IADVL Textbook of Trichology Madura C, BS Chandrashekar
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abscess 216
formation 229
Acanthosis nigricans 302, 537, 541
Acetylcholine 196
Acne 207, 538
conglobata 207
decalvans 206
keloidalis 88, 208, 492
keloidalis nuchae 113, 208, 208f, 226, 405, 410
steps of excision of 411f
necrotica 208, 492
propionibacterium 207
therapy, dose for 542
Acquired hypertrichosis 296
lanuginosa 345
acquisita 296
Acquired immune deficiency syndrome 221, 265, 267
Acrodermatitis enteropathica 192
Acro-infundibulum 37, 53
Actinic keratosis 261, 272, 426
Actinomycin-D 187
Addison disease 343
Adenoma 303, 348
Adenosine 164, 165
monophosphate 164, 332
triphosphate 224, 358, 522
production of 372
Adipose-derived stem cells 166
Adjustment disorder 532
Adnexal mass 304
Adrenal disease 300
Adrenal hyperplasia, congenital 300, 302, 305, 306, 537
Adrenal malignancy 541
Adrenal tumors 541
Adrenaline 457
minimal 497
overdose 483
stability of 429
use of 475
Adrenocorticotrophic hormone 68, 82, 83, 300, 306, 332, 343
Advanced life support devices and drugs 14t
Agminate folliculitis 216, 217
Agonists piaglitozone hydrochloride 86
Airborne contact dermatitis 286
Albendazole 224
Aldosterone antagonist 542
Alexandrite laser 315, 315f
Alkaloids 164
Allergens 285
Allergic contact dermatitis 284, 397
clinical features 285
treatment 285
Allergic reaction 429
Alleviate pain 481
All-trans retinoic acid 165
Alopecia 17, 103, 178, 231, 232, 233f, 283, 324, 337, 338, 492, 513
around scar 484
atrophicans 205
causes of 169
chemotherapy induced 528
cicatrisata 205
congenital triangular 234b
diffuse 232
diffuse unpatterned 108, 140, 146f, 193, 194t, 426
male pattern androgenetic 73
measurement, extent of 380
mixed infiltration 208
partial 232
permanent 345
postpartum 184
pressure 212
radiation-induced 283, 496f
radiotherapy 111
retrograde 456
secondary scarring 491
senescent 73, 212
totalis 17, 19f, 24, 80, 171, 172f
types of 260, 261t
universalis 80, 171, 172f, 178
Alopecia areata 7, 18, 24, 44, 67, 78, 82, 82fc, 83, 83f, 108, 151, 151f, 157, 169, 169, 174, 179, 188, 194t, 217f, 254, 254t, 255, 255t, 338, 381, 385, 466, 509, 529, 533
active 186f
acute diffuse 24, 173
association of 170f
autoimmune nature of 169
band-like 172f
biopsy in 171
classification 173
clinical pattern of 173fc
diagnosis of 174
differential diagnosis 174
diffuse 19f, 24, 150, 151f, 185, 478
disease course 175
environmental factors 170
epidemiology 169
etiopathogenesis 169
genetics factors 169
histopathology of 171
history and general 169
incognita 108, 173
investigations 174
management 176
multiple patches of 19f
nail involvement in 173
pathogenesis of 80b
pathology 171
prevalence of 169
prognosis 175
single patch 19f
stable 463
treatment of 179
Alopecia mucinosa 188, 206, 254, 492
pathology 206
Alopecia tool
score, severity of 174, 385
Alpha-melanocyte-stimulating hormone 83
Ambosexual hairs 300
Ambras syndrome 233, 248, 292
Ambu bag 14, 421
Amenorrhea 537
American Society for Dermatologic Surgery Survey 5
Aminexil 164, 165
Amino acids 164
Aminolevulinic acid 315
Aminophylline 14
Ammonium thioglycolate 71
Amphotericin B lotion 221
Anagen 42, 457
Anagen bulb 62
indicative of 22
Anagen effluvium 20, 24, 111, 184, 185, 187, 344, 345f, 485
causes of 187t
clinical features 187
differential diagnoses 188
etiology 187
investigations 188
pathogenesis 187
treatment 188
Anagen hair 56, 103, 151, 164, 283
bulb 102
melanocytes 501
follicle 36, 170, 533
normal 123f
regrowth, induction of 164
Anagen
duration of 37, 44, 51
inducing signals 44
induction of 187
phase 56, 67
proceeds 64
proportion of 102
regeneration 65
release, immediate 185, 191
shortening of 73
transition 64
Anaphylaxis 286
Androgen 44, 63, 68, 297
dependent hair 40
excess
signs of 536
independent hair 40
levels, low 73
receptor blockers 312
role of 301
secreting neoplasms 300
secreting tumors 537
sensitivity to 300
society 537
stimulation 44
treatment 77
Androgenetic alopecia 4, 7, 23, 44, 45, 70, 75, 76, 76b, 77, 77t, 80f, 102, 108, 108f, 128, 137, 139, 139b, 140, 148b, 152t, 157, 163, 174, 184, 185, 186f, 188, 192, 194t, 240f, 338, 358, 371, 373, 375, 381, 425, 440, 478, 504, 506, 507f, 509, 512, 532, 534
advanced 456
associations 152
balding in 67fc
classifications of 140, 140t
clinical approach 139
clinical presentation 139
diagnosis of 154
diffuse patterned 145f, 146f
epidemiology 137
etiopathogenesis 137
female 466
gene testing for 151
inflammation in 78fc
management 152
medical management of 164
oxidative stress in 78fc
pathobiology of 138
pathogenesis 163
reverse pattern 140
treatment of 162
unpatterned 150
Androgenetic baldness, hereditary 434
Androgenic alopecia 146f, 538
stages of 539f
Androstenedione 538
Anemia 192
acquired pernicious 98
congenital pernicious 98
intermittent 341
Anesthesia 428, 457, 460, 463, 510, 518
administering of 518
dose of 472, 475
effect of 430
medication 427
reduces bleeding 481
section of 477
techniques of 430
topical 429
tray with tumescent filled 432f
types of 406
use of 456
Anesthetic fluid, intracystic injection of 407
Anesthetic solution 429, 475
acidic pH of 429
Angioedema 286
Angiokeratoma 279
Angiolymphoid hyperplasia 288
Angiosarcoma 279
Angora hair nevus 276
syndrome 277
Anorexia nervosa 363, 532
Anovulation 537
Anthralin 177, 264
mechanism of action 177
side effects 177
Antiandrogen 542
selective 8
therapies 163
Antibiotics 428, 502
Anticoagulant 345
therapy 477
Antidandruff shampoos 506
Antidepressants 345, 532
tricyclic 528
Antigen presenting cells 78, 259
Antihyperlipidemic drugs 528
Anti-inflammatory
agents 78
drugs 495, 501, 502, 510
Antimineralocorticoid 541
Anti-Müllerian hormone 540
Antineoplastic agents 345
Antinuclear antibody 192, 195
Antiplatelet drugs 474
Antiprotease systems 73
Antiretroviral drugs 161, 345
Antithyroid
drugs 184, 191, 345, 528
peroxidase 528
Antituberculosis
drugs 528
therapy 528
Anxiety 28, 432, 532
disorder 532
Anxiolytics 345, 429, 481, 532
Aplasia cutis 201
congenita 232, 235, 235f, 282, 286
clinical features 286
treatment 287
congenital, classification of 287t
trunk in 236f
Apocrine 348
gland 276
carcinoma 354
Aponeurosis gape 404
Aponeurotica 401
Apoptosis 42, 75, 522
Appendageal tumors 403
Arborizing vessels 204f
Areolae 344
Arndt-Schulz law 371
Aromatase inhibitor 345
formestane 345
letrozole 345
therapy 538
Aromatic amines 335
Arrector pili
detachment 164
insertion of 50
muscle 39, 75, 78, 137, 138, 138f
anchorage of 76, 78
role of 138
Arrhythmogenic right ventricular cardiomyopathy 246
ARTAS system 438, 520, 521f
Arteriovenous fistula 484
Artery disease, coronary 139, 475, 476
Arthroconidia 101, 218
Articaine 429
Asexual hair 300
Aspirin 427, 474
Association of Hair Restoration Surgeons of India 4
Asteroid bodies 210
Ataxia telangiectasia 334
Atomic force microscopy 124, 262
Atopic dermatitis 170f, 219, 262, 269, 270f, 507, 529
Atretic cephaloceles 282
Atrichia 248, 248f, 460
conditions 244
congenital 231, 232, 233f, 529
Atrophic epidermis 209
Atrophic scar 492
mustache transplantation for 494f
Atrophic skin damage 486
Atropine 14
Auber's line 54f
Auricular artery, posterior 403
Autoantigens 82, 170
leading 82
Autocrine
activation 64
method 62
Autografts, source of 434
Autoimmune
bullous diseases 340
diseases 170
mediated disorders 83
vesiculobullous disease 270
Automatic phototrichogram systems 131
Automizing capacity 417
Autosomal dominant
disease 354
wooly hair 88
Axillae 344
Axillary hairs 47
Azathioprine 178, 187, 270, 499, 529
B
Bacopa monnieri 367
Bacterial infections 7, 214, 229, 226
classification of 226b
Bacterial synthesis 324
Bacterium 227
Baldness type, smooth patch of 217
Ball and socket hair 238
Bamboo hair 101
Bandage, soakage of 481
Barber-Say syndrome 293, 295
Bard parker handle 13
Basal cell carcinoma 239, 276, 352, 355f
Basal stem cells, epidermal 503
Basaloid cells 254, 352
Basement membrane bullous diseases 340
Basophilic cells 353
BASP classification 144b, 145f
Bazex syndrome 232, 239
Bazex-Dupre-Christol syndrome 248
Beaded hair 232
Beard 509
and eyebrow transplant 460
and moustache restoration 460
extraction 457
hair transplantation 496f
Becker's nevus syndrome 277, 294
Bees, swarm of 82, 171
Benoxaprofen 297
Benzodiazepine 519
Benzyl alcohol 225
Berardinelli-Seip syndrome 293, 295
Bernard-Soulier syndrome 386
Beryllium chloride 77
Beta-catenin pathway 76
Betamethasone
dipropionate 176, 264
oral mini pulse 176
valerate 176
Bexarotene 178
Bimatoprost 178, 542
Bioactive peptides 166
Biochanin A 166
Biochemical androgen excess 537
Biocompatible fiber, high quality 504
Biofibre, open knot of 505f
Biomedical waste management 421
Biomimetic peptide 166
Biopsy, multiple 103
Biotin 165, 324, 363, 364
adequate intake 324
causes release of 165
deficiency 324
signs of 324
symptoms of 324
dietary source of 365
excess of 165
food sources 324
function 324
Biotinidase 165
Biowastes, disposal of 413
Bipedicle flaps 515
Bipolar cautery 419
Bird-headed dwarfism 334
Bjornstad syndrome 120, 232, 239
Black piedra 220
Blade holding tip 420
Blaschkoid pattern 276
Bleaches 310
Bleeding 481
Blend technique 311
Bleomycin 187
Blood
estrogen 215
tests 23, 150
vessels, small 54
Body 462
dysmorphic disorder 12, 531, 532
mass index 21, 540
Body hair 231
loss of 366
complete 18
restoration 456, 460
transplant, indications for 456
transplantaion 8, 405, 456, 457, 459
pitfalls of 456
Bone
hyperplasia 349
hypertrophy 349
morphogenetic protein 36, 37, 54, 6264, 68, 77, 166
function of 65fc
Book's syndrome 232, 334
Botulinum toxin 165
type A 164
Bowen's disease 271
Brain
areas 83
derived neurotrophic factors 63, 67, 68
Brassempouy, venus of 4f
Brauer nevus 234
Bromocriptine 191, 345
Brooke-Spiegler syndrome 354
Broom hair 107
Broomstick appearance 341
Brushing wet hair 31
Bubble hair 101
electron microscopic image of 72f
Bulbous-peg stage 36, 51
Bullous ichthyosiform erythroderma 261, 271
Bupivacaine 428, 429, 475
dosage for 457
Burn syndrome 532
Burnt matchstick sign 111f
Busulfan 528
Buttery tumors 282
C
Caffeine 164, 368
CAHMR syndrome 293, 296
Calcidiol 326
Calcineurin inhibitor 177, 281, 499
Calcipotriol 499
cream 268
lotion 268
Calcitriol 264
Calcium 363, 366
Caliber hair, smaller 462
Camouflage 179
Cancers, endometrial 536
Canities segmentata sideropaenica 98
Cantu syndrome 233, 249, 293, 295
Cap wig 395, 395f
Capless wig 395, 395f
Caput succedaneum 287
clinical features 288
investigation 288
treatment 288
Carbimazole 191
Carbohydrate 364
diet and hair loss, correlation of 365fc
Carbon dioxide 492
Carbon monoxide 177
Carboplatin 345
Carbuncle 211, 226
Card test 99f
Cardiac complications 483
Cardiac intensive care unit 477
Cardiac toxicity, lower 475
Cardiofaciocutaneous syndrome 236
Cardiomyopathy, left ventricular 246
Cardiovascular disease, rates of 536
Carotid system, internal 402
Carpet tack sign 339
Cartilage hair hypoplasia syndrome 232, 235
Carvajal syndrome 232, 239, 240f, 245, 246, 250
Catagen 42
completion of 44
phase 51
Cataract 293
Catecholamines 63
Cavernous lymphangioma 279
Cell 360
apoptotic 56
mediated immune response 75, 86, 87
Cellular elongation region 54
Cellular factors 519
Cellular grafts 499
Cellulitis 207
dissecting 24, 207, 492
Central centrifugal cicatricial alopecia 113, 200, 206, 492
pathology 206
treatment 206
Central nervous system 429, 483
Cephalohematoma 282, 404
large 529
Ceramic scrub tank 415f
Cerebral malformation 235
Cervical hypertrichosis
anterior 292
posterior 293
Cervical lymphadenopathy 217f
Cetrimide 506
Cetuximab 187, 296
Chand syndrome 232
Chediak-Higashi syndrome 102, 122, 233, 241, 242f, 244, 245, 250, 334, 342
Chemotaxis 82
Chemotherapy 189
alopecia 111
Chest extraction 302, 458
Cheveux incoiffables 98
Chitin synthase 1, sequence of 218
Chlorins 315
Chloroquine 333
Chlorotrichosis 98
Chlorpheniramine maleate 14
Choi implanters 421
Cholestatic agents 190
Chromophore 372
Chromosome 11q13 82
4Q27 containing interleukin-2 80
9Q311 82
Chronic obstructive pulmonary disease 475, 477
Chronic telogen 532
Chronic telogen effluvium 18, 24, 111, 190, 191, 191t, 192f, 194t, 466, 467
causes 190
classification 191
clinical features 191
differential diagnosis 193
investigations 192
management of 193, 195b
pathogenesis 191
Chrysarobin 333
Cicatricial alopecia 7, 18, 24, 85, 99, 174, 200, 209, 211, 232, 235, 338, 339f, 405, 467f, 471, 491, 494f, 497, 506, 506f
areas of 517
classification of 200, 200t, 492t
end stage nonspecific 209
pathogenesis of primary 85
primary 50, 52, 85, 86, 86b, 202, 280, 495f
secondary 209
surgery in 492
types of primary 103
Cicatricial pemphigoid 210, 210f
Ciclopirox olamine shampoo 221
Ciclosporin 203, 296
Cimetidine 161, 528
Cisplatin 345
Citalopram 256
Citrate phosphate dextrose adenine 378
Citrullinemia 120
Clarithromycin 207
Classical flag sign 341f
Clear cell acanthoma 354
Clindamycin 207, 228
Clinodactylism, partial 158
Clofibrates 190, 191
