Ralph M. Trüeb

• Professor
• Center for Dermatology and Hair Diseases Professor Trüeb

Trichoscopy has gained popularity as a valuable tool in the differential diagnosis of hair and scalp disorders. Nevertheless, as a diagnostic procedure, trichoscopy is to be understood as representing an integral part of a more comprehensive dermatological learning to include a stringent nosological classification based on a pathogenic understandin...

Introduction: Cutis verticis gyrata (CVG) is a medical condition that is characterized by thickening of the scalp giving the scalp a cerebriform appearance. Due to an apparent paucity of the condition, limited research exists, and causes are as yet undetermined. What is known, is that the condition may either be a feature of several syndromes or o...

Dear Editor, We read with interest the recent article in Clinical and Experimental Dermatology by Arora et al.,¹ reporting on evaluation of serum levels of cysteine in patients with chronic telogen effluvium (CTE) and healthy controls. The authors found neither low levels of cysteine nor any correlation between cysteine levels and hair loss severit...

IntroductionScalp psoriasis is one of the most common and challenging manifestations of plaque psoriasis for general practitioners, dermatologists, and patients, as successful topical management requires the choice of effective ingredients, an appropriate formulation, and clear application instructions to patients. To date, only limited experience...

Introduction: A fragment of hair penetrating the skin has been referred to as cutaneous pili migrans in the literature. The condition is regarded rare and the cause unknown. Case presentation: A 55-year-old female experienced painful sensations of the sole. Dermoscopy revealed hair fragments penetrating the skin, and histopathology a hair shaft...

Oral finasteride represented a breakthrough for treatment of male pattern hair loss (MPHL), with clinical studies having demonstrated high efficacy of treatment and a favorable safety profile. And yet, fertility issues, malignancy, and postfinasteride syndrome have been concerns of users and prescribers of the drug. Pre-existing mental health disor...

Background: marginal alopecia presents itself frequently in dermatological practice. For patients who present peripheral scalp hair loss, cicatricial and non-cicatricial alopecia should be considered, such as ophiasis, traction alopecia, and frontal fibrosing alopecia. In spite of the several types of hair loss that have been described in cutaneou...

Pattern hair loss (PHL) is the most frequent cause of hair loss in men and women, accounting for 65% of consultations in a hair referral center. PHL is understood to represent a hereditary, age-dependent progressive thinning of the scalp hair, which follows distinct clinical patterns with notable differences depending on sex and age of onset. Clini...

Altern ist ein grundlegender biologischer Vorgang, der für alle Organe charakteristisch abläuft. Der Alterungsprozess führt zur Abnahme der Maximalfunktion und Reservekapazität aller Organsysteme, einschließlich der Haut und ihrer Anhangsgebilde. Vom frühen bis ins späte Erwachsenenalter belaufen sich diese Verluste auf 50 % und machen das Individu...

Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findi...

Oxidative stress is an unbalanced condition in which the tissues of the body are not sufficiently able to counteract either exogenous or endogenous sources of reactive oxygen species. Oxidative stress is strongly associated with aging, both local and systemic, as well as a wide range of local health conditions. This review focuses on the oxidative...

Topical treatment is crucial for the successful management of plaque psoriasis. Topicals are used either as a stand-alone therapy for mild psoriasis or else in combination with UV or systemic treatment for moderate-to-severe disease. For the choice of a suitable topical treatment, the formulation matters and not just the active substances. This exp...

While the novel viral pandemic coronavirus disease 2019 (COVID‐19) has sparked uncertainties as to its origin, epidemiology, and natural course, the medical community strives to contribute to a better understanding of the disease based on the best available evidence gained from the scientific method of observation and statistics. The study of the c...

With today’s increasing life expectation and quality of life, the desire to look young and beautiful plays a bigger role than ever. Aging of the hair is particularly visible. And yet, cosmetic dermatology has paid comparatively little attention to the care of the aging hair. The professional market for cosmetic interventions into the face has prece...

Background: Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. Objectives and methods: We performed a multicenter retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epide...

Background/objectives: Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and lichen planopilaris (LPP). The existing literature on FAPD and current understanding of the epidemiology, pathogenesis, clinical features, diagnosis, and treatmen...

Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, e...

