Effective Home Remedies for Hair Loss

Peruvian Hair Loss Treatment

Peruvian Hair loss treatment is a natural product, best for hair loss restoration. The hair product works well because its composition is free from chemical impurities. Hair loss is a life-changing occurrence in the lives of many people. As much as people may make fun of a bald head individual, but they fail to understand that this individual is very frustrated as it is already. Hair loss impacts on the overall personality build of an individual. For some, it is what makes them feel less pretty while others have lost their self-esteem to hair loss. Even so, Peruvian Hair loss is not only a powerful anti-hair loss formula, but it also strengthens the hair. Biologically, the leading cause of hair loss is high production of hormone DHT which weakens the hair, and it begins falling off. The hormone DHT is a version of testosterone, but it is more active. The Peruvian Hair loss treatment, however, offers smooth, soothing sensation on the human scalp, thereby increasing the blood flow. Moreover, the hair formulae prevent the conversion of testosterone into DHT. Peruvian hair loss treatment is not only useful in restoring hairlines, but it also makes the hair bulky and shiny. Peruvian hair loss treatment works by stimulating the growth of the hair, thereby making it long and healthy. Read more...

Peruvian Hair Loss Treatment Summary

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Hair Transplantation

Hair transplantation is a procedure frequently performed in men. We have an experienced transplantation team, managed by Dr. Frank Neidel. Depending on the indication, we work with both slit and micropunch techniques, manually or with laser assistance. Precise surgical planning, the correct technique and the schedule of the hair transplantation team, which is made up of the surgeon and three assistants who prepare the hair roots, are all important factors.

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...

Potent Weapon in Forensic Medicine

(short sequences repeated thousands of times in tandem), which are common in the genomes of higher eukaryotes (see Fig. 24-8). The number of repeated units in these DNA regions varies among individuals (except between identical twins). With a suitable probe, the pattern of bands produced by DNA fingerprinting is distinctive for each individual. Combining the use of several probes makes the test so selective that it can positively identify a single individual in the entire human population. However, the Southern blot procedure requires relatively fresh DNA samples and larger amounts of DNA than are generally present at a crime scene. RFLP analysis sensitivity is augmented by using PCR (see Fig. 9-16a) to amplify vanishingly small amounts of DNA. This allows investigators to obtain DNA fingerprints from a single hair follicle, a drop of blood, a small semen sample from a rape victim, or samples that might be months or even many years old.

Growth Centers of Hairs

The hair follicle is a self-regenerating structure and contains a population of stem cells capable of reproducing themselves. It has been noted, at least in animal models, that a complete hair follicle can be regenerated even after the matrix-containing hair follicle is surgically removed. Although the dermal papilla is not technically part of the actual hair, it remains a very important site for future hair induction, and melanin production in terminal hairs.

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.

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.

Postoperative Considerations

The use of ice packs may reduce postoperative pain and minimize swelling. Analgesics are usually not required unless extensive areas are treated. Prophylactic courses of antiviral agents should be considered in patients with a history of herpes simplex infections in the to-be-treated area. Topical antibiotic ointment applied twice daily is indicated if posttreatment epidermal injury occurred. Mild topical steroid creams may be prescribed to reduce swelling and erythema. Any trauma, such as picking or scratching of the area, should be avoided. During the first week of healing, sun exposure should be avoided or sunblocks used. Make-up may be applied on the next day unless blistering or crusts have developed. The damaged hair is often shed during or after the first week of the treatment. Patients should be reassured that this not a sign of hair regrowth.

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

Postoperative Precautions

No bandage is necessary with modern surgical methods. There is no permanent visible scarring. The same criteria apply, however, after a hair transplantation as after any other operation in the facial area. Infection prophylaxis is given for 3 days after the operation. From the 3rd day the patient can wash his or her hair with a mild chamomile shampoo. The hair can then be washed daily. The hair transplants are fixed securely and firmly.

Clinical Manifestations

There are several major risk factors for malnutrition in the elderly that may serve as clinical clues to the diagnosis. Poverty, social isolation, dependence or disability, chronic multiple medications, and dental disorders all increase the risk of malnutrition in elderly adults. Obviously, many comorbidities are also risk factors (e.g., depression, stroke, congestive heart failure) and have specific symptoms and signs associated with the underlying disorder. Clinical clues of global undernutrition in elderly patients include low body weight, muscle wasting, sparse thinning hair, flaking dermatitis, cheilosis angular stomatitis, poor wound healing, and peripheral edema. Specific symptoms, signs, and laboratory abnormalities associated with micronutrient deficiency are shown in Table 1.

