August 2022 Vol 15* Issue-7 Total Pages : 36 100 Dermoscopy of Cirsoid Aneurysm In Skin of Color: A Case Report Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View AestheticBlepharoplastyTreatmentforSupplementsDietaryHairLossPart-ISurgery for the Dermatologist Uncommon Cause onPigmentationofFace:Argyria MUMBAI 2022 16th October'2022 1Day Conference, Hands on Workshop and Exhibition This Event is Supported by International Society of Cosmetic Dermatology Application & Research www.aestheticcon.com
Clinical practises about dermatology embrace several sub-disciplines, including dermatitis, cosmetic dermatology, dermatopathology, immunodermatology, etc. Clinical Dermatology addresses all aspects of clinical practice and fundamental understanding of dermatology and skin care practice. It features concise, practical information on the diagnosis and management of common skin disorders. Diagnostic features, cost-effective management, evidence-based medicine, and patients care are emphasized.
August 2022 3 EXECUTIVE EDITOR & PUBLISHER Dom Daniel CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA.
EMAIL:Website:theaestheticiansjournalindia@gmail.comtheaestheticiansjournal.com
The New Advances of Dermatology Helps ImproveOutcomePatients
TEL: +91 22 2345 1404 +91 22 2345 5844 Printed, Published, Edited and Owned by Dom Daniel Printed at Swastik Printer, Gala No.9 & 10, Vishal Industrial Estate, Bhandup (West), Mumbai- 400078. Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003. India.
The new advances covering all aspects of the management of dermatological conditions helps to understand, manage and treat the skin disease and thus improving patient outcomes.
Dermatology is the branch of medical science that deals with the skin, derma diseases and associated treatment regimes. It gives information about normal and pathological processes in skin development, basic research in dermal science, clinical insights and potential treatment options. Clinical dermatology encompasses all skin disorders and diseases as well as the manifestations which occur in the skin but which originate in another part of the body.
“The Aestheticians Journal” takes no responsibility for unsolicited photographs or material ALL PHOTOGRAPHS, UNLESS OTHERWISE INDICATED, ARE USED FOR ILLUSTRATIVE PURPOSE ONLY. Views expressed in this Journal are those of the contributors and not of the publisher. Reproduction in whole or in parts of texts or photography is prohibited. Manuscripts, Photographs and art are selected at the discretion of the publisher free of charge (advertising excluded). Whether published or not, no material will be returned and remains the property of the publishing house, which may make use of it as seen fit. This may include the withdrawal of publication rights to other publishing houses. All rights reserved. Reproducing in any manner without prior written permission prohibited. Published for the period of August-2022
- Dom Daniel Executive Editor & Publisher
In this issue we have the articles on Blepharoplasty, Dermoscopy, Pigmentation on Face, Dietary Supplements for Hair Loss etc.
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DietarySupplements Loss 30
Clinical Featuresyear married womenpresented with asymptomatic, growingnoduleoverherpubicShegavehistoryofshavingthe months’ back.history of similar lesions overbody. significant past familyOnhistory.examination 2-3 pinkregion.nodulepresentoverthemonspubichardpalpateand painless. small nodule thehelix ear the area earpiercing Dermoscopicalsofound.examination therevealed white scar anyhoweverwashypertropicdermoscpicBasedcollagen.congested.dermis;verticallynumberincreased.fibrocyteswasdeepcapillaries.increasedarrangedbundleswhichforTheareaswithmultipleshortlinearborizingvessels.wasexcisedsenthistopathologicalexamination,showedthickenedcollagenthatwerehaphazardlywithannumberthicksparsesuperficiallympho-plasmocyticinfiltratepresent.ThenumberindermisslightlyTherewasincreasedofcapillariesorientedthesuperficialmid-ofcapillarieswereTherenokeloidalonhistopathologicalfeaturesdiagnosiswasPatientfollowedformonths;patientnotdevelopscartheexcision.
Dr.TanujaRajagopal MBBS,JuniorResidentDepartmentofDermatologyS.NijalingappaMedicalCollege,Bagalkot,Karnataka,India Dr.BalkrishnaP. NikamAssociateMD Karad,KrishnaDepartmentProfessorofDermatologyInstituteofMedicalSciences,Maharashtra,India
Uncommon
Words: Cirsoid aneurysm,arteriovenous hemangioma, acralarteriovenous hemangioma,dermoscopy Introduction Cirsoidaneurysm alsoknownarteriovenous hemangioma orarteriovenous hemangiomais small vascular proliferationcharacterised small mediumsized vascular channels withfeatures arteries andwas reported by BibersteinJessner 1956 distinct, 28 2022 Dietary Supplements for Hair LossTreatment Part-I Dr.SonaliKohli MBBS,MD(SkinandVenerealDisease),M.Sc.(FacialAesthetics) DepartmentofAestheticDermatologySirH.N.RelianceFoundationHospitalandResearchCentre, Mumbai Hair role perceptionwithin decorationsociety.andat samestatus for andbeauty.hair represents onediffuse aesthetic issuesthe worldwide population. Hair psychologicalproblemonly women alsooverlookedmen.underappreciated condition50% men nearly ofwomen by pattern hair50.2There variousloss. Androgenetic alopecia(AGA) the commonform.1one mostcommonloss men, can tracedbackto action theandrogenichormones 5-alpha-reductase,malfunctioningleads growing weaknessof of notthreatening,and partthe process. Despite beingpart natural aging process,which affects scalp, cannegatively affect the quality ofindividual, with situationslead to state psychologicaldistress demoralization.To understand problems hairloss, important understandwhether lossnormal physiological process,otherwise abnormal representsnutritionassociatedimportantenzymes.cofactorwater-solublephysiologyknownsomeismineralsbalancestressfulconditions,essentialcausesacids,nutritionalincludeknownNutritionaltosinceproblemscomplicationcaused,forexample,byrelatedscalphairclassificationhairloss,baldness,andalopecia,alwayscomplexreductivetheyoftenexpressionmultiplethatcontributeonsetthesepathologies.deficienciesoflossmayinadequateunbalancedintake,inadequateproteins,minerals,essentialandcommonsuchdeficienciestraceelements,genetichormonalimbalances,events,canthehaircycle.usespecificvitaminsfortreatmenthairbasedpopulartraditions,elementsaretraditionallyplayanimportantthetheDeficienciesmineralssuchseleniummayhairBiotinvitaminessentialseveralimportantDietarydeficiencycofactorhasbeenloss.3ofdiettreatinglossdynamicandgrowinginquiry.
Dr. S. Manjula Nagarajan, M.B.B.S., D.D., M.D. Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View
20 August Uncommon Argyria Uncommon Cause ofPigmentation on Face:ArgyriaDr.SudarshanPramodGaurkar MBBS,MD(Dermatology)ConsultingDermatologistMuktanganSkinandHairClinic,Kolhapur,Maharashtra ExAssociateProfessor,GovernmentMedicalCollege(GMC), Kolhapur,Maharashtra Report 60-year-old female patientreferred from ophthalmologistskinchanges andneck.Thepatientcomplained slategreytobrown pigmentation the ofslowlyprogressiveovermany Onexaminationpatient distinctasymptomatic macular slate greycolored pigmentation of photoexposed area face, neck,hands Patient had bluishcolored pigmentation nailsinvolving lunula. Patients mucosahad bluish pigmentation.Photoprotected area alsodiffuse pigmentation it wasmilder than photo exposed area.After clinical examination followingpigmentedrevealed4mmdifferentialswereLichenplanuspigmentosusPigmentedcontactdermatitisOchronosisArgyriaskinbiopsytakenfromskinneckarea.Thepresenceextracellulardepositiondermis as as surrounding sweatglands hairfollicles.Depositionchiefly extracellular and showssmall round uniformly sizedbrown granules distributedand clustered. They heavyeyes.showingmedicine,examinationoftablets)herbalShecasePatientmelanophages.theresweatmembranehairpresentingreatestnumberaroundfolliclesbasementzonessurroundingtheglands.additionthismildperivascularinfiltratelymphocytesoccasionalchangesconsistentwithargyria.laterwasbreastcarcinomasurvivor.undergonemastectomythesameyearsShebeenonayurvedic/medicines(capsuleandsincethenpreventionrecurrencecancer.furtherayurvedic/herbalonethewassilvercolornakedProlongedexposurethisinpatientcouldleadargyriaourpatient. August
Dr. Balachandra S. Ankad, MD Dr. Tanuja Rajagopal, MBBS, Junior Resident Dr. Balkrishna P. Nikam, MD
A
August 20224 Blepharoplasty Aesthetic Surgery for the Dermatologist
BlepharoplastyAesthetic Surgery for the DermatologistDr.S.ManjulaNagarajan M.B.B.S.,D.D.,M.D.SeniorConsultantDermatologistErode,Tamilnadu,India Introduction Blepharoplasty procedure cosmeticsurgerydone havealert, hing, young looking Not aesthetic surgery. It improveyourvision. Anatomyof EyelidBefore procedure isjudicialis theanatomy eyelidsforLayeredperfectsurgery.anatomyof upper lowereyelidsandperiorbitalarea. BlepharoplastyAesthetic Dermatologist Figure (a&b)- Eyelid:Parts the (a) (b) 07 August Aneurysm Skin Dermoscopy of CirsoidAneurysm In Skin of Color:ACase Report Dr.BalachandraS.AnkadProfessorandHeadDepartmentofDermatologyS.NijalingappaMedicalCollege,Bagalkot,Karnataka,India Abstract Cirsoid aneurysm rarebenign vascular tumor and smallvascular proliferation characterisedby tomedium channelswith featuresveins. Clinically, arteriovenoushemangioma be difficultdiagnose as mimics basalcarcinoma amelanoticmelanoma. Histopathology featureshistopathologicalcaseconfirmatory.Herewereportcirsoidaneurysmwithanddermoscopicskincolor.
Dr. Sonali Kohli, MBBS, MD (Skin and Venereal Disease), M.Sc. (Facial Aesthetics) Peculiar Pink Nodule Over Pubic Area:ADermoscopic ViewDr.SavithaL.Beergouder MBBS,DDVLSenior S.DepartmentResidentDermatology,NijalingappaMedicalCollegeandResearchCentre,Bagalkot ConsultantDermatologistAnaghaSkinCareandCosmeticClinic,BagalkotIntroduction Nodular lesions overpubic have wide differentialdiagnosis ranging from benigntumors theregionpinkdiagnosis.procedureactstumorsSometimescellBasallikemalignantdermatofibromas,angiokeratomas,lipoma,etcpremalignantlesionskeratoacanthoma,nodularcellcarcinoma,squamouscarcinomamelanomas.differentiatingthesechallenging.Dermoscopyeasyhandyclinicalwhichcaninwepresentingcasenodularlesionthewhichdiagnosedofdermoscopy.
