Chronic Hair Loss Research Articles

Possible role of β-hydroxybutyrate in inducing inflammation in alopecia areata.

Alopecia areata (AA) is an autoimmune inflammatory disease characterized by non-scarring hair loss due to an immune response that targets hair follicles. The current treatment approach for AA involves the use of immunosuppressants and immunomodulators to reduce cytokine levels around affected hair follicles. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as potential anti-inflammatory agents with diverse beneficial effects in various medical conditions. This study investigates the role of beta-hydroxybutyrate (BHB), a ketone body produced during SGLT2 inhibition, in the pathogenesis of AA. Serum BHB levels were found to be significantly elevated in patients with AA compared with healthy controls, with higher levels correlating with severity of hair loss. BHB treatment increased inflammatory cytokine production in outer root sheath (ORS) cells, mimicking the inflammatory conditions seen in AA. The results suggest that elevated BHB levels may exacerbate the inflammatory immune response in AA patients and may be associated with chronic hair loss and resistance to treatment. Serum BHB levels may serve as a potential marker of poor prognosis in patients with severe AA. Further research is needed to elucidate the precise role of BHB in the pathogenesis of AA and its implications for disease management.

The role of platelet-rich plasma in androgenetic alopecia: A systematic review.

Androgenetic alopecia (AGA), also referred to as male or female pattern hair loss, is the commonest cause of chronic hair loss and affects up to 80% of men by the age of 70. Despite a high prevalence, there are few approved therapies, which show minimal efficacy. This systematic review aims to evaluate the efficacy of platelet-rich plasma (PrP) in the treatment of AGA in male patients. MEDLINE, EMBASE, Cochrane (CENTRAL), CINAHL, clinicaltrials.gov, Google Scholar and the Science Citation Index database were searched to identify eligible studies. All randomized controlled trials (RCTs) and prospective cohort studies related to PrP use in AGA were included. Primary outcomes included changes in hair density and hair count. Methodological quality was assessed using bias assessment tools. EightRCTs and one cohort study were included in the review with a total of 291 participants. Six studies reported a statistically significant increase in hair density in the PrP group versus the control. Five studies reported a statistically significant increase in hair count with PrP. Seven studies showed moderate risk and two showed lowrisk of bias. In a methodologically robust review on the effectiveness of PrP on male AGA, PrP demonstrated some potential to be used therapeutically. However, the low quality of evidence, moderate risk of bias, and high heterogeneity of included studies limit inferences and call for more robust designs to investigate this further.

Topical SCD-153, a 4-methyl itaconate prodrug, for the treatment of alopecia areata.

Alopecia areata is a chronic hair loss disorder that involves autoimmune disruption of hair follicles by CD8+T cells. Most patients present with patchy hair loss on the scalp that improves spontaneously or with topical and intralesional steroids, topical minoxidil, or topical immunotherapy. However, recurrence of hair loss is common, and patients with extensive disease may require treatment with oral corticosteroids or oral Janus kinase (JAK) inhibitors, both of which may cause systemic toxicities with long-term use. Itaconate is an endogenous molecule synthesized in macrophages that exerts anti-inflammatory effects. To investigate the use of itaconate derivatives for treating alopecia areata, we designed a prodrug of 4-methyl itaconate (4-MI), termed SCD-153, with increased lipophilicity compared to 4-MI (CLogP 1.159vs. 0.1442) to enhance skin and cell penetration. Topical SCD-153 formed 4-MI upon penetrating the stratum corneum in C57BL/6 mice and showed low systemic absorption. When added to human epidermal keratinocytes stimulated with polyinosinic-polycytidylic acid (poly I:C) or interferon (IFN)γ, SCD-153 significantly attenuated poly I:C-induced interleukin (IL)-6, Toll-like receptor 3, IL-1β, and IFNβ expression, as well as IFNγ-induced IL-6 expression. Topical application of SCD-153 to C57BL/6 mice in the resting (telogen) phase of the hair cycle induced significant hair growth that was statistically superior to vehicle (dimethyl sulfoxide), the less cell-permeable itaconate analogues 4-MI and dimethyl itaconate, and the JAK inhibitor tofacitinib. Our results suggest that SCD-153 is a promising topical candidate for treating alopecia areata.