Clonazepam 428
Clopidogrel 427
Cobalamine 363
deficiency 365
Cobb syndrome 279
Cobblestone appearance and pitting 487
Cockayne syndrome 235
Coffin-Siris syndrome 232, 233, 235, 248, 293, 295
Cognitive-behavioral therapy 256, 532, 534
Coiled hair 107, 186f, 255
Cold laser 372
Cole isolation technique 437
Collagen bundles 54
Coloboma 188
Color coded waste disposal bins 424t
Comb alopecia 206
Comedone extractor 485
Complete blood count 192, 195
Conditioners 390
benefits of 390
cationic molecules 390
hydrolyzed animal proteins 390
oils and waxes 390
polymers 390
Confocal microscopy 23, 103, 124
Congenital hypertrichosis 291, 292, 293fc
lanuginosa 291, 294f
Connective tissue
diseases 191, 337
disorders 337, 528
growth factor 376
sheets of 404
Conradi-Hünermann syndrome 201
Consanguinity 244
Contact dermatitis 267
Contact leukoderma 286
Continuous wheal technique 430
Contraceptive pills, stoppage of 29
Conversion personality disorders 28
Copper 165, 363, 366
Cork screw hair 100, 107, 114f, 186f, 219f, 341
Cornelia de lange syndrome 232, 233, 248, 293, 295
Corona psoriatica 260, 260f
Corona seborrheica 266, 266f
Corticosteroids 176, 179, 499, 529
topical 499
Cortico-Striato-Thalamic-Cortical circuits 256
Corticotropin-releasing hormone 83
Cortisol 63
Cortisone 45
Cosmetic 361
debris 223
treatment 541
Cosmetology 10
Costello syndrome 232
Cotrimoxazole 207, 224
Coudability sign 173, 173f
Counterirritating skin 430
Cowden syndrome 354
Crandall syndrome 120, 232
C-reactive protein 192, 195
Cri du chat syndrome 333
Crohn's disease 341
Cross-Mckusick-Breen syndrome 232
Crotamiton 225
Crowning glory 70
Cryptorchidism 158
Crystalloid 432
Curcumin 367
Cushing's syndrome 300, 343, 343f, 537
Cutis verticis gyrata 288, 288f
clinical features 288
investigation 288
treatment 288
Cyclophosphamide 187, 345, 528
Cyclosporine 178, 270, 499, 529
Cylindroma 354
Cyproterone acetate 81, 313, 359, 542
Cyst
classification of 348, 348t
dermoid 349
enucleation of 407f
epidermal 349
inclusion 350f
excision 406
Cysteine 326
Cytodifferentiation 63
Cytokines 63, 67, 493
Cytoplasmic fragments 375
Cytosine-adenine-guanine, number of 128
Cytotoxic drugs 184
Cytotoxins 227
D
Daily scalp hair counts 99
Danazol 297
Dandruff 221, 223
Dapsone 228, 270, 281
Darier's disease 258, 268, 269
Darier-White disease 258, 268, 269
Dark-colored skin 60
Darier's disease 261
Dasatinib 187
Deafness 237
Decalvans capillitii 88
Deep cervical nodes 403
Deep dermis 508
Deep folliculitis 211
Deep seated pigment 112
Deep vein thrombosis 477
Defeminisation, signs of 302
Dehydroepiandrostenedione 45
Dehydroepiandrosterone 538
sulfate 304306, 537, 540
Demipermanent hair dyes 391
Dendritic cells 170
Densitometry 7
Density telogen hairs 261
Deoxyribonucleic acid 77, 175, 219, 235
Depigmented hairs 73
Depression 28, 532
Depressive disorder 532
Derma operation theatre, regular 505
Dermal abrasion 352
Dermal cells, role of 36
Dermal condensation, mechanism of 66fc
Dermal fibrosis 206
Dermal papilla 54, 170, 240, 376, 475
anchoring of 166
cells 54, 77, 81, 157, 164
fibroblasts 44
forms 56
signals 56
Dermal sclerosis 103
Dermal sheath hyaline membrane 52
Dermascopy, live nits and lice on 223f
Dermatitis
artefacta 532,
chronic actinic 286
interface 103
irritant contact 286
passivata 532
Dermatofibrosarcoma protuberans 354
Dermatologic diseases 435
Dermatological therapy 534
Dermatology, integral part of 10
Dermatomyositis 271, 337, 339, 339f, 528
Dermatophyte 85, 214
growth of 215
Dermatophytid 217
Dermatoscope in trichoscopy, types of 130f
Dermatoscopic devices 105
types of 105
Dermatoses, life-threatening 532
Dermatosurgery theatre, regular 413
Dermato-Trichologist's communication skills 6
Dermis, upper 50
Dermoepidermal junction 52, 103, 280
Dermoid cyst 281, 350f, 405
clinical features 282
incidence of 281
treatment 282
Dermoscopy 12, 100, 105, 175, 218, 255, 261, 279
use of 123
Desmoplakins 340
Desmoplastic trichilemmoma 354
Desogestrel 541, 542
Dextrose 14
Diabetes mellitus 475, 476, 483, 486
type 2 536
Diamond-Blackfan anemia 235
Diazepam 428
Diazoxide 296
Dichlorodiphenyltrichloroethane 225
Dickkopf protein 77
Diclofenac 78
Diffuse unpatterned androgenetic alopecia 24
Diflorasone diacetate 264
Digital dermatoscope 105
Digital single lens reflexes 12
Diguanosine tetraphosphate 81
Dihydrotestosterone 73, 81, 137, 159, 163, 196, 301, 365, 366
activity of 75
inhibition 360
measurement of 538
Dihydroxyacetone 98
Dihydroxyphenylalanine 503
Dilantin, diazoxide 300
Diltiazem 161
Dinitrochlorobenzene 177, 179
Diode laser 292, 315, 316f
Diphenylcyclopropenone 177, 179
Discoid lupus erythematosus, complication of 338
Disposable biopsy punches 13
Distress, causes of 49
Dixyrazine 333
Docetaxel 345, 528
Docosahexaenoic acid 364
Dolly hair appearance 488f
Donohue syndrome 233, 249, 293, 296
Donor area 440, 441, 484, 459, 495
assessment 425
preparation 436
selection of 493
Donor density 456
Donor dominance, concept of 434
Donor fringe 456
Donor grafts 445
Donor hair 463
availability of 492
Donor harvesting, strip method of 440
Donor scars 426
Donor site 471, 475
effluvium after fue 485f
Donor zone
assessment 478
complications 483
thinning of 485
Dopachrome tautomerase 332
Dopamine 14, 84
Dormant hair follicles 543
Dot placement, pattern of 510
Double forceps method 451
Down syndrome 232, 234, 293, 295, 334
Doxorubicin 187
Drip set 14, 421
Drospirenone 541
Drug overdose 483
Drug therapy 312
Dry coarse hair 338f
Dry lusterless 341f
Dulbecco's modified eagle medium 501
Dutasteride 152, 160, 313, 359, 542
absorptions 160
adverse effects 161
bioavailability 160
contraindications 161
drug interactions 161
formulation 160
mechanism of action 160
metabolism and excretion 160
pharmacology 160
therapeutic guidelines 160
Dyskeratosis congenita 232
Dyslipidemia 536, 540
Dysmorphic disorder 28
Dysmorphic facies 234, 234f
Dysmorphophobia 532
Dysplasia, cranioectodermal 235
Dystrophic anagen 149, 151
hairs 338
E
Earbud appearance 123f
Ebling and Rook classification 143b, 143f
Eclipta alba 367
Ectodermal dysplasia 98, 232234, 234f, 249, 249f, 509
Ectodysplasin 65
Ectoparasitic infestation 222
Ectothrix 215
infection 217
invasion 101
Ectrodactyly-ectodermal dysplasia-clefting syndrome 188
Eczema 269, 297, 505
Edema, postoperative 482f
Efalizumab 281
Eflornithine 311
hydrochloride 311
topical 541
Ehlers-Danlos syndrome 240, 441
Eicosapentaenoic acid 364
Ejaculation disorder 160
Elastic stained sections 209
Electrocardiography 510
Electrodessication 354
Electrolysis 311
Electromagnetic rays 47
Electron microscopy 23, 124
Electronic combs 224
Electronic medical records 15f
Electro-optical synergy 316
technology 316
Electrosurgical epilation 311
complications 312
method 312
principle 311
Elejalde disease 342
Elejalde syndrome 233, 241, 244, 245, 334
hair microscopy 245
Eliot lateral scalp flap 515f
Emissary veins 403
Emotional stress 532
Encephaloelectrogram 283
Encephalopathy, chronic traumatic 30
Endocrine 170
abnormality 184
diseases 296, 342
disturbances 297
Endocrinopathy 187
Endothelial venule, high 259
Endothrix hair invasion 101
Endothrix infection 217
Endotracheal tube 14, 421
Enoxaparin 20
Enzyme 165
aromatase, higher levels of 538
deficiencies 301
Eosin 56
Eosinophilia 288
Eosinophilic compact keratin material 54
Epicranial aponeurosis 402
Epidermal cell 64
suspension 499, 502
Epidermal cyst formation 485
Epidermal growth factor 66, 333, 376, 522
receptor 260
Epidermal layer, repair of 49
Epidermal neoplasia 65
Epidermal nevus 201, 276, 277f, 348, 349f
syndrome 349
Epidermis 40, 49, 103, 354
regeneration of 49
Epidermoid cyst 353, 353t, 405, 489
Epidermolysis bullosa 201, 211
acquisita 340
dystrophic 232
Epilepsy 234
Epinephrine 432
addition of 481
vasoconstriction 432
Epithelial cell 49, 87
cluster 56
Epithelial hair lineages 43
Epithelial mesenchymal transition 75, 87
Epithelial stem cell 78
Epithelioma of Malherbe 352
Epitheliomas 348
Epithelium 53
Epitheloid cells 210
Erbium-doped: yttrium aluminum garnet 495
Erectile dysfunction 160
Ergocalciferol 366
Erosive pustular dermatosis 87, 209, 209f, 492
pathology 209
treatment 209
Erythema multiforme-like lesions 286
Erythematous
erosions 226f
plaques 260f, 270f
scaly plaques 280
Erythrocyte sedimentation rate 192, 195
Erythroderma 271
desquamativum 268
Estradiol 537
Estrogen 44, 63, 68, 542
effects of 45
levels 73
Estrone 537
Ethinylestradiol 542
Ethylenediaminetetraacetic acid 378
Etoposide 345
Exclamation mark hair 102, 107, 109f, 171, 255
Exogen 42, 44
Extracellular matrix 75, 76, 78, 81, 196, 519
integrity, loss of 163
role of 78
use of 519
Extracellular signal regulated kinase 80, 377
Extraction forceps 419
Eyebrow 18, 231, 319, 435, 462, 463f
aesthetics, Westmore's model of 462f
indications of 462
loss of 249f
restoration of 460, 461
transplant 464f
Eyelash 47, 231, 435
transplantation 464
Eyelid 267
tattooing 509
F
Facial dysmorphias 158
Facial erythema 206
Facial hair 460
restoration 456
Facial hemiatrophy 201
Facial psoriasis 261f
classification of 261b
Familial Lassueur-Graham-Little-Piccardi syndrome 88
Fanconi syndrome 334
Fascia, superficial 401
Fat 364
metabolism, dysregulation of 86
soluble vitamins 365
Fatty acids, essential 364
Faun tail 294
Favus 101, 216
characteristic lesions of 216f
dermatophytid of 218f
Female and male face sketch hairline 470f
Ferriman-Gallwey score 128, 302, 303f, 528
modified 129f, 302
Fetal
alcohol syndrome 296
dilantin syndrome 296
exposures 293
hydantoin syndrome 296
Fiber porosity 71
Fibroareolar tissue 440
Fibroblast growth factor 36, 44, 45, 6668, 360, 376, 499, 522
Fibromatous hamartoma 297
Fibronectin 54
Fibrosis 209
Fibrous tissue 85
Fibroxanthoma, atypical 354
Finasteride 76, 152, 159, 160, 162, 313, 359, 443, 542
absorption 159
adverse effects 160
clinical uses 159
contraindications 160
distribution 159
drug interactions 160
efficacy 359
formulation 159
intake 434
mechanism of action 159
metabolism and excretion 159
pharmacology 159
side effects 8, 359
therapy 459
Fine interfollicular scaling 112
Fisch syndrome 232, 334
Fitzpatrick type 319
Flag sign 98, 102, 341
Flame hair 107, 186f, 255, 257
Flap
multiple 515
surgery, tips for 410
technique 410
transfer 516
Flavoxetine 256
Floppy sock appearance 241f
Fluconazole 219, 222
Fluocinonide 176
Fluorescence microscopy 124
Fluorobutyrophenone 333
Fluoroscopy 345
Fluoxetine 20
Fluridil 313
Flutamide 313, 542
Fluticasone propionate 264
Focal dermal hypoplasia 201, 232, 236, 236f
Folate 363, 365
dietary source of 365
Fold sign 99
Folic acid 224
Follicle
bulge, epithelium of 164
growth of 488
layers of single 419
multiple 519
number of 441
openings, loss of 106, 113
primary 164
size of 299, 539
stimulating hormone 302, 306, 537, 540
unit transplantation, partial longitudinal 520
Follicular and eccrine opening, loss of 113f
Follicular atrophoderma syndrome 120
Follicular bulb 191
Follicular bulge stem cells 87
Follicular carcinoma 355
Follicular cell suspension 405, 499502
Follicular damage 436
Follicular degeneration syndrome 206, 209
Follicular dermal papilla 54
Follicular epithelial cells 63
Follicular epithelium 206, 254
Follicular extraction 8
instrument 418
Follicular germ, secondary 56
Follicular grafts 439
single 450
Follicular grouping 22
Follicular hair
single 519
transplant 520
Follicular hamartoma syndrome 232, 235
Follicular impetigo of Bockhart 226
Follicular infundibulum, segment of 52
Follicular isolation technique 437
Follicular keratinization 42, 207
Follicular keratinocytes 23, 54, 170
apoptosis of 77
Follicular keratosis 271
Follicular lichen planus 202
Follicular melanin unit 334, 501
Follicular melanocytes 170, 502
Follicular microinflammation 7477, 138
Follicular miniaturization, presence of 73
Follicular morphogenesis 35, 36, 37b, 51
Follicular mucinosis 88, 206
Follicular opening 109
Follicular orifice 35, 50, 174
single dilated 227
Follicular ostia 21, 255
Follicular papilla 54
Follicular papules 410
Follicular peg 51
Follicular plugging 280
Follicular protease 73
Follicular repigmentation 500
Follicular revascularization 79
Follicular spicules 106
Follicular stellae 150
Follicular stem cell 52, 138, 166
activation 166
destruction of 86
involvement of 85
Follicular structure 52, 476
Follicular syphilides 227
Follicular tissue 311
Follicular transection 434
fox test 435f
Follicular unit 39, 39f, 40, 52, 55, 138, 150, 164, 280, 360, 435, 438, 440, 441, 447, 456, 476, 487, 491
density 441, 521
extraction 212, 360, 405, 428, 434438, 438f, 440, 482, 493, 499502, 518
advantages of 502, 520
disadvantages of 502
indications of 435
limitations of 438
method 439, 439t
principles of 499
procedure 437
grafts 437
hair transplant 518
loss 209
problem of 435
separation extraction 435
single 437
transplantation 360, 405, 419, 434, 435, 479, 482, 493, 504, 509, 520
strip method of 440
Folliculitis 88, 226, 486, 487f
chronic 207, 226
dissecting 207
