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Expert Opinion on Pharmacotherapy Jun 2012Hair loss is a very common complaint. The diagnosis is based on clinical, dermoscopic and pathological examination. The treatment is usually continuous and requires... (Review)
Review
INTRODUCTION
Hair loss is a very common complaint. The diagnosis is based on clinical, dermoscopic and pathological examination. The treatment is usually continuous and requires strong compliance.
AREAS COVERED
This article aims to i) summarize current treatment options for the most common forms of hair loss; ii) update the literature on treatment options to emerge over the 3 years since the release of the first edition of this article in 2009; and iii) outline future strategies for treating alopecia.
EXPERT OPINION
There is good evidence-based information for the treatment of androgenetic alopecia. There are very few good-quality randomized studies, and no information about long-term results for most of the available treatments for alopecia areata and cicatricial alopecias. Significant research success has been achieved over the past few years through i) discovering the genetic profile of alopecia areata; ii) working on follicular neogenesis in androgenetic alopecia; and iii) discovering the PPAR-γ pathway in scarring alopecia.
Topics: Alopecia; Animals; Drug Discovery; Evidence-Based Medicine; Hair; Humans; Risk Factors; Treatment Outcome
PubMed: 22594679
DOI: 10.1517/14656566.2012.685160 -
The Journal of Investigative Dermatology Jul 2023Although progress has been made in developing outcome measures for AA, the use of these measures remains unstandardized. A scoping review was conducted to identify the... (Review)
Review
Although progress has been made in developing outcome measures for AA, the use of these measures remains unstandardized. A scoping review was conducted to identify the clinician-reported outcome measures (ClinROMs) and patient-reported outcome measures (PROMs) used in assessing and treating AA, the results of which revealed heterogeneity in AA outcome measures. Of 23 research studies ultimately included, only 2 ClinROMs were used by >15% of studies; likewise, of 110 clinical trials evaluated, numerous outcome instruments were used, but only one ClinROM was used by >5% of trials (Severity of Alopecia Tool). These results suggest the need for consensus and standardization in both research and trial settings.
Topics: Humans; Alopecia Areata; Alopecia; Outcome Assessment, Health Care; Patient Reported Outcome Measures; Psychometrics
PubMed: 37115113
DOI: 10.1016/j.jid.2023.02.020 -
Journal of the American Academy of... Apr 2009Clinical scarring alopecia in African American women has been recognized for years. The classification of this unique form of alopecia dates back to Lopresti, who first... (Review)
Review
Clinical scarring alopecia in African American women has been recognized for years. The classification of this unique form of alopecia dates back to Lopresti, who first described the entity called "hot comb alopecia." More recently, the term "central centrifugal cicatricial alopecia" has been adopted to describe a progressive vertex-centered alopecia most common in women of African descent. While this form of hair loss is widely recognized, and may even be on the rise, the causes of central centrifugal cicatricial alopecia are a constant source of debate and remain to be elucidated. This review outlines the descriptive evolution of central centrifugal cicatricial alopecia and the historical controversies ascribed to its pathoetiology; it also examines African hair structure and discusses how hair structure along with common physical and chemical implements utilized by individuals with African hair type may play a causal role in the development of central centrifugal cicatricial alopecia.
Topics: Black or African American; Alopecia; Forecasting; Hair; Humans; Hygiene; Terminology as Topic
PubMed: 19293013
DOI: 10.1016/j.jaad.2008.09.066 -
Skin Therapy Letter Jul 2016Frontal fibrosing alopecia, described just over 20 years ago, has become one of the most frequently seen causes of scarring alopecia at many specialist hair clinics....
