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Research Abstracts and Links to Original Sources


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12593800&dopt=Abstract alopecia, hair loss Ref: Curr Biol 2003 Feb 18;13(4):333-8

Notch/RBP-J Signaling Regulates Epidermis/Hair Fate Determination of Hair Follicular Stem Cells.

Yamamoto N, Tanigaki K, Han H, Hiai H, Honjo T.

Department of Medical Chemistry, Graduate School of Medicine, Kyoto University, Konoe-cho, Yoshida, Sakyo-ku, 606-8501, Kyoto, Japan

Notch signaling is involved in the cell fate determination of various cell lineages. Notch interaction with its ligand induces the cleavage of its intracellular domain (IC), and the Notch IC translocates to the nucleus and binds to RBP-J to transactivate transcription of target genes. All four Notches in mammals bind to RBP-J to exert their transactivation activities. Notch is expressed in developing or differentiating epidermis and hairs, inhibits the terminal differentiation of the epidermis, and regulates hair differentiation. The common stem cells that reside in the upper portion of hair follicles (the bulge) contribute to epidermal and hair cell formation. However, it is unknown what determines whether hair follicular stem cells will become hairs or epidermis. Here we report that conditionally disrupting the mouse RBP-J gene in a mosaic pattern to avoid embryonic lethality of RBP-J-deficiency caused hair loss, epidermal hyperkeratinization, and epidermal cyst formation. Cyst formation is probably due to a combination of the aberrant fate determination of RBP-J-deficient stem cells to epidermal progenitors and their accelerated differentiation into epidermis. These results suggest that Notch/RBP-J signaling regulates the cell fate determination of hair follicular stem cells at the bulge region.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12592073&dopt=Abstract alopecia, hair loss Ref: Dermatology 2003;206(2):85-95

Steroidogenic isoenzymes in human hair and their potential role in androgenetic alopecia.

Hoffmann R.

Department of Dermatology, Philipp University, Marburg, Germany.

Androgenetic alopecia (AGA) is the most common type of hair loss. The relatively strong concordance of the degree of baldness in fathers and sons is not consistent with a simple Mendelian trait, and a polygenic basis is considered to be most likely. So far, the predisposing genes for AGA are unknown and we do not understand the molecular steps involved in androgen-dependent beard growth versus androgen-dependent hair loss, but AGA can be defined as a dihydrotestosterone (DHT)-dependent process with continuous miniaturization of sensitive hair follicles. The type 2 5alpha-reductase plays a central role by the intrafollicular conversion of testosterone to DHT. However, due to the increasing knowledge in this field, we now know that there are many more steroidogenic enzymes involved in the onset and development of AGA, and this article shall provide a critical overview of recent discoveries.



Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12587927&dopt=Abstract alopecia, hair loss Ref: J. Anat 2003 Jan;202(1):125-31

Mouse models for human hair loss disorders.

Porter RM.

Cancer Research UK Cell Structure Research Group, School of Life Sciences, MSI/WTB Complex, University of Dundee, Dundee DD1 5EH, UK.

The outer surface of the hand, limb and body is covered by the epidermis, which is elaborated into a number of specialized appendages, evolved not only to protect and reinforce the skin but also for social signalling. The most prominent of these appendages is the hair follicle. Hair follicles are remarkable because of their prolific growth characteristics and their complexity of differentiation. After initial embryonic morphogenesis, the hair follicle undergoes repeated cycles of regression and regeneration throughout the lifetime of the organism. Studies of mouse mutants with hair loss phenotypes have suggested that the mechanisms controlling the hair cycle probably involve many of the major signalling molecules used elsewhere in development, although the complete pathway of hair follicle growth control is not yet understood. Mouse studies have also led to the discovery of genes underlying several human disorders. Future studies of mouse hair-loss mutants are likely to benefit the understanding of human hair loss as well as increasing our knowledge of mechanisms controlling morphogenesis and tumorigenesis.



Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12573818&dopt=Abstract alopecia, hair loss Ref: Mol Cell Endocrinol 2002 Dec 30;198(1-2):89-95

Androgens and alopecia.

Kaufman KD.

Merck Research Laboratories, Department of Clinical Research, Endocrinology and Metabolism, RY34-A248, 126 East Lincoln Avenue, 07065-0900, Rahway, NJ, USA

Androgens have profound effects on scalp and body hair in humans. Scalp hair grows constitutively in the absence of androgens, while body hair growth is dependent on the action of androgens. Androgenetic alopecia, referred to as male pattern hair loss (MPHL) in men and female pattern hair loss (FPHL) in women, is due to the progressive miniaturization of scalp hair. Observations in both eunuchs, who have low levels of testicular androgens, and males with genetic 5alpha-reductase (5alphaR) deficiency, who have low levels of dihydrotestosterone (DHT), implicate DHT as a key androgen in the pathogenesis of MPHL in men. The development of finasteride, a type 2-selective 5alphaR inhibitor, further advanced our understanding of the role of DHT in the pathophysiology of scalp alopecia. Controlled clinical trials with finasteride demonstrated improvements in scalp hair growth in treated men associated with reductions in scalp DHT content, and a trend towards reversal of scalp hair miniaturization was evident by histopathologic evaluation of scalp biopsies. In contrast to its beneficial effects in men, finasteride did not improve hair growth in postmenopausal women with FPHL. Histopathological evaluation of scalp biopsies confirmed that finasteride treatment produced no benefit on scalp hair in these women. These findings suggest that MPHL and FPHL are distinct clinical entities, with disparate pathophysiologies. Studies that elucidate the molecular mechanisms by which androgens regulate hair growth would provide greater understanding of these differences.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12573256&dopt=Abstract alopecia, hair loss Ref: Genomics 2003 Jan;81(1):6-14

Curly bare (cub), a new mouse mutation on chromosome 11 causing skin and hair abnormalities, and a modifier gene (mcub) on chromosome 5.

Johnson KR, Lane PW, Cook SA, Harris BS, Ward-Bailey PF, Bronson RT, Lyons BL, Shultz LD, Davisson MT.

The Jackson Laboratory, 600 Main Street, Bar Harbor, 04609, ME, USA

In the outcrossing of a new recessive mouse mutation causing hair loss, a new wavy-coated phenotype appeared. The two distinct phenotypes were shown to be alternative manifestations of the same gene mutation and attributable to a single modifier locus. The new mutation, curly bare (cub), was mapped to distal Chr 11 and the modifier (mcub) was mapped to Chr 5. When homozygous for the recessive mcub allele, cub/cub mice appear hairless. A single copy of the dominant Mcub allele confers a full, curly coat in cub/cub mice. Reciprocal transfer of full-thickness skin grafts between mutant and control animals showed that the skin phenotype was tissue autonomous. The hairless cub/cub mcub/mcub mice show normal contact sensitivity responses to oxazolone. The similarity of the wavy coat phenotype to those of Tgfa and Egfr mutations and the map positions of cub and mcub suggest candidate genes that interact in the EGF receptor signal transduction pathway.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12558623&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2003 Jan;28(1):25-7

Postmenopausal frontal fibrosing alopecia.

Naz E, Vidaurrazaga C, Hernandez-Cano N, Herranz P, Mayor M, Hervella M, Casado M.

Department of Dermatology, University Hospital La Paz, Madrid, Spain.

Recently a new entity, postmenopausal frontal fibrosing alopecia, was added to the established subtypes of scarring alopecias affecting postmenopausal women. This condition is characterized by a progressive frontal hairline recession associated with scarring. We studied the clinical and histopathologic features in four women with this disorder. Of note, a history of bilateral oophorectomy in two of them appears to be a new association. All four cases had frontoparietal recession of the hairline and two of them also had loss of their eyebrows. None of our four patients had any mucous membrane or other skin lesions. Histological examination showed perifollicular fibrosis and lymphocytic inflammation around the isthmus and infundibular areas of the follicles. No effective treatments have emerged for this type of postmenopausal alopecia, but progression of the hair loss and scarring appears to be self-limiting. We believe that this condition is a distinct clinicopathological variant of lichen planopilaris.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12557713&dopt=Abstract alopecia, hair loss Ref: Gan To Kagaku Ryoho 2003 Jan;30(1):105-9

Weekly administration of paclitaxel and pirarubicine for recurrent breast cancer

[Article in Japanese]

Shimizu T, Iwasa T, Koike S, Nakamura T, Kanai T, Komatsu D.

Dept. of Surgery, Matsumoto National Hospital.

The therapeutic efficacy of weekly coadministration of paclitaxel (TXL) and pirarubicin (THP) on docetaxel (TXT)- and epirubicin-resistant recurrent breast cancer, adverse reactions caused by this therapy, and the possibility of ambulatory treatment using it were evaluated. The present study was conducted in 11 patients with recurrent breast cancer with pretreatment with CEF and TXT. The site of recurrence was the lung in 9 patients, lymphnodes in 2, bones in 1, liver in 1 and local foci in 1. One cycle consisted of 20 mg/m2 of THP followed by 80 mg/m2 of TXL 4 h later, repeated three times every other week. Three to six cycles were conducted in each patient. An anti-emetic drug was administered before administration of THP as short premedication. Dexamethasone (16 mg; i.v.) and d-chlorpheniramine maleate (12 mg; p.o.) were administered 1 h before administration of TXL and ranitidine (100 mg; i.v.) was administered 30 min before administration of TXL. Ubidecarenone (30 mg/day; p.o.) was administered for 3 days. The response rate was 27.3% with a rating of PR in 3 patients, NC in 6, and PD in 2. Adverse reactions observed included transient facial hot flushes, alopecia grade 1 or milder grade 1 symptoms, and peripheral nerve damage. No adverse reactions such as myocardial disorders or congestive heart failure were noted. Grade 3 and grade 2 neutropenia occurred in 1 and 6 patients, respectively, and 4 patients were admitted for treatment of this. In conclusion, the short premedication was useful, and this was thought to make it possible to conduct ambulatory treatment with TXL + THP in some patients. The response rate of 27.3%, however, was not satisfactory. It will be necessary to clarify the characteristics of this therapy by administering it to a wider spectrum of patients.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12542742&dopt=Abstract alopecia, hair loss Ref: Tissue Antigens 2002 Dec;60(6):489-95

Role of the Autoimmune Regulator (AIRE) gene in alopecia areata: Strong association of a potentially functional AIRE polymorphism with alopecia universalis.

Tazi-Ahnini R, Cork MJ, Gawkrodger DJ, Birch MP, Wengraf D, McDonagh AJ, Messenger AG.

Alopecia areata is characterized by a reversible form of patchy or complete hair loss associated with T-cell infiltration of hair follicles. The lifetime disease risk of approximately 1.4% in the general population is increased to more than 30% in autoimmune polyendocrinopathy candidiasis ectodermal dysplasia syndrome (APECED), a recessive condition resulting from a mutation of the autoimmune regulator (AIRE) gene on chromosome 21q22.3. Aire protein is thought to have transcriptional regulatory activity but its role is not well defined at present. In this study, we have examined the possible involvement of AIRE in the pathogenesis of alopecia areata.

On screening the AIRE coding sequence, we identified 20 variants. Two of these at positions, G961C and T1029C, give rise to amino acid changes, S278R and V301A, located in the DNA-binding segment (SAND) and PHD1 zinc finger motif, respectively. We found no difference in the frequency of the AIRE T1029C polymorphism between the control and patient groups. We genotyped 202 alopecia areata patients and 175 matched Caucasian controls for the AIRE G961C alleles. The frequency of the rare allele (961G) was 0.08 in the controls and there was a significant increase to 0.13 in alopecia areata overall and 0.20 in severe disease (alopecia universalis). We found no association between the AIRE G961G variant and mild (patchy) alopecia areata or alopecia totalis. However, the AIRE 961G allele is a potent risk factor (> 3) for the severest form of alopecia areata, and for disease of early age at onset (at 30 years). The change from serine to arginine in the SAND domain of AIRE protein may have a significant effect on AIRE DNA-binding activity. Moreover, our results could provide a rational explanation of the unusually high frequency of AA in APECED patients, supporting the concept of AA as an autoimmune disease.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12535195&dopt=Abstract alopecia, hair loss Ref: J Invest Dermatol 2003 Jan;120(1):27-35

Fas and c-kit are involved in the control of hair follicle melanocyte apoptosis and migration in chemotherapy-induced hair loss.

