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Hair regrowth in a male patient with extensive androgenetic alopecia on estrogen therapy

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... However, hormonal therapy alone has only been rarely reported to induce significant regrowth. Adenuga et al. [34] reported a case of a transgender woman with a history of androgenic alopecia, who had almost full regrowth of scalp hair after 6 months of starting estradiol 30 mg/60 ml twice daily and aldactone 100 mg daily. Stevenson et al. [31] report a transgender woman on estradiol 5 mg daily and spironolactone 150 mg daily who experienced both scalp hair regrowth as well as thickening of preexisting hair after 6 months of treatment. ...
... Adenuga et al. [34] A 38-year-old transgender woman experienced full hair regrowth over a completely alopecic scalp after initiating feminizing hormonal therapy Giltay et al. [36] Hair growth and sebum production deceased after FHT; facial hair continued. MHT increased hair growth rate and sebum production Imhof et al. [19] MHT was associated with increased risk of androgenic alopecia, which was diagnosed an average of 12.8 years after initiating therapy Jain et al. [18] 28% (n = 11) reported decreased facial hair after FHT Kirisawa et al. [9] After 2 years on MHT, facial hair growth was observed in 53% (n = 45) and body hair growth in 38% (n = 32) ...
Article
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Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors’ own experiences treating this unique patient population.
... In general, when estrogen or hormone replacement therapy (HRT) is initiated, the balding progression is halted and patients may even experience marginal hair regrowth (23)(24)(25)(26). Regardless of these factors, minoxidil, finasteride, and spironolactone may be useful adjuncts to prevent further regression and stimulate marginal reversal (27)(28)(29)(30)(31). Spironolactone, a commonly used androgen antagonist and diuretic, acts to decrease hair loss by blocking the activity of 5-alpha-reductase thereby reducing the production of androgens and by directly blocking androgen receptors (32). ...
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Facial gender confirmation surgery (FGCS) is a series of procedures which seek to harmonize a patient's face with his/her self-image and gender identity. Originally described in San Francisco in the 1980s, FGCS has evolved to encompass all elements of the craniofacial skeleton and facial soft tissue. This field in plastic and reconstructive surgery has quickly gained more attention in the past decade due to the pioneering work of groups around the world along with increased social acceptance and medical care of the transgender community. This narrative review focuses on the upper third of the face. Key differences in the forehead and the hairline of cis men and women are discussed which inform pharmacologic and surgical interventions. Hairline modifying therapies including pharmacotherapy and hair transplantation are explained. Virtual surgical planning (VSP), a tool broadly used in surgical fields, has a special role in FGCS and we offer advice in using VSP when addressing the frontal sinus. Use of VSP allows the surgeon to provide reproducible and accurate results. We then discuss the history of the frontal sinus setback and offer our algorithmic approach to recontouring the forehead with detailed description of the operative steps and decision making. Finally, postoperative care and complications considered.
... Previous studies and observations have detailed the effects of hormones on hair and skin changes in transgender individuals. For those who undergo hormone treatment, male-to-female (MTF) transgender women have changes in distribution and reduced rates of hair growth on certain parts of their bodies, such as the face and chest; improved androgenic alopecia; and reduced rates of acne (Adenuga et al., 2012;Conrad and Paus, 2004;Gardner and Safer, 2013;Stevenson et al., 2016). In contrast, female-to-male transgender men have increased rates of terminal hair growth on the face and axillary regions, increased susceptibility to androgenic alopecia, and increased rates of acne (Gardner and Safer, 2013;Harper, 2006;Maheux et al., 1994;Randall, 2008;Sauerbronn et al., 2000;Thornton, 2013;Wierckx et al., 2014). ...
Article
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Many previous reviews and studies on transgender dermatology have highlighted the expected dermatologic manifestations of hormone affirmation therapy in transgender patients. Others have highlighted attitudes and practices of both transgender patients and medical professionals taking care of these patients. This review compiles data from other, lesser known aspects of transgender dermatology, including neovaginal concerns, neoplastic concerns (both neovaginal and cutaneous), autoimmune conditions, and the sequelae of injectable substances that have not been approved by the U.S. Food and Drug Administration. This review, like others, will be a stepping-stone and serve as an impetus for future research in transgender dermatology.
