Dermatol Surg. 2009 Aug 5

Contemporary Hair Transplantation.

Avram M, Rogers N.

BACKGROUND The field of hair transplantation surgery has evolved considerably over the last quarter century. Performed correctly, the cosmetic results of contemporary hair transplantation are virtually undetectable in women and men. Large, pluggy “punch grafts” have been replaced with natural-appearing follicular unit grafts, which maintain their existing anatomy and with proper technique can match the orientation of surrounding hair follicles. OBJECTIVE To review all of the steps involved in hair transplantation surgery and to provide an overview of medications used in conjunction with transplantation to help prevent hair loss. MATERIALS, METHODS, AND RESULTS The authors review key aspects of the consultation, physical examination, selection of appropriate candidates, excision of donor area, hairline design, graft creation and placement, and postoperative instructions. The role of medications such as minoxidil and finasteride in preventing ongoing hair loss is an essential part of the treatment plan. For nonsurgical candidates, other treatments such as wigs, hairpieces, and camouflages are reviewed. Future trends may involve the use of low-level laser light therapy, dutasteride, and cloning of follicles. CONCLUSION Patients and physicians alike are pleased with the results of contemporary hair transplantation, and physicians can now recommend the procedure without reservation. The authors have indicated no significant interest with commercial supporters.

slingtly edited for hair loss blogspot

Lymphokine Cytokine Res.
IL-1 alpha inhibits human hair regrowth

edited for blog use

We investigated the effect of IL-1 alpha on hair regrowth and hair fiber production. In the presence of 10 ng/ml IL-1 alpha, the growth of cultured human hair follicles ceased within 2-4 days, whereas control hair follicles grew for a period of 7-10 days. IL-1 alpha also inhibited hair fiber growth, but with an onset which occurred 3 days later than that of follicle regrowth inhibition. ..snip..The selective PKC inhibitor augmented IL-1-induced inhibition of hair regrowth, but did not itself affect hair growth. These findings indicate that IL-1 alpha exerts a rapid antiproliferative effect on hair follicles, and that inhibition of hair fiber growth is a secondary response. Thus, IL-1 may play a role in the pathophysiology of inflammatory hair loss conditions. snip

J Am Acad Dermatol. 2009;61(3):529

Melanocytes: a possible target in alopecia areata.

Trautman S, Thompson M, Roberts J, Thompson CT.

Why hair turns white in hair loss secondary to alopecia areata

Dermatol Clin. 1987;5(3):467

The biology of hair

Ebling FJ.

(edited for hair loss blog)

Hair is a product of small pits in the skin known as hair follicles. The most important feature of hair follicles is that their activity is intermittent; each active phase or anagen is succeeded by a transitional phase (catagen) and a resting phase (telogen), during which the fully formed “club hair” is retained for a period and then shed. The growth of facial, body, axillary, and pubic hair depends on androgens. Facial hair and body hair require high levels of testosterone and its conversion to 5-alpha-dihydrotestosterone. Pubic and axillary hair follicles require much lower levels of hormone, and 5-alpha-reduction appears to be unnecessary. Paradoxically, male pattern hair loss and its female equivalent also require androgen for their manifestation. The differing lengths of hair in the various regions of the body result largely from differences in the duration of anagen hair and only to a small extent from differences in the rates of growth. Some hair loss from the scalp can be characterized in terms of the hair regrowth cycle, and some involves long-term changes in the follicular architecture. Thus postfebrile and postpartum alopecias are telogen effluvia that involve shedding of club hairs, whereas drug-induced hair loss and alopecia areata involve shearing and loss of growing hairs. Male pattern baldness and female diffuse pattern baldness involve gradual shortening of the periods of anagen and shrinkage of the hair follicles over a long term.

J Am Acad Dermatol.Oct;15(4 Pt 1):571

Structural and functional changes of normal aging skin.

Fenske NA, Lober CW.

Solar-induced cutaneous changes are more prevalent and profound in older persons and, thus, are often inappropriately attributed to the aging process, per se. Structural and functional alterations caused by intrinsic aging and independent of environmental insults are now recognized in the skin of elderly individuals. Structurally the aged epidermis likely becomes thinner, the corneocytes become less adherent to one another, and there is flattening of the dermoepidermal interface. The number of melanocytes and Langerhans cells is decreased. The dermis becomes atrophic and it is relatively acellular and avascular…snip… There is a progressive reduction in the density of hair follicles per unit area on the face and scalp, independent of male-pattern alopecia. The hair shaft diameter is generally reduced but in some areas, especially the ears, nose, and eyebrows of men and the upper lip and chin in women, it is increased as vellus hairs convert to cosmetically compromising terminal hairs. Functional alterations noted in the skin of elderly persons include a decreased growth rate of the epidermis, hair, and nails, delayed wound healing, reduced dermal clearance of fluids and foreign materials, and compromised vascular responsiveness. Eccrine and apocrine secretions are diminished. The cutaneous immune and inflammatory responses are impaired, particularly cell-mediated immunity. Clinical correlates of these intrinsic aging changes of the skin include alopecia, pallor, xerosis, an increased number of benign and malignant epidermal neoplasms, increased susceptibility to blister formation, predisposition to injury of the dermis and underlying tissues, delayed onset and resolution of blisters and wheals, persistent contact dermatitis, impaired tanning response to ultraviolet light, increased risk for wound infections, prolongation of therapy necessary for onychomycosis, and thermoregulatory disturbances.

