Chronological changes in trichofolliculoma: Folliculosebaceous cystic hamartoma is not a very‐late‐stage trichofolliculoma

Some authors have reported that the secondary hair follicles in trichofolliculomas (TF) undergo regressive changes and are subsequently replaced by the developed sebaceous elements, and that folliculosebaceous cystic hamartoma (FSCH) is a TF at a very late stage. In the present study, we revaluated the histopathological features of 40 TF lesions, focusing on their chronological changes. The results of the present study indicate that while the secondary follicles in the TF exhibited the hair cycle, the normal hair cycle was out of control, and tertiary hair follicles randomly developed from the involuting secondary follicles. The repeated development of hair follicles in this disordered hair cycle caused the development of chains of several continuous hair follicles in late‐stage TF. In the TF lesions, no features indicating the replacement of the regressing secondary hair follicles by any sebaceous elements were observed, thereby suggesting that FSCH is not a very‐late‐stage TF.     

Pyoderma gangrenosum—an association with Hodgkin's disease

Pili annulati (ringed hair) is a rare hair anomaly characterized by alternating light and dark bands along the hair shaft. The light bands are due to air-filled cavities which scalier the light. It is inherited as an autusomal-dominant trait, although sporadic cases have been reported. The authors report the occurrence of three cases of piti annulati in a mother and two children. In both children, a buy and a girl 12 and IS years old, respectively, (he anomaly had been present since the first year of life. In the young girl, alopecia areata was also present from the age of 7; this unusual association seems to be fortuitous. The mother and one of her brothers were also affected less severely. All the patients clinically showed an increased brittleness of the hair that appeared otherwise normal. The nails and teeth were unaffected. Ammo-acid analysis of the hair was performed and showed low levels of serine and glycine and high levels of glutamic acid. The typical light, polarized and scanning-electron microscopy changes in the hair shaft are described. The inheritance of the disease is discussed.     

Plasticity and cytokinetic dynamics of the hair follicle mesenchyme during the hair growth cycle: implications for growth control and hair follicle transformations

Hair fiber production is the macroscopic end-point of a highly complex set of interactions between the hair follicle's epithelial and mesenchymal components. The nature of this relationship is largely set during hair follicle morphogenesis, but is dramatically revisited in the adult during the unique tissue remodeling events required for hair follicle cycling. Whereas significant attention has focused on the fate of the hair follicle epithelium during these events, associated changes in hair follicle fibroblast subpopulations remain unclear. Here, we present a speculative review that represents a critical and innovative synthesis of the current literature and summarizes a recently submitted original study by the authors, on the nature of hair cycle-dependent fibroblast dynamics and on how perturbations thereof may lead to several clinical manifestations of altered human hair growth.     

Association of pili torti and leukonychia

A patient with both pili torti and leukonychia had a family history indicating dominant inheritance for the nail changes. However, no relatives had hair abnormalities. The authors briefly review both of these unusual entities.     

Biochemical and trichological characterization of diffuse alopecia in women

One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.     

A Comparative Study of Axillar Hair Removal in Women: Plucking versus the Blend Method

Fourteen healthy adult Japanese females were selected to participate in a comparative study of hair plucking (a temporary hair removal technique) and the blend method (a permanent hair removal technique). The effectiveness of permanent hair removal and the safety of the blend method were examined in this study. If hairs of the left axilla were removed by the blend method, then hairs of the right axilla were removed by plucking, and vice versa. Every hair was removed and the number of hairs was counted each time. Sessions were conducted every three weeks, and the experiment continued until no new hair growth was seen using the same experimental standard. Electrologists with more than 1000 hours of experience were selected to perform electrolysis. Examinations of the axilla, before and after each test, were conducted by the authors. The results showed that the number of hairs decreased in the axilla with each session using the blend method: permanent hair removal was achieved in an average of 26.8 weeks or 9.9 sessions. However, the number of hairs did not decrease in the axilla after plucking. Also, there were no reports of hair removal related side-effects in this study. It was thus demonstrated that the blend method is a safe and effective way of achieving permanent hair removal.     

生长期毛发松动综合征二例毛发形态学观察

目的 探讨2例生长期毛发松动综合征患者毛发形态。方法 普通显微镜、扫描电镜、透射电镜观察患者的毛干及毛囊。结果 光学显微镜下见毛球变形,发干扭曲、损伤、断裂,远端明显尖细。扫描电镜下见患者毛球变形扭曲,毛护膜边缘呈波浪状等。透射电镜下见病变主要在内毛根鞘,内外毛根鞘细胞均见多数空泡化改变,细胞间黏附减低,桥粒结构减少或消失等。结论 生长期毛发松动综合征患者病变主要在内毛根鞘。     

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.     

