[Injection of PRP (Platelet-rich plasma) as a treatment for androgenetic alopecia : a systematic review of the literature]. / Injection de PRP (Plasma riche en plaquettes) comme traitement de l'alopécie androgénétique : une revue systématique de la littérature.

INTRODUCTION: Androgenetic alopecia is the most frequent alopecia both in men and women. Despite it affects a large proportion of the population, they are few therapeutic options often restrictive. The injection of PRP in alopecic areas is a new and easy therapeutic option. The aim of this article is to systematically review the literature about this topic by analysing the articles describing the clinical results of this new technique in the treatment of androgenetic alopecia in men and / or women with a follow-up of minimum 6 months. MATERIAL AND METHODS: A systematic review of the PRISMA type from several databases was carried out and identified 7 articles meeting the following inclusion criteria: 1) articles describing the clinical results of the injection of PRP for the treatment of androgenetic alopecia, 2 ) in men and / or women, 3) written in English or French, 4) with clinical follow-up of at least 6 months, and 5) with objective criteria for follow-up of patients and observed complications. These prospective clinical studies are analyzed and compared qualitatively. CONCLUSION: This systematic review of the literature resulted in a qualitative analysis of 7 scientific studies on the effect of PRP injection as a treatment for androgenetic alopecia. Although all the studies concluded in a favorable effect of this new treatment, a larger, rigorous study with objective analysis of the therapeutic effect is necessary.

INTRODUCTION: L'alopécie androgénétique est l'alopécie la plus fréquente que ce soit chez l'homme ou la femme. Bien qu'elle touche une grande partie de la population, les options thérapeutiques sont peu nombreuses et souvent contraignantes. L'injection de PRP dans les zones alopéciques est une nouvelle possibilité de traitement plus simple. Cet article a pour objectif de réaliser une revue systématique sur le sujet en analysant les articles décrivant les résultats cliniques de cette nouvelle technique dans le traitement de l'alopécie androgénétique, chez l'homme et/ou la femme, comprenant un followup de minimum 6 mois. Matériel et méthodes : Une revue systématique de type PRISMA au départ de plusieurs banques de données a été réalisée et a identifié 7 articles remplissant les critères d'inclusion suivants : (1) articles décrivant les résultats cliniques de l'injection de PRP pour le traitement de l'alopécie androgénétique, (2) chez l'homme et/ou la femme, (3) écrits en anglais ou en français, (4) avec un suivi clinique de minimum 6 mois, (5) avec description de critères objectifs pour le suivi des patients et des complications observées. Ces études cliniques prospectives sont analysées et comparées qualitativement. CONCLUSION: Cette revue systématique de la littérature a permis de réaliser une analyse qualitative de 7 études scientifiques sur l'effet de l'injection du PRP comme traitement de l'alopécie androgénétique. Bien que l'ensemble des études analysées soit en faveur d'un effet favorable de ce nouveau traitement, une étude de plus grande ampleur, rigoureuse avec analyse objective de l'effet thérapeutique est nécessaire.

Trichothiodystrophy-like hair abnormalities in a child with keratitis ichthyosis deafness syndrome.

Keratitis ichthyosis deafness syndrome is a rare congenital ectodermal disorder. It appears to be genetically heterogeneous and may be caused by mutations in the connexin 26 (Cx26) gene (GJB2) or in the connexin 30 gene. It is characterized by the association of ichthyosis-like skin lesions, hearing loss, and vascularizing keratitis. We report the clinical and molecular findings in a 5-year-old girl with keratitis ichthyosis deafness syndrome. DNA sequencing in our patient revealed a p.Ser17Phe mutation in GJB2. Besides the typical clinical features of keratitis ichthyosis deafness syndrome, a peculiar intriguing finding not previously described in the literature in this condition was that polarizing light microscopy of the scalp hair in our patient revealed striking bright and dark bands as seen in trichothiodystrophy. Amino acid analysis of the hair sample also disclosed a reduced cysteine index. We emphasize that it would be of great benefit to examine hair shafts in other patients with keratitis ichthyosis deafness syndrome for trichothiodystrophy-like abnormalities.

Earlier occurrence of severe alopecia areata in HLA-DRB1*11-positive patients.

BACKGROUND: Alopecia areata (AA) is a polygenic immune-mediated disorder affecting the hair follicle for which an association with human leukocyte antigen HLA-DRB1*11 has been described. OBJECTIVE: Two parameters including age of onset and extent of the disease (patchy AA and AT/AU forms) were correlated with the presence or absence of HLA-DRB1*11 and its alleles in 88 severe AA patients. METHODS: Patients and healthy controls were typed for HLA-DR and -DQ by molecular method. RESULTS: Among AA patients, 37.5% (a proportion rising to 72% when taking patients who began their first patch before the age of 20 years) were positive for HLA-DRB1*11 compared to 21.2% healthy controls (p = 0.004, RR = 2.1). DRB1*11-positive status was associated with earlier development of the first AA patch, at the mean age of 16 years compared to 27 years (p = 0.003) in DRB1*11-negative patients. Among the DRB1*11 alleles, the presence of DRB1*1104 was associated with the earliest occurrence of AA. CONCLUSION: Our data indicate that the HLA system largely through DRB1*1104 allele influences AA onset rather than extension considering patchy AA and AT/AU.

[Hair physiology]. / La physiologie du cheveu.

