Topical Cyperus rotundus essential oil for treatment of axillary hyperpigmentation: a randomized, double-blind, active- and placebo-controlled study.

BACKGROUND: The oil of the grass Cyperus rotundus (purple nutsedge) is an effective and safe treatment option for a variety of conditions. It has anti-inflammatory and antipigmenting properties. There have been no clinical trials comparing topical C. rotundus oil with skin-lightening treatments for axillary hyperpigmentation. AIM: To assess the efficacy of C. rotundus essential oil (CREO) in treating axillary hyperpigmentation, and compare with another active treatment hydroquinone (HQ) and a placebo (cold cream) in this study. METHODS: The study included 153 participants, who were assigned to one of three study groups: CREO, HQ group or placebo group. A tri-stimulus colorimeter was used to assess pigmentation and erythema. Two independent experts completed the Physician Global Assessment, and the patients completed a self-assessment questionnaire. RESULTS: CREO had significantly (P < 0.001) better depigmenting effects than HQ. CREO and HQ did not differ significantly in terms of depigmentation effects (P > 0.05); however, there were statistically significant differences in anti-inflammatory effects and decrease in hair growth (P < 0.05) in favour of CREO. CONCLUSIONS: CREO is a cost-effective and safe treatment for axillary hyperpigmentation.

Brigham Eyebrow Tool for Alopecia: A Reliable Assessment of Eyebrow Alopecia Areata.

There are no tools to evaluate eyebrow involvement in patients with alopecia areata. We developed and assessed the reliability of the Brigham Eyebrow Tool for Alopecia (BETA) as a quantitative evaluation of eyebrow alopecia areata. BETA uses facial landmarks of eyebrow anatomy and is calculated using surface area and density. A total of 50 eyebrow images with varying levels of hair loss were distributed to six board-certified dermatologists at three academic medical centers with standardized instructions and examples. Interrater and intrarater reliability were calculated using intraclass correlation coefficients (ICCs). BETA demonstrated high interrater (ICC = 0.88, confidence interval = 0.83-0.92 right eyebrow scores and ICC = 0.90, confidence interval = 0.85-0.94 left eyebrow scores) and intrarater (ICC = 0.90, confidence interval = 0.85-0.93 right eyebrow scores and ICC = 0.91, confidence interval = 0.87-0.94 left eyebrow scores) reliability. When measured in the same patient with varying degrees of hair loss over time, BETA demonstrated sensitivity to change. BETA is a simple and reliable objective assessment of eyebrow alopecia areata. BETA is easy-to-use and quick to calculate, making it feasible for a variety of clinical and research settings. Although developed for alopecia areata, we hope that BETA will be investigated in other etiologies of eyebrow alopecia to serve as a universal tool for monitoring disease progression, improvement, and response to treatment.

Patient-reported outcome assessment and objective evaluation of chemotherapy-induced alopecia.

PURPOSE: Alopecia is one of the most distressing side effects of chemotherapy. Evaluating and comparing the efficacy of potential therapies to prevent chemotherapy-induced alopecia (CIA) has been complicated by the lack of a standardized measurement for hair loss. In this study we investigated the correlation between patient-reported outcome assessments and quantitative measurement with the hair check to assess CIA in clinical practice. METHOD: Scalp cooling efficacy was evaluated by patients by World Health Organisation (WHO) of CIA, Visual Analogue Scale (VAS) and wig use. The Hair Check was used to determine the amount of hair (in mm2) per unit of scalp skin area (in cm2) (Hair Mass Index, HMI). CIA was also evaluated by doctors, nurses and hairdressers. RESULTS: Baseline HMI was not predictive for hair loss. HMI declined throughout all chemotherapy cycles, which was not reflected by patient-reported measures. HMI correlated with patient-reported hair quantity before the start of the therapy, but not with WHO and/or VAS during therapy. Patient's opinion correlated moderately with the opinion of doctors and nurses (ρ = 0.50-0.56 respectively), but strongly with hair dressers (ρ = 0.70). CONCLUSIONS: The Hair check is suitable to quantify the amount of hair loss and could complement research on refining outcome of scalp cooling, but the patient's opinion should be considered as the best method to assess hair loss in clinical practice. TRIAL REGISTRATION: Trialregister.nl NTR number 3082.

