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International Journal of Trichology logoLink to International Journal of Trichology
. 2012 Jul-Sep;4(3):226–232.

Poster Presentations

PMCID: PMC3500067
Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 1: A Case Report of Alopecia Totalis with Scleredema with all type Primary Systemic Amyloidosis and Multiple Myeloma

Aarti Shah

NHL Medical College, Ahmedabad, India

A 53-year-old female patient presented with alopecia totalis and loss of eyelashes since 2 years, edema with asymptomatic papulonodular lesions on both lower limbs since 3 years, and few hemorrhagic bullous lesions over both hands since 7-10 days. Facial edema and yellowish hue of face was seen. She was anemic and had leukocytosis. The renal function tests showed severe proteinuria (4+). Urine examination showed the presence of albumin (4+). Patient had hypothyroidism. Ultrasonography of the abdomen and pelvis showed the presence of multiple 1-2 cm sized lymph nodes in right inguinal region with subcutaneous edema in lower abdominal wall. Histopathologic examination showed scleredema adultorum. Renal biopsy specimen showed deposition of periodic acid-Schiff (PAS) negative material in mesangium (Congo red and Thio-T were positive). Patient was given tablet Melphalan 10 mg twice daily by the oncologist with steroids, but she expired of pleural effusion due to cardiac failure (? amyloid deposition) after 3 months of presentation at the skin department. Alopecia may be patchy or widespread in primary systemic amyloidosis. In our patient, alopecia totalis was present. Smooth, shiny, waxy papules or plaques are usually clustered in folds in axilla, anal, or inguinal region, face or neck, mucosal areas such as ear and tongue. Periorbital ecchymosis was also seen. Also, multiple myeloma can be associated with scleredema as seen with our case. High dose of chemotherapy is not recommended if more than two systems are involved or cardiac amyloid is present. Where myeloma and AL amyloidosis co-exist, choice of treatment for myeloma should take into account the extent of organ involvement with amyloid and the potential toxicities of individual treatments.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 2: Rare Cause of Cicatricial Alopecia of the Scalp

Adikrishnan S, Mahalakshmi Veeraraghavan, Prasanthi G, Murugan S, Krishnakanth M, Anandan S, Sudha R

Sri Ramachandra Medical College, Chennai, India

Lichen sclerosus et atrophicans (LSA) is a lymphocyte-mediated dermatosis that has a predilection for the genital skin in both sexes. The classical extragenital sites are the upper trunk, axillae, buttocks, and lateral thighs. Scalp involvement is a rare entity. A 24-year-old male presented with multiple patches of hair loss since 4 years. First, he developed a single area of hair loss over the occipital region of the scalp. There has been gradual increase in the size of the lesion since 2 years and development of newer lesions since 2 months. He did not have any complaints of skin rash elsewhere or tightening of foreskin. On examination, he was found to have four patches of alopecia arranged in a linear fashion and extending onto the nape of the neck as hypopigmented papules in a linear arrangement. Histopathologic examination revealed an atrophic epidermis with follicular plugging, perivascular lymphocytic infiltration, suggestive of LSA. LSA affects extragenital sites only in 20% of the patients. There have only been a few reports of LSA of scalp. However, the affection of the scalp is often preceded or accompanied by cutaneous and/or genital disease. Here, we report a case of isolated presentation of LSA of the scalp.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 3: Short Anagen Hair Syndrome: A Rare Condition with a New Association

Anitta Sara Thampi

Mahatma Gandhi Medical College and Research Institute, Pondicherry, India

Short anagen hair syndrome is a rare, idiopathic condition characterized by abnormally short scalp hair, in the absence of any hair shaft abnormality. No systemic associations have been reported so far. Here, we would like to report a case of short anagen hair syndrome with ventricular septal defect.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 4: An Unusual Case of Eruptive Vellus Hair Cyst

