Alopecia em pacientes anticoagulados / Alopecia in anticoagulated patients

Resumo A alopecia é uma complicação comum da terapia anticoagulante que pode ter repercussões psicológicas importantes nos pacientes, especialmente nos do sexo feminino, e interferir na decisão de extensão da anticoagulação. Esta revisão tem como objetivo descrever os mecanismos potencialmente envolvidos na gênese da alopecia durante a terapia anticoagulante, pois eles ainda não estão totalmente esclarecidos, e as terapias existentes, para a adoção das condutas mais adequadas.

Abstract Alopecia is a common complication of anticoagulant therapy that may have important psychological repercussions for patients, especially female patients, and can interfere with the decision to extend anticoagulation. This review aims to describe the mechanisms potentially involved in the genesis of alopecia during anticoagulant therapy, since these are not yet fully understood, and discusses the existing therapies for the most appropriate management.

Physiopathology and current treatments of androgenetic alopecia: Going beyond androgens and anti-androgens.

Androgenetic alopecia (AGA) is the most diagnosed hair loss dysfunction. Its physiopathology comprises a genetic predisposition affording an exacerbated response of the hair follicles cells to androgens aggravated by scalp inflammation and extrinsic factors. This paper presents a review of the mechanisms and extrinsic factors involved in the AGA physiopathology as well as its conventional and emerging treatments. The research focused on reports regarding AGA physiopathology and treatments published between January 2001 and July 2019 in medical and related journals. The most used medical treatments for AGA-minoxidil and finasteride-present non satisfactory results in some cases. Currently, the low-level laser therapy is recognized as a safe and effective treatment for AGA. Some minimally invasive techniques-mesotherapy, microneedling, carboxytherapy, and platelet-rich plasma-are also used to stimulate hair growth. Pharmaceutical substances with mechanisms differing from the anti-androgen activity are under current investigation and many of them have botanical origins; however, formulations with higher performance are required, and the hair follicles ability of being a drug and nanoparticle reservoir has been researched. The association of different strategies, that is, substances with synergic mechanisms and the use of advantageous technologies associated with lifestyle changes could improve the treatment outcomes.

Adult-onset Satoyoshi syndrome in a young male.

Satoyoshi syndrome is a rare condition of presumed autoimmune etiology that is characterized by intermittent painful spasms, diarrhea, hair loss, and bone abnormalities. We report the first case of adult onset Satoyoshi syndrome in South America. A 32-year-old Caucasian male presented with sudden involuntary muscle contractions and painful cramps that had started at the age of 21. He also presented with trismus and complete loss of body hair. Electroneuromyography showed abnormal spontaneous activity. Diagnosis of Satoyoshi syndrome was made after extensive investigation; improvement was achieved with corticosteroids and azathioprine. It is a rare disease; few cases have been described worldwide, most of them in Asian children and almost all sporadic. There are several atypical presentations described in the literature. Immunosuppression is the basis of treatment. Professionals dealing with neuromuscular diseases should be aware of this condition and its atypical presentations, given the possible response to immunosuppressive treatment.

DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms

Abstract The transforming growth factor-beta 1 (TGFβ1) promotes fibrosis, differentiating epithelial cells and quiescent fibroblasts into myofibroblasts and increasing expression of extracellular matrix. Recent investigations have shown that PPAR (peroxisome proliferator-activated receptor*) is a negative regulator of fibrotic events induced by TGFβ1. Dehydroepiandrosterone (DHEA) is an immunomodulatory hormone essential for PPAR functions, and is reduced in some processes characterized by fibrosis. Although scarring alopecia characteristically develops in the female biological period in which occurs decreased production of DHEA, there are no data in the literature relating its reduction to fibrogenic process of this condition. This article aims to review the fibrogenic activity of TGFβ1, its control by PPAR and its relation with DHEA in the frontal fibrosing alopecia.

DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms.

