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PubMed1995

HLA class II antigen associations help to define two types of alopecia areata.

BACKGROUND: Multiple HLA class I and class II antigen associations have been described for alopecia areata (AA). As in other immune-mediated diseases, the HLA antigens associated with AA could influence the patient's ability to respond to immune challenge from both self- and non-self-antigens and may offer clues to the cause and prognosis of and potential therapy for the disease. OBJECTIVE: Our purpose was to determine which HLA class II antigens are associated with two forms of long-standing AA, which we define to be long-standing patchy AA and long-standing alopecia totalis (AT) and alopecia universalis (AU). We also examined other factors such as age at onset of disease and familial and patient histories of autoimmune disease for correlation with the two groupings. METHODS: Patients were typed for HLA class I and class II antigens by serologic methods and were typed by molecular methods for the subtypes of the HLA class II antigens. RESULTS: HLA-DR11 (DRB1*1104) and HLA-DQ7 (DQB1*0301) were found to be highly significantly increased in frequency in patients with long-standing AT/AU (group III) but not in patients with long-standing patchy AA (group II); both patient groups showed increased frequencies of HLA-DQ3 (DQB1*03). Group III patients were unique in their early age at onset of disease. Familial incidence of AA was 37% in patients who had their first patch by 30 years of age and 7.1% with the first patch after 30 years of age. CONCLUSION: The data support the differential association of two well-defined clinical forms of AA, namely long-standing AT/AU and long-standing patchy AA, with specific HLA antigens and age at onset; they also suggest that the broad antigen HLA-DQ3, DQB1*03, is a likely candidate for general susceptibility to AA. Our findings also suggest a bimodal pattern of disease with an early-onset form associated with greater severity, long duration, and family history of the disease and a late-onset form characterized by milder severity, shorter duration, and low family incidence.

Alleles↗
PubMed1994

Alopecia areata. A pathological study of nonresponder patients.

Fourteen patients, four male and 10 female and ranging in age from 11 to 57 years, affected by longstanding alopecia areata that had not responded to sensitizing treatments, were submitted to scalp biopsy. Five patients had alopecia totalis and nine had alopecia universalis. The biopsy was performed on a scalp area that had been bald for > or = 1 year. We distinguished four distinct pathological patterns, which we termed "established bald patch," "early regrowth," "telogen," and "scarring," in four, seven, one, and two patients, respectively. Our study shows that, from a pathological point of view, nonresponder patients constitute a heterogeneous population. The pathological study of the scalp helps predict therapeutic failure only in the small proportion of nonresponder patients that shows a scarring pathological pattern.

Adolescent↗
PubMed1994

Androgenetic alopecia in the female. Treatment with 2% topical minoxidil solution.

BACKGROUND: Women generally regard their hair loss as socially unacceptable and go to great measures to conceal their problem. In some cases, the negative self-image brought about by hair loss may be the basis of psychiatric illness. The purpose of this study was to evaluate a 2% topical minoxidil solution (Rogaine/Regaine, The Upjohn Co, Kalamazoo, Mich) for the treatment of female androgenetic alopecia. A 32-week, double-blind, placebo-controlled trial was conducted in 11 US centers. Three hundred eight women with androgenetic alopecia were enrolled. Two hundred fifty-six of these women completed the trial. A refined photographic technique was used to objectively determine the number of nonvellus hairs regrown. RESULTS: After 32 weeks of treatment, the number of nonvellus hairs in a 1-cm2 evaluation site was increased by an average of 23 hairs in the 2% minoxidil group and by an average of 11 hairs in the placebo group. The 95% confidence interval for the difference in mean hair count change between the treatment groups was 5.9 to 17.5 hairs. The investigators determined that 13% in the minoxidil-treated group had moderate growth and 50% had minimal growth. This compared with 6% and 33%, respectively, in the placebo-treated group. Similarly, 60% of the patients in the 2% minoxidil group reported that they had new hair growth (20% moderate, 40% minimal) compared with 40% (7% moderate, 33% minimal) of the patients in the placebo group. No evaluations of dense hair growth were reported for either treatment group. No clinically significant changes in vital signs were observed and no serious or unexpected medical events were reported. CONCLUSIONS: Topical minoxidil was significantly more effective than placebo in the treatment of female androgenetic alopecia.

