Hair & Nails

New genetic research is yielding some important clues into the puzzling condition of alopecia areata, Dr. Maria Hordinsky reported at the women's and pediatric dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

By doing whole-genome analysis on thousands of samples gathered over the last 9 years, investigators have found four genes associated with the disease. Surprisingly, none of the genes is implicated in psoriasis, which has long been considered a risk factor for alopecia areata. Conversely, none of the genes associated with psoriasis appears to be implicated in alopecia areata. Investigators announced the findings this year at the annual meeting of the Society for Investigative Dermatology in Montreal.

These findings have important consequences for treatment and research, according to Dr. Hordinsky, chair of the dermatology department at the University of Minnesota, Minneapolis.

"We've all been scratching our heads for the past couple of years wondering why on Earth the new biologics that work so well in psoriasis are not working in this disease," she said. "So now with this data, maybe one possibility is that the diseases are just completely different in the way they're molecularly structured. The thinking has changed in the past couple of months. If you were to start a clinical trial today in alopecia areata, based on the new information, you probably wouldn't pick some of the biologics that were picked a few years ago."

For now, though, Dr. Hordinsky emphasized that there is no "best" treatment for alopecia areata. Patients with patchy alopecia areata sometimes respond to topical or intralesional corticosteroids, minoxidil solution, anthralin, steroid-containing shampoos, excimer laser therapy, or combination treatment.

For extensive alopecia areata, Dr. Hordinsky suggested prednisone, topical minoxidil, PUVA, immunotherapy, pulse methylprednisolone, narrow-band UVB, or combination therapy. Other possible treatments include cyclosporine, tacrolimus, dapsone, sulfasalazine, hydroxychloroquine, retinoids, and biologics.

She recommended focusing on the patient's nail to diagnose alopecia areata. Between 10% and 66% of patients with alopecia areata have nail abnormalities, and these abnormalities may precede, follow, or occur concurrently with hair loss, she noted. Nail pitting is the most common abnormality, but there may also be longitudinal ridging, koilonychia, brittle nails, onycholysis, onychomadesis, and periungual erythema.

Dr. Hordinsky's presentation concentrated on alopecia areata in children, but she said that there are few differences in the pathophysiology of pediatric versus adult disease. "It's a disease that affects all ages, all races, and is seen equally in males and females."

The difference in children involves the psychosocial aspects of the disease, and physicians need to be sensitive to these issues. "It's not like body dysmorphic disorder, where people get fixated on something that's not quite right, worrying that their nose is imperfect or something," she pointed out. "This disease can result in very rapid, and sometimes dramatic, alteration in physical appearance. So there's a psychological adaptation that has to take place. Patients have to figure out: How do you live with this disease? How do you make yourself more normal looking so you fit better into your age group, into your peer groups, into school?"

Physicians can refer patients and their families to the National Alopecia Areata Foundation (www.naaf.org

She encouraged all physicians to register patients—and their families—with the national Alopecia Areata Registry (www.alopeciaareataregistry.org

Dr. Hordinsky did not disclose relevant conflicts of interest in her presentation. SDEF and this news organization are owned by Elsevier.

A child with alopecia areata universalis is shown prior to any treatment.

Source Photos courtesy Dr. R. Berrada

The child had significant hair growth after undergoing 50 sessions of PUVA therapy.

Source Photos courtesy Dr. R. Berrada

New genetic research is yielding some important clues into the puzzling condition of alopecia areata, Dr. Maria Hordinsky reported at the women's and pediatric dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

By doing whole-genome analysis on thousands of samples gathered over the last 9 years, investigators have found four genes associated with the disease. Surprisingly, none of the genes is implicated in psoriasis, which has long been considered a risk factor for alopecia areata. Conversely, none of the genes associated with psoriasis appears to be implicated in alopecia areata. Investigators announced the findings this year at the annual meeting of the Society for Investigative Dermatology in Montreal.

These findings have important consequences for treatment and research, according to Dr. Hordinsky, chair of the dermatology department at the University of Minnesota, Minneapolis.