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 (

Clinical Focus Box 371

GnRH agonists (leuprolide acetate trade name Lupron ) are usually used in combination with other drugs in order to block most effectively androgenic activity. For example, one of the androgen-blocking drugs includes 5a-reductase inhibitors that prevent the conversion of testosterone to the highly active androgen dihydrotestosterone (DHT). In addition,

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.

Fred A Lopez MD Serge Lartchenko MD

Primary skin infections (ie, pyodermas) typically are initiated by some breach in the epidermis, resulting in infection by organisms, such as Streptococcus pyogenes and Staphylococcus aureus, that colonize the skin. Host-associated factors, such as immunosuppression, vasculopathy, neuropathy, or decreased lymphatic drainage, may predispose to skin infection. The clinical syndromes associated with skin infections are often characteristic and are defined most simplistically by anatomic distribution (Fig. 1). Although often mild and self-limited, skin infections can be more aggressive and involve deeper structures, including fascia and muscle. This article discusses skin and soft tissue infections, including impetigo, hair follicle-associated infections (ie, folliculitis, furuncles, and carbuncles), erysipelas, cellulitis, necrotizing fasciitis, pyomyositis, septic bursitis, and tenosynovitis.

Foreword by D Millesi

Many new techniques are at our disposition and the number is constantly growing. Apart from basic techniques, detailed technical points become more and more important for the successful outcome. It is nearly impossible to provide a complete survey of all techniques available today in a single textbook, not to mention the variety of technical details that are frequently not described. It is to W. L. Mang's credit that he elected the forum of a manual instead of a large textbook to present his great personal experience. In the first volume of his manual, W. L. Mang described his personal experience with rhinoplasty, rhytidectomy, eyelid surgery, and otoplasty. His techniques and his tricks are presented in the form of very instructive sketches, and any surgeon who wants to enter the field of aesthetic surgery can do this easily following the impressive illustrations. Now the second part of the Manual of Aesthetic Surgery is available. It covers liposuction, breast implants, hair...

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. b. hair follicles a. baldness

Symptoms And Conditions

Lichenification Legs

An inflammatory disease of the sebaceous glands and hair follicles alopecia Absence or loss of hair baldness A plug of sebum, often containing bacteria, in a hair follicle a black- Inflammation of a hair follicle hair follicle a boil Fibrous connective tissue Hair follicle Muscle (arrector pili) Nerve _ 16. alopecia a. severe itching redness of the skin baldness profuse sweating thickened scar

Immune Privilege of the Brain

Multiple sites in the body express varying degrees of immune privilege including the anterior chamber of the eye, brain, hamster cheek pouch, hair follicle, and pregnant uterus. The earliest explanation for the immune privilege of the brain suggested that the absence of conventional lymphatic vessels prevented antigens from leaving the brain and reaching regional lymph nodes, and

Associated Skin Structures

The sebaceous glands release an oily fluid, sebum, that lubricates the hair and skin and prevents drying. Hair is widely distributed over the body. Each hair develops within a sheath or hair follicle and grows from its base within the deep layers of the skin. Both hair and nails function in protection. Each nail develops from a growing region at its proximal end. Hair and nails are composed of nonliving material consisting mainly of keratin.

Structure Of Skin Germinative Layer

Germinative Layer Epidermis

Human Scalp with Hair Follicle Follicle root, with sheath embedded in pale adipose tissue, has sebaceous glands surrounding it near surface. (X10) Hair follicle Human Scalp with Hair Follicle Follicle root, with sheath embedded in pale adipose tissue, has sebaceous glands surrounding it near surface. (X10) Hair follicle Sebaceous gland Hair root Hair follicle Sebaceous gland Hair root Hair follicle

Linked Adrenoleukodystrophy

Adrenoleukodystrophy

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

Detecting Stimuli that Distort Membranes

Golgi Tendon Organ

Two other kinds of mechanoreceptors are found deeper in the skin. Ruffini endings, which are rather slowly adapting, are good at providing information about vibrating stimuli of low frequencies. Pacinian corpuscles, which are rapidly adapting, are good at providing information about vibrating stimuli of higher frequencies. Even deeper in the skin, dendrites of sensory neurons wrap around hair follicles. When the hairs are displaced, those neurons are stimulated.