The transforming growth factor-beta 1 (TGFß1) promotes fibrosis, differentiating epithelial cells and quiescent fibroblasts into myofibroblasts and increasing expression of extracellular matrix. Recent investigations have shown that PPAR (peroxisome proliferator-activated receptor*) is a negative regulator of fibrotic events induced by TGFß1. Dehydroepiandrosterone (DHEA) is an immunomodulatory hormone essential for PPAR functions, and is reduced in some processes characterized by fibrosis. Although scarring alopecia characteristically develops in the female biological period in which occurs decreased production of DHEA, there are no data in the literature relating its reduction to fibrogenic process of this condition. This article aims to review the fibrogenic activity of TGFß1, its control by PPAR and its relation with DHEA in the frontal fibrosing alopecia.

[Not Available]. / Síndrome de Graham-Little-Piccardi-Lassueur: variante disseminada de líquen plano folicular.

Graham-Little-Piccardi-Lassueur syndrome is a rare lichenoid dermatosis. It is characterized by the triad of scarring alopecia of the scalp, alopecia of the axilla and or groin, and keratotic follicular papules of the body. The present paper reports on two cases affecting young women. Histopathological findings suggest the disorder represents a generalized form of lichen planus follicularis.

Female Pattern Hair Loss: a clinical and pathophysiological review.

Female Pattern Hair Loss or female androgenetic alopecia is the main cause of hair loss in adult women and has a major impact on patients' quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological patterns. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal and environmental factors. In addition, response to treatment is variable. In this article, authors discuss the main clinical, epidemiological and pathophysiological aspects of female pattern hair loss.

Female Pattern Hair Loss: a clinical and pathophysiological review

AbstractFemale Pattern Hair Loss or female androgenetic alopecia is the main cause of hair loss in adult women and has a major impact on patients' quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological patterns. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal and environmental factors. In addition, response to treatment is variable. In this article, authors discuss the main clinical, epidemiological and pathophysiological aspects of female pattern hair loss.

Apoptose, microinflamação e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino / Apoptosis, microinflamation and expression of aryl hydrocarbon receptors in hair follicles of patients with female pattern hair loss

Alopecia de padrão feminino, ou alopecia androgenética feminina, é a principal causa de queda de cabelos em mulheres adultas, e inflige importante impacto na qualidade de vida das pacientes. Decorre da progressiva miniaturização de folículos pilosos e posterior diminuição da densidade dos fios, originando um quadro de alopecia difusa não cicatricial, com padrão clínico, dermatoscópico e histológico característicos. Apesar da elevada frequência e da relevância quanto ao impacto psicológico, sua fisiopatogenia não é ainda totalmente esclarecida, sofrendo influência de elementos genéticos, hormonais e ambientais. Além disso, a resposta ao tratamento é inconstante. Os receptores de hidrocarboneto arílico (AhR) podem ser ativados por diversos ligantes ambientais como poluentes (p. ex. dioxinas), fumaça do tabaco, radiação ultravioleta e pela ação microbiana (p.ex. Malassezia sp.), podendo exercer atividade proinflamatória, proapopótica, hormonal e carcinogênica, de acordo com o fator ativador e tecido alvo. Sua ação no folículo piloso e na alopecia de padrão feminino não foi ainda estudada. Neste trabalho, os autores avaliam a apoptose, infiltrado inflamatório e expressão de receptores de hidrocarboneto arílico nos folículos pilosos de pacientes com alopecia de padrão feminino. Foi conduzido um estudo transversal envolvendo 17 mulheres com alopecia de padrão feminino e cinco controles. Avaliaram-se amostras de pele do couro cabeludo que foram processados para HE, técnica do TUNEL e imuno-histoquímica para receptor de hidrocarboneto arílico. As variáveis foram comparadas de acordo com o grupo de folículos (terminal versus miniaturizado) e os grupos de pacientes (alopecia versus controles)...

Female pattern alopecia, or female androgenetic alopecia, is the main cause of hair loss in adult women and causes major impact on patient´s quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia, with characteristic clinical, dermoscopic and histological pattern. Despite the high frequency and relevance about the psychological impact, its pathogenesis is not yet fully understood, but is influenced by genetic, hormonal and environmental factors. In addition, response to treatment is incostant. In this article, authors discuss the main clinical, epidemiological and physiopathological aspects of female pattern hair loss...

Alopecia: botanical approaches in review.

