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PubMed1990

Effective therapy with low dose of oral cyclosporine A and prednisolone for alopecia universalis.

Although alopecia universalis is an incurable disease, we have obtained favorable results using a low dose of 2.5 mg/kg of cyclosporine A and 5 mg/day of prednisolone without adverse effects. We report our clinical experience of the treatment of two cases of alopecia universalis. Immunological examinations showed marked changes in the ratio of T cell subsets in peripheral blood. There was an increase of OKT8 positive cells and NK cells, reduction of IL-2R positive cells. These immunological changes following recovery from alopecia suggest a correlation between immunological disorders and the pathogenesis of this disease (alopecia universalis).

Administration, Oral↗
PubMed1990

[Significance of HLA-DR+ T cells and natural killer (NK) cells in the peripheral blood lymphocytes of alopecia areata (AA)].

HLA-DR+ T cell and NK cell subsets in peripheral blood lymphocytes of patients with AA were investigated. The percentages of HLA-DR+ T cell and NK cell subsets from a mild condition of patchy AA and an acute condition of alopecia totalis, for which hair regrowth occurred frequently with ease, were similar to those of the normal control. On the other hand, the percentages of HLA-DR+ Leu3a+ cells HLA-DR+ Leu2a+ cells and Leu7-Leu11+ cells from a severe condition of patchy AA and alopecia universalis, for which hair regrowth did not easily occur, were significantly higher than those of the normal control. The increase in the percentages of HLA-DR+ Leu3a+ cells, HLA-DR+ Leu2a+ cells and Leu7-Leu11+ cells from the severe condition of patchy AA and alopecia universalis was lessened and normalized by treatment with betamethasone. These findings suggest that the auto-immune disorders of HLA-DR+ T cell and NK cell may play important roles in disease activities related to severe patchy AA and alopecia universalis.

Administration, Topical↗
PubMed1989

[Alopecia areata: appropriateness of various laboratory parameters].

Over the past four years 190 patients with alopecia areata have been examined: hematochemical parameters have been assessed in each patient and the possible presence of organ-and non-organ-specific circulating antibodies has been assayed. No significant alterations were found with regard to the different hematochemical parameters examined. On the other hand, a highly significant increase of anti-gastric parietal cell autoantibodies was observed in patients with alopecia areata and alopecia universalis in comparison to normal control subjects; in addition, patients with alopecia universalis showed a significant increase of anti-thyroid antibodies.

Adult↗
PubMed1989

Evaluation of alopecia: a new algorithm.

The clinical evaluation of alopecia is becoming less precise as more histopathologic correlations become available. According to the classic approach, the clinician should initially differentiate between scarring and nonscarring alopecia. Because several case reports in the past ten years have demonstrated that the definition of "scarring alopecia" is ambiguous, the use of the traditional schema--scarring versus nonscarring--may well be outmoded. Therefore, we propose a new algorithm for the evaluation of alopecia that emphasizes the importance of both clinical and histologic findings.

Alopecia↗
PubMed1988

[Prevention of adriamycin-induced alopecia by scalp hypothermia with a deep-frozen Duncool-Cap].

In order to prevent Adriamycin (ADM)-induced alopecia, scalp hypothermia with a Duncool-Cap frozen in a freezer at -70 degrees C was carried out. Of the 18 patients studied, one patient given total ADM doses of 240 mg developed alopecia of moderate degree, and another patient treated with ADM at a dose level of 50 mg developed mild alopecia. Alopecia could be almost completely prevented in 10 of the 11 patients given total ADM doses of 100 mg or less, and in 6 of the 7 patients given total doses of 200 mg or more.

Adult↗
PubMed1988

Warfarin-induced alopecia.

Earlier reports of the association between oral anticoagulation and alopecia describe a high incidence of this complication (42 to 78 percent). However, judged by its extreme rarity in a survey of eight experienced, busy academic dermatologists in Boston, this association is not common, nor is the assumption that the alopecia tends to occur soon after the administration of warfarin necessarily true. Nevertheless, alopecia persists in the face of continued warfarin administration; the time required for hair to regrow after discontinuation of the drug may be too long to be practical if continued anticoagulation is necessary; the effect of oral substitutes for warfarin is unknown; and alopecia may recur if the patient is rechallenged with warfarin.

