ated with a desire to scratch [1] . Just like skin pruritus, its etiology may be of dermatological or non-dermatological origin. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to review the clinical signs of the most common causes of scalp itch and other less common causes that must be considered in a systematic approach to scalp pruritus. Materials and MethodsWe performed a MEDLINE search through PubMed (1975PubMed ( -2017, using the terms scalp itch and scalp pruritus and included clinical trials, review articles, case series, and case reports to search for the causes of scalp itch. PathophysiologyAlthough various pathogenic etiologies contribute to scalp pruritus, the scalp itself has distinct neuroanatomy and vasculature, specific neuromediators and corresponding receptors, as well as the presence of scalp sebum and microflora, which are all properties that may explain its tendency to be implicated in patients who complain of itch. Keywords Scalp · Itch · Pruritus · Seborrheic dermatitis · Contact dermatitis · Anxiety · Lichen planopilaris · Lice · Pediculosis · Psoriasis · Trichoscopy AbstractScalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.

Increased vascular flow of the deep plexus in cicatricial stages can be a consequence of superficial tissue ischaemia or fibrosis. It is difficult to establish if the increased flow in the inflammatory stage is due to neovascularization as seen in other ischaemic diseases or is the result of the inflammatory response. OCT may be a useful non-invasive tool in imaging FFA. Not only can the technology assist in monitoring disease activity in a non-invasive manner, but it may elucidate new pathophysiologic findings.

Angioimmunoblastic T-cell lymphoma (AITL) accounts for 15-20% of all peripheral T-cell lymphomas. It is a rare subtype of CD4 T-cell peripheral lymphoma that affects aged individuals, causing B symptoms, generalized lymphadenopathy and hepatosplenomegaly. Its pathogenesis is still unclear, but in some cases it has been associated with infection, allergic reaction or drug exposure. The majority of patients are diagnosed in an advanced stage and anthracycline based regimen is considered the first-line therapy. Skin involvement is not well characterized, occurring in up to 50% of patients and presenting as nonspecific rash, macules, papules, petechiae, purpura, nodules and urticaria. We present the illustrative case of a 55-year-old woman with an AITL who presented prominent skin findings, arthritis, lymphadenopathy and hypereosinophilia. Skin biopsy reported a T-cell lymphoma and the diagnosis of AITL was confirmed by an axillary lymph node biopsy, which was also positive for Epstein-Barr virus. Chemotherapy with CHOP-21 and thalidomide was given, accomplishing complete remission after six cycles.

Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies. However, since progression of FFA is very slow, it is very important to develop a noninvasive technique to assess disease activity to monitor treatment response. Objectives: To provide a standardized and objective method to assess FFA activity. Methods: We evaluated the correlation between trichoscopy and pathological features (degree of lymphocytic infiltration) in 20 dermoscopy-guided biopsies of FFA. At trichoscopy, we divided the severity of peripilar casts into 3 grades according to their thickness. To validate the trichoscopic visual scale, we showed the images to 7 dermatologists with interest in hair diseases. Concordance was assessed using the Kendall Tau-b concordance test. Results: A strong correlation between severity of peripilar casts at trichoscopy and degree of lymphocytic infiltrate was observed by the Kendall Tau-b test. Validation showed very good inter- and intraobserver agreement. Conclusion: The trichoscopic visual scale allows noninvasive assessment of scalp inflammation in FFA in different scalp regions and therefore provides optimal guidance for treatment.

IntroductionHair shedding is a common consequence of the normal hair cycle that changes with internal and external factors. Female pattern hair loss (FPHL) is difficult to assess in terms of shedding severity as the conscious perception of hair shedding varies according to each individual, and most utilized methods are semi-invasive or very time consuming. In this study, we establish and validate a hair-shedding scale for women with thick hair of different lengths.MethodsA visual analog scale was developed for thick hair of short, medium, and long lengths by dividing a bundle of hairs of each length into nine piles of increasing hair amount that were then photographed and arranged in order of size. Twenty women with no FPHL with each length of hair (60 total) were asked to select the photographed hair bundle that best correlated with the amount of hair they shed on an average day. A total of 94 women with FPHL with excessive shedding were then asked to repeat the same process.ResultsWomen with no FPHL and short, medium and long hair had mean shedding scores of 2.5, 2.35 and 2.4, respectively. Women with FPHL and short, medium and long hair had mean shedding scores of 7.25, 7.0 and 7.14, respectively. Statistically significant Spearman’s ρ coefficient and κ coefficient demonstrated correlation and inter-observer reliability.ConclusionOur results show that women with FPHL not only shed considerable hair more than women with no FPHL, but that this hair-shedding visual scale is a fast and effective method of evaluating hair-shedding amounts in an office setting.