Fellowship In Trichodermatology

Preamble:

Trichodermatology is a specialized field focused on the study of hair and scalp disorders. Hair is an important appendage with significant impact on the quality of life of an individual. There is an increasing trend of seeking consultations for hair and scalp concerns. There have been significant advancements in the field of trichodermatology including trichoscopic analysis and hair transplantation.There is an increasing demand for qualified trichodermatologists due to the rising awareness of hair and scalp health among the general population. So, the department of Dermatology, Venereology & Leprosy of Yenepoya Medical College is planning to start a fellowship in trichodermatologyto equip dermatologists with the necessary skills and expertise to diagnose and manage a wide range of hair and scalp disorders effectively.

Goal:To provide high-level in-house clinical training in trichodermatology fordermatologists so that the trained candidates can practice trichodermatologyand deal with all types of hair and scalp disorders.

Aim of the program

To make fellows competent in the field of trichodermatology to deal with all hair and scalp related disorders

Objectives/Outcomes

• PO1 - To conduct thorough patient evaluations for hair and scalp disorders, including comprehensive medical history and physical examinations.
• PO2 - To develop expertise in performing specialized diagnostic procedures such as trichoscopy, scalp biopsy, and accurately interpret findings to arrive at a diagnosis and treatment planning.
• PO3 - To formulate evidence-based treatment plans for hair and scalp disorders, incorporating pharmacological and non-pharmacological interventions, patient education, counselling, and follow up.
• PO4 - To attain skills of performing tricholasers, scalp injectables, and hair transplantation.

Program specific Outcomes PSO

PSO1	To make a diagnosis	To demonstrate proficiency in accurately diagnosing a wide range of hair and scalp disorders, including alopecia, scalp infections, and inflammatory conditions, through comprehensive patient evaluations and specialized diagnostic procedures.
PSO2	To formulate a treatment plan	To develop evidence-based treatment plans for hair and scalp disorders, incorporating pharmacological and non-pharmacological interventions, patient education, and follow-up monitoring strategies tailored to individual patient needs.
PSO3	To counsel the patient	To counsel the patient about the prognosis, duration of therapy, need for surgical intervention if any.
PSO4	To Perform appropriate Procedures	To be able to assist /perform various procedures like tricholasers, scalp injectables and hair transplantation.
PSO5	To Manage or prevent Complications	To assess the probable complications of the procedure and appropriate management of the same.

Eligibility for admission

MD (DVL)/ DNB (DVL)/ DDVL

Number of admissions

2/ year

Syllabus / Course contents

A. Basics in Trichology

1. Introduction into the Hair Sciences
   • History of Hair and Evolution of Trichology
2. Biology of Hair follicle
   • Embryology & Anatomy of the Hair follicle and follicular unit
   • Physiology of the pilosebaceous follicle
   • Biochemistry of the hair
   • The Hair Cycle
   • Pathologic Dynamics of Hair Loss as They Relate to the Hair Cycle
   • Hair Growth and Nutrition
   • Physical properties of hair
   • Endocrinal control of hair follicle
   • Variations by age, gender and race

B. Hair Disorders

1. Developmental Disorders
   • Congenital alopecias & Hypotrichosis
   • Structural abnormalities of the hair shaft
2. Hair Cycle disorders
   • Diffuse hair loss
   • Telogen effluvium
   • Anagen effluvium
   • Endocrine & Metabolic influences
3. Non-scarring alopecias - pathogenesis & clinical features
   • Male Androgenetic alopecia
   • Female Androgenetic alopecia
   • Alopecia Areata
4. Cicatricial Alopecia
   • Classification & Etiopathogenesis
   • Clinical Syndromes
5. Psycho-trichology
   • Psychological impact of hair disorders
   • Psycho-cutaneous disorders of the scalp
6. Pediatric hair disorders
   • Hair loss in children – Classification
   • Clinical syndromes
7. Hirsutism & Hypertrichosis
   • Classification and causes
   • Endocrinology
8. Scalp Disorders
   • Inflammatory dermatoses of the scalp
   • Infections
   • Infestations
   • Nevi, tumors & Cysts of the scalp
9. Hair Ageing
   • Hair dyspigmentation
   • Senescent alopecia
10. Traumatic alopecia & Miscellaneous disorders
    • Non–Scarring traumatic alopecias
    • Pressure alopecias

C. Hair Diagnostics

1. Clinical history in trichology
2. Clinical Examination
3. Wood’s lamp examination
4. Laboratory Work-up Relevant to Hair
5. Imaging
6. Quantifying hair loss
7. Photography
8. Trichoscopy
   • Equipment & Basics
   • Techniques of trichoscopy
   • Patterns and clinical correlation
9. Trichogram
   • Traditional Trichogram
   • Trichoscan
10. Tricho-mycology
    • KOH mount and fungal culture
11. Scalp histopathology
    • Scalp Biopsy Techniques
    • Histopathology of non-scarring alopecias
    • Histopathology of scarring alopecias
    • Histopathology of scalp disorders
    • Immuno-fluorescence in trichology
    • Advanced Diagnostic techniques

