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PubMed2002

[Alopecia areata: update on therapy].

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

Adolescent↗

PubMed2002

A retrospective study on the characteristics of androgenetic alopecia among Asian races in the National Skin Centre, a tertiary dermatological referral centre in Singapore.

OBJECTIVE: To study the characteristics and psychosocial impact of androgenetic alopecia among Asian races. METHODOLOGY: A retrospective telephone interview study of patients managed for androgenetic alopecia in 1997 in a tertiary dermatological referral centre in Singapore. RESULTS: Two hundred and fifty-six patients (111 females and 145 males) were included in the study. Their mean age at presentation was 33.7 years. There were no significant statistical mean age differences among the different races (Chinese, Malay and Indian). The mean duration of disease before consultation was 31.2 months; 33.2 months for males and 28.9 months for females (ns). Almost all patients (96.4%) were socially embarrassed and "unhappy" about their androgenetic alopecia. Most (90.5%) sought treatment for "cosmetic" reason. Slightly more males sought treatment for cosmetic reason than female (P = 0.01). 7.5% were worried about an underlying systemic disease as a cause of their alopecia. A positive family history of androgenetic alopecia was recorded in 58.9% (151/256). Male patients tend to have higher proportion of having a father or male sibling with similar problem, whereas female patients tend to have higher proportion of having a mother or females sibling with androgenetic alopecia. The predominant balding patterns for males were a combination of frontal, bi-temporal recession and vertex thinning (43%, 45% and 55%, respectively). Whereas in females, the predominant presentation was vertex thinning (60%) and, infrequently, frontal and bi-temporal thinning (19% and 15%, respectively). Diffuse pattern was also more predominant in females (28%) compared to males (10%). CONCLUSIONS: Most patients presented in their thirties with females presenting earlier than males and almost all patients presented for treatment for cosmetic reasons. Patients are generally unhappy about their appearance as a result of their alopecia. A strong positive family history appears to suggest that the disorder may be acquired through an autosomal dominant trait. Male patients tend to have a father or male sibling with similar condition and female patients tend to have a mother or female sibling with similar condition.

Adaptation, Psychological↗

PubMed2005

Age-related diffuse chronic telogen effluvium- type alopecia in female squirrel monkeys (Saimiri boliviensis boliviensis).

We investigated the diffuse alopecia affecting some female squirrel monkeys (Saimiri boliviensis boliviensis) housed in a breeding facility. We randomly selected 100 female and 10 male animals and performed a complete physical exam and a hair assessment on all animals; blood tests, trichograms, hair density; and skin biopsies in representative cases; and a dominance behavioral assessment of 50 animals. Hair coat was normal in 35 female monkeys and all 10 male animals. Of the 65 females with diffuse alopecia, 17 had mild, 22 moderate, and 26 severe hair loss. The alopecia group had a mean age of 9.6 +/- 0.6 years, whereas that of the normal group was 4.7 +/- 0.6 years (P < 0.05). The parity in the alopecia group was 4.2 +/- 0.6 but 2.0 +/- 0.6 (P < 0.05) in the normal group. There were no statistically significant differences in body weight, hemoglobin, blood urea nitrogen, serum glucose, liver aspartate aminotransaminase, or free thyroxine. The trichogram demonstrated 20.8% +/- 1.6% (mean +/- standard error) of telogen hairs in the alopecia group compared with 9.5% +/- 2.8% of the control group (P < 0.05). The hair density in the alopecia group was 52.8 +/- 4.1/cm2 and 79.6 +/- 14.3/cm2 in the control group. Skin biopsies in affected monkeys demonstrated increased telogen follicles, with no fibrosis or inflammation. There were no statistically significant differences in the dominance behavioral analysis. The findings are consistent with chronic telogen effluvium (CTE). A number of organic, behavioral, and dominance-related stress causes of CTE were excluded. CTE appears to be predominantly age-related in this population. CTE in female squirrel monkeys may serve as an animal model for human diffuse alopecia.

Age Factors↗

PubMed2005

[A case of advanced breast cancer markedly responding to chemo-endocrine therapy with only slight alopecia].