Alopecia Areata↗
PubMed1988

3 percent topical minoxidil compared with placebo for the treatment of chronic severe alopecia areata.

The efficacy of a 3 percent topical minoxidil solution (2,4-diamino-6-piperidinopyrimidine-3-oxide) in a propylene glycol-water-ethanol base applied twice daily for one year to half the scalp was evaluated in patients with severe chronic alopecia areata. A randomized, double-blind, bilateral comparison-controlled study design was used. Of the twenty-one patients, thirteen were women and eight were men; their ages ranged from nineteen to fifty-five years. All the patients had alopecia totalis or alopecia universalis, except for two who had lost two-thirds of their scalp hair. The mean disease duration was 11.5 years (range, one to forty years). Transient regrowth of sparse vellus hair occurred in twelve patients, bilaterally in eight, but it was not significant in any. No cosmetically acceptable results were achieved. No significant side effects were noted, except for a moderately severe bilateral dermatitis in one patient. The results indicate that 3 percent topical minoxidil solution is ineffective as treatment for severe chronic alopecia areata.

Administration, Topical↗
PubMed1987

Genetic disorders associated with severe alopecia in children: a report of two unusual cases and a review.

Moderate to severe alopecia in children may be due to a genetic disorder. This paper reviews the heritable causes of alopecia in children and gives a detailed account of two affected unrelated children. One has alopecia universalis while the other has alopecia postulated to be due to a new disorder of genetic etiology. The article concludes that for purposes of genetic counseling and prognosis it is crucial that a correct diagnosis be made.

Alopecia↗
PubMed1987

[Treatment of severe alopecia areata with topical applications of cyclosporin A].

Cyclosporin A (CyA) is a fungal peptide used as immunosuppressor in human organ transplantation. Increased hair growth appears to be a common side-effect of treatment, occurring in almost all patients treated with oral CyA. The development of hypertrichosis during CyA administration is not hormone-dependent; it may be mediated by a direct effect of the drug on the hair growth process. We used CyA topically (5 p. 100 oily solution) in 14 patients with severe alopecia areata (totalis 5, ophiasis 3, bald plaques 6). The drug was applied on the alopecia twice a day for 5 +/- 1.5 months. Patients were examined monthly. No clinical adverse effect was observed. Routine blood examination did not show any change, except for a transient increase of hepatic enzymes in one patient. CyA determinations were performed monthly by radioimmunoassay. No CyA was detected in the patients' serum. Treatment resulted in no regrowth in 8 patients, development of vellus hair in 3 patients (alopecia areata totalis 2, ophiasis 1) at the end of therapy, and normal hair growth in 3 patients with bald plaques. We may conclude that CyA is capable of inducing regrowth of hair when applied topically. However, the drug does not seem to be useful for the treatment of alopecia areata.

Administration, Topical↗
PubMed1987

[Alopecia areata in children].

Alopecia areata is a hair disease of unknown origin characterized by the sudden appearance of one or more bald patches. This disorder may develop in adults as well as in children. In childhood there is often an association with atopy. Most investigators feel that alopecia areata is an auto-immune phenomenon with heterogeneous aetiology. This article deals with hypotheses for the development of alopecia areata stressing also the psychosomatic aspects. Different therapy modalities have been propagated in alopecia areata, though complete satisfactory effects have been achieved by none. In childhood application of dithranol and locally applied corticosteroids are the only suitable therapeutic possibilities. Insufficient insight into the pathogenesis and associations of this disorder in childhood warrants further investigations.

Adrenal Cortex Hormones↗
PubMed1983

[Follicular psoriasis with cicatricial alopecia. Piccardi-Lassueur-Graham Little syndrome of a psoriatic nature].

