Significant relationship between temporal hair loss and other scalp areas in female pattern hair loss

Female pattern hair loss affects the central scalp, sparing the frontal hairline. The temporal area can also be affected by hair loss. We investigated the degree of temporal hair loss and correlation of other sites of scalp hair loss in Korean female pattern hair loss patients. A total of 109 women with female pattern hair loss were enrolled in this retrospective analysis. We measured hair density and thickness in five scalp sites including the frontal, vertex, occipital and bilateral temporal areas by phototrichogram. Frontal and vertex area hair loss were classified according to the Basic and Specific (BASP) classification, and temporal scalp and occiput areas were also assessed. Eighty-nine patients showed temporal hair loss. The mean of the hair density was lowest in the temporal area among all scalp areas. Total and thick hair densities of the frontal scalp were correlated with those of the vertex, temporal scalp and occiput in descending order, and hair thickness of the frontal scalp was more related with that of the temporal scalp than the vertex. In this study, temporal involvement is evident in female pattern hair loss. We suggest that temporal involvement should be added to pattern hair loss classification, especially BASP classification.     

Cicatricial marginal alopecia: is it all traction?

Background  In a specialized hair loss clinic, a group of patients was identified with focal or complete hair loss at the scalp periphery, with a normal scalp surface. Biopsy revealed complete loss of individual hair follicles, indicative of scarring alopecia. Not all patients had a history supportive of a diagnosis of traction alopecia.
Objectives  To identify and characterize further patients with scarring alopecia of the scalp margin using a retrospective review.
Methods  All biopsies of scarring alopecia carried out by a single clinician between 1 January 1999 and 29 September 2006 were reviewed. Patients in whom the hair loss was located at the periphery of the scalp were selected for retrospective chart review.
Results  A total of 15 patients met the study criteria, which included histological scarring alopecia and hair loss of the scalp margin. Six of the patients gave a history of relaxing or straightening their hair. Six denied hair care practices sufficient to cause traction alopecia. In three patients, the hair care history was unknown. Occipital hair loss was a common clinical finding, mimicking alopecia areata. The presence of scarring was often subtle histologically.
Conclusions  A group of patients with moderate to severe cicatricial alopecia of the scalp margin is described. The presence of scarring is difficult to diagnose both clinically and histologically. The lack of a history of severe traction or harsh styling practices in half the patients casts doubt on whether or not traction is the only pathogenic factor.     

Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study

Background Androgens are thought to have an adverse effect on female scalp hair growth. However, our clinical experience of androgen replacement therapy in women with androgen deficiency, in which hair loss was seldom reported, led us to question this concept. Objectives To evaluate the effect of subcutaneous testosterone therapy on scalp hair growth in female patients. Methods A total of 285 women, treated for a minimum of 1 year with subcutaneous testosterone implants for symptoms of androgen deficiency, were asked to complete a survey that included questions on scalp and facial hair. Age, body mass index (BMI) and serum testosterone levels were examined. Results Out of the 285 patients, 76 (27%) reported hair thinning prior to treatment; 48 of these patients (63%) reported hair regrowth on testosterone therapy (responders). Nonresponders (i.e. no reported hair regrowth on therapy) had significantly higher BMIs than responders (P = 0·05). Baseline serum testosterone levels were significantly lower in women reporting hair loss prior to therapy than in those who did not (P = 0·0001). There was no significant difference in serum testosterone levels, measured 4 weeks after testosterone implantation, between responders and nonresponders. No patient in this cohort reported scalp hair loss on testosterone therapy. A total of 262 women (92%) reported some increase in facial hair growth. Conclusions Subcutaneous testosterone therapy was found to have a beneficial effect on scalp hair growth in female patients treated for symptoms of androgen deficiency. We propose this is due to an anabolic effect of testosterone on hair growth. The fact that no subject complained of hair loss as a result of treatment casts doubt on the presumed role of testosterone in driving female scalp hair loss. These results need to be confirmed by formal measurements of hair growth.     

Hair pain (trichodynia): frequency and relationship to hair loss and patient gender

BACKGROUND: Patients complaining of hair loss frequently claim that their hair has become painful. OBJECTIVE AND METHODS: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. RESULTS: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. CONCLUSIONS: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual.     

