Complete Hair Regrowth Research Articles

A SUCCESSFUL TREATMENT OF ALOPECIA TOTALIS TREATED WITH DAILY DOSE FOLLOWED BY ORAL MINI-PULSE DOSE OF METHYLPREDNISOLONE

Alopecia totalis (AT) is a non-scarring, autoimmune-mediated hair loss with a chronic course that affects the entire scalp. Treatment is challenging and often incomplete. Pulse dose corticosteroids have been reported to be successful in multiple cases but currently little is known on the optimal regimen with maximum effect and least side effects. We report a 39-year old, otherwise healthy, female with AT who was treated with a four-week course of daily 30 mg methylprednisolone followed by three days weekly corticosteroid (oral mini-pulse dose) of the same dose. The patient showed hair growth after four weeks and an almost complete hair growth after twelve months of treatment. No side effects were observed in this patient. This case showed that daily dose of corticosteroid followed by mini-pulse dose is an effective and safe treatment in AT.

Successful Treatment of Alopecia Totalis with Topical Calcipotriol: Serial Case Report and Review of the Literature

Background: Alopecia totalis (AT) often responds poorly to standard therapies. This disease is chronic and relapsing, no effective cure treatment has been established. Calcipotriol is a vitamin D analog and acts as a potent immunomodulatory agent can be used in the treatment of alopecia areata (AA) with promising results. The active form of vitamin D mediates its action by binding to specific vitamin D receptors (VDR) located in the nuclei of target cells. Expression of VDR in keratinocytes is necessary for maintenance of the normal hair cycle. Objective: Our study aims to show the effectiveness of topical calcipotriol in the treatment of Alopecia Totalis patient. Methods: Three patients diagnosed with AT, duration of disease 6 – 12 months, refractory to other treatments were selected and were started on topical calcipotriol and were followed up every 4 weeks for 12 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score (SALT), Hair Pull Test and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse. Results: The patients showed excellent response with complete regrowth of scalp hair after a single 12-week treatment course of topical calcipotriol and no hair loss relapse was observed over the next 6 months. Conclusion: In our patients, a novel treatment option topical calcipotriol was successfully used in the management of AT, in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety, confirm efficacy, and disease remission protocol. To our knowledge, this is the first published case series of successful treatment for AT with single topical calcipotriol although the sample size was small.

Combination of photodynamic therapy with 5-aminolaevulinic acid and microneedling in the treatment of alopecia areata resistant to conventional therapies: our experience with 41 patients.

Alopecia areata (AA) is a complex immune-mediated disorder, which is difficult to treat. The available treatment options seem to have limited benefit, help only some patients and have a high relapse rate. We evaluated a new therapeutic option for moderate to severe AA based on the combination of photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) and microneedling (MN). In total, 14 patients were enrolled, and these were randomly divided into 3 groups: Group A (MN alone; n=9), Group B (ALA-PDT alone; n=15) and Group C (combination of MN and ALA-PDT; n=17). All patients were treated once every 3weeks for a total of six treatments. The best clinical outcome was achieved in Group C, with complete hair regrowth observed in three patients, and an improvement of≥50% and <50% of the treated areas obtained in seven and six patients, respectively. Our report suggests that combination of ALA-PDT with MN could be an additional therapeutic option in moderate to severe AA, as MN allows better skin penetration of ALA and subsequent indirect immunosuppression.

Treatment of chronic extensive alopecia areata by diphenylcyclopropenone alone versus in combination with anthralin.

Alopecia areata (AA) is a chronic inflammatory, recurrent, tissue-specific autoimmune disease, mediated by autoreactive CD8+ T cells, occurring in genetically predisposed individuals. Targeting intrabulbar and peribulbar lymphocytic infiltrate by using squaric acid dibutyl ester and diphenylcyclopropenone (DPCP) in contact immunotherapy is by far the best chemotherapy for AA. The aim of this work was to evaluate the efficacy and safety of combination therapy with DPCP and anthralin in chronic extensive AA. A total of 24 patients (12 were treated only with DPCP and 12 with DPCP and anthralin for at least 24 weeks) were evaluated. Complete hair regrowth was observed in 62.5 and 18.2% of the patients who received DPCP and combination therapy, respectively (p = .04). Hair regrowth duration was different in both groups. The DPCP therapy is superior to the combination therapy with DPCP and anthralin in terms of efficacy, the time of onset of hair regrowth, and the time of completion of hair regrowth, Moreover, combination therapy has more side effects in combination therapy group have been discussed in this work.

