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Patchy Nonscarring Alopecia

Alopecia areata (Fig 2 Zi1.) is said to account for between 1 and 3 of new patient visits to the offices of dermatologists. Prevalence is 0.1 to 0.2 of the population. It is a nonscarring, usually patchy but sometimes diffuse, hair loss of unclear cause. Many cases are familial, and it is believed that there may well be an autoimmune etiology. It is seen more commonly in patients with atopic dermatitis, thyroid disease, vitiligo, and Down syndrome. Usually this disease presents as asymptomatic, totally bald areas. Exclamation-point hairs are often noted at the margin of the bald spots. These are broken-off hairs that are thicker distally and thinner proximally near the scalp like the top part of an exclamation point ( ) and are considered pathognomonic of alopecia areata. Factors that bode a bad prognosis are young age at onset, extensive early hair loss, and associated atopy. If all the scalp hair is lost, the term alopecia totalis (Fig 27-2) is used and if all body hair is lost,...

Diffuse Nonscarring Alopecia

Loss of up to one half of the scalp hair may occur without clinically obvious hair loss. Among the more common causes of nonscarring hair loss are androgenic hair loss, telogen effluvium, alopecia areata, and tinea. An appropriate history and laboratory testing are necessary ( Iable.27-3). Table 27-3 Laboratory Studies to Evaluate Nonscarring Alopecia One must exclude syphilis, thyroid disease, iron deficiency, drug-induced ( Ta.b e ,.27.-.4) and toxin-induced (thallium, boric acid, heavy metal) causes, and systemic lupus erythematosus and dermatomyositis as etiologic factors. When acne and hirsutism or other reasons make one suspect an androgen excess, appropriate hormonal studies should be done. Careful questioning about current or recent illness, past medical history, weight loss, recent childbirth in women, drug ingestion, hairdressing procedures, and family history of baldness is important. Table 27-4 Some Drugs That Can Cause Alopecia Androgenetic hair loss (also called pattern...

Figure 276 Hair loss alopecia due to alopecia cicatrisata scarring Neutrogena Skin Care Institute

Alopecia of the scalp is of considerable concern to both men and women. It is helpful in differentiating among the many causes of alopecia to examine the hair and scalp and observe whether the hair loss is diffuse or patchy and whether the scalp appears scarred. A careful history and physical examination of the hair and scalp is most important. Nonscarring hair loss is more common than scarring hair loss ( Table27 2). Table 27-2 Types of Nonscarring and Scarring Hair Loss

Alopecia Areata

Topical corticosteroids and topical anthralin may be helpful and are fairly safe treatments for alopecia areata. Intralesional corticosteroids and psoralens with ultraviolet light have been used. Generally the adverse effects of systemic corti-costeroids do not warrant their use. Appropriate referrals for hairpieces and informing the patient of the existence of the National Alopecia Areata Foundation (P.O. Box 150760, San Rafael, CA 94915-0760 telephone 415-456-4644) for education information and local support group information are often helpful in this frequently very stress-producing disorder that lacks an effective treatment. 2. Clomipramine (Anafranil) has been reported effective for some patients with trichotillomania. Scarring (Cicatricial) Alopecia As skin disorders that can lead to a scarring hair loss one should include discoid lupus erythematosus, scleroderma, lichen planus (lichen planopilaris), fungal infections, and prolonged inflammatory tinea. Metastatic carcinoma and...

Iiiidentifying phenotype

It is important, when establishing a colony of potentially mutant mice, to examine all mice as soon after birth as possible and at regular intervals (at least every other day during the first two weeks) thereafter. Defects may be observable at birth that make the mutants easy to identify (as is seen in flaky skin fsn mice, which have a mild anemia at birth,6 or juvenile alopecia jal mice, which have easily identifiable abnormalities of the vibrissae as early as 2 to 3 days of age).7 Other defects may develop as the mouse ages, as in harlequin ichthyosis (ichq) mice, which are normal until 5 days of age when they develop thick, scaling skin, then die by 10 to 12 days of age,8 or matted (ma) mutants, in which the hairs form matted clumps, such that mutants can be identified at 2 to 4 weeks of age,9 and chronic proliferative dermatitis (cpdm), in which the skin lesions become apparent at 4 to 6 weeks of age.10 Some defects may even disappear as the animal ages, as with flaky tail (ft),...

Telomeres and Organismal Aging

Generation 3 TERC knockout mice displayed an increased incidence of hair graying, hair loss, and skin lesions over time. These observations correlated inversely with telomere length in the animals, suggesting a link between the two. The aged generation 3 TERC- - animals displayed decreased bodyweight, suffered from an impaired stress response, and a decreased wound healing capacity. Although the mice did not suffer from the full spectrum of age-related pathophysiological symptoms of aging, a critical role of telomeres for the overall fitness and well-being of aging organisms could be demonstrated (Rudolph et al. 1999 see also Chang, this volume).