D. Therapy

1. Tricho-pharmacology
2. Male androgenetic alopecia
3. Female androgenetic alopecia
4. Hormonal therapy
5. Nutritional therapy
6. Treatment of Alopecia areata (AA)
7. Treatment of Resistant AA
8. Treatment of Scarring alopecias
9. Management of premature canities
10. Psycho-therapy of alopecias
11. Treatment of chemotherapy induced hair loss
12. Treatment of scalp disorders
13. Sensitive scalp
14. Pitfalls, Tips & Tricks
15. Hair Anti-ageing treatments
16. Platelet rich plasma therapy
17. Evolving Controversial treatments

E. TrichoCare

1. Science of hair & its care
2. Shampoos
3. Conditioners and finishing/ styling products
4. Hair nutricosmetics
5. Hair Coloring and bleaching dyes
6. Hair camouflage
7. Micropigmentation and microblading
8. Adverse effects of hair care products & Procedures
9. Ethnic Hair

F. Tricho Surgery

1. Setting up Hair transplant centre
2. Choosing the right patient
3. Evolution of Tricho Surgery
4. Follicular unit transplantation
5. Anaesthesia: Blocks, local infiltration, role of sedatives
6. Harvesting with strip
7. Separation and role of magnification
8. Plantation by slit and space
9. Plantation by transplanter
10. Post operative care
11. Follicular unit extraction (FUE)
12. Harvesting with FUE
13. Plantation in FUE
14. FUE in FPHL
15. Balanced view, pros and cons of FUE
16. Importance of continuing medical treatment

LIVESESSION&HANDSONTRAINING

Donormarking, Donorsitepreparation, Shampoo, Pre-opdonormarking, Recipientmarking and hair line designing, Local Anesthesia, excision of grafts, slit making, implantation of grafts

G. TrichoLasers

1. The laser physics in Trichology
2. Lasers for hair removal
3. Lasers for hair growth
4. Choosing the right laser

H. Future Trichology

1. Introduction to hair follicle stem cells and tissue engineering.
2. Isolation, Culture and Expansion of hair follicle stem cells.
3. Pitfalls and breakthrough in follicular cell implantation
4. Setting up a trichology clinic

Programme structure

Duration of the course	13 months
Seminars/ Journal Clubs	1 hour per week
Practical and Clinics	6 hours per week
Contact hours	42 hours per week
Interdepartmental meetings (pathology, endocrinology, psychiatry, plastic surgery)	Total : 8 (2 per department)

Attendance requirements

After completing 13 months of course with 80% minimum attendance is required to appear for the University exam.

Academic Requirements

• At least one presentation/poster in international/national/state conferences
• Regular presentations in Local body dermatology meets
• Maintaining a Log of all Clinical work and Practice

Scheme of Examination:

• University Examination
  The final Examination (Fellowship in Trichodermatology of 200 marks) will include the Theory and Practical Examination of 100 marks each.
• THEORY PAPER: - Paper 1 and 2 (200 Marks)

Paper – I Biology of hair and hair cycle Hair cycle disorders Non-scarring alopecias Cicatricial alopecias Paediatric hair disorders Psychotrichology Scalp disorders Hirsutism Miscellaneous disorders	100 Marks
Paper – II Hair diagnostics Hair therapeutics Trichosurgery Tricholasers Recent advances in trichology Miscellaneous topics	100 Marks
Total	200 Marks

Nature and Number of Questions:
Each theory paper will consist of 10 long essays of 10 marks each

Duration of Theory Papers: 3 hours for each question paper

PRACTICAL: -

OSCE (Objective Structured Clinical Examination)	30 Marks
Long case × 1	30 Marks
Short case × 1	20 Marks
Viva Voce	20 Marks
Total	100 Marks

Criteria for Eligibility to Appear University Exam

• 80% attendance
• Maintaining log book duly signed by the course director and coordinator
• Paper/poster presentation either in national or state conferences

Criteria for pass

• Minimum 50 % marks in Theory
• Minimum 50 % marks in Practical

Declaration of results

Declared by the Yenepoya (Deemed to be University)/ Yenepoya Medical College

Logbook/Portfolio

The log book should be maintained, which must be countersigned by the course director

Reference books and Journals

A. Text books

1. Dawber R, Van Neste D. Hair and Scalp Disorders: Common presenting signs, Differential diagnosis. 2nd Ed. London: Taylor and Francis publications; 2004.
2. Sinclair RD, Banfield CC, Dawber PR. Handbook of Diseases of the Hair and Scalp. Oxford: Blackwell Science.1999.
3. Blume-Peytavi U, Tosti A, Whiting DA, Trüeb RM. Hair Growth and Disorders. Berlin: Springer International Publishers. 2008.
4. Olsen EA, editor. Disorders of Hair Growth – Diagnosis and Treatment. 2nd ed. New York: McGrawHill Publications; 2003.
5. Hilda B, editor. Hair Treatments – Poucher's perfumes, Cosmetics and Soaps. 10th ed: Amsterdam: Kluwer Academic Publishers; 2000.
6. Camacho F, Montagna W, editors. Trichology – Diseases of the Pilosebaceus Follicle. 2nd ed. Karger Publications; 2017.
7. Unger PW, Shapiro R, Unger M, Unger R, editors. Hair Transplantation. 5th ed. Thieme Medical Publishers Inc; 2010.
8. Dawber R, editor. Diseases of Hair and Scalp. 3rd ed. Blackwell Science Publications; 1997.
9. Whiting DA, Saunders WB. Dermatologic Clinics – Update on Hair disorders. Philadelphia Companypublications