Administration, Topical↗
PubMedDate not supplied

Alopecia associated with zidovudine therapy.

Alopecia has been described in patients infected with the human immunodeficiency virus (HIV). Zidovudine reportedly influences hair growth in these patients, causing regrowth or thickening. A 33-year-old HIV-infected man developed alopecia areata after beginning zidovudine therapy. The alopecia reversed after the drug was discontinued.

Adult↗
PubMed1996

Alopecia areata in children: treatment with diphencyprone.

We assessed the efficacy of diphencyprone (DPCP) treatment in a total of 26 children with alopecia areata (AA). Sixteen children had alopecia areata totalis (AAT) and 10 had alopecia areata localis (AAL). DPCP is an absolute contact sensitizer. Twenty-five children could be sensitized with a 2% DPCP solution, whereas one child could not be sensitized. Patients were treated, once a week for at least 3 months, for up to 1 year. Twenty-one of the 25 (84%) children showed hair regrowth to a greater or lesser extent after DPCP treatment. Eight of the 25 (32%) children showed cosmetically acceptable hair regrowth. Cosmetically acceptable regrowth at the end of the study was seen in four of the 15 (27%) children with AAT and in four of the 10 (40%) children with AAL. These results are comparable with those reported in an earlier study in children with AA. Our opinion is that DPCP is a beneficial therapeutic agent in children with severe AAT and AAL showing no spontaneous remission.

Adolescent↗
PubMed1996

[Finasteride: a new drug for the treatment of male hirsutism and androgenetic alopecia?].

Finasteride is a drug which inhibits the transformation of testosterone into its active metabolite, dihydrotestosterone, in the target organs, i.e. the skin, the scalp, the liver and the prostate. In the pathogenic mechanism of hirsutism and androgenetic alopecia, and important role is presumably played by alterations of the mechanisms which transform testosterone into dihydrotestosterone. In some conditions an increase in dihydrotestosterone has been demonstrated, due to increased activity of the enzyme 5 alpha-reductase. The effect of finasteride develops above all at the level of type II 5 alpha-reductase. Recent studies have evaluated the effect of finasteride in patients of both sexes with hirsutism and androgenetic alopecia. In women with various forms of hyperandrogenism, the use of the drug at the doses commonly used for the treatment of benign prostatic hyperplasia seems to have induced a significant reduction in the degree of hirsutism. Furthermore, both in animals and men with alopecia, the drug seems to have led to an increase in the number and an improvement in the shape of the follicles in the anagen phase, and a simultaneous decrease of dehydrotestosterone at the level of the scalp. This study represents a review of the main results obtained over the last two years and reports the prospects which the use of finasteride may have in this context.

Alopecia↗
PubMedDate not supplied

Protection from radiation-induced alopecia with topical application of nitroxides: fractionated studies.

