[Diagnostic defects and treatment set-backs in hair disorders]
[Article in French]

Piérard-Franchimont C, Quatresooz P, Piérard GE.

CHU du Sart Tilman et Sauvenière, Service de Dermatopathologie, Belgique.

Abstract
Hair loss, also called hair effluvium is often considered as an ancillary complaint. However, this situation is quite common in both genders. It is part of numerous clinical presentations in internal medicine and dermatology. Obviously, any correlation between a biologic abnormality and hair loss does not prove a relationship of causality. In absence of pathogenic diagnosis and causality criteria, chances are low to control adequately hair effluvium by a treatment given by the whims of fate. In addition, the risk and frequency of therapeutic inertia are increased. When the hair loss is not controlled and/or compensated by growth of new hairs, several types of alopecia inexorably develop.

modified for hair loss treatment blog

N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study.
Grant JE,et al

CONTEXT: Trichotillomania is characterized by repetitive hair pulling that causes noticeable hair loss.. OBJECTIVE: To determine the efficacy and tolerability of N-acetylcysteine in adults with trichotillomania. DESIGN: Twelve-week, double-blind, placebo-controlled trial. SETTING: Ambulatory care center. PATIENTS: Fifty individuals with trichotillomania INTERVENTIONS: N-acetylcysteine (dosing range, 1200-2400 mg/d) or placebo was administered for 12 weeks. MAIN OUTCOME MEASURES: Patients were assessed using the Massachusetts General Hospital Hair Pulling Scale, the Clinical Global Impression scale, the Psychiatric Institute Trichotillomania Scale, and measures of depression, anxiety, and psychosocial functioning...snip... RESULTS: Patients assigned to receive N-acetylcysteine had significantly greater reductions in hair-pulling symptoms as measured using the Massachusetts General Hospital Hair Pulling Scale and the Psychiatric Institute Trichotillomania Scale. Fifty-six percent of patients "much or very much improved" with N-acetylcysteine use compared with 16% taking placebo. Significant improvement was initially noted after 9 weeks of treatment. CONCLUSIONS: This study, the first to our knowledge that examines the efficacy of a glutamatergic agent in the treatment of trichotillomania, found that N-acetylcysteine demonstrated statistically significant reductions in trichotillomania symptoms.

edited for hair loss and hair regrowth blog.
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ACETYLCYSTEINE - HSDB

Distribution of epidermal growth factor receptors in rat tissues during embryonic skin development, hair formation, and the adult hair regrowth cycle.

Green MR, and Couchman JR.

In a previous study a close positive correlation was found between epidermal growth factor (EGF) receptor tissue distribution and areas of potential epithelial cell proliferation. We now report on the binding distribution of EGF, representing the tissue localization of available EGF receptors, during embryonic rat skin development including hair follicle formation and the adult hair growth cycle....snip...Between 17 and 20 days embryonic development, available receptors for EGF are consistently absent from epidermal basal cells overlaying the dermal condensates marking the first stage of hair follicle development. This restricted and temporary loss of EGF receptors above these specialized mesenchymal condensates implies a role for the EGF receptor and possibly EGF or an EGF-like ligand in stimulating the epithelial downgrowth required for hair follicle development. In the anagen hair bulb, receptors for EGF are detected over the outer root sheath and the epithelial cell layers at the base of the follicle and show a correlation with the areas of epithelial proliferation in the hair bulb. During the catagen and telogen phases of the hair cycle, receptors are observed in high numbers on all the undifferentiated or dedifferentiating cells of the degenerating epithelial strand and secondary hair germ. Dermal cells are, in general, less heavily labeled than the basal epithelial cells of skin except for the developing striated muscle (panniculus carnosus) in embryonic skin which is more heavily labeled. The data are discussed in terms of a possible role for the EGF receptor and associated EGF or EGF-like ligands in specific areas of epithelial tissue morphogenesis during embryonic skin maturation, hair follicle development, and hair cycling.

edited for hair loss treatment blog

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Hair loss and hair loss treatment

Redox cell signaling is an important process in hair loss and in hair loss treatment agents.

Surgical treatment of secondary cicatricial Hair loss of scalp and eyebrow.
Hassan AS. wr al

edited for hair loss treatment blog use

Secondary cicatricial alopecia occurs as a result of destruction of hair follicles by scar tissue formed in the scalp and eyebrows. It is a permanent condition and regrowth of hairs in the area is not expected. The purpose of the study was to select the appropriate method for treating cicatricial alopecia. 24 patients were admitted to our hospital during the period from June 2006 to July 2007. They were suffering from acquired cicatricial alopecia affecting the scalp and the eyebrow. Their ages ranged from 6-48 years with mean age 26-25 years. They were treated surgically by total excision of the lesions with direct closure of the defect in ten cases, excision of alopecia with advancement flaps with the aid of scalp expanders in seven cases, scalp reduction through serial excision of alopecia in three cases and excision of alopecia and reconstruction of the hair loss defect by strip composite hair-bearing scalp grafts in four cases. Our results suggest there are three key factors that decide the surgical methods for treating alopecia: size, location and shape. We also discuss and evaluate the various techniques of reconstruction. Good results were obtained in 18 patients.