Clinical Evaluation of Isolated ROA1 Family

Four out of the five sibs of the ROA1 family (Figure 4.3) were affected with an isolated, early-onset but slowly progressive optic neuropathy. Between 2 and 6 years of age, all patients complained of a visual impairment that could not be corrected by glasses. At age 10, fundus examination, fluorescein angiography, visual field testing, colour vision analysis and electrophysiological recordings of individual V2, led to the diagnosis of optic atrophy without retinal degeneration. The three younger sibs displayed the same phenotype (Figures 4.1 and 4.2). In all affected sibs, the progression of the disease was very slow (visual acuity ranging from 1 10 to 2 10 for distant vision at 36 < age of patients < 45 years old). Moderate photophobia and dyschromatopsia with red-green confusion was noted. None of the four patients had nystagmus. Both parents (IV1 and IV2), and V1 underwent complete ophthalmologic exploration and no symptom of optic neuropathy was noted. A normal ocular pressure...

Is the phenotypic deviant genetically determined

This is the first question to be addressed. The answer will come from two directions. First, one should investigate any change in environmental factors that could account for the phenotype infectious diseases, food, temperature, humidity, breeding and husbandry procedures, etc. For example, with alopecia and skin lesions in

What are the symptoms in adults

The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed up to 10 weeks. The rash often appears as rough, copper penny spots on the palms of the hands and bottom of the feet. The rash may also appear as a prickly heat rash, as small blotches or scales all over the body, as a bad case of old acne, as moist warts in the groin area, as slimy white patches in the mouth, as sunken dark circles the size of a nickel or dime, or as pus-filled bumps like chicken pox. Some of these rashes on the skin look like those of other diseases. Sometimes the rashes are so faint they are not noticed. Rashes last 2-6 weeks and clear up on their own. In addition to rashes, second stage symptoms can also include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when first or second stage...

Telomerase and Ageing

Late generations of mTR knockout mice and DC patients share similar pheno-types in terms of hair loss or early greying of hair, increased incidence of malignancy, decreased capacity for wound healing, and telomere shortening, which are common to the process of normal ageing. Furthermore, several syndromes diseases have also been considered to be related to telomere shortening, and have been referred to as premature ageing syndromes. These include cardiovascular disease (Cawthon et al. 2003), hypertension (Serrano and Andres 2004), paroxysmal nocturnal hemoglobinuria (PNH) (Beier et al. 2005), Fanconi anemia (Franco et al. 2004), Werner syndrome (Chang et al. 2004), ataxia telangiectasia (Metcalfe et al. 1996), Bloom syndrome (Cohen and Sinclair 2001), and Nijmegen breakage syndrome (Paull and Gellert 1999). In this chapter, DC, which is caused by mutations in the components of telomerase ribonucleoprotein complex, will be discussed in order to understand the role of telomerase in a...

Clinical Presentation of Dyskeratosis Congenita

DC is also known as Zinsser-Engman-Cole syndrome (Zinsser 1906, Engman 1926, Cole et al. 1930). Classically DC is characterized by the triad of abnormal skin pigmentation, nail dystrophy, and mucosal leukoplakia. A variety of other noncutaneous abnormalities have also been reported since its first description (Table 5.1), including dental caries, tooth loss, esophageal webs, epiphora, short stature, developmental delay, hypogonadism, osteoporosis, pulmonary disease, premature grey hair, and hair loss (Trowbridge et al. 1977, Womer et al. 1983, Wiedemann et al. 1984, Zijlmans et al. 1997, Knight et al. 1998, Solder et al. 1998, Dokal 2000, Mason et al. 2005). Hair loss early graying

Associated Medical Findings

Skeletal abnormalities like kyphoscoliosis and pes cavus, as well as diabetes and cardiac symptoms, are associated with Friedreich's ataxia. Cold intolerance, dry skin, and hair loss indicate hypothyroidism. Pulmonary and gynecological examination might show signs of bronchial or ovarian carcinoma, respectively. Cervical adenopathy might reveal Hodgkin's disease. Subacute, reversible ataxia associated with pyrexia suggests viral cerebellitis. Repeated bronchopulmonary infections suggest ataxia-telangiectasia. Examination of the cardiovascular system might disclose a structural cardiac lesion or rhythm disturbances, which indicate a possible