Sharov AA, Li GZ, Palkina TN, Sharova TY, Gilchrest BA, Botchkarev VA.

Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.

Chemotherapy alters the structure and function of hair follicle melanocytes. Molecular mechanisms controlling melanocyte responses during chemotherapy-induced hair loss, however, remain largely unknown. Using immunohistology and multicolor confocal microscopy, we show here that cyclophosphamide administration to C57BL/6 mice alters the activity and fate of hair follicle melanocytes. After 24-48 h, hair bulb melanocytes expressing Fas undergo apoptosis. The number of apoptotic follicular melanocytes is significantly reduced (p<0.01) in cyclophosphamide-treated Fas knockout mice compared to wild-type controls, suggesting that Fas signaling contributes to chemotherapy-induced melanocyte death. After 3-5 d, surviving hair bulb melanocytes express c-kit receptor, proliferate, and appear to migrate up the outer root sheath. Tyrosinase-positive and melanogenically active cells then appear in the epidermis. By Western blotting and immunohistochemistry, expression levels of the c-kit ligand, stem cell factor, in skin and epidermis are strongly increased after cyclophosphamide treatment. Cyclophosphamide-induced migration of the hair follicle melanocytes into epidermis is completely abrogated by administration of c-kit neutralizing antibody. These data suggest that chemotherapy induces a complex response in the hair follicle melanocytes, which includes apoptosis, proliferation, and migration. Pharmacologic manipulation of Fas and c-kit signaling pathways might be useful for the correction of skin hyperpigmentation as a side-effect of chemotherapy.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12524069&dopt=Abstract alopecia, hair loss Ref: Fertil Steril 2003 Jan;79(1):91-5

Treatment of hyperandrogenic alopecia in women.

Carmina E, Lobo RA.

Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy.

OBJECTIVE: To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia. DESIGN: Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients. SETTING: Endocrinologic outpatient practice in Italy. PARTICIPANT(S): A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels. INTERVENTION(S): Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year. MAIN OUTCOME MEASURE(S): Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness. RESULT(S): Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend. CONCLUSION(S): Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12518198&dopt=Abstract alopecia, hair loss Ref: Saudi Med J 2002 Dec;23(12):1489-91

Striae distensae - like lesions. A cause of scarring alopecia among children.

Sharquie KE, Al-Waiz MM, Al-Nuaimy AA.

Department of Dermatology & Venereology, College of Medicine, University of Baghdad, PO Box 61080, Postal Code 12114, Medical Collection Post Office, Baghdad, Iraq. Tel. +964 (1) 5560036. Fax. +964 (1) 4250243.

OBJECTIVE: Although alopecia areata is a common problem among children, many misdiagnoses for this condition can happen. The aim of this study was to demonstrate the striae distensae as lesions that cause scarring alopecia with a great resemblance to alopecia areata. METHODS: A total of 36 children with provisional diagnosis of alopecia areata of the scalp were assessed clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq, between June 1998 to June 2001. Their age ranged from 3 12 years and the mean + standard deviation (SD) was 7.30 + 2.59 years with equal sex ratio. RESULTS: All patients provided for this study had a history of patchy hair loss of few months duration. Their parents denied any history of obvious trauma and many modalities of treatment had been tried without benefit. The clinical examination revealed single or multiple (1-6) (mean + SD 2.41 + 1.22) complete linear hair loss patches resembling atrophic scar that was similar to striae distensae. The histopathological examination showed atrophy of the epidermis, full replacement of the dermis by collagen bundles, and complete loss of appendages. CONCLUSION: This is a new entity, which seems to be common among children and often confused with untreated cases of alopecia areata. This condition should be added to the differential diagnosis of patchy hair loss in children and the parents should be reassured of the cause of hair loss and no treatment therapy needed.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12496614&dopt=Abstract alopecia, hair loss Ref: Plastic and Reconstructive Surgery 2003; 111(1):414-421

Hair Transplantation for Men with Advanced Degrees of Hair Loss
Jeffrey S. Epstein, M.D.
In the field of surgical hair restoration, there is probably no greater challenge than treating the individual with advanced male pattern hair loss. Recent developments in follicular unit grafting and recognition of the natural appearance of the transplanted frontal forelock have now made it possible to obtain excellent, undetectable results in these patients. Over a 22-month period, the onset correlating with the time when the author began to use the technique of follicular unit grafting, 61 of 322 hair transplant procedures (approximately 20 percent) performed for male pattern hair loss were on men with, or at high risk of developing, advanced male pattern hair loss. Uniformly, the creation of some type of frontal forelock provided excellent results and high patient satisfaction. The concept of the frontal forelock is not new. Developments in aesthetic principles, enhanced understanding of its applicability, and the applied advantages of follicular unit grafting allow for the first time, truly undetectable results.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12485423&dopt=Abstract alopecia, hair loss Ref: J Invest Dermatol 2002 Dec;119(6):1237-43

Loss of cell adhesion in Dsg3bal-Pas mice with homozygous deletion mutation (2079del14) in the desmoglein 3 gene.

Pulkkinen L, Choi YW, Simpson A, Montagutelli X, Sundberg J, Uitto J, Mahoney MG.

Department of Dermatology and Cutaneous Biology, Jefferson Medical College, and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Pemphigus encompasses a group of autoimmune blistering diseases with circulating pathogenic autoantibodies recognizing several proteins, including the desmosomal cadherin, desmoglein 3. Targeted disruption of the Dsg3 gene by homologous recombination (Dsg3tm1stan) in mouse results in fragility of the skin and oral mucous membranes, analogous to the human disease. In addition, the Dsg3tm1stan mice develop phenotypic runting and hair loss, identical to that of the mouse mutant, Dsg3bal-2J. The Dsg3bal-2J mice are homozygous for a 1 bp insertion (2275insT) in the Dsg3 gene resulting in a nonfunctional Dsg3 mRNA. In this study, we characterized an allelic mutation, Dsg3bal-Pas, with clinical features similar to those in Dsg3bal-2J. We have identified a 14 bp deletion in exon 13 of the Dsg3 gene resulting in a frameshift and premature termination codon 7 bp downstream from the site of the deletion and causing a truncation of the desmoglein 3 polypeptide by 199 amino acids, eliminating virtually all of the intracellular domain. We demonstrate that, although a Dsg3 mRNA transcript was detectable in Dsg3bal-Pas skin, the corresponding protein for desmoglein 3 was completely absent in the oral mucosal epithelium of homozygous Dsg3bal-Pas compared with that of +/Dsg3bal-Pas mice. No significant changes in the expression of desmogleins 1 and 2 were detected. To elucidate a potential mechanism causing loss of cell adhesion in the Dsg3bal-Pas mice, we generated a myc-tagged truncated Dsg3bal-Pas desmoglein 3 protein and expressed it in keratinocytes. The myc-tagged truncated Dsg3bal-Pas desmoglein 3 protein was found predominantly in the cytoplasm possibly due to increased proteolytic degradation. Cell surface staining was also detected but was jagged, not linear along the cell-cell border like that observed for the full-length desmoglein 3. The expression of the myc-tagged truncated Dsg3bal-Pas desmoglein 3 protein resulted in a reduction in staining of other desmosomal proteins, including desmoglein 1 and 2, plakophilin 2, and plakoglobin. In addition, the cells expressing myc-tagged truncated Dsg3bal-Pas desmoglein 3 protein underwent dramatic changes in cell morphology and exhibited striking extensive filopodia. Collectively, these data showed that the perturbation of desmoglein 3 found in the Dsg3bal-Pas mice resulted in disadhesion of keratinocytes manifested with blistering phenotype.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12476680&dopt=Abstract alopecia, hair loss Ref: Kaohsiung J Med Sci 2002 Aug;18(8):379-85

Finasteride in the treatment of Taiwanese men with androgenetic alopecia: a 12-month open-label study.

Lin JH, Chen WC.

Department of Dermatology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan.

Finasteride 1 mg/day is effective in the treatment of androgenetic alopecia (AGA). Our open-label study assessed the efficacy and safety of finasteride for the treatment of Taiwanese men with AGA. We enrolled 34 Taiwanese men (aged 18-40 yr) with AGA of modified Norwood/Hamilton scale (MNHS) grade II-V. In investigator assessments at 12 months, five of 21 subjects (23.8%) had two-grade improvement in MNHS grade and 12 of 21 subjects (57.1%) had one-grade improvement; the others remained at the same grade. In global photographic evaluation, five of 31 subjects (15.1%) had observable hair growth at 6 months and 11 of 21 subjects (52.4%) had observable hair growth at 12 months. Patient self-assessment of hair growth was favorable across all questions in the treatment course, more significantly at 12 months than at 6 months; nine of 21 subjects (42.9%) were satisfied with their overall appearance at 12 months. Serum prostate specific antigen levels had decreased by 23.4% at 12 months. Adverse effects, including abnormal liver function (5/34), were minimal, and the causal relationship with finasteride could not be established. Thus, in Taiwanese men with AGA, finasteride 1 mg/day for 1 year slowed the progression of hair loss and increased hair growth.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12474572&dopt=Abstract alopecia, hair loss Ref: Pol Merkuriusz Lek 2002 Sep;13(75):208-11

Effect of minoxidil on hair growth in androgenic alopecia in women

[Article in Polish]

Brzezinska-Wcislo L.

Katedra i Klinika Dermatologii Slaskiej Akademii Medycznej w Katowicach.

The aim of the study was to carry out clinical and trichological examination (trichogram and assessment of hair loss) before and after treatment in 17 women aged 41-50 years with androgenic alopecia. Minoxidil (Loxon) was topically applied twice a day massaging the solution into the scalp over 6-12 months. It was revealed on the ground of clinical and trichological examination that the medication containing 2% solution of minoxidil externally applied on the scalp with androgenic alopecia over a few months caused normalization of hair root condition and decrease of hair loss in some patients of the observed group. The drug has a stimulating influence on hair growth and should be administered as an adjuvant therapy in androgenic alopecia in women.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12466204&dopt=Abstract alopecia, hair loss Ref: Development 2003 Jan;130(2):379-89

'Cyclic alopecia' in Msx2 mutants: defects in hair cycling and hair shaft differentiation.

Ma L, Liu J, Wu T, Plikus M, Jiang TX, Bi Q, Liu YH, Muller-Rover S, Peters H, Sundberg JP, Maxson R, Maas RL, Chuong CM.

Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.

Msx2-deficient mice exhibit progressive hair loss, starting at P14 and followed by successive cycles of wavelike regrowth and loss. During the hair cycle, Msx2 deficiency shortens anagen phase, but prolongs catagen and telogen. Msx2-deficient hair shafts are structurally abnormal. Molecular analyses suggest a Bmp4/Bmp2/Msx2/Foxn1 acidic hair keratin pathway is involved. These structurally abnormal hairs are easily dislodged in catagen implying a precocious exogen. Deficiency in Msx2 helps to reveal the distinctive skin domains on the same mouse. Each domain cycles asynchronously - although hairs within each skin domain cycle in synchronized waves. Thus, the combinatorial defects in hair cycling and differentiation, together with concealed skin domains, account for the cyclic alopecia phenotype.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12460300&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Nov;28(11):1035-42; discussion 1042

A philosophy and strategy for surgical hair restoration: a 10-year experience.

Lam SM, Hempstead BR, Williams EF.

Lam Facial Plastic Surgery Center, Dallas, Texas, USA.

