Herbal Treatment for Hair Loss

Peruvian Hair Loss Treatment

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Peruvian Hair Loss Treatment Summary

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Alopecia Male Pattern Baldness

Alopecia occurs when the hair shaft is lost and the hair follicle cannot regenerate. This results in permanent hair loss. Alopecia is associated with a familial history and the aging process. Some patients experience alopecia earlier than others. Some medications can cause temporary alopecia. These include anticancer (antineoplastic) agents, gold salts, sulfonamides, anticonvulsants, aminoglyco-sides, and nonsteroideal antiflammatory drugs (NSAIDs) such as indomethacin. Severe febrile illnesses, pregnancy, myxedema (condition resulting from hypothyroidism), and cancer therapies are conditions contributing to temporary hair loss. A 2 minoxidil (Rogaine) solution has been approved by the FDA for treating alopecia. Minoxidil causes vasodilation. This increases cutaneous blood flow and stimulates hair-follicle growth. However, alopecia returns within 3 to 4 months after the patient stops using minoxidil. Systemic absorption of minoxidil is minimal and adverse reactions seldom occur.

Alopecia Areata

Alopecia areata is characterized by asymptomatic, noninflammatory, non-scarring areas of complete hair loss, most commonly involving the scalp, but the disorder may involve any area of hair-bearing skin. B. Auto-antibodies to hair follicles is the most likely cause. Emotional stress is sometimes a precipitating factor. The younger the patient and the more widespread the disease, and the poorer the prognosis. C. Regrowth of hair after the first attack takes place in 6 months in 30 of cases, with 50 regrowing within 1 year, and 80 regrowing within 5 years. Ten to 30 of patients will not regrow hair 5 progress to total hair loss. D. Lesions are well defined, single or multiple, round or oval areas of total hair loss. Typical exclamation point hairs (hairs 3-10 mm in size with a tapered, less pigmented proximal shaft) are seen at the margins.

Flow Of Genetic Information

A gene is a segment of DNA that is located on a chromosome and that codes for a hereditary character. For example, a gene in hair follicle cells determines a person's hair color The gene directs the making of the protein called melanin (a pigment) through an intermediate the nucleic acid called ribonucleic acid, or RNA.

Epidemiological aspects

Sudden unexpected cardiac arrest in adults has an incidence of 0.1 to 0.2 per cent in the general population, with 80 per cent of cases due to coronary heart disease. The incidence of cardiac arrest increases exponentially with age, reflecting the escalating frequency of coronary heart disease, but at all ages men are at greater risk than women. For coronary heart disease populations, hereditary factors producing hypertension, diabetes, lipid abnormalities, and male-pattern baldness predispose to cardiac arrest. Racial characteristics are important, with increased risks in colored populations, although the reasons for this are unclear. Cigarette smoking is the major acquired (and preventable) risk factor, although sedentary occupation and diet also play significant roles.

P450s Identified Only by Catalytic Activities 3P 5aDiol Hydroxylase

Interestingly, one of the major constitutive forms of P450 in the brain is not listed in either Table 1 or 2 because its cDNA has not yet been cloned. This P450 that is known to metabolize steroids with 3p, 5a configuration, is abundantly expressed in prostate (48), brain (18), and pituitary gland (49), but is absent in liver and kidney (18). It is distributed evenly throughout the brain, is not sexually differentiated, and is not regulated by the adrenal or gonads. It does not metabolize steroids such as testosterone, corticos-terone, aldosterone or estradiol. It catalyses the 6a and 7a hydroxylation of 5a-andros-tane-3p,17 -diol (3p, 5a-diol) and its catalytic activity in the brain (300 nmol triols formed h g tissue) is much higher than that of any other microsomal steroid hydroxylase measured in the brain to date. In the prostate, it is the 3p- and not the 3a, 5a-diol that represents the major pathway for the formation of more polar metabolites and thus the elimination of...

Mogensen et al 8Institute of Medicine

Complex Mixtures At the opposite end of the spectrum is exposure to complex mixtures, which can be intentional or unintentional. During the Gulf War, military personnel were intentionally exposed to vaccines and preventive agents including anthrax vaccine and the chemical warfare antidote pyridostigmines (9). Unintentional exposures included chemical biologic agents and smoke and petroleum combustion products. Potential exposures could have been through a combination of inhalation, oral, and dermal routes. Such mixed exposures were associated with symptoms such as fatigue, abdominal pain, diarrhea, headache, memory loss, skin rashes, and hair loss. Also, the exposure occurred under varying environmental conditions of temperature, humidity, and high winds. These types of complex mixture exposures pose a formidable challenge for health risk assessors. In general, the availability of information on chemical mixtures encountered in the real world varies greatly between simple and...

Passive Animal Models of Pemphigus Vulgaris

The most impressive evidence for the central role of Dsg3 in intraepidermal adhesion was provided by Koch et al. (1997). They genetically engineered mice with a targeted disruption of the Dsg3 gene. These mice were normal at birth, but developed a runting phenotype later on. They presented with oral erosions blisters, leading to the observed weight loss due to the inhibited food uptake, and developed cutaneous blisters only when the skin was traumatized. Noteworthy, the Dsg3- -mice developed telogen hair loss. This finding provided strong support to the idea that anti-Dsg3 autoAb induce mucosal, but not cutaneous lesions, in PV

Active Animal Model of Pemphigus Vulgaris

Amagai et al. (2000a) have taken advantage of the availability of Dsg3- -mice to establish an active in vivo model of PV Dsg3- - mice immunized with recombinant mouse Dsg3 produced anti-Dsg3 Abs. Their splenocytes were then transferred into immunodeficient Rag- - mice that expressed Dsg3. The recipient mice produced anti-Dsg3 autoAbs and developed erosions of the mucous membranes with typical histological findings of PV In addition, the mice showed tel-ogen hair loss, as seen in Dsg3- - mice. This first active in vivo model of pemphigus will be useful for understanding how autoimmunity develops in PV and for evaluating therapeutic strategies aimed at specifically interfering with the T cell-dependent autoAb production by autoreactive B cells.