098 Simvastatin decreases AA-associated inflammation through effects on isoprenoid metabolites

Alopecia areata (AA) is a T-cell-mediated disorder in which lymphocytic infiltrate attacks and damages the hair follicle during the anagen phase of growth, leading to varying patterns of hair loss. At present, there is no treatment approved by the FDA for AA, and those treatments currently in use are associated with worrying side effects, prohibitive expense, or low rates of response. Previously, we have demonstrated the effectiveness of the lipid-lowering treatments simvastatin and ezetimibe in restoring T regulatory cell levels and hair growth in a mouse model of AA. Here, we aim to elucidate the mechanisms by which simvastatin exerts its effects on the autoimmune condition. Hair re-growth in the mouse model was associated with reduction of inflammatory markers in the skin, as well as reduced activation of STAT1 and reduced expression of NKG2D in skin-draining lymph nodes. These changes corresponded to a significant decrease in serum cholesterol and triglycerides in mice who responded with complete hair re-growth. Simvastatin was similarly able to decrease in vitro proliferation of both the IL-2-dependent cytotoxic T cell line CTLL-2 and primary mouse CD4+ and CD8+ T lymphocytes. This effect was shown to be at least partially mediated through the statin’s effects on isoprenoid metabolite production, as the addition of exogenous farnesyl pyrophosphate and geranyl geranyl pyrophosphate restored the proliferative ability of statin-treated CTLL-2 cells. Taken together with previous findings, these results indicate an immediate effect of simvastatin on the lymphocytic subpopulations responsible for hair follicle damage in AA through disruption of isoprenylation.

JAK inhibitors for alopecia areata: a systematic review and meta-analysis.

There have been a number of case reports and small clinical trials reporting promising outcomes of Janus Kinase (JAK) inhibitors tofacitinib, ruxolitinib and baricitinib for alopecia areata (AA). The majority of the literature to date is based on small volume data, with a lack of definitive evidence or guidelines. To determine the expected response of AA to JAK inhibitor therapy and factors which influence response and recurrence rates. A systematic review and meta-analysis was performed according to PRISMA guidelines. From 30 studies and 289 cases, there were 72.4% responders, good responders 45.7% and partial responders 21.4%. Mean time to initial hair growth was 2.2±6.7months, and time to complete hair regrowth was 6.7±2.2months. All 37 recurrences occurred when treatment was ceased after 2.7months. Oral route was significantly associated with response to treatment compared to topical therapy. No difference was found between paediatric and adult cases in proportion of responses. There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in AA. Future large-sized randomized studies are required to confirm findings.

Ustekinumab for skin reactions associated with anti-tumor necrosis factor-α agents in patients with inflammatory bowel diseases: A single-center retrospective study.

Anti-tumor necrosis factor (TNF)-α agents may induce skin reactions, in particular in patients with inflammatory bowel diseases (IBD). The objective of this study was to determine the efficacy of ustekinumab in these patients. IBD patients facing therapeutic issues because of cutaneous reactions or tolerance issues, consequently treated with ustekinumab in our department, were included. Retrospective review of case records and clinical photographs was carried out. Twenty-six patients were included. Twenty-three patients were treated for Crohn's disease and three for ulcerative colitis. Fourteen patients presented psoriasiform lesions, nine eczematiform lesions, four anaphylactoid reactions, two alopecia areata-like lesions, one injection-site reaction, one cutaneous polyarteritis nodosa and five other skin reactions. Most of them resolved under ustekinumab. In detail, eczematiform lesions completely resolved in all cases, psoriasiform lesions completely resolved in 12 cases (85.7%) and had partial response in two cases (14.3%). Two cases of alopecia areata showed complete response (complete hair regrowth). Fourteen patients showed complete digestive response, 10 patients partial digestive response (seven of which needed IBD treatment optimization) and only two failure. In conclusion, ustekinumab is a drug of choice in patients with IBD who cannot tolerate TNF blockers.

Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience.

BACKGROUND:Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders.OBJECTIVE:To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata.PATIENTS AND METHODS:The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months.RESULTS:After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects.CONCLUSION:Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

Weekly Azathioprine Pulse versus Betamethasone Oral Mini-Pulse in the Treatment of Moderate-to-Severe Alopecia Areata.

Background:Corticosteroids are the most common agents used in the treatment of alopecia areata (AA), however, their long-term use is associated with severe side effects. Therefore, other immunosuppressive agents have been tried and azathioprine appears to be an effective and promising alternative.Objective:The main objective of this study was to compare the efficacy of 300 mg once weekly azathioprine pulse (WAP) and 5 mg betamethasone on 2 consecutive days every week in the management of AA.Materials and Methods:In this open-label, randomized comparative study, 50 patients of AA with >10% scalp area involvement were treated with either 300 mg WAP or 5 mg betamethasone on 2 consecutive days every week for 4 months or till complete scalp hair regrowth and followed up for next 5 months. Primary efficacy parameters were average percentage scalp hair regrowth and change in average Severity of Alopecia Tool (SALT) score at 4 months.Results:Twenty patients in WAP group and 21 patients in betamethasone group completed the study. The median percent scalp hair regrowth and the median change in SALT score was 44.52 and 9.5 in WAP group compared to 71.43 and 14 in betamethasone group at 4-month, respectively, which were statistically similar in two groups, however, side effects were significantly higher in betamethasone group. On further follow-up at 9 months, 10 (50%) patients in WAP group and 13 (62%) patients in betamethasone group achieved complete hair regrowth. Lack of control group was a limitation of our study.Conclusion:WAP and betamethasone therapy, both appear to be effective in the treatment of AA. However, betamethasone caused several side effects; therefore, WAP can be used as a better alternative to corticosteroids in AA.

Late-Onset Alopecia Areata: A Retrospective Cohort Study

Background: Alopecia areata is an immune-mediated disease presenting with sudden onset of nonscarring hair loss. Onset is more common earlier in life, and little is known regarding late-onset alopecia areata. Objectives: To describe the epidemiology, clinical patterns, disease course, and outcome of late-onset alopecia areata in Israeli patients referred to a tertiary medical center. Materials and Methods: This retrospective cohort study considered patients whose disease onset occurred at age ≥50 years. Patients were recruited from among all alopecia areata patients visiting a tertiary center between January 2009 and April 2015. Results: Of the 29 people included, 25 (86.2%) were female (female-to-male ratio, 6.2:1). There was a family history of alopecia areata in 17.2%, thyroid disease in 31%, atopic background in 6.9%, and 17/29 (58.6%) reported a significant stressful event. The most common disease pattern was patchy, and disease was mild in the majority of participants. Complete hair regrowth was observed in 82.8% of participants, and 37.9% relapsed. Conclusion: Late-onset alopecia areata is characterized by marked female predominance, less extensive disease, and a high incidence of complete hair regrowth.

Topical Inhibition of the Electron Transport Chain Can Stimulate the Hair Cycle

Abstract While many signaling pathways have been implicated in control of activation of adult hair follicle stem cells and the hair cycle, less is known about cell intrinsic mechanisms of stem cell control. We previously identified lactate production as a key cell intrinsic regulator of hair follicle stem cell activity, suggesting that cellular metabolism is important in stem cell activation. Others have used transgenic methods to suggest that transgenic blockade of the Electron Transport Chain (ETC) leads to degeneration of the hair follicle. Here, we show that pharmacological abrogation of ETC activity, as opposed to complete ablation of ETC, can promote hair cycle activation without significant cell toxicity. Furthermore, metabolic data suggest that ETC inhibition leads to increased pyruvate accessibility for the Ldh enzyme and therefore increased lactate production, which we previously showed can promote hair cycle activation. Finally, this type of ETC inhibition can even be used to accelerate the hair cycle in aged mice. These results point toward an unexpected and safe method to promote hair follicle stem cell activation.

