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J Formos Med Assoc 2002 Mar;101(3):223-6

High-dose steroid pulse therapy for the treatment of severe alopecia areata.


Growing evidence shows alopecia areata (AA) to be a T cell-mediated organ-specific autoimmune disease. This study aimed to evaluate the efficacy of high-dose steroid pulse therapy in Taiwanese patients with severe widespread AA exceeding 40% of the scalp. A total of 17 Taiwanese patients with severe AA lasting less than 2 years were treated once monthly at the outpatient clinic for six sessions. Children younger than 12 years of age received oral prednisolone (5 mg/kg) in three divided doses, while for adults, 500 mg methylprednisolone was infused intravenously over 2 hours. Patients with multifocal AA exhibited the most favorable response, with more than 75% hair regrowth (9/11). Relapse occurred in two patients at 4 and 8 months after the last treatment, respectively. One patient with ophiatic AA showed a transient response, but subsequently lost hair even upon continuation of therapy. Two patients of four with alopecia totalis had full hair regrowth but one lost hair again 6 months later. In the only patient with alopecia universalis, less than 10% hair regrowth occurred. No major side effects were observed. In summary, 11 of 17 patients (64.7%) had more than 75% hair regrowth after steroid pulse therapy. Our results indicated that steroid pulse therapy, given at 5-10 mg/kg once monthly for an average of 6 months, is effective and well tolerated in Taiwanese patients with severe multifocal AA lasting less than 2 years.


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.


Oncology 2002;62(2):97-102

Effectiveness of the MSC cold cap system in the prevention of chemotherapy-induced alopecia.


OBJECTIVE: To study the effectiveness of the MSC cold cap system to prevent chemotherapy-induced alopecia. METHODS: The system was applied in 83 cancer patients (mean age 49.8 years) undergoing chemotherapy with alopecia-causing agents. Seven patients did not tolerate the system. Seventy-six patients were evaluable for assessment; 26 received anthracycline (group A), 33 taxane (group T), 5 anthracycline plus taxane (group AT), 7 intravenous etoposide (group E) and 5 ifosfamide with or without other alopecia-causing drugs (group I). In group A, 18 patients received conventional (subgroup Ac) and 8 high doses (subgroup Ah). In group T, 8 patients received docetaxel (subgroup D) and 25 paclitaxel (subgroup P). Alopecia grade 0-1 (Dean's system) was considered as treatment success. RESULTS: Grade 0-1 alopecia was achieved in 49/76 (64.5%) patients: group T 23/33 (69.6%), subgroup P 16/25 (64%) and subgroup D 7/8 (87.5%); group A 18/26 (69.2%), subgroup Ac 16/18 (88.8%) and subgroup Ah 2/8 (25%); group AT 1/5 (20%); group E 6/7 (85.7%), and group I 1/5 (20%). CONCLUSIONS: The MSC cold cap system is effective in preventing alopecia from anthracycline, etoposide or taxane but not from anthracycline-taxane combinations or ifosfamide-containing regimens.


Dermatol Clin 2001 Oct;19(4):711-26, ix

Hair and systemic disease.


Hair loss (alopecia) occurs as a manifestation of numerous systemic diseases, but usually can be categorized into one of five general groups: telogen effluvium, anagen arrest, follicular destruction, hair miniaturization, and hair shaft defects. An excess of hair also can be evidence of internal disease, and there are two general categories of increased hair density: hypertrichosis and hirsutism. The basic categories of hair disease and the systemic conditions associated with them are discussed. The history, physical examination, and histopathologic data usually are sufficient to categorize the form of hair disorder and may provide a clue to the nature of the underlying systemic disease.


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