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Scalp hair

Totalis Areata

Certain follicles of the scalp regress with age to produce tine vellus instead of coarse terminal hairs. This patterned baldness often starts as temporal recession, progressing to thinning of hair over the crown. It is common in males and is androgen dependent, prevented by prepubertal castration but not reversed by castration in maturity. Temporal recession is less common in women and may suggest virilisation. Loss or thinning of hair over the frontal region is an almost constant finding in the rare condition myotonic dystrophy, and is also seen in systemic lupus erythematosus. Alopecia is the term used to describe hair loss. It has many causes and pallems. Complete hair loss may occur following the administration of some cytotoxic drugs. The most common local disease of the hair of the scalp is alopecia areata, in which the hair falls out in patches. In active spreading alopecia areata, hairs shaped like exclamation marks (Fig. 2.12 arc found at the periphery of the bald area, which...

Dyskeratosis Congenita

Dyskeratosis congenita (DC) is characterized by ectodermal dysplasia and hematopoietic failure. The classic triad of ectodermal dysplasia consists of abnormal skin pigmentation, dystrophic nails, and leukoplakia of mucous membranes. In addition to the classic triad, there are a number of other somatic findings in DC. The most common of these are epiphora (tearing due to obstructed tear ducts), developmental delay, pulmonary disease, short stature, esophageal webs, dental caries, tooth loss, premature gray hair, and hair loss. Other ocular, dental, skeletal, cutaneous, genitourinary, gastrointestinal, and CNS abnormalities have also been reported.

Description Of Studies

Eastern Cooperative Oncology Group definition Markman and Gadducci used date of entry to date of appearance of disease (clinical or radiological) or date of death from any cause. Seven of the eight included trials that reported adverse effects, with the exception of the trial by Zylberberg. Toxicity criteria included the Southwest Oncology Group, Common Toxicity Criteria, and the World Health Organization, all of which were comparable for the toxicities described. Gadducci used the WHO criteria, but included four grades of alopecia therefore, these data could not be assimilated because the WHO criteria divide alopecia into only three grades. Quality of life scores were reported in the Armstrong trial using the Functional Assessment of Cancer Therapy scale, with General, Neurotoxicity, Pain, and Ovarian cancer subscales. This was reported at the 2004 annual American Society of Clinical Oncology meeting (14). Subgroup meta-analysis was not performed because data from the subgroups in...

Anthracycline Antibiotics

Doxorubicin (adriamycin) (Figure 3.56) is produced by cultures of Streptomyces peucetius var caesius and is one of the most successful and widely used antitumour drugs. The organism is a variant of S. peucetius, a producer of daunorubicin (see below), in which mutagen treatment resulted in expression of a latent hydroxylase enzyme and thus synthesis of doxorubicin by 14-hydroxylation of daunorubicin. Doxorubicin has one of the largest spectra of antitumour activity shown by antitumour drugs and is used to treat acute leukaemias, lymphomas, and a variety of solid tumours. It is administered by intravenous injection and largely excreted in the bile. It inhibits the synthesis of RNA copies of DNA by intercalation of the planar molecule between base pairs on the DNA helix. The sugar unit provides further binding strength and also plays a major role in sequence-recognition for the binding. Doxorubicin also exerts some of its cytotoxic effects by inhibition of the enzyme topoisomerase II,...

Currently Available Lasers and Light Sources Used for Hair Removal

This criterion clearly does not equate with permanent hair loss, as a delay in hair growth, which usually lasts for 1-3 months, is simply consistent with the induction of the telogen stage. Permanent hair reduction results should be based on the cyclic growth phases for hair follicles, and should refer to a significant reduction in the number of terminal hairs after a given treatment. There must be a reduction that is stable for a period of time longer than the complete growth cycle of hair follicles at any given body site.

Intense Pulsed Light Systems

Several studies have demonstrated the long-term efficacy of IPL hair removal devices (Gold et al. 1997 Weiss et al. 1999). In one study of 67 subjects of Fitzpatrick skin phototypes I-IV, mean hair loss was 48 at 6 months or more after a single treatment. In another study, after a single treatment, hair reduction ranging from 33 to 60 was observed at 6 months after treatment. Further studies of 14 subjects treated with this technology and followed for > 12 months after their last treatment showed a mean of 83 hair reduction was obtained after two to six treatments. As would be expected, repeated treatments appear to improve outcome. Despite this, some have suggested that more than three IPL treatments do not appear to increase the success rate. Not all would agree with this. Finally, treatment with IPL, with and without bipolar radiofrequency, has been said to be useful for the treatment of light-colored hair. Generally, more treatments are required and the results are not expected...