We report a case of good response to chemo-endocrine therapy with slight alopecia. A 55-year-old woman was diagnosed as advanced breast cancer with T4c, N3, M1, Stage IV, who was left cervical node-positive. She received 4 cycles of CTF (cyclophosphamide 100 mg/body/day 1-14, THP 30 mg/body/days 1,8, and 5-FU 750 mg/body/days 1, 8 4 wq) therapy in addition to oral tamoxifen (20 mg/body) administration. After this treatment, the primary tumor was markedly reduced (PR), and only slight alopecia was observed. Generally, 3 cycles of CAF (CEF) therapy induced severe alopecia (grade 3). But this CTF regimen caused grade 1 alopecia. Most women have strong resistance to alopecia. It seems that the quality of life for breast cancer patients was affected by the extent of the alopecia. Therefore, CTF therapy should be considered effective for advanced breast cancer patients while reducing the extent of alopecia.

Adenocarcinoma, Scirrhous↗

PubMed1980

[DNCB therapy for alopecia areata (author's transl)].

15 patients with alopecia areata were treated with local application of DNCB in acetone over a period of 3-9 months. 9 of these had alopecia areata totalis, 3 had alopecia areata fere totalis, and 3 had common alopecia areata. The results are comparable with those of other authors. The response did not depend upon the duration of the disease but upon its extension. In all patients with alopecia areata and alopecia areata fere totalis, hair growth was induced, while only 2 of the 9 patients with alopecia areata totalis responded satisfactorily. One third of the latter were children in whom the treatment may be less effective than in adults. Contact allergy was induced in all but 1 case in which no hair growth occurred. Since the mutagenic effect of DNCB has been demonstrated in the Ames test, DNCB ought to be replaced by other haptens, but its possible cancerogenic effect must be tested in other in vivo models.

Adolescent↗

PubMed1996

Ultrastructural abnormalities in the dermal papillae of both lesional and clinically normal follicles from alopecia areata scalps.

Alopecia areata is a form of balding whose aetiology is uncertain. Although the dermal papilla in the hair bulb regulates the follicle and may play a part in the pathogenesis of alopecia areata, its ultrastructure has not been well described. As clinically normal, i.e. non-balding, follicles from alopecia areata scalps show abnormalities at the light microscope level, it would be expected that they should exhibit the earliest pathological changes involved in the dysfunction of the follicle. This study was designed to investigate the ultrastructure of normal human scalp follicular dermal papillae and to see if changes occurred in the ultrastructure of dermal papillae from either lesional or non-balding regions of alopecia areata. Normal dermal papillae contained well formed fibroblast-like cells with large, oval nuclei and well-developed endoplasmic reticulum; the cells were separated from each other by extracellular matrix containing small pieces of collagen and basal lamina-like material. Dermal papillae from both clinically normal and lesional alopecia areata follicles were less well organized and the dermal papilla cells exhibited signs of cell injury and contained abnormal amounts of pigment; an increased concentration of fibrous material in the extracellular matrix and thickening of the dermal papilla-epithelial junction were also seen. Follicles from lesional areas showed more pronounced changes than clinically normal ones. Ultrastructural abnormalities in the dermal papillae of clinically normal scalp follicles support the study of these follicles as a prime research target. The changes detected suggest that dermal papilla cells in alopecia areata would be less able to synthesize regulatory factors and that these may have more difficulty crossing into the epithelial compartment. They are consistent with an early pathological role for the dermal papilla in alopecia areata, but do not distinguish whether this is a primary aetiological role or a secondary response to an insult elsewhere in the follicle.

Adolescent↗

PubMed1986

Element concentrations in serum, erythrocytes, hair and urine of alopecia patients.

The trace element concentrations of Se, Rb, Zn, Fe, Co, Cs, Mg, Ca, F, Cu, Cr and Ag in serum and of Se, Rb, Zn, Fe, Co and Cs in red cells of Finnish alopecia patients were determined. In addition the Cu and Zn content in 24 h urine and Cu, Zn, Cd, Cr and Se concentrations in the hair of these patients were studied. No differences in element concentrations of the samples mentioned above as compared to those of the normal population could be found. In addition, there was no tendency of excesses or deficiences of elements analysed in the samples. Statistically significant difference was found between the copper content of serum in alopecia areata and alopecia universalis patients and also between the copper content of serum in alopecia areata plus alopecia totalis and alopecia universalis patients. The selenium concentration in serum samples of a few patients was low, but this is in agreement with the fact that the selenium content in the Finnish population is low due to the scanty content of selenium in food.