Genetic and environmental influences on pubertal hormones in human hair across development.

Puberty is a complex biopsychosocial process that can affect an array of psychiatric and medical disorders emerging in adolescence. Although the pubertal process is driven by neuroendocrine changes, few quantitative genetic studies have directly measured puberty-relevant hormones. Hair samples can now be assayed for accumulation of hormones over several months. In contrast to more conventional salivary measures, hair measures are not confounded by diurnal variation or hormonal reactivity. In an ethnically and socioeconomically diverse sample of 1286 child and adolescent twins and multiples from 672 unique families, we estimated genetic and environmental influences on hair concentrations of testosterone, DHEA, and progesterone across the period of 8-18 years of age. On average, male DHEA and testosterone were highly heritable, whereas female DHEA, progesterone, and puberty were largely influenced by environmental components. We identified sex-specific developmental windows of maximal heritability in each hormone. Peak heritability for DHEA occurred at approximately 10 years of age for males and females. Peak heritability for testosterone occurred at age 12.5 and 15.2 years for males and females, respectively. Peak heritability for male progesterone occurred at 11.2 years, while the heritability of female progesterone remained uniformly low. The identification of specific developmental windows when genetic signals for hormones are maximized has critical implications for well-informed models of hormone-behavior associations in childhood and adolescence.

Use of low-level laser therapy in treatment of the androgenic alopecia, the first systematic review.

Alopecia is a common disease affecting more than half of the world total number of people. Alopecia exists in different types, but one of the most common of these types is the Androgenic Alopecia which has affected approximately 51% of the total number of males ranging between the age bracket of 40 years and 75 years. This type of alopecia is more common in females who are above the age of 65 years and above. Despite this widespread effect, much has not been done regarding identifying the possible drugs for treating this disease. At present, there exist only two possible medications that have been scientifically approved to cure this disease, include finasteride and minoxidil. Also, another possible form of treatment has been the case of hair transplantation. Despite the new possible treatment options available for treatment of different types of hair loss, there is a need for the invention for more efficient management and treatment options that are less costly, environmentally friendly, and most importantly human consumption friendly. Due to the recent evaluation that low-level laser therapy stimulated hair growth. This systematic review and meta-analysis was to determine whether the use of low-level laser therapy is an effective therapy for treatment of the Androgenic alopecia and also to some degree we reviewed the level of the patient's satisfaction. Some earlier studies had shown that the use of low-level laser therapy stimulated the hair growth when mice were treated with chemotherapy which was induced by the alopecia and also the other type of alopecia called alopecia areata. The researchers hypothesized that the primary mechanism of treating Androgenic alopecia to be the stimulation of the epidermal stem cells which are in the hair follicle making them bulge and shift the follicles into the anagen phase.

Reliability of pubertal maturation self-assessment in a school-based survey.

AIM: To assess the reliability of pubertal self-assessment of Thai adolescents. SUBJECTS: Some 927 girls and 997 boys, aged 8-18 years, from nine schools in Hat-Yai municipality. METHODS: The adolescents evaluated their pubertal status after being shown a line drawing of the five Tanner stages with a short description. Girls assessed their breast and pubic hair development, and boys assessed their pubic hair development. The pubertal self-assessments were compared to pubertal assessments made by a pediatrician who examined the children after their self-assessment. Kappa coefficient and percent agreement were used for statistical analysis. RESULTS: The percent agreement of breast and pubic hair development between the girl's self-assessments and the assessments by the pediatrician were 60.8% and 78%, respectively. Kappa coefficient for breast assessment was 0.50 (95% confidence interval, CI 0.47-0.53) and for pubic hair 0.68 (95% CI 0.65-0.72). Nearly 30% of girls aged younger than 10 years overestimated their breast development status while 45% of girls aged over 14 years underestimated their breast development (p<0.001). For boys, the percent agreement of pubic hair development between the adolescents and the pediatrician was 76.4%, with a weighted kappa coefficient of 0.68 (95% CI 0.65-0.72). CONCLUSION: Pubertal self-assessment using line drawings with a short description can be used as a reliable method to assess pubic hair maturation in boys and girls, but can be used with less reliability to assess the breast maturation in young girls.

