Abstracts
Androgen
Androgen
Some degree of hair loss with aging is inevitable in both men and women.
Balding tends to begin earlier in men and to develop in well-recognized patterns. Women have more diffuse hair loss that often occurs after menopause.
The available treatment options, such as topical minoxidil therapy, hair transplantation, and other surgical techniques, are not very successful. Lessening patients' anxiety about hair loss by reassuring them that they will not go totally bald immediately may be the most effective management.
Rubin MB: Androgenetic alopecia. Battling a losing proposition. Postgrad Med, 1997 Aug, 102:2, 129-31, 136.
Clinical Updates
Clinical Updates
It is now known that there are major differences in the systemic and cellular mechanisms that mediate hair loss in women versus men. The severity or degree of hair loss in women with androgenetic alopecia is usually much less than in men. It is usually assumed that the hormonal basis for androgenetic alopecia in women is the same as in men; that is, the same target tissue-active androgens, testosterone and dihydrotestosterone, are being produced systemically to aggravate scalp hair follicles, resulting in hair loss.
Research findings indicate that levels of androgen-metabolizing enzymes and receptors differ in the scalps of women versus men, which may be important in formulating more effective hair growth treatments in the future.
Sawaya ME: Clinical updates in hair. Dermatol Clin, 1997 Jan, 15:1, 37-43.
Coronary Heart Disease(Baldness)
Coronary Heart Disease
Assessed the relation between the extent and progression of baldness and coronary heart disease. Baldness was assessed twice, in 1956 and in 1962, in a cohort of 2,017 men from Framingham, Massachusetts. Extent of baldness was classified in terms of number of bald areas: no areas bald (n = 153), one area bald (n = 420), two areas bald (n = 587), and all areas bald (n = 857).
The cohort was followed for up to 30 years for new occurrences of coronary heart disease, coronary heart disease death, cardiovascular disease, and death due to any cause.
Extent of baldness was not associated with any of the outcomes. However, the amount of progression of baldness was associated with coronary heart disease occurrence, coronary heart disease mortalit, and all-cause mortality. Rapid hair loss may be a marker for coronary heart disease.
Herrera CR et al., Baldness and coronary heart disease rates in men from the Framingham Study. Am J Epidemiol, 1995 Oct 15, 142:8, 828-33.
Gastrointestinal Malignancy
Gastrointestinal Malignancy
Nail abnormalities may be markers of non-dermatologic disease. We present a case in which pronounced pincer nails and universal alopecia developed in association with a metastasising adenocarcinoma of the sigmoid colon.
This association represents a new ectodermal paraneoplastic syndrome.
Jemec GB & Thomsen K: Pincer nails and alopecia as markers of gastrointestinal malignancy. J Dermatol, 1997 Jul, 24:7, 479-81
Glutathione (Baldness)
Glutathione
Investigated the contribution of reactive oxygen species to the development of sebaceous gland hyperplasia and the characteristics of the glutathione S-transferase/glutathione system in male pattern baldness.
In comparison with the hairy occipital-donor areas, the following results were obtained in alopecic frontoparietal samples:
glutathione S-transferase-specific activity increased 7-fold;
enzyme affinity towards 1-chloro-2,4-dinitrobenzene decreased 2-fold;
glutathione content decreased 2.5-fold; and
thiobarbituric acid reactive substances increased 2-fold.
Results support the hypothesis that reactive oxygen species are involved in the pathogenesis of sebaceous gland hyperplasia in male pattern baldness.
Giralt M; et al., Glutathione, glutathione S-transferase and reactive oxygen species of human scalp sebaceous glands in male pattern baldness. J: J Invest Dermatol, 1996 Aug, 107:2, 154-8
Hair Loss
Hair Loss
As humans have evolved our hair has diminished to the point of being vestigial, yet it has assumed enormous psychological and social importance.
For many, hair loss is synonymous with ageing, loss of attractiveness and desirability and has the potential to undermine self confidence and social interactions. Those affected are likely to seek out treatment, at any cost, both conventional and unconventional.
The plethora of 'cures' for baldness and hair restoration clinics are testimony to the importance society places on a full head of hair and to the vulnerability of persons with hair loss.
Cargnello J: I think I'm losing my hair [see comments]. Aust Fam Physician, 1997 Jun, 26:6, 683-7.
Immunizations (Baldness)
Immunizations
Alopecia is a recognized adverse effect of numerous medications, but vaccines are not normally considered a cause for unexpected loss of hair.
A total of 60 evaluable reports submitted since 1984 and coded for "alopecia" after immunizations included 16 with positive rechallenge (hair loss after vaccination on more than 1 occasion), 4 of which were definite and 12 possible or probable. Of the 60 cases, 46 had received hepatitis B vaccines.