Guava (Psidium guajava L.) Leaf Extract as Bioactive Substances for Anti-Androgen and Antioxidant Activities.

Leaves of guava (Psidium guajava L.) have been used in Thai folk medicine without any supporting evidence as a traditional herbal remedy for hair loss. Androgenetic alopecia (AGA) is chronic hair loss caused by effects of androgens in those with a genetic predisposition, resulting in hair follicle miniaturization. Our objectives were to provide the mechanistic assessment of guava leaf extract on gene expressions related to the androgen pathway in well-known in vitro models, hair follicle dermal papilla cells (HFDPC), and human prostate cancer cells (DU-145), and to determine its bioactive constituents and antioxidant activities. LC-MS analysis demonstrated that the main components of the ethanolic extract of guava leaves are phenolic substances, specifically catechin, gallic acid, and quercetin, which contribute to its scavenging and metal chelating abilities. The guava leaf extract substantially downregulated SRD5A1, SRD5A2, and SRD5A3 genes in the DU-145 model, suggesting that the extract could minimize hair loss by inhibiting the synthesis of a potent androgen (dihydrotestosterone). SRD5A suppression by gallic acid and quercetin was verified. Our study reveals new perspectives on guava leaf extract's anti-androgen properties. This extract could be developed as alternative products or therapeutic adjuvants for the treatment of AGA and other androgen-related disorders.

Abstract P4-10-17: Alopecia among breast cancer survivors

Abstract Funding Source: Institutional funds at Mayo Clinic. Background: While alopecia is a common and distressing acute side effect of chemotherapy, chronic hair thinning is also reported by some survivors during endocrine therapy. The purpose of the current study was to evaluate real world experiences of late/long-term alopecia among breast cancer survivors. Methods: Breast cancer survivors participating in the ongoing prospective Mayo Clinic Breast Disease Registry (MCBDR) were mailed a survey six years after diagnosis, between June and November 2020. Respondents were asked to report how bothered they are by hair thinning and hair loss over the last year on a scale from 0 “not at all” to 4 “extremely”. They were also asked whether they used any hair thickening or regrowth products. Results: 552/899 survivors responded (response rate 61%); 403 survivors’ responses were available for analysis. Respondents’ median age was 66 years, and median time since diagnosis was 78 months. Seventy patients (17%) were diagnosed with stage 0 breast cancer, 195 (48%) were diagnosed with stage 1 cancer, 104 (26%) with stage 2, 25 (6%) with stage 3; 6 (1%) had been diagnosed with metastatic or recurrent disease at the time of this survey. 139 (34%) patients had received chemotherapy. Of the patients who received chemotherapy, 82 (59%) had received doxorubicin and cyclophosphamide, 41 (29%) received docetaxel and cyclophosphamide, 77 (55%) received paclitaxel, and 27 (19%) received carboplatin. 258 (64%) received endocrine therapy. Of these patients who received endocrine therapy, 131 (51%) received Tamoxifen and 186 (72%) received aromatase inhibitors. 309 survivors (77%) were 55 years or older. 189 (47%) of all patients reported that they were bothered by chronic hair loss, and 225 (56%) reported that they were bothered by hair thinning; 71 (18%) reported use of thickening/regrowth products. There did not appear to be differences in chronic hair loss or thinning by receipt of chemotherapy: 64 patients (46%) who received chemotherapy reported hair loss and 79 (56%) reported hair thinning, compared with 123 patients (46%) who did not receive chemotherapy and reported hair loss and 142 (54%) who reported hair thinning. Hair thinning or loss did not appear to differ based upon age (Table 1). Symptoms did not appear to be more common amongst current or previous endocrine therapy recipients, with 113 (44%) of that subset bothered by hair loss and 128 (50%) by hair thinning. Conclusion: Hair loss and thinning are frequently reported as bothersome symptoms by long-term breast cancer survivors. Future investigations into treatments for chronic hair thinning during and after cancer therapy are needed. Table 1.< 5555+Bothered by hair loss (n)%Bothered by hair thinning (n)%Bothered by hair loss (n)%Bothered by hair thinning (n)%Not at all5761%4649%15751%13142%Slightly1920%2426%8728%9731%Moderately77%910%3110%4113%BOTHERED BY HAIR LOSS (N)%BOTHERED BY HAIR THINNING (N)%BOTHERED BY HAIR LOSS (N)%BOTHERED BY HAIR THINNING (N)%Quite a bit77%1112%227%268%Extremely44%33%93%103%Missing00%11%31%41% Citation Format: Elizabeth Cathcart-Rake, Charles L Loprinzi, Janet E Olson, Fergus Couch, Brittany Dulmage, Maryam Lustberg, Nicole Larson, Kathryn J Ruddy. Alopecia among breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-17.