"We've all been scratching our heads for the past couple of years wondering why on Earth the new biologics that work so well in psoriasis are not working in this disease," she said. "So now with this data, maybe one possibility is that the diseases are just completely different in the way they're molecularly structured. The thinking has changed in the past couple of months. If you were to start a clinical trial today in alopecia areata, based on the new information, you probably wouldn't pick some of the biologics that were picked a few years ago."

For now, though, Dr. Hordinsky emphasized that there is no "best" treatment for alopecia areata. Patients with patchy alopecia areata sometimes respond to topical or intralesional corticosteroids, minoxidil solution, anthralin, steroid-containing shampoos, excimer laser therapy, or combination treatment.

For extensive alopecia areata, Dr. Hordinsky suggested prednisone, topical minoxidil, PUVA, immunotherapy, pulse methylprednisolone, narrow-band UVB, or combination therapy. Other possible treatments include cyclosporine, tacrolimus, dapsone, sulfasalazine, hydroxychloroquine, retinoids, and biologics.

She recommended focusing on the patient's nail to diagnose alopecia areata. Between 10% and 66% of patients with alopecia areata have nail abnormalities, and these abnormalities may precede, follow, or occur concurrently with hair loss, she noted. Nail pitting is the most common abnormality, but there may also be longitudinal ridging, koilonychia, brittle nails, onycholysis, onychomadesis, and periungual erythema.

Dr. Hordinsky's presentation concentrated on alopecia areata in children, but she said that there are few differences in the pathophysiology of pediatric versus adult disease. "It's a disease that affects all ages, all races, and is seen equally in males and females."

The difference in children involves the psychosocial aspects of the disease, and physicians need to be sensitive to these issues. "It's not like body dysmorphic disorder, where people get fixated on something that's not quite right, worrying that their nose is imperfect or something," she pointed out. "This disease can result in very rapid, and sometimes dramatic, alteration in physical appearance. So there's a psychological adaptation that has to take place. Patients have to figure out: How do you live with this disease? How do you make yourself more normal looking so you fit better into your age group, into your peer groups, into school?"

Physicians can refer patients and their families to the National Alopecia Areata Foundation (www.naaf.org

She encouraged all physicians to register patients—and their families—with the national Alopecia Areata Registry (www.alopeciaareataregistry.org

Dr. Hordinsky did not disclose relevant conflicts of interest in her presentation. SDEF and this news organization are owned by Elsevier.

A child with alopecia areata universalis is shown prior to any treatment.

Source Photos courtesy Dr. R. Berrada

The child had significant hair growth after undergoing 50 sessions of PUVA therapy.

Source Photos courtesy Dr. R. Berrada

New genetic research is yielding some important clues into the puzzling condition of alopecia areata, Dr. Maria Hordinsky reported at the women's and pediatric dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

By doing whole-genome analysis on thousands of samples gathered over the last 9 years, investigators have found four genes associated with the disease. Surprisingly, none of the genes is implicated in psoriasis, which has long been considered a risk factor for alopecia areata. Conversely, none of the genes associated with psoriasis appears to be implicated in alopecia areata. Investigators announced the findings this year at the annual meeting of the Society for Investigative Dermatology in Montreal.

These findings have important consequences for treatment and research, according to Dr. Hordinsky, chair of the dermatology department at the University of Minnesota, Minneapolis.

"We've all been scratching our heads for the past couple of years wondering why on Earth the new biologics that work so well in psoriasis are not working in this disease," she said. "So now with this data, maybe one possibility is that the diseases are just completely different in the way they're molecularly structured. The thinking has changed in the past couple of months. If you were to start a clinical trial today in alopecia areata, based on the new information, you probably wouldn't pick some of the biologics that were picked a few years ago."

For now, though, Dr. Hordinsky emphasized that there is no "best" treatment for alopecia areata. Patients with patchy alopecia areata sometimes respond to topical or intralesional corticosteroids, minoxidil solution, anthralin, steroid-containing shampoos, excimer laser therapy, or combination treatment.

For extensive alopecia areata, Dr. Hordinsky suggested prednisone, topical minoxidil, PUVA, immunotherapy, pulse methylprednisolone, narrow-band UVB, or combination therapy. Other possible treatments include cyclosporine, tacrolimus, dapsone, sulfasalazine, hydroxychloroquine, retinoids, and biologics.