Differential Diagnosis

Seborrheic dermatitis Lesions greasy, red, scaly, associated with scalp dandruff occurs in eyebrows and scalp without hair loss response is rapid to antiseborrheic local therapy, and sunlight tends to improve seborrhea (see Chap 13). Cases with scarring alopecia (see Fig 2.7.-6) are to be differentiated from alopecia cicatrisata (see Chap 27), old tinea capitis of endothrix type (see Chap 19), lichen

Appearance Preoccupations

Individuals with BDD are preoccupied with the idea that some aspect of their appearance is unattractive, deformed, ugly, or not right, when the perceived flaw is actually minimal or nonexistent (Phillips et al. 1993). Some patients describe themselves as hideous, repulsive, or looking like the Elephant Man (Phillips 1996a). Preoccupations usually involve the face or head, most often the skin, hair, or nose (e.g., acne, scarring, pale or red skin, thinning hair, a large or crooked nose). However, any body part can be the focus of concern, and patients typically worry about three or four body areas over the course of their illness (Phillips et al. 1993). In some cases, individuals with BDD report disliking their overall appearance or say they are generally ugly, because

Comparison to human diseases

An efficient way to determine if a new mutation is a likely candidate for a new model for a specific human disease would be to review the preliminary findings with a physician to narrow the differential diagnosis. Ideally, this review should be done collaboratively with a specialist. A thorough literature search, beginning with such databases as the Mouse Genome Database or Online Mendelian Inheritance of Man (see above), will often yield many helpful references on the disease. This literature review will provide data to create a table of all features reported to occur with the human disease and rank them in terms of importance or frequency. From these data, a matching list for the mouse mutation can be developed. This matching list provides a simple and rapid way to compare features and provides criteria to search for in the mutant mouse mutation and to determine which clinical features or clinical chemistry criteria should be investigated. For example, a mouse with hair loss or...

RAI Causes Your Hair to Fall

People say this because they're confusing RAI with external radiation therapy, which also doesn't cause hair loss unless the scalp is radiated. People may also be confusing this treatment with chemotherapy, which often causes hair loss. That said, hair loss during and after the hypothyroid preparation for radioiodine scanning or therapy is consequent to the changes in thyroid hormone status. It is completely unrelated to the radioactive iodine or to any radiation effect. All such hair loss is completely replaced by natural growth when the thyroid hormone levels are restored. It is typically minimal or unnoticed in most people, but some people seem to be particularly susceptible.

Disease Affecting the Hair

Alopecia areata (Fig 33-29) (see Chap, .27) a common disorder presenting with a sudden appearance of patches of smooth, sharply defined areas of hair loss. Short, tapering, exclamation point hairs tend to narrow as they enter the scalp. It is considered to be an autoimmune process involving the hair and has been associated with thyroiditis. The prognosis depends on the extent of the hair loss (the less the better), the area involved, and chronicity. The most commonly prescribed therapy is topical or intralesional corticosteroids. tonsurans) shows broken-off hairs and minimal inflammation making the diagnosis difficult. Fungal culture and potassium hydroxide mount can be diagnostic. The infection may be asymptomatic or present as seborrhea or inflammatory lesions of the scalp. A kerion (especially M. canis) is an inflammatory lesion with a pus-filled, boggy mass with hair loss. Treatment is with oral griseofulvin for at least 2 months. Newer antifungal agents (itraconazole,...

Abridged Dictionaryindex

Pustular Bacterid

Condition of zinc deficiency manifested by inflammatory periorificial and acral dermatitis, alopecia, and diarrhea. When zinc was added to pediatric formulas and to hyperalimentation regiments it became rare. Autosomal recessive. Alopecia, 88, 270-275. From the Greek alopekia, meaning hair loss. areata, 38, 94, 272-275, 273f, 274f, 371, 371f be bilateral. (See congenital triangular alopecia).

Mitochondrial DNA Mutations and Aging

The introduced mutation was designed to create a defect in the proofreading function of Polg, leading to the progressive, random accumulation of mtDNA mutations during the course of mitochondrial biogenesis. As the proofreading in the knockin mice is efficiently prevented, these mice develop an mtDNA mutator phenotype (mtDNA mutator mice) with a three to fivefold increase in the levels of point mutations, as well as increased amounts of deleted mtDNA molecules 75 . In contrast to the mitochondrial theory of aging, we have shown that the levels of somatic mtDNA mutations accumulate at a higher rate during the time of development from oocytes to early embryonic life of mtDNA mutator mice, than during the rest of their life when mutations accumulate in rather linear fashion 76 . The mtDNA mutator mice display a completely normal phenotype at birth and in early adolescence but subsequently acquire many features of premature aging. The increase in somatic...

