Alopecia Scores Research Articles

A Novel Dual Kinase Inhibitor for the Treatment of Chronic Graft Vs. Host Disease

Chronic Graft vs. Host Disease (cGvHD) remains a major debilitating and potentially fatal sequelae of allogeneic hematopoietic cell transplantation. Corticosteroids remain the initial therapy of clinically significant cGvHD. Since 2017 three targeted therapies have been approved for steroid refractory cGVHD, ruxolitinib, a JAK 1/2 inhibitor, is approved post one or two previous therapies. Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, and belumosudil, a ROCK2 inhibitor, are both approved after two previous lines of therapy. We tested RR- RR-1752 a single digit nM dual ROCK/AURK inhibitor in a mouse model of severe cGVHD. BALB/c recipient mice were preconditioned with 7.5 Gy TBI, 8 hours later they received 10 7 T-cell depleted (TCD) C57BL/6 bone marrow cells alone (Group A, n=7) or 10 7 TCD C57Bl bone marrow cells plus 10 6 splenocytes (Groups B, n=8 and C, n=8). Beginning day 7 post cell infusion animals received either oral vehicle control (groups A and B) or vehicle with 1.0 mg/kg RR-1752 (Group C) daily. Body weight, alopecia score and eye score were monitored 3×/week through day 56 or until termination. All animals in groups B and C developed signs and symptoms of chronic graft vs. host disease. Animals in group A exhibited 20% weight loss through seven days post irradiation and cell infusion but began to recover to baseline and recovered weight to 90% of baseline. Animal weights in groups B and C dropped to less than 80% at day seven post irradiation, but only recovered to 80.38% +/- 10.18 (Group B) and 87.11% +/- 7.90 (Group C) on day 14 and then declined to 74.10% +/- 4.19 in Group B and 80.23% +/- 7.35 in Group C by day 28 (Figure 1). Animals in Group A had no significant change in eye score or alopecia. In contrast all animals in groups B and C showed signs of cGvHD. Eye showed moderate effects in Group B and mild changes in group C, while alopecia scores were moderate in both groups B and C. All animals in group A survived through day 56, median survival in group B was 16.5 days, as compared to 38 days in group C (Figure 2). In a separate study in normal mice, RR-1752 given at 1.0 mg/kg/day for 2 weeks showed no negative effects on hemoglobin, hematocrit, platelets, total WBC, or neutrophils, and only a mild decrease in lymphocytes. Using a model for cGVHD, exhibiting weight loss, alopecia, and ocular changes, we demonstrated that RR-1752 1.0 mg/kg/day slows mouse body weight loss, increases survival and shows trends to ameliorate ocular toxicity. The dose tested did not ameliorate the alopecia in the cGVHD mice. Further studies are ongoing to assess higher dose levels and dose schedule effects in the severe cGVHD mouse model. Additional studies to compare effects on cGVHD to ruxolitinib and belumosudil and in combination with those standard of care therapies need to be conducted.

Efficacy of cooling therapy and α-lipoic acid derivative against chemotherapy-induced alopecia in an animal model.

Chemotherapy-induced alopecia is frequently induced by various regimens of chemotherapy and has a significant impact on mental health and quality of life. However, the effect of available current treatment for chemotherapy-induced alopecia is not sufficient. This study aimed to clarify the therapeutic effects and mechanism of skin cooling and the antioxidant α-lipoic acid derivative on chemotherapy-induced alopecia. We developed a chemotherapy-induced alopecia model of cyclophosphamide (120 μg/g) using Institute of Cancer Research mice. We used cooling therapy and α-lipoic acid derivative application as the treatments. We compared the alopecia score, hair bulb diameter, insulin-like growth factor-1 level, vascular permeability, and apoptosis between the control and treatment groups. The alopecia score significantly improved in each treatment group compared with that in the cyclophosphamide group. Hair bulb diameter significantly improved in the cyclophosphamide + cooling group compared with that in the cyclophosphamide group. The insulin-like growth factor-1 level and vascular permeability level was significantly retained and suppressed, respectively, in each treatment group compared with that in the cyclophosphamide group. The number of apoptotic cells in the vascular endothelium significantly decreased in the cyclophosphamide + α-lipoic acid derivative group compared with that in the cyclophosphamide group. In conclusion, cooling therapy and α-lipoic acid derivative facilitated recovery from chemotherapy-induced alopecia caused by cyclophosphamide through decreasing vascular permeability.

