Pediatr Dermatol 2017 Jun 13. Epub 2017 Jun 13.

Division of Dermatology, Children's National Health System, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.

Anagen effluvium (AE) is a type of alopecia with hair loss during the growth phase of a hair follicle and is most often associated with cytotoxic chemotherapy. This report describes a case of AE in a critically ill 2-year-old boy who developed cardiorespiratory failure requiring extracorporeal membranous oxygenation. We postulate that the combination of hypotension and hypoxia with subsequent reperfusion triggered an apoptotic cascade in the hair matrix, resulting in AE. Read More

J Am Acad Dermatol 2017 May 8;76(5):948-957. Epub 2017 Mar 8.

St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Department of Dermatopathology, St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas' Hospital, London, United Kingdom. Electronic address:

Background: Anagen effluvium with reversible scalp alopecia is a known side effect of chemotherapy. However, there are an increasing number of reports in the literature documenting permanent alopecia in patients treated with taxanes.

Objective: We sought to describe the clinicopathologic features in breast cancer patients who underwent treatment with taxanes and adjuvant hormonal chemotherapy. Read More

J Am Acad Dermatol 2017 Mar 20;76(3):472-477. Epub 2016 Dec 20.

Division of Dermatology, Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address:

Background: The hair pull test lacks validation and has unclear pretest guidelines.

Objective: We sought to quantify normal hair pull test values and elucidate the effect of pretest hair washing and brushing. The impact of hair texture and lifestyle was also examined. Read More

J Cosmet Dermatol 2016 Sep 23. Epub 2016 Sep 23.

ETC Research and Development, Oslo, Norway.

Postpartum effluvium is a well-known clinical fact. However, following some minor research activities in the 1960s, very little has happened on the research front of the subject. It was hypothesized that postpartum hair loss might be a manifestation of a change in the hair growth cycle occurring normally during pregnancy. Read More

J Dermatol 2017 Feb 20;44(2):180-185. Epub 2016 Aug 20.

Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, Korea.

Anagen effluvium develops because of disturbances in the hair follicle cycle, leading to acute and severe hair loss in humans. The objective of this study was to establish a mouse model of anagen effluvium by 5-bromo-2'-deoxyuridine (BrdU) treatment, and evaluate the pathological changes and underlying mechanisms. We treated 9-10-day-old pups and 3-7-week-old C57BL/6 mice with BrdU. Read More

Acta Dermatovenerol Croat 2016 Jun;24(2):150-3

Jana Zímová, MD. Department of Dermatology. University Hospital Ostrava. 17. listopadu 1790. 708 52 Ostrava - Poruba. Czech Republic;

Trichotillomania (TTM) is defined by the Diagnostics and Statistic Manual of Mental Disorders, 4th edition (DMS-IV) as hair loss from a patient`s repetitive self-pulling of hair. The disorder is included under anxiety disorders because it shares some obsessive-compulsive features. Patients have the tendency towards feelings of unattractiveness, body dissatisfaction, and low self-esteem (1,2). Read More

Indian J Dermatol Venereol Leprol 2016 Nov-Dec;82(6):677-680

Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Anagen effluvium, the shedding of anagen hair, leads to diffuse non-scarring alopecia. We report two cases of anagen effluvium in the same family secondary to the ingestion of tubers of Gloriosa superba, which contains the antimitotic alkaloid colchicine. Both patients developed anagen effluvium and gastroenteritis 1-2 weeks after consuming the tubers. Read More

Int J Trichology 2016 Jan-Mar;8(1):1-4

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Plica neuropathica also known as "birds nest" is irreversible matting of hair seen in otherwise healthy individuals and is usually associated with use of ionic/herbal soaps, shampoos, parasitic infestations, psychiatric alterations, or neglect. Anagen effluvium is a known side effect of many immunosuppressive drugs. Rarely matting of hair has been reported following azathioprine. Read More

Indian J Dermatol Venereol Leprol 2016 May-Jun;82(3):322-4

Skinnocence: The Skin Clinic and Research Centre, Gurgaon, Haryana, India.

JAMA Dermatol 2016 Jun;152(6):724-6

Division of Dermatology, University of Louisville, Louisville, Kentucky.

Dermatol Online J 2016 Nov 15;22(11). Epub 2016 Nov 15.

School of Medicine, Oregon Health and Science University, Portland, OR.

The skin and the eyes are prone to radiation-induced injury in fluoroscopic procedures. The degree of injury is related to various exposure and patient-related factors. We report a man who presented with an alopecic patch on the left occipital scalp following an extended fluoroscopically-guided endovascular procedure. Read More

J Clin Diagn Res 2015 Aug 1;9(8):WC01-4. Epub 2015 Aug 1.