... 27 However, there is very little in the published scientific literature about the effects of hormone treatment on the evolution of alopecia in transgender patients. 28 Despite the almost total lack of bibliographic references in this respect, 29 experience suggests that the approach most commonly used to treat the hairline in facial feminization surgery is hairline-lowering surgery. The objective of hairline-lowering surgery is twofold: to decrease the overall height of the forehead and to serve as an access point to reconstruct the frontonaso-orbital complex. ...
Article
Background: Reconstruction of the frontonaso-orbital complex is one of the best-described and most commonly used procedures in the field of facial feminization surgery. To a large extent, this complex determines the facial expression and plays a key role in the visual identification of facial gender. After the forehead, the hairline pattern is the second most important feature of gender identification within the upper third of the face. The combined evaluation of these two features should be a basic premise of facial feminization surgery. Methods: The authors present a new surgical sequence developed by their group in which reconstruction of the frontonaso-orbital complex and redefinition of the hairline by means of an autologous hair transplant are carried out during the same operation: forehead reconstruction and simultaneous hair transplantation. Results: Sixty-five male-to-female transgender patients treated with forehead reconstruction and simultaneous hair transplantation are presented along with the surgical technique, sequence used, and the results obtained. A classification method for hairlines in male-to-female transgender patients is proposed based on the observation of 492 patients. A modified temporoparietooccipital coronal (posterior coronal) approach is also described. Conclusion: The forehead reconstruction and simultaneous hair transplant technique makes it possible to address the entire upper third of the face in a single facial feminization operation.
... Estrogen and combined oral contraceptive (COC) drugs with estrogen or progestogen have been reported as effective, but data are limited (Adenuga et al., 2012;Raudrant and Rabe, 2003;Scheinfeld, 2008). They are thought to function through several mechanisms. ...
Article
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Female pattern hair loss is the most common cause of hair loss in women and one of the most common problems seen by dermatologists. This hair loss is a nonscarring alopecia in which loss occurs on the vertex scalp, generally sparing the frontal hairline. Hair loss can have significant psychosocial effects on patients, and treatment can be long and difficult. The influence of hormones on the pathogenesis of female pattern hair loss is not entirely known. The purpose of this paper is to review physiology and potential hormonal mechanisms for the pathogenesis of female pattern hair loss. We also discuss the current hormonal and hormone-modifying therapies that are available to providers as they partner with patients to treat this frustrating issue.
... Soy bean drinks are rich in isoflavones, and the isoflavone metabolite equol displays high levels of antioxidant [38,39,40] and estrogen-like activities [38,41,42,43]. There are many reports that isoflavone [44,45], antioxidants [46] and estrogens [43,47,48,49,50,51,52,53,54,55,56,57,58] are protective against alopecia. The previous reports found that orally administered soymetide-4 (MITL), a soy-derived immunostimulating peptide from soy bean beta-conglycinin alpha' subunit, suppressed the alopecia induced by the anti-cancer drug etoposide [52,59,60,61,62]. ...
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Although the genetic basis of androgenic alopecia has been clearly established, little is known about its non-genetic causes, such as environmental and lifestyle factors. This study investigated blood and urine heavy metals concentrations, environmental exposure factors, personal behaviors, dietary intakes and the genotypes of related susceptibility genes in patients with androgenic alopecia (AGA). Age, AGA level, residence area, work hours, sleep patterns, cigarette usage, alcohol consumption, betel nut usage, hair treatments, eating habits, body heavy metals concentrations and rs1998076, rs913063, rs1160312 and rs201571 SNP genotype data were collected from 354 men. Logistic regression analysis was performed to examine whether any of the factors displayed odds ratios (ORs) indicating association with moderate to severe AGA (≧IV). Subsequently, Hosmer-Lemeshow, Nagelkerke R(2) and accuracy tests were conducted to help establish an optimal model. Moderate to severe AGA was associated with the AA genotype of rs1160312 (22.50, 95% CI 3.99-126.83), blood vanadium concentration (0.02, 95% CI 0.01-0.04), and regular consumption of soy bean drinks (0.23, 95% CI 0.06-0.85), after adjustment for age. The results were corroborated by the Hosmer-Lemeshow test (P = 0.73), Nagelkerke R(2) (0.59), accuracy test (0.816) and area under the curve (AUC; 0.90, 0.847-0.951) analysis. Blood vanadium and frequent soy bean drink consumption may provide protect effects against AGA. Accordingly, blood vanadium concentrations, the AA genotype of rs1160312 and frequent consumption of soy bean drinks are associated with AGA.
