alopecia
Alopecia associated with fluconazole therapy.

Pappas PG, Kauffman CA, Perfect J, Johnson PC, McKinsey DS, Bamberger DM, Hamill R, Sharkey PK, Chapman SW, Sobel JD.

University of Alabama, Birmingham, USA.

OBJECTIVE: To describe the association between fluconazole and reversible alopecia. DESIGN: A retrospective survey of 1) patients enrolled in NIAID Mycoses Study Group (MSG) protocols involving the long-term use of fluconazole for treatment of endemic mycoses and 2) patients treated with fluconazole outside of a protocol setting but by the MSG investigators who were MSG members. SETTING: 26 MSG sites in the United States. PATIENTS: 33 patients with various deep and superficial mycoses who developed alopecia while receiving fluconazole. RESULTS: 11 of 26 investigators reported a total of 33 patients with substantial alopecia related to fluconazole therapy. Underlying mycoses included blastomycosis, sporotrichosis, histoplasmosis, cryptococcosis, coccidioidomycosis, and mucosal candidiasis. In separate MSG studies, 17 of 136 (12.5%) and 8 of 40 (20%) patients had substantial reversible alopecia associated with fluconazole therapy. Eight patients who were not in the protocol had similar adverse effects. Twenty-nine of 33 patients (88%) received at least 400 mg of fluconazole daily for a mean of 7.1 months. Alopecia developed a median of 3 months after initiation of fluconazole therapy and involved the scalp in all patients. Other sites were involved in about one third of patients. Three patients required wigs because of extensive hair loss. Alopecia resolved within 6 months of discontinuation of fluconazole therapy or reduction of the daily dose by at least 50%. CONCLUSIONS: Alopecia appears to be a common adverse event associated with higher-dose (400 mg/d) fluconazole given for 2 months or longer. This effect may be severe but is reversed by discontinuing fluconazole therapy or substantially reducing the daily dose.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7625624&dopt=Abstract alopecia, hair loss



alopecia
Pretreatment with 1,25(OH)2D3 protects from Cytoxan-induced alopecia without protecting the leukemic cells from Cytoxan.

Jimenez JJ, Alvarez E, Bustamante CD, Yunis AA.

Department of Medicine, University of Miami School of Medicine, Florida 33101, USA.

The authors previously demonstrated that pretreatment with 1,25(OH)2D3 protects from Cytoxan-induced alopecia in the rat model. The current study was designed to investigate whether 1,25(OH)2D3 protects the transplantable rat chloroleukemia (C51) cells from the cytotoxic effects of Cytoxan. In vitro, 4-hydroperoxycyclophosphamide had a dose-dependent cytotoxic effect on C51 cells. In separate experiments, preincubation with 1,25(OH)2D3 did not protect the C51 cells from the cytotoxic effects of 4-hydroperoxycyclophosphamide. In vivo, 4 groups of 10 5-day-old rats were treated as follows: Groups 1 and 2 received 0.2 micrograms of 1,25(OH)2D3 topically in ethanol daily starting on day 5 through day 10. Groups 3 and 4 received ethanol topically similarly. On day 7, all rats received 1 x 10(5) C51 cells intraperitoneally. On day 11, groups 1 and 3 received 35 mg/kg Cytoxan intraperitoneally. All rats in groups 2 and 4 were dead of leukemia by day 34. In groups 1 and 3, only 1 of 10 and 2 of 10 rats died of leukemia, respectively. Alopecia developed in all rats in group 3. In contrast, all rats in group 1 were protected from Cytoxan-induced alopecia. These results indicate that, in vivo, pretreatment with 1,25(OH)2D3 does not protect the rat chloroleukemia cells from the cytotoxic effect of Cytoxan, while protecting from Cytoxan-induced alopecia.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7631641&dopt=Abstract alopecia, hair loss



alopecia
PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology.

Taylor CR, Hawk JL.

Department of Photobiology, St John's Institute of Dermatology, St Thomas' Hospital, London, U.K.

