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PubMed1990

Biochemical and trichological characterization of diffuse alopecia in women.

One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.

Adolescent↗
PubMed1992

Scarring alopecia in discoid lupus erythematosus.

The clinicopathological features of the scarring alopecia of discoid lupus erythematosus (DLE) were studied. Scarring alopecia was present in 34% of 89 patients with DLE and was associated with a prolonged disease course. More than half these patients had scalp involvement at the onset of the disease. There was a significant reduction in size of sebaceous glands in affected scalp. Perifollicular lymphocytic inflammation was maximal around the mid-follicle at the level of the sebaceous gland, which seems to be an important functional level in the follicle. There are changes in the expression of the matrix molecules, the proteoglycans, in the connective tissue sheath and the keratin intermediate filaments in the outer root sheath cells at this level in normal scalp and in diseased scalp. Loss of a population of mid-follicular stem cells may be important in the pathogenesis of scarring alopecia in DLE.

Adolescent↗
PubMed1993

Chemically induced cosmetic alopecia.

Cosmetic causes of scarring alopecia are poorly documented. They include traction alopecia and hot-combing. Recently, another group has presented in the South London area, related to misuse of chemical hair straightening agents. Affected patients are young, female, of Afro-Caribbean origin, and typically display hair loss on the vertex of the scalp. Histology shows a pattern of fibrosis and inflammation characteristic of the physical damage seen with other cosmetic procedures. This histological pattern is distinguishable from other non-cosmetic causes of scarring alopecia.

Adult↗
PubMed1994

Cicatricial alopecia occurring in two sisters from Ghana.

We report two sisters from Ghana who presented with cicatricial alopecia simultaneously. In both cases the aetiology is unclear although both gave a history of previous scalp folliculitis. We classify the causes of cicatricial alopecia and the difficulties that can arise in placing such patients in a clinical category. Racial origin may be relevant in our cases; to our knowledge this is the first report of cicatricial alopecia occurring in two sisters.

Adult↗
PubMed2006

Topical immunotherapy with diphenylcyclopropenone in the treatment of chronic extensive alopecia areata.

Highly variable results have been described for the use of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata (AA). We enrolled 41 patients in a prospective open clinical trial. Of these, 17 patients had either AA totalis (AAT) or AA universalis (AAU), and 24 had severe alopecia (> 50% scalp involvement). After sensitization with DPCP 2% in acetone, progressively higher concentrations were applied once a week for a period of 6-12 months. Of the 41 patients, 38 (16 with AAT or AAU and 22 with extensive AA) completed therapy. Significant hair regrowth was observed in 15 of the 38 patients (39.5%) at 6 months: 5 with AAT or AAU (31.25%) and 10 with extensive alopecia (45.4%). The above results were sustained in 66.6% of patients for a 12-month-follow up- period. In our study, topical immunotherapy with DPCP proved to be an effective treatment, with prolonged therapeutic results.

Administration, Topical↗
PubMed1992

Alopecia universalis treated with oral cyclosporine A and prednisolone: immunologic studies.

Alopecia universalis is a refractory condition. Although the cause of this disease is unknown, immunologic abnormalities have recently been suspected. Thus, we treated six cases of refractory alopecia universalis with immunotherapy. Oral administration of cyclosporine A (2.5 mg/kg) and prednisolone (5 mg/day) resulted in marked symptomatic improvement. Cyclosporine A did not produce any side effects because the administered dosage was relatively low. At present, more than 6 months after the cessation of treatment, recurrence of alopecia has not been seen. Oral administration of low-dose cyclosporine A and prednisolone is considered to be an effective treatment for this disease. Immunologic examination of peripheral blood demonstrated improvement of immunologic function. In particular, CD8-positive T cells, NK cells, and C3, which had been reduced, were increased. A reduction in active CD4 cells, eosinophils, and circulating immune complexes was observed. Histology with fluorescent antibodies showed T-cell infiltration around the hair matrixes. This phenomenon was no longer observed after treatment. These improvements in immunologic function were seen in parallel with the resolution of the clinical symptoms, indicating that immunologic abnormalities are related to this disease.

