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      Trichoscopy of Pressure-Induced Alopecia and Alopecia Areata: A Comparative Study

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          Abstract

          Background:

          Pressure-induced alopecia is an uncommon type of alopecia. It can occur in both scarring as well as non-scarring form and occurs due to ischemia resulting from prolonged head immobilisation during surgery or hospitalisation. The patchy hair loss generally involves convexities of scalp specially vertex and occiput. The hair loss is usually noticed 3 -28 days after the inciting event and regrowth of hair occurs between 1 – 4 months.

          Objective:

          To describe trichoscopic features of pressure alopecia and compare it with the closest differential, alopecia areata.

          Methodology:

          It is a retrospective observational study. Trichoscopic features of six cases of pressure alopecia seen during the study period were compared with alopecia areata and analyzed using appropriate statistical methods.

          Results:

          The study had 30 cases, six cases of pressure alopecia and 24 cases of alopecia areata. The mean age of patients with pressure alopecia and alopecia areata was 45.16 and 29.08 years respectively. Comedone- like black dots, black dots and area of scarring were statistically significant for pressure alopecia while exclamation mark hairs were significant for alopecia areata.

          Conclusion:

          Trichoscopy is a non-invasive test for diagnosis of alopecia and “Comedone-like black dots” are unique trichoscopic feature of pressure alopecia.

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          Most cited references12

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          Postoperative pressure-induced alopecia: report of a case and discussion of the role of apoptosis in non-scarring alopecia.

          We report a case of postoperative pressure induced alopecia in a 21-year-old black female after multiple intraoperative procedures. The histopathology is distinctive and demonstrated features in common with trichotillomania and alopecia areata, including the presence of pigment casts, catagen follicles, melanophages and apoptotic bodies. External hair manipulation is considered the primary event in the etiology of pigment casts, however, our present case demonstrated numerous pigment casts despite a complete lack of evidence of external hair manipulation. We performed pattern analysis and in situ end-labeling in 19 cases of non-scarring alopecia. Pigment casts were seen in postoperative alopecia (1 case), alopecia areata (1 case) and trichotillomania (5 cases). These forms of alopecia have in common the sudden termination of the anagen phase of the hair cycle. When the anagen portion of the hair cycle is prematurely disrupted hairs enter into catagen. Pigment casts may represent a non-specific reaction pattern of follicles that are suddenly transformed from anagen to catagen. We therefore propose that hair manipulation is not uniquely responsible for the formation of pigment casts. The primary pathophysiology resulting in the formation of pigment casts more correctly reflects the sudden termination of the anagen phase of the hair cycle.
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            Pressure alopecia: clinical findings and prognosis.

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              Postoperative (pressure) alopecia.

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                Author and article information

                Journal
                Int J Trichology
                Int J Trichology
                IJT
                International Journal of Trichology
                Wolters Kluwer - Medknow (India )
                0974-7753
                0974-9241
                Jan-Feb 2022
                01 February 2022
                : 14
                : 1
                : 17-20
                Affiliations
                [1]Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
                [1 ]Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Deepak Vashisht, Department of Dermatology, Armed Forces Medical College, Pune - 411 040, Maharashtra, India. E-mail: deepak3975@ 123456gmail.com
                Article
                IJT-14-17
                10.4103/ijt.ijt_46_20
                8923146
                35300106
                a6770067-f756-4e55-848b-9ffb4330bb3c
                Copyright: © 2022 International Journal of Trichology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 02 April 2020
                : 17 April 2020
                : 13 October 2021
                Categories
                Original Article

                Dermatology
                postoperative alopecia,pressure alopecia,trichoscopy
                Dermatology
                postoperative alopecia, pressure alopecia, trichoscopy

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