Our 10-year experience with PUVA treatment for alopecia areata, partialis, totalis and universalis was retrospectively reviewed using charts and follow-up questionnaires for 70 patients at St John's Institute of Dermatology. In all cases, several previous therapies were judged to be unsatisfactory prior to starting PUVA, and many cases were already deemed clinically refractory prior to referral for PUVA. If cases of vellus hair growth are excluded, and those who lost their PUVA-induced regrowth rapidly on follow-up, the effective success rate was at best 6.3% for alopecia areata partialis, 12.5% for alopecia areata totalis and 13.3% for alopecia areata universalis. We affirm that PUVA is generally not an effective treatment for alopecia areata.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8547044&dopt=Abstract alopecia, hair loss



alopecia
Long-term results of topical immunotherapy in children with alopecia totalis or alopecia universalis.

Tosti A, Guidetti MS, Bardazzi F, Misciali C.

Department of Dermatology, University of Bologna, Italy.

BACKGROUND: Topical immunotherapy has been used in the treatment of children with alopecia areata with encouraging results. OBJECTIVE: Our purpose was to determine the long-term results in 33 children with severe alopecia areata treated with topical immunotherapy. METHODS: From 1983 to 1989 we treated 33 children with topical immunotherapy with squaric acid dibutylester. RESULTS: Complete hair regrowth was observed in 10 children (30.3%). During the follow-up period (mean, 5.9 years; range, 4 to 12 years), 7 of these 10 patients had severe relapses that were not responsive to further treatment. Only three clinically benefited from topical immunotherapy. Two maintained complete hair regrowth after treatment was stopped. CONCLUSION: Our results indicate that only a small proportion of children with severe alopecia areata will obtain a persistent benefit from topical immunotherapy.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8708020&dopt=Abstract alopecia, hair loss



alopecia
Growth factor mRNA levels in alopecia areata before and after treatment with the contact allergen diphenylcyclopropenone.

Hoffmann R, Wenzel E, Huth A, van der Steen P, Schaufele M, Konig A, Happle R.

Department of Dermatology, Philipp University, Marburg, Germany.

The early immune response in alopecia areata is characterized by a Th1 T helper cell cytokine pattern and an aberrant expression of ICAM-1 and HLA-DR molecules on lesional hair bulbs. A counteracting cytokine pattern induced by a therapeutic contact dermatitis is supposed to mediate the hair regrowth. In addition to cytokines, growth factors have been shown to influence immune responses, and we therefore investigated the expression levels for a panel of growth factors in untreated versus alopecia areata after treatment with the contact sensitizer diphenylcyclopropenone. Using semiquantitative reverse transcriptase polymerase chain reaction we detected a striking overexpression of transforming growth factor beta 1 mRNA in successfully treated patients. This cytokine has been shown to be a potent immune response modifier, which can suppress Th1 immune responses. The way in which topical immunotherapy induces hair regrowth in alopecia areata is unknown, but a lesional increased expression of transforming growth factor beta 1 may be a possible mechanism.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8721483&dopt=Abstract alopecia, hair loss



alopecia
Lymphocyte-mediated alopecia in C57BL/6 mice following successful immunotherapy for melanoma.

Becker JC, Varki N, Brocker EB, Reisfeld RA.

Department of Immunology, Scripps Research Institute, La Jolla, CA 92037, USA.

Successful immunotherapy of established B16 melanoma metastases in C57BL/6 mice can be achieved by antibody-targeted interleukin-2 administration. This therapeutic effect is accompanied in approximately 20% of the animals by induction of a population of lymphocytes that migrates to and substantially disrupts the cytoarchitecture of the skin, which results in progressive alopecia. The histologic changes associated with the hair loss, i.e., peri-, and intrafollicular inflammatory infiltrates consisting of both activated CD4+ and CD8+ T cells, as well as expression of major histocompatibility complex class I antigens on subinfundibular follicle epithelium, are similar to those observed in human alopecia areata. Furthermore, the alopecic phenotype can be transmitted horizontally by passive transfer of lymphocytes from treated animals to naive mice. Since lymphocytes from treated animals either lacking or displaying signs of alopecia are able to transmit these phenotypic changes to a similar percentage of naive animals, the initiation of alopecia seems to be dependent on the coincidence of at least two different events: the presence of specific lymphocyte populations as well as specific features of the skin disclosing a target for these cells.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8823372&dopt=Abstract alopecia, hair loss