Areas Of Alopecia Research Articles

How to avoid the principal complication of scalp reduction in the management of extensive alopecia.

Instead of risking the esthetic complication sometimes observed with the development of a vertical alopecic strip crossing the posterior aspect of the scalp, another method can be used to replace this. A small, round alopecic area similar to a small developing bald spot is created and eventually grafted later.

Alopecia reduction by scalp expansion.

Areas of alopecia may be eliminated by scalp expanders. This is accomplished by subgaleal placement of soft tissue expanders under normal scalp adjacent to defect. Subsequent inflation and advancement of the expanded scalp resurfaces the defect with an excellent aesthetic result.

Surgical Management of the Burned Scalp

Alopecia from scalp burns can present psychological problems. Reconstructive surgery with rotating hair-bearing skin flaps has been useful in the rehabilitation of these patients. In many patients, one flap shift can establish an acceptable hair line. In extensive cases, multiple operations are necessary, including fractional excision of small burns that have been skin-grafted or fractional excision of the donor site when large hair flaps were rotated. It is remarkable how the occipital flap can reach the forehead by a series of transfers without delay, using a rotation of 90 to 180 degrees. Worthen presented an interesting case of revascularization of the skull in a victim of an electrical burn. In conclusion, scalding hot liquids accidentally spilled on the young child's scalp will produce a deep burn with loss of hair. Small areas of alopecia that are skin-grafted can be handled by staged fractional excision. The hair line can be reestablished in larger areas of alopecia by a series of operative procedures that require years to accomplish. When the periosteum of the skull is affected, resection of the outer table of bone and skin grafting will expedite wound healing.

Role of scalp reduction in the treatment of male pattern baldness.

Scalp reduction applies the principle of staged excision to the alopecic area in male pattern baldness. Two to rarely five excisions are performed as outpatient office procedures under local anesthesia. The reduction greatly enhances the results obtainable by supplementary hair transplantation and may reduce or eliminate the need for it. A personal series of 30 patients is presented. Technique and expected results are illustrated. Complications and limitations of the method are discussed. Wider consideration of scalp reduction in the treatment of patients seeking hair restoration is encouraged.

Tzaraat— ℬbiblical leprosyℭ

Tzaraat refers to a group of skin diseases that, according to the Old Testament, renders one ritually unclean. Analysis of the text reveals that there are four categories of lesions discussed. Each category has a primary lesion as well as specific secondary changes. The primary lesions include depigmented lesions on previously healthy skin, lesions on previously abnormal skin, lesions on areas of diffuse alopecia, and lesions of localized alopecia. It is unlikely that these diseases have a modern-day counterpart.

Nerve fibre degeneration of the central and peripheral nervous systems in severe protein deprivation in rats

Knowledge from previous reports that kwashiorkor in man may lead to nerve fibre degeneration prompted this study on rats. The rats were subjected to severe protein deprivation from 6 weeks of age. Protein deprivation was achieved by feeding the rats ad lib with a diet containing only 1.5% protein. Control rats received an iso-caloric diet with 14% protein. The vitamin content in both diets was well above normal requirements. In relation to body weight the protein-deprived rats did not consume less food than the control rats. Protein deprivation resulted in stunted body growth, markedly reduced values of serum albumin, and changes in the fur accompanied by areas of alopecia. Furthermore, the protein-deprived rats showed degeneration of nerve fibres in the medial parts of the posterior columns of the cervical but not the sacral part of the spinal cord and nerve fibre degeneration in the distal but not the proximal parts of the longitudinal tail nerves. Teased nerve fibre preparations of the tail nerves revealed changes consistent with the Wallerian type of degeneration. It is concluded that severe protein deprivation in young rats may lead to a "dying-back" type of neuropathy in the central and peripheral nervous systems.

Direct Immunofluorescence Studies in Alopecia Areata and Male Pattern Alopecia

Direct immunofluroescence studies were performed on hairy and alopecic areas of scalp in patients with alopecia areata, alopecia totalis and male pattern alopecia. Abnormal deposits of C3 and occasionally of IgG and IgM were found in 92% of 12 patients with alopecia areata and in 21% of patients with male pattern alopecia. No abnormalities were seen in 4 patients with alopecia totalis. In both alopecia areata and male pattern alopecia, the deposits were most common along the basement zone of the inferior segment of hair follicles and occurred with equal frequency in alopecic and normal scalp. These observations suggest that immune factors may play a role in the pathogenesis of alopecia areata.