DEGENaC Gene Disruption

The DRG neurons of the ASIC2 null mouse have a significant impairment of the low-threshold rapidly adapting mechanoreceptors (RAM) in response to skin displacement (5-20 m).8 They also showed some decrease in sensitivity of the slow adapting mechanoreceptors (SAM) compared to the wild-type.8 However, other slowly conducting D hair afferents and myelinated and nonmyelinated no-ciceptors were not altered. The green immunostaining for ASIC2 was seen in the lanceolate neural network innervating the hair follicle of ASIC2+ + mice, but not in ASIC2- - mice.8-10

Sex Hormones and Immune Response to Trauma

In macrophage antigen presentation and T-cell proliferation (Fig. 6.1). In addition, a decrease in Th1 cytokines (IL-2 and IFN-y) and increase in Th2 cytokines (IL-4 and IL-10) was commonly reported under those injury conditions (Chaudry et al., 1990 Ayala et al., 1992 Wichmann et al., 1996a, 1997 Xu et al. ,1998 Angele et al., 2000 Kahlke et al., 2000a Knoferl et al., 2001, 2002 Jarrar et al., 2002). Females in the proestrus stage of estrus cycle, however, have normal maintained immune responses after trauma-hemorrhage (Fig. 6.1). Surgical removal of ovaries 2 weeks prior to trauma-hemorrhage, however, resulted in suppressed immune responses similar to those observed in male mice after trauma-hemorrhage (Kahlke et al., 2000a, 2000b Jarrar et al., 2000c Knoferl et al., 2001). Furthermore, castration 2 weeks prior to trauma-hemorrhage prevents the suppression of immune functions in male mice (Wichmann et al., 1996b). Administration of male sex hormones 5a-dihydrotestosterone (5a-DHT)...

Use of Male Sex Hormone Receptor Antagonist

The most widely used male sex hormone receptor antagonist in the treatment of experimental trauma is flutamide. Flutamide blocks receptors of testosterone, dihydrotestosterone, and 3a-androstenediol (Chaudry et al., 2003). Flutamide is a nonsteroidal agent and is known to inhibit androgen uptake or nuclear binding of the activated androgen receptor to nuclear response elements in the nucleus (Kolvenbag and Nash, 1999 Chaudry et al., 2003). It is used clinically for the treatment of androgen-sensitive pro-static carcinoma. Animal studies have shown that treatment of animals with flutamide is effective in preventing the deleterious effects of hemorrhagic shock on cell-mediated immunity, as well as in preventing the cardiovascular and hepatocellular depression (Angele et al., 1997 Angele et al., 1998a, 2000, 2001 Yokoyama et al., 2002 Chaudry et al., 2003). Another common antiandrogenic compound is bicalutamide (AstraZeneca Chicago, IL). Bicalutamide, similar to flutamide, is a...

Histrionic Personality Disorder

Theorized Pattern in Later Life and Possible Impact of Aging Older adults with Histrionic Personality Disorder are often described by their adult children as acting like spoiled children. Their self-centeredness and shallowness do not appear to diminish with age. Older individuals with this disorder are particularly intolerant of the physical changes that come with age (e.g., wrinkles, hair loss, sagging body parts) since their self-worth is based largely on superficial characteristics such as physical appearance. Because of their lifelong reliance on their physical attributes to attract attention, older histrionics may respond to normal physical changes by becoming excessive users of plastic surgery and other antiaging techniques. One of our older patients spent down her entire savings on surgery to prevent becoming an icky old lady.

Differential diagnosis

The diagnosis of trichotillomania in adults is usually straightforward since patients usually admit to pulling out hair. (3) However, young children may not admit to hair pulling and may never have been observed pulling out hair. (3.19 Dermatological conditions such as alopecia areata may then be mistakenly diagnosed.(9) Scalp biopsy will differentiate between trichotillomania and other dermatological conditions. (7)

Ethological parallels

Abnormal grooming behaviours in other species include canine acral lick in dogs, feline psychogenic alopecia in cats, and feather picking in birds. Grooming in animals is often considered to be a fixed-action pattern, a complex innate behavioural sequence mediated by deep brain structures such as the basal ganglia. Inappropriate fixed-action patterns, referred to as displacement behaviours, are observed in situations characterized by heightened physiological stress or arousal. The conceptualization of trichotillomania as a displacement behaviour is supported by phenomenological similarities to animal displacement behaviours as well as similar treatment responses of both trichotillomania and animal grooming disorders to serotonin-reuptake inhibitors and opiate antagonists. (19

Side Effects of Radiation

Organ dysfunction may result from radiation exposure if tolerance doses are exceeded (see Chap. 18). Standard whole-organ tolerance doses are as follows heart 15 Gy lungs 15 Gy kidneys 18 Gy liver 30 Gy bowel 30 Gy ovaries 10 Gy and testes 2 Gy. These doses are only general guidelines. Young children who are heavily pretreated with chemotherapy or who have had surgery may experience organ dysfunction at lower doses. Neurocognitive dysfunction and endocrine abnormalities as a result of brain irradiation are dependent upon the child's age, radiation dose, and volume of brain exposed. These issues are important to consider when treating skull and orbital lesions. Cataracts are common side effects of radiotherapy and thus doses to the lens should be minimized when treating the orbit. Most children will not have permanent alopecia after doses of 21 Gy or less, but a small percentage may have permanent thinning. Doses exceeding 21 Gy do pose the risk of permanent epilation in the...

Detection of gonosomal aberrations and testicular feminization ChrX marker testing

In the most countries, such as Germany, forensic scientists follow the principle that forensic DNA testing should not disclose diseases or genetic risks. This principle fully complies with STR typing strategies using well-established autosomal STRs, such as CODIS markers, ChrY markers, mtDNA analysis and nearly all established ChrX markers. Both ChrY and mtDNA typing may reveal some general information as to a person's ethnic origin, however, this cannot be considered as an intervention into the person's privacy. In principle, the same applies to gender identification typing with ChrX and ChrY markers. However, chromosomal aberrations such as Klinefelter syndrome and Ullrich-Turner syndrome may be recognized when ChrX markers are used. This may be diagnosed when females show (virtual) homozygosity in all the ChrX STRs investigated. Furthermore, androgen insensitivity syndrome (known also under the alternative titles of 'testicular feminization syndrome, androgen receptor deficiency or...