Administration, Oral↗
PubMed1992

Hormonal status in postmenopausal androgenetic alopecia.

The development of androgenetic alopecia is thought to be caused by increased androgen action on hair follicles with menopause. Testosterone, estradiol and sex hormone binding globulin (SHBG) serum levels were determined in ten postmenopausal women with androgenetic alopecia and in ten sex and age matched healthy controls. No statistically significant differences were found in the hormone levels between the patients and the controls. These findings suggest that a genetically determined functional alteration of androgen receptors and/or a metabolic disturbance may exist in the hair follicle keratinocytes in androgenetic alopecia.

Aged↗
PubMed1996

Treatment of alopecia areata with squaric acid dibutylester.

BACKGROUND: Among contact allergens that are frequently used in the treatment of alopecia areata (AA), squaric acid dibutylester (SADBE) stands out for its good tolerability and its mild side effects. METHODS: One hundred and forty-four patients with AA of varying degrees were treated with SADBE. Of these, 71 had AA affecting less than 50% of the scalp, and 73 had a severe form, including 13 patients with alopecia totalis (AT) and two with alopecia universalis (AU). The patients were treated using both traditional and nontraditional methods. RESULTS: In the less severe form, we obtained a 80% rate of regrowth, compared to the 49% of the more severe form including 13 cases of AT and the two of AU. The failure rate was higher for patients with the more severe form (29%) compared to a 7% rate only for patients with mild AA. We also observed four cases of initial regrowth on the side of the scalp opposite to the site of application ('castling phenomenon'). Among those patients who were treated with application of SADBE on the right side of the back, three displayed regrowth on the left side of the scalp, (i.e., on the opposite side) and in an area distant from the site of application; for two patients the regrowth began on the right side of the scalp and one of them also displayed growth of fine hairs in the right dorsal region, the site of application of the compound. CONCLUSIONS: Our data further support the hypothesis of a systemic action of SADBE; however, further confirmation on a larger sample of cases is needed.

Adolescent↗
PubMed2006

Androgenetic alopecia: does its presence change our perceptions?

BACKGROUND: The aim of this study was to evaluate the effects of androgenetic alopecia on males with and without hair loss and to delineate the level of stress gained by this type of alopecia. METHODS: Two hundred and 52 males (175 with hair loss, 77 without hair loss), between 16 and 72 years of age, participated in the study. A hair loss form (five questions for sociodemographical features, eight questions for dermatological features, eight questions for psychological evaluation) and a list of stressful life events were used. RESULTS: Desire for treatment was significantly different between the participants with and without androgenetic alopesia (AGA; chi(2) = 5.877, d.f. = 1, P = 0.015). Regardless of the presence of AGA, 61.4% accepted AGA as a natural condition with a solution that should be sought, 38.5% as a cause for increased attention, and 56.2% thought that the psychological effects of AGA would mostly be negative. The negative effects of their AGA on other family members, relationships with the opposite sex and occupation/academic life were considered by 37.1%, 43.0% and 36.3% of the participants, respectively. None of the psychological parameters differed significantly between the participants with and without AGA. A small portion (5%) of the variance in perception of stress (0.22(2) = 0.048) might be explained by the degree of alopecia. CONCLUSION: Social and cultural differences might alter perceptions concerning AGA regardless of its presence in an individual.

Adolescent↗
PubMed2006

Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study.

