Science topic

Alopecia - Science topic

Absence of hair from areas where it is normally present.
Questions related to Alopecia
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Is there any particular condition in which it is more worth,
Are there any practical tips on it from people doing it often?
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please I want to know the treatment dose of biotin supplements  for female for androgenic alopecia ?
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I am using PRP for Hair loss/Hair regrowth treatment. Currently I am using BD Vacutainer ACD Solution A 8.5Ml tubes.
I will explain the process that I am following currently.
I draw blood in 4 Vacutainer ACD Solution A 8.5ML tubes and centrifuge @ 3000 RPM for 10 minutes in 1st spin. Then I will transfer only buffy coat from the middle and little above buffy coat into another empty 15ml centrifuge tube and in 2nd I Spin it again @ 3500RPM for 5 minutes. Now I discard 75% of the above portion and remaining 25% I use for injecting into the Scalp and after injecting, I use 1mm derma roller on the scalp and then I just spread the PRP on the scalp.
Please let me know if there a better way to get the maximum PRP for hair loss treatment or if there is any change in the centification process.
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What is the concentration of platelets in the final solution?
Which Activator do you use?
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How do men experience the psychological impact of alopecia in comparison to women?
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Alopecia (hair loss) is a common dermatological condition that affects men and women of all ages, and has significant psychological impacts. However, men experience less psychological impact of alopecia than women. Please see the following useful links.
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If answer is YES, then what is the difference between Adverse effects and Side Effects. Usually we go for causality and severity assessment when we report unknown, uncommon or rare adverse drug reactions (ADRs). Majority of cancer patients those are on chemotherapy mostly experience very common side effects (ex. Nausea, vomiting, alopecia etc. ). For reporting these kind of common side effects also, do we required causality and severity assessment?
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thanks Nitin Kulkarni for your comments
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Please help. I am doing a systematic review of largely observational studies on the safety and effectiveness of treating autoimmune alopecia with Hydroxychloroquine in older adults. I was wondering if a subgroup analysis is feasible in a SR based largely on observational studies. Thank you.
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Subgroup analysis is feasible, provided that analysis according to the factors that you want to subgroup is provided in included or some of the included papers. Otherwise you should opt for individual patient data analysis. Rather than subrgrouping you can also consider meta-regression analysis taking in mind the factors that you want to adjust for. This might be more feasible in certain cases.
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Please help. Understanding immune privilege is largely viewed as integral to unlocking optimal treatment options for autoimmune sufferers. Yet there is a clear sexual dimorphism in autoimmune disease. Is there any correlation between immune privilege and gender?
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This is a fascinating question. Immune privilege can be thought of as antigens hidden away from the immune system by either physical (i.e. blood-brain barrier) or immunological barriers. Immunological barriers include low expression of MHC proteins, high balance between regulatory and effector cells or expression of protective molecules such as Fas or immune suppressive cytokines such as TGF-beta (as suggested as mechanisms of immune privilege in the anterior chamber of the eye). The reason that females are more susceptible to males for most classical autoimmune diseases, with exceptions being type 1 diabetes, myasthenia gravis, pemphigus vulgaris and Goodpasture's syndrome, is not clear. Some authors have suggested that women make stronger inflammatory responses to infectious agents than men because their survival is more important for continuance of the species. However, the detailed mechanism of this is not clear.
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Which are the best preclinical models for Acne & Androgenetic Alopecia considering different species??
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We are currently conducting a systematic review on models for Androgenetic alopecia (AGA). This will also include a meta-analysis. To include as many samples as possible and to control potential impact of publication bias, we are looking for unpublished or not yet published data on AGA models. These can be both animal and tissue culture models - however, the study will exclude drug efficacy and phytochemical interventions. Please send to: NTSSIN015@myuct.ac.za
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Definition of both
1- Telogen effluvium
Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in thetelogen phase (the resting phase of the hair follicle)
2- Androgenetic alopecia, which is the most common form of hair loss, affects up to 80% of men and 50% of women in the course of their life. Androgenetic alopecia is caused by a progressive reduction in the diameter, length, and pigmentation of the hair. Hair thinning is not diffuse, but rather is limited to the frontal, temporal, and vertex areas, where hair follicles are sensitive to the effects of the testosterone metabolite.