BACKGROUND: Three principal strategies have evolved for surgical hair restoration: follicular grafting, scalp reduction, and flap rotation. OBJECTIVE: Although grafting techniques have assumed a preeminent rank as the cornerstone of modern hair-replacement therapy, scalp reduction and rotation methods should not be entirely dismissed. METHODS: Over the past 10 years of clinical experience, the authors have relied on all three methods of hair restoration, carefully tailoring the optimal surgical approach to the patient's expressed concerns and particular regional hair deficit. RESULTS: We have found that scalp reduction and rotation provides a considerable density of hair unmatched by any grafting technique for the vertex and frontotemporal regions, respectively. CONCLUSION: Also we have concluded that the former yields the most natural result for a patient with significant crown baldness who desires hair restoration in that area. However, micro- and minigrafting still represent the overwhelming majority of our operative cases. This article attempts to review the surgical methodology and philosophy that have guided our approach to hair restoration.


Harv Mens Health Watch 2002 Nov;7(4):6-7

Baldness: Does appearance matter?
It lacks the pain of a heart attack, the threat of prostate cancer, and the complications of hypertension. Still, despite the best efforts of Michael Jordan, millions of men are distressed by hair loss.

Normal hair growth
Whether straight or curly, hair grows in a cyclical pattern that has three phases: growth (called the anagen phase by biologists), involution (catagen), and rest (telogen). The growth phase lasts the longest; its duration determines how long a hair will grow. That's why eyebrow hairs stay short (growth phase, 13 months) while scalp hairs are long (5–8 years). After the growth phase, each follicle undergoes a brief period of involution, when some of its cells die off. Then comes a spell of inactivity. At the end of the rest phase, the hair falls out of its follicle and the cells get back to work, growing a new hair. In humans, each hair follicle cycles independently; that's why humans don't "shed" each season, as many animals do.

At birth, the human body is covered by about 5 million hair follicles, including about 100,000 on the scalp. This number remains constant throughout life, but the activity and productivity of each follicle varies according to a person's age.

In a healthy scalp, more than 90% of hair follicles are in the growth phase, less than 1% are undergoing involution, and 5%–10% are resting.

Fragile follicles
Hair follicles contain living cells. Like all cells, they can be damaged, which halts hair growth. If the problem is mild, the follicle recovers and resumes growing hair, but if it's severe, the damage may be permanent.

Any severe stress, physical or emotional, can damage hair follicles, halting hair growth. That's why patients often lose their hair two or three months after a major illness or traumatic life event. It's a temporary problem technically known as telogen effluvium. It's easy to recognize with a simple pull test: If you can extract more than five or six hairs with a single pull, you're likely to have telogen effluvium, and you'll most likely grow back all your hair within a few months, even without therapy.

Medication can damage hair follicles; chemotherapy drugs are the leading examples. Less often, toxic chemicals, radiation, thyroid disease, or infections can do the job. Skin diseases that produce scarring can also result in hair loss, which may be permanent. Fortunately, all these problems are uncommon. Contrary to popular belief, common woes like seborrhea and dandruff do not cause hair loss.

Normal hair loss
Men with male pattern baldness may not regard it as normal, but it is. Like it or not, losing scalp hair is part of the human condition. It may cause psychological distress that's important in its own right, but it's not a disease.

Virtually all people, male and female, lose scalp hair as they age. In a sense, male pattern baldness, known technically as androgenic alopecia, is just an exaggerated form of a normal event. It has two requirements: a genetic predisposition and the male hormone testosterone.



The genetics of male baldness are complex. Most experts believe that one gene is responsible, but several may play a role. In any case, the abnormal gene has variable penetrance, which means it is more likely to produce hair loss in some men than others. The abnormal gene can be passed down from a mother or a father, and boys or girls can inherit it. But men are much more likely to suffer from the gene's activity because they have the second requirement, testosterone.

Testosterone makes the man: It is responsible for the large muscles, strong bones, and deep voice that characterize the gender. It is also essential for male genital development in fetal life, for the sexual awakening of adolescence, and for libido and fertility in adulthood. Testosterone acts directly on tissues to produce all these effects, but it acts indirectly on the prostate and on hair follicles. In these areas, an enzyme called 5-alpha reductase converts testosterone to dihydrotestosterone (DHT), and DHT acts on the tissues.

DHT stimulates the growth of hair follicles in the beard and body, but it has the opposite effect on scalp hair. Hair loss usually starts between the age of 17 and 40; by 50, about half of all men display some degree of male pattern baldness. It usually begins with a receding hairline over the temples, followed by thinning of the hair at the vertex, or top of the scalp. The rate of hair loss varies considerably; some men go bald in less than 5 years, but most lose their hair gradually, over 15–25 years. On average, men with androgenic alopecia lose about 5% of their scalp hair each year, but the process can slow down or speed up without apparent reason.

Although it's small comfort to balding men, their hair follicles don't actually disappear. Instead, each successive growth phase gets shorter and each resting phase longer. With an abbreviated growth phase, the hair becomes shorter and finer; with an extended resting phase, the hairs are less tightly anchored to the scalp, so they fall out during washing or combing.

Adverse effects
Male pattern baldness is not a disease. Its only consequences are cosmetic, and its only implications are psychological.

Although baldness does not cause disease, it may be a marker for increased cardiac risk. The Harvard-sponsored U.S. Physicians' Health Study found that men with bald spots were more likely to develop coronary artery disease than men with full heads of hair; mild vertex baldness was linked to a 23% increase, moderate baldness to a 32% rise, and severe baldness to a 36% increase in risk. The effect was greatest in men with hypertension or high cholesterol levels. Frontal baldness, the receding hairline, was not associated with cardiac risk.

Treatment
Doctors may not think male pattern baldness is a problem, but many men disagree. That's why 33 million Americans spend about $1.5 billion a year to replace or restore lost hair.

Treatment takes many forms, ranging from wigs and toupees to scalp surgery and hair transplants. Many men prefer wigs to surgery. Some are worn on top of existing hair; others are interwoven with a man's own hair. Interwoven wigs have to be adjusted every few weeks as the natural hairs grow, adding to the expense and inconvenience.

For generations, a bewildering array of concoctions claiming to restore lost hair have been sold to gullible men. In 1989, the FDA issued guidelines that cleared the shelves of many expensive but worthless products. At present, only two drugs are approved for male pattern baldness.

When sold in tablet form, minoxidil is a prescription drug for hypertension. But for more than 10 years it has also been available as Rogaine, a nonprescription lotion for hair loss. Regular Rogaine solution or spray contains 2% minoxidil, extra strength Rogaine, 5%. The drug increases the duration of the hair follicles' growth phase, but it works only on follicles that are still active, and its benefits last only as long as it is used regularly. Rogaine is more effective for bald spots than receding hairlines, but it's only partially effective at that; in one study, 36% of men who had used the product for several years felt it was worth the time and money.

According to the manufacturer, Rogaine should be applied twice daily. Scalp irritation can occur; dizziness and low blood pressure are less common side effects. The drug is expensive.

Finasteride is an oral prescription medication that inhibits 5-alpha reductase, thereby blocking the conversion of testosterone to DHT. In a 5-mg tablet, finasteride is sold as Proscar, for benign prostatic hyperplasia (see Harvard Men's Health Watch, July 2000); in a 1-mg tablet, it's marketed as Propecia, for male baldness.

To date, only four studies of Propecia, all funded by the manufacturer, have been reported. Two of the trials involved a total of 1,553 men with mild to moderate male pattern baldness that was most prominent at the top of the scalp. Half the men were given Propecia, the other half a placebo. After three months, the men who took Propecia were more satisfied with the appearance of their hair: After a year, they had an average of 876 hairs in a 1-inch circle on the scalp, while those treated with the placebo had 769 hairs.

The third trial evaluated 326 men with mild to moderate frontal hair loss; after a year, 50% of the men taking Propecia and 30% of the men taking the placebo thought their appearance had improved. Finally, a small 2002 study (66 men) reported that finasteride increases hair thickness as well as hair counts, thus enhancing its cosmetic benefit.



The 1,879 men in the three large trials were between the ages of 18 and 41, and none was completely bald. Since Propecia will not revive hair follicles that are inactive, it cannot be expected to regrow hair in older men who are bald. As a result, it warrants consideration only by younger men with partial hair loss.

Because Propecia must be taken daily, years of therapy are required to maintain even modest improvements. Propecia is even more expensive than Rogaine. It is well tolerated, but 1%–2% of men experience diminished libido and potency on Propecia. Because finasteride can produce genital abnormalities in males exposed before birth, the drug should never be taken by women of childbearing age.

To treat or not?
From a medical point of view, there is no need to treat normal hair loss. At best, the treatments are only partially effective, and although they are generally safe, some men may experience side effects. Take a look in the mirror and think it over. And before you decide, try to imagine how Michael Jordan would look with a bit of hair.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12452996&dopt=Abstract alopecia, hair loss Ref: Int J Dermatol 2002 Nov;41(11):748-53

The pattern and profile of alopecia areata in Singapore - a study of 219 Asians.

Tan E, Tay YK, Goh CL, Chin Giam Y.

National Skin Center, Singapore.

BACKGROUND: Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. OBJECTIVE: To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. METHODS: Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed. RESULTS: Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss. CONCLUSIONS: Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451369&dopt=Abstract alopecia, hair loss Ref: J Am Acad Dermatol 2002 Dec;47(6):856-62

Primary follicular mucinosis: long-term follow-up of patients younger than 40 years with and without clonal T-cell receptor gene rearrangement.

Brown HA, Gibson LE, Pujol RM, Lust JA, Pittelkow MR.

Department of Dermatology and Section of Dermatopathology, Mayo Clinic, Rochester 55905, USA.

Since the original descriptions of follicular mucinosis, accumulating experience shows that patient age, distribution of lesions, and duration or extent of disease do not reliably distinguish benign primary follicular mucinosis from secondary follicular mucinosis, associated with cutaneous lymphoma. More recently, it has been suggested that individuals with follicular mucinosis demonstrating a clonal T-cell receptor gene rearrangement may be at higher risk for the development of lymphoma. Long-term follow-up of 7 patients younger than 40 years with primary follicular mucinosis are reported. In all cases, there was no clinical or histologic evidence of associated dermatoses or lymphoma at the time of diagnosis. Five of the patients have clonal T-cell gene rearrangement as determined by Southern blot analysis. Clinically, at the time of diagnosis, lesions of primary follicular mucinosis ranged from papules confined to the face to widespread cutaneous plaques. After a mean follow-up of 10 years (range, 5-23 years) from the onset of disease, the majority of patients continue to have cutaneous manifestations of follicular mucinosis despite various treatments. There is no evidence of progression to cutaneous T-cell lymphoma in any patient despite the presence of a clonal T-cell receptor gene rearrangement. Continued prolonged follow-up of patients with clonal primary follicular mucinosis is necessary to determine the significance of infiltrates harboring a T-cell receptor gene rearrangement. However, in our experience with this group of selected patients, primary follicular mucinosis has been a clonal disorder with limited or "benign" cutaneous manifestations.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451364&dopt=Abstract alopecia, hair loss Ref: J Am Acad Dermatol 2002 Dec;47(6):809-18; quiz 818-20

Approach to the adult female patient with diffuse nonscarring alopecia.

Chartier MB, Hoss DM, Grant-Kels JM.

Department of Dermatology, University of Connecticut Health Center, Farmington 06032, USA.

Alopecias are traditionally categorized by the presence or absence of scarring and by a diffuse or localized pattern. A common clinical conundrum is that of a woman presenting with the chief complaint of diffuse, nonscarring hair loss. We review the 4 main diagnostic possibilities for this clinical scenario: (1) female pattern hair loss (androgenetic alopecia), (2) acute and chronic telogen effluvium, (3) diffuse alopecia areata, and (4) loose anagen syndrome. We also outline our approach to the individual patient, emphasizing the pertinent history, physical examination, and appropriate diagnostic testing. This approach usually allows the clinician to make a definitive diagnosis or limited differential diagnosis and to offer the patient therapeutic options.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12444520&dopt=Abstract alopecia, hair loss Ref: Hautarzt 2002 Dec;53(12):798-804

TrichoScan. A new instrument for digital hair analysis

[Article in German]

Hoffmann R.