The case of a 21 years old female patient is reported who has had scaly lesions on the scalp since the age of 3, alopecia (later scarring alopecia) since the age of 5, and erythematous and squamous lesions on the trunk and limbs since the age of 14. More recently she developed grouped follicular papules on the trunk, back of the neck and upper limbs. Seven biopsies from the scalp, trunk and sole of foot were performed which showed typical psoriatic changes in all but one, from the scalp, where only scarring alopecia changes could be found. In one lesion from the trunk pseudogranulomatous features were observed in some papillae which were probably due to ectasia, tortuosity and endothelial proliferation of papillary blood vessels. The oral administration of RO 10-9359 was followed by a good remission of the lesions with exception of the scalp alopecia. The differential diagnosis, particularly with pityriasis rubra pilaris and lichen planus, is discussed and the similarities of our case with the Piccardi-Lassueur-Graham Little syndrome emphasised. If one accepts multiple diseases as the cause of the syndrome psoriasis could be admitted as one of them.

Adult↗
PubMed1984

Treatment of alopecia areata with three different PUVA modalities.

Seventy-six patients with severe alopecia areata were treated with either local or oral 8-methoxypsoralen and UVA irradiations. In 43 cases (57%) a good-to-excellent result was obtained. The number of irradiations required for regrowth varied, but 20-40 treatments were sufficient in most cases with a positive response. Patients with circumscribed or ophiasic alopecia responded better than patients with total or universal alopecia. Non-atopic patients responded better than patients with atopy, while a family history of alopecia areata did not seem to have any significance on the outcome of the therapy. The age of onset of the disease seemed to be of importance, as well as the duration of the treated attack. Patients over 20 years old at the first attack showed a better response than patients with an earlier onset of the disease. During a follow-up period of 6-68 months, 22 of 43 successfully treated patients had a relapse.

Adult↗
PubMed1995

Keratinocyte growth factor is an important endogenous mediator of hair follicle growth, development, and differentiation. Normalization of the nu/nu follicular differentiation defect and amelioration of chemotherapy-induced alopecia.

The growth and development of hair follicles is influenced by a number of different growth factors and cytokines, particularly members of the fibroblast growth factor (FGF) family. Keratinocyte growth factor (KGF or FGF-7) is a recently identified 28-kd member of the FGF family that induces proliferation of a wide variety of epithelial cells, including keratinocytes within the epidermis and dermal adnexa. Because KGF induces marked proliferation of keratinocytes, and both KGF and KGF receptor (KGFR) mRNA are expressed at high levels in skin, we sought to localize KGF and KGFR in skin by in situ hybridization. KGFR mRNA was relatively strongly expressed by keratinocytes in the basilar epidermis as well as throughout developing hair follicles of rat embryos and neonates. KGF mRNA was expressed at lower levels than was KGFR but could be localized to follicular dermal papillae in rat embryos and neonates. These results prompted us to investigate the effects of KGF on hair follicles in two distinct murine models of alopecia. In the first model, recombinant KGF (rKGF) induced dose-dependent hair growth over most of the body in nu/nu athymic nude mice when administered intraperitoneally or subcutaneously over 17 to 18 days. When administered subcutaneously, rKGF induced the most extensive hair growth at the sites of injection. Histologically, rKGF induced marked follicular and sebaceous gland hypertrophy, a normalization of the nu/nu follicular keratinization defect, and an increase in follicular keratinocyte proliferation as assessed by bromodeoxyuridine labeling. In the second model, a neonatal rat model of cytosine arabinoside chemotherapy-induced alopecia in which interleukin-1, epidermal growth factor, and acidic FGF have all demonstrated some degree of alopecia cytoprotection, rKGF induced a dose-dependent cytoprotective effect, abrogating as much as 50% of the alopecia in this model when administered beginning 1 day before the onset of chemotherapy. Taken together, these data suggest that KGF is an important endogenous mediator of normal hair follicle growth, development, and differentiation.

Alopecia↗
PubMed1994

Chemotherapy-induced alopecia in mice. Induction by cyclophosphamide, inhibition by cyclosporine A, and modulation by dexamethasone.