701 Rethinking alopecia scores: Correlating measures of hair loss with established photographic scoring systems

Alopecia scoring systems have traditionally been designed to assess and track severity and progression of specific types of alopecia. Each scoring system’s design and clinical validation is limited to only one alopecia type (e.g., Severity of Alopecia Tool score for alopecia areata (AA), Sinclair visual analogue scale for female pattern hair loss (FPHL), Olsen top extent scale for central centrifugal cicatricial alopecia (CCCA)), even though all forms of alopecia share a common feature of decreasing hair density. We propose that a scoring system that measures percent hair loss would be useful across different types of hair loss. We tested correlations between the AA, FPHL, and CCCA scoring systems and the underlying percent hair loss. On a dataset of 284 top-view scalp images taken from 250 subjects, 3 raters manually scored each image using the 3 different scoring systems. After an intraclass correlation analysis demonstrated reliability between the raters, we established a final consensus set of 3 scores per image. Using regression models, we analyzed the score correlations within and across alopecia types. Our results suggest that there is a precise and quantifiable correlation between these scoring systems and the underlying hair loss percent: both CCCA and FPHL scoring systems show a logarithmic relationship with respect to percent scalp area affected (a proxy for the AA scale), resulting in an R2 of 0.793 and 0.804, respectively. Additionally, the CCCA and FPHL scoring systems show a linear relationship with each other, resulting in an R2 of 0.963. These findings suggest that distinct alopecia scoring systems measure percent hair loss as a common underlying feature, and that an automated algorithm quantifying this percent hair loss from photographs may be designed and applied to all forms of hair loss.

Abstract P4-10-01: Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05)

Abstract P4-10-01: Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05)

Effect of Pregnancy and Age on Alopecia in Adult Female Baboons (Papio hamadryas spp).

Alopecia occurs frequently in captive populations of nonhuman primates. Because multiple factors can play a role in alopecia, a better understanding of its etiology will help identify potential welfare concerns. The purpose of this study was to investigate risk factors for alopecia in a breeding colony of baboons with a focus on pregnancy and age. Alopecia was scored on a scale of 0 (no alopecia) to 5 (severe alopecia) in 253 female baboons during routine physicals. The subjects ranged in age from 4 to 23 y (Mean = 9.6) and were categorized as pregnant (n = 83), nursing (n = 60) or control (n = 110). Resulting alopecia scores were combined into 2 categories (mild = 0 or 1; moderate = 2 or 3); no animals scored a 4 or 5. Significantly more pregnant females had moderate alopecia than did control females. There was no effect of age on alopecia. An unexpected outcome was that among nursing females, more of those with female infants had moderate alopecia than did those with male infants. The impact of the infant's sex on alopecia may be due to sex differences in maternal contact or maternal investment. This information adds to our understanding of alopecia risk factors in captive nonhuman primates.

Early onset androgenic alopecia: not a cosmetic problem but a sign of life time risk factors. Male phenotypic equivalent of polycystic ovarian syndrome: Is There a Male Phenotype of PCOS

