Treating Hair Loss

Peruvian Hair Loss Treatment

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Follicular Diseases Causing Scarring Alopecia

Follicular destruction results in scarring alopecia that can be classified as primary or secondary. In primary scarring alopecias, the follicle is the target of inflammation. In secondary scarring alopecias, the follicle is an innocent bystander that, nevertheless, is destroyed. Examples of secondary scarring alopecias include morphea and tumors (alopecia neoplastica). In this chapter, we will consider only the primary scarring alopecias. In this group of diseases, the inflammation can be primarily lymphocytic or neutrophilic. Although all parts of the follicle can be involved, the disease is felt to destroy the bulge area of the follicle, where the arrector pili muscles insert. This area contains the follicular stem cells necessary for regeneration of the lower follicle during normal follicular cycling. When this part of the follicle is destroyed, the follicle is doomed. The sebaceous glands are also destroyed in primary scarring alopecias. The destruction of these structures and the...

Androgenetic Alopecia

Androgenetic alopecia is the most common type of hair loss in humans. Its prevalence in any population has not been accurately studied, but it occurs much more often in Caucasians than in other races (6). Androgenetic alopecia affects approximately 50 of men over 40 years of age and may also affect just as many women (7). It occurs in both men and women as a result of genetic and hormonal factors. Androgenetic alopecia appears to be autosomal dominant with gene expression apparently determined by hair follicle location (7). Expression of androgenetic alopecia can vary considerably from one person to another. In androgenetic alopecia, genetically predisposed hair follicles become progressively miniaturized over time. In men, the thick, pigmented terminal hairs in the affected area of the scalp eventually are replaced by the fine, unpigmented vellus hairs. Eventually, the affected scalp may become completely devoid of any hair. Women, however, rarely become completely bald but usually...

Lupus Erythematosus and Alopecia Areata

Diffuse alopecia and especially frontal alopecia due to increased hair fragility is more typical for SLE. Scarring alopecia is a frequent clinical feature of DLE and SLE. Alopecia areata is rarely associated with LE. In a large study of 736 patients with alopecia areata, only 2 had DLE and 2 had SLE (Muller and Winkelmann 1963). In 1975, Lerchin et al. (Lerchin et al. 1975) reported a single case of DLE associated with alopecia areata. Werth et al. (Werth et al. 1992) found 4 patients with alopecia areata in a group of 39 patients with LE. Two of the patients had DLE and two had SLE. The first of the reported patients had scarring alopecia as well. In each patient, continuous granular deposits of IgG at the dermoepidermal junction were detected. The authors believed that the incidence of alopecia areata in patients with LE is increased because of the common lines of evidence of both diseases.

Hair Follicles and Sweat Ducts

Hair Ostium

Possible routes of penetration through hair follicles could involve the hair fiber itself, through the outer root sheath of the hair into the viable cells of the follicle, or through the air-filled canal and into the sebaceous gland. In addition, the release of sebum by the sebaceous glands may provide a lipoidal pathway that may influence absorption by this route (228). The route for the sweat duct may involve diffusion through either the lumen or walls to below the epidermis and through the thin ring of kera- tinized cells. Dense capillary networks closely envelop the bases of both the hair follicles and sweat ducts, providing access to the circulation for most molecules reaching these regions. Hueber et al. (229) used the observation that a higher reservoir and permeability barrier function in appendage-free (scar) SC than in normal SC, as supporting evidence for a significant contribution of the appendageal route to overall skin transport. There are estimated to be close to...

Diffuse Alopecia

Patients afflicted with diffuse alopecia typically complain of hair loss all over the scalp not just in the areas usually seen in androgenetic alopecia. However, the differential diagnosis of diffuse alopecia versus androgenetic alopecia, particularly in females, can be difficult because of the similar presentation, and biopsy and histological assessment may be required to confirm the diagnosis. The course of the diffuse alopecia can be continuous or episodic. Diffuse alopecia may present as telogen or anagen effluvium and can be caused by drug and chemical exposure, thyroid disorders, nutritional influences, and psychological stress. Telogen effluvium is characterized by abrupt, diffuse hair loss. Common causes are childbirth, febrile illnesses, surgery, psychological stress, crash diets, and drug therapy (38). The excessive shedding usually begins 3 to 4 months after the inciting event (39). Anagen effluvium is characterized by widespread or circumscribed loss of anagen hairs from...

Localized Hair Loss

Spironolactone Hair Loss Women

Alopecia areata Nonscarring Alopecia Intact Hair Follicles 2. Alopecia areata (AA) 4. Androgenetic alopecia (AGA) male or female pattern baldness Scarring alopecia Loss of Hair Follicles N.B. If scalp biopsy performed (e.g., scarring alopecia), ideally a 4-mm punch biopsy is taken of a symptomatic or early active disease for transverse sectioning and H&E if lupus suspected, take additional 4-mm punch biopsy bisect this piece vertically, and submit half for vertical sectioning, and half for DIF. *In general, scarring alopecias should be referred to a dermatologist. Physical Well-circumscribed areas of complete hair loss on any hair bearing surface (scalp 90 ) may see nail pitting exclamation point hairs at periphery of bald patch Totalis entire scalp universalis all hair-bearing areas ophiasis hair loss confluent along temporal & occipital scalp DDx androgenetic alopecia, tinea capitis, trichotillomania, telogen effluvium Androgenetic Alopecia (Male and Female Pattern Baldness)...

Hair Loss

Our culture places great importance on hair and its appearance. Hair loss can cause embarrassment and loss of self-esteem. Your hair grows continually for 2 to 6 years, then rests for 2 or 3 months before falling out naturally. Shedding 50 to 100 hairs each day is a normal process, and each shed hair is replaced by There are many different types of hair loss, with a number of different causes. Hair A high fever or severe infection can produce hair loss, as can an overactive or underactive thyroid gland. Other causes of hair loss include an inadequate amount of protein in your diet, iron deficiency, or cancer treatment. Certain prescription medications such as those for gout, arthritis, depression, heart disease, or high blood pressure can cause hair loss in some people. Large doses of vitamin A also can cause hair loss. If you notice that your hair is falling out in large amounts after you brush or comb your hair, see your doctor as soon as possible to determine the cause. For men,...

Alopecia Areata

Many diseases of hair follicles result in alopecia, which is simply defined as any type of hair loss. The alopecias are conventionally grouped into nonscarring and scarring categories. Nonscarring alopecias may be localized or diffuse. Since the follicles are not destroyed in the nonscar-ring alopecias, there is potential for regrowth or return to normal hair density in these conditions. Follicular diseases that result in follicular destruction and permanent hair loss are termed scarring alopecias. There is some confusion in this categorization scheme because some of the nonscarring alopecias can eventuate over many years into areas of permanent alopecia through follicular drop-out.


Three types of alopecia can be detected in patients with LE (Sontheimer and Provost 1996). In addition to the permanent scarring alopecia associated with discoid lupus lesions, patients with SLE may experience transient alopecia with increased disease activity. Two types of transient hair loss, a result of the severe catabolic effect of the lupus disease flare, have been detected. One is classic telogen effluvium, in which the patient develops prominent and at times alarming loss of hair all over the scalp. If the patient's SLE is a chronic active disease process, the telogen effluvium may persist for a prolonged time. However, with quiescence of the lupus disease process, normal growth of hair resumes. The second form of alopecia, related to a flare of the SLE process, is termed lupus hair or woolly hair . It is most likely a type of telogen effluvium characterized by the development of thin, weakened hairs most prominent at the periphery. These hairs easily fragment the hair becomes...