'Atrophic telogen effluvium' from cytotoxic drugs and a randomized controlled trial to investigate the possible protective effect of pretreatment with a topical vitamin D analogue in humans

BACKGROUND: Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle. There are conflicting reports on a protective effect of pretreatment with a vitamin D analogue on cytotoxic drug-induced hair loss in rodents. OBJECTIVES: To investigate the process of cytotoxic hair loss and any protective effect on the hair of pretreatment with topical calcipotriol. METHODS: Breast cancer patients who were about to receive cycles of chemotherapy with cyclophosphamide 600 mg m(-2), methotrexate 40 mg m(-2) and 5-fluorouracil 600 mg m(-2) were recruited and randomized to receive calcipotriol scalp solution 50 microg mL(-1) or vehicle. The solution was applied twice daily from 4 days prior to chemotherapy and continued for 14 days in each treatment cycle. Shed, plucked and cut hairs were sampled. Absolute shed rates, the proportion of major hair types, the presence of proximal hair shaft changes, regrowth (using the new anagen hair count) and hair density were assessed. RESULTS: Ten patients receiving calcipotriol and 14 receiving vehicle completed three treatment cycles and nine from both groups completed six cycles. There was no detectable effect of calcipotriol on the proportion of patients experiencing minimal hair loss from chemotherapy, shed rates, plucked telogen and fractured hair counts, the morphology of shed and plucked hair, hair regrowth or hair density. Combining results of the treatment groups, there was a large variation in the impact of chemotherapy on hair loss, from total loss in five patients to no obvious loss in five. Excluding the latter, during chemotherapy shed telogen hairs (mean 81% of shed hairs) predominated over fractured (12%) and anagen hairs (6%) (P = 0.0002). The major pathological change was proximal hair shaft tapering, baseline mean 3% of shed hairs rising to 48% (P = 0.0005) during treatment, and there was a consequent decrease in normal telogen hairs, baseline mean 98% of all telogen hairs falling to 55% (P = 0.0005) during treatment. The pathological tapered telogen hairs had normal or small, sometimes diminutive, bulbs. Fracturing of hairs with diminutive bulbs produced typical 'exclamation mark' hairs. CONCLUSIONS: The cardinal effects of cytotoxic drugs found in this study were tapering of the proximal hair shaft and premature entry of the follicle into telogen, conflicting with the conventional view that affected hair follicles continue in anagen. There was a resulting effluvium of a mixture of tapering telogen hairs and fractured hairs. As entry into telogen is an integral part of the process, cytotoxic hair loss may be regarded as a variant of the conventional 'telogen effluvium' and we propose the term 'atrophic telogen effluvium'. There was no obvious protective effect on the hair loss of prior treatment with topical calcipotriol.     

Pronounced perifollicular lymphocytic infiltrates in alopecia areata are associated with poor treatment response to diphencyprone

Some authors have reported that severe destruction of follicular structures and even scarring patterns occur in those patients with alopecia areata (AA) who fail to respond to topical immunotherapy with contact sensitizers, such as diphencyprone (DCP). Other studies, however, gave contradictory results. Therefore, we re-examined histopathological changes in scalp samples obtained from 85 patients with severe alopecia areata before initiation of DCP treatment (40 responders and 45 non-responders in terms of hair regrowth after DCP treatment). The following parameters were evaluated: i) perifollicular lymphocytic infiltration; ii) perifollicular fibrosis, and iii) miniaturized hair follicles. No difference between responders and non-responders could be observed in the degree of miniaturization of hair follicles and proliferation of perifollicular fibrous tissue. In neither group was there any evidence of scarring or severe follicular destruction. 18 non-responders but only 6 responders showed a very dense perifollicular lymphocytic infiltration. In contrast, a particularly scarce infiltrate was seen in 9 non-responders and in 19 responders. We conclude that non-responders to topical sensitizers tend to have rather pronounced inflammatory reactions with dense perifollicular lymphocytic infiltrates.     

Dynamic ultrastructural changes of the connective tissue sheath of human hair follicles during hair cycle

Summary Ultrastructural changes of the connective tissue sheath (CTS), including the hyaline membrane, of human hair follicles during the hair cycle, were studied in normal scalp skin specimens. In early anagen, the CTS was composed of a thin basal lamina and surrounding collagen tissue. The collagen tissue gradually thickened during the development of the hair and hair follicle. In mature anagen hair follicles, the collagen tissue was separated into three layers. The inner collagen layer, just outside the basal lamina, was thin and composed of collagen fibres running longitudinally parallel to the hair axis. The middle collagen layer was very thick with its collagen fibres running transversely against the hair axis and surrounding the inner hair tissue. Many fibroblasts were present among the collagen fibres in the middle layer, whereas the inner layer contained almost none. In the outer collagen layer, collagen fibres ran in various directions parallel to the outer surface of the outer root sheath cells. In late anagen, the basal lamina became very thick. In catagen, the basal lamine and the inner collagen layer became corrugated and showed oedematous change and degeneration. Surrounding fibroblasts showed active production of new collagen fibres, which seemed to fill the spaces left by the retraction of the hair follicle and hyaline membrane. These ultrastructural changes of the CTS show that there may be dynamic metabolic changes of the connective tissue around human hair follicles during the hair cycle.     

