Hair breakage in normal and weathered hair: focus on the Black patient

Hair breakage and fragility are a large problem for many patients as well as a treatment challenge to the dermatologist. Understanding the factors that lead to acquired hair shaft fragility and breakage is paramount to recommending appropriate treatment to affected patients. African or Black hair is known to be more affected by breakage with easily observed fragility in vivo. To date there are no known structural or chemical differences in Black hair as compared to Caucasian or Asian hair that explains this observed fragility. This review explores the impact of hair care practices on the development of hair breakage with a focus on patients of color. The examination and recommended ancillary testing for the process are discussed, and advances in the measurement of mechanical fracture of human hair are reviewed.     

Acquired progressive kinking of the hair: clinical features, pathological study, and follow-up of 7 patients.

BACKGROUND: Acquired progressive kinking of the hair (APKH) is a relatively rare condition, with fewer than 20 cases reported in the literature. Whether APKH is a separate entity or a variety of androgenetic alopecia is still controversial. This study reviews the clinical and pathological features and long-term follow-up of 7 patients with APKH. OBSERVATIONS: Since January 1989, we have diagnosed APKH in 7 males aged 15 to 22 years. All patients had strong family history for androgenetic alopecia. Hair kinking affected the frontotemporal region and/or the vertex where the hair appeared curly, frizzy, and lusterless. The pathological features of the affected scalp were consistent with the diagnosis of the early stages of androgenetic alopecia. In all patients, APKH evolved into androgenetic alopecia during the follow-up period. Mean follow-up was 4.5 years (range, 2-9 years). Treatment with topical minoxidil did not prevent development of hair thinning in the scalp areas affected by hair kinking. CONCLUSIONS: The term acquired progressive kinking of the hair encompasses a number of conditions characterized by acquired curling of the scalp hair. Acquired hair kinking on the androgen-dependent areas of the scalp represents a modality of onset of androgenetic alopecia associated with poor prognosis.     

Marie Unna congenital hypotrichosis: clinical description, histopathology, scanning electron microscopy of a previously unreported large pedigree

Marie Unna congenital hypotrichosis (MUCH) is a rare autosomal dominant condition in which abnormalities are confined to hair shaft structure and hair density. We report a six-generation pedigree consisting of 59 members of whom 16 are affected; nine identified affected individuals are living. Affected individuals are born with adequate, normal to coarse hair. During early infancy the scalp hair becomes more coarse and wiry and stands out from the head. All affected individuals have sparse to absent eyebrows, eyelashes and body hair including secondary sexual hair. In some individuals, scalp hair is progressively lost beginning at puberty or beyond, until only a sparse fringe in the tonsorial distribution remains. The hair shafts are uniformly increased in diameter, measuring up to 0.12 mm. Individual hair shafts are deeply pigmented, variable in diameter, twisted, and bent at odd angles; some have a longitudinal groove visible on scanning electron microscopy. Cross-sectional shapes are variable and irregular, exhibiting oval, angular to reniform shapes. Multiple anagen hairs are extractable on gentle hair pull. Other ectodermal structures are unaffected except for exceptionally widely spaced upper incisor teeth seen in 50% of affected individuals. Histologically, there are dramatically reduced numbers of follicles per unit area, averaging nine total hairs per 4 mm cross-section as compared with a normal of 40. A mild to moderate inflammatory infiltrate is present, but little fibrosis and no scarring. The mechanism of progressive hair loss is unknown.     