Quantitative assessment of growing hair counts, thickness and colour during and after treatments with a low-fluence, home-device laser: a randomized controlled trial.

BACKGROUND: At-home laser and intense pulsed-light hair removal continues to grow in popularity and availability. A relatively limited body of evidence is available on the course of hair growth during and after low-fluence laser usage. OBJECTIVES: To assess growing hair counts, thickness and colour quantitatively during and after cessation of low-fluence laser treatment. METHODS: Thirty-six women with skin phototypes I-IV and light to dark-brown axillary hairs were included. Entire axillary regions were randomized to zero or eight self-administered weekly treatments with an 810-nm home-use laser at 5·0-6·4 J cm(-2). Standardized clinical photographs were taken before each treatment and up to 3 months after the final treatment for computer-aided quantification of growing hair counts, thickness and colour. RESULTS: Thirty-two women completed the study protocol. During sustained treatment, there was a reduction in growing hair that reached a plateau of up to 59%, while remaining hairs became up to 38% thinner and 5% lighter (P < 0·001). The majority of subjects (77%) reported 'moderately' to 'much less hair' in treated than untreated axilla, and assessed remaining hairs as thinner and lighter (≥ 60%). After treatment cessation, hair growth gradually returned to baseline levels, and 3 months after the final treatment the count and thickness of actively growing hair exceeded pretreatment values by 29% and 7%, respectively (P ≤ 0·04). CONCLUSIONS: Sustained usage of low-fluence laser induced a stable reduction of growing hair counts, thickness and colour. The reduction was reversible and hairs regrew beyond baseline values after cessation of usage. Computer-aided image analysis was qualified for quantification of hair counts, thickness and colour after laser epilation.

Advances in the assessment of cortisol exposure and sensitivity.

PURPOSE OF REVIEW: To review recent progress in the field of cortisol exposure and sensitivity, and its implications for research concerning obesity and related metabolic disturbances. RECENT FINDINGS: In the past few years, scalp hair analysis had been successfully introduced as a marker for long-term cortisol exposure. With this relatively novel method, increased long-term cortisol levels have been linked to cardiovascular disease, metabolic syndrome, and stress-related measures. At the tissue level, the effect of cortisol is modulated by genetically determined glucocorticoid sensitivity. Polymorphisms in the glucocorticoid receptor gene that influence glucocorticoid sensitivity have been associated with differences in metabolic syndrome components. SUMMARY: Hair analysis provides exciting new opportunities to study the influence of long-term cortisol exposure on a wide range of health outcomes, in both observational and interventional studies. We propose that addition of genetically determined glucocorticoid sensitivity to these studies may bring about a more thorough understanding of the long-term effects of cortisol.

[(3) H]-L685,458 binding sites are abundant in multiple peripheral organs in rats: implications for safety assessment of putative γ-secretase targeting drugs.

γ-Secretase is a multimeric enzyme complex that carries out proteolytic processing to a variety of cellular proteins. It is currently explored as a therapeutic target for Alzheimer's disease (AD) and cancer. Mechanism-based toxicity needs to be thoroughly evaluated for γ-secretase inhibitory and/or modulatory drugs. This study comparatively assessed putative γ-secretase catalytic sites in rat peripheral tissues relative to brain and explored an effort of its pharmacological inhibition on hair regeneration. Using [(3) H]-labelled L685,458, a potent γ-secretase inhibitor, as probe, we found more abundant presence of γ-secretase binding sites in the liver, gastrointestinal tract, hair follicle, pituitary gland, ovary and testis, as compared to the brain. Local application of L658,458 delayed vibrissal regrowth following whisker removal. These results suggest that γ-secretase may execute important biological functions in many peripheral systems, as in the brain. The development of γ-secretase inhibitors/modulators for AD and cancer therapy should include close monitoring of toxicological panels for hepatic, gastrointestinal, endocrinal and reproductive functions.

