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In a study of 24 patients with alopecia areata, scalp biopsies were examined for immunofluorescence; all were negative. A number of other tests also failed to confirm an auto-immune aetiology for this disease. A possible explanation lies in the heterogeneity of alopecia areata, only a small proportion of cases being of the auto-immune type.
Sex hormone binding globulin (SHBG), plasma testosterone and saliva testosterone were measured in sixty-four men with androgenetic alopecia and in forty males within the same age range without alopecia. There was a significant reduction in SHBG levels in bald men, compared with controls. Plasma testosterone levels were not raised in bald men, but their salivary testosterone levels were significantly higher than in controls.
The unit area trichogram was defined in the frontal and occipital areas of ten normal men and ten normal women and the results compared with the findings in ten male and fifteen female patients with androgenic alopecia. The epilation technique provided accurate data of normal hair density (higher than previously reported) and the phases of hair growth. The measurement of hair diameter showed that of 7603 hairs, 1241 were less than 40 microns in diameter, of which only 21 were more than 80 mm in length. Variation in the diameter of individual hair fibres was recorded. The number of hairs less than 40 microns diameter per cm2 of scalp was increased in both men and women with androgenic alopecia. It was concluded that the number of hairs greater than 40 microns in diameter per cm2 (meaningful density) reflected most closely the amount of hair usefully contributing to an individual's clinical appearance.
Mitogen-induced T cell blastogenesis was determined in 47 patients with severe alopecia areata, before and after treatment with topical 5% minoxidil, and compared with control values. The group of 36 responders, who demonstrated terminal hair regrowth, showed significantly increased lymphocyte stimulation with concanavalin A and PHA before treatment, which decreased towards control values following hair regrowth. Lymphocytes from non-responders showed no significant differences from controls either before or after treatment. The results suggest that enhanced T cell blastogenesis may predict the response of severe alopecia areata to topical 5% minoxidil therapy.
Diphencyprone is a potent topical sensitizer, but is non-mutagenic in the Ames test (unlike dinitroclorobenzene) and remains relatively stable in solution (unlike squaric acid dibutyl ester). Seventeen patients with total loss of scalp hair (eight alopecia totalis, nine alopecia universalis) were treated by maintaining on one side of the scalp an allergic contact dermatitis induced by 2,3 diphenylcyclopropenone-I ('diphencyprone'), and on the other side an irritant contact dermatitis using tretinoin gel (Retin A). After 20 weeks, treatment with tretinoin was stopped and diphencyprone was applied bilaterally for a further 10 weeks. Satisfactory regrowth of terminal hair on the scalp was achieved in only one patient. Eyebrow, eyelash and beard regrowth was achieved in one individual whilst in another, moderate, but not cosmetically satisfactory, scalp regrowth took place. In no patient did regrowth take place at tretinoin treated sites until after diphencyprone was substituted.
Twelve children with extensive alopecia areata or alopecia totalis were treated with the contact allergen diphencyprone. The duration of treatment ranged from 5 months to 1 year. Eight of the 12 (67%) regrew scalp hair and in four (33%) there was a complete regrowth. Six months after treatment was discontinued three of the four children with complete regrowth maintained their hair, one had lost all the regrowth and a further child with patchy regrowth at the end of treatment subsequently regrew hair completely while off therapy.
Hair-bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the non-alopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n = 3), while transitional regions consistently showed the presence of activated T-cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CD1 epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T-cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.
A scanning electron microscope was used to compare the distal ends of exclamation mark hairs from alopecia areata patients with the fracture surface of normal hair fibres, mechanically broken by traction. The exclamation mark hairs shows minimal damage to the cuticular cell pattern of the hair shaft. Where the cuticle was absent, cortex and medulla showed low-density features fanning out into a fringe-like structure at the distal ends. The fracture surfaces of normal hair fibres, mechanically broken by traction showed a markedly abnormal cuticular scale pattern, whereas the features of cortical and medullary tissue were normal. These morphological differences between the fracture surface of exclamation mark hairs and normal hair fibres, mechanically broken by traction, may enhance our understanding of the pathogenesis of alopecia areata.