Morgans Contributions

Ageneticist named Thomas Hunt Morgan at Columbia University made several key discoveries using fruit flies between 1910 and 1920. He and his colleagues discovered mutations in flies that showed different patterns of inheritance in males and females, which led to association of these genes with the sex-determining X and Y chromosomes. Traits affected by genes on these chromosomes show a sex-linked pattern of inheritance in which recessive traits appear more often in males than in females. Human sex-linked traits, for example, include hemophilia, color-blindness, and baldness.

Sideeffect profile

Common adverse reactions with leflunomide include diarrhoea, nausea, reversible alopecia and rashes. Diarrhoea has been reported by > 15 of patients in clinical trials. This side effect is of particular concern as it often causes patients to discontinue treatment. There is some evidence that omitting the loading dose reduces the frequency and severity of diarrhoea. Hypertension is sometimes seen and regular blood pressure monitoring is recommended. However, other concomitant therapies such as NSAIDs can also raise blood pressure so it can be difficult to identify the contribution of each agent. Occasionally, patients report weight loss with leflunomide treatment, although its relationship to therapy has not been proved. There is

Chemotherapeutic agents that may induce rheumaticlike disorders are the following

Granulocyte colony-stimulating factor (G-CSF) may be associated with Sweet's syndrome. Interleukins and interferons have been associated with the development of signs and symptoms of autoimmune disease or auto-antibodies. Treatment with interferon-alfa is associated with Raynaud's syndrome and SLE-like illness. The manifestations vary depending on the underlying disease being treated. When used to treat myeloproliferative disorders, interferon-alfa can induce formation of antinuclear antibodies and rheumatoid factor, polyarthritis, or polyarthralgia. The incidence for these complications appears to be much lower in patients treated for carcinoid or viral hepatitis. Ongoing clinical trials of Il-4, IL-10, IL-1ra, and other biologic response modifiers should continue to monitor for any increase in auto-antibodies or autoimmune complications. O. Bone marrow transplantation may be associated with chronic graft-versus-host disease that includes scleroderma-like skin changes, alopecia,...

Cronkhite Canada Syndrome

This syndrome includes generalized GI polyposis in association with neuroectodermal changes consisting of alopecia, hyperpigmentation and nail atrophy. Electron microscopic studies of the skin reveal increased numbers of melanin granules in kerato-cytes, increased number of melanosomes in melanocytes, increased melanocytes, compact hyper-keratosis, perivascular inflammation and exocytosis. A number of haematologic, neurologic and metabolic abnormalities are associated with Cronkhite-Cana-da syndrome.

Treatmentrelated Toxicities

Toxicities of radiotherapy may limit the dose that can be delivered. These toxicities range from mild and temporary to more serious and potentially permanent and debilitating. Side effects are divided into acute and delayed toxicities. Acute toxicities, which generally are temporary, include hair loss, skin reaction, sore throat, dysphagia, Eustachian tube dysfunction with plugged ears, nausea and vomiting, and fatigue. In patients with leptomeningeal spread of their primary cancer, acute toxicities

History of the Disease

This multifactorial regulation produces many extremely different clinical features and the main difficulty lies in relating a peculiar disease to a multifactorial genetic disease. Most likely, before the APC gene was identified, many syndromes were known Turcot's syndrome (FAP, neoplasia of central nervous system) Gardner's syndrome (intestinal polyps, multiple osteomata, cysts, desmoid tumours, gastro-duodenal polyps, mesenteric fibromatosis, lymphoid hyperplasia of the distal ileum, ileal adenomas and dental abnormalities) Cronkite-Canada syndrome (gastrointestinal polyps, skin hyperpigmentation, nail dystrophy and alopecia) and attenuated FAP (< 100 intestinal polyps, primarily located in the right colon) 6,7 , which now simply reflect different locations of mutations along the gene.