High Prevalence Of Androgen Deficiency In Hivinfected Men And Women

Early studies (1-4) suggested that as many as 30-50 of HIV-infected men have serum testosterone levels that are below the lower limit of the normal range for healthy, young men. For instance, Dobs et al. (1) reported that 50 of HIV-infected men had low testosterone concentrations. Grinspoon et al. (2) described a reduction in free testosterone levels in 49 of HIV-infected men with AIDS wasting. In a prospective survey (5) conducted in 1998 during the early days of protease inhibitor therapy, we prospectively measured serum total and free-testosterone and dihydrotestosterone (DHT) levels in 148 consecutive HIV-infected men and compared the results to 42 healthy men. Thirty-one percent of HIV-infected men had serum testosterone levels less than 275 ng dL, the lower limit of the normal male range (5). Overall, serum testosterone, free-testosterone, and DHT levels were lower in HIV-infected men than in healthy men, but serum DHT-to-testosterone ratios were not significantly different...

Physiology Of Cortisol Metabolism

Cortisol Metabolism Hsd

Role in bile acid metabolism (41). 5a-reductase activity is catalysed by two isozymes from different genes (Table 18.2) (42). 5a-reductase type 1 is expressed in liver, non-genital skin, brain and to a lesser extent in stromal cells of adipose tissue (43). In addition to metabolizing cortisol, it also converts testosterone to the more potent androgen receptor agonist 5a-dihydrotestosterone. 5a-reductase type 2 is expressed in human liver, specific areas of the developing central nervous system (CNS) involved in reproductive behaviour, prostate and genital skin. In the latter tissues it is essential to enhance local androgen receptor activation and development of the

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

Descent Of The Ovaries

The indifferent duct system and external genitalia develop under the influence of hormones. Testosterone produced by Leydig cells in the testes stimulates development of the mesonephric ducts (vas deferens epididymis), while MIS produced by Sertoli cells in the testes causes regression of the paramesonephric ducts (female duct system). Dihydrotestosterone stimulates development of the external genitalia, penis, scrotum, and prostate (Fig. 14.26). Estrogens influence development of the paramesonephric female system, including the uterine tube, uterus, cervix, and upper portion of the vagina. They also stimulate differentiation of the external genitalia, including the clitoris, labia, and lower portion of the vagina (Fig. 14.26). Errors in production of or sensitivity to hormones of the testes lead to a predominance of female characteristics under influence of the maternal and placental estrogens.

Folliculitisfurunclescarbuncles

Folliculitis is an infection of the pilosebaceous unit and involves only minor inflammation of an individual hair follicle. This infection is associated with minimal pain and surrounding erythema. A furuncle is a deeper, more aggressive infection of a hair follicle or a cutaneous gland. These lesions range in size from 5 mm to 3 cm diameter and occur most commonly on hairy areas exposed to friction, trauma, or macerations (i.e., buttocks, face, neck, axillae, groin, thighs, upper back). Patients present with a painful, often fluctuant swelling. Pruritus, local tenderness, and erythema are often associated. As pus forms in the center of the lesion, the overlying skin becomes thin, the lesion becomes elevated, pain increases, and spontaneous drainage of pus ultimately occurs.

Androgen And Prostate Growth

Pseudohermaphrodites

The prostate gland is dependent on androgens that are produced exogenously by the testicles to facilitate normal development and to maintain normal structure and function (1). Briefly, the testes are stimulated to produce and secrete testosterone and other steroids by an exogenous protein, luteinizing hormone, which is made in the pituitary gland. Testosterone (T) is converted to its reduced form, dihydrotestosterone (DHT), by the enzyme 5a-reductase in the prostate. Both T and DHT bind to and activate the androgen receptor, causing a cascade of events that results in stimulation and maintenance of prostatic epithelial and stromal growth and secretion. DHT has a greater affinity for the androgen receptor than T and is normally the major prostate growth stimulant. Currently, attempts to interrupt or alter the stimulatory effects of exogenous factors that control prostate growth target aspects of the pituitary-testis-prostate axis. One approach is to alter the production and secretion...