Appendix The Extinction Of Silphium

Silphium was originally discovered in what is now Libya after a mysterious black rain fell around 600 b.c. This plant subsequently spread throughout the region 38 and became valuable because of the particular taste of meat from animals that fed on it. Silphium was also a highly effective medicine. The dried sap of the plant could be used on a variety of disorders from fevers and warts to hair loss. Because of the broad uses of the plant, and a reported inability to cultivate it 38 , silphium became highly prized. Because the plant was difficult to find naturally, Julius Caesar held on to nearly a ton of the dried resin in the Roman treasury 39 . Eventually, the lack of supply drove the value of the plant resin so high that the Roman Empire declared a

Eyelid Lesions and Tissues of Origin

Microcystic Adnexal Carcinoma

The dermis also contains epithelial appendages which are the source for many eyelid lesions. The pilosebaceous unit consists of the hair follicle and associated holocrine sebaceous gland and apocrine sweat gland of Moll. All of these structures can be the site of origin for eyelid lesions. The diverse cellular components of this apparatus can give rise to many different lesions that can look similar clinically. Lesions are grouped into four major categories depending upon differentiation towards sebaceous, hair follicle, apocrine, or eccrine tissues. Within these groups lesions are further subdivided into hyperplasias, hamartomas, adenomas, and carcinomas. The hair follicle is a tubule with root cells at the base around the papilla and bulb (Fig. 3). Higher up follicular epithelium lines the follicle, and finally cortical cells lay down the outer keratin layers to the hair. Tumors arising from proliferations of cortical cells are termed piloma-trixomas. Solid proliferations of...

Studies in MS and Other Conditions

Aromatherapy has been studied in a few other unrelated conditions. Small studies on older people with dementia have produced mixed results. Inhalation of black pepper extract may decrease the craving for cigarettes. People with a form of baldness called alopecia areata may benefit from scalp massage using a mixture of thyme, rosemary, lavender, and cedar-wood oils.

Discoid Lupus Erythematosus

Discoid Lip

Generally progressive, and resolution of the lesions leaves more or less evident atrophy and scarring, depending on the duration and severity of the lesions during the active phase. This may result in considerable mutilations, particularly when present in acral regions on the face, such as the tip of the nose and the ears, or in irreversible scarring alopecia on the scalp. A characteristic pitted, acneiform scarring is also a common feature of the perioral area (Fig. 6.8). Cutaneous lesions of DLE predominantly occur in light-exposed areas, such as the face, particularly the cheeks and ears, but the forehead, eyebrows, eyelids, nose, and lips can also be included (Fabbri et al. 2003, McCauliffe 2001, Patel and Werth 2002). Symmetrical, butterfly-shaped DLE plaques will occasionally be found over the malar areas and the bridge of the nose. Such lesions are not to be confused with the more transient, edematous erythema reactions that occur over the same distribution in patients with...

Biomarker Approaches in the Discovery of Early Markers of Drug Toxicity

Some examples of toxicity biomarker discovery efforts are worth noting as cases in point. An early gene expression profiling effort in toxicology applied oligonucleotide microarrays in a rat study of a panel of well-studied compounds and led to identification of response profiles of drug metabolism, metabolic effect, and stress response genes some of these were previously characterized or otherwise verified by qRT-PCR.76 In an interesting twist of profiling for toxicant or drug metabolic response transcripts, a variant approach has been described as a means to select for potential targets that are specific to drug effect in a target tissue and not coincidentally up- or downregulated as part of a drug absorption, distribution, metabolism, and excretion (ADME) pharmacokinetic response pathway by restricting screening of transcripts to those that are not expressed in cells derived from ADME-related tissues (liver, colon, and kidney), this may provide a means to more selective potential...

Subacute Cutaneous Lupus Erythematosus

Subacute Cutaneous Lupus

Several other skin lesions that are not specific for LE have been described in patients with SCLE (Parodi et al. 2000, Sontheimer 1989). The most frequently encountered of these include nonscarring alopecia, painless mucous membrane lesions, livedo reticularis, periungual telangiectasias, and Raynaud's phenomenon (Callen et al. 1986, Callen and Klein 1988, David et al. 1984, Herrero et al. 1988, Molad et al. 1987, Sanchez-Perez et al. 1993, Sontheimer 1985a). Cutaneous vasculitis of the lower extremities is a frequent finding in anti-Ro SSA antibody-positive patients with SCLE also described under the rubric of Sjogren's syndrome LE overlap syndrome (Provost et al. 1988). Furthermore, cutaneous calcinosis maybe seen rarely in patients with SCLE, and HPV-11-associated squamous cell carcinomas of the skin were noted in one patient with SCLE (Cohen et al. 1992). In one additional case, annular poly-cyclic SCLE lesions were reported over time to progress to plaques of morphea (Rao et al....

Lupus Erythematosus Profundus

Lupus Profundus

Single or multiple sharply defined, persistent, asymptomatic or sometimes painful subcutaneous plaques or nodules of varying sizes are the typical lesions of LEP (Costner et al. 2003, Peters and Su 1989). The overlying skin ultimately becomes attached to the firm lesions, producing a deep depression into the subcutis with a normal or erythematous, inflammatory surface (Fig. 6.16). Dystrophic calcifications or ulcerations within older lesions of LEP, leaving atrophic scars or sometimes resembling lipatrophy, may occur and at times can be a prominent clinical feature of the disease requiring surgical excision. In addition, LEP may produce breast nodules that can mimic carcinoma, clinically and radiologically (Holland et al. 1995, Peters 2000), and linear involvement of the extremities or the scalp has also been observed (Nagai et al. 2003, Tada et al. 1991). Most lesions of LEP are usually found in areas of increased fat deposition, such as the trunk, buttocks, and proximal upper and...

Clinical manifestation

Skin changes facial plethora striae ecchymoses and purpura telangiectasias skin atrophy hirsutism and male pattern balding in women increased lanugo facial hair steroid acne acanthosis nigricans Central obesity increased adipose tissue in the face (moon facies), upper back at the base of neck (buffalo hump), and above the clavicles

Lower Facial Dissection

This is essential because the flap will later be advanced by securing it to the superior occipital fascia with deep permanent sutures. As dissection continues inferi-orly in the occipital region, the plane become more superficial but still must remain beneath the hair follicles to avoid producing alopecia. As a general rule, if you see hair follicles, they probably are damaged. Flap elevation is carried out from behind, working toward the sternocleidomastoid muscle. In this area, sharp dissection will be required. We prefer to use the electrosurgical unit, but dissection can be carried out with a blade or scissors.

Skin Excision And Closure

Next the temple tissues are elevated. No skin is removed, but a strong permanent suture to the underlying dermis and temporoparietal fascia of the inferior temporal flap is placed and advanced posteriorly and superiorly, securing it to the temporalis fascia. By avoiding any skin excision, the scar will be thin, with little chance of hair loss. Still, this strong deep suture provides effective elevation of the temple area without a stretched look.

Fresh Discoid Lupus Erythematosus Lesions

In psoriasis vulgaris, again, individual psoriatic plaques may be similar to DLE, especially fresh lesions and those of the photosensitive type. Psoriatic plaques are round and well demarcated their scales, however, are large, silvery, and easily detachable. They do not lead to hair loss or epidermal atrophy. At the clinical overview, psoriasis differs from DLE by its exanthematic distribution and its totally different predilection sites. Also, psoriatic plaques of the face are rare. As antimalarials can aggravate psoriasis, psoriasis should be ruled out before treatment of DLE is started.

Dissecting cellulitis of scalp

Chronic inflammatory disease characterized by painful suppurating lesions of the scalp, leading to scarring alopecia Associated with acne conglobata, hidraden-itis suppurativa, and pilonidal cysts, all of which have follicular blockage as the common mechanism retained material dilates and causes follicular rupture keratin and organisms from the damaged hair follicles initiate neutrophilic and granulomatous response bacterial infection secondary event Perifollicular pustules tender nodules (some discharging pus or gelatinous material) intercommunicating sinuses between nodules patchy alopecia with scarring frequent recurrences over many years

Dyskeratosis congenita

Cutaneous manifestations developing between 5 and 15 years of age tan-to-gray, hyperpigmented or hypopigmented macules and patches in a mottled, or reticulated pattern, sometimes with poikilo-derma located on the upper trunk, neck, and face, often with involvement of sun-exposed areas scalp alopecia mucosal leu-koplakia on the buccal mucosa, tongue, oropharynx, esophagus, urethral meatus, glans penis, lacrimal duct, conjunctiva, vagina, anus dental caries progressive nail dystrophy increased incidence of malignant neoplasms, particularly squamous cell carcinoma of the skin, mouth, nasopharynx, esophagus, rectum, vagina, and cer

Steroids and Lipoproteins in the CNS

Estrogenic control of apoE mRNA is directly shown in vitro. In mixed glial cultures (65-75 astrocytes, 15-20 microglia, 10-15 oligodendrocytes originated from cerebral cortex from 1-5 day old rat pups), the levels of apoE mRNA are increased 2-fold by the addition of 17p-estradiol at a concentration of 0.1nM (approximately blood levels at late proestrus or pregnancy). This apoE induction occurs in both astrocytes and microglia. However, no induction is caused by corticosterone or dihydrotestosterone (Fig. 3.3). This upregulation is dependent upon cell-cell interactions, as neither astrocytes or microglia respond to estrogen with increased apoE mRNA when grown in monotypic culture.26 Cell-cell contact is also necessary for this increase,29 as separation of astrocytes and microglia with a 0.45 im pore-size filter removed the estrogen effect.

