全秃再生发呈马蹄形、蛇形嵌合型分布1例

报道了一种特殊全秃头发再生类型（马蹄型、蛇形嵌合型），该患者15年前在1个月内头发全部脱光，经治头颈、前额及右颞发际处仍无头发再生已持续14年。从前额直到枕部头发成片缺失，距离发际线仅3－5cm，酷似雄性激素源性秃发（Hamilton分级Ⅵ级），此外右耳上发际处见一鸡蛋大秃发区。再生发总体外观呈马蹄形、蛇形嵌合型分布。嘱5％米诺地尔外用，每天2次，随访1年，无新脱发斑，但亦未见头发新生。     

Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation

Alopecia areata is a common cause of nonscarring alopecia that occurs in a patchy, confluent, or diffuse pattern. Dermoscopy is a noninvasive technique for the clinical diagnosis of many skin diseases. Topical minoxidil solution 5% and platelet rich plasma are important modalities used in treatment of alopecia areata. We aimed to evaluate the efficacy of PRP versus topical minoxidil 5% in the treatment of AA by clinical evaluation and trichoscopic examination. Ninety patients were allocated into three groups; the first was treated with topical minoxidil 5% solution, the second with platelets rich plasma injections, and the third with placebo. Diagnosis and follow up were done by serial digital camera photography of lesions and dermoscopic scan before and every 1 month after treatment for 3 months. Patients treated with minoxidil 5% and platelets rich plasma both have significant hair growth than placebo (p < .05). Patients treated with platelets rich plasma had an earlier response in the form of hair regrowth, reduction in short vellus hair and dystrophic hair unlike patients treated with minoxidil and control (p < .05). In conclusion, platelets rich plasma is more effective in the treatment of alopecia areata than topical minoxidil 5% as evaluated by clinical and trichoscopic examination.     

Management of alopecia areata: Updates and algorithmic approach

Alopecia areata is a chronic, recurrent and non‐scarring alopecia. The prognoses of patients are very diverse. The larger the area of hair loss, the poorer the treatment response and greater the probability of chronic disease progression. Numerous treatments have been introduced, but curative treatments have yet to be established. The long‐term efficacy of the current treatments is minimal, and the therapeutic response varies widely. Recent clinical trials have attempted to apply therapeutic metrics, such as the Severity of Alopecia Tool, and many have been designed as randomized controlled studies, enabling a more precise evaluation of existing treatments. There have been updates in practice, efficacy or indications of therapeutics that have been previously used. Moreover, the use of novel treatments such as biologics has recently been introduced. Commonly, the most important factor in determining the treatment modality for alopecia areata has been the extent of hair loss. However, if the disease activity is high and likely to progress, combination therapy with adjuvant modalities will be more desirable. This review will discuss the therapeutic effects of existing and newly‐introduced treatments based on their quantity, quality of evidence and expected complications. In addition, an algorithmic approach to management of alopecia areata is proposed according to clinical subtype, severity, onset and activity of the disease.     

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.     

富血小板血浆治疗斑秃的研究进展

目前有文献报道富血小板血浆治疗斑秃安全有效,血小板血浆可通过释放大量的细胞因子促进毛囊干细胞的增殖、分化并改善毛囊周围环境,从而促进毛发生长,本文对富血小板血浆治疗斑秃的研究进展进行了综述。     

The role of the National Alopecia Areata Foundation in the management of alopecia areata

Like a mysterious thief in the night, alopecia areata (AA) suddenly appears without warning—seemingly without rhyme or reason—randomly robbing the hair and subsequently the self-esteem of those affected. Very persuasive scientific evidence now suggests that AA is a T-lymphocyte-mediated autoimmune disease directed against an as yet unidentified hair follicle autoantigen in genetically susceptible individuals. The severity of the clinical phenotypes seen in AA run the gamut from patchy hair loss localized in one or more areas, to total scalp hair loss [alopecia totalis (AT)], to complete body hair loss [alopecia universalis (AU)]. Although not life threatening, AA is most certainly life altering, and its sudden onset, recurrent episodes, and highly unpredictable course have a profound psychological impact on the lives of those with the disease. There are a limited number of therapeutic agents available to treat AA. Responses vary widely and the hard fact remains that any treatment, no matter how successful, does not alter the ultimate course of this capricious and recalcitrant disease. Founded in 1981 to meet the challenges of AA and mollify the deep emotional pain inflicted by this disease, the National Alopecia Areata Foundation (NAAF) now serves as the world center of information and hope for those with AA. The foundation plays a crucial role in the management of AA by encouraging and funding medical research for better treatment and an ultimate cure, by providing support and resources for those with the condition, and by raising public awareness of the disease.     