The Role of Differential Gene Expression in Cell Differentiation

Differentiated cells are recognizably different from one another, sometimes visually as well as in their protein products. For example, certain cells in our hair follicles continuously produce keratin, the protein that makes up hair, nails, feathers, and porcupine quills. Other cell types in the body do not produce keratin. In the hair follicle cells, the keratin-encoding gene is transcribed in most other cells in the body, that gene is not transcribed. Activation of the keratin-encoding gene is a key step in the differentiation of hair follicle cells.

QSwitched NdYAG Laser

Q-switched Nd YAG lasers have been used to target topically applied carbon particles that have previously been applied to the hair follicle. This method was one of the first available laser hair removal techniques. This short term hair removal technique has also been used without the prior application of carbon. Immediately after Q-switched 1064-nm laser irradiation of carbon coated hairs, the carbon is heated to its vaporization temperature of about 3,700 C. Vaporization leads to a huge volume expansion with resultant supersonic proliferation of high pressure waves. These shock waves, in turn, produce mechanical damage, as well as the development of heat. It is not clear how much mechanical and or heat energy produced by this mechanism is required for destruction of a hair follicle. However, histo-logic evidence of follicular damage is seen after such a laser exposure. This results in a clinical delay of hair growth. Depending on the position and amount of the topically applied...

Foreword by H U Steinau

The new chapters Implantation and Adjuvant Treatment of Wrinkles , Hair Transplantation , Liposuction and Body Contouring, Including Aesthetic Breast Surgery and Abdominoplasty provide basic guidelines for safe and proper procedures and step-by-step operative details for different body regions.

Peripheral Transformation Degradation and Excretion of Hormones in Part Determine Their Activity

Peripheral Transformation of Hormones. Specific hormone transformations may be impaired because of a congenital enzyme deficiency or drug-induced inhibition of enzyme activity, resulting in endocrine abnormalities. Well-known transformations are the conversion of testosterone to dihydrotestosterone (see Chapter 37) and the conversion of thyroxine to triiodothyronine (see Chapter 33). Other examples are the formation of the octapeptide angiotensin II from its precursor, angiotensinogen (see Chapter 34), and the formation of 1,25-dihydroxychole-calciferol from cholecalciferol (see Chapter 36).

Physiopathology of Hypogonadism

High levels of PRL suppress GnRH secretion and, consequently, decrease gonadotropin and testosterone production (5,6). In some cases, hyperprolactinemia induces clinical hypogonadism notwithstanding normal serum FSH, LH, and testosterone levels. There is an exaggerated diurnal variation in testosterone in men with PRL-producing tumors, so that normal morning values do not guarantee normal values throughout the day (7). Others have suggested a reduced conversion of testosterone to dihydrotestosterone (DHT) (8,9). If so, the hypogonadism associated with hyperpro-lactinemia may not solely result from the decrease in serum testosterone. In fact, testosterone replacement therapy may not reverse the loss of libido that is typical of men with prolactinoma until the PRL level is normalized by the administration of a dopamine agonist (10). Furthermore, human chorionic gonadotropin (hCG) administration did not increase DHT levels in men with hyperprolactinemia induced by sulpiride treatment,...

Testicular Control Of Gonadotropin Secretion

GnRH doses (57), testosterone suppressed LH secretion less than in normal men, implying that testosterone controls GnRH secretion. Moreover, suppression by testosterone was blocked by the aromatase inhibitor testolactone (57), and in separate experiments, dihydrotestosterone had no effect (58). Together, these data imply that the pituitary effect of testosterone to inhibit LH was through bioconversion to estradiol. Whether it is testosterone and or the estradiol derived from testosterone by aromatase in the central nervous system or in peripheral tissues that controls LH secretion is of considerable interest. The finding that dihydrotestosterone (DHT), a nonaromatizable androgen, decreases LH pulse frequency strongly supports a role for androgens in the regulation of the GnRH pulse generator. Furthermore, LH pulse frequency is increased in patients with nonfunctional androgen receptors (AR) in the complete androgen insensitivity syndrome, indicating that AR signaling regulates GnRH...