Universitats-Hautklinik, Marburg, Germany.

BACKGROUND/OBJECTIVE: Hair loss or hair thinning is a common complaint in clinical dermatology. Patients seeking advice for hair loss are not necessarily bald. In addition, the effects of therapy are hard to measure. Consequently, there is a need for a sensitive tool to monitor hair loss and treatment response. Such a method must be able to analyze the biological parameters of hair growth, which are: 1: hair density (n/cm(2)), 2: hair diameter (micrometer), 3: hair growth rate (mm/day) and 4: anagen/telogen ratio. PATIENTS/METHODS: We present the TrichoScan as a method which combines epiluminescence microscopy (ELM) with automatic digital image analysis for the measurement of human, and potentially animal hair, in situ. The TrichoScan is able to analyze all biological parameters of hair growth with a so called intraclass correlation of approximately 91% within the same operator and an intraclass correlation of approximately 97% for different operators. RESULTS: The application of the technique is demonstrated by comparison of the hair parameters in individuals without apparent hair loss with men with untreated AGA and men after treatment with finasteride (1 mg/day), and women who were treated with minoxidil. We were able to detect a significant increase in hair counts and cumulative hair thickness 3 and 6 months after treatment. CONCLUSION: The advantage of the TrichoScan is that it can be used for clinical studies to compare placebo versus treatment or to compare different hair growth promoting substances, it can be used for studying AGA or other forms of diffuse hair loss, and it can be adopted to study the effect of drugs or laser treatment on hypertrichosis or hirsutism.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12444334&dopt=Abstract alopecia, hair loss Ref: Dermatology 2002;205(4):374-7

Hair pain (trichodynia): frequency and relationship to hair loss and patient gender.

Willimann B, Trueb RM.

Department of Dermatology, University Hospital of Zurich, Switzerland.

Background: Patients complaining of hair loss frequently claim that their hair has become painful. Objective and Methods: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. Results: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. Conclusions: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12444333&dopt=Abstract alopecia, hair loss Ref: Dermatology 2002;205(4):367-73

Acute Diffuse and Total Alopecia of the Female Scalp. a new subtype of diffuse alopecia areata that has a favorable prognosis.

Sato-Kawamura M, Aiba S, Tagami H.

Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan.

Background: Athough alopecia areata (AA) usually starts with focal lesions of hair loss and then presents several different clinical forms, AA may begin as diffuse hair loss. We examined 9 female patients who presented with acute, diffuse and total hair loss of the scalp and took a similar clinical course with a favorable prognosis. Objective: To categorize such cases as a new subgroup of diffuse alopecia. Methods: We studied 9 patients who showed acute, diffuse and total hair loss of the scalp within 1 month after their first visit to our hospital by comparing their clinical course, laboratory tests and histopathological findings with those of common, patchy AA, alopecia totalis or alopecia universalis. Results: None of the patients had a background of systemic diseases or telogen effluvium. All the patients were female, and 8 of the 9 cases recovered cosmetically acceptable hair growth within 6 months regardless of steroid administration. The histology of he lesions was indistinguishable from that of AA except for a remarkable eosinophilic infiltrate. Conclusions: These cases can be categorized as a new subtype of inflammatory noncicatricial alopecia that is characterized by a marked female predominance, tissue eosinophilia and uniquely short clinical course. We suggest to name it 'acute diffuse and total alopecia of the female scalp (ADTAFS)'.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12437546&dopt=Abstract alopecia, hair loss Ref: Pediatr Dermatol 2002 Nov-Dec;19(6):482-5

Alopecia areata in children: a clinical profile.

Nanda A, Al-Fouzan AS, Al-Hasawi F.

Pediatric Dermatology Unit, Asad Al-Hamad Dermatology Center, Salmiya, Kuwait.

Alopecia areata (AA) is prevalent among children in Kuwait. In this prospective survey we studied 215 children with AA to determine their clinical and epidemiologic features. Ninety-seven percent of the children were of Arab ancestry. Girls outnumbered boys by a 2.5:1 ratio. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5.7 +/- 2.8 years. A majority of the patients (80.5%) had mild disease and extensive disease (more than 50% hair loss) was seen in 13% of the children. A positive family history of AA was obtained in 51.6% of cases and nail changes were seen in 26.5% of the children. The age of onset, a positive family history of AA, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. The results were compared with those reported elsewhere for this age group.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12433001&dopt=Abstract alopecia, hair loss Ref: J Dermatol 2002 Oct;29(10):665-9

Depression circumstantially related to the administration of finasteride for androgenetic alopecia.

Altomare G, Capella GL.

Department of Dermatology, Ospedale Maggiore IRCCS, University of Milan, Italy.

In this paper we report 19 patients (14 males, 5 females; mean age 28.16 years +/- 7.68 SD) out of a series of 23 (17 males, 5 females) who developed a mood disturbance (moderate to severe depression) during treatment with finasteride, 1 mg/day orally, for androgenetic alopecia (Hamilton subtypes III-V; Ludwig subtypes I-II). Depression, which significatively impaired sociofamilial relations, sleep and eating behaviour, was associated to marked anxiety in some cases, developed after 9-19 weeks of treatment with finasteride, and promptly resolved after suspension of the drug. Two patients accepted reintroduction of the drug, and depression relapsed within 2 weeks. Depression as an adverse effect of finasteride has been reported only once. Further studies are needed to confirm our circumstantial observations, which are based on a retrospective series of patients.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12433000&dopt=Abstract alopecia, hair loss Ref: J Dermatol 2002 Oct;29(10):661-4

Seventeen cases of alopecia areata: combination of SADBE topical immunotherapy with other therapies.

Morita K, Nakamura M, Nagamachi M, Kishi T, Miyachi Y.

Department of Dermatology, Graduate School of Medicine, Kyoto University, Japan.

Topical immunotherapy is effective for severe alopecia areata. However, there are patients with alopecia areata refractory to topical immunotherapy alone. We tried SADBE (squaric acid dibutylester) topical immunotherapy combined with topical dry ice cryotherapy, carpronium chloride (a parasympathetic nerve stimulant) and/or oral cepharanthin (a biscoclaur alkaloid) in alopecia areata refractory to topical SADBE. Seventeen patients with alopecia areata (3 multiple, 3 ophiasis, 5 totalis and 6 universalis) were treated with SADBE in our department in 1999 to 2001. In 3 cases (2 multiple and 1 universalis) out of the 17 cases, cosmetically acceptable regrowth of hair was observed in several months with topical SADBE alone. In the other 14 cases, the SADBE therapy alone for several months (mean: 6.9 months) resulted in no or poor regrowth of hair. However, with subsequent combination therapy of topical SADBE for several months (mean: 7.6 months), satisfactory regrowth of hair was observed in 6 of the 14 cases. Our cases indicate that combination therapy of topical SADBE with other therapies can be a choice for alopecia areata which is refractory to topical SADBE therapy alone.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12432998&dopt=Abstract alopecia, hair loss Ref: J Dermatol 2002 Oct;29(10):653-6

Idiopathic CD4+ T lymphocytopenia associated with disseminated flat warts and alopecia areata.

Gubinelli E, Posteraro P, Girolomoni G.

Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy.

Idiopathic CD4+ T lymphocytopenia is a very rare condition characterized by persistent depletion of circulating CD4+ T lymphocytes, without evidence of HIV or HTLV infection, or other identifiable causes of immunodeficiency. The syndrome can present with dermatological diseases, including viral, fungal and bacterial infections, as well as Kaposi's sarcoma, epithelial cell malignancies, lymphoma and inflammatory dermatoses. We report the case of a 47-year-old woman with idiopathic CD4+ T lymphocytopenia who presented with a 10-year history of disseminated and refractory flat warts from which human papillomavirus type 3 DNA was identified. The patient also had alopecia areata.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12423443&dopt=Abstract alopecia, hair loss Ref: Australas J Dermatol 2002 Nov;43(4):311-2

Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia.

Sinclair RD, Mallari RS, Tate B.

Skin and Cancer Foundation, Melbourne, Victoria, Australia.

We report a 24-year-old woman with androgenetic alopecia who became sensitized to topical minoxidil following use of an extemporaneous preparation of minoxidil 4% with retinoic acid in a propylene glycol base. She subsequently also became sensitized to saw palmetto (Serenoa repens), a topical herbal extract commonly promoted for the treatment of hair loss.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12421036&dopt=Abstract alopecia, hair loss Ref: J Assoc Physicians India 2002 Aug;50:1073-4

Alopecia universalis in a case of systemic lupus erythematosus.

Chaudhuri S, Basu K, Dhar MC, Das S, Chatterjee G, Banerjee G, Mitra K.

Department of Medicine, RG Kar Medical College, Calcutta.

We report a case of systemic lupus erythematosus (SLE) who presented with alopecia universalis. MR, a 23 years female patient was admitted with alopecia universalis and other features of SLE like peripheral arthritis, fever, nephritis, butterfly rash over the malar regions, positive ANA and anti-ds DNA antibodies. There was a gap of four years between the onset of alopecia universalis and other clinical features of SLE. The alopecia was of non-scarry variety and responded to systemic and topical steroids.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12410711&dopt=Abstract alopecia, hair loss Ref: Br J Dermatol 2002 Nov;147(5):982-4

There is no clear association between low serum ferritin and chronic diffuse telogen hair loss.

Sinclair R.

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

BACKGROUND: Low iron stores are considered a possible cause of chronic diffuse telogen hair loss in women. Estimation of serum ferritin is recommended as part of the initial assessment when women present with chronic diffuse telogen hair loss, and iron supplementation therapy is commonly recommended for those found to have low iron stores. OBJECTIVES: To evaluate the relationship between low serum ferritin ( 20 micro g L-1. Cessation or reversal of hair loss was not seen in any of these women. CONCLUSIONS: No direct relationship between low serum ferritin and hair loss can be established. The usefulness of serum ferritin in the routine investigation of women with chronic diffuse telogen hair loss is unclear, as is the role of iron supplementation therapy in the management of hair loss.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12410672&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Oct;28(10):894-900; discussion 900

The potential role of minoxidil in the hair transplantation setting.

Avram MR, Cole JP, Gandelman M, Haber R, Knudsen R, Leavitt MT, Leonard RT Jr, Puig CJ, Rose PT, Vogel JE, Ziering CL; Roundtable Consensus Meeting of The 9th Annual Meeting of The International Society of Hair Restoration Surgery.

Department of Dermatology New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA.

BACKGROUND: Over the last decade surgical management of hair loss has become an increasingly popular and satisfying procedure for both men and women, as innovations in donor harvesting, graft size, and hairline design have resulted in consistently natural-appearing hair restoration. OBJECTIVE: In addition, a better understanding of the regulation of the hair-growth cycle has led to advances in the pharmacologic treatment of androgenetic alopecia. METHODS: Currently there are two U.S. Food and Drug Administration (FDA)-approved agents that promote hair regrowth: over-the-counter topical minoxidil solution for men and women and prescription oral finasteride tablets for men. In October 2001, a group of 11 international experts on hair loss and hair transplantation convened to review the physiology and effects of pharmacologic treatments of hair loss and to discuss the value of administering topical minoxidil therapy as an adjunct to hair transplantation. RESULTS: This article presents the key findings and consensus points among the participants, including their current use of pharmacologic treatments, strategies for optimal results both pre- and postsurgery, and the importance of realistic patient expectations and compliance. CONCLUSIONS: Based on the surgeons' clinical experience, the use of approved hair regrowth agents in hair transplant patients with viable but suboptimally functioning follicles in the region to be transplanted can increase hair density, speed regrowth in transplanted follicles, and complement the surgical result by slowing down or stopping further hair loss.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12410671&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Oct;28(10):873-93

The art of repair in surgical hair restoration--part II: the tactics of repair.

