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Saudi Med J 2002 Dec;23(12):1489-91
Striae distensae - like lesions. A cause of scarring alopecia among children.
OBJECTIVE: Although alopecia areata is a common problem among children, many misdiagnoses for this condition can happen. The aim of this study was to demonstrate the striae distensae as lesions that cause scarring alopecia with a great resemblance to alopecia areata. METHODS: A total of 36 children with provisional diagnosis of alopecia areata of the scalp were assessed clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq, between June 1998 to June 2001. Their age ranged from 3 12 years and the mean + standard deviation (SD) was 7.30 + 2.59 years with equal sex ratio. RESULTS: All patients provided for this study had a history of patchy hair loss of few months duration. Their parents denied any history of obvious trauma and many modalities of treatment had been tried without benefit. The clinical examination revealed single or multiple (1-6) (mean + SD 2.41 + 1.22) complete linear hair loss patches resembling atrophic scar that was similar to striae distensae. The histopathological examination showed atrophy of the epidermis, full replacement of the dermis by collagen bundles, and complete loss of appendages. CONCLUSION: This is a new entity, which seems to be common among children and often confused with untreated cases of alopecia areata. This condition should be added to the differential diagnosis of patchy hair loss in children and the parents should be reassured of the cause of hair loss and no treatment therapy needed.
Harv Mens Health Watch 2002 Nov;7(4):6-7
Baldness: Does appearance matter?
It lacks the pain of a heart attack, the threat of prostate cancer, and the complications of hypertension. Still, despite the best efforts of Michael Jordan, millions of men are distressed by hair loss.
Normal hair growth
Whether straight or curly, hair grows in a cyclical pattern that has three phases: growth (called the anagen phase by biologists), involution (catagen), and rest (telogen). The growth phase lasts the longest; its duration determines how long a hair will grow. That's why eyebrow hairs stay short (growth phase, 13 months) while scalp hairs are long (5–8 years). After the growth phase, each follicle undergoes a brief period of involution, when some of its cells die off. Then comes a spell of inactivity. At the end of the rest phase, the hair falls out of its follicle and the cells get back to work, growing a new hair. In humans, each hair follicle cycles independently; that's why humans don't "shed" each season, as many animals do.
At birth, the human body is covered by about 5 million hair follicles, including about 100,000 on the scalp. This number remains constant throughout life, but the activity and productivity of each follicle varies according to a person's age.
In a healthy scalp, more than 90% of hair follicles are in the growth phase, less than 1% are undergoing involution, and 5%–10% are resting.
Fragile follicles
Hair follicles contain living cells. Like all cells, they can be damaged, which halts hair growth. If the problem is mild, the follicle recovers and resumes growing hair, but if it's severe, the damage may be permanent.
Any severe stress, physical or emotional, can damage hair follicles, halting hair growth. That's why patients often lose their hair two or three months after a major illness or traumatic life event. It's a temporary problem technically known as telogen effluvium. It's easy to recognize with a simple pull test: If you can extract more than five or six hairs with a single pull, you're likely to have telogen effluvium, and you'll most likely grow back all your hair within a few months, even without therapy.
Medication can damage hair follicles; chemotherapy drugs are the leading examples. Less often, toxic chemicals, radiation, thyroid disease, or infections can do the job. Skin diseases that produce scarring can also result in hair loss, which may be permanent. Fortunately, all these problems are uncommon. Contrary to popular belief, common woes like seborrhea and dandruff do not cause hair loss.
Normal hair loss
Men with male pattern baldness may not regard it as normal, but it is. Like it or not, losing scalp hair is part of the human condition. It may cause psychological distress that's important in its own right, but it's not a disease.
Virtually all people, male and female, lose scalp hair as they age. In a sense, male pattern baldness, known technically as androgenic alopecia, is just an exaggerated form of a normal event. It has two requirements: a genetic predisposition and the male hormone testosterone.
The genetics of male baldness are complex. Most experts believe that one gene is responsible, but several may play a role. In any case, the abnormal gene has variable penetrance, which means it is more likely to produce hair loss in some men than others. The abnormal gene can be passed down from a mother or a father, and boys or girls can inherit it. But men are much more likely to suffer from the gene's activity because they have the second requirement, testosterone.