So I see it important to differentiate between them especially when we need to management, like hair transplantation...
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I am working with female Balb/C strain mouse and I noticed some strangeness in them. Inıtially there is no problem about them. Now they don't have any mystacial vibrissae! Does someone have any experience like that!
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40-year-old female presents with an 8-year history of alopecia. No other symptoms, no regular medication. Clinical and dermoscopic features of alopecia areata (attached pictures). Reviewing her previous lab exams, I noticed persistent positive ANA (1/160) and high levels of anti-SSA/Ro (range: 69 to 108) since 2013. I failed to find any evidence associating AA with such serological markers. 
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There is no evidence associating alopecia areata (AA) with these serologic markers. However, AA has been associated with lupus (occurring in 10% of lupus patients vs. 0.42% in the general population) in an older study by Werth et al (Arch Dermatol. 1992 Mar;128(3):368-71). This increased incidence underlines the frequent co-occurrence of skin diseases of possibly autoimmune etiology.
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What are the reasons for Androgenic alopecia
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The reason for Androgenic alopecia..  
hormonal factors
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Androgenic alopecia  is the most commen type of hair in both sex or not.....
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yes Dr in both sexes,affecting high percentage of population worldwide.
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I live in an industrial area, particularly manufacture of steel and cellulose, and I have been observing an increasing incidence of AA in patients with no other comorbidities or autoimmune diseases. Only on this Friday, I had 3 new cases (attached photos).
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This can be multifactorial.  The cause can be the products itself, as well as the by products during the processes.  Even being exposed to a concentrated source of heat from a distance may be the cause.  Protective Gear or helmets can give off chemical substances that are influenced with the industrial product/byproduct to produce local effects on the scalp.  If all three are from the same company/same working location it is worth checking the conditions very carefully.  Alopecia areata may also have psychogenic cofactors.  keep that in mind also.
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Gómez-López-Hernández syndrome is a rare genetic disease characterized by scalp alopecia with trigeminal anesthesia, brachycephaly or turribrachycephaly, midface retrusion, and rhombencephalosynapsis.
What is your experience with this syndrome, which is the long-term prognosis?, is there any genetic study that certifies this diagnosis?
My patient have turribrachycephaly, prominent forehead, bilateral parietotemporal alopecia, strabismus. The  Magnetic resonance
imaging of the brain show complete rhombencephalosynapsis and hydrocephalus.
There are not many publications on this syndrome and I would like to know your experience
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It is a rare neurocutaneous syndrome with less than 40 cases described around the world. Given your expertise, I think it would be good to conduct a systematic review of cases available.
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is there any conclusive genetic testing for androgenic alopecia ?
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I never had knowledge of one. there are a lot of clinics that practice hair implantation for androgenic alopecia. I never heard about any rejection., but most of that stuff happen commercially
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Explanation about multiple lines of treatment of alopecia areata.
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Is super potent topical steroid (clobetasol) is effective or not?
If effective used alone or with other medication?
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I have an Australian cattle dog with alopecia. Have somebody any experience with colour dilution alopecia to help me with this clinical case?
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Color Dilution Alopecia
Also Known As: Color Mutant Alopecia
Transmission or Cause: This is a genetic defect affecting the way pigment is distributed in the hairs of affected dogs. Dogs with unusual haircoat coloration such as blue or fawn are affected. Abnormal pigment (melanin) clumping in the hairshafts and subsequent changes in light refraction are responsible for the unusual coloration, and in severely affected animals, excessive pigment clumping causes breakage of the hairshafts and abnormal or stunted hairgrowth.