Objective: Polycystic ovarian syndrome (PCOS) was thought to be a gynecologic disorder and then accepted as a general endocrine and metabolic syndrome. The genetic component of PCOS seems to be very important in its etiology. Because of this reason there should be a male PCOS equivalent. Early androgenetic alopecia (EAGA) is a specific pattern of hair loss and it should start before age 30 years and it is claimed to be a male equivalent of PCOS in women.
 Materials and Methods: In this study we aimed to investigate the hormonal and metabolic parameters of men with EAGA and compare them with healthy age-matched controls. Thirty men with EAGA and 30 controls were screened for free testosterone, DHEAS, gonadotropins, 17OH progesterone, ACTH, fasting glucose, fasting insulin, homocysteine and metabolic profile. Homeostasis model assessment (HOMA) results were used for the marker of insulin sensitivity. Alopecia classification was made by using the scale of Hamilton with Norwood modification.
 Results: Patients with EAGA had higher free testosterone (25,12±3,05 vs 21,3±1,77), DHEAS (634,90±27,09 vs 578±17,82), LH (9,16±0,28 vs 5,13±0,40). The EAGA group had insulin resistance but the control group did not (HOMA results were 3,34±0,47 vs 1,43±0,3). The homocysteine levels of EAGA group were higher than controls (12,37±1,31 vs 9,33±2,12) which is another cardiovascular risk factor. The correlations that we found in our study among HOMA, serum androgen levels, homocysteine and alopecia scores were positive in EAGA patients. We didn’t find any correlations among those parameters in control group. Because of these findings men with EAGA can be considered as male synonym to PCOS syndrome. These young men should be followed for the same long time risk profile like PCOS women. Insulin resistance and its results like metabolic syndrome, diabetes and cardiovascular diseases are real risks but there may be even a risk for infertility.
 Conclusion: We aimed to investigate whether EAGA can be accepted as the male phenotype of PCOS and if they have elevated risk factors for chronic complications than their age and sex matched controls.

Abstract P2-12-14: A pilot evaluation of cold-capping efficacy under real world conditions for the prevention of chemotherapy-induced alopecia in early stage breast cancer

Abstract Background: Alopecia is a common and distressing adverse effect of curative-intent chemotherapy in early stage breast cancer. Machine-based scalp cooling (such as Paxman® or DigniCap®) is effective for alopecia reduction/prevention, however availability of these devices is geographically limited. Cold-cap based systems are FDA-approved alternatives that can be accessed by motivated patients regardless of geographic location. Cold-cap based systems were shown to be highly effective in prospective trials, however dedicated research staff were responsible for cold-cap implementation in these trials. Here, we report the results of a pilot study to evaluate efficacy of cold-capping under real world conditions whereby patients and caretakers are responsible for cold-cap implementation. Methods: Key eligibility criteria included: 1) no hair loss at baseline (Dean’s scale 0); 2) no pre-existing scalp condition; 3) planned curative-intent chemo (ACT/HP, TC, TCHP, or TH); and 4) availability of caretaker(s) to assist with cold-cap implementation. Patients and caretakers were required to undergo a standardized cold-capping training session, which included didactic and hands-on simulation designed to educate on proper cold-capping use as advised by the manufacturer (Penguin®). The primary endpoint was 30-day post-treatment hair retention using the Dean’s alopecia score, with success defined as <50% hair loss (score 0-2 on 5-point scale). Secondary outcomes included toxicity (CTCAEv4.0) and patient-reported outcomes (“Was it Worth It” scale). Results: Twelve patients were enrolled and underwent training. Two patients withdrew consent before initiating treatment. 80% (n=8/10) of evaluable patients met the primary efficacy endpoint of Dean’s scale 0-2 (table 1). Trial failures were reported in 2 patients (20%), one due to treatment discontinuation and another due to >50% hair loss. One cap-related toxicity of grade 1 head sore was reported. 90% (n=10) of subjects reported that participation was worthwhile (“yes” on Was it Worth It? scale). Conclusions: With the assistance of a hospital-sponsored training session, caretaker-implemented cold-capping is effective at preventing/reducing alopecia, and is worthwhile to patients. Efficacy was observed even with anthracycline-based chemotherapy. Cold-cap scalp cooling may serve as an alternative to machine-based scalp cooling, and is available to interested patients regardless of geographic location. Scholarships are available to subsidize the cost of cold-capping for patients in need. Clinical Trial OutcomesArmRegimen"Was it Worth it?" QuestionnaireFinal Dean's Alopecia Scale ScoreArm 1 (n=3)ACT/HPYes: 3/3 (100%)1: 2/3 (66%); 2: 1/3 (33%)Arm 2 (n=5)TCH/PYes: 4/5 (80%; Unknown: 1/5 (20%)0: 2/5 (40%); 1: 2/5 (40%); 3: 1/5 (20%)Arm 3 (n=1)TCYes: 1/1 (100%)2: 1/1 but discontinued early (100%)Arm 4 (n=1)T/HYes: 1/1 (100%)0: 1/1 (100%)Total (n=10)Yes: 9/10 (90%); Unknown: 1/10 (10%)0: 3/10 (30%); 1: 4/10 (40%); 2: 2/10 (20%); 3: 1/10 (10%) Citation Format: Manaz Rezayee, Alison K Conlin, Janet Ruzich, Nicole Fredrich, Amanda Y Seino, Susan Mulligan, Tracy L Kelly, Julie Cramer, Walter J Urba, David B Page. A pilot evaluation of cold-capping efficacy under real world conditions for the prevention of chemotherapy-induced alopecia in early stage breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-14.