keloidalis 208
manifesting 226f
pre-existing 227
superficial 226
Folliculitis decalvans 24, 113, 206, 227, 492
clinical features 207
diagnosis of 228
end-stage variant of 207f
et atrophicans 202
etiology 207
multiple pustules in 227f
pathology 207
treatment of 207, 228
Folliculocentric
papules 208
scale 267
Folliscope 23, 131, 150
software 133f
Forceps method 451
FOX procedure 436
FOX test 435
Fractured hair 254, 255
Fragmentary ivory figurine 4f
Free hair fragments 206
Friar tuck sign 253, 253f
Fringe sign 282
Frontal fibrosing alopecia 19f, 24, 86, 87, 112, 200, 202, 203, 270, 466, 469
Frontal hair line 18
follicles 538
Frontostriatal-thalamic pathways 84
Frontotemporal
angle 18
hairline 144
point 470
FUE techniques 436
Fumigation, formalin gallipot for 418f
Fungal culture 218
Fungal infections 7, 211
Fungal spores 218f
Furunculosis 226
Fusidic acid 227, 228
G
Gabapentin 484
Galea 401
aponeurotica 402
Galeal scoring 513
Gallipots 417
Gamma benzene hexachloride 225
Gemcitabine 297
Genes 85
Genetic disorders 231, 232, 235, 236, 242
broad spectrum of 231
hair changes in 244
Genetic hair disorders, classification of 231
Genetic testing 128
Genetically heterogeneous syndrome 206
Genetically mediated disorder 137
Genitalia 344
Genodermatoses 244
Genogram score 529
Genotrichoses 231, 244, 527, 529
classification of 232b
management of 244
pathophysiology of 231
Genus pediculus 222
Germ stage 36, 51
Germinative follicular epithelium 254
Gestational diabetes 541
Giant cells 210
foreign body 209
Langhans type of 218
of Langhan's 281
Giant hemangioma 278
Giant pilomatricoma, excision of 410
Giemsa stain 206
Gilliam classification 337
Gingival
fibromatosis 294
hyperplasia 248
Ginkgo biloba 481
Glaucoma, congenital 236
Glia-derived neurotrophic factors 43, 44, 63, 67
Global hair counts 128
Glucocorticoids 296
Glucose
intolerance 537
tolerance test, impaired 540
Glutamate system 84
Glutathione 85
Glycogen synthase kinase-3β 77
Glycoprotein 137
Glycosaminoglycans 54, 78
Golf tee hair 238
Gonadotropic abnormalities 540
Gonadotropic function, dysregulation in 540
Gonadotropin releasing hormone agonist 81, 313, 345
Goosebumps, formation of 39
Graft cutting 443
Graft extraction 436
Graft failure 495
Graft growth, faster onset of 522
Graft handling 413, 478
Graft harvesting 461, 463, 475
method 471, 472, 474
Graft implantation 464
Graft implanter 455
Graft insertion 450
Graft placement 449, 450
Graft requirement 441, 471
Graham-Little-Piccardi-Lasseur syndrome 88, 236
Granite wall cladding 414f
Granular cell layer 353
Granulomatous inflammation 209
Gray hair 320, 328, 331, 335
characteristics of 331
follicles 331
treatment of 320
undergoes 334
Gray patch tinea capitis 217f
Gray patch type 217
Grenz ray therapy 263
Griscelli syndrome 102, 122, 123f, 233, 241, 242f, 244, 245, 250, 334, 342, 529
hair microscopy 245
Griseofulvin 219
Growing hairs 533
Growth factors 63, 67, 75, 76, 79, 376
Growth hormone 45, 68
Growth phase 51
Growth rate 459
Guanidine hydroxide 71
Gynecomastia, complained of 160
H
Hemorrhage, intraepithelial 254
Hair 7, 59, 70, 233, 245, 281, 392
abnormalities 231, 342
absence of 277f
acquired progressive kinking of 244, 247
analysis 49
anatomy 7, 313
and skin, interconnection of 49
angle of 447, 521
ball of 26f
barrier functions of 48f
bearing
flaps 512, 513
skin, diseases of 214
biology 49
bleach 285
block 107
blond 241
silver 245
brittle 237, 341f
broken 107, 110f, 114f
bulb 38, 54, 55f, 72
assessment of 149
melanocytes 331
miniaturized 171
bulge stem cells, activation of 76
caliber 457
camouflaging 152, 392, 394
disadvantages 392
topical fibers 392
card test 21, 21f, 97, 99, 148, 149f
casts 101, 106, 107
cells of 67fc
changes 345
drug-induced 344
typical 338f
club 193f
coarse 338f
collar sign 235
color 97, 245
abnormalities 98
colorants 335
colorless 276
comma 107, 114f, 186f
complete loss of 248f
comprises, aging of 70
cortex 215
cosmetics 7, 16, 389
categories of 389
conditioners 389
history 18
shampoos 389
type A 389
type B 391
coudability 107, 108, 186f
count, sixty second 99
crayons 393
cream
red brown 245
yellow brown 245
curly 232, 239
cycle 37, 42, 52, 187, 312
anagen of 311
clock 43
consists 185
control 43f
disorders of 184
dynamics of 171
endocrine controls of 44
evaluation 151
in anagen 45
molecular mediators of 43
phase 37b, 52
regulation of 63fc, 166
stages of 184b
degradation of 311
density 97, 139, 151, 346
changes 98
total 131
dermoscopy 12
destruction of 313
development and growth, control of 63t
diameter diversity 107, 150f, 186f
diameter index 447
diameter of 457
diseases 107t
disorder 10, 49, 97, 97t, 245t, 337, 340, 341, 342, 528
hereditary 88
management of common 529
dye 7, 285, 391
classification of 391
dermatitis 286b
dysplasia 231
excess of 7, 291
extensions 31
types 396
external surface of 124
facilitate cooling 47
fall 18
fiber 51, 71, 73, 392
absence of 99
change 74
producing unit 51
use of camouflage-like 472
follicle 35, 40, 44, 45, 4951, 52f, 54, 62, 74, 81, 106, 165, 187, 192, 215, 276, 301, 312, 313, 331, 426, 428, 441, 502, 503, 520
aging of 70, 72
anagen phase of 82
anatomy of 35f, 50f
anchorage of 188
apoptosis of 185
bioengineered 166
cells 326
cycling, regulators of 45fc
density of 102, 214
development 36
empty 186f
gross anatomy of 56, 56t
hamartomas 201
induction 66fc
microscopic anatomy of 37, 52
miniaturization of 163
miniaturized 137
morphogenesis 62, 64
movement of 49
normal 59f
nutrition and energy 164
openings 106
part of 206
single 113f, 461
stem cells, microenvironment of 75, 86
thinning of 75
types of 40
vascularization of 40
follicles immune privilege 82
collapse of 170
dysfunction of 82
follicular
growth, inhibiting 77
melanocytes 502
stem cells 76
unit 460, 463, 499
folliculogenesis and cycling 377f
fractures 122f
fragility test 23f
function of 47, 48f
germ, secondary 42
graying 72
histopathology of 334
gross structure of 35, 50
growth 44, 67, 371
cycle 36, 313
cycle, normal 51
effects on 527
factors controlling 62
factors enhancing 62
hormonal control of 68
initial 177
methods of control of 62fc
minimum terminal 538
pattern of 302
rate 151
window 97, 100
huge balls of 192f
implantation, artificial 405, 504, 508
in periphery, tufts of 207f
infections of 214b
infestations of 101
inspection of 98
intermediate miniaturized 139
interrupted 107
intrapilary portion 215
invasion, types of 101
keratin proteins, synthesis of 363
length and
fragility of 245
styling 428
light microscopy of 241
lightly depigmented 241
line recreation 456
line with pitting, lower 487
line, low and flat 487f
loss 7, 17, 17f, 27, 29, 31, 49, 73, 85, 165, 169, 185, 291, 324, 328, 338, 344, 367, 368, 380, 528, 529
challenges and counseling 26
chemotherapy induced 528
diagnosis of 151
diffuse 98, 339f, 468f, 539f
disorders, majority of 24
drug-induced 528
evaluation 17, 139b
evaluation of 17
evaluation questionnaire 18b
female 467
female pattern 7, 73, 108, 137, 139, 192, 206, 373, 466, 467, 467f, 468f
general assessment of 18
herbal diet in 367
impact of 26
in female, patterned 20f
in men, patterned 20f
Ludwig pattern in female-pattern 143f
Ludwig pattern in male-pattern 142f
male pattern 23, 75, 76, 128, 140, 159, 373, 466
management of 358, 360t
marginal 98
medical management of patterned 156
Norwood pattern of 487
pathogenesis of 81f
patients 30
pattern of 18, 21t, 24, 73, 97, 98
permanent 200, 288
prevalence of 156
progression of 18
quantifying 192
reverse 284b
role of diet in 363
severe 144f
treatment for male-pattern 153fc
treatment of 156
treatment of female-pattern 153fc
triggering of 190
types of test performed in 193t
maintains 434
massages 229
micronutrients 323
microscopic examination of 23
microscopy 119
miniaturization of 148f
morphogenesis 67t
completion of 65
mount
test 22, 149
simple 120f
normal 71f
number of 163
nutrition 360
papilla gets 42
patch of white 98
peg stage 36, 51
photoaging of 71
physiology 313
pieces
integration 396
patches 396
toupee 396
types 396
pigment anomalies of 331
pigmentation 310, 332
pinning devices containing metals 285
pluck test 175
pomades 268
powders 255
premature graying of 245, 333
presence of 405
primordial 36, 51
promotion of 360
prosthesis, types of 394
pull test 21, 22f, 97, 99, 99f, 149, 149f, 175, 188, 189, 192194, 254
modified 22f
question mark 107
red 98, 241
regeneration 67t, 68t
regrows 487
regrowth
begins 464
promotion of 164
removal 315
nonlaser methods of unwanted 309
Research Society of India 4
restoration 434
restoration surgery 7, 434, 360, 424t, 434, 478
father of 434
root 106, 151
sample collection, methods of 7
segmented heterochromia of 98
shaft 39, 47, 53f, 55, 56, 74, 115f, 150, 218f, 246f
abnormalities, types of 100
abnormality 98, 231
abrupt breakage of 254f
aging 71
cross-section of 37f, 53f
defects 101, 244
diameter 102
disorders 7, 114, 231, 236, 240, 529
disorders, classification of 246t
examination 21
genetic of 231
inner root sheath 51
light microscopy, normal 120f
malformation of 120
maturation 365
medulla 52
nit attached to 123f
normal 124f, 125f
shedding 24
short regrowing 186f
snow white 245
stimulates growing phase of 79
stimulating complex 81
straightening 391
style, particular 469
styling products 390
sudden whitening of 334
syndrome 250
tapered 102, 107
thickness 151
thinning 18, 24
total number of 151
transplant 413, 466, 474, 510f
diagnostic tool in 116
epinephrine in 432
female 472
results of 509, 522
surgeon 476
surgery 11, 468, 472
transplantation 6, 152, 410f, 413, 423f, 432, 445, 466, 472, 478, 481, 482, 486, 491, 492, 495f, 496f, 522, 543
complications in 478, 482
electronic movements for 417f
operation theater setup 413
patient selection for 424
purpose of 468
steps of 494f
surgery 6
theater, location of 413, 414
tufted 107
tug test 22
tulip 107, 109, 111, 111f, 255
tumors 7
types of 299
units, single 470
unruly 232
upright regrowing 107, 193f
weathering 71
white 149
forelock 245
with atrophy
loss of 204f
patchy loss of 205f
yellow 98
Hairline 446, 446f, 470f
design, problems with 487
designing 468, 475
higher position of 475
part of frontal 480f
regression of 469f
Hairstyling products 285
gels 285
mousses 285
oils 285
tonics 285
Hairy
areas, implantation in 452
elbows 293
Hallermann-Streiff syndrome 232, 235, 334
Haloperidol 256
Hamartoma syndrome, multiple 354
Hamburger sign 254
Hamilton's classification 137, 140
Hamilton's grades 507
Hand eczema 286
Handheld dermatoscope 105, 130f
Heart disease 258
congenital 234
Hedgehog signaling pathway 80
Helical rims 434
Heliotrope rash 339f
Hemangioma 279
Hematoxylin 56
Hemidesmosomal transmembrane collagen 86
Hemocrine method 62
Hemolysis 325
Hemophagocytosis 529
Hemorrhage 481
degree of 279
Hemostasis 406
advantage of 407
duration of 432
Henle's layer
inner root sheath 42
keratinizes 54
Hepatic growth factor 44
Hepatitis B virus vaccination 88
Hepatocyte growth factor 43, 45, 67, 157
Hereditary hair
disorders, pathophysiology of 88t
loss, hereditary 29
Hermansky-Pudlak syndrome 232, 245
Hiccups 483
Hidradenitis suppurativa 207, 228
acne inversa 228
diagnosis of 229
management of 229
Hirsutism 7, 44, 291, 292, 292f, 292t, 299, 309, 528, 537, 538
androgenic alopecia 538
causes of 300
diagnosis and evaluation 301
differential diagnosis of 305t
etiology 300
grades of 304f
investigation of 304, 306t
management of 309
pathogenesis 301
presence of 538
prevalence 300
Histiocytes 207, 210
Histocompatibility complex, major 67, 82, 83, 170
Hockey-stick appearance 123f, 149
Hodgkin's disease 267
Hoffman's disease 207
Homocystinuria 245
Homodimeric glycoprotein 540
Honeycomb pigment pattern 60, 113, 150
Hormonal control 63
Hormone 191, 299, 359
analysis, interpretation of 304
Horseshoe-shaped area 440
Hot comb 31
Hot-air treatment 224
HoVert technique 127, 127f, 280
Human hair 40, 57
generation 77
wig 394
Human immune system 511
Human immunodeficiency virus 190, 191, 215, 267, 333, 386
Human leukocyte antigen 80
Human recombinant thrombin 387
Human scalp 214
Human sodium-dependent multivitamin transporter 324
Hunter syndrome 233, 249, 293
Hurler's syndrome 233, 249, 293, 295
Huxley's layer 54
Hydrocortisone 14, 78
buteprate 264
Hydrogen bonds 71
Hydroxychloroquine 203, 270, 536538
Hydroxyprogesterone 305, 306
Hyperandrogenemia, biochemical 538
Hyperandrogenetic syndrome 139
Hyperandrogenic skin syndrome 313
Hyperandrogenism 536, 537, 540
signs of 159
Hyperesthesia 483
Hyperglycemia 176
Hyperinsulinemia 301, 537, 539, 540
Hyperkalemia 542
Hyperkeratosis 262f, 354
Hyperostosis 207
Hyperplasia 348
benign prostatic 159
endometrial 541
Hypersensitivity reaction 86, 87
Hypertension 476
history of 20
Hyperthyroidism 297, 334
Hypertrichosis 233, 242, 248, 291, 292, 292t, 293, 294, 295t, 297
acquired causes of 296b
congenital generalized 293t
cubiti 293
drugs-induced 297
lanuginosa 242, 248
temporary 297
universalis congenita 295
Hypertrophic scar 484, 484f, 485, 492, 495
Hypnotherapy 256