鸟巢状发一例

鸟巢状发是不可逆的毛发异常，通常与使用离子/草药肥皂、洗发液、寄生虫感染、精神疾病的改变有关，本文报道1例女性患者，53岁，全部头发缠结4周。皮肤科检查见头顶有0.27m长、0.15m宽的头发缠结块。诊断鸟巢状发，建议患者剪除患发。     

Hair growth in scalp grafts from patients with alopecia areata and alopecia universalis grafted onto nude mice

A basic question in both mild and severe forms of alopecia areata (AA) relates to whether the disease is inherent to the affected tissue or secondary to circulating factors. This question has been addressed by grafting 2-mm grafts of scalp from affected areas of seven patients with AA or alopecia universalis (AU) onto congenitally athymic (nude) mice. Hair growth in these grafts has been compared with that of 2-mm grafts from hair-bearing skin remnants from two individuals undergoing elective plastic surgical procedures. Because cyclosporine seems to directly affect hair growth, a group of grafted mice was treated with this agent. By day 48, hair growth was present in many surviving grafts. Cyclosporine affected hair growth; this was most prominent by day 78 when the number of hairs per graft and the mean length of hair had increased significantly over untreated groups. Grafts from patients with AU had more hairs per graft and had greater hair length than did similar grafts from patients with AA. These experiments show that hair growth ability in situ is likely normal in AA and AU, and that the factors causative to this disease in situ are mediated humorally. Furthermore, cyclosporine seems to directly influence hair growth in this model system.     

Healthy Hair: What Is it?

Shiny hair with a smooth texture and clean-cut ends or tapered tips is generally perceived to be healthy. Hair texture and shine relate to hair surface properties, whereas the integrity of hair ends relates to the hair cortex. Hair can be straight, wavy or curly, blonde, black, brown, red, gray white, and its natural variations are important to our identity. Manipulation of the normal structure of the hair shaft is epidemic and dictated by culture, fashion, and above all, celebrity. Although cosmetic procedures are intrinsically safe, there is potential for damage to the hair. Loss of lustre, frizz, split ends, and other hair problems are particularly prevalent among people who repeatedly alter the natural style of their hair or among people with hair that is intrinsically weak. This may be due to individual or racial variation or less commonly an inherited structural abnormality in hair fiber formation. Hair health is also affected by common afflictions of the scalp as well as age-related phenomena such as graying and androgenetic alopecia. Hair products that improve the structural integrity of hair fibers and increase tensile strength are available, as are products that increase hair volume, reduce frizz, improve hair manageability, and stimulate new hair growth.     

Loose Anagen Hair in Hypohidrotic Ectodermal Dysplasia

We report a 4 year-old boy affected with hypohidrotic ectodermal dysplasia in whom loose anagen hair syndrome (LAHS) was suspected clinically. The diagnosis was confirmed by examination of hair by optic and scanning electron microscopy. Loose anagen hairs have not been previously described in the ectodermal dysplasias. It is possible that our patient had real LAHS or an ectodermal dysplasia with loose anagen hair as an epiphenomenon.     

Acquired progressive kinking of hair. Report of six cases and review of literature

Acquired progressive kinking of hair is an entity distinct from woolly hair in its onset at or after puberty, predominant involvement of frontal, temporal, and vertex regions of the scalp as well as the supra-auricular and postauricular margins, and a tendency for affected hairs to resemble pubic hair both in texture and color. We consider the condition to be androgen dependent and likely to progress to male pattern baldness. The condition "whisker hair" is probably a variant of acquired progressive kinking of hair.     

Marie Unna hypotrichosis in a Chinese family

Marie Unna hypotrichosis is a rare, autosomal dominant hypotrichosis characterized by sparse or absent hair at birth with regrowth of coarse, wiry hair from childhood, followed by progressive loss on approaching puberty. We report a Chinese mother and child seen at our skin center with features of Marie Unna hypotrichosis. The family pedigree showed two affected sisters and one affected brother, consistent with an autosomal dominant mode of inheritance. The clinical, genetic, histologic, and ultrastructural features were consistent with the diagnosis of Marie Unna hypotrichosis. This is the first Chinese family reported.     

