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Clinical studies with finasteride in men with androgenetic alopecia

As in the development program in men with BPH, initial clinical studies with finasteride in men with male pattern hair loss (androgenetic alopecia, AGA) were directed toward demonstration ofbiochemical efficacy (Kaufman 1996). Androgen receptor number, DHT content and 5aR activity were all reported to be higher in balding than non-balding scalp from subjects with AGA, lending further support to the hypothesis that lowering DHT content in the scalp would be useful in the treatment of patients with AGA (Dallob et al. 1994 Price 1975 Randall et al. 1991 Sawaya 1991). Subsequent immunolocalization and enzyme inhibitor studies demonstrated that type 2 5aR protein was expressed in structures within the hair follicle (Bayne et al. 1999 Hoffmann and Happle 1999). The early studies with finasteride in men with AGA demonstrated that daily oral administration reduced the DHT content ofthe affected scalp in a dose-dependent manner, based on analysis of scalp biopsies, and suggested that the dose...

Alopecia Clinical Summary

It can be classified into scarring (absence of follicles) and nonscarring (presence of follicles) alopecia. Scarring alopecia is commonly caused by discoid lupus erythematosus (erythematous mottled pigmentation and atrophic scalp scarring) and folliculitis decalvans (multiple crops of pustules on the scalp). Occasionally, prolonged bacterial and inflammatory fungal infections (kerion) can induce scarring on the scalp. Nonscarring alopecia results from alopecia areata (annular areas of alopecia on the scalp or beard area), telogen effluvium (diffuse scalp shedding of hair 2 to 3 months after a stressful event, illness, or new medication), anagen effluvium (diffuse scalp shedding after chemotherapy), trichotillomania (constant pulling of the hair), traction alopecia (chronic tension of braided hair causing alopecia), and tinea capitis. Syphilis can cause a patchy, moth-eaten alopecia.

Hair Loss

Hair loss, known as alopecia, is a fairly common side effect of chemotherapy or radiation to the scalp. Severity may range from hair thinning to complete loss of hair. Strangely, when hair grows back, it may be softer, thicker, or of a different texture than before. Sometimes gray hair that falls out is replaced with hair of the patient's original color. Occasionally, patients may also lose hair in other area of the body, such as from the eyebrows, arms, groin, and so on. Although much less disturbing to the body's functioning than nausea or other side effects, patients are often devastated psychologically by hair loss because hair is frequently an integral part of the patient's body image. To minimize hair loss and protect new hair that's growing in If hair loss is expected, choose a wig before treatment. Synthetic wigs are more comfortable and less expensive than wigs made from real hair. Consider obtaining a wig through the American Cancer Society, the hospital, or support groups....

Cytotoxic Chemotherapeutic Agents

Cytotoxic chemotherapeutic agents can be defined as those that inhibit tumor growth by killing tumor cells directly. These agents rely on tumor cells' dividing more rapidly than normal cells to achieve an acceptable therapeutic index. Still, their actions are necessarily nonspecific and many common cyto-toxic chemotherapy side effects (e.g., myelosuppression, alopecia) reflect effects on normal dividing cells. General indications for cytotoxic chemotherapy include curing certain tumors, palliating symptoms, or prolonging progression-free survival. Most patients with a CNS tumor receive chemotherapy for this last reason. Relative contraindications include active infections, limited probability of prolonged survival even if tumor regression occurs, and severe debilitation.

Keeping Track Of Your Side Effects

* Examples dry mouth, urinating frequently, rash, acne, stomachaches, insomnia, headaches, fatigue, hair loss, problems with concentration, hand tremor, If you're not sure which medication causes which side effect, simply list each side effect you experience and put a * next to each one.

Structure and function of the hair follicle

The main functions of mammalian hair are insulation and camouflage. These are no longer necessary for the naked ape, although vestiges of this remain in the seasonal patterns of our hair growth (Randall and Ebling 1991) and the erection of our body hairs when shivering with cold. Mammals often have specialised hairs as neuroreceptors e.g. whiskers and this remains slightly in human body hair with its good nerve supply. However, the main functions of human hair are protection and communication. Eyelashes and eyebrow hairs prevent substances entering the eyes and scalp hair may protect the scalp and back of the neck from sun damage during our upright posture. During puberty the development of axillary and pubic hair signals the beginning of sexual maturity in both sexes (Marshall and Tanner 1969 1970 Winter and Faiman 1972 1973) while the male beard, like the mane of the lion, readily distinguishes the sexes. BALDING SCALP Androgen sensitive

What happens if I develop bone pain

When multiple painful bone metastases are present, hemibody radiation may be used. Because this therapy affects a larger area of the body, there are more side effects, including lowering of the blood pressure (hypotension), nausea, vomiting, diarrhea, lung irritation, hair loss, and lowering of the blood count. Hemibody radiation is also given over several treatment sessions. It can lead to pain control that lasts up to one year in as many as 70 of individuals.

Radiation Therapy

Complications associated with radiation therapy can be divided into two time frames acute effects occurring during or shortly after treatment, and late effects occurring months to years after completion of treatment. Acute side effects in adults are usually more pronounced than in children and consist of nausea, vomiting, fatigue, alopecia, skin erythema, significant

Acute Physical Effects of Malignancy and Treatment

Many childhood cancers are initially invisible to the child and family. They become evident through common and seemingly benign symptoms, such as bruising, fatigue, loss of appetite, or weight loss. Other types of cancers cause more severe or dramatic symptoms, such as seizures, diplopia, confusion, paralysis, weakness, or fractured bones. For many children, however, the physical difficulties of dealing with cancer are associated primarily with the treatment rather than the disease. Pain, nausea, amputation, infections, and ulcerations are all acute side effects of cancer treatment. Radiation and antitumor chemotherapy target rapidly dividing cells, a characteristic of most malignancies. However, mucosa, hair, skin, and bone marrow are also made up of rapidly dividing cells, so these are also destroyed by chemotherapy and radiation, resulting in the characteristic problems of nausea, hair loss, bleeding, anemia, and immunosuppression seen in cancer patients during active treatment...

Adjuvant Systemic Therapy

Therefore, the recommendation for adjuvant therapy is determined by the patient's risk, which depends on the lymph node status, tumor diameter, and tumor histologic grade. Other factors that contribute to prognosis in a less quantifiable way include S-phase fraction and HER-2 neu overexpres-sion.21,27,89,106,110,114 Estrogen receptor status is an independent predictor of both overall survival and of positive response to treatment with tamoxifen. It indicates that relapses are likely to be delayed, as compared with relapses in patients who are estrogen-receptor negative with otherwise identical prognostic features.92 Overall, patient risk assessment as well as patient medical comorbidities and hormone-receptor status determine the recommended treatment options. At present, a shared decision-making process, with the patient taking an active role, is the most common approach. Some patients may elect a less efficacious therapy, such as tamoxifen alone, to avoid toxicity such as alopecia...