2830
Dermoscopy
Dr. Savitha L. Beergouder, MBBS, DDVL Cause of Pigmentation on Face: Argyria Dr. Sudarshan Pramod Gaurkar, MBBS, MD (Dermatology) of Cirsoid Aneurysm In Skin of Color: Case Report
Dietary Supplements for Hair Loss Treatment Part-I
August 2022 5
Editorial Board
Dr. Savitha L. Beergouder MBBS, DDVL Senior S.DepartmentResidentofDermatology,NijalingappaMedicalCollege and Research Centre, Bagalkot Consultant Dermatologist Anagha Skin Care and Cosmetic Clinic, Bagalkot
6 August 2022
Dr. S. Manjula Nagarajan M.B.B.S., D.D., M.D. Senior Consultant Dermatologist Erode, Tamilnadu, India
Dr. Balkrishna P. Nikam AssociateMD KrishnaDepartmentProfessorofDermatologyInstituteofMedical Sciences, Karad, Maharashtra, India
Dr. Sudarshan Pramod Gaurkar MBBS, MD (Dermatology) Consulting Dermatologist Muktangan Skin and Hair Clinic, Kolhapur, Maharashtra Ex Associate Professor, Government Medical College (GMC) Kolhapur, Maharashtra
Dr. Sonali Kohli MBBS, MD (Skin and Venereal Disease), M.Sc. (Facial Aesthetics) Department of Aesthetic Dermatology Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai Dr. Tanuja Rajagopal MBBS, Junior Resident Department of Dermatology S. Nijalingappa Medical College, Bagalkot, Karnataka, India
Dr. Balachandra S. Ankad ProfessorMD and Head Department of Dermatology S. Nijalingappa Medical College, Bagalkot, Karnataka, India
Figure 1 (a&b)- Eyelid: Parts of the eyelid (b)(a)
Aesthetic Surgery for the Dermatologist
Dr. S. Manjula Nagarajan M.B.B.S., D.D., M.D. Senior Consultant Dermatologist Erode, Tamilnadu, India Introduction Blepharoplasty is the procedure of cosmetic surgery done to have alert, refreshing, young looking eyes. Not only a aesthetic surgery. It might improve your vision. Anatomy of the Eyelid Before the procedure it is judicial is know the anatomy of the eyelids for perfect Layeredsurgery.anatomy of the upper and lower eyelids and periorbital area.
August 2022 7
Blepharoplasty
Blepharoplasty Aesthetic Surgery for the Dermatologist
• Visual field testing is important in patients with upper eyelid ptosis and upper eyelid skinfolds that interfere with the visual axis.
Upper PreoperativeEyelid
• A Schirmer test: The test is performed by first anesthetizing the conjunctiva in the inferior lateral fornix with tetracaine eyedrops. Any excess tear film is then blotted away and a Shirmer strip is placed in the lateral fornix and the patient is asked to gaze straight ahead. Decreased tear production is identified by less than 10 mm of wetting after a 5-minute period.
• Visual acuity: (Visual acuity is determined with the patient wearing eye glasses or contact lenses. This is to document the baseline preoperative •vision).Fineexamination of the lid margin for chronic blepharitis.
The physical examination should include:
Preoperative evaluation should include:
• Thyroid disease
Canthal tilt
• A negative canthal tilt may indicate descent of the lateral canthus from disinsertion, laxity, or the presence of a prominent eye.
Figure 2- Anatomy of the upper lid Lower Eyelid Figure 3- Surgical anatomy of lower eyelid
• Recurrent herpes zoster or simplex infections
• A positive canthal tilt is one where the lateral canthus is positioned superior to the medial canthus.
• A positive vector is seen where the globe is posterior to the infraorbital rim and overlying soft tissue.
• Normal globe prominence is in the range of 15 to 17 mm.
• Keloid tendency
• Patients with enophthalmos have a measurement of less than 15 mm.
• Patients with exophthalmos have measurements greater than 17 mm.
• Both prominent and deep set eyes are at increased risk for •complications.Primarylower lid spacers and infraorbital rim implants may be considered in patients with prominent eyes to correct the poor globe support.
• A detailed history concerning dry eyes
• Evidence for lid retraction or laxity.
• Signs of associated systemic disease such as thyroid disease.
• Diplopia can occur as a result of injury to the inferior or superior oblique from prior blepharoplasty.
• Ocular mobility is then assessed by asking the patient to follow an object through the six cardinal positions of gaze.
• Of particular note is the presence of scleral show in the preoperative patient. This should serve as a “red flag” sign of caution since it is often associated with a prominent eye, lower lid laxity, and poor infraorbital
• Tear film break-up time.
August 20228 Blepharoplasty Aesthetic Surgery for the Dermatologist
• In reviewing the objectives of surgery with the patient postoperatively. Perform an organized sequential assessment of the orbit, including the upper lid and brow the brow is evaluated for:
August 2022 9 support, which define patients at high risk for postoperative complications. Photographs are taken of each patient, these are helpful for:
• In acquired ptosis, levator function is often normal with an excursion of 10 mm or greater.
• Ptosis
• Symmetry
• Signs of brow ptosis include lateral upper eyelid hooding and descent below the orbital rim.
• Myogenic ptosis including myasthenia gravis.
• In men, the brow should be more horizontal, traversing the supraorbital rim.
• This can be corrected with tarsolevator advancement at the time of the blepharoplasty procedure. The cover test is recommended in the evaluation of minimal unilateral acquired ptosis. Floppy eyelid syndrome Floppy eyelid syndrome, although uncommon, may be present in large sturdy men who present for
• The eyelid crease is typically high in these patients as the dermal anchor of the levator fibers forming the crease have been disrupted.
• On physical examination, the levator function is measured by stabilizing the eyebrow and measuring lid margin excursion.
• Asymmetry in the amount of tissue in the upper lid
• Mechanical ptosis secondary to a tumour or trauma.
• Upper lid retraction
Dry Eyes Patients at risk for postoperative eye dryness are easily identified with a history of contact lens intolerance. Each patient is then evaluated for the presence of a Bell’s phenomenon, as a poor reflex will predispose patients to significant postoperative corneal dryness. These patients are further evaluated using a Shirmer’s test. Dry eyes
• As an intraoperative reference
• Neurogenic ptosis including Horner’s syndrome.
• Aponeurotic dehiscence
• Congenital ptosis is present from birth and characterized by poor levator function. The measured excursion is generally less than 4 mm and often requires correction by means of a frontalis sling procedure.
• This requires resection of a portion of the lateral tarsal plate along with a canthoplasty of the upper eyelid.
• Preoperative planning
• Upper lid ptosis
• The relationship between the nasal and lateral brows. This is done with the brow under conscious relaxation, with the absence of active furrowing of the forehead.
• Asymmetrical brow ptosis In patients presenting with upper lid ptosis, it is important to identify the etiology on history and clinical evaluation. The differential diagnosis
•includes:Congenital ptosis
•blepharoplasty.Thesyndrome is characterized by upper eyelid eversion during forced lid closure and may be addressed by shortening the lid laterally.
Blepharoplasty Aesthetic Surgery for the Dermatologist Figure 4 -
• If brow laxity is not corrected or if brow is not stabilized, it will predispose the patient to further descent of the brow following •blepharoplasty.Anunstable brow will require elevation or stabilization in order to avoid worsening of brow ptosis after upper blepharoplasty. Upper eyelid fold asymmetry may be caused by several factors:
• In women, the brow should arch above the supraorbital rim with a peak above the lateral limbus.
(LASIK) Patients who have had recent laser in situ keratomileusis (LASIK) surgery for vision enhancement should avoid blepharoplasty for at least 6 months in order to allow the corneal incision adequate time to heal and to minimize the risk of superinfection in the event lagophthalmos and dryness occur after blepharoplasty.
Redundant upper lid tissue secondary to underlying pathophysiology such as recurrent edema as found in renal failure, cardiac disease, or angioneurotic edema.
• For example, the upper eyelid crease lies 6 to 8 mm from the lid margin in the young Caucasian.
• Therefore, the aged occidental upper lid resembles the youthful Asian lid.
Dermatochalasis
Figure 5
Redundant upper eyelid tissue Although the surgical approaches may be the same, an appreciation of the difference between blepharochalasis and dermatochalasis, that is, the etiology for the redundant upper eyelid tissue, should be understood. blepharochalasis:Blepharochalasis
Dermatochalasis is the commonly found redundancy of upper eyelid tissue secondary to the senescent process with or without ptotic eyebrow changes. Anatomy and pathophysiology between racial and age groups
• Patients with dry eyes should have conservative skin excision to minimize lagophthalmos and proper lateral canthal anchoring to prevent Liberalectropion. use of perioperative lubrication is advocated and postoperative insertion of punctual plugs may be needed in some refractory cases.
• This may require the use of free fat grafting, in addition to a fat- conserving blepharoplasty, if the orbit has become skeletonized with age or previous excisional surgery. Operative Technique Anaesthesia
• During the upper blepharoplasty dissection, care must be taken to avoid inadvertent removal of the gland, and gland suspension may be necessary.
Upper
• The lid fold is created by extensions of the levator to the lid skin. In the senescent or “baggy” Caucasian upper eyelid, septal laxity and tissue relaxation allow preaponeurotic fat to prolapse anteriorly, lowering the eyelid fold and moving it closer to the lid margin.
• This age-related pathophysiology is analogous to the normal anatomy found in the youthful Asian upper eyelid. Here the eyelid fold is low and variably closer to the lid margin, with fullness created above it owing to prolapsed preaponeurotic fat extending to the insertion of the levator aponeurotic elements on the overriding lid skin.
• Local anaesthesia consisting of lidocaine 2% with epinephrine 1:100,000 is injected using a 27-gauge needle into the upper eyelid, lateral canthus, lower eyelid, and inferior orbital rim.
• Blepharoplasty can be performed under general anaesthesia or under intravenous conscious sedation.
An important concept in appreciating upper eyelid functional and cosmetic surgery is illustrated by contrasting nuances in the anatomy and pathophysiology between racial and age groups.
