Cephalalgia Alopecia or Nummular Headache With Trophic Changes? A New Case With Prolonged Follow‐Up

Cephalalgia alopecia is a rare and recently described headache syndrome in which recurrent, burning head and neck pain is associated with hair loss from areas of scalp affected by the pain. We here report the case of a 33‐year‐old woman with continuous unilateral occipital pain and colocalized alopecia, only responsive to onabotulinumtoxin A injections. We hypothesize whether this clinical phenotype may correspond to either cephalalgia alopecia or nummular headache with trophic changes, conditions that might represent 2 manifestations of the same spectrum of disorders.     

Dopaminergic effects after chronic treatment with nandrolone visualized in rat brain by positron emission tomography

Anabolic–androgenic steroids (AAS) have recently been shown to induce neurochemical alterations in areas of the male rat CNS related to behavioural changes that have been observed among AAS misusers. In the present study, positron emission tomography (PET) is suggested as a suitable in vivo method in order to visualize the density of the dopamine transporter ([¹¹C]-FE-β-CIT) as well as the dopamine D₁-like ([¹¹C]-(+)-SCH23390) and the D₂-like receptors ([¹¹C]-raclopride) in the male rat brain. Chronic treatment with the AAS nandrolone decanoate (15 mg/kg/day for 14 days) caused an up-regulation of the binding potential of the dopamine transporter in the striatum.     

In vivo reflectance confocal microscopy assessment of the therapeutic follow‐up of cutaneous T‐cell lymphomas causing scalp alopecia

Cutaneous T‐cell lymphomas involving the scalp and determining scarring alopecias are difficult to be followed up during treatment because of the peculiar anatomical site of onset. In vivo reflectance confocal microscopy has already been reported to be useful for cutaneous T‐cell lymphoma evaluation and for therapeutic follow‐up in inflammatory skin conditions. We describe a case of a 26‐year‐old man affected by cutaneous T‐cell lymphoma affecting the scalp in which reflectance confocal microscopy demonstrated to be useful for in vivo evaluation of the therapeutic response to topical and systemic treatment.     

The Relationship Between Alopecia Areata and Alexithymia,Anxiety and Depression: A Case-Control Study

Background:

Alopecia areata (AA) is a skin disease characterized by the sudden appearance of areas of hair loss on the scalp and other hair-bearing areas, but its aesthetic repercussions can lead to profound changes in patient''s psychological status and relationships.

Aim:

The goal was to investigate a possible relationship between AA and alexithymia as well as two other emotional dimensions, anxiety and depression.

Materials and Methods:

Fifty patients with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, Sfax were included in this study. Anxiety and depression were evaluated by Hospital Anxiety and Depression scale questionnaire, alexithymia was assessed by Toronto Alexithymia scale 20, and severity of AA was measured by Severity of Alopecia Tool.

Results:

Patient''s mean age was 32.92 years. 52% of patients were females. Depression and anxiety were detected respectively in 38% and 62% of patients. There was statistically significant difference between patients and control group in terms of depression (P = 0.047) and anxiety (P = 0.005). Forty-two percent of patients scored positive for alexithymia. No significant difference was found between patient and control groups (P = 0.683) in terms of alexithymia. Anxiety was responsible for 14.7% of variation in alexithymia (P = 0.047).

Conclusions:

Our study shows a high prevalence of anxiety and depressive symptoms in AA patients. Dermatologists should be aware of the psychological impact of AA, especially as current treatments have limited effectiveness.     

Histopathological investigation of clinically non‐affected perilesional scalp in alopecias detected unexpected spread of disease activities

Histopathological comparison between clinically affected and intact regions in alopecia patients has been considered to facilitate better understanding of the pathophysiology of ongoing disease. Theoretically, adjacent intact regions should provide ideal controls as they should share close histological characteristics, however, to what extent clinically non‐affected neighboring regions maintain their pathological integrity has not been fully assessed. The goal of this study is to delineate histopathological characteristics of clinically intact perilesional regions in the patients with various forms of alopecia. Transverse sections of 4‐mm punch biopsy at the levels of isthmus and suprabulbar portion were obtained from seemingly unimpaired perilesional scalp of 50 Japanese alopecia patients (16 alopecia areata [AA] multiplex, 19 scarring alopecia [SA], 15 other conditions) and subject to histopathological investigation. Initial screening detected decrease in anagen (anagen : telogen ratio = 82.4:17.6) when compared with previously reported standard hair counts in normal Asian scalp. This finding prompted further investigation. Unexpectedly, 33 (66%) specimens demonstrated some microscopic abnormalities, 10 (62.5%) AA specimens showed increase in telogen ratio, vellus hair count and miniaturization, while perifollicular inflammatory cell infiltration was detected in 5 (26.3%) SA cases. Exclusion of histologically affected specimens yielded average hair count numbers resembling those reported in Koreans, supporting the pathological integrity of selected samples and, more importantly, indicating normal hair counts in east Asians. These findings indicated a less recognized significance of histopathological investigation of clinically non‐affected perilesional scalp in alopecias for better assessment of the spread of disease activities, which should enable better management of hair loss conditions.     

Parathyroid hormone‐related peptide and the hair cycle – is it the agonists or the antagonists that cause hair growth?

