The Higher Number and Longer Duration of Kenogen Hairs Are the Main Cause of the Hair Rarefaction in Androgenetic Alopecia.

The progressive reduction of the number of terminal hairs and the simultaneous increase in the number of vellus hairs (hair miniaturization) are the current explanation of human baldness. In a 2.5-year study on 43 male subjects with androgenetic alopecia (AGA), we found that oral finasteride augmented the total number of hairs by 55%, but failed to decrease the prevalence of vellus hairs. While our data may explain why, in AGA, hairs become progressively softer and combable, they cannot explain why areas of hair rarefaction develop. We propose that the longer duration and higher frequency of kenogen hairs are the real mechanism through which the scalp hairs rarefy.

Exogen Hairs in Women with and without Hair Loss.

Contrary to the classical view of the hair cycle, in which telogen is the resting phase that precedes the release of the hair shaft, another phase has been introduced, exogen. Exogen is the phase wherein the processes for the release of the hair shaft are initiated and successfully executed. Exogen ends when the shaft is liberated. Accordingly, human hairs would be preferably released not with telogen but with exogen roots. To better understand this somehow revolutionary point and what occurs in telogen effluvium (TE) and in androgenetic alopecia (AGA), we undertook a morphological study. We examined 25 women of comparable age by collecting shedding hairs by the Modified Wash Test under stringent diagnostic criteria. Eight patients were "normal", 5 had AGA, 9 TE, and 3 had a TE+AGA overlap. Hair roots were divided into early telogen, full telogen, and exogen. Exogens accounted, in normal women, for 2.6% of all hairs, for 5.2% in AGA, for 6.6% in TE, and for 2.3% in TE+AGA, without any significant difference. Our exogen prevalence (2.6%) did not vary in patients with AGA and TE. Therefore, the pathogenetic role of exogen in AGA and TE seems negligible.

Polymorphous Light Eruption.

Polymorphous light eruption (PLE) is the commonest immuno-mediated photodermatosis. It occurs after solar or artificial UV-light exposure and affects only the sun-exposed areas with preference of the V-area of the chest, of arms and forearms, legs, upper part of the back, and rarely the face. The lesions are itching or burning, and vary morphologically from erythema to papules, vesico-papules and occasionally blisters, plaques, sometimes erythema multiforme-like, insect bite-like wheals and purpura. The clinical manifestations befall within a few hours to days from light exposure, last a few days, and subside in about a week without sequelae. Its diagnosis is based on history, morphology and phototests. PLE is considered as a delayed hypersensitivity response to newly UV induced, but still unidentified, antigen(s). Usually, MED is normal, but the provocative phototests with UVA or UVB reproduce the spontaneous lesions in about 50% of the patients. Broad spectrum sunscreens and antioxidants, photohardening with PUVA or narrow band UVB may be beneficial to prevent the disease. Therapy is based mainly on topical or systemic corticosteroids.

Setting reference values in trichology.

BACKGROUND: In clinical trichology, reference values are often arbitrary. The difficulty in setting them up depends mostly on the presence of the androgenetic alopecia (AGA) genotype in subjects with clinically unapparent forms. Prepubertal children, who lack 5α-reductase (a real indicator of the AGA phenotype), might provide reference values independent from AGA. We verified whether the vertex/occiput ratios (V/O) of hair density and the V/O of hair diameter are suitable parameters. METHODS: In sixty 4-10-year-old Caucasian children, we measured the ratio between the hair density at the vertex and the occiput. The same was done for the diameter. RESULTS: The V/O of density averaged 1.07 ± 0.17 and the V/O of diameter 1.02 ± 0.11. CONCLUSIONS: Taking the mean ± 2SD as normal values, our "normal" V/O of density ranged between 0.73 and 1.41 and our "normal" V/0 of diameter between 0.8 and 1.24. People with lower ratios would have, therefore, AGA with 95% of probability. Moreover, we found that hair shedding using the hair pull test and the modified wash test come to 1-2 hairs/day.