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.

Sertoli Cells Have Multiple Functions

Androgen-binding protein (ABP) is a 90-kDa protein, made of a heavy and a light chain, that has a high binding affinity for dihydrotestosterone and testosterone. It is similar in function, with some homology in structure, to another binding protein, sex hormone-binding globulin (SHBG), synthesized in the liver. ABP is found at high concentrations in the human testes and epididymis. It serves as a carrier of testosterone in Sertoli cells, as a storage protein for androgens in the seminiferous tubules, and as a carrier of testosterone from the testes to the epididymis.

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.

Alterations In Testosterone Feedback Restraint

Whether or how sex-steroid negative feedback is altered in older men is controversial. For example, three clinical studies report heightened negative feedback by exogenous androgens in the aging male. These analyses were based on short-term i.v. infusion of testosterone and or dihydrotestosterone (DHT) for 4 d (33) or transdermal delivery of 5-a-DHT for 11 d (72) or testosterone for 12 mo (73). Two other investigations describe reduced androgen feedback efficacy in the older male after several weeks of im injection of high-dose testosterone (54,74). Two interventional studies using an estrogen- and or androgen-receptor antagonist and one biomathematical construct imply reduced LH secretory adaptations to muted sex-steroid feedback in elderly men (56,75,76). From another vantage, cross-correlation analysis of 24-h (paired) LH and testosterone concentration profiles identifies impaired negative feedback by endogenous androgen in older volunteers (29). Based on immunocytochemical...

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...

Intense Pulsed Light Systems

Intense pulsed light (I PL) systems are high intensity pulsed light sources which emit polychromatic light in a broad wavelength spectrum of 515-1200 nm. The emitted wavelengths determine not only the absorption pattern of the emitted light but also the penetration depth of the light. With the aid of different cut-off filters (515-755 nm), which only allow a defined wavelength emission spectrum, the optimal wavelength spectrum can be filtered to correspond to the depth of the target structure (i. e., hair follicles). Similarly, the emitted wavelengths can be adopted to the patient's individual skin type. Higher cutoff filters reduce the emission of melanin-absorbing wavelengths thus being safer for darker skin types. The pulse duration of IPL systems can be set to a wide range of parameters. The use of single pulses is possible. In the alternative, high flu-ences can be divided into multiple pulses. The intervals between individual pulses can be set at values between 1 and 300 ms....

Concentration and Metabolism

An increase in body weight and fat tissue is associated with several abnormalities of sex steroid balance in premenopausal women. They involve both androgens and estrogens and their main transport protein, sex hormone-binding globulin (SHBG). Changes in SHBG, which binds testosterone and dihydrotestosterone (DHT) with high affinity and estrogens with lower affinity, also lead to an alteration of androgen and estrogen delivery to target tissues. The concentrations of SHBG are regulated by a complex of factors, which include estrogens, iodothyronines and growth hormone (GH) as stimulating, and androgens and insulin as inhibiting factors (5). The net balance of this regulation is probably responsible for decreased SHBG con-

Acknowledgements

I have already mentioned all of my medical colleagues in Volume 1 with whom I have been working since 1975 and have had the privilege to learn from, as well as everyone who has helped me on the way. In addition to these, I would also like to mention my long friendship with Prof. Ivo Pitanguy. I first visited Prof. Pitanguy at his clinic in Rio de Janeiro in 1972. Since then, Prof. Ivo Pitanguy has often taken part in conferences in Lindau and is always a very welcome guest in our home. His professional competence, his charm, his gentlemanly nature, his warm-heartedness and his ability to get things done, as well as his pioneering spirit and his love for aesthetic plastic surgery have perhaps encouraged me to continue resolutely in this specialty and to pass on my knowledge to young colleagues. This young team of enthusiastic aesthetic plastic surgeons at my clinic has also helped me to complete Volume 2 of the manual. For this, I would like to give particular thanks to Dr. med. Klaus...

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...

