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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.


Ann Dermatol Venereol 2002 May;129(5 Pt 2):831-6

Alopecia areata: update on therapy


The management of patients with alopecia areata is obviously not restricted to the prescription of a treatment inducing hair growth. It requires thorough exploration (history of hair loss, treatments and concomitant pathologies), detailed clinical examination of the integument and palpation of the thyroid. The patient must, systematically, be given a simple explanation of his/her pathology, thus avoiding any feelings of mystery, hopelessness and guilt and hence paradoxically turning alopecia into "just another disease", even if flares are unpredictable and cannot always be treated. Innovations over the past few years have not met dermatologist's expectations: in particular immunosuppressors administered locally have not shown efficacy in human, as opposed to animal models of alopecia areata. Moreover, we must remain critical and rigorous with regard to "false" innovations: several recent publications are, methodologically, open to criticism. Older products provide clear descriptions of their indications and use, and relatively standardize the therapeutic approach to alopecia. Some of them lead to hair growth on the treated area: localized immuno-therapy that in certain cases induces hair growth where other treatments have failed. PUVA-therapy, however, because of frequent relapses on withdrawal and the characteristic recurrence of alopecia, rapidly leads to the use of high cumulative doses; balneo-PUVA therapy is effective with lower doses (PUVA-turban). Recently, UVB TL01 has shown efficacy in anecdotal studies. Local corticosteroids; notably injectable and anthralin, an old treatment which remains a useful therapeutic approach in alopecia areata plaques and in the ophiasic forms in children and adults. Finally, among the available treatment arms, systemic corticosteroids still have a place in recent extended forms: although still under experimentation, the bolus appears efficient during the primary episodes of alopecia areata, when administered within the first three months


J Dermatol 2002 Jul;29(7):414-8

Effect of two consecutive earthquakes on outbreaks of alopecia areata.


The pathogenesis of alopecia areata (AA) is still unknown. We investigated whether two consecutive earthquakes in Duzce, Turkey within a 3-month interval could precipitate AA. Patients who developed AA after the first earthquake in Duzce were included in this study. The admittance rate and demographic characteristics of AA patients admitted in the same period of the previous year (BE=before earthquake group) were compared to that of AA patients admitted after the earthquake (AE=after earthquake group). The admittance rate and onset of AA after the first earthquake were investigated retrospectively. In addition, possible relationships between the earthquake and age at the first attack, severity of the disease, and ophiasis were studied. The ratio of AA patients in the BE group was 12/1,121 (0.9%), while this value was 26/1,430 (1.8%) in the AE group (p=0.07). There were no significant differences with regard to sex, age of the first attack, severity of the disease, or ophiasis between the two groups. AA appeared between 18-28 weeks after the first earthquake in 14 (53.8%) of the patients. The earthquake did not increase the admittance rate of AA significantly. This finding suggests that a stressful event such a natural disaster is not a unique factor in AA outbreaks.


Ther Umsch 2002 May;59(5):211-6

Androgenetic alopecia in the man


Androgenetic alopecia (AGA) occurs in approximately 40% of men at the age of 40 and 50% at 50, respectively. Especially for young men progressive hair loss can be distressing. Therefore, understanding of these patients' concerns is important for appropriate management. Current understanding of the pathophysiology of AGA mainly focuses on androgen metabolism as it affects hair growth. As a result, pharmacologic treatment has made considerable progress through the introduction of selective 5 alpha-reductase inhibition with finasteride. In placebo-controlled clinical trials in men with AGA, treatment with oral finasteride proved to be effective. Minoxidil is the only pharmacological substance for topical application with proven efficacy. So far, other treatment modalities have no proven efficacy in clinical trials, so that their use cannot be recommended. Options for advanced AGA not amenable to pharmacologic treatment are autologous hair transplantation and hair replacement, both of which have recently also made progress in terms of cosmetic appeal.


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