The lack of significant changes in scalp hair follicle density with advancing age

BACKGROUND: Age-related reduction in hair is seen in the axillary and pubic regions as well as the scalp; however, it has not been investigated qualitatively on the scalp. Horizontally sectioned scalp biopsy is an ideal tool to investigate the impact of advancing age on scalp hair follicle density and morphology. OBJECTIVES: To examine the effect of age and follicle miniaturization on total hair count in 1666 horizontally sectioned mid-scalp biopsies from 928 women aged between 13 and 84 years with hair loss. METHODS: Setting: Specialist hair loss referral clinic in a teaching hospital. Design: Analysis of data set. Methods: All scalp biopsies were 4 mm in diameter and taken from the crown. Miniaturization was assessed by calculating the ratio of terminal to vellus-like hairs (T/V) at the mid-isthmus level and considered significant if the ratio was < or = 4 : 1. Fibrosis was documented when present. Linear regression was used to examine the association between total hair count, age and miniaturization. RESULTS: The average number of hair follicles per biopsy was 39.6 (SD +/- 10.8). A highly significant negative association (P < 0.0001) was found between age and total follicle number, although the predictive value of age in total hair count was found to be small [root error mean square (R2) < 2%]. Controlling for T/V < or = 4 : 1, the association was weakened, but remained significant. The relationship unconfounded by T/V < or = 4 : 1 shows that for every additional year of ageing, 0.077 total hair follicles (0.22%) are lost per biopsy. CONCLUSIONS: Age and follicular miniaturization were found to be extremely weak predictors of total hair count in women with hair loss.     

脂水肿性脱发1例

 报告1例脂水肿性头皮伴脂水肿性脱发。患者女,44岁,因头皮肿胀、增厚伴脱发5年余就诊。皮肤专科检查：患者头顶部可见一面积约9 cm×18 cm的梭形毛发稀疏区域,残留断发＜2 cm,脱发区头皮呈黄褐色,稍隆起,明显增厚,触之柔软,似海绵状;拉发试验阴性。头部MRI示头皮下脂肪层不均匀增厚。皮损组织病理示：毛囊数量减少,毛囊由增生的纤维组织替代,少许淋巴细胞浸润。诊断为脂水肿性头皮伴脂水肿性脱发。患者及家属拒绝治疗,随访半年余,病情未进展。     

Circumscribed scalp hair loss following multiple hair-cutter ant invasion

A 32-year-old woman presented with an abrupt, localized loss of scalp hair that occurred on the previous day. Her nails, skin, and mucosae were normal. On the vertex of the scalp, there was a circular patch of alopecia; the hairs were broken at approximately equal lengths above the skin surface. Several erythematous macules were seen in the affected area, but scale, twisted hair, and exclamation-mark hairs were not present. Further examination revealed the presence of ants on the scalp. This patient is one of several referred to our department presenting with hair loss associated with hair-cutter ant invasion.     

Physiological changes in scalp, facial and body hair after the menopause: a cross-sectional population-based study of subjective changes

Background Significant changes in scalp, facial and body hair occur after the menopause. These can have a significant negative impact on self‐esteem and are also potential markers of endocrine or metabolic diseases. Knowledge of postmenopausal hair changes is important for clinicians to distinguish between normal physiological change and those that require further medical investigation. Objectives To assess the subjective experience of scalp, facial and body hair change in a large cohort of normal postmenopausal females. Methods Postmenopausal females aged 45 years or over of northern European origin completed a questionnaire detailing scalp, facial and body hair changes following the menopause. Women with a history of thyroid disease, oophorectomy or premature menopause were excluded from the study. The Mann–Whitney U‐test and the χ² test were used to assess the correlation between scalp, facial and body hair changes with age. Results Diffuse generalized hair loss was the most common form of scalp hair loss, reported by 26% of women. Frontal hair loss was reported by 9% of women. Facial hair gain was cited by 39% of females with the chin being the most frequent site for new growth (32% of women). Body hair loss was significantly correlated with older age (P < 0·001) and was most frequent at androgen‐sensitive sites. We noted two patterns: (i) diffuse hair loss in which diffuse generalized scalp hair loss was significantly correlated with body hair loss and increasing age (P < 0·05); and (ii) frontal hair loss which was associated with higher facial hair scores and relatively younger age (P < 0·05) compared with women with diffuse hair loss. Conclusions This is the first comprehensive study of the subjective hair changes in postmenopausal women. This study demonstrates two distinct patterns of hair change relating to age, which may reflect different underlying pathophysiological mechanisms and are of relevance to the medical management of these women as well as being possible predictors of health outcomes.     

A review of scalp camouflaging agents and prostheses for individuals with hair loss

Hair loss is a common problem for both men and women and may impact negatively on self-esteem. A variety of medical and surgical treatment options are available depending on the type of alopecia. Many patients also seek the advice of their physicians about options to hide or reduce the appearance of hair loss with hair prostheses (wigs, hairpieces, and extensions) or hair camouflaging agents (hair fibers, powder cakes, lotions, sprays, hair crayons, and scalp tattooing). Herein, we review current methods to hide or reduce the appearance of hair loss and discuss their associated costs, advantages, and disadvantages. Knowledge of products available to cover scalp, eyebrow, and eyelash hair loss may not only better equip clinicians to respond to questions from concerned patients, but may provide additional options to help these patients best cope with their hair loss.     