Dermatoses: common in blacks.
Kenney JA Jr.

Some skin disorders are more common in blacks than in whites or are so rare in whites as to be almost peculiar to blacks. Pigmentary abnormalities, either dark or light spots, often occur in association with inflammatory skin diseases. Curvature of the hair follicle is thought to be at the root of two other painful conditions, pseudofolliculitis of the beard and keloidal folliculitis. Certain hairstyles and treatments are damaging and can even cause hair loss if continued.

Case of baldness treated with pantothenic acid alcohol.

ABIRACHED IA.

PMID: 14879858

Dr Proctor comments: The original paper reporting that pantothenate works some for hair loss treatment

Pattern hair loss is a genetically determined physiological event, the exact mode of inheritance of which is unknown. The shortening of the anagen phase of the hair cycle leads to the consequent increase in the proportion of telogen hairs. Autosomal dominant inheritance with increased penetrance in males had been suggested, but there are reports of multifactorial inheritance as well. The role of androgen along with their interaction with genetic factors is demonstrated in men, but in women baldness is often associated with elevated levels of circulating androgens (e.g. in polycystic ovary disease). In both the sexes, the factor determining androgenic alopecia is the manner in which the follicles of the frontal and vertex region of the scalp react to the circulating androgens. Till date the correlation between testosterone levels and the extent of baldness has not been established. snip

edited for hair loss blog....

Long-term survival of skin allografts in rats treated with topical cyclosporine.
Lai CS, et al

The use of topical cyclosporine (CsA) was studied in skin allografts from Buffalo to Lewis rats. CsA prepared in olive oil and dimethyl sulfoxide was administered in various dosages topically on allografts. Untreated allografts were rejected in 7.4 days but survived for 18. or 40.6 days after 10, 20, or 28 days of topical CsA treatment (10 mg/rat/day), respectively. Long-term graft survival (greater than 100 days) was seen with continuous CsA treatment at 10 mg/rat/day, 10 mg/rat/2 days, and 5 mg/rat/day, as compared with rejection in 13.1 +/- 2.3 and 8.9 +/- 0.9 days with CsA 10 mg/rat/3 days and 5 mg/rat/2 days, respectively. The therapeutic blood level of CsA ranged from 250 to 500 ng/ml. Most grafts were rejected when CsA blood levels fell below 200 ng/ml. Direct administration of topical CsA onto the allografts resulted in longer survival compared with those applied on the normal recipient skin 6 cm distal to the allografts, with both high and low doses. Locally high concentrations of CsA in allografts may play an important role in prolongation of graft survival. Minimal cell infiltration and loss of hair follicles were the main histological features in long-surviving allografts.

Edited for hiar regrowth blod use. cyclosporin sometimes stimulates hair regrowth.

Pronounced perifollicular lymphocytic infiltrates in alopecia areata are associated with poor treatment response to diphencyprone.
Freyschmidt-Paul P, et al

Some authors have reported that severe destruction of follicular structures and even scarring patterns occur in those patients with hair loss due to alopecia areata (AA) who fail to respond with regrowth to treatment with contact sensitizers, such as diphencyprone (DCP). Other studies, however, gave contradictory results. Therefore, we re-examined histopathological changes in scalp samples obtained from 85 patients with severe hair loss before initiation of DCP treatment (40 responders and 45 non-responders in terms of hair regrowth). The following parameters were evaluated: i) perifollicular lymphocytic infiltration; ii) perifollicular fibrosis, and iii) miniaturized hair follicles. No difference between responders and non-responders could be observed in the degree of miniaturization of hair follicles and proliferation of perifollicular fibrous tissue. In neither group was there any evidence of scarring or severe follicular destruction. 18 non-responders who did not regrow hair but only 6 responders to hair loss treatment showed a very dense perifollicular lymphocytic infiltration. In contrast, a particularly scarce infiltrate was seen in 9 non-regrowers and in 19 responders. We conclude that non-responders tend to have pronounced inflammatory reactions with dense perifollicular lymphocytic infiltrates.

Demodectic mange in a tamarin.
Hickey TE, et al

A young female tamarin (Saguinus geoffroyi) developed erythema, hai rloss , and papule formation on the skin of the limbs, tail, and head. Examination of skin scrapings and a biopsy specimen revealed mites identified as Demodex sp. Histologically the mites were found in hair follicles, and they were associated with focal degenerative and inflammatory changes in the skin. Successful treatment included topical application of 1% ronnel solution and rotenone ointment.