Associated behaviours

More than 90 per cent of patients perform one or more compulsive and often time-consuming behaviours, the usual intent of which is to examine, improve, or hide the perceived defect. The most common behaviours are comparing themselves with others, checking in the mirror, excessive grooming (e.g. applying make-up, shaving, or hairstyling), camouflaging (e.g. with a hat, clothes, or make-up), seeking reassurance or attempting to convince others of the 'defect's' ugliness, skin picking, dieting, excessive exercising, and seeking surgical, dermatological, and other non-psychiatric medical treatment. However, BDD behaviours are virtually unlimited. One man who worried about hair loss, for example, searched his pillow each morning for hair, saved those he found in a plastic bag, and developed complex mathematical formulas to determine the rate of hair loss. Some people compulsively cut their hair, trying to make it exactly even or 'just right' this can leave them with little hair and lead...

Skin Elimination And Reactivity

Under conditions of deficiency, magnesium losses are minimized through strict renal conservation. In healthy volunteers kept on a magnesium-free diet for 18 days, the renal retention was efficient enough to conserve all but 1 mEq of Mg per day (8). Normally, most magnesium is excreted through the gut and kidneys, whereas elimination through skin plays a minor role. Because magnesium is incorporated into hair and skin tissue, elimination of this metal occurs through hair loss and desquamation. Loss through sweat can become significant during muscular work and at elevated temperatures (9). In test subjects exposed to high temperatures over extended periods, the loss of magnesium in sweat was estimated at 25 of the total excreted and reached 2.3 mg hr (10). Elemental analysis by plasma atomic emission spectroscopy (11) of human cerumen showed the presence of magnesium in the range of 0.54-1.1 mg g dry weight (12). Magnesium is among the 30-odd metals detected in human hair to date. Scalp...

Furuncles and Carbuncles

A furuncle, or boil, is an acute perifollicular staphylococcal abscess of the skin and subcutaneous tissue. Lesions appear as an indurated, dull, red nodule with a central purulent core, usually beginning around a hair follicle or a sebaceous gland. Furuncles occur most commonly on the nape, face, buttocks, thighs, perineum, breast, and axillae.

The androgens and oestrogens

The androgens and oestrogens represent the major male and female sex hormones respectively (Figure 11.B3). The testicular Leydig cells represent the primary source of androgens in the male, of which testosterone is the major one. Testosterone, in turn, serves as a precursor for two additional steroids, i.e. dihydrotestosterone and the oestrogen called oestradiol. These mediate many of its biological effects.

Pentosan Polysulfate Sodium Elmiron

2 to 6 of pentosan polysulfate sodium is excreted unchanged in the urine. The response to treatment varies from 28 to 32 .41,42 The dosage is 100mg three times a day. The medication is generally well tolerated with adverse reaction rates varying from 1 to 4 .43 The most common reported adverse effect is dyspepsia. Other uncommon reactions include reversible alopecia and increased bruising.

Combination oral contraceptives

Androgenic effects attributable to progestin include hair growth, male-pattern baldness, nausea and acne. If such side effects develop, a switch to a second- or third-generation agent with lower androgenic potential may resolve these problems. Women who experience nausea may benefit from taking the medication at night.

Leflunomide Pharmacology

Leflunomide is an isoxazole derivative first isolated and described nearly 20 years ago. Leflunomide is a prodrug that is converted nonenzymatically, primarily in the intestinal mucosa and plasma, but also by the liver, to the active metabolite malononitrilamide, termed A77 1726 (68). A77 1726 has a long half-life of approximately two weeks. Treatment with oral leflunomide is initiated with a loading dose of 100 mg once daily for three days and continued at a dose of 10-20 mg once daily. In placebo-controlled trials, leflunomide is superior to placebo in improving signs and symptoms of RA and is comparable with sulfasalazine and MTX in terms of clinical response rate (9,11,69). It is also comparable to MTX (9) and sulfasalazine (11) for reducing the rate of radiographic progression of RA. The overall withdrawal rates in clinical trials are approximately 28 , and these are mostly due to adverse effects including diarrhea, nausea, rash, elevated liver transamin-ases, and alopecia...

Dyskeratosis congenita

Other clinical manifestations include developmental delay, short stature, ocular, dental and skeletal abnormalities, hyperhidrosis, hyperkeratinization of the palms and soles, bullae on minimal trauma, hair loss, sometimes gonadal failure, and features of premature ageing.

Combination sequential monotherapy

Clinical trials have shown that, compared with single-agent chemotherapy, combinations have a better response rate and greater time to progression and modest improvement in overall survival but at the expense of some increased treatment-related toxicities of leucopenia, hair loss, nausea, and vomiting (15, 16).

Psychiatric assessment

Physical evaluation should include vital signs and an evaluation of height and weight relative to age. The physician should also look for general hair loss, lanugo, abdominal tenderness, acrocyanosis (cyanosis of the extremities), jaundice, edema, parotid gland tenderness or enlargement, and scars on the dorsum of the hand should be sought.

The Molecular Endocrinology Of Diabetes Mellitus

The most characteristic features of this syndrome are chronic mucocutaneous candidiasis, hypoparathyroidism, Addison's disease, and T1ADM other features include other autoimmune endocrinopathies (such as hypothyroidism or hypogonadism), malabsorption syndromes, pernicious anemia, and alopecia. The gene for this disorder is the autoimmune regulator or AIRE (OMIM 607358), which appears to be a transcription factor. The exact mechanism by which it causes the syndrome is not known (131,132).

