治疗雄激素性脱发药物的研究进展

雄激素性脱发的治疗是一个棘手的问题。随着对雄激素性脱发机理的深入研究 ,不断开发出新的治疗雄激素性脱发的药物。就国外最近的研究结果 ,按作用机理将各种药物分类综述。     

治疗雄激素性脱发药物的研究进展

雄激素性脱发的治疗是一个棘手的问题。随着对雄激素性脱发机理的深入研究，不断开发出新的治疗雄激素性脱发的药物。就国外最近的研究结果，按作用机理将各种药物分类综述。     

雄激素受体与雌激素性脱发关系的研究进展

目的：毛囊单位的雄激素受体（AR）在雄激素性脱发的发病中起着重要的作用，在遗传易感性个体，由于局部头皮AR的差异，对正常或偏高的雄激素产生放大效应，从而导致脱发。本综述了AR的结构、功能、定位、作用机制、AR与雄激素性脱发关系的实验研究等，以进一步了解雄激素性脱发的机理。     

女性型脱发的临床进展

女性型脱发(female pattern hair loss,FPHL)是成年女性脱发的主要原因,临床表现具有特征性,发病机制尚不完全清楚,可对患者生活质量造成影响[1].最初,该病被泛称为女性弥漫性脱发.1942年,Hamilton证实了雄激素在男性型脱发(male pattern alopecia,MPA)中的作用后,开始使用雄激素性脱发这一术语,以强调激素和遗传因素的作用.由于女性弥漫性脱发曾被认为是与MPA为同一疾病的不同亚型,人们开始改称女性雄激素性脱发.尽管男女两型脱发的毛囊改变相似,但其临床表现和对抗雄激素治疗的反应有差异,而雄激素在女性型脱发中的致病作用尚未完全阐明,故FPHL的命名比女性雄激素性脱发更合适[2].     

激光疗法在雄激素性脱发中的应用

近年来，国内外研究表明光疗法治疗雄激素性脱发效果良好。波长650~785 nm的低能量光、波长1550 nm和1927 nm的非剥脱性点阵激光以及剥脱性二氧化碳点阵激光治疗雄激素性脱发有效，其中，655 nm激光的疗效证据最充分。本文对不同波长的低能量激光和高能量点阵激光在雄激素性脱发治疗中的应用进行综述。     

男性雄激素性脱发的激素参数

血浆激素水平的测定对依赖激素治疗的皮肤病是有用的诊断方法,也是激素治疗剂量是否恰当的依据。女性脱发常常是雄激素过高的指征,男性脱发则提示与多基因遗传有关,而雄激素性脱发是由于在脱发区雄激素代谢增强所致。5α—还原酶活力升高,将睾丸酮转成有活性的双氢睾丸酮,增加了结合在脱发区头皮皮脂腺中的雄激素受体,通过其靶器官—皮肤本身来调整血浆雄激素。在男子型脱发的女性病人中雄激素受体结合部位也增高。然而在男女性雄激素脱发中,很少有文献反映激素情     

毛乳头细胞与雄激素相互作用的研究进展

雄激素在体内对毛发的生长发育起一定的刺激作用 ,但对局部毛发亦能诱导毛发脱失 ,导致雄激素性脱发 ,在这个过程中毛乳头细胞起着重要的作用。本文综述了毛乳头细胞与雄激素代谢及相互作用之间的关系 ,以进一步了解雄激素性脱发的机理。     

毛乳头细胞与雄激素相互作用的研究进展

雄激素在体内对毛发的生长发育起一定的刺激作用，但对局部毛发亦能诱导毛发脱失，导致雄激素性脱发，在这个过程中毛乳头细胞起着重要的作用。本文综述了毛乳头细胞与雄激素代谢及相互作用之间的关系。以进一步了解雄激素性脱发的机理。     

雄激素性脱发的发病机理和治疗进展

雄激素性脱发是临床的常见病，其病因还不完全清楚，治疗上也一直没有一个有效的方法。最近在脱发的发病机理和治疗方面有了一些新的进展，本文就雄激素性脱发的发病机理和治疗进展做一综述。     

雄激素源性脱发与血液流变学变化的关系探讨

检测57例雄激素源性脱发患者的血液流变学变化,其中男性患者(男性型脱发)35例,女性患者(女性弥漫性脱发)22例,并与健康体检者进行对照,结果显示:男性患者全血黏度、红细胞压积、全血高切相对指数等均高于正常对照组,全血黏度以高切变率增高为主;女性患者红细胞压积高于正常对照组。提示:雄激素源性脱发与血液流变学变化存在相关性,血液黏度增高、血瘀可能是本病发病机制之一;雄激素源性脱发患者存在红细胞变形能力下降。     

Direct immunofluorescence studies in alopecia areata and male pattern alopecia.