The Comparison of Trichoscopic Findings in Female Pattern Hair Loss (FPHL) and Chronic Telogen Effluvium (CTE) in Female Patients

Background: Chronic hair loss is a major complaint in middle-aged females. It is sometime difficult to differentiate between female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients. Trichoscopy is a non-invasive technique that can help to distinguish between FPHL and CTE.
 Aims: To compare the trichoscopic findings in female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients.
 Materials and Methods: It is a cross sectional prospective comparative study carried out in the department of dermatology, Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Wardha, Maharashtra. Adult female patients with ages ranging from 30 to 60 years old complaining of diffuse hair loss were included in the study. Patients with scarring alopecia were excluded from the study. Patients were divided into two groups consisting of 20 patients in each group. Group A and B included patients with FPHL and CTE respectively. Trichoscan (SIF hair analysis system) was performed on frontal region of the scalp.
 Results: Hair diameter variability was significantly seen in FPHL. Hair diameter was reduced in FPHL (0.045) as compared to chronic telogen effluvium (0.063) with statistical difference between them. Hair density was significantly reduced in FPHL (32 ± 12.24) as compared to CTE (60.66 ± 18.12). Vellus hair density was significantly more in FPHL (22.4 ± 14.3) as compared to chronic telogen effluvium (7.73 ± 6.71). Single hair unit was more in FPHL (65 ± 17.08) as compared to chronic telogen effluvium. Density of yellow dots is more significantly observed in female pattern hair loss as compared to chronic telogen effluvium.
 Conclusion: Trichoscopic features based on hair shaft diameter, hair follicular density, vellus hairs, yellow dots and variability in hair shaft diameter can easily help to distinguish female pattern hair loss from chronic telogen effluvium. This differentiation can help dermatologists to plan better and specific management of hair loss in female patients.

Effect of Platelet-Rich Plasma (PRP) in the treatment of patients with androgenic alopecia

Background: Platelet-rich plasma (PRP) is one of the most important derivatives of blood. Over the past several years, the use of PRP has focused on the medical treatment in conditions such as skin rejuvenation and chronic ulcer treatment and hair loss. Also, PRP has been transmitted to the peripheral environment of the hair follicle through several intradermal injections to treat hair loss. The objective of this clinical trial was the evaluation of the effect of Platelet-Rich Plasma (PRP) in treatment of patients with androgenic alopecia. Methods: In this randomized clinical trial, 20 patients with androgenic alopecia referring to dermatology clinic of Sina Hospital in Tabriz were assigned into the study. Interfollicular injections of Platelet-Rich Plasma (PRP), 0.1 ml/cm2 were performed 2 times in each patient in selected areas of the scalp at intervals of 30 days. The clinical manifestations and dermoscopy were used to evaluate the patients with androgenic alopecia. Before the intervention, 1 month, 3 months after the intervention were followed up, respectively. Results: Twenty patients (16 males and 4 females) were examined. The mean age of the patients was 32.88 ± 1.3 and in range of 24 to 48 years. The results of this study showed a significant increase in the mean number of hair in treated areas in the third month compared with the beginning of the study. In the treated areas there was an average increase of 13.9 after first month and 33.6 hairs per cm2 after 3 months. Conclusion: According to the results of this study, PRP has a positive effect on the treatment of patients with androgenic alopecia.