The use of herbal medications in dermatologic disease has become common practice among consumers. In this paper, the authors review and discuss the existing evidence-based botanical modalities in the peer-reviewed literature with a particular focus on various presentations of alopecia. To maximize potential clinical application, this review has been limited human studies. The goal of the study was to provide a thorough evaluation of the current understanding of the use of non-pharmaceutical botanical products in the management of hair loss.

Androgenetic alopecia and insulin resistance in young men.

BACKGROUND: Epidemiological studies have associated androgenetic alopecia (AGA) with severe young-age coronary artery disease and hypertension, and linked it to insulin resistance. We carried out a case-control study in age- and weight-matched young males to study the link between AGA and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR) index or metabolic syndrome clinical manifestations. METHODS: Eighty young males, 18-35 years old, with AGA > or = stage III in the Hamilton-Norwood classification, and 80 weight- and age-matched controls were included. Alopecia, glucose, serum insulin, HOMA-IR index, lipid profile and androgen levels, as well as metabolic syndrome criteria, were evaluated. RESULTS: The HOMA-IR index was significantly higher in cases than controls. Nonobese cases had a higher mean diastolic blood pressure and a more frequent family history of AGA than nonobese controls. A borderline difference in the HOMA-IR index was found in obese AGA cases vs. obese controls [P = 0.055, 95% confidence interval (CI) 2.36-4.20 vs. 1.75-2.73]. Free testosterone values were significantly higher in controls than cases, regardless of body mass index (BMI). A statistically significant additive effect for obesity plus alopecia was found, with significant trends for insulin, the HOMA-IR index, lipids and free testosterone when BMI and alopecia status were used to classify the participants. CONCLUSIONS: Our results support the recommendation for assessing insulin resistance and cardiovascular-related features and disorders in all young males with stage III or higher AGA, according to the Hamilton-Norwood classification.

A mosaic pattern of alopecia in the oral-facial-digital syndrome type I (Papillon-Léage and psaume syndrome).

We present an infant girl with oral-facial-digital syndrome type I, who had alopecia following the scalp lines of Blaschko, and we discuss the characteristics of alopecia in this syndrome.

Implante pilosebáceo. Sistematización y conducta / Hair implant (Graft). sistematization and Technique

Se consideran algunos puntos anatomohistoquímicos como esenciales para obtener éxito en el transplante de la unidad pilosebásea para el tratamiento quirúrgico de la calvicie. Se efectúa un estudio en humanos sobre la presencia y ubicación de los receptores hormonales

Implante pilosebáceo. Sistematización y conducta / Hair implant (Graft). sistematization and Technique

Se consideran algunos puntos anatomohistoquímicos como esenciales para obtener éxito en el transplante de la unidad pilosebásea para el tratamiento quirúrgico de la calvicie. Se efectúa un estudio en humanos sobre la presencia y ubicación de los receptores hormonales

Hialinosis cutáneo-mucosa en tres hermanos / Mucocutaneous hyalinosis: report of 3 brothers

La hialinosis cutáneo-mucosa es un desorden raro, autosómico y recesivo, que afecta la piel, mucosas y órganos internos, cuya característica esencial es el depósito de un material hialino en y alrededor de la membrana basal de los capilares, seguido de infiltración difusa y a veces masiva del tejido intersticial. Presentamos el caso de tres hermanos con manifestaciones clásicas: cicatrices atróficas, pérdida de elasticidad palpebral, infiltración de labios, glotis y cuerda vocal. Se enfatiza en los escasos casos familiares de esta entidad

Hialinosis cutáneo-mucosa en tres hermanos / Mucocutaneous hyalinosis: report of 3 brothers

La hialinosis cutáneo-mucosa es un desorden raro, autosómico y recesivo, que afecta la piel, mucosas y órganos internos, cuya característica esencial es el depósito de un material hialino en y alrededor de la membrana basal de los capilares, seguido de infiltración difusa y a veces masiva del tejido intersticial. Presentamos el caso de tres hermanos con manifestaciones clásicas: cicatrices atróficas, pérdida de elasticidad palpebral, infiltración de labios, glotis y cuerda vocal. Se enfatiza en los escasos casos familiares de esta entidad (AU)