Fenugreek Methi Trigonella foenumgraecum Fabaceae

Fenugreek seeds, like those of most legumes, are rich in protein, so fenugreek adds valuable nutrients as well as flavor to the diet. The plant is native to west Asia and southeast Europe. Charred seeds from the Middle East date from about 4000 bc onwards. Fenugreek was present in Tutankhamen's tomb and was a component of the holy smoke used for fumigation and embalming. It was used in a medieval cure for baldness. The steroid in its seeds may be useful in oral contraceptives, and is widely used as a galactagogue (to increase milk supply). Fenugreek is an important component of curry powders, a popular ingredient of Egyptian and Ethiopian bread, and the principal flavoring of artificial maple syrup.

Folliculitis decalvans

Inflammatory process caused by obstruction or disruption of individual hair follicles and the associated pilosebaceous units, leading to scarring alopecia because of destruction of the follicular units role of staphylococcal follicular infection uncertain Occurs in women after age 30 and in men from adolescence onward bogginess or induration of affected areas of the scalp or other hair-bearing sites successive crops of pustules late finding of scarring alopecia

TRAFMediated TNFRFamily Signaling

The tumor necrosis factor (TNF) superfa-mily consists of a wide variety of proteins, some cell-bound and others secreted, that regulate many cellular processes. In particular, TNF-family proteins regulate the life and death not only of tumor cells, but of activated cells of the immune system. They modulate the activation state of immune cells, and as we are increasingly becoming aware, they mediate the signals that these cells send to each other. TNF-family proteins have been implicated in areas outside of inflammation and immunity, including bone homeostasis, lymph node organogenesis, hair follicle development, and mammary gland development (Locksley et al., 2001).

Pharmacologic Highlights

Other Therapy Common side effects are alopecia, nausea, vomiting, fatigue, myelo-suppression, and stomatitis. Patients who are receiving chemotherapy are administered antinausea drugs, antiemetics, and pain medicines as needed to help control adverse experiences. Experimental drugs currently in clinical trials include paclitaxel, topoiso-merase-3 inhibitors, nucleoside analogues, monoclonal antibodies, and interferon. During irradiation, the patient may suffer from dry mouth, loss of taste, dysphagia, nausea, and vomiting, which can be managed with frequent mouth care. Explore ways to limit discomfort, such as ice chips. Attempt to provide desired foods to support the patient's nutrition. Keep any foul-smelling odors clear of the patient's environment, particularly during meals. Manage skin irritation and redness by washing the skin gently with mild soap, rinsing with warm water, and patting the skin dry. Encourage the patient to avoid applying lotions, perfumes, deodorants, and...

Demonstration of a Structure Toxicity Relationship A Strategy for Lead Progression

The drug-sparing 30-day toxicology protocol designed by Piper required that my laboratory need only prepare 8-12 g of each test compound. The use of such limited drug quantities was feasible, as the protocol would involve the dosing of only three rats per sex. As the rationale of the study was to enable the expeditious identification of oxazolidinones having at least a 10-fold therapeutic index in the rat, the test compounds were dosed orally, twice daily (b.i.d.), at a dosage level 10-fold the ED50 (the effective dose (mgkg_ 1) that protected 50 of the mice from death after an injection of a lethal dose of S. aureus). As the comparative study progressed, the toxicologists reported several distinct toxicological findings that were readily apparent by clinical observation in the group of rats dosed orally with ( + )-DuP-721 at 100mgkg_ 1 day_ 1. Those findings included alopecia, severe anorexia, ataxia, and the death of one of the six animals another two animals observed in a moribund...

Inverted Follicular Keratosis

Inverted Follicular Keratosis

INTRODUCTION Inverted follicular keratosis is a benign skin lesion that is common on the face and less frequently on the eyelids. It occurs in older individuals from the fifth decade on, and is considerably more common in males. It is frequently mistaken for a malignant tumor. These lesions arise from the infundibular epithelium of the hair follicle and therefore are related to epidermoid cysts. Inverted follicular keratosis may be an irritated form of seborrheic keratosis or verruca vulgaris.

Differential Diagnosis at Particular Sites Discoid Lupus Erythematosus of the Scalp

Scutula Favus

DLE of the scalp (Fig. 11.2A) typically arises as one or a few roundish erythematous plaques identical to DLE lesions elsewhere on the skin. When atrophy develops, they gradually transform into patches of scarring alopecia that may be surrounded by rims of scaly erythema. In the early phase, it must be distinguished from psoriasis and seborrheic dermatitis (see previously herein). In advanced stages, DLE may Fig. 11.2. A Atrophic alopecia in discoid lupus erythematosus. Note the widened erythematous follicular openings between flattened atrophic areas. B Lichen ruber planopilaris confluent small areas of atrophic skin with interspersed unaffected hair-bearing follicles Fig. 11.2. A Atrophic alopecia in discoid lupus erythematosus. Note the widened erythematous follicular openings between flattened atrophic areas. B Lichen ruber planopilaris confluent small areas of atrophic skin with interspersed unaffected hair-bearing follicles resemble all other instances of scarring alopecia. One...

Discharge And Home Healthcare Guidelines

Discuss with the woman helpful coping mechanisms. Encourage her to be open with her partner, her family, and her friends about her concerns. Help the patient cope with hair loss. Teach her cosmetic techniques to deal with hair and body changes. Explore alternative methods to medication to manage nausea and vomiting.

Conditions That May Simulate Tinea

Tinea of the scalp may be confused with any scalp disorder that causes patchy alopecia, inflammation, or scale. The presence of hairs broken off a short distance above or right at the scalp surface should cause immediate suspicion. Occasionally TCa does not produce hair breakage. Alopecia areata causes patchy hair loss and may show erythema of the scalp. Scale is absent, however, and the presence of exclamation-point and dystrophic anagen hairs should differentiate it. In older patients with alopecia areata, gray hairs continue to grow within the patches of alopecia. An active impetigo of the scalp, on rare occasions, can produce enough inflammation to cause hair loss and may simulate a kerion. Hairs can be readily epilated but come out by the root rather than by breakage. Whenever there is a question, hair KOH exam and fungal culture are indicated.

Classification Antihypertensive depresses sympathetic nervous system

And a drug to minimize tachycardia such as a beta-adrenergic blocking agent). Minoxidil can produce severe side effects it should be reserved for resistant cases of hypertension. Close medical supervision required, including possible hospitalization during initial administration. Topically to promote hair growth in balding men. Contraindications Pheochromo-cytoma. Within 1 month after a MI. Dissecting aortic aneurysm. Special Concerns Safe use during lactation not established. Use with caution and at reduced dosage in impaired renal function. Geriatric clients may be more sensitive to the hypotensive and hypothermic effects of minoxidil also, it may be necessary to decrease the dose in these clients due to age-related decreases in renal function. BP controlled too rapidly may cause syncope, stroke, MI, and ischemia of affected organs. Experience with use in children is limited.