Specific micronutrient deficiencies

Zinc deficiency is associated with primary immune deficiency disorders such as common variable immune deficiency or hypogammaglobulinemia, Di George syndrome and IgA deficiency, as well as other conditions including fetal alcohol syndrome, sickle cell disease due to hyperzincuria, celiac disease, enteritis and diarrhea. Zinc deficiency due to loss occurs in epider-molysis bulosa and in p-thalassemia due to chelation protocols required to remove excess iron secondary to chronic blood transfusion for anemia. Zinc deficiency inhibits Th1 cytokine responses, thymic hormone activity, and lymphopoiesis 1, 58, 68 . Acrodermatitis enteropathica, a genetic defect in zinc absorption, presents in infancy as skin lesions (acute dermatitis or hyperkeratotic plaques), diarrhea, alopecia, and increased susceptibility to infection, and is resolved with zinc supplementation 68 . Because zinc competes with copper for GI uptake, zinc supplements may induce copper deficiency, and may cause neutropenia 69...

Bone Anchored Hearing

Baha Abutment Infected

Preoperative evaluation is limited to audiometric testing and imaging studies. A high-resolution computed tomography (CT) imaging study of the temporal bone is performed in anyone whose sigmoid sinus, middle fossa plate, or facial nerve position is in question as in congenital ear cases. Informed consent should include local infection, subcutaneous tissue reduction in the area, alopecia in the operative site, bleeding from violated sigmoid sinus, and possible dural disruption if a shallow bone plate or low-lying middle fossa is present. In addition reasonable hygiene is expected because the implant penetrates the skin. The surgical steps are relatively simple and are easily learned. Most adults can have this performed under local anesthesia, whereas children usually have a general anesthetic for practical purposes only. 3. The flap is thinned of subcutaneous tissue and sometimes hair follicles.

Essential Fatty Acid Requirements

In patients receiving long-term parenteral nutrition without lipid, continuous glucose infusion results in high circulating levels of insulin that inhibit lipolysis and depress release of EFA from adipose fat stores (131). Development of EFAD in infants, children, and adults maintained on continuous fat-free or minimal-fat parenteral nutrition has been reversed by oral or intravenous administration of C18 2n-6 ( 151). Parenteral nutrition containing only amino acids and completely free of glucose does not produce evidence of EFAD (153). Clinical signs of EFAD include alopecia, scaly dermatitis, increased capillary fragility, poor wound healing, increased platelet aggregation, increased susceptibility to infection, fatty liver, and growth retardation in infants and children ( 153).

Bacterial Skin Diseases

Only a few species of bacteria commonly invade the intact skin directly, which is not surprising in view of the anatomical and physiological features discussed earlier. Hair follicle infections exemplify direct invasion. Hair Follicle Infections Infections originating in hair follicles commonly clear up without treatment. In some instances, however, they progress into severe or even life-threatening disease. Folliculitis, furuncles, and carbuncles represent different outcomes of hair follicle infections. In folliculitis, a small red bump, or pimple, develops at the site of the involved hair follicle. Often, the hair can be pulled from its follicle, accompanied by a small amount of pus, and then the infection goes away without further treatment. If, however, the infection extends from the follicle to adjacent tissues, causing localized redness, swelling, severe tenderness, and pain, the lesion is called a furuncle or boil. Pus may drain from the boil along with a plug of inflammatory...

Carmustine Lomustine and Semustine

The nitrosoureas produce severe nausea and vomiting in most patients 4 to 6 hours after administration. The major site of dose-limiting toxicity is the bone marrow leukopenia and thrombocytopenia occur after 4 to 5 weeks. Less frequent side effects include alopecia, stomatitis, and mild abnormalities of liver function. Pulmonary toxicity, manifested by cough, dyspnea, and interstitial fibrosis, is becoming increasingly recognized as a complication of long-term nitrosourea treatment. As alkylating agents, these drugs are potentially muta-genic, teratogenic, and carcinogenic.

Androgen Receptor Antagonists

Spironolactone (Aldactone) is a compound originally developed as a mineralocorticoid antagonist and is used as a diuretic and antihypertensive agent (see Chapter 21). However, at high doses spironolactone binds to the androgen receptor. In clinical practice it is a weak androgen antagonist used to treat hirsutism in women by blocking testosterone binding to androgen receptors in hair follicles. Use of spironolactone in women for the treatment of hirsutism or male pattern baldness can result in elevated serum potassium levels these levels should be checked within 1 month of starting the medication. Flutamide (Eulexin) is a nonsteroidal androgen receptor antagonist that inhibits androgen binding to its nuclear receptor. It is effective in inducing prostatic regression and is approved for the treatment of prostatic carcinoma. For maximum clinical effectiveness it has to be used in combination with a GnRH antagonist (e.g., leuprolide acetate) that inhibits androgen production. Flutamide...

Chemotherapeutic agents commonly used in MBC

Their use is limited by cumulative dose-dependent cardio toxicity, above 450 mg m2 of doxorubicin or 1,000 mg m2 of epirubicin. They are also associated with significant acute toxicity (nausea and vomiting, myelotoxicity, alopecia). The side effects of paclitaxel include hypersensitivity reactions (such as shortness of breath or skin rash), myelosupression, peripheral neuropathy, cardiac rhythm disturbances, joint or muscle pain, diarrhoea, nausea and vomiting, or hair loss. Patients often receive premedication before receiving paclitaxel to prevent possible allergic reactions. Capecitabine monotherapy at 1,250 mg m2 twice daily for 14 days every 21 days has been well tolerated. When used following failure of anthracycline and taxane therapy, it has achieved response rates of 15 - 26 and a median survival in excess of 1 year (33-36). The common adverse events are hand-foot syndrome, diarrhoea, and nausea but Myelo-suppression and alopecia are rare. Gemcitabine, a nucleotide analogue...

Case Study V Finasteride and Prostate Cancer

The Prostate Cancer Prevention Trial (PCPT) is a doubleblind chemoprevention trial of prostate cancer in 18,882 non-symptomatic, healthy men who were randomized to 5 mg day of finasteride or placebo for 7 years.79 Finasteride is an inhibitor of ( 90 of) 5-a-reductase, an enzyme involved in hormone metabolism of testosterone to dihydrotestosterone (DHT), the most active androgen in the prostate. Intraprosta-tic DHT is thought to be a major stimulus for prostate cancer cell growth, as evidenced by in vitro and in vivo studies.80,81 Thus, reducing DHT by inhibiting 5-a-reductase activity is a plausible strategy for preventing prostate cancer development.