... Soy bean drinks are rich in isoflavones, and the isoflavone metabolite equol displays high levels of antioxidant [38,39,40] and estrogen-like activities [38,41,42,43]. There are many reports that isoflavone [44,45], antioxidants [46] and estrogens [43,47,48,49,50,51,52,53,54,55,56,57,58] are protective against alopecia. The previous reports found that orally administered soymetide-4 (MITL), a soy-derived immunostimulating peptide from soy bean beta-conglycinin alpha' subunit, suppressed the alopecia induced by the anti-cancer drug etoposide [52,59,60,61,62]. ...
... 107 One report documented complete hair regrowth in a transsexual individual with MPHL on estrogen. 108 In Europe, topical estrogens are available and used for various hair disorders. A recent study of topical estrogen (fulvestrant) documented increased hair growth in a murine model, but failed to show improvement in men and women with pattern baldness. ...
Article
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Hair loss is a commonly encountered problem in clinical practice, with men presenting with a distinctive pattern involving hairline recession and vertex balding (Norwood-Hamilton classification) and women exhibiting diffuse hair thinning over the crown (increased part width) and sparing of the frontal hairline (Ludwig classification). Female pattern hair loss has a strikingly overwhelming psychological effect; thus, successful treatments are necessary. Difficulty lies in successful treatment interventions, as only two medications - minoxidil and finasteride - are approved for the treatment of androgenetic alopecia, and these medications offer mediocre results, lack of a permanent cure, and potential complications. Hair transplantation is the only current successful permanent option, and it requires surgical procedures. Several other medical options, such as antiandrogens (eg, spironolactone, oral contraceptives, cyproterone, flutamide, dutasteride), prostaglandin analogs (eg, bimatoprost, latanoprost), and ketoconazole are reported to be beneficial. Laser and light therapies have also become popular despite the lack of a profound benefit. Management of expectations is crucial, and the aim of therapy, given the current therapeutic options, is to slow or stop disease progression with contentment despite patient expectations of permanent hair regrowth. This article reviews current perspectives on therapeutic options for female pattern hair loss.
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Androgenetic alopecia (AGA) is the most common type of hair loss in adults and may be particularly distressing for gender minority patients, given the close relation between hair and gender expression. Furthermore, use of gender affirming hormones such as testosterone in transmen and estrogen/antiandrogens in transwomen has a direct effect on hair growth distribution and density. Clinicians should thus be knowledgeable about the effects of sex hormones on the hair growth cycle to comfortably diagnose and treat AGA in gender minority patients.
Article
Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.
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Aufgrund der Vielgestaltigkeit der Ausfallsmuster und der zahlreichen möglichen Ursachen betrachten viele Ärzte Haarausfall bei Frauen als crux medicorum. Doch das Problem ist beherrschbar. Grundsätzlich ist zu unterscheiden, ob der Haarausfall durch hormonelle oder nicht hormonelle Ursachen bedingt ist und ob im Fall einer androgenetischen Alopezie eine manifeste Hyperandrogenämie oder nur eine erhöhte Sensitivität der Haarfollikel gegenüber Androgenen vorliegt.
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Aufgrund der Vielgestaltigkeit der Ausfallsmuster und der zahlreichen möglichen Ursachen betrachten viele Ärzte Haarausfall als crux medicorum. Doch das Problem ist beherrschbar. Wichtig ist, zu unterscheiden, ob der Haarausfall durch eine bestehende Hyperandrogenämie oder nur durch eine erhöhte Sensitivität der Haarfollikel gegenüber den Androgenen verursacht wird.
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In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
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The present 35th book deals with hair loss that is important for human psychological and sociological wellbeing and identity. Are there any descriptions of hair loss in the Bible? Which character was affected? What are types of hair loss, etiology, clinical characteristics, associated diseases, comorbidities, and contemporary approach to hair loss? What can we learn from the biblical description of the disease? All biblical texts were examined and verses dealing with hair loss in one character were studied closely.
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Background: Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual's quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia. Objectives: The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence. Results: The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes. Limitations: Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals. Conclusions: An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.