Cyclophosphamide Cytoxan

Bone marrow depression, primarily of white cell series, and predisposition to infection, both of which may be life-threatening but reversible with discontinuation of drug. Alopecia, drug-induced infertility with amenorrhea or defective spermatogenesis, hemorrhagic cystitis (in up to 25 of patients), fibrosing cystitis, carcinoma of the bladder, hematopoietic malignancies, anorexia, nausea, vomiting, and pulmonary fibrosis. Antidiuretic hormone-like activity may occur with large doses and result in hyponatremia.

Medical Terminology Case Studies - Skin

Lymphotomes

A recent physical examination showed diffuse erythroderma with scaling and hyperkeratosis, plus alopecia. She had painful leukoplakia and ulcerations of the mouth and tongue. L.C. was hospitalized and given two courses of topical chemotherapy. She was referred to Dental Medicine for treatment of the oral lesions and discharged in stable condition with an appointment for follow-up in 4 weeks. Her discharge medications included hydrocortisone ointment 2 to affected lesions q hs, Keralyt gel bid for the hyperkeratosis, and Dyclone and Benadryl for her mouth ulcers prn. a. baldness

Linked Adrenoleukodystrophy

Adrenoleukodystrophy Pictures Images

The usual age at onset of AMN is within the third or fourth decade,but ranges from 14 to 60 years. Most patients with an adult onset form of XALD have AMN. Neurological deficits are primarily due to a myelopathy and to a lesser extent a neuropathy. Affected males have a slowly progressive paraparesis, disturbed vibration sense of the legs, voiding disturbances, and a variable degree of sexual dysfunction. Signs of a distal polyneuropathy may also be found. Approximately two-thirds of the patients have overt or biochemical signs of adrenocortical insufficiency, which may precede or follow neurological dysfunction. Twenty percent of the patients have signs of hy-pogonadism with infertility. Many patients have scanty scalp hair. The disease is slowly progressive over decades. About half of the patients with AMN develop some cerebral involvement, with usually mild cognitive dysfunction. Visual memory, spatial cogni

Diseases of the skin and subcutaneous tissue L00L99

_I Alopecia areata L63.0 Alopecia (capitis) totalis L63.1 Alopecia universalis L63.8 Other alopecia areata L63.9 Alopecia areata, unspecified Androgenic alopecia Includes male-pattern baldness Drug-induced androgenic alopecia Use additional external cause code (Chapter XX), if desired, to identify drug. Other androgenic alopecia Androgenic alopecia, unspecified _ Other nonscarring hair loss Excludes trichotillomania ( F63.3 ) L65.0 Telogen effluvium L65.1 Anagen effluvium L65.2 Alopecia mucinosa L65.8 Other specified nonscarring hair loss L65.9 Nonscarring hair loss, unspecified Alopecia NOS __Cicatricial alopecia scarring hair loss L66.8 Other cicatricial alopecia L66.9 Cicatricial alopecia, unspecified

Androgen And Prostate Growth

Pseudohermaphrodites

Neither male-pattern baldness nor acne. More importantly, it was observed that their prostate glands, which were poorly developed at birth, grew minimally after puberty despite other masculinizing changes. It was this observation, which is directly tied to the deficiency in 5 a-reductase activity, that led researchers to consider the possibility of therapeutic inhibition of 5 a-reductase enzymes in the treatment of symptomatic BPH.

Alternative Surgical Techniques

Less Haired Mons Pubis

Traditionally, encephaloceles have been treated neurosurgically via a transcranial approach, which is associated with significant morbidity a loss of sense of smell, postoperative intracerebral hemorrhage, cerebral edema, epilepsy, frontal lobe dysfunction with memory and concentration deficits, and potential osteomyelitis of the frontal bone flap. In addition to these risks, repair by this technique requires 5-7 days in hospital, hair loss along the incision line, and a period off driving postoperatively.

Endocrine myopathies

Myotonic dystrophy is an inherited disease that begins early in adult life. It is manifested by distal muscle weakness and atrophy. Deep tendon reflexes are reduced. Ptosis may be present, and closure of the eyelids is also weak. Atrophy of the temporalis and sternocleidomastoid muscles is severe. Other clinical features include early frontal alopecia, cataracts, blepharitis, conjunctivitis, and testicular atrophy. Mental retardation may occur. Dystrophic cardiac disease occurs late. The disease can be quite variable, and some patients and affected family members may manifest only one or two features.