Planning in Hair Transplantation

The size of an area to receive hair transplants can be minimized by designing a conservative hairline and by surgical reduction of the area of alopecia. A pattern of dispersion of grafts for optimal aesthetic effect is presented together will suggestions about frequency of sessions and amount of transplantation done each time. Hair transplanting begun prior to complete alopecia has advantages that are explained.

Management of alopecia of the scalp by a combination of excisions and transplantations.

Since the number of grafts that are available in any given patient is a fixed quantity, significant benefits may be derived by surgically reducing the size of the area of alopecia in combination with prior and later punch hair transplantation. This paper outlines and describes techniques of excisions that achieve such reductions.

Pituitary dwarfism in German Shepherd dogs.

ABSTRACTEleven German Shepherd dogs with pituitary dwarfism were examined. They were severely stunted in growth and possessed abnormal hair coats with persistence of the soft puppy (lanugo) coat and symmetrical areas of alopecia. Various other physical defects were often present in affected dogs. Detailed hormonal studies demonstrated a severe deficiency in growth hormone in all five cases so evaluated. A decrease in somatomedin activity was present in three of these cases. Changes in growth plates epiphyses and ossification centres were apparent on radiographic examination of four of the eleven dogs. Epiphyseal dysgenesis was confirmed histologically in two of these cases. Of the six brains which were examined post mortem, four showed large cystic lesions involving the adenohypo–physis and two had pituitary hypoplasia with virtual absence of adenohy–pophyseal tissue.

Tinea Capitis Due to Trichophyton soudanense

Trichophyton soudanense (Joyeux, 1 1912) is a frequent cause of tinea capitis in certain regions of Africa. Infections of skin and nails are less frequent. 2 To our knowledge, this is the first published report of a scalp infection by this dermatophyte in the United States; however, two reports of tinea corporis have been published. 2,3 Report of a Case A 6-year-old, American girl who had never left the Philadelphia area developed four pruritic, round areas of alopecia in the occipital area of her scalp. The plaques were slightly elevated, scaly, dull red, and 1- to 4-cm in diameter. The follicles contained black dots that were broken hairs containing spores 6 to 7 μ in diameter. There were enlarged lymph nodes in the posterior cervical and postauricular areas. Inoculation of broken hairs on Sabouraud's glucose agar yielded a folded, yellow to dried apricot colony surrounded by submerged mycelium. Results of

Pilonidal Cyst of the Scalp

Following trauma in a 5-year-old boy, recurrent inflammation in an area of posttraumatic alopecia on the occiput of the scalp occurred. Surgical intervention at age 13 uncovered a small collection of hair. Removal of this pilonidal cyst resulted in a cure.

The Cutaneous Amyloidoses

Histologic features of specimens of skin from 40 patients with systemic amyloidosis were correlated with the clinical findings. In primary systemic amyloidosis (including patients with myeloma) papules were correlated with amyloid deposits in dermal papillae, plaques with diffuse involvement of the corium, and nodules and tumefactions with infiltration of the reticular corium and subcutaneum. In patients with purpura, amyloid was deposited in the walls of dermal blood vessels. There was involvement of pilosebaceous units in all biopsy specimens from areas of alopecia. The electron microscopic appearance of the amyloid in skin in primary systemic amyloidosis was similar to that found in localized forms of cutaneous amyloidosis. Among 100 patients with secondary systemic amyloidosis who came to autopsy, no instance could be found of a clinical lesion caused by the deposition of amyloid in the skin. Among 60 clinical examples of cutaneous amyloidosis, no patient was found to have secondary systemic amyloidosis. Thus, when a dermatologic lesion is attributable to amyloid, an aggressive search for such conditions as tuberculosis is unwarranted, since secondary systemic amyloidosis would be a most unlikely cause. When a dermatosis is present in a patient with secondary systemic amyloidosis it may be related to the underlying disorder, but it is almost certainly not caused by amyloid.

Histangic patterns in seborrheic alopecia.