Hypoesthesia 483
permanent 405
Hypoestrogenic state 74
Hypofibrinogenemia 529
Hypoglycemia 483, 529
Hypohidrosis 234
Hypohidrotic ectodermal dysplasia 188, 234f, 239
Hypopigmentation 484, 488
Hypopigmented atrophic macules 236f
Hypopigmented scars, tiny oval 485
Hypoproteinemia 529
Hypotension, risk of 426
Hypothalamic gonadotropin-releasing hormone 537
Hypothermia 529
Hypothermosol 522
Hypothyroidism 184, 297, 343, 343f, 463
Hypotrichia
associated conditions 244
congenital 460
Hypotrichosis 248, 529
congenital 233
simplex, congenital 232, 233
I
Ichthyosis 201, 237, 248
absence of 249
acquired 296
presence of 249
Ikeda classification 173
Illumina microarray technique 80
Imiquimod 204
Immune privilege 67, 170
in hair, mechanism of 67fc
Immune reactions 82
Immunobullous disorder 210
Immunodeficiency disorders, primary 272, 272t
Immunofluorescence, indirect 189
Immunoglobulin
deposits of 52
granular deposits of 103
Immunological protection of stem cells, impaired 75, 87
Immunosuppressive drugs 345
Immunotherapy, topical 177
Impetigo 226, 267
contagiosa 226
Implantation 419, 458, 495, 519
by double forceps technique 451f
by needle and forceps 451f
Implanters 421, 454
Impulse control disorders 533
Inactive melanocytes 500
Incontinentia pigmenti 201
Indoleacetic acids 79
Infantile
hemangiomas 277
seborrheic dermatitis 267
Infection, superficial 87
Infectious disease 227
Infertility 541
Infiltration anesthesia 406408
Inflammatory
bowel disease 170, 229, 341, 342
cells
exocytosis of 103
infiltrate of 171
disease, severe 268
disorders 113
infiltrate, types of 50
scalp disease 269
stress 333
Infundibular epithelia 227
Infundibulum 35, 37, 50, 52
Injection technique 430
Insulin 68
like growth factor 43, 45, 68, 80, 157, 365, 377, 522
resistance 528, 537, 539
clinical marker of 139
signal transmission 540
Intense pulsed light 316, 317f, 541
Interareolar region 458f
Intercellular adhesion molecule-1 260
Interferon 82, 296
Interfollicular
dermis 36
epidermis 64
levels 44
red loops 61f
region 112
scales 107
space 5961
vascular loops 60
Interleukin 260, 522
Internal malignancy 345
International Association of Trichologists 4, 7
International Society for Hair Restoration Surgery 4, 5
Intracrine method 62
Intradermal injection 166, 518
Intra-follicular neutrophilic infiltrate 207
Intralesional
corticosteroids 176, 203
cryotherapy 410
steroids 206, 410
triamcinolone 485
acetonide 492
injections 484
Intraocular pressure 178
Intrapilar hyphae 215
Intravenous dextrose normal saline 483
Invaginata 120
Ionizing radiation 184
Iron 325, 363, 366
deficiency 191, 192, 325, 341
anemia 185
dietary source of 366
regulation 325
source 325
status, assessment of 325
supplementation 326
Ischemia reperfusion injury 428
Isolated genotrichoses 244
Isolated pili torti 245
Isoniazid 20
Isotretinoin 20, 208
low dose 506
Isthmus 38, 54
Itraconazole 219, 222, 268
Ivermectin 224, 225
J
Jacquet's sign 97
Jadassohn nevus phakomatosis 349
James Harris's three-step extraction technique 437
Janus kinase
inhibitors 170
signal transducer 164, 167
Japanese hair straightening 71
Jaundice in perinatal period 529
Joints, disorder of 258
Juri flap 514, 514f
Juvenile cataract 98
Juvenile macular dystrophy 248
Juxtacrine method 62
K
Kaposi's varicelliform eruption 489
Kasabach-Merritt syndrome 278
Keloidal scars 484
Keloids 458, 485
Keratin
bonding hair extensions 397f
debris 216
epidermal 78
ichthyosis and deafness syndrome 232, 249
Keratinocyte 43, 54, 72, 276, 326, 500503
apoptotic 87
cortical 72, 73
growth factor 43, 45, 54
hyperproliferation 259fc
of interfollicular epidermis 76
proliferation 80
terminal 73
Keratinocytic nevus syndromes 277
Keratoacanthoma 349, 355f
Keratosis follicularis spinulosa decalvans 206, 258, 271, 271f, 492
pathology 206
Keratosis pilaris atrophicans 212, 236
follicularis 236
Keratotic
plugging 106, 112f
spiny lesions 206
Kerion 216
Ketoconazole 78, 164, 165, 221, 264, 268, 542
Kidney
function tests 428
tray 13
Kimura disease 288
Kinky hair 487
Klippel-Trenaunay syndrome 234
Knock down resistance 224
Kwashiorkor 102, 341
L
Lactic acidosis 293
Lamellar
fibroplasias 206
ichthyosis 232
Langer's lines 401
Langerhans cell 49, 53, 171
histiocytosis 258, 271, 271f
Lanugo hairs 47
hypertrichosis of 296
L-arginine 164
Laron syndrome 120
Laryngoscope 14
blades 421
Laser
hair reduction 313, 320
complications 319
contraindications 317
indications 317
parameter selection 317
postprocedure care 319
principles of 313
light therapy, low level 12
rooms 15f
scanning confocal microscope 132, 133f
surgery 352
therapy, low-level 166, 360, 371373, 543
Lassueur-Graham-Little-Piccardi syndrome 270
Latanoprost 178, 335, 542
Lawsonia alba 335
L-cysteine 164
Led pedestal lamp 417f
Leiner's disease 258, 265, 268
Leprosy 211, 463
Leukemia, acute lymphocytic 392
Leukotrichia, permanent 320
Levamisole 224
Levonorgestrel 541
Liaison treatment 16
Lichen planopilaris 18, 21, 24, 52, 86, 87, 103, 109, 112, 127, 202, 202f, 262, 270, 270f, 426, 466, 489, 492, 495f
pathophysiology of 86
stages of 112f
Lichen planus 202, 202f, 269
of skin 426
pigmentosus-like changes 286
Lichen spinulosis et folliculitis decalvans 203
Lichenoid lymphocytic infiltrate 203
Lidocaine 428, 429
solution 432
Light-assisted devices 371
Light-emitting diode 372
Lignocaine 428, 475
mixture of 457
use of 519
Lindane 225
Linear
donor scar 439
epidermal nevus 348
morphea 209f
scar 485
Linking extensions 397f
Lip, upper 302
Lipid dependent species 265
Lipid membranes 522
Lipid metabolism
dysregulation of 86
role of 75
Lipodystrophies 233
Lipoma 18, 403, 405
enucleation of 409f
Liposomal adenosine triphosphate, use of 522
Liposomal lidocaine 429
Liquid chromatography 538
Lithium 345
chloride 77
Liver
failure 191
fibrosis 87
function 192, 477
tests 428
L-lysine 364
Local anesthesia 428, 474, 475, 505
Local anesthetic
agents 428
eutectic mixture of 429
Local infiltrative anesthesia 406
Lone hairs with yellow dots 112f
Lonely hair sign 112
Loose anagen syndrome 24, 102, 111, 121, 184, 188, 232, 240, 240f, 241f, 254
clinical features 188
differential diagnoses 189
epidemiology 188
etiology 188
investigations 189
pathogenesis 188
treatment 189
Lorazepam 429
Loss of scalp hair 233f
body hair 233f
eyebrows 233f
eyelashes 233f
Lower arc 448
Low-level laser therapy, mechanism of action of 371
Ludwig's classification 140, 467, 468f
Ludwig's grade 467f
Ludwig's scale 137, 142b
Ludwig's system 143
Lumbosacral hypertrichosis 294
Lupus erythematosus
chronic cutaneous 86, 87, 103, 203, 204f
cutaneous 339
discoid 24, 112, 127, 279, 280, 338, 339f, 426
predilection of 528
Lupus hair 338, 338f
Lupus vulgaris 211
Lusterless hairs 188
Luteinizing hormone 302, 306, 537
Lymphangioma 279
circumscriptum 279
cutaneous 279
Lymphatic drainage 403
Lymphocytes 228
Lymphocytic leukemia 392
Lymphoid
cells 207
enhancer-binding factor 1 64
Lymphomatoid papulosis 286
Lymphoplasmacytic infiltration 206
M
Mace hair 110f
Macrocyclic lactone 224
Macrogingivae, congenital 295
Macrophages 170
Madarosis 463
Maffuci syndrome 279
Magnesium 363, 367
Magnifying loups, types of 420f
Malaria 191
Malassezia 165, 221, 265
furfur 265
phospholipases 265
species 78, 214, 259, 265
yeast 165, 265
colonization 259
Malathion 225
Malignant tumors 354
Malnutrition 192
Mammals, locomotion of 49
Marasmus 341
Marathon runners 49
Marie Unna hereditary hypotrichosis 240
Mass spectrometry 538
Matrix
apoptosis of 43
cells 62
keratinocytes 73
metalloproteinase 78, 81, 196
Medication, preoperative 427
Megakaryocytes 375
Megasessions 522
Melanocortin 1 receptor 332
Melanocyte 170, 333, 501, 502
epidermal 502
for repigmentation, reservoir of 500f
number of inactive 501
produce cytoplasmic organelles 72
reservoir of 500
stem cells 54
proliferation of 503
stimulating hormone 82, 332
transfer 499
Melanocytic cells 52
Melanocytic nevi, congenital 294
Melanogenic melanocytes 72
Melanoma 355f
Melanosome 72
transfer, defect of 72
Melatonin 45, 164
use of 77
Menke's kinky hair
disease 122f, 244, 245, 249, 250, 529
diagnosis of 245
syndrome 120
Menke's syndrome 237, 239f, 342
Menstrual
disturbances 536
dysfunction 541
Mental
disorder 83
statistical manual of 251
health counselors 531
retardation 293
Mephenesin 333
Mephentermine 14
Mepivacaine 428, 429
Mercury poisoning 345
Merkel cell carcinoma 354
Mesenchymal
cells 503
origin germinative cells 79
stem cells 166, 335
Mesh grafts 499
Mesoderm interaction mechanism 47
Mesotherapy 178
Messenger ribonucleic acid 358
Metabolic diseases 49
Metabolic syndrome 4, 232, 334
Metallothionein 326
Metanagen 51
Metformin 313, 541
Methionine 326, 364
sulfoxide repair 335
Methotrexate 20, 178, 187, 203, 281, 529
Meticulous hemostasis 408
Microcystic adnexal carcinoma 354
Microinflammation 78
Micromotors, essential for 416
Micropigmentation 509
contraindication 509
indications 509
postoperative instructions 510
procedural steps 509
Micropunches, manual and motor-driven 436f
Microsporum 215
audouinii 219
canis 219
species 218
Microsurgical flap transfer 512
Microthrombotic vasculopathic lesions 338
Microvascular tissue 515
Minoxidil 75, 152, 156, 158, 159, 163, 176, 206, 296, 358, 472, 542
absorption 157
adverse effects 158
clinical uses 158
distribution 157
drug interactions 159
efficacy 358
lower concentration of 158
mechanism of 157, 358
off-label indications 158
pharmacology 157
side effects 359
solution 493, 497
sulfate 157
topical 152, 159, 162, 495
Missense mutation 88
Mitochondrial
disorders 232, 241
encephalomyopathy 293
enzymes 165
Mitogen-activated protein kinase 80, 377
Molecular signaling pathways 377
Molluscum contagiosum 279
Mometasone furoate 176, 264
Monilethrix 88, 101, 114, 120, 223, 232, 238, 247
hair 107, 111, 115, 115f, 115t
Monoaminergic systems 84
Morphea 209, 339, 466
Morphogenetic proteins 44
Morse code hair 107
Mosquito artery 14
Motorized follicular unit extraction 437
Moustache 509
restoration of cleft lip 462f
Moynahan's syndrome 232, 235
Mucocutaneous herpes simplex infection 532
Mucopolysaccharide rich stroma 54
Mucopolysaccharidoses 233
Mucous membrane pemphigoid 340f
Muir-Torre syndrome 351
Multibladed knives 442
Multicomponent vessel pattern 113
Multifollicular units 487
Multi-hair follicular unit 150
Multiorgan disease 536
Multiple anomaly syndrome 235
Multiple wheal technique 430
Multipotent matrix cells 261
Multipotent stem cells, reservoir of 54
Multisystemic disorders 528
Mupirocin 227, 228
Muscle insertion 35
Musculoskeletal system 249
Myasthenia gravis 170
Mycophenolate mofetil 203, 270, 281, 499
Mycotic infections 214
Myeloid leukemia, acute 392
Myofibroblast transformation 87
Myotonic dystrophy 334
N
N-acetylcysteine 256
in trichotillomania 85fc
Nail
changes 174
disorder of 258
ectodermal dysplasia 88
patella syndrome 188
Nandrolone 297
National Cholesterol Education Program Guidelines 540
Natural hair 395, 395t
Natural killer
cell markers 171
ligands of 80
Naxos disease 232, 239, 246, 250
Necrobiosis lipoidica 210
Necrosis 483
Neodymium-doped yttrium aluminium laser 228, 511, 315
Neonatal cephalohematoma 287
clinical features 287
investigations 287
treatment 287
Neonatal erythroderma 238f
Neoplasms 211, 301
Nerve
blocks 430
fibers 54
growth factor 43
root plexus 49
Netherton syndrome 120, 237, 238f, 245, 250, 529
Neuralgia 483
Neurodegenerative disorders 342
Neurodermatitis 269, 532
Neuroectodermal melanolysosomal disease 342
Neurofibromatosis 188
Neurogenic inflammation 75, 86
Neurologic disorders 221
Neuromas 483
Neuromuscular junction 196
Neurotrophin 63, 67, 68
Neutrophilic cicatricial alopecias 206
Neutrophilic inflammatory disorder 227
Neutrophils 228
Nevoid hypertrichosis 248, 294
simple 294
Nevus 18
comedonicus 276
syndrome 277
sebaceous 277f, 349, 405, 408, 410f
lesions 349
serial excision of 409f
syndrome 277
New anagen hair 163
Niacin 363, 365
deficiency 527
source of 365
Nicotinamide adenine dinucleotide 328
phosphate 328
Nicotine 427
Nicotinic acid 190, 191
Nitric oxide, production of 372
Nocebo reactions 28
Nocturnal sedation 428
Nodulo-squamous syphilide 227
Nonbullous impetigo 226
Noncaseating epithelioid cell granulomas 281
Nonchemotherapeutic drugs 187
Noncicatricial alopecia 110, 231, 232, 339
Nonclassical adrenal hyperplasia 541
Nondermatologists practicing trichology 8
Nonhormone-dependent excessive hair 291
Noninfectious scaly scalp
diseases 272
disorders 258
Noninflammatory variants 217
Nonpolarized dermoscopy 105
Nonpulling light products 31
Non-scalp transplant 460
Nonscarring alopecia 20f, 22, 23, 75, 108, 133, 184, 235, 240f, 254, 337, 338, 341, 371, 413
irregular patchy 252f
Nonscarring tinea capitis 188
Nonspecific scarring alopecia 205
Nonsteroidal anti-inflammatory drugs 259, 386, 427, 474
Noonan's syndrome 188, 232, 236
Norepinephrine systems 84
Norgestimate 541
Norgestrel 541
Normal scalp, dermatoscopy of 59
Norwood-Hamilton classification 141b, 141f
NPRT system classification 146, 147b
