Alopecia em pacientes anticoagulados / Alopecia in anticoagulated patients

Resumo A alopecia é uma complicação comum da terapia anticoagulante que pode ter repercussões psicológicas importantes nos pacientes, especialmente nos do sexo feminino, e interferir na decisão de extensão da anticoagulação. Esta revisão tem como objetivo descrever os mecanismos potencialmente envolvidos na gênese da alopecia durante a terapia anticoagulante, pois eles ainda não estão totalmente esclarecidos, e as terapias existentes, para a adoção das condutas mais adequadas.

Abstract Alopecia is a common complication of anticoagulant therapy that may have important psychological repercussions for patients, especially female patients, and can interfere with the decision to extend anticoagulation. This review aims to describe the mechanisms potentially involved in the genesis of alopecia during anticoagulant therapy, since these are not yet fully understood, and discusses the existing therapies for the most appropriate management.

DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms

Abstract The transforming growth factor-beta 1 (TGFβ1) promotes fibrosis, differentiating epithelial cells and quiescent fibroblasts into myofibroblasts and increasing expression of extracellular matrix. Recent investigations have shown that PPAR (peroxisome proliferator-activated receptor*) is a negative regulator of fibrotic events induced by TGFβ1. Dehydroepiandrosterone (DHEA) is an immunomodulatory hormone essential for PPAR functions, and is reduced in some processes characterized by fibrosis. Although scarring alopecia characteristically develops in the female biological period in which occurs decreased production of DHEA, there are no data in the literature relating its reduction to fibrogenic process of this condition. This article aims to review the fibrogenic activity of TGFβ1, its control by PPAR and its relation with DHEA in the frontal fibrosing alopecia.

Female Pattern Hair Loss: a clinical and pathophysiological review

AbstractFemale Pattern Hair Loss or female androgenetic alopecia is the main cause of hair loss in adult women and has a major impact on patients' quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological patterns. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal and environmental factors. In addition, response to treatment is variable. In this article, authors discuss the main clinical, epidemiological and pathophysiological aspects of female pattern hair loss.

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.

Apoptose, microinflamação e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino / Apoptosis, microinflamation and expression of aryl hydrocarbon receptors in hair follicles of patients with female pattern hair loss

Alopecia de padrão feminino, ou alopecia androgenética feminina, é a principal causa de queda de cabelos em mulheres adultas, e inflige importante impacto na qualidade de vida das pacientes. Decorre da progressiva miniaturização de folículos pilosos e posterior diminuição da densidade dos fios, originando um quadro de alopecia difusa não cicatricial, com padrão clínico, dermatoscópico e histológico característicos. Apesar da elevada frequência e da relevância quanto ao impacto psicológico, sua fisiopatogenia não é ainda totalmente esclarecida, sofrendo influência de elementos genéticos, hormonais e ambientais. Além disso, a resposta ao tratamento é inconstante. Os receptores de hidrocarboneto arílico (AhR) podem ser ativados por diversos ligantes ambientais como poluentes (p. ex. dioxinas), fumaça do tabaco, radiação ultravioleta e pela ação microbiana (p.ex. Malassezia sp.), podendo exercer atividade proinflamatória, proapopótica, hormonal e carcinogênica, de acordo com o fator ativador e tecido alvo. Sua ação no folículo piloso e na alopecia de padrão feminino não foi ainda estudada. Neste trabalho, os autores avaliam a apoptose, infiltrado inflamatório e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino. Foi conduzido um estudo transversal envolvendo 17 mulheres com alopecia de padrão feminino e cinco controles. Avaliaram-se amostras de pele do couro cabeludo que foram processados para HE, técnica do TUNEL e imuno-histoquímica para receptor de hidrocarboneto arílico. As variáveis foram comparadas de acordo com o grupo de folículos (terminal versus miniaturizado) e os grupos de pacientes (alopecia versus controles)...

Female pattern alopecia, or female androgenetic alopecia, is the main cause of hair loss in adult women and causes major impact on patient´s quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological pattern. Despite the high frequency and relevance about the psychological impact, its pathogenesis is not yet fully understood, but is influenced by genetic, hormonal and environmental factors. In addition, response to treatment is incostant. In this article, authors discuss the main clinical, epidemiological and physiopathological aspects of female pattern hair loss...

Hair transplantation: standard guidelines of care.