Role of Iron Deficiency in Chronic Hair Loss

Role of Iron Deficiency in Chronic Hair Loss

The Clinical Efficacy and Safety of Autologous Activated Platelet-Rich Plasma Injection in Androgenetic Alopecia

Introduction: Androgenetic alopecia (AGA) is a common, chronic hair loss disorder. Platelet-rich plasma (PRP) is a novel therapeutic tool for AGA. The objective of this study was to assess the clinical efficacy and safety of autologous activated PRP injections in AGA. Methods: Twenty-four AGA patients were enrolled in the study. All the patients received 4 PRP treatments at baseline (T1), 3 weeks (T2), 6 weeks (T3), and at 14 weeks (T5). We evaluated hair density (hairs/cm²) at 6 time points (T1–T3, T4 [9 weeks], T5, and T6 [7 months]) and patient satisfaction was assessed at T6 with a patient satisfaction questionnaire. Hair count (hairs/0.48 cm²) was assessed using dermoscopic photographs and hair density (hairs/cm²) was calculated accordingly. Results: Twenty-three men and one woman were included with baseline hair density of 102.25 ± 18.463. Hair density significantly increased at all time points with p < 0.001 compared to the baseline. Patients were satisfied with a mean result rating of 72.92 on a linear analogue scale of 0–100. Other than mild pain felt during injections, no remarkable adverse effects were noted. Conclusions: PRP injections may have a positive therapeutic effect on AGA without major side effects.

Histologic and clinical cross-sectional study of chronic hair loss in patients with cutaneous chronic graft-versus-host disease

While scalp alopecia represents a distinctive feature of chronic graft-versus-host disease (cGVHD), little is known about the clinical and histologic presentation of hair loss. We sought to classify the clinical presentations and histologic findings of chronic hair loss in patients with cutaneous cGVHD. A prospective cohort of 17 adult hematopoietic cell transplantation (HCT) recipients with cutaneous cGVHD was enrolled. Dermatologic examinations were performed, and punch biopsy specimens of the scalp were obtained. Biopsy specimens were analyzed with hematoxylin-eosin and immunohistochemical stains in all cases and fluorescence in situ hybridization analyses in specific cases. Clinically, 4 patterns of hair loss were described-patchy nonscarring (41.2%), diffuse nonscarring (11.8%), diffuse sclerotic (11.8%), and patchy sclerotic (5.9%). The location of the inflammatory infiltrate on hematoxylin-eosin-stained specimens correlated with the hair loss pattern patients had clinically, with cell populations around the bulb and bulge in nonscarring and sclerotic cases, respectively. Fluorescence in situ hybridization studies in female cGVHD patients with male donors demonstrated green Y chromosomes limited to the area of the hair follicle affected by inflammatory cells. This study describes the various clinical and histologic subtypes of long-standing alopecia in adult cGVHD patients and suggests that this alopecia may be a direct manifestation of cGVHD of the hair follicle.

A Study of Serum Ferritin Level in Female Patient with Alopecia

ABSTRACTIntroduction: Total body iron store is an integral factor in the development of hair follicle. Numerous studies have been done seeking for the relationship between body iron store and various forms of chronic diffuse hair loss, with relatively contradictory findings in various reports in these studies. The main objective of this study is to find out if there is any association between total body iron store and various types of chronic diffuse hair loss in females in reproductive age.Materials and Methods: This is a hospital based case control study conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. Sixty female patients of age group 15-50 years with chronic diffuse hair loss with equal number of age- and sex- matched controls were studied. Both of the study groups were evaluated for various parameters of iron status. Results: The mean value of serum ferritin in cases was significantly lower as compared to controls (p=0.018). Patients with alopecia areata (p=0.008) and androgenetic alopecia (p=0.021) had significantly lower serum ferritin, whereas there was no statistically significant difference in telogen effluvium and controls (p=0.857).The mean value of hemoglobin, hematocrit and mean corpuscular hemoglobin was found to be significantly lower in alopecia areata and androgenetic alopecia. However, there was no statistically significant difference in RBC indices of patients of telogen effluvium and controls.Conclusion: Diffuse chronic hair loss shows definite association with serum ferritin and various RBC indices in female of reproductive age group. Alopecia areata and androgenetic alopecia show major association with total body iron stores. Keywords: alopecia areata; androgenetic alopecia; serum ferritin; telogen effluvium.