Methods of hair loss evaluation: a comparison of TrichoScan(®) with the modified wash test.

The reliability of the methods currently used for diagnosing hair loss is ill defined. We studied 41 subjects complaining of hair loss, including androgenetic alopecia and telogen effluvium, and compared the results obtained with the modified wash test (MWT) and TrichoScan(®) . Data were analysed statistically with the t-test and the Cohen κ statistic. The concordance between the clinical diagnosis and that of MWT (5% cut-off) was fair (κ = 0.32) and that between clinical diagnosis and TrichoScan(®) was still fair though less satisfactory (κ = 0.22). Only in 17 patients (41%) were the MWT and TrichoScan(®) diagnoses concordant. MWT was better in general and especially at detecting telogen effluvium (TE) (29% vs 19%). In conclusion, the clinical observation should be assisted by MWT and dermoscopy, leaving the biopsy for very difficult cases. TrichoScan(®) is less useful and may be even misleading in TE.

Polymorphous light eruption and benign summer light eruption in Italy.

BACKGROUND/PURPOSE: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest. METHODS: Five Italian Photodermatology Centres recruited retrospectively 346 patients with typical clinical history and/or presentation of PLE. Age, gender, skin type, family history and presence of atopy were considered. UVA and UVB MEDs and provocative phototests with UVA and UVB were obtained with a standardized procedure. Photopatch tests were applied according to the IRCDG rules. ANA were assessed by indirect immunofluorescence. RESULTS: Four criteria (predominance of women, shorter latency, uninvolvement of the face and absence of relapse during summer) identified BSLE in only 6.1% of cases. All had positive phototests, mostly with UVA. Uninvolvement of face, short latency and no seasonal relapses identified 11.7% patients, mostly with positive phototests to UVA. Short latency and no seasonal relapses in women identified 11.2% patients. Uninvolvement of face and no seasonal relapses in women identified 8.1% of patients. Uninvolvement of face and short latency in women identified 17.6% of patients. CONCLUSION: Criteria diagnosed BSLE in only a minority of patients, who were positive at phototesting, mostly with UVA.

Photopatch tests: an Italian multicentre study from 2004 to 2006.

BACKGROUND: Evaluation of possible photoallergic contact dermatitis in at-risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used. OBJECTIVES: We conducted a retrospective multicentre study to determine the prevalence of photoallergic contact dermatitis in Italy. METHODS: A total of 1082 patients with histories and clinical features suggestive of photoallergic contact dermatitis were evaluated. All the patients had undergone photopatch testing with allergens proposed for Italy as well as other substances suggested by each patient's personal history. RESULTS: 234 patients (21.6%) were positive to at least one test substance of the standard photopatch testing series or to added substances. 234 patients (21.6%) were positive to at least one substance with a total of 290 reactions. 204 of the reactions were typically photoallergic; 68 reactions were allergic and within this group 10 were photoaugmented reactions; 18 reactions were considered to be phototoxic. CONCLUSION: The predominant group of photoallergens was drugs, followed by organic UV filters and antimicrobial agents.

Serum antioxidant capacity in polymorphic light eruption.

Polymorphic light eruption is one of the few dermatological diseases in which some antioxidants have been said to be reduced in both the epidermis and the blood. This study measured the hydrosoluble antioxidant capacity in the serum of patients with polymorphic light eruption, using a commercially available kit. All patients were tested in winter, in order to avoid the influence of exposure to ultraviolet light. The results showed that a hydrosoluble antioxidant capacity was significantly decreased (by 29%) in patients with polymorphic light eruption, and b) that females (both patients and controls) has less hydrosoluble antioxidant capacity (by 27%) than males. In addition, the hydrosoluble antioxidant capacity values for females with polymorphic light eruption increased significantly with age, possibly accounting for the well-known propensity of young women to polymorphic light eruption. These last observations have not been reported previously.

Distinguishing androgenetic alopecia from chronic telogen effluvium when associated in the same patient: a simple noninvasive method.