PURPOSE: Hair loss resulting from irradiation of the head and neck or from whole brain irradiation often leads to cosmetic, social, and psychological problems for the radiotherapy patient. Few successful clinical interventions are available. We have shown that nitroxides (stable free radicals) afford radiation protection against single-dose radiation-induced alopecia in a guinea pig model. Here we determine if topical nitroxide application provides protection from fractionated radiation treatment. MATERIALS AND METHODS: Two symmetrical and contralateral areas (3 x 5 cm) of skin on the dorsal trunk of guinea pigs were shaved to a hair length of 0.25 cm. A 2 mL solution containing 70 mg/mL nitroxide (Tempo or Tempol) in 70% ethanol was topically applied to the skin surface of one side; 70% ethanol was applied to the contralateral (control) side 10 minutes before irradiation. Animals were placed in a special jig that held skin without decreasing blood flow to the treatment area and fractionated external beam radiation (7 Gy) was delivered daily for eight fractions over 10 days via a 4 MeV linear accelerator. Alopecia (hair density) was scored weekly for 13 to 14 weeks after radiotherapy, using a standardized reference with respect to hair loss and regrowth in the treatment field. RESULTS: After radiation treatment, dry desquamation and gradual hair loss were observed for both control and nitroxide-treated skin; however, over weeks 4 to 11 postirradiation hair loss was much more pronounced in control animals when compared with nitroxide-treated animals. Hair density measurements for Tempol treatment over weeks 9 to 13 were approximately 75% compared with measurements in controls of approximately 25%. Tempo-treated animals exhibited hair density values of approximately 90% compared with 12% in controls over weeks 11 to 14. Tempol and Tempo treatments resulted in significant radioprotection. Histologic evaluation showed that radiation treatment alone in ethanol controls resulted in a marked decrease in the number of hair follicles and poor development of remaining follicles; however, nitroxide pretreatment resulted in no appreciable decrease in hair follicles and hair follicles appeared mature. This was also observed in unirradiated ethanol controls. Electron paramagnetic resonance studies revealed that topical nitroxide application did not result in measurable systemic concentrations of either drug. CONCLUSIONS: The results of this study suggest that topical application of nitroxides may be useful in a clinical setting to reduce the undesirable toxicity of radiation-induced alopecia.

Administration, Topical↗
PubMed1997

The use of tissue expansion for the treatment of burn scar alopecia.

Tissue expansion is an ideal reconstructive procedure for burn scar alopecia. Donor tissue is generated in situ, allowing for the use of hair-bearing tissue to reconstruct an area of alopecia. The process of tissue expansion results in a redistribution of the remaining hair follicles to replace the area of alopecia.

Alopecia↗
PubMed1997

Increased scalp skin and serum 5 alpha-reductase reduced androgens in a man relevant to the acquired progressive kinky hair disorder and developing androgenetic alopecia.

BACKGROUND: The acquired progressive kinking of scalp hair is a disorder in which affected hairs resemble secondary sexual hairs. Some authors have evoked an androgen-related disorder that heralds the onset of androgenetic alopecia. To verify this hypothesis, we focused our attention on a 23-year-old man who has this unusual disorder, which is progressing toward androgenetic alopecia. Patient's circulating 5 alpha-reductase reduced androgen levels; scalp skin 5 alpha-dihydrotestosterone formation; and trichography, histological, scanning, and polarizing electron microscopy analyses were compared in normal and affected scalp skin areas. OBSERVATIONS: Results of histological and scalp skin 5 alpha-dihydrotestosterone formation analyses and comparison of growth pattern of kinky hair in the affected areas with that of healthy hair were similar to those found in androgenetic alopecia. CONCLUSIONS: No data are available to confirm the presence of a sole entity, even if our arguments support our hypothesis. The confirmation of this tendency warrants further investigation.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1997

Frontal fibrosing alopecia in a postmenopausal woman.

A case is presented of a 52-year-old woman in whom clinical and histopathologic findings suggested cicatricial alopecia. Our patient had an uncommon, but distinctive, clinical presentation. It was characterized by bandlike frontal hair loss. This was recently described as patterned cicatricial alopecia, presented in a recent study as postmenopausal frontal hairline recession with scarring. Our patient's case should be differentiated from recognized forms of scarring alopecia.

Alopecia↗
PubMed1997

[Alopecia areata: diagnostic and therapeutic approach].

Alopecia Areata is a frequent cause of alopecia. This benign pathology can be psychologically very disabling; it is very important to give these patients a good support. The exact aetiology is unknown; there are several hypotheses, but the most likely seems to be the autoimmune mechanism. The importance of the symptoms can vary from a very small bald area to a complete loss of hair and influences the psychological impact, the prognosis and the therapeutic strategy. Several kinds of treatments can be proposed; they should be used in accordance with the type and the extent of the lesion, with the side effects and with the possible associated risk factors. A psychological support can be necessary in the management of an Alopecia Areata.