• Care is taken to avoid injury to the marginal arterial arcades and the deep orbital structures in order to reduce the risk of eyelid or retro-bulbar hematoma. Lid Markings - Markings for upper lid
August 202210 Blepharoplasty Aesthetic Surgery for the Dermatologist
• Excess retroorbicularis oculi fat (ROOF) may be removed in a conservative manner lateral to the supraorbital nerve. This procedure may be combined with an internal browpexy in order to raise and suspend the lateral aspect of the Patientsbrow.are asked to bring photographs taken approximately 10 years prior to their consultation. These images can be used as a guide to reestablishing the patient’s individual orbital contour and volume.
• Nasally, the amount of tissue to be excised is tapered in a conservative •fashion.Over-resection of skin and muscle is poorly tolerated nasally resulting in lagophthalmos that can cause corneal dryness in addition to a poor aesthetic result.
• At a minimum, 10 mm of skin should be preserved between the lower border of the eyebrow and the upper lid marking at the level of the lateral canthus.
Lower Lid Markings
• First, the upper eyelid crease is marked at the level of the midpupillary line. In women, this is 8 to 10 mm superior to the lash margin, and roughly 7 mm above the lash margin in men.
•rim.The superior margin of the planned excision is determined by using utility forceps to pinch and identify the quantity of excess skin and muscle.
• If the incisions are placed too close together, postoperative webbing or distortion can occur. The nasal extension of the marking parallels the lid margin and should be as close to the lash line as possible because the scar becomes more apparent when placed lower.
• The marking is tapered caudally at the nasal and lateral lid margins following the gentle curve of the upper lid crease.
• The lateral extension should be hidden in a crow’s foot skinfold and not extend past the lateral orbital
• This exposes the orbital septum, which is then opened along the length of the incision.
• From the level of the lateral canthus, a line is extended inferolaterally for approximately 6 to 10 mm within a prominent crow’s foot crease.
August 2022 11
• Preliminary markings are made in the preoperative area to ensure that the scar will be in a crow’s foot with the patient smiling in the vertical position, and are completed on the operating room table following the induction of anaesthesia.
• This is done using loupe magnification and calipers to ensure symmetry of markings on both eyelids. A fine, woodentip applicator is used to mark the incisions with methylene blue.
• Using a scalpel, the upper lid markings are incised through the skin and into the orbicularis muscle.
Upper Lid Blepharoplasty
• The nasal aspect of the marking should not extend medially to the caruncle, so as to avoid webbing or the development of epicanthal folds above the medial canthus.
• At the lateral canthus, the lateral marking should be 5 to 6 mm above the lash line.
• A needle-tip cautery is used to incise the orbicularis oculi muscle along the superior incision.
• The septum is opened first along the upper incision in order to avoid injury to the levator aponeurosis, which is located immediately behind the orbicularis oculi muscle in the lower incision at the lid crease.
• The superior mark is drawn parallel to the contour of the lower marking.
Figure 6 - Upper lid blepharoplasty Blepharoplasty Aesthetic Surgery for the Dermatologist
• Roughly 10 mm of skin is preserved between the lateral extension of the upper and lower blepharoplasty incisions.
•pad.Fat preservation should be considered to avoid creation of a hollow, more aged-appearing orbit.
• Care is taken to preserve the interpad septum separating the central and nasal fat.
• Pads.
Blepharoplasty Aesthetic Surgery for the DermatologistBefore After Figure 8
• Repair of the orbicularis muscle reduces the tension on the dermis, resulting in a less perceptible scar.
• In addition, the interposed muscle prevents adhesion formation from the dermis to the aponeurosis to the skin, thereby minimizing contour irregularity and lagophthalmos. - Before and after blepharoplasty
• Over-resection of fat in this area will result in a hollow “A-frame” or peaked arch deformity of the supratarsal crease.
August 202212
• To achieve the aesthetic goals, the peak of the brow should be placed just above the lateral corneoscleral •limbus.Internal browpexy should be considered to correct lateral brow instability and prevent further brow ptosis caused by upper •blepharoplasty.Followingremoval of excess skin, muscle, and fat, the upper lid incision is generously irrigated with normal saline to remove any residual liquefied fat that can result in postoperative granuloma formation. Closure • The incision is closed with initial sutures placed superior to the lateral canthus with interrupted 6-0 nylon suture, which aligns the skin and muscle.
• Clamping, resecting, and cauterizing fat should be discouraged because this can result in uncontrolled bleeding.
• Excess skin, muscle, and septum are then resected with scissors bevelling away from the levator insertion into the upper lid crease.
Figure - Lower lid blepharoplasty
• The incision lateral to the canthus is closed with interrupted 6-0 nylon and the incision medial to the lateral canthus is closed with a running 6-0 nylon suture.
• If lateral brow instability is present, an internal lateral browpexy can be performed through the upper blepharoplasty incision.
Figure - Before and after blepharoplasty
• Resection of the lacrimal gland can cause postoperative dry eye syndrome and is not recommended.
7
• While a subcuticular suture is commonly used, including the muscle in the repair may eliminate the fine, white dermal scar often seen following subcuticular closure.
• Inadequate cauterization can result in bleeding from the nasal fat
Lower lid blepharoplasty
Patient-2Patient-1
9
• In these situations, the use of a Frost suture should be considered. It is placed in the lower lid margin lateral to the lateral limbus and either sutured to the eyebrow or suspended to a Steri-Strip above the eyebrow. Blepharoplasty Aesthetic Surgery for the Dermatologist
• Significant periorbital ecchymosis or chemosis of the conjunctiva at the completion of the procedure may indicate signs of delayed healing.
Figure 10 - Steps of blepharoplasty
• The orbicularis oculi muscle is divided with electro cautery into the sub muscular space.
Postoperative Care
• The skin muscle flap is dissected anterior to the septum to the infraorbital rim.
August 2022 13
• Laxity measurements of 3 to 6 mm of lid distraction indicates moderate laxity of the lower eyelid. A lateral canthopexy should be used to correct moderate lid laxity.
• Lid distraction of 1 to 2 mm indicates minimal lid laxity, requiring minimal lateral canthal support with orbicularis suspension only.
•considered.Theobjective of lateral canthopexy is to suture the tarsal plate and lateral retinaculum to the periosteum of the lateral orbital rim, thereby tightening the lower lid tars ligamentous sling.
• Scissors are then used to incise the remainder of the lower lid skin incision along the lid margin with a second incision through the orbicularis preserving a 5-mm strip of pretarsal orbicularis muscle.
• The suture is then placed inside the lateral orbital rim periosteum from deep to superficial, allowing the lateral canthus and lower lid to be tightened posteriorly and superiorly to maintain the position of the lower lid margin against the globe.
• A horizontal mattress suture of 4-0 is used to incorporate the tarsal plate and lateral retinaculum.
•rim.The orbito-malar ligament is divided along the entire extent of the infraorbital rim.
• The lower lid skin is incised lateral to the canthus with a scalpel exposing the underlying orbicularis oculi muscle.
• Release of the orbitomalar ligament allows elevation of the suborbicularis oculi fat (SOOF) with the skin muscle flap.
Lateral Canthal Anchoring
• Fat can be removed in a conservative fashion from all three lower lid compartments, and the orbital septum is resected, along with the excess fat.
• Removal of the septum may reduce the risk of subsequent septal scar formation. Care should be taken to identify and avoid injury to the inferior oblique muscle between the nasal and central fat pads.
• The degree of lower lid laxity should be further evaluated intraoperatively by placing anterior traction on the lower eyelid away from the globe and using caliper measurement to determine the amount of lid distraction.
• The inferior oblique muscle is reportedly the most common extraocular muscle injured during blepharoplasty from indiscriminate cauterization.
• When the lid can be distracted greater than 6 mm away from the globe, significant lid laxity is present and a lateral canthoplasty should be
• Dissection continues to the infraorbital rim just superficial to the periosteum separating the orbicularis from periosteal attachments at the lateral orbital
• Head elevation and the application of ice to the periorbital region is used for 48 hours after surgery.
• Permanent diplopia can occur from thermal injury to the inferior oblique or superior oblique muscles from electro cautery. Strabismus surgery may be required for patients who do not improve with conservative management.
BeforeOutcomes
• Diplopia can also occur following blepharoplasty and is usually temporary, resulting from edema.
• Occasionally the edematous conjunctiva can be surgically
August 202214
• Lower lid ectropion or persistent lid malposition following a 2- to 3- month period of conservative management may require surgical intervention.
• In the upper lid, ptosis may occur after surgery from failed preoperative recognition or from levator dehiscence during surgery. To minimize this risk, supratarsal fixation of the pretarsal skin muscle to the levator aponeurosis should be performed.
Complications Given the delicate anatomy of the periorbital region, complications can be common with blepharoplasty surgery.
• Mild lid malposition may contribute to lagophthalmos and corneal •exposure.Lagophthalmos may require bandage contact lenses to protect the cornea and conservative massage of the lower lid margin until the patient passed the critical 6-week postoperative time period, which corresponds with the proliferative phase of healing.
• Sutures, including the Frost suture, are removed 5 to 7 days after surgery.
• Patients are asked to avoid the use of eyelid makeup on the suture lines and contact lenses for 2 weeks following surgery.
• Ophthalmic antibiotic ointment is applied along the suture line, as well as on the globe, to prevent or to reduce evaporative tear film loss.
After Before After Figure 12 - Before and after blepharoplasty
FigurePatient-311 - Before and after blepharoplasty Patient-4
• These techniques minimize corneal exposure in the immediate postoperative period.
• Rapid surgical decompression and administration of mannitol, acetazolamide, and oxygen is advocated as part of the initial management of retroorbital hematoma.
• Signs of corneal irritation or impaired visual acuity require careful ophthalmologic evaluation.
Blepharoplasty Aesthetic Surgery for the Dermatologist
•drained.Persistent postoperative chemosis can be treated with liberal ophthalmic ointments and eye
• The most devastating complication after blepharoplasty is visual loss. Although rare, the estimated incidence is 0.04% and is caused by either retroorbital hemorrhage compromising ocular circulation or direct globe perforation.
•chemosis.Severe chemosis that herniates through the palpebral fissure requires more aggressive management with liberal ophthalmic ointment, patching the eye closed for 24 to 48 hours, and applying gentle pressure from a wrap to reduce the swelling.
•drops.Additionally, Voltaren drops and fluorometholone (FML) 0.1% ophthalmic suspension can be used for 2 weeks to minimize the early inflammatory changes that result in
•revision.Therisk of frank ectropion is reduced when conservative skin excision and lateral canthal support are performed in combination.
