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PubMed2005

The E211 G>A androgen receptor polymorphism is associated with a decreased risk of metastatic prostate cancer and androgenetic alopecia.

The androgen receptor (AR) gene encodes a transcription factor, which mediates androgen action in target tissues, including the prostate. Prostate cancer is androgen dependent, implicating AR in susceptibility to this male condition. Male pattern balding, androgenetic alopecia, has recently been associated with prostate cancer, suggesting shared androgen pathways. The CAG and GGC repeats in the AR have been studied extensively as markers of prostate cancer susceptibility, with inconclusive findings, whereas the AR-E211 G>A polymorphism has been associated with androgenetic alopecia. We assessed the repeat linked single nucleotide polymorphism as a marker of risk association in prostate cancer, including androgenetic alopecia, in an Australian population-based case-control study. In 815 prostate cancer cases and 719 controls, the proportion of A-allele carriers was the same in each group. Overall, there was no evidence for an association between the A allele and risk of prostate cancer, however, the proportion of A-allele carriers in metastatic prostate cancer (5%) was lower than in less advanced disease (16%, P = 0.03). The proportion of A-allele carriers was 24% in nonbald men but it was lower in men with vertex alopecia alone (13%, P = 0.001) or in combination with frontal alopecia (7%, P < 0.0001). This inverse association between the A allele and baldness was independent of prostate cancer status (P for interaction = 0.2). These results suggest that the AR-E211 A allele, in linkage with the functional repeat sequences, is associated with a lower risk of metastatic prostate cancer and a lower risk of alopecia.

Alopecia↗
PubMed2000

A case of lipedematous alopecia occurring in a male patient.

A 30-year-old Japanese man presented with a thickening of the scalp and diffuse alopecia on the vertex. A skin biopsy specimen of the thickened scalp showed an increased thickness of subcutaneous adipose tissue and a marked decrease in the number of hair follicles. By an MRI examination, the irregularly thickened subcutaneous fatty tissue was visualized. These findings indicated that the patient had been suffering from lipedematous alopecia. This is a rare condition characterized by diffuse alopecia due to the thickening of the layer of adipose tissue covering the scalp. Only 4 female cases of lipedematous alopecia have been reported previously. MRI is thought to be useful for the differentiation of lipedematous alopecia from lipoma. The present case is considered to present the first male patient with lipedematous alopecia.

Adipose Tissue↗
PubMed2002

Effectiveness of the MSC cold cap system in the prevention of chemotherapy-induced alopecia.

OBJECTIVE: To study the effectiveness of the MSC cold cap system to prevent chemotherapy-induced alopecia. METHODS: The system was applied in 83 cancer patients (mean age 49.8 years) undergoing chemotherapy with alopecia-causing agents. Seven patients did not tolerate the system. Seventy-six patients were evaluable for assessment; 26 received anthracycline (group A), 33 taxane (group T), 5 anthracycline plus taxane (group AT), 7 intravenous etoposide (group E) and 5 ifosfamide with or without other alopecia-causing drugs (group I). In group A, 18 patients received conventional (subgroup Ac) and 8 high doses (subgroup Ah). In group T, 8 patients received docetaxel (subgroup D) and 25 paclitaxel (subgroup P). Alopecia grade 0-1 (Dean's system) was considered as treatment success. RESULTS: Grade 0-1 alopecia was achieved in 49/76 (64.5%) patients: group T 23/33 (69.6%), subgroup P 16/25 (64%) and subgroup D 7/8 (87.5%); group A 18/26 (69.2%), subgroup Ac 16/18 (88.8%) and subgroup Ah 2/8 (25%); group AT 1/5 (20%); group E 6/7 (85.7%), and group I 1/5 (20%). CONCLUSIONS: The MSC cold cap system is effective in preventing alopecia from anthracycline, etoposide or taxane but not from anthracycline-taxane combinations or ifosfamide-containing regimens.