Adolescent↗

PubMed1983

PUVA treatment of alopecia areata.

Twenty-three patients with alopecia areata were treated with photochemotherapy combining oral or topical methoxsalen and UV-A irradiation of the scalp or of the whole body. Eleven of 17 patients with multiple plaques of alopecia areata, alopecia totalis, and alopecia universalis, who were treated with oral methoxsalen and total body irradiation, had complete or more than 90% hair regrowth. Three patients had a relapse. The mean energy required was 505 joules/sq cm. In six cases, topical applications of methoxsalen or oral methoxsalen combined with local irradiation of the scalp were treatment failures. In the patients responding to treatment, the result did not seem to depend on the age of onset or the extent or duration of disease. However, patients with long-lasting alopecia had a higher risk of recurrence notwithstanding a good initial regrowth of hair. Few side effects of psoralens and UV-A (PUVA) treatment were noted. The mean follow-up period was 18.6 months after the completion of treatment. We discuss the possible mechanisms of action of PUVA in the treatment of alopecia areata.

Adolescent↗

PubMed2002

Mediation of alopecia areata by cooperation between CD4+ and CD8+ T lymphocytes: transfer to human scalp explants on Prkdc(scid) mice.

OBJECTIVE: To determine the role of CD4+ and CD8+ T lymphocytes in the pathogenesis of alopecia areata. DESIGN: Relapse of alopecia areata was induced in autologous human scalp grafts on Prkdc(scid) mice by injection of activated T lymphocytes derived from lesional skin. CD4+ and CD8+ T cells were separated by magnetic beads before injection. SETTING: University-based dermatology practice. PARTICIPANTS: Eleven patients with either alopecia totalis or severe alopecia areata. MAIN OUTCOME MEASURES: Hair regrowth, hair loss, and immunohistochemical findings of scalp explants. INTERVENTION: Transfer of scalp T cells to autologous lesional scalp explants on Prkdc(scid) mice. RESULTS: Injection of unseparated T cells and mixed CD4+ plus CD8+ T cells resulted in significant hair loss (P<.01) in 5 of 5 experiments. However, injection of purified CD4+ or CD8+ T cells alone did not result in reproducible hair loss. CD4+ and CD8+ T cells induced follicular expression of intercellular adhesion molecule 1 (CD54), HLA-DR, and HLA-A, HLA-B, and HLA-C after injection into scalp grafts. CONCLUSIONS: CD4+ and CD8+ T cells have a role in the pathogenesis of alopecia areata. It is hypothesized that CD8+ T cells act as the effector cells, with CD4+ T cell help. It is now necessary to look for HLA-A, HLA-B, and HLA-C associations with alopecia areata. Therapeutic manipulations that interfere with CD8+ activity should be examined.

Adult↗

PubMed2005

The alopecias associated with vitamin D-dependent rickets type IIA and with hairless gene mutations: a comparative clinical, histologic, and immunohistochemical study.

OBJECTIVE: To establish the unique and common clinical and microscopic characteristics of the alopecias associated with vitamin D-dependent rickets (VDDR) type IIA and with hairless gene mutations. DESIGN: A comparative clinical, histologic, and immunohistochemical study of the alopecias in 6 patients with VDDR IIA and 4 patients with atrichia with papular lesions (APL) and/or alopecia universalis congenita (AUC) (hereinafter "APL/AUC"). MAIN OUTCOME MEASURES: Clinical data were gathered from medical records, personal interviews, and physical examinations. Histologic and immunohistochemical studies were performed on 6 scalp punch biopsy specimens from each of the 2 studied groups. RESULTS: The alopecias in VDDR IIA and APL/AUC showed similar clinical, histologic, and immunohistochemical features. The clinical presentation of the VDDR alopecia resembled either the APL phenotype (ie, with papules and milia) or the AUC phenotype (without papules and milia). The main histologic findings included void infundibula; absence of the lower two thirds of the hair follicles, often replaced by vertically oriented irregular epithelial structures or epithelial cysts; irregular epithelial structures, often with small cysts in the middle and lower dermis; and small, medium, and large keratinizing cysts at all levels of the dermis. The larger epithelial cysts in the upper dermis stained positively for cytokeratin (CK) 10, which suggests an infundibular derivation, whereas the remaining irregular epithelial structures and cysts in the middle and lower dermis stained positively most frequently for CK17, CK19, and CD34, which suggests an outer root sheath derivation. CONCLUSIONS: The alopecias associated with VDDR IIA and with hairless gene mutations show striking clinical and microscopic similarities. Disintegration of the lower two thirds of the hair follicles seems to be the underlying defect, and a common pathogenetic pathway might be involved.