Telogen effluvium after allergic contact dermatitis of the scalp

OBJECTIVE: After observing 2 cases of acute telogen effluvium induced by allergic contact dermatitis to hair dyes, we decided to evaluate the effects of acute contact dermatitis of the scalp on the hair cycle. DESIGN: Single-center, 6-month study of consecutive patients affected by acute scalp dermatitis. SETTING: Department of Dermatology, University of Bologna, Bologna, Italy. PATIENTS: Diagnosis of allergic contact dermatitis of the scalp was confirmed by patch testing. Eight women presenting with acute contact dermatitis of the scalp entered the study. Hair shedding was evaluated monthly for 6 months by pull test and wash test. Increased hair loss was detected in 4 of the 7 patients who completed the study. Hair loss was mild to moderate and appeared 2 to 4 months after the episode of scalp dermatitis. A scalp biopsy specimen from 2 patients confirmed the diagnosis of telogen effluvium. CONCLUSIONS: Allergic contact dermatitis of the scalp should be included among the possible causes of telogen effluvium. The pathogenesis of telogen effluvium caused by contact dermatitis is unknown but may be related to cytokine release during the inflammatory process.     

Ringworm on the scalp due to Epidermophyton floccosum

A 9-year-old male is described who had multiple erythematous pustular ringed lesions on the scalp without hair loss. Epidermophyton floccosum was grown on culture from scalp brushings.     

The changing patterns of hair density and thickness in South Korean women with hair loss: clinical office-based phototrichogram analysis

Background  The principal objective of this study was to investigate the clinical office-based phototrichogram (PT) findings of multiple scalp areas in South Korean women with hair loss.
Methods  Two hundred and fifty-eight women with hair loss were classified into 155 female pattern hair loss (FPHL) and 103 telogen effluvium (TE) patients. Hair density and thickness were measured via computer software-assisted PT. Eleven scalp sites, including the three points of the front, top, and back of the head and the right and left sides of the head area, were targeted in this investigation.
Results  PT profiles of the patients with hair loss showed significantly reduced hair density and thickness relative to the controls. The TE group showed the same order distribution as the control group, but the density and thickness were significantly lower than those of the controls. The values for the FPHL patient group declined with increasing Ludwig grade. The curve patterns of mean hair density and thickness by scalp site were shown to differ from group to group and to have a peculiar distribution.
Conclusion  The results of this study indicate that hair density and thickness vary over the entire scalp area in patients suffering from hair loss. The measurement of multiple scalp sites and the observation of changing patterns of hair parameters are very informative in terms of differentiating less apparent hair loss disorders. Through this study, we wish to introduce a doctor- and patient-friendly hair evaluation tool for use in clinic offices.     

脂肿性头皮伴脂肿性脱发一例

患者,女,52岁。头皮肿胀增厚伴脱发3个月余就诊。皮肤科查体：头皮明显肿胀增厚,头顶部增厚区域界限清楚的脱发斑。皮肤镜检查见脱发区毛囊明显减少,毛囊周围见褐色环状结构。组织病理示：皮下脂肪组织明显增厚,位置上移,由成熟脂肪细胞组成。诊断：脂肿性头皮及脂肿性脱发。     

Alopecia as a rare but distinct manifestation of pemphigus vulgaris

Background Pemphigus vulgaris (PV) patients may develop scalp erosions, however, the development of alopecia has been reported to be extremely rare. Objective To delineate the clinicopathological features of alopecia in PV and provide insight into the pathogenesis of this rarely observed manifestation. Methods A retrospective case note review was performed on five PV patients presenting with progressive hair loss and alopecic patches. Data were collected on demographics and clinical findings. Results for hair pull tests, direct immunofluorescence study of plucked hairs, established laboratory tests to detect anti‐desmoglein 1 and 3 autoantibodies and scalp swab culture were recorded. A combination of vertical and horizontal sectioning technique enabled detailed histopathological analysis of alopecic patches. Clinical course was monitored. Results Anagen hair follicles with the outer root sheath structure were easily pulled from perilesional scalp, with intercellular IgG deposition on the outer root sheath keratinocytes. Acantholysis between outer root sheath keratinocytes extending from the infundibulum to suprabalbar level was evident in anagen hair follicles of affected lesions. Perifollicular cell infiltration was observed in the lesions where scalp swabs detected micro‐organisms. The bulge stem cell area was mostly intact. Alopecia was non‐scarring and following 4 weeks of therapy hair re‐growth was seen in all patients. Conclusion In PV, the combination of anti‐desmoglein autoantibody‐mediated acantholysis in conjunction with secondary factors, such as inflammatory changes due to infection, may cause weakening of hair follicle anchorage resulting in hair loss and alopecic patches. This unusual clinical phenotype should alert physicians to PV as a potential diagnosis.     

