Acute Diffuse and Total Alopecia of the Female Scalp. a new subtype of diffuse alopecia areata that has a favorable prognosis.

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Dermatology 2002;205(4):367-73

Acute Diffuse and Total Alopecia of the Female Scalp. a new subtype of diffuse alopecia areata that has a favorable prognosis.

Background: Athough alopecia areata (AA) usually starts with focal lesions of hair loss and then presents several different clinical forms, AA may begin as diffuse hair loss. We examined 9 female patients who presented with acute, diffuse and total hair loss of the scalp and took a similar clinical course with a favorable prognosis. Objective: To categorize such cases as a new subgroup of diffuse alopecia. Methods: We studied 9 patients who showed acute, diffuse and total hair loss of the scalp within 1 month after their first visit to our hospital by comparing their clinical course, laboratory tests and histopathological findings with those of common, patchy AA, alopecia totalis or alopecia universalis. Results: None of the patients had a background of systemic diseases or telogen effluvium. All the patients were female, and 8 of the 9 cases recovered cosmetically acceptable hair growth within 6 months regardless of steroid administration. The histology of he lesions was indistinguishable from that of AA except for a remarkable eosinophilic infiltrate. Conclusions: These cases can be categorized as a new subtype of inflammatory noncicatricial alopecia that is characterized by a marked female predominance, tissue eosinophilia and uniquely short clinical course. We suggest to name it 'acute diffuse and total alopecia of the female scalp (ADTAFS)'.

J Dermatol 2002 Oct;29(10):665-9

Depression circumstantially related to the administration of finasteride for androgenetic alopecia.

In this paper we report 19 patients (14 males, 5 females; mean age 28.16 years +/- 7.68 SD) out of a series of 23 (17 males, 5 females) who developed a mood disturbance (moderate to severe depression) during treatment with finasteride, 1 mg/day orally, for androgenetic alopecia (Hamilton subtypes III-V; Ludwig subtypes I-II). Depression, which significatively impaired sociofamilial relations, sleep and eating behaviour, was associated to marked anxiety in some cases, developed after 9-19 weeks of treatment with finasteride, and promptly resolved after suspension of the drug. Two patients accepted reintroduction of the drug, and depression relapsed within 2 weeks. Depression as an adverse effect of finasteride has been reported only once. Further studies are needed to confirm our circumstantial observations, which are based on a retrospective series of patients.

Ann Dermatol Venereol 2002 May;129(5 Pt 2):801-3

Androgenetic alopecia

Androgenetic alopecia (AGA) is the combined result of an androgen-dependent process and genetic transmission. These characteristics have mainly, if not exclusively, been demonstrated in men and perhaps improperly extended to women. When considering the androgen-dependent process, AGA must only be limited to the androgen receptor areas. In the scalp, these receptors have only been detected in the frontal and vertex areas but never in the temporal or the occipital areas. Male AGA exhibits these clinical features, whereas in women hair loss is rarely limited to this localization, even when large areas of hair loss often appear with age. It is now commonly accepted that male AGA is associated with an increase in 5 alpha reductase activity leading to an increase in local production of dihydrotestosterone. The mechanism by which the local dihydrotestosterone increase leads to hair follicle loss is not clearly demonstrated. Inhibition of cell proliferation in the dermal papilla and a vascular process based on the inhibition in local production of vascular endothelial growth factor (VEGF) have been proposed. The increase in 5 alpha reductase activity is genetic and depends on androgen receptor polymorphism, characterized by a decrease in the number of CAG sequences on the exon 1. Male AGA is associated with an insulin-resistant process and to a higher risk of polycystic ovary in the lineage. Therapeutically, this hormone-dependent process explains the well demonstrated efficacy of 5 alpha reductase inhibitors. In women, except in some rare cases, alopecia is diffuse and the mechanisms are different. Their origin is unknown, and probably ambiguous. Based on an association with Hashimoto's thyroiditis, an auto-immune origin could be suggested in some cases. Alopecia is unaffected by thyroid substitution. Pharmacological doses of oestrogens (pregnancy, contraception) have a beneficial effect on such alopecia, probably through different mechanisms: anti-androgen effect, increased VEGF, proliferative effect of dermal papilla cells. However, it is important to mention that the dermal papilla has an aromatase, particularly in the occipital area, the activity of which has not been assessed in female alopecia. In practice 5 alpha reductase inhibitors are ineffective in women. It is likely that the predominance observed in the frontal and vertex areas, occasionally in elderly women, is a result of the two combined disorders, the almost physiological androgen-dependent hair loss combined with diffuse loss. Pharmacological doses of oestrogens associated with anti-androgen progesterone-like agents are widely used with positive results, but not demonstrated by clinical trials.

Ann Dermatol Venereol 2002 May;129(5 Pt 2):787-92

Hormonal interaction and hair growth

Androgenetic alopecia (AGA) is the most common form of hair loss in men and women. This continuous process results in a form of alopecia that follows a definite pattern in those individuals who are genetically predisposed. Although clinically different, the pathogenetic pathways leading to this type of hair loss are thought to be similar in both sexes. A genetic predisposition is a feature of AGA, but the predisposing genes are still unknown. Our understanding, however, of the hormonal effects on hair growth is far more advanced. AGA can be defined as a dihydrotestosterone (DHT)-dependent process with continuous miniaturization of sensitive hair follicles. So far, we do not understand the molecular steps involved in androgen-dependent beard growth versus androgen-dependent hair loss. However, the local androgen metabolism plays a central role in the intrafollicular conversion of weak androgens, such as DHEAS, to more potent androgens such as T or DHT within the hair follicle. The dermal papilla plays a central role by exhibiting an array of important steroidogenic isoenzymes. Provided that the dermal papilla (DP) cell triggers and regulates the growth of hair follicles, this physiological role may be reflected by metabolic differences, which could account for differences in androgen sensitivity as observed in hair follicles from different body sites, and in conditions such as male pattern baldness. The observation of STS, 17beta-HSD, 3beta-HSD, 3alpha-HSD and type 2 5alpha-R-activity within the DP could be a clue to understanding the regulation of androgen action in the human hair follicle by local androgen modification on target cell level. Hence, some of the intrafollicular steroidogenic enzymes would be potential pharmaceutical targets for the treatment of AGA or hirsutism.

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DHEA has been suggested to provide numerous potential benefits. DHEA (or dehydroepiandrosterone) is converted into androgens (male hormones) or estrogens (female hormones) in the cells. Our bodies produce decreasing amount of DHEA as we get older. various health benefits: To deter aging, improve sexual function/erectile dysfunction, treat cognitive decline, enhance athletic performance, facilitate weight loss, improve strength, prevent osteoporosis, enhance immunomodulation for rheumatic conditions, and treat depression.

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