Miscellaneous disorders affecting the hair

Propecia and Rogaine extra strength for alopecia. Med Lett 1998 40 25. Barrett S. Commercial hair analysis Science or scam JAMA 1985 254 1041. Dawber R. Hair and scalp disorders Common presenting signs, differential diagnosis and treatment. Philadelphia, Lippincott-Raven, 1995. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for androgenetic alopecia. J Am Acad Dermatol 1996 35 465. Elston DM, et al. Bubble hair. J Cutan Pathol 1992 19 439. Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia a frontal variant of lichen planopilaris. J Am Acad Dermatol 1997 36 59. Sharma VK. Pulsed administration of corticosteroids in the treatment of alopecia areata. Int J Dermatol 1996 35. Sommer S, Render C, Burd R, Sheehan-Dare R. Ruby laser treatment for hirsutism Clinical response and patient tolerance. Br J Dermatol 1998 138 1009. Sperling LC, Sau P. The follicular degeneration syndrome in black patients hot comb alopecia revisited and revised....

Progressive Diseases of Infancy and Childhood

Figure 31-3 Glutaricaciduria, biotinidase deficiency and biopterin-dependent phenylketonuria. Clockwise from left upper corner. Infant with glutaricaciduria type I (GAT I) showing dystonic posture and rigidity in flexion. MRI of the brain showing open operculum sign and frontotemporal atrophy in infant with GAT I. Alopecia in a biotinidase-deficient 9-month-old infant with frequent myoclonic seizures from age 3 months. Infant with biopterin-dependent phenylketonuria due to 6-pyruvoyl tetrahydropterin synthase (6-PTS) deficiency showing dystonic grimacing and fisting of hands and hypotonic pithed frog posture of legs. The reason for selective targeting of the auditory center is unknown. Alopecia (see Fig, 31 -3 ) and dermatitis in these patients are possible owing to depletion of fatty Biotin-responsive mild forms of HCS deficiency and milder forms of propionicacidemia must be ruled out by clinical and laboratory observations. Alopecia and rash can be encountered in deficiency of zinc...

Step 4 Elevation of the Coronal Flap and Exposure of the Zygomatic Arch

Superficial Fat Pad Name

After elevation of the anterior and posterior wound margins for 1 to 2 cm, hemostatic clips (Raney clips) are applied or bleeding vessels are isolated and cauterized. Indiscriminate cauterization of the edge of the incised scalp can result in areas of alopecia and should be avoided. A technique to expedite clip removal before closure involves positioning an unfolded gauze sponge the cut edge of the scalp before clip application. The gauze can be pulled off the scalp before closure, removing the accompanying row of clips. In some instances, bleeding encountered during the procedures is from small emissary veins exiting through the pericranium or exposed skull. Cauterization, bone wax, or both are useful for these vessels.

Clinical evaluation

Ear Notching Mice

Live mice should be carefully examined for both behavioral and physical abnormalities. Most homozygous recessive mutations (m m) are available with heterozygotes (+ m) or wild-type (+ +) age- and sex-matched controls on the same genetic background (where m the mutant gene being studied, and + the normal, or wildtype, gene). Controls should be examined side by side with mutants as a basis for comparison. Familiarity with the normal phenotype of the background strain is essential in assessing the phenotypic variances of the mutant, and is also important in determining the presence of disease. Many infectious diseases in mice can present as behavioral abnormalities, such as circling or torticollis associated with middle ear infections. If these are evident in both mutant and control mice, it will be important to do infectious disease surveillance studies on the colony. Some mutations have clinical phenotypes that resemble infectious diseases, such as cutaneous scaling (possibly ringworm)...

Clinical Manifestations

Doses of even a few Gray will cause temporary alopecia. Recovery takes 8-12 weeks after the end of treatment the hair starts re-growing at that point and usually grows at a normal rate thereafter. The hair can return a different texture or color the same phenomenon occurs after chemotherapy. Doses of 40 Gy and above to the hair follicles will cause permanent alopecia. Alopecia occurs through damage to the hair follicles. It is the most predictable skin reaction to chemotherapy. Drugs that cause alopecia include cyclophosphamide, doxorubicin, dactinomycin and others - the list of agents is very long. Alopecia of the scalp does not appear to require a large threshold dose and occurs after each cycle of the drug however, it is almost always reversible. Alopecia involving the eyelids and eyelashes is less predictable. Usually it requires higher and more prolonged courses of chemotherapy, but when it happens, it may sometimes be permanent 66 . In addition, permanent alopecia of the scalp...