Bernstein RM, Rassman WR, Rashid N, Shiell RC.

College of Physicians and Surgeons, Columbia University, New York, New York, USA.

BACKGROUND: As patient awareness of new hair transplantation techniques grows, the repair of improperly planned or poorly executed procedures becomes an increasingly important part of surgical hair restoration. OBJECTIVE: Part II of this series is written to serve as a practical guide for surgeons who perform repairs in their daily practices. It focuses on specific repair techniques. METHODS: The repairs are performed by excision with reimplantation and/or by camouflage. Follicular unit transplantation is used for the restorative aspects of the procedure. RESULTS: Using punch or linear excision techniques allows the surgeon to relocate poorly planted grafts to areas that are more appropriate. The key elements of camouflage include creating a deep zone of follicular units, angling grafts in their natural direction, and using forward and side weighting of grafts to increase the appearance of fullness. In special situations, removal of grafts without reimplantation can be accomplished using lasers or electrolysis. CONCLUSION: Meticulous surgical techniques and optimal utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12410158&dopt=Abstract alopecia, hair loss Ref: Ann Pathol 2002 Sep;22(4):328-30

Postmenopausal frontal fibrosing alopecia. Report of 3 cases

[Article in French]

Claude V, Blanchet P, Grossin M, Henin D.

Service d'Anatomie et de Cytologie Pathologique, 74575 Paris, France.

Postmenopausal frontal fibrosing alopecia is a rare aspect of scarring alopecia concerning elderly women. It appears as a receding anterior hair line localised in the frontal and temporal regions. It is a particular pathologic and clinical form of lichen planopilaris. The histologic aspect is that of a lichenoid inflammatory infiltrate affecting the dermal follicular junction, accompanied by a fibrous scarring aspect, the latter contributing to the diagnosis and individualization of this entity. Discoid lupus erythematous is the main histologic differential diagnosis. Postmenopausal period is the only associated condition found in affected women. Evolution is unpredictable and does not seem to be modified by treatment.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12407434&dopt=Abstract alopecia, hair loss Ref: Bone Marrow Transplant 2002 Nov;30(9):593-7

Relationship between irreversible alopecia and exposure to cyclophosphamide, thiotepa and carboplatin (CTC) in high-dose chemotherapy.

de Jonge ME, Mathot RA, Dalesio O, Huitema AD, Rodenhuis S, Beijnen JH.

Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands.

Reversible alopecia is a commonly observed, important and distressing complication of chemotherapy. Permanent alopecia, however, is rare after standard-dose therapy, but has occasionally been observed after high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin (CTC). We evaluated the relationships between total exposure to these three compounds and their different metabolites in the high-dose CTC regimen, and the subsequent development of irreversible alopecia. Twenty-four patients received two or three courses of high-dose CTC, each followed by peripheral blood progenitor cell transplantation. Plasma levels of cyclophosphamide, its active metabolite 4-hydroxycyclophosphamide, thiotepa, its active metabolite tepa, and carboplatin were determined, and the area-under-the-plasma concentration-versus-time curves (AUC) of the compounds were calculated. Eight of the 24 patients included in the study developed permanent alopecia, while seven had normal hair regrowth and nine patients developed incomplete and/or thin hair regrowth. The carboplatin AUC and the summed AUC of thiotepa and tepa were both significantly associated with increasing irreversibility of hair loss. These results suggest that high exposure to carboplatin and the sum of the thiotepa and tepa exposure may lead to the development of permanent alopecia. This knowledge could guide therapeutic drug monitoring in order to prevent the occurrence of permanent alopecia and thereby improve the patients' quality of life.


J Am Acad Dermatol 2002 Nov;47(5):795

Female pattern hair loss.

Olsen EA, Hordinsky M, Roberts JL, Whiting DA; The Dermatologic Consortium for Women's Health.

Duke University Medical Center, Durham, NC 27710, USA.

In this issue of the Journal (pages 733-9), Shum et al1 describe 4 female patients with increased androgens whose central scalp hair loss responded to finasteride. This is an important observation and one that highlights why the term androgenetic or androgenic alopecia, as used to describe the hereditary pattern balding of men, should be replaced with the term female pattern hair loss when applied to women.2 It is clear that only a small but distinct subset of women with central scalp pattern hair loss, such as the patients presented in the report by Shum et al, has signs of hyperandrogenism such as acne, hirsutism, and irregular periods with or without elevation of serum androgens. Therefore these women may have hair loss resulting from a different mechanism and may respond differently to treatments targeted at androgen blockade than women with a similar type of hair loss but without evidence of hyperandrogenism. Certainly these women with hyperandrogenemia may develop, in contradistinction to those without hyperandrogenemia, a Hamilton pattern of hair loss (male pattern baldness). Many of these women may, on more careful evaluation, have polycystic ovarian syndrome.

It is not surprising that a 5-reductase inhibitor such as finasteride, which has documented efficacy in men with androgenetic alopecia3,4 and has been shown to advantageously affect hirsutism,5,6 may cause hair growth in women with female pattern hair loss and hyperandrogenism. The fact that finasteride has not previously been shown to induce hair growth in postmenopausal women with “androgenetic alopecia”7 speaks for (1) adoption of different terminology for this type of hair loss in women and (2) separate evaluation of the different subgroups of women with female pattern hair loss as recently described,2 that is, early onset with and without hyperandrogenemia and late onset/postmenopausal with and without hyperandrogenemia. We should not be too quick to rule out efficacy of a potential therapeutic agent in all women with female pattern hair loss without first testing it in all the various subsets of women.

Clearly, finasteride may be an effective treatment for women with early-onset female pattern hair loss and hyperandrogenemia, but definitive results would require a large, well-controlled trial. Such a trial would likely necessitate inclusion of a “placebo” run-in phase with an oral contraceptive, both to protect these women of child-bearing potential from getting pregnant while taking a drug known to cause genital abnormalities in male fetuses and to rule out any effect from the oral contraceptive alone on female pattern hair loss (a study that needs to be conducted in any case). Anecdotal reports, such as that presented by Shum et al,1 should ignite interest in evaluating finasteride and other 5-reductase inhibitors, either type II or combination type I/II, in women with female pattern hair loss, a group of patients whose current treatment options are extremely limited.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12399766&dopt=Abstract alopecia, hair loss Ref: J Am Acad Dermatol 2002 Nov;47(5):733-9

Hair loss in women with hyperandrogenism: four cases responding to finasteride.

Shum KW, Cullen DR, Messenger AG.

Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK.

Oral finasteride, a type II 5 alpha-reductase inhibitor, has been shown to increase hair growth and slow progression of thinning in men with androgenetic or male pattern balding (Hamiliton type) but has no affect on hair growth in postmenopausal women with female pattern hair loss (Ludwig type). We describe 4 cases of hair loss with characteristics of both male and female patterns in women with hyperandrogenism in which finasteride has improved or stabilized the alopecia. Improved hair growth was seen after 6 months, 1 year, 2 years, and 2.5 years, respectively. The finding that finasteride treatment improves pattern hair loss in women with hyperandrogenism but does not affect those postmenopausal women with female pattern hair loss without hyperandrogenism supports the concept that not all types of female hair loss have the same pathophysiology.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12399436&dopt=Abstract alopecia, hair loss Ref: Endocrinology 2002 Nov;143(11):4389-96

Vitamin D3 analogs stimulate hair growth in nude mice.

Vegesna V, O'Kelly J, Uskokovic M, Said J, Lemp N, Saitoh T, Ikezoe T, Binderup L, Koeffler HP.

Cedars-Sinai Medical Center/University of California Los Angeles School of Medicine, Los Angeles, California 90048, USA.

The active form of vitamin D3 can regulate epidermal keratinization by inducing terminal differentiation; and mice lacking the vitamin D receptor display defects leading to postnatal alopecia. These observations implicate the vitamin D3 pathway in regulation of hair growth. We tested the ability of 1,25 dihydroxyvitamin D3 and its synthetic analogs to stimulate hair growth in biege/nude/xid (BNX) nu/nu (nude) mice exhibiting congenital alopecia. Nude mice were treated with different vitamin D3 analogs at doses that we had previously found to be the highest dose without inducing toxicity (hypercalcemia). The mice were monitored for hair growth and were scored according to a defined scale. Skin samples were taken for histological observation of hair follicles and for extraction of RNA and protein. Vitamin D3 analogs dramatically stimulated the hair growth of nude mice, although parental 1,25 dihydroxyvitamin D3 had no effect. Hair growth occurred in a cyclical pattern, accompanied by formation of normal hair follicles and increased expression of certain keratins (Ha7, Ha8, and Hb3). Vitamin D3 analogs seem to act on keratinocytes to initiate hair follicle cycling and stimulate hair growth in mice that otherwise do not grow hair.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12397096&dopt=Abstract alopecia, hair loss Ref: FASEB J 2002 Dec;16(14):1967-9

Androgen-inducible TGF-beta1 from balding dermal papilla cells inhibits epithelial cell growth: a clue to understand paradoxical effects of androgen on human hair growth.

Inui S, Fukuzato Y, Nakajima T, Yoshikawa K, Itami S.

Department of Dermatology, Course of Molecular Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan.

We attempted establishing an in vitro coculture system by using human dermal papilla cells (DPCs) from androgenetic alopecia (AGA) and keratinocytes (KCs) to explore the role of androgens in hair growth regulation. Androgen showed no significant effect on the growth of KCs when they were cocultured with DPCs from AGA. Because the expressions of mRNA of androgen receptor (AR) decreased during subcultivation of DPCs in vitro, we transiently transfected the AR expression vector into the DPCs and cocultured them with KCs. In this modified coculture, androgen significantly suppressed the growth of KCs by approximately 50%, indicating that overexpression of AR can restore the responsiveness of the DPCs to androgen in vivo. We found that androgen stimulated the expression of TGF-beta1 mRNA in the cocultured DPCs. ELISA assays demonstrated that androgen treatment increased the secretion of both total and active TGF-beta1 in the conditioned medium. Moreover, the neutralizing anti-TGF-beta1 antibody reversed the androgen-elicited growth inhibition of KCs in a dose-dependent manner. These findings suggest that androgen-inducible TGF-beta1 derived from DPCs of AGA is involved in epithelial cell growth suppression in our coculture system, providing the clue to understand the paradoxical effects of androgens for human hair growth.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12382573&dopt=Abstract alopecia, hair loss Ref: Zhonghua Zheng Xing Wai Ke Za Zhi 2002 Jul;18(4):219-20

Dense-packing hair grafting technique for restoration of cicatricial alopecia

[Article in Chinese]

Wang J, Fan J.

Hair Transplantation Center, Plastic Surgery Hospital of CAMS, Beijing 100041, China.

OBJECTIVE: To investigate the possibility of using dense-packing hair grafting technique for restoration of cicatricial alopecia. METHODS: Under local anesthesia, a scalp strip was harvested from the back of the head. A series of micro-grafts with 1-3 hairs and mini-grafts with 4-6 hairs were created from this strip. In the scarring recipient area, micro-slots were made with a 18 G needle for the micro-grafts and mini-slits were made with a No. 64 mini-blade for the mini-grafts. The grafts were then implanted into these holes. RESULTS: Ninety-six patients with 128 bald scarring areas, resulted from burn, trauma or infection, were treated with the above-mentioned technique from April. 1998 to February. 2000. All of the patients were satisfied with the appearance. In the micro-graft area, the graft density reached 10-15 mini-grafts/cm2 per session. In the micro-graft area, the graft density reached 16-19 micro-grafts/cm2 per session. Postoperative following-up for more than 1 year showed that the grafted hairs were growing well with 90%-95% survival of the hair. One third of the patients obtained satisfactory results with only one session. Two thirds of the patients needed the second session to improve the appearance. CONCLUSIONS: The dense-packing hair grafting technique is a simple, safe and effective method for hair restoration surgery. It is not only used for male pattern baldness, but could also be applied for restoration of cicatricial alopecia.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12376073&dopt=Abstract alopecia, hair loss Ref: Med Hypotheses 2002 Nov;59(5):522-6

The hydraulic influence in androgen-related hair growth: implications in autoimmune disease.