1365 Interest of Biotrinine®, a mix of Nasturtium officinale and Tropaeolum majus extracts, for chronic hair loss treatment

The hair follicle (HF) undergoes cycles of growth (anagen), regression (catagen) and resting (telogen) phases. Chronic hair loss is caused by the shortening of the active growing phase (anagen) and the extension of the quiescence phase (telogen) of the HF, which occurs mainly under the control of androgens that activate the expression of hair growth cycles inhibitors in dermal papilla cells. This imbalance leads first to the miniaturization of HFs, then to the loose of their ability to generate new hair shafts. The aim of this study was to evaluate the effect of Biotrinine® dry extract on signals and molecular markers of human dermal papilla cells (HDPCs) that regulate anagen phases onset, HF growth maintenance and the transition of anagen to catagen phase. Potential synergistic activities with adenosine triphosphate (ATP) were also investigated. Wnt/b-catenin pathway activation was measured using a gene reporter assay strategy (transfection of HDPCs with a lentivirus expressing luciferase gene under the control of TCF/LEF promoter). Keratinocyte Growth Factor (KGF), Hepatocyte Growth Factor (HGF) and Dickkopf-related protein 1 (DKK1) protein expression levels were measured in HDPCs culture supernatants using ELISA and Luminex technology. Aromatase expression in HDPCs was analysed at mRNA level (Q-PCR analysis) and proteic level (western blot analysis) following respectively 24 and 48 hours of incubation with Biotrinine® dry extract. We found that Biotrinine® dry extract activated Wnt/b-catenin pathway (+38%), enhanced KGF and HGF secretion when tested in association with ATP with synergistic activities (respectively +72% and +133%), and inhibited DKK1 production and release (-65%). Aromatase expression was also induced by Biotrinine® dry extract (+48%). The results of this study indicate that Biotrinine® is a good candidate for chronic hair loss treatment and could be associated with ATP to potentiate their respective effects.

Utility of trichoscopy

Trichoscopy is evolving as an indispensable aid to the dermatologist by providing valuable clues on dermatoscopy of the scalp and hair. Trichoscopy presents as a bridging tool between clinical and histological diagnosis. It is useful to distinguish congenital atrichia from other forms of childhood hair loss such as alopecia universalis. There are a set of women who present with chronic hair loss without any discernible reduction in hair density over the crown. Such early forms are often overlooked, and clinical evaluation may not be adequate to make the right diagnosis. Trichoscopy has been widely used as a diagnostic as well as a prognostic tool to measure anisotrichosis in cases of overt androgenetic alopecia and female pattern hair loss (FPHL) and to distinguish them from telogen effluvium. It can be used to distinguish FPHL from diffuse and subtotal alopecia areata (AA) as well as trichotillomania from AA which can have similar clinical presentations. Trichoscopy also helps in monitoring treatment response in patients of AA. It is also useful in diagnosing infectious conditions such as noninflammatory tinea capitis, seborrheic dermatitis, piedra, and pediculosis. Trichoscopy represents a valuable, noninvasive and low-cost technique, still underutilized, to rapidly differentiate clinically frequent hair disorders.

Correlation of serum ferritin levels, in female patients with chronic diffuse hair loss: A cross sectional study

Context: Iron is involved in critical physiological processes within the hair follicle, suggesting that iron deficiency (ID) could disrupt hair synthesis. The relationship between body iron status and hair loss has been investigated in a number of studies, however, with relatively discrepant findings. Aim: The aim of this study is to evaluate whether chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) in patients were associated with decreased tissue iron stores, as measured by serum ferritin levels. Setting and Design: This was a cross-sectional study, conducted in a teaching hospital. Materials and Methods: Forty female patients aged between 15 and 45 years, having chronic diffuse hair loss, were recruited. Statistical Analysis Used: Statistical analysis used in this study was Mean ± standard deviation, Pearson's correlation coefficient, and one-sample t-test. Results: The mean serum ferritin levels in all participants, CTE, and FPHL were 18.6 μg/L, 16 μg/L, and 36.64 μg/L, respectively. Almost 57.5% of participants had serum ferritin levels Conclusion: Participants of this study had low serum ferritin levels at different definitions of ID, and the participants showed ID, which was significant. Hence, chronic diffuse hair loss was associated with decreased iron stores.