Step 1 Locating the Incision Line and Preparation

Two factors are considered when designing the line of incision. The first is the hairline of the patient. In males, expected recession at the widow's peak as well as male pattern baldness should be contemplated. The incision for balding males might be placed along a line extending from one preauricular area to the other, several centimeters behind the hairline (Fig. 6-7), or even more posteriorly. Incision made farther posteriorly need not reduce access to the operative field, because Figure 6- 8 Incision placement for most female patients and males with no signs or family history of baldness. The incision is kept approximately 4 cm behind the hairline. Figure 6- 8 Incision placement for most female patients and males with no signs or family history of baldness. The incision is kept approximately 4 cm behind the hairline.

The Numbers of Cancer Survivors Who Encounter Employment Problems

Unlike many years ago, when cancer was a literal death sentence, today, most working-age survivors return to work 6 . Helen Crothers' summary of several studies from the 1970s and 1980s concluded that 80 of employees returned to work after being diagnosed with cancer 6 . Physicians are now more aware of cancer survivors' employment problems 16 and offer more flexible outpatient treatment programs to accommodate survivors' work schedules 5 .They also have an improved medical arsenal with which to combat the side effects of cancer,such as the risk of infection, nausea and hair loss 8 .

Rickettsia Slovaca Tickborne Lymphadenopathy And Dermacentorbornenecrosiserythemalymphadenopathy


The number of R. slovaca infections in Europe is still, probably, under-evaluated. From January 1996 to April 2000, its role in this syndrome was evaluated in 67 patients from France and Hungary presenting with TIBOLA (112). A total of 17 cases of R. slovaca infection were confirmed in this cohort by molecular methods. Recently, 14 patients were reported from southern France. It has been suggested that R. slovaca may be responsible for as much as 25 of SFG rick-ettsioses in this region (113). Infections were most likely to occur in children and in patients bitten by a tick during the colder months of the year. Fever and rash were uncommon and sequelae included localized alopecia at the bite site and chronic fatigue. Similar cases have also recently been reported in Bulgaria (114) and Spain (115). Finally, the isolation of R. slovaca from a patient has been recently reported, providing definitive evidence that R. slovaca is a human pathogen (116). treatment doxycycline, except for a...

Seborrheic dermatitis

Certain misconceptions that have arisen concerning this common dermatosis need to be corrected. Seborrheic dermatitis cannot be cured, but remissions for varying amounts of time do occur naturally or as the result of treatment. Seborrheic dermatitis does not cause permanent hair loss or baldness unless it becomes grossly infected. Seborrheic dermatitis is not contagious. The cause is unknown, but an important etiologic factor is the yeast Pityrosporum ovale. 1. Management of cases of dandruff must include explaining the disease and stating that it is not contagious, that there is no true cure, that it will not cause baldness, and that there are seasonal variations. Therapy can be very effective, but only for keeping the dandruff under control.

Telomere Shortening and Organismal Aging

Of this hypothesis, increasing evidence links human premature aging syndromes and mouse models of premature aging with DNA damage-induced genome dysfunction. Mutant mice unable to repair accumulated DNA damages exhibit symptoms of premature aging and die early (Rudolph et al. 1999, Tyner et al. 2002, Cao et al. 2003, de Boer et al. 2002, Wong et al. 2003), suggesting that proper maintenance of genomic integrity is essential for longevity. Late-generation telomerase null animals display a subset of aging phenotypes, including alopecia, hair greying, a reduced stress response, and decreased longevity (Rudolph et al. 1999). These animals also exhibit elevated genomic instability, manifested as chromosomal fusions and increased cancer incidence. Enhanced sensitivity to genotoxic agents such as ionizing radiation and alkylating agents is also noted in late generation mTerc ' mice and derivative cell lines (Wong et al. 2000, Goytisolo et al. 2000, Lee et al. 2001), suggesting that...

Associated Neurological Findings

Assessment of vital signs, preferably performed prior to administration of medications, is very important. Fever should always be construed as a sign of organic disease and should trigger consideration of a spinal tap. In a patient taking a neuroleptic, fever may accompany the neuroleptic malignant syndrome and may warrant consideration of this diagnosis. Once the vital signs are known, the general physical examination should be performed with the aim of identifying contributory factors to a behavior disorder. The general appearance may reveal obesity or cachexia. Central obesity and hirsutism suggest endocrine derangements, whereas hair loss may indicate lupus, thyroid disease, or simply an unrelated skin condition. Weight loss may be evident by excessive skin folds or a cachectic appearance and may accompany depressive syndromes. Changes in skin color may suggest endocrine disorders or a neurocutaneous syndrome. Evaluation of the head may reveal evidence of trauma or gingival...