Reproductive and Developmental Toxicology Carole A Kimmel PhD Judy Buelke Sam

Gametogenesis Males And Females

Agents that interfere with the development of the reproductive system and the normal hormonal patterns necessary to regulate development may alter the intricate processes involved in a number of different ways. For example, the normal structure of the ovaries, uterus, oviducts, cervix, and vagina can be altered during development, resulting in interference with fertility and pregnancy. This was the case with the drug diethylstilbestrol (DES), a potent synthetic estrogen used in the 1950s and 1960s to prevent spontaneous abortion. Unfortunately, the drug was not effective in preventing labor but had profound effects on the development of the reproductive system in both boys and girls exposed before birth and produced a rare form of cancer (vaginal adenocarcinoma) in females not detected until after puberty (28). Synthetic androgens and antiandrogens also alter the structure of reproductive organs by interfering with the normal hormonal milieu during development. For example, ethinyl...

Molecular Control of Skin Angiogenesis

The biological importance of epidermis-derived VEGF for cutaneous angiogenesis in vivo has been confirmed in transgenic mouse models, using the keratin 14 promoter to selectively target expression of murine VEGF164 to basal epidermal keratinocytes and to follicular keratinocytes of the outer root sheath of the hair follicle. VEGF transgenic

Valproic Acid Sodium Valproate

Valproic acid causes hair loss in about 5 of patients, but this effect is reversible. Transient gastrointestinal effects are common, and some mild behavioral effects have been reported. Metabolic effects, including hyperglycemia, hyperglycinuria, and hyperammonemia, have been reported. An increase in body weight also has been noted. Valproic acid is not a CNS depressant, but its administration may lead to increased depression if it is used in combination with phenobarbital, primi-done, benzodiazepines, or other CNS depressant agents.

Antitumor Antibiotics and Related Synethetic Compounds

Dose-limiting toxicities are related to myelosuppression and mucositis. Variable susceptibility to congestive car-diomyopathy is an associated complication from cumulative dose administration of anthracyclines. Emetogenic potential is considerable. Reversible alopecia is not unusual. They are also among the most potent vesicants available, and thus scrupulous attention should be given during the administration of these agents to prevent tissue extravasation. Photo-sensitivity, hyperpigmentation, and pigmentation of the nails and urine are common. Another interesting toxicity is the radiation recall phenomenon. As the term suggests, pain, erythema, and blistering or ulceration occur on previous radiation sites within 3 to 7 days of administration of the antitumor antibiotic. This phenomenon may be observed on any epithelial surface and may thus manifest as dermatitis, enteritis, pneumonitis, or stomatitis. The drugs most commonly implicated are the anthracyclines doxorubicin and...

Cited Publications

Wilhelm et al., Monitoring of cadmium, copper, lead and zinc status in young children using toenails Comparison with scalp hair. Sci. Total Environ. 103, 199-207 (1991). 46 S. A. Mulhern, W. B. Stroube, and R. M. Jacobs, Alopecia induced in young mice by exposure to excess dietary zinc. Experientia 42, 551-553 (1986).

Adverse Effects Contraindications and Drug Interactions

The adverse effects of valacyclovir and acyclovir are similar. Toxicity is generally minimal, consisting largely of headache, nausea, and diarrhea. Less frequently observed are skin rash, fatigue, fever, hair loss, and depression. Reversible renal dysfunction (azotemia) and neurotoxicity (tremor, seizure, delirium) are dose-limiting toxicities of intravenous acyclovir. Adequate hydration and slow drug infusion can minimize the risk of renal toxicity.

Hormone Receptor Targeted Therapies

Normal prostate cells and tumor cells are sensitive to androgens, which are produced by two major sources the testicles, which produce testosterone (95 of all androgens), and the adrenal glands, which produce dehydroandrosterone, dehy-droandrosterone sulfate, and androstenedione. Both are under the influence of luteinizing hormone (LH), which in turn is controlled by GnRH produced by the hypothalamus. Testosterone levels have a negative feedback effect on GnRH release from the hypothalamus. Targeted endocrine medical treatment of prostate cancers aims to decrease the activity of androgens on the AR, either with antiandrogens (i.e., nonsteroidal agents such as flutamide, biclutamide) that competitively block dihydrotestosterone (DHT) binding to AR, and subsequent activation of AR-regulated genes, or by suppression of LH secretion (i.e., using specific LH agonists that ultimately inhibit LH secretion, thus reducing androgen production).

Clinical features Hair pulling sites

Scalp hair is pulled out in approximately 80 per cent of cases, resulting in diverse patterns of bald patches and or hair thinning. (3) One pattern of hair loss, tonsure ( 1), is characterized by a circular denuded patch over the top of the scalp. Fig. 1 Tonsure pattern of hair loss in trichotillomania.

Other Cytotoxic Drugs

Although azathioprine is the most popular cytotoxic drug used for immunosuppression, others have been employed. Among these is cyclophosphamide, a cycle-specific agent that acts by cross-linking and alkylating DNA, thereby preventing correct duplication during cell divisions. Methotrexate is a phase-specific agent that acts by inhibiting folate metabolism. It is highly toxic and appears to offer no advantages over azathio-prine. Chlorambucil, an alkylating agent, has actions similar to those of cyclophosphamide. In contrast, its adverse effects are fewer in that alopecia and GI intolerance are almost never encountered. See Chapter 56 for further details of these agents.

Vitamins

These vitamins have been isolated in foods and their chemical structures identified as part of the B group, although the activity of para amino benzoic acid (PABA) is quite different from other B vitamins. Biotin acts as a coenzyme in the metabolism of fats, carbohydrates, and protein. Prolonged use of antibiotics and antiseizure medicines interfere with its production. It is destroyed by raw egg white. The vitamin strengthens brittle nails and lowers blood glucose levels preventing diabetic neuropathy. Deficiency symptoms include fatigue, lack of appetite, dermatitis, hair loss, anemia, nausea, and depression.