•position.Lateral canthal support, most commonly with lateral canthopexy, represents an important step in the technique to maintain lid shape and reduce the risk of lower lid malposition or postoperative round eye syndrome.
Complications associated with lateral canthoplasty include: • Canthal angle webbing or asymmetry, which requires surgical
Conclusion This article briefly describes the techniques of standard upper and lower eyelid blepharoplasty. Practically, the rejuvenation of this complex anatomical area requires a combination of therapies including fat excision, repositioning or transfer, simultaneous brow or midface lift, and adjunctive treatment for skin resurfacing and periorbital hollows.
August 2022 15
3.BLEPHAROPLASTY.NaikMN,Honavar SG, Das S, Desai S, Dhepe N. Blepharoplasty : A overview. J cutanAesthet surg. 2009(Jan-Jun); 2(1): 6-1.
Blepharoplasty Aesthetic Surgery for the Dermatologist
• Maintaining the preoperative shape of the palpebral fissure is emphasized, with particular attention to maintaining lower eyelid
2. Yasmeen soulassy –
References 1. Subramaniyam N. Blepharoplasty. Indian J plast surg. 2008 oct; 41(suppl): S88-S92.
• In addition to minimizing the risk of complications, maximizing the aesthetic result is directly related to safe management of periorbital fat, the orbicularis muscle, and SOOF.
• The compromise, which should be discussed with patients prior to surgery, is that the lower lid may appear tight, which may last 2 to 3 weeks after surgery.
catching
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AESTHETICCON, a 1 Day Conference, Hands on Workshop and Exhibition focused on practical learning experiences in Aesthetic Dermatology. to you by “The Aestheticians Journal” serving you since 2010 with 12 years in print and digital publications and over a 100 educational workshops and conferences.
August 202216 To the point: A unique knowledge sharing platform Skill up: Hands on training by Masters in Aesthetic Dermatology with CertificateInternationalExpo: Update yourself of the New Products and Latest Devices
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MUMBAI 2022 16th October' 2022 1 Day Conference, Hands on Workshop and Exhibition
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August 2022 17 1 Day Conference, Hands on Workshop and Exhibition MUMBAI 2022 16th October'2022 Advisory Board Dr. Abhishek De MD FAGE SCE (Dermatology) FRCP Edin Consultant Dermatologist Aesthetician and Laser Surgeon Wizderm Kolkata Dr. Meera James MD Beau Aesthetica The Cosmetic Dermatology Clinic and Academy, Kerala Dr. Satish Bhatia MD Dermatologist and CCutaneous Surgeon Dermdestination Mumbai Dr. Farida Modi MD Dermatologist and Cossmetologist Dermacare Skin Clinic & Cosmetic Center, Mumbai REGISTRATION FEES & DETAILS Conference registration fees: Rs.2500/Dr+ 18% GST* (Early bird For payments received till 31st August) Rs.4000/Dr +18% GST* (For payments received between 1st September to 30th September s/t availability) *Registration fee includes access to conference and lunch ONLY 1. Botulinum toxin : Basic Indications 2. Botulinum toxin : Advanced Indications 3. Fillers 4. Thread Lifts HANDS ON WORKSHOP on Aesthetic Dermatology Procedures with INTERNATIONAL CERTIFICATE from an INTERNATIONAL SOCEITY OF COSMETIC DERMATOLOGY Rs.5000/Workshop +18% GST#(Early bird For payments received till 31st August) Rs.7500/Workshop +18% GST#(For payments received between 1st September to 30th September s/t availability) #Registration fee include access to individual registered Hands On Workshop only, conference, lunch and CERTIFICATE from INTERNATIONAL SOCIETY OF COSMETIC DERMATOLOGY APPLICATION & RESEARCH (www.internationalsocietyofcosmeticdermatology.com) Topics of Hands On Workshop Terms & Conditions: 1. Only for Dermatologist. Please share your PG in Dermatology Credentials while registering. 2. Compulsory prior registration required. On the spot registration not available 3. Hands On Workshops have limited seats and will be available on first come first serve basis on prior registration only. 4. Hands On Workshops may extend beyond stipulated time, causing them to overlap inadvertently. 5. Cancellations not permitted. No refunds will be made Contact us Contact. No. +91 8928866175 Email : aestheticconindia@gmail.com www.aestheticcon.com This Event is Supported by IInternational Society of Cosmetic Dermatology Application & Research
FDA cautions against using OTC products to remove skin spots, moles Several skin lesions are very common, like moles, freckles, skin tags, benign lentigines, and seborrheic keratosis etc. Moles are growths on the skin that are usually brown or black. Moles can appear anywhere on the skin, alone or in groups. Moles occur when the cells in the skin grow in clusters instead of spreading evenly throughout the skin. These cells are what give skin its pigment, so moles appear darker than the skin. Those moles, skin tags, and liver spots should stay on our skin until we see a doctor, according to a new alert from the U.S. Food and Drug Administration.
August 202218 NEWS
Introduce allergens early, say French allergists Allergy is a worldwide problem, and there is a high prevalence of allergic syndromes like allergic asthma and food allergies among children. It is important to understand what triggers and how to prevent/treat an allergic reaction. Allergy occurs when, for some reason, the immune system creates a response against a harmless substance, like pollen or a certain kind of food. Allergies are very common, and it is estimated that around one in three people has some type of allergy. Allergy can generate a reaction in any part of the body. For all newborns, regardless of whether they have a history of atopic or non atopic dermatitis, food diversification is now recommended from 4 months of age instead of 6 months, as was previously recommended. If the child does not develop atopic dermatitis or develops only a mild form, peanuts, eggs, and nuts may be introduced at home.However, if the child experiences severe atopic dermatitis, an allergy testing panel for peanuts, nuts, eggs, and cow’s milk proteins should be performed. An oral food challenge may be conducted at the allergist’s discretion.
The latest prevention data from two major studiesviz LEAP Lifestyle Eating and Performance and EAT(Enquiring About Tolerance) suggest never delay the introduction of the primary allergens anymore, regardless of whether children are at risk for a food allergy, and particularly a peanut allergy. The idea is to introduce everything, especially peanuts, between 4 and 6 months of age and to no longer do so gradually, one food after another, as was being done until now, beginning at 6 months and over.
The alert warns against the use of over-the-counter (OTC) products for removing moles, seborrheickeratoses (wart-like growths that are often brown), or skin tags, emphasizing that none are approved by the FDA for at-home use. Dermatologists and the FDA say these products may lead to scarring and disfigurement. Risks include “skin injuries, infection requiring antibiotics, scarring, and delayed skin cancer diagnosis and treatment,” according to the alert, which adds that the agency has received reports of people “who developed permanent skin injuries and infections after using products marketed as mole or skin tag removers. These products come in the form of gels, liquids, sticks, or ointments and commonly contain ingredients like salicylic acid, which are cytotoxic, or cell-killing. These chemicals are what make the products potentially dangerous, as each contains unregulated and likely very high, amounts of these corrosive agents. Even products marketed as natural or organic have these same issues, also the researcher notes that bloodroot is another ingredient found in these products. Dermatologists explained that using these products without the supervision of a health care provider can create a chemical burn in the skin, leading to scarring. They treated patients for open wounds and infected ulcers caused by these products. “They have seen many cases of patients coming in with self-inflicted harm due to using these quote, unquote, safe and natural products to remove benign, or even worse, potentially malignant neoplasms.
Atopic eczema is a chronic inflammatory condition that can have a large impact on sufferers, their families, and healthcare. It is estimated that one in six children aged one to five has atopic eczema, and there has been a global rise over recent decades.
NEWS
August 2022 19
Vitamin D supplements during pregnancy could reduce the risk of atopic eczema in babies
The first randomized, controlled trial to show evidence of reduced risk of atopic eczema in infants of mothers who took Vitamin D supplements during pregnancy. More than 700 pregnant women took part in the research – with 352 taking the supplements from 14 weeks until they gave birth and 351 taking a Theplacebo.eczema research aim was to see whether taking 1000IU of Vitamin D (cholecalciferol) as a supplement during pregnancy would decrease the risk of atopic eczema in babies and also wanted to establish whether breastfeeding had any effect on this. This study results showed that babies of mothers who received supplements had a lower chance of having atopic eczema at 12 months, which supports recommendations for Vitamin D supplements to be routine during pregnancy. The researchers found no effect at 24 and 48 months suggesting that other postnatal influences might become more important beyond infancy or that the babies themselves might also need to be supplemented during the postnatal period for a sustained effect.
In patients with the autoimmune disorder, the body attacks its own hair follicles and hair falls out, often in clumps. In February, the FDA granted priority review for baricitinib in adults with severe AA. Baricitinib is a Janus kinase (JAK) inhibitor, which blocks the activity of one or more enzymes, interfering with the pathway that leads to inflammation. The FDA reports the most common side effects include upper respiratory tract infections, headache, acne, hyperlipidemia, increase of creatinine phosphokinase, urinary tract infection, elevated liver enzymes, inflammation of hair follicles, fatigue, lower respiratory tract infections, nausea, Candida infections, anemia, neutropenia, abdominal pain, herpes zoster (shingles), and weight gain. The labeling for baricitinib includes a boxed warning for serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis.
Baricitinib was originally approved in 2018 as a treatment for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more tumor necrosis factor (TNF)–blockers. It is also approved for treating COVID-19 in certain hospitalized adults.
The decision came after review of the results from two randomized, double-blind, placebo-controlled trials (BRAVE AA-1 and BRAVE AA-2) with patients who had at least 50% scalp hair loss as measured by the Severity of Alopecia Tool (SALT score) for more than 6 months. Patients in these trials got either a placebo, 2 mg of baricitinib, or 4 mg of baricitinib every day. The primary endpoint for both trials was the proportion of patients who achieved at least 80% scalp hair coverage at week 36.
FDA approved first systemic treatment for alopecia areata Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair bearing sites. The U.S. Food and Drug Administration approved baricitinib oral tablets on June 13 as the first systemic treatment for adult patients with severe alopecia areata. The disorder with the hallmark signs of patchy baldness affects more than 300,000 people in the United States each year.
Taking Vitamin D supplements during pregnancy could substantially reduce the chances of babies up to a year old suffering from atopic eczema, according to a new study. The research revealed that babies had a lower risk of developing atopic eczema in their first year if their mothers took 1000 international units (IU) of Vitamin D a day from when they were 14 weeks pregnant until they delivered. The effect was particularly seen in babies who were later breastfed for more than a month.