Bhandari K, Phiske M, Ghate SS, Dandale, A, Dhurat R

LTMMC and General Hospital, Mumbai, India

Eruptive vellus hair cysts (EVHC) are unusual developmental abnormality of vellus hair follicles first described in 1977 by Esterly, Fretzin, and Pinkus with about 50 cases reported till date. It may occur sporadically or be inherited in an autosomal dominant pattern with males and females equally affected. A strong overlap between EVHC and steatocystoma multiplex has been suggested with similar histological features. It has been considered as a developmental abnormality of vellus hair follicles, where a gradual disruption occurs between the proximal and distal parts of the follicle, usually at the level of the infundibulum, which results in the retention of hairs, cystic dilatation of the proximal follicle, and subsequent atrophy of the hair bulb. It has also been considered a type of follicular hamartoma. A 28-year-old housewife presented with multiple, small, asymptomatic raised lesions localized over the chest since 6 months. The lesions were smooth, painless, and not grouped, with no history of similar presentation in the family or in the past. A thorough general and systemic examination revealed no abnormality. Cutaneous examination revealed multiple discrete acneiform papules and comedones over the anterior chest along the midline and forearms. A skin biopsy was done which revealed a cystic structure in the mid-dermis arising from the infundibulum of a hair follicle containing multiple cross-sections of vellus hairs and layered laminated keratinous material, lined by squamous epithelium without any sebaceous structures. This case has been reported for its rarity.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 5: Trichodynia Associated with Female Pattern Hair Loss Responsive to Spironolactone (Anti-Androgen Treatment): A Case Report

Deepani Rathnayake, Rhiannon Llewellyn, Rodney Sinclair

St. Vincents' Hospital, Melbourne, Australia

Trichodynia refers to pain, discomfort, and/or paresthesia in the scalp and hair. It has been demonstrated in up to 34% of patients with hair loss. The literature describes trichodynia in telogen effluvium, androgenetic alopecia, and alopecia areata. Trichodynia in association with hair loss is reported to be more common in patients with psychiatric co-morbidities. Treatment up until now has consisted of analgesia and antidepressants. Here, we report a case of trichodynia in a girl with female pattern hair loss (FPHL), which responded to the anti-androgen spironolactone given for the hair loss. A 25-year-old female attended the hair clinic with a 10-year history of increased hair shedding. The loss of hair volume was estimated by the patient as three-fourths of the ponytail volume. She complained of trichodynia associated with her hair loss. She also gave a history of depression with possible traits of obsessive personality disorder in the past. Clinically she had Sinclair stage 1 FPHL and was confirmed with a scalp biopsy. She was started on spironolactone for the hair loss 14 months before, and her scalp and hair pain disappeared after 3 weeks of starting the treatment. A period of non-compliance caused the pain to return within 3 weeks. Recommencement of spironolactone results in disappearance of trichodynia within a similar timeframe. This case report suggests that trichodynia associated with FPHL responds to anti-androgen treatment with spironolactone.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 6: Pili Torti with Mental Retardation, Atopy, and Color Blindness: A New Association

Mary Thomas, Uday Sharadchandra Khopkar

Seth Gordhandas Sunderdas Medical College and King Edward Memorial College, Mumbai, India

Pili torti is an uncommon genetic hair shaft defect which may be associated with various syndromes. Two siblings born of a consanguineous marriage presented to us with features of mental retardation, atopy, and color blindness, in association with pili torti. The second sibling was less affected than the first, suggesting an autosomal recessive inheritance. This association has not been described previously.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 7: Coexistence of Alopecia Areata with Lichen Sclerosus et Atrophicus