Gerontologic Alert

With long-term administration, the female patient may experience mild to moderate masculine changes (virilization), namely facial hair, a deepening of the voice, and enlargement of the clitoris. Male pattern baldness, patchy hair loss, skin pigmentation, and acne may also be seen. Although these adverse effects are not life threatening, they often are distressing and only add to the patient's discomfort and anxiety. These problems may be easy to identify, but they are not always easy to solve. If hair loss occurs, the nurse can suggest the wearing of a wig. The nurse advises the patient that mild skin pigmentation may be covered with makeup, but severe and widespread pigmented areas and acne are often difficult to conceal. Each patient is different, and the emotional responses to these outward changes may range from severe depression to a positive attitude and acceptance. The nurse works with the patient as an individual, first identifying the problems, and then helping the patient,...

Pharmacologic Therapy

Because neither the anatomic nor the chemical source of dyspepsia was determined until the late 19th century, therapy before that time was empiric and often quite imaginative. Recommendations included sedum (stonecrop), chewing green tea, and magnesia. For centuries, relief from dyspepsia was provided by chalk, charcoal, and slop diets.94 At the turn of the 20th century, proprietary medicines were popular, and were offered not only as cures for heartburn but also for impotence and alopecia.94 Therapy at that time centered on avoidance of acidic foods, otherwise bland diets free of cap-saicin, milk, antacids, and elevation of the head of the bed. In addition to their acid-neutralizing effects, antacids were subsequently demonstrated to increase lower esophageal sphincter pressure and decrease gastroe-sophageal reflux.95,96 Alginic acid, which reacts with saliva to form a viscous coating that protects the esophagus (and stomach) was shown to have effects on reflux symptoms similar to...

Lupus erythematosus

The characteristic lesion of DLE is a scaly plaque that ranges in color from red to violaceous, with sharply-defined borders, central atrophy, telangiectasia, and areas of hypopigmentation or hyperpigmentation. Keratinous plugging of the hair follicles can sometimes be detected as tiny rough projections across the lesion. Lesions may be multiple and asymmetric and are most commonly found on the head and neck, particularly in the malar areas, ears, and scalp. When the scalp is involved, hair loss with scarring at the site of the lesion results. Lesions on the oral and nasal mucosae may ulcerate. Lesions of DLE produce scarring those that result in severe scarring may, infrequently, produce skin cancer. 6. Alopecia can be of two types in SLE. a. Scarring alopecia is produced when discoid lesions affect the scalp these lesions are easily recognized. b. More subtle is the reversible (diffuse or patchy) alopecia that may arise. Diffuse alopecia is more...

Interferons

Interferons are not effective by mouth, therefore are injected. IFN-a is much more active in vivo than IFN-p or IFN--y, probably because the latter do not achieve or maintain the required blood levels after intramuscular administration. Toxic side effects are regularly observed and may be marked with doses in excess of 107 units per day, even when highly purified cloned IFN subtypes are employed. Fever regularly occurs at high dosage but lasts only a day or so. Severe fatigue is the most debilitating symptom and may be accompanied by malaise, anorexia, myalgia, headache, nausea, vomiting, weight loss, erythema and tenderness at the injection site, partial alopecia (reversible), dry mouth, reversible peripheral sensory neuropathy, or signs referable to the centra nervous system. Various indicators of myelosuppression (granulocytopenia, thrombocytopenia, and leukopenia) and abnormal liver function tests, both reversible on cessation of therapy, are regularly observed if high-dose...

Complications

The most feared complication is migration of the filler down to the upper eyelid. This can be avoided by using the proper technique and injecting only small quantities of the required product. Other complications, such as those found in association with surgical procedures (e.g., numbness, paresis, scars, alopecia, and nerve damage) do not occur as a result of treatment with fillers.

Molting in Mammals

When they lose hair, mammals, including humans, are molting. Like feathers, a hair grows outward from a follicle in the skin and, as new hairs grow, old hairs will be lost. Under normal conditions in humans, hair loss will be a gradual process over an individual's lifetime and it does not occur all at once. Molting in many mammals is directly influenced by length of day and interactions between the endocrine system and the nervous system. The number of molts per year varies, and

Result

A 50-year-old patient with Norwood type V hair loss, and 12 months after the operation, following two procedures with a total of 3,120 follicu-lar units. mini-micrografting techniques. Dermatol Surg 24 957-963 Devine JW, Howard PS (1985) Classification of donor hair in male pattern baldness and the Er YAG laser. J Cutan Laser Ther 1 229-231 Nordstr m REA (1971) Hair transplantation. The use of hair-bearing compound grafts for correction of alopecia due to chronic discoid lupus erythematosus, traumatic alopecia and male pattern baldness Suppl 1 . Scand J Plast Reconstr Surg (Thesis and academic dissertation) Orentreich N (1959) Autografts in alopecias and other selected dermatological conditions.

