Manejo de alopecia no paciente em tratamento oncológico / Management of alopecia in oncologic treatment patients

INTRODUÇÃO: O tratamento do câncer vem evoluindo a cada dia. Entretanto, efeitos adversos como alterações dermatológicas apresentam um grande impacto psicossocial ao paciente oncológico. Uma dessas alterações dermatológicas é a alopecia, caracterizada pela perda dos fios da sobrancelha e do couro cabeludo. RELATO DE CASO: Foram referidos dois casos de pacientes em tratamento quimioterápico com alopecia parcial e total. Ambas receberam tratamento por meio do Minoxidil, de uso tópico, havendo repilação completa após três meses. Não foram observados efeitos adversos. CONCLUSÃO: A loção tópica de Minoxidil mostrou-se um método efetivo e seguro para tratar a alopecia parcial e total em pacientes que ainda estão em tratamento oncológico.

INTRODUCTION: The treatment of cancer has been evolving every day. However, adverse effects such as dermatological changes have a great psychosocial impact on cancer patients. One dermatological change is alopecia, characterized by loss of eyebrow and scalp strands. CASE REPORT: Two cases of patients undergoing chemotherapy with partial and total alopecia were reported. Both were treated with Minoxidil, which was topically used, with complete repilation after three months. No adverse effects observed. CONCLUSION: Minoxidil topical lotion has proven to be an effective and safe method to treat partial and total alopecia in patients still undergoing cancer treatment.

Monilethrix: a typical case report with microscopic and dermatoscopic findings

Monilethrix is a rare hereditary condition generally considered to be an autosomal dominant disorder with variable penetrance. A case of a 6-year-old girl without a familial background for this disease is reported. The diagnosis was made by optic microscopy and dermoscopy. A therapeutic trial with topical minoxidil was conducted.

Female pattern hair loss.

Female pattern hair loss (FPHL) is a common cause of hair loss in women characterized by diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. Its prevalence increases with advancing age and is associated with significant psychological morbidity. The pathophysiology of FPHL is still not completely understood and seems to be multifactorial. Although androgens have been implicated, the involvement of androgen-independent mechanisms is evident from frequent lack of clinical or biochemical markers of hyperandrogenism in affected women. The role of genetic polymorphisms involving the androgen and estrogen receptors is being increasingly recognized in its causation and predicting treatment response to anti-androgens. There are different clinical patterns and classifications of FPHL, knowledge of which facilitates patient management and research. Chronic telogen effluvium remains as the most important differential diagnosis. Thorough history, clinical examination, and evaluation are essential to confirm diagnosis. Patients with clinical signs of androgen excess require assessment of biochemical parameters and imaging studies. It is prudent to screen the patients for metabolic syndrome and cardiovascular risk factors. The treatment comprises medical and/or surgical modalities. Medical treatment should be initiated early as it effectively arrests hair loss progression rather than stimulating regrowth. Minoxidil continues to be the first line therapy whereas anti-androgens form the second line of treatment. The progressive nature of FPHL mandates long-term treatment for sustained effect. Medical therapy may be supplemented with cosmetic concealment in those desirous of greater hair density. Surgery may be worthwhile in some carefully selected patients.

Androgenetic alopecia: An update.

Androgenetic alopecia (AGA) is one of the commonest reasons for dermatological consultation. Over the last few years our understanding of the pathophysiology of AGA has improved and this has paved way for better diagnostic and therapeutic options. Recent research has dwelled on the role of stem cells in the pathophysiology of AGA and has also identified newer genetic basis for the condition. Dermoscopy/trichoscopy has emerged as a useful diagnostic tool for AGA. While the major treatment options continue to be topical minoxidil, systemic Finasteride and hair transplantations, newer modalities are under investigation. Specific diagnostic and treatment recommendations have also been developed on evidence based principles. This article reviews the recent concepts in relation to AGA. With regards to the pathophysiology we have tried to stress on recent knowledge of the molecular and genetic basis of AGA. We have emphasized on an evidence based approach for treatment and diagnosis.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.