While the effects of PTHrP have been studied for almost 20 years, most of these studies have focused on effects on the termination of the anagen phase, giving an incomplete picture of the overall effect of PTHrP on the hair cycle. PTHrP was determined in several experimental models to promote transition of hair follicles from anagen to catagen phase, which by itself would suggest that PTHrP blockade might prolong the anagen phase and promote hair growth. However, clinical trials with topically applied PTHrP antagonists have been disappointing, leading to a reconsideration of this model. Additional studies performed in mouse models where hair follicles are damaged (alopecia areata, chemotherapy‐induced alopecia) suggest that PTHrP has effects early in the hair cycle as well, promoting hair follicles’ entry into anagen phase and initiates the hair cycle. While the mechanism of this has yet to be elucidated, it may involve activation of the Wnt pathway. Thus, the overall effect of PTHrP is to stimulate and accelerate the hair cycle, and in the more clinically relevant models of hair loss where hair follicles have been damaged or become quiescent, it is the agonists, not the antagonists, which would be expected to promote hair growth.     

黄芪颗粒联合复方甘草酸苷治疗斑秃疗效评价

目的:评价黄芪颗粒对斑秃患者临床疗效和外周血T细胞亚群的影响。方法:对照组55例口服复方甘草酸苷片,50 mg/次,日3次。治疗组58例,加服黄芪颗粒,4g/次,日2次,疗程共3个月。流式细胞仪检测斑秃患者外周血T细胞亚群的变化。结果:治疗组痊愈率、复发率优于对照组(P0.01)。治疗后CD4~+T细胞明显高于疗前和对照组,(P0.05;P0.01)。结论:黄芪颗粒联合复方甘草酸苷治疗斑秃有效。     

Male androgenetic alopecia

Male pattern hair loss is the most common cause of balding. The pathogenesis involves androgen, and in particular dihydrotestosterone, binding to androgen receptors in the dermal papilla of sensitive hair follicles. Hair follicle sensitivity is genetically determined and shows regional specificity. Androgen stimulation of scalp dermal papilla cells induces transforming growth factor beta (TGF-B) and results in cyclical miniaturization of the entire hair follicle. The resulting hair produced from that follicle is shorter and finer and provides less complete scalp coverage. In contrast androgen stimulation of beard dermal papilla cells produces insulin growth factor -2 (IGF-2) and results in cyclical enlargement of the entire hair follicle. The resulting hair produced from that follicle is longer and thicker and provides more complete facial skin coverage. Some degree of androgenetic alopecia is universal among ageing men, especially bitemporally, however less than half become bald in the Hippocratic sense. Although scalp hair coverage has little functional importance, it has cosmetic significance. Baldness changes the facial appearance of affected men. When that change is perceived as adverse it has the potential to produce emotional morbidity.     

Th17相关细胞因子与斑秃关系的研究

目的探讨Th17相关细胞因子与斑秃发病的关系。方法将40例斑秃患者分为活动期组20例和稳定期组20例,采用ELISA法检测患者血清中IL-17和IL-23的水平,与20例正常对照组比较,并分析IL-17和IL-23之间的相关性。结果斑秃活动期组血清IL-17水平明显高于稳定期组和正常对照组,差异有统计学意义（P〈0．01）,斑秃稳定期组血清IL-17水平亦明显高于正常对照组,差异有统计学意义（P〈0．05）;斑秃活动期组血清IL-23水平明显高于稳定期组和正常对照组,差异有统计学意义（P〈0．05和P〈0．01）,斑秃稳定期组血清IL-23水平亦明显高于正常对照组,差异有统计学意义（P〈0．05）。斑秃患者血清IL-17与IL-23水平呈正相关关系（相关系数r=0．50,P〈0．01）。结论斑秃的发病可能与Th17相关细胞因子平衡失调有关,表现为Th17相关细胞因子反应亢进。     

Alopecia areata im Tiermodell – Neue Einblicke in Pathogenese und Therapie einer T‐Zell‐vermittelten Autoimmunerkrankung

Alopecia areata is a common disease, but for ethical reasons it seems difficult to perform large‐scale studies to elucidate the pathogenesis and to develop new therapeutic approaches in man. It is therefore helpful to develop appropriate animal models. The Dundee experimental bald rat (DEBR) and the C3H/HeJ mouse are well‐established animal models for alopecia areata and can be used for the study of genetic aspects, pathogenesis and therapy of the disease. In C3H/HeJ mice alopecia areata can be experimentally induced by grafting lesional skin from an affected mouse to a histocompatible recipient which offers the possibility to study the influence of various factors on the development of the disease. Studies on the C3H/HeJ mouse and the DEBR have corroborated the concept that alopecia areata is a T‐cell mediated autoimmune disease and various steps and aspects of the pathogenesis have been elucidated. Based on this knowledge new therapeutic options may be developed such as inhibition of lymphocyte‐homing by an anti‐CD44v10 antibody, or inhibition of costimulation by monoclonal antibodies. Therapeutic studies in the C3H/HeJ mouse and the DEBR suggest that alopecia areata can be treated by topical tacrolimus but treatment in humans may only be successful after development of an improved vehicle that facilitates penetration of tacrolimus down to the hair bulb. Current investigations in mice are designed to elucidate the mechanisms how contact sensitizers act in the treatment of alopecia areata, and this will hopefully lead to the development of more specific approaches based on the beneficial effect of contact sensitizers.