Long-Term Prognosis of Alopecia Totalis and Alopecia Universalis: A Longitudinal Study with More than 10 Years of Follow-Up: Better than Reported

Background: In alopecia totalis (AT) and alopecia universalis (AU), the chance of full hair regrowth is known to be less than 10%. However, this information is based on a few older studies conducted in the 1950s and 1960s. Objective: We investigated the current long-term prognosis of individuals with AT/AU. Methods: A retrospective chart review was performed in patients with AT/AU between 1994 and 2005. Outcome data were collected by reviewing outpatient clinical files or by phone interviews. Finally, the long-term assessment of 70 patients with valid outcome data was performed. Results: Twelve out of 70 patients with AT/AU (17.1%) had complete hair regrowth. Five out of 24 patients with AT (20.8%) showed complete hair regrowth, and 7 of 46 patients with AU (15.2%) achieved complete regrowth. Seventeen out of 70 patients with AT/AU (24.2%) reported hair regrowth greater than or equal to 90%. Thirty patients with AU (65.2%) remained in an alopecic state without improvement, while 5 patients with AT (20.8%) showed no hair regrowth. Conclusion: Our results suggest that the long-term prognosis of AT/AU is more favorable than previously thought. However, the clinical burden of AT/AU is still substantial.

Sequential high- and low-dose systemic corticosteroid therapy for severe childhood alopecia areata.

Given the limited number of therapeutic options, severe childhood alopecia areata (AA) poses a clinical challenge. The best and most rapid response rates can be achieved with high-dose systemic corticosteroids, however, relapse following treatment discontinuation is inevitable. Due to systemic side effects, long-term high-dose corticosteroid regimens are not feasible. Following initial pulse therapy, continuation of corticosteroid therapy at a dose below the Cushing threshold might be able to suppress disease activity without causing severe side effects. Thirteen children with severe AA were enrolled in our open observational study. Seven had alopecia totalis or universalis; the remaining six children had multifocal alopecia affecting more than 50% of the scalp. The treatment regimen consisted of initial pulse therapy with prednisolone 2mg/kg PO, which was subsequently tapered to a maintenance dose below the individual Cushing threshold within nine weeks. Children were followed-up for one to three years. Sixty-two percent of individuals showed complete hair regrowth. The mean time to response was 6.6 weeks. Said response was sustained with maintenance therapy for the entire follow-up period. Noticeable side effects included weight gain (1-3kg), which was observed in all children, and mild steroid acne in 23% of cases. Sequential high- and low-dose prednisolone therapy is an effective and safe therapeutic option for childhood AA.

Evaluation of the wound healing efficacy of chemical and phytogenic silver nanoparticles.

Wound healing requires a series of cellular events and a cascade of co-ordinated and systemic biochemical events. Silver nanoparticles possess many beneficial properties for wound management including antibacterial, anti-inflammatory and pro-healing properties. In this study, the authors investigated the wound healing properties of Cinnamomum verum extract mediated nanosilver (CENS) particles in comparison with 1% povidone iodine, citrate mediate NS and CE treatments. The topical application of CENS showed good antibacterial activity and accelerated wound healing with complete epithelialisation and normal re-growth of hair in all three models of study: namely, excision, incision and dead space models in rats compared with all other treatments. CENS was also found to promote collagen synthesis, stabilise wound besides countering oxidative stress and stimulating cellular proliferation CENS could be a novel therapeutic agent for wound management.