Testosterone makes the man: It is responsible for the large muscles, strong bones, and deep voice that characterize the gender. It is also essential for male genital development in fetal life, for the sexual awakening of adolescence, and for libido and fertility in adulthood. Testosterone acts directly on tissues to produce all these effects, but it acts indirectly on the prostate and on hair follicles. In these areas, an enzyme called 5-alpha reductase converts testosterone to dihydrotestosterone (DHT), and DHT acts on the tissues.
DHT stimulates the growth of hair follicles in the beard and body, but it has the opposite effect on scalp hair. Hair loss usually starts between the age of 17 and 40; by 50, about half of all men display some degree of male pattern baldness. It usually begins with a receding hairline over the temples, followed by thinning of the hair at the vertex, or top of the scalp. The rate of hair loss varies considerably; some men go bald in less than 5 years, but most lose their hair gradually, over 15–25 years. On average, men with androgenic alopecia lose about 5% of their scalp hair each year, but the process can slow down or speed up without apparent reason.
Although it's small comfort to balding men, their hair follicles don't actually disappear. Instead, each successive growth phase gets shorter and each resting phase longer. With an abbreviated growth phase, the hair becomes shorter and finer; with an extended resting phase, the hairs are less tightly anchored to the scalp, so they fall out during washing or combing.
Adverse effects
Male pattern baldness is not a disease. Its only consequences are cosmetic, and its only implications are psychological.
Although baldness does not cause disease, it may be a marker for increased cardiac risk. The Harvard-sponsored U.S. Physicians' Health Study found that men with bald spots were more likely to develop coronary artery disease than men with full heads of hair; mild vertex baldness was linked to a 23% increase, moderate baldness to a 32% rise, and severe baldness to a 36% increase in risk. The effect was greatest in men with hypertension or high cholesterol levels. Frontal baldness, the receding hairline, was not associated with cardiac risk.
Treatment
Doctors may not think male pattern baldness is a problem, but many men disagree. That's why 33 million Americans spend about $1.5 billion a year to replace or restore lost hair.
Treatment takes many forms, ranging from wigs and toupees to scalp surgery and hair transplants. Many men prefer wigs to surgery. Some are worn on top of existing hair; others are interwoven with a man's own hair. Interwoven wigs have to be adjusted every few weeks as the natural hairs grow, adding to the expense and inconvenience.
For generations, a bewildering array of concoctions claiming to restore lost hair have been sold to gullible men. In 1989, the FDA issued guidelines that cleared the shelves of many expensive but worthless products. At present, only two drugs are approved for male pattern baldness.
When sold in tablet form, minoxidil is a prescription drug for hypertension. But for more than 10 years it has also been available as Rogaine, a nonprescription lotion for hair loss. Regular Rogaine solution or spray contains 2% minoxidil, extra strength Rogaine, 5%. The drug increases the duration of the hair follicles' growth phase, but it works only on follicles that are still active, and its benefits last only as long as it is used regularly. Rogaine is more effective for bald spots than receding hairlines, but it's only partially effective at that; in one study, 36% of men who had used the product for several years felt it was worth the time and money.
According to the manufacturer, Rogaine should be applied twice daily. Scalp irritation can occur; dizziness and low blood pressure are less common side effects. The drug is expensive.
Finasteride is an oral prescription medication that inhibits 5-alpha reductase, thereby blocking the conversion of testosterone to DHT. In a 5-mg tablet, finasteride is sold as Proscar, for benign prostatic hyperplasia (see Harvard Men's Health Watch, July 2000); in a 1-mg tablet, it's marketed as Propecia, for male baldness.
To date, only four studies of Propecia, all funded by the manufacturer, have been reported. Two of the trials involved a total of 1,553 men with mild to moderate male pattern baldness that was most prominent at the top of the scalp. Half the men were given Propecia, the other half a placebo. After three months, the men who took Propecia were more satisfied with the appearance of their hair: After a year, they had an average of 876 hairs in a 1-inch circle on the scalp, while those treated with the placebo had 769 hairs.