甲氨蝶呤是否能有效安全地维持全秃患者的头发再生? 一个经过严格评价议题

Alopecia areata (AA) is a common disorder causing hair loss, which can range from patches, to complete hair loss on the scalp (alopecia totalis), or involving all hair‐bearing sites (alopecia universalis). It can cause anxiety, depression and low self‐esteem. Treatment can be difficult – there are several options but they don't always work and can have unwanted side effects. Hair can in fact regrow without any treatment. The aim of this study was to assess the current evidence regarding use of a drug called methotrexate for getting hair to regrow, and then remain, in people with alopecia. The authors looked at 13 studies comprising 226 patients with alopecia varying from 30% hair loss to alopecia universalis at the start. Methotrexate was usually given with drugs called systemic corticosteroids to start hair regrowth rather than regrowth maintenance. Regrowth, defined as anything from 50% to complete regrowth, was reported in 20‐90% of patients. Relapse (meaning hair re‐grew but then fell out again) occurred in 20‐80%, with variable regrowth on retreatment. Unwanted side effects ranged from 7‐60%. The authors found insufficient evidence to conclude whether methotrexate is useful for maintaining regrowth in extensive alopecia areata. They found some evidence to suggest that hair regrowth may be started by methotrexate when used in combination with systemic corticosteroids, but it was difficult to say which of the treatments this was due to, or if the hair was going to regrow anyway. Further trials are needed.     

Ichthyosis and alopecia after maprotiline: corneolysis caused by temporary disorder of keratinization]

A 37-year-old woman developed ichthyosiform desquamation of the skin and a severe diffuse alopoecia 3 weeks after taking the antidepressant maprotilin. No signs of inflammation were present. Histology revealed acanthosis with preserved stratum granulosum, follicular hyperkeratosis and dystrophic changes of the hair follicle. Electron microscopy revealed rarefication of tonofilaments and necrobiotic changes of epidermal keratinocytes with vacuolar degeneration of the cytoplasm and disorganization of the organelles. Pathogenetically this disease represents a drug-induced transitory disorder to keratinization, which had resulted in desquamation of the stratum corneum and alopecia. The authors propose the designation corneolysis for this pathogenetic principle.     

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.     

Investigation of hair shaft in seborrheic dermatitis using atomic force microscopy

Background/purpose: We have investigated the changes of seborrheic dermatitis (SD) on the hair shaft in the morphological and physical properties using atomic force microscopy (AFM). Methods: Hair samples were obtained from the lesional and perilesional regions in 15 patients with SD. Fifteen healthy adults were included as the control group. From the topography of hair obtained by AFM, the height of the scale, step height, roughness, diameter, and pit were determined. Results: The scale thickness of the SD‐affected hair was sevenfold more than in the control hair showing statistically significance. The lesional hair showed greater roughness parameters of S_a, S_q, and S_z than the perilesional and the control hair, but this difference was not significant. The cuticle of the lesional hair was significantly damaged while perilesional hair showed a very distinct cuticle structure with smooth edges and a regular interval between the cuticles. The diameter of the lesional hair was significantly lesser by 10–35% than that of the perilesional hair. The pit was rarely observed in the SD‐affected hair collected from both the lesional and perilesional regions. Conclusion: The changes in the hair shaft affected SD was measured using AFM non‐invasively. AFM could be a useful tool in monitoring the treatment response and the severity of SD.     

绝经后女性头发变化与雌激素受体β基因多态性的关系

目的探讨绝经后女性头发生长特征的变化,对其与雌激素受体β基因多态性的关系进行分析。方法选择健康中老年绝经后女性作为受试对象,使用毛发检测仪对顶部和颞部受试区头发进行拍照,图像分析软件计算头发生长速度、密度和白发率;同时采集受试者抗凝静脉血,应用聚合酶链反应-限制性片段长度多态性技术,对受试人群的雌激素受体β基因RsaⅠ和AluⅠ酶切多态性进行分析。结果 131名绝经后女性基因型频率分布符合Hardy-Weinberg平衡定律(P0.05)。受试者顶部和颞部白发率与RsaⅠ酶切位点有相关性,差异有显著性(P=0.040,P=0.008)。头发密度、生长速度在各组间有一定差异,但无显著性(P0.05)。结论雌激素受体β基因RsaⅠ酶切多态性与绝经后女性白发的发生有关。     

Evaluation of long‐term efficacy of finasteride in Korean men with androgenetic alopecia using the basic and specific classification system