BACKGROUND: Frontal fibrosing alopecia (FFA) is an acquired scarring alopecia currently considered a clinical variant of lichen planopilaris (LPP). Our purpose was to examine the clinicopathological features of FFA. In addition, we investigated the similarities and differences between FFA and LPP. METHODS: Biopsies from the scalp lesions of eight patients with FFA and eight patients with LPP were microscopically analyzed. Two cases of FFA and four cases of LPP were studied using direct immunofluorescence. RESULTS: In spite of the completely different clinical characteristics of FFA and LPP patients, the histopathological findings for the two entities were similar. Common microscopic findings for both FFA and LPP included an inflammatory lymphocytic infiltrate involving the isthmus and infundibulum of the hair follicles, the presence of apoptotic cells in the external root sheath, and a concentric fibrosis surrounding the hair follicles that resulted in their destruction with subsequent scarring alopecia. Biopsies taken from FFA patients showed less follicular inflammation and more apoptotic cells than those from LPP patients. In some cases of LPP, the inflammatory infiltrate involved the interfollicular epidermis, a finding never present in our FFA cases. Direct immunofluorescence was negative in the two cases of FFA studied and showed deposits of immunoglobulins and/or complement in two of the four LPP cases examined. CONCLUSIONS: The characteristic findings for FFA were more prominent apoptosis and less inflammation than found in LPP, along with spared interfollicular epidermis. FFA cases showed a rather characteristic histopathological pattern, although we could not find any clear-cut histological differences between FFA and LPP.

Aged↗
PubMed2006

A novel locus for alopecia with mental retardation syndrome (APMR2) maps to chromosome 3q26.2-q26.31.

Congenital alopecia may occur either alone or in association with ectodermal and other abnormalities. On the bases of such associations, several different syndromes featuring congenital alopecia can be distinguished. Alopecia with mental retardation syndrome (APMR) is a rare autosomal recessive disorder, clinically characterized by total or partial hair loss and mental retardation. In the present study, a five-generation Pakistani family with multiple affected individuals with APMR was ascertained. Patients in this family exhibited typical features of APMR syndrome. The disease locus was mapped to chromosome 3q26.2-q26.31 by carrying out a genome scan followed by fine mapping. A maximum two-point logarithm of odds (LOD) score of 2.93 at theta=0.0 was obtained at markers D3S3053 and D3S2309. Multipoint linkage analysis resulted in a maximum LOD score of 4.57 with several markers, which supports the linkage. The disease locus was flanked by markers D3S1564 and D3S2427, which corresponds to 9.6-cM region according to the Rutgers combined linkage-physical map of the human genome (build 35) and contains 5.6 Mb. The linkage interval of the APMR locus identified here does not overlap with the one described previously; therefore, this locus has been designated as APMR2.

Alopecia↗
PubMed1993

Spotted cicatricial alopecia in dark skin. A dermoscopic clue to fibrous tracts.

Study of areas of cicatricial alopecia in a 42 year old black woman by dermoscopy with oil revealed uniform pale dots associated with a radiating pigment network. Scalp biopsy showed a cicatricial alopecia with lichen planopilaris and multiple fibrous tracts. The pale dots appear to correspond to focal decrease in epidermal melanin pigment overlying the site of the fibrous tracts and may provide a dermoscopic clue in analysing the cicatricial alopecias.

Adult↗
PubMed1995

Female androgenetic alopecia: an update.

Androgenetic alopecia is an androgen dependent disorder occurring in genetically susceptible individuals. The pattern of hair loss in women differs from that of classical male pattern alopecia, being more diffuse and with retention of the frontal hair line in most cases. Characteristic histopathological changes occur but biopsy is rarely helpful in diagnosis. Although research has shown subtle alterations in the androgen status of women with androgenetic alopecia, most patients presenting with this disorder are normal endocrinologically. Anti-androgen therapy will result in some improvement in up to 50% of patients after 6 to 12 months of therapy, but in practice will usually only decrease the rate of hair loss and not result in new hair growth.

Alopecia↗
PubMed1989

An adult case of psychogenic alopecia universalis.