In BRAVE AA-1, 22% of the 184 patients who received 2 mg of baricitinib and 35% of the 281 patients who received 4 mg of baricitinib achieved at least 80% scalp hair coverage, compared with 5% of the 189 patients in the placebo group. In BRAVE AA-2, 17% of the 156 patients who received 2 mg of baricitinib and 32% of the 234 patients who received 4 mg achieved at least 80% scalp hair coverage, compared with 3% of the 156 patients in the placebo group.
August 202220 Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View
Introduction Nodular lesions on skin over pubic area have a wide differential diagnosis ranging from benign tumors like angiokeratomas, lipoma, dermatofibromas, keloids etc and malignant and premalignant lesions like keratoacanthoma, nodular Basal cell carcinoma, squamous cell carcinoma and melanomas. Sometimes differentiating these tumors is challenging. Dermoscopy acts as easy and handy clinical procedure which can help in Herediagnosis.1weare presenting a case of pink nodular lesion over the pubic region which was diagnosed with the help of dermoscopy.
Clinical Features 23 year old married women presented with an asymptomatic, slow growing nodule over her pubic region. She gave history of shaving the area few months’ back. No history of similar lesions over the body. No significant past or family Onhistory.examination a 2-3 cm pink nodule present over the mons pubic region. It was hard to palpate and painless. A small nodule over the helix of right ear at the area of ear piercing was also found. Dermoscopic examination of the lesion revealed white scar like areas with multiple short linear and arborizing vessels. The nodule was excised and sent for histopathological examination, which showed thickened collagen bundles in the dermis that were arranged haphazardly with an increased number of thick walled capillaries. A sparse superficial and deep lympho-plasmocytic infiltrate was present. The number of fibrocytes in the dermis was slightly increased. There was increased number of capillaries oriented vertically in the superficial and middermis; some of the capillaries were congested. There was no keloidal Basedcollagen.on histopathological and dermoscpic features diagnosis of hypertropic scar was done. Patient was followed up for 3 months; however patient did not develop any scar at the area of excision.
Dr. Savitha L. Beergouder MBBS, DDVL Senior S.DepartmentResidentofDermatology,NijalingappaMedicalCollege and Research Centre, Bagalkot Consultant Dermatologist Anagha Skin Care and Cosmetic Clinic, Bagalkot
Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View
Figure 3: Dermoscopy image of hy pertrophic scar showing white scar like areas (black star) and arborizing vessels (black arrow).
August 2022 21 A Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View
Figure 4: Histopathology of hypertrophic scar showing thickened collagen bundles in the dermis which are arranged haphazardly (black star) with an increased number of thick walled capillaries (black arrow).
Raised linear, firm lesion develop within months of injury, it remains within the boundaries of original scar and can regress spontaneously. Raised, hard dermal outgrowth develop up to 1 year of injury, it spreads outside wound margins. It does not regress spontaneously.
Histopathology
Discussion Hypertrophic scar and keloid are described as variations of typical wound healing, during maturation imbalance occurs between collagen production and more collagen is produced than is degraded, and the scar grows in all directions. Keloids present as raised, hard dermal outgrowth develop up to 1 year of injury, it spreads outside wound margins. It does not regress spontaneously. Unlike keloids, the hypertrophic scar reaches a certain size and subsequently stabilizes or regresses.2, 3, 4
Collagen shows nodules containing fibrillar collagen with regular thickness arranged parallel to the epidermis with absence of myxoid extracellular matrix with high density of Bloodcells. vessels are arranged vertically around nodules. Collagen forms large, broad eosinophilic focally fragmented and haphazardly arranged collagen complexes reffered to as keloid collagen, with variable amount of myxoid extracllular matrix. Small aggregating blood vessels just below epidermis.
Table 1- Clinical, histopathological and dermoscopic differences between keloid and hypertrophic scar Hypertrophic scar Keloid Clinical features
Figure 2: Dermoscopic image of hypertrophic scar showing white scar like areas (black star), arborizing vessels (red arrow), linear (yellow arrow) and comma vessels (green arrow).
Dermoscopy White scar like areas with less vascular components. White scar like areas with vascular components.
Figure 1: Clinical image of hyper trophic scar as a pink nodular lesion over the pubis.
Dermoscopy For Malignant And Benign Tumors:Indication And Standardized gy;calet8.609.Dermoscopy.Vascularand7.624(JanuaryEgyptianKeloidNohaSaber.Dermoscopic6.384.AmnosisTW.5.565–573.ClinicsUpdateSouza,4.Surg.functionandDS.3.1999;and2.minology.Hautarzt.2017aug;653-673.terEnglishRS,ShenefeltPD.Keloidshypertrophicscars.DermatolSurg.25:631–638.CraigRD,SchofieldJD,JacksonCollagenbiosynthesisinnormalhypertrophicscarsandkeloidasaofthedurationofthescar.BrJ1975;62:741–744.FelipeBettiniRabello,CleytonDiasJaymeAdrianoFarinaJúnior.onhypertrophicscartreatment.(SaoPaulo).2014Aug;69(8):LeeJY,YangCC,ChaoSC,WongHistopathologicaldifferentialdiagofkeloidandhypertrophicscar.JDermatopathol.2004;26:379–[PubMed][GoogleScholar]MahmoudAbdallah¹,MarwaYassin¹,FeaturesofversusHypertrophicScar.TheJournalofHospitalMedicine2018)Vol.70(4),Page622-YooMGandKimIH(2014):KeloidsHypertrophicScars:CharacteristicStructuresVisualizedbyUsingAnnDermatol.,26:603-BeerTW,BaldwinHC,GoddardJRal.(1998):AngiogenesisinPathologiandSurgicalScars.HumanPatholo29:1273-1278 Peculiar Pink Nodule Over Pubic Area: A Dermoscopic View
Conclusion Dermoscopy has gained a lot of importance in diagnosis malignant lesions and also it helps to differentiate benign and malig nant tumors. We present this case for its rarity of presentation and also to discuss dermoscopic features of keloids and HTs. 1. Blum A, Stolz W, Haenssle H et al.
August 202222 Diagnosis of keloid and HTS (hypertrophic scar) is usually clinical. Nevertheless, occasional ly both appear similar and pose a diagnostic difficulty. Dermoscopy acts as non invasive,office based diagnostic method by demonstrat ing definitive patterns of many der Accordingmatosis. to study conducted by Abdallah, et al and Yoo and Kim vascular structures like arborizing vessels, comma vessels and linear vessels are more commonly found in keloids than in hypertrophic scar. This difference is probably attribut ed to the histological differences between keloids and hypertro phic scars particularly in terms of vasculature. The blood vessels in keloids are numerous and aggre gating just beneath the epidermis while they are vertically oriented around the collagen nodules in hy pertrophic scar. As the dermoscope provides a horizontal view of the le sion, the vasculature is much easi er to be detected in keloids than in hypertrophic scars.5, 6 Dermoscopy in our case has shown arborizing vessels, comma vessels which may be attributed to early detection of the lesion. Histopathology acts as a gold standard for confirming the diagno sis. Most common findings in HTs are flattening of the epidermis and replacement of the papillary and reticular dermis by scar tissue with prominent vertically oriented blood vessels and in keloids are flattening of the epidermis and replacement of the papillary and reticular dermis by scar tissue with prominent vertically oriented blood vessels.3, 4, 7, 8
References
Discovery may lead to new treatments to reduce inflammation in vitiligo disease
Until now, the interaction between immune cells, melanocytes, and keratinocytes in situ in human skin has been difficult to study due to the lack of proper tools. By combining non-invasive multiphoton microscopy (MPM) imaging and single-cell RNA sequencing (scRNA-seq), we identified distinct subpopulations of keratinocytes in lesional skin of stable vitiligo patients along with the changes in cellular compositions in stable vitiligo skin that drive disease persistence. In patients that responded to punch grafting treatment, these changes were reversed, highlighting their role in disease persistence.
According to recently published study, researchers have discovered that a signaling molecule called SCUBE3 (signal peptide CUB-EGF-like domain-containing protein 3) potently stimulates hair growth and may offer a therapeutic treatment for androgenetic alopecia.
Vitiligo is an autoimmune skin disease that is characterized by the progressive destruction of melanocytes, which are mature melanin-forming cells in the skin, by immune cells called autoreactive CD8+ T cells that result in disfiguring patches of white depigmented skin. This disease has shown to cause significant psychological distress among patients. Melanocyte destruction in active vitiligo is mediated by CD8+ T cells, but until now, why the white patches in stable disease persist was poorly understood.
SCUBE3 may offer a therapeutic treatment for androgenetic alopecia Androgenetic alopecia (AGA) is a common form of hair loss in both men and women. It is characterized by hair follicles that gradually decrease in size and lead to baldness over time.
A new study reveals the unique cell-to-cell communication networks that can perpetuate inflammation and prevent repigmentation in patients with vitiligo disease. In this study, we couple advanced imaging with transcriptomics and bioinformatics to discover the cell-to-cell communication networks between keratinocytes, immune cells and melanocytes that drive inflammation and prevent repigmentation caused by vitiligo. This discovery will enable us to determine why white patches continue to persist in stable vitiligo disease, which could lead to new therapeutics to treat this disease.
MPM is a unique tool that has broad applications in human skin. MPM is a noninvasive imaging technique capable of providing images with sub-micron resolution and label-free molecular contrast which can be used to characterize keratinocyte metabolism in human skin. Keratinocytes are epidermal cells which produce keratin. Most studies on vitiligo have focused on active disease, while stable vitiligo remains somewhat of a mystery. Studies are currently underway to investigate when metabolically altered keratinocytes first appear and how they may affect the repigmentation process in patients undergoing treatment. The findings of this study raise the possibility of targeting keratinocyte metabolism in vitiligo treatment. Further studies are needed to improve the understanding of how keratinocyte states affect the tissue microenvironment and contribute to disease pathogenesis.
August 2022 23
Although it’s well known that dermal papilla cells play a pivotal role in controlling hair growth, the genetic basis of the activating molecules involved has been poorly understood until now. Researchers have determined the precise mechanism by which the dermal papilla cells promote new growth. At different times during the hair follicle life cycle, the very same dermal papilla cells can send signals that either keep follicles dormant or trigger new hair growth says researcher. We revealed that the SCUBE3 signaling molecule, which dermal papilla cells produce naturally, is the messenger used to ‘tell’ the neighboring hair stem cells to start dividing, which heralds the onset of new hair growth.