Foote SI.


Androgen-related changes in hair growth represent something of a mystery. Through the action of dihydrotestosterone (DHT), hair growth is increased in specific areas of the body. Elevated levels of DHT produce a general increase over the larger part of the body, often accompanied by hair loss in specific areas of the scalp. Because of this 'opposite' effect, a genetic difference in the hair follicles is proposed. This view is supported through the success of the 'plug graft' transplantation technique. However, this is unsatisfactory, because transplantation procedures that should work well according to this theory, ultimately fail. There is an alternative 'mechanism', that demonstrates its origins in the prime function of hair as an insulator. This simple mechanism makes sense of all the recognized effects of DHT in the dermal system, and throughout the body. In DHT-related hair growth it can be directly observed. The implication is that DHT achieves its effects through a primary physiological action that can be easily tested given the necessary expertise. Given existing knowledge, such a proven action of DHT would have serious implications for further understanding of female susceptibility to autoimmune disease.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12372084&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2002 Sep;27(6):458-60

Disappearance of pili annulati following an episode of alopecia areata.

Green J, Sinclair RD, de Berker D, Sinclair RD.

Department of Medicine (Dermatology), University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia.

Pili annulati is a distinctive autosomal dominant hair shaft disorder that produces alternating light and dark bands that can give a spangled appearance to the hair. The literature contains three case reports of patients in whom the condition has disappeared following recovery from alopecia totalis. None of these reports contain a direct microscopic comparison of pre- and post-regrowth hairs. We report a 6-year-old girl who was first noted to have pili annulati at the age of 2 years and who developed alopecia totalis at the age of 3 years. When the hair regrew spontaneously, 18 months later, the pili annulati was no longer visible. Hair samples obtained before and after the episode of alopecia areata were compared by normal and cross-polarized light microscopy. While not apparent on careful clinical examination, banding was present on light microscopy in 20% of the hairs. Eighty per cent of the affected hairs displayed banding throughout their entire length. In contrast, prior to the episode of alopecia totalis, when the pili annulati was clearly visible, 50% of the hair obtained was banded on microscopy and 90% of the affected hairs showed banding throughout their microscopic length.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12366432&dopt=Abstract alopecia, hair loss Ref: Br J Dermatol 2002 Oct;147(4):789-92

Loose anagen syndrome as a severity factor for trichotillomania.

Thai KE, Sinclair RD.

Department of Medicine (Dermatology), The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.

Loose anagen syndrome (LAS) is a condition of childhood where anagen hairs are easily and painlessly extracted. The condition is due to poor adhesion between the cuticle of the hair shaft and the inner root sheath. A 4-year-old girl presented with patches of hair loss and a clinical diagnosis of trichotillomania was made. A hair pull test extracted multiple hairs easily and painlessly. Light microscopic examination was consistent with LAS. A biopsy was performed, which showed features of trichotillomania. However, on request the child did not display sufficient dexterity to pull out her own hair. It was subsequently determined that her hair loss was likely to be due to a third person plucking out her hair. It appears that in this case the LAS was not the cause of her hair loss, but rather acted as a severity factor for trichotillomania by proxy in that the lack of pain on plucking the hairs removed the principle deterrent.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12324807&dopt=Abstract alopecia, hair loss Ref: Support Care Cancer 2002 Oct;10(7):529-37

Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy.

Protiere C, Evans K, Camerlo J, d'Ingrado MP, Macquart-Moulin G, Viens P, Maraninchi D, Genre D.

INSERM U379, 232 boulevard de Sainte-Marguerite, 13273 Marseille Cedex 9, France.

The applicability and efficacy of a scalp cooling system were studied in 105 breast cancer patients receiving four cycles of adjuvant chemotherapy with mitoxantrone + cyclophosphamide (NC chemotherapy). Women accepting the scalp-cooling system were compared for alopecia both against those who refused and against a "reference" group of 109 patients similarly treated but without being offered a scalp-cooling system. Hair loss in the 105 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy. Concomitantly, tolerance and side-effects of the helmet were also recorded in 48 accepting patients. Similarly to reference group patients, a subsample of 27 accepting patients self-assessed hair loss using a specific questionnaire measuring its frequency and severity and the distress associated with this symptom. Nurses' ratings ( n = 105) indicated that hair loss frequency was constantly lower, at each cycle of chemotherapy, in study patients with scalp-cooling system ( n = 77) than in those without ( n = 28). Differences between the two groups were statistically significant at cycles 1 and 3 ( P < 0.05). When compared with those reported by reference group patients ( n = 109), study patients' self-measures of alopecia frequency ( n = 27) provided even more marked results than those achieved by nurses (cycles 1-3: P < 0.01; cycle 4: P < 0.05). Tolerance was generally good and no scalp metastasis was observed among the 77 accepting patients followed up. This study demonstrates that scalp cooling was an effective method of protection against hair loss caused by NC chemotherapy. Its routine use as part of adjuvant chemotherapy, especially in cancers with low prevalences of scalp metastasis, should be seriously considered.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269873&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Sep;28(9):804-7

A random study of Asian male androgenetic alopecia in Bangkok, Thailand.

Pathomvanich D, Pongratananukul S, Thienthaworn P, Manoshai S.

Center for Cosmetic and Hair Surgery, Bangkok, Thailand.

BACKGROUND: Androgenetic alopecia remains the most common cause of male pattern baldness (MPB) in all races. The prevalence of MPB in Caucasians is well documented. The prevalence of MPB in Asians is believed to be very low, only one-fourth to one-third on average compared to Caucasians. However, according to my previous study, there is a clear trend indicating that it is approaching that of Caucasians. OBJECTIVE: To assess the prevalence of MPB in the Asian population in Bangkok, Thailand; to compare this prevalence to previous studies conducted on Asians; and to compare the results to previous studies conducted on Caucasian. METHODS: This study was conducted by two physicians and assisted by two registered nurses. The questionnaire included age, sex, Norwood classification, diet, family history of baldness, income, and education. The physicians examined the scalp of each interviewee upon completion of each questionnaire. The ethnic focus group in this study was Thai and Chinese who reside in Bangkok, Thailand. The interviews were conducted in hospitals, nursing homes, classroom, medical meetings, temples, parks, and villages. RESULTS: A total of 1124 men were randomized in this study. The prevalence of cosmetically significant MPB (Norwood III-VII) was 38.52% and steadily increasing with age, approaching that of Caucasians. Variant MPB was found to be 0.67% and other types of androgenetic alopecia was 0.6%. From an ethnic point of view, the majority of the groups were of mixed blood and mostly of Chinese origin, thus we were unable to distinguish between Chinese and Thai. CONCLUSION: This study shows that the prevalence of MPB in Asians is not as low as previously thought. The cause of this increasing prevalence is uncertain. There are no past studies in Thailand for comparison, however, it can be extrapolated that the socioeconomic environment and westernized diet may contribute to this prevalence.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269871&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Sep;28(9):795-8; discussion 798-9

Does the recipient site influence the hair growth characteristics in hair transplantation?

Hwang S, Kim JC, Ryu HS, Cha YC, Lee SJ, Na GY, Kim do W.

Department of Dermatology, Kyungpook National University School of Medicine, Taegu, Korea.

BACKGROUND: Recently hair transplantation has been widely applied not only to correct androgenetic alopecia, but also to correct hair loss on other parts of the body such as the eyebrows and pubic area. It is believed that the transplanted hairs will maintain their integrity and characteristics after transplantation to new nonscalp sites. OBJECTIVE: To evaluate whether the transplanted hairs maintain their hair growth characteristics after transplantation to a new anatomic site other than the scalp. METHODS: Three study designs were used. Study I: Hair transplantation from the author's occipital scalp to his lower leg was performed and clinical evaluations were made at both 6 months and at 3 years after the transplantation. Study II: After finding changes in hair growth characteristics, transplanted hairs were harvested from the leg and retransplanted to the left side of the nape of the neck (group A). As a control study, occipital hairs were transplanted to the opposite side (group B). Observations were made at 6 months after the operation. Study III: An observational study was done in 12 patients with androgenetic alopecia about 1 year after transplantation of occipital hair to frontal scalp. At each step, survival rates were documented and the rate of growth and the diameter of the shafts were measured for both recipient and donor sites. RESULTS: Study I: Surviving hairs on the lower leg showed a lower growth rate (8.2 +/- 0.9 mm/month), but the same diameter (0.086 +/- 0.018 mm) compared with occipital hairs (16.0 +/- 1.1 mm/month, 0.088 +/- 0.016 mm). The survival rate 3 years after transplantation was 60.2%. Study II: There was no significant difference in the growth rate, shaft diameter, and survival rate between retransplanted hairs (group A) and controls (group B). Groups A and B showed a lower growth rate, but the same diameter, compared with occipital hairs. Study III: There was no significant difference in the growth rate and shaft diameter between the transplanted hairs on the frontal scalp and the occipital hairs. CONCLUSION: These results strongly suggest that the recipient site affects some characteristics of transplanted hairs, such as their growth and survival rates.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269870&dopt=Abstract alopecia, hair loss Ref: Dermatol Surg 2002 Sep;28(9):783-94

The art of repair in surgical hair restoration part I: basic repair strategies.

Bernstein RM, Rassman WR, Rashid N, Shiell RC.

College of Physicians and Surgeons, Columbia University, New York, New York, USA.

BACKGROUND: An increasingly important part of many hair restoration practices is the correction of hair transplants that were performed using older, outdated methods, or the correction of hair transplants that have left disfiguring results. The skill and judgment involved in these repair procedures often exceed those needed to operate on patients who have had no prior surgery. The use of small grafts alone does not protect the patient from poor work. Errors in surgical and aesthetic judgment, performing procedures on noncandidate patients, and the failure to communicate successfully with patients about realistic expectations remain major problems. OBJECTIVE: This two-part series presents new insights into repair strategies and expands upon several techniques previously described in the hair restoration literature. The focus is on creative aesthetic solutions to solve the supply/demand limitations inherent in most repairs. This article is written to serve as a guide for surgeons who perform repairs in their daily practices. METHODS: The repairs are performed by excision with reimplantation and/or by camouflage. Follicular unit transplantation is used for the restorative aspects of the procedure. RESULTS: Using punch or linear excision techniques allows the surgeon to relocate poorly planted grafts to areas that are more appropriate. In special situations, removal of grafts without reimplantation can be accomplished using lasers or electrolysis. The key elements of camouflage include creating a deep zone of follicular units, angling grafts in their natural direction, and using forward and side weighting of grafts to increase the appearance of fullness. The available donor supply is limited by hair density, scalp laxity, and scar placement. CONCLUSION: Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative hair transplantation work faces distinct challenges. Meticulous surgical techniques and optimal utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12267514&dopt=Abstract alopecia, hair loss Ref: Contracept Fertil Sex (Paris) 1985 Dec;13(12):1265-8

Hair loss during treatment with oral contraceptives

[Article in French]

Lehucher-ceyrac D, Weber-buisset, Puissant A.

Oral contraceptives with a dominant androgen component can cause or worsen androgen-dependent alopecia in women. This diagnosis can only be made if other causes of alopecia (which can occur at the same time as treatment with oral contraceptives) have been excluded. The patient's endocrine profile must be investigated sometimes, this being in order to detect any excess production of androgens. These types of alopecia call for the stopping of the oral contraceptive and sometimes also calls for oral anti-antigen treatment.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12227482&dopt=Abstract alopecia, hair loss Ref: J Dermatol 2002 Aug;29(8):489-98

Comparative efficacy of various treatment regimens for androgenetic alopecia in men.

