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      Monilethrix in Pattern Distribution in Siblings: Diagnosis by Trichoscopy

      case-report

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          Abstract

          Monilethrix is a heritable hair shaft defect characterized by localized or diffuse alopecia resulting from hair fragility over friction areas, predominantly the temporal and occipital regions, and follicular keratosis over the occipital region. However, it lacks macroscopic features that enable easy and rapid diagnosis in medical practice. Hair shaft microscopy is the basis for diagnosing monilethrix. We present a report of two Indian male siblings aged 24 and 21, who presented with thinning and hair loss from the scalp in male pattern distribution and multiple skin-colored follicular papules over the nape of the neck and bilateral forearms since childhood. Trichoscopy of scalp hair revealed characteristic uniform elliptical nodes and intermittent constrictions along with variation in hair shaft diameter, presence of few vellus hair and yellow dots, suggesting a diagnosis of monilethrix with early-onset androgenetic alopecia. Dermoscopy of the papules revealed multiple stubs of broken hair arising from them with a similar beaded appearance, suggesting a diagnosis of monilethrix. The diagnosis of monilethrix was confirmed with light microscopy and hair clipping. This report highlights the patterned distribution of hair loss in monilethrix probably due to the early unmasking of androgenetic alopecia and the use of trichoscopy as the diagnostic modality.

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          Most cited references9

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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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            Hair diameter diversity: a clinical sign reflecting the follicle miniaturization.

            The degree of androgenetic alopecia is generally evaluated either by global clinical scales or time-consuming methods like phototrichogram or histological studies. We describe a new clinical and reliable scoring method based on hair diameter diversity. (1) The clinical macroscopic scoring we propose for hair density was significantly correlated with Hamilton classification and with histological hair density. (2) Diversity in hair diameter was the main and most accurate clinical parameter linked to follicle miniaturization. (C) The anagen-telogen ratio decreased in parallel with the decrease in clinical hair density score. Considering that hair follicle miniaturization is the key point during androgenic alopecia onset and development, diversity in hair diameter represents an important feature to consider as an accurate clinical sign reflecting hair follicle miniaturization. Moreover, diversity in hair diameter seems to be an easily accessible and reliable parameter that should be taken into consideration for further characterization of hair disorders. By itself, we believe that this clinical feature constitutes a new tool of substantial help for the diagnosis and management of androgenic alopecia.
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              Dermoscopy as a tool for rapid diagnosis of monilethrix.

              Monilethrix is a rare cause of hair loss. We present a case of a 44-year-old female, in whom dermoscopy enabled a rapid diagnosis of monilethrix. Dermoscopy images in this patient showed hair shafts with uniform elliptical nodes and intermittent constrictions. Hairs were bended regularly at multiple locations and had a tendency to fracture at constriction sites. The diagnosis of monilethrix was confirmed by light microscopy. In a second patient hair shafts appeared irregularly constricted and had no tendency to bend or break, which was consistent with the diagnosis of pseudomonilethrix. We suggest the term "regularly bended ribbon sign" for describing the specific dermoscopic feature of monilethrix. It differentiates monilethrix from pseudomonilethrix and other causes of hair loss.
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                Author and article information

                Journal
                Int J Trichology
                IJT
                International Journal of Trichology
                Medknow Publications (India )
                0974-7753
                0974-9241
                Jan-Jun 2010
                : 2
                : 1
                : 56-59
                Affiliations
                Department of Dermatology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Uday Khopkar, Department of Dermatology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India. Email: drkhopkar@ 123456gmail.com
                Article
                IJT-2-56
                10.4103/0974-7753.66918
                3002417
                21188029
                7783baa1-e605-465a-bfe7-73cf4a06a6ca
                © International Journal of Trichology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Dermatology
                androgenetic alopecia,monilethrix,trichodermoscopy,hair shaft disorder
                Dermatology
                androgenetic alopecia, monilethrix, trichodermoscopy, hair shaft disorder

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