Failure of passive transfer of serum from patients with alopecia areata and alopecia universalis to inhibit hair growth in transplants of human scalp skin grafted on to nude mice

We have previously demonstrated regrowth of hair in scalp skin grafts taken from patients with alopecia areata (AA) and alopecia universalis (AU) following engraftment on to nude mice. This present study was to determine whether serum from patients with AA and AU, has a role in the process of hair loss and the role of antibodies and complement. Forty mice were grafted with transplants obtained from seven patients. One group of the grafted mice was given patients' serum and another group normal serum. The mice were treated topically with cyclosporin (CyA), or olive oil. Hair growth was noted in most grafts and intravenous injections of serum did not prevent or inhibit this process. Immunofluorescence studies before grafting showed deposition of immunoglobulins and complement in hair follicles in both normal and affected scalp skin, but a more striking deposition was noted in the affected skin. Deposition of immunoreactants after grafting was observed only after the injection of serum from the patients but not with normal serum. Thus the sera from patients with AA or AU, when injected into nude mice with hair transplants from the scalp skin of patients with these disorders, does not alter the hair growth despite deposition of immunoreactants around the hair follicles.     

念珠状发家系Ⅱ型毛发角蛋白基因突变的研究

目的 探讨汉族念珠状发家系Ⅱ型毛发角蛋白(hHb)基因的突变情况.方法 采集该家系成员及50例毛发外观正常者外周血并提取基因组DNA.运用PCR扩增hHb1、hHb3、hHb6外显子1和外显子7,DNA直接测序检测突变位置.测序结果采用BLAST软件在互联网上进行比对.扫描电镜下观察毛干结构.结果 扫描电镜下,病发呈典型的念珠状表现,狭窄部见明显的纵嵴和纵沟,病发毛小皮厚薄不均,其中1例病发大部分皮质和髓质消失.经网上比对分析,该家系患者hHb6外显子7第1289位碱基鸟嘌呤(G)被腺嘌呤(A)取代,导致第430位精氨酸突变为谷氨酰胺(即R430Q).而该家系中未患病者和50位正常对照组均未发现该突变,hHb1、hHb3外显子1和外显子7及hHb6的外显子1未发现突变.结论 hHb6外显子7的R430Q错义突变是一种新的突变,可能与该家系的发病有关.     

Ultrastructural observations on the hair bulb melanocytes and melanosomes in acute alopecia areata

It is well recognized that alopecia areata (Aa) may preferentially affect pigmented hair and may spare white hair, and that regrowing hair in the disease is often initially white. In addition, there is an association with vitiligo and ocular depigmentation. To date, the pathomechanisms of the melanocyte effects are unclear. We have studied 10 patients with untreated acute alopecia areata, and three normal patients without hair loss. Morphologic changes, studied by conventional light and electron microscopy, in the cytoplasm of affected melanocytes often predated nuclear hyperchromatism. Increased numbers of bizarre melanosomes were found in affected melanocytes compared with normal ones; such melanosomes had incomplete or "aborted" melanization, resulting in poor pigment deposition, and were disrupted, enlarged and rounded, with loss of normal ellipsoidal shape. An unusual outer root sheath (ORS) distribution of hair bulb melanocytes was seen. Other atypical melanosome effects included marked pigment displacement into peribulbar and DP melanophages. In the DP clumped melanin granules formed giant spherical complexes without discernible limiting membranes, which were sometimes associated with lymphocytes. These morphologic changes indicate an active involvement of hair bulb melanocytes in alopecia areata.     

Three percent topical minoxidil therapy for female androgenetic alopecia

Effective treatment of female androgenetic alopecia involves cessation of hair shedding and promotion of normal anagen hair growth. The topical use of hormones such as progesterone or an androgen receptor-binding drug such as spironolactone has not been associated with significant hair regrowth.¹ In contrast, the topical use of minoxidil has resulted in decreased hair shedding and hair growth promotion, particularly in men with androgenetic alopecia.² To investigate the usefulness of topical minoxidil therapy in female androgenetic alopecia, we studied the efficacy and safety of 3% topical minoxidil in 25 affected women. Results were correlated with disease extent and activity.     