Algorithms↗
PubMed1998

Transient leucoderma appearing in an untreated area following contact immunotherapy for alopecia areata.

One of the possible unwanted side effects following contact immunotherapy of alopecia areata is skin hypopigmentation, either in the form of a transient, post-inflammatory hypopigmentation or as the development of a persistent, depigmented patch. A case of leucoderma occurring on the forehead of a 16-year-old girl following application of squaric acid dibutylester to the scalp for the treatment of alopecia areata is described. Past medical and family history were negative for vitiligo and autoimmune disorders. The hypopigmented patch was distant from the scalp area where squaric acid dibutylester had been applied, and it was not preceded by any sign of eczema, erythema or itch in the same area. Moreover, it faded as soon as treatment was discontinued. A 4-year follow-up revealed no evidence of vitiligo. In conclusion, the possible occurrence of a transient leucoderma in untreated areas should be included among the side effects of contact immunotherapy of alopecia areata with squaric acid dibutylester.

Adolescent↗
PubMed1998

A practitioner's guide to cancer-related alopecia.

Alopecia due to the side effects of the treatment of cancer is one of the most common and emotionally troublesome effects of cancer therapy. Preventive measures, primarily scalp hypothermia, can be effective in some cases, but the worry of subsequent scalp metastasis remains. Investigative studies in animals are hindered by a poor animal alopecia model. Several promising agents require translation into clinical practice. Until then, disguising the alopecia with wigs, hats, or turbans remains the mainstay of treatment.

Alopecia↗
PubMed1998

Cellular and developmental aspects of androgenetic alopecia.

The hair follicle is a highly complex system that can be investigated at many levels and from multiple perspectives. However, underlying the cyclic production of all hair fibres are a set of common developmental processes. Many current investigations of androgenetic alopecia concentrate on the direct influences of hormones on hair follicles at the cellular or intracellular level. This paper attempts to step back from this and consider the process of terminal to vellus transition in androgenetic alopecia in terms of basic cellular and developmental mechanisms. Ideas about the mechanism and timing of follicle size reduction are put forward, but the paper also tries to point out inherent difficulties in the investigation of androgenetic alopecia and important gaps in current knowledge.

Alopecia↗
PubMed1999

Psychogenic alopecia in cats: 11 cases (1993-1996).

OBJECTIVE: To determine signalment, history, clinical signs, and response to treatment of cats with psychogenic alopecia (PA) and to identify factors associated with its onset and propagation. DESIGN: Retrospective study. ANIMALS: 11 cats. PROCEDURE: A survey was used to obtain information about breed, sex, age at time of weaning, frequency and duration of licking bouts, age at time of onset of PA, situations eliciting licking bouts, results of diagnostic tests, treatment, response to treatment, and current status of the cats. Additional information was obtained from medical records and by telephone conversations with owners and attending veterinarians. RESULTS: Four cats were purebred, and 7 were domestic shorthair. Six were female, and 5 were male; all were neutered. Eight cats were kept exclusively indoors. Age at time of onset of PA ranged from 6 months to 12 years. Environmental stresses initiated or exacerbated PA in 9 cats. Various methods were used to confirm the diagnosis, including therapeutic trials with antidepressant and anxiolytic drugs in 10 cats. All 5 cats treated with clomipramine, 2 of 3 treated with amitriptyline, and 1 of 4 treated with buspirone responded positively. Only 3 cats were still receiving medication at the time of this study; none of those 3 groomed excessively while receiving medication. Psychogenic alopecia resolved in 6 cats after drug treatment, environmental modification, or both. Psychogenic alopecia continued to be a problem in the remaining 2 cats. CLINICAL IMPLICATIONS: Environmental stress may initiate or exacerbate PA in cats. Drug treatment, environmental modification, or both may be useful in treatment of affected cats.

Alopecia↗
PubMed2006

[Alopecia mucinosa].

