Areas Of Hair Loss Research Articles

Prevalence and characterisation of, and producers' attitudes towards, hock lesions in UK dairy cattle

The objectives of this paper were to characterise lesions found at the hock and to establish their prevalence across a large sample of dairy cows in the UK. In addition, the study aimed to examine farmers' perceptions of these lesions. Seventy-seven farms were visited; both hocks on a random sample of approximately 50 cows were scored on a categorical scale for hair loss, ulceration and swelling. In addition, the size and location of lesions were marked on a hock map. A questionnaire designed to explore attitudes towards lesions was conducted with the owner. Hair loss and ulceration were seen at five locations. Hair loss was identified on 5,619 of 6,896 hocks (mild: 43.7 per cent; moderate: 25.1 per cent; severe: 12.6 per cent) and 1,137 of 6,896 hocks had areas of ulceration (mild: 8.6 per cent; moderate: 5.8 per cent; severe: 2.1 per cent). The majority of lesions were small; however, a small proportion had extensive areas of hair loss (maximum size 113.3 cm2) and ulceration (maximum size 95.5 cm2). Moderate swelling was recorded on 20 per cent of hocks, and 2.0 per cent had severe swelling. Interview results suggested that more than 90 per cent of participants were aware of hock lesions and a third had sought treatment for them; most felt that lesions had at least some impact on productivity and welfare.

Demonstration of autoantibodies against tyrosine hydroxylase in patients with alopecia areata

There is strong evidence to suggest that alopecia areata (AA) is a tissue-specific, T cell-mediated autoimmune disease, which is usually characterized by patchy areas of hair loss on the scalp. Tyrosine hydroxylase (TH) is a known B-cell autoantigen in patients with autoimmune polyendocrine syndrome type 1 (APS1) associated with the presence of AA. In addition, melanocyte-specific proteins, gp100 and MelanA, are putative T-cell autoantigens in AA and so may also represent targets of the humoral immune response. To analyse the sera of patients with AA for the presence of antibodies against TH and the melanocyte-specific proteins tyrosinase, tyrosinase-related protein (TRP)-1, TRP-2, gp100 and MelanA. Radioimmunoassays were used to detect the relevant antibodies in sera from patients with AA (n = 32) and in sera from healthy individuals (n = 28). Of 32 patients with AA, six (19%) were positive for TH antibodies. A significant increase in the frequency of TH antibodies in the AA patient group was evident when compared with controls (P = 0·03). Only three of 32 (9%) patients exhibited antibody responses to tyrosinase, TRP-1, TRP-2 and gp100. No immunoreactivity against MelanA was detected in any patient with AA. Antibodies against TH can be present in patients with AA unrelated to APS1. Humoral immune responses against tyrosinase, TRP-1, TRP-2, gp100 and MelanA are not prevalent in patients with AA. Overall, a dominant melanocyte-specific B-cell autoantigen in AA has yet to be identified.

Circumscribed Alopecia: An Unusual Manifestation of Pediculosis Capitis

A healthy 10-year-old girl was referred for evaluation of patchy hair loss on the scalp of longer than 6 months duration. She had been diagnosed and treated for head lice approximately 1 month before onset of the hair loss. Examination of the scalp showed discrete ovoid patches of hair loss at the vertex scalp. A scrape of the area of hair loss was performed, and a nit was visible on microscopic examination. Focal hair loss may represent an atypical manifestation of ongoing pediculosis capitis.

Alopecia Areata

Alopecia aerata (AA) is an autoimmune disease that presents as well defined patches of nonscarring hair loss with no overt epidermal changes. The life-time risk of AA in the general population is approximately 1.7%. As many as 60% of patients with AA have disease onset before 20 years of age. AA most commonly manifests as sudden loss of hair in well demarcated, localized area in the scalp. The hair loss is usually limited to a single patch. The lesion is usually round or oval. "Exclamation point hairs" are frequently seen at the periphery of the lesion. Because of the high rate of spontaneous recovery especially in those with small areas of hair loss or with a recent onset, not all patients require pharmacological treatment. A "watch-and-wait" approach is often recommended. Psychological support may be offered if necessary. For patients who actively desire treatment, topical corticosteroids and/or minoxidil are the treatment of choice. Interleukin (IL)-31 antibodies and 308-nm Excimer laser as novel treatment modalities appear promising in the armamentarium against this distressing disease. The review also outlined recent patents on the treatment of alopecia.