Hair regrowth and hair loss treatment

Curr Probl Dermatol.1983;11:171

A sensitive assay for the enzyme activity in hair follicles and epidermis that catalyses the peptidyl-arginine-citrulline post-translational modification.

Rogers GE, Rothnagel JA.

In 1977, Rogers et al described an enzymic activity in hair follicles that converts arginine to citrulline in situ in proteins. The protein precursor substrate in the hair follicle was identified as trichohyalin in the inner root sheath and medulla. …snip… The possibility of further improvement of the procedure is being investigated, including using other, related substrates. Using the assay, the enrichment and properties of the enzyme are under study in the richly medullated follicles of the guinea pig. The enzyme has an apparent Km of 18 mM for Bz-14C-arg and an absolute requirement for Ca2+ with a broad maximum around 10 mM. It is stable at +4 degrees C and -80 degrees C for at least four weeks and can be freeze-dried with some activity loss.

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Hair loss blog

J Toxicol Environ Health. 1977 Dec;3(5-6):859-69.

Alopecia induced by inhalation exposure to phenyl glycidyl ether.

Lee KP, et al

Rats and dogs were exposed to heated phenyl glycidyl ether (310 degrees C) vapor at average levels of 1.3, 5.0, and 11.8 ppm (v/v) for 6 hr/day, 5 days/wk, for 90 days. No adverse effects were observed in the dogs and rats other than alopecia in rats at the dose levels of 5.0 and 11.8 ppm. Microscopically, the skin lesions revealed slight acanthosis, hyperkeratosis, and occasional patchy parakeratosis in the epidermis. Follicular keratin plugs were observed with hyperkeratosis of epithelium in the hair follicles and sebaceous glands. Inflammatory reaction was mainly confined to the perifollicular region and affected the hair follicles, resulting in atrophy. The number of hair follicles in the resting stage appeared to increase. The hair shafts revealed impairment of keratinization and fragmentation. Extracted hairs showed an increase in the number of dystrophic follicles and constricted or broken hair shafts.

Hautarzt. 1992 Aug;43(8):505-8.

Loose anagen hair

Trüeb RM, Burg G.

We report on a 5-year-old girl whose hair could be pulled out with no effort and without causing pain. Occipital alopecia in a patchy pattern and with no sign of scalp inflammation or scarring was noted. A trichogram from the clinically involved area disclosed a striking predominance of anagen hair with absence of external root sheaths. Histological examination of the hair suggests abnormal premature keratinization of the inner root sheath, resulting in the loss of its anchoring function between the hair shaft and the follicle. Zaun first reported this new type of hair loss in children in 1984. The name loose anagen hair of childhood has recently been suggested for this disease. The differential diagnosis includes hair loss due to alopecia areata, trichotillomania, and congenital hypotrichosis.

Br J Dermatol. 1997 Nov;137(5):699-702.

A non-steroidal antiandrogen, on human hair production by balding scalp grafts maintained on testosterone-conditioned nude mice.

De Brouwer B, et al

Human hair regrowth can be monitored for several months after the transplantation of scalp samples from men with androgen-dependent alopecia (hair loss) on to female nude mice. Hair production from balding sites has been shown to be inhibited in testosterone-conditioned nude mice. We used this recently reported model to study the effect of a new non-steroidal antiandrogen-RU58841-on human hair growth. Twenty productive scalp grafts from balding men were maintained for 8 months after grafting on to nude mice, and hair production was monitored monthly for 6 months. All mice were conditioned by the topical application of testosterone (testosterone propionate, 300 micrograms in 10 microL; 5 days/week) on the non-grafted flank. The scalp samples were divided equally according to the estimated hair production potential, which was based on the amount of hair present on the scalp samples before grafting. Each of the two equal groups of grafts was further allocated at random to be treated topically (5 days/week) with blinded solutions of either RU58841 1% in ethanol, or ethanol as a control. Twenty-eight active follicles appeared on the 10 control grafts. Among them only two follicles (7%) initiated a second hair cycle. However, the 10 RU58841-treated grafts bore a total of 29 active follicles, and eight of them (28%) showed a second cycle. The values for the linear hair growth rates (LHGR) were significantly higher in the RU58841-treated group. Recycling and increased LHGR indicate a positive action for RU58841 on human hair growth from balding samples grafted on to testosterone-conditioned nude mice, and encourage a clinical trial to evaluate its potential in the treatment of androgen-dependent alopecia.

hair loss treatment

Int J Dermatol. 1995 Aug;34(8):542-5.

Antismooth muscle and antiparietal cell antibodies in Indians with alopecia areata.

Kumar B, et al.

BACKGROUND: hai rloss in Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases. METHODS: A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique. RESULTS: Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Antismooth-muscle-antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata. Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels. CONCLUSION: Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.