Can we predict prostate size by scoring baldness? The relationship of androgenic alopecia and lower urinary tract symptoms.

IntroductionProstate growth and androgenic alopecia are both under the influence of dihydrotestosterone. Dihydrotestosterone can make prostates larger and men balder. Therefore, we assessed the association of men suffering from lower urinary tract symptoms and androgenic alopecia.Material and methodsWe enrolled 177 subjects which underwent a Green Light Laser Vaporization Procedure of the prostate between 2006 and 2017. We identified two groups of males with different levels of androgenic alopecia, classified according to the Norwood-Hamilton scale, which we compared in this study. lower urinary tract symptoms were evaluated using the International Prostate Symptom Score questionnaire. Other parameters included demographics, urodynamics, prostate volume and prostate-specific antigen.ResultsMean patient age was 68 (47–87) years. Mean International Prostate Symptom Score was 20 (1–35). 59.3% of subjects were classified as bald using the Norwood-Hamilton scale (androgenic alopecia score). Mean prostate size (range) was 77.5 ml (21–245), mean Qmax was 9 ml/s (1–25), and mean PSA was 4.7 ng/ml (0.3–39). The androgenic alopecia score correlated with none of the other parameters. PSA and prostate volume correlated with the Schäfer obstruction classification. Qmax correlated with the Schäfer classification and International Prostate Symptom Score. International Prostate Symptom Score correlated with QoL. Schäfer classification correlated with PSA, prostate volume, Qmax and age.ConclusionsAs expected, various lower urinary tract symptoms parameters in our study correlated with each other. However, no correlation was found between the androgenic alopecia score and LUTS or prostate volume. This score cannot be used to estimate prostate size.

SYK inhibitor entospletinib prevents ocular and skin GVHD in mice.

Graft-versus-host disease (GVHD) is a major complication of hematopoietic stem cell transplantation (HCT). The tyrosine kinase SYK contributes to both acute and chronic GVHD development, making it an attractive target for GVHD prevention. Entospletinib (ENTO) is a second-generation highly selective SYK inhibitor with a high safety profile. Potential utility of ENTO as GVHD prophylaxis in patients was examined using a preclinical mouse model of eye and skin GVHD and ENTO-compounded chow. We found that early SYK inhibition improved blood immune cell reconstitution in GVHD mice and prolonged survival, with 60% of mice surviving to day +120 compared with 10% of mice treated with placebo. Compared with mice receiving placebo, mice receiving ENTO had dramatic improvements in clinical eye scores, alopecia scores, and skin scores. Infiltrating SYK+ cells expressing B220 or F4/80, resembling SYK+ cells found in lichenoid skin lesions of chronic GVHD patients, were abundant in the skin of placebo mice but were rare in ENTO-treated mice. Thus, ENTO given early after HCT safely prevented GVHD.

Alopecia areata treated with hydroxychloroquine: A retrospective study of nine pediatric cases.