Effects on Academic Functioning

In addition to the medical obstacles to school attendance, children may feel uncomfortable at school. Changes in their appearance, such as hair loss, may make them self-conscious. They may feel unable to explain to their peers or teachers why they missed an activity or did not complete an assignment. Teachers may also feel ill prepared to explain the situation to their other students or may be fearful of having the child reenter the classroom while on active treatment. To address these issues, pedi-atric cancer programs have information they can send to schools, or they can have someone communicate directly with the teacher and or school nurse. School reintegration can also be facilitated with a visit to the classroom by a trained person, allowing children to ask questions (Labay et al. 2004).

Emergency Department Treatment and Disposition

Evaluation of alopecia in the emergency department should focus on the history and infectious etiologies. Treatment for tinea capitis and kerions requires systemic antifungals, long-term treatment, and periodic laboratory monitoring. Referral to a dermatologist or primary care physician is recommended. In an at-risk patient, screening for syphilis should be considered. Bacterial infections should be treated with antibiotics after bacterial cultures are obtained. Other forms of alopecia can be referred to a dermatologist. Alopecia. Alopecia totalis is loss of all scalp hair and eyebrows. (Photo contributor Lawrence B. Stack, MD.)

Classification and symptoms of hypogonadism

Voice mutation will not occur. The frontal hairline will remain straight without lateral recession, beard growth is absent or scanty, the pubic hairline remains straight. Hemoglobin and erythrocytes will be in the lower normal to subnormal range. Early development of fine perioral and periorbital wrinkles are characteristic. Muscles remain underdeveloped. The skin is dry due to lack of sebum production and free of acne. The penis remains small, the prostate is underdeveloped. Spermatogenesis will not be initiated and the testes remain small. If an ejaculate can be produced it will have a very small volume. Libido and potency will not develop. A lack of testosterone occurring in adulthood cannot change body proportions, but will result in decreased bone mass and osteoporosis. Early-on lower backache and, at an advanced stage, vertebral fractures may occur. Once mutation has occurred the voice will not change again. Lateral hair recession and baldness...

Impact of Breast Disease on the Patient

Most commonly, women with invasive breast cancer and axillary lymph node involvement require chemotherapy for periods up to 6 or 7 months after mastectomy. Many of the agents used to treat the patient have significant side effects, including nausea, vomiting, and alopecia. There are medicines available to help control the nausea and vomiting, but the alopecia presents another special problem. Although the woman recognizes that she will lose her hair and knows that it will grow back, she suffers further from low self-esteem. In our society, hair is a

Past Clinical Studies

A further study included trials with no replicates, and contained six studies. It showed that in five out of six cases the main outcomes were positive however, these were limited to very specific criteria, such as small airways resistance for common colds (Cohen and Dressler, 1982), prophylaxis of bronchi for bronchitis (Ferley et al., 1989), lessening smoking withdrawal symptoms (Rose and Behm, 1993, 1994), relief of anxiety (Morris et al., 1995), and treatment of alopecia areata (Hay et al., 1998). The alleviation of perineal discomfort (Dale and Cornwell, 1994) was not significant.

Phase I And Phase Ii Studies

Or the use of minoxidil in androgenetic alopecia. It is widely accepted that a phase I study is one that examines the initial introduction of a drug in human beings with the treatment tested either in normal volunteers or in patients. The main issues are the pharmacokinetics, pharmaco-dynamics and tolerability of the drug being tested with a focus on assessing inter-patient variability. While problems with systemic drugs in dermatology do not differ from those usually encountered in other speciality areas, some peculiarities exist with the assessment of topical drugs. Penetration within the deep epidermal layers and dermis is a parameter of particular interest since it clearly affects the local activity of the drug itself. On the other hand, pharmacokinetic parameters describing such a penetration are less stringent as compared with systemic drugs. The assessment can be performed on normal or diseased skin. Relevant methods are those which allow measurements of the concentration of...

Tumour typeRecommended margin

The technique is most commonly used for oral and nasal tumours that are not amenable to surgical resection. The prognosis is, however, still guarded and many tumours recur 6-9 months after treatment. Side effects, such as erythema of exposed skin and mucous membranes, alopecia, skin thickening and abnormal hair coloration, may also occur. Owners must therefore be given careful advice before embarking on a treatment programme so that they are fully aware of the possible outcomes.

What It Can Do for You

It is what light therapy cannot do for you that must be carefully examined. There is no acceptable evidence that light therapy in any of its manifestations will cure cancer, arthritis, menstrual difficulties, tooth decay, hair loss, Alzheimer's disease, or any of the other diseases and conditions it promises to treat.

Laboratory Evaluation

Where the 2 g 24 hr accounts for nitrogen losses from GI epithelium, skin, hair loss, and sweat. The total urine nitrogen can be determined by dividing the 24-hour urinary urea nitrogen by 0.85. In patients with extensive diarrhea or other losses of nitrogen (e.g., through pancreatic fistula), other methods must be used to calculate nitrogen losses, such as by the use of pyrochemiluminescence.

Dermatological disease

The frequency and cosmetic impact of male pattern balding has, over millennia, led to innumerable attempted cures. Prompted by a paradoxical claim that topical testosterone could cause hair regrowth, a double-blind, randomised study of 51 balding men showed that topical application of 1 testosterone propionate cream daily to one side of the scalp for a median of 4-5 months was no more effective than placebo applied to the other half of the scalp (Savin 1968). Given the dependence of male pattern balding on masculine levels of androgen exposure after puberty, acceleration of hair loss might have been expected but the study endpoints (investigator and patient subjective global grading of regrowth) were not designed to detect this. More recently controlled studies of a topical 5a-reductase inhibitor have added a selective anti-androgen to the already vast list of baldness cures (Rittmaster 1994).

Sheehans Syndrome 1977 1995

In 1995, Natalie Lomeo was delivered by elective Cesarean section at her local Community Medical Center (CMC) in Pennsylvania. She had an extensive blood loss during the operation, and a postpartum hemorrhage followed. Although she exhibited signs of hemorrhagic shock, blood was not transfused until much later in the day. Over the next 3 years, she complained of fatigue, weakness, dizziness, hair loss, amenorrhea, dyspareunia, and vasomotor symptomatology. In 1998, the diagnosis of Sheehan's syndrome was made. She then took legal action against her obstetrician and the CMC. However, the defendants filed for summary judgment, asserting that her claim was time-barred under Pennsylvania law, as it had been filed more than 2 years after the allegedly negligent conduct. The Common Pleas Court denied the motion for dismissal, saying that the litigation clock only started to run when Sheehan's syndrome was diagnosed27. What happened next was not reported, so the case was probably settled.

Rationale for and development of 5areductase inhibitors

The findings in subjects with genetic 5aR deficiency established essential roles for DHT in both male external genital development in utero and the pathogenesis of common, androgen-dependent disorders of adult men. Subsequently, several laboratories attempted to synthesize inhibitors of the human 5aR enzyme intended for clinical investigation to test for utility in the treatment of patients afflicted with these disorders, which include BPH, prostate cancer and male pattern hair loss (androgenetic alopecia, AGA).

