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PubMed1980

Antigenic competition as a therapeutic concept for alopecia areata.

Alopecia areata can be treated effectively by topical application of potent contact allergens. To explain the response, the following hypothesis is presented. Alopecia areata is considered an autoimmune disease. The characteristic peribulbar round cell infiltrates probably reflect a cell-mediated immune reaction to some hair-associated antigen. With the elicitation of contact allergy, a second antigen is introduced at the same site. The infiltrates of the allergic contact dermatitis contain suppressor T cells and suppressor macrophages which, in terms of local immunoregulation, exert a nonspecific inhibitory effect on the immune response against hair follicles. Regrowth of hair would be due to a change in the local balance between helper and suppressor cells. In conclusion, the phenomenon of antigenic competition is proposed as a therapeutic concept.

Alopecia Areata↗
PubMed1989

Rickets with alopecia-remission following a course of 1-alpha-hydroxy vitamin D3 therapy.

A child is described with rickets and alopecia who did not respond to high doses of vitamin D3 but who responded to a small dose of 1-alpha-hydroxyvitamin D3. Treatment was continued for 2 years and then stopped. She has not shown any signs of relapse 1 year after stopping treatment. Her alopecia, however, has remained unchanged. One year after stopping treatment, her serum 25-hydroxycholecalciferol and parathormone levels were within normal limits but serum 1,25-dihydroxycholecalciferol was elevated.

Alopecia↗
PubMed1978

[The histodynamic of alopecia areata in the dependence on the griseofulvin-induced epithelial proliferation (author's transl)].

The histodynamic of the alopecia areata--without or with the medicamentous induction of the hair growth respectively--was investigated comparatively. 1. Griseofulvin induced an epithelial proliferation in alopecia areata, which is noticeable in the surface epithelium as well as in the follicular epithelium. 2. Under the influence of griseofulvin a deeper penetration of the follicles into the fatty tissue--in connexion with a cutan-subcutaneous volume increase--results; at the same time the supra- and infraseboglandular follicular areas are lengthened. 3. The matter for discussion is that these epithelial changes originate from an increase of metabolic activity or blood supply respectively in the adjacent cutan- and subcutaneous tissue.

Alopecia Areata↗
PubMed1990

Protection from ifosfamide-induced alopecia by topical thiols in young rats.

An animal model for testing substances that might prevent alopecia induced by oxazaphosphorines has been developed. It is based on the fact that the rat pups experience virtually total hair loss following administration of oxazaphosphorines. Using this model, we showed that epicutaneous treatment with sodium thioglycollate prevented ifosfamide-induced hair loss on the treated area. These experiments indicate that prevention of oxazaphosphorine-induced alopecia in man may be achieved by topical thiols.

Administration, Cutaneous↗
PubMed1990

Mitomycin C and mitoxantrone chemotherapy for advanced breast cancer: efficacy with minimal gastrointestinal toxicity and alopecia.

In an attempt to examine the possibility of decreased toxicity in patients with advanced breast cancer who had not previously received chemotherapy, 33 women were given combination chemotherapy consisting of mitomycin C (10 mg/m2) every 6 weeks and mitoxantrone (6 mg/m2) every 3 weeks. The patients had predominantly visceral disease and received a median of two cycles of therapy. Of the 32 evaluable subjects, 15 (47%) achieved a partial response lasting a median of 7 months. Hematological toxicity was generally mild, although there were two episodes of sepsis. One patient developed hemolytic-uremic syndrome, and one subject developed pulmonary fibrosis, both presumably attributable to treatment with mitomycin C. Another patient died of hepatic failure (hepar lobatum). Thus, there were five patients who sustained life-threatening toxicities; this may have been due to the poor performance status and advanced age of some of the patients. Gastrointestinal toxicity and alopecia were minimal. Patient acceptance was high and there was an improvement in symptomatology in the majority of patients. In conclusion, mitomycin C and mitoxantrone chemotherapy is an active drug combination for the treatment of advanced breast cancer that seldom causes significant distressing gastrointestinal side effects or alopecia; however, the duration of response to this regimen appears to be shorter than that obtained with either cyclophosphamide - methotrexate - 5-fluorouracil (CMF) or cyclophosphamide - Adriamycin - 5-fluorouracil (CAF) combination chemotherapy.