Alopecia areata is a common hair loss condition that is often emotionally devastating for patients. There is a paucity of effective treatments available. Hydroxychloroquine has been reported as variably effective in inducing significant hair regrowth in adults with alopecia areata. The objective of this retrospective study was to assess the benefit and tolerability of hydroxychloroquine in pediatric alopecia areata. We conducted a retrospective review of nine children with a history of alopecia areata treated with hydroxychloroquine. Clinical data were obtained from patients treated at two tertiary care centers in the United States between July 1, 2013, and July 1, 2015. Alopecia scores of five patients improved by 6 months of treatment. Four patients experienced no improvement from baseline evaluation. The most common side effect associated with treatment was gastrointestinal intolerance and headache. This retrospective series suggests that hydroxychloroquine can be considered as a treatment option for alopecia areata in children.

Hair growth promotion effect of cedrol cream and its dermatopharmacokinetics.

Topical use of cedrol ethanol has been reported to have a beneficial effect on hair loss. However, the use of cedrol has been limited by application-related issues, such as poor water solubility and volatile features. Therefore, the present study developed a cream formulation of cedrol and evaluated various physicochemical parameters of the prepared cream. The optimized cedrol cream was selected after orthogonal tests and determined further. The dermatopharmacokinetics were studied to investigate the absorption difference between cedrol cream and cedrol ethanol after dermal application, and the concentrations of cedrol in skin were analysed by the gas chromatography-mass spectrometry (GC-MS) method. By comparison, the area under the curve (AUC0–24 h) of cedrol cream was almost three times higher than that of cedrol ethanol. Moreover, this study was undertaken to evaluate the hair growth promoting efficacy of cedrol cream in C57BL/6 mice and Wistar rats. Macroscopic assessment and alopecia score showed that C57BL/6 mice treated with cedrol cream showed a faster production of pigmentation and a higher score at different growth stages than other groups. The hair length of the cedrol cream-treated group was much longer than those of the cedrol ethanol and minoxidil groups. Histological analyses indicated that in the cedrol ethanol group, most follicles of the C57BL/6 mice were in the catagen phase, whereas nearly 83% of hair follicles in the cedrol cream group remained in the anagen phase. Taken together, our data strongly suggest that the cream formulation of cedrol has a stronger hair growth promotion effect, gave no irritation and was safe for topical administration.

Are 2D:4D finger-length ratios an indicator of androgenetic alopecia in males?

BACKGROUNDAlthough the pathogenesis of androgenetic alopecia is not completely understood, the roles of genetic susceptibility and androgens are well-known. A lower ratio of the second digit (index finger = 2D) to the fourth digit (ring finger = 4D) length has been hypothesized to reflect prenatal androgen exposure and/or higher sensitivity to androgens.OBJECTIVESTo determine the relationship between the second to fourth digit length ratio and androgenetic alopecia.METHODSFinger length measurements were made by a digital vernier calliper. Androgenetic alopecia severity was assessed using the Hamilton-Norwood scale. Subjects with an androgenetic alopecia score of grade III or more were included in the study.RESULTSA total of 189 males with androgenetic alopecia and 171 healthy controls were enrolled in the study. The age range of participants was 19-65 years. The 2D:4D ratios in patients with androgenetic alopecia were significantly lower than those of healthy controls for the right hand; however, no significant difference was found for the left hand. Average 2D:4D ratios in androgenetic alopecia patients were also lower than in controls. No significant relationship was observed between androgenetic alopecia severity and 2D:4D ratios.CONCLUSIONOur data support the anatomical evidence of in utero androgen exposure and/or an individual’s sensitivity to androgens in patients with androgenetic alopecia. Furthermore, the right hand 2D:4D ratio might be an indicator of androgenetic alopecia development.

Improvement of androgenetic alopecia with topical Sophora flavescens Aiton extract, and identification of the two active compounds in the extract that stimulate proliferation of human hair keratinocytes.