Anatomy

The hair follicle is the sac-like housing of the hair shaft. The germinative part of the hair shaft is the hair matrix (see p. 39, Fig. 2.15). Melanocytes migrate into the matrix and the melanins that they produce are responsible for the different colours of hair. Each follicle passes, independently of its neighbours, through regular cycles of growth (anagen) and resting shedding (lelogen). (he duration of these stages varying in different regions of the body. The anagen phase of scalp hair may last for up to 5 years, accounting for its length. This phase is shorter and the telogen phase longer in eyebrow and sexually determined hair. Moulting does not normally occur in humans unless the hair cycles in neighbouring follicles become synchronised, as sometimes occurs after childbirth and various pyrexic illnesses (telogen effluvium). Inspect the scalp hair for its lustre, calibre, structure, tensile strength and density. If alopecia is present, determine if the abnormality affects the...

Folk Rusmari

An infusion of the plant with borax is used as a hair wash for preventing hair loss. Rosemary oil, in combination with the essential oil from thyme, lavender and cedarwood, showed improvement in hair growth by 44 after 7 months of treatment for alopecia areata. (Natural Medicines Comprehensive Database, 2007.)

Neurologic disease

Cytotoxic drugs are used in either severe corticosteroid-resistant disease or in the context of unacceptable steroid side effects. In patients with diffuse proliferative glomerulonephritis, cyclophosphamide has shown to retard progression of scarring in the kidney and reduce the risk for end-stage renal failure. Monthly infusions of IV pulse cyclophosphamide (0.5 to 1.0 g m2 of body surface area) preserve renal function more effectively than do corticosteroids alone, but the rate of relapse following a 6-month course is high. Most patients require extended therapy. Potential toxicities are substantial nausea and vomiting (often requiring treatment with antiemetic drugs) alopecia (reversible) ovarian failure (nearly universal in patients more than 30 years old) or azoospermia and hemorrhagic cystitis, bladder fibrosis, and bladder transitional cell or squamous carcinoma. Intermittent IV cyclophosphamide may decrease the incidence of bladder complications associated with daily oral...

Types Of Infections

These mold infections are extremely common causes of superficial fungal lesions of the skin throughout the world (21). The annual cost in the United States exceeds 400 million. Dermatophytoses can be acquired from other people, animals, or the environment. Although they do not generally cause life-threatening illness, they do affect quality of life and social embarassment is a concern. Lesions may appear as annular patches with raised margins and inflammation. Clinical appearances varies with the site and host immune response, as well as with the causative fungal species. Tinea pedis is most often caused by T. rubrum and T. mentagrophytes and results in the well-known lesions of athlete's foot. Tinea cruris may be caused by T. rubrum and E. flaccosum and manifests groin lesions. Tinea corporis or ringworm may be caused by several dermatophytes, and clinical patterns vary with the site of infection and causative organism. Scalp ringworm or tinea capitis is a disease of children and is...

History

Maiman, using a ruby crystal in 1960, developed stimulated laser emission of a 694-nm red light. This was the first working laser, and it is from this prototype that today's lasers are derived. Since 1960, research and technical advances have led to modern day lasers. Leon Goldman, the father of laser surgery, published preliminary results on the effects of a ruby laser for the treatment of skin diseases. Ohshiro et al. noted hair loss from nevi after treatment with a ruby laser (Ohshiro et al. 1983).

Treatment Approach

All of the lasers and intense pulsed light sources described in this chapter, when used with almost all fluences, can lead to temporary hair loss at all treated areas. However, choosing appropriate anatomic locations and using higher fluences will increase the likelihood of permanent hair reduction after multiple treatments. Even though permanent hair loss is not to be expected in all individuals, lessening of hair density and thickness is an expected finding. Prolonged and permanent hair loss may occur following the use of all the aforementioned described millisecond systems. However, great variation in treatment results is often seen. Most patients with brown or black hair obtain a 2- to 6-month growing delay after a single treatment. There is usually only mild discomfort at the time of treatment. Pain may be diminished by the use of topical or injected anesthetics.

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