Alkylating Agents↗
PubMed2004

[Androgenetic alopecia].

Androgenetic alopecia is the most common form of hair loss in men and women. Although the clinical manifestations are different in men and women, the pathogenetic pathways leading to this type of hair loss are similar in both sexes. In short genetically predestined hair follicles show an increased sensitivity to androgens. In recent years, much new data concerning the pathophysiology, management and therapy of androgenetic alopecia has been gathered. This article gives a critical overview of these new findings and assesses their practical relevance.

Alopecia↗
PubMed1999

[Pathogenetic significance of 5-alpha reductase isoenzymes for androgenetic alopecia].

Androgenetic alopecia is the most common form of hair loss in men and women. Although clinically different, the pathogenetic pathways leading to this type of hair loss are similar in both sexes. Recent experimental data enable us to explain some pathogenetic steps suggesting a pivotal role of type 2 5 alpha-reductase in the pathogenesis of androgenetic hair loss. In this review our current knowledge about the pathophysiology and treatment options of androgenetic alopecia is summarized.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMedDate not supplied

Aesthetic reconstruction of burn alopecia by using expanded hair-bearing scalp flaps.

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a "sideburn" scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.

Adolescent↗
PubMed2004

Histological features of peripilar signs associated with androgenetic alopecia.

BACKGROUND: A study of the scalp in a large cohort of volunteers with androgenetic alopecia using macrophotographs showed the presence of peripilar signs (PPS) around the hair ostia. OBJECTIVE: The aim of the present study was to establish the histopathological features related to PPS. DESIGN: Prospective clinicopathological study. SETTING. Department of Dermatology, University Hospital of Bologna. PATIENTS: A group of 40 patients (21 males and 19 females) participated in the study. Macrophotographs of the scalp were taken using a Dermaphot camera and PPS were scored using a three-point scale. Hair density and PPS were clinically scored according to reference scales. Two punch biopsies from the photographed area were obtained from each subject and histological analysis was performed on vertical and horizontal sections. OBSERVATIONS: Clinical parameters indicated that PPS were already detectable on scalp with high hair density. Moreover, in patients with high hair density (score >4), a significant relationship was found between the PPS score and the global score for perifollicular infiltrates. Thus PPS are linked to superficial perifollicular lymphocytic infiltrates in early androgenetic alopecia. CONCLUSIONS: PPS could be the clinical signs reflecting the presence of perifollicular infiltrates.

Adult↗
PubMed2006

Induction of cellular immunity against hair follicle melanocyte causes alopecia.

Alopecia areata (AA) is generally regarded as an organ-specific autoimmune disease. Although it has been hypothesized that the autoimmunity is mediated by T cells and that hair follicle melanocyte is one of the targets, definitive evidence is lacking. We here demonstrate that AA-like lesions can be induced in mice by inducing CD8(+) T-cell-mediated immunity to hair follicle melanocytes. We found that hair loss was induced in mice-bearing interleukin-12-producing B16 melanoma cells by the depletion of CD4(+) T cells, accompanied by vitiligo-like coat color change. The alopecic lesions varied in size from pachy to extensive. In many instances, hair loss developed and was followed by the regrowth of white hairs. Histological analysis revealed that mononuclear cells infiltrated in and around the bulb region of hair follicles. Furthermore, immunohistochemical examination clearly showed the intra-follicular infiltration of CD8(+) T cells. Neither the vitiligo-like coat color nor AA-like lesions were induced when CD8(+) T cells were codepleted. These observations indicate that the induction of CD8(+) T-cell-mediated immunity against hair follicle melanocytes causes alopecia. It is thought that there are many types of AA with different mechanisms, targets etc. Although hair follicle melanocytes have long been thought to be one of the targets of AA, evidence to support the hypothesis is sparse. Therefore, we believe that our observation is significant to support the hypothesis.

Alopecia↗
PubMed2006

In vivo levels of IL-4, IL-10, TGF-beta1 and IFN-gamma mRNA of the peripheral blood mononuclear cells in patients with alopecia areata in comparison to those in patients with atopic dermatitis.