Alopecias / Alopecia

Desde los inicios de la humanidad el cabello ha tenido una importancia trascendental desde el punto de vista religioso, racial, sexual y ornamental. En los seres humanos el pelo es un vestigio evolutivo, a diferencia de otros seres vivos, que cumple funciones de protección y regulación de la temperatura. El número de pelos que se desprenden normalmente es de aproximadamente 100 por día y esta tasa aumenta al final del verano y principios de otoño, quizás debido a efectos de la mayor radiación solar y temperatura. La alopecia es la pérdida anormal del cabello, resultado de un proceso patológico. Las causas de alopecia son diversas y representan un desafío tanto para el médico como para el paciente. El objetivo de esta revisión es profundizar en la fisiopatología del cabello, las causas de alopecia y su tratamiento.

Hair has been always an important issue for humanity, from a religious, racial, sexual and ornamental point of view. In human beings hair is an evolution vestige. In other animals, hair serves to regulate body temperature and also has protective functions. Normally one hundred hairs fall in a day, and this rate increases by the end of summer and the first days of autumn, may be because of the more temperature end radiation. Alopecia is the abnormal loss of hair because of a pathologic process. The causes of alopecia are diverse, and they represent a challenge for the doctor and patient. The aim of this study is to deepen in the physiopathology of hair, causes of hair loss and their management.

Utilidad y seguridad del 17-alfa-estradiol 0, 025 por ciento versus minoxidil 2 por ciento en el tratamiento de la alopecia androgenética / Usefulness and safety of 0.025 percent 17-alpha-estradiol versus 2 percent minoxidil in the treatment of androgenetic alopecia

Introducción: La calvicie más común es la alopecia androgenética, la cual consiste en una pérdida progresiva del cabello inducida por la acción de los andrógenos a nivel del folículo piloso. Objetivos: Evaluar la utilidad y seguridad del 17-alfa-estradiol al 0,025 por ciento en el tratamiento de la alopecia androgenética. Material y Métodos: Uso de una solución tópica capilar de 17-alfa-estradiol al 0,025 por ciento versus minoxidil al 2 por ciento en solución tópica capilar, durante 12 semanas, en pacientes chilenos con diagnóstico de alopecia androgenética mediante el análisis cuantitativo del videotricograma. Resultados: Se observó una tendencia al aumento de los cabellos en anágeno y disminución de los cabellos en telógeno en los pacientes tratados con 17-alfa-estradiol al 0,025 por ciento en la zona frontoparietal sin aparición de efectos adversos.

Introduction: Androgenetic alopecia is the most common cause of baldness. It consists of progressive hair loss induced by the action of androgens in the hair follicle. Aim: To evaluate usefulness and safety of 0.025 percent 17-alpha-estradiol in the treatment of androgenetic alopecia. Material and Methods: Use of a topic hair solution of 0.025 percent 17-alpha-estradiol versus 2 percent minoxidil topic hair solution for twelve weeks in Chilean patients with clinically diagnosed androgenetic alopecia through quantitative analysis with videotrichogram. Results: Patients treated with 0.025 percent 17-alpha-estradiol showed a tendency to increase the number of hair follicles in anagen phase and a decrease in telogen phase in the frontoparietal zone with no adverse events.

Efficacy of combination therapy for the management regime of Alopecia areata.

Alopecia areata is a world wide cosmetic problem. Cases are seen in Bangladesh. Due to financial constraint and lack of modern facilities the patients of this country needs cheap, easily available and conveniently usable treatment modality. The present study revealed that the oral administration of prednisolone for 06 weeks followed by topical application of 02% minoxidil for another period of 14 weeks is noninvasive and could act as better remedy for alopecia areata. It is claimed that steroid could induce hair growth through immunosuppression rather than a direct effect on hair growth promotion. When applied together steroid it induced regrowing hair gave more encouraging result. The combination therapy indicated that the gradual loss of hair could be minimized and regrowth of hair could be made possible. To fulfill the demand for the best compliance of treatment modality further study should be directed and dictated amongst a large group of population.