Clinical Features

Lutzner Cells

Sezary syndrome is an uncommon CTCL which accounts for less than 5 of CTCL (4,5). Sezary syndrome is characterized by distinct clinical features with erythroderma accompanied by intense and generalized pruritus, diffuse alopecia, palmoplantar hyperkeratosis and onychodystrophy as well as lymphadenopathy (Figs. 1-3). In the peripheral blood, lymphoid cells with hyperconvoluted nuclei (so-called Sezary or Lutzner cells) of varying size (8 to 12 micrometer in diameter) and number are found (6). Interestingly, clinicopathologic manifestations of SS

Drug interactions

Alopecia areata Hypersensitivity to drug class or compo- Pressure alopecia nent systemic fungal infection caution in patients with congestive heart failure, seizure disorder, hypertension, diabetes melli- Traction alopecia tus, tuberculosis osteoporosis impaired liver function

Acne Keloidalis Nuchae Also Known As Folliculitis Keloidalis

Ophiasis Pattern Alopecia Areata

Figure 1 (A) Well-clrcumscribed areas of nonscarring hair loss in typical alopecia areata. (B) Marginal hair loss in ophiasis pattern alopecia areata. (C) Diffuse hair loss in diffuse alopecia areata. (D) Exclamation point hairs (arrows) in an active patch of alopecia areata. Figure 1 (A) Well-clrcumscribed areas of nonscarring hair loss in typical alopecia areata. (B) Marginal hair loss in ophiasis pattern alopecia areata. (C) Diffuse hair loss in diffuse alopecia areata. (D) Exclamation point hairs (arrows) in an active patch of alopecia areata. Figure 2 (A) Low power view demonstrating normal follicular density, numerous telogen follicles ( 90 ), and follicular miniaturization in alopecia areata (T V 1 3). (B) Four telogen germinal units (thin arrows) and several pigment casts (thick arrows) in a biopsy of alopecia areata. (C) Peribulbar lymphocytic infiltrates around vellus hair follicles in alopecia areata. (D) Peribulbar lymphocytic infiltrate around a terminal hair follicle in...

Primary Nursing Diagnosis

Topical fluorouracil may be used to manage some SCC skin lesions. During treatment, the patient's skin is more sensitive than usual to the sun. Healing generally occurs in 1 to 2 months. With metastatic SCC, radiation, chemotherapy, and surgery may be combined. The chemother-apeutic agent commonly used is cisplatin or doxorubicin, or both. External beam radiation therapy may be used in cases where a tumor is difficult to remove surgically because of its size or location and in situations in which the patient's health precludes surgery. As an adjuvant therapy after surgery, radiation can be used to kill small deposits of cancer cells that were not visible during surgery. Radiation may also be used when NMSC has spread to other organs or to lymph nodes. If the patient undergoes radiation therapy, prepare the patient for common side effects such as nausea, vomiting, diarrhea, hair loss, and malaise.

Description Medical Other Infectious and

Begins with the penetration of the infecting organism, the spirochete Treponema pallidum, into the skin or mucosa of the body. Within 10 to 90 days after the initial infection, the primary stage begins with the appearance of a firm, painless lesion called a chancre at the site of entry. In women, the chancre often forms in the vagina or on the cervix and therefore goes unnoticed. If it is left untreated, the chancre heals spontaneously in 1 to 5 weeks. As this primary stage resolves, systemic symptoms appear, thus signaling the start of the secondary stage. Secondary stage symptoms include malaise, headache, nausea, fever, loss of appetite, sore throat, stomatitis, alopecia, condylomata lata (reddish-brown lesions that ulcerate and have a foul discharge), local or generalized rash, and silver-gray eroded patches on the mucous membranes. These symptoms subside in 1 week to 6 months, and the infected person enters a latent stage, which may last from 1 to 40 years. During latency,...

Description Of Lesion

If a chancre exists, palpate the surrounding lymph nodes for hard, painless nodules. Also inspect the scalp, skin, and mucous membranes for hair loss, rashes, or mucoid lesions, which are characteristic of the secondary stage. Inspect the fingernails for signs of pitting.

UL for Women 51 years3000 yigday of preformed vitamin A

There arc limited case report data of hypervitaminosis A (e.g., bulging anterior fontanels, increased intracranial pressure, hair loss, increased suture markings on the skull, and periosteal new bone formation) in children and adolescents after doses ranging from 7,000 jig day in young children to 15,000 yig day in older children and adolescents (Farris and Erdman, 1982 Siegel and Spackman, 1972 Smith and Goodman, 1976). Given the dearth of information and the need for conscrvativism, the UL values for children and adolescents arc extrapolated from those established for adults. Thus, the adult UL of 3,000 yig day of preformed vitamin A was adjusted for children and adolescents on the basis of relative body weight as described in Chapter 2 with use of reference weights from Chapter 1 (Table 1-1). Values have been rounded.

Who Was First There Will Always Be Somebody Before

It is a misbelief that Alibert was the first to describe mycosis fungoides (MF). Almost 200 years earlier, Bontius (1) Citing Pesino from Italy described a disease, which today we would classify as cutaneous T-cell lymphoma (CTCL). The erythrodermic and leukemic variant of MF was not described for the first time by Sezary and Bouv-rain (2). Twenty years earlier, Leo von Zumbusch at the 9th reunion of the Munich Dermatological Society presented a 71-year-old male patient suffering for 5 months with erythroderma, leukocytosis (21,000 mL) and lymphocytosis ( 70 ), with lymphoid skin infiltrates, hair loss, and hyperkeratosis (3). This probably is the first documented description of what we refer to today as Sezary syndrome.

Hair Replacement Surgery

Hair replacement surgery for male pattern baldness is one of the most common cosmetic surgery procedures performed on men. Usually it involves grafting hair from the sides and back of the person's scalp (called the donor sites) to the bald area. Sometimes this technique is combined with another procedure called scalp reduction, in which the surgeon removes skin from bald areas of the scalp and uses elastic scalp extenders and expanders placed under the skin to stretch the remaining skin over the scalp. In another surgical procedure, called the flap technique, the surgeon moves areas of the scalp containing hair from the sides or back of the head to the top of the head. The flaps cover more area than the usual graft, and part of the flap remains attached to the original blood supply. The type of hair replacement procedure you choose depends on the kind of hair loss you have. If you are considering hair replacement surgery, discuss your options with your plastic surgeon to determine the...

Trichilemmal Sebaceous Cyst

Trichilemmal Carcnoma

INTRODUCTION The trichilemmal cyst is also referred to as a sebaceous or pilar cyst. It is derived from the outer root sheath of the deeper parts of a hair follicle and consists of a well-keratinized epidermal wall surrounding semi-solid hair keratin and cholesterol-rich debris, rather than just sebaceous material. Trichilemmal cysts are more common in females and most cases occur in the sixth and seventh decades of life. They differ from epidermoid cysts in that they lack a granular layer in the lining epithelium. Foci of proliferating cells and mitoses can occasionally be seen producing the proliferating trichilemmal cyst or pilar tumor. Some authors regard these as malignant tumors.

Chloro13Dinitrobenzene 6Chloro13Dinitrobenzene

This substance is one of the strongest primary skin irritant known, and a universal contact allergen. Occupational dermatitis has been reported, but current use is decreasing or performed with completely closed systems. DNCB is sometimes used for topical treatment of alopecia areata, severe warts, and cutaneous metastasis of malignant melanoma.

Lupus Erythematosus and Lichen Planus

The coexistence of both diseases in four patients. Additionally, several cases of the coexistence of both diseases have been reported (Baumann 1997, Camisa et al. 1984, Davies et al. 1977, Dimitrova et al. 1982, Piamphongsant et al. 1978, Plotnick and Burnham 1986, Razzaque et al. 1982, Romero et al. 1977). Most of the reported cases are patients with DLE and coexistent LP. In 1982, our group (Dimitrova et al. 1982) described a 55-year-old woman whose disease began with scarring alopecia. Two years later, discoid lesions appeared on her face. One year later, itching papules appeared on her back and wrists. The histologic and immunologic findings were compatible with both diseases. The case reported by Razzaque et al. (Razzaque et al. 1982) had LP associated with SLE. The diagnosis was based on the criteria of the American Rheumatism Association for SLE and on findings from histologic and immunofluorescence studies suggestive of LP. LE discoides and LP verrucosus in the same patient...

Dermatosurgical and Laser Therapy in Cutaneous Lupus Erythematosus

In patients with treatment-resistant lesions, different surgical techniques may offer additional alternatives. For many years, cryotherapy has been used to treat LE lesions however, systematic studies are lacking, and the reported numbers in treatment series are low (Ting and Sontheimer 2001). Further surgical techniques that have been reported in individual cases include dermabrasion, laser resurfacing, hair transplantation, and surgical excision of disfiguring lesions. Owing to the disease-specific nature of LE, a test area should probably be treated first so that avoidance of the Koebner phenomenon and adequate healing may be ensured.

