Skin Drugs

Acta Med Port. 2011 Mar-Apr;24(2):207-14. Epub 2011 May 20.

[Alopecia areata: a retrospective study of the paediatric dermatology department (2000-2008)].

Rocha et al

Abstract

INTRODUCTION:

Alopecia areata usually presents as patchy, nonscarring hair loss. It seems to be an immune mediated disease, whereas genetic predisposition, environmental and psychological triggers may be involved in its aetiology.

OBJECTIVES:

To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in the paediatric population of Peadiatric Dermatology outpatients over a 9-year period. Some psychologic characteristics were also assessed.

METHODS:

Descriptive and retrospective study of all newly diagnosed AA cases seen from January 2000 to December 2008 at the Hospital de São Marcos’ Paediatric Dermatology Department. Fifteen patients with AA were interviewed for psycologic evaluation.

RESULTS:

Forty-eight cases (54% male/46% female) were identified. Mean age at presentation was 7.8 years. Family history of AA was reported in 10% of the cases, and in 25% there was a personal and/or family history of atopy. The majority of patients (82%) had mild disease and topical corticotherapy was the first-line treatment for limited AA. Fifty-four percent of these patients had a complete resolution of the lesions with treatment. Systemic treatment (corticosteroids and/or ciclosporin) was used in 71% of patients with extensive disease (more than 50% hair loss). Only one of these patients had a sustained clinical improvement after treatment. Twelve out of 15 respondents (80%) recalled stressful events preceding hair loss.

DISCUSSION:

Our findings are similar to those reported in other studies. Epidemiologic studies of AA are available in adulthood but there is a paucity of literature on children with AA. A holistic approach is important in the management of childhood AA as the disease can have a severe psychologic impact on an individual’s well-being.

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J Drugs Dermatol. 2011 Dec 1;10(12):1404-11.

The role of inflammation and immunity in the pathogenesis of androgenetic alopecia.

Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N.

Abstract

Background: Female pattern hair loss affects many women; its pathogenetic basis has been held to be similar to men with common baldness. Objective: The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles. Materials and Methods: 52 women with androgenetic alopecia (AA) underwent scalp biopsies for routine light microscopic assessment and direct immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted. Results: A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with androgenetic alopecia (male pattern hair loss) showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group. Conclusion: A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in androgenetic alopecia and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result. J Drugs Dermatol. 2011;10(12):1404-1411.

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J Dtsch Dermatol Ges. 2011 Feb 2. doi: 10.1111/j.1610-0387.2011.07609.x.
Current standards in the diagnostics and therapy of hair diseases - hair consultation.
Blume-Peytavi U, Vogt A.

Abstract
Hair and scalp diseases present an extensive diagnostic and therapeutic task. Treating them is often a challenge for the physician in daily practice. Unclear diagnoses, chronic conditions with long-lasting therapies and the uncertainty of the patient may often lead to unsatisfying situations for both the patient as well as the doctor. The complaints can be divided into (1) hair loss, (2) increased hair growth and (3) abnormal hair quality. A structured history and the objectification of the clinical findings with the help of standardized diagnostic methods and score systems or classifications enable a diagnosis in most patients already at the first visit. Moreover, such structured processes strengthen the treatment satisfaction and compliance of both the patient and the therapist. In the meantime, diagnostic measures and clinical practice guidelines are available for the most common hair disorders. Expertise in basic psychosomatic care and an empathetic approach to the fears and concerns as well as practical advice for the daily contact with hair disorders should be integrated as separate elements in the management of hair diseases; in most cases they are gratefully welcomed by the patients. The aim of this article is to provide the physician with a guideline for the structured management of a hair patient. An overview of recent new developments and the currently available clinical practice guidelines for diagnosis and therapy of hair disorders is presented.

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