Alopecia areata and increased prevalence of psychiatric disorders.

BACKGROUND: The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses. METHODS: Two hundred and ninety-four community-based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR). RESULTS: Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population. CONCLUSIONS: Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.

Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA).

The prevalence of various chronic diseases was compared in 517 individuals with alopecia areata, and 2,969 of their first degree relatives. As previous reports have suggested an increased incidence of diabetes in relatives of patients with alopecia areata, special attention was given to the prevalence of Type 1 and Type 2 diabetes in the patients and in their relatives. Several immunologic diseases were increased in alopecia probands and relatives. Thyroid disease, vitiligo, Addison disease, and pernicious anemia were more prevalent in probands and in their relatives than in the general population. Specifically, a high rate of thyroid disease was found in probands (14.7%) and in their first degree relatives (4.2%). Only one proband had Type 1 diabetes, yet there were 14 sibs with Type 1 diabetes. Thus, Type 1 diabetes was significantly more prevalent in the sibs (1.2%) than in either the probands with alopecia (0.2%), or the general population (0.12-0.25%) (P < 0.05)). In contrast, Type 2 diabetes was not more common in probands or in sibs than in the general population. These data suggest that alopecia areata protects against Type 1 diabetes in predisposed individuals. The high rate of thyroid disease suggests that screening probands and first degree relatives for thyroid disease should be considered.

Profile of alopecia areata: a questionnaire analysis of patient and family.

Eight hundred patients with alopecia areata (AA) responded to a detailed questionnaire that was compiled, distributed, and analyzed by Help Alopecia International Research, Inc. (HAIR). Among those responding, 28% were men and 72% were women. Fifty percent had localized alopecia, 30% had alopecia totalis, and 20% had alopecia universalis. Forty-eight percent developed their initial onset before the age of 20. A very strong family history of 42% was found. There were 333 additional family members with AA. Many patients and relatives had concurrent atopic diseases (seasonal rhinitis, bronchial asthma, and atopic dermatitis). Associated autoimmune diseases including vitiligo, thyroid disease, and collagen vascular disease in patients and relatives appeared consistent with previous reports. Insulin dependent diabetes mellitus (IDDM) was not increased in patients but greatly increased in relatives. Additional analysis suggests a genetic association between the two diseases where expression of AA may prevent the development of IDDM.

Cowden's disease: familial goiter and skin hamartomas. A report of three cases.

Multiple hamartoma syndrome (Cowden's disease) consists of characteristic skin lesions of the face, mucous membranes and distal extremities in association with a variety of benign and malignant internal tumors, especially of the thyroid and breast. We describe a family in which the father, daughter and son were found to have goiter associated with the skin lesions of Cowden's disease. Review of the 40 reported cases of this syndrome indicates that thyroid disease occurs in two thirds of patients with Cowden's disease and most often presents as goiter at an early age. Thyroid cancer has occurred in only three (7.5%) of the patients.Surgical removal of the large goiter of the son showed that it was composed of multiple encapsulated follicular adenomas and a few areas of lymphocytic thyroiditis. Studies of the thyroid tissue showed that peroxidase activity was decreased, the thyroglobulin had a reduced content of thyroxine and triiodothyronine (perhaps due to the therapeutic suppression of thyroid-stimulating hormone) and thyroxine 5'-monodeiodinase was greatly increased; increased outer ring monodeiodinase activity may be a characteristic of human follicular adenomas.

2% Miconazole nitrate powder in aerosol spray form: its efficacy in treating tinea pedis.

Forty-six patients with acute tinea pedis were treated with either 1% tolnaftate aerosol spray powder or 2% miconazole nitrate aerosol spray powder, not previously available. Products were coded, and the study was conducted in a double-blind manner. At the end of 28 days of therapy, 68% of the miconazole-treated group achieved therapeutic cure, versus 50% in the tolnaftate-treated group. Symptomatic relief and mycological clearing based on potassium hydroxide examination took place in less time for the patients treated with miconazole nitrate. The aerosol spray powder form is an effective alternative vehicle to both cream and solution.

Comparison testing of soap irritancy using aluminum chamber and standard patch methods.

Five soaps were tested for irritancy potential using both the aluminum chamber and a standard 21-day patch testing method. One of the products showed marked potential for irritation after 21 days of patch testing but not with the chamber method of testing. An explanation of the varying results obtained by the two methods requires further investigation.

pHresh 3.5: a new low pH liquid skin cleanser.

pHresh 3.5, a new low pH liquid skin cleanser, was evaluated for safety and efficacy in four clinical studies. In 5- and 21-day predictive patch tests the cleanser was rated mild compared to four other widely used cleansers. As a degreasing agent it was found effective during a 4-week study period, especially in subjects with severe facial oiliness. Daily use of the product for a month in tretinoin-treated acne patients failed to indicate any lack of compatability of the two agents. Resolution of pre-existing skin irritation was not impaired by pHresh 3.5 usage.

Use of a polyester fiber sponge as an adjunct in the treatment of psoriasis.

Twenty patients with symmetric lesions of psoriasis were asked to use a polyester fiber sponge in addition to their other anti-psoriatic medications. The sponge was used to remove scales from those lesions on the left side only. The hypothesis was that removal of scales would enhance penetration by topical corticosteroid and/or coal tar preparations. At the end of four weeks, as well as at each weekly evaluation, all patients showed a statistically significant difference between the treated and control sides. In 70 percent of the subjects, results were graded good to excellent when the treated side was compared with the control side after four weeks' evaluation.

Pruritic skin diseases, psychological stress, and the itch sensation. A reliable method for the induction of experimental pruritus.

A method of inducing controlled levels of terminable itching was developed. This method consists of administering constant monophasic pulsations of electric current by means of noninvasive electrodes. Once experimental pruritus had been reliably reproduced, two variables, hypothesized to be relevant to the perception of itching, were investigated, viz, the presence of a positive or a negative history of a pruritic dermatosis, and the presence of a high or low level of psychological stress. Both variables were found to be related to the perception of itching, but in different manners. A positive history of a pruritic dermatosis lowered the threshold for the perception of itch stimuli, while a high level of psychological stress enhanced the ability to discriminate among the more intense itch stimuli, with no effect on the itch threshold.