Khandpur S, Suman M, Reddy BS.

Department of Dermatology and S.T.D., Maulana Azad Meical College and Associated Lok Nayak Hospital, New Delhi, India.

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223969&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):841-4

The hair follicle as a target for gene therapy

[Article in French]

Cotsarelis G.

Departement de Dermatologie, Universite de medecine de Pennsylvanie, Philadelphie, PA 19104 USA.

The hair follicle possesses progenitor cells required for continuous hair follicle cycling and for epidermal keratinocytes, melanocytes and Langerhans cells. These different cell types can be the target of topical gene delivery in the skin of the mouse. Using a combination of liposomes and DNA, we demonstrate the feasibility of targeting hair follicle cells in human scalp xenografts. We consider liposome composition and stage of the hair cycle as important parameters influencing transfection of human hair follicles. Transfection is possible only during the early anagen phase. Factors and obstacles for the use of gene therapy in treating alopecia and skin diseases are discussed. A theoretical framework for future treatment of cutaneous and systemic disorders using gene therapy is presented.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223968&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):837-40

Indications for micrograft hair transplantation

[Article in French]

Bouhanna P.

14, rue Theodore-Banville, 75017 Paris, France.

Advances in treatment of androgenetic alopecia have led to the development of novel medical or surgical therapies adapted to the severity of hair loss and balding. Follicular units or tiny micro-graft hair transplants are a fundamental technical progress. This technique leads to the simple and painless permanent restoration of hair in male and female baldness. It provides the patient with a group of 1 to 3 hairs, emerging from a single orifice. The difference between androgenic receptors of occipital areas and those of other areas explains the permanent nature of the implanted hair growth. The degree of male or female androgenetic alopecia can be determined according to Hamilton's static classification or Ludwig's Classification, or it can be measured and monitored more accurately with Bouhanna's Dynamic Multifactorial Classification. The current indications for micro-graft transplantation are


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223967&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):831-6

Alopecia areata: update on therapy

[Article in French]

Assouly P.

Centre de Sante Sabouraud, 2, place du Docteur-Alfred-Fournier, 75010 Paris, France.

The management of patients with alopecia areata is obviously not restricted to the prescription of a treatment inducing hair growth. It requires thorough exploration (history of hair loss, treatments and concomitant pathologies), detailed clinical examination of the integument and palpation of the thyroid. The patient must, systematically, be given a simple explanation of his/her pathology, thus avoiding any feelings of mystery, hopelessness and guilt and hence paradoxically turning alopecia into "just another disease", even if flares are unpredictable and cannot always be treated. Innovations over the past few years have not met dermatologist's expectations: in particular immunosuppressors administered locally have not shown efficacy in human, as opposed to animal models of alopecia areata. Moreover, we must remain critical and rigorous with regard to "false" innovations: several recent publications are, methodologically, open to criticism. Older products provide clear descriptions of their indications and use, and relatively standardize the therapeutic approach to alopecia. Some of them lead to hair growth on the treated area: localized immuno-therapy that in certain cases induces hair growth where other treatments have failed. PUVA-therapy, however, because of frequent relapses on withdrawal and the characteristic recurrence of alopecia, rapidly leads to the use of high cumulative doses; balneo-PUVA therapy is effective with lower doses (PUVA-turban). Recently, UVB TL01 has shown efficacy in anecdotal studies. Local corticosteroids; notably injectable and anthralin, an old treatment which remains a useful therapeutic approach in alopecia areata plaques and in the ophiasic forms in children and adults. Finally, among the available treatment arms, systemic corticosteroids still have a place in recent extended forms: although still under experimentation, the bolus appears efficient during the primary episodes of alopecia areata, when administered within the first three months


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223962&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):801-3

Androgenetic alopecia

[Article in French]

Jamin C.

169, boulevard Haussmann, 75008 Paris, France.

Androgenetic alopecia (AGA) is the combined result of an androgen-dependent process and genetic transmission. These characteristics have mainly, if not exclusively, been demonstrated in men and perhaps improperly extended to women. When considering the androgen-dependent process, AGA must only be limited to the androgen receptor areas. In the scalp, these receptors have only been detected in the frontal and vertex areas but never in the temporal or the occipital areas. Male AGA exhibits these clinical features, whereas in women hair loss is rarely limited to this localization, even when large areas of hair loss often appear with age. It is now commonly accepted that male AGA is associated with an increase in 5 alpha reductase activity leading to an increase in local production of dihydrotestosterone. The mechanism by which the local dihydrotestosterone increase leads to hair follicle loss is not clearly demonstrated. Inhibition of cell proliferation in the dermal papilla and a vascular process based on the inhibition in local production of vascular endothelial growth factor (VEGF) have been proposed. The increase in 5 alpha reductase activity is genetic and depends on androgen receptor polymorphism, characterized by a decrease in the number of CAG sequences on the exon 1. Male AGA is associated with an insulin-resistant process and to a higher risk of polycystic ovary in the lineage. Therapeutically, this hormone-dependent process explains the well demonstrated efficacy of 5 alpha reductase inhibitors. In women, except in some rare cases, alopecia is diffuse and the mechanisms are different. Their origin is unknown, and probably ambiguous. Based on an association with Hashimoto's thyroiditis, an auto-immune origin could be suggested in some cases. Alopecia is unaffected by thyroid substitution. Pharmacological doses of oestrogens (pregnancy, contraception) have a beneficial effect on such alopecia, probably through different mechanisms: anti-androgen effect, increased VEGF, proliferative effect of dermal papilla cells. However, it is important to mention that the dermal papilla has an aromatase, particularly in the occipital area, the activity of which has not been assessed in female alopecia. In practice 5 alpha reductase inhibitors are ineffective in women. It is likely that the predominance observed in the frontal and vertex areas, occasionally in elderly women, is a result of the two combined disorders, the almost physiological androgen-dependent hair loss combined with diffuse loss. Pharmacological doses of oestrogens associated with anti-androgen progesterone-like agents are widely used with positive results, but not demonstrated by clinical trials.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223960&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):787-92

Hormonal interaction and hair growth

[Article in French]

Hoffmann R.

Department of Dermatology, Philipp University, Marburg, Germany.

Androgenetic alopecia (AGA) is the most common form of hair loss in men and women. This continuous process results in a form of alopecia that follows a definite pattern in those individuals who are genetically predisposed. Although clinically different, the pathogenetic pathways leading to this type of hair loss are thought to be similar in both sexes. A genetic predisposition is a feature of AGA, but the predisposing genes are still unknown. Our understanding, however, of the hormonal effects on hair growth is far more advanced. AGA can be defined as a dihydrotestosterone (DHT)-dependent process with continuous miniaturization of sensitive hair follicles. So far, we do not understand the molecular steps involved in androgen-dependent beard growth versus androgen-dependent hair loss. However, the local androgen metabolism plays a central role in the intrafollicular conversion of weak androgens, such as DHEAS, to more potent androgens such as T or DHT within the hair follicle. The dermal papilla plays a central role by exhibiting an array of important steroidogenic isoenzymes. Provided that the dermal papilla (DP) cell triggers and regulates the growth of hair follicles, this physiological role may be reflected by metabolic differences, which could account for differences in androgen sensitivity as observed in hair follicles from different body sites, and in conditions such as male pattern baldness. The observation of STS, 17beta-HSD, 3beta-HSD, 3alpha-HSD and type 2 5alpha-R-activity within the DP could be a clue to understanding the regulation of androgen action in the human hair follicle by local androgen modification on target cell level. Hence, some of the intrafollicular steroidogenic enzymes would be potential pharmaceutical targets for the treatment of AGA or hirsutism.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12223959&dopt=Abstract alopecia, hair loss Ref: Ann Dermatol Venereol 2002 May;129(5 Pt 2):783-6

Implication of VEGF, steroid hormones and neuropeptides in hair follicle cell responses

[Article in French]

Castex-Rizzi N, Lachgar S, Charveron M, Gall Y.

Institut de Recherche Pierre Fabre, Centre Europeen de Recherche sur la Peau et les Epithelium de Revetement, Laboratoire de Biologie Cellulaire Cutanee, 2, rue Viguerie, BP 3071, 31025 Toulouse Cedex 3, France.

Human hair follicles progress independently through the anagen, catagen, telogen and latency phases that correspond to growth arrest and hair shedding before initiation of a new anagen phase. Hair follicles are self-renewing and contain reservoirs of multi-potent stem cells. Identification of the messenger molecules and pathways operating in the growth and cycling of hair follicles, have provided substantial data. However, only a limited number of these signals is well understood. The specific response of hair follicle cells to these signals is correlated with the expression of their corresponding receptors. What regulates these responses? In this review, we will focus on the hair cycle and its control mechanisms. We will provide some elements in answer to these questions and present some of the markers of hair follicle cells, and hormonal and vascular growth factors, which may regulate respectively hair follicle cell metabolism and cycle, and the neuropeptide impact on hair follicle response and hair growth. The results of our study show the modifications in various expression patterns of receptors in dermal papilla cells, and demonstrate the cross-interaction between these different components. In conclusion, we present an accumulation of evidence suggesting that the regulation of hair growth requires a combination of hormonal, vascular and neuropeptide approaches that will provide further insight in defining new treatments for hair loss.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12220271&dopt=Abstract alopecia, hair loss Ref: Pediatr Dermatol 2002 Jul-Aug;19(4):298-301

A clinical study of childhood alopecia areata in Singapore.

Tan E, Tay YK, Giam YC.

National Skin Center, Singapore.

Alopecia areata (AA) is a common cause of nonscarring alopecia. The aim of this epidemiologic study is to review the clinical characteristics and treatment of childhood alopecia areata in a mixed ethnic population. The study population consisted of a total of 392 children seen over a 4-year period with AA diagnosed before the age of 16 years. The female:male ratio was 1:1.4. There were 309 Chinese (78.8%), 51 Malays (13.0%), and 32 Indians (8.2%). The mean age at the time of diagnosis was 11.2 years. The majority of patients (71.7%) had alopecia of less than 6-months duration and 6% had previous episodes of AA. Females appeared to have more severe involvement. A familial history of AA was observed in 33 patients (8.4%). Associated atopy was found in 26.6% of patients and in 32.3% of their first-degree relatives. Other associations such as vitiligo or Down syndrome were rare. For limited AA, topical and/or intralesional corticosteroid was the first-line treatment used and squaric acid dibutyl ester was the choice of treatment for patients with extensive involvement. The profile of the poor respondents to therapy included young age of onset, past history of AA, Down syndrome, and extensive involvement.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12218222&dopt=Abstract alopecia, hair loss Ref: Dermatology 2002;205(2):108-10

Kenogen. A new phase of the hair cycle?

Rebora A, Guarrera M.

Department of Endocrinological and Metabolic Diseases, Section of Dermatology, University of Genoa, Italy.

BACKGROUND: A novel phenomenon has been described by the phototrichogram: the emptiness of the follicle after teloptosis. We called this phenomenon kenogen, from the Greek kappaepsilonnuovarsigma, 'empty'. OBJECTIVE: To describe the kenogen phase in its details. METHODS: Analysis of the existing literature. RESULTS: The original observation in 2 women was confirmed in 10 balding and non-balding males studied for 14 years in whom kenogen lasted about 4 months increasing up to about 7 months and affecting 80% of all hair cycles. In 2 women with progressing androgenetic alopecia studied for 2 years, kenogen involved 22% of the hair follicles, lasting from 3 months to 1 year. In a prepubertal boy studied for 1 year, it involved 8% of hairs and lasted about 2 months. CONCLUSION: During kenogen, the hair follicle rests physiologically, but duration and frequency are greater in androgenetic alopecia, possibly accounting for baldness. In addition to the classical cycle, the hair follicle may follow an alternative route during which the telogen phase, not accompanied by a coincident new early anagen, ends with teloptosis leaving the follicle empty.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12213673&dopt=Abstract alopecia, hair loss Ref: Eur J Endocrinol 2002 Sep;147(3):357-61

An endocrinopathy characterized by dysfunction of the pituitary-adrenal axis and alopecia universalis: supporting the entity of a triple H syndrome.