The production of activating molecules by the dermal papilla cells is critical for efficient hair growth in mice and humans. In people with androgenetic alopecia, dermal papilla cells malfunction, greatly reducing the normally abundant activating molecules. A mouse model with hyperactivated dermal papilla cells and excessive hair, which will facilitate more discoveries about hair growth regulation, was developed for this research. Studying this mouse model permitted us to identify SCUBE3 as the previously unknown signaling molecule that can drive excessive hair growth. Further tests validated that SCUBE3 activates hair growth in human follicles. Researchers microinjected SCUBE3 into mouse skin in which human scalp follicles had been transplanted, inducing new growth in both the dormant human and surrounding mouse follicles. These experiments provide proof-of-principle data that SCUBE3 or derived molecules can be a promising therapeutic for hair loss.
NEWS
Dr. Sudarshan Pramod Gaurkar MBBS, MD (Dermatology) Consulting Dermatologist Muktangan Skin and Hair Clinic, Kolhapur, Maharashtra Ex Associate Professor, Government Medical College (GMC), Kolhapur, Maharashtra Case Report
A 60-year-old female patient was referred from ophthalmologist for skin changes in face and neck. The patient complained of slate grey to brown pigmentation of the skin of face, slowly progressive over many Onyears.examination patient had distinct asymptomatic macular slate grey colored pigmentation of the photo exposed area like face, neck, hands etc. Patient also had bluish grey colored pigmentation in nails involving lunula. Patients mucosa also had bluish pigmentation. Photoprotected area also had diffuse pigmentation but it was milder than photo exposed area. After clinical examination following differentials were kept. 1. Lichen planus pigmentosus 2. Pigmented contact dermatitis 3. Ochronosis 4. 4mmArgyriaskin biopsy was taken from the skin of neck area. The biopsy revealed presence of extracellular pigmented deposition in the dermis as well as surrounding the sweat glands and hair follicles. Deposition is chiefly extracellular and shows fine small round uniformly sized brown black granules distributed singly and clustered. They are present in greatest number around hair follicles and in basement membrane zones surrounding the sweat glands. In addition to this there is mild perivascular infiltrate of lymphocytes with occasional melanophages. These changes were consistent with argyria. Patient later revealed that she was a case of breast carcinoma survivor. She had undergone mastectomy for the same 11 years ago. She had been on few ayurvedic/ herbal medicines (capsule and tablets) since then for prevention of recurrence of cancer. On further examination of the ayurvedic /herbal medicine, one of the tablets was showing silver like color to naked eyes. Prolonged exposure to this heavy metal in this patient could have lead to argyria in our patient.
August 202224 Uncommon Cause of Pigmentation on Face: Argyria
Uncommon Cause of Pigmentation on Face: Argyria
Discussion Argyria is an uncommon acquired condition characterized by grey-blue pigmentation of skin and mucous membranes caused by the exposure to or ingestion of silver, and it presents with the insidious onset of gray or blue mucocutaneous discoloration. The word argyria is derived from the ancient Greek word for silver, argyros.The term “argyria” was coined by Fuchs.[1] Argyria can be localized or generalized. Examples of localized argyria are associated with the use of mouth fresheners and sugar coated particles, silver earrings and eyelash dye. Generalized argyria can be due to intake of home remedies containing silver, due to ayurvedic prepara tions containing silver, in psychiatric illnesses etc.[2],[3] The body accumulates a small amount of natural silver, so the total content in the body increases with age. The reservoir may contain a binding protein, is present in many tissues, without clinical effect. When a large amount of silver is pres ent, the photoactivation and metal reduction cause bluish gray skin in areas exposed to light discolor ation and has also been reported to lead to a generalized stimulation of melanin production.[2] The discolor ation of skin in argyria is very slow in onset and progression. It is viewed as persistent tan by majority of the Silverpatients.has had medicinal uses since ancient times. Historically, silver ni trate was used for neurological dis orders such as epilepsy and tabes dorsalis. In the late 19th and early 20th century, silver compounds and colloidal silver proteins for their an timicrobial, caustic, astringent and hemostatic properties had varied spectrum of usage. Silver com pounds were used for treatment or prevention of infectious diseases like gonorrhea including Crede's meth od for ophthalmia neonatorum and syphilis, gastrointestinal disorders, oral ulcers, for removal of warts and for bladder irrigation. Silver was also used in allergy and cold remedies, eye drops, nasal sprays, lozenges and antismoking pills.[4] In present day medicine, the use of silver is mainly confined to silver dressings for burns/wound management and in medical appliances. Clinically, the main differential diag nosis of Argyria is with Addison's disease, hemochromatosis, methe moglobinemia; ochronosis, pigmen tation due to other chemicals such as gold, mercury, arsenic, bismuth; drugs such as minocycline, antima
August 2022 25 Uncommon Cause of Pigmentation on Face: Argyria A B C D
Figure 2: Bluish grey colored pigmentation in nails involving lunula (A) Before Treatment (B) 1 month after treatment
Figure 1: Slate grey to brown pigmentation on face (A&B) Before Treatment (C&D) 1 month after treatment A B
1. Wadhera, Akhil, and Max Fung. “Sys temic argyria associated with ingestion of colloidal silver.” Dermatology Online Journal 11.1 (2005).
August 202226 larials, amiodarone, chlorproma zine, quinacrine or chemotherapy.[5] Treatment Stopping the silver exposure and sun-protection with sunscreen are useful for preventing further progres sion of pigmentation. Various treat ment options such as chelation, hy droquinone and dermabrasion are not effective. Recently, Q-switched 1064-nm neodymium-doped yttri um aluminium garnet laser has been reported to be useful for resolving the skin discoloration in argyria.[5] Conclusion Case is reported here to emphasis the rarer causes of pigmentation and the need to look for causative factors before going ahead with treatment plan. References
2. Molina-Hernandez AI, Diaz-Gonzalez JM, Saeb-Lima M, Dominguez-Cherit J. Argyria after silver nitrate intake: Case report and brief review of literature. Indi an J Dermatol 2015;60:520
3. Drake PL, Hazelwood KJ. Expo sure-related health effects of silver and silver compounds: A review. Ann Occu pHyg 2005;49:575-85.
4. Lansdown AB. Silver in health care: Antimicrobial effects and safety in use. CurrProblDermatol 2006;33:17-34.
5. Kubba A, Kubba R, Batrani M, Pal T. Argyria an unrecognized cause of cuta neous pigmentation in Indian patients: A case series and review of the litera ture. Indian J 2013;79:805-811DermatolVenereolLeprol
Uncommon Cause of Pigmentation on Face: Argyria
August 2022 27 For children and young people, skin disorders can have a devastating impact on physical and mental wellbeing, yet effective treatments are few and far between. Skin disorders can have a negative impact on all aspects of life, from schooling and relationships to career and lifestyle choices. Adolescence in particular is a time of self-consciousness, self-doubt and exaggerated concern with appearance and physical attractiveness. It represents a critical period in physical and psychological development, which is skin disorder, which are very common in this age group, can have such an enduring impact. That's why the Medical Research Foundation is pledging £1 million of new funding to help advance scientific understanding of these conditions, which could ultimately lead to improved support and treatment for children and young people living with skin disorders. According to a 2020 survey by the All Parliamentary Group on Skin, 98 per cent of patients with a skin disorder report that their condition affects their emotional and psychological well-being, yet only 18 per cent have received some form of psychological support. New research will investigate two skin disorders in particular eczema and ichthyosis which are both known to have a profound impact on quality of life. Eczema is an inflammatory skin disease affecting 20 per cent of children and eight per cent of adults. It is strongly linked to severe impacts on quality of life, as well as psychological and psychiatric illness such as anxiety, depression and attention-deficit hyperactivity disorder (ADHD). Eczema often starts before the age of two, and affected babies may develop poor sleep habits early. Eczema persists into adolescence or adulthood in around 30 per cent of cases, meaning that people with eczema can suffer with itchy skin and disturbed sleep for large parts of their Researcherslives.
FDA approves ruxolitinib for vitiligo Vitiligo is a condition in which the skin loses its pigment cells (melanocytes). This can result in discolored patches in different areas of the body, including the skin, hair and mucous membranes. The FDA has approved the topical ruxolitinib (Janus kinase inhibitor) for the treatment of nonsegmental vitiligo in adolescents and adults. Ruxolitinib (1.5% cream) is the first FDA-approved treatment for repigmentation in patients with vitiligo. The approval was based on data from two phase 3 TRuE-V clinical trials, which included more than 600 people with nonsegmental vitiligo. At week 24, approximately 30% of patients treated with Ruxolitinib had at least a 75% improvement in facial Vitiligo Area Scoring Index (F-VASI75), compared with approximately 8% and 13% of those in the vehicle arms. At week 52, approximately 50% of patients achieved F-VASI75 and about 30% achieved F-VASI90. It’s important to know that repigmentation takes time. Some patients respond early, some may take a little more time. But the longer you use the medicine, the more benefits the patient will get resercher said. When they look at different subgroups, all the patients seem to have a consistent response. The scientists and development teams that have made this milestone possible, and we're pleased that eligible vitiligo patients now have a choice to address repigmentation. NEWS New funding to help advance scientific understanding of skin disorders in children and young people
The researchers hope that by doing this, they will be able to find changes in the skin of patients with ichthyosis that could potentially be improved by new treatments. To test potential treatments, they will grow skin cells in the lab, which will allow them to see if such drugs are able to 'treat' ichthyosis in the lab.
know that genetic ichthyosis can be caused by changes in DNA that affect skin cells, but little is known about how such DNA changes cause the skin to become scaly and inflamed. In some cases, skin cells are formed at a faster rate than they are needed, and they pile up on the skin surface, thickening the skin. In other forms, the cells are produced at the normal rate but instead of brushing off when they reach the surface, they cannot become detached from the cells beneath them and so they build up in layers.
Dr. Tanuja Rajagopal MBBS, Junior Resident Department of Dermatology S. Nijalingappa Medical College, Bagalkot, Karnataka, India
August 202228 Dermoscopy Of Cirsoid Aneurysm In Skin Of Color: A Case Report
Dr. Balkrishna P. Nikam AssociateMD KrishnaDepartmentProfessorofDermatologyInstituteofMedical Sciences, Karad, Maharashtra, India
Dr. Balachandra S. Ankad ProfessorMD and Head Department of Dermatology S. Nijalingappa Medical College, Bagalkot, Karnataka, India Abstract Cirsoid aneurysm (CA) is a rare benign vascular tumor and small vascular proliferation characterised by small to medium sized channels with features of arteries and veins. Clinically, arteriovenous hemangioma may be difficult to diagnose as it mimics basal cell carcinoma and amelanotic melanoma. Histopathology is confirmatory. Here we report a rare case of cirsoid aneurysm with its histopathological and dermoscopic features in skin of color.