Dermatologic Physical Exam

Drawing Person Clothes

Microdistribution Follicular distribution is encountered on rare occasions. The disease may attack any hair bearing area. Follicular LP may be seen with other typical skin and mucous membrane lesions or may occur alone. It presents as pin-head-sized conical, rough red papules pierced by a hair. Permanent hair loss may occur.

Acne A Introduction

Ization of the epithelium lining the hair follicle, which may lead to obstruction of the follicle with resulting comedone (blackhead) formation. Propionibacterium acnes, a gram-positive commensal bacterium, proliferates within the obstructed hair follicle, and may break down the lipid esters of sebum to liberate potentially irritating fatty acids (13). Eventual rupture of the wall of the obstructed follicle and the release of fatty acids into the surrounding dermis will result in an inflammatory response.

Graftvs Host Disease as a Model of Systemic Lupus Erythematosus

It is well known that chronic graft-vs-host (GVH) disease in mice has similarities to human SLE, and several models have been used for these investigations. The GVH model offers significant advantages over the existing, spontaneous SLE-prone mice in that it can be reliably induced and it follows a predictable, relatively short time course. Gleichmann and associates successfully induced a syndrome strongly resembling SLE in a suitable chronic GVH disease made in nonirradiated, H-2-incompati-ble (C57BL 10 x DBA 2)F1 mice injected intravenously with DBA 2 spleen cells and lymph node cells (Gleichmann et al. 1982, Van Rappard-Van Der Veen et al. 1983). Their model develops subepidermal immunoglobulin deposits like inbred SLE-prone mice. (BALB c x A J)F1 mice inoculated with A J lymphocytes show mixed connective tissue disease-like symptoms, including finger swelling, alopecia, and proteinuria (Gelpi et al. 1988). Because chronic GVH models for SLE are useful for investigating

Epidemiology of the Cutaneous Manifestations of Lupus Erythematosus

ACLE appears in 30 -60 of patients with SLE. It includes localized (malar) erythema, widespread (face, scalp, neck, upper chest, shoulders, extensor arms, and back of hands) erythema, and bullous (toxic epidermal necrolysis-like) LE. Additionally, nonspecific but disease-related cutaneous manifestations can appear in patients with LE, including photosensitivity, alopecia, urticaria, livedo reticularis, dermal vasculi-tis, and Raynaud's phenomenon (Yell et al. 1996). Alopecia ( ) Hair loss is a common and characteristic finding in patients with SLE. The variability in recording alopecia resulted in its exclusion from the ACR criteria. It may be scarring, if preceded by DLE, or nonscarring.

Prognosis of Cutaneous Lupus Erythematosus

Classic variants of specific CLE lesions are DLE and SCLE. Other typical CLE subsets, such as LE profundus panniculitis, LE tumidus, urticaria vasculitis, hypertrophic LE, and bullous LE, are rather rare variants. Butterfly rash and macular exanthema are characteristic skin lesions of SLE rarely found in patients with CLE. DLE and SCLE may appear at any age, but the most common age at onset is 20-40 years in females and males, with a female predominance of 3 1 in DLE and 3 1 to 6 1 in SCLE. Nonspecific LE skin lesions such as generalized or acrolocalized vasculitis (4 -30 ), livedo reticularis (22 -35 ), and alopecia (38 -78 ) are frequently seen in patients with CLE (Beutner et al. 1991,Callen 1985,1986,Molad 1987,Moschella 1989, Sontheimer 1979, Tebbe and Orfanos 1992).

Cortisol release and its modification by glucocorticoids

Androgens are masculinizing substances. The endogenous male gonadal hormone is the steroid testosterone from the interstitial Leydig cells of the testis. Testosterone secretion is stimulated by hypophyseal luteinizing hormone (LH), whose release is controlled by hypotha-lamic GnRH (gonadorelin, p. 242). Release of both hormones is subject to feedback inhibition by circulating testosterone. Reduction of testosterone to dihydrotestosterone occurs in most target organs the latter possesses higher affinity for androgen receptors. Rapid intrahepatic degradation (plasma t1 2 15 min) yields androsterone among other metabolites (17-ketosteroids) that are eliminated as conjugates in the urine. Because of rapid hepatic metabolism, testosterone is unsuitable for oral use. Although it is well absorbed, it undergoes virtually complete pre-systemic elimination. Testosterone (T.) derivatives for clinical use. T. esters for i.m. depot injection are T. propionate and T. heptanoate (or enanthate)....

Microanatomical And Embryological Considerations

Although we often think of hair follicles, sebaceous glands, and apocrine glands as distinct elements, all three components actually stem from the same structure, which has been termed the folliculosebaceous-apocrine unit. For practical purposes, the terms follicle, hair follicle, folliculosebaceous unit, and folliculosebaceous-apocrine unit are used interchangeably. The folliculosebaceous-apocrine unit is a structure that provides insulatory, cosmetic, and pheromonic functions to the mammalian organism. The eccrine unit is a completely independent structure that serves as a thermoregulatory device via secretion of sweat.

See Risk For Impaired Skin Integrity

Defining Characteristics (Specify radiation effects erythema, dryness, itching, increased pigmentation, dry desquamation, necrotic tissue chemotherapy and antibiotic induced side effects local phlebitis, stomatitis, mucositis, maculopapular rash, hyperpigmentation, nail changes, pruritus, dermatitis, alopecia, photosensitivity, acne, erythema, poor wound healing.)

Discoid Lupus Erythematosus Classic Appearance

Lesions evolve according to a characteristic time course. Fresh lesions first present as small, round, well-defined, slightly raised erythemas with dull surfaces that soon become rough to the touch and scaly. Scales are adherent and are often attached to the hair follicles ( carpet tack phenomenon). Follicular orifices are first widened with keratotic plugs and may then disappear completely there is a gradual loss of hair in the lesions, leading to irreversible scarring alopecia. Lesions spread slowly and regress at the centers, which become smooth and sunken. Intermediate lesions become elevated and indurated at variable degrees and develop atrophy and loss of normal skin texture in their centers. At the periphery, rests of the active lesion remain as ring-like, arcuate, or polycyclic scaly erythemas that continue to spread. Old (burnt-out) lesions may be disfiguring they are large, with irregular borders, sharply demarcated, depigmented (porcelain white in dark skin), hairless,...

Dehydroepiandrosterone DHEA

DHEA has multiple possible adverse effects. It may cause liver injury. Other side effects include acne, hair loss, voice deepening, fatigue, altered menstruation, abdominal pain, hypertension, and increased risk of some hormone-sensitive cancers, including breast, endometrial, and prostate cancer. The safety of long-term DHEA use has not been established.

Health Monitoring

Monitoring the health of research animals is a necessary prerequisite to sound science and cost-effective research. Programs traditionally include one element which relies on observational data where animals are monitored for overt signs of disease such as diarrhea, sneezing, lethargy, hair loss, and weight loss. A second element uses diagnostic tests to identify clinical conditions. The animal care and veterinary staff, working in conjunction with investigators and their technicians, normally observe, diagnose, and treat clinical conditions.

Specific History

A careful medication history is essential, and any medication reported to cause an LP-like eruption should be discontinued. The features of these drug eruptions are sometimes strikingly similar to the idiopathic disease both clinically and microscopically, and offending drugs will be uncovered only by careful history. The list of medications that cause these reactions continues to grow and any agent should be suspect. These drug-induced eruptions are slow to clear and it is not unusual for improvement to take 2 or 3 months. LP has also been associated with an increased incidence of autoimmune diseases (Sjogren's syndrome, sicca syndrome, alopecia areata, vitiligo, ulcerative colitis, myasthenia gravis, and diabetes mellitus), chronic dermatophyte infections, and chronic liver disease (primary biliary cirrhosis, alcoholic cirrhosis, chronic active hepatitis B and C). The presence of a fungal infection is usually significant the authors have seen many cases of LP that clear and...

Pigmentary Changes

Antimalarial therapy can cause altered pigmentation. Premature graying of scalp hair, eyelashes, eyebrows, and beard has been detected. Also, diffuse hyperpigmenta-tion or linear horizontal bands of pigmentation can be detected in nails. A blue black patchy hyperpigmentation has also been noted on the mucous membranes and over the anterior shins. These pigmentary alterations associated with antimalarial therapy disappear with discontinuation of therapy.