Cytoskeleton

Intermediate filaments are rods that anchor the nucleus and some other organelles to their places in the cell. They maintain the internal shape of the nucleus. Hair-follicle cells produce large quantities of intermediate filament proteins. These proteins make up most of the hair shaft.

Exercises Lesson

An acute inflammatory lesion produced by the infection of a hair follicle or skin gland by streptococci bacteria. b. An acute, inflammatory lesion produced by the infection of a hair follicle or skin gland by staphylococci bacteria. c. An acute lesion produced by an infection of a hair follicle by fungal organisms. d. An acute, inflammatory lesion produced by the infection of a hair follicle by allergens.

Mitoxantrone

Like doxorubicin, mitoxantrone is rapidly and highly tissue-bound. The main clinical use of mitoxantrone has been as an alternative to doxorubicin in advanced breast cancer, as it is substantially less cardiotoxic, less vesicant, and causes less alopecia. However, mitox-antrone is less effective than doxorubicin. It has some activity against other solid tumours, including non-Hodgkin's lymphoma and non-lymphocytic leukaemia.

Mitomycin C MMC

Haemolytic-uraemic syndrome, pulmonary fibrosis and, cardiac complications are all uncommon, especially at low cumulative doses, but are potentially fatal. Other toxicities such as nausea and vomiting, alopecia, and stomatitis are usually mild, but extravasation can be serious.

Herbal Medicines

The basis of an ancient ointment called Narcissimum. The powdered flowers have been used as an emetic in place of the bulbs, and in the form of a syrup or infusions for pulmonary catarrh. A decoction of the dried flowers acts as an emetic, and has been considered useful for relieving the congestive bronchial catarrh of children, and also useful for epidemic dysentry. In France, narcissus flowers have been used as an antispasmodic. A spirit has been distilled from the bulb, used as an embrocation and also given as a medicine and a yellow volatile oil, of disagreeable odour and a brown colouring matter has been extracted from the flowers, the pigment being quercetin, also present in the outer scales of the onion. The Arabians commended the oil to be applied for curing baldness and as an aphrodisiac (Grieve, 1998). Conveniently, the bulbs of N. tazetta have also been used as a contraceptive (Matsui et al., 1967). The influence of daffodil on the nervous system has led to giving its...

Irradiation

Four placebo-controlled RCTs (Ib) investigated the effects of treatment with total lymphoid irradiation (TLI). One good quality small RCT found no beneficial effects of treatment,202 one reported an initial beneficial effect which was no longer significant after 18 months follow-up,203 one reported a beneficial effect for one of the two outcomes investigated204 and the other reported an overall beneficial effect of treatment.205 The study which reported an overall beneficial effect of treatment was stopped prematurely due to decreased patient entry because of the availability of 3-interferon.205 All studies reported a greater incidence of adverse events in the TLI treated groups. These included nausea, hair loss, amenorrhoea, infections, thrombocytopenia and pancytopenia.

Conclusion

In summary, while the role of gender in the outcome of trauma patients remains to be established, the results obtained in experimental models of trauma-hemorrhage support the suggestion that gender does play a significant role in shaping the host response after injury. Furthermore, from the experimental studies, it appears that steroids that could be useful adjuncts in the treatment of trauma include 170-estradiol and flutamide. In addition, 5a-reductase inhibitors that prevent the conversion of testosterone into 5a-dihydrotestosterone could be used in the treatment of shock. The hormones agonists, which appear particularly useful, include dehy-droepiandrosterone, androstenediol, prolactin, and metoclopramide. The concept for the use of such agents comes from experimental studies demonstrating that administration of estrogen, flutamide, prolactin, metoclo-pramide, or DHEA restored the depressed immune, cardiac, and liver functions and decreased the lethality from subsequent sepsis.

Hormonal effects

Cross-sex hormonal effects are more pronounced in females. The deepening voice and beard growth and perhaps scalp hair loss can metamorphose the female's appearance dramatically. For the male, vocal retraining is required and perhaps surgical alteration of the larynx to effect a woman's voice. Extensive facial hair electrolysis is usually mandatory.

Avoidant behaviours

Hair pullers may avoid situations which could reveal hair loss.(3) Swimming, wind, well-lit conditions, or environments in which others might look down upon the scalp (e.g. sports ground seating, restaurants) are often avoided. Hair stylists may be avoided as well as doctors. Some hair pullers isolate themselves from intimate relationships or, if entered into a relationship, never reveal the real reason for their hair loss. Hair pullers often spend excessive amounts of time styling their hair. Wigs, scarves, and hats are used to conceal hair loss. Wide-rimmed glasses, false eyelashes, or extensive make-up are applied in cases of lash or brow pulling.

Androstenedione

Receptor in its basal state is bound to heat shock proteins in a conformation that prevents DNA binding. When free testosterone enters prostate cells, most of it is converted to dihydrotestosterone by 5a-Reductase. The affinity to the Androgen Receptor is fivefold higher for dihydrotestosterone than for testosterone. Once the Androgen Receptor binds dihydrotestosterone, it undergoes a conformational change that leads to its dissociation from the heat shock proteins and to receptor phosphorylation. The Androgen Receptor is then translocated to the nucleus, and binds as a homodimer to androgen response elements in the promoter regions of target genes Feldman and Feldman 2001 . The Androgen Receptor coalesces with two nuclear receptor coac-tivators NCOA1 (Nuclear Receptor Coactivator 1, Steroid Receptor Coactivator 1, SRC1) and NCOA2 (TIF2, Transcriptional Intermediary Factor 2). The coactivation of the Androgen Receptor by CDC25B may induce higher expression levels of Steroid Receptor...

Functional Assays

Dihydrotestosterone facilitated learning processes and cognitive abilities in humans (93-95), and enhanced or restored memory retention in rodents (11-12,96-107). It has also been proposed that the neuromodulatory actions of neuroactive steroids on GABAa and NMDA receptors may explain, in part (along with a sites), their ability to enhance or restore learning memory processes in rodents (99,103-106).