Dermoscopy of Cirsoid Aneurysm In Skin of Color: A Case Report
Key Words: Cirsoid aneurysm, arteriovenous hemangioma, acral arteriovenous hemangioma, dermoscopy Introduction Cirsoid aneurysm (CA), also known as arteriovenous hemangioma or acral arteriovenous hemangioma is a small vascular proliferation characterised by small to medium sized vascular channels with features of arteries and veins. It was first reported by Biberstein and Jessner in 1956 as a distinct,
Dermoscopy Of Cirsoid Aneurysm In Skin Of Color: A Case Report
Figure 1: Clinical image of cirsoid aneurysm showing red papule on the nose Figure 2: Dermoscopy of cirsoid aneurysm shows short linear (arrow), globular (star) vessels and follicular prominence (circle) on the reddish background. Figure..3: Histopathology of cirsoid aneurysm shows multiple thick-walled vessels in papillary dermis. Many vessels are filled with erythrocytes and thrombi. [H and E, 10 x] Discussion Dermoscopy is an adjunctive diagnostic tool that helps in the visualization of skin structures.3 Dermoscopy of cirsoid aneurysm, described by Zaballos et al showed non-arborizing vessels on homogenous or multicolored background. Despite of being vascular tumor, dermoscopy revealed lacunae in a very few cases.4 Similar features were noted in our case. However, follicular prominence was the additional finding which is probably due to the location of the tumor on the facial skin. As mentioned above, CA is confused with basal cell carcinoma and melanoma. Basal cell carcinoma shows arborizing vessels, spoke wheel structures and blue ovoid nests. Whereas amelanotic melanoma shows milkyred areas, dotted and irregular vessels with hairpin-like vessels.5 However, these features were not found in this case.5 Thus dermoscopy is helpful not only in the recognition of CA but also differentiates it from other malignant tumors. Conclusion To conclude, CA is a rare benign vascular tumor that shows definitive dermoscopic features. These features are well correlated with histopathological changes. References 1. Biberstein HH, Jessner M. A cirsoid aneurysm in the skin. Dermatology. 1956; 2.113(3):129-41.VaralaS,Arakkal GK, Malkud S, Narayana B. Cirsoid aneurysm of scalp. Indian J Dermatol Venereol Leprol 2018; 84: 57-58.
August 2022 29 benign acquired cutaneous tumor of vascular origin.1 It appears as a solitary or grouped blue or red coloured asymptomatic papule mainly affecting the head, neck and extremities of the young adults.2 Clinically, arteriovenous hemangioma may be difficult to diagnose as it mimics basal cell carcinoma and amelanotic melanoma. Histopathology is confirmatory. Here we report a rare case of cirsoid aneurysm with its histopathological and dermoscopic features in skin of color. Case Report A 45-year-old male, presented with single asymptomatic red lesion over the nose since 8 months. The lesion was gradually increasing in size. It was painless and did not bleed on manipulation. There was no history of trauma prior to the onset of lesion. No other associated comorbidities like hypertension, chronic liver disease, diabetes, or Human Immunodeficiency Virus infection were noted. On examination, a non-pulsatile solitary dome shaped, 2x3 mm reddish papule with smooth surface was noted (Figure 1). Dermoscopy, in polarised mode, revealed short linear vessels with globular vessels on a homogenous red background. Follicular prominence was also noted (Figure 2). An excisional biopsy was done and histopathology revealed multiple, grouped thick-walled vessels in the papillary dermis. The wall of thick-walled vessels consisted of fibrous tissue and smooth muscle cells and was lined by single layer of endothelial cells. Many vessels were filled with erythrocytes and thrombi (Figure 3). Based on the dermoscopic and histopathological features, a diagnosis of cirsoid aneurysm was made.
3. Adya KA. Dermoscopy: An overview of principle, procedure and practice. In: Dermoscopy- Histopathology Correlation by Ankad BS, Mukherjee SS, Nikam BP (edrs). Singapore: Springer Nature publications, 4.2021.pp.1-14.ZaballosP, Medina C, Del Pozo LJ, Gomez-Martin I, Banuls J. Dermoscopy of arteriovenous tumour. A morphological study of 39 cases. Australas J Dermatol. 2018; 5.59(4):e253-7.AdyaKA, Ankad BS. Premalignant and malignant tumors. In: DermoscopyHistopathology Correlation by Ankad BS, Mukherjee SS, Nikam BP (edrs). Singapore: Springer Nature publications, 2021. pp. 251278.
The use of specific vitamins and minerals for the treatment of hair loss is often based on popular traditions, some elements are traditionally known to play an important role in the physiology of the hair.2 Deficiencies in other minerals such as selenium may also be a factor in hair loss. Biotin is a water-soluble vitamin and an essential cofactor for several important enzymes. Dietary deficiency of this important cofactor has also been associated with hair loss.3 The role of nutrition and diet in treating hair loss represents a dynamic and growing area of inquiry.4
Dietary Supplements for Hair Loss Treatment Part-I
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Dietary Supplements for Hair Loss Treatment Part-I
Mumbai Introduction Hair plays a major role in perception within society. Hair serves as decoration and at the same time, it is a status symbol for wealth and beauty.1 But, hair loss represents one of the most diffuse aesthetic issues among the worldwide population.2 Hair loss is a major psychological problem not only for women but also for men.1 Hair loss is often an overlooked and underappreciated condition3 with 50% of men and nearly 50% of women affected by pattern hair loss by age of 50.2 There are various forms of hair loss. Androgenetic alopecia (AGA) is the most common form.1 It is one of the most common causes of hair loss in men, which can be traced back to the action of the androgenic hormones and the malfunctioning of the enzyme 5-alpha-reductase, which leads to a growing weakness of the hair.2 The loss of hair is not lifethreatening, and it is a natural part of the ageing process.2 Despite being part of the natural aging process, which also affects the scalp, it can negatively affect the quality of life of each individual, with situations that can lead to a state of psychological distress and demoralization.2 To understand the problems of hair loss, it is important to understand whether hair loss falls within the normal physiological process, or otherwise if it is an abnormal complication caused, for example, by problems related to the scalp or hair bulb.2 The classification of all forms of hair loss, baldness, and alopecia, is always complex and reductive since they are often the expression of multiple factors that contribute to the onset of these pathologies.2 Nutritional deficiencies are also a known cause of hair loss and may include inadequate and unbalanced nutritional intake, inadequate intake of proteins, minerals, essential fatty acids, and vitamins.3 Other common causes such as deficiencies of essential trace elements, genetic conditions, hormonal imbalances, or stressful events, which can alter the balance of the hair growth cycle.2
Sir H. N. Reliance Foundation Hospital and Research Centre,
Dr. Sonali Kohli MBBS, MD (Skin and Venereal Disease), M.Sc. (Facial Aesthetics)
Department of Aesthetic Dermatology
Proposed mechanisms for zincassociated hair regrowth include antimicrobial, anti-inflammatory, antioxidant, and anti-5 -reductase activity. Zinc has been studied as both a topical and oral supplement. Oral supplementation of zinc has been studied for AGA and AA. AA may present with concomitant zinc deficiency, and oral supplementation may be beneficial at a dose of 50 mg daily, with positive results seen in 67% of patients in one study and complete resolution seen in a child with diffuse
Thesupplementation.4exactmechanism of action is unclear, one possibility centers on zinc’s role as an essential component of numerous metalloenzymes important in protein synthesis and cell division. Another possibility is zinc’s role in the Hedgehog signaling pathway, a critical component in the pathways that govern hair follicle morphogenesis. In patients with AA and low serum zinc levels, supplementation has been shown to have therapeutic effects.5
Fatty Acids Deficiency of the polyunsaturated essential fatty acids linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid) can result from inappropriate parenteral nutrition and malabsorption disorders such as cystic fibrosis. Hair changes include loss of scalp hair and eyebrows as well as lightening of hair. Unsaturated fatty acids may modulate androgen action by inhibition of 5-reductase, similar to the drug finasteride. Additionally, arachidonic acid, an omega-6 fatty acid, may promote hair growth by enhancing follicle proliferation.5 Animal and plant oils, which are rich in polyunsaturated fatty acids (PUFA), are used in various countries as traditional remedies for skin irritations, rheumatic symptoms, and hair loss.