Nucleotide polymorphisms, single 80
Nucleus accumbens 84
Numerous yellow dots 186f
Nutrition 7
Nutritional deficiencies 368
Nutritional diseases 341
O
Oasthouse disease 334
Obesity 527, 540
abdominal 537
Obsessive-compulsive disorder 83, 4, 252, 532
Occasional diarrhea 341
Occipital artery 403
Occipital scalp 228
Octreotide 191
Ocular hypertelorism 296
Oculocerebrocutaneous syndrome 235
Oculodental digital dysplasia 237
Odonto-onycho-dermal dysplasia 88
Oleic acid 221
Oligoanovulation 537
Oligomenorrhea 537
Oligoovulation 536
Olsen's classification 467
Omega-3 fatty acids 77
Omphalocele 158
Onychophagia 253, 532
Onychotillomania 253, 532
Operation theater wall 414f
Ophiasis inversus 171
Ophiasis pattern 172f
Ophthalmitis 206
Optical coherence tomography 124, 133, 175
Optical microscopy, normal 119
Oral antibiotics 206
Oral antifungals 268
Oral antioxidants, use of 77
Oral azole antifungal agents 221
Oral contraceptive 191, 297, 312, 528
pill 189191, 541
therapy 542
Oral corticosteroids, short course of 203
Oral finasteride 359
duration of 162
Oral glucose tolerance test 540
Oral isotretinoin 268
Oral mini plus 179
Oral pediculicides 224
Oral terbinafine 221, 268
Orbital cysts 235
Orentreich's landmark 512
Organogenesis 63
Organoid nevus syndromes 277
Orofacial digital syndrome 232, 235
Osteitis 207
Osteochondrodysplasia 233
Osteopenia 334
Osteoporosis 176
Outer root sheath 37, 38, 42, 52, 54
Ovarian
carcinoma 345f
disease 300
dysfunction 536, 537
function 537
hyperandrogenism, functional 537
Ovulatory dysfunction 537
Oxidative stress 7577, 85, 138, 164
Oxygen cylinder 14, 421
Oxyhemoglobin 314
P
Pachyonychia congenita 232
Paclitaxel 187, 345
Pain, atypical chronic 532
Palmoplantar hyperhidrosis 333
Palmoplantar keratoderma 206, 234, 250, 271
Pancreatic
cancer 356
diseases 191
Pancytopenia 529
Pangeria 333
Pantothenic acid 328, 363, 364
Papillary capillary dilatation 113
Papillomatous hyperplasia 349
Papular lesions 232
Papules, formation of 410
Para-aminobenzoic acid 335
Paracrine method 62
Paradoxical hypertrichosis 297, 320f
Parakeratosis 262f
Paraminobenzoic acid 429
Paraneoplastic syndrome 267
Parasitic infestations 214, 222
Parasitosis, delusions of 532
Parathyroid hormone 67, 68, 326
Paratoluenediamine sulfate 286
Paroxetine 256
Patches 396f
coalescing, small 172f
large 172f
multiple 172f
Patchy hair loss 98
Pautrier's microabscesses 206
Pazopanib 187
Pectus excavatum 529
Pediatric hair disorders, management of 529
Pediculicides, topical 224
Pediculosis capitis 101, 114, 214, 222, 225t
clinical features 222
diagnosis 222
differential diagnosis 223
life cycle 222
risk factors and transmission 222
treatment 223
with secondary eczematization 223f
Pediculus humanus var capitis 222
Peg-shaped teeth 249f
Pelvic ultrasound 540
Pemphigoid 340
benign mucosal 210
Pemphigus 340
foliaceous 261, 270f
vegetans 340
vulgaris 270, 340, 340f
Penicillamine 296, 493, 497
Peptides 196
mechanism of action of 196fc
synthesis, solid phase 196
Pericranium 402
Perifollicular
area 106
blood flow 165
blue gray dots 202f
erythema and edema 319f
fibrosis 77
hematoma 533
hemorrhage 254
inflammation 163
microinflammation 78
plugging with white patches 204f
pustules 113
scales 61f, 106
vascularization 164
Perifolliculitis capitis abscedens et suffodiens 207
Perineum 344
Periodic acid Schiff's 221
Periorbital dermatitis 286
Periorbital dermoids 282
Periosteum 401
Peripheral blood
mononuclear cells 82
smear 241
Peripheral nerves 428
Peripilar
casts 112, 112f
erythema 113
keratin cysts 101
keratin hair casts 223
scales 113
sign 106, 108f, 149, 186f
Permethrin 225
Perming agents 391
Pernicious anemia 170
Peroxiredoxin 5 82
Perpendicular injection technique 430
Phacomatosis pigmentokeratotica 277
Pharmacy and hair accessories and cosmetics 16f
Phenothiazine 297, 315
Phenyl acetic acids 79
Phenylketonuria 245
Phenylthiourea 333
Phenytoin 296
maternal consumption of 296
Pheomelanin 332
Phobias, cutaneous 532
Phosphate buffered saline 501
Photoaged hair, electron microscope picture of 72f
Photocontact dermatitis 286
Photography room 12f
Photophobia 206
Photosensitivity, drug-induced 267
Photothermal destruction 314
Photothermolysis, selective 314
Phototrichogram 23, 103, 129, 130, 150, 151
contrast-enhanced 103, 151
Phrenic nerve 483
Phthalocyanins 315
Phthiraptera 222
Physiologic stress 191
Phytic acid 326
Piccardi-Lassueur-Little syndrome 203
Piebaldism 509
Piedra 101, 122, 220
diagnosis of 220
treatment 220
Piedraia hortae 220
Pigmentary hair disorders 7
Pigmentation, honeycomb pattern of 60f
Pigtail hair 107
Pilar cysts 353, 407
Pili annulati 102, 116, 121, 241
lowers, acquired 71
Pili canaliculi 241
Pili pseudoannulati 121
Pili torti 101, 115, 120, 238, 247
Pili trianguli 116
et canaliculi 98
Pilli annulati 101
Pilomatricoma 352, 352f, 405
histopathology of 353f
on scalp 411f
Piloscope 521
disadvantages of 521
Pilosebaceous structure 52
Pimecrolimus 179, 499
Pimozide 256
Pin-point white dots, large number of 106
Piperidino-pyrimidine derivative 157
Piperonyl butoxide 225
Pituitary function, abnormal 537
Pityriasis
amiantacea 268, 269
etiology of 269b
circinata 272
rotunda 272
rubra pilaris 269, 271, 272f
steatoides 272
Pityrosporum 221
orbiculare 215
Placode formation, mechanism of 66fc
Plakoglobin 340
Plasma cells 207, 209, 228
Plastoquinone derivatives 335
Platelet 375
activation of 378
derived growth factor 79, 80, 166, 360, 376, 377, 522
lifetime of 427
physiology of 375
Platelet-rich plasma 80f, 165, 179, 212, 360, 375, 379, 385, 387, 443, 486, 519f, 522
application 383t
method and frequency 380
centrifuge unit and kits 13
classification of 377
kits 378
method 378
preparation of 377, 382t
procedure 386t
contraindications for 386
role of 179, 197
therapy 80, 360, 375, 380
Pluck test 23, 151
Plucking hairs 218
Pohl-Pinkus constrictions 100, 101, 107, 111
Polarizing microscopy 23
Polarized light microscopy 102
Polyamide
fiber 504
mixture 504
Polybutylene terephthalate 504, 505
Polycystic ovarian
disease 305, 306, 528
syndrome 536, 537, 538f, 539f
and hair loss 536
Polycystic ovary 536, 537, 539
syndrome 22, 23, 313, 540
Polydioxanone 442
Polyethylene terephthalate 505
high quality 504
Polymenorrhea 537, 542
Polymerase chain reaction 218
Polyostotic fibrous dysplasia 201, 232
Polystyrene 504
Polyurethane 504
Polyvinylpyrrolidone 390
Ponytail hair style 469
Porocarcinoma 355f
Porokeratosis of Mibelli 212
Porphyrins 315
Postauricular grafts 493
Postburn cicatricial alopecia 211f, 507f
Postimplantation care 455
Postinflammatory hyperpigmentation 319f, 458
Postlaser hypertrichosis 297
Postmenopausal frontal fibrosing alopecia 78
Postvaricella 297
Potassium hydroxide 174, 218, 221
P-phenylenediamine 285
Precipitated sulfur 221
Pregnancy-induced hypertensive disorders 541
Premature canities, pathogenesis of 332
Premolar hypodontia 333
Prenatal follicular germ unit, primary 56
Preslits method 451
Prilocaine 428, 429
Proanthocyanidins 164
Procyanidin 164
Progeria 333
syndrome 232
Progestin-releasing implants 345
Proinflammatory cytokines 78, 87
Prolactin 45, 68
Prolidase deficiency 334
Proliferating trichilemmal cysts 353
Propranolol 20
Propylene glycol 158
Propylthiouracil 191
Prostaglandin 81, 157, 165
analogues 164, 178, 179
D2 in androgenetic alopecia 79f
imbalance 75, 76, 79, 138
levels of 543
Protamine microparticles 385
Protein 68, 363
calorie malnutrition 191
composed of 519
loss, chronic 334
Proteoglycans 519
Proteus syndrome 277, 279
Protozoal infections 211
Prurigo nodularis 286
Pruritus 482
ani 531
Pseudo effluvium patient fears 28
Pseudo infundibulum 505
Pseudoeffluvium 194t
Pseudomonas 207, 226
Pseudomonilethrix 247
hair 115, 115t
Pseudonits 101, 223
Pseudopelade 506
Pseudopelade of Brocq 18, 113, 128, 205, 205b, 466
familial cases of 88
Pseudopyogenic granuloma 288
Psoralen 296
and ultraviolet-A 179
Psoriasis 99, 260t, 261t, 267, 269, 505, 529
aggravating factors for 259b
dermascopy of 262f
grading of 263t
histopathology of 262f
scalp severity index 263
sign of 260
Psychiatric disorders 7, 532
primary 531, 532
secondary 532
Psychic disorders, consequence of 532
Psychocutaneous
disorders, subcategories of 251
medicine encompasses disorders 531
Psychodermatological
disease 532
disorders 532
Psychodermatology 251, 531
Psycho-emotional stress 86
Psychogenic
excoriation 532
pseudoeffluvium 185
Psychopathologic disorders 28
Psychopharmacotherapy 532
Psychophysiological disorders 532, 534
Psychosomatic disorders 532
Psychotrichological disorders 532, 533
management of 531
Punctate corneal epithelial defects 206
Pupillary line 470
Purpurins 315
Pus
discharge 483
gram stain of 227
Pustulosis 207
Pyoderma gangrenosum 229
Pyogenic granuloma 489
Pyogenic infection, contagious superficial 226
Pyrethrins 225
Pyridine-2,4-dicarboxylic acid 166
Pyridoxine 363
Q
Qomoris methenamine silver stains 221
Quinquaud's disease 206, 227
R
Radiation-induced alopecia 283, 284b, 284f
Radiofrequency 408
unit 13
Rapid infiltration, avoidance of 518
Rapp-Hodgkin syndrome 232
Reactive oxygen species 164, 333
Rebora's classification 191
Rebora's method 100
Red blood cells 379
Red dots and globules 113f
Reflectance mode 103
Reflected light microscopy 102
Regional lymphadenopathy 216, 223f
Relaxation techniques 534
Relaxed skin tension line 402f, 404
Renal failure, chronic 191
Renal fibrosis 87
Renal functions 192
Renal impairment 477
Reperfusion injury 522
Repigmentation, marginal 500
Retinal dysplasia 98
Retinoic acid 327, 365
Retinoids 44, 164, 165, 190, 191, 264
induced telogen 191
Retroauricular area 260, 483
Riboflavin 363
Ribonucleic acid 235
Richard Meharg hair growth table 314t
Ridge melanocytes 60
Rifampicin, combination of 207
Ringer's lactate solution 443
Risperidone 256
Rituximab 281
Robotic device, use of 520
Robotic hair transplantation 438
Romberg's syndrome 201
Rombo syndrome 232
Root sheath, inner 37, 38, 54
Ropivacaine 429, 475, 483
Rotation flap 410
Rothmund-Thomson syndrome 232, 235, 245, 333, 334
Rotterdam criteria 300
Rubinstein-Taybi syndrome 233, 293, 296
Ruxolitinib 178
S
Sabouraud's sign 99
Sacral hirsutism 294
Safe donor area 434, 521
Safety valve hemotoma 404
Salbutamol, topical 281
Saline, normal 437
Sanfilippo's syndrome 293
SAPHO syndrome 207
Sarcoid 267
Sarcoidal infiltrates compress 210
Sarcoidosis 210, 281
clinical features 281
treatment 281
SAVA and Choi implanters 423f
Saw palmetto 164, 165, 367
berry 81
Scabies 262
Scales
presence of 61
types of 261
Scaling disorders 7
Scalp 70, 151, 266, 272f
allergic contact dermatitis of 285t
alopecia of 231
anatomical units of 405
and photographs, normal 144f
anesthesia 406
biopsy 23, 97, 103, 150, 174, 187, 405, 406
section of 78
technique 407f
block 406
brushings 218
chronic folliculocentric pustuloses of 226
closure techniques on 410
dermatoscopic examination of 23f
dermoids 281, 282
dermoscopy 59
diseases 276
disorders 7
dermoscopic findings in 108
types of 50
dissecting cellulitis of 113, 228
elasticity of 440
emissary veins connect surface of 404
erosive pustular dermatosis of 271
erythema 112
examination 97
exercise 441, 444
flaps 513
lateral 514
microvascular 515f
frontotemporal part of 157
fungal infections of 214
glidability of 21, 440
greasy flakes 266f
hair 49, 445, 460
decoration of 57
diffuse hypomelanosis of 334
follicle 52
premature graying of 334
protect 47
transplantation of 405
histopathology 50
hypotrichosis of 249f
immersion proxigraphy method 24, 103
incisions 404
infections 214, 214b, 229
classification 214
secondary causes of 229
inflammatory boggy swelling of 216f
involvement 270
laxity determines 404
laxity paradox 441
layers of 401, 401f
lesions 18
lipoma of 407
lymphatic drainage of 405
macular atrophy of 205
micropigmentation 509, 511f
mid 446, 446f, 449
modified psoriasis area and severity index 263
muscles of 403
neurovascular supply of 402
neurovasculature of 405
normal 50, 61
pathology 22
photography, tips for 12
possesses, midline 403
preparation 405, 407f
psoriasis 113, 219, 258, 259, 261f, 262, 263, 264t
differential diagnosis of 262t
epidemiology 258
histopathology 261
pathogenesis 258
phases of treatment 263
prevalence of 258
quality of life in 262
systemic treatment 265
treatment 263, 263t
reduction 512
surgeries 512, 513f
techniques, role of 516
with primary closure 512, 513
with tissue expansion 512
ringworm of 215
surface of 435
surgery 355f
surgical layers of 401, 403
tumors 348, 348t, 355
excision of 11
with trichoscope, visualization of 100f
Scanning electron microscopy 124
Scar 460
area 485
hypertrophy 492
phobia 484
reconstruction 456
revision 405, 435
tissue 519
Scaring alopecia, lipid in 86fc
Scarring 24, 464, 474, 484
abnormal 485
alopecia 20, 78, 112, 200, 204f, 209f, 210f, 211, 216f, 236, 261, 466, 491
classification 200
epidemiology 200
in psoriasis 260f
of scalp 340f
permanent 208
primary 103, 491
with follicular papules 270f