Hormones

Estrogens have only minimal effects on hair growth. Androgens are the most important determinant of the type of hair distributed throughout the body. The principal circulating androgen, testosterone, is converted in the hair follicle by 5-alpha reductase to dihydrotestosterone (DHT), which stimulate the dermal papilla to produce a terminal melanized hair. The effect of androgens on hair growth is skin area-specific, due to local variations in androgen receptor and 5-alpha reductase content). While the effect of androgens on hairs (i. e., terminalization of vel-lus hairs) will be more readily apparent in skin areas with a greater numbers of hair follicles, hair follicle density does not correlate with fol-licular sensitivity to androgens. Some areas of the body, termed nonsexual skin (e. g., that of the eyelashes, eyebrows, and lateral and occipital aspects of the scalp), are relatively independent of the effect of androgens. Other areas are quite...

Wool and Woolens

At every hair's base is a saclike hair follicle. The hair grows from the bottom of the follicle, nourished by blood vessels in a structure called a papilla. The papilla extends into the follicle and into the hair's root. A tiny muscle is attached to each hair follicle. Action of the nervous system can cause the muscle to contract to make hair stand on end. Hair follicles produce hairs in cycles of hair growth, in which the hair follicle and the shaft pass through a complex series of morphological changes. During hair growth, the follicle penetrates into the dermis, and cells of the shaft are joined together. In addition, the follicle's mela

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...

Disadvantages

It is impossible to estimate the exact amount of energy absorbed by each hair follicle after laser irradiation owing to skin nonhomogene-ity, multilayering, and anisotrophic physical properties of hair growing at different angles in relation to the laser impact. In addition, because growing hair depths vary between 2 and 7 mm depending on the body location, laser absorption characteristics will vary depending on the anatomic site. Finally, the percentage of anagen and telogen hairs varies from site to site, from person to person, and from season to season. It is not even clear whether the treatment of anagen as compared to catagen or telogen hairs even matters. Many studies now show the hair follicle to be an incredibly resilient structure, regrowing after a seemingly lethal injury. It is the delivery of adequate fluences, optimizing wavelengths, and pulse durations, while reducing unwanted epidermal injuries that leads to the optimal treatments of pigmented hair. Unfortunately, the...

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

Outcome Measures

At monthly interviews, the investigator rated the patient's enjoyment of sexual contact and his erectile and ejaculatory difficulties. Blood was also collected monthly for endocrine assessment (testosterone, 5 a-dihydrotestosterone, estradiol, sex hormone-binding globulin SHBG , FSH, LH, and prolactin).

Prostate Disease

Most urologists believe that androgens do not induce BPH, but androgens should not be used in subjects with lower urinary tract obstructive symptoms until these symptoms have been treated. There is no direct evidence in hypogonadal young or older men that androgen replacement will induce the formation of prostate cancer or convert a latent, histological prostate cancer to a clinically significant or metastatic cancer (68). However, androgens should not be used in a hypogonadal man who has had prostate cancer. There are possible rare exceptions, e.g., a patient with a distant completely resected intraprostatic cancer and long-standing near-undetectable PSA levels who is suffering from severe symptoms and signs of testosterone deficiency. Treatment of such a patient may be justified but only with careful surveillance and well-documented informed consent. It is not known whether testosterone treatment, together with the 5-a reductase inhibitor finasteride or an androgen that cannot be...

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...

Folliculitis

Folliculitis refers to a circumscribed superficial pustular infection of the hair follicle. These pruritic lesions, which are up to 5 mm in diameter, often present as small red papules with a central area of purulence that may rupture and drain. Systemic signs and symptoms are rare. Lesions typically are located on the head, back, buttocks, and extremities. The most common organism isolated is S aureus. A condition known as hot tub folliculitis is attributable to hot tub or whirlpool water contaminated with Pseudomonas aeruginosa-, the ear canal, the breast area, and other skin locations covered by a swim suit are commonly involved. A condition known as eosinophilic pustular folliculitis should be considered in the differential diagnosis of chronic excoriated-appearing follicular infections in HIV-infected patients who have a peripheral eosinophilia and CD4 count of less than 250 mm3 6,7 . In normal hosts, folliculitis usually resolves spontaneously without systemic treatment, and 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.)

Eyelid Infections

Bacterial Conjunctivitis Lashes Mattered

Hordeola are infections of the lid margin sebaceous glands and manifest in two clinical forms external (stye) and internal. These two forms are differentiated by the particular group of sebaceous glands infected. An external hordeolum (stye) is an infection of the glands of Zeis, which extend along the base of the eyelash hair follicle. It is by far the most common type of hordeolum, and Staphylococcus aureus is the predominant microbial pathogen.