Senior Resident, Department of Dermatology, Venereology and Leprosy, ESIC Medical College Kalaburagi, Karnataka, India .

Background: Diffuse hair loss is a common complaint encountered by dermatologists in their daily clinical practice. Hair loss in women is a distressing condition. Various underlying factors individually or in combination contribute to the pathogenesis. Read More

Curr Probl Dermatol 2015 20;47:97-106. Epub 2015 Feb 20.

In this chapter, we will discuss the most common alopecias due to drugs and other skin and systemic disorders. The following hair disorders will be analyzed: telogen effluvium (acute and chronic); anagen effluvium; folliculotropic mycosis fungoides; and folliculitis due to bacteria, fungi, parasites, human immunodeficiency virus disease, lupus erythematosus, and sarcoidosis. We will cover topics including the epidemiology, etiology, clinical picture, and diagnosis of and current treatments for each disease. Read More

Biosci Biotechnol Biochem 2015 4;80(1):74-9. Epub 2015 Aug 4.

a Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan.

Alopecia impairs the physical and mental health of patients. We have previously shown that 8-week-old ob/ob mice have no reactivity to depilation, which is a stimulus that induces anagen transition in normal mice, while no hair cycle abnormalities have been reported in other studies until mice reach 7 weeks of age. Therefore, we hypothesized that ob/ob mice have abnormalities in hair cycle progression beyond 7 weeks of age. Read More

Skinmed 2015 Mar-Apr;13(2):98-101

Effluvium capillorum is a form of nonscarring alopecia characterized by diffuse hair shedding. This condition occurs when the normal balance of hairs in growth and rest phases is disrupted. Trichoscan is a computerized program used for digital measurement of hair growth and hair loss. Read More

Indian J Dermatol 2015 May-Jun;60(3):324

Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. E-mail:

J Dermatol 2015 Oct 24;42(10):1027-9. Epub 2015 Jun 24.

Department of Dermatology, Hospital del Mar-Parc de Salut Mar (Barcelona), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.

J Dermatol Case Rep 2015 Mar 31;9(1):1-5. Epub 2015 Mar 31.

Department of Dermatology, Medical University of Warsaw, Poland;

Background: Loose anagen hair syndrome (LAHS) is typically diagnosed in girls older than 2 years who present with hair that "will not grow". Hair microscopic examination shows absent inner and outer root sheaths, ruffling of the cuticle on the proximal hair shaft and deformed pigmented anagen bulbs.

Objective: The aim of the study was to assess whether there are characteristic trichoscopic features favoring the diagnosis of LAHS. Read More

Hepat Mon 2015 Mar 20;15(3):e24804. Epub 2015 Mar 20.

Department of Pathology, Ministry of Health Bagcilar State Hospital, Istanbul, Turkey.

Introduction: Various types of dermatological manifestations have been reported due to hepatitis C virus (HCV) infection and anti-HCV therapy. Some of them have been described during IFN-based therapies. PEG-IFN-α-2a/RBV combination is used as the international standard of treatment for HCV infection for a long time. Read More

Rev Med Liege 2014 Dec;69(12):686-91

The diagnosis of most alopecia problems is based on the clinical history and a well conducted clinical examination. The additional contributions of dermoscopy, trichoscopy and trichogram are helpful. However, a scalp biopsy is occasionally necessary to establish the correct diagnosis. Read More

J Cutan Med Surg 2015 Jul-Aug;19(4):400-3. Epub 2015 Mar 16.

Department of Plastic and Reconstructive Surgery, Wellington Hospital, London, UK.

Ablative surgery for skin cancer of the face can often leave patients with significant deformities. These disfigurements can include loss of hair in conspicuous areas such as the eyebrows, leaving the patients with unsightly facial asymmetry. Eyebrow transplantation serves to address this issue; however, it has often been discouraged in patients who are destined to receive radiotherapy to the cutaneous area in question. Read More

Clin Exp Dermatol 2015 Jul 16;40(5):485-8. Epub 2015 Feb 16.

Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.

Background: Pemphigus vulgaris (PV) is a known cause of loss of 'normal' anagen hair; that is, shedding of intact anagen hairs covered by root sheaths. However, studies on this subject are limited.

Aim: To investigate anagen hair shedding in patients with PV, and ascertain its association with disease severity. Read More

Turk J Med Sci 2014 ;44(3):432-8

Department of Dermatology, Yüzüncü Yıl University, Van, Turkey.