In 19 cases of early seborrheic trichomadesis (alopecia seborrhoides praematura) and in 15 cases of trichophalakrosis (calvities seborrhoides inveterate) the basal cutaneous flow of the scalp – as ascertained by dermal <sup>131</sup>Jodine clearance rate, skin temperature, and thermopill flowmetric recording – is evaluated in comparison with 10 normal controls. High flow values, with uniform and symmetrical distribution, with average rates not significantly different from the normal controls, were generally obtained. In a relatively small percentage of the inveterate cases, a slightly lower flow regimen with a delayed reheating time test, were encountered. Critical and short-time hyperemic responses were elicited by perspiratory (thermal, emotional) or psychical (mental reckoning) stimuli, in subjects with peculiar lability of microcirculatory adjustment of the affected areas. A close correlation between basal flow rate and metabolic intensity of the corresponding scalp fragments confirmed the strict linkage between both histangic factors. Rubbing and hyperemising topical procedures were followed by a small increase of the mean blood flow of the scalp. Following conclusions were drawn: 1. There exists a stabilizing mechanism of the scalp blood flow, with thermoregulatory properties, that undergoes some perturbations only in wide and inveterate stages of hair denudation. 2. Seborrheic alopecic skin areas are often characterized by unbalanced perfusion control against perspiratory and emotional impact situations, but not by a significant reduction of the basic skin flow, that even in severe follicular impairment seems to be largely exceeding the metabolic needs of the tissue. 3. There is a satisfactory linearity between oxydative metabolism and flow of the affected areas. Circulatory changes seem therefore to be secondary to the parenchymatous changes of the hair, in histangic connection therewith. 4. A sound circulatory foundation for the flow-increasing treatment of the scalp (as is today largely used in the therapeutic trial of seborrheic alopecias) does not exist.

Dermal Changes Associated With Carbon Monoxide Intoxication

Severe carbon monoxide (CO) poisoning can produce several types of lesions of the skin. The lesions vary in degree from areas of erythema and edema to marked blister and bulla formation. These lesions can easily be mistaken for burns or trauma. The bullous lesions heal by eschar formation. The scalp lesion of edema and erythema evolve into areas of alopecia.

Dermal changes associated with carbon monoxide intoxication.

Severe carbon monoxide (CO) poisoning can produce several types of lesions of the skin. The lesions vary in degree from areas of erythema and edema to marked blister and bulla formation. These lesions can easily be mistaken for burns or trauma. The bullous lesions heal by eschar formation. The scalp lesion of edema and erythema evolve into areas of alopecia.

The pathogenesis of alopecia areata.

SUMMARY.— The pathogenesis of alopecia areata was studied by plucking hairs from each of a series of concentric zones, using felt patterns placed over lesions. It was possible to group lesions according to the zone with the greatest proportion of club hairs. The results are logically interpreted to mean that a wave of hair follicle damage or arrest moves centrifugally from a focal point beyond the area of alopecia. It is suggested that follicles may react in I of 3 ways. Firstly, severe damage may weaken the hair in the keratogenous zone, this being followed by breakage when the weak zone reaches the plane of the scalp; at the same time the follicle is precipitated into catagen and the hair is extruded as an exclamation mark. Secondly, the follicle may be precipitated into catagen with loss of the club in a normal manner, followed by replacement with a dystrophic anagen hair. Thirdly, the follicle may become dystrophic without a catagen phase.