Topoisomerase Inhibitors

Side effects include mucositis, myelosuppression, alopecia, phlebitis, hypersensitivity reactions, and secondary leukemias. Irinotecan, a camptothecin analog, inhibits topoisomerase I to interfere with DNA synthesis through the active metabolite SN38, which is 100-fold more potent in vitro. The pharmacokinetics of irinotecan are best described by a three-compartment model, with an a-half-life of 0.07 hours, a P-half-life of 2.2 hours, and a terminal half-life of about 18 hours.19 Irinotecan has shown activity in the treatment of cancers of the colon, rectum, cervix, and lung. Irinotecan induced diarrhea may be life-threatening. IV atropine should be used to treat diarrhea that occurs during the first 24 hours of administration. Loperamide, 2 mg every 2 hours or 4 mg every 4 hours until diarrhea has stopped for 12 hours, should be used for diarrhea occurring for more than 24 hours after administration. Other side effects include myelosuppression, fatigue, and...

The ideal tissueselective androgen

The requirements for female androgen substitution differ from males. Anabolic action on muscle and bone as well as libido are the positive effects of androgen action in women. Hirsutism, acne, male pattern baldness and voice change are severe side effects. In general a weak, but safe androgen is required, in order to avoid these side effects. Again an androgen which is not 5 a-reducible would be useful, as 5 a-reductase mainly enhances androgen action in skin and hair follicles (see 20.2.1). Alternatively, a SARM with antagonistic effects in these organs, but agonistic response in muscle, bone and brain would be ideal.

Clinical Use and Adverse Effects of Specific Antiepileptic Drugs

Valproic acid is a branched-chain fatty acid that was approved for use in the United States in 1978. The enteric-coated preparation, divalproex sodium, became available in 1983. Multiple mechanisms likely contribute to its broad spectrum of action, including inhibition of sustained repetitive firing through blockade of voltage-gated Na+ channels. Valproic acid is effective against generalized and partial seizures including absence, myoclonic, and tonic-clonic seizures. High protein binding and hepatic enzyme inhibition contribute to the high incidence of drug interactions. Adverse reactions include tremor, weight gain, alopecia, hyperammonemia, carnitine deficiency, and thrombocytopenia. Fulminant hepatic failure and fatal pancreatitis have been reported. Valproate is available in 250-mg tablets and syrup (250 mg 5 ml), and divalproex sodium in 125-, 250-, and 500-mg tablets and 125-mg sprinkles for mixture with food. Rectal and parenteral formulations are being developed.

Musculoskeletal Diseases

Myotonic dystrophy is the most common of the muscular dystrophies. This autosomal dominant disease shows characteristic facial features (a thin narrow face with drooping eyelids, frontal baldness) and muscle weakness of the neck, hands, and extremities. The patient has a high steppage gait and difficulty in grasp relaxation (myotonia). Fifty percent ofsuch patients have a cardiomyopathy (137) and occasionally complete heart block (138).

Progressive Diseases of Infancy and Childhood

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

Table 34 Causes and associations of trachyonychia

Idiopathic (twenty-nail dystrophy) (Figure 3.34) Alopecia areata (Figure 3.32) Lichen planus (Figures 3.37, 3.38) Eczematous histology Chemicals and alopecia areata makes it common to observe trachyonychia in other conditions frequently associated with alopecia areata, such as atopic dermatitis, ichthyosis or Down's syndrome. Table 3.4 lists the known causes and associations of trachyonychia. alopecia areata a clinical and pathological study, J Am Acad Dermatol 25 266-270. Tosti A, Bardazzi F, Piraccini BM, Fanti PA (1994) Trachyonychia (twenty nail dystrophy) clinical and pathological study of 23 patients, Br J Dermatol 131 866-872.

The mechanism of androgen action in the hair follicle

Men with 5a-reductase deficiency also contribute to our understanding because they exhibit axillary and female pattern pubic hair, but very little beard growth they are not reported to have male pattern baldness either (Griffin and Wilson 1989) (Fig. 6.3). A role for 5a-reductase in male pattern baldness is also supported by the ability of oral finasteride, a 5a-reductase type 2 inhibitor, to promote hair regrowth (Kaufman et al. 1998 Shapiro and Kaufman 2003). This suggests that the formation of terminal pubic and axillary hair can be mediated by testosterone itself, while that of the secondary sexual hair of men requires the presence of 5a-dihydrotestosterone. This demonstrates a third paradox in androgen effects on hair follicles. Why does the stimulation of increasing size in some follicles e.g. beard require 5a-dihydrotestosterone formation, while follicles in the axillary and pubic regions carry out the same changes in the absence of 5a-dihydrotestosterone Since androgens are...

Intracranial Lipoma Embryologic Origin

Intracranial Lipoma Sites

(intracerebral and bony) Mandibular hypoplasia, macrostomia, upper vertebral anomalies, and epibulbar dermoids Soft scalp masses with overlying alopecia, papular skin lesions over face and eyes, and progressive intracranial calcifications Midline craniofacial anomalies, hypertelorism, cranium bifidum, cleft lip or nose, and mental retardation Caf -au-lait lesions, neurofibromas, Lisch nodules, plexiform neuromas

Table 43 Causes and associations of onychogryphosis Dermatological

Positive, homogeneous, rounded or oval, amorphous masses surrounded by normal squamous cells which are usually separated from each other by empty spaces caused by the fixation process. These clumps, which coalesce and enlarge, have been described in psoriasis of the nail, onychomycosis, eczema and alopecia areata, and also in some hyperkeratotic processes such as subungual warts and pincer nails. The horny excrescences of the nail bed are not very obvious, but the ridged structure may become apparent if the nail plate is cut and shortened.

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

Hypothyroidism is considered primary when increased TSH levels accompany low T3 and T4 levels, suggesting thyroid pathology. In secondary or central hypothyroidism, low T3 and T4 are associated with low TSH and suggest pituitary insufficiency. Thyroid hormone deficiency causes mental retardation in infants, growth delay in children, and myxedema in adults. Symptoms of thyroid hormone insufficiency include cold intolerance, weight gain, memory loss, dry skin, hair loss, brittle nails, constipation, increased sleep demand, and fatigue. Severe, untreated hypothyroidism can lead to coma and even death. Hypothyroidism from TSH or TRH deficiency can result from hypothalamic or pituitary destruction (neoplastic, inflammatory, granulomatous, vascular, traumatic, autoimmune, or from radiation necrosis). In the presence of an expanding pituitary mass (i.e., pituitary adenoma), loss of TSH secretion is typically associated with other hormonal abnormalities because there is a step-wise loss of...

Masculine secondary sexual adornments a comparative perspective

Nasalis Larvatus Skica

The relatively conspicuous visual traits of adult human males include facial hair, male pattern baldness, and body hair all these traits vary considerably in their expression both within and between human populations. A score of 10 was allocated for these sexually dimorphic characters in men (Dix-son et al. 2005), which is high, given the relatively modest sex differences in human body weights. Among the monkeys and apes which have polygy-nous mating systems, scores for male-biased sexual dimorphism in visual adornments are significantly correlated with the degree of sexual dimorphism in body size the largest males have the most striking secondary sexual adornments (Figure 17.19). It is probable that the human male would justify even higher scores using this rating scale, if sex differences in facial morphology were to be taken into consideration. Very little is known about the origins of the human beard, or of male pattern baldness, and the marked reduction of human body hair. One...