A Spilt Head Study of Efficacy of Placebo versus Platelet-rich Plasma Injections in the Treatment of Androgenic Alopecia.

Background:Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma with haemostatic and tissue repairing effects. Being enriched by various growth factors, PRP has become the focus of attention in numerous fields of medicine. Androgenic alopecia (AGA) is a common chronic hair loss disorder, characterised by progressive hair loss. Despite the therapeutic options available, there is low patient compliance and satisfaction rate. The topical and often systemic adverse effects of therapy has lead to the search of new treatment options for AGA. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss.Aim:To compare the efficacy of placebo versus PRP injections in the treatment of male AGA.Patients and Methods:Fifty male patients with AGA (Grade III to VI) were enrolled in the study. PRP was prepared using the double-spin method and injected in the androgen-related areas of scalp on the left side. Normal saline was injected on the right side in a similar fashion. Treatment sessions were performed with an interval of 21 days, and six sittings were completed for every patient.Results:Hair loss reduced with evidence of new hair growth. Digital image analysis showed an overall improvement in hair density and quality as lanugo-like hair became thicker, normal hair. An improvement in hair density, quality and thickness on trichoscopy was noted.Conclusion:Our data suggest that PRP injections have therapeutic effect on male pattern hair loss with no major side effects and high patient satisfaction overall.

A possible solution for hair loss by inhibiting corticotropin-releasing factor (CRF) receptor from traditional Chinese medicine

Corticotropin-releasing factor (CRF) and corticotropin-releasing factor receptor (CRFR) play important roles in stress response, including anxiety and depression syndrome. The CRF expression also relates to chronic stress-related hair loss. This study utilizes the world’s largest traditional Chinese medicine (TCM) database and molecular dynamics (MD) simulations to investigate novel CRFR inhibitors for treatment of alopecia. The docking and screening from TCM database results indicate the vitamin B2, 3 beta-isodihydrocadambine, and caribine display higher binding affinity than maltose in maltose binding protein (MBP). However, the results of MD simulation shows the caribine-facilitated CRFR approach closer to MBP, the 3D structure conformation of MBP and CRFR complex forms compact structure. Interestingly, the distance between the two proteins is reducing significantly after caribine dock into MBP binding site. Beside, from Ligand channel analysis, the paths of caribine demonstrate that residence time is increased in binding pocket. Hence, our finding suggests that caribine might be a potential lead compound to stimulate MBP and CRFR interaction, and help for baldless therapy in further study.

Trichoscopy criteria for diagnosing female androgenic alopecia.

AbstractDifferential diagnosis of chronic hair loss remains a challenge in dermatology. The aim of the study was to evaluate the value of a new scalp visualization technique, trichoscopy, in differential diagnosis of hair loss. Trichoscopy was performed in 131 females (59 with androgenic alopecia, 33 with chronic telogen effluvium, 39 healthy controls). Based study results, a standardized trichoscopy report was developed and diagnostic criteria for female androgenic alopecia were established. Major criteria: increased number of yellow dots and thin hairs, as well as decreased average hair thickness in frontal area. Minor criteria: increased frontal area to occiput ratio of single-hair units (&gt;2:1), vellus hairs (&gt;1.5:1) and follicles with perifollicular discoloration (&gt;3:1) Fulfillments of 2 major criteria or 1 major and 2 minor is diagnostic for female androgenic alopecia with a 92% specificity. In conclusion, trichoscopy is the first method which allows differential diagnosis of hair loss and establishing the diagnosis of female androgenic alopecia.