The first hair follicles appear on the body toward the end of the 8th week of intrauterine life. The appearance on the scalp is more tardive 7th month. The hair is a keratin-containing appendage that grows from cavities called follicles. Hair follicles extend from the surface of the skin through the stratum corneum and the epidermis into the dermis. Keratin contains almost all aminoacids but particularly rich in cystein. Hair fibers grow in three distinct stages. The first one, the anagen stage, is the growing phase with a duration of 3 to 5 years. The catagen stage, the transition stage, lasts only a few weeks; it precedes the telogen stage, resting or shedding phase, lasts for 2 months.

[Alopecia areata and treatment]. / La pelade et son traitement.

Alopecia areata is a non scarring inflammatory hair disease, frequently recurrent. It commonly presents as round patches of hair loss which can be the first manifestation of a more severe alopecia: totalis or universalis. A CD4 lymphocytic infiltrate surrounds the hair follicle and is presumed to play a role in the hair fall. There are many treatments available which may help stimulate regrowth. The efficacy, risks, and benefits of each treatment have to be considered when choosing a treatment plan.

Finasteride increases anagen hair in men with androgenetic alopecia.

BACKGROUND: The growth of scalp hair is a cyclical process of successive phases of growth (anagen) and rest (telogen). In previous clinical trials in men with androgenetic alopecia, treatment with finasteride increased scalp hair counts in a defined area (i.e. increased hair density). OBJECTIVES: The current study used a phototrichogram methodology to assess the effect of finasteride on the phases of the hair growth cycle. PATIENTS/METHODS: Two hundred and twelve men, age 18-40 years, with androgenetic alopecia were randomized to receive finasteride 1 mg daily or placebo for 48 weeks. At baseline and at 24 and 48 weeks, macrophotographs were taken to measure total and anagen hair count in a 1-cm(2) target area of the scalp. RESULTS: At baseline, mean total and anagen hair counts in the finasteride group were 200 and 124 hairs, respectively (% anagen = 62%) and the anagen to telogen ratio was 1.74 (geometric mean). In the placebo group, the respective values were 196 and 119 hairs (% anagen = 60%) and 1.57. At week 48, the finasteride group had a net improvement (mean +/- SE) compared with placebo in total and anagen hair counts of 17.3 +/- 2.5 hairs (8.3% +/- 1.4%) and 27.0 +/- 2.9 hairs (26% +/- 3.1%), respectively (P < 0.001). Furthermore, treatment with finasteride resulted in a net improvement in the anagen to telogen ratio of 47% (P < 0.001). In this study, treatment with finasteride 1 mg day(-1) for 48 weeks increased both total and anagen hair counts, and improved the anagen to telogen ratio. CONCLUSIONS: These data provide direct evidence that finasteride 1 mg daily promotes the conversion of hairs into the anagen phase. These data support that finasteride treatment results in favourable effects on hair quality that contribute to the visible improvements in hair growth observed in treated patients.

Further evidence for autosomal dominant inheritance and ectodermal abnormalities in Kabuki syndrome.

Most cases with Kabuki syndrome (KS) were reported sporadically. Recently, a few familial cases of KS were reported. This report provides further evidence that the KS is inherited as a dominant trait with variable expressivity. The proposita is an 18-month-old girl with facial findings characteristic of Kabuki syndrome, prominent fingertip-pads, a midsagittal cleft of vertebral body D4, hypotonia, and psychomotor retardation. Her mother had a similar facial appearance, prominent, cup-shaped ears, an abnormal dentition, early breast development, and low-normal intelligence. Because mother and daughter both had evident Kabuki syndrome, we conclude that KS in this family is inherited as a dominant trait. Further family history supports this finding. Microscopic examination of the hair of the proposita shows abnormalities consisting of trichorrhexis nodosa, twisting of the hairshafts, and irregularity of the diameter of the hair, as was described recently in a patient with KS. This could be another occasional finding in this syndrome, but further studies are required. The presence of abnormal hair, nails, and the commonly described tooth abnormalities in KS further suggest ectodermal involvement in this syndrome.

Pulse steroid therapy for children's severe alopecia areata?

Seven children with severe, rapidly evolving alopecia areata (AA) were treated with pulse steroid therapy (PST). AA had been present for 3-44 weeks and involved more than 30% of the scalp. One patient had alopecia totalis. Intravenous methylprednisolone (5 mg/kg twice a day) was administered for 3 days. No serious side effects were noted. At the 12-month follow-up, complete regrowth had occurred in 5 patients (71%). The patient with alopecia totalis had no regrowth. PST appears to be a promising and safe treatment for extensive, recent-onset AA in children. No response is to be expected in alopecia totalis or long-standing AA.

Netherton's syndrome: a severe neonatal disease. A case report.

A male infant was born with generalized erythroderma and scaling; the newborn demonstrated poor neonatal development and developed several complications such as hypernatremic dehydration, septicemia, gastroenteritis and seizures. In the neonatal period, the erythema faded, but exfoliation persisted. The parents are healthy but related. One older brother, who died at the age of 3 months, had shown the same clinical picture in the neonatal period and was diagnosed with congenital psoriasis. All clinical investigations, including serum immunoglobulins, complement levels and lymphocyte counts, were normal. Only raised total IgE and multiple positive specific IgE reactions were noted. Skin biopsy revealed an image of ichthyosis. Polarization microscopy of scalp hair showed trichorrhexis nodosa and discrete focal twisting of the hair shaft. This clinical picture and all histological findings are compatible with the indications of Netherton's syndrome. The purpose of this report is to call attention to this severe presentation of congenital ichthyosis in the neonatal period and to the difficulty of a correct diagnosis when confronted with congenital erythroderma.