A 9substituted camptothecins

Reversible, noncumulative, and dose-related neutropenia was the DLT in all five schedules (309-313). With a 24-h continuous infusion every 3 weeks, thrombocytopenia was an added DLT in heavily pretreated patients (310). Neutrophil and platelet count nadirs occurred between days 10 and 15, with recovery by day 22. Nonhematological toxicities included mild to moderate gastrointestinal toxicity (nausea, vomiting, stomatitis, diarrhea), fatigue, asthenia, and alopecia (309-313). Transient and reversible liver dysfunction was also observed, and in a Japanese study this event was dose limiting at the dose of 6.65 mg m2 (309,312). Diflomotecan, one of the fluorinated homocamptothecin derivatives, has entered Phase I clinical testing. Oral diflomotecan administered once daily for 5 days every 3 weeks was limited by dose-dependent myelosuppression (317). Other toxicities observed were gastrointestinal (i.e., mild nausea and vomiting), alopecia, and fatigue. The recommended dose for Phase II...

Psychosomatic aspects of atopic dermatitis

The prevalence of anxiety and depression was mostly investigated. Depression scores and suicidal reflections were mostly found in the cases of disfiguring skin diseases Gupta et al14 found suicidal thoughts in 7.2 of the inpatient psoriatic patients, in 5.6 of the patients with (non-cystic) acne, in 2.1 of AD and outpatient psoriatic patients, while alopecia areata patients reported no suicidal thoughts at all. In an investigation in German departments of dermatology, 23.2 of the heads of the departments found psychotherapeutic therapy to be a necessary requirement in addition to dermatological treatment.15 14. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998 139 846-50.

Directed Neurological Examination

The examiner may recognize sudomotor failure by noting a dryness of the skin and a lack of resistance to gentle stroking with the fingerpads or to a tuning fork run over the skin. Sudomotor failure may take the form of an isolated generalized anhidrosis or a diffuse autonomic failure with other associated findings. A search should be made for localized increases in or absence of sweating and for asymmetrical patterns of skin temperature or color. In patients with disturbances of autonomic innervation of the face, the physician may note gustatory sweating, flushing, and facial anhidrosis. Acral vasomotor changes that may be observed include acrocyanosis, pallor, mottling, livedo reticularis, or erythema. y Skin temperature changes can be assessed by palpation. Other findings to be noted include atrophic skin changes, alopecia, hypertrichosis, nail thickening, skin decoloration or deformation, and Charcot's joints. Allodynia and hyperalgesia are components of a complex regional pain...

Use Of Essential Oils Mainly As Chemical Agents And Not For Their Odor

Alopecia areata was treated in a randomized trial using aromatherapy carried out over 7 months. The test group massaged a mixture of 2 drops of Thymus vulgaris, 3 drops Lavandula angustifolia, 3 drops of Rosmarinus officinalis, and 2 drops of Cedrus atlantica in 3 mL of jojoba and 20 mL grapeseed oil into the scalp for 2 min minimum every night. The control group massaged the carrier oils alone (Hay et al., 1998). There was a significant improvement in the test group (44 ) compared with the control group (15 ). The smell of the essential oils (psychological physiological) and or their chemical nature on the scalp may have achieved these long-term results. On the other hand, the scalp may have healed naturally anyway after 7 months.

Structure and Physiology

Accidentes Vivo Pulidores

Hair loses its pigment, which commonly results in ''graying'' of the hair. With the reduction in the number of hair follicles, there is hair loss all over the body head, axilla, pubic area, and extremities. With the reduction in estrogens, an increase in hair may actually develop in many older women, especially on the chin and upper lip. Chin hairs on a 79-year-old woman are shown in Figure 25-4.

Toxicities and Management of Preparative Regimens

Myelosuppression is a frequent dose-limiting toxicity for antineoplastics when administered in the conventional doses used to treat cancer. However, because myelosuppression is circumvented with hematopoietic rescue in the case of patients receiving HSCT, the dose-limiting toxicities of these myeloablative preparative regimens are nonhematologic and vary with the preparative regimen used. Most patients undergoing HSCT experience toxicities commonly associated with chemotherapy (e.g., alopecia, mucositis, nausea and vomiting, and infertility), albeit these toxicities are magnified in the HSCT population.

Electromagnetic Therapies

By the eleventh and twelfth centuries, lodestones were thought to have curative powers and were used to treat gout, arthritis, baldness and other ailments, as described by medieval writers. Scholars of the time also believed that magnets could cause and cure melancholy. Aphrodisiac powers were attributed to lodestones probably because of their magnetic ability to attract.

The paradoxical effects of androgens on human hair growth

Normal Man Body

In utero the humanbodyiscoveredwith quite long, colourless lanugo hairs. These are shed before birth and at birth, or shortly after, babies normally exhibit pigmented, quite thick protective hairs on the eyebrows and eyelashes and variable amounts on the scalp by the age of three or four the scalp hair is usually quite well developed, though it will not yet have reached its maximum length. These readily visible pigmented hairs are known as terminal hairs and are formed by large deep terminal follicles (Fig. 6.2). This emphasises that terminal hair growth on the scalp, eyelashes and eyebrows is not androgen-dependent. The rest of the body is often considered hairless but, except for the glabrous skin of the lips, palms and sole of the feet, is normally covered with fine, short almost colourless vellus hairs produced by small short vellus follicles (Fig. 6.2). The molecular mechanisms involved in the distribution and formation of the different types of follicles during embryogenesis are...

Role of 5areductase in androgen physiology and pathophysiology

During the last century, the identification and characterization of the major sex steroids, which include androgens, estrogens, and progestins, helped define their biologic functions. Androgens were demonstrated to be essential for normal male sexual differentiation in utero and for development and maintenance of male secondary sexual characteristics, including terminal body hair growth, muscle mass, sexual behavior and fertility. Androgens are steroid hormones and, as such, produce effects by binding to an intracellular receptor, forming a hormone-receptor com-plexthat interacts with DNAto modulate protein transcription (Mainwaring 1977). Testosterone, the major circulating androgen in adult men, was logically suspected to be the hormone responsible for these effects. Observations in 46XY subjects with inborn androgen insensitivity (syndrome of testicular feminization) confirm that the sexual phenotype in humans is predominantly female in the absence of androgen effects (Morris et...

Parrot Beak Nails Raynauds

Raynaud Syndrome And Toe Nails

Renal dialysis transplant thyroid disease Dermatoses alopecia areata Darier's disease lichen planus psoriasis Club-shaped terminal phalanges mandibular hypoplasia, delayed cranial closure dysplastic clavicles atrophy of skin over hands and feet alopecia AR or XR Unusual facies with large nose

Clinical studies with finasteride in women

Finasteride is not indicated for use in women. Due to its mechanism of action (type 2 5aR inhibition), finasteride use is contraindicated in women when they are or may be pregnant because of the risk of undervirilization of a developing male fetus. However, several studies have been published testing finasteride in women with a variety of disorders, including female pattern hair loss and hirsutism. 18.7.1 Study in postmenopausal women with androgenetic alopecia To determine whether finasteride has utility in the treatment of women with AGA (female pattern hair loss), a randomized, placebo-controlled, one-year study of 137 postmenopausal women with AGA was conducted (Price etal. 2000). Women were eligible if they were assessed by the investigator as being Ludwig class I to II (Ludwig 1977) and Savin scale hair density and pattern classification 3 to 5 (Savin 1994). At the end of one year, no benefit of finasteride treatment compared to placebo was demonstrated in any predefined...

