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Clin Exp Dermatol 2003 Jan;28(1):25-7
Postmenopausal frontal fibrosing alopecia.
Recently a new entity, postmenopausal frontal fibrosing alopecia, was added to the established subtypes of scarring alopecias affecting postmenopausal women. This condition is characterized by a progressive frontal hairline recession associated with scarring. We studied the clinical and histopathologic features in four women with this disorder. Of note, a history of bilateral oophorectomy in two of them appears to be a new association. All four cases had frontoparietal recession of the hairline and two of them also had loss of their eyebrows. None of our four patients had any mucous membrane or other skin lesions. Histological examination showed perifollicular fibrosis and lymphocytic inflammation around the isthmus and infundibular areas of the follicles. No effective treatments have emerged for this type of postmenopausal alopecia, but progression of the hair loss and scarring appears to be self-limiting. We believe that this condition is a distinct clinicopathological variant of lichen planopilaris.
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
Clin Exp Dermatol 2002 Jul;27(5):373-82
Male androgenetic alopecia.
Androgenetic alopecia (AGA) is the most common type of hair loss in men. The relative strong concordance of the degree of baldness in fathers and sons is not consistent with a smiple 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 DHT-dependent process with continuous miniaturization of sensitive hair follicles. The type 2 5aR plays a central role by the intrafollicular conversion of T to DHT. Due to the inceasing knowledge in this field, this article shall privide an critical overwiew of recent discoveries.
Skin Res Technol 2002 May;8(2):106-11
Contrast enhanced phototrichogram pinpoints scalp hair changes in androgen sensitive areas of male androgenetic alopecia.
BACKGROUND/AIM: In male androgenetic alopecia (AGA), global changes of scalp hair observed on many years are the cumulative result of discrete changes. Such changes reflect structural and/or functional modifications occurring at the level of individual hair follicles. The patterning of scalp hair loss is the phenotypic expression of clusters of hormone sensitive follicles located in specific scalp areas.The aim of this study was to evaluate, in 21 untreated male subjects with AGA, the relation between various hair measurements using a new validated photographic method with clinical staging (modified Norwood-Hamilton scale) as compared with five controls. METHODS: As recently demonstrated by comparison with transverse sectioning of scalp biopsies, dynamic changes occurring at the level of individual hair follicles can be accurately explored with the contrast enhanced phototrichogram technique (CE-PTG). This is a further improvement of the PTG (combined analysis of two photographs taken at 48 h interval) using contrast enhancement together with the scalp immersion proxigraphy method. Visible hair counts per unit area were first evaluated on photographs without and with CE. Then other scalp hair variables (anagen hair counts and proportion of thin hair (
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