Murugan S, Adikrishnan S, Sudha R, Mahalakshmi V, Anandan S, Sundaram M

Sri Ramachandra University, Chennai, India

Alopecia areata is a T-cell mediated autoimmune disorder affecting hair and nails. It has been associated with disorders like diabetes, vitiligo, lichen planus, and rarely, lichen sclerosus et atrophicus. A 6-year-old girl reported with complaints of multiple patches of hair loss of 3 months duration and linear ivory-colored lesions over the right leg of 6 months duration. The oval-shaped scalp lesion started first over the temporal region, which progressed to the present size of 3-4 cm. Then, multiple smaller lesions of 1 inch diameter appeared. The surface of the skin was smooth. Ivory-colored, lightly thickened, linear plaques studded with micropapules measuring 10 cm in length and 5 cm in width were noticed extending from the medial side of the right knee to the ankle. Routine investigations were normal. Skin biopsy of the right leg plaque was suggestive of lichen sclerosus et atrophicus. Patient was advised to apply topical minoxidil 2% solution for the scalp and topical tacrolimus ointment for the leg lesions. Oral prednisolone 10 mg/day was given. Skin and scalp lesions showed gradual response. This coexistence of alopecia areata with lichen sclerosus et atrophicus is reported in view of its clinical rarity.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 8: Therapeutic Response of Methotrexate in Lichen Planopilaris: A Case Report

Murugan S, Adikrishnan S, Sudha R, Mahalakshmi V, Anandan S, Sundaram M

Sri Ramachandra University, Chennai, India

A 19-year-old female patient presented with multiple itchy irregular patches of hair loss of 1 year duration. After relevant investigations it was diagnosed as lichen planopilaris with hypothyroidism. She had had treatment with topical, intralesional, and oral steroids with topical tacrolimus, with no clinical improvement. She was administered methotrexate 15 mg/week with antihistamines. Skin lesions started responding with resolution of atrophy and new hair growth. At the end of 3 months, there was full growth of hair. Lichen planopilaris induces marked inflammatory changes inducing atrophy and finally cicatricial alopecia. The response to treatment is variable. We report the dramatic therapeutic response with methotrexate by not only resolving the disease but also inducing new hair growth.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 9: The Medusa Head: Dermascopic Diagnosis of Woolly Hair Syndrome

Nidhi R Sharma, Sharmila Patil, Nitin Nadkarni, Kiran Godse, Manjyot Gautam

DY Patil Medical College and Hospital, Navi Mumbai, India

Hair shaft abnormalities are extremely common in genodermatoses. Hair changes may be a significant finding or even the initial presentation of a syndrome, giving the clue to the diagnosis. Videodermascopy of hair and scalp (trichoscopy) is a new method, which allows viewing hair shafts in vivo in many-fold magnification without the need of pulling hair for diagnostic purposes of examination. A 25-year-old male presented with abnormal hair over the scalp since infancy. He complained that the hairs were easily broken, slow-growing, and that they seldom required cutting, with similar complaints among family members. Microscopic examination of hair was essentially normal. Hematological and biochemical parameters were also normal. Trichoscopy of hair shafts was performed too. Trichoscopy of hair shafts demonstrated a “crawling snake” appearance with short wave cycles under 20× magnification, which was suggestive of woolly hair syndrome. We liken this appearance to the head of the mythical character Medusa, a character in Greek mythology, whose scalp hair was made of living snakes. This case has been reported to emphasize on the value of trichoscopy in diagnosing woolly hair syndrome, without using light microscopy. This can be applied to most of the hair shaft disorders where characteristic light microscopy features may be visualized by trichoscopy without the need of plucking hairs for diagnostic purposes.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 10: Diode Laser Hair Removal – Experience Over a Decade

Nirmaladevi P, Selvam A

AKJ Skin and Laser Centre, Tirunelveli, India

Diode laser hair removal is an established method and most suitable for skin types I-III. Though it is equality efficacious in skin types IV-VI, it produces some side effects which are usually reversible. Here, we share our experience with this laser for over a decade on South Indian skin (type IV and V). Patients with hypertrichosis and classical hirsutism and also some nevoid cases with hair growth who asked for laser hair removal were enrolled from March 2002 after explaining the procedure, expected outcome, and side effects, and obtaining informed consent including photography. Patients were investigated for hormonal abnormalities, polycystic ovarian disease (PCOD), and other features s/o hyperandrogenism (HA). Clinical features including hair type, density, sites, signs of HA, and irregular periods were recorded. Patients were treated with Light Sheer Diode (800 nm, single pulsed) ET, USA 9 mm Χ 9 mm sapphire tip with in-built cooling, with or without topical anesthetic cream at an interval of 6 weeks to 2 months and with anti-androgens in required cases. A total of 332 cases (330 females and 2 males) were treated, with age ranging from 12 to 60 years and majority in 2nd and 3rd decades. Classical hirsutism accounted for 61% (with HA 36%, normal 35%), hypertrichosis 29%, doubtful hirsutism/hypertrichosis 8.2%, postmenopausal women 2-3%, and nevus with hypertrichosis 3 cases. Thick hairs with fair complexion responded very well without side effects as also dark-skinned patients, but with certain reversible side effects like immediate burns and post-inflammatory melanosis. Number of sittings required ranged from 3 to 9; the average for hypertrichosis was 4, classical hirsutism with hormonal changes 7 and without 6, and for postmenopausal women 3. Diode laser is one of the best lasers useful for hair removal in South Indian skin. All cases except hypertrichosis of lips need to be investigated. Classical hirsute women needed more sittings, anti-androgens, and menstrual regulation for better outcome. Irregular periods and/or PCOD without evident HA by itself are independent factors promoting hirsutism and required more sittings and specific treatment.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 11: Silvery Hair Syndrome: Report of Three Cases