We introduce cyclophosphamide-induced alopecia (CYP-IA) in C57BL-6 mice as a clinically relevant model for studying the biology of chemotherapy-induced alopecia and for developing anti-alopecia drugs. One injection of CYP to mice with all back skin follicles in anagen VI induces severe alopecia that strikingly reproduces the follicle response, recovery, and histopathology seen in human CYP-IA. CYP dose-dependently induces abnormal follicular melanogenesis and dystrophic anagen or, in more severely damaged follicles, dystrophic catagen. Both dystrophy forms are followed by an extremely shortened telogen phase, but differ in the associated hair loss and in recovery patterns, which determines hair regrowth. This follicular response to CYP can be manipulated pharmacologically: systemic cyclosporine A shifts it toward a mild form of dystrophic anagen, thus retarding CYP-IA and prolonging "primary recovery". Topical dexamethasone, in contrast, forces follicles into dystrophic catagen, which augments CYP-IA, but accelerates the regrowth of normally pigmented hair ("secondary recovery").

Alopecia↗
PubMed1996

Apoptosis of hair follicle cells during doxorubicin-induced alopecia in rats.

Alopecia is a common side effect of cancer chemotherapy, and to date, little progress has been made in alopecia prevention or treatment. The present studies were undertaken to topographically localize the site of injury in the hair follicle after doxorubicin (DXR) administration and to investigate the mechanism of DXR-induced alopecia. Tissue samples of head and proximal neck skin obtained from newborn rats treated with DXR were histologically examined by light and electron microscopy and stained by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling method. Light microscopy revealed pyknotic cells in the matrix and in the upper bulb and a decrease in the number of mitotic cells. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-digoxigenin nick-end labeling analysis evidenced cells with nuclear staining indicative of apoptosis, as confirmed by ultrastructural analysis. Kinetics studies indicated that even a single DXR treatment induced apoptosis and a decrease in mitotically active cells. Our data show that DXR treatment induces injury in a cell subset localized in the hair matrix. The successful prevention of drug-induced alopecia in patients may depend on the selective protection of these cells of the hair follicle.

Alopecia↗
PubMed1998

Scalp metastases mimicking alopecia areata. First case report of placental site trophoblastic tumor presenting as cutaneous metastasis.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare neoplasm of intermediate trophoblastic cells of the placenta. There is a wide range of biologic behavior, with metastases occurring in about 15% of cases. Cases with metastases have all presented with abnormal vaginal bleeding or gynecological symptoms. METHODS: We describe a 31-year-old G3P3003 woman who presented with several alopecic patches resembling alopecia areata, which on biopsy proved to be metastatic, previously unsuspected, PSTT. CONCLUSIONS: This represents the first case in which PSTT presented initially with metastases, and specifically, with cutaneous metastases. A new primary tumor source of alopecia neoplastica is presented. The role of mitotic counts in predicting prognosis in PSTT is supported. Alopecia areata was mimicked very closely. Dermatologists should be alert to any features atypical of alopecia areata, including erythema, induration, or palpability, and maintain a low threshold for biopsy in atypical cases.

Adult↗
PubMed1965

Alopecia mucinosa and lymphoma. Report of two cases and review of literature.

A total of 90 cases of alopecia mucinosa (follicular mucinosis) have been reported in the world literature since Pinkus described the entity in 1957. Alopecia mucinosa appears morphologically in any variety of three basic clinical types: grouped folliculopapules, plaque forms of folliculopapules, and as boggy nodular masses. Characteristic histochemical changes of follicular mucinosis have been demonstrated in alopecia mucinosa as well as in selected cases of mycosis fungoides and lymphoma. The majority of case reports of alopecia mucinosa have been in children and young adults (58%), and the course of the dermatosis was usually uneventful. Beyond age 40, the disease appears to behave differently in that it follows a prolonged chronic course, and of 28 cases in this category four (15%) developed into either mycosis fungoides or lymphoblastoma.

Aged↗
PubMed1999

[Reappearance of alopecia areata in a coeliac patient during an unintentional challenge with gluten].

A patient with coeliac disease presenting alopecia areas as the only symptom is described. Alopecia disappeared completely after a few months of strict gluten free diet and reappeared after an unintentional prolonged introduction of gluten. After a severe gluten free diet, a new and persistent hair growth in the alopecia areas was observed. The possibility a direct relationship in some cases, between coeliac disease and alopecia areata is confirmed.

English Abstract↗