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Androgenetic alopecia (AGA), also known as common baldness, is characterized by a marked decrease in hair follicle size, which could be related to the loss of hair follicle stem or progenitor cells. To test this hypothesis, we analyzed bald and non-bald scalp from AGA individuals for the presence of hair follicle stem and progenitor cells. Cells expressing cytokeratin15 (KRT15), CD200, CD34, and integrin, α6 (ITGA6) were quantitated via flow cytometry. High levels of KRT15 expression correlated with stem cell properties of small cell size and quiescence. These KRT15(hi) stem cells were maintained in bald scalp samples. However, CD200(hi)ITGA6(hi) and CD34(hi) cell populations--which both possessed a progenitor phenotype, in that they localized closely to the stem cell-rich bulge area but were larger and more proliferative than the KRT15(hi) stem cells--were markedly diminished. In functional assays, analogous CD200(hi)Itga6(hi) cells from murine hair follicles were multipotent and generated new hair follicles in skin reconstitution assays. These findings support the notion that a defect in conversion of hair follicle stem cells to progenitor cells plays a role in the pathogenesis of AGA.
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We have investigated the expression of 52 of the 54 keratins in beard hair medulla. We found that not only 12 hair keratins but, unexpectedly, also 12 epithelial keratins are potentially expressed in medulla cells. The latter comprise keratins also present in outer- and inner-root sheaths and in the companion layer. Keratins K5, K14, K17, K25, K27, K28, and K75 define a "pre-medulla," composed of cells apposed to the upper dermal papilla. Besides K6, K16, K7, K19, and K80, all pre-medullary epithelial keratins continue to be expressed in the medulla proper, along with the 12 hair keratins. Besides this unique feature of cellular keratin co-expression, the keratin pattern itself is highly variable in individual medulla cells. Remarkably, both epithelial and hair keratins behave highly promiscuously with regard to heterodimer- and IF formation, which also includes keratin chain interactions in IF bundles. We also identified cortex cells within the medullary column. These exhibit all the properties of genuine cortex cells, including a particular type of keratin heterogeneity of their compact IF bundles. In both keratin expression profile and keratin number, medulla cells are distinct from all other cells of the hair follicle or from any other epithelium.
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Epidermolysis bullosa simplex (EBS) is a group of autosomal dominant inherited skin diseases caused by mutations in either the keratin 5 (K5) or the keratin 14 (K14) genes and characterized by development of intraepidermal skin blisters. The three major subtypes of EBS are Weber-Cockayne, Koebner, and Dowling-Meara, of which the Dowling-Meara form is the most severe. We have investigated five large Danish families with EBS and two sporadic patients with the Dowling-Meara form of EBS. In the sporadic Dowling-Meara EBS patients, a novel K14 mutation (N123S) and a previously published K5 mutation (N176S) were identified, respectively. A novel K14 mutation (K116N) was found in three seemingly unrelated families, whereas another family harbored a different novel K14 mutation (L143P). The last family harbored a novel K5 mutation (L325P). The identified mutations were not present in more than 100 normal chromosomes. Six polymorphisms were identified in the K14 gene and their frequencies were determined in normal controls. These polymorphisms were used to show that the K14 K116N mutation was located in chromosomes with the same haplotype in all three families, suggesting a common ancestor. We observed a strict genotype-phenotype correlation in the investigated patients as the same mutation always resulted in a similar phenotype in all individuals with the mutation, but our results also show that it is not possible to predict the EBS phenotype merely by the location (i.e., head, rod, or linker domains) of a mutation. The nature of the amino acid substitution must also be taken into account.
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To report the clinical features of the loose anagen hair syndrome and to test the hypothesis that the typical gap between the hair and the inner root sheath may result from hereditary defects in the inner root sheath or the apposed companion layer. Case series. A pediatric dermatology unit (referral center). A consecutive sample of 17 children (13 girls). For 9 of them and their first-degree relatives, molecular analyses were performed in the K6HF gene with 50 appropriate controls. Minoxidil therapy (5% lotion) in 11 patients for 1 to 12 months. Clinical and follow-up features and determination of mutations in the K6HF gene. Most patients had easily pluckable hair with no sign of scalp inflammation or scarring. Ten patients seldom cut their hair, and 4 had unmanageable hair. One patient had hypodontia. Two patients had an additional clinical phenotype of diffuse partial woolly hair. The family history was positive for loose anagen hair syndrome in 5 patients. Marked improvement was noted after treatment with 5% minoxidil lotion in 7 of the 11 patients treated. Polymerase chain reaction analysis of the gene segments encoding the alpha-helical 1A and 2B subdomains of K6hf, the type II cytokeratin exclusively expressed in the companion layer, was performed in 9 families. In 3 of these 9 families, a heterozygous glutamic acid and lysine mutation, E337K, was identified in the L2 linker region of K6HF. Diffuse partial woolly hair can be associated with loose anagen hair syndrome. A keratin mutation, E337K in K6HF, was possibly causative in 3 of the 9 families studied. Another keratin, and possibly the type I partner of K6hf, could be responsible for loose anagen hair syndrome in other patients, or the gene involved may be a minor gene.