Cytotoxic Chemotherapy

Introduced in the last half of the twentieth century were non-specific, affecting dividing cells with little discrimination (see Chapter 4). This meant that they were destructive not only to cancer cells but also to healthy, rapidly dividing tissues such as the hair follicles and the gastric epithelium, which accounts for many of the adverse effects noted with these agents, such as hair loss and mucositis. An understanding of the molecular biology of cancer, the interactions between malignant cells and their environment, is the first step in designing effective new agents. This approach should improve outcomes and minimize side effects while permitting efficient use of resources.

Life stages and the skin

Certain physiologic skin changes occur. Perspiration is increased. Hyper-pigmentation of the abdominal midline, nipples, vulva, and face (chloasma) is seen, and, in some brunettes, nevi and freckles also become more prominent and more pigmented. Malignant melanoma is not more common in pregnancy. Hypertrichosis of the scalp may be unnoticed until the excess hair begins to be shed after delivery. Striae of breasts, abdomen, and thighs appear. The skin diseases of pregnancy are herpes gestationis (see Fiig.M 26-11D-E), impetigo herpetiformis, vulvar pruritus (often due to candidal infection), palmar erythema, spider hemangiomas, pyogenic granulomas, rarely erythema multiforme, and pedunculated fibromas. The following dermatoses are usually better, or disappear, during pregnancy psoriasis, acne (can be worse), alopecia areata, and, possibly, systemic scleroderma. MENOPAUSE. Common physiologic changes in the skin of women during menopause include hot flashes, increased...

Figure 2615 Periungal fibromas Koenens tumor in tuberous sclerosis

Plaques, and maculopapular eruptions are relatively specific lesions for this disease. Lupus pernio is the most characteristic skin lesion in sarcoidosis. It consists of chronic, violaceous, indurated plaques with a predilection for the face, nose, ears and lips. Skin plaques are similar to lupus pernio, but they are located on the limbs, face, back, and buttocks. These plaques may have central atrophy or a hypopigmented appearance. Erythema nodosum is the most common nonspecific cutaneous manifestation of sarcoidosis and is a hallmark of acute disease with associated hilar adenopathy. Erythema nodosum is a hypersensitivity reaction that occurs with exposure to various antigens and appears clinically as tender, erythematous, subcutaneous nodules predominantly on the anterior shins. Other nonspecific skin changes include alopecia, erythroderma, erythema multiforme, pruritus, acquired ichthyosis, and dystrophic calcification.

The Role of Discovery Versus Confirmation

Certainly, the production of hypoglycemia and seizure disorder was not part of the research protocol for Dr. Janbon and colleagues, and their unanticipated findings fell into the category of exploratory research. Janbon and colleagues would not be criticized for pursuing the surprise findings of their research efforts. The discovery that the antihypertensive agent minoxidil could unexpectedly reduce hair loss, and the finding that the antihypertensive, anti-anginal compound sidenafil can temporarily reverse erectile dysfunction are contemporary examples of the fruits of discovery.

The mTerc Wrn Compound Mutant Mouse as a Model of Human Werner Syndrome

Extensive physiological analyses of telomerase-knockout mice revealed that late-generation mTerc ' animals that have short, dysfunctional telomeres exhibit decreased lifespan, a range of aging phenotypes including alopecia, hair graying, a reduced capacity to cope with acute and chronic stress, and a modestly increased incidence of cancer (Rudolph et al. 1999). Age-matched animals at earlier generations that possess longer telomeres do not manifest these phenotypes, which suggests that telomere dysfunction is important for the emergence of premature aging phenotypes. However, only a subset of these human aging phenotypes is present in mice with dysfunctional telomeres, suggesting that other factors contribute to human aging.

Management of Established Problems 16351 Management and Rehabilitation

Temporary alopecia from radiotherapy or chemotherapy needs no particular treatment and will resolve in time. Permanent alopecia from radiation therapy cannot be reversed, but hair transplants have been reported to be effective. This can only be done if there remains a large portion of unaffected scalp from which to harvest plugs of normal hair, and if the area of alopecia involves well-healed scalp 27 . Hair transplantation has also been reported to be effective following permanent busulfan alopecia, used during bone marrow transplantation. Although allotransplantation is usually unsatisfactory, it will work if the hair grafts are harvested from the same patient that provided the donor marrow 57 .

Skin and Mucous Membranes

Severe skin reactions, including permanent hyper-pigmentation, telangiectasias and skin ulcerations, are rarely seen with the use of modern day megavolt-age RT, unless the skin is intentionally treated with a high dose. Doxorubicin and actinomycin can interact with radiation to produce severe skin reactions and may contribute to late skin effects. When these drugs are given early in the course of radiation such reactions may be seen after low doses of 20-30 Gy. If they are delivered after radiation,the phenomena of radiation recall may occur, in which skin reactions appear in the treated field 14, 26 . Skin often remains chronically dry due to damage to the sebaceous and eccrine glands. The sebaceous glands are as radiosensitive as the basal epithelial cells of hair follicles eccrine glands are less sensitive 27 . Epilation within the treatment field usually occurs 2-3 weeks into the course of radiation treatment. The permanency of the epilation depends on the total dose of radiation...

