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Alopecia - FAQ

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The loss of hair is named effluvium or defluvium and is a condition that results in alopecia proper (baldness). Patients consider baldness differently to medics and often are very worried about hair-thinning. Alopecia can be classified as healing alopecia and non-healing alopecia, potentially reversible.

Dear Doctor, Iím a woman of 41 years afflicted with androgenetic alopecia for the last 17 years. I havenít got polycystic ovaries nor unbalanced hormones, but a genetic predisposition (Grandmother and Aunt on my fatherís side suffered from baldness). Until 5 years ago my condition was optimum because the thinning was very slow and even then I had a full head of hair, you didnít see anything. Following a very stressful period, psychologically and physically, 4 and a half years ago telogen effluvium started and lasted 3 years! 6 months ago the telogen phase ended but has resulted in alopecia and Iím rapidly losing hair, mainly around the hairline at the front and at the top. I have seen many dermatologists in and around my city. I have noticed a complete inability to confront this problem on account of it being extremely rare, and being in the position of someone with a tendency to experiment with, for example, local electrostimulation a cost of Ä55 a go! Iím spending all my savings, the fruit of years of working, Iím anxious and depressed and Iím going forward with... The last dermatologist to see me prescribed a lotion of 5% minoxidil, what do you think? Will it help? If you suspend the treatment, assuming that it produces some effect, after a while, my hair will start to fall out again, right? I had thought of autografting but I was advised against it because the results are unsatisfactory and the transplanted hair would fall out again more than in men. Searching on the web I found that they can graft artificial hair, called..., onto the bald area and that you must repeat the process once a year. I would like to know what you think of both the treatment and the artificial implants. I donít know what to do, Iím depressed and desperate. I thank you for the help that you can and want to give me.

Dear Madam, androgenetic alopecia is a loss of hair very frequent in men, not so common in women. In women you donít observe a complete baldness, as you do in men, but a general thinning, mostly on the top of your head. As indicated by yourself, the disease is genetically based and is attributed to an augmented response of the hair follicle to circulating dihydrotestosterone. Such a hormone induces a progressive miniaturisation of the hair follicles and a reduction in the diameter of the hair, ending up as downy hair. In women, itís useful to exclude the existence of endocrine disorders, often investigating the ovarian-adrenal axis. Itís also appropriate to exclude the existence of thyroid problems. Unfortunately, once endocrinological problems have been excluded, an effective treatment doesnít really exist for the treatment of this condition in women, in spite of the impressive number of products offered in case of need. The phenomenon, we repeat, doesnít lead to total loss of hair in women. 2% minoxidil lotion is the only treatment that has demonstrated some effectiveness in women and men. In men, the systemic administration of finasteride has also been proposed. Even so, the effects are not astounding. Sometimes women are advised to take the contraceptive pill containing cyproterone acetate, a competitive progesterone antagonist against androgens. Or instead spironolactone, a diuretic with antiandrogenic effects. I would not advise you to try autografting (taking the follicles from the nuclear region and grafting them into other regions, usually for aesthetically more important regions like the frontal region), nor the artificial hair grafting. Alas, the final solution is to cover it over with a wig. Best regards, Dr. Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Good evening, I would like to ask you a few questions. Iím a woman of 25 years and I have been suffering from alopecia areata. Periodically patches form that then grow again, using 5% minoxidil. Apart from stress (not in my case) what else can cause this disease? I would like to know if there is a definite cure where problems to arise again. Also can ovarian cysts be a cause alopecia? I thank you in anticipation of your kind attention. Best regards.

