Abstracts
Women
Women
Assessing how many hairs are actually shed by patients complaining of hair loss is a difficult task. Many methods have been proposed, but all need standardization.
Tests included: the pull test (PT), daily count (DC) and wash test (WT).
Dispersion of the data was very high. The medians of the PT, DC and WT were 0.6, 60.5 and 122 hairs, respectively.
Subjects complaining of hair loss proved to shed a higher number of hairs than those with various degrees of baldness.
The PT is a poorly sensitive method, while telogen percentage is not correlated with the severity of hair loss. As the DC is a cumbersome procedure, the WT is probably the best method to adopt. Standardization of methods and assessment of normality in prepubertal children are imperative.
Guarrera M et al., Quantitating hair loss in women: a critical approach. Dermatology, 1997, 194:1, 12-6.
Autoimmune disorders
Autoimmune Disorders
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".
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.
Treem-WR: Ulcerative colitis and total "alopecia" in a mother and her son. Gastroenterology. 1993 Apr; 104(4): 1187-91
Chemotherapy (1)
Chemotherapy (1)
Some side effects of "chemotherapy" are preventable, while other can be minimized if tended to promptly. This review covers the spectrum to toxic events and offers practical guidance on managing them.
Griffith-RS et al: Making "cancer" chemotherapy tolerable. Patient-Care, 1995 Mar 30; 29(6): 65-8, 71-5, 79-80 (9 ref 10 bib).
Chemotherapy (2)
Chemotherapy (2)
Alopecia as a result of cancer chemotherapy has been reported to cause changes to the self-concept and body image. In a prospective longitudinal study, self-concept and body image were analysed in 29 patients after histological confirmation of gynaecological malignancy, mainly ovarian cancer, who were assigned to receive a complete-alopecia-inducing PEC combination chemotherapy (cisplatin 50 mg/m2, epirubicin 60 mg/m2, and cyclophosphamide 500 mg/m2 in 1 day every 28 days).
The analysis was performed before the commencement of treatment and repeated when alopoecia was complete and after completion of therapy when patients had already experienced regrowth of hair, using the Frankfurt self-concept scales (FSKN) and Frankfurt body concept scales (FKKS). Significant differences were observed in the various evaluation scales FSAP (general ability to solve problems), FSSW (general self-esteem), SGKB (state of health), and SKEF (physical fitness).
For all scales the results worsened during chemotherapy but did not return to normal or improve when patients experienced regrowth of hair. It was found that 73% of the patients did not feel as self-confident as before treatment and that for 47% alopecia was the most traumatic side effect of chemotherapy.
Since there is no chemotherapeutic regimen or any other effective treatment that can prevent alopecia, either of the following conclusions can be drawn: the observed differences may not be related exclusively to alopecia, but also associated with coping processes initiated by chemotherapy and perhaps enhanced by alopecia; or the changes persist even after the discontinuation of chemotherapy. Regrowth of hair and other adaptive processes do not normalize or improve the impaired body image and self-concept.
Münstedt K et al., Changes in self-concept and body image during alopecia induced cancer chemotherapy. Support Care Cancer, 1997 Mar, 5:2, 139-43.
GI Malignancy
GI 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. It is suggested that 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.
Immunizations
Immunizations
Alopecia is a recognized adverse effect of numerous medications, but vaccines are not normally considered a cause for unexpected loss of hair.
Reviewed spontaneous reports to the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System.
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. Both of the currently available recombinant products, as well as the former plasma-derived product, were represented. 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.
Wise RPet al., Hair loss after routine immunizations. JAMA, 1997 Oct 8, 278:14, 1176-8.
Male Pattern Baldness
Male Pattern Baldness
A weak positive association between male pattern "baldness" and "ischemic" "heart disease" has been suggested previously.
No dose-response relation with degree of baldness was seen. Although these findings are tempered by the absence of information concerning the type of baldness (frontal or vertex), they provide support for earlier studies that indicate 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.
Nutritional Deficiency
Nutritional Deficiency
In this study, we have presented consequences of "nutritive" deficit on status of pilosebaceus follicle.
Damages are reversible in condition which permit normal diet and remove all physical and psychical of "stress".
Mutevelic-Arslanagic-N: [The effect of "nutritional" deficiency on hair roots (trichogram)]. Med-Arh. 1994; 48(2): 57-9.
Pregnancy (Alopecia Areata)
Pregnancy
In a 32-year-old woman, alopecia universalis went into unequivocal remission during pregnancy and prednisolone therapy.
Thyroid function and glucose tolerance were normal, and other clinical evidence of collagen vascular disorders was not found. In this patient, alopecia was considered to have been caused by autoimmune abnormalities. This is the first documentation of remission of autoimmune alopecia universalis during pregnancy.
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
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.
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