Aim: In this study, we investigated the sensitivity of TrichoScan, a computer-based phototrichogram, in the evaluation of diffuse hair loss in women and the relationship between iron deficiency anemia and hair loss.

Materials And Methods: We recruited 100 female patients with diffuse hair loss. In all of the patients, a 1-cm2 area of hair located in a temporoparietal region was shortened to 0. Read More

Indian J Dermatol 2014 Nov;59(6):633

Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore, Tamil Nadu, India.

A 47-year-old Indian woman with dark hair developed dramatic alopecia of the occipito-vertical area two weeks after a fluoroscopically-guided endovascular procedure for treatment of cerebral aneurysm. There was spontaneous repopulation of hair in 14 weeks. Neuro-radiological intervention procedures are becoming commoner by the day in India, and the rare but documented possibility of such reactions occurring in patients should be kept in mind by the treating surgeon as well as dermatologist. Read More

Clin Exp Dermatol 2014 Dec 22;39(8):868-73. Epub 2014 Aug 22.

Department of Pathology, Unicamp, Campinas, São Paulo, Brazil.

Background: Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes.

Aim: To analyze a number of histomorphometric and immunohistochemical findings through vascular endothelial growth factor (VEGF), Ki-67, and CD31 immunostaining in scalp biopsies of 20 patients with CTE, 17 patients with mild FPHL and 9 controls. Read More

G Ital Dermatol Venereol 2014 Oct 30;149(5):555-65. Epub 2014 Jun 30.

Dermatology and Venereology Private Practice Bari and Barletta, Italy -

Hair disorders are frequently observed in various systemic diseases, including autoimmune connective tissue diseases (CTDs), with predilection of lupus erythematosus (LE), followed by dermatomyositis (DM) and scleroderma. Hair disorders in CTDs may manifest as various clinical patterns, such as telogen hair loss, diffuse thinning or fragility of hair, and scarring alopecia. Less common hair disorders include anagen effluvium, alopecia areata, and trichomegaly. Read More

Br J Dermatol 2014 Mar;170(3):643-50

Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Background: In women with breast cancer, chemotherapy-induced alopecia is a highly feared but common side-effect of antineoplastic treatment. The onset, pattern and amount of hair loss differ depending on the therapy regimen and have not yet been quantified using standardized techniques.

Objectives: To evaluate objectively and compare the effect of antineoplastic therapy with chemotherapy or tamoxifen on hair loss, quantifying trichological parameters. Read More

Pediatr Clin North Am 2014 Apr 21;61(2):427-42. Epub 2014 Jan 21.

Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 2nd Floor Dermatology, Philadelphia, PA 19104, USA. Electronic address:

Alopecia in childhood is a source of high concern, frustration, and anxiety. Delineating types of alopecia and those that are chronic or potentially related to underlying medical problems is important. There are 5 common types of hair loss in children: alopecia related to tinea capitis, alopecia areata spectrum/autoimmune alopecia, traction alopecia, telogen effluvium, and trichotillomania/trichotillosis. Read More

Postepy Dermatol Alergol 2013 Dec 18;30(6):343-9. Epub 2013 Dec 18.

Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland. Head: Prof. Grażyna Broniarczyk-Dyła MD, PhD.

Introduction: Treatment of the severe forms of acne vulgaris remains a challenge. Isotretinoin is a drug often used in these cases. Retinoids affect the mechanisms that play a role in the pathogenesis of acne, reduce the production of sebum and sizes of the sebaceous glands. Read More

Vet Clin North Am Equine Pract 2013 Dec 10;29(3):629-41. Epub 2013 Oct 10.

Department of Clinical Sciences, Colorado State University, 300 West Drake, Fort Collins, CO 80523, USA. Electronic address:

Noninflammatory, nonpruritic alopecias are uncommonly encountered in the horse. Alopecia areata, an apparently autoimmune hair follicle bulbitis produces focal, multifocal to widespread hair loss. The skin is otherwise normal. Read More

Indian J Dermatol Venereol Leprol 2013 Sep-Oct;79(5):604-12

Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Disturbances of hair follicle cycling lie at the heart of most hair growth disorders, and have dramatic effects on visible hair growth and shedding. The two common disorders due to aberration in hair follicle cycling are telogen and anagen effluvium. Though a lot of literature addresses the problem of telogen effluvium, there are not many reviews on anagen effluvium or anagen hair loss. Read More

J Eur Acad Dermatol Venereol 2014 Jul 20;28(7):878-81. Epub 2013 May 20.

Department of Dermatology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey.