Hair Growth Biology

Actively growing hair follicles penetrate the entire epidermis and dermis. There are approximately 5 million total body hair follicles, of which 100,000 to 150,000 are scalp follicles. In adults, 90 of the hair follicles are in the growing (anagen) stage and the remainder are in the resting (telogen) stage. Follicular density decreases with age (1135 cm2 at birth to 485 cm2 at 30 years to 435 cm2 at 80 years). Scalp hair grows at a rate of 0.37 to 0.44 mm day and normal scalp hair loss or shedding in adults ranges from 50 to 100 hairs per day (2). There are four types of hair follicles terminal, vellus, miniaturized, and senescent. Terminal follicles bear terminal hairs at some time during the life of an individual, whereas vellus follicles do not bear terminal hairs at any time during an individual's life. Miniaturized follicles are those terminal follicles that have lost their ability to produce terminal hairs and instead produce vellus hairs....

Topical Retinoids

Topical retinoids, including tretinoin and isotretinoin, act by decreasing epidermal proliferation and reducing the abnormal keratinization process in the hair follicle. This prevents new comedones forming and softens and removes existing comedones. There is also a reduction in the level of P. acnes within the hair follicle. Although topical retinoids are of particular value in severe acne, when there are numerous comedones present, they are also effective in other forms of mild to moderate acne. Initially, there may be some increased irritation and pain, but this usually settles with use. Tretinoin cream is preferable to tretinoin gel for those with dry or fair skin.



Distichiasis is a congenital or acquired condition in which there is an accessory row of eyelash cilia behind the normal row. The disorder may be familial with an autosomal dominant pattern of inheritance, but may also follow severe inflammatory or traumatic injury. It is believed that these abnormal lashes develop as a result of metadifferentiation of primary epithelial germ cells originally intent upon meibomian gland development. The meibomian glands are modified sebaceous glands that are not associated with the eyelashes or other hairs. In the skin sebaceous glands are usually associated with a hair follicle and an apocrine sweat gland to form a pilosebaceous unit. Under some circumstances it is believed that the meibomian gland can undergo differentiation into a primitive pilosebaceous unit producing an abnormal distichitic eyelash.


The future for hair growth research and potential forms of treatment is very bright. The cross-disciplinary efforts of academia, the pharmaceutical industry, and clinicians have led to new understanding of hair growth regulation, both biochemically and genetically. Sawaya and Price (8) have recently shown that there are differences in the amounts of steroid-metabolizing enzymes in the hair follicles of males and females with androgenetic alopecia. The isolation of two forms (type I and type II) of the enzyme 5a-reductase requires further study to elucidate their specific roles in regulation of hair follicle growth regression. The recent finding that the enzyme aromatase is specifically located in the outer root sheath of hair follicles refocuses our efforts to study the entire hair follicle, not just the dermal papilla cells (8). Based on the numerous patent applications since 1995 (1), it is clear that industry is highly involved in developing hair growth enhancers. And finally,...


Discoid Lupus Erythematosus Eyelids

INTRODUCTION Madarosis refers to the loss of eyelashes. It may result from trauma, rubbing the eyelids, or it can follow eyelid surgery with injury to the lash follicles. Madarosis is also associated with systemic diseases such as alopecia areata, but here hair loss is usually seen in other parts of the body as well. Discoid lupus erythematosis involving the eyelids presents with erythema, scarring, and madarosis, but the latter can be the only presenting finding before any other

Brow Ptosis

TREATMENT Several procedures are available for the correction of brow ptosis. The choice depends upon a number of factors (i) the sex of the patient and, therefore, the desired brow contour (ii) the relative position of the brows (iii) the density of the brow cilia (iv) the presence of associated deformities such as crow's feet and prominent transverse glabellar folds and (v) the height of the scalp hair line or presence of male-pattern baldness. Each procedure has its advantages and disadvantages, and selecting the most appropriate operation must be individualized for each patient. The brow pexy is the simplest technique where the deep fascia of the frontalis muscle is fixed to periosteum to prevent the action of gravity from pulling the brows downward. More recently the trans-blepharoplasty Endotine (Coapt) has made this procedure more effective. In the direct brow lift an ellipse of skin is removed from above the brow, leaving a fine scar just above the brow hairs. However, this...


Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.


The adverse effects of retinoids are legion, and are mostly associated with hyper-vitaminosis A (acute or chronic). Fetal malformations, spontaneous abortions, hyperlipidemia (particularly elevated triglycerides), bone abnormalities, skin and mucosal dryness, retinoid dermatitis, pruritus, hair loss, pseudotumor cerebri, arthralgias, myalgias, and abnormal liver function tests (increased liver transami-nases and alkaline phosphatase) are among the myriad potential adverse effects of retinoid therapy (29). Most of the above effects are reversible upon discontinuation of the retinoid, although some serious effects, such as fetal malformations and bone abnormalities, are not. We do not have sufficient case population data to be certain of cause and effect and no true double-blind studies exist. Recently, two classes of nuclear receptors, the RARs (retinoic acid receptors) and the RXRs (retinoid x receptors) have been identified, which are thought to play an important


Enzyme Regulation Stomach

The skin is the largest organ of the body, accounting for more than 10 of body mass, and the one that enables the body to interact most intimately with its environment. Figure 1 shows a diagrammatic illustration of the skin. In essence, the skin consists of four layers the stratum corneum (nonviable epidermis), the remaining layers of the epidermis (viable epidermis), dermis, and subcutaneous tissues. There are also several associated appendages hair follicles, sweat ducts, apocrine glands, and nails. Many of the functions of the skin can be classified as essential to survival of the body bulk of mammals and humans in a relatively hostile environment. In a general context, these functions may be classified as protective, maintaining homeostasis, or sensing. The importance of the protective and homeostatic role of the skin is illustrated in one context by its barrier property. This allows the survival of humans in an environment of variable temperature water content (humidity and...

Follicular mucinosis

Alopecia mucinosa Pruritic, pink to yellow-white, follicular papules and plaques may be solitary or multiple face and scalp most common sites non-scarring alopecia Alopecia areata telogen effluvium andro-genetic alopecia keratosis pilaris lichen spinulosus lichen planopilaris

Chondroid Syringoma

Lower Eyelid Pilomatrixoma

INTRODUCTION Chondroid syringoma is also known as pleomorphic adenoma or mixed tumor of the skin. These benign lesions are of possible eccrine gland or hair follicle origin, although several reports showed apocrine differentiation. They usually occur on the head and neck. They only occasionally involve the eyelid. Rarely, malignant variants have been reported.


Epidermolytic Hyperkeratosis

CLINICAL PRESENTATION In lamellar ichthyosis the skin shows, course, yellow scales with raised corners which range is size from fine to large and plate-like. These scales are arranged in a mosaic pattern resembling fish skin and are easily shed. Fine, light to dark thick scales are present on the eyelid skin and at the base of the eyelashes. Alopecia of the scalp and loss of eyelashes is common. Often there is keratinization of the lid margin and palpebral conjunctiva, accompanied by a papillary reaction. With time the skin tightens resulting in ectropion which may be very severe. Corneal exposure with secondary scarring and vascularization is a constant threat. HISTOPATHOLOGY A moderate degree of hyperkeratosis and a thin or absent granular cell layer are the usual findings in ichthyosis vulgaris. Keratotic follicular plugs may result from extension of hyper-keratosis into hair follicles.

Gardner Syndrome

Epidermoid Cyst Removal

Cutaneous manifestations of FAP help to define Gardner syndrome. These include epidermoid cysts and fibromas (Figure 17.1). Cutaneous cysts are usually multiple, and most occur on the scalp and face. Many begin to develop before puberty. While some cysts have no distinctive features, a study of cysts from a large kindred of Gardner syndrome patients revealed foci of pilomatrical differentiation in 63 of lesions (Figure 17.2A and 17.2B). Pilo-matrical cells are those cells of the hair follicle that differentiate into the keratinizing cells that form the hair shaft. While the finding is of unknown specificity, such differentiation was not found in any of 100 randomly selected cysts (11). Multiple pilomatricomas may also be a cutaneous marker of Gardner syndrome (12). Nuchal-type fibroma is a deep-seated fibrous tumor, usually of the posterior neck, which may be associated with Gardner syndrome or, more commonly, diabetes mellitus. Tumors are composed of thick bundles of hypocellular...