Adult↗
PubMed1988

Nuchal nevus flammeus as a skin marker of prognosis in alopecia areata.

In this work, the incidence of nuchal nevus flammeus was studied in 205 patients suffering from various forms of alopecia areata, as well as in a group of 555 volunteers without alopecia areata examined in our outpatient clinic. The incidence of nuchal nevus flammeus in the totalis-universalis form of alopecia areata was 58.2% (examined patients, n = 79), in ophiasis-extensive forms 22.8% (examined patients, n = 70) and in simple forms of alopecia areata 3.6% (examined patients, n = 56). In the group of 555 volunteers without alopecia areata the incidence of nuchal nevus flammeus was 4.5%. Our results show that nuchal nevus flammeus could be a valuable skin marker indicating a more severe course of alopecia areata.

Adolescent↗
PubMedDate not supplied

Psychosomatic factors in first-onset alopecia areata.

Although the onset of alopecia areata has often been anecdotally linked with emotional stress, findings from the few controlled studies have not been univocal. The authors compared outpatients experiencing a recent onset of alopecia areata (N=21) with outpatients affected by skin conditions commonly believed as having a low psychosomatic component (N=102). Participants were administered Paykel's Interview for Recent Life Events, the Experiences in Close Relationships scale, the 20-item Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support. Multiple logistic regression was used to control for age and gender. The total number of recent life events (last 12 months) was not different between the alopecia patients and the comparison subjects. Also, the alopecia patients and the comparison subjects did not differ in terms of the number of undesirable or major events. The comparison subjects even experienced a greater number of uncontrollable events. Alopecia areata tended to be associated with high avoidance in attachment relationships, high alexithymic characteristics, and poor social support. The results suggest that personality characteristics might modulate individual susceptibility to alopecia areata.

Adolescent↗
PubMed2006

A randomized clinical trial of a videotape intervention for women with chemotherapy-induced alopecia: a gynecologic oncology group study.

PURPOSE/OBJECTIVES: To evaluate changes in body image and self-esteem in women with gynecologic malignancies who experience chemotherapy-induced alopecia and to examine the effectiveness of a videotape intervention on body image and self-esteem. DESIGN: A prospective, randomized study. SETTING: Subjects were accrued from 11 Gynecologic Oncology Group (GOG) member institutions participating in 14 GOG treatment protocols. SAMPLE: 136 women with chemotherapy-induced alopecia, a mean age of 57.7 years, and advanced disease at study entry. METHODS: Prior to the first course of chemotherapy, all subjects received standard counseling regarding hair loss. Body image and self-esteem scores were obtained prior to course 1 and 3 and after course 4 of chemotherapy. Prior to course 3, women with grade 2 alopecia were allocated randomly to the videotape intervention or no intervention. MAIN RESEARCH VARIABLES: Total body image and self-esteem as measured by the Body Cathexis/Self-Cathexis Scale (BCSCS). FINDINGS: A small but statistically significant change (p = 0.045) in body image was observed after chemotherapy-induced alopecia, with no change in self-esteem. The videotape did not produce a significant effect on body image score. CONCLUSIONS: The study results support prior studies that have reported changes in body image as a result of chemotherapy-induced alopecia. The intervention employed (a videotape) was not effective. The BCSCS is a simple and quick measurement for use in future studies IMPLICATIONS FOR NURSING: Chemotherapy-induced alopecia has an adverse effect on body image. Novel interventions are needed to assist women in coping with this consequence of treatment.

Adaptation, Psychological↗
PubMed1999

Alopecia due to psychotropic medications.

