Question 1

Hair Loss: Probable Causes and Treatment Options

Accepted Answer

A 23-year-old female patient sought a second opinion about the causes of major hair loss resulting in small foci of alopecia. Notably, her hair used to be very thick.

Available data: laboratory blood analysis, including a full blood count, a basic metabolic panel, a comprehensive hormone panel, vitamin tests.

Problem Statement

Find out the cause of rapid and uncontrollable hair loss despite normal blood test results.

Selected Format

Video consultation

Outcome

Considering the data obtained from the available blood tests and an online video conference with the patient, a German dermatologist suspected Alopezia areata (spot baldness).

Generally, hair loss can have a variety of causes: infections, allergies, genetic predisposition, autoimmune disorders, psychological issues, and environmental factors.

In the lab tests, the doctor especially noted the abnormal cortisone level. Therefore, follow-up diagnostics, including thyroid function blood tests (TSH, Ft3, Ft4) and endocrinology examination, were recommended. The patient was also encouraged to do biotin, selenium and folic acid deficiency lab tests, since hair loss is frequently associated with their insufficiency.

Depending on the exam results, the following further procedures were suggested:

Replacement therapy in case of vitamin deficiency.

Topical treatment with platelet-rich plasma (PRP) alternating with a 1:1 mixture of triamcinolone acetonide (10 mg) and a local anesthetic injected in the problem areas. The course should include 3 to 6 PRP procedures with 4-week intervals, then 1 or 2 procedures every 4-6 months. Triamcinolone acetonide & local anesthetic injections should be administered every 2 weeks in the acute period. A follow-up examination (reevaluation) should be done in 3 months.

Medconsonline Comment

It was a good idea to hold a video conference since the expert could see the lesions and estimate the overall hair loss, so the assessment of the lab test results could be made in view of own clinical findings. As a result, adequate therapy was prescribed, which eventually gave the expected result.

It is worthwhile mentioning that the consulting specialist’s clinic does not only offer state-of-the-art diagnostics, but also provides most advanced therapy options.

Consulting expert

Said Hilton

Dr. Med., Founder and head of the largest private dermatology, venereal and allergy clinic in North Rhine-Westphalia. Specialist in the field of aesthetic medicine

Question 2

Reliable Exclusion of Melanoma: Controversial Diagnosis Management

Accepted Answer

A 49-year-old female patient with an operated neoplasm on the skin of the forearm. Initially diagnosed with malignant melanoma, repeated histological examination did not confirm the diagnosis. The patient sent histology samples for examination to Germany, to the University Institute of Pathology and asked for a second opinion from a dermatologist. Tumor photographs before and after surgery were also provided.

Problem statement

Confirmation or exclusion of malignant melanoma

Selected Format

Video consultation

Outcome

The pathologist of the University Medical Center did not completely remove the suspicion of melanoma, pointing out that the material after repeated processing did not contain tumor tissue in the region of maximum depth and only the marginal section could be analyzed.
The dermatological consultation was conducted by the director of the university dermatological clinic. The ultrasound examination result of the axillary lymph nodes and histological material with previous immunostaining were requested. Ultrasound examination revealed no pathology. Histological analysis of the provided samples differentiated the neoplasm as a halo nevus.
Given the insufficiency of the material provided, malignant melanoma could not be completely excluded. It was recommended to perform a second excision with a safe distance of 1 cm from the tumor edge. The professor also recommended a specialized dermatological check-up every six months in accordance with the recommendations for malignant melanoma in stage 1A.

Medconsonline Comment

In a situation where the primary sections of the tumor could not be provided to the expert, the consultant was able to assess the preserved material as much as possible and, in the absence of an unequivocal diagnosis, give recommendations that are a reliable tool for controlling the doubtful neoplasm.

Consulting expert

Said Hilton

Dr. Med., Founder and head of the largest private dermatology, venereal and allergy clinic in North Rhine-Westphalia. Specialist in the field of aesthetic medicine

Question 3

The probability of limited scleroderma transition to the systemic form

Accepted Answer

A 50-year-old female patient complaining of localized scleroderma symptoms. There are small, dark spots on the skin with a tendency to increase and spread throughout the body. After a course of light therapy, the pathological process temporarily stopped, but later became widespread. The patient is afraid of the transition of superficial scleroderma to a systemic form.
Available data: medical report, laboratory blood test with the determination of antinuclear antibodies, histological skin test examination, photos of body areas with skin lesions.

Problem statement

What is the probability of transformation of superficial scleroderma into a systemic form with internal organs damage?

Selected Format

Video consultation

Outcome

A consultant dermatologist examined the affected areas of the patient's skin during a video conference. No characteristic signs of a systemic lesion were found on the face. The appearance of the hands did not indicate a violation of blood circulation, the patient also did not note the corresponding symptoms. The skin condition was consistent with the result of a histological examination, which revealed scaly parakeratosis with slight lymphoid cell inflammation and slight connective tissue thickening. Determination of antibody titer also did not confirm the presence of systemic sclerosis.

According to the doctor, the absence of signs of an autoimmune disease confirms the well-known dermatology rule: superficial scleroderma does not degenerate into a systemic one. It is only a change in the connective tissue of the skin, expressed in the form of spots and seals. The possibilities of treating these processes are limited by local effects and can only slow down the pathological process expansion.

Medconsonline Comment

It took the consultant time to convince the patient that she did not have a life-threatening disease.

Consulting expert

Said Hilton

Dr. Med., Founder and head of the largest private dermatology, venereal and allergy clinic in North Rhine-Westphalia. Specialist in the field of aesthetic medicine

Dermatology