Expression of TRPV1

The rapidly growing list of human tissues that express TRPV1 currently includes human epidermal keratinocytes,47'48 mast cells,49 epithelial cells of hair follicle,48 sweat glands,48 sebaceous glands,48 bladder urothelium,50 kidney,51 cerebral cortex,51 cerebellum,51 and hypothalamus,52 among others. Thus, TRPV1 has been implicated widely in physiology and pathology, as comprehensively reviewed elsewhere.53'54

Hypothyroidism

Hypothyroidism is usually the result of primary failure or ablation of the thyroid gland, hypothalamic dysfunction, pituitary dysfunction, autoimmune thyroiditis, or lithium therapy. Clinical manifestations of hypothyroidism include fatigue, cold intolerance, lethargy, weakness, weight gain, constipation, menstrual irregularities, hair loss, slow reaction time, oedema, delayed reflexes, and bradycardia. Hypothyroidism occurs in as many as 10 per cent of patients taking lithium lithium-induced hypothyroidism is much more likely to occur in women.( .5)

Heteroplasmy

Heteroplasmy is most often observed in hair samples because genetic drift is allowed to operate and bottlenecks are created due to a hair follicle's semiclonal nature (Budowle et al., 2003). One disadvantage of using mtDNA for forensic individual identification is the possibility that the occurrence of heteroplasmy will confuse the interpretation of the results and potentially lead to an erroneous exclusion rather than a match. However, the presence of heteroplasmy can also increase the power of the match when it is present in both the unknown and reference samples.

Tinea capitis

Tinea capitis primarily affects school-aged children, appearing as one or more round patches of alopecia. Hair shafts broken off at the scalp may appear as black dots. Sometimes tinea capitis appears as non-specific dandruff, or gray patches of hair, or areas of scales, pustules and erythema. A localized, boggy, indurated granuloma called a kerion may develop. III. Tinea barbae. Tinea barbae affects the beard area of men who work with animals. It is often accompanied by bacterial folliculitis and inflammation secondary to ingrown hairs. Oral therapy with griseofulvin, itraconazole (Sporanox) or terbinafine (Lamisil) is preferred over topical therapy because the involved hair follicles do not respond well to topical therapy.

Indinavir

Quently in children (approximately 30 ) than adults (approximately 10 ) and can be minimized by drinking at least 1.5 L of water daily. Additional side effects include asymptomatic hyperbilirubinemia, alopecia, ingrown toenails, and paronychia. Hemolytic anemia rarely occurs. Rifampin should not be given with indi-navir.

Ifosfamide

Ifosfamide is less myelosuppressive than cyclophos-phamide but is more toxic to the bladder. It also may produce alopecia, nausea, vomiting, infertility, and second tumors, particularly acute leukemias. Neurological symptoms including confusion, somnolence, and hallucinations have also been reported. It is recommended

Busulfan

At usual therapeutic dosages, busulfan is selectively toxic to granulocyte precursors rather than lymphocytes. Thrombocytopenia and anemia and less commonly, nausea, alopecia, mucositis, and sterility also may occur. Unusual side effects of busulfan include gyneco-mastia, a general increase in skin pigmentation, and interstitial pulmonary fibrosis.

Dacarbazine

Dacarbazine may cause severe nausea and vomiting. Leukopenia and thrombocytopenia occur 2 weeks after treatment, with recovery by 3 to 4 weeks. Less common is a flulike syndrome of fever, myalgias, and malaise. Alopecia and transient abnormalities in renal and hepatic function also have been reported.

Bleomycin

A potentially fatal lung toxicity occurs in 10 to 20 of patients receiving bleomycin. Patients particularly at risk are those who are over 70 years of age and have had radiation therapy to the chest. Rarely, bleomycin also may cause allergic pneumonitis. Bleomycin skin toxicity is manifested by hyperpigmentation, erythe-matosus rashes, and thickening of the skin over the dorsum of the hands and at dermal pressure points, such as the elbows. Many patients develop a low-grade transient fever within 24 hours of receiving bleomycin. Less common adverse effects include mucositis, alopecia, headache, nausea, and arteritis of the distal extremities.

Etoposide

Etoposide is most useful against testicular and ovarian germ cell cancers, lymphomas, small cell lung cancers, and acute myelogenous and lymphoblastic leukemia. Toxicities include mild nausea, alopecia, allergic reaction, phlebitis at the injection site, and bone marrow toxicity.

Paclitaxel

Myelosuppression is the major side effect of pacli-taxel. Alopecia is common, as is reversible dose-related peripheral neuropathy. Most patients have mild numbness and tingling of the fingers and toes beginning a few days after treatment. Mild muscle and joint aching also may begin 2 or 3 days after initiation of therapy. Nausea is usually mild or absent. Severe hypersensitivity reactions may occur. Cardiovascular side effects, consisting of mild hypotension and bradycardia, have been noted in up to 25 of patients.

Defence Mechanisms

Neutrophils and macrophages of both murine and human origin are capable of killing dermatophytes. Of these the most important are the neutrophils, polymor-phonuclear cells or PMN, and infiltration of the outer stratum corneum or around hair follicles can be demonstrated in the course of a dermatophyte infection. Human PMN have been shown to destroy up to 60 of dermatophyte germlings within 2 h macrophages kill up to 20 in a similar time. Inhibitors of free radicals such as superoxide, including histidine or catalase inhibit killing which can proceed in the absence of ingestion (Calderon & Hay, 1987 Calderon & Shennan, 1987). The existence of a second non-oxidative method of phagocyte-mediated defense via a peptide mechanism, as occurs with Candida, for dermatophytes has not been investigated. of experimental murine versus human infections. In experimentally infected mice, dermatophyte invasion appears to be limited by the migration of neutrophils to the site of infection (Hay et al.,...

Figure 632

Tor levels with a resultant increased sensitivity to GnRH is termed up-regulation, while a decrease in GnRH receptors is termed down-regulation. In the hypothalamus, the negative feedback of testosterone involves both the conversion to dihydrotestosterone (DHT) and aromatization into estradiol.