She recommended focusing on the patient's nail to diagnose alopecia areata. Between 10% and 66% of patients with alopecia areata have nail abnormalities, and these abnormalities may precede, follow, or occur concurrently with hair loss, she noted. Nail pitting is the most common abnormality, but there may also be longitudinal ridging, koilonychia, brittle nails, onycholysis, onychomadesis, and periungual erythema.

Dr. Hordinsky's presentation concentrated on alopecia areata in children, but she said that there are few differences in the pathophysiology of pediatric versus adult disease. "It's a disease that affects all ages, all races, and is seen equally in males and females."

The difference in children involves the psychosocial aspects of the disease, and physicians need to be sensitive to these issues. "It's not like body dysmorphic disorder, where people get fixated on something that's not quite right, worrying that their nose is imperfect or something," she pointed out. "This disease can result in very rapid, and sometimes dramatic, alteration in physical appearance. So there's a psychological adaptation that has to take place. Patients have to figure out: How do you live with this disease? How do you make yourself more normal looking so you fit better into your age group, into your peer groups, into school?"

Physicians can refer patients and their families to the National Alopecia Areata Foundation (www.naaf.org

She encouraged all physicians to register patients—and their families—with the national Alopecia Areata Registry (www.alopeciaareataregistry.org

Dr. Hordinsky did not disclose relevant conflicts of interest in her presentation. SDEF and this news organization are owned by Elsevier.

A child with alopecia areata universalis is shown prior to any treatment.

Source Photos courtesy Dr. R. Berrada

The child had significant hair growth after undergoing 50 sessions of PUVA therapy.

Source Photos courtesy Dr. R. Berrada

The glutamate modulator N-acetylcysteine significantly reduces trichotillomania symptoms, according to a study of 50 patients.

In what the investigators described as the first clinical trial assessing a glutamatergic agent for this disorder, N-acetylcysteine was judged effective by both patients and physicians, to a degree comparable with other medications plus cognitive-behavioral therapy.

“N-acetylcysteine is an amino acid, is available in health-food stores, is cheaper than most insurance copayments, and seems to be well tolerated. [It] could be an effective treatment option for people with trichotillomania,” said Dr. Jon E. Grant and his associates at the University of Minnesota, Minneapolis (Arch. Gen. Psychiatry 2009;66:756–63).

Moreover, the study results indicate that “pharmacologic manipulation of the glutamate system (in the nucleus accumbens) may target core symptoms of compulsive behaviors,” they added.

Trichotillomania is the recurrent pulling out of hair—head hair, eyebrows, eyelashes, pubic hair, or other body hair—to obtain relief of tension, which leads to noticeable hair loss. There is no Food and Drug Administration-approved treatment for trichotillomania at present, but glutamatergic dysfunction has been implicated in the pathogenesis of disorders that have a compulsive component, and glutamate modulators like N-acetylcysteine have been used to treat cocaine urges and gambling behavior.

Dr. Grant and his colleagues assessed the agent in 45 women and 5 men (mean age, 34 years) who reported spending a mean of 65 minutes every day pulling out hair, usually from multiple sites. Most of these patients had never sought mental health treatment for hair pulling.

Thirty of the study subjects (60%) reported having at least one clinically important comorbid disorder, such as major depressive disorder; an anxiety disorder; another impulse-control disorder, such as skin picking or nail biting; or an eating disorder. Four patients were receiving psychotherapy, and 28 were taking a psychotropic medication or a stimulant.

Subjects were randomly assigned to receive 12 weeks of N-acetylcysteine or a matching placebo. A significant treatment effect was evident at 9 weeks and persisted for the duration of the study.

At the conclusion of treatment, those who had taken N-acetylcysteine showed significant improvement on both the severity subscale and the “resistance and control” subscale of the Massachusetts General Hospital Hairpulling Scale, as well as on the Psychiatric Institute Trichotillomania Scale.

A total of 56% of those in the active-treatment group said they were “much” or “very much” improved on the Clinical Global Impression (CGI) scale, compared with 16% of the placebo group.