Female patients complaining about hair loss: documentation of defective scalp hair dynamics with contrast‐enhanced phototrichogram

The complaint of chronic hair loss frequently affects female subjects and there is little or no objective technology available in the general dermatology or even in the hair clinics to guide the observer in the management of the patient. The purpose of this report is to share the results of refined hair growth measurements that were collected in 92 female subjects complaining about hair loss. Clinically they were classified as having a patterned hair loss according to Ludwig (L; n=50), diffuse hair loss (D; n=13) or no visible hair loss but complaining of hair shedding (N; n=29). Two scalp sites on the top of the head and one occipital site were investigated after clipping by close-up photography before and after a hair dye (contrast enhancement, CE). Forty-eight hours later a new photograph was taken after CE in view of phototrichogram analysis (CE-PTG). Finally a last hair clip was performed 30 days later and hair thickness and length determined for linear growth measurements (LHGR). Herein we confirm that the top of the head shows usually a higher hair density than occipital sites, a physiological observation that applies both to men and women. From the technological perspective, we also document that CE improves hair detection in all sites. Interestingly, in affected patients (L and D) the relative increase of hair counts after CE was much higher (range +22.4% to +28.3%) compared with apparently unaffected females (N; range +8.2% to +9.7%). This increase in hair counts was only due in part to the presence of less pigmented thinning hair (thickness less than 40 microm). Such thin hairs were found in statistically significantly higher proportions in younger patients with mildly severe (grade I) patterned alopecia (Ludwig: L). In other patients with hair loss and in more severe forms of patterned alopecia - especially in older patients - the thin hair is not detected in abnormal proportions. In all sites slower growth rates and decreased anagen percentages indicate a defective hair replacement programme distinguishing L patterns from diffuse hair loss and from apparently unaffected patients complaining of chronic hair loss. Globally, we also noted that increasing age is associated with significant regression of scalp hair (decreased hair counts, thinner hair and slower LHGR). On the basis of the present data together with female data from the literature and our own studies in male subjects, we suggest a three-step mechanism leading to hair loss 1. Shortening of growth phase the hair cycle with maintained thick hair, i.e. more frequent hair cycling that leads to more hair shedding. 2. Intermittent production of short thin hair, i.e. morphological evidence of miniaturisation. 3. Very occasional or almost no hair production, i.e. dormant follicles or irreversible follicular atrophy. Depending on the genetic background, hormonal microenvironment in the scalp and conditioning of individual hair follicle bio-responses, female and male patterned hair loss may end up into different phenotypes.

New and established methods for diagnosing hair diseases

Numerically speaking, patients with hair disorders play a significant role in dermatological practice. Precise diagnostic techniques are always necessary to reach the proper diagnosis and institute appropriate treatment. Thus, at first consultation, thorough anamnestic and physical examinations are indispensable. In contrast, so-called visual diagnoses often lead to misjudgment of the actual cause of acute or chronic hair loss or overlooking concomitant disease. A few methods for diagnostics of hair disorders are described in the following overview.

Incidence of Alopecia Areata in Olmsted County, Minnesota, 1975 Through 1989

To assess the incidence and natural history of alopecia areata (AA) among unselected patients from a community. We conducted a retrospective population-based descriptive study of AA among residents of Olmsted County, Minnesota, for the period from 1975 through 1989. After identifying 292 Olmsted County residents first diagnosed with AA during the 15-year study period, we reviewed their complete (inpatient and outpatient) medical records in the community and statistically analyzed the effects of gender and age-group. The overall incidence of AA was 20.2 per 100,000 person-years and did not change with time. Rates were similar in the two genders and over all ages, and lifetime risk was estimated at 1.7%. Eighty-seven percent of patients were examined by a dermatologist who diagnosed AA, and 29% of cases were confirmed by biopsy. Most patients had mild or moderate disease, but alopecia totalis or universalis developed at some point during the clinical course in 21 patients. This study of the incidence and natural history of AA in a community shows that this disorder is fairly common and can be seen at all ages. Although spontaneous resolution is expected in most patients, a small but significant proportion of cases (probably approximately 7%) may evolve into severe and chronic hair loss, which may be psychosocially devastating for affected persons.