Marie Unna hypotrichosis in an Asian family

We report on two patients from one family with Marie Unna hypotrichosis who showed a diffuse hair defect which typically occurs as an isolated phenomenon. The ultrastructural hair findings consisted of longitudinal grooving of the hair shafts and a flattening in cross-section. Characteristically, scalp hair had been lost from the scalp margins and a high frontal and nuchal hairline had been present at birth. Eyelashes were absent, and eyebrows, axillary, and pubic hair were very sparse. Other affected cases have been reported in Caucasian families; however, this is the first case in the English medical literature of a family from Asia affected by Marie Unna hypotrichosis.     

Optimal Management of Hair Loss (Alopecia) in Children

Hair loss in children encompasses a wide range of conditions that can be congenital or acquired. A congenital hair abnormality may be an isolated finding in an otherwise healthy child or may exist as a feature of a clinical syndrome. A thorough understanding of basic hair biology and normal hair development enables accurate assessment of the child with hair loss. Knowledge of the normal range and variation observed in children's hair additionally enhances this assessment. Social and cultural factors also influence these norms. The psychological and cosmetic importance of hair is immense in our society. The clinical presentation of pediatric hair disorders ranges from subtle to disfiguring. Management of hair disorders requires a holistic approach to the child and family. Young children usually lack self-awareness and it may be the parent who, projecting their own concerns onto the child, most acutely feels any associated anxiety. In addition, parents of a child with an inherited hair condition often feel guilt, and siblings can develop unsupported fears that they may be affected. Hair loss for the older child can lead to low self-esteem, depression and humiliation. Congenital and hereditary hypotrichosis and hair shaft abnormalities often have no effective treatment. There is a variety of treatment options for alopecia areata and telogen effluvium, but no single treatment is 100% effective. Tinea capitis is an infective condition of the hair that responds readily to the appropriate medical therapy. If no effective treatment for the hair loss exists, cosmetic camouflage with wigs is the best option.     

Partial restoration of hair growth in the DEBR model for Alopecia areata after in vivo depletion of CD4+ T cells

Alopecia areata (AA) is widely believed to be an autoimmune disease. Hair loss is associated with a peri- and intrafollicular inflammatory infiltrate of anagen hair follicles primarily composed of CD4 + and CD8 + cells. A previous investigation involved in vivo depletion of CD8 + cells in the DEBR rat model to examine the cells' potential pathogenic activity in AA. The rat model is used here in a comparable study of CD4 + cell pathogenic activity. Eight AA affected DEBR rats were given intraperitoneal injections of a CD4 + cell depleting OX-35/OX-38 monoclonal antibody (MoAb) cocktail over a 15-day therapy course. A further eight AA-affected rats comprised a control group and were injected with equivalent volumes of an irrelevant MoAb, OX-21. Changes in both CD4 + and CD8 + peripheral blood cell populations were analysed by flow cytometry, and macrophotography was used to record any changes in hair growth. Of the eight CD4 + cell-depleted rats six responded with hair growth. The rats revealed significant hair growth within 23 days of treatment initiation. With rapid replacement of the CD4 + cell population the newly generated pelage hair was eventually lost. Two control rats also showed limited hair growth within the 112-day study period. In vivo depletion of CD4 + cells partially restores hair growth in AA affected rats. The response suggests that CD4 + cells may be actively involved in the pathogenesis of AA. Further research may elucidate whether CD4 + cells have a direct effect on hair follicles or exert their influence through their classic T helper cell supporting role for CD8 + cells.     