Patients who received N-acetylcysteine did not show a greater improvement in psychosocial functioning than those who received placebo. However, this sample may have been too small to detect a meaningful difference between the two groups, given that at baseline, most of the subjects had only mild psychosocial dysfunction and reported a quality of life in the “average” range, Dr. Grant and his associates said.

Dr. Grant has received research grants from Forest Pharmaceuticals, GlaxoSmithKline, and Somaxon Pharmaceuticals and has served as a consultant to Pfizer Pharmaceuticals and Somaxon. In addition, Dr. Grant, who also is a lawyer, has consulted for law offices as an expert regarding impulse control disorders.

This patient extracted most of the hair from a wide area of the scalp.

Source ©Elsevier 2004, Habif: Clinical Dermatology, 4th ed.

The glutamate modulator N-acetylcysteine significantly reduces trichotillomania symptoms, according to a study of 50 patients.

In what the investigators described as the first clinical trial assessing a glutamatergic agent for this disorder, N-acetylcysteine was judged effective by both patients and physicians, to a degree comparable with other medications plus cognitive-behavioral therapy.

“N-acetylcysteine is an amino acid, is available in health-food stores, is cheaper than most insurance copayments, and seems to be well tolerated. [It] could be an effective treatment option for people with trichotillomania,” said Dr. Jon E. Grant and his associates at the University of Minnesota, Minneapolis (Arch. Gen. Psychiatry 2009;66:756–63).

Moreover, the study results indicate that “pharmacologic manipulation of the glutamate system (in the nucleus accumbens) may target core symptoms of compulsive behaviors,” they added.

Trichotillomania is the recurrent pulling out of hair—head hair, eyebrows, eyelashes, pubic hair, or other body hair—to obtain relief of tension, which leads to noticeable hair loss. There is no Food and Drug Administration-approved treatment for trichotillomania at present, but glutamatergic dysfunction has been implicated in the pathogenesis of disorders that have a compulsive component, and glutamate modulators like N-acetylcysteine have been used to treat cocaine urges and gambling behavior.

Dr. Grant and his colleagues assessed the agent in 45 women and 5 men (mean age, 34 years) who reported spending a mean of 65 minutes every day pulling out hair, usually from multiple sites. Most of these patients had never sought mental health treatment for hair pulling.

Thirty of the study subjects (60%) reported having at least one clinically important comorbid disorder, such as major depressive disorder; an anxiety disorder; another impulse-control disorder, such as skin picking or nail biting; or an eating disorder. Four patients were receiving psychotherapy, and 28 were taking a psychotropic medication or a stimulant.

Subjects were randomly assigned to receive 12 weeks of N-acetylcysteine or a matching placebo. A significant treatment effect was evident at 9 weeks and persisted for the duration of the study.

At the conclusion of treatment, those who had taken N-acetylcysteine showed significant improvement on both the severity subscale and the “resistance and control” subscale of the Massachusetts General Hospital Hairpulling Scale, as well as on the Psychiatric Institute Trichotillomania Scale.

A total of 56% of those in the active-treatment group said they were “much” or “very much” improved on the Clinical Global Impression (CGI) scale, compared with 16% of the placebo group.

Patients who received N-acetylcysteine did not show a greater improvement in psychosocial functioning than those who received placebo. However, this sample may have been too small to detect a meaningful difference between the two groups, given that at baseline, most of the subjects had only mild psychosocial dysfunction and reported a quality of life in the “average” range, Dr. Grant and his associates said.

Dr. Grant has received research grants from Forest Pharmaceuticals, GlaxoSmithKline, and Somaxon Pharmaceuticals and has served as a consultant to Pfizer Pharmaceuticals and Somaxon. In addition, Dr. Grant, who also is a lawyer, has consulted for law offices as an expert regarding impulse control disorders.

This patient extracted most of the hair from a wide area of the scalp.

Source ©Elsevier 2004, Habif: Clinical Dermatology, 4th ed.

The glutamate modulator N-acetylcysteine significantly reduces trichotillomania symptoms, according to a study of 50 patients.

In what the investigators described as the first clinical trial assessing a glutamatergic agent for this disorder, N-acetylcysteine was judged effective by both patients and physicians, to a degree comparable with other medications plus cognitive-behavioral therapy.