Parul Thakur, Sacchidanand S, Sahana MS, Ravi HN

Bangalore Medical College and Research Institute, Bangalore, India

Silvery hair is a rare syndrome of the pediatric age group, comprising Chediak-Higashi syndrome, Griscelli syndrome, and Elejalde disease. We report three cases with common presentation of silvery hair but varied systemic and clinical manifestations. Case 1: A 5-month-old female child, born of second-degree consanguineous marriage, presented with silvery hair and recurrent infections since birth. Investigations revealed anemia, neutropenia, and hepato-splenomegaly. Hair shaft microscopy showed irregular pigment clumps. Based on these findings, a diagnosis of Griscelli syndrome was made. Case 2: A 15-day-old male child, born of second-degree consanguineous marriage, presented with silvery hair since birth all over the body. Elder sibling with similar history died of recurrent infections at the age of 5 months. Investigations revealed anemia with thrombocytopenia and hepato-splenomegaly. Irregular pigment clumps were seen on hair microscopy. A diagnosis of Griscelli syndrome was thus made. Case 3: A 4-year-old female child, born of second-degree consanguineous marriage, presented with silvery hair all over the body since birth, spastic diplegia with delayed milestones, microcephaly, and bilateral congenital cataract. Hair microscopy showed numerous pigment clumps. A diagnosis of Elejalde disease was made. These case reports highlight the spectrum of disorders in children presenting with silvery hair. Early recognition and investigation can aid in improving the course of illness in these patients. Occurrence of bilateral congenital cataract with Elejalde disease has not been reported to the best of our knowledge, and needs further investigation.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 12: Keratosis Pilaris Atrophicans: Report of Two Cases

Priyadharshini S, Nirmaladevi P, Punithavathy K, Dhanalakshmi K, Judith Joy S, Sivayadevi P

Tirunelveli Medical College, Tirunelveli, India

Keratosis pilaris atrophicans (KPA) is a rare folliculo-centric keratotic disorder associated with scarring alopecia and widespread keratosis pilaris described in both sexes. Here, we are reporting two cases, one male and the other female. Our first case is a 16-year-old male and the second one is a 17-year-old female, both born of non-consanguineous marriage. Both presented with papular skin lesions with oozing and crusting, with onset from 1 to 2 years. Both had extensive keratosis pilaris over the entire trunk and extremities, prominent around umbilicus and sides of chest, and erythema over cheeks. Both had palmoplantar keratoderma. The first case has diffuse hair loss over the entire trunk and extremities, with remnant patchy hairs over the axillae, chest, and forearm. The second case had erythema over eyebrows, with scarring alopecia of lateral half with erythema over cheeks suggestive of ulerythema ophryogenes. She also had anhidrosis. Investigations showed fairly normal counts except increased eosinophils. IgE was increased in the second case. Biopsy of papule of the first case showed follicular hyperkeratosis with dense lympho-histiocytic infiltration and plasma cells in infundibular area and fibrosis of destroyed follicles. Papule from the second case showed dense lympho-histiocytic infiltrate with scattered eosinophils in the entire perifollicular and perivascular regions with fibrosis of destroyed follicles. Biopsy from eyebrow lesion showed perifollicular lympho-histiocytic infiltration and destruction. Both patients were treated with oral retinoids and doxycycline, with disease remission to some extent.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 13: Ichthyosis Follicularis with Alopecia and Photophobia Syndrome: Case Report with Treatment Response