Selfconcept body image sexual identity

Cancer has the potential to influence development of self-concept, a key task, among young people (Rowland 1990). Alterations in physical appearance, including weight changes, hair loss, amputations, placement of catheters to facilitate treatment administration, scars and alterations in skin colouration and texture, not only make children and teens feel different from peers but also may represent frightening changes in the body with an adverse impact on self-esteem. Fears that the body will never return to its original appearance, of not being recognized by others or of being mistaken for an individual of the opposite sex, often lead to shame, social isolation, and regressive behaviours (Die-Trill and Stuber 1998). These sometimes sudden alterations in body image are often perceived by patients as a threat to their well-being, causing anxiety. Also, self-image and life outlook appear to be worse among survivors who perceive treatment-related physical limitation as being moderate to...

Hair Changes

When you are hypothyroid, hair may become thinner, dry, and brittle, causing you to need additional hair conditioner. Hair loss may also occur to the point where balding sets in. (See Hair Changes under the list of symptoms in Chapter 4 for more details.) You will also lose body hair such as eyebrow, leg, and arm hair, as well as pubic hair. Much of this grows back after some time on thyroid hormone replacement. If you have your thyroid hormone levels change over a short time, such as going from hypothy- roidism to normal (euthyroidism) or from euthyroidism to hypothyroidism, you may experience transient increased hair loss, which will grow back.

Gray hair

Graying of the hair is a normal process of aging and develops earlier in Caucasians than in African-Americans by about a decade. By age 50 years, half of whites are 50 gray. There are cases of repigmentation in senile white hair following electron-beam therapy, but these are rare, and loss of pigment is generally permanent. Premature graying may indicate underlying disease such as pernicious anemia. Patchy white hair may develop in areas of the scalp affected by alopecia areata. A frontal white patch of hair may be inherited as an autosomal dominant trait (piebaldism). Persons who are said to have turned gray overnight have probably had a diffuse form of alopecia areata in which the dark hairs were lost preferentially to gray hairs.

Valproic Acid

Valproic acid appears to have the most favorable side effect profile of all available antimanic drugs. Dose-related and common initial side effects include nausea, tremor, and lethargy. Gastric irritation and nausea can be reduced by dividing the dose or using enteric coated preparations. Valproic acid has been associated with potentially fatal hepatic failure, usually occurring within the first 6 months of treatment and most frequently occurring in children under age 2 and individuals with preexisting liver disease. Transient, dose-related elevations in liver enzymes can occur in up to 44 percent of patients. Any change in hepatic function should be followed closely and patients should be warned to report symptoms of hepatic failure such as malaise, weakness, lethargy, edema, anorexia, or vomiting. Valproic acid may produce teratogenic effects including spina bifida (1 percent) and other neural tube defects. Other potential side effects include weight gain, inhibition of platelet...


Trichotillomania (TTM) is a complex, secretive condition of distressed hair pulling (O'Sullivan et al., 2000). There are limited data on the phenomenology of this disorder, but it appears to share many features with the other OCD spectrum disorders (Swedo and Leonard, 1992). TTM is characterized by the recurrent pulling out of one's hair resulting in noticeable hair loss. There is increased tension immediately before pulling or when attempting to resist the urge to pull and a sense of gratification or relief after the right hair has been plucked. This cycle must cause significant distress or impairment in order for the diagnosis of TTM to be made (American Psychiatric Association, 2000). Many people who suffer from problematic hair pulling do not meet the strict DSM-IV criteria, as they may not experience anxiety preceding the hair pulling and or conscious relief after completing the behavior. The prevalence rate for TTM based on DSM-IIIR criteria in college students was found to be...

Basic immunology

This condition results in loss of hair in circular patches. It may extend to the entire scalp or all body hair. Histology demonstrates an infiltrate of T cells around affected hair follicles. Both autoantibodies and autoreactive T cells have been demonstrated. It is possible to transfer alopecia areata to human scalp on immunosuppressed mice by injection of T cells.

Surgical Anatomy

A previously popular incision used to gain access to the superolateral orbital rim is the eyebrow incision. No important neurovascular structures are involved in this approach, and it gives simple and rapid access to the frontozygomatic area. If the incision is made almost entirely within the confines of the eyebrow, the scar is usually imperceptible. Occasionally, however, some hair loss occurs, making the scar perceptible. Unfortunately, in individual who has no eyebrows extending laterally and inferiorly along the orbital margin, this approach is undesirable. Incisions made along the lateral orbital rim outside of the eyebrow are very conspicuous in such individuals, and another type of incision may be indicated. The main disadvantage of the approach is extremely limited access.