Direct immunofluroescence studies were performed on hairy and alopecic areas of scalp in patients with alopecia areata, alopecia totalis and male pattern alopecia. Abnormal deposits of C3 and occasionally of IgG and IgM were found in 92% of 12 patients with alopecia areata and in 21% of patients with male pattern alopecia. No abnormalities were seen in 4 patients with alopecia totalis. In both alopecia areata and male pattern alopecia, the deposits were most common along the basement zone of the inferior segment of hair follicles and occurred with equal frequency in alopecic and normal scalp. These observations suggest that immune factors may play a role in the pathogenesis of alopecia areata.     

Altered polyamine profiling in the hair of patients with androgenic alopecia and alopecia areata

Hair follicles are among the most highly proliferative tissues. Polyamines are associated with proliferation, and several polyamines including spermidine and spermine play anti‐inflammatory roles. Androgenic alopecia results from increased dihydrotestosterone metabolism, and alopecia areata is an autoimmune disease. This study aimed to investigate differences in polyamine profiles in hair samples between patients with androgenic alopecia and alopecia areata. Polyamine concentrations were determined through high‐performance liquid chromatography‐mass spectrometry. Hair samples were derivatized with isobutyl chloroformate. Differences in polyamine levels were observed between androgenic alopecia and alopecia areata compared with normal controls. In particular, polyamine levels were higher in alopecia areata patients than in normal controls. Certain polyamines displayed different concentrations between the androgenic alopecia and alopecia areata groups, suggesting that some polyamines, particularly N‐acetyl putrescine (P = 0.007) and N‐acetyl cadaverine (P = 0.0021), are significantly different in androgenic alopecia. Furthermore, spermidine (P = 0.021) was significantly different in alopecia areata. Our findings suggest that non‐invasive quantification of hair polyamines may help distinguish between androgenic alopecia and alopecia areata. Our study provides novel insights into physiological alterations in patients with androgenic alopecia and those with alopecia areata and reveals some differences in polyamine levels in hair loss diseases with two different modes of action.     

Alopecia in an ophiasis pattern: traction alopecia versus alopecia areata

We present a case series of 3 black women who presented with alopecia along the anterior and posterior hairline on physical examination. The initial clinical suspicion was traction alopecia from tension placed on the hair and traumatic removal of hairweaves. Two cases were supported histologically as traction alopecia, while the remaining case was alopecia areata in an ophiasis pattern. Interestingly, the case of alopecia areata was associated with the mildly traumatic removal of a weave. Traction alopecia may present in an ophiasis pattern from hair care practices. Although clinical history and physical examination may suggest traction alopecia, alopecia areata must be ruled out. The cases of interest are presented in addition to a brief review of hairweaving practices and hairweave removal techniques.     

Incidence of alopecia areata in lupus erythematosus.

BACKGROUND--A small percentage of patients with alopecia areata have connective diseases such as systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, and scleroderma. Lupus erythematosus is associated with a number of different types of alopecia, but the incidence of alopecia areata in lupus erythematosus has not been examined. OBSERVATIONS--Of our cohort of 39 patients with lupus erythematosus, alopecia areata developed in 10% (four patients), in contrast to 0.42% of general dermatologic patients. Biopsy specimens of alopecia areata lesions in each of our patients showed continuous granular deposition of IgG at the dermoepidermal junction, a finding usually found in only a minority of alopecia areata cases. Intralesional injections of corticosteroids were effective treatment. CONCLUSIONS--The incidence of alopecia areata in patients with lupus erythematosus is increased. Recognition of this form of alopecia allows for specific therapy with intralesional corticosteroids.     