Background: In pregnancy, increased numbers of hair follicles remain in the anagen phase for longer periods due to hormonal changes and return to the telogen phase within 3-6 months of delivery with a sudden drop in hormone levels. This results in excessive shedding of hair known as post-partum telogen effluvium.

Objective: To determine the changes in the hair cycle during gestation and the post-partum period. Read More

Hautarzt 2013 May;64(5):371-9; quiz 380-1

Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.

Hair loss and alopecia occur frequently in children. The prevalence of the underlying causes and conditions, treatment options and prognosis differ in part significantly from adulthood. This article focuses on frequent forms of acquired alopecia which are not associated with inflammation or scarring of the scalp. Read More

Ann Hematol 2013 Oct 10;92(10):1417-9. Epub 2013 Mar 10.

Am J Dermatopathol 2013 Dec;35(8):818-26

*Department of Pathology, The Dermatology Group, Verona, New Jersey †New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey.

Follicular counts from transverse sectioning of scalp biopsies have not been statistically scrutinized across disease entities in a standardized fashion. We applied uniform histological criteria and strict statistical measures to compare nonscarring and scarring alopecia. We studied 700 consecutive cases including 355 nonscarring alopecia [136 telogen effluvium, 115 alopecia areata (AA), 95 androgenetic alopecia, and 9 trichotillosis] and 345 scarring alopecia [238 central centrifugal cicatricial alopecia, 29 traction alopecia, 26 lichen planopilaris, 21 end-stage alopecia, 20 lupus erythematosus, 11 folliculitis decalvans]. Read More

Br J Dermatol 2013 Mar 12;168(3):520-5. Epub 2012 Dec 12.

Dermatology Research Centre, Salford Royal Hospital, The University of Manchester, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester, UK.

Background: Although there are clinical reports of hair loss associated with levodopa and dopamine agonists, it is unclear whether dopamine exerts any direct effects on the human hair follicle (HF).

Objectives: Given the widespread use of dopamine agonists and antagonists in clinical medicine, we sought to determine whether dopamine exerts direct effects on human HF growth and/or pigmentation in vitro, and whether human HFs express dopamine receptors (DRs).

Methods: Microdissected human scalp HFs from women were treated in serum-free organ culture for 7 days with dopamine (10-1000 nmol L ), and the effects on hair shaft production, HF cycling (i. Read More

Dermatol Clin 2013 Jan 18;31(1):67-73. Epub 2012 Sep 18.

Department of Medicine, St. Vincent's Hospital, University of Melbourne, Aikenhead Wing, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia.

Hair loss is a common complaint, both in men and women, and use of prescription medications is widespread. When there is a temporal association between the onset of hair loss and commencement of a medication, the medication is commonly thought to have caused the hair loss. However, hair loss and in particular telogen effluvium may occur in response to a number of triggers including fever, hemorrhage, severe illness, stress, and childbirth, and a thorough exclusion of these potential confounders is necessary before the hair loss can be blamed on the medication. Read More

Osteoporos Int 2013 Mar 12;24(3):1127-9. Epub 2012 Apr 12.

Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China.

Strontium ranelate is an effective drug that was developed for treating osteoporosis. Here, we report the case of a 62-year-old woman who developed headache and diffuse scalp hair loss 1 week after receiving strontium ranelate treatment for osteoporosis. The treatment was subsequently stopped because of the intractable headache. Read More

Endokrynol Pol 2011 ;62 Suppl 1:29-34

Klinika Dermatologii, Warszawski Uniwersytet Medyczny, Warszawa.

Hair loss may accompany several endocrine disorders, including hypopituitarism, hypothyreosis, hyperthyreosis, hypoparathyroidism, diabetes mellitus, growth hormone deficiency, hyperprolactinaemia, polycystic ovary syndrome, SAHA syndrome, congenital adrenal hyperplasia, Cushing syndrome, or virilising tumours. Most patients with endocrine disorders present with diffuse non-scarring alopecia, such as anagen effluvium, telogen effluvium or androgenetic alopecia. Focal non-scarring alopecia, such as alopecia areata coexisting with autoimmune thyroiditis, is less frequent and scarring alopecia is a rare finding in patients with endocrine abnormalities. Read More

Pediatr Dermatol 2012 May-Jun;29(3):264-9. Epub 2011 Nov 2.

Department of Dermatology, Hospital Universitario Dr. Jose E. Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.

