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Dermatology 2003;206(2):85-95
Steroidogenic isoenzymes in human hair and their potential role in androgenetic alopecia.
Androgenetic alopecia (AGA) is the most common type of hair loss. The relatively strong concordance of the degree of baldness in fathers and sons is not consistent with a simple Mendelian trait, and a polygenic basis is considered to be most likely. So far, the predisposing genes for AGA are unknown and we do not understand the molecular steps involved in androgen-dependent beard growth versus androgen-dependent hair loss, but AGA can be defined as a dihydrotestosterone (DHT)-dependent process with continuous miniaturization of sensitive hair follicles. The type 2 5alpha-reductase plays a central role by the intrafollicular conversion of testosterone to DHT. However, due to the increasing knowledge in this field, we now know that there are many more steroidogenic enzymes involved in the onset and development of AGA, and this article shall provide a critical overview of recent discoveries.
Ther Umsch 2002 May;59(5):243-50
Scarring alopecias
The irreversibility and the possible important cosmetic consequences of scarring alopecia demand special diagnostic attention in order to promptly attain a precise diagnosis and specific treatment. Scarring alopecias are either due to permanent damage to essential parts of the hair follicle or destruction of the entire hair follicle. They are classified into the categories of primary scarring alopecias, where the hair follicle is the primary target of destruction, and secondary scarring alopecias, where the follicular damage results incidentally from events around impinging on the follicular unit. The differential diagnosis of the more common primary scarring alopecias, e.g. follicular lichen planus, chronic cutaneous lupus erythematosus and folliculitis decalvans, can be difficult when based only on anamnestic and clinical findings. The scalp biopsy is essential for appropriate nosologic classification and has prognostic relevance. The primary therapeutic goal is to halt progression of the irreversible process as early as possible by means of immunomodulatory, immunosuppressive or antiinfectious agents, respectively.
Dermatol Surg 2002 May;28(5):394-400; discussion 401
A method for evaluating and treating the temporal peak region in patients with male pattern baldness.
BACKGROUND: In the past, hair restoration surgeons have focused most of their attention and efforts on the reconstruction of the hairline region and the area on top of the head. However, little attention has been given to the temporal peaks and the areas immediately posterior to them. OBJECTIVE: The goals of this article are to describe the pattern baldness process at the temporal peaks and the region immediately posterior to them, and to describe a method for the evaluation and treatment of these very important and often neglected areas. METHODS: A method for evaluating and grading the temporal peak region is given. A surgical technique for treating this problem is described. This method consists of making 1.0 mm spear blade incisions at a very acute 10 degrees angle in the newly designed anterior peak and in between the hair follicles that remain in the area posterior to the peak. The grafting of the finest one-haired grafts available in between existing hair follicles is accomplished with the help of 3.5x expandable loupes. The anterior temporal peak design is coordinated with the position of the frontal hairline restoration; the more anterior the hairline, the more anterior the temporal peak and vice-versa. RESULTS: The results of evaluating the temporal peak areas and treating them appropriately have consistently restored the cosmetic harmony between the frontal hairline and the temporal peak region. It is important, however, to only utilize the finest hairs available to create an aesthetically pleasing result. CONCLUSION: When evaluating patients for hair restoration surgery, it should be a common practice to evaluate the temporal peak regions and the areas immediately posterior to them. These areas should be appropriately treated so that the frontal hair restoration coordinates with that of the temporal peak. The further anterior one comes with the hairline, the more anterior must come with the temporal peak restoration and vice-versa.
Pediatrics. 2003 Mar;111(3):685-7.
Toe tourniquet syndrome in association with maternal hair loss.
Increased hair loss a few months after delivering an infant is a common postpartum condition known as telogen effluvium. A much less common condition involving young infants is the hair-thread tourniquet syndrome, or toe tourniquet syndrome, which involves hair or thread becoming so tightly wrapped around an appendage that pain, injury, and sometimes loss of the appendage result. This case report is the first known description of the hair-thread tourniquet syndrome in association with maternal telogen effluvium. A literature review shows that accidental cases involving human hair almost always involve the toes, and usually occur at the age when mothers are experiencing excessive hair loss. This association is significant in that anticipatory guidance of new parents experiencing rapid hair loss may prevent cases of the toe tourniquet syndrome and its associated morbidity.
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