OBJECTIVE: To review the literature and describe the incidence and nature of psychotropic drug-related alopecia to assist clinicians in their therapeutic decisions when this adverse event occurs. DATA SOURCES: A MEDLINE search (December 1966-March 1998), using each drug name and the keywords alopecia or hair loss, was conducted. A database from the Clarke Institute of Psychiatry in Toronto was also searched. Additional English-language articles were identified through the bibliography of the reviewed literature. Certain pharmaceutical companies were also consulted. STUDY SELECTION: All published case reports and review articles were considered for study evaluation. DATA EXTRACTION: When possible, details regarding psychotropic drug therapy, development of alopecia, and clinical outcomes were collected for each case. DATA SYNTHESIS: Hair loss from the scalp, eyebrows, and pubic area was identified as a possible, yet uncommon, adverse effect of most psychotropic medications. There are few effective management options for alopecia; however, resolution was achieved on discontinuation of the offending drug in almost all of the cases reported. Alopecia was perceived to be an undesirable effect by most patients, often resulting in poor compliance and hence therapeutic failures. CONCLUSIONS: Due to the self-limiting nature of mild to moderate hair loss with psychotropic medications, clinicians should consider continuing therapy if there is a good clinical response and the patient agrees with this decision. If severe alopecia occurs, it is recommended to discontinue the medication and pursue therapy with another agent. This is to ensure positive therapeutic outcomes and improved patient compliance.

Alopecia↗
PubMed1994

Evidence for a complement-mediated inhibition and an antibody-dependent cellular cytotoxicity of dermal fibroblasts in alopecia areata.

Immunological mechanisms have long been suggested to mediate hair loss in alopecia areata. In this process hair bulb melanocytes and dermal papilla fibroblasts are believed to be primarily involved. In the present study we further investigated the role of humoral factors in alopecia areata. Three different experiments were performed on normal human epidermal melanocytes as well as normal human dermal fibroblasts: (i) incubation with medium containing 2, 10, or 20% alopecia areata serum (n = 12 patients) for 16 h, (ii) incubation with medium supplemented with preheated alopecia areata serum (1 h at 56 degrees C) and healthy human fresh serum as a complement source (1:1) and (iii) incubation with 2, 10 or 20% alopecia areata serum but, in addition, containing peripheral blood mononuclear cells from healthy subjects (effector/target ratio, 50:1). As controls, normal human fibroblasts and normal human epidermal melanocyte cultures were also incubated with serum from healthy individuals (n = 5) under the same culture conditions. The results showed that alopecia areata serum exerted a significant stimulation of proliferation of both normal human fibroblasts (p > 0.05 at 2%, p > 0.05 at 10%, p < 0.05 at 20%), and normal human epidermal melanocytes (p > 0.05 at 2%, p < 0.05 at 10%, p > 0.05 at 20%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Underlying medical conditions in cats with presumptive psychogenic alopecia.

OBJECTIVE: To identify underlying medical conditions in cats with a presumptive diagnosis of psychogenic alopecia. DESIGN: Case series. ANIMALS: 21 adult cats referred with a presumptive diagnosis of psychogenic alopecia. PROCEDURES: A detailed behavior and dermatologic questionnaire was completed by the primary caregiver, and complete behavioral and dermatologic examinations were performed. A standard diagnostic testing protocol that included cytologic examination of skin scrapings, fungal culture of hairs, evaluation of responses to parasiticides and an exclusion diet, assessment for atopy and endocrinopathies, and histologic examination of skin biopsy specimens was used to establish a definitive diagnosis in all cats. Cats that did not respond to an elimination diet were treated with methylprednisolone acetate to determine whether pruritus was a factor. RESULTS: Medical causes of pruritus were identified in 16 (76%) cats. Only 2 (10%) cats were found to have only psychogenic alopecia, and an additional 3 (14%) cats had a combination of psychogenic alopecia and a medical cause of pruritus. An adverse food reaction was diagnosed in 12 (57%) cats and was suspected in an additional 2. All cats with histologic evidence of inflammation in skin biopsy specimens were determined to have a medical condition, but of 6 cats without histologic abnormalities, 4 had an adverse food reaction, atopy, or a combination of the 2, and only 2 had psychogenic alopecia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that psychogenic alopecia is overdiagnosed in cats. Thorough diagnostic testing should be done before ascribing a behavioral cause to hair loss in cats.