Background: The frequency of different types of alopecia is not clearly reported in recent studies. Objective: To analyze the frequency of the types of alopecia in patients consulting at specialist hair clinics (SHC) and to assess for global variations. Methods: Multicenter retrospective study including data from patients evaluated at referral...

Post-finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat either hair loss or benign prostatic hyperplasia, independent of age, dosage, or indication. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of fina...

Background: Fibrosing alopecia in a pattern distribution (FAPD) has only been described in Caucasian patients, and it is not clear whether it can develop in dark-skin ethnicities. Materials and methods: Sixteen Brazilian female patients, 12 of African descent and 4 Hispanic, with progressive scarring alopecia in a pattern distribution were analy...

Minoxidil sulfate is the active metabolite required to exert the vasodilatory and hair growing effects of minoxidil. For hair growth, sulfotransferase enzymes expressed in outer root sheath of the hair follicle sulfonate minoxidil. The large intra‐subject variability in follicular sulfotransferase was found to predict minoxidil response and thus ex...

Ichthyosis is a heterogeneous group of inherited skin disorders characterized by a defect of keratinization. Patients diagnosed with lamellar ichthyosis (LI) and some ichthyosiform syndromes, such as the Conradi–Hünermann‐Happle syndrome (CHHS), usually present with hair loss. Even though only few dermatologic complaints carry as many emotional ove...

Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, e...

Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, e...

Facial lichen planus pigmentosus (LPPig), a rare variant of classic lichen planus, was first described in patients with frontal fibrosing alopecia (FFA) by Dlova [Br J Dermatol 2013; 168: 439–442] in 2013. The diagnosis of facial LPPig is sometimes not easy, since clinical signs and histopathological features may frequently be confused with melasma...

Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. The best way to alleviate the distress related to hair loss is to effectively treat it. In fact, one of the oldest medical professions is the Egyptian physician who specialized on diseases of the head. And yet, from ancient Egypt down to modern times, human h...

Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. The best way to alleviate the distress related to hair loss is to effectively treat it. In fact, one of the oldest medical professions is the Egyptian physician who specialized on diseases of the head. And yet, from ancient Egypt down to modern times, human h...

Background Ultraviolet radiation (UVR) is known to be harmful to normal human epidermal keratinocytes (NHEKs) of the epidermal skin layer, as well as to hair-follicle-associated keratinocytes. An oral formulation containing l-cystine, thiamin, calcium d-pantothenate, medicinal yeast, keratin and p-aminobenzoic acid (Panto[vi]gar®) has demonstrated...

Worldwide, breast cancer is the most common invasive cancer in women, affecting about 12%.¹ The incidence has significantly increased since the 1970s; however, with the advances and sophistication in diagnosis and treatment, survival rates have become high, with between 80% and 90% of patients with breast cancer alive for at least 5 years. Neverthe...

Traditionally, syndromes have been named after the physician who originally identified the condition. These are referred to as eponymous syndromes. Nevertheless, the term eponym is to be regarded in a broader sense, since - by definition - an eponym is a person, place, or thing after whom or which something is named. Accordingly, some eponymous syn...

Observations on the Laron syndrome originally offered the opportunity to explore the effect of insulin-like growth factor 1 (IGF-1) deficiency on human hair growth and differentiation. According to its expression in the dermal hair papilla, IGF-1 is likely involved in reciprocal signaling. It has been shown to affect follicular proliferation, tissu...

Alopecia areata is a common hair loss condition that is characterized by acute onset of non-scarring hair loss in usually sharply defined areas ranging from small patches to extensive or less frequently diffuse involvement. Depending on its acuity and extent, hair loss is an important cause of anxiety and disability. The current understanding is th...

Frontal fibrosing alopecia represents a peculiar condition with a quasi-symmetrical, marginal scarring alopecia along the frontal and temporal hairline. The condition has been associated with further histopathologic and/or clinical evidence of lichen planopilaris. Since its emergence with the original report of Kossard in 1994, frontal fibrosing al...

Background/aims: Alopecia areata is a common immune-mediated hair condition with limited treatment options and success rates. There is evidence that statins, which are used for reducing atherogenesis and cardiovascular disease, have immunomodulatory activities and therefore may also be used for treatment of selected dermatologic conditions, includ...