Androgenetic alopecia (AGA) is a hair loss disorder that commonly affects middle-aged men. To date, the properties of a number of natural or synthetic substances have been investigated for their ability to improve the condition. To evaluate the hair growth-promoting activities of an extract from the root of Sophora flavescens Aiton. We used a human hair keratinocyte proliferation assay and ex vivo organ cultures of human hair follicle to examine the potential of the extract to stimulate hair growth via anagen elongation. We isolated the compounds promoting the growth of epithelial cells, and determined their chemical structures. A randomized, double-blinded, placebo-controlled clinical study for S. flavescens extract was carried out for 6 months with patients with AGA. The extract stimulated the proliferation of hair keratinocytes at a concentration of 0.1 ng/mL, while 100 ng/mL of the extract had a marked effect on hair shaft elongation in an organ culture of human hair follicle. Cell proliferation assay-directed fractionation led to the identification of two pterocarpan derivatives, L-maackiain and medicarpin, as active compounds that promote the proliferation of human hair keratinocytes. Studies in human subjects showed that improvement in the inspected alopecia scores in the lotion plus extract group were significant over a period of 6 months (P < 0.01). S. flavescens root extract is effective for the treatment of AGA. The isolated two pterocarpans might have important role in this effect.

Efficacy of Scalp Cooling in Preventing Chemotherapy-Induced Alopecia in Breast Cancer Patients Receiving Adjuvant Docetaxel and Cyclophosphamide Chemotherapy

BackgroundChemotherapy-induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC (docetaxel [Taxotere] and cyclophosphamide) chemotherapy regimen is typically associated with complete alopecia. Scalp cooling with cold caps has been reported to minimize or prevent CIA. We conducted a prospective study to assess efficacy of scalp cooling in preventing CIA among women receiving adjuvant TC chemotherapy for breast cancer. MethodsWomen at the Weill Cornell Breast Center who independently elected to use scalp cooling with cold caps during adjuvant TC chemotherapy were asked to participate. Degree of hair loss was assessed by a single practitioner using Dean's alopecia scale (grade 1/excellent [< 25% hair loss], grade 2/good [25%-50% hair loss], grade 3/moderate [50%-75% hair loss], grade 4/poor [> 75% hair loss]), by digital photographs, and by patient self-report of hair thinning or the need to wear a wig/head covering, or both. Assessments were made before each chemotherapy treatment and at follow-up visits between 3 weeks and 3 months after completion of chemotherapy. ResultsOf 20 evaluable patients, 10% reported a need to wear a wig/head covering at the follow-up visit. Dean's alopecia score was excellent for 65% of patients, good for 25% of patients, and moderate or poor for 10% of patients. The majority of patients reported hair thinning after every chemotherapy cycle. No patient discontinued therapy because of an intolerance to cold caps. ConclusionScalp cooling with cold caps appears to be effective in preventing CIA among the majority of women undergoing treatment with TC chemotherapy.

Alopecia in three macaque species housed in a laboratory environment.

Alopecia is a persistent problem in captive macaque populations and despite recent interest, no factors have been identified that can unequivocally explain the presence of alopecia in a majority of cases. Seasonal, demographic, and environmental factors have been identified as affecting alopecia presentation in rhesus macaques, the most widely studied macaque species. However, few studies have investigated alopecia rates in other macaque species. We report alopecia scores over a period of 12 months for three macaque species (Macaca nemestrina, M. mulatta, and M. fascicularis) housed at three indoor facilities within the Washington National Primate Research Center (WaNPRC) in Seattle. Clear species differences emerged with cynomolgus (M. fascicularis) showing the lowest alopecia rates and pigtails (M. nemestrina) the highest rates. Further analysis of pigtail and rhesus (M. mulatta) macaques revealed that sex effects were apparent for rhesus but not pigtails. Age and seasonal effects were evident for both species. In contrast to previous reports, we found that older animals (over 10 years of age) had improved alopecia scores in comparison to younger adults. This is the first report on alopecia rates in pigtail macaques and the first comparison of alopecia scores in pigtail, cynomolgus, and rhesus macaques housed under similar conditions.