“N-acetylcysteine is an amino acid, is available in health-food stores, is cheaper than most insurance copayments, and seems to be well tolerated. [It] could be an effective treatment option for people with trichotillomania,” said Dr. Jon E. Grant and his associates at the University of Minnesota, Minneapolis (Arch. Gen. Psychiatry 2009;66:756–63).

Moreover, the study results indicate that “pharmacologic manipulation of the glutamate system (in the nucleus accumbens) may target core symptoms of compulsive behaviors,” they added.

Trichotillomania is the recurrent pulling out of hair—head hair, eyebrows, eyelashes, pubic hair, or other body hair—to obtain relief of tension, which leads to noticeable hair loss. There is no Food and Drug Administration-approved treatment for trichotillomania at present, but glutamatergic dysfunction has been implicated in the pathogenesis of disorders that have a compulsive component, and glutamate modulators like N-acetylcysteine have been used to treat cocaine urges and gambling behavior.

Dr. Grant and his colleagues assessed the agent in 45 women and 5 men (mean age, 34 years) who reported spending a mean of 65 minutes every day pulling out hair, usually from multiple sites. Most of these patients had never sought mental health treatment for hair pulling.

Thirty of the study subjects (60%) reported having at least one clinically important comorbid disorder, such as major depressive disorder; an anxiety disorder; another impulse-control disorder, such as skin picking or nail biting; or an eating disorder. Four patients were receiving psychotherapy, and 28 were taking a psychotropic medication or a stimulant.

Subjects were randomly assigned to receive 12 weeks of N-acetylcysteine or a matching placebo. A significant treatment effect was evident at 9 weeks and persisted for the duration of the study.

At the conclusion of treatment, those who had taken N-acetylcysteine showed significant improvement on both the severity subscale and the “resistance and control” subscale of the Massachusetts General Hospital Hairpulling Scale, as well as on the Psychiatric Institute Trichotillomania Scale.

A total of 56% of those in the active-treatment group said they were “much” or “very much” improved on the Clinical Global Impression (CGI) scale, compared with 16% of the placebo group.

Patients who received N-acetylcysteine did not show a greater improvement in psychosocial functioning than those who received placebo. However, this sample may have been too small to detect a meaningful difference between the two groups, given that at baseline, most of the subjects had only mild psychosocial dysfunction and reported a quality of life in the “average” range, Dr. Grant and his associates said.

Dr. Grant has received research grants from Forest Pharmaceuticals, GlaxoSmithKline, and Somaxon Pharmaceuticals and has served as a consultant to Pfizer Pharmaceuticals and Somaxon. In addition, Dr. Grant, who also is a lawyer, has consulted for law offices as an expert regarding impulse control disorders.

This patient extracted most of the hair from a wide area of the scalp.

Source ©Elsevier 2004, Habif: Clinical Dermatology, 4th ed.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Ingrid E. Roseborough, MD and Amy J. McMichael, MD

The unique properties of hair in those patients of African descent allow a limitless range of hair-care options. For the clinician, a general understanding of hair-care practices is an important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review highlights common hair-care practices in women, men, and children of color. Cleansing, moisturizing, and styling techniques are discussed, as well as potential complications associated with their use.

*For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Jennifer M. Fu, MD, and Vera H. Price, MD, FRCP(C)

Hair loss in women of color represents a unique diagnostic challenge that requires a systematic approach. In women of color, clinical examination of the hair and scalp is most helpful when performed first and used to guide subsequent history-taking to arrive at a clinical assessment. The most common hair problems in women of color are hair breakage, traction alopecia, and central centrifugal cicatricial alopecia. A careful detailed clinical examination and history will guide the clinician to appropriate counseling and management. It is important to recognize that a patient may have more than one of these 3 diagnoses and each requires separate attention. Traction alopecia is completely preventable with appropriate education of the public and medical establishment.

 *For a PDF of the full article, click on the link to the left of this introduction.

Philippe Assouly, MD, and Pascal Reygagne, MD

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

*For a PDF of the full article, click on the link to the left of this introduction.

Philippe Assouly, MD, and Pascal Reygagne, MD

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

*For a PDF of the full article, click on the link to the left of this introduction.

