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Alopecia: diagnosis and management.

Hair loss is a common problem that may affect both males and females in all age groups. Although androgenetic alopecia (common baldness) is the most frequently occurring type of hair loss, hair loss can result from a variety of local and systemic conditions. A detailed history, complete physical examination and directed use of laboratory tests are indicated in making the diagnosis. Specialized tests such as "hair pluck" and scalp biopsy may also be required. Treatment is focused on removing the cause of secondary hair loss, patient education and specific interventions for individual types of alopecia. All treatment strategies should address the significant cosmetic and psychologic impact of hair loss.

Alopecia↗

[Madarosis and alopecia areata of eyelashes].

We presented the clinical features of a 9-year-old girl and a 52-year-old man with alopecia areata of eyelashes. Alopecia areata refers to the idiopathic lesions of the eyelashes and is generally classified as being partial, total or universal.

Alopecia Areata↗

[Lithium-associated alopecia].

A 39-year-old woman who developed alopecia shortly after treatment with lithium carbonate was initiated is described. The alopecia resolved 2 months after lithium was discontinued. Though this side-effect is relatively rare, we suggest that patients getting lithium for short or long term treatment be monitored for it.

Adult↗

[Diffuse alopecia].

Diffuse alopecia is a clinical entity with a diversified aetiology, that allows to distinguish from circumscribed or cicatricial alopecia or male baldness. It may be explained by several causes: endocrinological, andrological or thyroid dysfunction, pharmacological treatment or side effects of a drug, microbial infection, etc. Its treatment falls under three groups: hormonal (cyproterone), vitamin (B5, B8), amino acids (cystine) or local (minoxidil, progesterol). Its diagnosis, confirmed by biological tests, trichograms and biopsies, is indispensable for the treatment to be applied and its duration.

Acute Disease↗

The transversely sectioned scalp biopsy specimen: the technique and an algorithm for its use in the diagnosis of alopecia.

The discussion of the transverse section scalp biopsy specimen technique review of the microanatomy of the scalp in transverse section, and algorithm outline hopefully will be a useful starting point for the dermatopathologist and dermatologist interested in exploring the potential of this technique in the diagnosis of alopecia. These procedures are not without limitations and further refinements are essential, but they can be a valuable aid in the diagnosis of alopecia.

Algorithms↗

The development of an oncology alopecia wig program.

Many of the physically uncomfortable side effects of chemotherapy are well controlled today, but little has been addressed about the emotionally devastating effects of alopecia. In 1991, The Moses H. Cone Memorial Hospital developed an Oncology Alopecia Wig Program that provides emotional support and teaches selection of and care of wigs.

Alopecia↗

[Study on preventing alopecia caused by chemotherapy with cold pillow compresses].

Thirty cancer patients were studied by using cold pillow compress to prevent alopecia resulting from chemotherapy. The result indicated that persistent use of cold pillow compress, which made the patients comfortable, could reduce the hair follicles inhibition or damage which caused by chemotherapeutic agents. So alopecia can be prevented or decreased.

Alopecia↗

A comparison of the culture and growth of dermal papilla cells from hair follicles from non-balding and balding (androgenetic alopecia) scalp.

Male pattern baldness is a common, androgen-dependent skin problem in adult men which is not well understood, although androgens are believed to act on the hair follicle via the mesenchyme-derived dermal papilla situated in the middle of the hair follicle bulb. Since dermal papilla cells retain specific characteristics in culture, such as hair-growth promoting ability and appropriate features of the mechanism of androgen action, dermal papilla cells from follicles undergoing androgen-stimulated miniaturization may provide a useful in vitro model system. Therefore, dermal papilla cells have been derived from intermediate follicles from balding and nearly clinically normal sites of men with androgenetic alopecia. Balding dermal papillae were much smaller than non-balding ones and grew much less well under normal growth conditions. Supplementing the medium with human serum, rather than fetal calf serum, increased both the yield of established cultures and the number and health of the dermal papilla cells produced. Non-balding cells also grew faster in human serum. Balding cells retained the normal fibroblastic shape and aggregative behaviour of dermal papilla cells, but always grew less well than non-balding cells. Nearly clinically normal dermal papillae were similar, or slightly smaller, in size to non-balding ones, but their growth resembled balding cells. Since balding dermal papilla cells can be cultured, though with much greater difficulty than nonbalding ones, and exhibit differing growth characteristics to non-balding cells, they merit further investigation which may increase our understanding of, and ability to control, androgenetic alopecia.

