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

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:

• 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:

• Telogen effluvium (TE) Diffuse shedding, positive hair pull test
• Female pattern hair loss (FPHL) Frontal or vertex thinning with preserved frontal hairline
• Alopecia areata (AA) Patches of non-scarring alopecia
• 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

• 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.

• Photographic Documentation • High-resolution digital images of scalp regions 6. Laboratory investigations:

The following laboratory serum tests will be done:

• Complete blood count.
• serum ferritin.
• Thyroid stimulating hormone.
• serum vitamin D3.
• Erythrocyte sedimentation rate.
• Glycated hemoglobin.

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%) o No known chronic illness
• Consent to participate

Exclusion criteria

• 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)