Alopecia↗
PubMed1987

A clinical study of topical mucopolysaccharides & polydeoxyribonucleoprotein (Foltene) therapy in alopecia.

We performed clinical trials to evaluate the therapeutic effects of Foltene in patients of the several types of hair fallings. Thirty patients with male pattern baldness, alopecia areata and seborrheic alopecia were included in this study. Foltene was applied every other day for 40 days, and followed by maintenance therapy of twice application a week. The duration of whole therapy was 6 months. We conclude that Foltene is an effective and agent for male pattern baldness, alopecia areata and seborrheic alopecia from the following results. Ten patients with male pattern baldness was treated with Foltene for 6 months. Foltene had therapeutic effects of 50% in hair regrowth, 70% in decreased hair falls, 30% in decreased dandruff, 50% in decreased seborrhea. Thirteen patients with alopecia areata was treated with Foltene for 6 months. Foltene had therapeutic effects of 61.6% in hair regrowth, 53.9% in decreased in hair falls, 53.9% in decreased dandruff, 77.0% in decreased seborrhea. Seven patients with seborrheic alopecia was treatment with Foltene for 6 months. Foltene had therapeutic effects of 85.8% in hair regrowth, 57.2% in decreased hair falls, 42.9% in decreased dandruff, 85.8% in decreased seborrhea. The degree of therapeutic success was related to the duration of therapy. The side effects were as followed: itching sensation developed in 2 patients (6.7%); tingling sensation in 3 patients (10.0%); burning sensation in 1 patient (3.3%); erythema in 3 patients (10.0%).

Administration, Topical↗
PubMed1999

A narrative study of chemotherapy-induced alopecia.

PURPOSE/OBJECTIVES: To describe the experience of alopecia in people undergoing chemotherapy. DESIGN: Qualitative. SAMPLE: Using announcement flyers, 15 participants (13 women and 2 men) were recruited to participate in audiotaped, in-depth interviews. METHOD: In-depth interviews and narrative analysis of participants' "stories" using a sociolinguistic approach to narrative analysis. FINDINGS: Alopecia is a significant and disturbing side effect of chemotherapy. Preparing for hair loss, experiencing hair falling out, realizing an altered sense of self, trying to look normal, being reminded of disease, joking about alopecia, sharing being bald, having problems with wigs, taking control, and experiencing hair growing back emerged as aspects of the experience. CONCLUSIONS: Understanding the full significance of the experience of alopecia in an individual's everyday life and personal identity is critical to providing support during the course of illness and developing strategies to help clients cope with the difficult changes that occur during cancer treatment. IMPLICATIONS FOR NURSING PRACTICE: Information about alopecia can help to cognitively prepare the person, but the emotional response to alopecia is difficult to anticipate. Nurses need to create an atmosphere that encourages patients to tell their stories.

Adaptation, Psychological↗
PubMedDate not supplied

Occurrence and severity of alopecia in patients on combination chemotherapy.

The aim of the study was to evaluate the occurrence and severity of alopecia resulting from combination chemotherapy on cancer patients. The study was conducted during the period 1994-1996 on 58 confirmed cases of malignancies attending the Kasturba Medical College Hospital, Mangalore, South India. The treatment regimens followed were standard protocols recommended for those malignancies and which are widely adopted. Specific drug combinations, their dosage and routes and schedules of administration were studied. The influence of 20 different treatment regimens, most of them in combination chemotherapy, were studied. The patients studied were not receiving any other medication which could have caused alopecia as observed in the present study. The pathophysiology of the hair, as influenced by the treatment regimens, were studied by examination of samples of the affected hairs under a Leica compound microscope. Alopecia was the most dominant side effect influencing 35 of the 58 patients undergoing the treatment (60%). The severity of alopecia was assessed by grouping them in four distinct grades. Specific drugs and their combinations causing varying degrees of severity were identified. The initiation of hair loss in different treatment regimens were analysed. It is seen that alopecia is an early manifestation of cutaneous side effects of cancer chemotherapy. In a majority of patients, the manifestation initiated after the first or the second cycle of administration of the rapeutic regimen, indicating a time interval of 1 to 8 weeks after the start of chemotherapy. Single agent drugs, when used alone or in combination with immunomodulator drugs seem to cause much less side effects, including alopecia, when compared to multiple drug regimens. Microscopic examination of the affected hair showed trichorrhexis, fragmentation, decrease in diameter and depigmentation of the hair shaft.