follicular keratosis 236
Schaumann bodies 210
Schimmelpennig syndrome 277
Schinzel-Giedion syndrome 293, 296
Scleroderma 209, 210f, 528
Sclerotic dermis 209
Scrota 531
Scurvy 341
symptoms of 341
Sebaceous adenoma 351
histopathology 351
Sebaceous carcinoma 349
Sebaceous cysts 403
Sebaceous duct 54
Sebaceous gland 39, 50, 64, 76, 79, 276, 281, 354
absence of 209
duct 35
loss of 206
Sebaceous nevus 277, 276, 279, 349, 350f
clinical features 349
histopathology 349
management 349
pathophysiology 349
Sebocytes 51, 64
Sebopsoriasis 113, 265
Seborrhea 505, 506
severe 507
Seborrheic dermatitis 18, 99, 113, 190, 191, 214, 219, 221, 223, 261, 262, 265, 266f, 267, 272t
dermoscopy 267, 268f
diagnosis of 267
epidemiology 265
etiopathogenesis 265
hallmark of 21
histopathology 267
of scalp 265, 266t
treatment 267
type 217
Seborrheic keratosis 350, 351f
differential diagnosis 351
management 351
Seborrhiec dermatitis 269, 507
Sebum plugs, formation of 507
Seckel syndrome 334
Secretory proteins 376
Selective photothermolysis, extended theory of 314
Selenium 363, 366
sulfide 221, 506
Semipermanent hair dyes 391
Senescent alopecia, characteristics of 73b
Sensation, loss of 487
Sensenbrenner syndrome 232, 235
Serenoa repens 164, 165
Serotonin 84
reuptake inhibitors, selective 256
Sertraline 256
Serum
ferritin 23
prolactin 306
triglyceride levels, elevation of 529
vitamin D 23
zinc concentration, low 326
Sex hormone-binding globulin 365, 540
low levels of 137
production of 537
Sexual hairs 300
Sezary syndrome 267
Shampoos and conditioners 285
Shiny tiny skin colored pinpoint papules 248f
Short anagen
phase 185, 191
syndrome 111
Short stature 237
Short vellus hair 255
Sidepin alopecia 174
Signal transducer 44, 76, 178
Signaling pathways 63, 76
role of 75, 77
Signal-regulated kinases 377
Silicon 367
Silver nitrate 417
Silvery gray hair syndrome 233, 241, 241f
Silvery hair syndrome 245, 245t, 250
Silvery white scales 21
Sinclair scales 137
Sisaipho pattern 173f
Sjogren's syndrome 170, 528
Skin 281, 401
biology 49
biopsy specimen 210f
diseases 507
disorder of 258, 337
electron microscopy of 241
fragility syndrome 232, 250
histopathology of 241
repigmentation 40
tension lines 403
with acneiform rash over face 343f
Skull
bone 356
deep component of 403
Slit
blade holders 423f
identification of 452
method 471
Slivering plate 419, 422f
Smooth triangular patch 234f
Sodium
bicarbonate 432
ampoules 14
hydroxide 71
tetradecyl sulfate 279
valproate 20
Somatic dysfunction 28
Somatoform 28
Sonic hedgehog 43,65, 67, 76
Sorafenib 187
Soudanense 219
Spa therapies 18
Sparing hair along scalp periphery 173f
Sparse hair 240f
Sparse inflammatory infiltrate 508
Sparse terminal hairs 113
Spina bifida 349
Spinal
cord defects 294
dysraphism 294
needle technique 430
Spinosad 224, 225
Spiradenomas 349, 354
Spironolactone 312, 542
Spirulina 367
Spongiosis 103
Spun glass hair 98, 102, 240
Squamous cell carcinoma 349, 355f
Squamous epithelium 281
Squaric acid dibutylester 177, 179
Stainless steel
surgical bins 418f
wall cladding 414f
Stanozolol 297
Staphylococcal
disease 226
infections 226
Staphylococci 269
Staphylococcus
aureus 87, 207, 226228, 239
epidermidis 227
lugdunensis 227
Starburst pattern hyperplasia 107
Starburst sign 113
Steel and titanium punches 419f
Stem cells 164, 166, 502
population 78
properties, maintenance of 86
regenerative 47
transition of 66
Stemoxydine 166
Stereomicroscopy 124
Sterile folliculitis 486
Sterilization equipments 426
Steroidogenesis, abnormal 537
Steroids 206
topical 176
Stethoscope 14
Stiff skin syndrome 233, 293
Stratum granulosum 203
Streptococcal infections 226
Streptomyces fradiae 311
Streptomycin 297
Stress hormone 83
Striate palmoplantar keratoderma 240f
Strip method 439t, 466, 476
Stroma 537
Stromal volume 539
Sulfasalazine 178, 341
Sulfides produce 311
Sulfonamide-containing antibiotic 224
Sulfonylurea receptor 157
Sulfur-containing amino acids 326
Sunitinib 187
Superantigens 227
Superciliary ridge 462
Supraorbital artery 403
Supraorbital foramen 430
Supraorbital nerve 406, 430
blocks 431b
Supraorbital notch 430
Supraorbital ridge 430
Supratrochlear 463
arteries 402, 403
nerve 402f, 406
veins 403
Surfactants 389
types of 390t
Sweat glands 281
Swelling, history of 18
Swollen pale keratinocytes 353
Syncopal attacks 426
Syncope 483
Synovitis 207
Synthetic hair 395, 395t
Synthetic wigs 394
Syphilis 211, 227
management 227
secondary 174
Syringocystadenocarcinoma papilliferum 354
Syringocystadenoma papilliferum 276, 351, 352f, 354
histopathology 352
Systemic lupus erythematosus 174, 279, 337, 338f, 527
T
Tacalcitol 264
Tachycardia 483
Tacrolimus 177, 179, 204, 206, 499
Tamoxifen 191, 297
Tazarotene 204
Telangiectasia and white atrophic areas 112f
Telogen 42, 44, 47, 103, 131, 457
effluvium 7, 24, 29, 44, 102, 105, 108, 128, 138, 174, 184, 186f, 188, 190, 192, 337, 344, 345b, 443, 527, 528
acute 102, 111
chronic 195b
classification 184
clinical features 185
differential diagnoses 185
epidemiology 185
etiology 184
investigations 186
pathogenesis 184
treatment 187
follicles 157
empty 193f
germ unit 42
hair 102, 149, 151, 158, 163, 166, 190, 192, 338, 426, 457
detection 131
follicle 51, 56
look lighter 458f
loss, chronic diffuse 190, 192
proportion of 253
short-lived 138
loss, simple 17
phase 56, 73, 184
release 158
immediate 185, 191
stage 44, 56
Temporal arteries, superficial 402, 403
Temporal peak 147f
grading 147f
Temporal triangular alopecia 232, 234
Temporal vertical flaps 514
Temporary hair
colorants 335
dyes 391
Teratogenic syndromes 296
Terbinafine 219
Term folliculitis keloidalis 208
Terminal anagen follicle bulbs 52
Terminal hair 73, 139, 292, 299
follicles 137
growth 302
hypertrichosis of 296
per vellus hair 40
presence of 528
Terminalization of hairs 301
Test grafts 493f
Testosterone 304
Tetracycline 206
Tetrahydroquinolines 79
Textile dyes 335
Thalidomide 281
Thallium poisoning 344
Thermolysis 311
Thermoregulation 47
Thiamine 363
Thiazolidinediones 541
Thick scars 492
Thioglycollate 311
Thrombin receptor agonist peptide 387
Thyroid
abnormality 22
disorders 97, 191, 192, 528
function tests 192
hormones 68
profile 23
screening 174
stimulating hormone 540
Thyrotoxicosis 343
Thyroxine 44
Tietze syndrome 232
Tiger tail
appearance 238f
pattern 120
Tinea capitis 24, 101, 114, 120, 122, 174, 186f, 215, 216, 217f, 218f, 219, 262, 269
complications of 217
epidemiology of 215
etiology 215
pathogenesis 215
risk factors 215
Tinea nodosa 220
Tissue 360
expansion 491, 515, 516f
disadvantages 515
planning 516
principles of 515
procedure 516
grafts 499
necrosis 486
reimplantation of 522
Tofacitinib 178
Tonsure alopecia 253f
Topical immunotherapy
contraindications 177
side effects 177
Touch sense 49
Tourette's syndrome 85
Toxicity 429
feature of 427
severe 483
Traction alopecia 19f, 110, 174, 211, 211f, 282, 283f, 460, 466
clinical features 282
in African women, risk factors of 283b
laboratory evaluation 283
treatment 283
Transforming growth factor 37, 44, 67, 82, 260
alpha 376
beta 36, 68, 79, 376, 522
Transmission electron microscopy 124
Transmitted light microscopy 102
Trauma 87
Traumatic alopecia 211, 211f
Traumatic scars 509
Treacher Collins syndrome 334
Treponema pallidum 227
Triamcinolone 428
Triangular alopecia, congenital 109, 110, 111f, 174, 232, 234, 234f
Trichilemmal cyst 353, 353t, 403, 405, 407
enucleation of 407f
histopathology 353
Trichilemmal keratin 54
central mass of 56
lines 54
Trichilemmal keratinization 353
Trichilemmoma 354
Trichobezoars 252
Trichoblastoma 354
Trichoclasis 101, 107, 232, 238
Tricho-dento-osseous syndrome 64
Trichodynia 18, 28
Trichoepithelioma 352, 352f, 354, 405
histopathology 352
Trichofolliculoma 351
Trichogram 23, 29, 102, 119, 150, 151, 153, 188, 189, 253
integral part of 123
Trichological parameters 129, 131
Trichology 10
birth of 3
future of 8
history of 7
practice 12
quackery in 7
rise of 5
surgical 401
unit
infrastructure of 11f
requirements for setting up 10
setting up 10
Trichomalacia 254, 283, 533
Trichomycosis
axillaris 101
nodularis 220
Trichonodosis 101, 107
Trichophytic closure 406, 442, 442f, 519
Trichophyton 215
infections 219
species 217, 218, 219
tonsurans 219
verrucosum 216
violaceum 215, 219
Trichoptilosis 101, 107, 254
Trichorhinophalangeal syndrome 188, 232, 234
Trichorrhexis
invaginata 101, 115, 121, 232, 236, 238, 238f, 246, 247
nodosa 101, 115, 116f, 120, 223, 232, 234, 236, 237, 237f, 246, 247
acquired 122f
Trichoscan 7, 13f, 103, 131
Trichoschisis 101, 232, 236, 237, 246
development of 71
Trichoscope 27
Trichoscopy 12, 22, 59, 100, 105, 108, 128, 149, 150f, 153, 194, 255
guided biopsy 100
of discoid lupus erythematosus 204, 204f
of lichen planopilaris 202f
of normal scalp 106
Trichosurgery 401, 405
advanced 405
tips for 405
working classification of 405b
Trichothiodystrophy 101, 121, 237, 237f, 238f, 246, 247
classification of 237t
Trichotillomania 24, 83, 84f, 109, 174, 185, 186f, 188, 212, 251253, 253t256t, 255, 256, 283, 532, 533
complications 254
differential diagnosis 254
epidemiology 251
investigations 254
over vertex area 110f
pathogenesis of 84b
pathophysiology 252
severity assessment 253
treatment 256
Trichotillosis 251
Trigeminal herpes zoster 211
Triglycerides 71
Trimethoprim-sulfamethoxazole 224
Triparanol 333
Tuberculosis 191
Tuberous sclerosis 245
Tufted angioma 297
Tufted folliculitis 207f, 228f, 340f
Tumescent anesthesia 406, 410, 427, 431, 441, 463
additives in 432
Tumor 303
classification of 348
like masses 410
necrosis factor 36, 87, 259, 260
Turner syndrome 234
Twisted capillary loops 107
Typhoid 191
Tyrosinase 332
Tyrosine kinase 178
inhibitors 334
Tyrosine level 540
U
Ulcerative colitis 170
Ulerythema ophryogenes 236
Ultra-thin split-thickness graft 499
Uncombable hair syndrome 102, 121, 188, 232, 236, 240, 244, 247
Universal atrichia, congenital 232
Unnatural hair line, correction of 487f
Urinary bladder diverticula 529
Urticaria 286
Uterine bleeding, abnormal 537
V
V hair 110f
Vaginal ultrasound 539
Valproic acid 77, 324, 345
Vascular endothelial growth factor 44, 67, 67fc, 79, 157, 165, 260, 358, 376, 522
Vasospasms 404
Vellus hair 40, 44, 50, 128, 150, 291, 293, 299, 310
carpet of 111f
cysts 239
hypertrichosis of 296
percentages 131
Vellus hypertrichosis 343
Venereal disease research laboratory testing 227
Verbal distraction 430
Verhoeff elastic-van Gieson stain 209
Vernix caseosa 47
Verrucous epidermal nevus 348, 349f
Vertex
parts of 448, 448f
transition
point 447f
zone 446, 448, 449
transplant 448b
Vertical autoclave machine 418f
Vessels 60
Videodermatoscopy 128
Videodermoscopy 12, 60, 100, 153
Viral infections 211
Virilisation, signs of 302, 345
Viscosity of dye 510
Vismodegib 187
Vitamin 364, 427
A 189, 327, 363, 365, 368
B 224
complex 364
B1 363
B12 192, 363, 328, 335, 484
deficiency 334, 365, 368
source of 365
B2 363
B3 363
B5 328, 363, 364
B6 328, 363, 484
C 363, 365
deficiency 341
dietary source of 365
D 67, 75, 80, 326, 327, 363, 366, 368
deficiency 170, 326
dependent rickets 529
dietary source of 366
functions 326
receptor 43, 171, 326
resistant rickets, hereditary 232, 233
role of 76
source of 326
supplements 327
D3 192, 264, 268
D3 deficiency 191
E 324, 325, 363, 365, 368
dietary source of 366
food sources 325
forms of 324
recommended dietary allowance 325
K 363, 368, 427, 428
Vitiliginous patch 246f
Vitiligo 499
disease activity score 499
repigmentation in 500f
Vogt-Koyanagi syndrome 232
Voltage sensitive sodium channel 225
V-sign 255
W
Waardenburg syndrome 232, 233, 245, 246f, 334
Warfarin 427, 474
Warts 279
Wash test 97, 100, 128
modified 193
Waste containers 13
Waxing 310
Weight gain 540
Werner's syndrome 232, 235, 245, 333, 334
White forelock 246f
White piedra 101, 220, 223
Whorl pattern observed on vertex 449f
Wide door with automatic closure 414f
Widow's peak 469
Winchester syndrome 233, 295
Winged helix nude 67
Wingless type integration site 43
Wiskott-Aldrich syndrome 272, 386
Wnt activation 44
Wnt dependent cells 64
Wnt independent cells 63
Wnt inhibited state 64
Wnt inhibitors 77
Wnt-mediated
functions 65t
signal transduction 63
Wnt signaling 64, 76, 77, 164, 166
in hair stimulation 76f
inhibitor of 36
pathway 63
roles of 76
Wood's lamp examination 100, 174, 218
Woolf syndrome 232, 245, 334
Woolly hair 98, 101, 121, 188, 232, 236, 239
diffuse 248f
disease 244
disorders 246
nevus 232, 234, 239
World Trichology Society 10
Wound dehiscence 483, 484f
Wound margin, necrosis of 484f
Wound superficial 404
X
Xanthotrichia 98
X-linked rare follicular syndrome 271
Y
Yellow dots, large number of 106
Yellowish thin verrucous plaque 277f
Yersinia pestis 222
Z
Zigzag hair 107, 109
Zinc 326, 363, 366
bioavailability 326
deficiency 326, 341
severe 326
signs of 527
food sources 326
oxide 310
pyrithione 81, 221, 222, 264, 506
sulfate 228
Ziprkowski-Margolis syndrome 232, 245, 334
Zolpidem 428
Zygomaticotemporal nerves 463
×
Chapter Notes