Efficacy and safety of diphenylcyclopropenone alone or in combination with anthralin in the treatment of chronic extensive alopecia areata: A retrospective case series

Some patients with chronic extensive alopecia areata (AA) may be refractory to topical immunotherapy. Combination therapy is recommended for such patients. Efficacy and safety of a combination therapy with diphenylcyclopropenone (DPCP) and anthralin in chronic extensive AA is unknown. We sought to determine whether the combination therapy of DPCP and anthralin is superior to DPCP alone in chronic extensive AA. We retrospectively analyzed the efficacy, side effects, and relapse rates of DPCP (alone or with anthralin) in chronic extensive AA. A total of 47 patients (22 were treated only with DPCP, and 25 with DPCP and anthralin for at least 30 weeks) were evaluated. Complete hair regrowth was observed in 36.4% and 72% of the patients who received DPCP and combination therapy, respectively (P= .01). Hair regrowth duration was shorter with combination therapy (P= .01). Regrowth rates of the eyebrows, eyelashes, and beard in patients on combination therapy were higher than those in patients on DPCP (P= .01). Side effects such as folliculitis, hyperpigmentation, and staining of skin, hair, and clothes were more common in combination therapy group. The retrospective design and small number of patients are limitations. Combination therapy with DPCP and anthralin is superior to DPCP alone in chronic extensive AA.

Detailed clinicopathological characterization of progressive alopecia areata patients treated with i.v. corticosteroid pulse therapy toward optimization of inclusion criteria.

The management of progressive alopecia areata (AA) is often challenging. Recently, i.v. corticosteroid pulse therapy has been reported to be effective for acute and severe AA, however, inclusion criteria have not been sufficiently precise, leaving a chance that its efficacy could be further improved by optimizing therapeutic indications. In our attempts to delineate the factors that correlate with favorable outcomes, we minutely evaluated the clinicopathological findings and the prognoses of single-round steroid pulse-treated progressive AA cases with full sets of image and pathology records during the course. Almost complete hair regrowth has been achieved and maintained up to 2 years in five out of seven AA patients with varying degrees of clinical severity. Interestingly, the worst clinical presentation observed during the course correlated with the size of the area where hairs with dystrophic roots were pulled rather than the extent of visible hair loss on the first visit. Dermoscopy detected disease spread but contributed little in assessing prognoses. Dense perifollicular cell infiltration was detected in all cases treated within 4 weeks of onset and those treated later but with excellent response. Importantly, the cases with poor or incomplete hair regrowth were treated 6-8 weeks of onset and showed moderate inflammatory change with high telogen conversion rate. These findings mandate global dermoscopy and hair pull test for judging the treatment indication and suggest that early administration of high-dose corticosteroid, ideally within 4 weeks of onset, enable efficient suppression of active inflammation and maximize the effectiveness of the remedy.

Oral Zinc Sulphate in Treatment of Alopecia Areata (Double Blind; Cross-Over Study)

Background: Alopecia areata is a common autoimmune disease that encountered world-wide. Many modalities have been used but no one was universally effective. Zinc sulphate has been used in the treatment of many skin diseases. Objective: To establish the effectiveness of oral zinc sulphate in the treatment of patchy alopecia areata Patients and Methods: Patients with alopecia areata who attended the Department of Dermatology-Baghdad Teaching Hospital was recruited into randomized, placebo-controlled, double-blind cross- over trial between February 2008 and September 2009. Patients were randomly allocated to receive either zinc sulphate 5mg /kg/day in three divided doses (Group A) or identical placebo capsules (Group B). Zinc sulphate and placebo capsules were given in a double-blind manner, following 3 months of starting the treatment, the patients crossed over, i.e. patients on zinc sulphate shifted to placebo and vice versa. Results: One hundred patients (60 males and 40 females) with patchy AA met the inclusion criteria and enrolled for the study. Sixty-seven patients completed the study, 41(61%) males and 26 (39%) females, their ages ranged from 1.6 - 68 (22.031 ± 14.8505) years. Duration of the disease ranged from 1 - 48 (14.4 ±14.8875) weeks. In group A, at the end of third month, complete hair re-growth with terminal hairs have been obtained in 22 (59.45%) patients. After shifting to placebo treatment the hair continued to grow without relapse and at the end of sixth month, the complete hair re-growth was occurred in 23(62.16%) patients. In group B, at the end of third month, complete hair re-growth had been obtained in 3 (10%) patients. While, after shifting to zinc sulphate the complete hair re-growth obtained in 20 (66.67%) patients. No important side effects were reported apart from mild gastric upset in 8 (11.9%) patients. Conclusion: Oral zinc sulphate is one of the effective treatment options for AA with low relapse rate after stopping of the treatment.

