Hair Changes in Females With Type 2 Diabetes Clinical and Trichoscopic Examination

Overview

The aim of this thesis is to investigate the effect of diabetes mellitus on hair by assessing and comparing clinical and dermoscopic hair changes in diabetic patients versus age and sex-matched healthy controls.

The patients will be recruited from the dermatology and endocrinology outpatient clinics of Al-Zahraa University Hospital. Inclusion criteria • Cases: Female patients aged 20-60 years Diagnosed with type 2 diabetes mellitus for at least 1 year HbA1c ≥ 6.5% o Consent to participate * Controls: Age-matched healthy females (no history of diabetes or insulin resistance) Normal fasting blood sugar (\<100 mg/dL) and HbA1c (\<5.7%) No known chronic illness Consent to participate Exclusion Criteria (for both groups) * Current pregnancy or lactation * Thyroid dysfunction * Polycystic ovary syndrome (PCOS) • Anemia (Hb \< 10 g/dL) * History of chemotherapy, radiotherapy, or recent acute illness * Scalp diseases (e.g., tinea capitis, scarring alopecia) * Recent use of drugs known to affect hair growth (e.g., isotretinoin, spironolactone) All patients and control will undergo: 1\. Full history taking 2. Clinical Assessment All participants will undergo generalized dermatological examination including the scalp and body hair. The following aspects will be documented: A. General Scalp Examination • Hair density: visual inspection (reduced, normal) • Scalp condition: erythema, scaling, atrophy, scarring • Presence of inflammation or follicular hyperkeratosis • Hair shaft fragility or breakage • Sebum level: dry, normal, oily B. Hair Loss Type Classification Hair loss will be clinically categorized into one of the following types: 1. Telogen effluvium (TE) Diffuse shedding, positive hair pull test 2. Female pattern hair loss (FPHL) Frontal or vertex thinning with preserved frontal hairline 3. Alopecia areata (AA) Patches of non-scarring alopecia 4. Chronic diffuse hair loss Shedding \>6 months without clear pattern C. Hair Pull Test • Performed by grasping \~50 hairs from the frontal, parietal, and occipital regions • Considered positive if \>6 hairs are easily extracted • Helps diagnose active shedding, especially in TE 3. Dermoscopic (Trichoscopic) Assessment Dermoscopy will be performed using a handheld dermoscope ( dermasight DS175 -cutechs LLC, Cairo, Egypt ) at 10× magnification, with or without immersion fluid. A. Sites Examined * Frontal scalp (midline, 2 cm behind hairline) * Vertex * Occipital region (serves as internal control) Each site will be examined systematically, and the following features will be documented: B. Dermoscopic Parameters Hair shaft diameter diversity (HSDD) \>20% variation Yellow dots Peripilar signs (brown halos) Short vellus hairs Thin hairs \<30 μm Empty follicular openings Black dots Exclamation mark hairs Broken / dystrophic hairs 4\. Blinding and Reproducibility • Two independent dermatologists will assess dermoscopic images. • In case of disagreement, a third reviewer will be consulted. • Observers will be blinded to diabetic status to minimize bias. 5\. Photographic Documentation • High-resolution digital images of scalp regions 6. Laboratory investigations: The following laboratory serum tests will be done: 1. Complete blood count. 2. serum ferritin. 3. Thyroid stimulating hormone. 4. serum vitamin D3. 5. Erythrocyte sedimentation rate. 6. Glycated hemoglobin.

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