B. Books and Atlas

1. Atlas of Trichology – David A Whiting
2. Atlas of Anatomy & Histopathology of the Hair Follicle – David A Whiting
3. Atlas of Hair and Nails by Hordinsky; Sawaya; Scher, Churchill Livingstone Publications
4. Atlas of Cosmetic Dermatology by Zoe Diana Drelos, Churchill Livingstone Publications
5. Diagnosis and Treatment of Hair Disorders – An Evidence Based Atlas by Antonella Tosti; Bianca Maria Piraccini, Taylor and Francis Publications

C. Journals

1. International Journal of Trichology – Official Publication of the Hair Research Society of India, PubMed indexed
2. Journal of Cutaneous and Aesthetic Surgery – Official journal of Association of Cutaneous Surgeons of India, PubMed Indexed

Any other

1.Faculty (Internal):

9.1 Course director
Dr. Manjunath Shenoy M
Professor & Head
Department of Dermatology, Venereology & Leprosy
Yenepoya Medical College
Yenepoya (Deemed to be University), Deralakatte, Mangalore

9.2 Course co- Ordinator Dr. Vishal B
Professor
Department of Dermatology, Venereology & Leprosy
Yenepoya Medical College
Yenepoya (Deemed to be University), Deralakatte, Mangalore

2.Subject experts (External):

1. Dr Rachita Dhurat
Professor & HOD
Department of Dermatology, Venereology & Leprosy
LTMMC & GH, Mumbai – 400022
Mob: 9833394951

2. Dr B. S. Chandrashekhar
Chief Dermatologist & Medical Director
CUTIS Academy of Cutaneous Sciences
Vijayanagar, Bengaluru – 560040
Mob: 9740091155

ANNEXURES

ANNEXURE 1. Blueprint for theory and practical examination

Theory- Paper I

Topic	Number of Questions	Marks
Biology of hair follicle	1	10
Hair cycle disorders	1	10
Hair shaft defects	2	20
Non-scarring alopecias	1	10
Cicatricial alopecias	1	10
Paediatric hair disorders	1	10
Psychotrichology	1	10
Scalp disorders	1	10
Hirsuitism	1	10

Theory- Paper II

Topic	Number of Questions	Marks
Hair diagnostics	1	10
Hair therapeutics	2	20
Trichosurgery	4	40
Tricholasers	1	10
Recent advances in trichology	2	20

Practical examination

Question	Topic	Number of questions	Marks
OSCE	Hair shaft defect	1	5
	Hair cycle disorders	1	5
	Non-scarring alopecias	1	5
	Cicatricial alopecias	1	5
	Hair transplantation	1	5
	Trichoscopy	1	5
Long case	Non-scarring / cicatricial alopecias	1	30
Short case	Hair cycle disorders / hair shaft defects	1	20
Viva-voce	Therapeutics		10
	Instruments		10

ANNEXURE 2 - Question paper layout and model question paper 1 and 2 for theory examinations

YENEPOYA (Deemed to be University)

FELLOWSHIP EXAMINATION
TRICHODERMATOLOGY - Paper 1

Exam Date:
Max Marks: 100 (10X10)
Time: 3 hours

Your answers should be specific to the questions asked.
Draw neat labelled diagrams wherever necessary. Answer all the questions

Short Essays

1. Anagen effluvium
2. Trichothiodystrophy
3. Seborrheic dermatitis of the scalp
4. Frontal fibrosing alopecia
5. Psychotrichological disorders
6. Surgical management of scarring alopecias
7. Management of hirsutism in a 26-year-old female
8. Discuss about hair in systemic disease
9. Management of ophiasis in a 5-year-old female
10. Hair micronutrients

YENEPOYA (Deemed to be University)

FELLOWSHIP EXAMINATION
TRICHODERMATOLOGY - Paper II

Exam Date:
Max Marks: 100 (10X10)
Time: 3 hours

Your answers should be specific to the questions asked.
Draw neat labelled diagrams wherever necessary. Answer all the questions

Short Essays

1. Discuss the medical management of androgenetic alopecia
2. Laser hair reduction
3. Scalp flaps
4. Eyebrow transplantation
5. Stem cell therapy
6. Body hair transplantation
7. Biomedical waste management in trichology
8. Trichoscopy of androgenetic alopecia
9. JAK inhibitors in the management of alopecia
10. Scalp micropigmentation