RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKABANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE
ADDRESS / DR. JAYAPATHAK
FIRST YEAR, POST GRADUATE
DEPARTMENT OF DERMATOLOGY
VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE
#82 EPIP AREA, NALLURAHALLI,
WHITEFIELD, BANGALORE- 560066.
2. / NAME OF THE INSTITUTION / VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE,WHITEFIELD, BANGALORE
3. / COURSE OF STUDY AND SUBJECT / M.D. DERMATOLOGY
VENEREOLOGY AND LEPROSY
4. / DATE OF ADMISSION TO COURSE / 24thMAY 2012
5. / TITLE OF THE TOPIC / THE ROLE OF DERMOSCOPY IN THE DIAGNOSIS OF CICATRICIAL AND NON-CICATRICIAL ALOPECIAS

6. BRIEF RESUME OF THE INTENDED WORK

6.1NEED FOR THE STUDY

Dermoscopy (also known as dermatoscopy,epiluminescence microscopy, amplified surfacemicroscopy, and surface diascopy) is anon-invasive examination technique ofevaluation of the colors and microstructures ofthe epidermis, dermoepidermal junction, andpapillary dermis not visible to the naked eye;hence enhancing the diagnostic accuracy.[1]

Some dermoscopic patterns that are consistent with certain diseases can be used for diagnosingthe disease.The standard methods used to diagnose hair loss disorders (e.g. simple clinical inspection, pull test, and biopsy) vary in sensitivity, reproducibility, and invasiveness. Dermoscopy is a new and valuable tool in this arsenal. Subtle features (e.g. hair shafts, hair follicle openings, the perifollicular epidermis and cutaneous microvessels) not seen with the naked eye are visibly enhanced, and novel patterns of disease that are diagnostically meaningful are revealed. Scalp dermoscopy does not only facilitate diagnosis of hair disorders but it can also give clues about disease stage and progression.[2]

The number of studies carried out on dermoscopy of alopecias in India is limited.Hence, I would like to undertake a study to evaluate the use of dermoscopy in investigating and diagnosing cicatricial and non-cicatricialalopecias.

6.2 REVIEW OF LITERATURE

For humans, hair is an important indicator of individual characteristics such as self-image, identity, ethnicity and health, among other attributes. Hence,diseases that result in hair loss lead to disorders related to self-esteem and psychosocial interactions.Therefore, in conditions such as alopecias, prompt diagnosis and timely therapeutic intervention are of extreme importance in the prognosis of patients.[3]

Dermoscopy provides a non-invasive option that can be used to diagnose and monitor the progression of hair disorders. Hair loss due to alopecia areata, androgenetic alopecia, telogen effluvium or hair shaft disorders like monilethrix can be differentiated via dermoscopy. Scalp conditions like tineacapitis, discoid lupus erythematosus, seborrheic dermatitis, pseudopalade of broque, lichen planopilaris or trichotillomania show different patterns under a dermoscope. Further, the procedure of dermoscopic analysis is easy, patient friendly and can be repeated on multiple occasions for follow up.[4]

Dermoscopic patterns seen in normal and affected scalps are: [2]

1)interfollicular patterns; and

2)follicular patterns.

Interfollicular patterns are of two types:

a)vascular pattern; and

b)pigment pattern (honeycomb pigment).

Dermoscopic observations can be interpreted and utilized in an algorithmic manner and correlated with clinical features to reach a diagnosis of the common hair loss diseases.[5]

Tosti A et al, have carried out a study on 70 patients using a dermoscope to diagnose alopecia areata incognita. Seventy patients with alopecia areata incognita were evaluated clinically and with a dermoscope during the period of 2002 to 2006. Pathology was performed in 50 patients. The presence of numerous, diffuse, round or polycyclic yellow dots, different in size and uniformin color and distribution, was a typical dermoscopic feature in all patients. Short regrowing hairs were alsopresent. The dermoscopic findings were correlated and supported by the histologic features of the scalpspecimens. The authorshave concluded that dermoscopy is the first step before performing a biopsy. It can help the clinician to find the right place to take the sample, but can also avoid unnecessary biopsies.[6]Kose Oet al, in their study of alopecias on 144 patients suggest that a handheld dermatoscope attached to a digital camera provides a practical and useful aid for the clinical diagnosis of alopecias. In all, 144 patients with alopecia and 144 age- and sex-matched control subjects were enrolled inthe study. Diagnoses were established clinically, and confirmed by scalp biopsy in doubtful cases.Dermatoscopic examination was performed by a polarized-light handheld dermatoscope with a 10-foldmagnification. The images were obtained by a digital camera with a 3-fold optical zoom. The dermatoscopic patterns of circular hairs, dirty dots, epidermal scales, and pustules showed nostatistically significant difference between patients and control subjects. The following features weresignificantly more common, or observed solely, in particular types of alopecia: hair diameter diversity,peripilar sign, and empty follicles in androgenetic alopecia; yellow dots, black dots, tapering hairs, andbroken hairs in alopecia areata; absence of follicular openings, tufted hairs, white dots, follicularhyperkeratosis, pili torti, red dots, honeycomb pigment pattern, pink-white appearance, crusts, andpustules in primary cicatricial alopecias.[7]