The assessment of cortisol in human hair: associations with sociodemographic variables and potential confounders.

To inform the future use of hair cortisol measurement, we have investigated influences of potential confounding variables (natural hair colour, frequency of hair washes, age, sex, oral contraceptive (OC) use and smoking status) on hair cortisol levels. The main study sample comprised 360 participants (172 women) covering a wide range of ages (1-91 years; mean = 25.95). In addition, to more closely examine influences of natural hair colour and young age on hair cortisol levels, two additional samples comprising 69 participants with natural blond or dark brown hair (hair colour sample) as well as 28 young children and 34 adults (young age sample) were recruited. Results revealed a lack of an effect for natural hair colour, OC use, and smoking status on hair cortisol levels (all p's >0.10). No influence of frequency of hair washes was seen for proximal hair segments (p = 0.335) but for the third hair segment indicating lower cortisol content (p = 0.008). We found elevated hair cortisol levels in young children and older adults (p < 0.001). Finally, men showed higher hair cortisol levels than women (p = 0.002). The present data indicate that hair cortisol measurement provides a useful tool in stress-related psychobiological research when applied with the consideration of possible confounders including age and sex.

The assessment of the contribution of hair to methyl mercury excretion.

Due to its ability to avidly accumulate methyl mercury from blood, scalp hair has been widely used as a biological monitor for human exposure. The question arises that hair may also be an important route of elimination of methyl mercury from the body. Taking original publications and reviews on the physiology of hair (including growth by weigh and density) and on the deposition parameters for methyl mercury in the body (including the hair to blood concentration ratio of methyl mercury), one can calculate the rate of elimination of methyl mercury in hair. The result indicates that hair accounts for only a small fraction, less than 10%, of the total elimination of methyl mercury from the body. This relationship is expected to be maintained at every level when the dominant form of mercury is methyl. Other species of mercury I eliminated by hair even at a lower rate.

Optimal age of sexual maturation in Egyptian children.

To establish the optimal age of sexual maturation in Egyptian children, Tanner's maturity stages were determined for a sample of children and adolescents (1550 girls, 1563 boys) ranging from 6.5 to 18.5 years. The mean age for attainment of pubic hair (stage PH2) was 10.46 (SD 1.36) years for girls and 11.86 (SD 1.45) years for boys. For axillary hair (stage A2), mean age was 11.65 (SD 1.62) years for girls and 13.55 (SD 1.52) years for boys. The mean age at menarche in girls was 12.44 years and for breast development (stage B2) was 10.71 (SD 1.30) years. Testicular volume by palpation showed that the mean age of genital stage G2 for boys was 10.56 (SD 1.40) years. The study results can aid in the assessment of sexual maturation and pubertal disorders in Egyptian adolescents.

Worldwide diversity of hair curliness: a new method of assessment.

BACKGROUND: For many years, cosmetic scientists have attempted to measure the physical features of human hair, such as its shape and colour, as these can be artificially modified using cosmetic products. With regard to hair shape, previous anthropologic studies have emphasized its variability within and between human ethnic groups. Many studies have broadly distinguished three ethnic human subgroups: African, Asian, and Caucasian. Such a broad classification cannot account for the great complexity of human biological diversity, resulting from multiple, past or recent mixed origins. The verbal description of hair shape ranges from the classic to the more sophisticated, with terms such as straight, wavy, curly, frizzy, kinky, woolly, helical, etc. Although these descriptions evoke a global appearance, they remain confusing as their definitions and limits are unclear. Assessments are therefore required to more accurately define such verbal attributes. OBJECTIVE: The work reported here attempts to address the following issues: (i) to define hair types according to specific shape criteria through objective and simple measurements; and (ii) to define such hair types without referring to human ethnicity. METHODS: Measurements of four parameters related to hair curliness (curve diameter, curl index) or kinking of the hair (numbers of waves, numbers of twists) were performed on hair from 2449 subjects from 22 different countries. Principal components analysis and hierarchical ascendant classification were used to identify homogeneous groups of hair and to determine key variables for the assignment of group membership. Finally, a segmentation tree was prepared in order to establish simple rules for predicting group membership of new subjects. RESULTS AND CONCLUSIONS: This study has shown that it is possible to classify the various hair types found worldwide into eight main groups. The approach involves objective descriptors of hair shape, and is more reliable than traditional methods relying on categories such as curly, wavy, and kinky. Applied to worldwide human diversity, it avoids reference to the putative, unclear ethnic origin of subjects. Briefly, a straight hair type I is just that, and whether it originates from a Caucasian or an Asian subject is not at issue. The hair types defined here also more adequately reflect the large variation of hair shape diversity around the world, and may possibly help to trace past mixed origins amongst human subgroups.

