Treatment of hyperandrogenic alopecia in women.

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Fertil Steril 2003 Jan;79(1):91-5

Treatment of hyperandrogenic alopecia in women.

OBJECTIVE: To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia. DESIGN: Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients. SETTING: Endocrinologic outpatient practice in Italy. PARTICIPANT(S): A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels. INTERVENTION(S): Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year. MAIN OUTCOME MEASURE(S): Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness. RESULT(S): Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend. CONCLUSION(S): Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.

Int J Dermatol 2002 Nov;41(11):748-53

The pattern and profile of alopecia areata in Singapore - a study of 219 Asians.

BACKGROUND: Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. OBJECTIVE: To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. METHODS: Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed. RESULTS: Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss. CONCLUSIONS: Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.

J Dermatol 2002 Oct;29(10):661-4

Seventeen cases of alopecia areata: combination of SADBE topical immunotherapy with other therapies.

Topical immunotherapy is effective for severe alopecia areata. However, there are patients with alopecia areata refractory to topical immunotherapy alone. We tried SADBE (squaric acid dibutylester) topical immunotherapy combined with topical dry ice cryotherapy, carpronium chloride (a parasympathetic nerve stimulant) and/or oral cepharanthin (a biscoclaur alkaloid) in alopecia areata refractory to topical SADBE. Seventeen patients with alopecia areata (3 multiple, 3 ophiasis, 5 totalis and 6 universalis) were treated with SADBE in our department in 1999 to 2001. In 3 cases (2 multiple and 1 universalis) out of the 17 cases, cosmetically acceptable regrowth of hair was observed in several months with topical SADBE alone. In the other 14 cases, the SADBE therapy alone for several months (mean: 6.9 months) resulted in no or poor regrowth of hair. However, with subsequent combination therapy of topical SADBE for several months (mean: 7.6 months), satisfactory regrowth of hair was observed in 6 of the 14 cases. Our cases indicate that combination therapy of topical SADBE with other therapies can be a choice for alopecia areata which is refractory to topical SADBE therapy alone.

Zhonghua Zheng Xing Wai Ke Za Zhi 2002 Jul;18(4):219-20

Dense-packing hair grafting technique for restoration of cicatricial alopecia

OBJECTIVE: To investigate the possibility of using dense-packing hair grafting technique for restoration of cicatricial alopecia. METHODS: Under local anesthesia, a scalp strip was harvested from the back of the head. A series of micro-grafts with 1-3 hairs and mini-grafts with 4-6 hairs were created from this strip. In the scarring recipient area, micro-slots were made with a 18 G needle for the micro-grafts and mini-slits were made with a No. 64 mini-blade for the mini-grafts. The grafts were then implanted into these holes. RESULTS: Ninety-six patients with 128 bald scarring areas, resulted from burn, trauma or infection, were treated with the above-mentioned technique from April. 1998 to February. 2000. All of the patients were satisfied with the appearance. In the micro-graft area, the graft density reached 10-15 mini-grafts/cm2 per session. In the micro-graft area, the graft density reached 16-19 micro-grafts/cm2 per session. Postoperative following-up for more than 1 year showed that the grafted hairs were growing well with 90%-95% survival of the hair. One third of the patients obtained satisfactory results with only one session. Two thirds of the patients needed the second session to improve the appearance. CONCLUSIONS: The dense-packing hair grafting technique is a simple, safe and effective method for hair restoration surgery. It is not only used for male pattern baldness, but could also be applied for restoration of cicatricial alopecia.

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