The treatment of androgenpotentiated hair disorders

6.5.1 Androgenetic alopecia Currently, the most effective treatment for male pattern baldness is the transplant of follicles from non-balding sites into the balding region, capitalising on the retention ofthe different intrinsic responses to androgen discussed earlier. This has significant disadvantages not only is it very invasive and heavily reliant on the skill of the operator for a good cosmetic result, but the alopecia continues to progress behind the transplanted area so that further transplants are often required. Minoxidil, a vasodilator used for hypertension, stimulated excessive hair growth as a side-effect. This provoked major interest in hair follicle biology because it demonstrated that vellus follicles could be stimulated to form terminal hairs. Topical application of minoxidil has been used in both male and female androgenetic alopecia. It stimulates regrowth in up to 30 with only about 10 obtaining complete regrowth, probably by acting as a potassium channel regulator...

Seals of Excavated Tombs

In places where there is too much light (chhing, clear) water, disease of the scalp (thu alopecia, ringworm, psoriasis, etc.) and goitre (ying) are commonly found. In places where there is too much heavy (chung, turbid) water, people suffering from swellings and oedematous ulcers of the lower leg (thung1) are commonly found and there are many seriously affected who are unable to walk at all (pi). Where sweet (kan) water abounds, men and women will be health y and handsome. Where acrid (hsin) water abounds there will be many skin lesions, such as abscesses (chii) and smaller boils (iso) where bitter (khu) water abounds there will be many people with bent bones (wang yii).

B dosefinding trials

Numerous Phase I clinical trials with topotecan in different schedules of drug administration have been performed (183). Based on the in vitro data on long-term exposure and the fact that efficacy of the drug has been demonstrated to be dependent on the schedules of administration, two schedules were selected for Phase II studies. Firstly, there is a 30-min i.v. infusion daily for 5 consecutive days every 3 weeks, at a dose of 1.5 mg m2 day. In this schedule, the DLT is short lasting, noncumulative myelosuppression (184-186). Nonhematological toxicities are usually mild and reversible and include nausea, vomiting, fatigue, alopecia, and sometimes diarrhea. Phase II studies with the drug administered in this schedule revealed response rates ranging from 9.5 to 25 in pretreated patients with ovarian cancer, and response rates of 10-39 in patients with SCLC (187-190). In addition, a comparative randomized, multicenter trial in which patients with recurrent ovarian cancer were treated,...

Clinical Features

Although any body part or aspect of physical appearance may be a source of concern and several body parts may be involved simultaneously, concerns generally focus on the patient's face or head (e.g., size or shape of the nose, eyes, lips, teeth, or other facial features thinning hair excessive facial hair acne wrinkles scars). Individuals may spend hours per day checking their appearance, engage in excessive grooming or exercising to minimize or erase the defect, and or become housebound.

Category C Severely Symptomatic

Anemia, neutropenia, nausea, anorexia, fatigue, insomnia, headache, myalgia, myopathy Pancreatitis, peripheral neuropathy, hyperamylasemia, hyperuricemia, transaminase elevations Peripheral neuropathy (dose-dependent), pancreatitis, rash, stomatitis, gastrointestinal disturbances Peripheral neuropathy, arthralgia, myalgia, anemia, asthenia, gastrointestinal complaints, headache, insomnia Pancreatitis, paresthesias, peripheral neuropathy, rash, cough, headache, dizziness, fatigue, hair loss, insomnia

Associated Neurological Findings

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

Metabolism of androgens in different tissues

Testosterone is metabolised to the more active androgen dihydrotestosterone (DHT) by 5a-reductase, which has much greater affinity to the AR than T and enhances AR-mediated transcription of target genes amplifying therefore the action of testosterone. The reductase is expressed especially in organs like skin, hair follicle and prostate and thereby contribute to undesired side-effects of androgens on baldness, acne, hirsutism (in women) and on the prostate.

Statureforage and Weightforage percentiles

Is there evidence of traumatic alopecia from pulling out of the hair The damaged hair is broken at various lengths. Are small, circular, punched-out lesions of uniform size present These may represent cigarette burns. A large circular-type burn on the buttocks and thighs may result from the infant's immersion in scalding water. Inflicted tap water scalds are the most common type of nonaccidental burn injury. The most common sites include the perineum or extremities. The child pictured in Figure 24-32 has first- and second-degree burns on the penis, thighs, and inguinal and suprapubic areas. The buttocks and sacrum were spared. These burns were caused by holding the child under hot water from the faucet. Burns by a hot object are the second most common type of inflicted burns. A well-circumscribed affected area with the outline of the hot object used is commonly seen. Figure 24-33 shows the typical appearance of specific types of burns. The diagnosis of physical child abuse is...

Secondary Syphilis Clinical Summary

The rash of secondary syphilis occurs 2 to 10 weeks after resolution of the primary lesions. It begins as a nonpruritic macular rash that evolves into a papulosquamous rash involving primarily the trunk, palms, and soles. The rash is often annular in shape. Diffuse, painless lymphadenopathy is also seen at this stage. Mucous patches represent mucous membrane involvement of the tongue and buccal mucosa. Condyloma lata can be seen during this stage, as can patchy alopecia. The manifestations of this stage resolve without treatment in several months.

Associated Medical Findings

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

Coloured lines

Multiple Normal increase with age after early adulthood (Figures 3.1, 3.3, 3.4) With all causes of thin nail plates Lichen planus (Figure 3.5) Rheumatoid arthritis Graft-versus-host disease Psoriasis Darier's disease Poor circulation Collagen vascular diseases Radiation Frostbite Alopecia areata Nail-patella syndrome _Systemic amyloidosis_

Figure 328

It has been shown that regular pitting may convert to rippling or ridging, and these two conditions appear, at times, to be variants of uniform pitting (Figures 3.26-3.28). Nails showing diffuse pitting grow faster than the apparently normal nails in psoriasis. Occasional pits occur on normal nails. Deep pits can be attributed to psoriasis, and profuse pitting is most often due to this condition (Figures 3.29, 3.30). In alopecia areata (Figure 3.31) shallow pits are usually seen and they are often numerous, leading to trachyonychia (rough nail) and twenty-nail dystrophy however, curiously, one nail often remains unaffected for a long time, Pits may also occur in eczema or occupational trauma. In some cases a genetic basis is thought likely. In secondary syphilis and pityriasis rosea pitting occurs rarely. One case of the latter has been observed with the pits distributed on all the finger nails at corresponding levels, analogous to Beau's lines.