Arch Dermatol. 1992 Oct;128(10):1349

Loose anagen hair as a cause of hereditary hair loss in children.Baden HP,et al

BACKGROUND AND DESIGN–The loose anagen hair syndrome is a recently described disorder with enhanced hair loss in which anagen hairs can be painlessly pulled from the scalp. RESULTS–In three families, we have observed an autosomal dominant form of inheritance. We have confirmed that the extracted bulbs consist only of cortical cells and that the hair shafts have an abnormal shape. Using routine light and electron microscopy, we observed disadhesion between all layers of the follicle and within some layers and premature keratinization of the inner root sheath of the follicle. In addition, abnormal maturation of the various layers was observed at the electron microscopic level, including regions of the cortex that contained decreased numbers of filaments. The disorder appears to be cyclic, since relatively normal and markedly affected regions of the shaft can be observed within a single follicle. CONCLUSIONS–Possible mechanisms responsible for the disease include abnormal intercellular signaling and disturbances of desmosomal components and/or cadherins.

Lab Invest. 1991 Nov;65(5):588-600.

Hairpatches, a single gene mutation characterized by progressive renal disease and alopecia in the mouse.

Shultz LD, et al

A new murine mutation, hairpatches (Hpt), is on chromosome 4, 18.1 recombination units distal to brown near the interferon alpha and beta chain structural gene complex. On the inbred HPT/Le strain background, Hpt is semi-dominant, and Hpt/Hpt mice die in utero by 6 to 8 days of gestation. Such death in utero is associated with abnormalities of embryonic ectodermal derivatives. However on the segregating hybrid background, Hpt is a fully dominant mutation. HPT/Le Hpt/+ mice can be recognized by 3 to 4 days of age by patches of lightly pigmented skin. These mice show reduced numbers of hair follicles, abnormalities in hair follicle structure, and patchy absence of hair throughout life. By 2 weeks of age, abnormal hair follicle development is accompanied by thickening of the epidermis, reduction in levels of subcutaneous fat, and dermal inflammation. Progressive glomerulosclerosis, resulting in chronic kidney failure, is accompanied by increases in glomerular mesangial matrix, deposition of immune complexes, and glomerular enlargement. Scanning electron microscopic studies revealed abnormalities of podocytes including disorganization, swelling, and fusion of the foot processes. Increase in serum blood urea nitrogen levels accompanies conspicuous renal histopathologic changes. Cardiovascular changes in Hpt/+ mice are evidenced by hypertrophy of the left heart ventricle. Increased systolic blood pressure in these animals was found by 3 months of age. Anemia occurs in Hpt/+ mice by 40 weeks. The Hpt/+ mutation provides a valuable new animal model for chronic kidney disease accompanied by skin abnormalities and ventricular hypertrophy. The pathologic changes caused by this mutation are similar to those reported in affected family members with a newly described autosomal dominant human disease.

J Immunol. 1982 Dec;129(6):2673-7.

The effect of hypophysectomy on thymic aging in mice.

Harrison DE, Archer JR, Astle CM.

Surgical removal of the pituitary (hypophysectomy) followed by endocrine supplementation in middle-aged rats has been reported to reverse immunologic decline with age. We attempted to confirm and extend these reports by using a well-defined and readily available mouse model system. Hypophysectomy and endocrine supplementation in 8- to 9-mo-old C57BL/6J (B6) male retired breeder mice improved some, but not all, T dependent immune functions tested at 15 mo of age. In hypoxed mice, spleen cell proliferation in response to phytohemagglutinin (PHA) in vitro, and delayed type hypersensitivity (DTH) responses to sheep red blood cells (SRBC) measured by footpad swelling improved to levels shown by young controls. Direct anti-SRBC plaque-forming cell (PFC) responses by spleen cells, and serum agglutination responses against SRBC were not improved. Hypoxed mice had larger thymuses and much higher ratios of cortex-medulla areas than did age-matched controls. Hair regrowth after shaving was much faster in hypoxed mice. Nevertheless, hypophysectomy reduced mean and maximum longevities. These results conflict in several ways with the previously reported studies in rats, in which direct PFC responses and maximum longevities were improved by this treatment. There have been no previous studies of the effect of hypophysectomy and endocrine supplementation on thymic aging in mice, nor has it previously been reported that this treatment causes improvements in PHA and DTH responses and in thymic morphology. These effects show that at least some aging processes are reversible in aging individuals. They also suggest that hypophysectomy of middle-aged mice will be useful for studying neuroendocrine and thymic interactions that occur during the aging process.

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Arch Dermatol. 1978 Jul;114(7):1036-8.

Treatment of alopecia areata with dinitrochlorobenzene
.
Daman LA, Rosenberg EW, Drake L.

Persistent refractory alopecia areata in 26 patients was treated topically with dinitrochlorobenzene (DNC. Sixteen patients have had excellent regrowth of hair loss; three patients could either not be initially sensitized or an adequate allergic contact dermatitis on the scalp did not develop. Two patients discontinued therapy within two months; hair regrowth did not develop in five patients despite an adequate trial. Augmentation of the T-lymphocyte pool via DNCB sensitization and challenge may become effective therapy for some patients with severe alopecia areata.