Adult↗

Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months' follow-up.

Forty-eight patients (23 male, 25 female) with severe alopecia areata were sensitized and treated with topical diphencyprone. Thirty-eight per cent of the subjects had good regrowth of hair at a mean follow-up period of 30.8 months. The presence of nail changes, a personal history of atopy and a long duration of alopecia had an adverse prognostic effect.

Administration, Cutaneous↗

[Testing the significance of psychic factors in the etiology of alopecia areata. II. Examination of personality by means of Eysenck's Personality Inventory (MPI) adapted by Choynowski].

We evaluated the role of psychic factors in the etiopathogenesis of alopecia areata on the basis of Eysenck's Personality Inventory adapted by Choynowski. 55 patients were tested (28 women and 27 men). The control group consisted of 50 volunteers. The analysis of the results showed that the neurotic type of personality was predominant in the group of patients (43.64%). Neurotic personality found in such a high percentage of the patients with alopecia areata may be an additional element in the group of psychic factors that possibly have some influence on the development of the disease.

Adult↗

[Psychic factors in case histories of patients with alopecia areata--preliminary report].

We tested the significance of psychic factors in the etiopathogenesis of alopecia areata. We analysed the patient on the basis of a detailed examination based on the case history, including important events in his/her life, personality traits, serious events and the loss of emotional attachment. General important events happened to 80% of the patients, personality traits able to cause the disease were present in 73%, serious events in 62% and the loss of emotional attachment was also found in 62% of the patients. We tested 60 patients (31 women and 29 men). The evidence obtained from the detailed examination based on case histories indicated significantly frequent occurrence of the psychic factors preceding the occurrence of alopecia areata.

Adult↗

A flowcytometric study of CD4+ & CD19+ cell lymphopenia in patients with alopecia areata.

Twenty five patients with alopecia areata and 20 healthy controls were studied by flowcytometry employing direct two colour immunofluorescence in erythrocyte lysed whole blood. A significant reduction was observed in helper/inducer (CD4+) lymphocytes (29.4 +/- 7.4 vs 39.45 +/- 8.0, P < 0.01) and B (CD 19+) lymphocytes (11.04 +/- 6.57 vs 15.0 +/- 5.05, P < 0.01) in comparison with healthy controls. Decrease in T-lymphocytes (CD3+) and suppressor/cytotoxic (CD8+) was not significant and activated (HLADR+) lymphocytes and natural killer cells (CD16+ and CD56+) were within normal limits. Our findings suggest a significant T helper (CD4+) and B (CD19+) cell lymphopenia in alopecia areata.

Adolescent↗

Hair growth modulation by topical immunophilin ligands: induction of anagen, inhibition of massive catagen development, and relative protection from chemotherapy-induced alopecia.

Selected immunophilin ligands (IPLs) are not only potent immunosuppressants but also modulate hair growth. Their considerable side effects, however, justify at best topical applications of these drugs for the management of clinical hair growth disorders. Therefore, we have explored hair growth manipulation by topical cyclosporin A (CsA) and FK 506 in previously established murine models that mimic premature hair follicle regression (catagen) or chemotherapy-induced alopecia, two major pathomechanisms underlying human hair loss. We confirm that topical CsA and FK 506 induce active hair growth (anagen) in the back skin of C57BL/6 mice with all follicles in the resting stage (telogen) and show that both IPLs also inhibit massive, dexamethasone-induced, premature catagen development in these mice. Furthermore, we demonstrate that CsA and FK 506 provide relative protection from alopecia and follicle dystrophy induced by cyclophosphamide, possibly by favoring the dystrophic anagen pathway of follicle response to chemical damage. Although it remains to be established whether these IPLs exert the same effects on human hair follicles, our study provides proof of the principle that topical IPLs can act as potent manipulators of clinically relevant hair-cycling pathomechanisms. This strongly encourages one to explore the use of topical IPLs in the management of human hair growth disorders.