Females predominated in all age groups. The majority of patients recovered, but clinical features, such as intervals from vaccination until onset and the extent and reversibility of hair loss, varied widely. Nine patients reported previous medication allergy.
There may be an association, probably very rare, between vaccinations and hair loss. More than 1 pathophysiologic mechanism may be responsible. Since apparently nonrandom distributions by vaccine, age, and sex could reflect biased case ascertainment, further research will be needed in defined populations with consistent case detection.
Wise RP et al., Hair loss after routine immunizations. JAMA, 1997 Oct 8, 278:14, 1176-8
Ischemic Heart Disease (Baldness)
Ischemic Heart Disease
A weak positive association between male pattern baldness and ischemic heart disease has been suggested previously. Data came from the Epidemiologic Follow-up Study of the First National Health and Nutrition Examination Survey.
Male pattern baldness that occurs before age 55 years may be by some mechanism related to ischemic heart disease.
Ford ES et al., Baldness and ischemic heart disease in a national sample of men. Am J Epidemiol, 1996 Apr 1, 143:7, 651-7.
Male Pattern Baldness (Baldness)
Male Pattern Baldness
Male pattern baldness is a common affliction affecting up to half the adult male population. Although females can be affected, the manifestations are usually limited to thinning of the hair.
Over the past decade there has been increasing interest in treating male pattern baldness sparked by the introduction of minoxidil (Rogaine). This article will review the etiology, current treatments, and future developments.
Duplechain G & White JA: Male pattern baldness. J La State Med Soc, 1994 Jan, 146:1, 7-8.
Myocardial Infarction (Baldness)
Myocardial Infarction (Copenhagen City Heart Study)
Investigated the possible relation between aging signs such as graying of the hair, baldness, and facial wrinkling and myocardial infarction (MI).
Found a correlation between graying of the hair, facial wrinkling, and frontoparietal baldness and crown-top baldness and MI in men.
With regard to gray hair, a similar although weaker and not statistically significant trend was seen in women. We conclude that, in addition to established coronary risk factors, aging signs like graying of the hair, male baldness, and facial wrinkling indicate an additional risk of MI.
Schnohr P et al., Gray hair, baldness, and wrinkles in relation to myocardial infarction: the Copenhagen City Heart Study. Am Heart J, 1995 Nov, 130:5, 1003-10.
N-Acetylcysteine and Alopecia
N-Acetylcysteine and Alopecia
This rat model found that "N-acetylcysteine" effectively prevented cyclophosphamide-induced "alopecia" when administered parenterally or applied topically in liposomes (ImuVert).
Jimenez, J et al., Treatment With ImuVert/N-Acetylcysteine Protects Rats From Cyclophosphamide/Cytarabine-Induced Alopecia. Cancer Investigation, 1992;10(4):271-276.
Remission
Remission
In a 32-year-old woman, alopecia universalis went into unequivocal remission during pregnancy and prednisolone therapy.
In this patient, alopecia was considered to have been caused by autoimmune abnormalities.
Asanuma N et al., Alopecia universalis with remission during pregnancy and prednisolone therapy. Am J Med Sci, 1997 Jan, 313:1, 67-9.
Scalp Cooling (Baldness)
Scalp Cooling
To assess any difference in the incidence of alopecia during treatment and of skull metastases during follow-up among breast cancer patients undergoing scalp cooling during chemotherapy and those treated at ambient temperatures.
Hypothermia was administered with electrically cooled caps (SCS II: Amit Technology, Jerusalem) for 1 h after treatment.
A significant difference was detected in the incidence of alopoecia: 48% (9 patients) of those who had undergone cooling suffered alopoecia, while 81% (13 patients) of the group who had not undergone cooling lost scalp hair. Patient comfort levels were high. Follow-up (median time 14 months) has disclosed no scalp metastases.
The implementation of routine scalp hypothermia as part of adjuvant chemotherapy treatment, especially in cancers without tendencies to bone metastases, should be seriously considered.
Ron IG et al., Scalp cooling in the prevention of alopecia in patients receiving depilating chemotherapy. Support Care Cancer, 1997 Mar, 5:2, 136-8.
Tinea Capitis
Tinea Capitis
Tinea capitis in adults is supposed to be rare; we have recently observed a significant increase in cases.
Scalp scaling and alopecia were the most frequent clinical features. A zoophilic dermatophyte was recovered in 50% of cases.
These cases represent 11% of all tinea capitis observed in the same period of time (higher than the 3-5% observed in the literature). Secretion of sebum and colonization by Pityrosporon orbiculare are supported to protect the scalp against dermatophytic invasion after puberty, but an immune defect may also facilitate hair invasion.
Cremer G et al., Tinea capitis in adults: misdiagnosis or reappearance? J: Dermatology, 1997, 194:1, 8-11.
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