Alopecia Following Initiation of Lisdexamfetamine in a Pediatric Patient

To the Editor: Lisdexamfetamine, a prodrug of dextroamphetamine, is indicated for the treatment of attention-deficit/hyperactivity disorder (ADHD) in both pediatric and adult patients.1 One of the advantages cited includes an inactive prodrug status.2 The side effect profile is consistent with other stimulants. In children aged 6–12 years old, the most common adverse reactions by frequency are decreased appetite, insomnia, upper abdominal pain, and irritability.1 Alopecia or diffuse hair loss has not been reported in the manufacturer's information or with postmarketing analysis of adverse drug effects reported to poison centers.3 As confirmed by a PubMed literature search utilizing the search terms alopecia and lisdexamfetamine, we report the first case of diffuse thinning hair loss secondary to lisdexamfetamine use in a pediatric patient. Case report. The patient, a 5-year old white girl, was referred in 2008 for evaluation of behavior concerns at school and home. Prior to presentation at our clinic, her caregiver tried several products from a health food store without success. A complete assessment was performed in conjunction with information from the school and home. She met DSM-IV-TR criteria for the diagnosis of ADHD, combined type. A trial of extended-release mixed amphetamine salts 5 mg/d was initiated. Some improvement was noted over the first 2 weeks, especially at school. The dose was increased to 10 mg/d with substantial improvement. This dose worked well until the early afternoon when her medication would wear off. At that time she became irritable and emotional for several hours. Some mild appetite suppression during the day was experienced, which resolved in the afternoons. No substantial weight change was noted at the 1-month follow-up visit. During this visit options were discussed and a trial of lisdexamfetamine 30 mg was started. Mild nausea resolved after the first day. Five days after the start of lisdexamfetamine, the caregiver called, alarmed about hair loss. No bald areas were reported but generalized hair loss noticed on brushing was reported. Lisdexamfetamine was discontinued and the patient was medication-free for 2 days. During that time, it was reported that the hair loss stopped. At the caregiver's request, treatment with extended-release mixed amphetamine salts 10 mg each morning was restarted. To date no further problems with hair loss have been noticed. Alopecia secondary to amphetamine use was reported as early as the 1960s when amphetamines were used for weight loss.4,5 The mechanism was not identified.6 The type of hair loss experienced in our patient was a general diffuse thinning, consistent with previous reports,4–6 rather than isolated or discrete areas of hair loss seen in alopecia areata.4–6 The onset of the thinning occurred 5 days following therapy initiation and was less marked 2 days following discontinuation. Hypothyroidism was not suspected as the caregiver reported consistently high motoric activity and the absence of constipation. Applying the Naranjo algorithm to evaluate the probability of an adverse drug reaction yielded a score of 7, indicative of a probable medication-related event.7 The temporal connection to presentation and resolution was also supportive of a medication effect. The authors encourage clinicians prescribing lisdexamfetamine to be aware of the potential for this effect.

Discoid lupus erythematosus presenting with cysts, comedones, and cicatricial alopecia on the scalp