In light of the existing international studies on dermoscopy, it is important to evaluate the use of dermoscopy in diagnosing alopecias in India as well.

6.3OBJECTIVES OF STUDY

1)To study the dermoscopic findings of scalp and hair shafts in cicatricial and non-cicatricialalopecias.

2)To explore the utility of dermoscopy in the examination and diagnosis of various hair loss disorders.

7.MATERIALS AND METHODS

7.1 SOURCE OF DATA

All male and female patientswith various hair loss disorders, attending the outpatient clinic of the DepartmentofDermatology, Venereology and Leprosy at Vydehi Institute of Medical Sciences & Research Centre, Whitefield, Bangalore.

7.2 METHOD OF COLLECTION OF DATA

  • Informed written consent of the participating patients will be taken.
  • A pre-structured proforma shall be used to collect the baseline data.
  • Detailed history will be taken and clinical and dermatological examination will be done.
  • The hair and scalpwill be evaluated using a dermatoscope for follicular and interfollicular patterns.
  • Additionalinvestigations including skin biopsy will be done as and when required.

STATISTICAL ANALYSIS:

Type of study: Cross sectional study.

Analysis of data:Statistical analysis of the data will be carried out using proportions and percentages.

The study is time bound from January 2013 to April 2014.

Sample size: Study of a minimum of 100 patients with hair loss disorders.

INCLUSION CRITERIA:

  • All consenting male and female patients, with hair loss disorders, attending the Department of Dermatology, Venereology and Leprosy.

EXCLUSION CRITERIA:

  • Hair loss occurring due to any external injury.
  • Hair loss occurring due to chemotherapy and any other drugs.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals?

Yes

Investigations

  • Dermoscopy
  • Skin biopsy, as and when required.

7.4 Has ethical clearance been obtained from your institution?

Yes

8. LIST OF REFERENCES

1.TanakaM. Dermoscopy. J Dermatol. 2006;33(8):513-7.

2.TostiA.Dermoscopy of hair and scalp disorders with clinical and pathological correlations. London: Informa Healthcare;2007:1-14.

3.Duque-Estrada B. Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris.An Bras Dermatol.2010;85(2):179-83.

4.Kharkar V. Overview of trichoscopy. In: Khopkar U, editor. Dermoscopy and trichoscopy in diseases of the brown skin. 1sted. New Delhi:Jaypee Brothers Medical Publishers (P) Ltd;2012:169-70.

5.Inui S. Trichoscopyfor common hair loss diseases: algorithmic method for diagnosis. J Dermatol. 2011;38:71-5.

6.Tosti A, Whiting D, Iorizzo M et al. The role of scalp dermoscopy in the diagnosis of alopecia areata incognita. J Am AcadDermatol. 2008;59(1):64-7.

7.Karadağ ÖK, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am AcadDermatol. 2012;67(2):206-14.

9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDE / DERMOSCOPY COULD BE A USEFUL TOOL FOR
MAKING A CORRECT DIAGNOSIS IN DAY TO DAY PRACTICE.
11. / NAME AND DESIGNATION OFGUIDE
SIGNATURE
HEAD OF DEPARTMENT
SIGNATURE / DR. RAJENDRAN S C
PROFESSOR,DEPARTMENT OF DERMATOLOGY
VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE, BANGALORE, KARNATAKA.
DR. K. HANUMANTHAYYA
PROFESSOR AND HOD
DEPARTMENT OF DERMATOLOGY
VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE, BANGALORE, KARNATAKA.
12. / REMARKS OF THE CHAIRMAN AND PRINCIPAL
SIGNATURE