Serumalopecia.6zinc concentrations were shown to be significantly lower among women with female pattern hair loss, which can be halted or improved with zinc supplements. Zinc supplements can increase hair growth in patients with alopecia areata.3 The main dietary sources of zinc are fish and meat. Zinc deficiency can occur in patients consuming large amounts of cereal grain (which contains a phytate considered to be a chelating agent of zinc), in those with poor meat consumption or total parenteral nutrition (TPN), and in infants on milk formula. Alcoholism, malignancy, burns, infection, and pregnancy may all cause increased metabolism and excretion of zinc.4
The purpose of this review is to highlight hair loss and nutrients relationship, also, highlighting minerals, vitamins, and other elements that can help or concretely contribute to prevent or treat and reduce hair loss2, the role of vitamins and minerals, such as vitamin A, vitamin B, vitamin C, vitamin D, vitamin E, iron, selenium, and zinc, in hair loss.4 Iron Iron deficiency (ID) is the world’s most common nutritional deficiency, which contributes to telogen effluvium (TE) and is a well-known cause of hair loss.4, 5 The mechanism of action by which iron impacts hair growth is not known, hair follicle matrix cells are some of the most rapidly dividing cells in the body, and ID may contribute to hair loss via its role as a cofactor for ribonucleotide reductase, the ratelimiting enzyme for DNA synthesis. In addition, multiple genes have been identified in the human hair follicle, and some may be regulated by iron. Certain populations are at higher risk for ID, and a medical and dietary history may reveal risk factors.5 The serum ferritin (iron-binding protein) level is considered to be a good indicator of total body iron stores and is relied upon as an indicator in hair loss studies. Iron deficiency is common in women with hair loss. The association of hair loss and low serum ferritin level has been debated for many years.4 Vegans and vegetarians are also at higher risk for ID, as their requirements for dietary iron are considered to be 1.8 times higher than for meat consumers. Non-heme iron, found in plants, has a lower bioavailability than heme iron, found in meat and fish.5 Zinc Zinc is an essential trace element involved in enzyme catalysis, protein folding, and gene expression.6 It is an essential mineral required by hundreds of enzymes and multiple transcription factors that regulate gene expression.5 Low zinc levels have been identified in patients with alopecia areata (AA), androgenetic alopecia (AGA), and telogen effluvium (TE).6 Alopecia is a well-known sign of established zinc deficiency with hair regrowth occurring with zinc
In addition, several case reports have described clinical improvement in scalp dermatitis, alopecia, and hair depigmentation with topical application of safflower oil (which is rich in omega-6 polyunsaturated fatty acid, the linoleic-acid-precursor of TheAA).7nutritional supplement assessed in one study is a combination of specific omega-3 and omega-6 fatty acids from fish and blackcurrant seed oils, lycopene, vitamin C, and vitamin E. A study showed a positive impact of a diet rich in omega-3 and omega-6 on sparse hair and hair condition. The main ingredients of the present supplement are fish oil, rich in omega-3 PUFAs (Eicosapentaenoic acid – EPA and Docosahexaenoic – DHA), and blackcurrant seed oil containing the optimal dietary balance of omega-6 (linoleic acid – LA and Dietary Supplements for Hair Loss Treatment Part-I
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Vitamin C Vitamin C plays an essential role in the intestinal absorption of iron due to its chelating and reducing effect, assisting iron mobilization and intestinal absorption. Therefore, vitamin C intake is important in patients with hair loss associated with iron deficiency. Humans are naturally deficient in an enzyme called L-gulonolactone oxidase that is required for vitamin C synthesis, and should therefore take vitamin C through their diet. Citrus fruits, potatoes, tomatoes, green peppers, and cabbages have particularly high concentrations of vitamin C.4 Berries are loaded with beneficial compounds and vitamins that may promote hair growth. This includes vitamin C, which has strong antioxidant properties. Antioxidants can help protect hair follicles against damage from harmful molecules called free radicals. These molecules exist naturally in the body and the environment. Also, the body uses vitamin C to produce collagen, a protein that helps strengthen hair to prevent it from becoming brittle and breaking. Vitamin C helps the body absorb iron from the diet. Low iron levels may cause anemia, which has been linked to hair loss. Sweet peppers are an excellent source of vitamin C, which may aid hair growth. One yellow pepper provides nearly 5.5 times as much vitamin C as an orange. Vitamin C helps promote collagen production, which can help strengthen your hair strands. It’s also a strong antioxidant, which can protect hair strands against oxidative stress.9
Spinach is also a great plant-based source of iron, which is essential for hair growth.9
August 202232 c-linoleic acid – GLA) and omega-3 acids (a-linolenic acid – ALA and, to a lesser degree, stearidonic acid – SA). The supplementation with a combination of specific omega 3&6 and antioxidants improves the overall scalp coverage and hair condition. The nutritional supplement provides a new alternative in the treatment of FPHL.8 Selenium Selenium is an essential trace element required for the synthesis of more than 35 proteins.4 It plays important role in protection from oxidative damage as well as hair follicle morphogenesis.5 There is limited research on selenium deficiency and alopecia in humans. One case report in a child described sparse hair, which improved after dietary supplementation. Given the lack of human research, it is surprising that some hair loss supplements are marketed as containing selenium. This is concerning, as selenium toxicity from nutritional supplementation is well documented. Toxicity can result in generalized hair loss, as well as blistering skin lesions, gastrointestinal symptoms, and memory difficulties.5
Minimal information in the literature exists regarding the benefits of vitamin E supplementation on hair loss. One study of 21 volunteers who received tocotrienol supplementation (100 mg
Vitamin D modulates the growth and differentiation of keratinocytes through binding to the nuclear vitamin D receptor (VDR). Murine hair follicle keratinocytes are immunoreactive for VDR, showing their highest activity in the anagen stage. The role of vitamin D in the hair follicle is evidenced by hair loss in patients with vitamin D-dependent rickets type II. These patients have mutations in the VDR gene, resulting in vitamin D resistance and sparse body hair, frequently involving the total scalp and body alopecia.4 Vitamin E Tocotrienols and tocopherols are members of the vitamin E family and are potent antioxidants. Deficiency results in haemolytic anemias, neurologic findings, and skin dryness.5
Vitamin D Vitamin D is a fat-soluble vitamin synthesized in epidermal keratinocytes. Vitamin D obtained from the diet or synthesis in the skin is inactive and needs to be activated enzymatically.4 Vitamin D plays a role in hair follicle cycling.5 Vitamin D receptors are intracellular receptors expressed in hair follicles, essential for normal hair cycle and differentiation of the interfollicular epidermis. Meta-analyses have reported that AA patients have a higher prevalence of vitamin D deficiency and lower 25-hydroxy vitamin D serum levels compared to healthy controls.6
Dietary Supplements for Hair Loss Treatment Part-I
Vitamin A Vitamin A represents a group of fatsoluble retinoids that includes retinol, retinal, and retinyl esters. This vitamin serves many roles in the body: it is critical for vision, involved in immune function, and is necessary for cellular growth and differentiation.4 Dietary vitamin A has been shown to activate hair follicle stem cells, although its role is recognized as complex and “precise levels of retinoic acid are needed for optimal function of the hair Vitaminfollicle”.5 A exists in the diet as preformed vitamin A (from animal sources) and as provitamin A carotenoids (sourced from plants). Both sources of vitamin A must be metabolized intracellularly to their active forms (retinal and retinoic acid).4 Spinach is loaded with folate, iron, vitamins A and C, which may promote hair growth. A deficiency in these nutrients may result in hair loss.
References 1. Braun N, Heinrich U. What Can Complex Dietary Supplements Do for Hair Loss and How Can It Be Validly Measured—A Review. Applied Sciences. 2020; 30547302;018-0278-6.2019HairTosti4.PMID:10.1155/2015/841570.Reswithgrowthmarineevaluatingdouble-blind,3.10:150.HairSupplements:2.https://doi.org/10.3390/app1014499610(14):4996.LabrozziA(2020)NutrientsinHairEvaluationoftheirFunctioninLossTreatment.HairTherTransplantAblonG.A3-month,randomized,placebo-controlledstudytheabilityofanextra-strengthproteinsupplementtopromotehairanddecreasesheddinginwomenself-perceivedthinninghair.DermatolPract.2015;2015:841570.doi:Epub2015Mar25.25883641;PMCID:PMC4389977.AlmohannaHM,AhmedAA,TsatalisJP,A.TheRoleofVitaminsandMineralsinLoss:AReview.DermatolTher(Heidelb).Mar;9(1):51-70.doi:10.1007/s13555-Epub2018Dec13.PMID:PMCID:PMC6380979.
Folic Acid Folic acid is found in leafy greens and many foods are fortified with folic acid, making deficiency uncommon. Deficiency mainly results in megaloblastic anemia, without the manifestation of hair loss. No significant difference in serum folate levels was seen in 91 patients with diffuse hair loss as compared to controls. Another study of 200 women with chronic TE showed 28.5% had elevated serum folic acid, although methodology of the study was not included and therefore limited conclusions may be drawn.5 Biotin Biotin, or vitamin H, serves as a cofactor for carboxylation enzymes. Symptoms of deficiency include eczematous skin rash, alopecia, and conjunctivitis. One study of an infant fed with a formula lacking sufficient biotin content reported manifestations of periorificial dermatitis and patchy alopecia, both of which resolved with daily oral supplementation of biotin.5 The vitamin B complex includes eight water-soluble vitamin substances— thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, biotin (B7), folate, and vitamin B12—that aid in cell metabolism. Only riboflavin, biotin, folate, and vitamin B12 deficiencies have been associated with hair loss. Vitamin B7 (Biotin) Biotin, also known as vitamin B7 or vitamin H, is a B complex vitamin and cofactor for carboxylase enzymes involved in the fatty acid synthesis, amino acid catabolism, gluconeogenesis, and mitochondrial function in hair root cells. A recent review identified 11 cases of hair loss secondary to biotin deficiency, from either an inherited enzyme deficiency or medication, where biotin was an effective supplementation for hair regrowth.6
5. Guo EL, Katta R. Diet and hair loss: effects of nutrient deficiency and supplement use. DermatolPract Concept. 2017;7(1):110. Published 2017 Jan 31. doi:10.5826/ 6.dpc.0701a01Hosking AM, Juhasz M, AtanaskovaMesinkovska N. Complementary and Alternative Treatments for Alopecia: A Comprehensive Review. Skin Appendage Disord. 2019 Feb;5(2):72-89. doi: 10.1159/000492035. Epub 2018 Aug 21. PMID: 30815439; PMCID: PMC6388561. 7. Munkhbayar S, Jang S, Cho AR, Choi SJ, Shin CY, Eun HC, Kim KH, Kwon O. Role of Arachidonic Acid in Promoting Hair Growth. Ann Dermatol. 2016 Feb;28(1):5564. doi: 10.5021/ad.2016.28.1.55. Epub 2016 Jan 28. PMID: 26848219; PMCID: 8.PMC4737836.LeFloc'hC, Cheniti A, Connétable S, Piccardi N, Vincenzi C, Tosti A. Effect of a nutritional supplement on hair loss in women. J CosmetDermatol. 2015 Mar;14(1):76-82. doi: 10.1111/jocd.12127. Epub 2015 Jan 8. PMID: 25573272. 9. Hayk S. Arakelyan‘Huys’ International JV Corporation • Interactive Clinical Pharmacology,Treatment Tactics,General Medicine and Clinical Research. Dietary Supplements for Hair Loss Treatment Part-I
August 2022 33 of mixed tocotrienols daily) showed a significant increase in hair number as compared to a placebo group.5
Vitamin E Derivatives (Tocotrienols) Vitamin E consists of fat-soluble compounds known as tocopherols and tocotrienols that function as antioxidants by scavenging peroxyl Severalradicals.6 clinical studies have implicated oxidant/antioxidant discrepancy in patients with AA, which is disease dependent on autoimmunity, genetic predisposition, emotional and environmental stress. These studies have been reviewed, with most reviewers reporting increased levels of oxidative stress biomarkers and decreased levels of protective antioxidant enzymes in patients with AA. Vitamin E is involved in the oxidant/antioxidant balance and helps to protect against freeradical damage.4
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