Adolescent↗
PubMed1976

Occipital alopecia following cardiopulmonary bypass.

Postoperative alopecia is a minor complication of surgery but a cosmetic disaster to the patient. Over a 3 year period, 60 cases of occipital alopecia were discovered in patients following open-heart surgery and 5 cases on other surgical services. In contrast to previous reports, 29 patients had alopecia one year later, presumed to be permanent. Extensive operations, with prolonged recovery and elective overnight mechanical ventilation, were common to all. Retrospective analysis and prospective studies clearly demonstrated that localized scalp pressure was the cause of the alopecia and that the duration of pressure determined the extent of the damage. Moving the patient's head at regular intervals during operation and recovery eliminated the alopecia. The type of head rest used did not modify the development of alopecia. Electrical injury and the use of heparin, hypothermia, electrocautery, or hypotension were eliminated as possible causes. Conclusive evidence correlating periperative events with the formation of pressure sores in man has not been previously reported.

Adult↗
PubMedDate not supplied

Interferon-gamma in alopecia areata.

Alopecia areata is a common type of hair loss. In clinical practice most patients will present with reversible patchy hair loss whereas others may develop complete baldness. Although the etiopathogenesis of alopecia areata is poorly understood, evidence is accumulating that it can be regarded as a T-cell mediated tissue-restricted autoimmune disease of the hair follicle, especially expressing the T-helper-type 1 cytokines interleukin-1beta, interleukin-2, and interferon-gamma. The aim of the study was to compare the serum levels of interferon-gamma in patients with alopecia areata and the control group and also to investigate the difference between the localized form of the disease with the extensive forms like alopecia totalis (AT) and alopecia universalis (AU). Forty patients with alopecia areata and 20 healthy controls were enrolled in the study. Nineteen patients had localized AA (LAA) and twenty-one patients had AT, AU or AT/AU. The serum levels of interferon-y were measured using enzyme immunoassay techniques. The mean serum IFN-gamma level in AA patients (n = 40) was 14.25 +/- 8.76 pg/mL (mean +/- SD), whereas that of LAA (n = 19) or extensive (AT, AU or AT/AU) (n = 21) was 13.45 +/- 6.75 pg/mL or 14.98 +/- 10.37 pg/mL, respectively. The mean serum IFN-gamma level in controls was 9.95 +/- 2.6 pg/mL. Serum levels of IFN-gamma in patients with AA were significantly higher than those in controls (p < 0.05). Significant difference was observed in serum levels of IFN-y between patients with LAA and control group (p < 0.05). Serum levels of IFN-gamma in patients with AT, AU or AT/AU were significantly higher than those in controls (p < 0.05). There was no significant difference in levels of IFN-gamma between patients with LAA and extensive group (p > 0. 05). We conclude that the elevated serum levels of IFN-gamma may reflect the inflammatory symptoms in AA, especially in the extensive form and that control of IFN-gamma production may be important to management of this disease. And also the measurement of serum IFN-gamma in patients with AA may be useful in discriminating those likely to progress to AU from the remaining LAA, or as a prognostic indicator.

Alopecia Areata↗
PubMedDate not supplied

Effective treatment of female androgenic alopecia with dutasteride.