Contrast enhanced phototrichogram (CE-PTG): an improved non-invasive technique for measurement of scalp hair dynamics in androgenetic alopecia--validation study with histology after transverse sectioning of scalp biopsies

Global changes of scalp hair represent the cumulative end result of discrete changes of individual hair follicle structure and/or function. Monitoring of such changes requires an accurate non-invasive method. The phototrichogram (PTG) appears to be an appropriate choice to do so. However, a known weakness of the method is the lack of detection of less pigmented or thinning hair. Balding scalp of male subjects with androgenetic alopecia (AGA) was analysed with our previously published PTG method and with contrast enhanced (CE-)PTG followed by biopsy and transverse section examination with the light microscope. As compared with PTG, the CE-PTG method significantly improved detection not only of thin but also of thick hair. Equal numbers of thick (diameter > 40 mm) hair were detected with CE-PTG and with histology. CE-PTG was also able to detect the severely miniaturised hair fiber (down to 8 mm diameter) and was comparable to scalp biopsy analysis. The latter could identify hair fibres, which did not reach the scalp surface, a measure that is considered as not clinically significant. All growth stages - anagen, catagen and telogen - as well as the empty follicle stage could clearly be observed with CE-PTG. Staging of the more severely affected hair follicles was not always possible neither with CE-PTG nor histology - even with serial sectioning. The finding of such technological advantages makes the CE-PTG a first choice method for detailed analysis of hair cycling in androgenetic alopecia - a scalp disorder characterised by extreme hair follicle miniaturisation, decreased hair pigmentation and hair thinning.     

Hair growth inhibition as a method of screening drugs for local antimitotic activity.

The intradermal injection of certain drugs with antimitotic properties in the guinea pig resulted in localized areas of reversible hair loss or hair growth inhibition. The size of the affected field was related to the dose. This may provide a useful and simple method for the rapid screening of potentially useful agents for local cytostatic activity.     

An essential role for dermal primary cilia in hair follicle morphogenesis

The primary cilium is a microtubule-based organelle implicated as an essential component of a number of signaling pathways. It is present on cells throughout the mammalian body; however, its functions in most tissues remain largely unknown. Herein we demonstrate that primary cilia are present on cells in murine skin and hair follicles throughout morphogenesis and during hair follicle cycling in postnatal life. Using the Cre-lox system, we disrupted cilia assembly in the ventral dermis and evaluated the effects on hair follicle development. Mice with disrupted dermal cilia have severe hypotrichosis (lack of hair) in affected areas. Histological analyses reveal that most follicles in the mutants arrest at stage 2 of hair development and have small or absent dermal condensates. This phenotype is reminiscent of that seen in the skin of mice lacking Shh or Gli2. In situ hybridization and quantitative RT-PCR analysis indicates that the hedgehog pathway is downregulated in the dermis of the cilia mutant hair follicles. Thus, these data establish cilia as a critical signaling component required for normal hair morphogenesis and suggest that this organelle is needed on cells in the dermis for reception of signals such as sonic hedgehog.     

Strategies of coping and quality of life in women with alopecia

BACKGROUND: Measurements of the quality of life (QoL) have recently become an integral part of dermatological studies. Our hypothesis is that QoL in patients with certain diseases can be affected by strategies of coping behaviour, as well as by personality traits. OBJECTIVES: The aim of this study was to explore the particular correlation between QoL and strategies of coping in female patients with alopecia. PATIENTS: Fifty female patients, diagnosed with either diffuse or androgenetic alopecia, were evaluated by the use of Hairdex, an instrument developed to measure QoL in patients with hair loss. Most patients also underwent additional psychological assessments. RESULTS: Findings indicated that patients with highly visible hair loss reported a more negative impact on four Hairdex dimensions (functioning, emotions, self-confidence and stigmatization) than patients whose hair loss was only slightly visible. However, a subgroup of patients, with non-visible symptoms of hair loss, showed striking signs of psychological disturbance. These disturbed patients displayed either dysmorphophobic or affective disorder tendencies. CONCLUSIONS: Future studies using QoL as an instrument in research on patients with alopecia should consider that in cases of female alopecia these measurements may be affected by psychological disturbances.