Perfil clínico y manejo de pacientes con alopecia areata en el Servicio de Dermatología de la Pontificia Universidad Católica de Chile / Study of patients diagnosed with alopecia areata, and treated at the Dermatological Service of the Diagnostic Center at Universidad Catolica de Chile

Estudio retrospectivo de pacientes atendidos con diagnóstico de Alopecia Areata en el Servicio de Dermatología del Centro de Diagnóstico de la Pontificia Universidad Católica de Chile. Se revisaron las fichas de 77 pacientes con diagnóstico de Alopecia Areata, 38 por ciento hombres, 62 por ciento mujeres, con un promedio de edad de 26.7 (DSI 15.7; rango 2-65): 15 por ciento presentaron depresión, 11 por ciento rinitis alérgica, 6,5 por ciento presentaron ansiedad, 3,9 por ciento hipotiroidismo y 2,6 por ciento, vitíligo. La Alopecia Areata se asocia a un evento estresante en 27 por ciento de los pacientes. Dentro de los exámenes solicitados, un 2/26 tuvieron anticuerpos antitiroídeos positivos y 2/27, TSH alterada. Se discuten las diversas modalidades terapéuticas para tratar la Alopecia Areata.

Influence of minoxidil on ischemic cutaneous flaps in rats

OBJETIVOS: Avaliar a influência do minoxidil, um vasodilatador, na prevenção de necrose, em retalhos isquêmicos, em ratos. MÉTODOS: Preparam-se retalhos cutâneos ventrais, medindo 8x4 cm, baseados na artéria epigástrica cranial direita, em 20 ratos - Wistar. Administrou-se 50 mg/kg/dia de sulfato de minoxidil aos ratos do grupo experimento e o mesmo volume de solução salina isotônica aos do grupo controle, por sonda oro-gástrica. Iniciou-se o tratamento 24 horas antes da operação e manteve-se, diariamente, por 7 dias, no pós-operatório. Realizou-se a avaliação da microcirculação dos retalhos fluxometria a laser 24 horas antes da operação, no pós-operatório imediato e após 7 dias. Desenhou-se a área de necrose do retalho em molde e avaliou-se em relação ao tamanho total por 2 métodos: planimetria e peso/papel. RESULTADOS: Constatou-se aumento de fluxo na extremidade distal e medial (M1) (p=0,0484), no grupo experimento. Houve diferença na prevenção da necrose nos retalhos do grupo experimento (p=0,0433), porém quando esta se instalou, não houve diferença quanto ao tamanho da área necrosada (p=0,1051 e p=0,2799). CONCLUSÃO: O uso de minoxidil é efetivo para evitar a instalação da necrose de retalhos potencialmente isquêmicos, porém, quando o processo se instala, não existe diferença na sobrevida destes, com a dose e a via empregadas neste estudo, em ratos.

Treatment of anal fissures using a combination of minoxidil and lignocaine: a randomized, double-blind trial.

AIM : Anal fissures are associated with hypertonia of the internal anal sphincter and pain. We evaluated the efficacy of local application of a combination of minoxidil and lignocaine in healing anal fissures. METHODS: In this prospective, randomized, double-blind study, 90 patients with anal fissure were recruited. Patients received local applications of ointments containing 5% lignocaine (n=28), 0.5% minoxidil (n=36), or both (n=26). Healing of anal fissure at 6 weeks was used as the primary end-point. RESULTS: Rates of complete healing of fissure were similar in the three groups (lignocaine alone 8/27, minoxidil alone 10/34, combination 7/22; p=ns). Mean (SD) time taken for complete healing with combination treatment [1.9 (0.6) weeks] was significantly shorter than that with minoxidil alone (3.1 [1.7] weeks; p=0.001) or with lignocaine alone (3.3 [0.8] weeks; p=0.002). Rates of pain relief were similar in the three groups. Stoppage of bleeding occurred more often with combination treatment than with lignocaine alone. No patient had systemic or local side effects. CONCLUSION: Combination treatment with minoxidil and lignocaine helps in faster healing of anal fissures and provides better symptomatic relief than either drug alone.

Minoxidil tópico en la cirugía filtrante experimental de glaucoma / Topical minoxidil in the glaucoma experimental filtration surgery