Curries

Left to right double-edged thinning scissors - for thinning hair and blending in the coat carbon steel straight-cutting scissors Filipino heavy-duty scissors - used on 'feathers' for straight cuts two pairs of different-sized curved scissors for cutting hair around the feet Fig 9.4 Grooming scissors. Left to right double-edged thinning scissors - for thinning hair and blending in the coat carbon steel straight-cutting scissors Filipino heavy-duty scissors - used on 'feathers' for straight cuts two pairs of different-sized curved scissors for cutting hair around the feet

Sulphur

Sodium and chloride are the major electrolytes in the body water. They are needed for acid-base balance and for the regulation of the concentration of the body fluids. Chloride is a component of bile and hydrochloric acid. Fish, eggs, whey and poultry meal are rich in both sodium and chloride. A deficiency of these minerals can arise from excessive fluid loss, such as occurs in vomiting and diarrhoea. Signs include exhaustion, inability to control water balance, dry skin and hair loss. An excess will cause a greater than normal fluid intake and may predispose animals to hypertension and therefore heart and kidney problems.

Complications

Two minor side effects of beam therapy are pubic hair loss and fatigue. The hair loss may be temporary or permanent, but the radiation does not affect hair on the head. Fatigue, which may be marked, usually begins three to four weeks after the treatment course begins. Exercise can help one study reported that men who walked for thirty minutes each day during the treatment period experienced less radiation fatigue.6

Fat Soluble Vitamins

Although your body controls the creation of vitamin A from beta-carotene, it has no control when you ingest straight vitamin A, which can be found in vitamin tablets. Over-supplementation can be extremely toxic, resulting in general fatigue and weakness, severe headaches, blurred vision, insomnia, hair loss, menstrual irregularities, skin rashes, and joint pain. In extreme cases, there can be liver and brain damage. Huge doses taken in the prenatal period can cause birth defects.

Selfmutilation

Self-mutilation usually affects young stallions. It is thought that this behaviour occurs more in stallions than in mares as they groom themselves more often. Self mutilation is usually initiated by a stressful event such as moving to a different yard or major changes within a breeding or exercise programme. Most self-mutilating horses bite a specific area of their bodies, often the forelimbs, the pectoral area, stifle, flanks or thighs. Some horses will grunt, stall walk and stare at the specific area prior to the act of self-mutilation. Other presenting signs include licking, alopecia and leukotrichia in one localized area.

Valproic Acid

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

Pregnancy

Breeders become experts in diagnosing pregnancy. At 21 days the queen's nipples become more vascular and turn a rosy pink. Later the nipples grow larger and a discrete area of hair loss occurs around them, often aided by the queen plucking hairs. By 35 days there should be a noticeable increase in abdominal girth and by 49 days the individual kittens may be observed and felt to move.

Cryotherapy

Cryotherapy can be easily mastered for treatment of many skin lesions. Cryotherapy is well tolerated and results in minimal to no scar. It is best used in those with lighter skin and in non-hair-bearing areas because of occasional pigment changes or hair loss with deeper treatments. Liquid nitrogen, the most widely available, cost-effective cryogen for medical therapy,

Phenotype

The appearance and maintenance of a male sexual hair pattern is a good parameter for monitoring testosterone replacement (see Chapter 6). In particular, beard growth and frequency of shaving can easily be recorded. Hair growth in the upper pubic triangle is an important indicator of sufficient androgen substitution. While women, boys and untreated hypogonadal patients have a straight frontal hairline, androgenization is accompanied by temporal recession of the hairline and - if a predisposition exists - by the development of baldness. The pattern of male sexual hair is of greater importance than the intensity of hair growth since no correlation could be found between the intensity of body hair growth and serum testosterone levels in the normal range (Knussmann etal. 1992). A well-substituted patient may have to shave daily. However, if there is no genetic disposition for dense beard growth, additional testosterone will not increase facial hair.

Skin Section

Baldness can be treated surgically by several different methods of hair transplantation. In the method shown, skin and hair are taken from a donor site, often at the back of the scalp or behind the ears. The removed hairs and their attached follicles are then inserted in the bald area (the recipient site). A mild sedative is usually given, and both sites are anaesthetized. The transplanted hairs will fall out shortly after the transplant, but new hair starts to grow from the transplanted follicles 3 weeks to 3 months later.

Transplanted Hairs

Are you over 55, and has the hair loss taken place slowly over many years possible cause Male-pattern baldness (which can also affect women) typically causes this type of hair loss. In this condition, which often runs in families, hair follicles are oversensitive to the male hormone testosterone. In women, the levels of these hormones in the body often rise after the menopause. action Hair loss cannot be prevented. Recent treatments, such as the drug minoxidil applied to the scalp or finasteride taken as tablets, will produce hair regrowth in some people, but this growth will be lost again when the treatment is discontinued. Surgical transplantation of hairs is another option (see Hair transplant, above). action Treat your hair gently, avoiding the excessive use of chemicals (perms and dyes) or heat on your hair. If your hair loss is extensive, or if you are concerned, consult your doctor. possible causes Patchy hair loss may be the result of ringworm (especially if the scalp is...

Hypothyroidism

This may result from primary thyroid failure, Hashimoto's thyroiditis, as a consequence of thyroid surgery, or secondary to pituitary failure. The diagnosis is suggested by tiredness, cold intolerance, loss of appetite, dry skin and hair loss. It may be confirmed by the finding of a low serum thyroxine concentration, associated, in primary thyroid failure, with a raised serum TSH concentration.

Thallium

Thallium compounds are highly toxic if inhaled, ingested, or absorbed through the skin (IPCS 1996). Following ingestion, the onset of gastrointestinal symptoms may occur after 12-48 hours. These include nausea, vomiting, metallic taste in the mouth, hypersalivation, and retrosternal and abdominal pain. Systemic features occur 2-5 days post exposure, the main effects being, in addition to gastroenteritis, a polyneuropathy characterized by numbness around lips, paraesthesia of fingers and toes becoming severe and spreading to arms and legs, and paralysis eventually affecting all muscles. Hair loss (alopecia) occurs at 10-15 days. Death is usually from cardio-respiratory failure and often occurs 10-12 days post exposure, although with very high doses death may occur within 24 hours. In some cases it may take symptoms 2-3 weeks to reach their maximum severity. If recovery occurs following thallium poisoning it is likely to be slow. The characteristic effects of thallium poisoning are...

Sertoli cell tumour

This tumour of the Sertoli cells, which line the seminiferous tubules within the testis and secrete oestrogen, is usually associated with a retained testis. Clinical signs often seen in dogs over 6 years old include bilateral symmetrical alopecia over the flanks, enlargement of the mammary tissue and onset of attractiveness to male dogs. The unaffected testis may be atrophied. Diagnosis is based on clinical signs, and hormonal assay demonstrating high levels of oestrogen.