Autologous cytokine-induced killer cells therapy on the quality of life of patients with breast cancer after adjuvant chemotherapy: a prospective study

To explore the effect of autologous cytokine-induced killer cells on the quality of life in patient with breast cancer who have already finished the adjuvant chemotherapy. One hundred and twenty-eight postoperative patients with breast cancer who underwent anthracycline-based adjuvant chemotherapy were enrolled in this prospective study, and they were randomized into 2 groups, i.e., treatment group, which received the therapy of CIK cells transfusion, and control group, which was given regular follow-up. Meanwhile, patients with positive hormone receptor in the two groups were given endocrine therapy, and the patients with positive axillary lymph nodes were given radiotherapy to the chest wall and regional lymph nodes. The difference of quality of life between the two groups was analyzed according to the EORTC QLQ-BR53 quality of life questionnaire, and the adverse reactions were monitored. As regarding the functional evaluation, the physical function scores of patients of the treatment group were (83.43 ± 14.87) and (88.55 ± 11.62) at 3 and 6 months after the CIK cell therapy, respectively, significantly higher than the baseline value [(74.83 ± 13.82), P < 0.05)]. Global health status/QOL scores were (83.30 ± 19.09) and (89.68 ± 10.81), significantly higher than the baseline value [(77.72 ± 21.05), P < 0.05]. As regarding symptoms, the scores of fatigue, nausea, vomiting and loss of appetite of patients in the treatment group were higher than the baseline value, with significant differences (P < 0.05). The nausea and vomiting scores in the control group at 3 and 6 months of followed-up were (26.67 ± 22.56) and (21.47 ± 21.06), significantly lower than the baseline values [(33.31 ± 27.07), P < 0.05]. The scores of worrying about the future in the patients of treatment group were (47.56 ± 30.84) and (42.33 ± 26.95) after 3 and 6 months, significantly better than the baseline value [(57.41 ± 30.63), P < 0.05]. The systematic therapy side effects scores were (31.95 ± 27.52) and (23.72 ± 22.87), significantly better than the baseline value [(40.56 ± 26.28), P < 0.05]. The scores of arm edema were (45.26 ± 25.42) and (36.61 ± 20.51), significantly milder than the baseline value [(55.11 ± 22.82), P < 0.05]. In the control group, the scores of arm edema were (44.85 ± 28.94) and (38.64 ± 23.68), significantly lower than the baseline values [(53.26 ± 23.84) points, P < 0.05]. Alopecia scores were (29.93 ± 24.72) and (24.18 ± 22.66), significantly lower than the baseline values [(35.92 ± 22.08), P < 0.05]. In the treatment group, the patients' physical function, social function and global health status/QOL, fatigue, insomnia, and worrying about the future rates were significantly higher than that of the control group (P < 0.05 for all). Three patients after CIK reinfusion had transient fever, and 6 cases felt pain in the lower limb, but the symptoms were relieved after symptomatic treatment. Therapy of autologous CIK cells transfusion can significantly improve the quality of life of breast cancer patients, and the adverse reactions during the treatment can be alleviated by symptomatic treatment.

Prospective Cohort Study on the Effects and Tolerability of Flutamide in Patients with Female Pattern Hair Loss

Flutamide has been rarely used for the treatment of female pattern hair loss (FPHL). Flutamide treatment for FPHL has not been evaluated in long-term studies with sufficiently large numbers of women. To evaluate long-term effects, safety, and tolerability of flutamide in women with FPHL. A prospective cohort study was conducted in our tertiary care university hospital. The cohort included 101 women diagnosed with FPHL from January 1991 to January 2006. These women received yearly reducing doses (250, 125, and 62.5 mg/day) of flutamide for 4 years. The cohort included 33 patients treated with flutamide alone and 68 treated with flutamide combined with an oral contraceptive. Clinical and endocrine evaluations were assessed semiannually and annually, respectively, in the first 3 years of the study, and once in the following year. Liver function was evaluated quarterly. Both groups showed a marked decrease in alopecia scores after 12 months of flutamide therapy, compared with baseline values. The maximum drug effect occurred after 2 years and was maintained during the following 2 years of treatment. Androgens were strongly suppressed. During the first year of treatment, 4% of patients abandoned the study due to hepatic disorders related to the drug. During the following years, with the lower treatment regimen, no patient abandoned the study because of hepatic alterations. Flutamide is a satisfactory therapeutic regimen for treatment of FPHL in the long run. Moreover, the use of very low doses (62.5 mg/day) of flutamide is associated with complete hepatic tolerability and high adherence.