富血小板血浆在雄激素型脱发治疗中的应用

 富血小板血浆（PRP）富含生长因子、细胞因子等多种生物活性物质,具有促进细胞增殖、分化、基质合成、组织再生与修复等作用。其制作过程虽不复杂,但全球仍没有一个统一的制作标准。 近年来已有多个实验及临床研究证明PRP治疗雄激素型脱发（AGA）有效且安全。治疗方法除了单纯头皮下注射PRP,还衍生出PRP联合微针、药物、脂肪移植、低能量激光疗法、非剥脱性Er:YAG等。本文整理分析近年来相关文献及实验,综述PRP在治疗AGA的作用机制、制备方法、治疗方法等方面的研究进展,为临床医生提供更多理论及实践依据。     

Regrowth of black hair in two red‐haired alopecia areata patients

The occurrence of alopecia areata (AA) in a red‐haired individual is considered to be rare. We report two cases of red‐haired men who were afflicted with patch‐type AA. Astonishingly, the hair regrowth was coloured black, in contrast to the surrounding red hair, an event which has been reported only once in the past after cyclophosphamide administration. This phenomenon raises some interesting questions regarding the significance of pigmentation and the melanocortin‐1 receptor in AA pathogenesis.     

Topical photodynamic therapy with 5-aminolaevulinic acid does not induce hair regrowth in patients with extensive alopecia areata

BACKGROUND: Photodynamic therapy (PDT) is a new modality involving the administration of a photosensitizer, or photosensitizer precursor, followed by its activation with light to generate a therapeutic effect. 5-Aminolaevulinic acid (ALA) is a photosensitizer precursor that is transformed by cells into protoporphyrin IX (PpIX), which can in turn be activated by red light. OBJECTIVES: To investigate the effect of PDT in alopecia areata (AA). METHODS: In six patients with extensive AA, topical ALA lotion at 5%, 10% and 20% as well as the vehicle lotion alone were applied separately to different scalp areas, followed 3 h later by exposure to red light at each treatment session. RESULTS: No significant hair growth was observed after 20 twice-weekly treatment sessions. A significant increase in erythema and pigmentation was observed for the three concentrations of ALA lotion vs. the vehicle, implying that a phototoxic PDT effect was achieved in the skin. In vivo fluorescence spectroscopy in one patient showed an increase in red PpIX fluorescence 3 h after ALA application followed by a decrease after light exposure. On fluorescence microscopy, bright red fluorescence was present in the epidermis and sebaceous glands, but not in the inflammatory infiltrate surrounding the hair follicle following ALA application. CONCLUSIONS: PDT was ineffective in the treatment of AA.     

Serum sickness disease in a patient with alopecia areata and Meniere’ disease after PRP procedure

Background: Platelet rich plasma procedure (PRP) is considered to be one of the safest aesthetic procedures. Adverse reactions after PRP administration are extreme rare. Purpose: We present the patient with serum sickness disease (SSD) after PRP procedure. Objective and methods: 41 years old female suffers from alopecia areata for 5 years with frequent relapses and she has been suffering from Menier's disease recurrent symptoms for 6 years. The patient developed SSD after third PRP rejuvenating procedure and she has also noticed new alopecia areata lesions, but without Menier's disease symptoms. After SSD, 4 months later, she developed severe symptoms of Menier's disease with an episode of sudden sensorineural hearing loss. It alleviated only after intravenous administration of methylprednisolone. In our opinion, significant contraindication of PRP procedure is an autoimmune disease in the active phase.