Priyanka Jain, Rachita Dhurat, Meghana Phiske, Ameet Dandale, Smita Ghate, Meeta Mantri

Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India

Ichthyosis follicularis is a keratinization disorder characterized by spiny follicular papules all over the body since birth and, when associated with alopecia and photophobia, it is known as IFAP syndrome. IFAP syndrome results from congenital absence or marked defect in pilo-sebaceous apparatus. The prognosis is variable, and treatment modalities include keratolytics, emollients, urea preparations, and topical retinoids. A 3-year-old boy, born of a third-degree non-consanguineous marriage, presented with dry rough skin over body and scalp, with partial loss and easy breakability of hair since birth. There was a history of photophobia since birth. His growth and developmental milestones were normal. There was no history of hearing deficit. Cutaneous examination revealed diffuse thinning of scalp hair with partial loss of eyebrows and multiple keratotic papules giving a sand papery texture to skin all over the body. There was no scarring around hair follicles. Hair mount revealed no hair shaft defect. Our patient had good response following topical retinoids and 2% minoxidil along with oral biotin. Thus, we report a case of IFAP syndrome which is a rare entity. This case is reported for its good response to treatment and its resemblance to keratosis pilaris variants which should be considered in its differential diagnosis.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 14: Congenital Generalized Terminal Hypertrichosis with Gingival Fibromatosis: A Report of Two Cases

Rahul Kumar Sharma, Tanumay Raychaudhury, Sarah Mathai, Renu George

Christian Medical College, Vellore, India

Congenital generalized terminal hypertrichosis (CGHT) with gingival fibromatosis is a distinct entity caused by mutation in locus X24 - X27.1. We describe two females presenting with this syndrome. Case 1: A 7-year-old girl of non-consanguineous parents presented with excessive terminal hair growth all over the body since birth. The mother took methyl dopa for pregnancy-induced hypertension in the last trimester. There was no family history of similar problem. Patient had generalized hypertrichosis affecting the entire body, sparing only the palms and soles. She also had depressed nasal bridge and gingival fibromatosis affecting upper gums. Her endocrine workup was normal. She had mild hepatomegaly on ultrasound. Case 2: A 2-year-old girl born of non-consanguineous parents presented with complaints of excessive hair growth all over the body since birth and delayed eruption of teeth. The development milestones were normal. There was no family history of similar problem. Cutaneous examination revealed generalized hypertrichosis affecting the face, trunk, extremities including the dorsum of fingers and toes. A single cafι-au-lait macule was noted over the trunk. She had gingival fibromatosis of the upper gums. Based on these features, diagnosis of the CGHT with gingival fibromatosis was made. Patient 1 was also noted to have a depressed nasal bridge, which has been reported previously. These cases are reported here for their rarity. The differentials of CGHT will be discussed.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 15: Down's Syndrome with Hypertrichosis

Sundaram Rajagopal

KG Hospital and Postgraduate Medical Institute, Coimbatore, India

A 23-year-old male was referred to skin department from Intensive Medical Care Unit (IMCU) for associated skin problems. He was admitted in IMCU with seizure-like activities, hyperventilation, stridor, irritability, and restlessness. He was found to be having bilateral vocal cord palsy and hypocalcemia. On examination, he was in altered sensorium. Dermatological examination showed furunculosis, deep folliculitis of posterior neck, low-set small ears, keratosis pilaris, scrotal tongue, and strikingly excessive growth of scalp hair. Down's syndrome is usually and very commonly associated with alopecia areata and sparse hair. This case is presented for its rare presentation of hypertrichosis with Down's syndrome.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 16: Cutis Verticis Gyrata