Evaluating Paint Rollers as an Intervention for Alopecia in Monkeys in the Laboratory (Macaca nemestrina)

Adult female macaques (Macaca nemestrina) in the laboratory with alopecia from known or suspected overgrooming were subjects in a study evaluating effectiveness of a grooming device. The intervention evaluated was a paint roller on a metal bar hung on the cage, replaced weekly for 6 weeks. In a within-subjects design, 6 monkeys were randomly assigned to first experience the paint roller (PR) and later the control (C) condition (roller bar only); 6 monkeys were randomly assigned to C followed by PR. Coat condition scores quantifying alopecia were taken cageside weekly. During PR, PR use was scored 3 times a week based on wear. Alopecia scores during PR did not differ significantly from C. Although all the monkeys used the paint rollers, PR use scores did not correlate significantly with improvement in coat condition. Paint rollers do not appear to be an effective intervention for alopecia from overgrooming.

Permanent alopecia after cranial irradiation: Dose–response relationship

Purpose To develop a dose–response relationship for the occurrence of permanent alopecia after cranial irradiation and to analyze potential confounding variables that may contribute to this unwanted and often unavoidable complication of treatment. Methods and materials Twenty-six patients were enrolled in this study. Three reviewers independently assessed 61 scalp regions and assigned a score for the degree of alopecia in each region using a 4-point scale. Patient and treatment data were collected using a patient questionnaire and outpatient medical chart review. The hair follicle dose was calculated for each scalp region and correlated with the alopecia score for that region. A dose–response relationship was established using the data from these correlations. Results Permanent alopecia correlated significantly with the follicle dose only ( p < 0.001). A personal history of alopecia and the use of chemotherapy correlated with permanent alopecia with borderline statistical significance ( p = 0.059 and p = 0.068, respectively). Patient age, family history of baldness, gender, tobacco use, diabetes, and beam energy did not correlate with alopecia. Conclusion We report the first human dose–response relationship describing the effect of the follicle dose on the subsequent development of permanent scalp alopecia after cranial irradiation. This information will assist the radiation oncologist, physicist, and dosimetrist in designing a treatment plan that might minimize the risk of this untoward side effect of cranial irradiation.

Treatment of Hyperandrogenic Alopecia in Women

Many women with androgenic alopecia have normal circulating androgen levels. Increased scalp sensitivity to androgens may account for these cases. Even when androgen levels are increased, no particular pattern has emerged. Classical anti-androgen measures have proved disappointing, in contrast to the results obtained in women with hirsutism or acne. This study evaluated flutamide and finasteride in 36 premenopausal, hyperandrogenic women presenting with androgenic alopecia. Frontal hair thinning was assessed in photos of the frontoparietal region using the Ludwig grading system. Thirty ovulatory women matched for age and body weight served as a control group. Groups of 12 subjects received 50 mg cyproterone acetate (CPA) on cycle days 5-15 plus 25 μg ethinyl estradiol (EE) on days 5-25, 250 mg flutamide daily, or 5 mg finasteride daily, all for 1 year. The alopecic women had significantly higher serum levels of testosterone, unbound testosterone, and dehydroepiandrosterone than the normal control women. Women in all treatment groups had comparable serum androgen levels and alopecia scores at the outset. After a year of treatment, only flutamide significantly relieved alopecia, lowering Ludwig scores by 21% (Fig. 1). Self-reports supported this finding. Eight of 12 flutamide-treated patients reported that hair loss had slowed, but hair regrew in only 3 cases. Three women given CPA-EE and 1 given finasteride reported a slowing of hair loss. Assessment by the investigators also showed flutamide to be the most effective treatment, but the difference from CPA-EE treatment was not significant (Fig. 2). Two patients had mildly increased liver enzymes after 6 months on flutamide. Treatment continued, and no worsening was noted; the enzymes were normal 2 months after treatment ended. Flutamide, in a daily dose of 250 mg, led to modest improvement in alopecia after 1 year in these hyperandrogenic women. Possibly more extended treatment would yield better results.