Trichotillomania

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

Phase Iii Trials

Exclusion criteria have the function of selecting the 'more suitable' patients among all possible candidates (e.g., excluding patients in whom the treatment under investigation is contraindi-cated). This selection also has the aim of reducing factors of variability in the study population, in order to maximise the chance of detecting and quantifying the treatment effect (e.g., excluding patients who are too young or too old). The best way to provide an account of the selection process is a log that lists the included and excluded patients and specifies the reasons for exclusion. This is rarely found in clinical trial reports concerning skin disorders. An example of how far exclusion criteria may operate and limit the possibility of generalising the study results is offered by a clinical trial on the effectiveness of a Chinese herbal extract called 'Dabao' in the treatment of alopecia androgenetica.35 Among the 3000 patients available to take part in the trial, only 396 were eventually...

Medical Overview

SLE is the most common autoimmune connective disease of childhood. SLE is multisystemic in onset and lifelong with no known cure (Kone-Paut et al. 2007). Treatment is aimed not only at symptom management but also at prevention of further complications (e.g., organic involvement). The musculoskeletal system is frequently affected, resulting in arthritis that may be extremely painful during the initial onset and throughout the course of the disease. Other complications of pediatric SLE that may be associated with significant pain and disability include ischemic necrosis of the bone, serotosis, and vasculitis. Cutaneous manifestations (e.g., malar rash, dermatitis, alopecia, photosensitivity) also occur frequently in these patients. In addition, specific organ systems (e.g., renal, hepatic, lung, cardiac, hematological) may become involved thus, the disease may be life threatening (Kone-Paut et al. 2007) (see Table 24-2). Brittle hair or hair loss

Doxorubicin

Doxorubicin has shown clinical activity in breast, esophageal, bladder, lung, ovarian, and head and neck cancers, along with lymphomas and multiple myeloma. This red drug causes a red-orange discoloration of the urine. Cumulative doses greater than 550 mg m are associated with cardiomyopathy. Doxorubicin is a vesicant and may cause significant pain when administered into the peritoneal cavity. Other side effects include myelosuppression, alopecia, mucositis, and nausea and vomiting. model, with a terminal half-life of 30 to 90 hours. Liposomal doxorubicin has shown significant activity in the treatment of breast and ovarian cancer, along with multiple myeloma and Kaposi's sarcoma. Side effects include mucositis, myelosuppression, alopecia, and palmar-plantar erythrodysesthesia. The liposomal doxorubicin may be less cardiotoxic than doxorubicin. biliary excretion. Epirubicin has shown clinical activity in the treatment of breast, esophageal, lung,...

Part Seven Overview

The history of electromagnetic therapies parallels the discovery of electricity and its use in modern society. When it was understood that different frequencies operating at varying levels of power produced different effects, opportunists and entrepreneurs in substantial numbers found ways to apply those variations to the diagnosis and treatment of illness and other problems. As products failed to produce benefits (such as the electric hairbrush sold to eliminate baldness), they were dropped, quickly to be replaced by yet other products that relied on the newly discovered miracle of electric power.

Bleomycin

Longed to 21 hours in patients with renal impairment. Bleomycin has shown clinical activity in the treatment of testicular cancer and malignant effusions, squamous cell carcinomas of the skin, and Kaposi's sarcoma. Hypersensitivity reactions and fever may occur, so premedication with acetaminophen may be required. The most serious side effect is the pulmonary toxicity that presents as a pneumonitis with a dry cough, dyspnea, rales, and infiltrates. Pulmonary function studies will show decreased carbon monoxide diffusing capacity and restrictive ventilatory changes. Bleomycin lung is associated with cumulative dosing greater than 400 units and occurs rarely with a total dose of 150 units. The pulmonary toxicity is potentiated by thoracic radiation and by hyperoxia. Additional side effects include fever with or without chills, mild to moderate alopecia, and nausea and vomiting. Bleomycin has been used to manage malignant effusions at doses of 15 to 60 units through installation into the...

The Surgical Plan

The Women's Cancers Program is a perfect example of a well-intentioned but potentially confusing environment. A multidisciplinary team must manage women with breast or gynecologic cancer. In the case of breast cancer treatment, the key members of the medical team are the surgeon, the medical oncologist, and the radiation oncologist. But there are other important specialists who play vital roles. Pathologists define the extent of the tumor and document its biology. Psychologists or psychiatrists and social workers may be required to deal with severe emotional reactions. Social workers are also often needed to help patients cope with insurance issues and family crises. In addition to a large multi-disciplinary staff, women with breast cancer may need very specialized facilities, including an educational resource room and a specially designed boutique to help them choose prostheses and handle chemotherapy-induced hair loss. After the patients complete their surgical treatment and go on...

Appendix D Glossary

Essential fatty acid deficiency Deficiency of linoleic acid, linolenic acid, and or arachidonic acid, characterized by hair loss, thinning of skin, and skin desquamation. Long-chain fatty acids include trienes (containing three double-bonds, e.g., 5,8,11-eicosatrienoic (or Mead) acid, trienoic acids,) and tetraenes (containing four double bonds, e.g., arachidonic acid). Biochemical evidence of essential fatty acid deficiency includes a triene tetraene greater than 0.2 and low linoleic or arachidon-ic acid plasma concentrations.

History

In a recent study, female athlete participation had grown to 1 in 2.5 of high school athletes and 43 of all college athletes in the United States.11 Recent findings of six medical societies have found that questions relating to eating, amenorrhea, and osteopenia osteoporosis need to be emphasized. The combination of all three symptoms has been termed the female athlete triad.12 Some things that should be screened for include dry skin and mucous membranes, history of fractures, menstrual history, and hair loss.

The Road to Truth

Whatever the functions of these cutaneous specializations in human beings may be, it is clear that the degree of expression of such secondary sexual traits in human males (beard, male pattern baldness, and body hair) is commensurate with that which occurs in polygynous non-human primates. Comparative studies of visually striking, secondary sexual traits in male monkeys, apes, and humans (see Figure 7.19) strengthen the view that polygyny has played a significant role during the origins of human sexuality.

Cutaneous diseases

Nail Diseases And Disorders Chart

Psoriasis, Reiter's disease, vesicular or bullous disease, lichen planus, alopecia areata, multicentric reticulohistiocytosis The terms 'onychoptosis defluvium' or 'alopecia unguium' are sometimes used to describe traumatic nail loss. Onychomadesis usually results from serious generalized diseases, bullous dermatoses, drug reactions, intensive X-ray therapy, acute paronychia or severe psychological stress or it may be idiopathic. Nail shedding may be an inherited disorder (as a dominant trait) the shedding may be periodic, and rarely associated with the dental condition amelogenesis imperfecta. Longitudinal fissures, recurrent onychomadesis and onychogryphosis can be associated with mild degrees of keratosis punctata. Minor traumatic episodes (as in 'sportsman's toe') may cause onychomadesis of the toe nails (Figure 4.12).

Common

Psoriasis (Figures 3.26, 3.27, 3.29, 3.30) Alopecia areata (Figure 3.31) Eczema Small, superficial and regular pits are typical of alopecia areata An isolated pit is not diagnostic and may be dye to minor trauma Multiple nail pits 'rippled' effect in alopecia areata. Table 3.3 lists the causes of nail pitting. Multiple nail pits 'rippled' effect in alopecia areata. Table 3.3 lists the causes of nail pitting. 1 Trachyonychia and a past history or clinical evidence of alopecia areata. Trachyonychia (rough nails) due to alopecia areata. Trachyonychia (rough nails) due to alopecia areata. Trachyonychia is typically associated with severe alopecia areata of children. According to the authors' data trachyonychia is observed in 12 of children and 3.3 of adults with alopecia areata. The frequency of this condition is closely related to the severity of the disease it is more frequent in males than in females, with a male to female ratio of 4 1. The onset and course of the nail changes are not...