Ramesh V

Skin and Laser Clinic, Warangal, India

A 21-year-old male patient presented with folds over the scalp. The folds started around puberty and increased in number. On examination, the folding of the skin over scalp was arranged in an antero-posterior direction over vertex and was transverse over the occiput region. Hair was sparse over the convexities of the folds. Cutis verticis gyrata (CVG) is a morphological syndrome in which there is hypertrophy and folding of the skin of the scalp to present a gyrate or cerebriform appearance. Polan and Butterworth classified CVG into primary and secondary forms. Primary CVG of unknown etiology is more common in men. There is a strong association with mental retardation. Secondary CVG has been described with wide range of underlying causes. Congenital melanocytic nevi appear to be the most common, but many other nevoid abnormalities have been reported. The essential abnormality appears to be overgrowth of the scalp in relation to underlying skull. CVG typically affects the vertex and occipital scalp, but it may involve the entire scalp. The folds are usually arranged in an antero-posterior direction, but may be transverse over the occiput. Hair density may be reduced over the convexities of the folds. Investigations and treatment are aimed at identifying and treating the underlying causes.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 17: Dissecting Cellulitis of the Scalp

Ramesh V

Skin and Laser Clinic, Warangal, India

A 20-year-old male patient presented with painful confluent nodules forming tubular ridges with an irregular cerebriform pattern on a red and edematous background near the vertex of the scalp. Thin blood-stained pus was exuding from crusted sinuses. There was some scarring and alopecia in the area. The condition was present since 2 years. There was no cervical adenitis, and it was not associated with hiadradenitis suppurativa, acne conglobata, pilonidal sinus, and spondyloarthropathy. Clinical photographs were taken; routine to special investigations like culture for bacterial and fungal growth and a scalp biopsy were carried out. The histopathology showed perifollicular infiltrate of lymphocytes, histiocytes, and polymorphonuclear cells. The patient responded well to isotretinoin (1 mg/kg) with prednisolone (1 mg/kg) and erythromycin 500 mg four times daily.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 18: Marie Unna Hereditary Hypotrichosis: A Rare Case Report

Sahana MS, Sacchidanand S, Hiremagalore R

Indira Gandhi Institute of Child Health, Bangalore, India

Marie Unna hypotrichosis is a rare autosomal dominant inherited condition that has a distinctive type of hair loss that varies with child′s age. It is characterized by sparse or absent hair at birth with regrowth of coarse, wiry, twisted hair from childhood, followed by progressive loss on approaching puberty. A 12-year-old male child born of consanguineous marriage presented with progressive worsening hair thinning and loss since puberty. He had absent hairs on scalp, eyebrows, and all over the body from birth. There was regrowth of hairs from the age of 4 years, with progressive loss of hair again from past 2 years. There was no history of similar symptoms in the family or siblings. Examination revealed coarse, dry, wiry, twisted hair, with patches of hair loss on occipital area. Sparse eyebrows and eyelashes were present. No other abnormalities were present. Hair shaft examination showed irregular twisting. Based on history and examination, diagnosis of Marie Unna type of hereditary hypotrichosis was made. Hair abnormalities are commonly seen in genetic syndromes. Diffuse hereditary hair defects as isolated phenomenon are rare, but hereditary hypotrichosis is an example of such a disorder. It is important that any case of uncombable hair should be looked for facial dysmorphism and associated abnormalities, and carry out pedigree anomalies to come to exact diagnosis. This case is presented for its rarity and its association with unaffected family.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 19: Hairy Mouth