BACKGROUND: Distinguishing chronic telogen effluvium (CTE) from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. OBSERVATIONS: One hundred consecutive patients with hair loss who were clinically diagnosed as having CTE, AGA, AGA + CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided "blindly" into 5 cm or longer, intermediate length (>3 to <5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having at least 10% of them were classified as having AGA. We assumed that patients shedding 200 hairs or more had CTE. The kappa statistic revealed, however, that the best concordance between clinical and numerical diagnosis (kappa = 0.527) was obtained by setting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 with 10% or more of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having AGA; 34 with fewer than 10% of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 with 10% or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA + CTE; and 14 with fewer than 10% of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CTE in remission. CONCLUSION: This method is simple, noninvasive, and suitable for office evaluation.

Measures of late effects in conservative treatment of breast cancer with standard or hypofractionated radiotherapy.

AIMS AND BACKGROUND: To confirm the equivalence in terms of late effects between two fractionation schedules of radiotherapy in conservative treatment of breast cancer. METHODS: Fifty-eight patients treated at our institution from 1999 to 2002, with a median follow-up of 15 months (range, 7-46 months), were evaluated retrospectively. Twenty-nine patients (group A) were treated with standard fractionation: 5000 cGy/25fx/5 weeks, and 29 patients (group B) were treated with a hypofractionated schedule: 4500 cGy/15fx/5 weeks, three fractions per week. Late effects were evaluated using the LENT-SOMA scoring scale. The cosmetic results were assessed on a five-point scale. Skin elasticity was measured using a dedicated device (Cutometer SEM 575). RESULTS: There were no differences in breast volume, age at diagnosis and follow-up between groups. The LENT-SOMA toxicity observed in groups A and B, respectively, was as follows: grade 2-3 pain in five patients in each group; grade 2 breast edema in two and three patients; grade 2-3 and grade 2 fibrosis in six and eight patients; grade 2 and grade 2-3 telangiectasia in two and three patients; grade > or = 2 and 2 arm edema in two and one patients; no ulceration or atrophy were observed. Two patients in group A and one patient in group B needed treatment for breast and arm edema and arm edema, respectively. Very good, good-acceptable, and poor cosmetic results were observed in seven and two, fifteen and nineteen, and six and eight patients, respectively. Median skin elasticity loss due to treatment was -4.19% in group A and -6.29% in group B. These results are not statistically different. CONCLUSIONS: LENT-SOMA toxicities were minimal and no differences were observed between groups. Few patients in the hypofractionated group had very good cosmetic results, but it is debatable if radiotherapy was the only cause. Skin elasticity was not different between groups. Our results seem to suggest that it is possible to treat patients with both schedules, with similar late toxicity.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND: Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE: The aim of the study was to establish some guidelines for a correct diagnosis. METHODS: A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS: Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION: Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Kenogen. A new phase of the hair cycle?

BACKGROUND: A novel phenomenon has been described by the phototrichogram: the emptiness of the follicle after teloptosis. We called this phenomenon kenogen, from the Greek kappaepsilonnuóvarsigma, 'empty'. OBJECTIVE: To describe the kenogen phase in its details. METHODS: Analysis of the existing literature. RESULTS: The original observation in 2 women was confirmed in 10 balding and non-balding males studied for 14 years in whom kenogen lasted about 4 months increasing up to about 7 months and affecting 80% of all hair cycles. In 2 women with progressing androgenetic alopecia studied for 2 years, kenogen involved 22% of the hair follicles, lasting from 3 months to 1 year. In a prepubertal boy studied for 1 year, it involved 8% of hairs and lasted about 2 months. CONCLUSION: During kenogen, the hair follicle rests physiologically, but duration and frequency are greater in androgenetic alopecia, possibly accounting for baldness. In addition to the classical cycle, the hair follicle may follow an alternative route during which the telogen phase, not accompanied by a coincident new early anagen, ends with teloptosis leaving the follicle empty.