Beard alopecia areata: a multicentre review of 55 patients.

BACKGROUND: Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. METHODS: This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. RESULTS: Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. CONCLUSIONS: According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain.

BACKGROUND: Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge. OBJECTIVE: To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU. METHODS: This retrospective multicenter study included patients diagnosed with AAT/AAU with a minimum follow-up of 12 months. Response was assessed based on the regrowth of scalp hair. RESULTS: In all, 132 patients (92 women and 40 men) - 80 (61%) diagnosed with AAU and 52 (39%) diagnosed with AAT - were included. The median time between the presentation of alopecia areata (AA) and the development of extensive AA was 1 year and it was less than 4 years in 121 patients (91%). There was an initial response to treatment in 64% of patients, although only 14% presented a persistent response. Adverse side effects from the medications used were detected in 33% of patients. The prognostic factors associated with poor response were the presence of AAU and a positive family history of AA. CONCLUSIONS: Treatment of AAT and AAU is challenging. Although an initial regrowth may be achieved, the duration of response is usually short. There were no significant differences on the effectiveness or duration of response between the various systemic therapies.

Study of frontal hairline patterns in Spanish Caucasian women.

BACKGROUND: Anterior hairline measurements and their possible relationship with androgen levels, sebum production, and skin hydration have not been reported in white Spanish women. MATERIAL AND METHODS: This was a prospective descriptive and analytical observational study conducted on 103 healthy premenopausal white Spanish women recruited from the health staff of Hospital Universitario Virgen Macarena in Seville, Spain. Measurements were made of anterior hairline implantation, sebum levels, and the degree of hydration of the stratum corneum. Androgen levels were also determined in 50 volunteers from this group 3 to 5 days after the end of the menstrual cycle. RESULTS: The mean age of the women was 29.7 years. A widow's peak was observed in 94.17% of the group. The mean dimensions of the widow's peak were a height of 1.01 cm and width of 2.13 cm. The mean hormone levels were within normal limits for our hospital's laboratory with the exception of 17-hydroxyprogesterone, with a mean level of 1.39 ng/mL (range, 0.6-5.9ng/mL; normal limits, 0.15-1.10 ng/mL). The mean prostate specific antigen level was 0.04ng/mL (range 0.02-0.08ng/mL; normal limits, 0.00-0.02ng/mL). CONCLUSIONS: The hairline measurements of the white Spanish women in this study differ from those reported in American women. Knowledge of this normal pattern of anterior hairline implantation can be important in the evaluation of women with female androgenetic alopecia with male pattern, frontal fibrosing alopecia, or other established scarring alopecia seeking a surgical solution by hair transplantation.

M-plasty in the treatment of carcinomas located on the interglabellar region.

One of the main tasks of current cutaneous surgery is to completely eliminate the tumor while avoiding unnecessary normal tissue extirpation. This is especially important when removing facial tumors close to the external canthus, mouth angles and perialar regions. In all these areas we advise fusiform excision but with distal M-plasty in the nearest angle so as to avoid angle retraction. The same is true for mediofrontal tumors, as this often causes a drawing together of the eyebrows. We have reviewed all mediofrontal excisions carried out during the last six years. M-plasty following fusiform excision was always performed in the interglabellar area. The good results achieved allow us to recommend this technique in this location.

Primary multifocal localized hypertrichosis.

We describe a new variant of congenital hypertrichosis, primary multifocal localized hypertrichosis in a mother and her son. They presented with long vellus hair on the trunk and arms in foci from birth. They also associated some forms of hair dysplasia.

Alopecia areata, stress and psychiatric disorders: a review.

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.

Ultrasonic monitoring of malolactic fermentation in red wines.

The progress of malolactic fermentation in red wines has been monitored by using ultrasonic techniques. The evolution of ultrasonic velocity of a tone burst 1MHz longitudinal wave was measured, analyzed and compared to those parameters of oenological interest obtained simultaneously by analytical methods. Semi-industrial tanks were used during measurements pretending to be in real industrial conditions. Results showed that the ultrasonic velocity mainly changes as a result of the conversion by lactic acid bacteria of malic acid into lactic acid and CO2. Overall, the present study has demonstrated the potential of the ultrasonic technique in monitoring the malolactic fermentation process.

Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under 26 years old.

BACKGROUND: Finasteride is a 5alpha-reductase inhibitor that has proved to be an effective treatment for men with androgenetic alopecia. OBJECTIVES: To investigate the hormonal influence of finasteride 1 mg daily on hormonal levels and hair growth in men of different ages and with different degrees of alopecia according to the Hamilton-Norwood scale. METHODS: Two hundred and seventy men aged 14-58 years with male androgenetic alopecia III-VI Hamilton-Norwood score (II-III Ebling score) were treated with finasteride 1 mg daily. Steroid hormone (free testosterone, 5alpha-dihydrotestosterone, dehydroepiandrosterone-sulphate, delta4-androstenedione, 17-hydroxyprogesterone), prostate-specific antigen (PSA) and sebum levels, and trichogram changes were determined at baseline, and at 6 and 12 months of treatment. RESULTS: According to significant hormonal statistical analysis, the patients were divided by age (up to or over 26 years). In the group of patients26 years. No variations in sebum levels were observed. CONCLUSIONS: High levels of 5alpha-dihydrotestosterone in patients

Lamb waves beam deviation due to small inclination of the test structure in air-coupled ultrasonic NDT.