Ichiki K, Nakamura T, Fujita N, Honda K, Hiraga T, Ishibashi S, Ishikawa S.

Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical School, Tochigi 329-0498, Japan.

We demonstrate the rare disorder of triple H syndrome in a 25-year-old man. He was pointed out as having short stature, at -5.9 s.d., and diagnosed as GH deficient at 6 years old. Approximately a year ago, he noticed systematic hair loss. He lost body weight by 7 kg during the last half year. He was admitted to Jichi Medical School Hospital because of unconsciousness. Physical findings showed disturbance of consciousness with Japan Coma Scale I-3. He had emaciation and alopecia universalis. Laboratory findings showed plasma glucose was as low as 1.11 mmol/l. GH and ACTH deficiency with hypoadrenocorticism were clarified. His intelligence was in the low normal range with a WAIS IQ of 70, and anterograde amnesia was suggested in the presence of a little, but not significant, morphological change in the hippocampus on a magnetic resonance imaging scan. Replacement by a physiological dose of hydrocortisone normalized plasma glucose, and restored body weight and growth of hair during the 7 month therapeutic period. The present finding strongly supports a clinical entity of triple H syndrome, including ACTH deficiency, alopecia universalis and anterograde amnesia, and that there may be some variation of the triad among the subjects.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12213548&dopt=Abstract alopecia, hair loss Ref: Exp Gerontol 2002 Aug-Sep;37(8-9):981-90

Molecular mechanisms of androgenetic alopecia.

Trueb RM.

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

Androgenetic alopecia (AGA) is hereditary and androgen-dependent, progressive thinning of the scalp hair that follows a defined pattern. While the genetic involvement is pronounced but poorly understood, major advances have been achieved in understanding principal elements of the androgen metabolism involved: androgen-dependent processes are predominantly due to the binding of dihydrotestosterone (DHT) to the androgen receptor (AR). DHT-dependent cell functions depend on the availability of weak androgens, their conversion to more potent androgens via the action of 5 alpha-reductase, low enzymatic activity of androgen inactivating enzymes, and functionally active AR present in high numbers. The predisposed scalp exhibits high levels of DHT, and increased expression of the AR. Conversion of testosterone to DHT within the dermal papilla plays a central role, while androgen-regulated factors deriving from dermal papilla cells are believed to influence growth of other components of the hair follicle. Current available treatment modalities with proven efficacy are oral finasteride, a competitive inhibitor of type 2 5 alpha-reductase, and topical minoxidil, an adenosine-triphosphate-sensitive potassium channel opener which has been reported to stimulate the production of vascular endothelial growth factor in cultured dermal papilla cells. Since the clinical success rate of treatment of AGA with modulators of androgen metabolism or hair growth promoters is limited, sustained microscopic follicular inflammation with connective tissue remodeling, eventually resulting in permanent hair loss, is considered a possible cofactor in the complex etiology of AGA.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12196747&dopt=Abstract alopecia, hair loss Ref: J Am Acad Dermatol 2002 Sep;47(3):377-85

A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.

Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ.

Duke Dermatopharmacology Study Center, Durham, North Carolina, USA.

BACKGROUND: Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy. OBJECTIVE: The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA. METHODS: A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment. RESULTS: After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil. CONCLUSION: In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved. Topical minoxidil (5% and 2%) was well tolerated by the men in this trial without evidence of systemic effects.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12192893&dopt=Abstract alopecia, hair loss Ref: : Gynecol Endocrinol 2002 Jun;16(3):213-6

Ovarian steroid cell tumor and a contralateral ovarian thecoma in a postmenopausal woman with severe hyperandrogenism.

Cserepes E, Szucs N, Patkos P, Csapo Z, Molnar F, Toth M, Dabasi G, Esik O, Racz K.

Department of Radiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.

A 49-year-old woman presented with rapidly progressing hirsutism, receding hairline, male-pattern baldness and deepening of voice, which had developed over the past 2 years. Hormonal evaluation showed a markedly elevated serum testosterone level (418 ng/dl) and no evidence of increased production of cortisol, dehydroepiandrosterone, dehydroepiadrosterone-sulfate, androstenedione, or 17-hydroxyprogesterone. Transvaginal ultrasound examination suggested the presence of a small mass within the left ovary, but all other radiological studies, including adrenal and ovarian computed tomography, magnetic resonance imaging, radio-labelled cholesterol scintigraphy and positron emission tomography, were negative. Subsequently, bilateral selective venous sampling showed a marked testosterone gradient in the right ovarian vein. Bilateral salpingo-oophorectomy was performed (the patient had had a previous vaginal hysterectomy), and histopathological examination revealed a 10-mm steroid cell tumor within the right ovary and a 15-mm thecal cell tumor within the left ovary. The postoperative serum testosterone level returned to normal and the patient showed a slow regression of clinical symptoms. The simultaneous occurrence of a virilizing ovarian steroid cell tumor and an apparently non-functioning thecoma within the contralateral ovary emphasizes the potential pitfalls that may exist in the preoperative evaluation of patients with markedly increased testosterone production.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190862&dopt=Abstract alopecia, hair loss Ref: J Invest Dermatol 2002 Aug;119(2):392-402

Gene array profiling and immunomodulation studies define a cell-mediated immune response underlying the pathogenesis of alopecia areata in a mouse model and humans.

Carroll JM, McElwee KJ, E King L, Byrne MC, Sundberg JP.

Genetics Institute/Wyeth Research, Cambridge, Massachusetts, USA.

Alopecia areata is a suspected autoimmune hair loss disease. In a rodent model, alopecia areata can be induced in normal haired C3H/HeJ mice by transfer of skin grafts from mice with spontaneous alopecia areata. At weeks 2, 4, 6, and 10 after surgery, grafted mice were euthanized, skin collected and processed for histology, and RNA extracted. Age-matched sham-grafted mice, and mice with and without spontaneous alopecia areata, were similarly processed. For comparison, skin biopsies from alopecia areata and androgenetic alopecia affected humans were also collected. Skin mRNA processed to cDNA was analyzed using Affymetrix mouse 11K and human 6800 gene chip(R) array technology. Microarray results indicated 42 known genes upregulated or downregulated during onset of mouse alopecia areata consistent with an inflammatory cell-mediated disease pathogenesis involving antigen presentation, costimulation, and a T helper 1 lymphocyte response. In contrast, 114 genes, many regulating immunoglobulin response, were altered late in disease development. In alopecia areata affected humans, 95 genes were significantly modulated. As confirmation of microarray analysis results, lymph node and spleen cells from alopecia areata affected mice injected into normal haired littermates transferred the alopecia areata phenotype. Alopecia areata onset could be inhibited in skin-grafted mice by modulation with B7.1- and B7.2-specific monoclonal antibodies. In addition, depletion of CD4+ CD8+ expressing cells in chronic alopecia areata affected mice using monoclonal antibodies permitted hair regrowth. The results consistently demonstrated the importance of an immune cell-mediated disease mechanism in alopecia areata pathogenesis and suggested targeting antigen-presenting cells and reactive lymphocytes may be effective in alopecia areata treatment.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190643&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2002 Jul;27(5):418-21

Cosmetics and hair loss.

Gummer CL.

Procter and Gamble Europe Ltd, Egham, Surrey, UK.

Cosmetic hair care products are often implicated by the user or the clinician in cases of hair loss. Yet, these products are used ad lib, in a wide variety of home conditions and on a wide variety of hair types, by millions of consumers every day with no adverse effects. Based on this extensive data set, the absence of literature reports, and a detailed understanding of the mode of action of cosmetic hair care products, we can conclude that they do not cause hair loss. Clinicians investigating cases of hair loss must fully appreciate the hair cycle, the length of time a single fibre may be present on the head, and its biological and cosmetic history in order to understand the causes of hair loss and make the correct diagnosis. With a better understanding of the cosmetic practices used by everyday consumers, the clinician will be in a strong position to help patients re-grow their hair and guide them through a high quality hair care regime.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190642&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2002 Jul;27(5):410-7

Alopecia areata - animal models.

McElwee KJ, Hoffmann R.

Department of Dermatology, Philipp University, Marburg, Germany.

Several rodent models with spontaneous and induced alopecia areata (AA), a nonscarring inflammatory hair loss disease with suspected autoimmune elements, have been identified. Of these, the C3H/HeJ mouse and DEBR rat have been most extensively used in examining AA development. Flow cytometry and micro array characterization, manipulation of inflammatory cells by in vivo cell depletion or cell receptor blockade, lymph node cell transfer between affected and unaffected rodents, and the recent use of transgenic knockout mice have given important insights into the development of AA. From our current understanding of rodent models, the development of AA relies upon a general genetic susceptibility where major susceptibility genes may be supplemented by minor disease severity modifying genes. However, the actual onset of AA, its duration, extent, and persistence in individual rodents may be modified by epigenetic factors. Rodent AA seems to be fundamentally, but not exclusively, Th1 cell mediated. Onset of disease may be dependent on several factors including the break down of the putative anagen stage hair follicle immune privilege, appropriate antigen presentation with costimulation of lymphocytes, presence of autoreactive lymphocytes, and a deficiency of functional immune system regulatory cells. Rodents have already been used in examining a variety of current AA treatments and developing new therapies with some success. With a greater understanding of AA disease mechanisms through rodent model research, improved and more specific treatment interventions may be defined.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190641&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2002 Jul;27(5):405-9

Epidemiology and genetics of alopecia areata.

McDonagh AJ, Tazi-Ahnini R.

Department of Dermatology and Division of Genomic Medicine, Royal Hallamshire Hospital, University of Sheffield, UK.

The frequency of alopecia areata and observed patterns of heritability are in keeping with a polygenic inheritance model but the genetics of alopecia areata is still poorly understood. The role of environmental factors in triggering disease initiation or exacerbation remains almost entirely speculative. Using the candidate gene approach, three susceptibility/severity factors have been identified. HLA alleles were the first to show a strong association with alopecia areata and some DQB and DR alleles have been demonstrated to confer a high risk for disease by both case-control and family-based studies. Interleukin (IL)-1 cluster genes, mainly the IL-1 receptor antagonist, show a strong association with disease severity in alopecia areata and a number of other autoimmune and inflammatory diseases. Finally, the association of alopecia areata with Down's syndrome, the high frequency of alopecia areata in autoimmune polyglandular syndrome type I due to mutations of the autoimmune regulator (AIRE) gene on chromosome 21q22.3 and the finding of association with MX1, another gene in the Down's syndrome region of chromosome 21 indicate this area of the genome as a promising target for future-family based investigations. The role of individual genes of the MHC, IL-1 cluster or chromosome 21q22.3 is difficult to establish and further genetic and functional investigations are needed to confirm their involvement in the pathogenesis of alopecia areata.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190640&dopt=Abstract alopecia, hair loss Ref: Clin Exp Dermatol 2002 Jul;27(5):396-404

Nutritional factors and hair loss.

Rushton DH.

School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.

The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein-energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hard, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status. Rushton et al. first published data showing that serum ferritin concentrations were a factor in female hair loss and, 10 years later, Kantor et al. confirmed this association. What level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established but 70 micro g/L, with a normal erythrocyte sedimentation rate (< 10 mm/h), is recommended. The role of the essential amino acid, l-lysine in hair loss also appears to be important. Double-blind data confirmed the findings of an open study in women with increased hair shedding, where a significant proportion responded to l-lysine and iron therapy. There is no evidence to support the popular view that low serum zinc conce