Outcome Criteria

Teach parents and child about the disease process, surgical procedure, what to expect with procedures done preoperatively, and what will be experienced postoperatively including radiation and chemotherapy and its benefits and effects (alopecia, stomatitis, nausea, vomiting, diarrhea are possible but temporary).

Epidermoid Cyst

Adnexal Structures

INTRODUCTION The epidermoid cyst is also referred to as infundibular cyst, epidermal inclusion cyst, keratinous cyst, or frequently and erroneously sebaceous cyst. The sebaceous cyst is similar clinically but arises from obstruction in the hair follicle and is referred to as a pilar or trichilemmal cyst. The epidermoid cyst is a very common skin lesion that arises from traumatic entrapment of surface epithelium or from aberrant healing of the infundibular epithelium of the hair follicle following episodes of follicular inflammation. They can also be seen following any injury to the skin, including surgery. When congenital, they likely arise from sequestration of epidermal rests along embryonic fusion planes. Epidermoid cysts are not of sebaceous origin, but rather produce normal keratin rather than sebum. These cysts may present anytime from adolescence through adulthood, but commonly in the third and fourth decades.

Telogen Effluvium

Telogen Effluvium Crown

Figure 3 Mild female pattern hair loss (FPHL) with early widening of the part on the crown (A), compared with the occipital scalp (B). Severe female pattern hair loss with thinning hair over the entire crown, vertex, and posterior vertex (C) with relative sparing of only the lower occipital scalp (D). Figure 3 Mild female pattern hair loss (FPHL) with early widening of the part on the crown (A), compared with the occipital scalp (B). Severe female pattern hair loss with thinning hair over the entire crown, vertex, and posterior vertex (C) with relative sparing of only the lower occipital scalp (D). Figure 5 (A) Severe thinning of the parietal scalp hair in a woman with severe acute telogen effluvium (TE) that occurred four months after hospitalization for pneumonia and cirrhosis. (B) Acute TE causing temporal thinning in a woman three months postpartum. (C) Same patient as in A demonstrating partial regrowth of hair after four months. (D) Photograph taken nine months after A...


Anemia, leukopenia, thrombocy-topenia. Pulmonary Bronchopul-monary dysplasia with interstitial pulmonary fibrosis. Ophthalmologic Cataracts after prolonged use. Der-matologic Hyperpigmentation, especially in clients with a dark complexion also, urticaria, erythema multiforme, erythema nodosum, alopecia, porphyria cutanea tarda, excessive dryness and fragility of the skin with anhidrosis, dryness of the oral mucous membranes, cheilosis. Metabolic Syndrome resembling adrenal insufficiency, including symptoms of weakness, severe fatigue, weight loss, anorexia, N&V, and melanoderma (especially after prolonged use). Also, hyperuricemia and hyperuricosuria in clients with chronic myelogenous leukemia. Oral Dry mouth, stomatitis, cheilosis. Miscellaneous Cellular dysplasia in various organs, including lymph nodes, pancreas, thyroid, adrenal glands, bone marrow, and liver. Also, gynecomastia, seizures after high doses, cataracts after prolonged use, hepatotoxicity, cholestatic jaundice,...

Leukemia Cutis

Leukemia Monocytic

Associated orbital disease is not uncommon and presents with pain, lid edema, and exophthalmos. Systemic manifestations include purpura due to thrombocytopenia, urticaria, pruritis, erythema multiforme, leonine facies, alopecia, exfoliative dermatitis, and infection with opportunistic organisms may be seen. Death may result from infection or hemorrhage.

Lupus Erythematosus

Keratoconjunctivitis Sicca Lupus

Common nonscarring eyelid lesions include a pruritic eruption of the lower eyelids. Scarring lesions often present as sharply demarcated purple-red, slightly raised, circumscribed plaques covered with thin adherent whitish scales and telangiectasias. Often such lesions are localized to the lateral aspect of the lower eyelids. Such lesions may enlarge to reach a size of about 5 to 10 mm. The major disfigurement of discoid lupus occurs as the lesions involute where atrophic scarring may lead to trichiasis and entropion. Often, pronounced hypopigmentation or hyper-pigmentation occurs. Other common skin manifestations include the classic butterfly rash, cutaneous vasculitic foci, urticaria, vesiculobullous lesions, and nonscarring alopecia. Ocular manifestations include retinal hemorrhages, cotton wool spots, retinal vasculitis, papillitis, diffuse retinal edema, keratoconjunctivitis sicca, and band keratopathy. Associated systemic findings in lupus erythematosus include arthralgia,...


Since the initial formulation of the Gilliam nomenclature and classification system more than 2 decades ago, several attempts have been made to improve on this system or to provide altogether new approaches to the problem of classification of cutaneous manifestations of LE. In 1991, Beutner et al. (Beutner et al. 1991) first presented the results of their studies on a new criteria set developed by the European Academy of Dermatology and Venereology (EADV) for the purpose of classification of patients with CLE. The European system differs from the ARA classification criteria for SLE by using a greater number of better-defined dermatologic criteria, such as Raynaud phenomenon, alopecia, and urticarial vasculitis. Furthermore, the group by Beutner et al. (Beutner et al. 1992,1993) subsequently presented additional work in this area, which includes an effort to develop a new criteria set for identifying SLE in patients with cutaneous disease using a two-step model. However, although...

Sex hormones

Sex hormones are major regulators of bone turnover and remodeling in both genders. Estrogens reduce bone loss by inhibiting the generation of new osteoclasts, reducing the activation frequency of the BMU and promoting apoptosis of mature osteoclasts via mechanisms that are not well understood. Some of the effects of estrogen seem to be mediated via the modulation of growth factors and cytokines, while others are associated with binding to at least two different estrogen receptors (ERa, ERb). A reduction in circulating endogenous estrogen levels, as occurs during and after menopause, has been shown to prolong osteoclast survival and stimulate the recruitment and hence generation of osteoclasts. The result is an increase in the activation frequency of the BMU, reflected in a high bone turnover state.14 While there is no doubt that androgens (i.e., testosterone, dihydrotestosterone) play a dominant role in male bone health, it also appears that circulating estradiol levels are important...

Gentamicin sulfate

Additional Side Effects Muscle twitching, numbness, seizures, increased BP, alopecia, purpura, pseudotumor cerebri. Photosensitivi-ty when used topically. After ophthalmic use Transient irritation, burning, stinging, itching, inflammation, angioneurotic edema, urticaria, vesicular and maculopapular dermatitis, mydriasis, conjunctival paresthesia, conjunctival hyperemia, nonspecific conjunctivitis, conjuncti-val epithelial defects, lid itching and swelling, bacterial fungal corneal ulcers.

Pirbuterol acetate

Contraindications Cardiac arrhythmias due to tachycardia tachycardia caused by digitalis toxicity. Special Concerns Safety and efficacy have not been determined in children less than 12 years of age. Additional Side Effects CV PVCs, hypotension. CNS Hyperactivity, hy-perkinesia, anxiety, confusion, depression, fatigue, syncope. Oral Bad taste or taste change, stomatitis, glossitis, dry mouth. GI Diarrhea, anorexia, loss of appetite, abdominal pain, abdominal cramps. Der-matologic Rash, edema, pruritus, alopecia. Miscellaneous Flushing,

Follicular Delivery

Lieb et al. (175,176) proposed that liposomes may be useful for targeting drugs to skin follicles for the treatment of diseases, such as acne and alopecia. Their initial experiments, using the hamster ear pilosebaceous unit, demonstrated that carboxy-fluorescein, incorporated into phospholipid liposomes, was more efficiently targeted to follicles than when formulated as a simple aqueous solution, a propylene glycol (5 ) solution, or a sodium dodecyl sulfate (0.05 ) solution (175). However, most of the carboxyfluorescein was located in the epidermis. In later experiments, application of cimetidine, incorporated in phospholipid and nonionic liposomes, was compared with its application in a 50 alcohol solution (176), and generated data that was similarly equivocal. In this case, although small amounts of drug were located within the pilosebaceous unit, most was located on the surface or within the stratum corneum (determined by tape-stripping). Nonetheless, the data showed that the...