Congenital Lipedematous Alopecia: Adding to the Differential Diagnosis of Congenital Alopecia

Lipedematous alopecia is a rare condition of unknown etiology characterized by a thick boggy scalp with varying degrees of hair loss. It is usually seen in adult African-American females, and a case in a 9-year-old was the youngest patient reported thus far. We report on the appearance of this condition in two children, a 6-year-old child and a 10-year-old child. Each presented with congenital patchy hair loss on the occipital area and the left temple. A boggy hairless scalp with soft swelling was detected in both patients. Histological examination showed increased thickness of the subcutaneous fat tissue with a decrease in hair follicles. These features were consistent with a diagnosis of lipedematous alopecia. We report two cases of congenital lipedematous alopecia, which has not been reported previously. Although congenital, these distinct clinical features should be kept in mind in the diagnosis of alopecic hair loss.     

瘢痕性女性型脱发1例

报道1例瘢痕性女性型脱发。患者女,36岁,因脱发加重十余年就诊。皮肤科检查：弥漫性头发稀疏,发质细软,可见多数铅笔橡皮擦样大小的灶性秃发区。TrichoScan检查提示额部毛发密度明显降低,毛发直径变异度大于20%,毳毛比例明显增加。毛发镜检查：毳毛增加,可见大量直径3 ~ 5 mm的灶性秃发区域,部分毛囊开口消失,可...     

Familial hypotrichosis of the scalp. Autosomal dominant inheritance in four generations.

We describe a Danish family of four generations suffering from hypotrichosis of the scalp. Age at onset was 6-17 years and almost total scalp alopecia was reached by the age of 14-21 years. No associated ectodermal defects were present. Nine of 22 persons covering four generations were affected. Growth of the scalp hair slowly decreased and was accompanied by a gradual, diffuse hair loss without regional variation. A scalp biopsy was performed, revealing a non-scarring alopecia with features of androgenetic alopecia. The pedigree was compatible with autosomal dominant inheritance.     

Syphilitic alopecia

A case of alopecia as the only symptom of secondary syphilis in a 32-year old Indian man is described. The man presented with patchy hair loss on the scalp, eyebrows, chest and legs, and generalized nontender lymphadenopathy. Laboratory tests were positive for RPR (rapid plasma reagin test) at 1:64, FTA Ab (fluorescent treponema antibody absorption test). He had a history of heterosexual contact 9 months previously. He was treated with procaine penicillin 600,000 units im daily for 10 days, and hair growth resumed within 6 weeks. Hair loss described as "moth eaten alopecia" is common in secondary syphilis. Other patterns of hair loss related to treponema infection include diffuse, extensive alopecia as a penicillin reaction, and peripheral scalp[ alopecia in infants with congenital syphilis.     

头皮局限性神经纤维瘤伴脱发一例

患者,男,22岁。脱发1年余,头皮棕褐色肿物6个月。病理可见毛囊微小化,真皮下部大量细长梭形瘤细胞,波浪状排列。S-100多克隆(+),SOX-10(+),MelanA(+),Vimentin-10(+)。诊断为头皮局限性神经纤维瘤。后行手术治疗,随访中。     

Alopecia areata is a T-lymphocyte mediated autoimmune disease: lesional human T-lymphocytes transfer alopecia areata to human skin grafts on SCID mice

Much evidence suggests that alopecia areata is a tissue restricted autoimmune disease. Alopecia areata responds to immunosuppressive agents, and is associated with other tissue restricted autoimmune diseases, including autoimmune thyroiditis and vitiligo. Furthermore, hair regrows when involved scalp is transplanted to nude mice. This study was undertaken to determine whether alopecia areata is mediated by T lymphocytes. Involved scalp from alopecia areata patients was grafted onto SCID mice. Additional biopsies from lesional scalp of the same patients were used to isolate T lymphocytes. These T lymphocytes were cultured with hair follicle homogenate, as well as autologous antigen presenting cells. The T lymphocytes were then injected into autologous scalp grafts on the SCID mice, which had regrown hair. Injection of scalp T lymphocytes resulted in hair loss. Hair loss was associated with the histologic and immunochemical changes of alopecia areata, including perifollicular infiltrates of T cells, along with HLA-DR and ICAM-1 expression by the follicular epithelium. Scalp T lymphocytes that had not been cultured with hair follicle homogenate did not have this effect. Preliminary data suggests hair loss requires a collaboration between CD8+ and CD4+T cells. These studies have demonstrated that alopecia areata can be induced by the transfer of T cells that recognize a hair follicle autoantigen.