Affected Animals: Dogs with blue or fawn haircoats. Doberman pinschers are often most severely affected, but it can occur in any breed. Color dilution alopecia does not occur in all dogs with blue or fawn coats, and the frequency varies within affected breeds.
Clinical signs: Hair breakage and hairloss in color dilute areas usually begins in late puppyhood or young adulthood and may progress to total hairloss over several years. The underlying skin is normal, but the hair follicles often become occluded with skin cells and fragments of broken hairs, leading to secondary bacterial skin infection/folliculitis. There is usually no itching unless secondary skin infection occurs, and there are no systemic signs of illness.
Diagnosis: It is necessary to rule out other causes of hairloss such as hormonal disorders or skin infections. Consideration of dog breed and coloration, demonstration of hairloss only in color dilute areas, and visualization of pigment clumping and hairshaft abnormalities when the hair is viewed under the microscope (trichogram) are all supportive of color dilution alopecia. Skin biopsy shows abnormal hairshafts and distorted hair follicles full of keratin and melanin.
Treatment: There is no cure for color dilution alopecia. Treatment is aimed at controlling secondary skin infections and avoidance of harsh grooming products and abrasive brushes which can worsen hair breakage. Mild shampoos containing sulfur and salicylic acid may be helpful in reducing follicular plugging. In some dogs, supplementation with oral melatonin or retinoids can be helpful to stimulate partial hairgrowth.
Prognosis: Although the prognosis for normal hairgrowth is poor, this is only a cosmetic disorder which does not interfere with an affected pet’s quality of life.
Prevention: Since this is a genetic disorder, prevention involves avoidance of breeding affected or carrier dogs.
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I found only Russian researches, but it is strange, because the medicine is from UK.
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Yes, there is only one Russian article regarding this extract, in literature (Vishniakova KhS, Popov KV, Voroteliak EA, Faĭzullin RR, Artiukhov AS, Egorov YE.Possible role of autophagy activation in the stimulation of regeneration.Mol Biol (Mosk). 2013 Sep-Oct;47(5):796-805.). It looks really interesting. However, the authors have not  provided  an enough and exact evident in this paper.
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I don´t know if I am sure, but during the World Congress of Hair Research (Miami Nov 18th-21st, 2015), Dr Elise Olsen presented some data from a "possible" North American Clinical Trial for Frontal Fibrosing Alopecia. Someone knows if it´s published and where I can find it?
Thanks!
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We need to look into common factors. Hormones are the likely link, and the only hormone source that makes sense as a stimulus at this point is the influence of the complex growth stimulating system known as milk (and all the products that are made with it). Could I ask you to consider the fact that the folliculosebaceous unit is actually the folliculopilosebaceous unit, composed of three distinctly different physiological units, all of which are impacted by the androgens and their fellow-travellers (and whey and casein-derived facilitators) present in dairy products. Melnik has written extensively on this (See PMID 23883112 and 22891897 Free PMC Articles) and we are finding it to be a very significant influence in acne vulgaris and acne inversa (hidradenitis suppurativa).
The 'system' facilitates anything that depends upon activation of the androgen receptors. Think acne, alopecia, weight gain, fat babies, etc etc etc.
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Dear Dr. Bashir Have you records that would allow a breakdown of the diets studied to isolate dairy foods and high-glycemic load foods from the others? Some carbohydrates are not a problem, some fats are not a problem, some proteins are not a problem, and some amino acids are not a problem.
But simple sugars raise insulin, butter and fatty cheeses contain androgens and their precursors, milk proteins contain whey and casein that increase insulin and IGF-1, and  branched-chain amino acids are also bioactive. The net result of these dairy and carbohydrate-related influences is the most likely stimulus to both increased weight and the acnes.
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In a hypothetical experiment, do you think that having a patient soak their scalp in a solution suspected to have hair growth promoting effects would be more beneficial than simply applying the solution topically with a dropper or fingertips? Especially if the solution contained herbal or natural ingredients that would not cause harm if introduced into the bloodstream. Say for 10 minutes soaking time and submerging the head in a bowl shapped apparatus or container filled with the solution.