Shanmuga Sekar C, Kumaresan M

PSG Hospitals, Coimbatore, India

Ameloblastoma is a benign, locally invasive odontogenic neoplasia, usually affecting the bones of the maxillary-mandibular complex. We report a case of hair growth in the oral cavity post grafting for ameloblastoma. A 19-year-old male came with complaints of hair in the oral cavity since 2 months. Patient had a slow-growing mass in the mandible for the past 7 years. Biopsy was done and he was diagnosed with ameloblastoma. Surgical resection was done and bone graft was placed from the fibula along with the overlying skin. Patient noticed hair growth in the grafted site 15 days after surgery. The hair was plucked from the grafted site. Patient has been asked to follow-up after 1 month. Ameloblastoma is one of the most common types of odontogenic tumors; however, it accounts for only 1% of all oral tumors. It is a benign tumor whose importance lies in its potential to grow to enormous size resulting in bone deformity. Radical surgical excision with bone grafting is the treatment of choice for larger lesions. The patient presents with hair growth in the oral cavity 15 days post grafting. Hair growth in the oral cavity post grafting may be due to the donor dominant nature of the skin graft. Sebastian et al. have reported a case of intraoral hair growth in the transferred skin pedicle up to 3 months after surgery. We report this case because of its clinical rarity.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 20: A Vicious Cycle of Telogen Effluvium, Menorrhagia, and Anemia: A Case Report and Critical Analysis

Sindhura M, Jayadev Betkerur, Basavaraj KH, Kanthraj GR

JSS Medical College and Hospital, Mysore, India

We report a 15-year-old female patient who presented to the skin department with complaints of diffuse hair loss since 2 years after menarche. She gave a history of menorrhagia since 1 year. There was no h/o similar complaint in the family and chronic illness. Hair examination showed diffuse sparse, brittle, lusterless, and hypopigmented hair. Hair pull test was strongly positive with effortless pull. On routine investigations, the hemoglobin was only 2 g/dl and peripheral blood smear showed microcytic hypochromic anemia. Serum ferritin was as low as 6 ng. Telogen effluvium is a form of non-scarring alopecia characterized by diffuse hair shedding, often with an acute onset. A chronic form with a more insidious onset and a longer duration also exists. It is a scalp disorder characterized by thinning/shedding of hair resulting from the early entry of hairs into the telogen phase. Emotional or physiological stressful events may result in an alteration of the normal hair cycle. It is a reactive process caused by a metabolic, nutritional, or hormonal stress, or by medications. Generally, recovery is spontaneous and occurs within 6 months. Telogen effluvium should be considered as a marker of anemia. Women in India, like our case, require careful monitoring for menorrhagia and anemia. In premenopausal women, common causes of anemia are menstrual blood loss and pregnancy. Hemoglobin concentration can be used to screen for iron-deficiency anemia, the most common type of anemia leading to diffuse hair loss.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 21: Tinea Capitis in Rural Tamilnadu

Sivasankari S, Senthamarai S, Anitha C, Amsavathini SK, Venugopal, Sundaram M

Meenakshi Medical College and Research institute, Kanchipuram, India

Tinea capitis in rural areas is mistaken for folliculitis, eczema, and pediculosis by rural medical practitioners, resulting in chronicity and refractory course without proper treatment. A male aged 8 years with kerion and female aged 4 years with tinea capitis are being reported. Treatment given by rural medical practitioners in the form of topical medications combining antibiotics, steroids, pediculocidal lotions, oral antibiotics, and antihistamine could not offer cure and disease progressed unabated. Routine hematological and biochemical investigations were found to be normal. Microbiological culture revealed staphylococci and streptococci. Scrapings and hair root for fungus showed the presence of dermatophytes. Fungal culture (Sabouraud′s medium) was done to confirm and identify the species. Topical antifungal lotion and oral terbinafine showed good response. Early diagnosis and proper antifungal therapy is essential to prevent the cicatricial alopecia and distressing disfigurement that follow improper treatment of tinea capitis.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 22: Acute Telogen Effluvium Associated with Chikungunya Fever: A Case Report

Sivasankari S, Senthamarai S, Anitha C, Amsavathini SK, Venugopal, Sundaram M

Meenakshi Medical College and Research Institute, Kanchipuram, India

A female aged 20 years developed fever and arthralgia of 10 days duration, which was later diagnosed as chikungunya fever and confirmed by investigation. While under treatment, she started losing hair over the scalp, progressing even after the treatment is over. After 2 months of the disease, she presented with baldness over the frontal and parietal areas. Bizarre bald patches were seen in the parietal area. The surface appeared smooth without the presence of rudimentary hair. Routine investigations were normal. Serological tests were positive for chikungunya. Treatment with topical steroids, minoxidil, and tacrolimus could not help. This case is reported for the alarming rapidly progressing nature of non-scarring alopecia secondary to the common viral epidemic of chikungunya.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 23: Hair Transplantation in Frontal Fibrosing Alopecia: A Report of Two Cases