Thank you for your message. The term ďalopeciaĒ is derived from the greek word ďalopexĒ which means fox and indicates loss of hair for whatever reason. The relationship between fox and loss of hair isnít clearly defined. Many words are modified over time away from the context in which they were originally intended and thus from their true meaning. The term ďalopecia areataĒ is a disease rather common (it affects around 1 in every 10 000 people every year) and is associated with the loss of hair in patches of varying dimensions. You can have just one bald patch or several on your scalp and also occasionally on other parts like the beard area in men (alopecia areata of the beard). In rare cases, hair loss over the whole scalp (alopecia areata totalis) can be experienced and sometimes, loss of hair over the whole body (alopecia areata universalis). In general, hair lost in localised patches regrows spontaneously in around a month. Spontaneous regrowth of hair is less frequent in those suffering from complete or universal alopecia. Even though itís a rather common illness, we donít understand precisely what causes alopecia areata. Itís probable that a genetic predisposition exists among sufferers and that environmental factors such as physical and mental stress can influence itís occurrence. The underlying cause is probably that of an autoimmune response. The bodyís immune system reaction against other parts of itself: In the case of alopecia areata against antigens expressed in hair follicles. I donít believe that ovarian cysts have anything to do with the illness in your case. Effective treatments that are sure to work arenít available for alopecia areata nor are there any absolute cures. Moreover, there arenít any controlled studies of good quality to support a particular method of treatment. At times, the regrowth attained with much effort to be then followed by reloss is rather frustrating for the patient. The initial treatment that is generally proposed is a topical steroid in a lotion or local infiltrating agent that can be put with minoxidil. In cases resistant to topical steroids you can consider a course of the aforementioned topical immunotherapy specifically with squaric acid or diphenylcyprone. Itís a rather demanding and laborious method of treatment not devoid of annoying side-effects. At times using a minibolus of a systemic steroid can be considered. Research into the positive effects of a ďbeneficial reddeningĒ by topical irritants such as antraline and acetic acid have also been proposed. Such products over time have lost all interest. A further method of treatment, of which the effectiveness is in controversy, is PUVA therapy (the joining of ultraviolet light and a drug called psoralen). In recent analyses, although the range of possible treatments is rather frustrating, there is a high probability of spontaneous definitive regrowth, to which the localised form of alopecia areata largely concurs. Best regards, Dr. Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Do you know of any non-steroidal anti-inflammatory drugs that are effective in the treatment of alopecia areata? Our 15 year old son has it since July of 2002. Regards.

I'm sorry to answer that, at this time, there is no evidence that any NSAIDS (non-steroidal anti-inflammatory drugs) have real utility in the treatment of alopecia areata. Anyway there are some steroidal drugs (such as mometasone) that are suitable also for children. Best regards. dott. Lorenzo Peli. - MD - GISED.

Hello, Iím a man of 25 years and for the last 2 years I have suffered from an extensive loss of hair on the entire upper part of the cranium (I must say first that there are no cases of alopecia in my family). Initially, I tried to take nutritional supplements like... with optimum results, but on ceasing the treatment had a sudden re-loss of hair and restarting the treatment didnít help. I took a course of 5% minoxidil with good results but even then when suspended I found myself back where I started. Now, Iím retaking 5% minoxidil to treat the problem again but with 1ml I canít manage to cover the entire area and therefore am impelled instead to treat myself with 3ml twice a day. I wanted to know if this dosage will create problems and if, given the strange diminution that has afflicted me, must I handle it in a different way? I thank you in anticipation for your attention and take the opportunity to give you my best regards.

Dear Writer, I would advise you to go for a check-up visit with a trusted dermatologist. The dosage of minoxidil that you indicate is too high; even so, these treatments are only effective if continued, and only in some types of alopecia, therefore it is necessary that your problem is diagnosed precisely before you commence a new treatment. Best regards, Dr. Lorenzo Peli Ėdermatologist Ė GISED.

Dear Doctor, Iím a 30-year old man who, for the last 6 months, has suffered from alopecia areata of the whole beard and other areas. The alopecia, I notice, every so often widens and affects new areas whilst there is a slight regrowth of blonde hair in the area that was affected first. I would like to know whatís the probability of such alopecia affecting the hair on my head as well? Whatís the connection between alopecia and the pink patches and itchiness that Iíve had under my armpit for the last year, as no dermatologist in my area... has been able to cure it? Moreover, I would like to point out a strange coincidence or perhaps just my impression, which is an increase in this phenomenon following application of the treatment. I would like, above all, to understand how many more times could this illness manifest itself in my lifetime? In the hope that you reply, best regards.

Dear Sir, thank you for your message. In spite of the fact that itís rather common, alopecia areata is a disease that remains quite unpredictable. In more than 70% of cases, the disease stops itself and regrows in about a year. The frequency of the relapses is nevertheless high, with 80% of patients (over the last 20 years) relapsing. In the variety more common (that which arises in those aged between 20 and 40 years and doesnít associate itself with the so-called atopic variety) the disease resolves completely, in general, in around 3 years. In this variety it is very rare (less than 10% of patients) that you observe an extension into alopecia totalis or a persistence of the lesions. The regrowth can occur initially as depigmented hair (as in your case). You canít exclude that the disease which initially started in the beard region will not also appear on your scalp. I donít really believe that the application of a potent steroid is responsible for the extension of the lesions, in your case. The topical steroids or local infiltration, is one of the most common treatments for this illness. Other possibilities consist of topical minoxidil and in particularly severe cases topical immunotherapy and photochemotherapy (association of ultraviolet light and a photosensitive drug, psoralene). I donít believe a relationship exists between alopecia areata and the red patches that you described under your arms (even if it could be a manifestation of atopic dermatitis). Best regards. Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

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