To the Editor: Discoid lupus erythematosus (DLE) of the scalp usually starts with red-purple macules, papules, or small plaques that then develop into erythematous hairless patches. In early lesions, ostia may still be present, and in the course of the disease, hair follicles are irreversibly destroyed and the lesions become atrophic.1Olsen E.A. Bergfeld W.F. Cotsarelis G. Price V.H. Shapiro J. Sinclair R. et al.Summary of North American Hair Research Society (NAHRS)-sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001.J Am Acad Dermatol. 2003; 48: 103-110Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 2Whiting D.A. Cicatricial alopecia: clinico-pathological findings and treatment.Clin Dermatol. 2001; 19: 211-215Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar, 3Headington J.T. Cicatricial alopecia.Dermatol Clin. 1996; 14: 773-782Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar A 33-year-old female patient of East Indian descent was referred to the University of British Columbia hair clinic with a complaint of patchy hair loss. The patient had developed DLE lesions on the lateral aspect of the upper nose, cheeks, and on her left ear, and small areas of hair loss on the scalp 1 and a half years before her visit at our clinic. Her previous dermatologist treated her with hydroxychloroquine 200 mg twice daily, intralesional triamcinolone acetate 5 mg/cc on five occasions, and topical betamethasone dipropionate 0.05% lotion twice daily for 1 year and strongly emphasized sun protection. Over the past year, her facial lesion had considerably improved. However, her scalp lesions progressed in spite of the treatment. On her first visit, the patient showed several skin colored plaques and nodules on her scalp, displaying cicatricial alopecia. Four lesions presented with cribriform openings, releasing yellow-brown horn-like material similar to fistulated comedones (Fig 1). The scalp biopsy showed classic pathologic features of the DLE and epidermal inclusion cysts (Fig 2).Fig 2A, A 2-mm punch biopsy showing a deep lymphocytic, perivascular infiltrate and an interface dermatitis in the follicular epithelium. B, Prominent interface dermatitis. (Original magnification: A, ×40; B, ×100.)View Large Image Figure ViewerDownload Hi-res image Download (PPT) We continued oral treatment with hydroxychloroquine and treated the lesions topically with tretinoin 0.025% cream (Retisol-A 0.025% cream; Stiefel Canada Inc, Montréal, Quebec, Canada) for 2 and a half months. The scalp lesions did not improve, and we decided to discontinue both hydroxychloroquine and topical tretinoin. Oral isotretinoin was suggested as a treatment option, but the patient refused. Four weeks later, the patient developed a new DLE lesion on her face and three new firm subcutaneous nodules without associated comedones on her scalp. Moreover, two of the scalp lesions showed a marked progression in size and an increase of comedone-like openings within the lesions. We treated the remaining lesions with intralesional triamcinolone acetate injections 10 mg/cc every 6 weeks and clobetasol 0.05% lotion twice daily and restarted oral treatment with hydroxychloroquine. On subsequent visits, we added mechanical extraction of the comedones to our treatment plan. Under this combination therapy, the lesions flattened and stabilized. We decided to refer the patient for an excisional biopsy of one large stable lesion on her vertex area. The lesion measured 2 cm in diameter and was reconstructed with a bilateral rotation flap. The histologic findings showed benign epithelial inclusion cysts and comedones with surrounding scarring; however, there were no features of active lupus erythematosus. Excision of the remaining cystic lesion was refused by the patient. DLE has been described with acneiform lesions and comedones.4Chang Y.H. Wang S.H. Chi C.C. Discoid lupus erythematosus presenting as acneiform pitting scars.Int J Dermatol. 2006; 45: 944-945Crossref PubMed Scopus (13) Google Scholar, 5Deruelle-Khazaal R. Ségard M. Cottencin-Charrière A.C. Carotte-Lefebvre I. Thomas P. Chronic lupus erythematosus presenting as acneiform lesions.Ann Dermatol Venereol. 2002; 129 ([French]): 883-885PubMed Google Scholar, 6El Sayed F. Dhaybi R. Ammoury A. Bazex J. Lupus comedonicus (in French).Ann Dermatol Venereol. 2007; 134: 897-898Crossref PubMed Scopus (5) Google Scholar, 7Pramatarov K.D. Chronic cutaneous lupus erythematosus—clinical spectrum.Clin Dermatol. 2004; 22: 113-120Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Whether the nodules and comedones in our case are primary or a secondary change is not clear. The site of our first punch biopsy, which was taken 1 and a half years after the patient developed her first lesions, showed comedone-like structures and histologically cysts and features of DLE. These findings suggest that the cysts and comedones are part of the primary DLE lesion. The excised lesion on the vertex area showed no histopathologic features of DLE but still showed epidermal inclusion cysts. This can be possibly regarded as the secondary change of the scarring process.