Philippe Assouly, MD, and Pascal Reygagne, MD

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

*For a PDF of the full article, click on the link to the left of this introduction.

Ralph M. Trüeb, MD

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously numerous and interacting factors influence the shedding pattern. The major approach to minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of poor quality. Several experimental approaches to the development of pharmacologic agents are under evaluation and include drug-specific antibodies, hair growth cycle modifiers, cytokines and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers. Ultimately, the protection should be selective to the hair follicle; for example, topical application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the severity or shorten the duration of CIA, but could not prevent CIA.

*For a PDF of the full article, click on the link to the left of this introduction.

Ralph M. Trüeb, MD

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously numerous and interacting factors influence the shedding pattern. The major approach to minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of poor quality. Several experimental approaches to the development of pharmacologic agents are under evaluation and include drug-specific antibodies, hair growth cycle modifiers, cytokines and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers. Ultimately, the protection should be selective to the hair follicle; for example, topical application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the severity or shorten the duration of CIA, but could not prevent CIA.

*For a PDF of the full article, click on the link to the left of this introduction.

Ralph M. Trüeb, MD

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously numerous and interacting factors influence the shedding pattern. The major approach to minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of poor quality. Several experimental approaches to the development of pharmacologic agents are under evaluation and include drug-specific antibodies, hair growth cycle modifiers, cytokines and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers. Ultimately, the protection should be selective to the hair follicle; for example, topical application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the severity or shorten the duration of CIA, but could not prevent CIA.

*For a PDF of the full article, click on the link to the left of this introduction.

Seema Garg and Andrew G. Messenger

Alopecia areata is a common condition causing nonscarring hair loss. It may be patchy, involve the entire scalp (alopecia totalis) or whole body (alopecia universalis). Patients may recover spontaneously but the disorder can follow a course of recurrent relapses or result in persistent hair loss. Alopecia areata can cause great psychological distress, and the most important aspect of management is counseling the patient about the unpredictable nature and course of the condition as well as the available effective treatments, with details of their side effects. Although many treatments have been shown to stimulate hair growth in alopecia areata, there are limited data on their long-term efficacy and impact on quality of life. We review the evidence for the following commonly used treatments: corticosteroids (topical, intralesional, and systemic), topical sensitizers (diphenylcyclopropenone), psoralen and ultraviolet A phototherapy (PUVA), minoxidil and dithranol.

 *For a PDF of the full article, click on the link to the left of this introduction.

Seema Garg and Andrew G. Messenger

Alopecia areata is a common condition causing nonscarring hair loss. It may be patchy, involve the entire scalp (alopecia totalis) or whole body (alopecia universalis). Patients may recover spontaneously but the disorder can follow a course of recurrent relapses or result in persistent hair loss. Alopecia areata can cause great psychological distress, and the most important aspect of management is counseling the patient about the unpredictable nature and course of the condition as well as the available effective treatments, with details of their side effects. Although many treatments have been shown to stimulate hair growth in alopecia areata, there are limited data on their long-term efficacy and impact on quality of life. We review the evidence for the following commonly used treatments: corticosteroids (topical, intralesional, and systemic), topical sensitizers (diphenylcyclopropenone), psoralen and ultraviolet A phototherapy (PUVA), minoxidil and dithranol.

 *For a PDF of the full article, click on the link to the left of this introduction.

Seema Garg and Andrew G. Messenger

Alopecia areata is a common condition causing nonscarring hair loss. It may be patchy, involve the entire scalp (alopecia totalis) or whole body (alopecia universalis). Patients may recover spontaneously but the disorder can follow a course of recurrent relapses or result in persistent hair loss. Alopecia areata can cause great psychological distress, and the most important aspect of management is counseling the patient about the unpredictable nature and course of the condition as well as the available effective treatments, with details of their side effects. Although many treatments have been shown to stimulate hair growth in alopecia areata, there are limited data on their long-term efficacy and impact on quality of life. We review the evidence for the following commonly used treatments: corticosteroids (topical, intralesional, and systemic), topical sensitizers (diphenylcyclopropenone), psoralen and ultraviolet A phototherapy (PUVA), minoxidil and dithranol.

 *For a PDF of the full article, click on the link to the left of this introduction.