Alopecia areata (AA) has been considered to be supported by an aberrant expression of IFN-gamma as a result of antigen dependent immune response. On the other hand, AA sometimes concurs with atopic diseases, although the mechanism of the concurrence is not clear. This study was designed to elucidate the immune status of AA and the similarity between AA and atopic dermatitis (AD) by analysis of in vivo levels of mRNA of Th1, Th2, and suppressive cytokines of peripheral blood mononuclear cells (PBMC). Using semiquantitative RT-PCR, the levels of cytokine mRNA were measured in freshly isolated PBMC of 47 patients with AA, 15 patients with AD, and 12 healthy controls (HC). The levels of IL-4, IFN-gamma, and TGF-beta1 mRNA were lower in patients with AA than those in HC. The levels of IL-10 mRNA in AA were comparable with those in HC. Decreased levels of IFN-gamma and TGF-beta1 were also shown in patients with AD. These results indicated a similarity (decreased levels of IFN-gamma and TGF-beta1) between AD and AA based on the cytokine profile. In addition, decreased levels of IL-4 mRNA in AA might also explain the experience that the severity of atopic disease coincident with AA is mild in the most of cases. Next, we compared the levels of these cytokine mRNA among the three subgroups of AA that were categorized based on the severity of the symptoms: mild, severe and totalis. Although there was no significant difference between any combinations of the subgroups, there was a tendency to increase the levels of IFN-gamma mRNA and to decrease the levels of IL-4 mRNA according to the severity of alopecia. However, the levels of IFN-gamma mRNA in any subgroups were less than those of HC. These results suggest that IFN-gamma is therefore involved in the pathogenesis of AA, although the information from PBMC is limited. In conclusion, AA might be induced by an aberrant expression of IFN-gamma in individuals whose PBMC produce low amounts of IFN-gamma and TGF-beta1. Further analysis is therefore required to investigate the phenotypes of the population in PBMC with or without reference to regulatory T cells.

Adolescent↗
PubMed2003

Alopecia congenita universalis, microcephaly, cutis marmorata, short stature and XY gonadal dysgenesis: variable expression of El-Shanti syndrome.

UNLABELLED: Alopecia congenita, laryngomalacia, and XY gonadal dysgenesis has been reported recently as a new syndrome in two unrelated Arab families from Jordan. We report a 4-year-old girl of first cousin Arab parents who had alopecia, microcephaly, cutis marmorata, short stature and borderline cognitive development. Karyotype analysis revealed a male constitution (46,XY) with no deletion of STSor SRY. She showed entirely normal female external genitalia and absence of female internal genitalia. Histological examination of the very small testicles found on laparascopy showed developed spermatic cords and paratesticular tissue with no testicular parenchyma, no Sertoli or Leydig cell development, and no seminiferous tubular development. Hormonal profile was that of a normal female child. Southern blotting and PCR assays showed an intact Y chromosome. Limited sequencing of the SRYgene revealed no mutations. CONCLUSION: this patient, together with the recently reported consanguineous families, represent a previously unrecognised autosomal recessive trait with pleiotropic effects including XY gonadal dysgenesis.

Abnormalities, Multiple↗
PubMed2003

Notch4, a non-HLA gene in the MHC is strongly associated with the most severe form of alopecia areata.

Alopecia areata (AA) is a disorder primarily affecting the hair and nails in which associated autoimmune or atopic disease is common. Genetically, it is a complex trait with evidence of a role for genes of the major histocompatibility complex (MHC), the interleukin-1 cluster and chromosome 21 in the pathogenesis. The strongest association is with HLA class II alleles, although whether this indicates a direct contribution to the pathogenesis or results merely from linkage disequilibrium with nearby disease genes is unknown. Notch4 is a recently defined gene in the HLA class III region. Notch signalling is a direct determinant of keratinocyte growth arrest and entry into differentiation. A possible role for Notch in hair growth has been indicated by transgenic mouse findings that activation of the Notch pathway in the hair cortex leads to aberrant differentiation of adjacent hair-shaft layers. Notch4 is therefore a plausible candidate gene for AA. We have examined two polymorphisms in the coding sequence of the Notch4 gene at positions +1297 and +3063 in a case-control study of 116 AA patients and 142 ethnically matched, healthy control subjects. The initial analysis showed a significant association of AA in the overall data set with the Notch4(T+1297C) polymorphism (P<0.001) but not with Notch4(A+3063G). To confirm this association, we genotyped an additional 62 patients and found that the risk for disease was higher in Notch4(+1297C) homozygotes [odds ratio (OR) 3.43 (1.63, 7.19)] than in heterozygotes [OR 2.58 (1.57, 4.24)]. On classifying the patients by severity of disease, the association appeared to be confined to the severest form (alopecia universalis) [OR 4.02 (1.64, 9.88), P=0.0014]. These results support previous findings showing that different HLA susceptibility alleles are associated with mild and severe AA.

