Vol. 34. No. 2


The June issue of Seminars in Cutaneous Medicine and Surgery is dedicated to the diagnosis and treatment of hair and nail disorders. As you know, this is not an easy task. There is considerable clinical and histopathologic overlap in many of the diseases discussed here, and some are rarely encountered. Visits can be lengthy and emotional, and many providers have limited experience, and, more importantly, limited confidence in treating affected patients. There is a definite need for informed, capable physicians and practitioners. It is hoped that this volume will help provide just that. The topics in this issue were chosen to provide helpful, practical information from experts in the field. I am grateful for the contributions of each of the talented authors and co-authors who participated, whose expertise and hard work made this endeavor possible. Drs Thomas Chu, Leopoldo Santos, and Kevin McElwee start off with a discussion of hair biology that is both insightful and easy to understand. Dr Eleanor Knopp takes over with a “primer” on how to approach and interpret a scalp biopsy. From there, Drs Fernanda Torres and Antonella Tosti help us distinguish the two most common forms of diffuse alopecia, telogen effluvium, and female pattern hair loss, with the help of our dermatoscopes. Drs Maria Hordinsky and Ana Lucia Junqueria update us on alopecia areata. Drs Tee Siah and Jerry Shapiro delve a little deeper into the scarring alopecias, and Drs Ashley Semble and Amy McMichael provide insight into hair disorders that affect patients of color. Dr Nicole Rogers then concludes the hair section with an eloquent description of hair transplantation. Capping off the issue is a nail triad, consisting of superb, detailed discussions from Dr Eckart Haneke on nail anatomy and biopsy technique, Dr Beth Ruben on pigmented lesions of the nail unit, and Drs Molly Hinshaw and Adam Rubin on inflammatory diseases of the nail. In addition, behind the scenes, medical student Denise Wong read all the manuscripts and offered helpful suggestions. Empowered with this vital information, it is hoped that dermatology providers will take on the challenge of evaluating and treating patients with hair and nail disorders. Like with all dermatologic disorders, a differential diagnosis can be generated clinically, narrowed by biopsy, and confirmed or excluded with clinicopathologic correlation. Standard therapeutic regimens, albeit based more on experience than hard data, can be instituted and personalized. While there is much unknown and many questions now unanswerable, the progress being made is undeniable. This year has been a significant one for the field of alopecia. Phones were ringing and inboxes filling when reports of patients with severe alopecia areata experiencing complete regrowth hit the press. While we had to explain to our patients that these medications need more study and are not (yet) widely available, it is exciting that the path from genetic studies to case reports of effective drugs has shortened considerably. It is reasonable to assume this pace will continue, and we will have even more to offer our patients in the future.

Biology of the hair follicle and mechanisms of nonscarring and scarring alopecia

Kevin J. McElwee, PhD | Leopoldo Santos, MD | Thomas W. Chu, MD

There are many hair disorders, all of which involve alterations in normal hair biology. Essentially, hair disorders involve changes to hair fiber caliber, density per unit area, and/or the duration of anagen and telogen in the hair growth cycle. Hair disorders may be triggered by inflammation, genetics, the environment, or hormones; the relative contributions of these factors vary for different hair disorder diagnoses. Suitable treatments may either address the underlying causal factors or directly act on hair follicle biology. The objectives are to normalize the hair growth cycle, modulate the size of hair follicles, and potentially regenerate hair follicles to stabilize hair density. The purpose of this manuscript is to review the basic biology of the hair follicle, as well as causal mechanisms for the disordered hair follicle using some selected examples of hair disorders. Semin Cutan Med Surg 34:50-56 © 2015 Frontline Medical Communications


The scalp biopsy for hair loss and its interpretation

Eleanor Knopp, MD

The diagnosis of alopecia is an area of dermatology that frequently relies on the close correlation of clinical and pathological features. Therefore,careful selection of the scalp biopsy site, optimal biopsy technique, and proper specimen processing followed by informed histological interpretation are essential steps in the successful evaluation of both cicatricial and noncicatricial alopecias. This review will serve as a primer for clinicians and pathologists alike wishing to optimize their approach to the scalp biopsy and interpretation of key noncicatricial and cicatricial alopecias. Semin Cutan Med Surg 34:57-66 © 2015 Frontline Medical Communications


Female pattern alopecia and telogen effluvium: figuring out diffuse alopecia

Antonella Tosti, MD | Fernanda Torres, MD

Diffuse hair loss in women causes a significant impact on quality of life, reduces self-esteem, and increases stress. One of the major challenges when evaluating patients with diffuse hair loss is to determine whether you are dealing with either female pattern alopecia, telogen effluvium, or both, as they can coexist. Establishing the correct diagnosis is mandatory for optimal patient care. This article will highlight how to distinguish between and properly manage these 2 conditions. Semin Cutan Med Surg 34:67-71 © 2015 Frontline Medical Communications


Alopecia areata update

A.A. Marghoob, MD | Alde Carlo Gavino, MD

There is neither a cure for alopecia areata (AA) nor any universally proven therapy that induces and sustains remission in patients afflicted with this autoimmune disease. AA is characterized as a nonscarring alopecia which affects children and adults. It can be relatively easy to treat when the disease is patchy and limited; but when children and adults present with long standing extensive scalp and body hair loss, successful management can be challenging. Of the treatment choices available, physicians and midlevel providers usually select a cost-effective treatment approach based on disease duration, disease activity, age of the patient, and disease extent. In this manuscript, the clinical presentation, epidemiology, pathophysiology, plus current and evolving treatments for AA will be reviewed. Semin Cutan Med Surg 34:72-75 © 2015 Frontline Medical Communications


Scarring alopecias: a trichologic emergency

Jerry Shapiro, MD | Tee W. Siah, MRCP

Scarring or cicatricial alopecias represent a group of poorly understood and uncommon disorders that cause permanent hair loss. Scarring alopecias are regarded as trichologic emergencies as hair loss is irreversible, rapidly progressive, and can be disfiguring. Patients could experience tremendous anxiety, low self-esteem, and extreme psychosocial stress. Hence, prompt diagnosis and aggressive treatment are essential in the management of active primary scarring alopecias as early intervention may slow down or prevent further hair loss. This article will review different types of primary scarring alopecia in hopes of helping clinicians accurately diagnose these conditions as well as provide appropriate treatment. Semin Cutan Med Surg 34:76-80 © 2015 Frontline Medical Communications