Antitumor Efficacy

The dosage regimen of topotecan approved for clinical use is 1.5 mg m2 day given as a 30-min i.v. infusion daily for 5 days every 3 weeks. Dose-related, reversible, and noncumulative myelosuppression is the most important side effect of topotecan (229). Neutropenia - the nadir is usually approximately 9 days after the start of the treatment and the median duration is approximately 7-10 days - occurred more frequently and is often more severe than thrombocytopenia. Also, neutropenia was more severe in heavily pretreated patients compared with minimally pretreated patients (229). Besides myelosuppression, stomatitis (24-28 of patients) and late-onset diarrhea (40 ) were noted at higher doses (65,229). Other nonhematological toxicities reported included alopecia (76-82 of patients), nausea (75-78 ), vomiting (53-64 ), fatigue (30-41 ), and asthenia (21-22 ) (229).

Tinea Capitis

Tinea capitis, the most common dermatophytosis in children, is an infection of the scalp and hair follicle. Transmission is fostered by poor hygiene and overcrowding and can occur through contaminated hats, brushes, and pillowcases. After being shed, affected hairs can harbor viable organisms for more than 1 year. Tinea capitis is characterized by irregular or well-demarcated alopecia and scaling (Fig. 33-49). Cervical and occipital lymphadenopathy may be prominent. When hairs fracture a few millimeters from the scalp, black dot alopecia is produced. Tinea scalp infection also may result in a cell-mediated immune response termed a kerion, which is a boggy, sterile, inflammatory scalp mass

Randall

Androgenetic alopecia Androgenetic alopecia Hair growth plays significant roles in human social and sexual communication. People all over the world classify a person's state of health, sex, sexual maturity and age, often subconsciously, by assessing their scalp and body hair. The importance of hair is seen in many social customs in different cultures, such as shaving the head of Buddhist monks or no cutting of scalp hair by Sikhs. Body hair is also involved for example, the widespread customs of daily shaving men's beards and women's axillary hair in Northern Europe and the USA. When this is considered, it is not surprising that abnormalities of hair growth, either greater or less than normal, even including common male pattern baldness, cause widespread psychological distress. Androgens are the most obvious regulators of human hair growth. Although hair with a major protective role, such as the eyelashes, eyebrows and scalp hair, is produced by children in the absence of androgens,...

Hair growth

Male pattern baldness is described by a loss of scalp hair and affects up to 80 of males by the age of 80 years. Abalding scalp is caused by androgens and expression of the AR in the respective hair follicle and is thus known as androgenetic alopecia (see Chapter 6). One can assume that the influence of the CAG repeat polymorphism on androgenicity causes a variation of androgenetic alopecia. In men with such a clinical condition, significantly shorter CAG repeats were described in comparison to controls by two studies (Ellis etal. 2001 Sawaya and Shalita 1998). Thus, the CAG repeat polymorphism is likely to play a role in modulation of androgen influence on male hair pattern, but since statistical significance is weak in a reasonable number of patients due to high interindividual variability, the cosmetic consequence for the individual is questionable.

Dystrophia Myotonica

This is a disease of autosomal dominant inheritance characterized by muscle weakness and muscle contraction persisting after the termination of voluntary effort. Other features may include frontal baldness, cataract, sternomastoid wasting, gonadal atrophy and thyroid adenoma. Problems which affect anaesthetic management include the following.

Daunorubicin

Daunorubicin is an anthracycline that is sometimes referred to as an antitumor antibiotic. Daunorubicin inserts between base pairs of DNA to cause structural changes in DNA however, the primary mechanism of cytotoxicity is the inhibition of topoi-somerase II. The pharmacokinetics are best described by a two-compartment model, with a terminal half-life of about 20 hours. The predominant route of elimination of daunorubicin and hydroxylated metabolites is hepatobiliary secretion. Daunorubi-cin has shown clinical activity in the treatment of acute lymphocytic leukemia, non-Hodgkin's lymphoma, neuroblastoma, and Ewing's and Kaposi's sarcomas. Myelosuppression is the major toxicity, along with alopecia, stomatitis, and mild to moderate nausea and vomiting, and it imparts a red to color to the urine so that patients need to be educated on side effects. Cardiac toxicity is dose related and manifested as

Cyclophosphamide

Cyclophosphamide prevents cell division by cross-linking DNA strands. Cyclophos-phamide is activated to phosphoramide mustard and acrolein. Acrolein, which has no tumor activity, causes hemorrhagic cystitis of the bladder. The pharmacokinetics of cyclophosphamide are best described by a two-compartment model, with a terminal half-life that ranges from 4 to 10 hours. Approximately 15 of the dose is excreted unchanged by the kidney. Cyclophosphamide has shown clinical activity in numerous types of cancer, ranging from leukemias to lymphomas to breast and ovarian cancer. Whether the drug is administered orally or IV, patients need to be counseled on the importance of good hydration and frequent voiding to prevent hemorrhagic cystitis. Nausea and vomiting may occur 12 hours after administration, so patients need to have antiemetics available after the acute treatment period. Other side effects include myelosuppression, alopecia, SIADH (usually with doses greater than 50 mg kg), secondary...

Adverse Effects

Nausea, lethargy, tremor, weight gain, hair loss rarely abnormal liver function, pancreatitis Nausea, paresthesia, intermittent claudication, ergotism Weakness, nausea, thirst, tremor, lethargy, slurred speech, blurred vision Muscle cramps, nausea, diarrhea, abdominal discomfort

Motor Changes

Symptoms are usually most pronounced distally. This is especially true with polyneuropathies, in which symptoms of stumbling, clumsiness, and weakness are most common because of the effects on the intrinsic muscles. Motor symptoms can range from mild weakness to complete paralysis. Diminished DTRs may be one of the early signs of motor dysfunction. Denervation of muscles causes eventual atrophy. An example is the sharp shin sign, whereby atrophy of the tibialis anterior muscle gives a prominent appearance to the tibia. As the intrinsic muscles deteriorate, the wasting gives the hands and feet a skeletal appearance. In long-standing neuropathies, trophic changes such as high-arched feet (pes cavus), hammertoes, kyphoscoliosis, and hair loss with or without ulcerations can be seen. Cramps, fasciculations, and restless legs may also be present.

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Hair Loss Prevention

Hair Loss Prevention

The best start to preventing hair loss is understanding the basics of hair what it is, how it grows, what system malfunctions can cause it to stop growing. And this ebook will cover the bases for you. Note that the contents here are not presented from a medical practitioner, and that any and all dietary and medical planning should be made under the guidance of your own medical and health practitioners. This content only presents overviews of hair loss prevention research for educational purposes and does not replace medical advice from a professional physician.

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