Adolescent↗

PubMed2005

Recurrence of alopecia areata in a patient receiving etanercept injections.

BACKGROUND: Alopecia areata is a common condition of patchy hair loss that has been postulated to have an autoimmune pathogenesis involving inflammatory cytokines, including tumor necrosis factor (TNF) alpha. Etanercept is a novel medication that blocks TNF-alpha-mediated processes. We report a case involving the recurrence of alopecia areata in a patient receiving etanercept. OBSERVATIONS: We describe a 49-year-old man with a history of rheumatoid arthritis and alopecia areata who developed a recurrence of his alopecia areata while being treated with etanercept for more than 2 years. CONCLUSIONS: The anti-TNF-alpha effect of etanercept therapy may not be sufficient to prevent the recurrence of alopecia areata. The possible role of TNF-alpha in the pathogenesis of alopecia areata may be called into question if our observation is repeated.

Alopecia Areata↗

PubMed1997

Changes in self-concept and body image during alopecia induced cancer chemotherapy.

Alopecia as a result of cancer chemotherapy has been reported to cause changes to the self-concept and body image. In a prospective longitudinal study, self-concept and body image were analysed in 29 patients after histological confirmation of gynaecological malignancy, mainly ovarian cancer, who were assigned to receive a complete-alopecia-inducing PEC combination chemotherapy (cisplatin 50 mg/m2, epirubicin 60 mg/m2, and cyclophosphamide 500 mg/m2 in 1 day every 28 days). The analysis was performed before the commencement of treatment and repeated when alopoecia was complete and after completion of therapy when patients had already experienced regrowth of hair, using the Frankfurt self-concept scales (FSKN) and Frankfurt body concept scales (FKKS). Significant differences were observed in the various evaluation scales FSAP (general ability to solve problems), FSSW (general self-esteem), SGKB (state of health), and SKEF (physical fitness). For all scales the results worsened during chemotherapy but did not return to normal or improve when patients experienced regrowth of hair. It was found that 73.3% of the patients did not feel as self-confident as before treatment and that for 46.6% alopecia was the most traumatic side effect of chemotherapy. Since there is no chemotherapeutic regimen or any other effective treatment that can prevent alopecia, either of the following conclusions can be drawn: the observed differences may not be related exclusively to alopecia, but also associated with coping processes initiated by chemotherapy and perhaps enhanced by alopecia; or the changes persist even after the discontinuation of chemotherapy. Regrowth of hair and other adaptive processes do not normalize or improve the impaired body image and self-concept.

Adult↗

PubMed2001

Alopecia areata universalis in an infant.

BACKGROUND: Alopecia areata (AA) is common during childhood and rarely reported in infants. The four reported cases of AA in infants all exhibited circumscribed patches of alopecia that appeared at birth or shortly thereafter. OBJECTIVE: We report a case of alopecia areata universalis that developed after birth along with fingernail changes of shortening (onychomadesis) and onycholysis. Scalp biopsy at 2 years of age revealed rare, intermediate, terminal follicles in catagen associated with sparse peribulbar lymphocytic infiltrates. RESULTS: This constellation of clinicopathologic features was interpreted as AA. We discuss the differential diagnosis of generalized alopecia in healthy infants, in particular, Clouston's syndrome, a hair-nail (hidrotic) ectodermal dysplasia found in this region. Genetic testing for linked polymorphisms to the Clouston gene locus were negative in this child and his parents. CONCLUSIONS: Alopecia areata should be included in the differential diagnosis of generalized alopecia presenting at or shortly after birth. For purposes of genetic counseling and prognosis, it is crucial that a correct diagnosis be made.

Alopecia Areata↗

PubMed2003

[Alopecia areata. Clinical aspects, pathogenesis and rational therapy of a T-cell-induced autoimmune disease].

