Objectives: 1.The hair restorative Surgeons need to know the fine difference between various types of scarring &Non scarring alopecia.
2.By simple steps of detailed history , clinical scalp examination, trichoscopy, blood chemistry and biopsy for histopath can detect the root cause for hair loss and bring a better outcome for patient.
3.For conditions that are deceptive like diffused Alopecia Areata, chronic Telogen effluvium one may confuse it with Patterned hair loss.
4. for scarring alopecia too , sometimes one has to be sure to offer an appropriate treatment if in remission period.
Introduction: the clinical history should focus on areas where one can ascertain the type of hair loss and any pre existing medical condition leading to hair loss. detailed scalp exam and trichoscopy can pick up exclamation mark hair , sparring of greys , pattern of hair loss, scalp condition , folliculitis, crusts, tufted hair follicular plugging etc Trichoscopy gives detail about follicular ostia, casts ,scales, hair type and ratio, etc. the blood chemistry detects iron/vit D, zinc deficiency, thyroid malfunction or autoimmune diseases. Histopath classifies follicular infiltrate and telogen/anagen ratio.
Materials / method: for scalp examination, hair pull test was done along with detailed exam of scalp for an eczematous condition, depressed patches, pattern of hair loss,any signs of inflammation or infection to rule out syphilis, dissection folliculitis, acne conglobata or fungal cause.Skin, oral mucosa & nails were examined too. for trichoscopy,hair follicles were assessed as having yellow/red/white dots, crusts, keratotic plugs. perifollicular pigment/ halo/pustules were recorded. in some cases histopath was done too. blood chemistry for nutritional def, endocrine /autoimmune causes and VDRL for syphilis sent
Results: most of the cases needed detailed clinical history and examination to come to the diagnosis. blood biochemistry and trichoscopy serve as a great help to detect the coexisting nutrional/metabolic causes of hair loss. some confusing cases with suspicion of scarring were helped out by finding follicular ostia presence.In diffuse hair loss, on close exam & VDRL,syphilis could be detected & successfully traeted medically.For connective tissue disease, SLE/DLE/ wide spread LP biopsy serves as a best tool to finalise your diagnosis. with 2 year remission these patients can opt hair transplant.
Conclusion: before offering the surgical treatment FUT/FUE as a solution , always practice these guidelines to avoid any complication later . In the best interest of patients- these simple steps are of utmost importance and every hair transplant surgeon should be well versed with these conditions to offer the best to their patients.
Disclosures
Did you receive any funding to support your research for this TOPIC?
No
Were you provided with any honoraria, payment or other compensation for your work on this study?
No
Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No
This work was not supported by any direct or non direct funding. It is under the author's own responsability