Faculty Bibliography

PURPOSE OF REVIEW: Androgenetic alopecia (AGA) or male pattern hair loss is a very common condition that has a significant psychosocial impact for patients. Many advances in the pathogenesis and treatment of AGA have been discovered recently. We discuss the pathogenesis and treatment of AGA. RECENT FINDINGS: Wide genome analysis showed an association of AGA and chromosome 20pll in addition to androgen-receptor gene. Also, a locus on chromosome 3q26 was found to have a linkage with AGA. Dutasteride has been shown to be more effective than finasteride in the treatment of AGA but is not yet a recommended therapy. In an in-vitro study, a new topical liposomal finasteride formulation showed more than five-fold higher deposition of drug in skin than the corresponding plain drug solution. SUMMARY: These recent developments in the field of AGA hold some promise and may play a role in the future management

The relationship of the stress response to the pathogenesis of alopecia areata (AA) was investigated by subjecting normal and skin graft-induced, AA-affected C3H/HeJ mice to light ether anesthesia or restraint stress. Plasma corticosterone (CORT), adrenocorticotropic hormone (ACTH), and estradiol (E2) levels were determined by RIA, whereas gene expression in brains, lymphoid organs, and skin was measured by quantitative RT-PCR for corticotropin-releasing hormone (Crh), arginine vasopressin (Avp), proopiomelanocortin (Pomc), glucocorticoid receptor (Nr3c1), mineralocorticoid receptor (Nr3c2), corticotropin-releasing hormone receptor types 1 and 2 (Crhr1, Crhr2), interleukin-12 (Il12), tumor necrosis factor-alpha (Tnf alpha), and estrogen receptors type-1 (Esr1) and type-2 (Esr2). AA mice had a marked increase in hypothalamic-pituitary-adrenal (HPA) tone and activity centrally, and peripherally in the skin and lymph nodes. There was also altered interaction between the adrenal and gonadal axes compared with that in normal mice. Stress further exacerbated changes in AA mouse HPA activity both centrally and peripherally. AA mice had significantly blunted CORT and ACTH responses to acute ether stress (physiological stressor) and a deficit in habituation to repeated restraint stress (psychological stressor). The positive correlation of HPA hormone levels with skin Th1 cytokines suggests that altered HPA activity may occur as a consequence of the immune response associated with AA

BACKGROUND: Few data exist documenting the effectiveness of psoriasis day-care treatment programs (PDTPs) using standardized efficacy measurements. OBJECTIVES: We sought to analyze the efficacy of a PDTP using the Psoriasis Area and Severity Index (PASI). METHODS: A retrospective review was performed on 132 patients treated at our PDTP. Sufficient data existed to permit PASI analysis using a simplified method for a representative subgroup of 64 patients, who formed the study population. Patients received phototherapy and topical treatments over 2 weeks. The outcome measures included a baseline and day 11 PASI, a physician global assessment (PGA), and adverse events reported by the patients. RESULTS: Mean baseline PASI was 13.6 (N = 64), with a 59.6% reduction by day 11. A PASI reduction of > or = 50% was seen in 75% of patients, with 30% of patients achieving > or = 75% reduction of PASI. Day 11 PGA demonstrated a 69.9% improvement. CONCLUSION: With a reduction in PASI of 59.6% at 11 days, our PDTP, with phototherapy and topical agents, seems to be a rapid and effective therapy for psoriasis

Basal-cell carcinoma (BCC), the most common neoplasm in humans, occurs in a variety of morphological presentations. The mechanisms of BCC development downstream of the initial genetic mutations are not well understood, and different BCC morphological presentations might exhibit distinct gene expression patterns. We investigated superficial (n=8), nodular (n=8), and morpheiform (n=7) BCCs using 21K cDNA microarrays. Global gene expression profiles between respective BCC subtypes, and as compared with normal skin (n=8), were statistically defined by significance analysis of microarrays (SAM). Thirty-seven genes were subsequently validated by quantitative reverse transcriptase-PCR analysis using an expanded set of 31 BCCs. Gene ontology analysis indicated that gene expression patterns of BCC subtypes in multiple biological processes showed significant variation, particularly in genes associated with the mitogen-activated protein kinase (MAPK) pathway. Notably, genes involved in response to DNA-damage stimulus were uniquely upregulated in morpheiform BCCs. Our results indicate a relative similarity in gene expression between nodular and superficial BCC subtypes. In contrast, morpheiform BCCs are more diverse, with gene expression patterns consistent with their more 'invasive' phenotype. These data may help us understand the complex behavior of BCC subtypes and may eventually lead to new therapeutic strategies

Various nonfollicular scalp conditions can cause secondary scarring or permanent alopecia. Possible causes are congenital defects, trauma, inflammatory conditions, infections, and neoplasms (rarely drugs). Associated signs and symptoms and other diagnostic procedures such as histopathology may aid in the diagnosis. Detection of the underlying disorder may be difficult in end-stage lesions. Treatment is specific for active conditions. Surgery and hair transplantation are options for localized scars

Pseudopelade of Brocq (PPB) is a rare, idiopathic, slowly progressive hair disorder, resulting in cicatricial alopecia. It typically presents in Caucasian adult patients as small, smooth, flesh-toned and slightly depressed alopecic patches with irregular outlines. It primarily involves the parietal and vertex portions of the scalp with a chronic prolonged course. Controversial opinions still exist as to whether PPB is a single entity or an end stage of several cicatricial alopecic disorders. A practical approach to diagnosis of PPB and therapeutic update are discussed in this review

Folliculitis decalvans is a rare inflammatory scalp disorder. The present paper gives a practical approach to diagnosis and patient management and reviews possible pathogenetic factors and treatment options. Folliculitis decalvans is classified as primary neutrophilic cicatricial alopecia and predominantly occurs in middle-aged adults. Staphylococcus aureus and a deficient host immune response seem to play an important role in the development of this disfiguring scalp disease. Lesions occur mainly in the vertex and occipital area. Clinically, the lesions present with follicular pustules, lack of ostia, diffuse and perifollicular erythema, follicular tufting, and, oftentimes, hemorrhagic crusts and erosions. Histology displays a mainly neutrophilic inflammatory infiltrate in early lesions and additionally lymphocytes and plasma cells in advanced lesions. Treatment is focused on the eradication of S. aureus anti-inflammatory agents