Alopecia areata is a T-cell mediated autoimmune disease directed against an unknown auto antigen of the hair follicle. There is a genetic predisposition to develop alopecia areata, whereas environmental triggers have so far not been identified. The diagnosis can be established by characteristic clinical features of alopecia areata including its severe forms alopecia areata totalis and universalis. Nail changes may help confirm the diagnosis. On rare occasions a histopathological examination may be necessary, whereas other laboratory investigations are unnecessary. Because of the high rate of spontaneous remission, the efficacy of a rational treatment of alopecia areata has to be proven in controlled studies and it should be associated with only minor side effects. According to the rules of evidence-based medicine, treatment with a contact sensitizer is at present the most effective treatment of alopecia areata showing only mild side effects. However, it is time-consuming and in some cases ineffective, making it desirable to develop new, more specific forms of treatment.

Alopecia Areata↗

PubMedDate not supplied

Aesthetic results of treatment of large alopecia with total scalp expansion.

In the last 7 years, 18 patients with large alopecia (approximately one-third of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 44 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience gained with these cases led us to make some modifications in the surgical technique. We applied some simple surgical maneuvers and Z-plasties to the last 18 cases with large alopecia. The major complication rate of 3.2% observed in this study is comparable to the lower complication rates of 6-12% reported in the literature for different degrees of alopecia. We believe that these simple modifications and meticulous approach improve the results of conventional treatment of alopecia with tissue expansion and flap. In this paper, details of the insertion technique and reconstructive procedures and their relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.

Adolescent↗

PubMed1981

Pressure-potential alopecia areata.

In order to create awareness of a potential adverse effect of extraoral orthodontic appliances, we report the development of alopecia areata in two patients. Both patients experienced the onset of alopecia areata directly under sites of pressure from thier "headgear." In one patient the hair loss began 2 weeks after she began using her appliance. The other girl noticed patchy alopecia 2 to 3 weeks following an increase in the pressure and duration of use of an extraoral appliance. One of the patients also developed other areas of alopecia areata in sites unrelated to pressure. In both cases relief of the pressure was accompanied by regrowth of hair in about 5 months. One of the patients received corticosteroid injections into the patches of alopecia areata; the other had no medical therapy. We conclude that alopecia areata can be made manifest by local pressure, such as that from orthodontic appliances.

Adolescent↗

PubMed1993

Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects.

BACKGROUND: Several studies have examined the psychological impact of androgenetic alopecia on men but scientific evidence is absent regarding its effects on women. OBJECTIVE: Our purpose was to determine the psychosocial sequelae of androgenetic alopecia in women and, comparatively, in men. METHODS: Subjects were newly referred patients with androgenetic alopecia (96 women and 60 men) and 56 female control patients. Subjects completed standardized questionnaires to assess their psychological reactions to their respective conditions and to measure body image, personality, and adjustment. RESULTS: Androgenetic alopecia clearly was a stressful experience for both sexes, but substantially more distressing for women. Relative to control subjects, women with androgenetic alopecia possessed a more negative body image and a pattern of less adaptive functioning. Specific correlates of the adversity of patients' hair-loss experiences were identified. CONCLUSION: The results confirm the psychologically detrimental effects of androgenetic alopecia, especially on women. The implications for patient care are discussed.

Adaptation, Psychological↗

PubMed1994

Scalp cooling has no place in the prevention of alopecia in adjuvant chemotherapy for breast cancer.

35 patients were studied to determine the effectiveness of scalp hypothermia in the prevention of alopecia caused by adjuvant chemotherapy for breast cancer. Scalp hypothermia was induced by the newly developed Theracool cooling machine. The chemotherapeutic regimen consisted of one perioperative course of doxorubicin 50 mg/m2, cyclophosphamide 600 mg/m2 and 5-fluorouracil 600 mg/m2 (EORTC protocol 10854). Only 4 (11%) patients showed acceptable hair preservation (no or minor alopecia). 12 patients (34%) had moderate alopecia, all requiring a wig. 19 patients (54%) had complete alopecia. No scalp metastases were observed after scalp cooling. These results and a review of the literature suggest that scalp hypothermia to prevent alopecia may only be effective in a cytotoxic regimen containing an anthracycline as the sole alopecia-inducing agent. With current adjuvant chemotherapy for breast cancer, in which a combination of cyclophosphamide and an anthracycline is often used, there is no place for scalp hypothermia.

Adult↗