm2 showed regrowth in 86% of cases. In MPAA with no significant inflammation, regrowth occurred in 77% of cases, versus 55% in cases with significant inflammation. Horizontal sections of scalp biopsy specimens in MPAA provide more diagnostic information than vertical sections and appear to have a predictive value for hair regrowth.
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                Author and article information

                Journal
                Clin Cosmet Investig Dermatol
                Clinical, Cosmetic and Investigational Dermatology
                Clinical, Cosmetic and Investigational Dermatology
                Dove Medical Press
                1178-7015
                2011
                19 July 2011
                : 4
                : 101-106
                Affiliations
                Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
                Author notes
                Correspondence: Katherine A Gordon, 1600 NW 10th Ave, RMSB Room 2023, Miami, FL, 33136, USA, Tel +1 407 716 5105, Email kagordon@ 123456med.miami.edu
                Article
                ccid-4-101
                10.2147/CCID.S10182
                3149477
                21833160
                © 2011 Gordon and Tosti, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Review

                Dermatology

                alopecia, treatment, evaluation

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