Epithelial mucinosis (follicular mucinosis) is a reactive histological pattern characterized by the accumulation of mucin in the infundibular, follicular, and sebaceous epithelium, that may occur in multiple skin conditions and cannot be considered a specific disease. Alopecia mucinosa is a clinicopathological entity with distinctive skin lesions, mucin deposits in the hair follicles and periadnexal lymphoid infiltrates. Three types of mucinous alopecia have been described: idiopathic, persistent or benign chronic, and associated to lymphoma. For some authors, these types of mucinous alopecia are not independent diseases, but rather represent variants of mycosis fungoides with epithelial mucinosis.

Adrenal Cortex Hormones↗
PubMed2005

A pilot study evaluating the efficacy of topically applied niacin derivatives for treatment of female pattern alopecia.

BACKGROUND: Female pattern alopecia is a common dermatologic condition that manifests after puberty. The only approved drug treatment for this condition is 2% minoxidil for topical application. AIMS: This pilot study examined the effect of topical application of two niacin derivatives, octyl nicotinate and tetradecyl nicotinate, on hair fullness in female alopecia. PATIENTS/METHODS: Sixty female subjects with Ludwig types I-III female pattern hair loss were evaluated in a double-blinded, placebo-controlled (40 active, 20 placebo) design using standardized 35-mm photographic analyses for assessment of efficacy after 6 months of application. RESULTS: The niacin derivatives demonstrated a statistically significant increase in hair fullness (P = 0.04 compared to the placebo). CONCLUSION: Whereas evaluation of hair growth in women is challenging, this 6-month pilot study demonstrated statistically significant increase in hair fullness on blinded 35-mm photographic analysis. Long-term topical application of nicotinic acid derivatives offers promise for providing benefit in female alopecia and warrants further study.

Journal Article↗
PubMed2025

Comparative Efficacy of Janus Kinase Inhibitors Indicated for Severe Alopecia Areata: A Bayesian Network Meta-Analysis and Matching-Adjusted Indirect Comparison.

Systemic Janus kinase inhibitors (JAKIs) have markedly advanced the therapeutic landscape for alopecia areata (AA). Although baricitinib and ritlecitinib are approved in the United States (US) and Europe, and deuruxolitinib in the US for severe AA, the lack of head-to-head randomized controlled trials (RCTs) limits evidence-based prescribing decisions. Moreover, prior meta-analyses excluded data on certain oral JAKIs or incorporated findings from agents and dosing regimens that were abandoned, investigational, clinically ineffective, or associated with unacceptable safety profiles. To compare the efficacy of oral JAKIs, limited to FDA, EMA, or MHRA approved drugs and doses-baricitinib (2 and 4 mg QD), ritlecitinib (50 mg QD), and deuruxolitinib (8 mg BID)-for severe AA, using advanced indirect comparison methodologies. A systematic review was performed following PRISMA 2020 guidelines (CRD420251116775). Bayesian network meta-analysis (NMA) synthesized data from RCTs reporting Week 24 outcomes on Severity of Alopecia Tool (SALT) ≤ 10 and SALT ≤ 20 thresholds. Multilevel network meta-regression (ML-NMR) evaluated heterogeneity and adjusted for baseline imbalances. Additionally, unanchored matching-adjusted indirect comparisons (MAIC) were conducted using individual patient-level data from THRIVE trials. Surface under the cumulative ranking (SUCRA) values were calculated to rank treatments. Seven RCTs (n = 4560 participants) were included. Deuruxolitinib 8 mg significantly outperformed baricitinib 2 and 4 mg on both SALT endpoints. Differences with ritlecitinib 50 mg were directionally favorable for deuruxolitinib but not statistically significant in NMA and ML-NMR models. MAICs confirmed superior odds for deuruxolitinib versus baricitinib 2 mg (OR = 71.55) and ritlecitinib (OR = 18.27) for SALT ≤ 20. SUCRA rankings also consistently favored deuruxolitinib. Among approved oral JAKIs, deuruxolitinib 8 mg shows the highest short-term efficacy for severe AA. These findings provide preliminary evidence to guide treatment decisions but should be interpreted as exploratory pending confirmation.

Humans↗