Vaggu Anand Kumar, Damkerng Pathomvanich1, Ratchathorn Panchaprateep1, Shobit Caroli1, Kulakarn Amonpattana1, Oravan Pathomvanich1

Krishnanagar Colony, Hyderabad, India,1DHT Clinic, Bangkok, Thailand

Objective: To evaluate the long-term result of hair transplantation in frontal fibrosing alopecia (FFA) in conjunction with medical treatment. Materials and Methods: We performed complete hair transplantation of scalp and eyebrow in the first case and only scalp hair transplantation in the second case. Two years of stability was noted in both the cases. In the first case, medical therapy with dutasteride and pimecrolimus was started when we noticed loss of grafts on temple and eyebrows after 1½ years of surgery. Unlike the first case, in spite of good growth of transplanted grafts in the second case, we advised simultaneous use of dutasteride 0.5 mg one tablet daily and topical pimecrolimus 0.1% ointment twice daily for external application. Results: Results of both cases were analyzed by photographic analysis. In the first case, after 1 year, graft growth was excellent, but after 1½ years, there was minimal hair loss over eyebrows and temple. Regrowth of lost hair was noted on eyebrows, but not on temple with medical therapy. Whereas in the second case, good growth was noted after 8 months and the patient wanted second transplantation which was done 10 months after the first one. Conclusion: Hair transplantation in FFA should be carefully performed only after stabilization of the disease for few years. Medical treatment pre- and post-operatively can give appreciating long-term results. However, as this is an ongoing study, long-term results of these cases need to be analyzed. Lastly, it is very important to inform all the patients of FFA about the disease nature, recurrence, variable response to medical therapy, and subsequent graft loss at any time in life.

Int J Trichology. 2012 Jul-Sep;4(3):226–232.

P 24: Griscelli Syndrome: Two Case Reports

Shankari.J, Shubha, Tharini, Janaki C, Manoharan K

Department of Dermatology, Madras Medical College, Chennai, India.

Introduction: Griscelli syndrome is an autosomal recesive condition characterized by silvery hair, partial albinism with or without immunodeficiency and neurological manifestation. Case 1: Four yrs old female child was brought by her parents with complaints of grey coloured hair all over the body since birth and no other complaints. General and systemic examination were normal. Dermatological examination revealed silvery hair all over the body. Palms, soles, nails and mucosa were normal. Provisional diagnosis of silvery hair syndrome was made. Hematological and biochemical parameters were within normal limits. Case 2: Seven yrs old male child born of second degree consanguinity was brought with complaints of grey hair since birth and history of recurrent respiratory tract infections. General and systemic examination were normal, except for hepatosplenomegaly. Dermatological examination revealed silvery hair. Palms, soles, nails and mucosa were normal. Differential diagnosis of Chediak higashi syndrome and Grescili syndrome was made. Hematological parameters showed pancytopenia. Biochemical parameters were normal. Direct microscopy of the hair shaft showed large irregular clumps of pigment in both the cases. Histopathological examination was also similar for the above two cases which showed enlarged hyperpigmented basal melanocytes with sparsely pigmented adjacent keratinocytes. Based on these findings, Clinical diagnosis of Griscelli syndrome Type III and Type II was made for case 1 & 2 respectively. Discussion: The main pathogenesis in Griscelli syndrome is Impaired melanosome transport, giving rise to failure of transfer of melanin to keratinocytes which results in the pigmentary abnormalities like silvery hair in scalp & eyelashes, hypopigmented areas in the fundus, recurrent chest infections and psychomotor retardation. Conclusion: Griscelli syndrome seems to be invariably lethal at an early stage. Awareness of the clinical presentation of this syndrome is crucial, so that life saving therapy like stem cell transplantation can be started early. The 2 cases are being reported for its rarity and to highlight the importance of early diagnosis.

Articles from International Journal of Trichology are provided here courtesy of Wolters Kluwer -- Medknow Publications

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