A band-like balding disorder

An erythematous, non-scaling indurated plaque appeared on the forehead of a 34-year-old white man. Over a period of approxinately 1 year, it extended onto the scalp, resulting in a linear non-scarring alopecia, seemingly following the lines of Blaschko (fi gure). Initial therapy with topical glucocorticoids failed, and a skin biopsy was taken. Histopathological examination showed a normal epidermis, accumulation of mucin in the dermis, and lymphocytic panniculitis (fi gure). Linear cutaneous lupus profundus was diagnosed. Laboratory tests were normal, apart from positive antinuclear anti bodies (1:200) and slightly increased C3d complement. Under oral hydroxychloroquine therapy the disorder resolved within 12 weeks, followed by complete regrowth of hair. No relapse occurred during 1 year of maintenance treatment. The face and scalp are predilection sites of cutaneous lupus erythematosus profundus. This can result in an alopecia areata-like clinical picture or nonscarring linear alopecia, which has thus far mainly been reported in east Asians.

Targeted photochemotherapy in alopecia areata

Alopecia areata (AA) is a common cause of localized non-scarring alopecia. Usage of targeted UVA after the topical application of 8-methoxypsoralen (8-MOP) is one of the rising treatment modalities for AA. Our aim was to assess the efficacy and safety of topical 8-MOP plus targeted UVA phototherapy in the treatment of patchy AA. Seven patchy AA patients were treated by topical 8-MOP application to the lesions followed by UVA irradiation 3 times a week, with 15 to 24 sessions in total. At the end of the treatment all patients were evaluated for response on a four-point scale (0 = no hair, 1 = white vellus hair, 2 = regrowth cosmetically acceptable for the patient, 3 = complete hair growth). The mean cumulative UVA dose was from 7.5 to 39.6 J/cm(2) . For all 7 patients, average response score was calculated as 2, which means cosmetically acceptable regrowth. Targeted UVA phototherapy combined with topical 8-MOP may be an effective and safe alternative treatment protocol for patchy AA, which should be kept in mind in order to choose the best for the patient, especially for patients incompatible with other treatments that are systemic and invasive.

Treatment of alopecia X with medroxyprogesterone acetate

Alopecia X is a common cause of noninflammatory alopecia in Pomeranian dogs. In the past, treatment with growth hormone injections resulted in hair regrowth in many individuals. Progesterone can induce mammary-derived growth hormone and is used to treat dogs with congenital growth hormone deficiency. To determine whether progesterone induces endogenous insulin-like growth factor-1 (IGF-1) and causes hair regrowth in dogs with alopecia X. Eight neutered Pomeranian dogs with alopecia X for 1-2 years. In part 1, two male and three female dogs received 5 mg/kg medroxyprogesterone acetate injected subcutaneously (s.c.) every 4 weeks for a total of four injections. In part 2, one male and two female dogs received 10 mg/kg medroxyprogesterone acetate injected s.c. every 4 weeks for four injections. Dogs were monitored monthly with physical examinations and complete blood counts, chemistry panels and urinalyses. In part 3, two coated Pomeranian dogs and two normal-coated small breed dogs received two s.c. injections of 10 mg/kg medroxyprogesterone acetate. Serum was saved from each visit for IGF-1 analysis. In part 1, two dogs had partial hair regrowth of ~40-60%. In part 2, one dog had partial hair regrowth and one dog had complete hair regrowth 2 months after completion of the study. Unlike the normal-coated dogs, whose IGF-1 concentrations increased, the IGF-1 concentrations in alopecic and coated Pomeranian dogs were low and remained unchanged. No adverse effects were noted. Results of this study showed that medroxyprogesterone injections resulted in partial hair regrowth in three and complete hair regrowth in one of eight Pomeranian dogs with alopecia X.