Please explain why or why not. Thank you.
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hello
although it seems possible, but how simple or practical it is
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I´m starting a research about cicatricial alopecias and psychoemotional aspects related to the diagnosis of them. 
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Hello Ademir,
Have you considered the Patient Reportet Outcome Measurement Information System (PROMIS) initiative yet? It covers a set of tools/itembanks for measuring different aspects of health-related quality of life (mental, social, physical), using a flexible Item-Response Theory approach for development and evaluation. Especially the Depression and Anxiety scales are well-validated tools, applied in various patient populations. You can find more information here: http://www.nihpromis.org/measures/domainframework
Hope this helps - good luck!
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The loss of hair in male balding is the result of a gradual reduction in the duration of anagen and a prolongation of the latent period of the hair cycle, and miniaturization of terminal hair follicles.
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Dear Hassan thanks for sharing us opinion, medical school not usually learn us everything that's because it hasn't every informations so proposal for new research are pushing medicine forward. Elderly are usually whom suffering from androgenetic alopecia so that's might keep some energy for them. It is just a proposal no available evidence for the time being.
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Tufted hair folliculitis is a rare, progressive pattern of scarring alopecia that affects the scalp. Its characteristic feature is the presence of groups of 10-15 hairs emerging from a single follicular opening. The cause of this disorder is unknown.
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After failure of topical corticosteroids (clobetasol) and antiseptics, an option to treat severe tufted hair folliculitis (folliculitis decalvans) is a combination of systemic clindamycin plus rifampicin (both 300 mg twice daily for at least 2-3 months). There are a number of anecdotal reports on this treatment and I have successfully treated several patients myself. Alternatives include retinoids, TNF antagonists or laser (again, weak evidence).
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histopathology of skin sample is done to evaluate the extent of alopecia.
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Some drugs are recommended for androgenic alopecia but these may carry certain risks. In certain parts of the world bizarre natural remedies are used like camel's urine! Are they a myth?
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Natural Interventions for Alopecia Treatment
Some good potential sources have already been cited above. What I add here is a summary of my findings from a recent internal review I completed on the issue of natural interventions for alopecia. Note that I deliberately confine my attention solely to human clinical studies. What's important to note is that we have several natural agents that have a plausible degree of evidentiary support through based on human clinical data, and my own observation is that these may on their own provide clinically significant relief from alopecia, and they may also provide a synergistic or at least additive benefit to current conventional treatments (note; several other interventions - like millet seeds, among others - have shown some preliminary promise, but I focus on the more robust of the studies, to be updated as new evidence appears].
Essential Oils
A double-blind, placebo-controlled trial1 found efficacy for a treatment oil containing essential oils of thyme, rosemary, lavender, and cedarwood in a grape seed and jojoba oil base. The clinical significant benefit of essential oils in the treatment of alopecia was further confirmed in a randomized placebo-controlled double-blind study of a pulsed electromagnetic field in combination with essential oils2.
Vitamins/Minerals/ Amino Acids
Biotin/Zinc/Silicon: High - and potentially dangerous - dose zinc aspartate and biotin in combination showed preliminary benefit3 for alopecia areata in children, but I note that this was in conjunction with the ultrapotent corticosteroid clobetasol, a problematic deployment in children. In addition, biotin and niacin appear to have some preliminary positive activity4,5. And a proprietary form of silicon (choline-stabilized orthosilicic acid) has shown some promise6,7.
Cysteine: A combination oral supplement of cysteine, histidine, copper and zinc induced a significant mean change in total hair count in male and female patients8.
Melatonin
One double-blind study found that the pineal hormone melatonin, applied topically to the scalp as a 0.1% solution, may be helpful for women with diffuse hair loss9.