Dihydrotestosterone is the main molecule responsible for androgenic alopecia. Finasteride, which reduces transformation of testosterone into dihydrotestosterone and decreases dihydrotestosterone activity, is approved for treatment of androgenic alopecia in men. We describe the case of a 46-year-old woman with androgenic alopecia, non-responsive to minoxidil, who initially benefited from finasteride. Due to only limited improvement after finasteride and persisting profound psychological distress resulting from androgenic alopecia, another 5-reductase inhibitor, dutasteride, was introduced. Clinical evaluation and trichogram were applied for assessment of dutasteride efficacy in this patient. Additionally, mean hair diameter was monitored by means of computer dermoscopy. After 6 months of therapy, significant improvement was observed and after 9 months the clinical diagnosis of androgenic alopecia could no longer be made in this patient. No side effects were observed. In conclusion, theoretical data and our experience in this case show that dutasteride might develop into a true alternative in treatment of androgenic alopecia.

5-alpha Reductase Inhibitors↗
PubMed1992

Protection from 1-beta-D-arabinofuranosylcytosine-induced alopecia by epidermal growth factor and fibroblast growth factor in the rat model.

The present study was designed to examine the effect of epidermal growth factor (EGF) and fibroblast growth factor (FGF) on 1-beta-D-arabinofuranosylcytosine (ARA-C)- and cyclophosphamide-induced alopecia in the young rat model. Seven-day-old rats were given ARA-C with or without human or murine EGF daily for 7 days. Alopecia was scored on the 12th day of the experiment. Both human and murine EGF protected rats from ARA-C-induced alopecia. The topical application of murine EFG in dimethyl sulfoxide offered significant protection limited to the treated area. In other experiments the administration of acidic FGF (aFGF) with ARA-C resulted in protection from alopecia limited to the site of FGF injection. Neither EGF nor FGF had any influence on alopecia from cyclophosphamide. It is concluded that both EGF and FGF are effective in protecting against ARA-C-induced alopecia in the rat model.

Alopecia↗
PubMed1991

Interleukin 1 protects against 1-beta-D-arabinofuranosylcytosine-induced alopecia in the newborn rat animal model.

Alopecia is one of the most psychologically distressing side effects of cancer chemotherapy. Previously, we made the following observations: (a) treatment of 8-day-old rats with 1-beta-D-arabinofuranosylcytosine (ara-C), doxorubicin, and cyclophosphamide (CYC) consistently produced either total body alopecia (ara-C and CYC) or alopecia confined to the head and proximal part of the neck (doxorubicin); (b) Imuvert, a biological response modifier derived from the bacterium Serratia marcescens, uniformly produced complete protection against alopecia induced by ara-C and doxorubicin but not that induced by CYC; and (c) the protective effect of Imuvert against chemotherapy-induced alopecia is mediated by a monocyte-mediated cytokine. In the experiments reported here, interleukin 1 was examined as the potential cytokine. Interleukin 1 offered excellent protection against alopecia induced by ara-C but not that produced by CYC in the newborn rat animal model.

Alopecia↗
PubMed1989

Alopecia: histologic changes.

The major types of alopecia that can be diagnosed histologically are androgenic alopecia, alopecia areata, trichotillomania, inflammatory scarring alopecias, pseudopelade, and anagen and telogen effluviums. Important to recognize are the common histologic features in chronic alopecias, which include follicular plugging, decreased numbers of hair follicles, frequent increased fibrous tracts, and superficial changes of actinic damage. Specific helpful changes to be observed are (1) the presence of actinically damaged skin that would reveal a chronic alopecic condition, (2) the presence and site of the dermal inflammation, (3) whether there is a decrease in the numbers of hair follicles and the presence of a reversal of the anagen/telogen ratio, (4) miniaturization of the hair follicle, (5) evidence of involution, and (6) the presence of scarring as demonstrated with elastic fiber stains. By assessing these histologic changes, the dermatopathologist can make a reasonably specific diagnosis of alopecia.

Acute Disease↗