Scalp dermoscopy of androgenetic alopecia in Asian people

Although dermoscopy is used mainly for diagnosing pigmented skin lesions, this device has been reported to be useful in observing alopecia areata and frontal fibrosing alopecia. Herein, we investigated the dermoscopic features and their incidence of androgenetic alopecia (AGA; n = 50 men) and female AGA (FAGA; n = 10 women) in Asian people. More than 20% hair diameter diversity (HDD), which reportedly is an early sign of AGA and corresponds to hair follicle miniaturization, was observed in the affected area of all AGA and FAGA cases, suggesting that HDD is an essential feature to diagnose AGA and FAGA. Peripilar signs, corresponding to perifollicular pigmentation, were seen in 66% (33/50) of AGA and 20% (2/10) of FAGA women. This incidence in the present study was lower than previously reported in white subjects possibly because the Asian skin color conceals slight peripilar pigmentation. Yellow dots were observed in 26% (13/50) of AGA and 10% (1/10) of FAGA cases and the number of yellow dots in AGA and FAGA was limited to 10 on the overall hair loss area. Yellow dots possibly indicate the coincidence of AGA and enlargement of the sebaceous glands caused by common end-organ hypersensitivity to androgen. In conclusion, dermoscopy is useful to diagnose AGA and FAGA and provides insights into the pathogenesis of AGA.

Scalp Reconstruction and Repair

Reconstruction and repair of scalp deformities poses several challenges. The repair and/or removal of the existing defect is often difficult; however, the appearance of the repair is often the most difficult challenge. Thus, an understanding of normal hair morphology, anatomy, and physiology is important to achieve long-lasting, satisfying results. We must anticipate future hair loss, communicate that to the patient, and consider it in surgical planning. In addition, residual effects such as radiation therapy after cancer resection may pose additional challenges. Today, many extraordinary techniques are available that allow creation of natural and almost undetectable hairlines, but these techniques are often unsuitable for repairing large scarred areas of hair loss. By using more traditional techniques of scalp reduction and tissue expansion, however, excision of many large scarring defects can be accomplished. Combining older methods with modern hair restoration surgery permits the satisfactory treatment of many previously untreatable conditions.

Superficial Liposuction for Permanent Hair Removal

Introduction: Superficial liposuction is the most common procedure for facial and body contouring. This article reports the results of a study in which superficial liposuction was utilized for permanent hair removal on the face (sideburn areas), the chin including the submental area, the neck, back, and upper and lower extremities of female and male patients. Possible complications are discussed. Materials and Methods: Thirty patients (25 women and 5 men) between 22 and 65 years of age were included. All patients were of Fitzpatrick skin types III or TV. Results: In 22 patients, 19 women and 3 men, 70–80% complete hair loss was noted by all observers in a single session. Follow-up at 3 months, 6 months, 1 year, and 2 years, showed no hair regrowth in any patient in the hair loss areas. In 8 patients, 6 women and 2 men, 50–60% of hair loss was noted after a single session. Complete hair loss was noted in all cases in the central areas where liposuction of the subcutaneous fat was complete, the direction of the dermal tunnels was superior, and where subsequent inflammation and postoperative hardening were intense. Conclusion: Superficial liposuction for hair removal is a quick method of permanent hair removal in selected patients removing maximum number of hairs in a single session. It is safe in experienced hands.

Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases

To determine dermoscopic findings of alopecia areata (AA) from a large-scale study that can be used as clinical indicators of disease. Dermoscopic examination of areas of hair loss on the scalp of 300 Asian patients with AA was performed using a DermLite II pro, which can block light reflection from the skin surface without immersion gels. Using the Spearman rank-order correlation coefficient by rank test, correlations between the incidence of each dermoscopic finding and the severity of disease and disease activity were examined. The sensitivity and specificity of the findings as diagnostic clues for AA were evaluated. Characteristic dermoscopic findings of AA included black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs (shorter than 10 mm) in the areas of hair loss. Black dots, yellow dots, and short vellus hairs correlated with the severity of disease, and black dots, tapering hairs, broken hairs, and short vellus hairs correlated with disease activity. For diagnosis, yellow dots and short vellus hairs were the most sensitive markers, and black dots, tapering hairs, and broken hairs were the most specific markers. Dermoscopic characteristics, such as black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs, are useful clinical indicators for AA.

Fatal necrotising fasciitis and myositis in a cat associated with Streptococcus canis

Necrotising fasciitis and necrotising myositis are rare but serious life threatening conditions reported mainly in human beings and dogs. Most cases to date have been caused by β-haemolytic streptococci of...