Finasteride 1 mg is considered to be the standard treatment method for male androgenetic alopecia (AGA). However, there have only been a few studies investigating its long‐term efficacy. Moreover, its effect on various types of AGA remains unknown. In this study, the authors investigated the 5‐year efficacy of finasteride 1 mg in Korean men with AGA and analyzed the changes in hair growth according to the distribution of hair loss. The medical records of male AGA patients who were treated with oral finasteride for a period of at least 5 years at two university hospitals were retrospectively reviewed. Patients' photographs were evaluated using the basic and specific (BASP) classification and investigator's global assessment. Of the total 126 patients, 108 (85.7%) showed improvement after 5 years of treatment. According to the BASP classification, hair loss of the anterior hair line (basic type), vertex (V type), and frontal area (F type) was improved in 44.4%, 89.7% and 61.2% of patients, respectively. The V type showed a more rapid and steady improvement compared with the other types. Progression of alopecia after peak improvement was seen in 10.3% of cases of the V type, 16.2% of the F type and 0% of the basic type. In conclusion, finasteride 1 mg showed a sustainable effect for at least 5 years in Korean male AGA patients. The exact time points showing signs of first clinical improvement and sustainability were different depending on the type of alopecia.     

Objective evaluation of photoepilation by phototrichogram

Photoepilation is one of the most popular cosmetic procedures. However, there has been no objective method to evaluate the efficacy of hair removal. The goal of this study is to evaluate the effect of photoepilation more objectively using a phototrichogram method. Thirteen young, healthy, female volunteers were enrolled in this study. At initial work-up, semi-permanent tattoos were marked in both axillae of all the volunteers and hair variables were evaluated by phototrichogram and digital camera. Intense pulsed light-assisted photoepilations were performed in both axillae of the volunteers twice at 4-week intervals. At each visit, dermatologists checked changes of hair parameters. Clinically, 8 weeks after two treatments, hair reduction of all patients was achieved. Total hair counts, changes of anagen ratio, non-vellus hair counts, hair density, anagen growth rate and hair diameter were decreased sequentially and the reduction was statistically significant. No correlations were found between power, pain, patient and doctor evaluations at 4 weeks. Doctor evaluations correlated with anagen hair counts, anagen/total hair ratio, anagen/telogen ratio and total growth rate. Using phototrichograms could be an objective evaluation technique for hair removal. Anagen parameters and total growth rate of hairs in phototrichograms may be able to be predictable values for evaluating epilation.     

600例白癜风毛发及指甲变化的分析

目的：了解白癜风毛发和指甲的变化情况。方法：对600例白癜风患者的毛发和指甲变化情况进行临床分析。结果：600例白癜风患者中，80例（13．33％）出现点状白甲，2例出现线状白甲，1例出现双手全指甲营养不良，4例指甲出现点状凹陷，40例（6．67％）出现程度和数量不等的甲横沟、纵嵴或甲分离；385例（64．17％）头部出现数量不等的白发；28例（4．67％）部分眉毛变白，37例（6．17％）部分胡须变白，45例（7．50％）部分阴毛变白，25例（4．17％）部分腋毛变白，31例（5．17％）躯干或四肢部分毳毛变白，而白发区无皮肤变白；554例（92．33％）有白斑区部分毛发变白；41例患者（6．83％）合并斑秃。结论：毛发和指甲可能是白癜风皮肤以外较为常见的受累部位。     

Characteristic features of ageing in Korean women’s hair and scalp

Background The effect of age on hair properties has previously been investigated in white and Japanese women; however, little is known of the age‐related characteristic features of hair in Korean women. Objectives To determine the ageing features of Korean women’s hair by examining physical and biological factors in sufficient numbers of participants. Methods In total, 150 healthy Korean women (aged 23–69 years) living in Seoul were allocated to five age‐graded groups. Age‐related changes of various features of the scalp and hair shaft were measured, including hair density, diameter, tensile strength and lustre, and grey‐hair ratio. The hair‐shaft compositions of minerals, amino acids and steroid hormones were analysed by high‐performance liquid chromatography. Results Hair‐loss parameters (hair density, diameter and tensile strength) and hair lustre decreased significantly with age, beginning in the subjects’ 40s. The hair‐whiteness value increased significantly with age, beginning in their 60s, due to an increase in the ratio of grey hair. Calcium and magnesium levels greatly exceeded the reference ranges and declined in an age‐dependent manner, while potassium and phosphorus levels increased with age. No age‐related change of hair‐shaft amino acid content was evident. The contents of sterols and their metabolites (cholesterol, desmosterol, lanosterol and pregnenolone) increased significantly with age, but there was no correlation between the examined sex steroids and age. Conclusions  These results show that intrinsic ageing produces diverse changes in the hair and scalp features of Korean women from their 40s, and the ageing features of Korean women’s hair could be partially different from that of women in other countries.