The Dundee experimental bald rat (DEBR) undergoes hair loss associated with the development of peri- and intrafollicular mononuclear cell infiltrates, as occurs in human alopecia areata. We studied the effect of orally administered cyclosporin A (10 mg/kg; 5 days/week for 7 weeks) on established lesional DEBR rats displaying extensive areas of hair loss. New hairs appeared after 10 days and there was simultaneous regrowth of hair over the whole body with restoration of a full pelt by 5 weeks. Semiquantitative histological examination of flank skin biopsies revealed early reduction of the cellular infiltrate associated with conversion of dystrophic anagen follicles to normal, hair-producing follicles. These results confirm the value of the DEBR model of alopecia areata in evaluating existing and new therapies for this disease in humans.
Alopecia areata has been reported in association with various autoimmune diseases. Idiopathic primary hypophysitis is an organ specific autoimmune disease affecting the pituitary gland. We report a case of alopecia areata occurring in a patient of idiopathic primary hypophysitis. The constellation of the two diseases can be explained by autoimmunity, which is a major aetiologic factor in both diseases. To the best of our knowledge, this is the first report of such an association.
BACKGROUND: In some individuals, dandruff may be recurrent and even chronic. This represents a difficult-to-treat condition. Excessive hair shedding and diffuse alopecia may develop. OBJECTIVES: To evaluate the chronobiological aspects of dandruff, hair shedding and alopecia. METHODS: This study was performed in eight men suffering from such a scalp condition. They were examined 40 times at regular intervals for five consecutive years. Hair-density assessments and trichograms were performed at least twice per trimester on the parietal region of the scalp, corresponding to an area where dandruff was present. RESULTS: A positive correlation was found between the percentage of telogen hairs and dandruff severity as assessed by the squamometry index. Bimodal yearly biorhythms were found for dandruff severity, telogen counts and hair loss between two consecutive visits. The chronobiological fluctuations were prominent in some study participants, but remained inconspicuous in others. The biorhythms were almost synchronized in all participants, showing variations over the year. CONCLUSIONS: The biorhythms on the hair cycle in dandruff are not fundamentally different from those previously reported in subjects without dandruff. The periodicity may be an intrinsic feature of human skin.
OBJECT: To evaluate the treatment with cyproterone acetate and ethinyl oestradiol of diffuse androgen-dependent alopecia in women. DESIGN: Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once daily from Day 5 to Day 15) and ethinyl oestradiol (EE2, 30 micrograms once daily from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 micrograms/l. PATIENTS: Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse androgen-dependent alopecia, were enrolled into this study. MEASUREMENTS: Hair variables were assessed initially by the unit area trichogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months. RESULTS: In the treated group, a significant (P less than 0.01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 micrograms/l. However, in the control group a significant (P less than 0.05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established. CONCLUSION: Patients treated with the anti-androgen cyproterone acetate and ethinyl oestradiol respond best when serum ferritin is above 40 micrograms/l.
OBJECTIVE: To determine the frequency of polycystic ovaries (PCO) on ultrasound and the incidence of clearcut endocrine disorders leading to virilization in patients complaining of hirsutism or androgenic alopecia. The major purpose was to determine a coherent policy for the routine biochemical assessment of such women. DESIGN: A prospective study of women attending a joint skin/endocrine clinic complaining of these problems. PATIENTS: Three hundred and fifty consecutive women with hirsutism and/or androgenic alopecia were assessed. MEASUREMENTS: Baseline endocrine screens were conducted on two occasions and included measurement of serum testosterone, androstenedione, dehydroepiandrosterone sulphate, sex hormone binding globulin, LH, FSH, 17-hydroxyprogesterone and PRL. The ovaries were visualized by high-resolution pelvic ultrasound scanning. RESULTS: Eight women were identified with relevant endocrine disorders; of these, one was acromegalic and one had a microprolactinoma--in both cases the association may have been fortuitous. Three had clear-cut 21-hydroxylase deficiency, one a rare hepatic enzyme deficiency (11-reductase), one a virilizing adrenal carcinoma and one a Leydig cell tumour. The latter six cases all had persistently elevated levels of serum testosterone (> 5 nmol/l). In all, 13 women had baseline testosterone levels in excess of 5 nmol/l. Polycystic ovaries were present in 81% of the cases who had erratic cycles and 52% of those with regular cycles; PCO were present in two of the women with 21-hydroxylase deficiency and in the woman with 11-oxoreductase deficiency. The Leydig cell tumour (1.2 cm diameter) was not detected on ultrasound or CT scan. CONCLUSIONS: For the exclusion of enzyme deficiencies and virilizing tumours clinical assessment and a single serum testosterone measurement will suffice.