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1Introduction to Trichology
Section Outline
  1. Trichology: An overview
  2. Setting up a trichology unit
  3. Approach to a patient with hair loss
  4. Hair loss patient: Challenges and counseling2

Trichology: An OverviewCHAPTER 1

Venkataram Mysore,
Namitha Chathra
 
INTRODUCTION
Hair in Homo sapiens, who are also known as the naked apes, may sound like an oxymoron, but whatever little is left in them is of profound importance. Although hair no longer is a primary factor in temperature regulation and that we may be totally devoid of hair in the next centuries as a result of natural selection, its role in sexual identification remains undiminished at present. It comes as no surprise then, that there has been an explosion of hair care and management products in the last two decades and a renewed interest in physiology, pathology and management of hair.
 
HISTORY
Hair has always been of utmost fascination to the human race. Mythology all over the world has amusing tales associated with the hair.
In the Jewish bible, the secret of Samson's heroic strength was attributed to the length of his hair. Among the Hebrews, baldness was considered not only a defect, but also a curse.
Venus of Brassempouy, one of the earliest known realistic representations of a human face, is a fragmentary ivory figurine from the Upper Paleolithic (circa 23,000 BCE) found in Brassempouy, France. The checkerboard-like pattern on the head has been interpreted as a wig, a hood, or simply a representation of hair (Fig. 1.1). Combs are amongst the most ancient objects that archaeologists have found in their excavations.
The Native Americans believed that longer hair implied presence of more thoughts. For them, the hair has profound significance, for they believe that thoughts originating in the head emerge along with the hair.
Similarly, a peek into Chinese culture reveals the importance attributed into the arrangement of hair all through its history. The form of use of hair had a strong symbolic meaning, as haircuts or hairstyles always marked social or civil status, religion or profession. Not sporting any form of hair arrangement was considered by them as a sign of disease or depression.
Closer home, kesh is the most important of all the precepts of Sikhism. It is the practice of never cutting the hair as a symbol of respect for the perfection of God's creation.
These anecdotes are a few examples that illustrate humankind's obsession with hair.
As much as a lush mane on the scalp and abundant facial hair in men is universally desirable, presence of hair over other body parts in women is despised in several cultures worldwide. Distress caused by loss of hair over scalp is in the same league as that caused by the growth of hair over undesired sites. Thus the presence, as well as the absence of hair can be a cause of grave concern depending on the affected person's gender, race, age, and ethnicity.
Naturally, the study of hair and its disorders is a subject of keen interest across the globe.
 
The Birth of Trichology
Trichology is the name given to the study and practice concerned with the hair and scalp. It owes its origin to the ancient Greek word “thrix”, which means hair. In the modern era, the seeds of trichology were first sown around 1860 in a London barbershop by an academic named Professor Wheeler. However, it came to be officially known as trichology only in 1902, the year that also saw the formation of the first official professional association for trichologists–The Institute of Trichologists.4
zoom view
Fig. 1.1: Venus of Brassempouy, a fragmentary ivory figurine from the Upper Paleolithic era. The checkerboard-like pattern on the head has been interpreted as a representation of hair.
Over the next few decades, the branch started gaining momentum and the first trichology course was developed in 1974 at the University of Southern California under the tutelage of David Salinger, an office bearer of the Institute of Trichologists and also the newly formed International Association of Trichologists (IAT). The International Society for Hair Restoration Surgery was founded in 1993, while The Hair Research Society of India and Association of Hair Restoration Surgeons of India came into being in 2005 and 2008, respectively.
 
HAS HAIR LOSS AND BALDNESS BEEN INCREASING?
There is a general impression amongst trichologists that there is a steady increase in the number of patients with hair loss, patterned hair loss in particular. This opinion is ably supported by the findings of an Australian survey, in which 98.6% of men and 64.4% of women had reported bitemporal hair loss.1 Increasing awareness, availability of treatment modalities and easy access to care have perhaps contributed to the hike in the number of patients. Another reason for the rise could be androgenetic alopecia's (AGA) link to metabolic syndrome, a condition whose incidence has been increasing over the last few decades. Several studies have pointed towards association of AGA, early onset type in particular, with metabolic syndrome.28 A corollary to this is trichologists’ observation of a shift in the age group of the patients, present day patients being far younger than their predecessors.
 
PSYCHOLOGICAL ASPECTS
Being a naked ape, what remains of hair has proved increasingly important to the Homo sapiens–be it the lack or excess of it. There is an important link between hair and identity.9
People with severe hair loss are more likely to experience psychological distress.10 The experience of alopecia is psychologically damaging, causes intense emotional suffering, and leads to personal, social, and work-related problems.11 About 40% of women with alopecia have had marital problems as a consequence, and about 63% claim to have had career-related problems.12
At the same time, a high number of women seek effective treatment for hirsutism as it is viewed as a presumptive loss of feminity in many cultures. An Indian study estimated the prevalence of hirsutism to be 10% in women of child-bearing age group.13
A study on the psychological impact of hirsutism in women showed that a considerable amount of time was5 spent on the management of facial hair (mean—104 min/week). Two-thirds (67%) in the study population reported continually checking in mirrors, 76% reported checking by touch and 40% felt uncomfortable in social situations. High levels of emotional distress and psychological morbidity were detected; 30% had levels of depression above the clinical cut off point, while 75% reported clinical levels of anxiety; 29% reported both. Although overall quality of life was good, scores were low in social and relationship domains–reflecting the impact of unwanted facial hair.14,15
Another study found that the quality of life improved dramatically with Laser hair removal. The number of days spent removing hair reverted to baseline at 12–30 months post laser hair removal, and a significant decline was seen in the emotional burden on quality of life over time (p = 0.04).16
Several papers have documented the impact of loss or excess of hair on the psyche. Many of these patients may also be suffering from body dysmorphophobia, which needs to be identified and addressed at the earliest.17,18
 
DERMATOLOGIST—IS HE THE TRUE TRICHOLOGIST?
This question has arisen as many other specialists, alternative medicine doctors and non-doctors are advertising themselves as trichologists. Nearly 30% of hair transplant surgeries are performed by such doctors.
Hair is one of the three main subjects of study in dermatology, skin and nails being the other two subjects in the triad. Learning about the structure and function of hair is an integral part of dermatology syllabus. Following adequate training during postgraduation, a young dermatologist is quite capable of diagnosing most disorders affecting the hair and the scalp.
Management of hair disorders requires the clinical acumen of a physician as well as the dexterity of a surgeon's hands. A dermatologist, who inherits both these qualities by virtue of the postgraduate training, can master techniques of hair surgeries on completion of advanced training. The term “dermato-trichologist” may soon be the norm to address a dermatologist trained in and practicing ethical trichology.19
However, what has been observed over the years has been the rise of nondermatologist as a trichologist. Doctors from other specialties, alternative medicine specialists and even non-doctors are practicing as trichologists, the reasons for which are not hard to seek.
 