Microsporum canis . [Descriptions of Fungi and Bacteria

Abstract A description is provided for Microsporum canis . Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: Primarily a pathogen of the cat and dog, frequently transmitted to man. Also recorded from the chimpanzee, chinchilla, fox, lion, monkey, pig, rabbit, sheep and tiger. Experimental animals are susceptible to infection. DISEASE: Ringworm (dermatophytosis, tinea). Infected hairs and animal claws usually fluoresce bright green under Wood's light and hairs are surrounded by ectothrix sheaths of small spores in a mosaic arrangement. In cats the lesions are usually inconspicuous. They may occur on any part of the body, but particularly the face and paws, and the whiskers and claws may be involved. In dogs infection is more noticeable, and is characterized by small circular areas of scaling and alopecia, sometimes with oedema and crust formation, on any part of the body. The claws may also be infected. Infections in dogs have a well defined seasonal incidence with a peak in Oct. -Feb., but the incidence in cats is poorly defined (Kaplan & Ivens, Sabouraudia 1: 91-102, 1961). In man the scalp (tinea capitis), glabrous skin (tinea corporis), and rarely the beard (tinea barbae), foot (tinea pedis) and nails (tinea unguium, onychomycosis) may be infected (mycoses). Children are most susceptible, particularly to scalp infection which is very rare in adults. Scalp lesions are scaling, inflammatory areas containing broken hairs or with total hair loss. Pustulation and kerion formation are not uncommon. Skin lesions are circinate, with a scaling centre and vesicular border. Kligman (RMVM 1, 2510; 2, 2484) studied the pathogenesis of tinea capitis caused by M. canis . GEOGRAPHICAL DISTRIBUTION: Africa (Algeria, Angola, Cape Verde Islands, Egypt, French W. Africa, Sahara, Tunisia, Union of S. Africa); Asia (Ceylon, India, Philippines, Turkey); Australasia & Oceania (Australia (N.S.W.), New Zealand); Europe, North America, Central America and West Indies (Costa Rica, Cuba, Guatemala, Mexico, Panama, Puerto Rico); South America (Argentina, Brazil (south of Pernambuco), Chile, Colombia, Ecuador, Peru, Uruguay, Venezuela).

Microsporum audouinii . [Descriptions of Fungi and Bacteria

Abstract A description is provided for Microsporum audouinii . Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: Primarily a pathogen of man. Also recorded on the dog, gibbon, guineapig and monkey. Most strains are not pathogenic for experimental animals. DISEASE: Ringworm (dermatophytosis, tinea). Infected hairs usually fluoresce bright green under Wood's light and are surrounded by an ectothrix sheath of small spores in a mosaic arrangement. In man, the scalp (tinea capitis) and less frequently the glabrous skin (tinea corporis) may be infected. Children are most susceptible, and in adults infection is usually confined to the glabrous skin, although a few scalp infections have been reported. Rothman et al. (RMVM 1, 614) noted that fatty acids from adult hair fat inhibited M. audouinii in vitro and suggested that this was the reason for lower incidence of infection in adults, but Kligman & Grinsberg (RMVM 1, 1800) found that adult sebum was not more fungistatic than that of children. Scalp lesions are usually circular, scaling areas of alopecia and, in contrast to M. cants infections, there is generally very little inflammatory reaction. Skin lesions are usually circulate scaling areas with clearing centres. Kligman (RMVM 1, 2510; 2, 2484) studied the pathogenesis of tinea capitis due to M. audouinii . GEOGRAPHICAL DISTRIBUTION: Africa (Algeria, Chad Republic, Cameroons, Congo, Egypt, French West Africa, Guinea Republic, Madagascar, Morocco, Mozambique, Nigeria, South Africa, Tunisia); Asia (India, Java, Palestine, Persia, Turkey), Australasia & Oceania (Australia (New South Wales, Western Australia), New Zealand), Europe (Austria, Belgium, Czechoslovakia, Denmark, France, Germany, Great Britain and Ireland, Hungary, Italy, Netherlands, Poland, Portugal, Romania, Spain, Sweden, Switzerland, U.S.S.R., Yugoslavia), North America (Canada, U.S.A.), Central America and West Indies (Cuba, Jamaica, Puerto Rico); South America (Argentina, Brazil, Chile, Ecuador, Venezuela).

Chromosomal analysis in a case of orofacial-digital syndrome.

GORLIN, Anderson and Scott1 recently described 4 patients with hypertrophied frenula, oligophrenia, familial trembling and hand anomalies.1 The term orofacial-digital syndrome has been applied to this condition. In May, 1961, Ruess et al.2 described 12 similar patients, among whom a chromosomal abnormality had been identified in a mother and child. Subsequently, Gorlin3 elaborated on his cases, suggesting that a chromosomal abnormality was present in 1 of the No. 1 pair of chromosomes. Case Report A 4-year-old girl who had been noted at birth to have several areas of alopecia, cysts on the gums and tongue, partial cleft palate, webbed fingers . . .