Websites of Interest

Http American Behcet's Disease Association http American Hair Loss Council http American Porphyria Foundation http www.porphyria National Alopecia Areata Foundation http National Association for Pseudoxanthoma Elasticum http

Eyelids Palpebrae

Eyelids are skin folds, which can be actively moved. They consist of a tough connective tissue skeleton H (tarsus superior and tarsus inferior). Toward the outside, it is covered by the musculus orbicularis oculi (pars palpebralis) 2. The surface covering of the eyelid is a multilayered keratinizing squamous epithelium with only a few velum hairs. The outer lid is about 2 mm wide and consists of a dull anterior 4 and a sharp-edged posterior palpebral limb O. This tissue continues in the multilayered nonkeratinizing squamous epithelium of the palpebral part of the conjunctiva (conjunctiva tarsi) 0 .A multi-layered columnar epithelium with goblet cells is only found beyond the level of the fornix of the conjunctiva. Long cilia (eyelashes) C3 protrude from the anterior rim of the lid. They are rooted in the lid plate (see Fig. 626). The sebaceous glands (Zeis glands), apocrine scent glands and the sweat glands of the cilia (Mollglands) end in the hair follicle of the eyelashes. The right...

Sebaceous Adenoma

Sebaceous Adenoma

INTRODUCTION Cutaneous adnexal neoplasms showing sebaceous differentiation are difficult to classify. Because of the intimate relationship of sebaceous glands with other adnexal structures associated with the pilosebaceous unit these lesions often display complex histologic features combining sebaceous, hair follicle, and sweat gland tissues. Sebaceous neoplasms run the gamut from benign to malignant lesions. These include sebaceous gland proliferation (sebaceous hyperplasia), congenital sebaceous hamartomas (nevus sebaceum), sebaceous adenoma, and sebaceous carcinoma. Sebaceous adenoma is an uncommon, often solitary lesion usually seen in patients over 40 years of age, with a predilection for the eyelid and brow, occurring in elderly patients.



INTRODUCTION Trichoepithelioma is a benign adnexal tumor of hair follicle origin that may occur as a solitary lesion or as an inherited form with multiple lesions, each with a predilection for the face. They can occur at any age, but the mean age is 45 years. Solitary lesions tend to present in older patients. These lesions are nonaggressive and assymptomatic, but may cause significant cosmetic disfigurement. Multiple lesions may occur in an inherited, autosomal dominant pattern called epithelioma adenoids cysticum of Brooke. This syndrome begins in the second decade of life with the appearance of multiple lesions that tend to involve the face, particularly in the region of the nasolabial folds, lips, nose, and eyelids. The scalp, neck, and trunk may also be involved. HISTOPATHOLOGY Trichoepitheliomas are dermal tumors composed of islands of basaloid cells that may exhibit peripheral palisading. Trichoepitheliomas often have small keratinous cysts lined by stratified squamous...


Additional Side Effects CV Allergic myocarditis, hypotension. Dermatolog-ic Alopecia, exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome. Miscellaneous Anaphylactic reactions, respiratory distress including pneumonitis and pulmonary edema.


Cores White Hair Follicle

INTRODUCTION Trichofolliculoma is an uncommon hamartoma of hair follicle tissue typically occurring on the face of adults. They are not associated with systemic disease or with other skin disorders. Trichofolliculomas are believed to represent abortive differentiation of pluripotent skin cells on their way to develop into hair follicles. They are associated with minimal clinical morbidity. There is no sexual or racial predilection. HISTOPATHOLOGY Trichofolliculomas have a dilated hair follicle, containing keratinous debris and hair shaft fragments, from which radiate numerous small follicles that exhibit variable degrees of maturation (shown below). The follicles that radiate from the central follicle may branch further to give rise to secondary or tertiary follicles. The radiating follicles may contain hair shafts, rudimentary pilar structures, or there may be only cords of epithelial cells.


Diphencyprone is a potent contact allergen used in topical immunotherapy, to treat some severe alopecia areata. It is responsible for occupational contact dermatitis in chemists and dermatology department staff. diphencyprone in a chemist. Contact Dermatitis 32 363 Temesv ri E, Gonz lez R, Marschalk M, Horv th A (2004) Age dependence of diphenylcyclopropenone sensitization in patients with alopecia areata. Contact Dermatitis 50 381-382

Boils and Carbuncles

A boil is a collection of pus beneath the top layer of skin. It is caused by bacterial infection of a hair follicle, the tiny pit in the surface of the skin in which a hair grows. Boils can cluster under the skin such a cluster is known as a carbuncle. Boils may result from infection of a cut or scrape in the skin, poor hygiene, cosmetics that clog the pores, exposure to chemicals, and friction from tight clothing or shoes. Perspiration contributes to the development of boils and carbuncles and can make them worse. Boils and carbuncles usually appear on the scalp, beard area of the face, arms, legs, underarms, and buttocks.


Overlying and posterior to the sternocleidomastoid muscle, there are often thick attachments between the skin and the deeper structures of the neck and it may not be possible to develop a superficial plane with the cannula. If there is resistance in this area, we desist and depend on later sharp dissection. This is also true in the posterior triangle of the neck. It is important to avoid going too deep in the posterior triangle as the spinal accessory nerve may be at risk. We avoid all lipodissection beneath the hair bearing skin in the occipital scalp to avoid damage to hair follicles, which can easily result in permanent alopecia.

Mouse Phenotype

Although embryonic development of the r r mice appeared to be normal, as early as approximately 4 weeks of age they began to develop thick skin and patchy hair loss accounted for by dermal fibrosis. In older mice ( 5-6 months) skin abnormalities consisting of thickening and roughening, associated with patchy hair loss and small ulcerations were regularly observed.33 Indeed, in our initial report, we had not yet systematically examined the younger mice. Examination of skin sections revealed that the dermis from the r r mutant mice was significantly thicker than that from control (r r) mice and was filled with dense collagen fibers (Fig.10.4). The collagen fibers were irregular in form and penetrated deeply into the hypodermis. The overall increased thickness of the skin in the homozygous r r mice, extending from the epidermis to the muscular layer, was accounted for by the increase in thickness in the dermis. The hair follicles appeared to be buried within the dense collagenous...

Trace elements

The daily intake of selenium varies from 80 to 130 ig. The RDA is set at 150 ig. The toxic dose is about 30 times the RDA. Acute intoxication has been reported after ingestion of about 30 mg. Symptoms were nausea, abdominal pain, diarrhea, nail and hair changes, peripheral neuropathy, fatigue, and irritability. Chronic dietary intake of approximately 5 mg day has been found to result in fingernail changes and hair loss (selenosis). In the seleniferous zone of China, a daily dietary intake of 1 mg of sodium selenite for more than 2 years resulted in thickened but fragile nails and garlic-like odor of dermal excretions.


Most retinoids of the first and second generation were usually used orally with dosages of 1-2mg kg day. The most commonly reported side effects of these agents are dryness of the skin and mucous membranes, pruritus, increased levels of liver enzymes, hypertriglyceridemia, hypercholesterolemia, axial osteoarthropathy with bone pain, arthralgias, myalgias, and hair loss. Most of these side effects are reversible except for axial osteoarthropathy resulting in stiffness of spine and decreased axial mobility.


Thrombocytopenia, anemia, infections, bleeding, packed cell transfusions, platelet transfusions. CV Bradycardia and hypotension (including during the infusion), hypertension, severe CV events (including asymptomatic ventricular tachycardia, bigeminy, syncope, completeAVblock), abnormal ECG (including nonspecific repolarization abnormalities, sinus tachycardia, premature beats). Muscu-loskeletal Peripheral neuropathy (including mild paresthesia), myalgia, arthralgia. Oral Mucositis. GI N&V, diarrhea. Miscellaneous Alopecia, fever associated with severe neutropenia infections of the urinary tract and upper respiratory tract as well as sepsis due to neutropenia. Drug Interactions Ketoconazole Inhibition of metabolism of paclitaxel by ketoconazole How Supplied Injection 6 mg mL

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