Frontal fibrosing alopecia, described just over 20 years ago, has become one of the most frequently seen causes of scarring alopecia at many specialist hair clinics. Considered a clinical variant of lichen planopilaris (LPP), it has distinctive features and associations which distinguish it from LPP. Although largely affecting postmenopausal women, a small but increasing number of men and premenopausal women are affected. The spectrum of the disease has expanded from involvement of the frontal hairline and eyebrows, to potentially affecting the entire hairline, facial and body hair. Genetic and environmental factors have been implicated but the aetiology remains uncertain. A range of treatments have been used in management of the condition, but clinical trials are required to establish effectiveness.
Topics: Alopecia; Environment; Female; Fibrosis; Humans; Lichen Planus; Male
PubMed: 27388531
DOI: No ID Found -
Postgraduate Medicine Aug 1997Some degree of hair loss with aging is inevitable in both men and women. The exact underlying mechanism is not well understood. Although genetic factors have a role in... (Review)
Review
Some degree of hair loss with aging is inevitable in both men and women. The exact underlying mechanism is not well understood. Although genetic factors have a role in the development of androgenetic alopecia, the outcome in an individual patient cannot be reliably predicted on the basis of family history. Balding tends to begin earlier in men and to develop in well-recognized patterns. Women have more diffuse hair loss that often occurs after menopause. The available treatment options, such as topical minoxidil therapy, hair transplantation, and other surgical techniques, are not very successful. Lessening patients' anxiety about hair loss by reassuring them that they will not go totally bald immediately may be the most effective management.
Topics: Alopecia; Female; Humans; Male
PubMed: 9270705
DOI: 10.3810/pgm.1997.08.289 -
Journal of the American Academy of... Sep 2014Hair loss (alopecia) is a common problem and is often a major source of distress for patients. The differential diagnosis of alopecia includes both scarring and... (Review)
Review
Hair loss (alopecia) is a common problem and is often a major source of distress for patients. The differential diagnosis of alopecia includes both scarring and nonscarring alopecias. In addition, many hair shaft disorders can produce hair shaft fragility, resulting in different patterns of alopecia. Therefore, an organized and systematic approach is needed to accurately address patients' complaints to achieve the correct diagnosis. Part 1 of this 2-part continuing medical education article on alopecia describes history taking and the clinical examination of different hair loss disorders. It also provides an algorithmic diagnostic approach based on the most recent knowledge about different types of alopecia.
Topics: Alopecia; Alopecia Areata; Beauty Culture; Diagnosis, Differential; Humans; Hyperandrogenism; Physical Examination; Prognosis; Scalp; Stress, Psychological; Trichotillomania
PubMed: 25128118
DOI: 10.1016/j.jaad.2014.04.070 -
Deutsches Arzteblatt International May 2016Hair loss is caused by a variety of hair growth disorders, each with its own pathogenetic mechanism. (Review)
Review
BACKGROUND
Hair loss is caused by a variety of hair growth disorders, each with its own pathogenetic mechanism.
METHODS
This review is based on pertinent articles retrieved by a selective search in PubMed, on the current German and European guidelines, and on the authors' clinical and scientific experience.
RESULTS
Excessive daily hair loss (effluvium) may be physiological, as in the postpartum state, or pathological, due for example to thyroid disturbances, drug effects, iron deficiency, or syphilis. Androgenetic alopecia generally manifests itself in women as diffuse thinning of the hair over the top of the scalp, and in men as receding temporal hairlines and loss of hair in the region of the whorl on the back of the head. Alopecia areata is patchy hair loss arising over a short time and involving the scalp, eyebrows, beard, or entire body. The hair loss of alopecia areata is reversible in principle but hard to treat. Folliculitis decalvans is a form of alopecia with scarring, characterized by inflamed papules, pustules, and crusts at the edges of the lesions. Lichen planopilaris generally presents with small patches of baldness, peripilar erythema, and round areas of skin scaling. Kossard's frontal fibrosing alopecia is characterized by a receding hairline and loss of eyebrows.
CONCLUSION
Hair loss is a symptom, not a diagnosis. The pathogenesis of the alopecias involves a range of genetic, endocrine, immune, and inflammatory processes, each of which calls for its own form of treatment.