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).

Pulse Duration

Laser pulse width seems to play an important role in laser-assisted hair removal. Thermal conduction during the laser pulse heats a region around each microscopic site of optical energy absorption. The spatial scale of thermal confinement and resultant thermal or thermome-chanical damage is therefore strongly related to the laser pulse width. Q-switched laser nanosecond pulses effectively damage individual pigment cells within a hair follicle by confinement of heat at the spatial level of melano-somes (Zenzie et al. 2000). They can induce leukotrichia and cause a temporary hair growth delay, but do not inactivate the follicle itself.

Anabolic Effects

Testosterone and 5-a dihydrotestosterone (DHT) are powerful anabolic hormones that stimulate nitrogen retention and protein synthesis (16). During puberty, testosterone acts in concert with other hormones to increase bone mass and to initiate the adolescent growth spurt. In the adult, testosterone is needed to maintain protein anabolism and, thereby, structural proteins. Athletes who use anabolic steroids (i.e., pharmacologically derived testosterone-like compounds) take advantage of this effect to facilitate the development of increased skeletal muscle mass (3,6,16,17,19). This latter action by testosterone results from androgen-receptor binding, which, in turn,

Prader Willi Syndrome

The use of anabolic steroids may result in reversible hypogonadotropic hypogonadism (see Chapter 16) and is manifested by a decrease in T and dihydrotestosterone concentrations and suppressed spermatogenesis (138,139). Suppression of the hypothalamic-pitu-itary-gonadal axis after androgen therapy may last more than 16 wk after discontinuation of the drug (138). Chronic treatment with pharmacologic doses of glucocorticoids may also cause hypogonadism (140). Chronic use of narcotic analgesics may also suppress LH secretion and result in reversible hypogonadotropic hypogonadism (141).

Treatment Approach

The hair removal treatment technique with all lasers and intense pulsed light sources commences with preoperative shaving of the treatment site. This reduces treatment-induced odor, prevents long pigmented hairs that lie on the skin surface from conducting thermal energy to the adjacent epidermis, and promotes transmission of laser energy down the hair follicle. A small amount of posttreatment crusting and erythema is to be expected. In darkly pig-mented or heavily tanned individuals, it may be beneficial to use topical hydroquinones and meticulous sunscreen protection for several weeks prior to treatment in order to reduce inadvertent injury to epidermal pigment. Individuals with recent suntans should not be treated until pretreatment hydroquinones have been used for at least 1 month. Postinflamma- 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...

Hair Cycle

The overall length of the hair is determined primarily by the duration of the anagen phase. Human hair appears to grow continuously, because the growth cycles of different hair follicles are in dysynchrony with each other. The histologic appearance of a hair follicle also differs dramatically with the stages of growth. The anagen follicle penetrates deepest in the skin, typically to the level of subcutaneous fat. Catagen is characterized by pyknotic changes in the nuclei of the kerotinocytes, followed by apoptosis of the transient portion of the follicle. The entire transient portion (which begins at the level of the insertion of arrector pili muscle and extends to the deepest portion) is absorbed, except for the basement membrane. As the new anagen progresses, the secondary hair germ descends, enlarges, and begin to produce a hair shaft. tiveness of hair removal with each consecutive treatment. Another explanation might be that the follicle is not destroyed immediately, but shows a...

Result

Basel Cell Surgery

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 Limmer B (1997) The density issue in hair transplantation. Dermatol Surg 23 747-750 Lucas MWG (1988) The use of minigrafts in hair transplantation surgery. J Dermatol Surg Oncol 14 1389-1392 Lucas MWG (1990) Micro and mini hair grafting. J Dermatol Surg Oncol 16 69-70 Lucas MWG (1991) Large vs small grafts, slits vs holes, vol 2, no 1. Hair Transplant Forum, Lucas MWG (1994) Planning a hair transplantation the artist's touch. Am J Cosmet Surg Marritt E (1984) Single-hair transplantation for hairline refinement a practical solution. J Dermatol Surg Oncol 10 962-963 Montagna W (1992) Atlas of normal human skin. Springer, New York, p 314 Morrison ID (1981) An improved method of suturing the donor...

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