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Epidermolysis bullosa simplex (EBS) is a mechanobullous genodermatosis that may be caused by mutations in the genes KRT5 and KRT14 encoding the basal epidermal keratins 5 (K5) and 14 (K14). Three main clinical subtypes of EBS exist, differing in onset, distribution and severity of skin blistering. Previous reports of KRT5 and KRT14 mutations suggest a correlation between the location of the mutation and the severity of the associated EBS phenotype. The prevalence of KRT5/KRT14 mutations and the genotype-phenotype correlation in the largest tissue-confirmed EBS population is investigated. KRT5 and KRT14 genomic DNA and cDNA sequences of 76 clinically well-defined unrelated EBS probands were amplified and then subjected to direct sequencing and product length analysis. Immunofluorescence microscopy on patients' skin biopsies with antibodies against K5 and K14 was performed to study protein expression. In 57 of 76 (75%) probands 41 different KRT5 and KRT14 mutations were identified, of which 12 were novel. Mutations affecting the highly conserved helix boundary motifs of the rod domains of K5 and K14, and the K14 helix initiation motif in particular, were associated with the severest, EBS Dowling-Meara, phenotype. In 21 EBS probands (37%) the mutation was de novo. In 19 probands (25%) KRT5 or KRT14 mutations were excluded. The phenotype-genotype correlation observed in this large EBS population underscores the importance of helix boundary motifs for keratin assembly. Only three-quarters of biopsy-confirmed EBS probands have KRT5 or KRT14 mutations, indicating genetic heterogeneity in EBS. Alternative gene candidates are discussed.
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Loose anagen hair syndrome (LAHS) is a disorder in which the hair pulls out easily and painlessly from the scalp. It first manifests in early childhood when the main concern of parents is that the sparse hair does not grow. The hair density and length improve with age, but the looseness persists into adulthood. Light and electron microscopic studies of hair follicles were performed to better define the microscopic changes seen in LAHS. Biopsy specimens were obtained from 4 patients, 3 children and 1 adult. The hair follicles were studied by light and electron microscopy. The most conspicuous structural changes were found in the inner root sheath complex of the anagen follicle. With light microscopy, the keratinized Henle cell layer showed a tortuous and irregular swelling. Irregular keratinization of the cuticle cells of the inner root sheath and a swollen appearance of Huxley cells were also found. With electron microscopy, the major pathological changes consisted of intercellular edema in the prekeratinized Huxley cell zone and dyskeratosis of Henle cells and cuticle cells of the inner root sheath. The studies were done on a small number of patients. Structural abnormalities of the inner root sheath appear to disturb its normal supportive and anchoring function and result in a loose attachment of the hair shaft to the anagen follicle.
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Unlabelled: Male and female pattern hair loss affects a large percentage of the population, and patients frequently present for treatment of this to their dermatologist. Here we review the many treatments available for hair loss. We review the evidence for each, and outline the most effective treatment strategies for both men and women. Learning objective: At the conclusion of this article, the reader should be able to describe the most effective treatments for hair loss, understand their mechanism(s) of action, and explain which treatments are the best in different settings.
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A distinctive new hair condition, the loose anagen syndrome, features anagen hairs that are loosely anchored and easily pulled from the scalp. The children studied had sparse hair that did not grow long and that pulled easily from the scalp. The majority of patients were blond girls, aged 2 to 5 years, but both sexes and those with dark hair can be affected. The hair was not fragile, and easily pulled hairs were misshapen anagen hairs without external root sheaths. Histologic examination of the hair showed abnormal premature keratinization of Huxley's and Henle's layers of the inner root sheath in some samples. Length and density of hair gradually increased with age, but anagen hairs remained loosely anchored in adulthood. This report describes findings in 22 children and five adults with the loose anagen syndrome.