Alopecia (hair loss) is often singled out as the most distressing side-effect of cancer chemotherapy treatment. This paper provides a comprehensive and critical review of the research literature on scalp cooling, a procedure introduced to prevent chemotherapy-induced alopecia. In spite of a considerable amount of research (both nursing and medical) over a 15-year period, the evidence on scalp cooling is inconclusive. Although concerned with a specialist issue, this paper may interest the general reader as it illustrates the value of a literature review in raising questions about current practice and in identifying issues for future research.
An alopecia and dermatopathy following pelvic fractures associated with vehicular trauma is reported in three cats. The animals presented 3-4 weeks post injury with acute hair loss, glistening appearance of the skin and erosions involving the lower back. Histological examination revealed atrophy of the hair follicles and adnexal structures and follicular telogenization, dermal fibroplasia and mild lymphocytic infiltrate, fibroplasia and inflammation in the panniculus. Vascular damage secondary to the external trauma to blood vessels supplying the skin over the lumbar region and subsequent ischaemia may represent the pathomechanism of this type of alopecia. Focal permanent hair loss can be expected.
An oestrogen receptor pathway that regulates the telogen-anagen hair follicle transition in mice has been described. The purpose of this study was to investigate whether fulvestrant, a pure oestrogen receptor antagonist, would cause hair regrowth in Pomeranian dogs with hair cycle arrest (alopecia X). Eleven Pomeranian dogs with hair cycle arrest were randomly assigned to receive two intramuscular injections of either 10 mg kg(-1) fulvestrant (n = 6) or an equal volume of saline (n = 5) 1 month apart. Complete blood count, chemistry panel, and urinalysis were monitored prior to the first injection and monthly for 2 months. Dogs were evaluated each month for degree of hair growth, percentage of body affected, and quality of new hair growth. Three control dogs received fulvestrant after the completion of the study. In addition, one control dog and one treatment dog received two subcutaneous injections of 20 mg kg(-1) fulvestrant 1 month apart. No dogs that received 10 mg kg(-1) fulvestrant had any evidence of hair regrowth. The control dog that received 20 mg kg(-1) fulvestrant had substantial hair regrowth 1 month after the first injection. No adverse effects from the treatment were noted. Fulvestrant does not appear to be a feasible treatment for dogs with hair cycle arrest (alopecia X) when administered intramuscularly at 10 mg kg(-1). A higher dose of fulvestrant requires more investigation but may be cost-prohibitive.
Topical anthralin application producing a brisk irritant contact dermatitis has been reported to have therapeutic benefit in alopecia areata. A pilot clinical study was undertaken to determine whether topical anthralin application in doses low enough to produce only minimal contact dermatitis would produce a similar therapeutic response. None of the patients in the study received any benefit from this low-dose regimen. If anthralin is of benefit in the therapy of alopecia areata, a significant irritant contact dermatitis is apparently required.
Eleven patients with severe alopecia areata (localized and totalis types) were treated with topically applied nitrogen mustard. Nine patients had terminal hair regrowth; in 7 of the 11 patients, it was cosmetically acceptable. Hair regrowth began approximately 1-2 months after the initiation of therapy. Two patients had an allergic contact dermatitis reaction to the mechloretamine solution; no systemic side effects were seen. During a follow-up period of 12 months, only two patients had a recurrence. These preliminary results indicate that topically applied nitrogen mustard has a significant effect in alopecia areata.