Toxicity in Women

Drogen for any reason, facial hair growth may progress to total body hair growth, baldness may develop, breasts may shrink, and the voice may deepen. In addition, cli-toral hypertrophy, uterine atrophy, and menstrual irregularities may develop. Although some of the symptoms are reversible and disappear upon cessation of therapy, several effects baldness, growth of facial hair, clitoral enlargement, and deepening of the voice are commonly irreversible. Steroids taken by women during pregnancy may cause pseudohermaphroditism in the genetically female fetus and may even cause its death.

Vitamin Toxicity

Acute hypervitaminosis A results in drowsiness, headache, vomiting, papilledema, and a bulging fon-tanel in infants. The symptoms of chronic toxicity include scaly skin, hair loss, brittle nails, and he-patosplenomegaly. Anorexia, irritability, and swelling of the bones have been seen in children. Retardation of growth also may occur. Liver toxicity has been associated with excessive vitamin A intake. Vitamin A is ter-atogenic in large amounts, and supplements should not be given during a normal pregnancy. The IOM has reported the UL of vitamin A to be 3,000 g day.

Trace Element Dosing

Treatment of zinc deficiency may require up to tenfold increments of the parenteral zinc dosages. If infused steadily over the course of 24 h, dosages of 50 to 100 mg d elemental zinc can be tolerated. Zinc deficiency signs and symptoms include alopecia, diarrhea, glucose intolerance, hypospermia, impaired chemotaxis, night blindness, depression, apathy, and delayed wound healing. Adverse reactions to zinc include nausea, vomiting, anorexia, and hyperamylasemia. The reciprocal relationship of zinc and molybdenum to copper must also be respected, particularly because copper can be depressed with zinc loading over long periods of time. The sideroblastic anemia that results is manifested by an iron-like microcytic, hypochromic anemia, and neutropenia. Other zinc deficiency signs and symptoms include skin lesions, dermatological anergy, growth retardation, impaired taste, immu-nological impairment, glucose intolerance (similar to chromium deficiency), alopecia, hypogonadism, hypospermia,...

Diseases Of The Skin

(1) Furuncle (also called boil. ) This is an acute, inflammatory lesion produced by the infection of a hair follicle or a skin gland by staphylococci bacteria. The lesion begins as a pustule. As the pustule enlarges, the skin becomes reddened, tense, and shiny. Pain and tenderness develop. The furuncle rapidly matures (comes to a head), and usually ruptures spontaneously, discharging pus. The treatment is heat, and incision and drainage. Under certain circumstances, antibiotics, such as penicillin, are indicated.

Symptoms

Most people colonized by these molds have no symptoms at all. Others complain of itching, a bad odor, or a rash. In ringworm, a rash occurs at the site of the infection and consists of a scaly area surrounded by redness at the outer margin, producing irregular rings or a lacy pattern on the skin. On the scalp, patchy areas of hair loss can occur, with a fine stubble of short hair left behind. Involved nails become thickened and brittle and may separate from the nailbed. Sometimes, a rash consisting of fine papules and vesicles develops distant from the infected area. This rash is referred to as a dermatophytid, or id reaction, a reflection of allergy to products of the infecting fungus.

Pathogenesis

The normal skin is generally resistant to invasion by dermatophytes. Some species, however are relatively virulent and can even cause epidemic disease, especially in children. In conditions of excessive moisture, dermatophytes can invade keratinized structures, including the epidermis down to the level of the keratin-producing cells. A keratinase enables them to dissolve keratin and use it as a nutrient. Hair is invaded at the level of the hair follicle because the follicle is relatively moist. Fungal products diffuse into the dermis and provoke an immune reaction, which probably explains why adults tend to be more resistant to infection than children. It also explains why some people develop the allergic id reactions.

Mechlorethamine

The dose-limiting toxicity of mechlorethamine is myelosuppression maximal leukopenia and thrombocytopenia occur 10 to 14 days after drug administration, and recovery is generally complete at 21 to 28 days. Lymphopenia and immunosuppression may lead to activation of latent herpes zoster infections, especially in patients with lymphomas. Mechlorethamine will affect rapidly proliferating normal tissues and cause alopecia, diarrhea, and oral ulcerations. Nausea and vomiting may occur 1 to 2 hours after injection and can last up to 24 hours. Since mechlorethamine is a potent blistering agent, care should be taken to avoid extravasation into subcutaneous tissues or even spillage onto the skin. Reproductive toxicity includes amenorrhea and inhibition of oogenesis and spermatogenesis. About half of premenopausal women and almost all men treated for 6 months with MOPP chemotherapy become permanently infertile. The drug is teratogenic and carcinogenic in experimental animals.

Corticosterone

PREG produced from cholesterol can undergo one of two conversions it may undergo 17a hydroxylation to 17a hydroxypregnenolone, or it may be converted to PROG. The conversion of PREG to PROG is catalyzed by the enzyme 3p hydroxysteroid dehydrogenase. This enzyme has two distinct enzymatic activities 3p dehydrogenation and isomerization of the double bond from C5,6 in the B ring (A5 steroids) to C4,5 in the A ring (A4 steroids) (57-59). This enzyme is encoded by multiple distinct genes that are expressed in a tissue-specific manner. The enzymes can be classified in two groups those that function as dehydrogenase isomerases and those that function as 3-ketosteroid reductases (reviewed in 60). Human beings have two 3 HSD isoforms, types I and II, and these two enzymes share greater than 90 amino-acid sequence identity. Expression of these two isoforms in transient transfection assays demonstrated that the catalytic efficiency (Vmax Km) of type I is 5.9-, 4.5-, and 2.8-fold higher than...

Cyclophosphamide

Bone marrow suppression that affects white blood cells more than platelets is the major dose-limiting tox-icity. Maximal suppression of blood cell count occurs 10 to 14 days after drug administration recovery is generally seen 21 to 28 days after injection. Cyclophos-phamide reduces the number of circulating lymphocytes and impairs the function of both humoral and cellular (i.e., B and T cell) aspects of the immune system. Chronic therapy increases the risk of infections. Nausea may occur a few hours after administration. Alopecia is more common than with other mustards.

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