The third trial evaluated 326 men with mild to moderate frontal hair loss; after a year, 50% of the men taking Propecia and 30% of the men taking the placebo thought their appearance had improved. Finally, a small 2002 study (66 men) reported that finasteride increases hair thickness as well as hair counts, thus enhancing its cosmetic benefit.
The 1,879 men in the three large trials were between the ages of 18 and 41, and none was completely bald. Since Propecia will not revive hair follicles that are inactive, it cannot be expected to regrow hair in older men who are bald. As a result, it warrants consideration only by younger men with partial hair loss.
Because Propecia must be taken daily, years of therapy are required to maintain even modest improvements. Propecia is even more expensive than Rogaine. It is well tolerated, but 1%–2% of men experience diminished libido and potency on Propecia. Because finasteride can produce genital abnormalities in males exposed before birth, the drug should never be taken by women of childbearing age.
To treat or not?
From a medical point of view, there is no need to treat normal hair loss. At best, the treatments are only partially effective, and although they are generally safe, some men may experience side effects. Take a look in the mirror and think it over. And before you decide, try to imagine how Michael Jordan would look with a bit of hair.
J Dermatol 2002 Apr;29(4):197-201
Ultrastructural study of acquired pili torti-like hair defects accompanying pseudopelade.
Acquired structural hair defects are caused by various physical and chemical manipulations. Plucked hairs and hair follicle biopsy specimens of pili torti-like hairs that arose from pseudopelade scalp were studied. In scanning electron microscopy, the hair shafts had a segmental pili torti-like appearance, accompanied by oblique or longitudinal grooves and ridges. In light microscopy, the hair follicles showed an asymmetric hair bulb and inner root sheath, and a shortened keratogenous zone within sclerosing fibrous connective tissue. In transmission electron microscopy, the numbers and thickness of the hair cuticle cells were different on the opposite sides of the hair shaft. The hair cuticle was irregularly shaped and formed asymmetric waves. The tonofilaments in the hair cortex ran almost parallel to the hair axis. From these findings, it was clear that the grooves and ridges were produced by the deformed hair cuticle and cortex, whose shapes were modulated by the asymmetric inner root sheath. This asymmetry most likely resulted from a dysfunctional dermal papilla, which was affected by fibrosis. The pili torti-like appearance appeared to be caused by the grooves and ridges that ran obliquely on the hair shaft surface.
J Invest Dermatol. 2003 May;120(5):771-5.
Major locus on mouse chromosome 17 and minor locus on chromosome 9 are linked with alopecia areata in C3H/HeJ mice.
Alopecia areata is an autoimmune disease that targets actively growing (anagen) hair follicles in humans, mice, rats, dogs, horses, and cattle. C3H/HeJ mice spontaneously develop alopecia areata from 5 mo of age and older in females and later in males. Frequency of disease approached 20% in a colony by 18 mo of age. C57BL/6J mice do not develop alopecia areata. A segregating F2 population of female mice (n=1096) was generated from crossing these two strains. Alopecia areata (n=138) and clinically normal (n=214) mice were genotyped at 12 mo of age using 211 microsatellite probes. The peak logarithm of odds ratio score on mouse chromosome 17 (10.9) was around marker D17Mit134 at 16.9 cM from the centromere. The mouse histocompatibility locus, H2, the mouse equivalent of human leukocyte antigen in humans, was a likely candidate. Twelve-month-old C3H.SW-H2b/SnJ mice (C3H/HeJ congenic mice in which the H2k purported susceptibility locus was replaced with the H2b purported resistance locus) did not develop alopecia areata, supporting this locus as being important in alopecia areata. A suggestive linkage was also found on mouse Chromosome 9 (logarithm of odds ratio score 2.0) around D9Mit206, 20 cM from the centromere. The interval on mouse Chromosome 17 contains several orthologous genes potentially associated with human alopecia areata.
Seeing is believing. Learning by anecdotal observations is an old way of science.
It is not reasonable to stop taking daily food and herbal supplements altogether just because of scietific/clinical support: our life must go on until we have better understandings of food and herb. There are two merits that Hair Million enjoys: Firstly, Hair Million is relatively inexpensive, and secondly, it is made only of edible herbs that are known to be safe when consumed in regular quantities.
Propecia is a clincally validated prescription medication for hair loss.
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