Chemotherapy used in the treatment of malignancies produces multiple mucocutaneous adverse reactions that may be clinically challenging. These mucocutaneous reactions are common and sometimes not diagnosed. The objective of this study was to determine the clinical patterns of the mucocutaneous manifestations during and after chemotherapy in children with a hematologic malignancy and to determine whether nutritional status influences the clinical presentation. Read More

Int J Trichology 2010 Jul;2(2):110-2

P. D. Hinduja Hospital, Mahim, Mumbai, India.

A 54-yr-old woman, on azathioprine for interstitial lung disease, developed pancytopenia and presented with sudden onset of extensive hair loss from the scalp followed overnight by appearance of elongated broad mass of uncombable matted hair which had the typical appearance of Plica neuropathica. Microscopic examination of hair clipped from the matted mass revealed irregular, nodal, superficial fractures of the hair shaft resembling Trichorrhexis nodosa and irregular ruffling of the cuticles. The areas of cuticular damage appeared dark under polarized light. Read More

Am J Dermatopathol 2011 Jun;33(4):345-50

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

Anagen effluvium due to chemotherapy is usually reversible with complete hair regrowth. However, there is increased evidence that certain chemotherapy regimens can cause dose-dependent permanent alopecia. The histological features of this type of alopecia and the mechanisms of its origin are not known yet. Read More

J Eur Acad Dermatol Venereol 2011 Jul 15;25(7):808-10. Epub 2010 Oct 15.

Division of Dermatology, I.F.C.A. GRUPPO G.I.O.M.I., Florence, Italy.

Background: Several patients, especially women, seek advice because of hair loss. They may be diagnosed clinically as having telogen effluvium (TE) or androgenetic alopecia (AGA), but histopathology may reveal that a proportion of them have in fact alopecia areata incognita (AAI).

Objectives: To detect dystrophic anagen hairs in such patients. Read More

Endokrynol Pol 2010 Jul-Aug;61(4):406-11

Department of Dermatology, Medical University of Warsaw, Poland.

Hair loss may accompany several endocrine disorders, including hypopituitarism, hypothyreosis, hyperthyreosis, hypoparathyroidism, diabetes mellitus, growth hormone deficiency, hyperprolactinaemia, polycystic ovary syndrome, SAHA syndrome, congenital adrenal hyperplasia, Cushing syndrome, or virilising tumours. Most patients with endocrine disorders present with diffuse non-scarring alopecia, such as anagen effluvium, telogen effluvium or androgenetic alopecia. Focal non-scarring alopecia, such as alopecia areata coexisting with autoimmune thyroiditis, is less frequent and scarring alopecia is a rare finding in patients with endocrine abnormalities. Read More

Australas J Dermatol 2010 Aug;51(3):163-7

Dermatology Research Centre, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.

Background/objectives: Chronic telogen effluvium and diffuse cyclical hair loss in women are well-described clinical entities characterized by chronic and fluctuating increases in hair shedding without loss of hair volume. We sought to investigate the follicular dynamics of chronic telogen effluvium and diffuse cyclical hair loss using a previously validated computer simulation known as the follicular automaton.

Methods: Using our model, we were able to simulate reductions in both the mean and variance of anagen duration and thus investigate their consequences with respect to both hair volume and hair shedding. Read More

Semin Cutan Med Surg 2009 Mar;28(1):11-4

Department of Dermatology, University Hospital of Zurich, Gloriastr 31, CH-8091, Zurich, Switzerland.

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. Read More

J Clin Endocrinol Metab 2008 Nov 26;93(11):4381-8. Epub 2008 Aug 26.

Department of Dermatology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.

Context: Both insufficient and excess levels of thyroid hormones (T3 and T4) can result in altered hair/skin structure and function (e.g. effluvium). Read More

Curr Drug Saf 2006 Aug;1(3):301-5

Department of Dermatology, University of Bologna, Via Massarenti 1, Bologna, Italy.

Drugs may induce hair loss, stimulate hair growth or, more rarely, induce changes in the hair shape and colour. Drug-induced hair loss is usually completely reversible and is, in most cases, a consequence of a toxic effect of the drug on the hair follicle matrix. In rare cases alopecia may be permanent. Read More

Clin Dermatol 2008 May-Jun;26(3):296-305

Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, 22280-020 Rio de Janeiro, Brazil.

In this article, the nail, hair, and pigment changes caused by systemic diseases will be reviewed. Among the subjects discussed are abnormalities of shape, attachments, surface, and color of the nails; hair alterations such as telogen and anagen effluvium, scarring alopecia, hypertrichosis, and hirsutism; and pigment changes due to connective tissue disorders, sarcoidosis, and metabolic and endocrinologic diseases, among others. Read More