Shaving Someone With Hypertrichosis

Frequent shampooing does not damage normal scalp hair. 3. Dandruff does not cause hair loss unless the scalp becomes severely secondarily infected. 4. Excessive brushing of the hair can cause hair breakage and hair loss. alopecia (hair loss) Figure 27-1. Hair loss (alopecia) due to alopecia areata. (Neutrogena Skin Care Institute) Figure 27-2. Hair loss (alopecia) due to alopecia areata totalis. (Neutrogena Skin Care Institute)


Panniculitis (lupus profundus), vasculitis, alopecia, livedo reticularis, and periungual telangiectasias are some of the other skin findings that can be seen in systemic lupus erythematosus. The skin shows induration and thickening. This may start as Raynaud's phenomenon (Fig. BdSB) or nonpitting edema of the hands and fingers. Flexion contractures and sclerodactyly may eventually evolve. The disease slowly extends to involve the upper extremities, face, trunk, and possibly the lower extremities. It begins as painless edema, which leads to tightening of the skin. In the final or atrophic stage, the skin becomes smooth, hard, tense, and bound down to underlying structures. This leads to the mask-like facies that consists of microstomia, radial furrowing around the mouth, and tightening of the skin over the nose, giving it a beak-like appearance. Mat-like telangiectasias of the face and upper trunk, as well as alopecia and anhidrosis, are also seen.

Twenty Nail Dystrophy

Twenty-nail dystrophy is characterized by lackluster appearance with longitudinal striations, roughness, and some pitting, which may be seen in all 20 nails, usually in children. This may improve spontaneously over some years. Although this problem was described as a primary nail disease, many authors believe these are the nail changes of psoriasis, lichen planus, or alopecia areata that are seen without other manifestations of the disorder. Less commonly, IgA deficiency and autoimmune hematologic abnormalities are associated. It may represent a subgroup of endogenous eczema with a predilection for the nail matrix or an autoimmune response in the nail matrix. Nonspecific and specific nail changes can occur along with alopecia areata, Darier's disease, epidermolysis bullosa, ichthyosis, and many other dermatoses. nail disease secondary to internal disease


Radiodermite Acuta

Acute radiodermatitis is divided into three degrees of severity, similar to the reactions from thermal burns. The first degree is manifested by the slow development of erythema, hyperpigmentation, and usually hair loss. A single dose of x-rays necessary to produce these changes is called an erythema dose. All of the changes in the first degree are reversible. The second degree is characterized by vesicle formation, erosions, hair loss secondary to infection, and delayed healing. Atrophy and telangiectasia are the end results.


When the issue of chemotherapy is raised with patients, most patients tend to have dramatic images of the expected toxicity. Specifically, nausea, vomiting and hair loss are felt by many to be uniformly associated with all kinds of chemotherapy. As mentioned earlier, traditional adjuvant chemotherapy for colorectal cancer has been 5-FU based. These regimens are usually reasonably well tolerated. The most common adverse effects are diarrhea, stomatitis, neutropenia and leukopenia. However, these side effects are actually seen in a minority of the patients, generally in the range of 20 . Older patients seem particularly vulnerable to these toxicities. As such, an individualized risk benefit ratio is particularly appropriate when considering adjuvant therapy for patients with advanced age.

Skin Changes

Some specific changes are not related to thyrotoxicosis and may be associated with autoimmune diseases, such as Graves' disease. Loss of pigmentation (vitiligo) is an autoimmune attack on melanin-containing skin cells. Likewise, some people with Graves' disease develop thickening in the skin over the lower legs called pretibial myxedema. The skin becomes firm and swollen and slightly darker in color. This is thought to be a reaction to the autoimmune antibodies of Graves' disease and is sometimes treated with steroid creams or ointments. Sometimes the skin under the fingernails becomes remarkably thick, causing the ends of the fingers to thicken, called thyroid acropachy. In addition, loss of hair from autoimmune disease may be permanent and result in baldness over the entire body (alopecia areata or totalis).

About the

Sundberg has received research grants from the National Institutes of Health, American Cancer Society, National Alopecia Areata Foundation, and private industry. He has published over 180 research and clinical papers, 50 technical bulletins, 95 book chapters, and two books. His current major research interests relate to mouse mutations as models of human and domestic animal dermatological diseases, the comparative pathology and molecular evolution of papillomaviruses, and spontaneous diseases of inbred laboratory mice.

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