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It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. To evaluate the efficacy of oral antiandrogen therapy in the management of women with FPHL using standardized photographic techniques (Canfield Scientific), and to identify clinical and histological parameters predictive of clinical response. For this single-centre, before-after, open intervention study, 80 women aged between 12 and 79 years, with FPHL and biopsy-confirmed hair follicle miniaturization [terminal/vellus (T/V) hair ratio < or = 4 : 1] were photographed at baseline and again after receiving a minimum of 12 months of oral antiandrogen therapy. Forty women received spironolactone 200 mg daily and 40 women received cyproterone acetate, either 50 mg daily or 100 mg for 10 days per month if premenopausal. Women using topical minoxidil were excluded. Standardized photographs of the midfrontal and vertex scalp were taken with the head positioned in a stereotactic device. Images were evaluated by a panel of three clinicians experienced in the assessment of FPHL, blinded to patient details and treatment and using a three-point scale. As there was no significant difference in the results or the trend between spironolactone and cyproterone acetate the results were combined. Thirty-five (44%) women had hair regrowth, 35 (44%) had no clear change in hair density before and after treatment, and 10 (12%) experienced continuing hair loss during the treatment period. Ordinal logistic regression analysis to identify predictors of response revealed no influence of patient age, menopause status, serum ferritin, serum hormone levels, clinical stage (Ludwig) or histological parameters such as T/V ratio or fibrosis. The only significant predictor was midscalp clinical grade, with higher-scale values associated with a greater response (P = 0.013). Eighty-eight percent of women receiving oral antiandrogens could expect to see no progression of their FPHL or improvement. High midscalp clinical grade was the only predictor of response identified. A placebo-controlled study is required to compare this outcome to the natural history of FPHL.
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Epidermolysis bullosa simplex (EBS) is a mechano-bullous disorder characterized by intraepidermal blistering within the basal keratinocytes as a result of trauma to the skin. As part of the DNA diagnostics program, our laboratory has analyzed a cohort of 57 patients with the initial referral diagnosis of EBS. Among these patients, 18 were found to harbor heterozygous mutations in the keratin 5 or keratin 14 genes, KRT5 and KRT14, respectively, whereas in 14 cases, the disease was associated with mutations in both alleles of the plectin gene. Among the keratin mutations, 12 were distinct and six were novel, and in most cases there was no family history of a blistering disease. Prenatal diagnosis of eight pregnancies with keratin gene mutations, at risk for EBS either because one of the parents was affected (three cases) or history of a previously affected child as a result of a de novo mutation (five cases), predicted two fetuses being affected and six being normal. No recurrence of the de novo mutations in these pregnancies was disclosed. Collectively, the data suggest that a significant number of cases diagnosed as EBS are due to plectin mutations, and many cases result from de novo mutations in KRT5 and KRT14 genes. These findings have implications for genetic counseling and prenatal diagnosis for EBS.
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While it is undisputed that estrogens (17β-estradiol, E2) are mainly involved in skin physiology and operate as potent hair growth modulators, our knowledge about the estrogen target cells in skin and exact signaling pathways is still very limited. The current review provides an overview of estrogen effects on hair follicle cycling, cutaneous expression of estrogen receptors, and potential functions of estrogens in hair biology. We discuss potential target genes of estrogen receptor-mediated signaling in the skin, explore the interplay of estrogens with other hormones, growth factors and enzymes, and define major open questions in this intriguing and far too long neglected area of hair research. Östrogene (17β-Östradiol, E2) haben maßgeblichen Einfluß auf die Physiologie der Haut und das Haarwachstum, es mangelt jedoch an grundlegenden Kenntnissen über die genauen Wirkungsmechanismen und Zielzellen, die diesen Einflüssen zugrunde liegen. Die Effekte von Östrogenen auf den Haarfollikelzyklus, die unterschiedlichen Expressionsmuster der Östrogenrezeptoren im Haarfollikel von Mensch und Maus, sowie bekannte und vermutete Funktionen der Östrogene in der Haarbiologie werden in dieser Arbeit vorgestellt. Potentielle Zielgene sowie die Einflüsse der zahlreichen Modulatoren, wie Wachstumsfaktoren, Hormone und Enzyme in der Vermittlung von Östrogen-Effekten auf die Haut und den Haarfollikel werden diskutiert und offene Fragen erörtert, deren Klärung für die Haarforschung von großer Bedeutung wäre.
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Androgenetic alopecia (AGA), or male pattern hair loss, affects approximately 50% of the male population. AGA is an androgen-related condition in genetically predisposed individuals. There is no treatment to completely reverse AGA in advanced stages, but with medical treatment (eg, finasteride, minoxidil, or a combination of both), the progression can be arrested and partly reversed in the majority of patients who have mild to moderate AGA. Combination with hair restoration surgery leads to best results in suitable candidates. Physicians who specialize in male health issues should be familiar with this common condition and all the available approved treatment options.