Este estudio evaluó los efectos clínicos e histopatológicos del Minoxidil 120 mM tópico en la cirugía filtrante de glaucoma en un modelo animal. A conejos albinos de Nueva Zelanda se les realizó una cirugía filtrante y fueron tratados tópicamente con Minoxidil 120 mM o vehículo (placebo). Los conejos en forma aleatoria se asignaron a los diferentes grupos de tratamientos. Grupo A (10 conejos) recibieron Minoxidil 120 mM por 5 días, grupo B (10 conejos) por 14 días y grupo C por 21 días. El ojo contralateral fue el control. La presión intraocular (PIO) y la apariencia de la ampolla fue monitoreada. Después de los períodos de tratamiento, los ojos se removieron cuidadosamente y procesados para miscroscopia de luz. Minoxidil a 120 mM, disminuyó significativamente la PIO (p=0,01). El promedio de la PIO postoperatoria en el grupo Minoxidil 120mM vs. control fue de 10,42 ñ 1,68 vs. 13,63 ñ 1,78 mm de Hg, 10,72ñ 231 vs. 13,86 ñ 1,79mm de Hg y 10,00 ñ 2,00 vs. 11,5 ñ 1,97 mm de Hg (XñDS), para los días 5, 14 y 21 del postoperatorio, respectivamente. La presencia de ampolla, en el grupo minoxidil vs. control, se observó en un 93,33 por ciento vs. 56,66 por ciento, 95 por ciento vs. 35 por ciento y 100 por ciento vs. 30 por ciento, para los días 5, 14 y 21 del postoperatorio, respectivamente (P<0,05). Hubo una disminución significativa en el contaje de fibroblastos en el grupo minoxidil vs. control de 32,5 ñ13,77 vs. 83,9ñ32,47, 34,8ñ33,44vs 79,8ñ40,45 y 45,6ñ24,67 vs. 102,4ñ54,51 (XñDS), para los días 5, 14 y 21 del postoperatorio, respectivamente (p<0,0001); correspondiendo a un 61,26 por ciento, 56,39 por ciento y 55,47 por ciento de reducción respecto al control. El examen histológico en los ojos tratados con Minoxidil, mostraron esclerectomías permeables y ampollas con cavidades bien formadas e hipocelulares. El minoxidil fue bien tolerado y parece seguro y no tóxico. Minoxidil retarda la cicatrización de la herida, prolongando la sobrevida de la cirugía filtrante. En concentración 120 mM, Minoxidil inhibe la proliferación fibroblástica en el punto máximo de la fase proliferativa de la cicatrización de la herida, aumentando la longevidad de la ampolla y causando una disminución significativa de la presión intraocular

Tratamiento de la alopecia areata / Treatment of the alopecia areata

En una patología como la alopecía areata, la que se presenta de distintas formas clínicas, con asociaciones variadas, donde las remiciones son posibles y los tratamientos disponibles no son 100 por ciento eficaces, es dificil evaluar la terapéutica más adecuada. lLos tratamientos disponibles pueden dividirse en tópicos y sistémicos. Los corticoides ocupan un lugar importante en el arsenal terapéutico, en especial los tópicos o en inyecciones intralesionales. Otrs productos se usan con resultados varioables como la inminoterapia tópica, en especial con el minoxidil, la difenciprona y la antralina. La medicación sistïrmica se reserva para casos severos (corticosteroides,ciclosporina A, etc). La mayoría actuarían alterando la respuesta inmune y en otros en controvertida. Consideramos a la afección dentro de su marco general, más que etético, pero sin descuidar la integridad del individuo y hacia esto debemos apuntar en nuestra estrategia de tratamiento. La relación paciente-médico es fundamental para manejar esta enfermedad en la que aún no tenemos una medicación curativa.

Síndrome del cabello en anágeno suelto / Syndrome of capillus in anageno loose

Se presenta un caso de síndrome del cabello en anágeno suelto en una niña de dos años y medio de edad. De cabello rubio y ondulado presenta zonas de alopecía de las que se desprenden los cabellos fácilmente a la tracción suave, sin provocar dolor. La aplicación diaria de una loción conteniendo minoxidil y ácido retinoico permitió disminuir significativamente la caída del cabello

Minoxidil alopécias / Minoxidil in alopecia

Este trabalho é uma revisåo bibliográfica sobre o uso do minoxidil nas alopécias androgênica e areata, abordando o histórico, os mecanismos de açåo, as aplicaçöes terapêuticas e os efeitos colaterais desta droga

Alopecia androgênica / Androgenic alopecia

A alopecia Androgênica (AAG) representa a queixa de um número crescente de pacientes que procuram o consultório do dermatologista, principalmente do sexo feminino. Dada a sua importância médica e/ou estética, neste trabalho säo apresentados os conceitos atuais sobre a etiologia envolvendo os fatores genéticos e hormonais, como também a correlaçäo entre a etiopatogenia, a clínica, o diagnóstico laboratorial e o tratamento com as respectivas diferenças, tanto no homem como na mulher