Topics: Alopecia; Combined Modality Therapy; Dermatologic Agents; Diagnosis, Differential; Evidence-Based Medicine; Finasteride; Hair; Hormone Replacement Therapy; Humans; Minoxidil; Scalp Dermatoses; Treatment Outcome
PubMed: 27504707
DOI: 10.3238/arztebl.2016.0377 -
International Journal of Dermatology 1982
Review
Topics: Alopecia; Biopsy; Diagnosis, Differential; Female; Folliculitis; Hair; Humans; Male; Scalp; Sex Factors
PubMed: 6749712
DOI: 10.1111/j.1365-4362.1982.tb03137.x -
Seminars in Diagnostic Pathology Feb 1996Histologic evaluation for alopecia can be difficult and in part can be attributed to confusing categorization and limited information derived from examination of... (Review)
Review
Histologic evaluation for alopecia can be difficult and in part can be attributed to confusing categorization and limited information derived from examination of traditionally prepared biopsy specimens. The transverse section technique has many advantages, and with experience is the preferable method for evaluating specimens for alopecia. Using this technique, numerous follicles can easily be seen in one tissue profile allowing evaluation of follicular density, follicular unit morphology, and follicular growth dynamics, ie, anagen-telogen ratio. Specimens are categorized as scarring or nonscarring alopecia, and further diagnostic criteria discussed herein assist the pathologist in making specific diagnoses of nonscarring and scarring alopecias. Scarring alopecia may be primary or secondary, and primary scarring alopecias are further classified as lymphocyte-associated and neutrophil-associated. Although the clinical impression is very important in diagnosing alopecia, transversely sectioned biopsy specimens can greatly aid the diagnosis and management of patients with alopecia.
Topics: Alopecia; Biopsy; Diagnosis, Differential; Humans; Microtomy; Scalp
PubMed: 8834512
DOI: No ID Found -
Acta Dermatovenerologica Alpina,... Dec 2021Cicatricial alopecia (CA) results from irreversible destruction and fibrosis of hair follicles. Trichoscopy offers a noninvasive method for diagnosis.
INTRODUCTION
Cicatricial alopecia (CA) results from irreversible destruction and fibrosis of hair follicles. Trichoscopy offers a noninvasive method for diagnosis.
METHODS
Thirty-two patients clinically diagnosed with CA were subjected to trichoscopy and histopathology assessment. The sensitivity and specificity of clinical and trichoscopic diagnoses were compared to histopathology.
RESULTS
Thirty-two patients were clinically diagnosed as follows: 12 with discoid lupus erythematosus, four with lichen planopilaris (LPP), two with frontal fibrosing alopecia (FFA), three with folliculitis decalvans (FD), nine with central cicatricial centrifugal alopecia (CCCA), and two with long-term alopecia areata. Trichocopy revealed discoid lupus in 13 patients, LPP in nine, FFA in two, FD in three, central centrifugal alopecia in four, and pseudopelade in one. Histopathology confirmed discoid lupus in 13 patients, LPP in five, FFA in two, FD in three, CCCA in six, pseudopelade in two, and sarcoidosis in one. The sensitivity and specificity of clinical diagnosis were 69.2% and 84.2% in discoid lupus, 40.0% and 92.6% in LPP, 100.0% and 100.0% in FFA, 66.7% and 96.6% in FD, and 66.7% and 80.8% in central centrifugal alopecia. The sensitivity and specificity of trichoscopy were 84.6% and 89.5% in discoid lupus, 100.0% and 85.2% in LPP, 100.0% and 100.0% in FFA and FD, 66.7% and 100.0% in central centrifugal alopecia, and 50.0% and 100.0% in pseudopelade.
CONCLUSIONS
Trichoscopy can be equivalent to histopathology for diagnosing some cases of CA.
Topics: Alopecia; Humans
PubMed: 34929988
DOI: No ID Found