Correcting hairline deformities after facial rejuvenation

The author treats hairline deformities after face lift procedures with implantation of follicular units harvested from the occipital area and implanted in common hair loss areas such as the forehead, temporal, and sideburn areas. For a natural appearance, he recommends creating an irregular and asymmetric new hairline.

Apply directly to the forehead: Holmes, Nana, and hennapecia

Apply directly to the forehead: Holmes, Nana, and hennapecia

"Bubble hair," a report of two cases

Case 1 A 20-year-old woman presented with a patchy area of hair loss in the occipital scalp area. The patient's hair care included the use of a blow dryer. Microscopic evaluation of a gentle hair pull revealed vacuolization of the hair shafts. The hair shafts were enlarged in the areas of vacuolization. There was no evidence of dermatophyte hyphae on examination with KOH technique. A diagnosis of bubble hair was made. The patient's alopecia improved with gentle hair care and discontinuation of blow drying. At 1-year follow-up, there was no evidence of residual alopecia. Case 2 A 42-year-old woman presented with diffuse hair loss and increased hair fragility (Fig. 1). The patient had a history of blow drying her hair with the heat set on the “high” setting on a daily basis. She also reported holding the blow dryer close to her scalp. Examination of her hair shafts revealed multiple areas of vacuolization of the hair shafts (Fig. 2). Examination with KOH technique showed no evidence of dermatophyte hyphae. The patient was instructed to discontinue the use of high heat in her hair care regimen. At 1-year follow-up, the patient's alopecia had improved. Figure 1. A 42-year-old woman with diffuse thinning and increased fragility of the hair Download figure to PowerPoint Figure 2. Hair shafts reveal large irregular vacuoles on direct microscopic enduration (unstained × 10 objective) Download figure to PowerPoint

Demodex tortellinioides n. sp. (Acari: Demodecidae) from the agile antechinus, Antechinus agilis dickman, parnaby, crowther and king, 1998 (Marsupialia: Dasyuridae) in Australia

Demodex tortellinioides n. sp. is described in all life stages from the agile antechinus, Antechinus agilis Dickman, Parnaby, Crowther and King (Dasyuridae), 1998. The elongate bodies of the immature instars are coiled such that the gnathosoma overlaps the posterior region of the opisthosoma. This is the first report of immature mites with a coiled body form. Demodex antechini Nutting and Sweatman and an undescribed species of Demodex were also present on the host. All mites were recovered in skin scrapings from areas of hair loss and crusty lesions.

Topical Estrogen Accelerates Hair Regrowth in Mice After Chemotherapy-Induced Alopecia by Favoring the Dystrophic Catagen Response Pathway to Damage

Estrogen receptor ligands are important modulators of skin physiology and are involved in the control of normal hair follicle cycling. Here, we have studied the effects of topically applied 17-beta-estradiol on pathologic hair follicle cycling as seen during chemotherapy-induced alopecia, one of the major unresolved problems of clinical oncology. For this study we employed a well-established murine model that mimics chemotherapy-induced alopecia in humans. For precisely quantifying the area of hair loss and hair regrowth in this model in vivo, we developed a simple planimetric assay (dotmatrix planimetry). We show that topical 17-beta-estradiol significantly alters the cycling response of murine follicles to cyclophosphamide, whereas the estrogen antagonist ICI 182.780 exerted no such effects. Initially, topical 17-beta-estradiol enhanced chemotherapy-induced alopecia significantly by forcing the follicles into the dystrophic catagen response pathway to hair follicle damage, whereas follicles treated by ICI 182.780 or vehicle shifted into the dystrophic anagen response pathway. Consequently, the regrowth of normally pigmented hair shafts after chemotherapy-induced alopecia was significantly accelerated in the 17-beta-estradiol treated group. Our data encourage one to explore topical estrogens as a potential stimulant for hair re-growth after chemotherapy-induced alopecia.