A 39-year-old male with psychogenic alopecia universalis is reported to be a rare adult case. There are two characteristic features which are the reactive depressive state and hair loss on the head, eyebrows, axilla and genital organ. Discussions on the psychogenesis of these findings are as follows: The first is that the psychic escape from social life may be represented as the hair loss. And the second is that the depressive and anxious states as a result of his suffering from the initial alopecia areata which brought him changes in the physical image exaggerate the skin findings which lead to alopecia universalis.

Adult↗
PubMed1994

Alopecia areata associated with haloperidol.

A patient with a 7-year history of depression relapsed after self-discontinuation of antidepressant drugs. He was admitted to our hospital and re-administered amoxapine 150 mg. p.o. per day, and further given haloperidol 5 mg i.m. or p.o. per day because he was suicidal and excited. One month later, an area of alopecia was found on the back of his head. Immediately, he received dermatological treatment. The psychotropic drugs were continued, but the hair loss was unchanged after one month. So, haloperidol alone was discontinued. One week later, the hair loss had stopped and a month later alopecia had virtually disappeared. We suggest that alopecia areata is associated with haloperidol.

Administration, Oral↗
PubMed2005

Alopecia areata treatment with a phototoxic dose of UVA and topical 8-methoxypsoralen.

Twenty-five patients with alopecia totalis (AT) or alopecia universalis and 124 patients with alopecia areata (AA) were treated with photochemotherapy, combining topical 8-methoxypsoralen (8-MOP) with UV irradiation of the scalp at a phototoxic dose. The mean energy required was 15 J/cm2 for AA and 42 J/cm2 for AT. Ninety-four patients had multiple bald patches and 12 with AT had complete or > 50% hair regrowth. Positive treatment results did not seem to depend on the age of onset or the duration of the disease. Few side-effects of topical psoralens plus UVA (PUVA) treatment were noted, except a for few days of slight erythema caused by the high dose of UV.

Administration, Topical↗
PubMed1994

The use of retention sutures and tensed Silastic-Dacron strips for the prevention of stretch-back after alopecia-reducing procedures.

BACKGROUND: A comparison between using retention sutures (N = 25), a tensed Silastic-Dacron strip (N = 25), or nothing (N = 25) for the prevention of stretch-back (after alopecia-reducing procedures) was performed between 1990 and 1992. OBJECTIVE: The purpose was to determine if retention sutures or a tensed Silastic-Dacron strip placed subgaleally from one donor fringe to the other would reduce the amount of stretch-back after alopecia-reducing procedures. METHOD: A prospective study of a total of 75 patients was performed. The width of the bald area was measured immediately after the surgery and at 3 months with each of the three modalities. RESULTS: Retention sutures resulted in some prevention of stretch-back. Tensed Silastic-Dacron strips totally prevented stretch-back and in some cases made the bald area compressed. CONCLUSIONS: Retention sutures placed through subgaleal tunnels reduces stretch-back after alopecia-reducing procedures. Tensed Silastic-Dacron strips totally prevent stretch-back and in approximately half the cases compress the area of baldness.

Adult↗
PubMed1994

Treatment of severe alopecia areata with squaric acid dibutylester in pediatric patients.

Topical squaric dibutylester (SADBE) is currently used in Europe to treat alopecia areata in adults. We attempted to determine this drug's effectiveness and convenience in treating children with severe alopecia areata who are psychologically disturbed and resistant to other therapies. Twenty-eight children under 13 years of age who had extensive and long-standing alopecia areata and were not responsive to conventional therapies were sensitized on the head with 2% SADBE in acetone and treated with weekly applications for 12 months. Nine patients (32.1%) achieved complete or cosmetically acceptable regrowth, and another six (21.4%) had significant regrowth. No correlation was found between response and sex, age of onset of illness, extent, duration, or clinical type of disease. In 14 patients followed for a period ranging from 18 months to 8 years SADBE remained efficacious for relapses as well. This study demonstrates that SADBE is a valid and suitable treatment for children, particularly those who are resistant to conventional therapies.

Administration, Cutaneous↗