Administration, Topical↗

Cronkhite-Canada syndrome: report of two cases, biopsy findings in the associated alopecia, and a new treatment option.

Two patients with Cronkhite-Canada syndrome (CCS) are reported, both of whom had diffuse alopecia, nail and skin changes, gastrointestinal polyposis, diarrhea, and wasting. A scalp biopsy was performed in one patient, and the specimen showed a marked noninflammatory loss of follicular units, miniaturization of the hair shafts, markedly dilated follicles, and a heavy deposition of glycosaminoglycans in the reticular dermis. This patient responded to prednisone therapy. The other patient was found to have elevated gastric acid levels and responded to ranitidine therapy. The conditions of both patients are now in remission two and six years later, respectively. Our patients have shown a temporally related remission of disease during treatment with prednisone and ranitidine, suggesting that each agent may be effective in CCS. However, randomized placebo-controlled trials are needed to prove the efficacy of these therapies. Further investigation of the histopathologic features of the associated alopecia may determine its cause.

Aged↗

[Thymopentin in alopecia areata].

Alopecia areata is a common cause of hair loss which leads to localized bald areas predominantly on the scalp. Etiological factors are not clear yet, but it is generally considered as a consequence of an autoimmune process. Histological findings revealed perifollicular infiltration of T-cells and antigen-presenting cells. Autoreactive T-cells are reported to amplify this abnormality by interacting with follicular epithelium. There is no effective treatment available at the moment. We report on a 53-year old climacteric woman who developed a bald lesion on her scalp spontaneously in november 1995. Alopecia areata was documented before and after therapy. Treatment with thymopentin 50 mg subcutaneously was offered successfully for 10 weeks, while continuing hormone replacement therapy. Other therapeutical strategies did not proof to be successful before.

Adjuvants, Immunologic↗

Vitamin D-dependent rickets type II: extreme end organ resistance to 1,25-dihydroxy vitamin D3 in a patient without alopecia.

Vitamin D-dependent rickets type II (VDDR II) is a rare syndrome resulting in severe rickets and is resistant to treatment with vitamin D and its derivatives. Patient with this disease, who are frequently the children of consanguinous marriages, present with elevated circulating concentrations of 1,25-dihydroxy vitamin D, the active metabolite of vitamin D, and in vitro studies have indicated a failure of intracellular binding of the hormone. Alopecia has been noted in many of these patients and it has been suggested that this feature may indicate a more marked resistance to treatment. However we describe a 3-year-old boy with this disease who, although having normal hair growth, displayed extreme resistance to treatment with active vitamin D metabolites. In vitro studies of skin fibroblasts disclosed not only an absence of hormone binding or 1,25(OH)2D3-induced 24-hydroxylase activity but reduced metabolism of 1,25(OH)2D3 itself. In this child, treatment with exogenous 1,25-dihydroxy vitamin D3 at doses of up to 24 micrograms/day, which increased the circulating concentration of the metabolite to greater than 100 times the normal adult mean, failed to alleviate his condition and he died at the age of 39 months. This would therefore suggest that absence of alopecia, in this condition, cannot be regarded as a constant predictive sign of a lesser resistance and of responsiveness to Vitamin D treatment.

Calcitriol↗

Endocrine alopecia in a miniature poodle.

Hypothyroidism and concurrent sex hormone imbalance associated with alopecia was diagnosed in a 5 year-old entire male Miniature Poodle. The dog had a 3-year history of alopecia, seborrhoea and recurrent superficial pyoderma. Abnormal thyrotropin releasing hormone stimulation test results supported a diagnosis of hypothyroidism. Partial hair regrowth occurred after interstitial cell tumours, which were present in both testicles, were removed by castration. Complete hair regrowth, however, occurred only after thyroid hormone supplementation. This case highlighted difficulties which may be encountered when interpreting serum hormone concentrations and endocrine function tests.

Journal Article↗

Linear alopecia mucinosa along Blaschko lines.

We present a case of linear reversible non-inflammatory alopecia mucinosa in a 25-year-old Nigerian patient. The patient exhibited an arciform bald patch on the scalp and follicular mucinosis in both lesions. The possible relationships between the unusual linear arrangement of alopecia mucinosa along Blaschko's lines and lichen striatus are discussed.

Adult↗