系统性红斑狼疮脱发的研究进展

脱发是SLE常见的临床表现之一。SLE脱发可表现为多种类型,如狼疮发、非瘢痕性斑状脱发、弥漫性休止期脱发、盘状红斑狼疮型脱发等,不同类型的脱发在临床表现和组织病理学方面有其各自的特点。SLE脱发与疾病活动性有一定的相关性。目前SLE脱发的发病机制尚未明确,自身免疫性炎症和血管炎造成的局部微环境的改变、毛发营养不良和毛囊周期失调均有可能参与其中。     

Frontal fibrosing alopecia: a survey in 16 patients

BACKGROUND: Postmenopausal frontal fibrosing alopecia (PFFA) was described by Kossard et al. as a progressive recession of the frontal hairline affecting particularly postmenopausal women. Further cases of PFFA have been reported to date, all of them considering it as a variant of lichen planopilaris on the basis of its clinical, histological and immunohistochemical features. OBJECTIVE: To describe clinical features, and response to treatment of 16 cases of frontal fibrosing alopecia diagnosed at our department in the last 6 years. METHODS: In addition to clinical data, biopsies and laboratory tests (antinuclear antibodies, sex hormones, thyroid hormones) were performed in order to rule out other causes of scarring alopecia. Patients were treated with intralesional corticosteroids, finasteride, and minoxidil, depending on the stage of the disease and association to androgenetic alopecia. RESULTS: All patients presented progressive alopecia localized to the frontal and temporal hairlines. Eight patients (50%) had loss of eyebrows, and six patients (37.5%) had axillar alopecia. Ages ranged from 45 to 79. Three of these women were premenopausal. Androgenetic alopecia was evident in seven patients (43.8%). All patients biopsied showed perifollicular lymphocitic infiltrate with lamelar fibrosis limited to the upper portions of the follicle. The progression of the condition stopped in most patients after a variable period on treatment. When treatment was abandoned the alopecia progressed to 'clown alopecia' appearance. DISCUSSION: Cases of Kossard's type scarring alopecia affecting premenopausal women made us consider that this condition is not exclusive of postmenopausal women. Differential diagnosis should take into account conditions like female androgenetic alopecia, fibrosing alopecia in a pattern distribution, alopecia areata, and chronic lupus erythematosus. Except for the pattern of alopecia, lichen planopilaris and frontal fibrosing alopecia are indistinguishable, thus the latter is included as a variant of lichen planopilaris. Although the disease tends to spontaneous stabilization, intralesional and topical corticosteroids, and anti-androgens may stop the progression of the disease and improve the female androgenetic alopecia that usually is associated to FFA.     

Decreased serum ferritin is associated with alopecia in women

Alopecia in women is a common problem, and conflicting observational data have failed to determine whether an association exists between alopecia and iron deficiency in women. We therefore utilized an analytical cross-sectional methodology to evaluate whether common types of alopecia in women are associated with decreased tissue iron stores, as measured by serum ferritin. We studied patients with telogen effluvium (n = 30), androgenetic alopecia (n = 52), alopecia areata (n = 17), and alopecia areata totalis/universalis (n = 7). The normal group consisted of 11 subjects without hair loss from the same referral base and source population as those patients with alopecia. We analyzed the data utilizing the unpaired Student's t test assuming unequal variances with an alpha adjustment for multiple comparisons to assess whether the mean ages, ferritin levels, and hemoglobin levels of women without hair loss differed from the means in each alopecia group. The mean age of patients and normals did not differ significantly. We found that the mean ferritin level (ng per ml [95% confidence intervals]) in patients with androgenetic alopecia (37.3 128.4, 46.1]) and alopecia areata (24.9 [17.2, 32.6]) were statistically significantly lower than in normals without hair loss (59.5 [40.8, 78.1]). The mean ferritin levels in patients with telogen effluvium (50.1 [33.9, 66.33]) and alopecia areata totalis/universalis (52.3 [23.1, 81.5]) were not significantly lower than in normals. Our findings have implications regarding therapeutics, clinical trial design, and understanding the triggers for alopecia.     

毛囊干细胞在脱发性疾病中的研究进展

脱发性疾病在临床比较常见,一般按临床表现和毛发是否可再生而将脱发分为瘢痕性脱发和非瘢痕性脱发,每种均包含了多种不同的脱发性疾病。目前脱发性疾病的发病机制仍不甚清楚。毛囊干细胞位于毛囊隆突区,其周期性地增殖和分化维持了毛发的正常生长、脱落与更替。研究表明,毛囊干细胞的损伤或缺失很可能参与了某些脱发性疾病尤其是瘢痕性脱发的发病过程。     

Male pattern alopecia and coronary artery disease in men

The prevalence of male pattern alopecia, coronary artery disease, hypertension and smoking habits were studied in 478 male Caucasian hospital in-patients, over the age of 20 years. No association was shown between coronary artery disease and either male pattern alopecia, premature male pattern alopecia or male pattern alopecia with a positive family history.