Anti-tuberculosis Drugs-induced Anagen Effluvium with Generalized Drug Eruption / 대한피부과학회지

Anagen effluvium is an abrupt loss of hair in its growing phase due to an event that impairs the mitotic or metabolic activity of the hair follicle. Anagen effluvium is commonly associated with the administration of chemotherapy, radiation, and drugs as well as exposure to toxic chemicals. However, alopecia due to the administration of anti-tuberculosis drugs has rarely been reported in the literature. A 50-year-old female was diagnosed with intestinal tuberculosis and was started on anti-tuberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide. After starting the treatment, erythematous to brown patches appeared all over her body, which was followed by diffuse hair loss on the scalp and body. Hair examination showed intact inner and outer root sheaths with fully pigmented hair bulbs, and histopathological examination of a scalp biopsy showed vacuolar degeneration in the interfollicular epidermis and perifollicular infiltration of mononuclear cells and eosinophils. The condition was diagnosed as anagen effluvium with drug eruption, and a potent corticosteroid lotion was prescribed for scalp application twice a day. After complete hair loss, the anti-tuberculosis medications were withdrawn, and hair regrowth started 4 months later. Here, we report a rare case of anagen effluvium with generalized drug eruption due to anti-tuberculosis medication.

El pelo: generalidades y enfermedades más comunes / Hair: its generalities and most common diseases

Resumen Las patologías del pelo reciben poca atención durante la formación del médico general, pero al tener alta prevalencia en la práctica clínica es importante considerar los principios básicos del crecimiento del pelo y las patologías más comunes que lo afectan, para llegar a un diagnóstico y un tratamiento correcto en cada situación.

Abstract Hair pathology is often overlooked during undergraduate medical training, however because of its high prevalence in the clinical practice it is important to know the basic principles of hair growth and the most frequent pathologies that afflict this structure and how to make an adequate diagnosis and treatment for each patient.

Anagen effluvium secondary to Gloriosa superba ingestion.

Anagen effluvium, the shedding of anagen hair, leads to diffuse non-scarring alopecia. We report two cases of anagen effluvium in the same family secondary to the ingestion of tubers of Gloriosa superba, which contains the antimitotic alkaloid colchicine. Both patients developed anagen effluvium and gastroenteritis 1–2 weeks after consuming the tubers. In addition, one of them had bicytopenia, pleural effusion, hematuria and altered liver function tests. Both were managed conservatively and counseled regarding the reversible nature of the hair loss. Follow‑up at 3 months showed regrowth of hair in both the cases.

Dermatological adverse reactions to cancer chemotherapy.

The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail fi nding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effl uvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of signifi cant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.

A 10-Year Retrospective Review of Non-Scarring Alopecia in a Tertiary Hospital in Malaysia

Background Non-scarring alopecia is a common hair disorder with paucity of clinical reviews. Objectives We aim to study the spectrum of non-scarring alopecia, its’ demographic, clinical and treatment pattern among patients at University Malaya Medical Centre. Methodology We have retrospectively reviewed the demography, clinical characteristics and treatment of non-scarring alopecia at University Malaya Medical Centre (UMMC). A total of 154 records were reviewed. Results A majority of patients had alopecia areata (28.6%), followed by androgenetic alopecia (12.3%), telogen effluvium (3.2%), tineacapitis (2.6%) and unspecified hair loss (53.2). Treatment for alopecia areata included topical steroids (53.3%), intralesional steroids (26.7%), topical minoxidil (17.8%), oral steroids (11.1%), oral finasteride (2.2%) and oral azathiopine (2.2%). Prescribed treatment for androgenetic alopecia comprised of topical minoxidil (68.1%) or oral finasteride (10.5%). Conclusion We concluded that alopecia areata was the most common cause of nonscarring alopecia diagnosed at UMMC and deduced that the high number of patients diagnosed with unspecified hair loss was attributed to the lack of confidence amongst out-patient physicians in diagnosing the cause of alopecia.

A Case of Anagen Effluvium Induced by INH (Isonicotinic Acid Hydrazide) / 대한피부과학회지

We report a case of a 30 year-old woman who presented with acute scalp hair loss induced by isonicotinic acid hydrazide gap (INH). Considerable hair loss started within 4 weeks of INH administration. There was no evidence of dermatitis, allergic reaction, or any other cause for the hair loss. INH was discontinued, and the hair loss stopped within 4 weeks, with new hair growth seen. There was complete recovery of hair loss after 12 weeks of alopecia. Medication-induced hair loss is an occasional adverse effect of many drugs, however hair loss induced by INH has been reported in only 1 case. The complete recovery from anagen effluvium is difficult to explain, but it could have been due to the early discontinuance of INH.

Normal Anagen Effluvium as the Presenting Sign of Pemphigus Vulgaris: a Case Report / 대한피부과학회지

Pemphigus vulgaris is an autoimmune blistering disease of the skin and mucous membranes. It is characterized, histologically, by intraepidermal blisters, and immunopathologically, by the bound and circulating IgG directed to the epithelial desmosomes. In the majority of patients, painful mucous membrane erosions, especially in the oral cavity, are the presenting sign. The hair follicle is also a preferential target for pemphigus autoantibodies as the desmosomal proteins are overexpressed in follicular epithelium. We herein report a case of pemphigus vulgaris presenting with normal anagen effluvium.