In Lamb waves inspection, an air-coupled transmitter transducer is oriented at a specific angle such that it generates a pure Lamb mode which propagates along the structure and interacts with any existing defects. For this inspection system, amplitude losses appears when small inclinations of the tested structure occurs. An important factor which affects directly these losses has been observed, it consists of the Lamb waves beam (LWB) deviation due to this bad alignment. In this work, a simple expression of LWB deviation has been deduced. This expression includes the test structure angle, phase velocity of generated Lamb mode, and the phase velocity of waves propagating in the coupled medium. A(0) Lamb mode is generated and detected in 1 mm thick aluminium plate sample using 1 MHz PZ27 piezoelectric transducers of 20 mm of diameter. Experimental LWB deviation angles are measured for different inclination angles of the test sample. A comparative study is released with theoretical results. For 1 degree of misalignment in the aluminium plate inclination, and transducers separation distance of 35 mm, LWB deviation angle is around 7 degrees and the amplitude is reduced by around 11%. Then, for a large separation distance, we must move the receiver transducer to detect the deviated LWB. It is shown that, for both theoretical and experimental studies, the LWB deviation and its measured amplitude are very sensitive to the alignment of the tested structure with respect to the transmitter-receiver transducers plane. In metal plates it is most satisfactory to use A(0) mode compared with S(0) mode since it is easy to excite and has a large amplitude and small deviation beam angles.

Diffraction aperture non-ideal behaviour of air coupled transducers array elements designed for NDT.

Air coupled piezoelectric ultrasonic array transducers are a novel tool that could lead to interesting advances in the area of non-contact laminar material testing using Lamb wave's propagation techniques. A key issue on the development of such transducers is their efficient coupling to air media (impedance mismatch between the piezoelectric material and air is 90 dB or more). Adaptation layers are used in order to attain good matching and avoid possible serious signal degradation. However, the introduction of these matching layers modify the transducer surface behaviour and, consequently, radiation characteristics are altered, making the usual idealization criteria (of uniform surface movement) adopted for field simulation purposes inaccurate. In our system, we have a concave linear-array transducer of 64 elements (electrically coupled by pairs) working at 0.8 MHz made of PZ27 rectangular piezoceramics (15 mm x 0.3 mm) with two matching layers made of polyurethane and porous cellulose bonded on them. Experimental measurements of the acoustic aperture of single excited array elements have shown an increment on the geometrical dimensions of its active surface. A sub-millimeter vibrometer laser scan has revealed an extension of the aperture beyond the supposed physical single array element dimensions. Non-uniform symmetric apodized velocity surface vibration amplitude profile with a concave delay contour indicates the presumed existence of travelling wave phenomena over the surface of the outer array matching layer. Also, asymptotic propagation velocities around 2500 m/s and attenuation coefficient between 15 and 20 dB/mm has been determined for the travelling waves showing clear tendencies. Further comparisons between the experimental measurements of single array element field radiation diagram and simulated equivalent aperture counterpart reveal good agreement versus the ideal (uniform displaced) rectangular aperture. For this purpose an Impulse Response Method (IRM) has been used.

Congenital triangular alopecia (Brauer nevus).

Congenital triangular alopecia is manifested at 3 to 5 years of age by unilateral or, less frequently, bilateral patches of alopecia in the frontotemporal region. At this age the differential diagnosis is important, particularly as regards alopecia areata. Only about 47 cases have been reported, probably because the lesion is benign and nonprogressive. In 6200 patients seen in index visits, we found 7 with triangular alopecia, a frequency of 0.11%. We believe that males do not require treatment because of the later development of androgenic alopecia, but in women, surgical treatment is successful.

Is aberrant mammary tissue a marker for chronic alcoholism or kidney-urinary tract malformations?

BACKGROUND: Numerous publications describe the relationship between aberrant mammary tissue (AMT) and kidney-urinary tract malformations, individual/ familial alcoholism and sense organ disorders. PATIENTS AND METHODS: We investigated these possible associations and reviewed 72 cases observed in our Department during the past 3 years: 30 men and 42 women, 17 of them with bilateral AMT (7 men and 10 women) and 25 patients from 9 families. Diagnosis was made according to Kajawa's classification. A detailed family history was performed asking for individual or familial alcoholism, especially in the mother, in addition to blood tests and ultrasonographic examination of the abdomen and the kidneys. RESULTS: We only found 1 family history of alcoholism in 3 families, but in the father, never in the mother or the affected subject. No congenital/ hereditary nephrourinary defects or sense organ disorders were found. CONCLUSIONS: We believe that in our population AMT is not a marker for alcoholism, kidney-urinary malformations nor sense organ disorders.

Sebaceus naevi: a clinicopathologic study.

OBJECTIVE: To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study. METHODS: We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN. RESULT: A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association. CONCLUSION: The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.