Vegetable/Fruit Based Interventions
Topical Onion/Garlic Extracts: Topical crude onion juice in the treatment of patchy alopecia areata was tested single-blind, placebo-controlled clinical study, hair regrowth being observed in 87% of patients treated with onion juice compared to only 13% of the control group10. And topical garlic gel was tested in conjunction with a corticosteroid, a beneficial effect being observed for the garlic gel on the therapeutic efficacy of topical corticosteroid therapy in patients with alopecia areata11.
Preliminary data12 also has found that topical khellin, an extract derived from the fruit of the Mediterranean plant khella ( Ammi visnaga) may promote new hair growth in combination therapy with ultraviolet light for alopecia areata.
Herbals and Phytochemicals
A combination of two herbals, peony-derived glucosides and licorice-dreived glycyrrhizin was tested in pediatric alopecia in a randomized controlled trial13 and found both safe and effective and an earlier RCT also confirmed efficacy in adults14. And the proanthocyanidine flavonoid procyanidine B induced significant mean changes from total hair count in male patients15.
Natural 5-α reductase (5AR) Inhibitors
One of the most extensively researched - and clinical successful - arenas of potential benefit dervies from natural 5-α reductase (5AR) inhibitors, given the fact that he conversion of testosterone to dihydrotestosterone (DHT) via the enzyme 5-α reductase (5AR) is a well-documented major contributing factor of alopecia disorders, and the same mechanisms is of course also implicated in the onset and progression of benign prostatic hyperplasia (BPH).
Curcumin: It is known that curcumin behaves as a natural 5-α reductase (5AR) inhibitor, and this activity was exploited in a multicenter, randomized, double-blind, placebo-controlled study16 which tested the efficacy of 5% hexane extract of Curcuma aeruginosa when added to 5% minoxidil, the combination inducing slowed hair loss and increased hair growth.
Saw Palmetto/Beta-sitosterol: A liposterolic extract of Saw Palmetto (Serenoa repens) and the plant sterol beta-sitosterol (found in Nigella sativa, Serenoa repens, Pygeum africanum, and sea-buckthorn, among other plant sources), both botanically derived 5AR inhibitors, were tested in a randomized, double-blind, placebo-controlled trial5 and found to induce a highly positive response.
Methodology for this Review
A search of the PUBMED, Cochrane Library / Cochrane Register of Controlled Trials, MEDLINE, EMBASE, AMED (Allied and Complimentary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, ISI Web of Science (WoS), BIOSIS, LILACS (Latin American and Caribbean Health Sciences Literature), ASSIA (Applied Social Sciences Index and Abstracts), and SCEH (NHS Evidence Specialist Collection for Ethnicity and Health) was conducted without language or date restrictions, and updated again current as of date of publication, with systematic reviews and meta-analyses extracted separately. Search was expanded in parallel to include just-in-time (JIT) medical feed sources as returned from Terkko (provided by the National Library of Health Sciences - Terkko at the University of Helsinki). Unpublished studies were located via contextual search, and relevant dissertations were located via NTLTD (Networked Digital Library of Theses and Dissertations) and OpenThesis. Sources in languages foreign to this reviewer were translated by language translation software.
References
  1. Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol. 1998;134:1349-1352.
  2. Bureau JP, Ginouves P, Guilbaud J, Roux ME. Essential oils and low-intensity electromagnetic pulses in the treatment of androgen-dependent alopecia. Adv Ther 2003 Jul-Aug; 20(4):220-9.
  3. Camacho FM, Garcia-Hernandez MJ. Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatr Dermatol. 1999;16:336-338.
  4. Draelos ZD, Jacobson EL, Kim H, Kim M, Jacobson MK. A pilot study evaluating the efficacy of topically applied niacin derivatives for treatment of female pattern alopecia. J Cosmet Dermatol 2005; 4(4): 258–61.
  5. Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med 2002; 8(2):143-52.