Hair transplantation is a surgical method of hair restoration. PHYSICIAN QUALIFICATION: The physician performing hair transplantation should have completed post graduation training in dermatology; he should have adequate background training in dermatosurgery at a centre that provides education training in cutaneous surgery. In addition, he should obtain specific hair transplantation training or experience at the surgical table(hands on) under the supervision of an appropriately trained and experienced hair transplant surgeon. In addition to the surgical technique, training should include instruction in local anesthesia and emergency resuscitation and care. FACILITY: Hair transplantation can be performed safely in an outpatient day case dermatosurgical facility. The day case theatre should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place and all nursing staff should be familiar with the emergency plan. It is preferable, but not mandatory to have a standby anesthetist. Indication for hair transplantation is pattern hair loss in males and also in females. In female pattern hair loss, investigations to rule out any underlying cause for hair loss such as anemia and thyroid deficiency should be carried out. Hair transplantation can also be performed in selected cases of scarring alopecia, eyebrows and eye lashes, by experienced surgeons. PREOPERATIVE COUNSELING AND INFORMED CONSENT: Detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and if more procedures are needed for proper results, it should be clearly mentioned. Patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Need for concomitant medical therapy should be emphasized. Patients should understand that proper hair growth can be expected after about 9 months after transplantation. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet count, bleeding and clotting time (or prothrombin time and activated partial thromboplastin time), blood chemistry profile including sugar. METHODS: Follicular unit hair transplantation is the gold standard method of hair transplantation; it preserves the natural architecture of the hair units and gives natural results. Mini-micro-grafting is a method hair transplantation involving randomly assorted groups of hairs, with out consideration of their natural configuration of follicular units, under loupe or naked eye examination. Mini-grafts consist of 4-5-6 hairs while micro-grafts consist of 1-3 hairs. Punch gives ugly cosmetically unacceptable results and should no longer be used. PATIENT SELECTION: Hair transplantation can be performed in any person with pattern hair loss, with good donor area, in good general health and reasonable expectations. Caution should be exercised in, very young patients whose early alopecia is still evolving, patients with Norwood grade VI or VII with poor density, patients with unrealistic expectations, and patients with significant systemic health problems. MEDICAL THERAPY: Most patients will need concurrent medical treatment since the process of pattern hair loss is progressive and may affect the remaining hairs. MANPOWER: Hair transplantation is a team effort. Particularly, performing large sessions, needs a well trained team of trained assistants. ANESTHESIA: 2% lignocaine with adrenaline is generally used for anesthesia; tumescent technique is preferred. Bupivacaine has been used by some authors in view of its prolonged duration of action. DONOR DISSECTION: Strip dissection by single blade is recommended for donor area. Steromicroscopic dissection is recommended for dissection of hair units in follicular unit transplantation; mini-micro-grafting does not need microscopic dissection. RECIPIENT INSERTION: Different techniques and different instruments have been used for recipient site creation ;these depend on the choice of the operating surgeon and have been described in the guidelines. Graft preservation is important to ensure survival. DENSITY: Minimum density of 35-45 units per sq cm is recommended. Results depend on donor characteristics, technique used and individual skills of the surgeon.

Implante pilosebáceo. Sistematización y conducta / Hair implant (Graft). sistematization and Technique

Se consideran algunos puntos anatomohistoquímicos como esenciales para obtener éxito en el transplante de la unidad pilosebásea para el tratamiento quirúrgico de la calvicie. Se efectúa un estudio en humanos sobre la presencia y ubicación de los receptores hormonales

Hialinosis cutáneo-mucosa en tres hermanos / Mucocutaneous hyalinosis: report of 3 brothers

La hialinosis cutáneo-mucosa es un desorden raro, autosómico y recesivo, que afecta la piel, mucosas y órganos internos, cuya característica esencial es el depósito de un material hialino en y alrededor de la membrana basal de los capilares, seguido de infiltración difusa y a veces masiva del tejido intersticial. Presentamos el caso de tres hermanos con manifestaciones clásicas: cicatrices atróficas, pérdida de elasticidad palpebral, infiltración de labios, glotis y cuerda vocal. Se enfatiza en los escasos casos familiares de esta entidad

Citoqueratinas y filagrina en psoriasis del cuero cabelludo: estudio inmunohistoquímico del folículo píloso en anágeno / Cytokeratins and philagrins in scalp psoriasis: inmunohistochemical study in the anagen hair follicles

Moderada a severa caída del cabello en psoriasis del cuero cabelludo se ha reportado. Sin embargo, la etiología de la alopecia en esta enfermedad aún no se conoce. El objetivo de nuestro estudio fue investigar, mediante inmunohistoquímica (técnica de APAAP), si el folículo piloso anágeno de cuero cabelludo afectado de psoriasis presenta cambios en la distribución de citoqueratinas y filagrina comparado con el folículo piloso de sujetos normales. La porción infraseboglandular del folículo piloso anágeno psoriático no presenta diferencias en la expresión de citoqueratina y filagrina en relación a los controles. En la porción supraseboglandular, el acrofundíbulo psoríatico muestra marcadas diferencias, similares a aquellas de la epidermis interfolicular. Los anticuerpos monoclonales anticitoqueratinas CK 8.12 Y PKK 2 marcan las capas suprabasales en la epidermis interfolicular como también en el acroinfundículo, mientras que normalmente se expresan sólo en la capa basal. Los anticuerpos monoclonales KL-1 U y CK 8.60 que marcan la capa basal y las citoqueratinas 1 y 2 (RPN 1161) no presentaron cambios en su patrón normal de marcaje de las capas suprabasales. Filagrina se mostró parcial totalmente ausente en las áreas paraqueratósicas de la epidermis interfoliar como también en la porción distal del acroinfundículo psoriático, mientras que la porción proximal se mostró prácticamente normal. De nuestros resultados concluimos que: 1) la porción no-permanente del folículo piloso anágeno psoriático no presenta cambios en la expresión de citoqueratinas y filagrina en comparación con los controles; 2) la caída del cabello en psoriasis debe atribuirse, por ejemplo, a efectos traumáticos de procedimientos terapéuticos y/o por la inflamación crónica que afecta a la porción permanente del folículo piloso

Síndrome de Netherton estudo de dois casos / Netherton syndrome: a two-case study

Sao apresentados dois casos de Síndrome de Netherton, afecçao nao registrada, até hoje, na literatura brasileira, 20 e 21 casos de literatura mundial. É feito confronto com os casos publicados, desde 1958 até 1971, revendo-se casos referidos em 14 publicaçoes. Os casos relatados sao irmaos de sexos diferentes, nos quais, sao estudados os seguintes aspectos: clínico, laboratoriais de rotina, exames micológicos direto e cultura, histopatológico de pele do tronco e couro cabeludo, microscopia dos cabelos, desenvolvimento somático e psíquico, exame neurológico, pesquisa alergológica, determinaçao da amino-acidúria e amino-acidemia e estudo genético