RISE OF TRICHOLOGY
The practice consensus released by the International Society of Hair Restoration Surgery (ISHRS) in 2017 had quite a few astounding findings:
  • It estimates that approximately 635,189 hair restoration procedures were performed worldwide in 2016, a whopping 60% surge as compared to 2014 (397,048 procedures performed).
  • Asia, the largest contributor with 195,284 surgeries, saw a surge of 36% in comparison with the contribution in 2014.
  • Extrapolated worldwide total number of hair restoration patients (surgical and medical) in the past year was 1,838,946, a massive increase of 74% when compared with the total number of 1,055,480 in 2014.20
According to the recently released 2014 American Society for Dermatologic Surgery (ASDS) Survey on Dermatologic Procedures, about 633,000 laser hair removal procedures were performed by its members in 2014—a 27% increase from 2013 and a 51% climb from 2012.21
This raising demand for trichology is not met fully by dermatologists because of several reasons:
  • The number of dermatologists is simply not enough to cope up with the workload.
  • Dermatologists are busy with dermatology, treating disorders affecting the skin such as skin cancer, psoriasis, eczema, leprosy, etc.
  • Dermatologists, even if they treat hair, do not have the time needed to handle hair cases.
  • Hair patients often have special requirements—they need detailed counseling, including psychological counseling, which are difficult to perform in a busy skin clinic.
  • Medical management options for hair disorders are limited with very few drugs and hence not challenging enough.
  • Surgical treatment is time consuming and has a steep learning curve.
This has led to the situation where nondermatologists have assumed the role of trichologists.
 
CHALLENGES FACED BY DERMATOTRICHOLOGIST
Successful management of hair disorders requires a two-pronged approach; expert handling of the technical aspect and empathetic dealing of psychological aspect.
On the technical front, factors that ensure a favorable outcome are—an accurate diagnosis, an in-depth understanding of the underlying pathophysiology, practice of evidence-based medicine, and standardized global photographic assessment and computer-assisted image analysis during every follow-up visit. While arriving at a diagnosis, the dermato-trichologist must explore the possibility of a multitude of factors underlying the hair disorder, and if found, a multitargeted treatment approach must be considered. Evidence-based medicine can be practiced effectively by integrating individual clinical experience with the best and latest available external evidence.22
It is a matter of some concern that despite extensive research, no new drugs have emerged for management of6 hair growth. All the drugs currently available are a result of serendipity. While so much is spent on research for the dead part of the hair, so little has been achieved for the living part of the hair. This has resulted in the industry advocating products with poor evidence and little scientific basis as standard treatment; for example, peptides, plant products, botanicals, mesotherapy, etc.
With respect to the psychological aspect, successful outcome depends largely on the dermato-trichologist's communication skills. Acknowledging the patient's concern and perception of hair loss forms the first step in establishing a rapport with the patient. After gaining the patient's trust, the dermato-trichologist must explore to assess the extent of patient's expectation from the treatment. The patient should then be educated about the biology of hair cycle and counseled about the need for patience while waiting for cosmetic recovery.2325
Patients are perceived difficult when they exhibit unrealistic demands with respect to the treatment outcome, and refuse to heed to the doctor's advice. Most often, these patients would have had a disillusioning experience with another physician in the past. However, a few of the difficult patients may have an underlying psychosomatic disorder, which has to be identified at the earliest. Ability to communicate well and an intent to understand and care for the patient will go a long way while handling a patient perceived to be difficult.26
Trueb RM has laid out the following recommendations for improvement of patient compliance:
  • Recommending treatments only in circumstances where they are required
  • Restricting the number of medications to a minimum, for example, prescribing a single compound comprising of a combination of several active ingredients
  • Improving the compliance by opting for preparations that need fewer doses during the day
  • Selecting a treatment modality that has lesser incidences of side effects or long-term risks
  • Discussing in detail about the possible adverse effects and methods to cope with them
  • Informing the patient about the importance of continuing medication irrespective of mild side effects
  • Ensuring regular follow-up and reassuring the patient about safety of the drug and benefits of continuing treatment
  • Forging a bond strong enough to allow a patient to confide the reason when unable to take a particular drug, allowing the doctor to suggest a more acceptable alternative.22
 
TEACHING TRICHOLOGY
While hair and its disorders are a normal fixture in the syllabi for residency and postgraduation courses, there is no doubt that not enough attention is paid to the teaching of this subject due to the crowded curriculum. While students learn about conditions like alopecia areata, hair shaft disorders and cicatricial alopecia, not enough time is spent on AGA, trichoscopy and drugs for AGA. Particularly, counseling skills, which are of paramount importance to a dermato-trichologist, are seldom imparted. The syllabus, therefore, needs to be revised thoroughly to encompass the topics discussed in Box 1.1.
 
HAIR TRANSPLANTATION SURGERY
Hair restoration surgery has had a checkered history, with many fits and starts; several discoveries have been made only to be forgotten, and to be retrieved and reused later. However, it can now be said that surgery has reached a stage of maturity and has produced consistent results. Surgical techniques have outstripped the advances in medicine, and it is no wonder that hair transplantation is now the most commonly performed cosmetic surgery. Surgeries are simpler, side effects commendably minimal and results are far more consistent than ever before. Several exciting advances such as robotics have seen light of the day. There is now a strong logic behind the methods of hair transplantation. Scientific advances in the field of instrumentation for extraction, holding solution, and cellular therapies have enhanced the consistency and efficacy of results. Greater amount of donor hairs can be harvested from beard and body, making it possible to treat even Stage 7 patients satisfactorily.
The procedures are now less invasive, with lesser down time. However, this has also resulted in the entry of technicians and doctors with poor techniques and training; and there is a fear that due to nonadherence to basic principles and standards of care, the technique may go into disrepute as it had happened in the 1960s. More seems to be merry as the number of grafts have consistently gone up, with surgeries extending over 3–4 days performed frequently. Poor standards of care have meant that unthinkable can occur, as in the case of the tragic death of a medical student in Chennai. There is a strong need to define standards of care.
 
Who Should Perform Hair Transplantation?
This has been a question that has been discussed often in recent times. The authors agree with the opinion of Association of Hair Restoration Surgeons that dermatologists and plastic surgeons are the natural and automatic choice as hair transplant surgeons. However, dermatologists need training in surgery and plastic surgeons in trichology. There have been claims that ear-nose-throat (ENT) surgeons can perform the surgery too, as ENT surgeons perform head surgery also.7
On the contrary, ISHRS permits all Bachelor of Medicine, Bachelor of Surgery (MBBS) doctors as members and leaves it to regulatory authorities in respective countries to regulate the physicians. While there is debate on this issue, there can be no doubt that dentists, alternate medicine physicians, and technicians should not perform this surgery.
 
Role of Technicians
Alarmingly, in the recent times, technicians are often employed by clinics to perform the surgery, often in the absence of a surgeon. With increasing mechanization and automation, this is likely to increase. However, this needs to be deplored strongly and role of technicians should be limited to assisting the surgeon and performing dissection of hair follicles.
 
QUACKERY IN TRICHOLOGY
The total market size for hair restoration surgery has increased by 64% since 2014, with an average number of 188 hair restoration surgical procedures being performed by an ISHRS member in 2016.20 Therefore, it is but natural that this field attracts young men and women from various specialties, the same way a flower attracts bees. The entry of nondermatologists is further fueled by the fact that many a times, obtaining an appointment with a dermatologist can be a time-consuming affair.
The International Association of Trichologists, which confers certification course in trichology, has only one eligibility criteria for accepting students—18 years and above. The association defines a trichologist as—“A trichologist helps people who have problems with their hair or scalp. The client may complain of sudden excessive hair loss from all over the scalp, a bald patch which has suddenly appeared, or itching and excessive scaling of the scalp. These are the sorts of problems a trichologist sees.” However, a disorder of hair is rarely that straightforward, the manifestation may just be the tip of an iceberg of underlying systemic illness. The pathogenesis of excessive hair growth or hair loss is most often a complex amalgamation of a multitude of factors. To manage such cases, interdisciplinary bonding with other specialties such as endocrinology, immunology, obstetrics and gynecology, psychiatry, and surgery is essential.19 These issues can be efficiently dealt with by a dermatotrichologist. On several occasions, the underlying disorders are not diagnosed by the quacks and the patients present to the dermato-trichologist at a much advanced stage of systemic issues.
Stringent laws have to be put forth to prevent the misuse of gullible patients at the hands of quacks masquerading as trichologists.
 
Role of Associations
Associations need to play a strong role in creating awareness, educating doctors and the public, imparting training, and influencing governmental organizations to ensure ethical practice. A case in example is the ISHRS, which through its website and social media activity, has played a major role in shaping public opinion about trichology.8 Indian Association of Dermatologists, Venereologists and Leprologists has laid down standard guidelines of care for hair transplantation and has also taken up with Medical Council and National Board of Examinations for starting fellowships in trichology.27
 
FUTURE OF TRICHOLOGY
It is a matter of concern that while millions of dollars are spent on products such as oils, shampoos, conditioners that target the shaft which is a dead portion of the hair, very little has been achieved so far for the living part of the hair. Drugs available currently for hair growth such as minoxidil and finasteride have been serendipitous discoveries and not products of designed research. And of these, compliance with minoxidil is poor, while there is profound apprehension about the side effects of finasteride. This is one of the main reasons why patients have often been unhappy with the treatment and sought help of alternative medicine healers.
Another factor to reckon with is the role of blatant advertisements by nondermatologists practicing trichology. Hyped advertisements with misleading content promising unrealistic results can be found in almost every city and town of India. Advertisements about platelet-rich plasma, stem cells, and follicular extraction are often confusing and misleading, and leave the patients in a quandary and doubt as to who is genuine and who is not.
The social media's habit of glorifying physical perfection has also played an increasing role in creating the demand for trichology services and has fueled its growth.
 
SUMMARY: WHAT IS IN STORE? HOW WILL TRICHOLOGY EVOLVE?
There is no doubt that the field and the time is ripe for major advances in the field. Much is needed in the field of:
  • Elucidation of immune privilege disorders such as alopecia areata and possible biologicals for such diseases
  • Cicatricial alopecia, and possible drugs for management to treat the fibroplasia
  • Drugs to convert vellus hair to terminal hair
  • Advances in instrumentation for follicular unit extraction and body hair transplantation
  • More selective antiandrogens with less concern about impotence
  • Stem cell treatment and cloning, which have remained in the realm of experimental treatment for long.
REFERENCES
  1. Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol Symp Proc. 2005;10(3):184–9.
  1. DeMuro-Mercon C, Rhodes T, Girman CJ, et al. Male-pattern hair loss in Norwegian men: A community-based study. Dermatology. 2000;200(3):219–22.
  1. Norwood OT. Male pattern baldness: Classification and incidence. South Med J. 1975;68(11):1359–65.
  1. Severi G, Sinclair R, Hopper JL, et al. Androgenetic alopecia in men aged 40-69 years: Prevalence and risk factors. Br J Dermatol. 2003;149(6):1207–13.
  1. Bakry OA, Moneim Shoeib MA, El Shafiee MK, et al. Androgenetic alopecia, metabolic syndrome, and insulin resistance: Is there any association? A case-control study. Indian Dermatol Online J. 2014;5(3):276–81.
  1. González-González JG, Mancillas-Adame LG, Fernández-Reyes M, et al. Androgenetic alopecia and insulin resistance in young men. Clin Endocrinol (Oxf). 2009;71(4):494–9.
  1. Mumcuoglu C, Ekmekci TR, Ucak S. The investigation of insulin resistance and metabolic syndrome in male patients with early-onset androgenetic alopecia. Eur J Dermatol. 2011;21(1):79–82.
  1. Cannarella R, Condorelli RA, Mongioì LM, et al. Does a male polycystic ovarian syndrome equivalent exist? J Endocrinol Invest. 2017.
  1. Weitz R. Rapunzel's Daughters: What Women's Hair Tells Us About Women's Lives New York: Farrar, Straus and Giroux;  2004.
  1. Hunt N, McHale S. Clinical review: the psychological impact of alopecia. Br Med J. 2005;331:951–3.
  1. Hunt N, McHale S. Reported experiences of persons with alopecia areata. J Loss Trauma. 2005;10:33–50.
  1. Hunt N, McHale S. Understanding Alopecia. London: Sheldon;  2004.
  1. Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev. 2000;21(4):347–62.
  1. Lipton MG, Sherr L, Elford J, et al. Women living with facial hair: the psychological and behavioral burden. J Psychosom Res. 2006;61(2):161–8.
  1. Keegan A, Liao LM, Boyle M. ‘Hirsutism’: a psychological analysis. J Health Psychol. 2003;8(3):327–45.
  1. Roche A, Sedgwick PM, Harland CC. Laser treatment for female facial hirsutism: are quality-of-life benefits sustainable? Clin Exp Dermatol. 2016;41(3):248–52.
  1. Cash TF. The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol. 1992;26(6):926–31.
  1. Kranz D. Young men's coping with androgenetic alopecia: acceptance counts when hair gets thinner. Body Image. 2011;8(4):343–8.
  1. Yesudian P. Hail the Dermato-Trichologist! Int J Trichology. 2014;6(3):85.
  1. 2017 Practice Census Results. International Society of Hair Restoration Surgery. Chicago, USA: Relevant Research, Inc.;  2017.9
  1. ASDS 2014 Survey on Dermatologic Procedures. Rolling Meadows, IL: American Society for Dermatologic Surgery;  2014.
  1. Trüeb RM. The difficult hair loss patient: A particular challenge. Int J Trichol. 2013;5(3):110–4.
  1. Eckert J. Diffuse hair loss and psychiatric disturbance. Acta Derm Venereol. 1975;55:147–9.
  1. Cash TF, Price VH, Savin RC. Psychological effects of androgenetic alopecia on women: Comparisons with balding men and with female control subjects. J Am Acad Dermatol. 1993;29:568–75.
  1. Maffei C, Fossati A, Rinaldi F, et al. Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia. Arch Dermatol. 1994;130:868–72.
  1. Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87:1115–45.
  1. Patwardhan N, Mysore V. Hair transplantation: Standard guidelines of care. Indian J Dermatol Venereol Leprol. 2008;74, Suppl S1:46–53.