  6. Barel A, Calomme M, Timchenko A, et al. Effect of oral intake of choline-stabilized orthosilicic acid on skin, nails and hair in women with photodamaged skin. Arch Dermatol Res. 2005 Oct 5. [Epub ahead of print].
  7. Wickett RR, Kossmann E, Barel A, et al. Effect of oral intake of choline-stabilized orthosilicic acid on hair tensile strength and morphology in women with fine hair. Arch Dermatol Res. 2007 Oct 25. [Epub ahead of print].
  8. Morganti P, Fabrizi G, James B, Bruno C. Effect of gelatin-cystine and serenoa repens extract on free radicals level and hair growth. J Appl Cosme-tol 1998; 16(3): 57–64.
  9. Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004;150:341-345.
  10. Sharquie KE, Al-Obaidi HK. Onion juice (Allium cepa L.), a new topical treatment for alopecia areata. J Dermatol 2002 Jun; 29 (6): 343-6.
  11. Hajhydari Z, Jamshidi M, Akbari J, et al. Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study. Indian J Dermatol Venereol Leprol 2007 Jan-Feb; 73 (1): 29-32.
  12. Tritrungtasna O, Jerasutus S, Suvanprakorn P. Treatment of alopecia areata with khellin and UVA. Int J Dermatol. 1993;32:690.
  13. Yang D, Zheng J, Zhang Y, Jin Y, Gan C, Bai Y. . Total glucosides of paeony capsule plus compound glycyrrhizin tablets for the treatment of severe alopecia areata in children: a randomized controlled trial. Evid Based Complement Alternat Med 2013; 2013:378219.
  14. Yang DQ, You LP, Song PH, Zhang LX, Bai YP. A randomized controlled trial comparing total glucosides of paeony capsule and compound glycyrrhizin tablet for alopecia areata. Chin J Integr Med 2012; 18(8):621-5.
  15. Kamimura A, Takahashi T, Watanabe Y. Investigation of topical application of procyanidin B-2 from apple to identify its potential use as a hair growing agent. Phytomedicine 2000; 7(6): 529–36.
  16. Pumthong G, Asawanonda P, Varothai S, et al. Curcuma aeruginosa, a novel botanically derived 5α-reductase inhibitor in the treatment of male-pattern baldness: a multicenter, randomized, double-blind, placebo-controlled study. J Dermatolog Treat 2012; 23(5):385-92.
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I am very willing to know the answers.
Thanks a lot for your kind comments and suggestions.
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Hello Su. I agree with Abdul's answer.
Have a look at PRP (platelet rich plasma) for alopecia.
This is a relatively new and safe way to treat different kinds of alopecia.
It deserves the research time and clinical applications.
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Thanks in advance.
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Hello Colleagues,
Even though my comment was written many months ago, after reading some new opinions I should like to add some short remarks: 1) There is no a single drug or remedy that cannot cause a side effect, at least in some individuals; 2) In my long term practice I have seen very few and always minor problems with finasteride 1mg in MAGA, as I mentioned in my previous annotation; 3) As urologists utilize higher doses and their patients are generally older than ours it is natural that they observe side effects more frequently.
Dr. Ali Abdil Razzaq Muhammed Noori Aldallal emphasizes the need of a clear explanation to the patients about how and when the pills must be taken. Really this is not a dangerous drug however he is right and I fully agree in the importance of meticulous information as the patients will take this medication for long time, maybe with no regular medical control.
It is a pleasure to exchange these comments with all of you. Best regards.
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I have noticed that, in some individuals, alopecia is associated with low HDL-cholesterol.
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I found few patient with Androgenetic alopecia have increased risk of cardiovascular
Disease
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Alopecia.
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Thank you so much for so expedite reply, if you find later any one, please let me know.
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This is a research I want to start as soon as I get a better model.
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Perhaps, this document could be of help.
J Investig Dermatol Symp Proc. 2015 Nov; 17(2): 23–26. doi: 10.1038/jidsymp.2015.35
Animal Models for Alopecia Areata: What and Where?
Best regards