Early Intervention with High-Dose Steroid Pulse Therapy Prolongs Disease-Free Interval of Severe Alopecia Areata: A Retrospective Study

Background

Spontaneous recovery of severe alopecia areata is rare and the condition is difficult to treat.

Objective

The aim of this study is to investigate and compare the effects and safety of steroid pulse therapy between oral and intravenous administrations between 1999 and 2010 at the Department of Dermatology, National Cheng Kung University Hospital.

Methods

Data were retrospectively retrieved. A satisfactory response was defined as more than 75% hair regrowth in the balding area.

Results

A total of 85 patients with more than 50% hair loss were identified and treated, with an overall satisfactory response rate of 51.8%. The mean follow-up time was 37.6 months, with a relapse rate of 22.7%. Patients with alopecia areata (hereafter, AA) of recent onset within one year showed higher response rates (p<0.001) and lower relapse rates compared to patients with AA persisting for more than 1 year. Further, even in patients with alopecia totalis, alopecia universalis or ophiasis type, early treatment resulted in a satisfactory response rate of 47% among the treated patients. In general, oral therapy was as effective and well-tolerated as intravenous therapy.

Conclusion

The response rate is determined by disease severity and time of intervention, not by the administration form of steroid pulse therapy. Oral steroid pulse therapy can be considered as the first-line treatment for patients with severe AA of recent onset within one year.     

Scalp infection by Candida Albicans in an immunocompetent patient: a description of a rare case

Candida is a large genus of yeast, consisting of about 150 species, among which C.albicans is the most prevalent fungal species of the human microbiota. C. albicans is the most important fungal opportunistic pathogen that can cause infection when the host becomes debilitated or immunocompromised. We report a case of a scalp infection by C.albicans in a patient without an obvious immunocompromised state.     

Current and future treatments of alopecia areata and trichotillomania in children

Introduction: Treatment options for hair disorders are generally very limited. These options are even more limited in children due to the lack of trials and clinical research. Moreover, physicians are sometimes scared to treat children with drugs without safety data, especially because most hair disorders are benign.

Areas covered: The objective of this paper is to review current and future treatments for alopecia areata and trichotillomania, two disorders that are sometimes encountered in differential diagnosis or even occur together and probably affect the mental condition of the patient involved more than others.

Expert opinion: Hair disorders are very stressful in paediatric population. Both physicians and families are often unsatisfied leading to non-compliance. New drugs with less side- effects are needed to increase the percentage of cure. It is also crucial to refine genetic studies on alopecia areata in order to identify new potential drugs worth studying. Moreover, studies on trichotillomania should not be evaluated only by psychiatrics, but also by dermatologists.     

益肾活血汤治疗雄激素依赖性脱发的临床观察

目的　观察益肾活血汤治疗雄激素依赖性脱发的临床疗效及对患者血液流变学的影响。方法　采用益肾活血汤治疗 86例雄激素依赖性脱发患者 ,观察治疗效果及对血液流变学的影响。结果　临床治疗有效率 61.6%。血液黏度、血浆黏度、红细胞压积比、红细胞聚集指数、红细胞刚性指数、纤维蛋白原等血液流变学指标治疗后与治疗前比较均有显著性下降 (P均 <0 .0 5 )。结论　益肾活血汤能降低雄激素依赖性脱发患者的血液黏度 ,治疗雄激素依赖性脱发有较好的临床效果。     

Grundlagen der hormonalen Kontrazeption

Ohne Zusammenfassung

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毛发生长的评价方法

如何对毛发生长情况进行评价一直是毛囊生物学研究者和皮肤科医生关注的焦点,特别是随着非那雄胺和米诺地尔治疗雄激素性秃发的广泛应用,已经越来越迫切需要准确而客观地评价毛发生长.毛发生长的主要生理性参数包括:毛发的密度、直径、毛发的线性生长速度和毛发循环的比例等,其中,休止期胜长期毛囊的比例是反映毛发循环比例的重要参数.目前,评价毛发生长的方法包括创伤性、半创伤性和非创伤性三大类,在应用过程中各有其适应范围和优缺点.     

何慧英治疗小儿斑秃经验探析

正斑秃最早见于《外科正宗》,称"油风",为一种突然发生的局限性斑片状脱发。该病可发生于任何年龄,小儿患者多发生于学龄期,且发展迅速、缠绵难愈,影响发育和心理健康。现一般认为斑秃是自身免疫性疾病,与精神因素、遗传因素和微量元素缺乏等有关。西医常外用激素或内服免疫抑制剂等治疗。何慧英老师认为小儿斑秃多与脾胃不调或受惊有关,现将何老师治疗该病经验介绍如下。1谨从病机辨证论治古人对斑秃的病机早有洞察。《诸病源候论》:     

Preferential Recognition of Hydroxyl Radical-Modified Superoxide Dismutase by Circulating Autoantibodies in Patients with Alopecia Areata

Background

Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The cause of AA is unknown but reports suggest an autoimmune etiology, where oxygen free radicals play an important role.

Objective

The aim of this study was to investigate the role of a hydroxyl radicals (·OH)-modified antioxidant enzyme, superoxide dismutase (SOD), in AA autoimmunity.

Methods

SOD was modified by ·OH radicals. Binding characteristics of autoantibodies in AA patients (n=26) against ·OH-modified SOD (·OH-SOD) were evaluated by immunoassays and the results were compared with those of healthy, age-matched controls (n=30). The effects of ·OH radicals on immunoglobulin G (IgG) isolated from AA patients were studied.

Results

Highly specific binding to ·OH-SOD was observed in 32% of the samples of patient sera, whereas normal human sera showed negligible binding with either antigen. Competitive inhibition immunoassays reiterated the results from direct binding. Protein-A-purified IgG from AA patients (AA-IgG) also showed strong binding to ·OH-SOD as compared to IgG from normal human controls (p<0.001). In addition, AA-IgG from patients with alopecia universalis recognized ·OH-SOD to a greater extent than did AA-IgG from patients with the patchy, persistent type of alopecia. Furthermore, sera from AA patients had lower levels of SOD activity as compared to control sera.

Conclusion

This is the first report showing an association between ·OH-modified SOD and AA. These novel results demonstrate that ·OH radical-mediated changes in SOD present unique neo-epitopes that might contribute to antigen-driven antibody induction in AA.