Dandruff-associated smouldering alopecia: a chronobiological assessment over 5 years.

BACKGROUND: In some individuals, dandruff may be recurrent and even chronic. This represents a difficult-to-treat condition. Excessive hair shedding and diffuse alopecia may develop. OBJECTIVES: To evaluate the chronobiological aspects of dandruff, hair shedding and alopecia. METHODS: This study was performed in eight men suffering from such a scalp condition. They were examined 40 times at regular intervals for five consecutive years. Hair-density assessments and trichograms were performed at least twice per trimester on the parietal region of the scalp, corresponding to an area where dandruff was present. RESULTS: A positive correlation was found between the percentage of telogen hairs and dandruff severity as assessed by the squamometry index. Bimodal yearly biorhythms were found for dandruff severity, telogen counts and hair loss between two consecutive visits. The chronobiological fluctuations were prominent in some study participants, but remained inconspicuous in others. The biorhythms were almost synchronized in all participants, showing variations over the year. CONCLUSIONS: The biorhythms on the hair cycle in dandruff are not fundamentally different from those previously reported in subjects without dandruff. The periodicity may be an intrinsic feature of human skin.

Bleaching phototrichogram: an improved method for hair growth assessment.

The phototrichogram (PT) is a non-invasive tool for monitoring hair growth in vivo. However, the majority of PT techniques are of little use to clinicians bacause they are time-consuming and/or difficult to perform. Consequently, there is a need for an easy and time-saving PT technique. This study was performed to evaluate the accuracy and availability of a modified PT, bleaching phototrichogram (BPT), by comparing it with the conventional phototrichogram (CPT). Ten healthy male volunteers (age range 26-33 years) comprised the study subjects. Hairs were clipped from two adjacent circular areas in the occipital region of each subject. The clipped hairs in the first area were bleached and photographed two days later. The second area was photographed just after clipping and two days later. In each area, the following biological parameters of hair growth were analyzed; 1: hair density (number/cm2), 2: anagen hair ratio (%), 3: linear hair growth rate (mm/day), 4: non-vellus hair ratio (%) and 5: anagen hair thickness (microm). The hair density, anagen hair ratio, linear hair growth rate, and anagen hair thickness by BPT were similar to the CPT values with no significant differences, although the non-vellus hair ratio by BPT was higher than the CPT value. The BPT has a higher clinical usefulness than the CPT because it saves much time with satisfactory accuracy.

Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome.

OBJECTIVE: The objective of this study was to determine performance characteristics of Ferriman Gallwey self-scoring in women with the polycystic ovary syndrome. DESIGN: A simultaneous Ferriman Gallwey map scoring design was used. SETTING: The study was performed at the General Clinical Research Center in a university medical center. PATIENTS: Twenty-one hirsute patients with the polycystic ovary syndrome were studied. INTERVENTIONS: Interventions included masked patient, physician, and research nurse simultaneous and independent Ferriman Gallwey map scoring. MAIN OUTCOME MEASURES: The main outcome measures were modified Ferriman Gallwey map scores. RESULTS: Agreement analysis demonstrated that patient self scores, physician scores, and research nurse scores were quite discrepant. CONCLUSION: The modified Ferriman Gallwey Map scoring system has too much variation to be clinically useful.