Synthetic hair implants are considered in alopecia when the patient requests an immediate result with minor surgery and with a poor donor area. However, the procedure has historically been marred by poor quality fiber and performance resulting in serious complications. Nevertheless, companies continue to market the procedure with the claim that pre...

Based on observations of Julianne Imperato-McGinley of Cornell Medical College, New York presented at a conference on birth defects in 1974 on a peculiar genetic disorder due to type 2 5α-reductase deficiency (5-ARD), oral finasteride was approved in 1992 by the U.S. Food and Drug Administration for treatment of benign prostatic hyperplasia (BPH),...

Alopecia areata is a common autoimmune disorder that targets hair follicles. Swarms of lymphocytes surround the basis of the follicles, inducing loss of pigmented terminal hair and subsequently inhibit further hair growth. Depending on the extent of involvement, alopecia areata can be associated with a dramatic reduction of quality of life. Current...

Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to detoxify the reactive intermediates or to repair the resulting damage. Reactive oxygen species or free radicals are highly reactive molecules that can directly damage lipids, proteins, and DNA. They are generated...

Similar to the rest of the skin, the hair is exposed to noxious environmental factors. While ultraviolet radiation (UVR) and smoking are well appreciated as major factors contributing to the extrinsic aging of the skin, their effects on the condition of hair have only lately attracted the attention of the medical community. Terrestrial solar UVR ra...

A case of acute diffuse and total alopecia of the female scalp associated with Borrelia-infection (acrodermatitis chronica atrophicans) is presented. Today, acute diffuse and total alopecia of the female scalp is recognized as a distinct variant of alopecia areata (AA) predominantly observed in women. Cases of AA have formerly been reported in asso...

Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. Eighteen children (10 girls, 8 boys) younger t...

A case of frontal fibrosing alopecia with nail involvement is presented. Nail involvement provides evidence for underlying lichen planus, and that the disease represents a rather generalized than localized process. Favorable response of the scalp condition to oral dutasteride points to an inflammatory reaction on the background of androgenetic alop...

Androgenetic alopecia (AGA), also referred to as male-pattern hair loss or common baldness in men and as female-pattern hair loss in women, is the most common hair loss disorder, affecting both men and women. The hair loss is genetically determined, androgen induced, age dependent, and with sex-dependent differences in incidence, pattern, and sever...

It is a common experience among dermatologists that a significant number of their patients have psychological overlays to their chief complaints. This particularly holds true for complaints related to conditions of the hair and scalp. The exact incidence in any particular dermatologic practice most likely depends on the dermatologist’s interest; ho...

Even with a correct diagnosis of a hair condition and appropriate treatment for that specific condition, a proportion of patients do not get better. Urquhart proposed three categories of nonresponse to treatment: (1) pharmacodynamic (nonresponse), (2) pharmacokinetic (nonabsorption), and (3) pharmionic (noncompliance).

In every art, there are many techniques, but few principles. The only way to achieve success is to have a firm foundation of principles to build upon and the right attitude about achieving one’s goals. In the chapters of this book, the basic principles of clinical trichology as well as the attitudes to effectively translate these principles into li...

Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. The best way to alleviate the emotional distress related to hair loss is to effectively treat it. As with any medical problem, the patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp,...

As with any medical problem, the patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp, and appropriate laboratory evaluation to identify the cause. The clinician also has a host of diagnostic techniques that enable classification of the patient’s disorder as a shedding disord...

Faith healing is healing allegedly through spiritual means. Believers claim that the healing of a person can be brought about by religious faith through prayer and/or rituals that stimulate a divine presence and power toward healing disease. In common usage, faith healing refers to ritualistic practices of communal prayer and gestures, such as layi...

The difficult patient can be defined as one who impedes the clinician's ability to establish a therapeutic relationship. Data from physician surveys suggest that nearly one out of six outpatient visits are considered difficult.

A side effect is an effect that is secondary to the one intended. The term is primarily used to describe unwanted or adverse effects. In the broader sense, the term can also apply to unintended, but beneficial effects from the use of the drug. An example is the hair growth-promoting effect of minoxidil that was originally a drug intended to lower t...

Clinical trichology should represent an integral part of medical training, and the dermatologist participates with the other medical disciplines in the diagnosis and treatment of all types of hair problems relating to systemic disease. On the other hand, hair loss is an important cause of discomfort and disability. The general physician is not alwa...