‘Horseshoe-shaped’ post-operative alopecia following lengthy head and neck surgery

We report a case of 'horseshoe-shaped' pressure-induced post-operative alopecia following a lengthy head and neck procedure. Post-operative hair loss is rare and to our knowledge has only previously been found in fields of surgery where careful head positioning is not an inherent part of the procedure. In these cases there has been a single area of hair loss from the central occipital area and per-operative pressure effects of the head resting on the operating table have been postulated as the likely cause. The case presented shows an area of hair loss closely corresponding to the shape of the head rest used during a long procedure. This strongly supports the theory that prolonged pressure is the likely cause. The mechanism of pathogenesis is discussed together with a suggested strategy for its avoidance. The single most important aspect of prevention of this complication of surgery is the knowledge of its existence and aetiology.

Expression of neuropeptide-degrading enzymes in alopecia areata: an immunohistochemical study.

Much clinical evidence suggests that the nervous system, including psychological factors, can influence the course of alopecia areata (AA). However, there has been little substantial evidence of specific participation of cutaneous neurogenic factors in the disease process. As previous studies have demonstrated that stress elicits the release of the neuropeptide substance P (SP) from peripheral nerves and that some patients with AA show prominent SP expression in nerves surrounding their hair follicles, we aimed to evaluate the role of SP in AA. We used immunohistochemistry to examine the expression of SP and SP-degrading enzymes in scalp biopsies from patients with AA and from healthy controls. Affected hair follicles in the centre of the areas of hair loss of patients with AA were richly innervated by SP-staining nerve fibres. Strong expression of the SP-degrading enzyme, neutral endopeptidase (NEP), was observed in hair follicles not only in the acute progressive phase of AA but also in the chronic stable phase. Expression of NEP in hair follicles from the margins of areas of hair loss was stronger than in normal controls, but was weaker than in the centre of the areas of hair loss. In addition, endothelial immunoreactivity for angiotensin-converting enzyme (also capable of degrading SP) was not observed in the centre of the areas of hair loss, which was in significant contrast to normal controls as well as to the margins of areas of hair loss where it was expressed. Further, intense expression of endothelial leucocyte adhesion molecule-1 on vessels and many degranulating mast cells was observed adjacent to affected hair follicles in AA, in admixture with dense lymphocytic inflammation. These findings suggest that SP is endogenously released by dermal nerve fibres around hair follicles and that it may play an important part in epithelial-mesenchymal-neuroectodermal interactions in AA. This study reveals that SP and its degrading enzymes are involved in the pathogenesis of AA, which in turn might explain the pathological significance of neurogenic and psychogenic aspects in the disease process.

Hock Lesions and Free-Stall Design

We compared the prevalence and severity of skin lesions on the hocks of lactating dairy cows in southern British Columbia, comparing 20 farms using three common bedding surfaces: sawdust, sand, and geotextile mattresses. Skin lesions were scored at five positions on the hock. For each position we noted if the lesion showed inflammatory attributes, and then assigned a severity score. Of the 1752 lactating cows scored, 1267 cows (73%) had at least one hock lesion. Of those cows with lesions, 87% had lesions on both legs, 76% had lesions on more than one location on the hock, and 78% had a lesion of at least moderate severity (i.e., evidence of skin breakage or an area of hair loss >10cm2). Lesions were most prevalent on farms that used geotextile mattresses (91% of cows) and least common on farms that used sand (24% of cows). Moreover, lesions on cows from farms using mattresses were more numerous and more severe than those on cows from sand-bedded farms. The prevalence and severity of lesions on farms using sawdust was intermediate. Lesions also varied in relation to location on the hock. For farms using geotextile mattresses, lesions were more common and more severe on the lateral surfaces of both the tuber calcis and the tarsal joint. On farms using sawdust, lesions were common on the dorsal surface of the tuber calcis and the lateral surfaces of both the tuber calcis and the tarsal joint. Lesions were rare on all five positions for cows from sand-bedded farms. Among the 10 farms sampled using sawdust, we found a significant negative relationship between the length of the stall and severity of lesions. For cows with lesions, the number and severity of lesions increased with age.

Spontaneous Cure of Traumatic Hair Loss after 20 Years

1. Marc A. Pomerantz, MD 1. Hinsdale, Illinois T.M. was a 25-year-old male postal worker when he was first seen in my office in December of 1998. He complained of a highly visible area of hair loss above his left ear. The area was lunate in shape, and it was just above, parallel to, and