Alleles↗
PubMed2004

Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches.

Despite advances in the treatment of many side effects associated with chemotherapy, alopecia remains an issue that is difficult to resolve. Chemotherapy-induced alopecia (CIA) is a condition that can have profound psychosocial and quality-of-life consequences, resulting in anxiety, depression, a negative body image, lowered self-esteem, and a reduced sense of well-being. Patients who fear CIA may sometimes select regimens with less favorable outcomes or may refuse treatment. When supporting patients with CIA, health care providers should use an individualized approach with a focus placed on the actual moment of hair loss. Education, support groups, and self-care strategies are important components of any management approach. No treatment modality for preventing CIA has been clearly shown to be effective. Recent evidence suggests that new scalp hypothermic regimens may be safe and effective. There remains a critical need for effective new approaches to this problem.

Alopecia↗
PubMed1984

1,25-Dihydroxyvitamin D resistance, rickets, and alopecia.

Two unrelated kindreds with four affected children having 1,25-dihydroxyvitamin D resistance, rickets, and alopecia are described. The children exhibited early onset of severe rickets with hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and secondary hyperparathyroidism. Radiography showed diffuse demineralization and classic changes of rickets. All affected children had total-body alopecia. Serum levels of 1,25-dihydroxyvitamin D3 were elevated and rose to extremely high values during treatment, with no apparent change in the mineral disorder. However, secondary hyperparathyroidism and hypophosphatemia did remit during treatment despite persistently low calcium levels. Skin biopsy was performed in the parents and affected children in one kindred. Analysis of 1,25-dihydroxyvitamin D3 receptors in cultured fibroblasts indicated apparent normal receptors in the parents and undetectable receptors in both affected children. After long periods of treatment with vitamin D metabolites and mineral replacement, healing took place in the older child in each kindred. These data suggest that the healing occurred spontaneously as the children reached seven to nine years of age rather than as a result of the treatment. The biochemical lesion in these children appeared to be a genetically transmitted defect in the 1,25-dihydroxyvitamin D3 receptor. The mechanisms by which healing was initiated and maintained remain to be elucidated.

Alopecia↗
PubMed1986

Tissue expansion in the treatment of alopecia.

During the period December, 1983 to August, 1984, 14 patients were treated for alopecia of the scalp using tissue expansion in the Northern Ireland Plastic and Maxillo-Facial Service. Nine of the defects were due to burns. Representative case reports are presented and the planning of advancement and rotation flaps described. The management and prevention of complications are discussed, and the conclusion drawn that tissue expansion is a valuable technique in the treatment of alopecia, allowing reconstruction of defects previously beyond adequate surgical repair.

Adolescent↗
PubMed1993

Ulcerative colitis and total alopecia in a mother and her son.

Extraintestinal autoimmune disorders are associated with ulcerative colitis in selected patients and lend support to the theory of immune-mediated injury in inflammatory bowel disease. Rarely, alopecia areata has been associated with ulcerative colitis, and familial aggregation and an HLA association have been reported for both disorders. The occurrence of both alopecia and ulcerative colitis in a mother and son are reported with a detailed investigation of antineutrophil cytoplasmic antibodies and HLA alleles in this family. Treatment with the immunosuppressive agent cyclosporine proved beneficial in the child leading to remission of the ulcerative colitis and nascent growth of scalp and body hair.

Adult↗
PubMed1990

Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil.

Thirty-one men with androgenetic alopecia completed 4 1/2 to 5 years of therapy with 2% and 3% topical minoxidil. Hair regrowth with topical minoxidil tended to peak at 1 year with a slow decline in regrowth over subsequent years. However, at 4 1/2 to 5 years, maintenance of nonvellus hairs beyond that seen at baseline was still evident. Topical minoxidil appears to be effective in helping to maintain nonvellus hair growth in men with androgenetic alopecia.

Administration, Cutaneous↗