As with any medical problem, the male patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp, and, as indicated, appropriate laboratory evaluation to identify the cause. The clinician also has a host of diagnostic techniques that enable classification of the patient’s disorder...

Any text with the least claim of authority is a mere shadow compared to the authority of the Bible in the history of mankind and civilization. Therefore, it would be negligent not to quote the Bible references to the condition of hair in man. The Bible, from Koine Greek tà biblía, which means the “the books,” is a canonical collection of texts cons...

Background: A sensitive scalp is a frequent problem in daily clinical practice and often represents a major challenge for dermatologists. Objective: The objective was to evaluate the efficacy of a Northamerican Virginian Witch Hazel (Hamamelis virginiana)-based shampoo and tonic (Erol® Energy) for treatment of the sensitive scalp. Methods: Retros...

Background: Androgenetic alopecia (AGA) is the most common form of hair loss in men and in women. Currently, minoxidil and finasteride are the treatments with the highest levels of medical evidence, but patients who exhibit intolerance or poor response to these treatments are in need of additional treatment modalities. Objective: The aim was to...

Diffuse partial woolly hair (DPWH) is an uncommon pilar dysplasia defined by the presence of two hair shaft populations with wooly hairs distributed diffusely among normal hairs throughout the scalp. So far the condition has been reported as an isolated disorder with familial occurrence. We report a case of DPWH in 35-year-old female patient with e...

Vernarbende Alopezien stellen eine diagnostische und therapeutische Herausforderung dar. Die Irreversibilität eines potenziellen kosmetischen Defektes erfordert eine sorgfältige Diagnostik. Leitsymptom ist der Schwund von Haarfollikelöffnungen, der zurückzuführen ist auf die irreversible Schädigung biologisch wichtiger anatomischer Haarfollikelstru...

Purpose: Chemotherapy-induced alopecia is very distressing for a patient and may have an impact on treatment decisions. On docetaxel-based therapy, alopecia occurs in a substantial proportion of patients. We aimed to investigate whether two different methods of scalp cooling can prevent hair loss. Methods: In this open-label, prospective, nonran...

Nahrungsergänzungsmittel sind Produkte zur erhöhten Versorgung des menschlichen Stoffwechsels mit bestimmten Nähr- oder Wirkstoffen im Grenzbereich zwischen Arzneimitteln und Lebensmitteln. Die moderne Ernährungswissenschaft beschäftigt sich zunehmend mit der Untersuchung spezifischer Nahrungsmittel, welche zusätzlich zu ihren nährenden Eigenschaft...

Few dermatologic complaints carry as much emotional overtones as hair loss. Adding to the patient's worry may be prior frustrating experiences with physicians, who trivialize hair loss. A detailed patient history, physical examination and few pertinent screening blood tests usually establish a specific diagnosis. Once the diagnosis is certain, trea...

Hair care, color, and style play an important role in people’s physical appearance and self-perception. Hair defines an individual’s gender, age, sexual attitude, and social status. There are no significant differences in the number of hair follicles between men and women or between different races. Differences in the appearance of hair are due to...

The psychosocial significance of hair and a religious connotation are well appreciated. In a monograph entitled The Unconscious Significance of Hair, Berg reviewed the anthropological literature on hair and emphasized its significance in many rituals. Hair has been recognized to have two perceived symbolic meanings in a spiritual context: shaven ha...

Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. Adding to some patient’s worry may be prior frustrating experiences with physicians, who tend to trivialize complaints of hair loss or dismiss them completely. This attitude on the part of physicians is related either to lack of comprehension of the impact of...

Global photographic assessment has successfully been established as a standard method for objectively monitoring hair growth in the course of the finasteride trials in men since 1992. Since its introduction, the technique has proven to be essential for follow-up of hair loss patients undergoing long-term treatment in daily clinical practice as well...

As with any medical problem, the female patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp, and appropriate laboratory evaluation to identify the cause. The clinician also has a host of diagnostic techniques that enable classification of the patient’s disorder as a shedding...

Clinical trichology should represent an integral part of medical training, and the dermatologist participates with the other medical disciplines in the diagnosis and treatment of all types of hair problems relating to systemic disease. On the other hand, hair loss is an important cause of discomfort and disability. The general physician is not alwa...